Care in the Community

I am spending a few days in Ekwendeni - the main mission station of the Presbyterian Church in Malawi. The station contains all aspects of mission - within the compound can be found a theological college, a nursing school, schools for the blind and for girls needing secondary schooling, a whole variety of youth work and community based work, and a general hospital.

Yesterday I had the introductory tour of the complex, meeting people involved in many areas of the work. They do very well as they try to serve their community, but the contrast between what we have and what they can provide is stark. However, some of the statistics are encouraging - especially in the area of AIDS. The proportion of those testing positive for HIV has dropped dramatically in the younger generations, and survival rates have risen for those who have been infected. Two statistics point out the progress that has been made. Maternal transmission to new born babies has dropped from 95% to 5%, thanks largely to compulsory testing of pregnant mothers and the corresponding ability to take preventative measures during birth and breast feeding. And in some areas nutritional programmes linked to the provision of anti-retroviral drugs have reduced the death rates for maternal infected children from about one a day to about one a year in those areas.

If yesterday was about listening to the theory, today was about seeing the practice - I went out with a community health team. These teams work with pregnant women and young families, providing anti-natal care and general health checks for children under five.The team leaves the hospital as soon as they can; which all to often is quite late because there are not enough vehicles in a roadworthy state, and everyone has to wait their turn.

The team drive to the clinic - a bare hut in one of the local communities; where the mothers and mothers to be are waiting in whatever shade they can find. The programme begins with encouragement and information - including a song about family planning, sung with a true African beat and encouraging the women to make sure they space their pregnancies to ensure each child has a chance to grow well in its earliest years. There are then talks on breast feeding and nutrition, general health and HIV, and the need to use mosquito nets for the babies. As it happens, in this clinic, there were also free nets for each child, which were to be distributed at the end of the clinic.

After the songs and the talking came the clinic itself. There were anti-natal check-ups and injections for mums to be; weighing, measuring and injections for babies and young children; and family planning advice and AIDS testing for the new mums (pregnant women would have been tested at the hospital when they first knew they were pregnant). Any problem that are discovered at the clinics, including malnutrition, are referred to the hospital for further treatment - and one of the vehicles took one woman back to the hospital with her child when we left the clinic to go home.

Of course, this time there was the distribution of the children's mosquito nets, but soon we were on our way back to the hospital, where the kitchen had laid on a meal for the staff (and helpers) - chicken, rice, cabbage.

Tomorrow I am back to Ekwendeni to go back to college, starting with morning prayers. More of that later.