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Letter from Malawi

UHMBT chaplaincy volunteer and retired doctor Gill Pilling visited Malawi last year to support healthcare charity Tiyanjane.

Gill, who has made repeated visits to the country, delivered a supply of medicines and spent time working in a charity-run clinic caring for a varied range of illnesses.

In this ‘Letter from Malawi’, Gill explains more about her visit and shares her impressions of the country...

It is almost 5 o’clock, still too hot to sit in the sun, even though it is sinking towards the horizon.

The sunsets in Africa are amazing so I’m sitting in the shade in anticipation, with a cup of Rooibus tea, of course! I have been back in Malawi for a few weeks and what a joy it gives me to be here.

The medicines all arrived with no questions asked - two large suitcases full. They duly put the cases through the scanner at the small disorderly airport on arrival here but I don’t think anyone was watching the screen as the medicines slipped through un-noticed. This is Malawi - cheerfully organised chaos.

The staff at the clinic were thrilled to receive the medicines; the paediatric palliative care clinic had not had Baclofen, a drug for muscle spasm, for two years. It makes such a huge difference to many of the children they care for.

I know how carefully they will dispense all the drugs, just sufficient for the patient’s need, carefully counted into small plastic bags printed with four pictures: the sun in the morning, the sun at midday and at sunset, and lastly, the moon. A small tick under the pictures indicates the times the patient should take the tablet. Most people do not possess watches.

So I’m back in the hot dusty city of Blantyre, with dilapidated minibuses careering everywhere, belching out fumes, hooting their horns, shouting out their fares to anyone in the vicinity.

The lodge where I stay provides a minibus each morning to the hospital - I shut my eyes and cling tight. Then I join the throng of Malawians crowding into the Hospital - mostly women with baskets or bundles on their heads.

These are the guardians taking breakfast to their relatives. A patient in hospital has to have someone (a guardian) with them, to look after them to cook their meals, do their washing, help them, be the advocate if the patient is too drowsy. It is usually a family member.

It makes the wards chaotic - people everywhere, sitting on the beds, on the floor, in the corridors. Most of the beds have rickety rusty iron frames and if there is a mattress it is plastic covered - but no sheets, just a couple of lengths of crumpled coloured cloth - chitenji - used for everything from skirts to carrying babies and bundles.

They are very colourful but are neither wide nor long enough to be much use for sheets. Malaria is the commonest cause of hospital admission but there are no mosquito nets in the hospital even though this is one of the biggest hospitals in Malawi.

Many windows on the wards are broken so they offer no barrier to the marauding mossies and sadly it is not uncommon to catch Malaria whilst an inpatient.

Tiyanjane, the charity that runs the clinic where I volunteer, has struggled for funding since Covid and sadly most of the experienced staff were made redundant.

The good news is that the Government now employs a small number of staff for the Paediatric and Adult Palliative Care clinics; albeit much less experienced nurses, but very enthusiastic.

Since its inception in 2005 the staff at the clinic have worked hard to teach many, many nurses in the rural Health Centres of South Malawi how to support people with end-of-life conditions and how to prescribe morphine for pain relief.

As a result far fewer patients need to make the minibus journey into the city to visit Tiyanjane for help and the clinic is much quieter.

The education program with nurses from elsewhere sitting in on clinics in order to learn from Tiyanjane has continued so there is plenty of opportunity to teach, which I have been doing both formally and informally.

I was impressed by the standard and enthusiasm of the BSc nurses both in the hospital and at Kamuzu University next to the hospital. Teaching them was a joy.

Until a few years ago there were no degrees in Malawi for nurses. I feel heartened to see that education is slowly making a difference, but the poor are still painfully poor.

Most families only manage one small meal a day and because of undernourishment many Malawians both male and female are very small in stature.

I witnessed the reality of the poverty when I went for a rural visit with the team from the clinic. The patient had had a severe stroke but had been discharged from hospital before her condition had been explained to her family or any advice given about managing at home.

Sudden discharge without explanation of the condition is a common occurrence. We went to assess and advise and provide any pain relief should it be necessary. The patient we visited was living in a very rural area, off the dusty dirt road down a path only wide enough for walking single file.

The ‘ambulance’ (a minibus - with only a hard metal floor to accommodate a patient should that be necessary) lurched and bumped through the bush crushing the vegetation as it went tipping and rolling from side to side. I thought we would turn over, but we made it.

The family were very poor. They had lost their annual crop of maize in very heavy rain earlier in the year (due to global warming) and had no spare seed to plant any more.

Although they were very caring for their mother they had few possessions and she was being nursed on a bamboo cane mat on the hard floor, no mattress, just a few chitenji.

The advice from the clinic staff would help the family cope, but living in these conditions and nursing someone on the floor who isn’t able to mobilise is so hard.

One of the small granddaughters outside the house had a brick-sized stone. She was wrapping it up in some old cloths and cuddling it as though it were a baby. I felt very sad. Children in rural Malawi have no toys.

Staying in the city doesn’t give a true picture of the poverty in Malawi. It is when I visit the villages, and see people in their home environments with few possessions, struggling to grow enough on their small plots of land that it really hits home.

I had also forgotten how desperate some of the cases which we see in the clinic are: a young man in his thirties very ill with end-stage TB and only one lung partly functioning, a young woman with a young family whose advanced cervical cancer was only discovered when she delivered her second child. Her children will be orphans.

TB is common in Malawi, particularly in the townships where poor people live in close proximity.

Cervical cancer (cancer of the cervix) is the second commonest cancer in women in Malawi. It is usually only discovered at a late stage. Although palliative chemotherapy to improve symptoms, though not cure, is now available in the two main cities in Malawi, many, many poor people living in rural areas are not able to afford the minibus fare to access treatment.

At least now morphine is available in these rural areas to ease the pain patients experience.

Medicins Sans Frontières (MSF or Doctors Without Borders) has been running a vaccination, screening and treatment programme for cervical cancer in Malawi since 2018 in collaboration with the Malawi Ministry of Health.

I spent a day with the Blantyre team and witnessed the impact they are making: progress, albeit slowly.

Laughter helps Malawians cope with their day-to-day struggles. It is an amazingly cheerful country and even though I only speak a few words of their language, Chichewa, I can still share laughter.

Malawi is called the warm heart of Africa and a friendly smile to people you meet is returned with a big beam of warmth and welcome. Laughter really is a tonic. It helps a lot when the internet or the electricity or the water supply are down, or all three together.

I had a few days away with a friend who lives in Malawi. She was in need of a break, and travelling through the country rather than just staying in the city gives me a slightly better knowledge of life in Malawi.

By Lake Malawi we watched the villagers come down to the water to wash their clothes, their cooking pots and themselves. The children have a great time splashing about. I find it sad that this is the water they have to use for everything, especially with the significant risk of schistosomiasis from the water.

I suppose that is looking at it from my western perspective though; for the Malawians here it is a daily cheerful and social occasion.

Thank you all for your prayers and for your help with the medicines. I really appreciate your support.

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