Update van Susannah Wood (in Engels):
Well, I had hoped at one point to write a proper email to you all soon after returning to the UK but my timing in these matters has not improved! Most of this was written following a very wet Christmas shopping experience in the centre of London – not something I have missed. Since then I have spent a very happy Christmas in the flat in London with Mum, Dad and 2 friends from my course who were unable to return to their respective homes in Japan and India during the holidays. I am now down in Salisbury for a few days, enjoying the escape from London although not doing as much walking as hoped due to lots more rain!
My last few months in Malawi were filled with goodbyes – a rather unexpected party held at the Diocese, a final Sunday School trip to the lake with fabulous performances of songs and drama, the official party at the hospital, held in my garden, and my last Sunday at church. But also, there were the last visits to each health centre, the last meeting with the chiefs and community representatives on the hospital’s advisory committee, farewells to a few special patients like Bridget, a diabetic teenager who I’d been treating for the last 2 years. At my last management meeting I was incredibly proud to receive a very smart certificate of recognition of service and at my last morning meeting with the clinicians I was presented with a beautifully carved chief’s chair.
Preparing speeches for the various leaving parties was a good opportunity to think back over the last 5 years. The struggles of the first few months when I felt so ignorant of so many things. My first clinical meetings discussing chest x-rays of HIV patients with possible tuberculosis; wondering how I was going to lead a team of clinicians who had so much more experience in these areas of medicine than I did. The slow and sometimes painful experience of learning to manage people, and the grace and patience of many of those people as I learnt. Considering the hospital now, while far from perfect, it feels a more united and peaceful place. Some of the tensions between different departments, especially administration and clinical/nursing, have reduced, though not disappeared. The re-scheduling of the daily morning prayers to avoid clashing with the clinical morning report seems to particularly represent and enhance that improved relationship – even though attendance is rather patchy!
The clinical team has grown; many clinicians who started out as interns have stayed, matured and are now taking on leadership roles. The nursing team has seen significant changes, especially through training and upgrading staff and with the arrival of the Steve Macheso, the new Principal Nursing Officer, last November. During the last 5 years, every health centre has started providing free maternity services through agreements with the government. The afternoon before I flew out of Malawi we signed the agreement for St Luke’s hospital – the culmination of over 3 years of negotiations. The number of women delivering in the safety of the hospital has risen by 35% since then.
My final Sunday was the day of Pentecost, and also the church’s harvest festival. So, on top of the normal 2 ½ hour service, the Sunday School performed a drama, the priest blessed the sacks of maize which people had brought as their tithes and I was presented with gifts from different groups in the church. With a certain amount of help beforehand I managed a short speech in Chichewa letting them know how important it had been for me to be a part of their congregation and the strength I received from praying there each week.
On top of the sadness of leaving were my concerns for the future. Despite some improvements in financial control and transparency the hospital remains in a fragile financial position and as dependent on donors as ever. This has become exacerbated in the last few months by deterioration in the economic and political situation of the country. From early in the year concerns were being raised about the increasingly autocratic tendencies of the Malawi president. Restrictions were placed on published material, all lecturers at Chancellor College, part of the University of Malawi, had stopped teaching due to well-founded fears about lack of academic freedom and the president’s wife had been given an extremely large salary for what people considered to be a charitable role. This concern was expressed in a private memo by the British High Commissioner back to the UK. Unfortunately it was leaked. He was given 48 hours to leave the country and Britain responded by removing the Malawi commissioner and holding all budgetary support to the Malawi Government. The EU and the US have followed suit leaving Malawi in a terrible financial situation. There isn’t enough foreign currency to buy fuel (already in short supply) so prices of both fuel and other daily commodities have been soaring. There is a shortage of drugs in the government medical stores and hospitals.
As many of you will know, civil society groups organised a mass demonstration in July, presenting the government with a 20 point petition. On the day 19 people were killed by police. Changes have been slow and partial.
Back at St Luke’s there is still no doctor to replace me. The one local doctor to apply for the position was unwilling to accept the salary and conditions we could offer. I felt very confident leaving the clinical department in the hands of Aunex Kwekwesa, Chief Clinical Officer, who had already proved his ability during my 3 month furlough 2 years earlier. But I know it would be better for the status of the hospital to have a doctor in place. Also, knowing the difference it made to have Kwekwesa as my ‘deputy’, I felt very sorry leaving him to carry the responsibility alone. Last month Kwekwesa started a degree in Health Management at the College of Medicine in Blantyre. Lenard Banda, Senior Clinical Officer, has taken over from him. I very much hope that a Dutch doctor, Eva, will be sponsored by the UN to start work there soon.
Knowing about the struggles for the hospital and the country has in some ways made it harder to settle back here. I feel bad about leaving them with so many problems.
There have been other sad events during this year. 2 weeks before I left, the hospital’s human resource officer became very sick, was admitted to the ward but died 2 days later, shortly after transfer to a private hospital in Blantyre. He had worked hard to improve the work and the name of the HR office in the year he was with us and it was incredibly sad to lose him.
A couple of months ago I heard from a number of people at the hospital about a fire in the house of the hospital’s anaesthetic officer, Mr Kachingwe. His 12 year old niece was studying by candlelight due to an electricity cut. It’s presumed she fell asleep and the candle fell over, setting fire to the place. Tragically, she died and the house suffered huge damage although a generous donation from MACS means it can be renovated again. Both Mr and Mrs Kachingwe have been at St Luke’s since the mid-‘70s and are 2 of the most committed and kindest people.
Settling back into life in the UK has not been as ‘shocking’ as one might imagine. I think my 3 month furlough in 2009 was good preparation for the increasingly rapid advances in internet technology and becoming a student again shields me a little from the speed and isolation of London life. But I have been surprised at how emotional I still feel when talking or thinking about certain aspects of Malawi and my time there.
At this time of year I miss the sun, the greenness of rainy season, the mangos dropping off the trees. I particularly miss friends. The routine treat of coffee in Zomba on a Saturday morning and walks on the plateau. Lunch with a friend from church and sitting out on the khonde afterwards chatting. I miss greeting everyone every morning at work, the strikingly different personalities of the team I worked with, the ways they had all learnt to compromise and form a team, the ways they had grown to understand and accept me. Finishing work late and finding my night watchman had come to walk me home in the dark. The brightness of the stars.
I am now studying for an MSc in public health for developing countries at the London School of hygiene and tropical medicine. It is a great opportunity to consolidate and build on some of the things I’ve learnt during my time in Malawi and it is a very supportive environment to be in as everyone in the class has similar experience. It is very different to studying medicine. Some of the more research-based subjects are familiar and suit the mathematical side of my brain quite well. Others such as health policy and health economics are rather foreign and take a bit of getting used to, though both useful and increasingly interesting. I don’t yet know where it will lead but I hope there will be opportunities to continue assisting and learning from Malawi and other countries like her.
I intend to remain in close contact with St Luke’s – hardly a week goes by without some news from them. Together with this email I’m attaching their November newsletter. This is the first of its kind for many years and I feel rather proud of the team involved and very much hope they will continue. I am also attaching the new 5-year Strategic Plan which was completed in September. Please don’t feel any obligation to read it but it helps to give an idea of the plans, hopes and aspirations of the hospital and health centres for the future for those who are interested.
During this term we studied the nature and importance of power and who holds it in the context of forming health policy. In the world this year we have seen enormous power overturned. We have also, in this country, seen financial power held onto, arguably at the expense of the most vulnerable in society. And now, during this season of Christmas, I am struck again by the challenge of the powerlessness of God as a baby.
I wish you all a very Happy New Year.