Wednesday, 20 April 2016

Q is for... Queen Elizabeth Central Hospital, Blantyre, Malawi

As those of you who know me or who have read some of the other posts on here will know, I've been back and forth to Malawi several times. Generally, I have been to Blantyre on these visits.

The main medical school in Malawi is at Blantyre, with the students doing their clinical training at the Queen Elizabeth Central Hospital. I was able to visit the hospital on one of my trips to Malawi, and followed a ward round on the general medical ward, which helped me to be able to describe the hospital in my book "The Wrong Kind of Clouds" when one of the characters is taken there.

Unlike the UK (and presumably the US and elsewhere) where many health issues are non-communicable diseases, the biggest health issues in Malawi are malaria, tuberculosis and HIV/AIDS, with malnutrition being both a major problem in itself and a complicating factor in most other conditions.

It's not just the kinds of things being treated in Malawi that are different - the system of nursing and the availability of beds and medicines are very different to UK hospitals.

On the ward round I followed, there were 64 patients in a ward designed for 32. 32 patients (the sickest) were in beds; the other 32 were on sheets on the floor between the beds. As the ward round progressed, these patients were dragged (on these sheets) out of the way so that that doctor and clinical officers could see those on the beds, and then dragged back afterwards. In the video below, you can see this doubling up in one of the wards (about 1:20 in; slightly alarmingly, the man in the bed on the right is cuffed to the bed at his ankle).

Nursing: washing, feeding and general nursing care is provided by the 'Guardians' - family members/friends who wait outside the hospital while the ward rounds are taking place but who then come in to care for their relative/friend. In the video at 3:06 you can see them making the food outside. The pile of cloths you can see in the video cover is the laundry about to be done by the guardians - you see some hanging to dry later.

As you might imagine, there is a shortage of many medicines and blood products. One patient I saw had severe malaria and as a consequence, her haemoglobin level was 5g/dL (the normal for a woman is about 11.5-16.5g/dL). She would have long since had a transfusion in the UK; there, they were waiting until it got below 5g/dL before they could consider it. There are many risks with blood products in a country with such a high rate of HIV/AIDS, and major shortages.

The video below takes you on a tour around the hospital. It isn't my video - I found it on YouTube - but it gives a pretty good impression of what the hospital is like. I will never complain about healthcare in the UK!

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