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Educating Health Workers where they are needed most

Edited from an article by Dr Tamsin Lillie, Volunteer CEO of the charity, Medic to Medic

It is hard to imagine where the confident health worker standing before you started out, the path they have walked. The moments of doubt, insecurity, blood, sweat and tears on their journey to serve. Being a health worker is not and shall never be easy. No matter where in the world you work or what specialty you choose to pursue, you will be pushed to your emotional and physical limits; at times, surviving on a few hours’ sleep, missed meals and constantly apologising to the ones that you love for missing special and significant occasions. It is a journey of sacrifice and putting others first – always. What you do matters. Welcoming a baby in to this world, stopping a mother from bleeding to death, telling a person they no longer have cancer, helping a patient recover from a stroke. The world is better for health workers. And throughout the world, particularly in Africa, there is a need for more health workers just to provide the most basic of health services.

Malawi a landlocked country in Southern Africa, famous for its lake, the third largest on the continent, and is rightly referred as the warm heart of Africa, due to its friendly and welcoming people, is home to some of the most resilient people in the world. Hardships and challenges that are impossible for an outsider to imagine; being the sole carer to your mum dying of AIDS with no source of income other than subsistence farming or having your home washed away in floods after late heavy rains destroyed your crops. Malawians have no choice but to be resilient, their futures are outside of their control. Many young people in Malawi want to gain an education, are talented and bright, but lack the financial security to progress further in their studies. Poverty limits choices and opportunity; it limits development and health and the cycle continues for generations.

Queen Elizabeth Central Hospital, Blantyre, Malawi

The education of health workers should not be a privilege for those that can afford it, but sadly this is a reality for so many. For every single discipline of health worker in Malawi, there is a shortage; be it nurses, doctors, physiotherapists, optometrists or radiographers. Some disciplines like audiology are so new, graduates have yet to be deployed to work in health facilities. The shortage of health workers limits the services that can be provided and further exacerbates poverty for those in ill health. Human resources are one of the six building blocks identified by the World Health Organisation to create a functioning health system. Health workers advocate for their patient community and are instrumental in keeping a population healthy for a strong economy.

There are a multitude of reasons for shortages of trained health personnel across Africa; the brain drain is commonly cited, both internally to the private sector and externally to seek greener pastures. Higher rates of infectious disease and death are an occupational hazard. Recently Covid has highlighted this across the world, but historically Ebola and HIV decimated a generation of health worker in Africa when they were needed more than ever in the fight against disease. Many shortages are also a result of not enough health workers being trained to sustain the needs of their populations. For example, New Zealand has two medical schools for a population of 5 million people; Malawi has one medical school training between 40-60 students a year for a population of 19 million. Students in Africa are instrumental in service provision in government hospitals during their training. They are an unpaid workforce. It is not uncommon to hear of students performing (rightly or wrongly), lumbar punctures (taking samples of spinal fluid for testing) or ascitic taps (using a needle to sample excess fluid in the abdomen), amongst many other procedures that would be reserved for senior colleagues in developed nations.

These reasons account for some of the shortages – but does anyone ever count the missed explanations? Who measures the dropout rate at university because a capable student couldn’t afford the fees? How many more health workers would there be if every student who entered university was able to excel because they didn’t have to worry about tuition payments? This group of students should be prioritised. Universities and Colleges only admit students that they have the capacity to train. Therefore supporting students who are at risk of dropping out of their courses due to financial insecurity enables countries to train their own health workers at a rate and capacity that they can manage, without creating pressure to educate extra students or employ extra graduates once they qualify.

The average wage for an unskilled subsistence farmer in Malawi is around 50,000 Malawi Kwacha (NZ$80, UK£40 or US$50) per month. The average cost of student tuition fees is 650,000 MWK (NZ$1015, UK£530 or US$640) a year. How can students from poor families afford to continue with their education and also account for family expenses at the same time? The truth is they can’t.

The non-governmental organisation Medic to Medic plays a vital role in supporting the training of health workers in Malawi by providing holistic scholarships to those who are most vulnerable to dropping out of their training due to their backgrounds. We guarantee tuition fee payments until a student has qualified, provide a medical equipment pack, textbooks, a laptop and, once a semester, a stationery allowance so that they have everything they need to reach their full potential and successfully qualify. We follow up our graduates so that we can monitor the progress in their careers. We have a network of over 170 alumni and currently support 105 students – our largest ever cohort across a range of health disciplines. We are proud that over 95% of our graduates remain in Malawi and over 97% remain in Africa, thereby proving that by supporting the most vulnerable students training in health, is an investment in a future health workforce because they do not leave for higher incomes of developed nations.

A previous cohort of students supported by Medic to Medic taken in November 2021

The Medic to Medic alumni are actively involved in giving back to the community that supported them – either through getting involved in fundraising events in Malawi, providing mentorship to their student peers when they may be struggling academically or making monetary donations so that the generation that follows can also benefit from support that they received.

I first became involved with Medic to Medic as a student in 2009 after reading an article about the organisation in the Student BMJ (British Medical Journal). This was rather serendipitous – I will admit to very rarely ever reading the subscription – yet I often contemplate how different would my life be had I not encountered this article. I am the volunteer Chief Executive Officer of Medic to Medic and my world has been entirely taken over by it.

One of the most helpful pieces of advice I received as a student was “Find your values and stick to it.” Being involved in Medic to Medic holds true to my values, ensuring that medical education is not just a privilege for those that can afford it and by virtue increasing capacity for health services in some of the most deprived areas of the world. It has been a humbling experience, a learning process of developing new skills – you are a jack of all trades but master of none, a problem solver and one who is responsible for many different duties.

My biggest challenge is to navigate the constant and over whelming need that exists in Malawi and manage compassion fatigue that hits daily. Unfortunately needy students are something that we are not short of. We become the victim of our own success – the more people that know about us, the more scholarship applications we receive and the more we need to fundraise, a onerous task at the best of times. It is impossible to help everyone, but we do what we can. It is not uncommon to receive 5-6 applications per day.

The challenges faced by many students remain a constant source of inspiration. Our students are truly amazing. Their determination and strength to overcome constant hurdles in their course to better themselves and help others is truly admirable. Just when I think I’ve heard everything, a new story will be narrated and I am left in awe once again.

In recent interviews, I met with a female student, we’ll call her Chimwemwe. It’s not uncommon for Deans of Students at universities to sneak in extra needy students to be interviewed over and above the numbers we have requested. They too feel overwhelmed by the need and student struggles that face them and are the strongest advocates for their student community and I can relate to why they would do this. I now know these routines and come in saying we have space for 2 students, knowing that they’ll sneak in another 4 and in reality we’ll need 6 places.

On this particular day, hungry and exhausted after listening and becoming involved in so many student journeys, I thought I had finished for the day. Sweat was glistening across my forehead and making my clothes stick flush to my skin and with voice hoarse and dust coating my ankles, I was looking forward to sitting by myself and letting my mind rest.

The Dean of Students arrived, “Would you mind seeing one more? She’s HIV positive, she is the sole caretaker to her mother who has AIDS, they rely on subsistence farming, her dad died, she was meant to attend last year but deferred because of fees. The course is being phased out, so if she doesn’t start now then she will not be able to rejoin and will likely not go to college at all.”

“That’s a lot of information to get in thirty seconds,” I thought.

“Joseph, you keep doing this to me. Please no more after this one.” I replied assertively.

They know, that I can never say “No” and sometimes I think this leaves me open to being taken advantage of. But, how could anyone say ‘no’? I had already taken on more than 5 students that we did not have capacity to support with the thought that, fundraising better go well this year. Each student costs approximately NZ$2000 a year in terms of tuition fees and semester allowances, though there are fluctuations depending on the college and exchange rates. Not a lot when you consider this supports one student with everything they’ll need over a whole year of training.

Chimwemwe verified her story and explained after she had deferred her place from last year, she had gone back to her village and they had managed to save 30,000 MK (NZ$50 at the time) from the family income over the previous twelve months. This provided her with enough money for transport to the college, but, she had no money for fees and attended in the hope that there would be other opportunities available to her. She was sharing a room with her friend off campus and sharing 2 meals a day – surviving on the little that her friends (also students and struggling) could provide.

She talked passionately about wanting to be a health worker to get the knowledge so that she could go back to her village and educate her community on public health practices. She is the first in her family to continue with school and the first to go to College. Chimwemwe didn’t share with me that she was HIV positive and neither was it my place to ask – a health questionnaire is not a condition of our scholarships.

Health workers in a Malawian Hospital (Wikipedia)

The need in Malawi is acute, overwhelming and devastating. A constant feeling that you are never doing enough and that you can always do more, when you’re doing all you can. These are our colleagues, after all, practising in sometimes the most hazardous conditions, with limited supplies, limited support and doing so to help their fellow countrymen. When many others would have left, they stand strong and compassionate. The anecdotal stories we hear from Deans of Students across the country are concerning. Students are vulnerable to sexual exploitation; when you have nothing left to sell and are so desperate to change your future prospects, you either willingly or unwillingly exploit yourself.

The impact of scholarships will be felt for generations. One alumnus told us, “I have now been able to build a house for my mum.” This graduate is from a polygamous family and has over 17 siblings. She is the sole breadwinner in her family and is able to provide for all their basic needs.

During our alumni survey of 2021, we found that, despite only 37% of graduates having children of their own, 75% were providing school fee support to at least one child, demonstrating the ripple effect of supporting tertiary education to gain access to professional employment. Another student mentioned, “Now that I have a scholarship, my family resources can ensure that my siblings go to secondary school. Before, all the family resources were being given to me for my college education.” There are a multitude of layers to providing scholarship support – be it individual, family or at a health systems level – impacts which will be felt for generations to come and which will break the cycle of poverty existing in many families.

Fundraising is a never ending and exhausting task. We have registered charitable status in three countries – UK, NZ and Malawi. This provides us with opportunities to fundraise in different regions and promote our organisation within different networks. Each country comes with its own reporting requirements and standards which must be upheld for charitable integrity, but which in their own way, take away from the time that could be devoted to programme coordination or income generating activities. Our team is small. We always need help with fundraising and there are many initiatives that we are trying to create to ensure our financial sustainability across different regions.

From September 2021 – April 2022, I took took a career break in New Zealand. Originally a qualified Urgent Care Fellow, I have been in Malawi to set up our local operations with a local team and to develop ongoing partnerships and fundraising events which can become locally operational. This is an important aspect when attempting to create charitable longevity. In the year ahead we hope to set up a student helpline for all college students to call when they feel overwhelmed and in need of psychological support. (See the previous Blog on the Walani initiative). Within our alumni community, we have previously supported psychosocial counsellors and mental health nurses and clinical officers. We hope that they will be able to run this evening helpline to provide additional holistic support to all students, where there are notable gaps to student welfare.

Strategically, over the next 5 years, we hope to have a presence at every college in Malawi where there are health workers in training and be able to raise 50% of what we need in country, so that we are less reliant on international funds. International funds can then be used to set up projects at new universities in neighbouring countries, where there is also a large need for more health workers.

One of our students

Overseas medical electives (part of medical student training in the UK and similar developed countries) have taken a travel hiatus during the covid pandemic, but when the time comes, we hope to be able to offer this as an option to medical students internationally. A student having an elective with a Medic to Medic graduate in Malawi will create an individualised experience and help us fundraise at the same time.

We are also working alongside the ministry of health to create a Continuous Professional Development course in resuscitation. This will involve our alumni becoming instructors and is another way that we can sustainably fundraise in country by offering a course to health providers and hospitals as a way to increase their skills.

Additionally, we are working alongside a female tailor in Blantyre to create chitenje scrub tops and hats – bright, colourful and patterned material that can be worn in the workplace. This helps support a female led African tailoring business where there are high rates of unemployment, as well as profits going directly back to supporting medical education in Malawi, where these tops are made. We are always developing more initiatives and look forward to what the future may hold for Medic to Medic. If you would like to get involved with us, please get in touch.

Just like there is no health without mental health, there is no health without global health. A global pandemic has shown us how interconnected we are. Medic to Medic advocates for the challenges facing students internationally and hope that you will join us in supporting the next generation of health workers where they are needed most.


Chief Executive Officer UK registered CIO 1149904, NZ registered charity CC58085, Malawi CONGOMA registered 1609/2022

Want to find out more about how you can support tomorrow’s future healthcare workers in Malawi, Uganda and Zambia? Check us out on social media (links below)

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You can also ask any questions in the comments box and we’ll endeavour to answer as soon as we can.

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