With the start of the new HRH Year 5, we have new faculty that have just arrived, and are eager to get started. We just had orientation last week, and both returning faculty and newbies are settling in to their respective roles.
A colleague of a colleague of mine wrote the following narrative, so I thought I would post it here.
I think it summarizes well our roles here as part of HRH. While most of us do not have the exact same conditions as this one in Malawi, we in Rwanda face similar challenges:
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Today there was no running water at Queen Elizabeth Central Hospital.
I found out when turning on the tap in the ART clinic. Just wanted to use a simple infection control technique before seeing patients, but instead I would have to borrow from a colleague's dwindling supply of hand sanitizer. I stood at the tap waiting and hoping for a drop. No madzi, no water.
Queen Elizabeth Central Hospital, QECH or Queens, serves many functions: as the hospital for the Blantyre district area, as a teaching facility for the students from many Malawian schools of nursing as well as the sole medical college, and along with Kamuzu Central Hospital in Lilongwe, is one of only two or three national referral centers for the entire country.
And today, at the national referral center, there was no running water. There was electricity, at least. I have never been there when there was no electricity, but the registrar, or medical resident, with us today mentioned that she thought they may have lost power for a time in the am today. In the six weeks since we arrived in Blantyre, Queens has frequently had to use generators to power the facility, Kamuzu College of Nursing (KCN), which is physically linked to the hospital and supplies substantial manpower to the facility, usually has no power at all (or uses a small generator to keep the library block lit), and the College of Medicine never seems to lose power. Interesting power dynamics.
My office at KCN is large with a comfortable desk and small windows set high above my head which do not let in direct sunlight. On the many occasions when there is no power, I will sit in semi darkness, meeting with students, working on the computer, reading masters proposals, until my computer battery runs down. Then I get whatever else done that requires no electricity, ride my bike home to a neighborhood that has less frequent blackouts, power up my device, and go back to reading the masters proposals. I am spoiled at home in comparison to the physicians. My GHSP medical colleagues live in a neighborhood immediately adjacent to Queens and KCN. They have had, at best, 12 hours of electricity a day since arriving here. They get up if the power goes on at 3 or 4 in the morning just to try to cook something, power up their devices, or make use of the light to accomplish something that they could not get done when they came home at dusk to a darkened house.
And in the city, we all are spoiled in comparison to the 80% of Malawians, perhaps 14 million people, that live in rural areas and have no electricity or running water at all. The women rise at 4am in darkness, using kerosene lamps or flashlights as they make their way to the boreholes or streams for water, dragging home the heavy containers, lighting fire, heating water, cooking, inhaling dangerous soot from cook stoves, sorting rice by hand, working their land, doing every activity with a child strapped to their back, and then going to bed not long after sundown to begin again in a few hours.
No electricity and no running water and for some, little food. The drought that has decreased the output at the hydroelectric power plants, has also contributed to increasing food insecurity in the rural areas. And economic conditions have led to increased inflation, decreasing a family’s ability to purchase staple foods now in comparison to the same time a year ago. When we notice people have lost weight in clinic we ask how many meals that the person can access per day, because weight loss may represent food insecurity rather the presence of disease.
At the hospital we sometimes do not have basic medicine. Supplies that should be here are not. The government officials that are honest try their best, but an entrenched culture of corruption drains resources. The PEPFAR funded programs, for some reason, seem to be mostly exempt from such problems, but other services funded by donor money are not, which make me wonder why we can’t structure all donor funded services to have provisions similar to PEPFAR.
I sometimes wonder what I am doing here. The undergraduate nursing and medical programs are rigorous. The nurses and physicians and health profession students that I have met are competent and knowledgeable. The faculty work very hard and are good at their jobs. They know what needs to be done but simply do not have the basic resources to do it.
I sometimes think that sending a good health economist and forensic accountant in might achieve more than the presence of any clinician. And sometimes I do see the value of us being here. Because this is time limited, we can tolerate the blackouts and the stock outs perhaps better than if we had to deal with it every day into an endless future. We can use our energy to work with our colleagues in pushing through new initiatives, leveraging our naivete as we don't have the experience of failure from pushing again and again to change highly entrenched systems.
We can use our outsiders’ perspective to get a better overview of the health system., noting the good things, the healthy patterns, and nurture their growth. We can listen to our colleagues and help them to develop their voices as patient advocates and stewards of the health system. We can cover classes, allowing our colleagues time to develop proposals and expand local research capacity. We can allow them the space to refresh their perspectives on their work, avoiding burn out.
In a place of drought, we can be like madzi, like water.
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