Where

Malawi

Malawi is a beautiful but small country in southern Africa, surrounded by Zambia, Tanzania and Mozambique. It has the third largest lake in the whole of Africa, Lake Malawi, which covers a fifth of the country. Malawi is called 'the warm heart of Africa' after its friendly and gentle people. Despite its beauty, Malawi is a very poor country and its economy relies on foreign aid and agriculture, particularly tobacco. Most of the population live on less than two dollars a day.

THE NEED IN MALAWI

Most people in Malawi will never see a doctor. That’s because in Malawi, there are only about 350 doctors in total. That’s roughly 1 doctor for every 50,000 people. In the UK, we have over 100,000 doctors – or 1 for every 500 people. There are even fewer specialist doctors in Malawi – for example, there is one neurosurgeon for the entire country. Only 8% of paediatrician and 9% of obstetrician posts are filled. But it’s not just doctors. In the whole of Malawi, 33% of nurses’ posts are vacant and prior to the development of the physiotherapy course at the College of Medicine, only 27 physiotherapists for the entire country.

This chronic shortage of health workers has led to Malawi having some of the worst health outcomes in the world. It is one of the most dangerous places in the world for a woman to give birth: one woman will die from childbirth for every 196 births. In the UK, 1 woman will die for every 8333 births. The lifetime risk of childbirth, which is the cumulative loss of life due to childbearing over the course of a woman’s life, was 1 in 36 for a Malawian woman in 2008. In the UK, it was 1 in 4,700. It is the same for children’s health: for every 1000 children born, 110 will die before they turned five. Women and children will particularly benefit from more health workers. This is why Medic to Medic is supporting health workers to train in Malawi - to help change these shocking statistics.

WHERE WE WORK IN MALAWI

The College of Medicine (COM) was set up in 1991 as part of the University of Malawi. It is based in Blantyre, the largest city in Malawi and the commercial centre. Initially, the College could only offer the clinical phase of training, and students were sent to the UK in order to do their preclinical years. Now all five years of the medical course are completed in Malawi, with clinical attachments at the Queen Elizabeth teaching hospital in Blantyre, Kamuzu Central Hospital in Lilongwe and the rural campus in Mangochi. An additional premedical or foundation year is offered for those students who don’t have science to A-level standard (A-levels tend to be offered only in private schools in Malawi). In addition to medicine, the College now offers degrees in pharmacy, medical laboratory technology, physiotherapy and health management.

Mzuzu University (MU) was initially a teacher training college set in the town of Mzuzu in the northern region of Malawi.  It expanded during the 1990’s and 2000’s to incorporate other faculties.  The nursing faculty opened in 2006.  Unlike students at COM, students at Mzuzu undertake clinical placements in the northern region of Malawi, which tends to be more rural compared to other regions and their training is centered on the rural health needs of the local population.  Students from the northern regions of Malawi are often underrepresented in tertiary education and our partnership with MU is an exciting opportunity to help disadvantaged students from the northern region.

St John of God College (SJOG) is located in the northern region of Mzuzu and was set up following discussions with the Brothers of Saint John of God Ireland in 1993.  Today SJOG provides education and training in mental health for clinical officers and nurses specialising in the field, as well as providing social services (including counselling and vocational training) to people in the region.  The college is a private institution and was set up as an alternative to the public universities.  They have the capacity to train more students than are currently enrolled and many students still struggle with the cost of tuition fees.  Medic to Medic has supported one student through his training as a psychiatric nurse and has also provided partial scholarships to four other students.  Mental health in Malawi is severely underfunded and the partnership with SJOG offers Medic to Medic an opportunity to ensure students wishing to specialise in Mental Health are also given an opportunity to qualify and go on to support Malawians with mental health problems.

Ekwendeni College of Health Sciences is affiliated to the University of Livingstonia in the northern region of Malawi.  In 2014 the clinical officer training programme started with just 12 students.  In 2016 the course had expanded to 68 enrolled students, many still struggle to pay for all their tuition fees and the costs of living.  A clinical officer is a health professional qualified to perform medial duties such as diagnosis and treatment of disease and injury, including ordering investigations, performing procedures and referring patients to tertiary facilities when patient need dictates.  In rural areas clinical officers manage and run missionary and district hospitals where there are no doctors and often hold similar responsibilities to their senior counterparts.  Clinical officer training is generally shorter (minimum of three years compared to six years for a doctor) and they subsequently undergo a one year internship.  Following qualification they can specialise in a department (such as medicine, surgery, paediatrics, obstetrics and gynaecology, psychiatry), following further postgraduate study.  This qualification is often not recognised in developed countries, therefore they are seen as an investment in the health workforce since they often do not leave the country after qualification.

Kamuzu College of Nursing (KCN) was founded in 1979 with it's mission to deliver high quality and cost effective nursing and midwifery education and other health related programs to students and other stakeholders through teaching, research, consultancy and outreach, advance professional growth and promote the health of the people of Malawi.  If is the biggest nursing and midwifery college in the Southern African Development Community (SADC) offering both undergraduate and postgraduate qualifications.  Through our partnership with KCN we are continuing to expand our support to nurses in training in Malawi.

Uganda

Known as the ‘Pearl of Africa’ due to its magnificent landscape and wildlife, Uganda holds much of Lake Victoria and the source of the Nile. It shares its borders with Kenya, South Sudan, Rwanda, Tanzania and the Republic of Congo. After independence from Britain, the dictatorial regimes of Idi Amin and Milton Obote caused many professionals to flee the country. Since 1986, President Yoweri Museveni has been in power and Uganda has made great progress. However, the Lord’s Resistance Army has caused huge amounts of violence and displacement in Northern Uganda. Although the region has been peaceful for a few years now, there is great disparity with the rest of Uganda.

THE NEED IN UGANDA

The World Bank ranks Uganda as one of the poorest countries in the world. The average life expectancy at birth is 50 years and the infant mortality rate is 79 per 1000. Uganda has still not recovered from the exodus of professionals under the dictatorial regimes. In the 1970s, the total number of doctors in the country fell from 978 to 574 whilst pharmacists dropped from 116 to just 15. Even today, Uganda has only around 2500 doctors to serve its entire population of 32.7 million and a mere 360 pharmacists. The state health services remain significantly understaffed, with the rural health centres being the worst affected.

In Northern Uganda, the World Health Organisation identifies the inadequate number of qualified health staff as one of most critical challenges to health service delivery. Although nationally 72% of the population have access to healthcare, this drops to 30% in the northern region. Up to 65% of health facilities remain closed even several years after the end of conflict. In Gulu, only 23% of healthcare posts are filled compared to the national average of 68%.

Students from the northern region are currently under-represented in healthcare training in Uganda. The lack of educational facilities and teachers make it difficult for them to compete with candidates from other regions, particularly in science subjects. Few manage to win the limited government scholarships available and even fewer have means to pay the university tuition fees themselves.


WHERE WE WORK IN UGANDA

Makerere University was established in 1922 with just 14 students studying Carpentry, Building and Mechanics. By the 1970’s it had introduced a variety of courses and had become one of the leading universities in Africa. It now has a student body of 30,000 undergraduates and 3,000 postgraduates. Makerere College of Health Sciences was incorporated into the main university in 2007 and offers courses in Pharmacy, Dentistry, and Nursing. It also offers several pharmacy Master’s degrees.

Zambia

Zambia borders Malawi and is a much larger country formed of high plateaus and river basins, with a number of national parks. Its main river, the Zambezi, forms the world-famous Mosi-oa-Tunya (Victoria Falls) near the town of Livingstone and the border with Zimbabwe. The 18 million people in Zambia live mainly around the capital, Lusaka, and the Copperbelt province in the north-west of the country. Historically, copper was Zambia’s main export, and though output declined in the latter part of the last century, mining for copper and other metals remains a very important industry. Agriculture is the other main area of employment and economic activity. Economic growth has meant that Zambia became a middle-income country in 2011. However this growth has mostly benefited only a small number of people and poverty is still widespread. The World Bank estimated in 2015 that 58% of Zambians earned less than the international poverty line of $1.90 per day.

 

THE NEED IN ZAMBIA

Much work has been done in Zambia on improving health, and life expectancy has been improving in recent decades. However there are many challenges. Around 1 in 16 children in Zambia do not survive to their 5th birthday and like many countries in the region, Zambia has been very affected by the HIV/AIDS pandemic. Roughly 11% of adults are HIV positive with the proportion twice as high in urban areas compared to rural areas. 

The number of health professionals (including doctors and nurses) remains well below the level recommended by the World Health Organization. Recent estimates are that there is one doctor for every 12,000 patients in Zambia. The health worker shortage is made worse by other longstanding issues, such as fewer staff working in rural areas and high staff turnover.  The population of Zambia is growing, so more and more staff will be needed in the future.


WHERE WE WORK IN ZAMBIA

The University of Zambia, based in Lusaka, is one of four government-run institutions in Zambia that train doctors and other health professionals. It was established in 1965 and has as its motto “Service and Excellence”. The medical school was the first in Zambia and is set opposite University Teaching Hospital, a tertiary referral hospital in Lusaka. Over 1,200 new doctors have graduated from the medical school since the first cohort in 1973 and the school now delivers postgraduate training in areas including surgery, paediatrics, obstetrics & gynaecology, and public health, as well as training nurses, pharmacists, biomedical scientists, and physiotherapists.