The Malawi Project, Inc.

     Because of its population that is higher than most other communities, and with its proximity to the capital city, the Mponela Trading Center enjoys a wide variety of local outlets and trading booths. Dried fish arrive from the lake several times a week, sugar and other cooking supplies and foodstuff arrive with the same frequency as can be found in a cash and commodity poor country. Fuel at the two petrol stations is available most of the time. Even electricity and phone service is available to some of the residents, most of the time.  Almost anything can be found in Mponela that is available in any other parts of the nation with the possible exception of these things being in more abundant supply in the four largest cities. Mponela has a definite African flair and hospitality, and the visitor is welcomed throughout the region.

An Unsure Trip to an Unknown Location, for an Unsure Outcome

    The Mponela Rural Hospital sits along a dusty back road behind the Peoples Trading Center grocery store in the center of the town. It will not be noticed by the highway traffic unless someone knows to turn and look off to the west side of the road.  It seems reflective and representative of most of the rural hospitals in the nation. It has no doctor, only two or three nurses, and almost no working equipment. It has supplies only part of the time, and the patient count rises and falls with the availability of the needed supplies. Patients who come to the hospital cannot expect much in the way of service, and if the case is serious the patient will probably be referred to the Dowa District Hospital or into the capital city of Lilongwe to Bottom Hospital or to Kamuzu Central Hospital. In this case the problems will arise with the patients inability to pay for the transportation costs, and the problem with friends or family traveling with them to care for the patients needs during the stay in the hospital. For many it will be an unsure trip to an unknown location, for an unsure outcome.

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Salima District
Capital and Hospital

    Although no evidence of its past is visible in the present the name “Salima” can drive cold chills down the back of even a novice historian. It was from Salima, during the dark days of the slave trade, that thousands upon thousands of people were sold into slavery and shipped away to places such as India and Arabia. They were never heard from again. At the height of the trade in human life it has been estimated that over 10,000 people were sold each year into slavery from the jumping off points at the notorious lake communities of Karangu, Nkhotokoka, and Salima.

      Salima comes in on the population chart at 9th in the nation, with an estimated population of 22,440 in 2005.

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    We have traveled approximately 80 kilometers from Blessings Hospital in Lumbadzi and we are nearing the east side of the old trading center of Salima. This area along the lake was once a notorious slave-trading center, but today it is a quiet crossroads community on the road from Lilongwe to Senga Bay, or the north south route from the northern part of the country to the south along the lakeshore of lake Malawi. A sign on the left side of the road indicates we are nearly there and we turn off the main road, and start up a narrow dirt road to the north. Two kilometers and we reach the Salima District Hospital.

    Government hospitals in Malawi are in tiers. There are the major hospitals in the biggest population centers at the top of the tier. These are Queen Elizabeth in the southern city of Blantyre, Lilongwe Central and Lilongwe Bottom in the central region in the capital city of Lilongwe, and Central Hospital in the northern city of Mzuzu. Just below them are a tier of regional, or district hospitals. These medical facilities function as referral centers for the main hospitals. The third layer is the rural hospitals. There are a large number of these scattered all over the countryside. They feed up the food chain, or referral line to the district hospital. In reverse, the supply line comes back down that chain. From central stores the supplies feed out to each of the main hospitals, and then are fed out to the district hospitals, and on to the rural hospitals. Or at least that is the way it is designed to work. In reality there are never enough supplies.  Whether Tylenol for a cold, a band-aid for a cut, rubber gloves for a surgical procedure, or simply burn ointment to ward off an infection there are never enough. The supplies coming down the chain often run out long before they reach the rural hospital out in the bush, yet it is here where the front line war on disease is being carried out. When it cannot be stopped here the hospitals up the line are overwhelmed. This is what is taking place in Malawi. The battle is being lost in the rural areas of the country because of a lack of staff, equipment and resources. In these hospitals you look to see if they have any working equipment. Do they have an X-Ray machine, and is it working? Chances are in most of the rural and regional hospitals there is none, or it has been broken for sometime and there are no funds to repair it.  The surgical center in many of the hospitals is just a table with stirrups in a half-clean (or half-dirty depending on how you look at it) room with a tiny lamp, and a single light bulb.  Sterilization equipment is broken, and a dingy wash pan or cooking pot is being used to boil the water that will half-sterilize the instruments. Bleach is hard to come by.  Needles are used more than once, and a pair of rubber gloves for use in a surgical procedure cannot be found. Wards seldom have enough beds, and never have sheets, pillowcases or towels. A washcloth is unheard of in nearly any hospital.

Unsure of What to Expect

    With this entire image in mind I turn into the drive of the Salima District Hospital and prepare to follow Suzi into the cavernous, dark interior. She has been here before. I have not. She knows what to expect. I do not. As I exit the Isuzu at the concrete car park I immediately notice the sign above the main entrance. "Salima District Hospital - Friendly To Babies". As we near the door a staff member calls out to Suzi, "Hello Mama. It is good to see you."  I quickly learn this is a medical person that was working in the central region and has been transferred here. A promotion of sorts. We walk into the entrance and along a clean hallway. Halfway down the first corridor I pull out my notebook and pen, as well as my camera and prepare to document the inspection. Almost immediately I am surprised at the comparative cleanliness of the long, wide corridors. Some excellent planning has definitely gone into the construction of this facility, although time and the elements are definitely taking their toll on the walls, windows, doors and ceilings. It looks like the facility has been here some 50 or 60 years, and there is no indication of much improvements that has taken place since then. I have been with her to a number of rural hospital evaluations, and I am not looking forward to viewing certain parts of this one. I would much rather be back at the compound writing a book, building some sort of shelf, or almost anything, rather than walking down the dingy, smelly halls of an African hospital.

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During a recent gathering of the African community in Indianapolis the Malawi Project was awarded the prestigious “Philanthropy For Africa Award” for the humanitarian work being done in Africa. The award and plaque were given during the annual "Taste of Africa" event held in downtown Indianapolis.

    Accepting the award on behalf of the Malawi Project and its supporters were Richard and Suzi Stephens, members of the Board of Directors. In accepting the award Richard reviewed the accomplishments of some many people both in Africa and in America who had made the program successful over the past 7 years.

    African Community International is a non-profit organization focusing on helping newly arrived Africans assimilate more easily into the U.S. culture. It provides free health care, community events, and educational materials that are designed to help make the transition from life in Africa to a new life in America easier. Families from over 50 nations are participants in the organization. 

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    We came from America to work in a rural hospital in Malawi. Since our team was already working in the trading center of Mponela we decided it would be the rural hospital in this community where we would set up shop. This way we could learn firsthand what it was like in one of their front line facilities before we set out to persuade others to come and work along side us. Before leaving the comforts of America I had read the book “Out of America” by Keith Richburg, the bureau chief for the Washington Post. Keith had come to Africa to find his roots and found himself based in Nairobi, Kenya and traveling from one war zone to the next. During the course of his travels he had gone in and out of a number of African hospitals. Some of his descriptions were a little more vivid than the average layman would want to experience. His words embedded themselves deep into my intellect. I played them over and over in my mind.

    “In almost every place, conditions were, to put it mildly, disgusting. Stiflingly hot, windowless rooms, with flies swarming through fetid air. Patients stacked up almost on top of one another in crowded wards. Blood everywhere. Sick people, most likely with TB, coughing uncontrollably in open wards. Family members lining the hallways and packing the courtyards, cooking meals for patients inside who might not otherwise eat. If you weren’t sick before you went into an African hospital, I always mused, you most certainly would be by the time you emerged.”

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