Annual Report 1999
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Excerpts from the
Embangweni Hospital
Annual Report 1999

Mission Statement:

The aim of Livingstonia Synod Health Programs is better health for the communities we serve and a clear Christian Witness to the love of God.

History and Location

Embangweni Hospital is a 134 bed hospital located in the southern part of Mzimba district in northern Malawi. Its catchment area is bounded by the Zambian border on the west and south, the M-1 highway (main north-south road in Malawi) on the east, and by Moses Chilenge and Emazwini villages to the north. The hospital serves a population of about 100,000 people, with referral cases often coming from much  further away, including Zambia. It also operates remote health centers located in Kalikumbi, Mbiri, and Mpasazi, though the latter was closed during much of 1999. Travel throughout the Embangweni region can be difficult, especially during the rainy months, November to April. The only access to the M- 1, a distance of 30 km, is by either the Jenda or Perekezi Forest dirt roads. While the terrain surrounding Embangweni is best described as flat savannah, it is a beautiful area, situated at an altitude of 4,000 feet.

Work to establish Embangweni Station, formerly called Loudon, was begun by Reverend Donald Fraser and his wife, Dr. Agnes Fraser, missionaries of the Free Church of Scotland, at the end of the 19th century. Clinical work by Dr. Fraser, a friend of Dr. David Livingstone, began in 1902. In 1926, under the direction of Dr. W. Turner, the facility expanded to become a rural hospital. Additional buildings were constructed in 1924 and 1940; a maternity ward was added in 1966. During the 1970s, the hospital doubled its size from 38 to 77 beds. Then in 1989 under the ministry of Dr. Kenneth and Mrs. Nancy McGill, the hospital greatly expanded its facilities and its services to include separate buildings for maternity, pediatrics, male and female general care, as well as a small operating theater for limited surgeries and caesarian-section deliveries.

Demographics

With a population nearing twelve million people, of which 85% live in rural areas, Malawi is one of the world’s poorest countries. In the northern region, where Embangweni lies, population is less dense than to the South, but it faces many of the population pressures consistent with underdeveloped countries. Population growth, estimated to be about three percent per year (fertility rate of six children per woman) represents too many children born to women at too early an age, too late in life, or too close together.  Another critical related problem is that most of the suitable land is already under cultivation. Reliant on rain-dependent crops, not only for subsistence but also as a means to hard currency, Malawians grow maize, tea, coffee, tobacco, cotton, and groundnuts. Tobacco remains the major export crop, accounting for 85% of export income. GNP per capita remains at less than US$170.

The lack of enough food and lack of nourishing food contributes to a high morbidity and mortality rate among children. Almost half of children under the age of five are stunted in their growth, suggesting a high prevalence of malnutrition. The maternal mortality rate in Malawi, according to WHO/UNICEF’s 1990 report, is 560/100,000 live births. Child mortality (under five) and infant mortality (under one) rates remain among the highest in the world, at 217 and 137/1000, respectively. Simply put, one in four children do not live to the age of five.

Life expectancy at birth is down to 41 years, principally due to the outbreak of HIV/AIDS. There are an estimated 710,000 people infected with the virus, a national infection rate of close to 15 percent (WHO 1998). At Embangweni hospital, it is believed that one out of three patients treated is affected by HIV/AIDS.

Literacy in Malawi is low. About half of all women (perhaps 80% in rural areas) are functionally illiterate or have not attended schools. About 70% of the men are literate, though only about 4.5% of those attending primary schools are able to continue on to secondary.

SOURCE:    UN AIDS/WHO Epidemiological Fact Sheet -- Malawi, 1998

Overview of Hospital and Health Center Services

Embangweni Hospital and its Health Centers, including their out-patient care and maternity wards, continue to be busy. In 1999, the hospital, in conjunction with the Health Centers, provided 36,613 inpatient days, 36,452 outpatient visits, and 8,325 well-child and antenatal visits with 1,647 children delivered. In the surgical theater, there were over 1,000 major and minor surgical procedures performed. The hospital’s health care services are led by a combination of two to three expatriate doctors and two Malawian clinical officers, as well as a cadre of skilled medical assistants, trained nurses, and additional trained allied workers, who together direct a dedicated hospital and its three health centers’ staffs, bringing the total number of workers to over 130. Based on reputation, the hospital remains incredibly busy. Given its remoteness, as well as the many transport hardships encountered by Malawians in accessing services, wards are often near capacity.

In addition, health services go to the people. Important outreach deliveryoccurs in 16 village centres who are served by mobile clinics. Immunizations (over 30,000) and growth monitoring, family planning and contraceptives distribution, antenatal visits for pregnant women, malaria prevention (bed net programming), and the Drug Revolving Fund (distribution of five different drugs for simple ailments, collection of payments, and purchase of more drugs for more distribution), make up important Primary Health Care (PHC) programming. Networking through community health committees within each of these centers is the system for dissemination of health information to whole groups of people in our catchment area. Trained traditional birth attendants provide the final extension of health workers.

In addition to the outreach services, essential Primary Health Care (PHC) work at Embangweni includes malaria, tuberculosis, and AIDS Control programs and the Nutritional Rehabilitation Unit (NRU). Between eight and nine thousand meals (malnourished children are served six meals a day) are provided to women and children staying in the NRU for ongoing treatment of diseases of malnourishment. A demonstration garden, showing the best agricultural practices, provides the harvest to be used by the home craft workers for food and instructing mothers on diet, nutrition, and food preparation.

To keep the Station operational, an impressive Projects Department works hard to maintain facilities, including staff homes, and to oversee new capital projects. Importantly, it also oversees the Shallow Wells program, in cooperation with Marion Medical Mission who has helped build over 1000 wells for people of Malawi since 1991. Knowing first-hand the relationship of good health and clean water, this station is proud of this public health intervention so generously supplied by churches and workers from the US.

From clinical officer to village health committee member, a model of integrated health care has been effected at Embangweni, inspired by vision of God’s love and healthy people, with the hope that Malawians will be empowered to take responsibility for their own health and the development of their communities.

Specific Services Provided

Out-patient Services
Doctor’s Clinic
Male and Female Ward
Children’s Ward
Obstetric Care
Premature Baby Care
Select Surgical Services
Tuberculosis Ward
Primary Health Care
Mental Health
Dental Health
Pharmacy
Laboratory
X-ray
Epilepsy Clinic
Eye Care

Top Five Inpatient Diagnosis By Ward

CHILDREN  MALE FEMALE
-Malaria  -Injury/infection -Complications of pregnancy
-Anemia   -Pneumonia  -Malaria
-Malnutrition -AIDS (EDZI) -Anemia
-Respiratory disorders  -Tuberculosis -Pneumonia
-Gastrointestinal disorders -Malaria -Tuberculosis

 

Staffing

Continuing with its goal to attract Malawian clinical and medical officers, 1999 brought to Embangweni two outstanding Clinical Officer interns: Lillian Gondwe and Kennedy Chirwa, both graduates of the Malawi College of Health Sciences in Lilongwe. Well trained, both are able to provide top quality in- and out-patient care, as well as provide obstetrical care, along with some surgeries. In addition, Embangweni Station continues to be staffed by four medical assistants, including those in-charge at our remote Health Centers.
   
Expatriate physicians include Dr. Neil Kennedy (Sara and Ben) from Presbyterian Church of Ireland in his third year; Dr. Martha Sommers from Presbyterian Church USA in her second year; and Dr. George Poehlman (Betty) also from Presbyterian Church USA, arriving in October. In November, Dr. Cosimo Storniolo (Meredith, Ninah, Sarah, Norah, and Baby Isabella) completed their three year term in Embangweni, returning to the US.

We were very pleased to receive five fully qualified, newly graduated Malawian Enrolled Nurses!  Midwives to our staff in 1999. Other new staff members include: new pharmacy assistant, new laboratory assistant, new dental assistant, new UN AIDS volunteer, new assistant environmental health worker in PHC, new station Maintenance Officer, and two new accounts assistants.

Primary Health Care

Activities of the Primary Health Care Department remain central to community health -- the hope for sustained changes in the health status of Embangweni Station’s people. Led by Joyce Ng’oma and assisted by Jodi McGill, MN, MPH, program development continues and program activity is monitored. Impact of programming in PHC is easily recognized -- when the communities are ble to take charge of their own health!

An overview of PHC’s 1999 calendar describes the myriad efforts of this Department to improve the health of Malawians: In January, Joyce went for a three day Traditional Birth Attendant supervisory training.  Global Health Action visited to discuss future programming with PHC . . February found Joyce co-facilitating Training for Transformation for Synod hospitals, training she received the previous year through Global Health Action of the US. Drug Revolving Fund volunteers from communities received four day training . .   In March, in-service training for homecraft workers who direct the activities of the Nutritional Rehabilitation  Unit started. Hoping to improve the cognitive development of children "shut down" by their malnourished state, they explored "crafting" and use of visual stimulation . . . .In April, Drug Revolving Fund training continued with workers learning more about simple ailments that can be diagnosed and treated with simple drugs at home in the community. Insecticide Treated Materials (MM) training took place over six days within the month....

Health Surveillance Assistants were brought in during May for briefing.... With crops planted and harvest underway, June, July, and August saw increased community Training For Transformation for villages throughout our catchment area. The hope is to empower communities, through community leadership, to take charge of its people’s health. This kind of health effort, at the moment, is our best tool in disease prevention   and control of the spread of HIV/AIDS HIV workshops were conducted in surrounding communities focusing on HIV counseling training. In October, a full month was devoted to training 17 Traditional Birth Attendants for improved monitoring of prenatal status of village women as well as improved methods in labor and delivery. Breast Feeding refresher courses were available to all the community support groups.... Margaret Sinumbe, a UN volunteer AIDS worker, arrived for a year stay to help in the expansion of AIDS community trainings . . . . In December, training of volunteers in remote villages who monitor growth of children was conducted. Additional trainings included neonatal resuscitation for nursing staff.

In addition to these efforts, which are designed to encourage sustainable, community-generated and community based programs, work at Embangweni Hospital remains constant. There are family planning services to oversee, both at Embangweni, at health centers, and remote sites; there is the Synod-wide initiative, Malaria and Mosquito Bed Nets program, intended to aid in the prevention of malaria-laden mosquito bites and reduction in cases of malaria, still the leading cause of death in children; there is the ongoing Baby Friendly Hospital exclusive breastfeeding program, a WHO/UNICEF initiative, to reduce the high rate of infant diseases and perinatal mortality due to gastrointestinal diseases. The important network of 16 mobile clinic continues, each a half-day to full-day event, that includes a health talk followed by visits with antenatal mothers and children under five. Children receive their vaccinations and have their growth monitored; mothers learn family spacing options and receive help in birth control. Finally, the work of the Nutritional Rehabilitation Unit/Food Program continues to reduce the suffering of little children.  Over 9,000 meals were served to malnourished children, referred to NRU from their villages or by medical staff. The NRU demonstration garden, which provides lessons in agriculture and food for patients, doubled in size, and the goat population, whose milk serves as an alternate protein source, also increased. An agri-forester was added to our part-time workers to help in reforestation efforts around the area, as well as promote programs of food security.