Blantyre Synod is a flare of hope in Mulanje
By Allen Kaombe, Communications Manager

The Church of Central Africa Presbyterian (CCAP) Blantyre Synod is a flare of hope to most rural people of at least 71 villages in Mulanje in providing health services through Mulanje Mission Hospital, its health facility. 

With commitment and dedication, Blantyre Synod established the health facility to “provide quality preventive, curative, rehabilitative and palliative health care to the community in the catchment area and all others who seek the hospital services, irrespective of gender, age, religion, ethnic origin, political affiliation or social status in an environment where Christian values are upheld.”

Although Mulanje Mission Hospital stocks a humble background, it is a significant social force in providing health services to people in Mulanje. Ground work for the facility began at Blantyre Mission where Scottish Missionaries were providing medical services from 1896. Mulanje Mission was a satellite terminal for providing medical services in remote areas in Mulanje, where Blantyre Mission’s medical work was concentrated after the government opened when Queen Elizabeth Central Hospital in 1958.

Mulanje Mission Hospital Administrator Michael Lazaro narrates that the first location of Mulanje Mission hospital was on the slopes of Mulanje Mountain, in order to avoid interruptions by slave traders. In 1928, after abandoning of the slave trade, the mission hospital was moved about ten kilometers to its present location.

The initial structure was a maternity facility until 1950 when a dormitory for trainee midwives was built, followed by an operating theatre in 1958. A large new maternity block was added in 1972, after a hostel was built two years before, to accommodate student midwives. In 1980, a new pediatric ward was erected along with many staff houses. The hospital finally changed from maternity clinic to a full fledged hospital in 1999, when a male ward was opened.

Currently, Mulanje mission hospital has developed into a 192 bed general hospital in Mulanje district with over 475,000 inhabitants. The immediate catchment area for the hospital and its Primary Health Care program is 71 villages with around 66, 000 people.

It offers quite a spread of health services that keep people in Mulanje ticking. The hospital rehabilitates malnourished children, provides training in orphan care; Voluntary Counseling and Testing (VCT); Anti Retroviral Therapy (ART); Cervical Cancer Screening services; Palliative care and Kangaroo mother care.

“Palliative care whose overall goal is to relieve suffering and promote quality of life in the terminally ill was introduced at Mulanje Mission Hospital in 2003. The main objective of this program at this hospital is to offer palliative care especially to AIDs sufferers and those with cancer or other terminal illnesses,” Lazaro said.

 The program has been tailored to work hand in hand with already existing services such as the ART and Home Based Care (HBC) programs. “This is so because patients who are on ART will at some point need palliative care and likewise some cancer patients on palliative care and are HIV positive will sooner or later be put on ART. And all these patients will finally go back to their community where they will need continuous care by the HBC volunteers,” he said.

Two-and-half-year-old orphan John Balakasi who lost his mother two years ago due to AIDS was diagnosed to have one of the commonest cancers in children here in Malawi, Burkis Lymphoma. He was also HIV positive, transmitted from his mother to him during birth.

He was first attended at the central hospital where he received the full course of chemotherapy. However, he improved for only a few months, then had recurrent attack of the disease, the cancer grew bigger, and he developed severe pains.

John was referred to Mulanje Mission hospital palliative care program for continuity of care, in which the staff tried to alleviate his suffering as much as possible, including the use of Morphine. John died peacefully in his grandmother’s home.

At its Nutrition Rehabilitation Unit (NRU), Mulanje Mission hospital accommodates significant malnutrition cases. Here children under the age of five who are malnourished are admitted with their parent or guardian to monitor their weight gain, providing health education, cooking and feeding demonstration and training how to manage a home garden. High energy milk and nutritious porridge (Likuni Phala) are supplied even after discharge on two weekly bases to prevent reoccurrence. In 2004 the NRU admitted 272 malnourished children. Moving around the unit, a visitor is greeted by a mixed group of children some as newcomers while others look rehabilitated.

Two-year-old Asiyathu is a typical example of the beneficiaries from this service. Struggling with malnutrition and in dire need of help, she reported at Misanjo Mobile Clinic for her regular under-five clinic. Her card showed that she completed all the vaccinations, but on examination she was ill looking with severe oedema of the feet and face.

Her weight was only 5.2 kg far below the growth line. A diagnosis of Protein Energy Malnutrition (PEM) was made and the child was referred to the NRU. At the hospital the Medical Assistant detected malaria and therefore admitted the child first at the pediatric ward for treatment. Fortunately, Asiyathu responded well to the treatment and after three days of satisfactory improvement enough to be discharged, and  she was sent to the NRU.

There she was put on special feeds and Likuni Phala, a nutritious porridge of maize, fortified with Soya. In the following weeks Asiyathu recovered completely, her mother received all the necessary education on nutrition, safe water and even training in how to keep a home garden.

After three weeks, she was discharged from the NRU, with a weight of 6.3 kg. Mulanje Mission hospital continued to monitor her and supplies of Likuni Phala were given every fortnight. Asiyathu is again singing songs with other girls she missed while at the hospital.

“Due to the increasing number of orphans and the low survival rate of these orphans within the first year of life, the hospital decided to take part in training the guardians on how to care for these little ones to save their life. Adjacent to the NRU any orphan below the age of two is admitted with a guardian for training and support and will receive artificial milk and Likuni Phala for two years. In 2004 the OCT supported 186 orphans,” Lazaro said.

Mulanje Mission Hospital is a leader in a national wide program to screen women to prevent cervical cancer, which is the most common cancer in women in Malawi. The screening method being used is called Visual Inspection of the cervix with Acetic Acid (VIA).

This method allows a trained provider to identify abnormal patches on the cervix that turn white with acetic acid. Early treatment of the abnormal patches with cryotherapy, or freezing the cervix, is immediately available to women who screen positive. This exciting program is low tech, simple, inexpensive, effective and safe. In 2004, 405 women were screened, of whom 29 were found VIA positive.

The impact of HIV/AIDS is enormous in the whole of Malawi, with an overall HIV prevalence rate of 19 %. Mulanje district is famed to have high figures even up to 35 percent of HIV prevalence and it is estimated that 70 % of the admissions are related to HIV/AIDS. Therefore the hospital started to train full time counselors and opened a special counseling centre. This service is the gateway to offer people ARV’s. By promoting VCT, the hospital also hopes to contribute in reducing the stigma which still lies around HIV/AIDS.

Incubators are scarce in Malawi and often too high-tech. to redress this problem, Mulanje Mission hospital resorted to, which is a natural method for caring for low birth weight infants, was introduced early this year 2005, and is called Kangaroo Mother Care (KMC). It was established through support from Safe Motherhood and a special ward was built and staff members were trained in this simple but cost-effective way of caring for low birth weight infants. Babies are being nursed skin to skin to the mother, preferably 24 hours a day.

The hospital’s operational survival depends on donors. Almost half of the income is from overseas partners and this makes it hard for the hospital to plan ahead. Although it is facing financial difficulties, Mulanje Mission hospital is a beacon of hope for people in Mulanje by providing standard and affordable health services to rural poor.