Dinner and dance in honour of Prof Robin Broadhead

Well you may wonder who Professor Robin Broadhead is in Malawi or at the University of Malawi,but ask any Malawian doctor and he will tell you everything about this man who has moved medicine well beyond where everyone else would have imagined it to be in Malawi within the last few years. To me this pediatrician he is a teacher, a mentor, a colleague, a friend and all you can say .To others he is the Principal of College of Medicine ,former head of paediatrics department at medical college ,blaah , blaah ,blaah!!!.
Well we will be having a dinner and dance in honour of him at Ryalls hotel in Blantyre on the 9th of October because I am told this has been his last term of office as a College Principal .I look forward to dining with him.
If you want to know what he has been able to achieve for college of medicine , visit the website at College of Medicine and you will see how far the college has moved.
I hope during the dinner we will have a moment to reflect on the life of Dr George Kafulafula ,his vice Principal who passed away at a very early stage only a few weeks ago .Dr Kafulula ,a young Malawian Obstetrics and Gynecologist had made a great contribution to the college together with Proffessor Robin Broadhead. If I was a good writer ,I would have written lots about these two and the College of medicine.But I am handicapped and tongue tied ,I don’t even know where to start to mention many of their success stories !!!!
For now ,I can only wish Broadhead a good retirement as the Principal of college of Medicine .
He will be missed by many.
Have you heard about Prof Robin Broadhead and his achievements in Malawi ? do you want to comment?
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Primary Health workers: Is Quantity better than Quality in Malawi?

Am no politician, but Health is politics, and if you are interested in health issues in Malawi then follow discussions and debate below.
How often do researchers aim to publish findings from our findings from studies in Malawi in top journals /magazines like the “New York times” ,“British Medical journal” ,"The economists” and many others ? Well not many Malawians have access to such papers and may not even read about issues affecting them.
This is why I am publishing our preliminary research results on this blog, hoping that a few people interested in Malawi will read the whole article.

I am trying to design methods/ways of how primary health care workers can be used to find blind and visual impaired children in the villages early and bring them to our hospital for surgical intervention .Health surveillance assistants (HSA) are the lowest cadre of health workers in Malawi and most of their work involves working in a community surrounding a Health Centre .In 2007 there were about 6,000 HSA’s in the whole country (1 per 2,000 population).Within the last 3 months the Ministry of Health through a grant from Global Fight for TB , HIV, and Malaria have almost doubled the number of HSA by employing another ?6000 (no one knows exactly how many more but this number is supposed to have been achieved) on a temporary basis.

Is it a matter of increasing the numbers or improving the quality of performance of the existing ones? To answer this question lets discuss what HSA’s do in the health system in Malawi?

HSA’s are the first level of contact with the patients in the community and they are supposed to give health promotion (HSA were first recruited in Malawi for Cholera prevention programmes), but unfortunately currently they do a lot; give immunisations to children, treat fever in children, treat pneumonia, malaria, supervise patients on TB and ARV, give support to home based care, implement NGO’s programmes and many other duties. Talks about them whether being qualified to give ARV’s have been debated with no consensus reached.
HSA’s only undergo a 3 month short training medical course and currently they need to have a certificate (MSCE/JCE) to be accepted for the course. After graduation they become experts on every disease in the community and are supposed to offer primary health care (first level care) and then refer difficulty cases.

Well my Research Team last month (January) conducted Focus Group discussions (FGD) in 3 districts in Southern Malawi interviewing 30 HSA’s on what they know and do about eye diseases .We started in Mulanje (Chisitu and Chonde health centres), and then went to Mangochi (Chilipa and Nkope and Namwera Health centre, 40mKm from Mangochi Boma,), and finished in Chirazulu (Monfort /Nguludi Health Centres).

What did we find?
Almost half of the HSA’s at health centres were new having been employed with the last 3 months. They had not attended any form of training and they did not know when they would go for the 3 months course. Most of the old HSA’s had been trained, however surprisingly some of the HSA had not been formally trained 2 years after they started they job (work was all learned on the job).
Concerning Eye care both the old and the new HSA did not know the causes of eye diseases and how to treat or prevent them .The trained ones indicated that the 3 months course did not cover any eye diseases. There was no difference in the level of knowledge of eye diseases between the trained and untrained ones .Asked what they do when they see eye patients in the community, most of them just gave any eye drops available.
More than 50% of HSA’s believed that traditional herbal medicine can be used to treat eye conditions, and reported knowing either a relative or themselves using herbal medicine .The herbs used mainly in form of powder or eye drops included pepper leaves, green tomato leaves, fresh urine from patient and mothers expressed breast milk. Two HSA had personally used these herbs for treating their own eyes.

All HSA’s admitted to seriously needing some form of training in primary eye care and plans are underway to train some of them hopefully starting by June.

We did not deeply access the HSA’s knowledge and performance on other diseases.

Conclusion
The numbers of HSA has indeed drastically increased in Malawi but their quality of performance in eyes diseases is very poor.
Massive training and evaluation programmes are needed to assess future impact of HSA on eye diseases and further research is needed to assess their knowledge and performance in other diseases.

Research funds provided by International Centre for Eye Health London

What do you say?
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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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Staff parties

Christmas is here; and it’s is a common tendency for management to organize parties for their staff. Apart from the celebrations and drinking that are associated with such parties, it is a good time for the senior management to know their staff.After all how often do you see nurses and the other health workers dressed in their normal causal clothing?They are mostly dressed in uniform and parties give a chance to see staff in other clothing styles.If a good party is organized; usually staff will loose their inhibitions after a few drinks and start talking about how good or bad the bosses or line managers are. And if you are a manager this can be a good opportunity for you to listen to how juniors view you in your leadership role. It was interesting for me to have over-heard staff at one party saying that juniors were afraid of coming to my office because I was always seen as being more serious and they preferred seeing the top boss himself (my boss) because he had a relaxed attitude.
Now that more parties are here again, I am looking forward to observe the new dancing steps. But I will make sure that other staff are covering the work that needs to be done while the rest are partying; otherwise patients will complain that they are being neglected.And I know I will be blamed again by junior staff for forcing them to work during party time;and ofcourse that's something I have to leave with.
Unfortunately there isnt a 13th Cheque for the staff.
I am looking forward to enjoying the next party at the eye Department of Queen Elizabeth Central Hospital in Blantyre ,Malawi and I am sure I am not the only one.

A rare encounter with the Donor

When the personal assistant to my Director asked me if I would be interested to go out for an organised event in London on Thursday night where someone from UK was going to talk about experiences concerning their visit to some blindness prevention programme in Africa, I said well, why not? after all I am in the blindness prevention field and this is what I do most times in Malawi and now that I am about to go back to Malawi soon to spend my Christmas in the village (Mzimba, Mtwalo, Ezondweni) this is an opportunity to see another building in London. Unfortunately I did not bother to ask more details of what was required and who would be there. I just got the address of the venue (Haberdashers hall, London) and said I will be there.
After being lost a few times in the streets of London, I finally got there late and in casual wear (sweater) only to notice that everyone is dressed formally and that this is indeed a very formal event.
The receptionist at the Hall asked for my name and gave me my name tag and said " puts this on your sweater and I will take you upstairs where the guest of honour is so that you can meet him". I say to myself o god! Why didn’t I ask for the dressing code?
To cut the story short I finally had a rare chance of meeting the top most senior staff, trustees and donors (individuals who support) of Sight Savers International, a UK based NGO that has been dedicated to fighting blindness all over the world for more than 50 years. Their current work stretches in over 30 countries throughout Asia, African and the Caribbean. Of most important to me is that Sight Savers International (SSI) began work in Malawi in the early 1960s and today supports programmes which cover the whole country. All the good eye work that I have been writing about in Malawi is to some extent supported by SSI. For an Organization of such a big magnitude and with its World Headquarters based in the UK, the probability of one local doctor meeting such top management is very small. But I was privileged to have met all of them.
In the first picture I am with “Lady Jean Wilson” in the middle and a colleague from Nigeria. Not only is she the Vice President of Sight savers International; but also Sight Savers International was founded by her late husband Sir John Wilson almost 50 years ago. I will have to write a whole blog about this amazing lady later.
In the second picture to my left is “Lord Nigel Crisp” (wearing a red/black tie) and to my right is a strong financial supporter of SSI (proceedings from his company go to SSI).
All the doctors and other health workers who have migrated from Malawi to UK should know who
Lord Nigel Crisp is ; previously known as Sir Nigel Crisp ;unless they have not heard of NHS (National Health Service ) where he has been the Chief executive for years. He is the chairman of board of trustees of Sight savers international. He knows so much about the Health issues in Malawi that I will have to write about him later.
Lastly I am with Dr Caroline Harper, the Chief executive of SSI .And I also met other many more senior SSI staff and talked lots and lots about the support they give us in Malawi. Honestly this was a rare meeting with the donor themselves; rather the supporting partners-as they prefer to be called.
I have posted two pictures indicating SSI assistance-among the many resources that SSI gives to Malawi to support Eye care.
And yes this was a good outing.
What do you think?
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The students we teach: Leaders of tomorrow

I have been a clinical ophthalmic lecturer for the last five years, and have seen several students pass through my classes; some very keen, hard working and others very lazy- just aiming for the paper/qualification. Of most interesting apart from student doctors and post graduate students at the College of medicine in Blantyre, Malawi; are the diploma ophthalmic students from all over Africa who come for one year training at the SADC Ophthalmic training school in Lilongwe, Malawi.
I keep on wondering what happens to them after they graduate and return back to their home countries. Are they successful in their career? Do they get promoted in their jobs?
During my trips/visits to neighboring counties I have met in Uganda, Kenya, Mozambique past students who trained in Malawi during the last five years.
And recently I met one of my past students in London at the London school of Hygiene and Tropical medicine who used a diploma qualification obtained from Malawi to gain entry for a degree programme .I was very proud of myself as this bright colleague( Yes he was no longer my student) was telling everybody that I taught him.
I am sure there are many other graduates out there who say good things about what I contributed to their life; but I am also very thankful to the many teachers out there that taught me to be a doctor. Then I did not understand what it was meant by saying that “students of today are the future teachers of tomorrow”.
Till then the journey of knowledge transfer continues. These pictures of the students I have taught are an obvious testimony.

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?
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We were in Chirazulu

These two with me are student doctors from canada;they spent 7 weeks with me in Blantyre in august.I took them to Chirazulu and Mulanje where we had so many eye patients.
Thank god everything went well.We treat;God Heals

Finaly we went back to Blantyre and had a drink with Richard at peoples shopping centre.
But the many we left there in the districts have never been to Blantyre to see the Ng'anga who can be found at
dokotala.blog.co.uk