Three weeks ago I flew to Malawi as both a medical student and a Medpacker member, to work in a small primary care clinic at the southern end of Lake Malawi. It is my first experience in practicing medicine in a developing country and also my first time in having to deal with supply shortages on a daily basis. Trying to provide good care with supply shortages and a difficult to impossible access to medical specialties such as surgery and radiology has been a challenge, but the ingenuity that is required of the doctors around me has delighted and inspired me. I’d like to share some of those experiences.
To start with some context: The Billy Riordan Memorial Clinic is located uphill from the shore of Lake Malawi, near to Chembe village and the greater Cape Maclear area. Our team consists of five young Irish and British doctors and a pharmacist who all volunteer here for up to six months. A Dutch tropical medicine doctor who has been here for nine years takes care of continuity and mentors us together with two long term nurses. Local men and women are trained to help us with medical tasks and translating English to Chichewa, as well as helping us with picking up on cultural differences which always influence medical care abroad. Next to our general clinic, there is a clinic specifically for the care of patients living with HIV, as well as a small laboratory.
Our diagnostic possibilities are limited to testing for malaria, HIV, syphilis, anemia, blood glucose levels, and urine analysis. Medicine for malaria and HIV is normally taken care of by the Malawian government, but for all other things we depend on donations. We have no x-rays, no further blood testing and no surgical possibilities. What we do have are our collective brains and the Oxford Handbook of Tropical Medicine. And a drop in mortality of three deaths per day during the first year of the clinic, versus none in the three weeks I’ve been here.
The area around Lake Malawi is a malaria hotspot, especially during the rainy season. While the government of Malawi normally takes care of antimalarial drugs, we’ve come across a shortage of injectable antimalarials which are needed to treat the worst cases of malaria. We’ve had to hold off on their use in adults unless absolutely necessary. Local adults have had malaria many times in their youth and have formed a partial immunity to it, decreasing their likelihood to succumb to malaria. Luckily, we’ve managed to gather additional medicine, but it does underline the shakiness of a necessary steady supply to essential medicine. We see at least ten patients daily with malaria, which sounds like a lot but is less than usual due to decreased rainfall this year. The decreased rainfall might lead to fewer cases of malaria, but sadly also leads to decreased crop growth and an increase in childhood malnourishment. A charity set up by our Dutch doctor imports peanut-based food products which are high in calories and nutritional value and are given to children who are underfed. Thanks to this initiative, I have luckily not seen a single case of kwashiorkor here.
Bone fractures can be difficult to deal with here, especially since we don’t have access to x-rays and referral options for orthopedic surgery are limited and costly for adults. Most are caused by motorcycle accidents, as the road is bad and the helmets are worse. One case of a femur fracture (though not caused by an accident) posed a problem since constant traction on the leg was required to let it heal in the correct position. Back home we’d have equipment for this. Here, the problem was solved by clever bandaging and a filled 5L bottle of cleaning solution as a weight. Similarly, splints to ensure that pediatric cannulas stay in place and tongue depressors are the same thing here. Empty medicine jars are urine canisters, and empty water bottles are asthma-inhaler chambers.
As for the Medpacker supplies, four of the local staff members that perform HIV tests are currently walking around in UMC Utrecht uniforms, and my stethoscope will find a place in the emergency room. While we do have small surgical instruments, the Medpacker additions are new and will ensure availability when old ones fail. As for me, I’m in the middle of an unforgettable experience which hopefully is not the last one that I will have in Africa. A profound thank you is in place for the wonderful staff of this clinic, and everybody in and around Medpacker that helped to make this first delivery possible.