Increased financial support is required to reach the remaining 50% of HIV positive people who do not have access to treatment. According to figures released by UNAIDS March 2010:

• In Malawi 888,000 people are living with HIV
• Mother to Child is the second most common form of HIV transmission and accounts for 30% of all new infections

“Providing pregnant women living with HIV with antiretroviral prevention and treatment reduces the risk of a child being born with the virus to less than 5%—and keeps their mothers alive to raise them. (UNAIDS 2010)
Neither technical nor scientific barriers stand in the way of providing this treatment.

The University of North Carolina-Chapel Hill, has commenced a partnership with Bwaila Maternity Hospital -They join The Rose Project Ireland and Freedom from Fistula Scotland, in an effort to improve maternal and infant health in Lilongwe the capital of Malawi.

Despite ongoing political unrest, Bwaila Maternity Hospital continues to look after the majority of the births in the Lilongwe district. Many missionary hospitals have had to close their doors due to the uncertain political environment.

Rachel Macleod - The Rose Project’s midwife representative at the hospital, continues to work with the Malawian team in an effort to raise the standard of clinical care in the labour ward.

The hospital has recently acquired a full time Kenyan obstetrician and also a full time fistula surgeon.
The challenge remains to address the high level of maternal mortality. Malawi has the highest rate of maternal mortality in the world, for a non conflict country.

The acute shortage of midwives and obstetricians is one of the contributing factors.

With 14,000 annual births and only one obstetrician this is a challenge-The National Maternity Hospital in Dublin, has 16 resident obstetricians - and 9,500 births.(2010).

HIV has had a profound impact on maternal and infant health. 30% of all new infections are the result of mother to child HIV transmission during pregnancy.

Additionally, Malawi is a predominantly rural country and access to antenatal care is extremely difficult for women. Long distance and poor transport being the principal problems.

Fistula Clinic at Bwaila Maternity Hospital (commenced 2010)

140 women have had fistula repairs at Bwaila Maternity Hospital in the past year thanks to the work of the Scottish organisation Freedom from Fistula who are funding a Fistula Surgeon.

Obstetric fistula is the most devastating and serious of all childbirth injuries. It happens because most mothers in poor countries give birth without any medical help. So many are young girls. Complications from pregnancy and childbirth are among the leading causes of death and disability for women of reproductive age in these places. Obstetric fistula was eradicated in the United States more than 100 years ago thanks to emergency caesarean section surgery.

After enduring days of agonizing, obstructed labour a woman’s body is damaged by childbirth. During labour contractions, the baby’s head pushes against the mother’s pelvic bone — causing tissue to die due to lack of blood flow to this area. The pushing creates a hole, or in medical terms a “fistula”, between the birth passage and an internal organ such as the bladder or rectum. A woman cannot hold her urine, and sometimes bowel content as well.

Her baby is unlikely to survive. If she survives, a woman with fistula is likely to be rejected by her husband because of her inability to bear more children and the odour created by the condition. She will be shunned by her community and forced to live an isolated existence. These women suffer profound psychological trauma resulting from the loss of status and dignity, in addition to suffering constant pain.

The clinic is situated next door to the new Bwaila Maternity Hospital in the centre of the capital city- Lilongwe. Both institutions work closely together, particularly in the area of prevention of mother to child HIV transmission in pregnancy.

Since the opening of the clinic:
54,340 people have been tested for HIV and counselled in relation to the virus

Number of people placed on treatment for HIV:

• 12,340 women and men
• 1198 expectant HIV positive women
• 196 children
• 5889 patients have received treatment for TB

In 2008 Lighthouse OPD Clinic and The Rose Project were keen to expand the clinic services out to the rural healthcare clinics surrounding Lilongwe.

This programme, co-funded by The Rose Project and Irish Aid is in its fourth and final year .

• 331,000 people have been tested for HIV and counselled
• 15,000 people placed who tested positive placed on treatment
• 5,000 HIV positive expectant women placed on treatment

331,000 people have been tested for HIV in the rural healthcare clinics surrounding the capital city. In a country where the incidence of HIV is high- it is important for everyone to know their HIV status.

Lighthouse Clinic is responsible for 42% of all HIV Counselling and testing and encounters in the Lilongwe District over the last three years These are remarkable figures!

Once tested, people are advised on how to remain negative - those who test positive, where possible - are offered treatment at the clinic, failing this they are referred to another clinic where the treatment is available. Unfortunately HIV treatment is not available all the health clinics due to logistical difficulties such as staff shortages.

The Rose Project home page shows healthcare workers heading out from lighthouse clinic to the rural areas on motorbikes(funded by The Rose Project).

Bwaila maternity hospital has had a busy year with 14,000 births. Despite efforts to recruit obstetricians, the hospital has had onlyt one registrar working in the labour ward during the year

The shortage of obstetricians continues to be a major obstacle however despite this maternal and infant mortality figures have improved. This is largely due to improved clinical care from midwives.

The Rose Project with support from UNICEF continues to Rachel Macleod - a senior midwife/tutor who continues to provide clinical care and teaching in the labour ward.

A Kenyan obstetrician started work at the hospital and is being funded by the Scottish foundation- Freedom from Fistula. This organisation opened a fistula repair unit at the maternity hospital 18 months ago and to date 120 women have had fistulas repaired.

Due to the ongoing civil unrest in Malawi many of the smaller hospitals have closed their maternity units. This has increased the existing burden at Bwaila Maternity and resulted in some women giving birth to their babies on the floor, due to overcrowding in the labour ward.

The hospital is also struggling with the effects of the drug shortages created by the political situation.

Located adjacent to the maternity hospital continues to work closely with the hospital particularly in the area of HIV prevention from mother to child in pregnancy. To date the clinic has placed 16,000 patients on HIV treatment - 3,300 of whom were expectant HIV positive women.

In an effort to bring HIV counseling, testing and treatment to rural areas surrounding the capital city, The Rose Project has funded a three year programme.. This programme used the existing rural health clinics to incorporate HIV testing and to provide prevention of mother to child HIV transmission services - within the existing antenatal clinics.

The programme implemented by Lighthouse and part funded by Irish Aid has proven to be remarkably successful. 12,000 patients were placed on HIV treatment and a further 3,208 HIV positive expectant women were also placed on treatment.

If you place HIV positive woman on treatment mid way through her pregnancy the risk of transmission of the virus to her baby is almost eliminated

There is an additional aspect of this programme which addresses the issue of gender violence and protection of human rights for vulnerable groups.

The striking success of the programme over the past two years is the number of people who have come forward for HIV testing. It is essential for everyone to know their HIV status in an effort to address the spread of the virus. Out of a population of 14 million -  one million are HIV positive.
In addition, there is an increase in women coming early in their pregnancy for HIV testing and those who test positive are referred for treatment in an effort to ensure that their babies are born negative-In the past six months, 49 women in this community have been referred for treatment- increasingly the women are accompanied by their spouses. In a strong patriarchal society - this is progress!

During The Rose Project’s time working with groups in this community it became apparent that there were many patients either for whom the Aids drugs arrived too late or who failed to respond to treatment.

In an effort to care for these patients, The Rose Project in partnership with The Irish Hospice Foundation are funding two palliative care nurses in the Lilongwe community programme-
This programme which is in its early stage will work in partnership with the Palliative Care Association of Malawi.

Riots have broken out in several cities in Malawi after police and the army
tried to disperse protesters demanding the resignation of President Bingu wa
Mutharika, whom they accuse of ignoring civil liberties and weakening the
economy.

In the capital, Lilongwe, witnesses said smoke was
billowing into the sky as demonstrators burnt cars, offices and shops belonging
to politicians from the ruling Democratic Progressive Party (DPP).

Troops were deployed in the normally sleepy commercial
capital, Blantyre, and police fired teargas at marchers who had gathered
outside the stock exchange.

“The earlier injunction has been withdrawn and we’re
proceeding on the planned route of the demonstration but sadly we’re being
smoked by teargas,” said Gift Makhwawa, president of the Malawi Law
Society.

A police spokesman, Willie Mwaluka, said security forces
were on high alert to curb the unprecedented wave of unrest in the landlocked
former British colony. “We’re assessing the situation as it unfolds. Right
now I don’t have any confirmed figures of arrests, and extent of property
damage,” he said.

Marchers in the northern city of Mzuzu ransacked the DPP’s
offices in a rare show of defiance against Mutharika, a former World Bank
economist who was first elected in 2004 and who has presided over six years of
aid-funded economic growth. His ratings faded this year when he became
embroiled in a diplomatic row with Britain, Malawi’s biggest donor, over a
leaked embassy cable that referred to him as “autocratic and intolerant of
criticism”.

After the expulsion of its ambassador to Lilongwe, Britain
kicked out Malawi’s representative in London and suspended aid worth $550m
(£341m) over the next four years. The freeze has left a hole in the budget of a
country that has historically relied on aid for 40% of its revenues.

Despite mounting commercial pressure on the currency and
repeated calls from the likes of International Monetary Fund for a devaluation,
Mutharika has vowed to stand firm. “We are not off-track. It is the IMF
which is off-track in Malawi,” he said in a lecture broadcast on state
media on Wednesday. “When other developed countries are receiving
bailouts, what we get in Malawi are demands to devalue our currency.”