Malawi Clinics

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An unknown outbreak has registered 133 cases, 95 in Malawi and 38 in bordering country-Mozambique. According to the Nation Newspaper of Friday 24 July 2009, Secretary for Health, Chris Kang’ombe  said the disease has so far killed 17, nine from Malawi and eight from Mozambique since May this year.

Five American health specialists arrived in the country. The Nation Newspaper said a press release from the American Embassy in Lilongwe said Malawi formally requested epidemiological aid assistance from the US Government on July 15.

In the first place samples were sent to South Africa. New samples have been again taken and sent to the Centre for the Disease Control in the USA for analysis.

The disease symptoms are a stiff neck, dehydration, fever, headache, joints pain, abdominal discomfort and loss of voice.

Dennis Kalimbira quotes the ‘Nation’ Newspaper.

Peter and Tiwonge (Not real names) three years ago tied a knot in a very colourful wedding ceremony, attended by big shots and have one child. In celebrating their third year marriage anniversary, they went to test their serostatus again. When the results came out, they were shocked!

Before the wedding they both tested non-reactive twice in a space of three months.

The above scenario might shock those of us who think married people are safe from HIV and AIDS.

The Nation Newspaper (One of the local papers in Malawi) of Tuesday July 7 2009 carried a story in which the Secretary for Nutrition and HIV and AIDS in the office of the President and Cabinet Dr. Mary Shawa revealed that “Recent mathematical models are indicating that most of new infections in Malawi are coming from the so-called stable and long-term sexual relationships, including marriages.” This revelation indicates that there is infidelity in marriages and the responsibility of protecting oneself is ignored at one point in their married life. Where do things go wrong?

In some cases lack of basic necessities like food drives a woman to out with other men who can secretly provide for her. Unfortunately women in Malawi grew up to think only men are decision makers so they do not negotiate for safer sex.

Heavy drinkers who become useless in bed also drives their spouses to seek pleasure outside marriage. Alcohol impairs judgment which makes people to forget their responsibility of protecting themselves and their spouses. Sometimes spouses are unsatisfied with their spouses’ performance. This entice them to find solace outside matrimonial home. In families people do not perform satisfactorily because of lack of knowledge of how to perform in such a way. And infertility also drives families to seek the services of  ‘Fisi’ (Hyena) for fear of being ridiculed by society of being ‘Osabereka’ (Infertile). Sometimes a woman would find a man without her husband’s knowledge to father her children.

These situations risk families to get HIV and AIDS.

To solve these problems it is suggested that families needs to take responsibilities of finding basic necessities by working hard and have small and manageable families. Government should continue with policies that enhance social-economic growth to alleviate poverty. Women should be empowered to initiate negociation for safer sex.

There should also be continued efforts to educate people on effective ways on how to achieve safe sex if being faithful to one partner is compromised. Education should base on partner protection. This can only be achieved by establishing family friendly reproductive services where families can get counselled on sexuality issues, conjugal satisfaction and home-making to keep couples at home. People should have where they can take their family grievances concerning sex satisfaction to in confidence. Churches also must assist in this matter.

People on the move-drivers, people attending workshops and those who go to school leaving their families should be continually reminded and counselled on their responsibilities of protecting their spouses and themselves and provided with ways on how to achieve this.

These might not be the only situations where things go wrong and ways to correct them. A comprehensive research has to be instituted to unearth more than what meets the eye and collectively find solutions before the marriage bed transforms into death bed.

Congratulations to colleagues at the University of Malawi, College of Medicine in Blantyre for publishing a fascinating randomised controlled trial of nutritional supplementation in HIV, published this week in the BMJ. The team compared supplementary feeding with fortified spread or corn-soy in wasted adults commencing anti retroviral therapy for HIV.

WHAT IS EATING FOR LIFE?

Denis Kalimbira had this to say:

• Eating for life is a programme Megan Taddonio-the then Peace Corps Volunteer at Kangolwa Health Centre in Ntchisi in 2007 and I introduced after seeing children who were discharged in Nutrition Rehabilitation Unit relapse into malnourished state after treatment is over.
• Eating for life emphasized in teaching families eating various kinds of locally available food, prepare them in a way that they can be delicious, providing all needed nutrients and practicing health seeking behaviours.However,the programme short lived because I left for school few months after introduction and Megan had few months too left on her contract.
• Of late in clinical allocation I chanced to work in Nutrition Rehabilitation Unit. During my two weeks stay the following happened which display that despite efforts in RHU,we still have the problem of malnutrition
• After discharging twelve children one Thursday, on Monday we re-admitted three of them.
• Once came a very sick woman with a marasmic child. She had no guardian except her six year old daughter. She was admitted in female medical ward and we were going to female ward to deliver milk (F 75) for the child and get the child for clinician review. That was happening when we had a thirteen year old girl attending to her kwashiorkor sister. Their mother is dead.
• Another day came a man with marasmic child. The child’s mother was admitted in female ward. The man complained of looking after other children at home and does small jobs to support his family.

Owing to the child’s condition we had no choice but stay and leave his other children in hands of who only God knows.

NUTRITION DEFICIENCIES (MALNUTRITION)

· The above scenarios display the need for eating for life programme to supplement NRU.Not eating for life result in nutrition deficiencies. Severe forms of nutrition deficiencies are:

(a)Marasmic-a condition arising when there is a deficiency in energy giving foods and other nutrients .Marasmic child usually extremely wasted, the weight is extremely low for age.

(b)Kwashiorkor-occurs when the child lacks proteins, energy and other nutrients, coupled with an imbalance between the production and removal of some compounds produced during infections which damages body tissues. The child presents with oedema and usually not underweight.

CAUSES OF MALNUTRITION

· Malnutrition is a result of the following major factors:

· Low food intake-due to poor feeding practices and lack of household food security.

· Frequent illness-from diseases like malaria, measles, diarrhea and AIDS due to inadequate maternal and childcare, insufficient health services and unhealthy environment.

· Frequent illness leads to:

· Malabsoption of food nutrients.

· Anorexia.

· Failure to eat adequately due to sores in the mouth.

EFFECT OF MALNUTRITION

Dangers of malnutrition are:-

· Inhibits growth and motor development in children-results in unintelligent children.

· Reduces immunity.

· Leaves a person in disease trap as is vulnerable to opportunistic infections.

· It is an obstacle to sustainable socio-economic development and poverty reduction.

· Increase mortality-both maternal and neonatal.

WAY FORWARD

• Regarding the above dangers, readily available help is admitting children in Nutrition Rehabilitation Unit, providing plumpy nuts and soya flour to mild malnourished children. This is helping but the challenge is that usually traditional programmes that rely on external food resources and paid health providers the children often relapse into their malnourished state as soon as feeding session are over.
• I suggest that above mentioned progress can be successful if we complement it with “eating for life”programmes in which we can tap into local wisdom for treating and preventing malnutrition and spread that wisdom throughout the community. This can be done by teaching people behaviors and practices which can able them successfully solve the problems and overcome formidable barriers. They should learn by doing.
• The programme can succeed because “eating for life”agrees: “while poverty is a tremendous factor affecting nutrition status, some impoverished families have demonstrated that this can be overcome,” CORE February 2003.
• Indeed this can be overcome when we involve every family in the fight against malnutrition in doing the following:

(a) Increase and diversify food supply and incomes.

(b) Eating various kinds of food to get all nutrients.

(c) Exclusive breast feeding-giving a child breast milk only from birth up to six months and continue breast feeding up to two years.

(d) Fair share of food.

(e) Pregnant mothers attends antenatal clinic and provide with nutrious foods –to give birth to healthy baby

(f) Use iodized salt

(g) Attend growth monitoring and immunization sessions.

(h) Apply cooking oil or groundnuts or Soya flour to vegetables-to make vitamin A, easily absorbed by the body.

(i) Eat fruits after food

(j) Sleep under insecticides treated nets.

(k) Practice family planning.

(l) Practice childcare, hygiene, sanitation and health seeking practices.

(m) Children should get vitamin A, iron supplements and dewormed.

(n) Grow crops in dimba and practice animal farming.

CONCLUDING REMARKS

The fight against malnutrition should centre at preventing its occurrence at all cost if we are to enhance sustainable socio-economic development and poverty reduction.

Programmes should involve all people, done at the cost they can afford-like people can grow and process Soya to get maximum proteins and vegetables for vitamins. As of now, let us recognize that malnutrition is a very big problem worth extra efforts and support to be eradicated-probably with “eating for life.”

This year the major theme is Making Hospitals Safer in Emergencies, including natural disasters and war zones.

The potential of mobile phones to become the dominant media for health communication has again been highlighted.

Ever wondered how we can make two way learning a reality? What can health professionals working in resource rich countries, like the UK, learn from their Malawian counterparts. Ron Neville and Jemma Neville highlight some aspects of healthcare in Malawi worthy of study.

Read the full article published in Human Resources in Health.

Clinical Officers working in clinics throughout Malawi are keen to improve their skills and keep up with clinical developments. Mr Francis Phiri is currently studying with The Regional Dermatology Training Centre - the only training institution for dermatology in Africa. He plans to graduate as a Dermato-veneriology officer after 2 years. Exams include General Dermatology, Pharmacology, STIs, Leprosy, Teaching & Learning and PHC. 

It is vitally important for Malawian clinical officers to be able to attend such courses and develop their skill base and expertise, within Malawi. Funding is a perenial problem and clinical officers are constantly looking for sponsorship opportunities.

Have you seen a challenging case recently? Do you want to share your experience or expertise with colleagues? Doctors, medical students, clinical officers, nurses and midwives can al learn from each other if we ask each other questions and share answers. How do we treat acute malaria in a resource poor setting? How do we persuade ‘at risk’ young adults to have their HIV status checked?

Any takers? Post a question and let’s see if we can help each other answer it……..

The Twinning of Malawi Clinics and Scottish General Practices Team have had discussions with the University of St Andrews (St A) about closer working relationships.  St A is the lead Scottish academic instituition for collaboration  to develop medical and clinical officer training in Malawi. St A is supporting the University of Malawi College of Medicine  (MCM) in curriculum design. St A has recently secured funding from the Scottish Government to develop continued Professional Development Courses (CPD) for Clinical Officers in Malawi. We hope clinical officers working in Malawi clinics will be able to benefit from this, and we hope project teams can work together.