The Medulawi Foundation has a close cooperation with the Paediatric Department of Kamuzu Central Hospital in Lilongue, Malawi’s capital. Rachel Mlotha-Mitole, a paediatrician with whom Jojanneke and Merel have worked during their training in Malawi, runs the department.
The department is divided into eleven sub departments and an emergency department. In total 300-500 children are hospitalized. Four paediatricians and 10 clinical officers, 2-5 interns, 3 medical officers are working in the department and medical students in their third year do a six-week internship here. There are 50 nurses working at the department, who care for about 400 children in total, 24 hours a day, seven days a week. Just to compare: for 20 hospitalized children in a Dutch hospital there is a pool of 80 nurses available.
The emergency department works with a triage system, according to which the sickest children are treated first. After the first treatment they can be admitted at several wards, depending on the severity of their illness. There is a kind of intensive care unit with six beds available for children who need CPAP (administration of oxygen under continuous pressure).Children who are admitted here would probably all be on the ventilator if they had been admitted in a Dutch hospital.The next ward is the Special Care Unit.
Children admitted on this ward are also very ill. Some of them need CPAP because of pulmonary problems, some are unconscious, for instance as a result of cerebral malaria.A child that is getting better moves to the “red zone”, from where they can be discharged.Children who get better, but need to stay in the hospital for longer go to the “medical zone”. Infants aged 0-6 months are admitted at the nursery care. Unfortunately, during night-time the nurses are not working on this ward, so that the sickest infants are moved to Special Care during the night.There is also a neonatology department that is divided in different levels of care.There is a high care unit, where also CPAP can be administered, a medium care and a kangaroo care unit. On the kangaroo care unit mothers are admitted with their small babies for weeks in a room with ten others, until their baby is big enough to be discharged. To be discharged, a baby needs to weigh at least 1500 grams.The neonatology department is very crowded. There is an extra room, which is not in use because the department is understaffed. During the night there is only one nurse for 40-50 admitted very sick and often small (from 700 grams on) infants.
In 2013 the Medulawi Foundation has appointed Jackline. Jackline is an intensive care nurse from Kenya who has trained the other nurses in basic and advanced paediatric life support. Under her leadership the acute care is delivered much better and more efficient. Unfortunately she has to return to Kenya again in 2014. The selection for a new intensive care nurse has already started. The Medulawi Foundation is planning to also appoint a nurse for the neonatology unit in 2014, to enable the hospital to use the second room again.
Finally we are planning to financially support further training facilities for the current staff.