The government run hospital system in Malawi is designed in a three-tiered network of interlocking medical facilities. The third tier is a large network of rural hospitals woven throughout the country. They serve as the first line of defense in the war against disease. Their services are free and they are often the only medical facility that many village people will see in their lifetimes. Most medical cases enter the system through the rural hospital nearest their home. There are almost no doctors and few nurses at any of the rural hospitals. Although many facilities have antiquated surgical equipment, there are no surgeons on staff to carry out even minor surgery, so these units remain out of service. Supplies to the rural hospitals are often not available. The overall system is designed to fill the needs of the top tier first, then to the second tier and finally to the rural hospitals on the third tier. The problem comes when there are only enough supplies for the top tier, and few for the other levels. When this happens the third tier receives no supplies at all. This can mean between supply shipments, a typical rural hospital may have nothing on its shelves, not even a band-aid or an aspirin. When its supplies run out the word spreads quickly through the catchment area, and the village people stop coming to the hospitals. Births, deaths and other illnesses are handled in the villages and disease spreads without any safeguards.
According to the government plan when a medical case is too critical for the rural hospital to handle, the system calls for the patient to be transferred to the district hospital. These facilities are centrally located in each of Malawi&rsuo;s 27 districts. This plan calls for the district hospitals to perform more involved surgery and handle the more difficult cases, but there are no surgeons, no doctors and few nurses even at the district level. Here, as with the situation at the rural level, the supplies run short. The system that is designed to feed from the top fails when there is not enough medicine or resources for even the top tier of the medical establishment.
The top tier is designed for patients to be referred to facilities that have more advanced technology, resources, medicine and medical personnel. Also when problems cannot be resolved at either of the two lower levels. These top tier hospitals are in the major urban areas. However, as with the other two tiers the shortage of supplies and medical personnel is overwhelming and fails to fill the needs. Few nurses and fewer doctors are even at the top tier in order to assist with a growing influx of HIV/AIDS, tuberculosis, malaria, childbirth, accident cases and a multitude of other medical needs for a nation of 12,000,000 people. Even at the top tier, as with the other two, the equipment is broken and in need of repair or even non-existent, the medical staff personnel works long hours with little protection from exposure to disease, and the supplies and medicines that are required to save lives are often not available. For the entire nation and for all three tiers of medical care there are registered less than 100 doctors and 3,000 nurses. The problem is compounded with the fact that nearly half of the graduating doctors and nurses from the Malawi Medical School system leave the country to practice.
Upon evaluating the efforts being made by most of the Malawi medical establishment Suzi Stephens, the Medical Director for the Malawi Project and a Registered Nurse concludes, “I have never been more proud to be a nurse and a part of the medical profession as when I see the gallant efforts being put forth by Malawi doctors and nurses in an attempt to stem the tide of death, disease and illness, and I see them doing it against such impossible odds.”
Meantime as the healthcare crisis continues to worsen, a broken medical system in one of the poorest nations in the world cries out to be heard. By and large the cries are going unheard and rest of the world does not see them or hear their plea.