Getting settled

Tuesday, February 28

We arrived on Sunday afternoon and were met by WAM's outstanding program manager, Laura. She took Amy and me to our backpacker hotel, Mufasa Lodge, and arranged for us to meet with the dynamic Dutch duo Rob and Renske. They have been helping Kabudula community and the surrounding area for a number of years by supporting some of their schools. Currently, they are helping to fund the building of school benches, so that the students don't have to sit on the ground during class. After a nice dinner at Don Briones of avocado vinaigrette (they are huge and in season!) and garlic cheese bread (not exactly the plato tipico of Malawi, I admit, but very tasty), I put my head down and slept for 15 hours. Monday was all about recuperating, changing money, and buying groceries. Tuesday morning we met at the Baylor pediatric AIDS clinic in order to head out to Kabudula. The team subjected to an hour long and mostly bumpy road trip was made up of Baylor clinicians and outreach workers, Renske and Rob, and Amy and myself. The Baylor group has been mentoring for the last 4 months at the antiretroviral clinic, and the outreach workers have been organizing home based care of HIV positive patients. Their HIV clinic (run by nurses and midlevel providers) has around 1,500 patients, and today being the pediatric clinic held on Tuesdays, the patients were spilling out of the small and crowded clinic into the yard. As a comparison, our HIV clinic in Santa Rosa has three doctors and about 400 patients, none of which are kids. About 13% of the Malawian adult population has HIV, as compared to 0.6% in the US.

Like the HIV clinic, the hospital itself was really busy. On Tuesdays, clinical officers from the capital come to run the specialty clinics of orthopedics, ophthalmology, and dermatology. Aubrey, the 25 year old Malawian clinical officer that is the head of hospital, met us and debriefed us.

Debriefing: Per the latest count, there are about 110 beds, not counting the nutritional rehabilitation unit (or NRU) for malnourished kids). A team of around 15 nurses, 6 of which are full RNs, are divided to cover the day and night shifts. There are two data clerks to track all of the data for the hospital, including how many admissions, discharges, deaths, causes of death, etc. Both are new and are getting their training on the job. They don't have a computer, so they use the hospital's one computer that lives in Aubrey's office. There is still not a pharmacy technician assigned to the hospital, so in addition to rounding on patients, taking women to the operating room for cesarean sections, fulfilling his administrative duties and seeing consultations, he is also the pharmacist for the hospital. There are about three newborn bassinets, and one non-functional newborn warmer. The lab currently has no way to check blood glucose, hemoglobin, screen for syphilis or hepatitis B, or test for pregnancy. They do have blood delivered to them from the Lilongwe blood bank, but the refrigerator alarm has been going off for a "long time", which makes me wonder if the appropriate temperature is maintained. Four medical assistants (2 years of training out of high school) see the approximately 200 outpatient visits per day.

Tour: Aubrey led us on a tour of the hospital grounds. We were excited to see a completed antenatal ward, that is still awaiting beds, so unfortunately is locked. It was built to house up to about fifty pregnant women who come from outside Kabudula town when they are close to delivery. Currently, these women still sleep outside on concrete, exposed to malaria carrying mosquitos, bats, and the like. We saw a motorcycle with a side-car set up as an ambulance that will be stationed at one of the outlying clinics. The radiology suite was in full swing, being ortho day, and Augustin, the technician, was very excited about getting an ultrasound with our shipment. My hope is that we can train the technician and clinical officers ultrasound skills, as well as send them perhaps to the referral hospital for additional training. We stepped into the malaria screening room to learn that there had been 62 cases of malaria diagnosed that day. And it was 11:00AM. They were using One Step malaria rapid tests that screen for the HRP 2 antigen to Plasmodium falciparum instead of the old school blood smears.

NRU: the nutritional rehab unit was the ward most in need of help. Or a wrecking ball (or a medium-strong wind, really). Separate from the rest of the wards, it is a water-stained, dark inferno without electrical plugs and with one working light. Therefore there are no electric kettles to boil water, and the mothers must start a fire (photo) throughout the night to boil water for formula. That
is, when there is formula available. The one thermos is broken beyond repair, there are no graduated measuring cups, nasal gastric tubes, beds, pots for cooking demonstrations, clock to help with the required three hour feeds, vitamin A, or toys. I take that back, there were two toys. Two. Two toys to stimulate the already starved brains of malnourished children. There are no sinks or soap in the NRU, and there isn't even a plasma screen TV. Shocking. There were about four patients today, one of which had the total body swelling associated with protein malnutrition, known as kwashiorkor (photo).

Staff housing: The best news of the day came when we visited the new house that WAM helped build. It is a duplex, with two rooms each, and it is almost finished! The roof is up, and there is actually running water (photo). Some internal work needs to be done, and the electricity still needs to be put in, but it's close, and people are really happy. There are nurses that are ready to be placed in it, even without working electricity. Progress. Slow, but definitely progress.