Malawi Clinics

In January, Pam Wilson returned from her extended placement as a Voluntary Services Oversees (VSO) nurse at Malawi College of Health Sciences, Zomba Campus. Pam initiated the first links between Scottish and Malawian clinics and the success of the Project today owes much to her relentless energy and dedication. We are delighted that she is going to remain involved in the Project.

While teaching at the Zomba Campus, Pam watched her student nurses grow in confidence and ability, and learnt a few things about herself along the way. As she prepared to settle back into life as a district nurse in urban Dundee, we caught up with her in the heart of Edinburgh’s Old Town on a crisp winter’s day to hear stories from her working life Malawi and share reflections about the first steps along the journey to realising the Twinning Project.

What did you know of Malawi three years ago?

“I had been nursing in Tayside all of my working life. I was ready for something different. VSO doesn’t allow applicants to handpick a choice of destination and originally I thought I was going to Papua New Guinea. It was the year before the Asian Tsunami happened so it would certainly have been a busy placement! However, the offer of Malawi came up very late on and the opportunity to work in training and education with the future nurses of Malawi was just what I wanted. I found out the details in February and left for the capital, Lilongwe, in April.

I really knew nothing of the history or culture of Malawi pre-departure but we were given an intensive course on our arrival in Lilongwe. This was great actually because we had guest lecturers who introduced us to crucial health issues like how to confront the stigma of living with HIV/ AIDS.”

When did you first hear about the Twinning idea?

“I had been sending my old colleagues at Westgate Medical Practice in Dundee regular ‘Malawi Reports’ and Ron (Neville) replied to one with a little idea he had. It was quite soon after that I met the then First Minister, Jack McConnell, and learnt about the financial support available for sustainable projects in Malawi. We had a long, long wait between submitting the proposal and hearing the good news. In fact I had been in Malawi for a year when Ron emailed me to say that funding was confirmed.”

How has the Project changed over time?

“The Project has definitely grown and developed for the better. It needed a lot of gentle scaling up from the small roots we nurtured in our spare time. Having two dedicated Project coordinators this year has increased momentum in a way that just wasn’t possible with Ron, Paul (Nkhoma) and I working in our evenings and weekends. There is a lot that needs to be done – Internet signal strength is very variable in some clinic areas and the appointment of a technology consultant has been postponed.”

What illnesses and conditions did you treat that you would never have seen in a Scottish waiting room?

“Zomba is near a big lake so we saw lots of hippopotamus bite-wounds on fishermen. Occasionally there were missing limbs from crocodile bites from the Shire River and Mangochi but these were rarely fatal.

Tragically, there were lots of cases of infection with expectant and post-natal mothers. These are conditions that are entirely preventable with good health education of the midwives and traditional birth attendants. There is no radiotherapy or chemotherapy so I saw some horrendously large cancer growths and women suffering from the late stages of breast cancer. Prostrate problems on men are ‘controlled’ rather than treated with the long-term use of catheters.

And cholera is the other obvious condition that I would never have seen back in Scotland. Together with diarrhoea, malaria, worms in children’s’ guts (this can make children very anaemic) and, of course, the high rate of HIV/AIDS.”

What can we learn from Malawi?

“The Malawian nurses work with basic resources and learn to make-do with a lot of home-based care. Health and safety in the UK has become far too stringent. It’s true that we can learn about the ‘Guardian’ concept but I do think that the Malawi health care system relies too much on the guardians. Family members need guidance and support.”

What first led you into nursing as a profession?

“My paternal aunt was a nurse and I was very fond of her. She is still alive so I think she’s quite proud of her niece!”

What do Malawians perceive of Scotland?

“Everyone wants to come here. It’s definitely a case of the grass being greener. But then our high rate of intro-venous drug use is quite shocking for Malawians to learn about.

Malawi needs to stamp out corruption and the continuous reliance on per diems and allowances for training courses is not helping this. And I was surprised to find racism in Malawian culture – there is definitely still an undercurrent of tribal tension that persists in Malawi.”

How has the experience of Malawi changed you as a person?

“My time in Malawi has broadened my view of healthcare – I approach it in a much more holistic way and like to think I am more sensitive to cultural beliefs.

In a personal capacity, the proximity of life and death side by side in Malawi has made me much more accepting of the shortness, and to some extent, futility, of life. I attended so many funerals in Malawi – coffin-maker workshops line the roadside – and loosing close colleagues ultimately impacts on working infrastructure and lost hours. A funeral ceremony lasts all day.

I’m also far less materialistic than I used to be. I even feel guilty about spending money and felt quite sickened by the Christmas spending spree on return to Scotland. Having said that, I’ve only been here for a month so let’s see how I fit back into old ways!

Teaching is, of course, its own particular skill and it’s been a steep learning curve for me. It’s frustrating to not be able to apply the skills back in Scotland because I don’t have the necessary qualifications on paper.”

Will you return to Malawi?

“Definitely! I’d like to return in two or three years time with a remit to review the Twinning Project and, of course, to see my friends. I miss the stars and the sudden darkness of Africa – the complete absence of twilight. But the sunrises and sunsets in Scotland make up for it.”

 

Pam is currently working at the Erskine Street Medical Practice in Dundee. She plans to keep an active role in the Twinning of Scottish and Malawian Clinics.

 

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