The things we take for granted...

25^th March 2012

Since we got here yesterday, the phrase we keep repeating is ‘things are so different back home’. It sounds obvious, given that we’re in rural Malawi, but it’s staggeringly true – particularly when it comes to the hospital itself. While we were having dinner last night, we got chatting to one of the hospital administrators about how everything works. Apparently, patients tend to present here fairly late in their illness, because they are often put off by the cost. Mission hospitals in Malawi receive no government funding; apart from the staff wages, everything has to be funded using donations or money received from the patients, who are charged a small fee for the consultations and then pay for their own investigations and medications. Despite this, it would appear that going to one of the government funded hospitals is a false economy. Although these hospitals have no consultation fee, there is a hierarchy meaning that ‘more important’ patients (those who know the right people) are the only ones who get proper medical treatment, with the rest often receiving inadequate or inappropriate care. These patients eventually end up coming to the mission hospitals anyway, at which point their conditions are usually worse, and therefore more difficult to treat.

This afternoon we had our hospital orientation, which nothing could have prepared us for. Our tour of the operating theatre involved the loosest usage of the word ‘sterile’ that I’ve ever heard. As someone who has watched a surgeon change completely because someone brushed his elbow, the broken windows and piles of equipment came as a bit of a shock. Given the conditions, however, they do try very hard to prevent infection. Everything is autoclaved and packaged before it is used, which in a hospital without a washing machine is quite an impressive feat. The nursing shortages were also obvious, with a single nurse covering both male and female wards. Tests that we take for granted, such as liver function tests, can’t be performed here – sputum cultures are the only test for TB, as chest X-rays aren’t available. Despite the shortages, however, the level of care is still very high. Women having their first baby are automatically kept in for at least two days, and an entire ward is dedicated to DOT (direct observed therapy) of patients who have TB which involves them taking their medication under supervision for two weeks. It’s a cliché, but the next three weeks are definitely going to be a life changing experience.

In other news, the mosquito repellent that I was so careful to buy in the UK is slightly less effective than water. I’ve switched to the stuff that everyone here swears by. We’re staying in accommodation which definitely has its downsides (more on that later) but the massive upside is that it is right on the banks of Lake Malawi, which is absolutely stunning. Every single person that we have met so far has gone out of their way to make us feel welcome, especially all of the people at the hospital. I’ve already fallen in love with this place.

Danni