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2020. Part 2

In Part 2 of our 2020 review, we have a post from our friends and partners at KCH about paediatric care, COVID and Malawi.

2020 - A View from Malawi

Dr Bip Nandi, Paediatric Surgeon at KCH

We were so surprised by your generosity at our first fundraising event in October 2019. Your support has been heartwarming and encouraged us to keep going when work gets tough. We are determined to use this money well. I often see NGO’s and institutions in Malawi waste money. Its painful watching this happen, when we think three times about paying £13 pounds for potentially life saving blood cultures or five times for a £150 CT scan. Its good that we think like that, we see the opportunity cost every day. I hope that as we grow we don’t change, and don’t see ourselves in a new Kids of Malawi four by four anytime soon. Malawi has thought us to be resourceful, innovative, and cheap

As we prepared to spend your money in early 2020 the global COVID crisis started. We can understand how terrifying this must be in countries where death is rare. Sadly we see a lot of death in Malawi, deaths that we know how to prevent. Some of us did not see what could be done in a country with the systems, resources and living conditions of Malawi to combat COVID. We also thought it wrong for the global health community to presume that COVID would effect Malawi in the way it was effecting Europe. Soon we saw wards with empty beds, where there had been four children on a bed. People were either unable to get to hospital, or had been scared away. We had no idea what COVID was going to do to Malawi, but suspected children were dying at home from treatable diseases. We wrote this in April 2020.

April to September the hospital largely shut down except for the most urgent cases. We had little work to do. It made no sense spending your money then. Some other well meaning supporters wanted to send us masks and PPE, we told them: ‘Save your money, we still aren’t seeing much COVID here. We will need your money when we resume normal services and have to cope with the backlog’.

It is now December and we still have little COVID here. We are not testing much, but neither are we seeing more respiratory disease than normal. For some reason it seems much much much less of a problem here. We hope that continues. We fear what our malaria, measles, malnutrition death rates will be as a result of decreased essential medical services from our response to COVID.

In 2019 Malawi became only the second country in Africa to have its election results overturned by the courts. As the country was about to go to the polls again, lock down threatened. It was not clear how much of response was being driven by science and how much by politics. We felt that the real disaster was likely to be hunger from lock downs rather than COVID in a very young population:

As lockdown loomed we distributed almost a ton of food to one of the high density areas in Lilongwe. I asked a community leader what people in Kawuma thought about lockdown. ‘They have never seen COVID, they think the politicans are making it up’. I asked him what he thought about coronavirus. ‘ Its killing white people like chickens, I’m afraid of what it is going to do to us’. When I asked him what the governemtns response should be he said ‘I think hand washing and hygiene is important, but if you lock me in I will fight you, because you are locking me in with my enemy, hunger’.

At the last minute, a lockdown was called off. The elections went ahead, and Malawi made history as the first African country to have a nullified election result overturned in an the re-run. We have a new government with a Hurculean task, but there is hope in the air.

In the last few months things have started to return to normal both in the community and at the hospital. Its reassuring that we are busy again. The eerie emptiness replaced by the familiar overcrowding. The backlog has not been as severe as we feared, maybe it is yet to come, but as work increases we have started using the KOM Uk grant to start employing nurses. International collaborations have been affected by COIVD. The paeds department each year receive a large group of motivated hard working Spanish doctors and nurses. They especially help out in the Malaria season at the start of the year when the wards are crazier than normal. One of them was in Spain dealing with the coronavirus crisis there. She commented how she had never been so busy in Spain, but that it was still not as bad as a normal Malaria season in KCH. The Spanish have upto now paid for their own airfare and accommodation. After many years they got EU funding, and are devastated that this year they are unable to come. We are considering how best to use their funding, and I suspect that we should be hiring locum staff to make up for the gaps the Spanish team will leave behind. We may use some KOM UK funds for this too. We are already using KOM USA funds to pay for nursing locums on the wards.

So in summary it's been a quiet year for KOM UK.. Luckily COVID has had little effect on Malawi. Sadly our response to it has meant delaying much needed non-emergency care. We expect next year to be a lot busier, but promise to use your funds as carefully and as impactfully as possible.

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