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Lasting change for Community Healthcare

It was just days before my 28th birthday when I found myself at Heathrow airport waving a tearful goodbye to my parents and wondering what lay ahead of me. Two years on, I am now health co-ordinator for a small UK based charity called Phunzira that works in north Malawi. Today I reflect on how and why I got here, what it means to be involved in community development and why it’s important for women all around the world to be able to share their skills and knowledge.

After completing my medical degree I did my junior doctor training at a South East London hospital. Since first going to Africa to do my medical elective four years earlier I’d had a burning desire to return and use the skills I was learning to help some of the more impoverished people in the world. Aware of what seemed to many as a hopelessly idealistic vision I decided nonetheless it was time to take the plunge. So I took a job in South Africa, working as a medical officer in a heavily understaffed and poorly resourced hospital in rural Kwazulu-Natal. The wards and outpatients were regularly bursting at the seams with children and adults suffering from a host of medical conditions, many of them largely preventable in the developed world. The ratio of doctors to patients is astonishingly low making a day’s work both rewarding and challenging. I learnt many valuable skills and knowledge but perhaps more importantly I gained enormous insight into how so many people in the world live, how privileged we are to have access to clean water, doctors and medicines and as women, to be empowered to protect ourselves and our children from the many hardships suffered the world over.

After working in South Africa for a year I travelled north eager to explore and learn more. My second visit to Malawi only confirmed my love for the “warm heart of Africa”. Malawi, which has earnt this nickname from its warm climate and exceptionally friendly people, is a beautiful country landlocked by Mozambique, Zambia and Tanzania. It boasts the third largest lake in Africa and is home to a host of tropical fish. Malawi ranks among the world’s most densely populated and least developed countries making it one of the poorest countries on Earth. It remains fundamentally dependent on international aid from institutions such as the World Bank and IMF, and has a GDP of just under $5 billion (2010 estimate). The average minimum wage currently stands at just under 50p a day. Of 15.8 million people living in Malawi, over 80% are living in rural areas. The average life expectancy is 50 years with almost half the population being under the age of 14 years. HIV and AIDS have had a devastating impact not only on morbidity and mortality but also on socio-economic progress and HIV is expected to further lower Malawi’s GDP by 10% in the coming years. 1 in 10 adults aged between 15 and 49 are known to be HIV positive, although in reality it is likely the figures are much higher as a large number of people living in rural areas have limited access or motivation for getting tested.  Malaria is endemic to the region and with only 57% of the rural population having access to safe water; the risk of waterborne diseases is also very high. Health expenditure is less than 5% of GDP and there are less than 0.2 physicians per 10,000 of the population.

It was during my second visit to Malawi that I was reintroduced to an old school friend, Rosa Nissim, founder and project co-ordinator for Phunzira. Phunzira, which focuses on long term, sustainable community development, was founded in 2009 in order to help impoverished children and adults in the north of Malawi receive better education and health care. The project is centred in a small fishing village called Ruarwe located along the northern shores of Lake Malawi. Like many other villages in the north, it is extremely rural and isolated with a stark lack of infrastructure. There are no roads making Ruarwe only accessible by boat or by foot, no power grids and limited phone reception. Water is pumped to wells from the nearby river but is untreated. Ruarwe had not had a doctor in the village for over 10 years and the small government health centre was practically redundant forcing patients to walk 5 hours to the nearest basic health services.

After a brief catch-up on life since primary school, Rosa and I discovered that we had many principals and ideals in common. There was already great progress on the education side of things with the education centre building almost complete. Finding someone to manage the health side had been more difficult and so Rosa invited me as a volunteer to see what we could do in the area. This was a very new and daunting challenge for me but my interest in public health and my understanding of social responsibility had been awakened and I decided that to try and fail would be better than to not try at all. So early in 2011 I headed over to my new home in Ruarwe. The health centre was just a shell of a building with no medical assistant, out of date medicines and a lot of clutter. We set to work tidying up and formulated a plan. As a government health centre it was essential to work with the local MP and District Health Officer for the region who were thankfully extremely helpful and interested in working with us. In April, Ruarwe health centre re-opened its doors offering essential basic health care free of charge to a population of around 3000. The health centre is now open 6 days a week and also runs an emergency out of hour’s service. In addition to drop in general clinics there are also more specialised clinics, such as antenatal care, family planning and the under 5s clinic. There is also now a small treatment room for minor procedures and wound dressings, 2 beds for patients who need to stay overnight and a drug stores room stocked with basic medicines. During the first 3 months of opening its doors, over 800 patients were seen with a wide variety of medical problems many of whom would have suffered unnecessarily if these essential medical services had not been so accessible. The health centre is currently staffed by one Malawian medical assistant and myself.

The health side of Phunzira is now growing and expanding into the community. Our vision is to improve the standard of living through education, community empowerment and initiating sustainable and innovative health development projects. Phunzira continues to work with and support this government health clinic. Only this last month we were able to hold our first complete under 5s clinic offering childhood vaccines as well as growth monitoring. Over 120 children were seen in clinic in one morning. Our new health initiatives are now reaching out into the community with a focus on education and women’s empowerment. One of the greatest social injustices found in the villages is the low status of women. We are setting up women’s groups which will provide a forum for women to discuss important issues together and to bring about social changes, especially those which will improve the lot of women and children. These groups will cover topics such as nutrition, health and hygiene, safe drinking water, family planning HIV and AIDS and income generation. The road ahead is long and there are still many challenges ahead. But together we are making lasting change through local leadership and activism that will enable poor communities to improve life for their future generations.

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