Been quiet for a while

It’s not only the baby that’s keeping me busy; but work and everything else.

Part of it is frustration I guess comes because  I have not featured into the new political regime in Malawi. My new ministry of Health is KK but I am also KK.I have been here for 17 years now seems  cant get any higher.

I like on being encouraged to be patient and that my time will come.

When is it coming?

Comment at : director@bicomalawi.org

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Death Announcement: Dr Moses Chirambo, Ophthalmologist & Minister of Health Malawi

It is with sadness that I announce the death of Dr Moses Chirambo, the first Malawian Ophthalmologist, and and a well known public health Ophthalmologist in the International ophthalmology sector .He died in South Africa yesterday on Saturday 14th August 2010 from an anesthetist related cardiac complication while undergoing Prostate removal surgery. See my previous blogs about him and his pcitures.
Dr Chirambo actively retired from Ophthalmology in 2008 when he was appointed Minister of Health and Member of Parliament for Malawi.
In 1983 , he established the Southern Africa Development corporation (SADC) school of Ophthalmology in Lilongwe, Malawi supported by Sight Savers International ; this school has trained over 500 clinical officers and cataract surgeons (midlevel eye personnel )from all over SADC countries and beyond ; and now several countries including Botswana, Namibia, Zimbabwe and Zambia have started their own training programmes
In 1995, Chirambo got an International ward from the American Academy and IAPB for his fight in blindness; and continued to get several awards (too many to mention). He was a Regional advisor for Sight Savers International for a long time.
Between 1983 and 1987, Dr Chirambo, Professor Johnson Gordon and many other colleagues conducted the first population based childhood blindness survey on vitamin A & Xerophthalmia studies in Africa.
For those who knew Chirambo, he will be missed by many.

Join us in Malawi in morning this great achiever in Public Health ophthalmology & epidemiology.want to know more about him? look here

more Information Chirambo

Its a sad day
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Eye specialists and Politics do not go together. We are here for the Blind

Welcome back Prof though you are still an honourable MP:

After a few months of being minister of Health ,I am told the Professor(Prof Chirambo, the eye specialist has been dropped by the other profffesor (our President)but Prof remains a member of parliament.Well some of us knew that African politics and too many brains in one place do not go together ,so it’s not strange that people like him do not last (speculate why).


I am proposing him to be VISION2020 ambassadordor to share success stories of VISION2020 activities in Malawi, and myself to be the deputy ambassodor (since he is sitting in the middle in the pcture and myself on one end).

Should such a genius have joined politics in the first place? What do you think?

Despite nepotism , i will contune ensuring that Malawian including ones from Thyolo have access to good quality eye care .

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if you have a problem with being non partisan in service delivery.

Primary Health Care (PHC): Fantasy or reality for Malawi

From the recent political blog, I am back to my senses after sobering up and ready to report on more community work. Today I am writing about Primary health Care, PHC in short.

There is a long definition of what PHC is supposed to be as given by World health Organisation: (WHO, Alma Ata Declaration. WHO1978 p.3-4) that includes 5 sets of principles, viz: affordable and sustainable health systems development, appropriate(user friendly) technology, intersectoral collaboration, community participation ,and equity to access of services –whatever these mean!!! “Remember the Health for all by the year 2000” this was one of the WHO initiatives that was going to use PHC.
Heard about Millennium development goals (MDG’s) - most of these need PHC to be achieved.
So why is an eye doctor in the forefront talking about PHC? Well, for your information we are supposed to be integrating primary eye care (PEC) into Primary Health Care (PHC).There is now renewed call by “WHO” for implementing PHC in developing countries.

But how are countries like Malawi doing on PHC at grassroots level? This is a political question so need to be answered by politicians; but I will only be giving my views based on my experiences with the communities mainly in Southern region of Malawi. For this blog I will concentrate on my experiences during my recent visit to Mangochi district.
Fact 1 : Health Surveillance Assistants (HSA’s) are the main provider of primary health care in all communities in Malawi .I was introduced to this group of workers in 2007 when I started my research in eye care and since then I have interview over 200 HAS’s and trained about the same number on primary eye care. They fall under two levels of employment by the Government; those employed before 2007 –referred as normal HSA’s and those after July 2007,referred as the Global HSAs’s (because they were deployed under the global fight against HIV/AIDS initiative).They all are supposed to undergo a 10 week orientation training in everything (preventive ,curative and rehabilitative services) and then attend other on-job trainings .
Fact 2: At most 50% of all HSA’s recruited in 2007 have not after 2 years formally attended their 10 week training in Mangochi, Zomba and Mulanje and are actively doing their day to jobs without training .
Are we sure these personnel are doing what we intended them to be doing? Are they doing standardised procedures?
Fact 3: Some of the health centres with a catchment area of higher than 10,000 persons have no medical assistants, or nurses and are left to be taken care by HSA’s who attend to and treat all sorts of patients including maternity patients . I witnessed this in Mangochi at a health centre I visited to screen blind children , I was told there was neither a nurse or medical assistant there ,the senior HSA was in charge and was doing all the clinical work (and he was staying in a beautiful institutional house that would have been used by the nurse of she were there)
Can these HSA’s treat patients even if they were trained for 10 weeks? Is this what PHC is for Malawi –HSA’s taking place of medical personnel?
For once they are not recognised and registered by any nursing or medical body in Malawi ,yet they are doing what they are not supposed to be doing .Is this what PHC is all about ?
In my view one cannot be qualified to offer medical treatment when they are only high school (secondary) leavers and have only attended 10 weeks orientation.
Fact 4 : the Maternal mortality (number of mothers dying in child birth) for Malawi is the highest in the world ; the same non trained HSA’s are supposed to be in the forefront in preventing these deaths.
Are you surprised therefore that the numbers of mothers dying is not reducing in Malawi (unless we start cooking up the figures so that they shrink)?
These HSA’s are underpaid, have poor skills and are not clinically supervised. They can only be motivated to do best by improving these?
PHC is supposed to be strengthened at grass root /community level; this is definitely not the case in Mangochi. I visited some health posts and health centres in Mangochi where they had not had any supervisory visits from the district hospital since the start of this year. In another busy health centre, I found an intern (trainee medical assistant ) running the hospital after being posted there 8 months ago; he told me he had never been supervised or told what he should exactly do.
Unless our leaders invest wisely in PHC in Malawi; we are doomed to fail.

Remember “Failing to plan is planning to fail”

Those who believe and say that we are achieving a lot through PHC should go and spend time in the communities and witness what is happening there; we may be making some progress , but some of us have collected figures that prove the contrary .Show me your statistics ,and I will show you mine. I was very optimistic about PHC when I started my research, now I have become pessimistic.
Do you more data from me?
Do you want to debate?
Or do you want just to comment?

What do you say?
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Check for my next blog? Which MDG’s can be achieved by 2015 in Malawi?

Wish I could write a book

Ignorance is a disease; lucky enough some of us know and acknowledge that we suffer from such a disease. For once I wish I was a writer, but I know I am useless when its comes to putting words on the paper .If I did not how to write I could write a few books about all these ideas I have in my mind, books such as “guidelines for training health workers in Malawi”; “Eye diseases and their prevention in Malawi”; “How to make money while working for less hours ” and many other books.But God did not bless me with such talent ,so everytime I decide to start writing a book I write a paragraph and my head goes blank. As an alternative I have ended to writing blogs –which I still do not do well. But why is this the case ? You see I am always in the field seeing and experiencing all these things, and I tell myself when I get home I will write them up but I don’t.I wish I could be at least a better blogger ,if not a writer .Has this got something to do with my origin or culture?

Is there anyone there who can give me good tips ? easy ones and not referring me to books and blogs to read .Sorry I do not have such time. Unless your blog is talking about blind children ,or poverty in the rural villages in Malawi ,I am unlikely to read it.

I will be waiting for your email .Right now in my head I have all these wonderful ideas about what could be done to the primary health workers in Malawi but cant just spell them out .On the contrary I have noted that when it comes to going to the filed to do the work I am the one who packs the bag first .Its a pitty that so much is done ,but only the tip of the iceberg is reported.
Any suggestions on what could be done ?
What do you say?
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Primary Health Workers for Malawi

If you are an NGO or an individual interested in community health issues, you probably be wondering how much impact the role of community health workers have in improving the health of Malawians. In particular to this cadre are the so called Health surveillance assistants (HSA), who are said to be the backbone of the health system in Malawi .HSAs are employed and paid by the Ministry of Health. But what skills do HSA’s have to implement health care; and if trained do they actually do their work.
There are currently an approximately 12,000 HSA’s in the Malawi public service ,as a result of the recent scale up (2007) with almost half employed by the ministry of Health under the Global fund and other funding parteners and the rest through normal employment. HSA’s are responsible for implemented most of the health initiatives in the community, and for disease surveillance .By education ,the newer HSA’s have reached at least high school (Form 4) ,while the order groups may have not been very educated .HSA’s only undergo a 3 months training in Preventive, Diagnostic and Curative measures and upon completion they become experts in all community diseases .
With all the community interventions in Malawi relying on HSA’s ;is there evidence that HSA’s have contributed to the reduction in morbidity and mortality of the common Malawians .What are the implications and limitations of using HSA’s in health programmes ?

A look at the maternal, mortality figures in Malawi indicates that Malawi has the highest mortality rates (1120deaths per 100,000 mothers delivery) despite the many health promotion messages being spread by HSA’s. Many causes of these deaths are attributed to low levels of maternal care.

Unicef States of the world children 2009 that over a period of 16 years (1990 and 2006) of intensive community programme interventions, Malawi has only managed to reduce under five mortality by 40% and that the main causes of deaths still remain preventable at the community level. HSA’s are taught the integrated management of childhood infections (IMCI).
Since 2007 I have been involved in training HSA’s in identifying blind and visual impaired children in rural communities in Malawi; and have been comparing their performance with a matched group of trained volunteers .
I have very interesting results –which will be published later ,but certain issues desrve to be mentioned at this stage.

I have noted that most NGO’s and government institutions assess the outcomes of HSA’s training through reports submitted to the interested parties ,and that rarely do the trainers observe and access the skills attained by HSA’s after the training. I have also noted that most HSA’s rate the trainings based on the amount of subsistence allowance received during the training, and not on the skills attained. The mismatch in expectations between the trainers and the HSA’s has more than often resulted in not having proper measures to measure the outcomes of trainings .
In my next blog I would like write about what incentives HSA’s have mentioned to be being necessary for them to do the work ; and whether when given such incentives they have successfully accomplished the desired tasks. I will also be introducing the tracking tools that we have developed to assess whether HSA’s are doing their work and the incentives that we give. In the picture I am listening to a group discussion by HSA’s from Zomba. The forms we have devised can be used for any time of training and I will be more than willing to share with you.

Are you involved in training HSA’s in health projects in Malawi? Do you have evidence based facts of their success in implementation after training?

Or do you want me to share our results with you? Or are you just interested or want to comment.

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Are you a health worker based in the UK ? Will you help?

A film for the World Health Organisation (WHO) is currently being produced by a company in the UK. The film will look at the improvements to Malawi's health services that the WHO has been helping to implement. The film makers would like to talk to Malawian doctors, nurses and midwives who are currently based and working in the UK. With your help, they would like to discover what impact the WHO's interventions are having on the ground in Malawi. Have your say on what needs to be done to improve the Health System in Malawi .

I have accepted to participate in the film.

Are you available for a chat with me before being introduced to them?

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New eye hospital in Zomba , Malawi facing severe eye health workers shortages

My specialist medical field is Ophthalmology or eye specialist as other people prefer it to be called .I am one of the few Ophthalmologist practising in Malawi.
We are lucky that we have had strong links with Lions Clubs International- thanks to the efforts of the oldest Malawian Ophthalmologist Professor Moses Chirambo who has being fighting blindness in Malawi since 1972. He is the person who attracted me to join ophthalmology We have as a result of his initiatives more eye hospitals than doctors in Malawi , currently we have three lions eye hospital in Malawi, one in Mzuzu, one in Lilongwe and one in Blantyre where I work. but this is not the end .The construction of the fourth Lions eye hospital in Zomba funded by Lions clubs of Norway has been going on very rapidly ,with the 50 bed hospital expected to be complete by as early as July 2009.But the major challenge is who will be working at the hospital and where will they come from? the Ophthalmologist incharge ,nurses and clinical officers .There is already currently very few eye workers in Malawi .As usual my name has come up to go to Zomba because we are a few of us in Blantyre ,and as you probably know I am tied up with finding blind children in the communities of Zomba in 2009.But I can not be in too many paces at once ,so we need to identify and send some junior doctors for training as eye specialist ,so that they can take over the leadership of eye hospital. There is also need for a lot of nurses and clinical officers and any well wishers who would like to spend sometime working in the eye department in Zomba will be welcome. Once the construction is completed the hospital will be handed over to the Ministry of Health

Are you interested in working in Zomba?

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FINDING BLIND CHILDREN IN MULANJE

Well its really getting difficulty to maintain writing on my blog yet keep up with the filed work in Malawi .
Since Blantyre Institute for Community ophthalmology ( BICO) was launched early this year at the Lions sight first eye hospital in Blantyre ;we have been very busy doing Community eye health work in Southern Malawi ; starting with Mulanje as a pilot District .In may this year we conduced several trainings of Village volunteers and also Health surveillance assistants on how they can identify blind children ;and now they have started doing their work in the field and we are busy travelling up and down following what they are doing; We have recruited a project coordinator who is doing a marvellous job ( being a University of Malawi graduate I expect them to excel anyway).We were privileged in May to have observers from the International Centre for Eye health, London who visited us and observed what we are doing in Mulanje. I am pleased to report that that they have been convinced we are on the right track ;and we look forward to having services of BICO expand to the rest of southern Malawi .

If you have money to spare; do us a favour ! help us print BICO tee- shits for volunteers and Health Surveillance assistants at a cost of USD 8 ( £4) per item; these will help us spread messages about blindness in children and also
motivate the staff.

If you want to help please
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Defining all odds

My daughter Tapiwa was born only after my wife carried her in the tummy for only 6 months and the decision to operate on the mother was based on the fact it was important to save life of the mother; initially there was doubt as to whether the baby would survive –and I remember crying in that ward while my sick wife was trying to comfort me. She was only weighing slightly more than a loaf of bread (950grammes) when she was wheeled to that intensive care unit at Saint Mary’s in Manchester where she spent the last 3 months of her growth in the incubator. The doctors cancelled my wife and I about the poor prognosis expected for her if she survived (maybe would end up in a wheel chair in all her life) and I did understand the situation (being a doctor and having read about the problems of very very premature babies ) but never understood why. Fortunately Tapiwa did not accept all this easy; and she decided to define the odds and change the way we think. She hardly gained any weight for the 3 months she was in the incubator and was discharged home at only 2 KG.
Today Tapiwa despite being still smallish is a bubbling girl who is walking when she is in the company of people she knows, but alas she doesn’t like strangers who were busy discussing her fate.
Miracles like this happen for a reason.
Tapiwa is now 23 months old; and so far everything has been well. Any complications initially thought of have not risen.
There is a God out there who has been keeping her live and we do not know the reasons.
She now gives me more reason to help the less privileged.
Have you experienced a miracle like this?
Let me know about it.
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Are you a Malawian nurse working in the UK? Willing to be interviewed?

A team of film makers from London approached me a few months ago about their intention to try and capture the effect of nurses brain drain from Malawi to the UK by filming and conducting interviews with nurses who have migrated to the UK and also nurses in Malawi who are intending to migrate to the UK. The film would then be used for advocacy to either persuade Malawian nurses to stay in MALAWI or may be persuade the UK government to pay for the loss to Malawi Government .They though I could help them in identifying such nurses and well since I know a few nurses (some of them married to fellow doctors) in the UK I said I would introduce them to the team. Moreover with my interest in writing about health issues on Malawi; I thought it would be good and easy for me to do this. I have proved myself wrong. Despite many attempts to speak to any of these nurses they have all refused to give an interview.
Well, are you a Malawian nurse working in the UK? Or do you know Malawian nurses working in the UK?
Would you or they be willing to talk to the film makers from London?
If so I would appreciate if you contact me so that I link you up.
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Empty Promises

A Malawian lady based in USA came across my blog site and emailed me that she was touched with the good work we were doing in the prevention of blindness in Malawi and asked whether she could fund some of the activities in one district of her choice in Malawi. She said she had good fiend in the USA who would raise some funds for us to use.A date for the planned activities was set in March and after so many email communications she confirmed that she would be raising the funds.
As usual I moblised my team to start announcing /publishing about the upcoming event ;and when all was almost done I contacted this lady to transfer the money but she did not respond to my emails. I tried every to get hold of her but did not succeed. Even though I knew she was based in Washington it was harder to know the exact adress. In the end activities were cancelled after already publishing as that did cost us some money.
Even though we do need money to do the various activities in Malawi we do not routinely ask for momey.We wait for well wishers to come forward on their own and we engage on negotiations with them on how they can help us fund the activities. Being as busy as I am; and considering that it takes time to communicate on email and get back to many people ;I hope that people who approach me should be serious if they intend to help.It is not nice to waiste so much time and at the end pull out without explaining the reasons. Sometimes it is good to communicate and apologise that things did not come up as they were meant to be and that we should cancel the programme.
We are always in constant need of equipment and other logistical things and whatever you will you may help with is welcome to us Currently we need to replace our outreach operating microscopes, we need theatre gowns and attire, we need computers for the research team and financing for such activities .If you have anything you can offer even a dollar , please get back to me –but not with empty promises.

I will be waiting for your email.

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Why more mothers die during child birth in Malawi !!!

Malawi has being quoted to have the highest maternal mortality (highest number of mothers dying in child birth) in the world, with more than 1000 women per every 100,000 dying during child birth. This figure is quite alarming, but when you visit some of the Health centres in rural Malawi and take note of the conditions there; you understand why this figure may be an underestimation.
A classical example is Namphungo Health Centre, a government run health centre in Mulanje District, southern Region of Malawi .My team recently visited this place for our eye research . It takes about an hour to drive on the dusty bumpy road from Mulanje District hospital to the Health centre .The population catchments area for the Health centre is 40,255 and there are 53 villages surrounding the centre. In terms of infra -structure there is a nice facility with a separate maternity unit which has about 6 beds, even though the unit is not functional.
Staff wise- there is only one medical assistant at the centre who sees general cases; and there is no nurse to attend to maternity cases hence the closure of maternity unit. There are 21 health surveillance assistants (HSA’s) who do health promotion but most of these are untrained. Recently the ministry of health have recruited more HSA’s with intention of having one HSA per village but this has not been achieved for Namphungo.

Unfortunately during our visit, the only medical assistant was away from the centre so there was no one to attend to patients; but we believe the untrained HSA’s were attending to patients and prescribing even though they are not allowed to do so.
A highly pregnant mother who has started labour walks into the centre only to be attended by untrained HSA. Due to our presence she is advised to go to the nearest health centred where there is a nurse so that she can deliver; and my enquiry reveals that this centre is Namilenga Health centre and the woman will have to walk there for at least an hour -that is if she doesn’t deliver or collapse on her way.
The critical shortage of health staff (nurses, doctors, paramedics) is much worse in Malawi that the Government would like to admit –imagine no nurse in a highly fertile population of 42,000! The brain drain and influx of medical staff to the West continues; with the west continuously paying a blind eye to the health problems in Sub-Saharan Africa.

Now you understand why more women die in childbirth in Malawi than anywhere else in the world.

Well , I am only a researcher and an eye doctor so I can only communicate this information for authorities to know how to address the situation.

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? The cursed position of “Director of Clinical services” in the Ministry of Health in Malawi

The Director of Clinical services at the Ministry of Health Headquarters is responsible for directing all services relating to clinical matters in all the Government Hospitals in Malawi .This is a very high position in the Ministry and the person heading the post is responsible (among many other things) for posting of Specialist Doctors, General doctors Clinical officers, medical offers and other paramedical clinical staff in various hospitals in Malawi. Most importantly this is the person who acts as a technical advisor to the Principal Secretary (PS) and sometimes directly to the Minister.
The appointment of a person to this position is political and no interviews are conducting whenever a vacancy exists. However the post is that of a top civil servant (Contract position –almost equivalent to PS ) and I do not know who appoints the officer but anecdotal evidence suggests that it is t the Health PS in position who suggest the suitable name to the Secretary of President and cabinet .
In a system where ministers of Health and PS’s are frequently changed one would expect the Director of clinical services to be the gate keeper of ministry of Health and remain in that vital position for a while.
In my 12 years of working in the ministry of Health I have noted that this position is one of the most cursed position in the Ministry; and that when one is nominated to take up the post; they should be preparing to leave the post anytime regardless of their performance (for once I do not know how they are assessed and who assesses them).
Just within the last 12 years there have been 7 Directors of Clinical Services (of whom 6 have been doctors and one a clinical officer).

The table below summarises terms served by the persons involved
Year, Directors names, What happened and where now?
1996-1998 Dr W Chaziya Removed & Practising outside Malawi
1998-1999 Dr R Pendame Promoted to PS and later removed; working outside Malawi
2001-2004 Dr R Mpazanje Removed and working outside Malawi
2004-2005 Mr Mthotha Demoted in 2005;working outside Malawi
2005-2006 Dr D Lungu Removed ;sent to work as a specialist in a hospital in Malawi
2006-2007 Mr Mthotha Promoted and sent outside Malawi as medical attaché
2007- Dr MC Joshua Demoted ;sent back to district hospital
2007-2008 Dr GC Mwale Currently in position

It is worth noting that once these top civil servants have been removed from the position of Director of clinical services; they normally get jobs outside Malawi.

But the question remains; with such a rapid turnover are these people able to grasp and act on the Ministry of Health needs? I don’t think so. By the time they start understanding the politics of the ministry and are ready to start implementing their plans then they are replaced.
Are wrong people being selected? Considering that this is such an important position should there be interviews to select people with appropriate credentials?

Next time the vacancy of Director of Clinical services exists at the Ministry of Health in Malawi, don’t suggest my name- because this position is cursed and one can not last no matter how good they claim to be.

Do you believe in Curses? I don’t!!

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I am now Honorable Dr KK- Minister -Guess why!!

A few weeks ago I got a text message on a Saturday morning while in Johannesburg South Africa, that I had been elected minister of Health in Malawi and that the ceremony was going to be on the coming Monday and that if possible I needed to get back home .I was in transit on my way to India to attend the 66th annual conference for Eye specialists .The reaction to the message was with mixed feeling; firstly why did the big boss not communicate to me /or tip me before electing me; and that if this was true then what would happen to my community job as an eye specialist.
I looked at the reasons why possibly I could have been considered for the post and they looked to be many; I have worked in the ministry of Health and have over 12 years experience as doctor; am a specialist Dr ,and possibly I am rightly qualified. Factors against me being elected were that I am non political, non partisans and stick to my profession ethics and have difficulties in following beaucratic ministerial procedures. Overall I considered it was going to be a good opportunity for me to be a health minister; the six figure salary, the Mercedes Benz with the personal driver, the games played in parliament and overall the lack of seriousness in working (just following orders from above) –and of course I could do the job better than other people who have been there before and it would be a good break for me to leave my dirty work in the community with poor blind people. I thanked the one (whoever it was) who had suggested my name to him who appoints. Yes I was ready to cancel my flight and get back to Blantyre Malawi and this time on a business class ticket. Well after many years of hard work my life seemed to have been transformed overnight.
I needed to verify this information before cancelling the ticket so I had to call Malawi; obviously my wife being also non political and rarely listening to Malawi news may or may not have heard this good news so I decided to call my boss (who was now my subordinate and would call me sir/honourable) and his reaction was laughter. He said I had almost made it to the Cabinet, by magic and by logical deduction. You see two people were elected as ministers of Health; the real minister and his deputy. The chosen minister’s first name was Khumbo but his surname was not “Kalua”. And imagine the deputy minister’s surname was Kalua but his first name was not Khumbo. So during the cabinet announcement people heard names of Khumbo and Kalua under the ministry of Health and it was right to conclude that it was me (but do I deserve the post?). For a brief moment I enjoyed the status of being a minister and a politician but I remain a “popper” as of today. I wonder why the big man had to tease me that way. Please don’t call me honourable next time we meet. I continue serving people who suffer from eye diseases from the rural communities of Malawi.
What do you think?
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Good services in Malawi can be a model for neighbouring countries

Considering all these bad things that you hear about Malawi
Have you ever wondered whether there is anything good that comes from Malawi and spreads to the neighbouring countries?

When I received an email in June 2007 from an International Eye Organisation that my name had been suggested as one of the team members that would be useful in setting up a new Eye care programme in the rural part of Mozambique; a few thoughts came into my mind. Firstly I wondered whether the current eye service delivery in Malawi would be a model for Mozambique (in the context of so many things still not being efficient in the Malawi programme) and why my name was given and who gave it. If they wanted a neighbouring country ,Why did they not look for a consultant in South Africa where there is so much expertise, I wondered ? The only plausible explanation I had at that time for being chosen for the job was that this was not a very interesting and well paying assignment (imagine spending two weeks in rural Mozambique where the main language is Portuguese and not English).Anyway somebody had to do this job so I wrote back that I would be interested to go.
Arrangements were made to meet Mozambican counterparts in Nampura Province at the Provincial hospital. I did not know what to expect when I arrived in Nampura .A language translator had been organised to be part of the team. I had my digital camera to record all the adventures

Interestingly there was so much fun when I got there and there were not many obstacles as I had anticipated. I observed that Eye diseases do not respect the political boundaries and do not need a VISA to cross borders so every other eye condition that I have seen in Malawi was there in Nampura. Unfortunately Nampura did not have an effective eye programme in place so the problems were much worse there (lots and lots of blind people) . However their villages,districts ,and health services were so similar to Malawi that more than often I forgot I was miles away from Malawi. Getting to the famous Nacala City (where the port is and the Nacala corridor -which the Malawi defence forces had been defending for years ) I expected to see a lot of unusual things. But all I met were nice friendly people and some of their food was the same as we have in Malawi (Nsima). It was during the meeting that we had at the District administrators offices that it transpired to me that these people had heard of so much good eye work that was being done in Malawi and were wondering why the same thing couldn’t happen to them and were hoping I was the solution.
A report about how a programme could be started in the Nampura province was submitted to the NGO a few weeks later and fortunately most of our recommendations were taken seriously such that the programme has actually started.
Looking back ,it would have been a difficulty assignment if a consultant from a well developed country who is not used to working in the community could have been chosen.And somebody,somwhere knew that this assignment could better be tackled by eye workers in Malawi.
The little good things that are happening in the eye sector in Malawi are being watched by many; and in this competitive world it is a rare opportunity for Malawi to spray its wings to the neighbouring countries and become a role model.

The Joys of working in a community in Malawi

How you ever thought of how hard and impossible it is for a professional person to work in a rural area in Malawi where there is no internet?The truth is that it is not that difficulty .
We are all faced with a series of great opportunities brilliantly disguised as impossible situations.
Charles R. Swindoll

A recent NGO International advert looking for health workers to work in developing countries caught my eye. It started like this :”Heroes not wanted. If the main motivation for applying for this job is money ,then we are probably not looking for you. “ I should have applied for this job, but didn’t because my currently job has almost the same conditions.
Working in a community in Malawi can be very challenging but also very rewarding (not financially).The job satisfaction comes from the fact that you are able to help in situations where communities feel helpless; and by the end of the day you have much more satisfaction(even though your pockets are still empty) .Initially we all crave for money, but eventuality we realise that money is not the only thing that we need to think about. Afterall all this evil, robbery, corruption, political wrangles that we have in Malawi have very little to do with people wanting to serve our country; but rather to enrich themselves.
If you really want to serve or do something for Malawians think of doing something peacefully in the community where people appreciate your role and you appreciate theirs.
One interesting thing about the rural Malawi is that despite the many problems available(HIV/Aids,Hunger,e.t.c),people are usually smiling and happy .This is in great contrast to the west where people have all this money and credit cards, but everyone looks so gloomy when you are with them in the trains and buses. You can be sure that when you spend a whole day in the community in Malawi, your face is full of smiles.
Of most interesting to me is the children I found everywhere I go in the rural communities of Malawi ,actively running after my car and willingly asking to have their pictures taken (not this business of asking for consent to take a picture in the west and being embarrassingly refused).As a result I end up with lots and lots of Photos of children from all the districts in Malawi.
Lunch is also served with a lot of respect from the following resthouses ( Nsanje discovery lodge in Nsanje, Matechanga in Chikwawa, Mulanje view motel and Chididi in Mulanje, Jali in Zomba, Chinese restaurant in Mangochi, Kanthunkhako in Mzuzu) and many other places all over Malawi.After all having a full meal with a drink and a lot of respect for only USD 2,who can complain !!!!
I love working in the community in Malawi.

Blind Children have no one to speak for them in Malawi but they also need treatment

You often read or hear about certain people in Malawi who have a particular disease that needs treatment outside the country and that they need finances to seek medical treatment otherwise they will die.

Do you know that there are at least blind children 1000 blind children in Malawi who also need financial assistance to get to effective treatment within Malawi?

I have decided to post these pictures of blind children from Malawi to highlight the need that is there.

Unfortunately these children have no one to speak or write for them and are doomed to remain blind for life. I have failed them, you have failed them and our society has failed them by not speaking or doing something about them.

The commonest treatable cause of blindness in children in Malawi is cataract (ng’ala); which can occur as a result of many things such as a mother having an infection during pregnancy; or being inherited (genes) from parents.

Children are either born blind or develop the cataract earlier in their lives.

If these children are not operated within the first few years of life (before 10 years of age), their brain switches off the light stimulus and these children will never regain sight even if they are operated later in life.

Most parents who have children blind from cataract do not know that this condition can be treated; as a result they stay within their communities or present at the hospital when it is very late.
Operations can be done in Malawi; but the surgical supplies and other requirements needed are a bit expensive so there is limitation as to how many can be helped. On top of operation itself, children need glasses which are usually expensive. They also need to stay in hospital for a few weeks.

A child who is blind will most likely not end up in school; remain uneducated, poor and continue the circle of poverty.
Unfortunately there is no Voice to speak for these children; so they get neglected and life goes own in Malawi and elsewhere.

My conscious tells me I should write more about blind children and try to engage people to do more.
I have already started researching ways of how to get blind children with cataract early from their villages to hospital in Blantyre but I have not sorted out all the logistics yet.

You can help. Email me!
I will tell you how

Greed among Professional and Business Malawians

Partnership and collaboration are two of the most common words I have been hearing recently since I have been attending several meetings here in London and everywhere else.
But are these two words applicable to professional and business Malawians at the moment?
To me partnership involves two or more organisations/bodies/firms/businesses/institutions (you name it) who have a memorandum of understanding to work together (lawyers may know how to really define this) under one umbrella.
Collaboration on the other hand as described by my colleagues involves two or more separate entities willing to work together but each one still operating other their mother entity. For example a University in UK may collaborate with a University in Malawi to do joint research but each institution continues to have its own values and virtues.

Malawians do not want to go into partnership because of greed and luck of trust .Do you know how many lawyers are practising in Malawi? To have a rough idea ;just count the number of lawyers you know in Malawi and that will roughly give you the number of legal firms available for them. Each one has their own legal firm named by their difficulty surname( Kalua and associates , chekacheka legal firm ;e.t.c) and situated in an old debilitated building somewhere in Blantyre. Why cant these lawyers come together and form one good posh legal firm and share the profits. Its all not possible because of greed( according to a lawyer friend of mine operating his own legal practice in Zomba).

What about in Health (my field)?
Each Doctor practising n Malawi has their own clinic; and claim to be specialists in everything .Why cant they come together and form one good clinic ?Greed again.

I was in a vibrant private clinic a few years ago but left after we could not agree on the percentage of share holding by each stakeholder within the clinic. Its really sad that even at a higher professional level we still can not agree to be partners.

This is evident in all other areas in Malawi ( accounting firms, construction companies, estate agents, car dealers and many more).

A few people I have spoken to say they can not trust a fellow Malawian to be a partner as Malawians are usually greed and steal from our own business.As a result each one wants to do business on their own but this becomes very hard when you experience some emergency situation. Recently I saw a vibrant legal firm closed down after the owner died as there was no one to take care of business. This could not have happened if there was a business partner involved earlier own.

Partnership is mainly a problem among the indigenous Malawians; However Malawians of Indian origin usually have a partner (or at least family members fully involved in business);and no wonder they excel in all business in Malawi.

The world is changing and business in the future will mainly thrive because of partnership and collaborations. Evidence is already available in Malawi where the new Game and Shoprite stores have taken over all the business from the common Malawian.

In Health ;its worse .If you are refusing to collaborate no one will give you any money for research or service delivery.

Collaborating and partnership promotes accountability (which most Malawians do not want).

Next time you think of starting business, seriously think of partnership or collaboration.
What do you think?
Email me!.

Lions Eye Hospital Blantyre Malawi

This is where I work in Blantyre.The hospital is part of Queen Elizabeth Central Hospital and is also a teaching hospital for College of Medicine and other Health teaching institutions in Malawi