Clinic Report 21Sep13

It appears that I have hit the ground running. Wednesday's arrival was the usual ritual of greeting and arranging accommodation. Thursday was supposed to be busier. Unfortunately, neither the reverend nor the headmaster were available in the morning, having been called to the Ministry of Education office in Kasungu to deal with urgent issues around the boarding facilities in the day schools. That gave me some time to go up to the site of the school Bishop's is building near Senior Chief Kaomba's court about 2 kilometres southeast of us. It is a very ambitious school set up and Ken Manda is acting as site manager. It is a school and does not appear to have a health facility included as had been rumoured.

We finally met the reverend to make begin making our plans in mid-afternoon. We were the folks at Makupo who represent the village on the clinic joint committee and myself. I explained the purpose of the visit and he was super agreeable with the purpose and the validity of the concerns that the Canadian clinic support folk had raised. We agreed to start our exploratory visits by going to St. Andrews and Kasungu District Hospital the next afternoon and begin to plan our trip to Lilongwe for next week.

I decided to travel with Lonjezo as Makupo's eyes and ears to this process. He was one of the 3 Makupo youth to begin health training at St Andrews earlier in the year and originally wanted to train as a nurse. Kenneth Alimekezeke Chikondi-Phiri is the minister in charge of the Chilanga CCAP mission. I wanted Kenneth to see what was happening at other church sites and how they function as compared to the Nkhoma method. Sautso will join me on Saturday and hopefully she will be our project management representative after I leave. She has worked with Nellie and I since the first well in 2004 and is a very trusted collaborator who is a competent administrator, and has completed a certificate in management including accounting

We arrived unannounced at St. Andrews to find Peter Minjale, the medical officer, on vacation and literally everyone else at lunch. Mrs Phyllis Bwanali, the Nursing matron graciously came to introduce us to the facility. I had not really visited the place since we went as group in 2008 and I was impressed at how much it has grown. In fact, it began as a small clinic, even smaller than what we are proposing. It is now a large sprawling facility with several wards, a surgery, delivery facilities and a dentist, ante-natal services, nutrition rehabilitation and outreach services. Most of what is there has been put in place over the last 10 years. A testament to its essential role in the health care system was the fact that the operating theatre was being used by a surgeon from Kasungu District Hospital while we were visiting, because of a problem with their facility. It was an essential orientation for we lay people.

We wanted to visit the District Health Officer at Kasungu District Hospital. We need to coordinate with him and his team around issues of government sanction, standards and support. Unfortunately, the vice-president had come to Kasungu on some specious mission to lay a cornerstone for a new maternity wing at the hospital, which was in fact an excuse for a political rally. The governing coalition of Joyce Banda is facing a real insurgence of the MCP especially in the heartland of Kamuzu Banda. The net result was that all people except essential medical staff were obliged to attend the rally as part of the protocol duties when the VP is in town. We therefore couldn't meet anyone at the hospital and a tour was not really necessary.

We still had some time together so we moved across the road to te Kasungu Inn and spent a couple of hours planning, discussing and sharing ideas. We have our first meeting set up with the Nkhoma Health Unit in Lilongwe for Monday morning and one with the contractor for that afternoon. On the way down to Lilongwe we will stop at Madisi and Lifeline to set up visits on Wednesday afternoon as we return from Lilongwe. So those 3 days are starting to look profitable and I am pleased with how things are shaping up.

Some brief background before I close off. Mission organisations still deliver well over half of Malawi's health care. So collaboration on issues of health care are with government and or the church. The Anglicans have set up St. Andrews as a satellite of their much larger facility in Nkotakota about 1.5 hours to the lakeshore to serve the much under-serviced region of eastern Kasungu. Despite the name Presbyterian as part of the CCAP moniker, Nkhoma Synod of the CCAP operates in the Central region in alliance with the old Dutch Reform Church now known as World Renewal, not the international Presbyterian church of Scottish heritage. Nkhoma is situated about an hour south of Lilongwe and has a rather elaborate set up including a large teaching hospital, training facilities for nurses and other health personnel. Their health unit is in Lilongwe so I will take the opportunity to pass by Nkhoma in a later phase of the trip when I go to the southern region.

The churches depend on outside help and are more than willing to collaborate with funding organisations even old non-believers like me. To that end Kenneth agrees that if it would help fund-raising efforts then we should create a local NGO to make the clinic structure arms length from the church and open to everyone in the community. Sautso is office manager for one of Malawi's preeminent law firms so we will explore the value of this option over the course of the visit with someone from there.