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Michael King has been visiting Malawi with his wife Elspeth for many years.  They are usually based at Nkhata Bay Hospital but visits other rural hospitals

 

The following are extracts from Michael King’s report to the Rotary Doctor bank:

 

We stayed in a single roomed cottage at Nkhata Bay and, for some visits, in hostels or mission guest houses.  I did several sessions at Mzuzu Central Hospital, a fine new hospital (250+beds) built by the Taiwanese, where I was able, as in other hospitals, to teach Clinical Officers.  These are the ‘paramedics’ locally  trained who do the bulk of the medicine and surgery in the country.

 

One of the problems working in Malawi is the lack of Histopathology Services, biopsies and specimens often cannot be examined.  I had some discussions with the heads of services and have been in contact with histopathologists in Europe who may be willing to volunteer for short periods of service in Malawi. 

 

I was able to take out some donated items of hospital equipment, sutures etc and while there buy some items (including 6 taps and light fittings and wood for making crutches).

 

Later this year we hope a container full of medical items and books and tools will be dispatched from Cambridge to Nkhata Bay.  Contacts were made with customs, firms and clubs in preparation for this.

 

As always I was given an enthusiastic welcome and remained pleasantly surprised at how, with decreasing resources and increases in staff shortages, most important things eventually get done.  There are plenty of frustrations for everyone, patients and staff:- water and power failures, drug shortages, broken equipment, etc.  One of the most preventable interferences to the care of patients are “workshops”.  The United Nations Agencies such as WHO, UNICEF, UNDP, UNFPA, are the worst offenders.  They continually take vital hospital staff away from their clinical duties to listen to lectures on often marginal issues that could easily be dealt with by a pamphlet or letter (reproductive health, breast Feeding, and gender).  For clinical staff these workshops are an income generating activity – the UN Agencies may pay them for one week at a workshop the equivalent of a whole month’s salary for treating patients in hospital.  It is a perk for the staff but their abandoned patients suffer – the UN Agencies do not want to hear such criticisms, as their Rich World philosophies must be imposed.  The poaching of staff (nurses and doctors) from poor countries by the Rich World also continues and makes any improvement of the health scene in Malawi less likely.

 

The number of funerals and orphans continues to rise.  The majority of patients in hospitals are HIV positive and many health staff are infected too.  There are possibly some hopeful developments however.  Through the Global Fund free ARV (anti-retro-viral) anti-AIDS drugs are starting to be prescribed in Malawi and there is no doubt that many patients can be helped.  But the adequate distribution and supervision of these drugs will be difficult.  There are already great staff shortages of doctors and nurses in the health care system and no extra staff available.  There is a danger of HIV-viral resistance developing if inadequate treatment is given or patients miss out doses.  If resistant strains of HIV develop, they may spread globally – as is already being seen in the Rich World.

 

Many anti-AIDS campaigns continue, mostly devoted to ‘behaviour change’ – with little effect other than to use up the funds of donors.  The recent Bankok conference attended by 20,000 delegates (costing perhaps £30 million) all paid for by the World Health Organisation seems to be a prime example?  “Never has there been so much spent on so many, to so little purpose”

 

Everyone in Malawi “knows about AIDS”, and it is significant that educated people have a higher rate of HIV infection that the uneducated.  The only worthwhile expenditure on AIDS is on scientific research, on palliative care and on orphans.