April 24 – by Heather
When people hear you work in palliative care in Malawi, they often comment on how depressing and sad it must be. True, I spend most of my day with patients who are incredibly sick, and may not see the next week or month. They will almost certainly not know any of their grandchildren. But this is not something unique to palliative care here. With an average life expectancy of 40 years, it will be uncommon for the current generation of young adults, 20% of whom are infected with HIV, to see more than the generation below them.
The concept of palliative care is reasonably new to Africa, and very new to Malawi. It has been only in the last three years or so that there has been any palliative care available at all to patients in this country. So really, it feels quite a privilege to be working in a clinic, where we prioritize a holistic approach, and spend time to talk to patients, and learn about more than just their physical problems. Whilst this is expected in medical practice in the West (although not necessarily always practiced), it is a luxury that most clinicians in Malawi cannot afford. Dave mentioned a study he heard. Someone looked at the average amount of time a clinical officer working in a community health centre in Malawi has for each consultation. The result was harrowing – 45 seconds. It is hardly surprising that the quality of assessments is poor, and ludicrous to expect there would be a chance for social assessment or counseling.
So, it is a privilege to have the time to talk to patients.
An example of one of these crazy health centres is in the township of Ndirande on the outskirts of Blantyre. It is the poorest and most populated township within greater Blantyre. I have had a few visits to the centre representing the Tiyanjane clinic (the palliative care clinic at Queens - tiyanjane being Chichewan for ‘we are together’). The first time here, I had been invited as the Guest of Honour to the pre-Christmas function of the volunteers working for Tiyanajne. There are around 100 men and women, who volunteer their time to visit less fortunate than themselves in their homes, around the Ndirande area. I wasn’t sure if I really deserved the title of “Guest of honour”, but agreed to attend nonetheless.
When people hear you work in palliative care in Malawi, they often comment on how depressing and sad it must be. True, I spend most of my day with patients who are incredibly sick, and may not see the next week or month. They will almost certainly not know any of their grandchildren. But this is not something unique to palliative care here. With an average life expectancy of 40 years, it will be uncommon for the current generation of young adults, 20% of whom are infected with HIV, to see more than the generation below them.
The concept of palliative care is reasonably new to Africa, and very new to Malawi. It has been only in the last three years or so that there has been any palliative care available at all to patients in this country. So really, it feels quite a privilege to be working in a clinic, where we prioritize a holistic approach, and spend time to talk to patients, and learn about more than just their physical problems. Whilst this is expected in medical practice in the West (although not necessarily always practiced), it is a luxury that most clinicians in Malawi cannot afford. Dave mentioned a study he heard. Someone looked at the average amount of time a clinical officer working in a community health centre in Malawi has for each consultation. The result was harrowing – 45 seconds. It is hardly surprising that the quality of assessments is poor, and ludicrous to expect there would be a chance for social assessment or counseling.
So, it is a privilege to have the time to talk to patients.
An example of one of these crazy health centres is in the township of Ndirande on the outskirts of Blantyre. It is the poorest and most populated township within greater Blantyre. I have had a few visits to the centre representing the Tiyanjane clinic (the palliative care clinic at Queens - tiyanjane being Chichewan for ‘we are together’). The first time here, I had been invited as the Guest of Honour to the pre-Christmas function of the volunteers working for Tiyanajne. There are around 100 men and women, who volunteer their time to visit less fortunate than themselves in their homes, around the Ndirande area. I wasn’t sure if I really deserved the title of “Guest of honour”, but agreed to attend nonetheless.
We drove through the dirt roads of the township, and virtually through the middle of the market, to reach the Health Centre. Fanny, the Tiyanjane clinic cleaner, accompanied me, and showed me to where the festivities had already begun. No less than 100 men and women (mostly women) were seated on concrete pews, in an open air type hall. There was a single wooden chair at the front, facing the audience. Unfortunately, this was for me. Harriet, the inspirational nurse that I work with at Tiyanjane, was hosting the event, and ushered me over to my chair. I smiled and nodded a greeting to the sea of faces sitting before me as I took my place (what felt like a ridiculous place) on my chair. No more than 30 seconds later, the crowd had broken out into song. Malawian singing is really quite something. There is a sense of rhythm and harmony in Africa that comes naturally to its inhabitants. This song was beautiful – cheery, harmonious, and beautiful. There was a lot of clapping involved. I smiled, thinking that it was a nice song. Harriet lent over to me, and told me this was a welcome song for me. At that point, the nice song became and incredibly moving gesture. I sat, smiling, thinking to myself that it was moments like these that make harder times worthwhile. I made a speech, thanking the volunteers for all of their hard work over the year (which did seem a little ironic as a volunteer myself). I didn’t think it was all that much, but judging by the Hallelujahs and Amens in response, I guess it was okay.
The second time I visited Ndirande Health Centre, was to do a clinic. The Tiyanjane clinic at Queens runs a clinic in Ndirande every second Friday. The patients seen are those who have been referred to palliative care from a variety of people. Usually Harriet, or one of the volunteers, has seen patients in their homes and asked them to come to the clinic if there were certain issues to be sorted out. This clinic was an eye opener for me. Each patient had clear physical issues (TB, liver failure, almost all with HIV) to be sorted out. But the social issues were more problematic. It was one thing to diagnose a physical problem, prescribe a drug or two, and explain the condition to the patient and guardian. But what could we do about the fact that the patient and family had no food? Or the fact that they couldn’t afford the transport money (MK30, equivalent to about A$0.20) to go to the hospital to collect the medication. Or the fact that the husband had left once he found out his wife had HIV, and left her with 5 children under 7 and no income. These are common stories in Malawi, and were not new to me. But the situation for the patients at this clinic were just that bit more dire.
I offered to take most of these patients into Queens to collect medications. One young lady (who needed to be admitted with likely TB), accepted, and I drove her, along with her mother and daughter back to Queens. The others needed to go home first, for a variety of reasons. Who knows if they made it to the hospital for their drugs. My three passengers climbed into the back of my car. With my Chichewa as dismal as it is, there was not much conversation on the way. There was a lot of coughing however, no doubt with lots of mycobacterium being splattered all over the car interior! I wondered….how did my passengers view me? The mzungu doctor with the flashy car.
