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

John 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.

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

Another beneficiary, Asiyathu, 2 years old reported to Misanjo Mobile Clinic for her regular under-five clinic. Her car 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 even a 2+ malaria and therefore admitted the child first at the pediatric ward for treatment. Fortunately, Asiyathu responded well to the treatment and after three days she was improved enough to be discharged and 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. the PHC department continued to monitor the child and supplies of Likuni Phala were given every fortnight. Asiyathu is again a happy girl.

Nutrition Rehabilitation Unit (NRU)

This service is conducted by the Primary Health Care department as part of the nutrition program. In this special centre 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.

Orphan Care Training Centre

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.

Cervical Cancer Screening and early Treatment Program

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.

Voluntary Counseling and Testing

The impact of HIV/AIDS is enormous in the whole of Malawi, with an overall HIV prevalence rate of 19 %. In Mulanje district the sentinel surveillance of 1999 showed figures even up to 35%. The impact on our health services is with no doubt tremendous, where 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 we also hope to contribute in reducing the stigma which still lies around HIV/AIDS. In 2004, a total of 1073 voluntary clients and 1416 patients were counseled and tested.

Anti Retroviral Therapy (ART) Clinic

This clinic started in April 2004 with support from Medicines Sans Frontieres (MSF)-Luxembourg and Stop-Aids-Now foundation- Netherlands. Clinicians and nurses were trained in providing ARV’s following WHO guidelines and the services are free of charge. Up to 1st July 2005 371 patients started on ARV treatment, of whom 280 are still alive and on daily treatment. This service gives hope to the many people infected and affected with this devastating HIV/AIDS epidemic.

Palliative Care Program

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. 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.

Kangaroo Mother Care

Incubators are scarce in Malawi and often too high-tech. Therefore KMC, which is a natural method for caring for low birth weight infants, was introduced early this year 2005. through support of Safe Motherhood a special ward was built and staff members were trained in this simple in this simple but effective way of caring for low birth weight infants. Babies are being nursed skin to skin to the mother, preferably 24 hours a day.

History

Medical work was done from the start but Blantyre Mission Hospital was opened in 1896. it was modified into a maternity hospital in 1943 when the government opened a male hospital. Blantyre Mission Hospital closed when Queen Elizabeth Central Hospital was opened in 1958 and all health services of Blantyre Synod were concentrated at Mulanje.

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 was moved about ten kilometers to its present location. A small hospital was built as well as a primary school, also used as a church, a small teacher training block and five staff houses. The initial clinic was a maternity facility (1928 to 1950). In 1950 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.

The hospital is now owned by the Church of Central Africa Presbyterian (CCAP) Blantyre Synod. The hospital is part of a CCAP station together with a primary school, a production unit for Soya enriched flour and a church.

Present

Currently the 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.

Vision

To have a community where people are able to recognize health problems and seek holistic health care services to improve the quality of life.

Mission Statement