In April/May 2004 I undertook an elective placement in Malawi, as part of my physiotherapy degree course; to gain varied experience and provide wider support to therapy services already available in the city of Blantyre, the placement involved working at three different centres in sequence. My work was with babies, through to elderly patients and as varied as respiratory care in an intensive care unit and district visits, to neurological rehabilitation.
Many challenges face you as a physiotherapist working in a third world country, in the most part you are not able to simply conform to traditional rules and treatments which apply in the U.K., which is where I trained. You have to adapt to a different culture, conditions, provisions, expectations and needs.
Initially the lack of privacy, provisions and handling and safety rules was obvious. However it was apparent that whatever short falls were presented in this manner, the attitudes, determination, comradeship, acceptance, gratitude and faith of patients and staff, were a striking contrast and a very positive aspect, which helped overcome these short falls. This notion seemed evident not only within the health care field but also in the culture and country of Malawi itself. I felt and experienced this on many occasions and it will be something I will always remember from my work there.
I will relate this to one specific patient, highlighting such aspects. This patient had paralysis of all four limbs with an undiagnosed condition, at stalemate situation in his treatments where progress was at a standstill. This patient had throughout his life been very active and was finding it very hard now being unable to do anything for himself. However throughout the entire period I was in Malawi this patient and his family, especially his wife who was his guardian and carer at the hospital (as all patients in Malawian hospitals have a guardian who stays with them) always remained as positive as possible. I found this remarkable given the situations they were faced with.
They had no real answers as to the cause or progression of the illness and were only able to see a doctor twice a week. They had to decide whether to sacrifice money saved for their childrens' education for medical tests. Once they had finally decided to go ahead with medical tests, they were then unable to do so, as the specific tests they needed could only be carried out on one certain machine at the Queen Elizabeth central hospital and this was currently broken. No intention or money provision by the government to fix it in the future existed. After several weeks, they were then told they could go to South Africa to undergo such tests and possible treatment, which they would have to pay for themselves. However this required permission and documents from the governments health department.
Several weeks later when I was leaving Malawi, they were still waiting for any action to be taken, and it is highly possible that this time delay could be allowing the illness/condition to progress further causing more potential and lasting damage. The delay was due to the soon to be held elections, meaning government officials were too busy to attend to this matter. The irony then being that at the time of elections, this patient and his family were at the hospital, many miles from their home town, and were therefore not eligible to vote. I would go and visit this patient and his family daily and they were constantly thankful for the care they were receiving and praised the health workers, such as myself, for everything we helped them with. They freely expressed their faith in God, that they would be well looked after and were grateful for those around them and each other, finding strength and courage through this. This aspect of faith and the passion this invokes, I also experienced through the staff at the hospitals, whether it was through conversations, or in a church service. I believe this to be a very important aspect of life in a country such as Malawi and also in health care in such a country, where hardship, poverty and death, is such a part of life. One service, which highlighted that no matter who you are, or how small a role you play in someone's life, you are valued and can always make a difference, summed up my experiences in Malawi. I saw that with this belief everyone worked hard to contribute to the grander scheme of the hospitals and care within the hospitals. More importantly however I think that such beliefs provide a true feeling of community and kinship that existed, from individual wards to entire hospitals, and this was also evident in Malawian society as a whole.
Malawi is a beautiful country with beautiful people that in the face of adversity always endeavour to make the most of life and I felt very honoured and privileged to be able to contribute in their hospitals and to experience life with these people. It is the most rewarding and humbling work I have done as a physiotherapy student and I feel I did not only learn to look at therapy work from a different view point, I also learnt to look at life from a different view point.
