Wednesday 21 March 2018

Gorey's generosity bears fruit in Malawi

Two Gorey-based doctors recently travelled to Malawi in southern Africa to deliver the first donation of aid thanks to the Gorey Malawi Health Partnership

Dr Nalini Ambivagar (right) at a hospital in Malawi
Dr Nalini Ambivagar (right) at a hospital in Malawi
Local children try out their new hats and cardigans
Dr Mar Contell discussing the asthma medication with the pharmacist in Mzuzu, Malawi

Thanks to the generosity of the people of Gorey, the Gorey Malawi Health Partnership has been able to make its first donation of aid.

Dr Nalini Ambiavagar and Dr Mar Contell from the Palms surgery in Gorey, pulling two suitcases full of asthma inhalers and spacer devices, landed last month in the capital Lilongwe. Following a recovery sleep, they headed for Mzuzu, Malawi's fourth-largest town to begin the work of improving asthma care.

This is a diary of the trip by Dr Nalini Ambivagar:

Like everything else in Africa, relationships have to be built up to establish trust. Donor organisations come and go, and Africans get used to the fact that aid, freely available one month, is absent the next.

Dr Joe Gallagher has built up a trusting relationship with Master Chisale, a laboratory scientist at Mzuzu Central Hospital, who understands that we do not wish to absent ourselves any time soon. This relationship will be central to delivery of our educational messages, and any other resources we can harness.

Malawi is emerging from the devastation of the AIDS epidemic of the 80s and 90s thanks to the programme of anti-retroviral drugs available through charitable donation. As life expectancy rises, Malawi, like Ireland, must learn how to identify and treat illnesses which were much less common.

Adult onset diabetes, high blood pressure, chronic lung disease, epilepsy, asthma and many others now present to hospitals and clinics in increasing numbers. We asked Master Chisale to choose a disease of priority to Mzuzu Central Hospital, and he chose asthma.

As a busy surgery, already coping with the demands of our own service to our Gorey patients, we have asked ourselves what is the most efficient way to assist in asthma care?

We aim not just to take donations out to Malawi, but to provide support to the doctors and other clinical staff out there. This support is in the form of education, record systems, and management protocols.

We are hoping to train some of the local healthcare staff so that they will be the ones to provide the care in future, thus providing a sustainable development.

Our first challenge was to establish what medications were presently being used to treat asthma in Malawi?

Most Irish asthmatics will have heard of salbutamol (market leader Ventolin). This is the drug most widely used in asthma's blue 'reliever' inhalers taken to relieve cough and wheezing, and in the plug-in nebuliser for younger children or more breathless patients.

Imagine how your health service might cope if it did not have a supply of this drug all year round? Or did not have spacer devices to administer more easily to children? Or had an intermittent supply of electricity to power the nebuliser? Or only had one nebuliser mask shared among all patients with its attendant risk of spreading infections from one patient to the next?

We discovered that an inexpensive drug freely available on the maternity ward, magnesium sulphate, could also be used in the breathless asthmatic, and therefore suggested that this drug could be used to treat asthma at Mzuzu Central Hospital.

It was important to for us to get a handle on what kind of conditions were presenting to the hospital and we arranged to do a ward round on the children's ward and to visit the adult outpatient clinic.

Again we were reminded that we were in one of the poorest countries in the world. Patients were unable to attend the hospital regularly to get their treatment and the hospital unable to get a regular and constant supply of drugs.

Blood pressure medications were frequently switched to whatever drug was available in the pharmacy, regardless of whether or not the patient's blood pressure was controlled on the drug. In spite of this, the patients themselves were not complaining.

The next day was the culmination of our trip. We made a presentation to the medical staff in Mzuzu Central. The room was packed with clinical officers, trained healthcare workers who are the backbone of the health service, and with student nurses but only the doctors seemed to be engaged and interested in what we were saying.

In spite of this, I think we got them interested enough to try and manage the asthma on a more steady basis.

After the presentation, we made a video with one of the student nurses. It was to demonstrate the use of the spacer devices which we had brought. These are used for children principally, or very breathless patients, to ensure the drug gets from inhaler to the lungs.

Understandably, the student did not know how to use the device, so before we could film him, we had to teach him how to use it.

Our second presentation was to the nursing tutors in St John's College of Nursing, a nursing school started by the Irish Medical Missionaries of Mary.

This was much more satisfying as they were far more interested and engaged with us. They were asking questions throughout and making comments about what they were doing themselves.

Interestingly, one of them had even used magnesium sulphate. The nursing tutors were very keen to have a protocol to follow on the wards, and we passed the information on to them. It finally felt like we had made some progress.

Before we left Mzuzu, we had a Skype session with our colleagues in the Palms, Gorey.

After a brief educational presentation from Drs Peter Harrington and Joe Gallagher at the Palms, students from Mzuzu University and St John's made a presentation about asthma and bronchitis.

They all seemed to enjoy it and felt that they were being heard. Hopefully Skype will be a useful way of maintaining our educational inputs over time.

Since our return, we have been pleasantly surprised by the enthusiasm we seem to have generated and the appetite for learning new stuff. Dr Joe Gallagher has had approaches from Malawi for Skype sessions for further educational experiences.

We wish to thank the people of Gorey, who have given so generously to us and made all of this work possible. To our fellow staff at the Palms surgery who rode in behind us and facilitated fundraising. And to Wade's pharmacy and Grant's pharmacy for assisting so generously with the gathering of inhalers.

We hope our trip has demonstrated our goodwill. With ongoing support of the people of Gorey we hope to be able to continue our work in the years to come.

Donations still welcome via or through the reception staff at the Palms surgery.

Gorey Guardian