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Embangweni Hospital

October 2013 Hospital Newsletter

Also see the hospital description at Marion Medical Mission

 The hospital has recently emerged from some administrative/financial challenges.  They are again on an upward track but need our help.  In April of 2011, they issued this Update on their situation.  This describes progress on a number of areas, along with lots of remaining areas of need.  It includes ways you can provide general financial support or can SPONSOR A BED or SPONSOR THE CARE OF A VERY SICK CHILD. See this UPDATE for more details.   Thank You.

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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.

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History and Location

Embangweni Hospital is a 130-bed hospital located in the southern part of Mzimba district in northern Malawi. The boundaries of our catchment area are the Zambian border on the west and south, the M-1 highway (main north-south road in Malawi) on the east, and 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 operates 4 remote health centers located in Kalikumbi, Mabiri, and Mpasazi, and one other. 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. Embangweni is situated at an altitude of 4,000 feet, in an area of flat brachystegia woodland.

Work to establish Embangweni Station, also known as "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. Scottish missionaries came to Malawi following the death of David Livingstone. Clinical work by Dr. Fraser began in 1902. In 1926, under the direction of Dr. W. Turner, the facility expanded to become a rural hospital. A maternity ward was added in 1966. During the 1970s, the hospital doubled its size from 38 to 77 beds. In 1989 under the ministry of Dr. Kenneth and Mrs. Nancy McGill, the hospital greatly expanded its facilities and services to include separate buildings for maternity, pediatrics, male and female general care, as well as an operating theatre for limited surgeries and caesarian-section deliveries. The Primary Healthcare department has greatly expanded in scope and size in the 1990's.

Together with our sister institutions (Presbytery, Robert Laws Secondary School, Primary School, School for Deaf Children), Embangweni Mission Station celebrated it's centenary in 2002.

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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

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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 2001, the hospital, in conjunction with the Health Centers, provided 35,506 inpatient days and 48,100 outpatient visits  with 1,914 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 one to two 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 delivery occurs 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 seven and eight 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 1700 wells for people of Malawi since 1990. 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.

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Specific Services Provided

bulletOut-patient Services
bulletDoctor’s Clinic
bulletMale and Female Ward
bulletChildren’s Ward
bulletObstetric Care
bulletPremature Baby Care
bulletSelect Surgical Services
bulletTuberculosis Ward
bulletPrimary Health Care
bulletMental Health
bulletDental Health
bulletPharmacy
bulletLaboratory
bulletX-ray
bulletEpilepsy Clinic
bulletEye Care

Top Five Inpatient Diagnosis By Ward - 2001

CHILDREN  MALE FEMALE
-Malaria  -Malaria -Malaria
-Anemia   -Pulmonary Tuberculosis -Miscarriage
-Pneumonia -AIDS (EDZI) -Pneumonia
-Malnutrition -Surgical cases -Anaemia
-Neonatal sepsis -Pneumonia  -HIV/AIDS

 

Staffing

We have a critical shortage of trained nursing staff. 26 nurses struggle to do the work of the 56 we should have (46% of nursing posts filled). We share this problem with many other mission and government hospitals. A shortage of tutors, the devastation wrought by AIDS, the arduous nature of the work, and inadequate financial rewards have all contributed to a country-wide crisis in nursing levels. In common with many other units, we have tried to improve terms and conditions by generous increases in allowances.   Nevertheless, the shortages are set to persist for several years. We ask for your prayers that more nurses will choose to work at Embangweni, and that the existing staff will be given the strength and compassion they need.
 
There are currently no expatriate physicians.  Mr. I.J.S. Nyirenda is the Medical Officer in Charge as of  2011. We have a strong, well-trained, experienced, and Malawian led management team, which has the skills to take the hospital forward.

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Primary Health Care

Activities of the Primary Health Care (PHC) Department remain central to community health -- the hope for sustained changes in the health status of Embangweni Station’s people.  Impact of programming in PHC is easily recognized -- when the communities are able to take charge of their own health!

The major programs in PHC include:Drug Revolving Funds, Water and Sanitation, Malaria Prevention / impregnated nets, Mobile Clinics, Nutrition Rehabilitation,Tuberculosis control, Antenatal and Family Planning Activities, Prevention of Mother to Child Transmission (PMTCT) of HIV project and the Child Survival Program.

More details on these plus more is available in the Annual Reports.