June 18th 2012
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.
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.
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.
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.