VISIT TO KAMUZU CENTRAL HOSPITAL

Located right in the middle of what is called Old Town and City Centre of the capital Lilongwe, Kamuzu Central, is one of Malawi’s three main referral hospitals. Opened in 1977, it was named after the country’s first president Dr Hastings Kamuzu Banda.

The hospital is located in the central region of Malawi, making it the largest referral hospital in the province which has nine districts. According to director of the hospital Dr Noor Alide, the facility serves a population of 5 million in its catchment area.

In short known as KCH, Kamuzu Central is the second largest among Malawi’s referral hospitals – after Queen Elizabeth Central based in the commercial city of Blantyre in the South, Zomba General, in the Eastern Region and Mzuzu Central in the Northern Region.

KCH has many key sections which include the Out Patient Department (OPD), Under-Five Clinic, Children Ward, Maternal Ward, Dialysis Room, Orthopedics, Surgical Ward, Laboratory, Drug and Surgical Stores and Kitchen. There is also a private ward where treatment is provided at a fee.

Recently I had a rare opportunity to tour this vast institution when I joined the country’s newly appointed minister of health, Professor David Mphande. Professor Mphande was on a tour of the hospital on August 20 to familiarize himself with its operations being only about a month-old in office.

Through this trip I discovered that KCH has four main problems: shortage of staff, limited drugs and equipment coupled with an ever increasing number of patients.

Our tour started with the Treatment Room where, we leant about the most common diseases that people seek treatment for at this facility. Here clinical officer Eugene Kaisire told us that malaria, renal failure, congested cardiac failure (CCF), high blood pressure, diabetes, and of late measles as Malawi is one of the many Southern African countries hit by an outbreak of the disease, are the common ailments.

Kaisire said he works for eight hours a day, from 7:30 AM to 4:30 pm. “The problem we face is what we have receive many patients but staff is limited. Kaisire pointed out that the problem is exacerbated by the fact that most of the people that seek medical attention are not necessarily referred district or rural hospitals as it is supposed to be case.

They come direct, jumping the chain of treatment, which requires patients to first be treated at the nearest health centre in their respective communities and be referred to a district hospital or central hospital (regional) depending on the seriousness of their ailment. Once they are here, they cannot be turned back home. “We work even over lunch on a daily basis just to cope with the increasing number of patients”, said Kaisire.

Our visit to the general treatment room was only the beginning of the many problems we were to observe during our tour of Kamuzu Central Hospital. One of the most critical sections of the treatment ward is Dialysis Ward. This is where patients with kidney failure are treated. The four dialysis machines available in this ward are in fact the only functional ones throughout the whole of Malawi. People with kidney failure from all corners of the country travel to this ward to be treated on the machines for four hours, three times a week. Apart from transplant, kidney failure has not other cure. The most appropriate alternative therefore is the use of these machines which filter accumulated waste products of metabolism from the blood of a patient whose kidneys are not functioning properly.

With only four machines this ward has the capacity to handles eight patients a day, said a nurse we found in the ward Jane Rajab.

However, it a direct conservation between the visiting minister and one of the patients who is a member of the Kidney Failure Patients Association of Malawi that revealed insights I never expected:

“I am your child, please, let me die at my own house”, said Ridson Chafulumira.

“The doctor is here. You will get better”, the minister replied apparently not known where the patient was driving at.

“I can’t, you know that kidney failure is not a one day disease, it’s a terminal disease, and this machine is only sustaining life for a few more days, actually” said Mr Chafumira.

“And you want that life to be sustained” said the minister.

“Yes, but while I am at home not here”, responded Mr Chafulumira while laying on his hospital bed.

“But if you go home how do you sustain your life”

“Where?” the patient asked.

“At home”, responded the minister.

“I cannot go home without the machines operational in Blantyre. What I am asking for is the operational of the machines in Blantyre. They have been installed already, but they are taking too long to start operating” said Mr Chafulumira, hitting at the core point of his argument.

“Thank you, we will find out more about that,” said the minister to cut the long story short. “We are praying for you, we are praying for all of you that God should touch you through the medical services you are receiving”, said professor Mphande as he left the room. Being new in the office he had little to say about such a major challenge.

“But God will work through people like you” – these were the last words the patient told the minister before I chipped in to find out more about him.

When I told him that I was George Kalungwe from Zodiak Radio, he was amused and went on to tell me that he has been shuttling between Blantyre and Lilongwe to be put on a dialysis machine for four years – a distance of about 400 kilometers kilometers.

“You might have seen my articles in the paper and heard me on your radio”, he said.

“Are you satisfied with the treatment you are receiving here” I cut him short.

“Let’s not talk about satisfaction here. I am going to be satisfied with these machines in Blantyre, rather than here because Blantyre is my home”, he responded.

From the Dialysis Ward, we continued our tour of KCH by passing through the Female Surgical Ward – 4 A. This room is over congested so much that some patients and guardians sleep on the veranda.

One of the nurses working here Gertrude Nyirenda told me the actual bed capacity of this ward is only eight, but on this day eighty patients were admitted. Nyirenda said one of the measures they are putting in place to deal with the congestion is make sure a patient does not stay long in the ward waiting for surgery. “When a patient comes with a guardian, we tell the guardian to sleep outside, because we cannot accommodate everyone here”, she said, adding that, “We make sure that the doctor sees them as early as possible, so that if surgery cannot be done soon, they can leave and come back on a particular day”.

When we left the female surgical ward we proceeded to the pediatric ward. This is where children between the ages of one month to 15 years are treated. As we visited the hospital 288 children were under the clinicians’ attention. We were told that the figure is almost the same on a daily basis. Ten nurses work in this room for eight hours during the day and 16 hours during the night, said nurse Janet Kadzamira.

In total Kamuzu Central Hospital has a one thousand beds, including those in the maternity wing which has just been extended to include an-all-inclusive pay ward in honor of the late first lady Madam Ethel Mutharika – the Ethel Mutharika Maternity Wing. This ward an internet café and a TV room among other facilities.

To ensure that the all the one thousand patients admitted to the hospital are fed the hospital has a kitchen. All kinds of foods are prepared here, but mostly it is beans, vegetables and msima(a thick porridge made out of maize flour) for patients in the public wards. Those in the pay wards order a meal of their choice.

Explaining the operations here was chief nursing officer Lucy Mkutumura. “There are some patients who are not supposed to eat food with salt or oil, we know how to make it here”, she said adding that, “For those with no restrictions we offer them meals depending on the menu of the day, sometimes we offer them meat...”

The chief nursing officer said the most significant challenge the KCH kitchen is facing is the increase in demand for its services. “The hospital is expanding, but this kitchen has remained the same since 1977 when we opened the hospital”, she noted.

The kitchen has four big electric pots and three industrial cookers. However Mrs. Mkutumura said there are plans to expand the kitchen to meet the growing demand.

The visit to the kitchen was not our last. We still had to see what happens in the laboratory, the pharmacy and surgical storeroom. The KCH laboratory is one of Malawi’s best, according to lab technician Edwin Chitandale. Some of the compartments it has include the Sample Reception, where specimen from patients are received and referred for testing; Safety Cabinet, where testing for contagious airborne diseases is done using vacuum machines and the Tag Room, where TB microscopic is done.

This lab however has only 17 technicians, thirteen short of the required thirty. Apart from shortage of staff, Chitandale said this 24-hour laboratory also faces regular short falls of reagents.

Another section of this lab is the blood bank which supplies patients in need of blood fusion with the precious commodity. Mainly these include accident victims, anemic patients and women in labour wards.

Limited blood supply is the major challenge facing the blood bank. “We are supposed to have at least a minimum of 40 units per day, but most of the times we do not have that”, said Chitandale, “It is our plea to the society that they must change their blood donating habits .When the population does not come to donate we are handicapped”.

Chitandale said the problem is usually worse during school holidays because most blood donors are the youth in the ages of 16 to 18 who are mostly form three and form four secondary students and donate blood from their schools during visits by the Malawi Blood Transfusion Service – a public trust.

With the advent of HIV and AIDS, another important section of this lab is the pediatric HIV testing room where children born from HIV positive mothers that have undergone the process of prevention of mother to child transmission is done. Most of the nine districts of the central region of Malawi rely on this laboratory for pediatric HIV testing for children below six months. With three technicians working on eight-hour shifts, up to a 130 infant samples are tested daily in this laboratory, according to Chitandale.

A major hospital like Kamuzu Central cannot be complete without a pharmacy. This is where outpatients receive drugs on a daily basis. The drugs supplied range from antibiotics to anti malarials. Seniors Pharmacist Macmillan Kondowe said up to one thousand patients receive medication from the KCH pharmacy each day.

Kondowe said, given that this is a referral hospital, the number is too large. “ Actually we should have been getting much lesser than that, but it difficult for us to differentiate who has been referred and who has not”, he said.

After leaving the pharmacy, we entered the surgical storeroom. This is where all non drug items, such as gloves, bandages, clips, and the like are stored.

To deal with theft of drugs and equipment, KCH is implementing a trial system called E-Pharmacy, a short form of Electronic Pharmacy Management System.

“What it is supposed to do is that if one goes through the registration point at the out patients department, they are supposed to be registered and on their health passport book it produces bar-coded label, which includes all your details – your name, sex, and everything”, said another senior pharmacists Albert Khuwi, adding that, “Ideally once somebody has been registered, they go to the clinician, he would also have a screen like this and then after making a diagnosis and a prescription is made out, the prescriber is supposed to enter that information into the machine again and that information on the prescription should be sent to pharmacy, the dispersing area. And then once the dispersing is done the patient is like checked out but the information is kept so that at the end of the day we should be able to check how many, say pain killers, antibiotics, we have dispersed on a particular day”.

“If there is a difference between the amount drugs registered in the machine as having been given out on a particular day and the figures manually recorded in the stores, then people managing the stores can be taken to task”, said Khuwi.

After the health minister professor Mphande finished visiting the hospital, I had the opportunity to interview the director of the hospital Dr Noor Alide. He said the hospital is trying within its limits to address some of the challenges it is facing, but there are other problems which can only be addressed by the government.

He said a system has been put in place to strengthen monitoring of drugs availability and prescribing methods. He added that the hospital has entered into contract with some companies and suppliers so that its equipment is serviced on contract basis. There are also plans to facelift the outlook of the whole three-storey building by remodeling it.

“But for human resource, we really have to depend on the ministry of health just the same as the issue of ensuring that all people that come to access help at the facility are only those that are referred from smaller hospitals” said Dr Alide.

Dr Alide indicated that KCH would also like ask the authorities to allow the hospital to hire staff such as nurses, doctors and clinicians on its own, without going through the ministry of health, saying doing so would help in quickly covering gaps that exists due to brain drain.

Dr Alide revealed that the hospital spends between 8 to 10 Malawi kwacha in hiring additional staff available on the open market to help in delivering effective services.

Asked about tendency of locals who despise hospitals in the likes of KCH to seek medical treatment outside the country, Dr Alide said: “The choice of where somebody gets services is an individual choice. As I have just told you people are bypassing health centres belonging to district health offices coming to central hospital, its their choice, and we cannot stop them from choosing”. “

But what I can say, for sure is that, if there is a hospital here in the central region with specialists and equipment capable of providing quality service then it is Kamuzu Central Hospital. May be the hotel side of the problem is deterring people from coming to access services here, but the staff and quality of service we provide in terms of medical care is of high standard”, challenged Dr Alide.

Being new in cabinet, minister of health professor David Mphande had little to say, other than ‘appreciating the challenges Kamuzu Central Hospital is facing’.

Professor Mphande said he was going to undertake a tour of many hospitals as possible and discuss with stakeholders how some of the challenges can be addressed on long term basis based on a report which he will compile after his countrywide tour of health facilities. “My visit here is an opener to the problems that most health facilities, especially big hospitals like this one, are facing in the country” said the minister.

Nonetheless he said he was impressed with the dedication of the members of staff and the cleanliness of the hospital and concurred with Dr Alide on the need to expand the facility to meet the increasing number of outpatients and those admitted.


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