An Open Letter to the Shira Community from Dr. Naor Bar-Zeev and Sarah Lodge Bar-Zeev:
We arrived in Malawi in January 2011.
Naor works as a paediatrician in infectious diseases at Queen Elizabeth Central Hospital, and as an epidemiologist coordinating large research projects relating to the introduction of 2 new vaccines, one against the bacteria that causes pneumonia and blood and brain infection, and the other against the virus that causes severe diarrhoea. These two organisms are responsible for more deaths in children under 5 than malaria, HIV and all other causes combined.
Sarah works as a midwife at the hospital, and is coordinating the implementation of sustainable evidence based interventions that are known to reduce maternal death and disease at health centres throughout the country for the Ministry of Health. Malawi has among the highest maternal mortality rates in the world.
The Queen Elizabeth Central Hospital serves a population of about 1 million people in the southern region of Malawi. Malawi is among the poorest countries in Africa.
The Department of paediatrics sees about 90,000 children a year, of whom about a third are admitted to hospital (last year over 31,500 admissions). On an average day there are 350 children (squeezed into 280 physical beds), and in the rainy season when malaria and diarrhoea are high, there are 450 children a day. (For comparison the new Royal Children’s Hospital in Melbourne has a maximum capacity of 357 beds.)
There is a team of 8 consultant paediatricians (3 foreign including Naor, and 5 Malawian), 5 paediatric junior trainees. There are very few government funded nurses. It is only through charitable donations that the paediatric department employs 15 nurses, 2 clinical officers (who work like junior doctors do in Australia), 5 homecraft workers and 8 cleaners. All of them are pensioned and remunerated fairly.
This equates to a nurse to patient ratio of 30. (In Australia the nursing industry standard is 1 to 4.) Due to extensive efforts at improving hospital care for children, the in-hospital mortality for children has declined from over 20% some 10 years ago to now 2.5%. Very high mortality rates are still seen among premature or sick newborns, and among children with severe malnutrition and those with HIV infection.
Improving child health and reducing mortality is complex, since the fundamental underlying causes of poor health are economic and political, as well as more directly biological.
They relate to literacy and female empowerment as much as they do to food security and availability of preventive interventions such as vaccination.
Malawi has engineered improvements in food security and seen improvements in literacy in recent years. It has been very proactive in introducing vaccines that have been in use in wealthy countries for many years but were unaffordable in most other countries. Hospital care for children is improving also.
But a major gap remains in availability of health staff.
With my own eyes and almost on a daily basis I see children die who would have survived if they had closer nursing care. Supporting a nurse not only provides better care for children, but also gives that nurse employment and helps her to support and educate her own family.
Shira Hadasha in Melbourne is collecting money for this purpose. All money collected is transferred into a foreign currency account of the Queen Elizabeth Paediatric Department held in Malawi. It will be used to provide employment for a nurse for the children’s wards. There are no overheads or other losses apart from bank fees for the funds transfer. All monies will pay salary, superannuation and other on-costs (eg medical insurance) for the nurse. The money in this account is regularly externally audited.
To donate to this important project please visit shira.org.au/malawi-hospital-drive
(All photos taken with permission of the parents/guardian for the purpose of disseminating information about the department for fund raising. Photos taken by Dr Sarita Depani and Dr Andrew Selman.)