The first Lady visits the new Bwaila Maternity Hospital in Lilongwe the capital of Malawi.
This hospital was funded by The Rose Project and opened in October 2009. In its first year 14,000 babies were born - an increase of 2,000 on 2009 figures. This is attributed to the good care at the hospital which has been a big hit with local people!
March 30th 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.
First Impressions
The night before starting in Bwaila Maternity Hospital in Lilongwe, I met with Rachel Macleod. Rachel is The Rose Project’s representative at the hospital and works as a clinical midwife in the labour ward. Rachel briefed me on what to expect and what would be expected of me. She gave me a background of the hospital, herself and the challenges they are faced with on a daily basis.
I felt daunted but excited to get started and experience Bwaila for myself.
The following morning I made my way to the hospital and was very impressed by the how modern the hospital was, particularly the labour ward having single rooms for women to deliver in.
Unfortunately due to the huge number of women coming through the doors of the hospital, most rooms accommodated two women and their guardians, which meant very tight space and no privacy for the women giving birth.
On my first day in Bwaila I observed Rachel deliver two sets of twins, a breech birth, a stillborn baby, perform Kiwi extractions for the many foetal bradycardias, care for severely eclamptic women and manage a post partum haemorrhage, not to mention the many neonatal resuscitations that she carried out.
By day three I was assisting her with neonatal resuscitation, a cord prolapse, shoulder dystocia, caring for eclamptic women and performing postnatal checks on women prior to being transferred to the postnatal ward.
The staff in Bwaila are constantly faced with emergency situations, there was no time to process any of it, for me all that I could do was swallow it and move on to the next emergency and think about it later.
One of the most distressing realisations I found was that women did not expect to survive childbirth, a harsh reminder of the insurmountable difference between my world and theirs.
I can honestly say that I found Rachel Macleod to be a truly inspiring midwife. Everyday she worked with an intensity that was hard to fathom considering the huge amount of women presenting to the unit on a daily basis. Her energy and enthusiasm for Bwaila was contagious. I was lucky enough to participate in the tutorials Rachel carries out twice a week for staff. These sessions were interactive and involved simulating emergency situations for the Midwives to practice their obstetric emergency skills.
Main challenges in the labour ward
Staffing seemed to be a major challenge on the labour ward. Although their seemed to be adequate staff in the morning, motivation and staff morale were evidently low. Staff themselves, were under huge pressure and obviously exhausted, however, this meant that sometimes women weren’t being cared for sufficiently.
Despite Rachel managing to be present in every room in the labour ward, constantly teaching and motivating, she is only one person and when she leaves, there is no one else who will carry on that motivation, ensuring that all women are getting the highest possible standard of care. Hopefully with time, additional staff and the effects of Rachel’s training, Bwaila will have additional enthusiastic motivated and less stressed midwives.
There were two obstetricians who I saw regularly, however they have now been transferred to the tertiary care hospital leaving Bwaila Maternity Hospital without a resident obstetrician.
It is important to remember that Bwaila Maternity Hospital has more annual births than the Rotunda Hospital (where I trained). In such an acute unit a full time obstetrician/obstetricians are necessary.
I intend to return myself when I have gained further experience, as I have just recently graduated with a higher diploma in midwifery. I think if there is a facility for sending midwives from Ireland to Bwaila for six-month rotations there would be a great interest and uptake from Irish Midwives. I certainly know of several people who would be keen to do this.
Advice I would give to others who would like to spend time at this hospital
I would recommend Bwaila maternity Hospital to anyone who has an interest in working in an emergency maternity care setting. It was emotionally and physically challenging but every positive outcome in the labour ward was rewarding. There is a level of pathology that would rarely be seen in the first world and every skill that a midwife has studied is put into practice. I would recommend to others visiting or intending to work in the hospital to spend a few months there. My time there was so short that I found it hard to process when I came home. It wasn’t until giving a presentation on my time in Bwaila to my class, lecturers and staff from the Rotunda that I came to terms with the enormity of what I had experienced within that short space of time. It was a huge privilege for me to be there and I am sure my midwifery career will take me there again in the not so distant future.
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.
Annie Lennox, singer, mother and passionate campaigner on HIV and Aids awareness last week visited Bwaila Maternity Hospital.
Lennox, who was awarded an OBE for her work in raising awareness of the HIV/ Aids pandemic across Africa, made her way to Malawi last week with the Scottish Parliament’s Presiding Officer, Alex Fergusson, at her own expense and is involved in a packed itinerary which also saw her visit Phuti School in Lilongwe, where Scots charity Mary’s Meals operate.
But as she comforts a child in Bwaila Hospital in Lilongwe, Malawi, Annie Lennox shows she is also a mother who understands the need for tender loving care.
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Live the Promise |
Live the Promise: HIV and AIDS campaign bulletin no. 1 / 2011
In this Bulletin…
Speak out during the UN AIDS review
How to get involved
EAA members mark World AIDS Day 2010
The Pope and HIV Prevention
Focus on: Christian Conference of Asia
Faith leaders respond to Kato’s death
Funding the Global Fund
Download the bulletin as a PDF hereFor past Action Alerts and Bulletins from the HIV and AIDS Campaign, see http://www.e-alliance.ch/en/s/news/
This clinic was built by The Rose Project in 2006, to provide HIV counselling, testing and treatment to people living with HIV or Aids.
In 2008, Lighthouse extended its clinical services to the rural areas bringing HIV counselling, testing and treatment to 33 rural health centres surrounding the capital city of Malawi. So far, 102,568 people have been tested. Those who are negative attend an education programme which deals with health and lifestyle which focuses on remaining negative. 8230 people who tested HIV positive were referred for treatment of whom 2345 were expectant women. Placing a HIV positive woman at 36 weeks on treatment almost eliminates the chance of HIV transmission to the baby.
Education is also provided on condom use and since the start of this programme 137, 370 male condoms and 5860 female condoms have been distributed.
A day in the life of our hospital…
I started at 7.15am ,and began by ensuring that the midwife allocation was carried out and that the blackboard with patient data was updated constantly during the day encouraging the charge nurses and students in their responsibilities. Every task or procedure I undertake is carried out whilst constantly teaching.
Yesterday I delivered 2 sets of twins; one complicated and the other not. 2 breech births, one that I was called to assist in emergency with an obstructed head. 3 vacuum extractions. Various prolonged labours. Supervised at least 6 other deliveries with students. Sutured 3 perineum’s whilst teaching clinical officer students. I resuscitated 4 babies, managed 1 PPH (post partum haemorrhage, diagnosed and sent to women to theatre . Managed I severe APH (anti partum haemorrhage) for placenta abruptia with a good outcome for mother and baby. I taught on the morning round consisting of clinical officers and clinical officer students, midwives, midwifery students, interns and doctors. I admitted 4 referral patients with acute pathology.
I finished after 5.30pm, there was no time for breaks. We delivered more than 52 babies in 24 hours! This was a busy day. But then most days are busy.
Rachel
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.
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 becomes a priority in Malawi. The Rose Project, with assistance from UNICEF, is funding a senior midwife- Rachel MacLeod to oversee clinical practice in the labour ward.
Rachel MacLeod, TRP representative at Bwaila with charge nurse Magrete.
We are also funding 20 midwives in partnership with Haukeland University Hospital Norway. These midwives will commence work in January 2011.
Progress at the hospital is being monitored and the 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.
This was my first visit to the new hospital since it opened and it was wonderful to see patients enjoying the facilities. 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 you who gave so generously a very big thank you from the women attending the hospital!!
The state of old hospital, built in 1939, meant that many women gave birth onto the stone floor.
Lighthouse Clinic
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. 30% 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:
The Rose Project, in partnership with Irish Aid, is funding a three-year HIV counselling and Testing programme in the 35 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 vital treatment to many people.
The figures for the first year and a half of this programme are encouraging and Lighthouse Clinic have been quite surprised at how well the programme is progressing, given the obvious challenges. Out of the 35 district Health Centres there is only one centre with a doctor! In some cases there are only 2 qualified nurses . The numbers attending the health centres are huge and the level of sickness - alarming.
Thus far, 147,531 people have been tested through this programme. These people receive extensive counselling on the importance of remaining positive. For most, this is the first ever health visit they have had! 11,261 people have now been treated, which is a great achievement in the 18 months of this outreach. Furthermore, 1628 expectant women were tested and referred onto treatment.
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 to have home-based care. There is a shortage of morphine at the moment and this is creating unnecessary suffering for patients. The Rose Project is looking for ways of resolving this recurring problem.
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.
