Quiet day today. Several people are off for Malawi's Independence Day celebration. Mrs. Kamanga and Matron Catherine Mzembe spent much of the morning opening and sorting cartons of donations from overseas. One box contained sterile surgical gloves, which was cause for some celebration until Catherine saw that they had expired in 2006 (see photo above).
A shadow quickly crossed her face. They will be able to use them as examination gloves but certainly not as surgical gloves. There isn't one expiration date for the U.K. and another for Malawi, she said in exasperation. Why would anyone send something that they would not use themselves?
Good news this afternoon. The baby with "congenital herpes" actually has chicken pox. Already she is doing much better and probably will be discharged soon.
A happy ending but it brings up a more disturbing issue: in trying to help, the volunteers from Massachusetts actually made things worse—bringing a child with a highly contagious infection into a hospital where many people have very weak immune systems.
After talking with Joyce and some of the other community health nurses here, I have learned something else about mobile clinics in rural Malawi. They work best for doing preventive care: checking expectant mothers to see how their pregnancy is developing, screening for high blood pressure, vaccinating children, educating the wider community about the need to refer someone with a chronic cough to the hospital—that sort of thing.
If you structure your mobile clinic to deliver what is known as acute care—treating someone with an infection, for example—you actually end up making things worse. (And the Embangweni staff should know—they tried giving acute care during mobile clinics before.) Antibiotics that are given out will be shared among family and friends—leading to drug resistance. Plus you are conditioning people to wait for the mobile if they have a major problem—like a headache that hasn't gone away for three days—instead of going to a health center or hospital right away.
Prevention and acute care have to work hand in hand. What's the point of screening pregnant women in the community, for example, if you don't have a hospital to send them to deal whenever you identify a problem? And similarly, what's the point of curing hundreds of children of malaria or diarrhea if you can't work with the community on mosquito control (making sure banana trees, which harbor lots of mosquitoes, are located away from the house, using bednets), clean water and basic sanitation?
(NB: This post was written on site in rural northern Malawi and posted now that I again have internet access.)