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Ekwendeni Mission Hospital, Malawi - Daniella Cox

After 2 years of planning, my elective trip had all come together and soon I found myself embarking on the 7000 mile journey south to Malawi. Ekwendeni Mission Hospital is situated in the north of Malawi about 20km from the nearest city, Mzuzu. It is a general hospital with just under 200 beds providing health care to the local catchment area of approximately 50,000 patients. The hospital has 5 wards; male, female, paediatrics, maternity and a private ward.

Prior to arriving in Malawi, I hoped to gain an insight into what life would be like working as a doctor in Africa. I had previously found an interest in infectious diseases, however never had experienced this first-hand. Malawi was the perfect opportunity for this. I anticipated that I would be doing practical procedures all the time, the hospital would be short staffed and the care would fall short of that in the UK. On arrival, I soon realised that the hospital functioned exceptionally well and was definitely not as I had expected. Initially I was unsure of my role however soon realised that I was going to be useful in other ways I had not realised. The care in the hospital was phenomenal and Ekwendeni was known around Malawi for being one of the best hospitals. Just after arriving during one of my first weeks, there was a meeting run by a group who audit Malawian hospitals looking specifically at paediatric mortality. They stated that the mortality rate for children who come to hospital was 10% throughout Malawi; however at Ekwendeni the rate was less than 0.5% which reflected the care that the hospital provided. I was so impressed with the hospital, and the staff. They were all happy to help whenever they could, teaching, helping and showing me different things around the hospital.

As you would expect, the common diseases included Malaria, Tuberculosis and HIV & AID's; however Diabetes Mellitus, Hypertension and Heart Failure also presented frequently. The lack of health education and increased westernisation of the country has led to an increase in so called “western diseases”. Whilst I was there, I had the opportunity to help set up a Chronic Care Clinic which was mainly focussing on the diagnosis and management of hypertension and Diabetes Mellitus. I aided in the creation of Ekwendeni specific protocols which were to be used in the clinic which we based on protocols used in the UK. I also aided in training counsellors to help patients understand their disease, understand healthy eating and the importance of a good diet and compliance to medications.

I also the opportunity to present at two of the Group Teaching Meetings on Thursday mornings along with my medical student colleague. As we perform ECG's almost daily on the wards back in the UK, we decided to do a teaching presentation on this topic and train the clinical officers on how to use it and the importance of its use. This went really well, and we hope that we have given the hospital another diagnostic tool to help in management of patients. The benefit of this teaching session is evident, and by recognising the deficiency in knowledge about ECG's we were able help practically.

My day started at 7.15am with prayers and a small sermon in Chitumbuka, the local language. This was something I came to really thoroughly enjoy and participate in. Next was hand-over from the night staff who presented all new admissions to the clinicians. This gave me an opportunity to identify the most interesting and most unwell patients to review later on with the doctors. The areas in which I helped out varied from day to day, however all started with ward rounds on our respective wards which is where the majority of learning was done from first-hand experience. I spent the majority of my time on general adult medicine however did a week in paediatrics, and a week in maternity. The ward round was performed by the clinical officer, and I shadowed this for the first few weeks before eventually running my own ward round by the end of my time at Ekwendeni. On the ward round we reviewed every patient and made a management plan for their care for the next 24 hours before reviewing them the next day. This was a great opportunity to learn, to teach yet also to help with diagnosis and management. By doing this I could contribute to the care of the patients directly, and could aid the clinical officers with their learning. This was then reviewed by one of the doctors and therefore provided more opportunities to understand more about diseases in Malawi. This was where I felt I learnt the most, and has provided me with a good understanding of tropical medicine.

After the ward round, we would review the sicker patients with one of the doctors. Occasionally none of us could work out the diagnosis, and needed to refer to textbooks for the rarer conditions. This again allowed a more in depth knowledge of tropical medicine and medicine as a whole and will aid me in the future as a doctor. In working alongside the doctors, we were able to help them as they helped us. My clinical examination skills have vastly improved as unfortunately in Malawi patients present late near the end stages of their disease. As a consequence, their clinical signs are extremely marked, and you see certain things that you would never see in the UK. Aside from the hospital and all the interesting things I learnt and saw, it was the Malawian people that made my elective what it was. Not only those who I met outside the hospital but the staff and the patients. The staff went out their way to care for these patients, working long hours for relatively little pay. Their hearts of compassion were evident, and only something I think I would have seen at a mission hospital. The patients as well were inspiring; despite being extremely unwell and suffering they were still continually praising God.

Outside of the hospital, I was able to fully get involved in Ekwendeni life. Within 2 hours of arriving to the village, I was warmly welcomed into the home of one of the Malawian families, by attending the local bible study! I also got involved in the local church, and the Boy's Brigade. This provided a lot of opportunities to meet local families and understand what life is like living in Malawi. I am still amazed at the generosity of these people despite their absolute poverty. Malawi is known as the “warm heart of Africa” and that is certainly what I experienced. Never before have I felt more welcomed into a community than at Ekwendeni.

Without sounding cliché my experiences in Malawi have been somewhat life changing. I had always known that I would want to come back to work in Africa again. However prior to going on elective I had never seriously considered tropical medicine as a specialty. For my elective I wanted to be able to experience first-hand what working in Malawi would be like and therefore gain an insight into working abroad in a rural African country.

In summary, my time at Ekwendeni Mission Hospital has allowed me to have first hand experience of what working in rural Africa would be like, and what tropical medicine as a specialty would be like. I have thoroughly enjoyed my experience and learnt so much. Before arriving at Ekwendeni I could have never imagined what experiences I was going to have, the hospital staff or the patients I was going to meet. These life-changing experiences have greatly influenced my faith, and my future career plans. At present it is early days and I definitely will need to learn more about tropical medicine and spend more time in rural settings. I plan to continue learning, and plan to take further future opportunities to work in this setting again.

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