Hospital Visit: Mulanje District Hospital

No matter how many times I have visited Malawi, one of the things that is always eye opening to me is seeing the local hospitals. The people of Mulanje are fortunate enough to have two hospitals in the district. There is Mulanje District Hospital that is owned and run by the government and Mulanje Mission Hospital, which was opened by Scottish Missionaries in 1896 and has been updated and added to periodically ever since.  These two hospitals serve a population of 550,000 in the Mulanje area.  Recently we were given a tour of the District Hospital by our friend Deliwe Chikuwo who is a Nurse Supervisor at the hospital. Having her show us around the hospital and explain different aspects of how the hospital is run was such a blessing. 

Because Mulanje District Hospital is run by the government, anyone can come in and receive free care. Although this sounds wonderful, logistically it causes some problems. It is not uncommon for the hospital to run out of certain medications, for example malaria medications. During peak malaria season most government hospitals run out of medication needed to treat malaria due to the high number of cases that come in. When this occurs patients are told to go to local pharmacies to try to buy the medication they need. In some cases the medication is too expensive and the patient will go without it, sometimes leading to more serious disease, or even fatalities. 

At the District Hospital there are currently only two doctors on staff. There are also clinical officers (similar to Physician Assistants or Nurse Practitioners) and a full nursing staff. Health care here in Malawi is very different than it is in the United States. There are no primary care physicians, so any health care that is needed is done at the local hospitals; this includes treatment and care for chronic conditions such as high blood pressure, diabetes and HIV. Since there are not electronic medical records, and the hospital staff is always changing, Malawians all carry health care record books that are called “health passports” where all illnesses, treatments, conditions, weight and height are tracked. In order to reduce infection rates, children are weighed using their mothers’ own chitenges that are hooked onto the scale. 

With the hospitals being the main source of care for the residents of the district, the hospitals tend to be very crowded and are often totally full. A major factor of this is HIV. The Mulanje district has a higher than normal rate of HIV (20% as opposed to the national average of 14%). This has a huge impact on health services in the district, with 60% of hospital admissions being HIV related.  

When a patient is admitted to the hospital, they are given a bed with just a mattress. Many of the beds and other hospital equipment has been donated by organizations in the United States, replacing worn out equipment.  It is the responsibility of the patient’s family to feed and take care of the patient during their stay in the hospital. It is very common to see women doing laundry, so you see clothing and fabric hanging out to dry around the hospital. Families can also be seen cooking and feeding their family members.

There are a few ambulances in the district, but many of the remote villages are not accessible by car. Because of this patients will have to walk for miles and miles in order to come into the hospital. There are also bike ambulances which are able to reach some of the more remote villages. They are used to help patients travel to and from the hospitals.  Since some of the villages are so far from the hospital, women will travel to the hospital weeks before they are due to have a baby, to ensure they are safely within distance of a hospital when their delivery time comes. New buildings have been constructed to house these awaiting mothers, which hopefully will decrease the rate of infant mortality due to birthing complications. 

As hard as seeing parts of the hospital can be, my favorite part of the visits is always seeing the newborn babies. This time as we walked through the nursery we saw two sets of twin boys that were just two days old! Walking through the nursery, you will not see any of the fathers of the children. In Malawi it is not customary for men to be present during the birth of children. These little babies that are all wrapped up, or snuggled against their momma’s chests are beautiful reminders of the bright future Malawi has.

Seeing a hospital in a developing nation such as Malawi after working in health care in the United States is heartbreaking. It seems so unfair that we have all sorts of life saving medications, procedures, facilities, and professionals readily available to us. Today I hope you join me in praying for justice in our world. Pray for the sick patients here in Malawi receiving the best care they have available to them. Pray for the families who have lost a loved one from an illness that would have been taken care of in a developed country. Pray for the health care workers here and all the challenges they face in order to bring their patients help. Pray for healthcare in Malawi.