This is how the hospital works… (Day 1)

Induction as expected, very slow and painfully detailed, including such details as the full list of all hospital employees and their government pay grade, from chief superintendent down to cook and porter. I found out that our night-guard, provided by the hospital, gets paid more than the VSO allowance for night-guards, which means we do not need to apply for the grant. Cross that off the list. I spend some of the time going over Chichewa verbs in my head, with the book next to me to glance at surrepticiously.

The structure of psychiatric services in Malawi was explained to us. Zomba is the only dedicated state psychiatric hospital. St John of God, run by the Catholic Church, is in the north and remains a model of good psychiatric care. The central hospital in Lilongwe has a single psychiatric ward apparently. These three centres receive patients from district hospitals, which in turn receive patients from community clinics. ZMH, as the main centre, receives patients from all over Malawi. There was some internal disagreement about the availability and use of hospital motor vehicles. There is a single Community Psychiatric Nurse, who has an assistant. This is where things get a bit unclear regarding the availability and use of hospital motor vehicles. The CPN is severely limited in how many patients she can see, as there is only a single shared vehicle for all district health visits, which must cater for general nursing visits as well. “The others cannot be waiting while the CPN says ‘I have another patient to go and see.'”
However, the hospital administrator subsequently told us that in fact there are six or seven motor vehicles available for use, but people must requisition them. He said he wasn’t sure what they were used for at the moment. All very mysterious.

This evening Rob, the lecturer in psychiatry in Malawi, is staying over with us, as he lives over an hour away in Blantyre and has clinics today and tomorrow. He and I walk through our back garden with beers, the red ground hard as concrete underfoot, as Rob explains what could be done with it. A gardener will work the land in exchange for a patch to grow his own maize on, apparently. I can barely imagine how one grows anything in this ground, though the rainy season is still coming, and it may be more workable then. After supper Dr. Rhada phones Steph, saying he is missing us all and the hospital he finds himself in is very untidy. He is living on bread and butter, though we are quite confident he will soon have organised himself a cook. I think I’ll go and visit him soon in Lilongwe some time.

Morning on the way to the hospital

Morning on the way to the hospital


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