Happiness, Hope & Hospitality at Mulanje Mission Hospital

My first week in Mulanje has flown by! It feels like I’ve already been here a month, and I never would have dreamed I would feel so at home in a place thousands of miles away. I’ve never felt more inner peace and personal satisfaction from doing the work I love in a place where a little goes a long way.

My lovely Dutch housemates, Sara and Arjan

My lovely Dutch housemates, Sara and Arjan

From the moment I arrived in Mulanje, I was immediately mesmerized by the beautiful rural countryside of Malawi, with the magnificent Mt. Mulanje in the background, and the hospitality of the Malawian people.

Mt. Mulanje in the background. Looks different every day!

Mt. Mulanje in the background. Looks different every day!

The first day on the job, I hadn’t brought lunch, and my colleague (who I met just hours before) invited me over for a traditional Malawian lunch. His wife showed me how to make nsima, a staple food made from maize flour. Before long, we were chatting like friends!

Traditional Malawian cuisine, eating with hands: nsima, fish, eggs, and spinach stew

Traditional Malawian cuisine, eating with hands: nsima, fish, eggs, and spinach stew

Mulanje Mission Hospital is filled with compassionate doctors, nurses, clinicians, and pharmacy staff, who made me feel right at home as I started to work on my mandate to help improve management of the hospital pharmacy.

The pharmacy staff was receptive to my arrival, and expressed a keen interest to learn from a volunteer from overseas.  I was equally interested to learn from them! I felt confident in being able to work on building capacity in such a positive environment.

Me, with the pharmacy team at MMH. From the left: Judith, Stanford, John, Patricia, and Dickson. Everyone's wearing the pharmacy buttons I brought! :)

Me, with the pharmacy team at MMH. From the left: Judith, Stanford, John, Patricia, and Dickson. Everyone’s wearing the pharmacy buttons I brought! 🙂

My first task was to conduct a baseline assessment of the current hospital pharmacy management, and develop a training program and management tools to optimize pharmacy services. My first workshop was a review of good dispensing practices and the rational use of medications. The staff were appreciative, and tried to apply some of the things they had learned right away.

My homemade counting tray

My homemade counting tray

Encouraged writing out complicated dosing regimens to help patients understand how to take them

Encouraged writing out complicated dosing regimens to help patients understand how to take them

There is a magical aura in the air here in Mulanje, and it makes me feel alive. I am touched by the dedication of the staff at Mulanje Mission Hospital in providing the patients with the best care given limited resources.  Malawi is indeed “The Warm Heart of Africa”. The strength of the human spirit is inspiring, and I am grateful for the opportunity to apply my knowledge and skills in an area of need.

Nurse Ethel, a palliative and HIV nurse, with the biggest, warmest heart anyone could have <3

Nurse Ethel, a palliative and HIV nurse, with the biggest, warmest heart anyone could have ❤

Magic at Majete

March 9-10. Majete Wildlife Reserve.

No trip to Africa is complete without going on a safari! Anna, Pippa and I decided to explore Majete Wildlife Reserve, an hour’s drive from Blantyre. Majete is home to the Big Five – lion, rhino, elephant, leopard, and buffalo.

The drive to Majete was incredibly scenic, and passing through Chikwawa yielded spectacular views of the valley below.  Kamuzu Viewpoint is a popular spot for locals and visitors, a grassy spot situated on a bend of highway allowing for panoramic views of the famous African Rift Valley.

Kamuzu Viewpoint

Kamuzu Viewpoint

View of the Rift Valley from Kamuzu Viewpoint

View of the Rift Valley from Kamuzu Viewpoint

My first elephant sighting was on the drive into Majete, serenely enjoying an afternoon stroll by the roadside! And we weren’t even at the park yet. Signs of good things to come!

First elephant spotted!

First elephant spotted!

The entrance to Mkulumadzi Lodge was across a suspension bridge over the Shire River. Quite grand indeed! We received a royal welcome and relaxed in our luxurious open chalets, each nestled into the African bush with a view of the river and surrounded by sounds of nature. Total paradise.

Suspension bridge entrance to Mkulumadzi Lodge @ Majete

Suspension bridge entrance to Mkulumadzi Lodge @ Majete

Total relaxation at Mkulumadzi Lodge

Total relaxation at Mkulumadzi Lodge

Looking out onto the Shire River from the porch

Looking out onto the Shire River from the porch

Our two-day all inclusive trip included three safaris: a jeep safari in the late afternoon-early evening, a walking safari at the crack of dawn, followed by a speedboat trip down the Shire. What a wonderful sight to see wild animals roaming in their natural habitats. A small family of elephants grazed in tall grasses; a young impatient elephant spraying water at us, close range; lazy hippos floating in the river with exaggerated yawns;  inquisitive nyala and impala curiously gazing at us from behind the trees; families of warthogs (Pumbaa!) disappearing into the bush at the first sign of approach;  a giant buffalo, formidable yet goofy looking with its curved horns.

Hungry hungry hippos!

Hungry hungry hippos!

Curious waterbuck

Curious waterbuck

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Male impala, not camera shy!

Playful elephant

Playful elephant

Buffalo = cow with bad hair style?

Buffalo = cow with bad hair style?

On the jeep ride back to the lodge, I looked behind us at the stars, millions of twinkling beacons against a backdrop of black. After an eventful day, I plopped onto the bed and fell asleep to nature’s soundtrack. I could stay here forever.

Supplies for Malawi

Thanks again to everyone who came out to support me at HUM’s launching event, Music for Malawi. Learn more about HUM at http://www.humcanada.com. A portion of the proceeds went towards purchasing medical supplies, and the remainder of the money went towards the ongoing operating room renovation project. A warm thank-you on behalf of Mulanje Mission Hospital 🙂

Special thanks to Kevin Kwok and Steven Ngo for making the concert possible! 

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Medical and first aid supplies for Malawi – Thanks, everyone! 🙂

Hospital pharmacy, Malawian style

March 8. First day on the job at MMH.

At 6:00am, a rooster’s call marked the beginning of my day and I awoke to soothing sounds of birds chirping and monkeys jumping on my roof. I attended morning handover rounds at 7:15am and headed over to the pharmacy for a tour.

MMH's pharmacy dispensary

MMH’s pharmacy dispensary from the front

The pharmacy staff was friendly and welcoming – Dickson, the pharmacy technician in charge; Patricia, Judith, Linda, and Stanford, who were pharmacy support workers.

Patricia, one of the pharmacy support workers in the dispensary

Patricia, one of the pharmacy support workers in the dispensary

In Malawi, pharmacists are few and far between. Most of the hospital pharmacies are staffed by technicians or assistants with training in dispensing, and support workers who have no pharmacy training at all.

The dispensary serviced mostly outpatients from the clinic and provided medications and supplies to the hospital wards. Wooden counters lined all four walls, cluttered with small cardboard boxes packed to the brim with commonly used medications.

For my pharmacy colleagues, the most common meds dispensed were: amoxicillin, septra, PNM (which is code for paracetamol), metronidazole, ciprofloxacin, and malaria treatments such as quinine and LA (lumefantrine-artemether).

Bottles of frequently used medications on the side counter

Bottles of frequently used medications on the side counter

Printed baggies of medications with blanks to fill in patient and drug info when dispensed

Printed baggies of medications with blanks to fill in patient and drug info when dispensed

Tablets were pre-packed into small ziploc bags labelled with abbreviated drug names and dose (eg cipr 250), for ease of dispensing. No traces of counting trays were seen, and counting by hand appears to be the method of choice.

Various drugs precounted into baggies for dispensing to patients

Various drugs precounted into baggies for dispensing to patients

What surprised me was the pharmacy stores area. All the supplies were clearly marked alphabetically in a temperature-controlled area, and cleanly stored! There was a decent supply of most commonly used medications, each with their own stock cards. Unfortunately, narcotics were in short supply – only meperidine and liquid morphine were available.

Pharmacy supply stores

Pharmacy supply stores

My next steps are to complete a baseline assessment of the current workflow, meet with the pharmacist at regional medical stores in Blantyre, and formulate a strategy to improve the quality of pharmacy services and build capacity. All in 3 weeks!

Connection woes

Sorry for the delay in posts! Internet connection was an issue in Mulanje because my dongle (ie internet connection stick) wasn’t working. Should be fixed now that I’ve gotten my hands on the appropriate stick! 🙂

My state of the art equipment

My state of the art equipment: $10 cell phone (with flashlight!), internet stick, airtime vouchers 

Finally arrived in Mulanje!

March 6-7. Blantyre en route to Mulanje.

Blantyre is the second largest city in Malawi, and vibrant African city life mixed in with the market scene give the place a lively vibe. We met many of the overseas volunteers staying at Kabula Lodge, including Pippa, who I met some months ago during my pre-departure orientation in Vancouver. Spectacular views of the hillside made breakfast more than enjoyable!

Lovely view from the dining area @ Kabula Lodge - incentive to wake up early!

Lovely view from the dining area @ Kabula Lodge – incentive to wake up early!

Lunch with WUSC volunteers and staff - Khakaza, Pippa, Anna, Believe, Me, and Philip (WUSC Regional Director)

Lunch at Hong Kong Restuarant (yes, really) with WUSC volunteers and staff – Khakaza, Pippa, Anna, Believe, Me, and Philip (WUSC Regional Director)

On the way down to Mulanje from Blantyre, we passed by acres upon acres of tea plantations, one of the country’s major exports. It was really quite remarkable – I could never tire of the sight of this countryside. Tobacco leaves hung out to dry on thatched wooden racks, carefully tended to by the villagers. Interestingly, I have not seen a single person smoke since I arrived in Africa even though the tobacco industry is booming here.

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People harvesting tea in the plantations lining the road to Mulanje

At Mulanje Mission, I was warmly greeted by Dr. Davie Mpate (Palliative Care physician), Dr. Ruth Shakespeare (Medical Director), and my work partner Dickson Chisale (Pharmacy Technician). My housemates, Arjan and Sara (medical students) from the Netherlands, helped me settle into my new home for the next 3 weeks.

Mulanje Mission Hospital - my home for the next few weeks!

Mulanje Mission Hospital – my workplace for the next few weeks!

My new abode is a short walk from the hospital, and it is a simple but quaint cottage. Shelves are filled with mementos from past volunteers which remind me of home. My biggest challenge will be adapting to the bucket showers!

Step 1. Fill big bucket. Step 2. Fill small bucket. Step 3. Devise creative ways to clean oneself using Steps 1 and 2. Repeat.

Step 1. Fill big bucket. Step 2. Fill small bucket. Step 3. Devise creative ways to clean oneself using Steps 1 and 2. Repeat.

We all jumped into Ruth’s car and went to the Mulanje Golf Club for dinner and bonded over Greens (aka Carlsburg). For 50 cents, this is the drink of choice here. Tomorrow, the real work begins!

Education Changes the World

Day 3. Orientation in Lilongwe.

First day of orientation today at the World University Service of Canada (WUSC) Malawi office, and were warmly welcomed by the staff. Alice, the Sector Programme Officer, and Jacob, the Country Director, walked us through our volunteering mandates and provided some practical tips on living and working in Malawi, including how to survive a minibus ride and navigate the market chaos!

With the WUSC Malawi Team - Phallys, Alice, Lawrence, Noel, Anna, me, Jacob, Bertha, Tendai

With the WUSC Malawi Team – Phallys, Alice, Lawrence, Noel, Anna, me, Jacob, Bertha, Tendai

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Meticulously stacked vegetables at the market

Vibrant, fresh produce at the local market in Lilongwe

Vibrant, fresh produce at the local market in Lilongwe

Although Malawi is a beautiful country with many natural resources, it is also one of the world’s poorest countries.

Some disheartening facts:

  • Average life expectancy is 36 years
  • Most deaths due to HIV/AIDS
  • Over 1 million orphans
  • Population of 13 million – over half live below the poverty line
  • In rural areas, illiteracy rate is over 80%, especially among girls

The Uniterra Leave for Change program gives Canadian volunteers an opportunity to participate in projects to build capacity and create sustainable change in developing communities. This can be done through educating and training, enabling individuals and organizations to achieve their goals more effectively.

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WUSC: Education Changes the World

Over the next few weeks at Mulanje Mission Hospital, my main goal is to increase the knowledge and skills of the pharmacy staff and develop a pharmacy management manual to improve organization and efficiency. I am also hoping to give some presentations on antibiotic prescribing and pain management.

Looking ahead, some of the potential challenges include achieving the mandate within a short period of time, managing cultural differences, and working with minimal resources. I’m determined to make the most of what I have, and learn from the local people along the way!

Travelling to Mulanje tomorrow to meet the hospital director and the rest of the staff – wish me luck!