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Last Updated: Friday, 7 April 2006, 00:55 GMT 01:55 UK
Diary of a journey back
Mary Ntata is a nurse from Malawi who trained in the UK and is currently living and working in Coventry. She travelled to Malawi to see what the conditions are like for the nurses who work there.

Mary Ntata. Credit: Eva Lotta Jansson
Malawian nurse Mary Ntata now works in England. All photos: Eva Lotta Jansson

Thursday, 30 March

I've just completed my last shift before leaving for Malawi.

It was a quiet shift - I settled the five patients in their private rooms and, with another nurse, kept an eye on them overnight.

Looking round the patient's rooms at their TVs, kettles and telephones, it makes me wonder how different the conditions will be when I visit the hospital in Malawi.

I am excited about coming back, seeing my family and friends, eating Malawian food and seeing what has changed in the two years since I left.

But I'm nervous about visiting the hospital.

Poor wages have led to massive shortages of nurses and I'm wondering how bad things have actually become.

Sunday, 2 April

We went to the main hospital in Lilongwe today and followed a nurse called Khetase past a long line of women and children to the children's ward.

I was so shocked by what I saw. The ward was dirty and although there was a cleaner mopping the floor, it made no difference because the ward was so crowded with patients and their guardians.

Many of the children were sharing a bed with another patient and this is on a ward where the children are seriously ill - the equivalent of a high dependency unit in the UK.

One boy, Godfrey, lay very still on the floor with his head on his grandmother's knee. He had acute diarrhoea.

Godfrey, sat on his grandmother's lap. Credit: Eva Lotta Jansson
Godfrey, mentioned in the diary, sat on his grandmother's lap

In the UK he would probably be on a drip but here there was not even a bed for him.

Philip, a small baby was malnourished and also seriously ill with acute diarrhoea. Khetase told me he is an orphan and his parents died from HIV/Aids.

Khetase told me how frustrating it is to work without the equipment she needs. Often she doesn't have the prescribed form of antibiotics for the children so she has to improvise, for instance, oral tablets instead of intravenous.

This affects the survival rate of the children. Usually they have to split intravenous fluid bags between the children as there aren't enough for everyone who needs one.

In the UK each bed would have oxygen available but here it is only available in three beds so the children have to swap around. None of the beds have sheets, just bare plastic mattresses.

The children were all crying or lying very still and it was so horrible to see. I wished I could do something to help.

Rainy season

Another nurse, Christine Chimbaza, took us to the women's medical ward. All the beds were full and so was the corridor outside, which is open to the elements and the rain in the rainy season.

One patient, Sarah Kamodzi, who needed a blood transfusion, was told it would not happen unless she could find a donor herself.

There is no blood in the hospital blood bank.

Christine was administering injections without protective gloves and this is on a ward where at least 30% of the patients are HIV positive.

She uses gloves only with patients who have been diagnosed with highly infectious diseases and did not even have a proper bin for used needles.

She understands the risks to her own health, but tries not to think about it as she feels compelled to ease the suffering of the patients.

Crowded hospital. Credit: Eva Lotta Jansson
Hosptials can become crowded and cooridoors end up as wards

Everyone who is admitted into the hospital is offered a test for HIV/AIDs, although many do not take it.

There are enough anti-retro viral drugs available for those who test positive and whose conditions are serious enough but not enough staff to administer the drugs.

So the patients have to leave their beds and queue for the drugs from 3am.

The nurses dispense the drugs from 7am but many of those who have been waiting through the night are turned away.

Christine told me that in the hospital there is one nurse for every 54 patients. This means that there is no time to do the most basic tasks like checking the vital signs of the patients.

Consequently if a patient has picked up an infection from another patient it usually goes undetected.

Like all the nurses in the hospital Christine works very long hours - sometimes three shifts without a break - for very little pay.

She takes home the equivalent of 40 a month and has four children to support. It is no wonder that the hospital only has a quarter of the nurses it needs.

I found today really upsetting, especially seeing the conditions on the children's ward. I wished I could use my nursing skills to help.

Monday, 3 April

Nurse college. Credit: Eva Lotta Jansson
Nurses learning their trade

Today we visited a college of nursing to meet the nurses of the future.

The British government is funding a scheme to help supplement the wages of key health workers by 50% and to train new nurses but the students know that the pay they can expect is still barely enough to live on.

Despite this most of the students told me that they planned to work in the government hospitals when they graduated.

The training school felt good after being in the hospital and it was great to meet such committed students.

However, the principal of the college told me that the college only produces about 60 nurses a year. With more funding, it could double this number.

We returned to the hospital in the afternoon and I was reminded of the extent of the needs here.

Nurse shortages are even worse than I expected and seeing how hard the nurses have to work and the lack of resources available it is hard to understand how they carry on.

Yet they show incredible spirit and commitment in almost impossible circumstances.

Coming back to Malawi has made me realise how much my skills are needed here, and made me even more determined to come back to help my people.

To find out more about Mary's story watch the BBC 6pm News on World Health Day Friday 7th April, or see:

World 'lacks 4m health workers'
06 Apr 06 |  Health
Cholera warning for West Africa
02 Sep 05 |  Africa

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