PUBLIC HEALTH CAMPAIGNS & CONFIDENTIALITY

[Thursday 29th March]


This is going to be a bit of a mixed-bag blog post, but over the past few days there are a few things that have struck me about working here.

The Malawi Ministry of Health clearly knows what its priorities for public health spending are: Malaria treatment, Anti-retroviral drugs for the treatment of HIV and Maternal Health.  Whilst a lot about healthcare here is disorganized, haphazard and a bit of a mystery [seriously, today I saw the clinical attendant in clinic prescribe amoxicillin for “cellulitis” which was almost certainly just a mosquito bite], the three areas I mentioned at the beginning of this paragraph are astonishingly good.

Malaria treatment is provided free of charge to everybody who pitches up at the clinic. The Ministry of Health has provided the hospital with “Rapid Detection Tests” [RDT] for Malaria, which take 30 seconds to give a result and free LA [The first-line anti-malarial treatment] is then available in well-designed, easy to understand packets. A disease that is potentially deadly has been reduced to the level of annoyance of the common cold [and a few hours waiting at a clinic to get some treatment]. Amazing.

As I’m sure you’re all aware, HIV is a huge problem in Sub-Saharan Africa with nearly 1 in 3 people in Malawi being infected. Whilst HIV [and the subsequent development of AIDS] was almost a death sentence 20 years ago, anti-retroviral drugs have turned this disease into a chronic condition. Not only do these drugs stop people from dying, but they also [almost] stop people from being able to infect others as they reduce the amount of virus in the blood to almost nothing. This is a fantastic public health campaign. Each patient is given free anti-retrovirals in clinic. Lots of details for monitoring their condition are taken on official WHO forms at each clinic session. It was nice to see that unlike in the UK, there was no stigma attached to having HIV. Again, amazing!

Just to quickly mention maternal health. Maternal mortality [the number of women who die around childbirth] should be zero. In the UK, There are usually less than 10 maternal deaths per year and each one is the subject of a huge inquiry. Sadly, this is not the case in the developing world, where it’s much more commonplace. The Health Ministry fully funds the maternity unit here at Mkope. Whilst the conditions are very, very [!!] different compared to the UK, the work here is amazing. Women here have 5 antenatal clinic appointments during their pregnancy and each time is an opportunity for some education. Women sit in groups and are taught the importance of lots of different aspects of their pregnancy and symptoms to look out for that could suggest a serious illness at each clinic appointment. We heard about a new campaign by the Ministry of Health encouraging women to keep having sex with their husbands all the way through pregnancy and then afterwards to stop their husbands finding sex elsewhere, thus containing the spread of HIV. It was an amazingly candid campaign, and whilst I imagine many feminists would hate it – I was impressed at the honesty.

A final word about confidentiality – one of the first things I learnt about in medical school. It is all-important for doctors in the UK to ensure that what our patients tell us is kept between doctor and patient. This health clinic doesn’t quite stick to the stringent confidentiality codes that we do. Several patients are often invited into the clinic room at the same time, a woman gave birth on the floor of the maternity room today [having 10 seconds early walked in carrying her own suitcase] with the door wide open and people watching. Best of all was this afternoon when the village priest was in the consulting room printing off some “proof of baptism” certificates [the clinic room has the only printer in the village] whilst patients were sharing intimate details of their sex lives. Awkward.