Our long-term electrician, Mr.
Mkandawire, is dying. I have just come from the rotating vigil
of staff and family. We know he will be going to a better place,
but we also know the pain his wife and many children will have
to pass through.
The goodbyes continue. A couple of key staff members and good
friends of mine who have been recruited to projects in the city
and are deciding whether to leave the frustrations at the hospital—poor
housing, poor wages, chronic overwork, and isolation. The vast
majority of trained nurses, nurse-midwives, medical assistants,
clinical officers, and doctors choose to leave. Eighty-five percent
of Malawians live in the countryside, but they are served by only
about 15 percent of the trained personnel within the country.
Every crisis spawns a host of new projects and non-governmental
organizations. Famine. AIDS. Orphans. The new organizations recruit
from the hospital and health centre staffs that have less than
half the trained personnel the government says they should have.
These healthcare workers take jobs they are overqualified for
but pay five to ten times what they were making. They move to
towns where indoor plumbing and other services are more available
and reliable. At the same time, they almost always say goodbye
to working nights, weekends, and holidays. Once they have left
the hospitals and health centres they rarely return. It is extremely
difficult to return to the heavy workload and to regain competence
in skills and knowledge that have not been used for a few years.
Because of this, even when projects end some qualified health
workers are unemployed. Others chang fields.
It is heartbreaking to witness the poor suffering more because
of the projects meant to benefit them. The Malawi Medical
Journal published a study showing the maternal mortality
rate in Malawi doubled from 1992 to 2002, and we now are the country
with the third worst rate in the world. The factors included lack
of trained personnel with more poorly managed cases. Of course,
if this is publicized widely, it will be followed by well-funded
projects to address this situation and they too will recruit away
the small number of nurse-midwives, clinical officers, and doctors
who presently still care for the pregnant women at the health
centres and hospitals of Malawi. |
