13th March 2013 Latest news from our healthcare programmes in Lilongwe
Bwaila Maternity Hospital
The new Bwaila maternity hospital, opened by Mary Robinson in October ’09 is buzzing with activity! The women are enjoying their surroundings and improved clinical care.
The hospital has created energy of its own and other national and international funding organisations are becoming involved to ensure that maternal and infant health remain a priority in Malawi. The Rose Project, continues to fund Rachel Macleod a senior midwife manager, to oversee management and clinical practice in the labour ward
Rachel MacLeod, TRP representative at Bwaila with charge nurse Magrete.
Progress at the hospital is being monitored and the hospital data shows that post partum haemorrhage has decreased over the past few months. There is now a concerted effort to address the high level of birth asphyxia at the hospital, with new protocols being implemented and in-service training in the area of resuscitation. In addition The Riose Project in partnership with the Unicersity of North Carolina is currently implementing the Emergency Obstetric Care (EMOC) programme
Women continue to enjoy their new surroundings. In the old hospital due to overcrowding many women experienced dehumanising conditions frequently being submitted to giving birth onto the stone floor and in some cases unassisted. To all of oyou who gave so. To all of oyou who gave so generously, a very big thank you form the women at Bwaila Maternity Hospital
The state of old hospital, built in 1939, meant that many women gave birth onto the stone floor.
Lighthouse clinic a HIV and AIDS Clinic (opened by The Rose Project in 2006) is next door to the new maternity hospital. The healthcare teams in both the hospital and clinic are working towards co-ordination of services. This is particularly relevant in the area of Prevention of Mother to Child HIV Transmission in pregnancy. 12% of the women attending the new maternity hospital are HIV positive. If a HIV positive expectant mother is placed on treatment at 26 weeks of pregnancy, the risk of HIV transmission to her child is almost eliminated. Mother to Child transmission is the second most common form of HIV transmission in Malawi. It accounts for 30,000 infant being born with the virus each year. Very few of these children celebrate their second birthday.
The Lighthouse clinic is now placing approx. 26 expectant mothers each month on HIV treatment, the majority have been referred from the new maternity hospital’s antenatal clinic. Additional family members of these expectant mothers are included in the service and are checked for HIV - where positive they are treated and followed up . All patients are routinely tested at the maternity hospital’s antenatal clinic - unless they request otherwise.
Rural HIV Counselling and Testing Programme:2008-2012
Rural HIV Counselling and Testing Programme:
The Rose Project, in partnership with Irish Aid, is funding a four year HIV counselling and Testing programme in the 31 rural district healthcare centres surrounding the capital city, Lilongwe. The programme is being run by Lighthouse Clinic. Training has taken place of 90 healthcare assistants and these assistants have been placed in the district health centres, for the most part this is near their homeplace. They carry out counselling and testing and where individuals are positive refer them to Lighthouse clinic or another Anti Retroviral Centre, nearby. A central part of the programme is Prevention of Mother to Child HIV Transmission. A healthcare assistant carryies out counselling and testing as part of the antenatal services at the health centres. The Ministry of Health is working towards having an anti-retrovial service available at each district health centre, however the acute shortage of doctors and nurses is seriouosly impeding the implementation of this service, and is the greatest challenge to healthcare delivery in Malawi.
Part of the funding includes motorbikes for supervisors to visit the centres as transport to the rural areas is scant and particularly expensive. Also some health centres are up to 100K from the city centre, where Lighthouse clinic is located. Despite the obvious challenges, the training of healthcare assistants has been hugely effective in many areas of healthcare delivery, and is going a long way to bringing neccessary treatment to many people.
The three year programme has been remarkably successful and has continued in a reduced format for a fourth year, concentrating on the 10 busiest rural health centres. The figures for the three years show that 375,000 people were tested. With such a high level of HIV among the general population in Malawi it is important for everyone to know their status. 13,700 people who tested positive were referred for treatment opf which 3505 were expectant mothers. those who tested positive are referred to health education programmes.
The fourth and final year figures will be available - early April 2013
Community Based HIV Programme- with CAFOD
Community Based HIV programme located in Kapiri on the Malawian Zambian border, focuses on Prevention of Mother to Child HIV Transmission in pregnancy. Despite the acute shortage of healthcare workers, the programme is progressing remarkably well principally due to an extraordinary committment from volunteers in the community.
The programme co-ordinator stipulates that all women presenting for their first ante-natal visit must be accompanied by their partner- in a patriarchal society such as Malawi, this is progress!! During this first visit, the couple are tested for HIV (unless they request otherwise.) Should a woman attend the first visit without her partner, she is supported to bring him along for the next visit or a health volunteer will visit him at home.
If positive, the treatment is commenced. In an area where 16% of the population is HIV positive, this programme is vital. I met many couples who had cycled into the healthcare centre- the women on the cross bars- all in great spirits!! A great sense of camaraderie and community prevails at this centre.
If a women tests positive, a community volunteer supports the couple through the pregnancy, ensuring treatment is adhered to and counselling is sought where necessary. When it comes to caring for neighbours- the Malawians are the experts!
John and Charity heading home having attended the antenatal clinic, they were both caunselled about HIV and later agreed to be tested. THis programme is on the Malawian/Zambian Border where HIV is at 16%, one of the highest in the country
If the man tests positive, he is counselled about living safely, ensuring that he does not transmit the virus to his partner.
In addition to the PMTCT programme, The Rose Project provides funding for terminally ill patients on the home based care programme. There is a shortage of morphine at the moment and this is creating unnecessary suffering for patients. The Irish Hospice Foundations are co-funding this aspect of the community program with The Rose Project.
Before we left Kapiri, a community volunteer brought us to visit a young woman who had given birth at the healthcare centre on 17th February. This woman called Mary had been distressed to discover that she was pregnant. She is HIV positive. Her husband, (now deceased) had been working in the Tobacco fields on the Zambian border and had become infected through prostitution. She has three children already. Mary has been on treatment and the baby will now be tested at 6 weeks. When a HIV positive expectant mother receives treatment during pregnancy, the risk of HIV transmission to the baby is reduced from 56% to 2%. Both mother and family will continue to be helped by Kapiri Community Health centre.
Mary holding her new baby with Agatha Dodo- CAFOD’s representative- Mary received treatment during her pregnancy to prevent HIV transmission to her baby.