Saturday, 23 January 2010


I know it’s been a long time since I last wrote to you all. Gone are the days of writing every week. What has happened? Why is it I can’t find the time to sit down and write to you of my joys and my concerns, my smiles and my frustrations, all that goes along with living and working with the people of Malawi? Things have changed for us over these past two years as we have settled down to making friends, getting a home together, attending school, weekends away at the lake and all that makes up a busy life here in Lilongwe. Sometimes I yearn for the simple way I viewed things and approached situations when we first arrived. Without the inside knowledge, that I have now, the deeper understanding of the situation here in Malawi, the role of the aid organizations and government bodies, the immense poverty and oppression of these lovely people, it was all so much easier. But the very nature of learning and understanding brings with it the realization of one’s smallness, the stark reality that however much I do, however much I give, it will never be enough. It brings feelings of deception, of use and abuse, of sadness and sometimes of hopelessness. These people deserve more, they deserve what I expect for myself but it is not possible and finding my way to live with that is sometimes so difficult. Mostly they have few expectations and demand little. My expectations for them are much more, are much greater than theirs, which means that I am daily coping with conflict and confusion within myself that leads me to sometimes setting unreachable goals and unattainable targets. Maybe that is why I don’t find time to write? Does that all sound rather negative? Maybe sometimes I do feel like that but certainly not always. I have always felt that I was clearly led to Malawi, to Bwaila, to the work I am doing and as my role and responsibilities have developed I have been challenged and excited to continue. I was prepared and happy to give at least another 2 years to help develop the potential and possibilities given by the new maternity unit. However, since I returned from Christmas in Europe I have not only had to face the continued daily challenges, frustrations, traumas, sadness and sheer hard work of Bwaila but have been having a difficult time sorting out my contract and funding. I had thought that I was assured a further 2 years funding but it seems I was mistaken. So as I write nothing is sure, nothing is certain except my inner conviction that I should be here, that I still have much to offer and I will not give up.
‘Ever tried. Ever failed. No matter. Try again. Fail again. Fail better’
As has happened in the past I had left instructions and had been given promises that outstanding works and deliveries would be completed whilst I was away. I don’t know why I was surprised to find on my return that very little progress had been made. There are still some items that havn’t been delivered and poor workmanship in the building and installations that needs to be followed up. Unfortunately the DHO who are now responsible for the new unit have very little government funding for administration and maintenance. The new unit is at least 4 times bigger than the old needing 4 times the maintenance. There is much more equipment meaning many more machines that can breakdown or go wrong. The fact is that they were unable to cover these areas in the old unit (much smaller and much less) so it is not surprising to find that the new unit is proving to be a huge challenge.
I will continue to hunt for funding to assist with the maintenance issues. Since returning I have worked on completing a list of outstanding repairs and damages and poor installations. I was horrified, but not surprised, on inspection to find many areas in need of important repair work only 3 months after moving in. The constructors will cover most, but not all, of these things during the first year but after that....what?
We had been waiting, since the opening, for the delivery of 7 new neonatal resuscitaires for the labour ward, theatre and nursery. The delivery had been finally promised for 18th December. They had not arrived when I returned in January. One of my first tasks was to check up on these. Can you imagine my joy when I finally unpacked and installed these last week? I felt as if someone was bringing me a personal Christmas present! The brand new photocopier was still sitting in the office, not yet unpacked. After 2 e-mails and 2 phone calls the Minolta agents for Malawi arrived informed me of the missing items and the cost of installation and left to await my call. The DHO are now responsible for this but as usual funds are not available. Fortunately I still have some money that I have been given by kind donors and will get it set up and working next week. The new anaesthetic machines are causing problems. Having been supplied from Germany it is not altogether straight forward when needing to find replacement parts. The old machine is still in use, it has half the possibilities but it’s familiar and comfortable to use! 2 of the 6 suction machines were not working. The Autoclaves for sterilizing instruments, installed just before I left, are functioning sporadically. Fortunately the representative for the suppliers ( a Brit.) once informed, does his very best to solve the problems. Unfortunately the general habit is to leave the non functioning items in a corner collecting dust and continue either with the old or make do without.
The on-going in-service training that I have been leading for the past 2 years was stopped just before I left to be taken up immediately on my return. This forms an extremely important part of life at Bwaila. It has become, over time, not only an important time for building practical and theoretical knowledge and training in life saving skills, but also for team building, motivation and moral boosting and generally keeping the staff together. Helping to maintain a team spirit is a huge challenge, hence the importance of these regular meetings, discussions and teaching sessions. Unfortunately there has been some mix up with the funding from UNICEF due to a duplication of projects. This has meant that the sessions have not yet been commenced. The staff enquire daily as to when we will start again. They too realize its importance. As I have commented before it is difficult to get people to attend any sort of training or meeting without receiving an allowance. This has become an integral part of Malawi life in all sectors. Invented by some NGO at some time to ensure good attendance it has become the nightmare of any person who is trying to encourage personal and professional growth without the need of economic reward. Last Thursday I was absolutely thrilled to lead a meeting of our Team Leaders/charge nurses without any allowances. I could not have done this without the help of the matrons who encouraged the midwives to attend. I did but them all a Fanta or Cocacola though which was greatly appreciated. This was a huge step forward and made me feel very good. These are the small things that continue to occur daily which give me the courage and strength to carry on.
I am trying to get back onto Labour Ward full time or as much as possible without completely dropping the other areas of higher management, administration and other responsibilities that have become part of my work and to which I am looked for to support the management team. I do just love being with the women and babies and being there this week reminded me of that. I hope you will be getting a few more stories from there in my next blog.
Until such time I will end by telling you that Lucas has settled back happily into school and social life. He is now in the junior squad swimming team and the junior football team. Time flies by, the rainy season is well underway and the maize is growing in the fields. Some areas of Malawi are not so fortunate and already having problems with their crops. This time of year is always a difficult time for the most poor as last year’s maize is running short and the harvest will not be for several weeks. The prices rise and many people in the villages become hungry. I am still supporting 2 lots of twins and the triplets who come to visit me regularly at the hospital. Pilirani’s twins will be 2 years old on 14th February I will drive out to the village to visit them and take some gifts.
I cannot end without telling you that on Friday we were presented with details of the Bwaila maternal deaths for the month of November 2009. I knew already that the numbers had been high. When auditing the case histories it became clear that the majority were young, had chronic anaemia, arrived very late at the hospital for assistance, had suffered severe haemorrhage, blood was not available and if so not enough to save their lives. These women had died in childbirth due to POVERTY. In 2010 this is a harrowing thought, with all the money and aid that is being poured into the developing countries this is still a reality.
I hope this blog has not been too negative. I find it thoroughly therapeutic to write down my thoughts and feelings. Those of you who know me well also know I am strong and determined. When I compare myself to my Malawian Mums I am very fortunate. Think of me often......for me I ask no more......but for them?
PS. Christmas with our family and friends was just wonderful. Just thinking of them and their love and support makes me feel good. My children are just such a joy to me. From Alasdair’s exams in his final year of Veterinary Studies, Fiona’s rollercoaster life and love and trying on wedding dresses and planning weddings with Katy who will be married next winter, I am kept busy and entertained with much to think and worry about as a mum. My Mum who shows no sign of her age or giving up on her hectic life (guess I must get it from somewhere!) continues to worry about me as if I was a teenager. I am looking forward to seeing her plans in the Spring if her plans work out. It will be a big challenge for her but I know that being able to see for herself the life and needs of the people she has been supporting for most of her life will be a real thrill for her. Not to mention visiting me and Bwaila.