It had been a late night, as we all tried to put the world straight. And it had been followed by time sorting pictures, and creating pages for the website. As in many parts of the world, the GSM system in Malawi is excellent, which also meant we could stay in touch with home, downloading impressions and staying close to loved ones. By now, several of the Advisory Group reported that folks back home were following our trip “virtually”, although it was ironic that one critique was “too many smiling children” in the pictures. I guess I can understand the comment, but I fail to understand why people in trouble can’t smile. Thank goodness that they do.
Anyway, this morning we were all set to “rock and roll” pretty smartly. Buffet breakfast at the Capitol Hotel was, as usual, excellent. And Ambrosius, the Hotel’s top rated employee for the last several months, was helpful in getting us all organized.
This morning we split into two groups. One, led by Gretchen, was meeting the US Ambassador. It was a most helpful and productive 2 hour discussion, and it brought its moments of truth. As Gretchen later wrote:
“The US Ambassador to Malawi, Roger Meece, an impressive foreign service professional, says that the most critical labour issue he confronts is whether or not the US government will pay the expenses of sending his employees’ coffins back to their villages when they die. On the streets of Lilongwe hand painted signs for coffin makers hang everywhere”
The other group visited Lilongwe Hospital, the main medical centre for the Country. By the side of the Hospital is a growing Medical Training University, where almost all professionals spend some of their time.
Lilongwe Hospital has about 1000 beds, and the evening before had 539 patients. 8 had died that night. Whilst the principal, nominal cause of death has usually been malaria, this year 40% are quoted as “malnutrition”. Each entry in the hospital log noted “very sorry” after the cause of death was recorded. The administrators told us that this was always the busiest time of year, but that 2002 death rate was the worst yet. An estimated 20% of the baby deaths were directly attributable to HIV and subsequent infections.
There are 15 doctors at the Hospital, and 285 Nurses. Matron Grace Manda, who has held that post since 1990, said they were 100 Nurses short. Many get trained in Malawi, and then seek better opportunities elsewhere – not least in the UK’s Hospitals. Hospital care is all free in Malawi, although many drugs cost money. For example, we later learnt that the 5% of patients who can afford HIV retroviral drugs have to pay 2500 Kwacha per month (US$ 38), roughly 2 months average wage.
Our first visit was to the Aids Wards, accompanied by Dr. Magomero. He had run this specialty for about a year. A propos of nothing, he had spent a year being educated at Eton in England – which he recounted as an interesting (and fortunately rewarding) experience for a young man from Africa.
In a Blantyre study, he told us that 80% of people who died from infectious diseases were HIV positive or had Aids. Whilst HIV testing is not compulsory, the Hospital does offer the test, and over 90% of people accept. People would like to know. The University of North Carolina is supporting the testing centre, and we saw several western doctors and interns at work in the wards as we walked around – from Europe as well as North America.
In Paediatrics, we were shown around by Doctor Kazembe. He has run the wards since 1990, having trained in Manchester and Vancouver. Tellingly, when asked how he could still do the job, he said “because 95% of my children leave OK”. Most children are in Hospital for 2/3 weeks, and then go home.
Right now the paediatrics ward was at 150% occupancy, with 20 – 30 new admissions each day. Usually there are 4 or 5 baby deaths each day, although one day in January saw 19. The World Food Program helps with the supplies, but the pressure is such that the Hospital can only give two good feeds a day (of milk, rice or maize), instead of the preferred two hourly feeds. Dr. Kazembe said they also tried to feed the mothers as much as they could whilst they were there – the mothers are officially also admitted as patients when their babies are admitted.
Unlike Mangochi, this Hospital had some resource. Incubators and other equipment. And the Doctor had encouraged students to brighten the wards with murals, painting and pretty curtains.
To say that we were impressed by the staff of the Hospital was an understatement. Thank goodness they had not all also decided to get better pay in the West.
There is another story here, which is both sad and inspiring at the same time.
One of our guides through Lilongwe was Chatinkha Nkhoma, the African representative of the Global Aids Alliance.
Chatinkha is a vivacious, intelligent and fun person to be around. She is also HIV positive, and is determined to build awareness of the issues and the action needed.
Whilst we were at Lilongwe Hospital, Karen interviewed Chatinkha with a view to US press coverage. More on that in due course.
So, it was time to get to the airport. It was a bit of a scramble, as both groups were late arriving – but we all made it!
We flew from Malawi, across Zimbabwe, towards Jo’burg. Interestingly, it was almost impossible to see where one country ended and the next began – the landscape and the “people-scape” was similar, as far as we could see through the clouds. However, as we descended towards Johannesburg, the difference was clear. Neat fields, neat houses, and many rich suburbs with houses and swimming pools – although the view over the townships showed more crowded conditions.
Checking into the Holiday Inn at the airport was like being in London or New York. Whilst nice, it was not why we were here. So, a sub group split off to go to Soweto, about an hour away in the evening traffic. First, we were lucky enough to talk our way into the garden of Nelson Mandela‘s old house – way past closing time. Then, we had dinner at Wandie‘s. A fun place, with local food, excellent South African wine, friendly staff and everyone’s business cards on the wall.
It was faster to get back to the hotel. A short shopping excursion (!) and then a visit to the bar gave a refreshing way to end a long day. Time to get ready for the next phase of our journey – Mozambique.