3rd December- Article by Mary Donohoe published in Irish Medical Times- Malawi Mums Need Support
Malawi mums need support
Mary Donohoe warns that when we recruit healthcare providers to Ireland from developing countries where shortages exist, we cause deaths
The Rose Project is an Irish non-governmental organisation, founded in 2003 by former nurse Mary Donohoe. The organisation has raised significant sums of money and supports locally led healthcare programmes in Malawi.
Malawi is a landlocked country in southern Africa and ranks among the most densely populated and least developed countries in the world. With the majority of people living on less than $2 a day, life is a challenge.
Travelling around the capital city of Lilongwe and its rural surroundings, one is struck by the sinister poverty, with lack of healthcare being a major contributing factor.
HIV positive
According to official figures, 15 per cent of the population is HIV positive; however speaking with hospital staff and healthcare professionals generally, it is estimated to be considerably higher in urban areas.
Prior to the advent of HIV, the healthcare system in Malawi was severely challenged; with its arrival, it has been brought to its knees. Efforts to increase access to healthcare and to maintain and improve the quality of care are being severely hampered, due to the acute shortage of health workers and appalling conditions in the hospitals and health centres.
In relation to healthcare workers, the situation is at crisis level, with only one doctor per 100,000 people and 56 nurses. Nowhere is this more evident than in the area of maternal and infant mortality.
Malawi has the highest rate of maternal mortality for a non-conflict country, with one in 14 women losing their life in childbirth. The country also has one of the highest levels of vertical HIV transmission in Africa, resulting in 30,000 babies being born HIV positive each year. Few of these infants reach their second birthday.
To exacerbate the above, Malawi has one of lowest ratios of healthcare professional per patient in east Africa. The Rose Project is addressing all three problems.
Last month, Dr Mary Robinson and the Vice President of Malawi, Ms Joyce Banda, opened a new maternity hospital in Lilongwe on behalf of the Rose Project. This hospital replaces a shed-like building which was constructed in 1939 to facilitate 4,000 annual deliveries.
There are now 12,000 annual deliveries. Many of the women at the old hospital delivered their infants onto stone floors due to overcrowding and unassisted due to lack of staff. In addition, 25 per cent of the expectant women are HIV positive, many with AIDS. This places enormous pressures on existing services.
State-of-the-art facility
While the new hospital is a state-of-the-art facility and the first of its kind in Africa to afford each couple a private room for the birth of their baby, it still has only has only one resident obstetrician and three qualified midwives for 12,000 annual births. To place this in context, the National Maternity Hospital in Dublin has 9,000 annual deliveries with 18 obstetricians and 138 midwives. The challenge is enormous.
Thirty thousand infants are born HIV positive in Malawi each year. This is preventable, however the greatest challenge is the shortage of healthcare workers to implement the necessary initiatives.
In 2006, the Rose Project funded the Lighthouse AIDS Clinic in the centre of Lilongwe. Prevention of HIV transmission from mother to child has been central to the care provided at this facility.
Co-funded by Irish Aid
In 2008, in an effort to bring PMTCT (preventing-mother-to-child transmission) to the rural areas The Rose Project awarded a three-year grant to Lighthouse Clinic. To date, the clinic has successfully implemented PMTCT at 30 of the 40 healthcare centres. This programme, which is being co-funded by Irish Aid, is working well but has serious challenges due to the shortage of healthcare workers at the centres.
Finally, many healthcare workers are themselves unwell having been infected in the workplace with TB/HIV or succumbed to the virus themselves. These individuals need to be cared for in a confidential and safe environment.
Wellness centres for healthcare workers are an initiative of the International Council of Nurses in Geneva and have been proven most successful in halting the attrition rate of healthcare workers in Lesotho and Swaziland, where they have been in operation for some time.
Critical shortage
Last month the Rose Project funded a new Wellness Centre in Lilongwe, which was opened by the Vice President of Malawi. Undoubtedly, the principal challenge to safe motherhood in Malawi is the critical shortage of healthcare professionals.
Africa has 25 per cent of the global disease burden with only 2 per cent of the global workforce. No one denies that developing countries, including Malawi, need to take the lead in providing solutions to this acute shortage of healthcare workers.
Despite limited resources, the Malawian government is attempting to do this; however given the huge level of illness created by the AIDS pandemic, they are keen for international support.
Ireland has one of the most highly skilled medical and nursing workforces in the world. According to UNICEF’s latest figures, Ireland is the safest place in the world to have a baby. Given this remarkable achievement, surely there is a great opportunity and an urgent need for individuals, medical and nursing institutions to become involved in what is now acknowledged to be one of the greatest tragedies of our time — the level of maternal and infant mortality in the developing world.
As a country we have benefited and continue to benefit from foreign healthcare workers, in some cases to the detriment of local healthcare systems. How much of this recruitment is ethical is questionable.
Everyone has a right to access the global labour market; however it is important to remember that few of these workers wish to leave their families and countries. They do so out of need. This need often fills gaps in healthcare systems in rich countries where investment in training has been insufficient.
We need to understand that the recruitment of healthcare workers from developing countries, where critical shortages already exist, is causing deaths. If recruitment must continue, it should be carried out in a fair and equitable manner in consultation with local governments; after all, for the most part they are funding the undergraduate training.
The Rose Project
Over the past 6 years the Rose Project has funded 28 HIV-related programmes in six east African countries, reaching approximately 200,000 people with treatment and care, including five new healthcare centres, medical/nursing training and salaries, large scale prevention programmes, nutrition, drugs and transport.
Mary Donohoe trained as a nurse in Saint Vincent’s University Hospital Dublin and is a governor of the National Maternity Hospital Dublin
For further information please visit: www.roseproject.org
