~ helping to create and develop sustainable healthcare for Malawi’s Children
FRIENDS OF SICK CHILDREN IN MALAWI (FOSCiM) is a UK registered charity, that for the past 24 years has been supporting a project based at The Queen Elizabeth Central Hospital, Blantyre, Malawi [‘QECH’]. That project is
creating and developing free and sustainable specialist healthcare for the children of the nation of Malawi
MALAWI– The Warm Heart of Africa - is one of the poorest countries in the world.
A better future for Malawi depends in part upon the health and wellbeing of the nation’s children. Half the population of Malawi is aged 18 years and under; in other words they are children. Life expectancy in Malawi is about an average 20 years lower than in the UK and many Malawians barely survive on less than the equivalent of £1 a day.
There is no primary healthcare in Malawi - i.e. no local General Practitioner surgeries, so hospitals and private clinics are the medical frontline. The public sector is severely resource constrained.
Sustainability is very important to us and in this context means that through education and training of Malawians to the highest standards possible and in their own nation, the service will develop into one that is led and managed by Malawians, reducing dependency upon Foreign Aid and resources.
Malawian paediatricians, Malawian paediatric nurses, Malawian clinical officers and related staff, most trained through and because of the project, will be the powerhouse of this healthcare service.
Exceptional commitment and drive by a small band of expatriate paediatricians, together with increasing donor generosity, have helped ensure the current level of positive progress.
Progress so far
Of all the children seen each year at QECH some 26,000 have to be admitted for specialist treatment.
We have 10 specialist children’s wards :
- Accident & Emergency unit (to be restructured and refurbished to meet the changing
demand and needs)
- High Dependency Unit (to come on stream Spring 2021
- Medical Bay for chronically ill and neurological problems
- Special Care for the very ill
- Malnutrition treatment
- Babies born outside hospital
- Neo-natal with high dependency facility
- Kangaroo Care for premature babies
· One Stop Centre for victims of abuse – children, girls and women
· Specialist outpatient clinics for HIV care, heart disease, neurological problems, sickle cell disease, TB, renal disease, diabetes, and general paediatrics
Staffing: (all Blanytre unless otherwise stated)
: Consultants - 15 Malawians (5 in Lilongwe)
- 5 expats
: Registrars - 12 Malawians
- 1 expat
: Clinical Officers - 21 qualified Malawians
: Students - 100 each year (5th year in Blantyre)
121 each year (3rd year in Lilongwe)
Inpatient child mortality has fallen to around 4%; 20 years ago it was about 20%.
Our biggest causes of death are now in neonates – prematurity and birth asphyxia.
We are working hard to improve neonatal care.
|Neo nates < 1month old||39||20||2.8||3.7|
|Infants < 1yrs||100||31||3.7||5.6|
|Child < 5yrs||173||42||4.3||6.5|
|Malawi child in-patient mortality||1 in 5||1 in 20||1 in 100|
(per 100,000 births)
|Life expectancy (years of age)||45||64||81||78.5|
It is very pleasing to see the trend of the numbers in Malawi but with still a long way to go and still many challenges ahead.
Data sources include - World Health Organisation; UN Inter-Agency Group; World Bank
With so much still to do and to achieve, it is essential for us to welcome new donors to join our loyal existing donors as we all strive to not only improve the lives of so many young Malawians but literally to give life to so many of them who otherwise would be lost to the nation and the world.
The care workload is seasonal. The hot rainy months of December to April or May bring such illnesses as malaria, typhoid, cholera, gastro enteritis and malnutrition - all against a backdrop of HIV/AIDS and stunted growth.
The mothers or grannies stay on the wards with their children and do much of the basic care. Little ones may need their mothers for breast milk.
The health services can often be overwhelmed by demand.
Human resources can prove scarce and without nurses or nurse auxiliaries and clinicians in the past it has not always been possible to provide effective care. Frequently, drugs have been in short supply and equipment and other resources unavailable or unaffordable.
Until Covid-19 donor funding meant that we were able to employ, alongside the government paid staff, retired nurses who had already served the government for 20 to 25 years. These nurses brought experience and commitment to their work. Unlike the government paid staff they were not moved from one unit to another every year. Covid-19 exposed this cadre of ‘mature’ nurses as very vulnerable and to protect them we very sadly had to say farewell to them. At the same time, the Government took steps to increase human resourcing in the face of the pandemic so separate staffing will not now be part of a FOSC strategy.
Three of the main areas of focus for the charity have to be:
1. Building a sustainable future
Training and development of Malawian healthcare professionals, nurses, clinical officers and post-grads has to be a focus and there are a number of funding support needs here.
2. Improving infrastructure
The Children’s A&E urgently needs a revamp and a redesign.
Overall, the infrastructure throughout the various PAEDS departments, wards and facilities need upgrading thus enabling better specialist services and improving healthcare delivery.
For example, all areas need better access to scanning/ultra sound equipment.
The access routes between some wards and facilities need improvement. This involves overhead cover in some cases, and floor surfaces and corridors around many others.
3. Drugs and Equipment and Medical Consumables
On-going needs in this area can be found in the NEEDS section.
There will also be specific needs for equipment and fittings when new facilities such as the new HDU come forward. The A&E project will give rise to similar needs.
FOSCiM raises some of the funds needed to train, develop, and retain doctors, nurses, clinical officers and related staff in Paediatrics, and to pay for some of the much needed equipment, consumables and other resources.
FOSCiM is dedicated to raising the funds necessary to support the essential work at the QECH and its expansion into Lilongwe and the rest of Malawi.
FOSCiM is a big sponsor of the hospital Orthopaedic Workshop making wheelchairs and other devices to mobilise Malawi children with severe mobility issues. 1,000 wheelchairs have been made and delivered so far and the workshop extended to meet the increased demand.