I spent my 10 week elective period at Nkhoma hospital, the heart of a small mission community in South West Malawi, 60km from the capital Lilongwe. The hospital has a bed capacity of around 230 (although often cares for many more patients!) – male and female medical wards, a children's ward, labour and antenatal/postnatal wards, two operating theatres, a surgical ward and a separate well-equipped and busy eye hospital. At the time of visiting, Nkhoma was staffed by four expatriate missionary doctors (of whom two are permanent), with a number of Malawian clinical officers, laboratory technicians, nurses and nursing students (training at the on-site nursing school).
Most elective students stay at Nkhoma's guesthouse a few minutes walk from the hospital; which is a great opportunity to get to know others working in the community; in the hospital, school or in other ministry teams. In terms of church life, the hospital staff meet each day in the chapel at 7:30am, and there are Sunday services in both English and Chichewa (the local language) in the village church. I was also privileged to be able to attend a weekly women's Bible study with several of the other Malawian and expat women in the village.
Life in the hospital
Like many others in sub-Saharan Africa, Malawi is one of the least developed and most densely populated countries of the world, with its healthcare systems in a desperate crisis.
Life expectancy is 53.1, under-5 mortality at 100 per 1000 live births in 2008, and prevalence of HIV is approximately 11%. At times it can be a devastating to witness these figures in reality on the wards, but the hospital does a fantastic job of serving the local community despite all the challenges of work in a resource-poor setting.
The pathology was very broad, with both tropical and 'Western' diseases, from heart failure and poorly controlled epilepsy to schistosomiasis, TB (with a whole spectrum of different organs involved), nephrotic syndrome and advanced malignancies. I spent much of my time on the male and female medical wards, although there was also opportunity for involvement in both elective and emergency surgery, as well as in outpatient clinics working in conjunction with a translator.
I also spent time on Nkhoma's maternity unit – which was an invaluable experience. The unit was well run with a great team of nursing staff, with ample opportunity to develop clinical skills with supervision. We were involved in neonatal resuscitation, conducting deliveries, vaginal examinations in labour, and also learnt to suture episiotomies and tears, assist at Caesarean sections as well as be involved in basic neonatal care. Mothers often arrive in labour having had no or little antenatal care – and the unexpected delivery of twins was a frequent event, and always interesting to be involved in!
My time on children's ward was some of the hardest of the elective; the mortality rates of 3-6% meant that death of a child or baby was a near daily occurrence, and that work here could be both emotionally and physically demanding. However, it was also extremely rewarding, and some of my fondest memories of my elective were formed whilst working in paediatrics.
The children's ward houses between 70-120 children and admits around 30 patients per day, with just 3-4 nurses looking after the ward at any one time. Despite a considerable amount of chaos, it was an incredibly efficient centre for malaria treatment – as well as caring for all range of other problems, including children staying long-term with severe burns or malnutrition.
In summary, I would definitely recommend Nkhoma to others as an elective placement; I learnt huge amounts from a medical, personal and spiritual perspective, and had the opportunity to meet some very inspirational people. However, it is worth being prepared for the potential for long days with a greater degree of independence than back in the UK, as well as being aware in advance of the high mortality rates and challenges that this poses.
