Archive for the ‘Bwaila Maternity Hospital’ Category

Bwaila Maternity Hospital in Lilongwe, (a Ministry of Health hospital) continues to handle the majority of the births in the capital city of Malawi.

In 2011 the hospital managed 14,000 births. The National Maternity hospital in Dublin, for the same period managed 9,500 births.

There are only 2 obstetricians in Bwaila Maternity and 20 fully qualified midwives. This principal challenge to safe births at the hospital and in Malawi in general is- the acute shortage of healthcare workers.

Bwaila Maternity hospital was funded by The Rose Project in 2009 replacing the old maternity hospital. For a number of reasons (including the building of an additional maternity hospital not far away) it was hoped that the number of patients attending the hospital would fall. However the number has in fact increased by three thousand annually.

Senior midwife tutor - Rachel Macleod, The Rose Project’s representative at the hospital, continues to teach the midwives and provide clinical care to the patients. Rachel, for the past three years has been actively working to assist the up skilling of midwives, in the area of clinical care delivery and management. This has taken place in partnership with the district Health officer and senior matrons at the hospital.
The impact has been substantial - manifesting itself in the reduction of maternal and infant deaths.

Good news: since the hospital was built a number of international partners have joined The Rose Project, in the effort to reduce infant and maternal deaths and improve the standard of clinical care provided to patients.

Among these partners are the University of North Carolina Chapel Hill -the Centre for Disease Control USA and Freedom from Fistula Foundation (Scotland). The latter opened a fistula unit at the hospital late 2010.

The Department for International Collaboration Norway who part funded the equipment for the hospital, continues to work with The Rose Project in the area of management training for the midwifery staff. This organisation are also funding a full time midwife at the hospital.

The partners together have implemented a number of new initiatives at the hospital including:
• A midwife clinical mentoring team
• Individual skills assessments and skills improvement for midwives
• New obstetric skills lab
• In service training for midwives
• Setting up of a hospital Library
• Norwegian exchange program and Management skills workshop
• Electronic register for admissions and discharges (Baobab International)

ACHIEVEMENTS in the Labour Ward

• 20 of the most experienced midwives have formed Bwaila clinical mentoring team. (BCMT) This team will ultimately be responsible for the supervision, training and mentoring of both full time staff and students, in the Labour ward.
• Three senior midwives travelled to Norway for a management training course and a follow up course will take place in Bwaila Maternity this year. Since their return there are signs that the labour unit is working more efficiently and there in a concerted effort to manage work rotas, shortages etc in a more efficient manner.
• Whilst BAOBAB International inserted the electronic system in the hospital last year , the midwives were not trained in its use. With additional funding, six IT technicians have been employed to work alongside the midwives 24/7 to orientate and support them through the initial months. It is proving to be very successful.

Lighthouse Outpatient Clinic (funded by The Rose Project in 2006)
Lighthouse clinic is situation next door to the Bwaila Maternity Hospital and works in partnership with the hospital in the area of prevention of mother to child HIV transmission. The workload at outpatient clinic continues to grow steadily, with over 4,000 visits per month. Approximately 234 HIV positive patients are commenced on treatment each month. 66% of the patient reviews are made by nurses, leaving the more complex cases for the few clinicians available. The acute shortage of healthcare workers is the principal challenge to healthcare distribution in Malawi.

HIV Counselling and Testing in Rural Areas (2008-2012)
This programme (co-funded by Irish Aid) is its fourth and final year. The aim of the programme is to bring HIV testing to the rural clinics surrounding the capital city of Lilongwe. A particular emphasis is on ensuring that all expectant women have access to HIV testing through the existing ante-natal clinics.

Overview of programme
A Joint initiative by TRP and Lighthouse in partnership with Irish Aid.

BACKGROUND HISTORY AND CHALLENGES
Approximately 30% of all new HIV infections are due to mother to child transmission.
In Lilongwe there are 90-100,000 births annually within a population of 1.5 million.
Of these 15,000 to 20,000 of babies are infected with HIV.
HIV status is known for fewer than 6% of births
There are still low numbers of HIV positive women receiving therapy at antenatal clinics (7%)
Main provider of PMTCT in Lilongwe University of North CArolin only provides 25% coverage.

PROJECT AIMS
Provide 50,000 HIV tests per annum tripling the number of women accessing HIV counselling and testing in antenatal settings in Lilongwe district from 25,000 to 75,000 thereby enhancing service provision and increasing coverage.

RESULTS
Total number of people tested 374,552
Total number of people referred for treatment 25,309

The Rose Bowl Sculpture commissioned in 2006 - Sponsored by D2
The Rose Project commissioned a sculpture of Rose Atieno in 2006 to commemorate her life and the 28 million lives lost due to the HIV on the African continent. St Stephens Green Park in Dublin was home to the sculpture for six years.

In June 201, the Office of Public Works indicated that they required the space for temporary exhibitions and invited us to find a new home for the sculpture.

The Board of the Rose Project are pleased to announce that the final ‘resting place’ for Rose will be in Dublin City University campus. Professor Brian Mac Craith accepted the offer of the sculpture indicating that it was a wonderful gift to the university.

Dublin City University will host an annual World AIDS Day lecture which will involve student participation.

DCU has a strong commitment to global health through a number of their schools particularly the school of Nursing which are involved in a Global Health Initiative with the Royal College of Surgeons in Ireland.

Current Political Situation
President Joyce Banda has already made a number of decisions which is likely to reinstate Aid from its principal donor - Britain. During the previous regime Aid had been cancelled due to corruption at the highest level of government. The official jet airline has been sold of with a number of Mercedes cars also being sold. Within the past week, The Malawian government has said it will not host an African Union summit in July because the continental body has insisted that Sudanese president Omar al- Bashir, wanted on charges of genocide, be allowed to attend the meeting.

The decision by Malawi’s new president, Joyce Banda, marks an about-turn in the country’s position towards Mr Bashir, who is wanted by the International Criminal Court for genocide, war crimes and crimes against humanity in Darfur.

Ms Banda’s predecessor, Bingu wa Mutharika, who died in office in April, had defied calls to apprehend Mr Bashir and allowed the Sudanese president to enter and leave the southern African country in October 2011.

In a recent letter to the Malawian government, the AU insisted that Mr Bashir be permitted to attend the summit, scheduled for July 9th to 16th, despite the arrest warrants pending against him. (Irish Times June 11th 2012)

From the health perspective, the new president has appointed Dorothy Ngoma as the government’s Safe Motherhood consultant. Ms Ngoma was been a huge force for change within the nursing and midwifery area and is acutely aware that unless the severe shortage of skilled healthcare attendants is address in Malawi, the tragically high number of infant and maternal deaths associated with giving birth will not be addressed.

April 19th 2012
President Joyce Banda is inaugurated as the new Malawian President. The country has been in the grips of an autocratic regime for the past number of years under the rule of Bingu Wa Mutharika. This has lead to immeasurable suffering for people requiring healthcare, due to shortages of medicines and hospital closures. Bwaila Maternity Hospital is grossly overcrowded, as many Christian Missionary Hospitals have been forced for financial reasons to close.

MARCH 2012.
Due to the ongoing political unrest in Malawi under President Mutharika essential drugs continue to be a huge challenge. Shortage of gloves, sutures, catheters, IV fluids and drugs have become a normal part of everyday life on the unit. Shortage of fuel continues to affect the provision of care to patients. Episodes without power due to fuel shortage continue. There were also long periods without a water supply in the month of April due to some important repairs on the main system. This was particularly challenging.

March 30^th 2011

Currently The Rose Project in partnership with Irish Aid, is funding a three year HIV counselling and testing programme in Lilongwe .  This programme is aimed at bringing counselling and testing to thirty four rural health centres surrounding Lilongwe city. The programme also has a strong focus on prevention of mother to child HIV transmission in pregnancy.

Results recently received from the programme are very promising.

Between September 2008 and Feb 2011:

·         11,605 patients have been referred for anti-retroviral treatment having tested positive at the health centre

·         Of whom  2,941 are pregnant women

·         312,390 people have been tested in total

Part of the programme ensures that those who test negative receive education on life styles-  highlighting the importance of remaining negative. 

This programme is being implemented by our partners at Lighthouse clinic, a clinic funded by The Rose Project in 2006

Lighthouse clinic is a HIV and AIDS outpatient facility which provides healthcare to some of the most economically and socially impoverished people living in the capital city and its surroundings.

Rachel has been working at the hospital for the past three years and was central to setting up the new Rose Project funded Bwaila Maternity Hospital.

I must admit having felt rather apprehensive during the last few days in UK after my yearly Christmas break but I was ready to return to Malawi. I felt strong and enthusiastic, but leaving the comfort and security of family to return to the huge challenges of living and working in one of the poorest countries in the world left me feeling somewhat fearful. So I returned to Bwaila. Having played such a substantial role in the setting up of the new Bwaila Maternity Unit it felt like going home as I walked through the doors of labour ward, that first day after nearly 6 weeks away, to be receive a great welcome from my midwife colleagues.

It had been a difficult December. The unit had been without regular medical cover leaving the midwives and clinical officers (a cadre of healthcare worker specific to Malawi. Clinical Officers undertake a four year training) to take full responsibility for the everyday running of what is probably the busiest maternity unit in Southern Africa.

Despite predictions that the work load at Bwaila Maternity would decrease substantially after the opening of the new tertiary care wing at the Lilongwe central  hospital ( Ethel Mutharika Maternity Wing) this has not proved to be the case and we continue to attend more than 1,000 births a month.

The high-risk mothers are now being transferred to the tertiary hospital. In addition the health centres  are sending their difficult cases directly to EMMW. However, we continue to have extremely sick women and emergencies to attend. I can honestly say that the past 6 weeks have been some of the busiest I have experienced since I arrived in Malawi 3 years ago.

January sees the start of the clinical placements for our midwifery students. This year with an increase in students being trained it also means an increase in the number of students needing close supervision and clinical teaching in the ward situation. We have also had a new set of interns and clinical officer students on the unit all of whom require supervision and teaching.

I decided on my return that I should make my priority during this time the teaching and supervision of students of all cadres. It has been a pleasure to work with the interns, most of whom are highly motivated and enthusiastic learners. They are quick to learn and quickly become essential to the safe medical coverage of the unit.

The student midwives are of varying levels of enthusiasm and competence. They have little input from the college staff due to shortage of tutors which means that their practical skills need to be taught by our own permanent midwifery staff. There is still some reluctance on the part of some of these to undertake this role, given their overstretched work situation.

Others truly do not have the necessary skills to pass on their knowledge to students. I have spent most of my time this past month dedicated to this. I enjoy this part of my work tremendously and find that my own enthusiasm plays a key part in effectively creating  greater  interest and understanding thus leading to better and more adequate care.

As well as teaching, very often I am the most experienced obstetric professional on the unit. This means that my expertise is being constantly sought to aid in difficult and emergency situations.  I was very pleased to welcome a new Nigerian registrar onto the unit. We have already worked together in the past. We refer to each other constantly which gives strength to the medical and midwifery cover. I truly feel that together the possibilities to effectuate change are more than ever present.

The Rose Project has been funding a senior clinical midwife tutor at Bwaila Maternity hospital for the past nine months. Rachel MacLeod has been teaching and mentoring existing staff, in an effort to address the high level of infant and maternal mortality at the hospital. Rachel is also involved in implementing the Prevention of Mother to Child HIV transmission programme which is operating at the hospital.

We are delighted to announce that UNICEF will support The Rose Project financially to continue with this initiative.

Sept 8th Lilongwe 2009

All is progressing well towards the opening of the new hospital with great excitement in the air I t is a real honour for the Rose Project to welcome former President of Ireland and UN High Comminissioner for Human Rights, to officially opening the hospital along with the Vice President of Malawi.  Dr Robinson  President of Realizing rights is championing the issue of maternal mortality

Whilst the building is ready the greatest challenge is the acute shortage of healthcare workers. The Rose Project along with a number of International partners including UNICEF is working to address the situation in particular the shortage of doctors and nurses. With the generous support of UNICEF we have employed a full time very experienced midwife Rachel Macleod, to work alongside her Malawian counterparts. Rachel’s made aim is to assist the senior nursing staff at the hospital, with up schilling of midwives and overseeing the smooth transition from old to  new maternity hospitals.

In addition the Royal college of Obstetricians and Gynaecologists (RCOG UK) is assisting The Rose Project to source medical staff from outside the country as a temporary measure,  with 12,000 annual births at the hospital  and only one full time resident obstetrician, all the assistance possible is needed. The good news is that the Malawian government is funding the College of Medicine to train more doctors however it will be a long time before there is a sufficient number. In addition it will be vital to ensure that the working conditions for these individuals is attractive otherwise when training is complete they will leave the country. There is an additional cadre of healthcare worker in Malawi, which does not exist n Europe. Clinical Officers carry out a four year training programme at the college of Health Sciences and deliver the bulk of medical care. These are very competent, though under acknowledged within the healthcare system. The Rose Project along with a number of national and international organisations  looking at ways to address this situation

Sept 9th 2009

A number of Irish donors including Denis O Brien visited the new hospital. They also visited the HIV clinic which is beside the new hospital. This clinic was funded by the Rose Project in 2006.The focus of care at the clinic is on Prevention of Mother to Child HIV transmission during pregnancy. Since the clinic opened 6,000 people have been placed on AIDS This clinic will work closely with the new maternity hospital in the area of mother to child HIV transmission

Sept 10th 2009

The meeting with the District medical Officer was focused on the need for the District to rise to the challenges the new hospital is presenting. This is very difficult due to the shortage of personnel. In a hugely under resoursed healthcare system, a new hospital is bound to present many difficulties, however Dr Ndovie is one of the most enthusiastic people I have worked with and so we are   fortunate. In the afternoon I visited the ministry of health and spoke with the chief district nursing officer who assured me that midwives finishing their training in both September and December will be joining the existing midwives at the new hospital. A total of 8 midwives will be allocated to the hospital but we need 40. To address the shortage the Rose Project is funding the sponsorship of additional nurses to train in midwifery at the university of Malawi. This programme will commence in December and will bring an additional 16 midwives to the force. Hopefully within the next two years the administration of the hospital will in a position to have a  three shift rota in place, each  shift for 8 hours. Presently there are only enough nurses to work a two shift rota, this leads to total exhaustion among the staff and  inevitable mistakes.

10th September 2009

Today, we organised a Chinese meal for all the senior nursing staff and it went off very well. Due to the staff shortages, we had the meal in the library next to the hospital rather in the Chinese restaurant.  It went very well and it was agreed by all to have been a good team building exercise .

11th Sept 2009

I visited the visited the College of Nursing.

The Rose Project is working with the department of nursing (Kamuzu College of Nursing) at the University of Malawi, on a midwife sponsorship programme.  We will fund extra midwives to be trained and in return the midwives will commit two years to the maternity hospital. This sponsorship programme will commence at the university in December 09 and the first group of midwives will join the staff at the maternity hospital, in December 2010

Sept 12th 2009

This morning I visited the  new Wellness Centre which is complete and the staff are fully installed. This is a new healthcare centre which the Rose Project has funded; it will be operated by The Malawian Association of Nurses and Midwives  with additional funding from the Norwegian Nurses Association. Healthcare workers in Malawi are severely overstretched and require support at many levels. The HIV pandemic has seriously overstretched an already challenged healthcare service. Many of the nurses  and midwives work 16 hour shifts due to the shortage of personnel. In addition many healthcare workers have become infected  through injuries in the work place such as needle stick.

In addition to providing holistic healthcare to the healthcare workers, this centre will also provide care to their families. The concept of a Wellness Centre is the brain child of the Swaziland Nurses Association where it has been in operation for five years and has proven to be most successful. Lesotho and Zambia followed suit and both these countries are experiencing a positive impact on the health force.

Sept 13th 2009

Finally this morning I finalised plans for the opening of the maternity hospital with Rachel our representative in Malawi, and ensured that all the invites had been delivered.

Mary