Malawi Clinics

Here is a full account from Syed Iftikhar of his visit:

Saturday 7th July 2018 – Fact Finding Mission To Malawi

I travelled to Lilongwe (Malawi) on the early morning, 7th July 2018, from Durban South Africa via Johannesburg. Lilongwe is the capital city of Malawi and its airport reflects the state of affair in that country. I had prefilled the visa application form to avoid any difficulty at the airport. I joined the queue for the visa counter. After half an hour, my turn came whereby my application form was collected and passport scrutinised. I was then instructed to go to next counter. When my turn came the lady asked me to deposit $75 visa fee. Then without any instruction I had to join the queue for the visa stamp. A gentleman at that counter took my biometrics i.e. picture, thumb impression and all four fingers impression of both hands. Once that was completed I was hoping to go and collect my luggage however, that was not enough, and I was stopped by two immigration officers who very diligently scrutinised my passport to see whether my visa stamp and passport were genuine. When they realised that I wasn’t prepared to pay them any sweetener for me to help them with my charity work I could proceed further.

At The Immigration Reception

Custom officials made me open my bag which I voluntarily opened without any fuss. It did surprise the officer but he did his job and was disappointed not to find any reason to extract any money out of me. After two hours of scrutiny and ordeal I came out of the airport. I was so happy to see Maulana Riaz (a wonderful host for five days of my time in Malawi) and Ismail (an accountant at the Mahboob Trust in Mangochi) as a reception party. I had never met these two individuals and found them exceptionally pleasant and nice. They first took me to a pizza shop so that I could travel well without hunger. World cup football fever, even a poor country like Malawi, had a big screen TV with football on for the restaurateurs.

The Exit road from the Lilongwe International airport was clean and well bill boarded. We had a 300-mile journey from Lilongwe to Mangochi. It was not too difficult as the road was large, had clean markings and good tarmac. The journey was fascinating as I witnessed things as never before. Young lads were selling rats and mice caught from the jungle. Apparently, people buy them on the way home to cook as delicacy. A village bazaar/market was colourful and full of hustle and bustle with trade. Generally, roads were clear of traffic, however, abundance of insects would hit the wind screen, smudge it and create a noise as if it was raining. So, raining insects rather than cats and dogs.

I was very pleasantly surprised to see a well-lit Mahboob centre. They were using solar light. My accommodation was in the guest lodge. The bed was well made, and a mosquito net was provided. I had taken every precaution to protect myself from malaria. I was taking Antimalarial tablets, body spray at dusk and dawn, and mosquito repellent electrical tablets to burn at night.

Sunday 8th July 2018 – First day at Mahboob Trust

My view at dawn was spectacular. Serene Lake Malawi with a few women washing linen and men preparing fishing lines. Imtiaz has been seconded from Niaz Trust in Bombay to streamline accounting and auditing.

The very first morning after breakfast I got down to work. My task was to assess the configuration, structure, system, organisation and functioning of the clinic. A quick visit to the building highlighted a newly constructed block and the clinic. An ambulance was parked in the corner of the grounds. I got very excited to see an NHS ambulance with British number plate, however, it was disappointing to learn that it had broken down within three months and they have not been able to get it repaired.

I found a bunch of onion in the consulting room cupboard. I wondered if that was put there to ward off any evil spirit. Doctor Abdus Salam gave me a simple explanation that he had bought them on his way to work and forgotten to take it home.

During my work in Pakistan I found it very difficult to get Pethidine and Morphine for pain control. It was pleasing to see that it was readily available in Mahboob clinic. They had a register to document the use of each ampule of pethidine used for accountability to the government.

Panoramic view of the primary school which has a secular syllabus/curriculum. Secondary school is similar. Furthermore, there are 200 boarding school students who are taught Islamic studies in the afternoon. The school in total, has 560 students of all cast, colour and religion.

On the very first morning after my visit to the clinic I met with Dr Abdus Salam, Mustafa (Pharmacist) and lab technician Tionge Matiki. I reviewed the patient’s data for the month of June. I then discussed the strengths and weaknesses of the service as they had perceived. It became very apparent that they were seeing significant number of patients and a third of those patients were victims of malaria.

The pharmacy was functioning well; however, Mustafa needed help, and suggested recruitment of an assistant pharmacist. The lab technician informed me that she does HIV, Malaria strip tests, peripheral film microscopy for malaria and full blood count. Her laboratory as yet didn’t have the equipment to perform Urea and Electrolyte test. It gave me a fair idea of the issues and areas in need of attention. Every patient has his/her diary. It is diligently filled by the doctors. That passport is taken by the patient as record of her past health care Colombo is a community liaison officer. He was bilingual; therefore, he was a great help in communicating with us all. Adam is deaf and dumb but communicates well with signs. He was the hardest working man in the entire setup.

Visit to Wangouti Island- Monday 9th July 2018

On Monday 9th July 2018, I travelled to Wangouti Island. It is a village which is a half hour boat ride from the base of Malawi marine force in Monkey bay. This village is accessible only by boat due to there being no road links. Beautiful and a distinct mosque recently constructed by Maulana Riaz and his team at the Island. Its shape is akin to khana Kaaba.

On my return journey, the boat engine stopped and weather was poor with strong wind and waves. Our boat started drifting towards the rock and for a while I thought that the boat would overturn and we would drown. However, as luck would be, the engine started again and the boat got sailing. Fish were being dried for consumption. Fish is dried in open as sun and air will take the water away and stop microorganism growth.

We had a visit to various villages and interaction with their inhabitants to explore possibilities of mobile clinics and medical care on site. We have put in place action to start a once a week mobile clinic for Wangouti Island

Work At Mahboob Trust – Monday 9th July 2018

Children in most junior class at the Primary school at Mahboob Trust. There was a child diagnosed with malaria. I took close observation of doctor’s clinical skills to evaluate efficiency and effectiveness. There was another girl with a burn. It was treated with paste made with used tea powder and leaves. It is a time-honoured method of treating burns and seemingly works effectively.

Clinic is conducted on cost to cost basis. It is functioning on Non- profit basis.

• Clinic accommodates 50 chairs in the reception for patients and relatives.
• There are always two nurses and a data collector at the reception.
• Vital measurements are done like Blood pressure, temperature, pulse rate and weight.

They have a self-generator for oxygen. Tionge Matiki the lab technician is very competent and works with basic machines for Full blood count, Malaria and HIV test. Absence of a machine to perform urea electrolyte and liver function test was very much evident.

Pharmacy

The pharmacy was well stocked and record keeping was very good. Chief pharmacist Mustafa is a very hard-working man and manages the department diligently. Payment for medicine is recorded well and no obvious embezzlement was noted.

Visit to Asalam Clinic

This clinic is run by a doctor, medical officers , a nurse, a lab technician and two pharmacists. I was impressed with their laboratory facility as it has an automated system for analysing urea and electrolyte. They also had a functioning ambulance.

Wednesday 11th July 2018 – Visit to Zumba Mental Hospital

Roads and communication channels are still poor. However, there was evidence of concerted effort of building and construction. Zumba mental hospital looked small from outside. I was pleased to see a poster of Hospital ombudsman.

We were received by Immaculate Chamangawana, director of the institute. After a brief discussion she gave us a detailed tour of the hospital. It’s an old hospital with infrastructure unchanged from the original construction. Currently crumbling and in need of urgent repair. Immaculate was very energetic and kind and spent few hours explaining and showing us the place. Sad part was that a number of men and women were incarcerated for ever.

I visited a friend’s father’s grave for Fatiha. His legacy to mankind endeared him to local population at large.

Diesel is expensive. Meter shows that 49.04 litre costed 40006.8 Khawacha (Malawian currency).

Visit to Al Barakah Trust and Mama Khadija Clinic

My last port of call on that day was Mama Khadija clinic. This clinic is based on a similar pattern as Asalam Clinic and Mahboob clinic. Dr Wadi was waiting for me. She is a very enthusiastic doctor and claimed to have experience of obstetrics. She would be keen to work at Mahboob Clinic if we develop our obstetrics service. The Place is set up in a very picturesque area. Dr Wadi, in discussion about the status of local and regional health care services and provisions, showed her HIV clinic which she had set up single handed.

Returning to Mangochi. Roads still under construction, did not allow easy travelling. Returning to Mahboob trust felt like returning home. With the hospitality extended by Maulana Riaz and Imtiaz it felt so good that it didn’t feel like travelling in a new country. Imtiaz at the gate of the school. Gate keeper was very pleased to see that I wanted a picture with him. People of Malawi are very nice gentle and accommodative except for immigeration officers. It was incredibly serene and peaceful within the compound outside our accommodation. Throughout my stay I had the famous fresh Chambu fish. It was delicious. They also have very tasty papaya.

Last morning leaving the place with good feeling about the place where education and health services are provided by God fearing honest people. Also, sad to have seen charcoal on sale throughout my travels. It only means cutting and decimation of jungles.

Summary

Mahboob Trust has a primary and secondary school for children from the local community, representing all religions and ethnic groups. There are 560 students currently registered at the school. 200 of those are residents. They are given religious teaching as well. The facility has a clinic which treats on average 1,600 patients per month. Care is reasonable, and staff are stretched. With the current configuration and desire of staff to move on to government jobs for ill perceived benefits, staff seem to be unhappy.

Recommendations

1. Utilisation of newly built wing to provide paediatrics and obstetrics is recommended.
2. Same new wing could house a Paediatric unit for sick children.
3. To provide doctors at night for in patient facility, it will need two more doctors. One fully fledge MBBS and the other a clinical officer
4. Facility will require good quality laboratory. To develop that, it will need a fully qualified experienced lab technician and another graduate lab worker.
5. There is a need to provide an automated biochemistry analysis machine.
6. There is a need to computerise the trust as a whole, with programmes communicating with each other.
7. Clinic should have a number of desktops, with advanced health care system.
8. Mosquito repellent plants should be planted in large numbers in the compound and in the vicinity. Especially in villages. That will be the best solution to control malaria.