SCOTLAND AND MALAWI
Background
Scotland and Malawi have had a long, historical friendship since the days of David Livingstone. Both are small countries and both have healthcare challenges.
Malawi, shown in the above map, is a land-locked country in Central Africa. The population is approximately thirteen million. Scotland is part of the United Kingdom and has a population of five and a half million.
Effective partnership
Unlike many non-governmental organisations, the Twinning Project is intended to be a two-way sharing of resources. Traditional one-way aid from Europe to Africa is being discredited for creating dependency and resulting in unsustainable, incomplete projects which lead to a mistrust of international partnerships. Rather, we want healthcare professionals in Scotland to learn lessons from Malawi; helping us re-connect with patient autonomy, health education seminars, the integration of public health with clinical care, and above all professional pride in caring for patients.
For example, in order to be accepted onto a long-term treatment programme patients in Malawi have to give a commitment to try to maintain their nutrition, take their medication as directed, and to attend for follow up appointments. To facilitate this patients must nominate a ‘guardian’ – usually a close family member. Patients in the UK requiring treatment for HIV, hepatitis B or C, and TB also need to maintain good nutrition, comply with medication regimes and attend for regular follow up. A voluntary guardian system might well be acceptable to UK patients and have the potential to favourably alter clinical outcome. Family partners may welcome an opportunity to become more involved in care and may be receptive to being given enhanced responsibility.
In return for the opportunity to view approaches to healthcare through a different lens, Scottish clinics support their Malawi counterparts by sharing technology resources and providing access to online medical journals and clinical discussion. Scottish clinics are welcome to supply surplus, brand new medical equipment to Malawi clinics but this is not the core business of the Project. In both Scotland and Malawi, participation in the Project should not detract from clinical commitments. Patients always come first.
Trends in health
Many of the daily complaints and conditions that healthcare staff examine is the same in both countries. For example, under-5 infant care, anti-natal and post-natal care and family planning. However, there are also some marked contrasts in the most common problems.
Scotland
In Scotland, a traditional diet that is rich in fat and salt, combined with a reduction in physical activity at work, has led to the prevalence of obesity in many patients. Obesity, heart disease and type 2 diabetes are very common in Scotland. Chronic lung disease and respiratory problems, often due to smoking or passive smoking, are also very common. The recent ban on smoking in public places may have an effect on this.
The patient population demographic in Scotland is increasingly older with life expectancy in the United Kingdom now at 80 years old. However, there is still relative poverty in parts of Scotland and in these areas average life expectancy can be as low as 60. An ageing population means that Scottish General Practitioners regularly treat strokes, mobility problems and arthritis.
Malawi
Malawi has one of the lowest life expectancies in the world. UNICEF puts the overall life expectancy for Malawians at 40 (but this can vary according to different reports) with a very high child mortality rate. The high prevalence of HIV (the Malawi Government estimates that 14.2 per cent of the total population are HIV positive) has led to over one million orphans. Healthcare staff devote much clinical time to voluntary counselling and testing, treatment of malnutrition and infant care.
Cases of cholera remain high in Malawi, despite having been eradicated in many other parts of the world. TB is also very prevalent in rural areas.
The above information is not detailed or authoritative. For accurate and up to date information, the British Medical Journal and the World Health Organisation provide useful search engines.
