Health system hierarchy in Malawi goes Special Hospitals – Central Hospitals – District Hospitals – Health Centres – Community level e.g. village clinics. Queen’s Elizabeth Central Hospital (QECH) is both a special hospital (used to treat leprosy cases) and a central hospital. There’re only four central hospitals in Malawi – you find them at Mzuzu (north), Lilongwe (central), Blantyre (south) and Zomba (south east). Theoretically patients should go to health facilities at the community or district level before reaching the central hospitals. However due to lack of facilities/health workers at these levels, many patients bypass the lower levels and just walk in to the tertiary hospitals.
With these in mind I was expecting to see maximally over-crowded hospital without even a space to stand and perhaps a pharmacy that was 10 times worse than Penang GH (my hometown General Hospital where my father once waited for medications at outpatient pharmacy for 5 hours!).
Well when I said I ‘was’ expecting that means it was not the case: at first glance it actually looked slightly better than Penang GH – well at least there were parking spaces available LOL!!! I was especially impressed at the paediatric department where you even get a special A&E for paediatric patients. I remembered what I read about Prof Dr Elizabeth Molyneux, a British paediatric specialist who had come to Malawi in the 1970s and contributed most parts of her life to QECH, together with his husband Prof Dr Malcolm Molyneux (a clinician-researcher-academician who specialised in hepatic research but was later involved in malaria research as a response to local needs). This couple has contributed a lot to the development of the hospital. Apart from expanding the paediatric wing, Malcolm is also the founder of Malawi-Liverpool-Wellcome Trust Programme Queen’s site. No doubt without their effort my previous assumption about Queen’s might be correct!
And again, when I said ‘at first glance’ means there was something else that I discovered after chatting with a few people working there. It looked just fine from outside but people are dying at a rate you wouldn’t have imagined. According to one of the friends who had worked at paeds, it’s very common to see children pass away (may be 2-3 a day..). The number is even higher for the adult wards (hmm that they don’t even bother to count!). Nurses are severely understaffed. They are on the move on all times. Nobody stopped and asked me hey you what are you doing here – they just have no time! Some wards, especially the medical wards, are overcrowded. Beds were arranged very closely to each other. Some patients were sleeping on the floor. Perhaps bed occupancy is something like 200 or 300%. Patients must have their family members with them to take care of food and laundry. Nurses don’t even have enough time to finish the clinical tasks let alone catering for patients’ food and bed linen! Therefore you could see large open space for patients’ family member to rest or ‘picnic’.. there is also lots of washing areas where patients’ carers (or patients themselves?) do their laundry. Everywhere in the hospital you go you could see lots of washing lines with bed linens, clothes, etc hanging on them.. when there isn’t enough space the ground is covered with wet clothes. If you just look at the picture with clothes may be you would think that’s second hand clothes for sale or something.
And of course I visited the pharmacy department. Although I had prepared myself to see very different things in the pharmacy here, seeing it myself was still somehow appalling. The pharmacy is huge, in space – contrary to what I imagined (I put Penang GH always as a comparison – where space is always an issue). And maybe it’s so huge I actually felt it’s so.... EMPTY. Maybe because there weren’t many people that’s why it felt empty. But many shelves have several bottles here and there.. as opposed to how we used to squeeze as many bottles/boxes into the shelves as possible. Drug store is quite small in comparison, considering they’re serving 15000 outpatients and 1250 inpatients daily. Yes – I do not add a zero to the number 15,000. Not 15000 drugs they’re dispensing but 15000 patients. And only with 1 pharmacist, 2 intern pharmacist and 4 pharmacy technicians; 3 windows at the outpatient pharmacy – we worked the maths out to come to a figure where you only have less than 1 minute with each patient – and that’s without lunch or toilet break (forget about coffee break!!!)… I walked past the manufacturing site – it looked as if it was not used for many years. I don’t know. May be I missed something here. It just felt lifelessly empty. Crazy workload yes.. and they’re blamed all the time for having no stock and no communication with doctors/nurses. Oh yes it’s all the pharmacists’ fault.. it’s not new story anyway..
However the most important thing that gave me some food for thought was I discovered almost half of the hospital sites are dedicated for research. Clinical trial wards exists next door to MoH (Ministry of Health) wards. Patients are treated under the same roof but as you could imagine, with different level of ‘service’ (not to comment too much here.. just try to imagine how a patient should be treated in a clinical trial in order to ‘ensure the rigor of the research’: drugs must be served on time - so out-of-stock mustn’t be a problem at all, transport must be taken care of to make sure patients come to the hospital on time – sometimes ambulance is used to transport patients). Research nurses (who receive higher pay from research project) work in close proximity with their MoH colleagues (who might well just be their former co-workers). I’m not making any statement here but you know what kind of conflict is going on here.. whether you get your drugs or not sometimes depends on whether you fit the ‘inclusion criteria’ or not. Tell me. How sad.
I just heard from the radio this is an important year for Africa as most countries will mark their 50th year of independence from their colonial masters. ‘Independence’? !?! Has Africa ever been free from colonisation...?
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