Monday, February 2, 2015

The Malawian Nurse's Experience


The Malawian health facility remains, largely, a net- catching up committed workers in a trap of adverse ‘circumstances’. These workers include nurses, midwives, medical assistants, clinical technicians, doctors, among others.
But what are the circumstances?   
“Human resource constraints, failure to retain staff and disparities between number of workers in rural and urban areas,” says Martha Kwataine, national coordinator for the Malawi Health Equity Network (MHEN).
These circumstances have particularly pinned one medical worker, the nurse, down. In rural health facilities, the nurse is the ‘doctor’, and often triples as nurse, midwife and medical assistant.
Not that no one cares, though; just that policymakers still drop, from time to time, in a vacuum of policy objectives that take us nowhere, enthuses Kwataine.
Indicators are that, unless Malawi presents better ‘Commitment Deeds’ towards its 13,066,320 population, it will be tough to fill this vacuum. On one hand, MHEN estimates that Malawi only has half the required number of nurses.
Against the national requirement of 10,000 nurses, for example, Malawi has 5000. One mind does the work of two.
It has been like this since independence that, in 2007, the Ministry of Health had 54 out of every 100 posts for nurses unfilled, a health system the Malawi Health Report described as “…close to collapse.
The World Health Organisation (WHO), on the other hand, indicates that Malawi is nursing a medical personnel crisis because, instead of 100 nurses serving 100,000 patients, 59 Malawian nurses serve 100,000 patients.
“This is why the nurse’s role remains unappreciated in our society,” says Dorothy Ng’oma, National Organisation of Nurses and Midwives (Nonm) executive director.
She says moral courage of nurses alone is insufficient to register national success unless it is executed as part of that greater entity called ‘collective action’.
Health Minister, Dr. Jean Kalirani, claims just that. She says Malawi has recently been taking the right direction, as seen by increased enrollment numbers. Over the past five six years, the intake to Kamuzu College of Nursing and Christian Health Association of Malawi training colleges has doubled.
This comes against the background of the national scare of 2009, when The Sector Wide Approach programme for medical students ended, and government officials were forced to withdraw student scholarships. Consequently, the majority of nursing students withdrew due to failure to raise K350, 000 for one year’s learning.
It was a temporary predicament, though, because, during the 2010/2011 Fiscal Year, government rescinded its decision and channeled K398 million towards tuition scholarships meant to benefit 1,200 medical students.
“This administration is very much committed to improve the situation, as seen by high level involvement in Safe Motherhood issues. The First Lady’s initiative is a sign of commitment on government’s part,” says Dr. Kalirani.
But Ng’oma maintains that nurses continue to face enormous challenges. She adds, however, that, against all these odds, Malawian nurses still play the lamb, and resist the human urge to make inconsistent demands for all their unsatisfied grievances.
“The nurse is the bastion of love and compassion,” says Ng’oma. “The issue of compromise also comes into play.”

Indeed, for the Malawian nurse, being there is a compromise because job opportunities abound Western countries, rife with better salaries and conditions. Ng’oma says local nurses do a ‘sacrificial and commendable’ job
Go to Mulanje Mission Hospital to get the real meaning of ‘commendable’. There, Blantyre C.C.A.P. Synod’s Health and Development Commission (BSHDC) is running a programme on Safe Motherhood.
 Before October 2010, Mulanje District Health Office’s reports were awash with statistics of deaths that could be avoided, adding on to Malawi’s tally of 675 deaths per 100,000 live births. But a 30 September 2011 report points to positive changes.
By working with 250 safe motherhood committee members in 25 villages, the initiative has strengthened referral systems for SRH services by increasing health-seeking behaviour among pregnant women.
Says Anthony Kanyoma, BSHDC Programmes Manager: “Among other outcomes, we have reduced community members’ dependence on Traditional Birth Attendants (TBAs). We have also engaged nurses to follow up on hospital attendance while midwives follow up on home deliveries,” says Kanyoma.
One of the success points is that TBAs have been incorporated, and serve as ‘referral agents’ who refer women to health facilities for proper care. To ensure compliance, Health Surveillance Assistants (HSAs) are monitoring the TBAs.
So far, 72 traditional leaders in T/A Mabuka, Chikumbu and Mkanda have joined the campaign. In T/A Chikumbu’s area, for instance, women choose between K500 and a goat in fines for home deliveries.
“However, because Mulanje Mission Hospital serves both Malawian and Mozambican women, TBAs continue to carry out deliveries on Mozambican women. They argue that Malawian laws cannot apply to Mozambicans,” says Kanyoma.
But not all community members are happy. One of the dissatisfied is Maxwell Nazombe of Salamba village.
“We are disappointed that HSAs are not trained in midwifery. I have seen pregnant women die from labour complications in HSAs’ presence. I fear for their (HSAs) lives because people may beat them up one day,” says Nazombe.
The situation is, however, different in Mangochi district, where a College of Medicine’s Centre for Reproductive Health (CRH) initiative has unveiled new type of ‘nurses’- community members.
Andrew Ngwira, CRH Research Officer and project assistant on youth affairs, says cases of early marriages leading into teen-age pregnancies used to be common, chocking services at Lungwena Health Centre and St. Martin’s Hospital.
“This has changed now following our intervention to improve the maternal mortality situation in Malindi, Lungwena and Makanjira by promoting contraceptives’ use,” says Ngwira.
The Community-Based Distribution Agents’ approach, which engages community volunteers in promoting best SRH practices, has reduced burdens associated with nurse-to-patients ratio.
“We have trained nurses in customer care, so that they may cordially handle clients. Early marriage incidences have been reduced. Fish-for-sex practices have been minimized and, so, have cases of fistula- issues that contributed to high maternal mortality rates,” says Ngwira.
However, as the situation improves in Mulanje and Mangochi, an SRH disaster rooms in other parts of Malawi, according SRH expert, Timothy Bonyonga.
“Good SRH practices will not lead into improved conditions because young people continue to get pregnant before the right age. This is creating a wave of mentally disturbed children, children who show signs of poor physical development as well. These children may be so brilliant in class, but lack that human touch in their way of doing things,” says Bonyonga.
Bonyonga warns that this situation could turn Malawi into a nation of “stubborn, selfish, irrational individuals”.
“Nobody wants this to happen to Malawi,” says Bonyonga. 

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