Holy Family Mission Hospital - Pro Phalombe

HOLY FAMILY MISSION HOSPITALHoly Family Mission HospitalNEWSLETTER DECEMBER 2007News from under the mountain…Holy Family Mission HospitalBox 144PhalombeMalawie-mail: phalombeholyhospital@yahoo.comBank accountNational Bank of Malawi, Mulanje branchA/C no. 0141175030100IBAN: NBMAMWMW001Editorial team:Mr. L. Malipa (Editor)Dr. R. Anten (Co-editor)Mr. S. Chanza (Secretary)Mr. NamalawaMr. R. ChinzuMr. M. Phwandaphwanda1

HOLY FAMILY MISSION HOSPITALIn this issue:-- Editorial Comment- Renovation of Male and Female ward- Tripartite agreement- Anti-retroviral therapy (ART) programat Holy Family Mission Hospital- Impressions of life at Holy FamilyMission Hospital- Reporting Religion (after theMissionaries, of Witches and Wizards)- Case reports (Burkitt’s lymphoma,hydrocephalus)- Poetry- Time to LoughEditorial CommentGreetings from the foot of Mt. Mulanje. Itis where Holy Family Mission hospital islocated. One of the oldest Missionhospitals in one of the newest districts ofMalawi. We are proud to present to youour first newsletter produced by a jointeffort of our editorial team with additionsof staff members.We have chosen the month ofDecember to bring out our firstnewsletter because it is the month ofreflection. Reflection on things that havehappened in the past year, and on theway forward.All the work, which has been done in thelast year, couldn’t have beenaccomplished with out assistance of ourdonors. At Holy Family we re blessedwith the continues support of Mr. Slager.A private person who cares about ourinstitution. He has financially supportedus in the past thirty years; anaccomplishment on it’s own. Few donorsare willing to support the running costsof a hospital, but due to his kinddonations, we were able to provide ourinstitution with electricity, water anddrugs for our patients.Pro-Phalombe, a Swiss associationfounded by friends of Chris (MedicalDoctor) and Silvia(Occupational therapist) who worked atHoly Family in the nineties. Thisassociation developed a long-termproject on improving the constructions atour hospital. In 2001 they financed theconstruction of a new paediatric ward.This year it was Male and Female wardthat were renovated with their financialassistance. All ready a new project is inthe pipeline: constructing a new theatreand laboratory.Cordaid, former Memisa has also beenassisting our hospital for many years.Initially by sending Dutch medicalDoctors to Holy Family. In the last yearsit has put it’s emphasis more ondeveloping human capacity andstrengthening organisationaldevelopment. Currently we have enteredtogether with Cortaid and AlbertSchweitzer Hospital (Dordrecht, theNetherlands) in a tripartite agreement.The aim of this agreement is to improvethe quality of medical care at HolyFamily, by supplying medical equipment,improving capacity and organisationalstructure and constructing staff housesand a guardian shelter. Also the nursingschool is to benefit from this agreement.Apart from these, other donors havebeen assisting us with their kinddonations and we fully appreciate theirsupport.The struggle against the HIV/AIDSpandemic in Malawi has a majorinfluence in our daily work. The majorityof our patients are struggling againstHIV related diseases, quite a numberof our staff are infected with HIV,developing an HIV/AIDS policy for thehospital is still a major challenge. One ofthe spear points of the fight againstHIV/AIDS is the countrywide program ofproviding eligible HIV (+) patients withHAART (Highly Active Anti RetroviralTherapy). At Holy Family we started anART clinic in 2005 and are currentlytreating over 1200 patients with HAART.This newsletter will also give youinformation on developments with in ourparish. The Comboni Missionaries havehanded the parish over to Malawianpriests from the Archdiocese of Blantyre.We interviewed a staff member onwitchcraft. “Whichcraft is real, just2

HOLY FAMILY MISSION HOSPITALremember to rely on God in every thinyou do”. Further more you will find in ournewsletter clinical reports on Burkitt’slymphoma and hydrocephalus. Medicalconditions relatively often seen in ourhospital.For a person to enjoy life to the fullest,there should be time for poetry andlaughter…On behalf of all staff members at Holy, Iwish all persons involved in the wellbeing of our hospital a wonderfulChristmas and a happy new year.Dr. AntenRenovation of Male and Female wardPro-Phalombe, a kindred spiritWard rounds in the newly renovated female wardDuring the time I have been working atHoly Family, I had the privilege to meetwith three members of the Pro-Phalombe Association (Marcus, Chrisand Silvia). During the process ofplanning and implementing projectsfunded by the association, I hadmany an opportunity to exchange ideas,experiences and thoughts on Malawiand particularly Holy Family Hospital.What always struck me in ourcommunication, was their sincere anddeep felt relation with our Hospital. Itwas, as Chris once wrote in aNewsletter Of Pro-Phalombe, a feelingof finding a kindred spirit.The relation between Pro-Phalombe andHoly Family Hospital has its source inthe nineties, when Chris and Silvia wereboth working at Holy Family. To assistthe hospital in the work they started,their friends in Switzerland started thePro-Phalombe association. Theyinitiated the development of a long-termplan to improve the structures with in thehospital. Funding was sourced from thelocal community in Switzerland.The first major project, which was takenon, was the building of a new paediatricward. It was finished in 2001 and is nowthe pride of our hospital. The secondproject was renovating male and femaleward. When I started working for thehospital in 2003 this project was still inits initial phase. Together with Marcus,management developed the definiteplan of renovations. Previously thewards consisted of small and darkspaces. The goal of the project was tomake better use of the existing space,and provide patients with a healthierenvironment. The construction worksstarted in October 2006. In July 2007 wewere able to move all the patients backin to new and specious wards. From thatday it is a joy to do ward rounds in awell-lighted specious male and femaleward.3

HOLY FAMILY MISSION HOSPITALA third project has been taken on. Itdeals with improving the water supply ofthe hospital. Already two boreholes havebeen drilled, new pipes are being laidand the existing water tanks will berepaired.Two new boreholes are being drilledThe fourth phase of the long term plan byPro-Phalombe will be the construction ofa new theatre and renovating of thelaboratory. Our friends in Switzerland areeager to take on this new challengetogether with Holy. Preliminarydiscussions on the new project were heldwith the architect and initial drawingswere made. Writing this down, andcontemplating what Pro-Phalombe hasalready done for the hospital, I amamazed by the commitment of membersof the Pro-Phalombe association and feelsuch gratitude towards these kindredspirits in Switzerland.Dr. AntenTripartite AgreementThis agreement is between the AlbertSchweitzer Hospital in Holland, Cordaidformer Memisa and d Holy FamilyMission Hospital. It had its official start inAugust 2006.The collaboration is based on equality ofall involved parties. It strives to improvethe quality of medical care delivered byour Hospital using the resources andcontacts of ASz and Cordaid.The focus is on improvement of medicaland teaching equipment, constructionand human recourse development.4

HOLY FAMILY MISSION HOSPITALChristmas came early this year…Unloading the containerIt is more as a year ago that we receiveda delegation from the Albert SchweitzerHospital and Cordaid. The reason fortheir visit was to formalize collaborationbetween them and Holy Family Hospitaland Nursing School (tripartiteagreement). We spent five days together,traveling through out phalombe district,meeting stake holders and dignitariesand most importantly, exchangingthoughts and ideas on our collaboration.Guiding principle in all discussions wasequality of all involved parties. As oneinvolved in the process of finalizing thetripartite agreement, I was pleasantlysurprised by he attitude of our colleaguesfrom ASz. Their enthusiasm, willingnessto listen and never imposing their ownbelieves, made us feel comfortableenough to share our thoughts and iedeaswith them.The deliberations ended with an officialceremony. The tripartite agreement wassigned by representatives of the threeparties and ended with traditionalMalawian dancing and singing.The focus in the first year was onproviding the hospital with medicalequipment and the school with books andcomputers. An inventory was made byHFMH on what equipment and goodswere really needed. This information wasused by ASz to source these from theirown institution. Technicians from ASztested the machines and computers ondurability. Finally all equipment andgoods were packed in a container andsend to Phalombe. Now the long waitingstarted……………..In the beginning of this year we foundthat we were running into problems withour theatre light. One by one the bulbswere going out. Subsequently surgerywas done in ever poorer light. Atelephone call was made to ASz,explaining our dilemma. With in a fewweeks bulbs arrived at the hospital andwe were able to see again.5

HOLY FAMILY MISSION HOSPITAL……. In the beginning of September wegot the good news that the container hadarrived in Blantyre. The only thingremaining was to clear the container withthe MRA (Malawian Revenue Authority).Surprisingly this went with out any delay.The only little problem was that the truck,on which the container was loaded, brokedown on its way to the hospital. On the….of September the container was finallydelivered. The unpacking of the container……………………………………………….Anti-Retroviral Therapy (ART)program at Holy FamilyMission Hospital.Holy Family Mission hospital with theinitiative of national aids commission(NAC) and not forgetting hard workingdoctors, clinicians and nurses started theART clinic in July 2005. All medical staffunderwent training on the treatment ofHIV (+) patients.From the start of theART program we have been facingmultiple challenges;The running of the clinic is in the handsof just a few clinicians and nurses. Thework is done on voluntary bases with outany additional financial compensation.The ART staff is expected to continuetheir regular duties next to running theART clinic. The clinic is situated in a preexistingbuilding, with small and poorlyventilated rooms. . From the community,stigma and discrimination are still major achallenge for the clients to attend ARTClinic. Especially the male populationseems to have difficult with the stigma.They are the ones reluctant to be testedon HIV. If not tested, these clients are notable to excess the ART clinic services.Most of the clients on ART have to travellong distances to get their monthly supplyof drugs.Quite a few clients are unable to managethis either because of their poor physicalcondition, or they lack the financialresources to pay for their transport.was like a little calibration. Staff of thehospital were gathered around, and eachitem coming out, was welcomed withcheers of joy. As one nurse said:Christmas comes early this year…………….. Sitting behind one of thecomputers donated by ASz, typing thisaccount of past happenings, I amconvinced that the two coming years ofour collaboration will be as fruitful as thefirst. Zikomo Kwambiri!!!!!……………………………………………….Despite all these challenges, the programstarted and now we are proud to say thatwe have managed to register 1296clients since the program started in 2005.OVERRAL REPORTTOTAL NUMBER OF MALES 485[38%]TOTAL NUMBER OF FEMALES791[61%]TOTAL NUMBER OF CHILDREN64[5.1%]Currently on average 35 new patients areregistered on ART every month. Theclinic is run every Tuesday andThursday. The number of staff comprisesof five nurses, four cliniciansand two clerks. In spite of the shortage ofhuman resource, we have managed toget a certificate of excellence inmanaging the clinic, handed out by theministry of health for every quarter sincethe start of the clinic.A new development is the opening of fourART clinics in health centers in thedistrict. Hopefully this will lead todecongestion of our clinic at Holy Family.All in all, Holy Family is doing a good jobin the HIV/AIDS program, despite that ithas a big catchment area (population of300.000). We also feel that there is agrowing sense amongst to population ofour district on the importance of findingout once HIV status and accessing theservices provided by our hospital.Hope to meet you next quarter.Mr. M. Phwandaphwanda, NMT6

HOLY FAMILY MISSION HOSPITALImpressions of Life at Holy FamilyMission HospitalThe first thing that impressed me when Ifirst started here was the beauty of theplace, let alone the friendliness of thepeople. Everyone is eager to help yousettle in quickly as a new member of thefamily. Located at the bottom of MulanjeMountain, we are exposed to themountain breeze. There is a saying;melons are difficult to grow but sweet toeat.Previously people had difficulties to travelto Holy Family due to a bumpy road fromChitakale, Mulanje. But very soon this willbe a thing of the past. Since there istremendous road construction inprogress.To help people either sick orhealthy, in pain or in sorrow, is our dailyassignment. This is so just because thehealth professionals are committed toassist people with love following theexample of the greatest physician, JesusChrist. Most people think that Hoy Familyis a hospital employs only catholic staff.This is not the case! All are welcome.There is a saying: All work and no playmade Jack a dull boy. Holy Family is notjust a hospital, as you probably beenmade to believe. There are several socialactivities offered, from sports to hospitalexcursions. The highlight being going tolake Malawi. Life I never dull at HolyFamily and you will cherish the timespent.S. Chanza, Medical AssistantReporting ReligionAfter the Missionaries….Holy Family Parish ChurchIt has taken long before the Parishionersof Phalombe parish came to realize thatthey could stand firm on themselves. Inthe past years they have been dependingon Missionaries. Now new developmentsare rooting in Phalombe parish.Phalombe parish (St Mary) wasestablished in the early 1930’s by theMontfort fathers. After their period ofservice the Montfort fathers handed overthe Parish to the Archdiocese ofBlantyre. After which the ComboniMissionaries, whose founder is DanielComboni, came in to run the Parish foralmost 30 years. After running the parishfor 30 years, the Comboni Missionarieshanded over the parish back to theArchdiocese of Blantyre. On the 10th ofSeptember this year, the ComboniMissionaries officially handed over theParish to the Diocesan priests. Thismarks the beginning of self-reliance ofthe Phalombe Parishioners, who7

HOLY FAMILY MISSION HOSPITALdepended much on the Missionaries,hence it has been a blessing indisguise. With the coming of he Diocesanpriests at Phalombe parish, we haverealized that we can produce somethingthat can be credited. Under theirguidance a lot of new developments haveso far taken place. In the past we couldcelebrate mass once every three weeksat the parish.Now we are able to celebrate mass everySunday and weekdays. More to this, ourfellows Catholic Christians at the outstations are also readily reached for thecelebration of the Eucharist (mass) atleast twice in a month. Still more, prayershave even over flowed to the hospital.……………………………………………….Of witches and wizardsAn interview with a staff member onwitchcraft“I have seen you here, who are you andwhat are you doing?”>” I am Molly. I work at Holy Family aspatient attendant. I have served thehospital for many years.”>”You look like a Christian. Are you?”>”Yes, how can I live without Jesus onmy side. I am a devoted member of theCCAP Church”.>“Being a devoted Christian, do youbelieve there is witchcraft in this world”.. >”My son, it shows you do not read thebible. The God’s servant John, who wrotethe book of revelation, wrote on chapter21v4 “those who practise magic… theirplace is the lake burning with fire andsulphur”.>”In your life, do you remember anyscenario that happened concerningwitchcraft?”>“Yes, in our neighbouring village, therewas a woman. She was a wizard. Sheused to attend night (magic) parties without any contribution. Her fellow wizardswere contributing human meet. Oneoccasion she was asked to host a partyof such kind. I will tell you, she wasPriests are celebrating mass at thehospital every second Wednesday ofeach month, giving an opportunity to theCatholic patients and guardians toreceive the Holy Communion. Other newdevelopments; the Church is puttingmuch emphasis on education andselfreliance. At the moment the Church isabout to start building a secondaryschool, which has been dragging for thepast three years. And Phalombeparishioners are being empowered onself-reliance so that they can stand firmto run the parish by themselves.Mr. L. Malipa, Mr. Namalawa, Mrs.Chiwambo……………………………………………panicking, since she had no children buta grandson who was productivefinancially living in Blantyre>”What Happened?”>”She decided to board a magic nightflight and cast spells on her grandson.“Had she known, comes last”. She didnot know that his house was alsomagically well protected. In a twinkling oftime she found herself landing onto thegraveyard.”>”Was she okay?”>”No, she had an unique appearance.She was naked. Her anatomy changed.She had long fingernails, protrudingmouth, lips of a duck. Her abdomen wasmassively distended”.>”How did the people learn about thisissue?”>”When it comes to this, anyone can seethe wizard, since the cat was let out ofthe bag”>”What was the reaction of the people?”>The matter was reported to LimbePolice, who referred the case to thepolice in Phalombe. When arriving at thepolice station she received a mockeryheroes welcome. People from all walks oflife gathered there ululating and shouting“Mfitiyo, Mfitiyo” meaning; wizard, seethe wizard”.8

HOLY FAMILY MISSION HOSPITAL>”Is she still alive?”>”She died after a few days. But beforeher death one of the senior chiefssplashed her with some watery herbsand changed her outlook back tonormal”.>”What is your last word?”>”Witchcraft is real, but just remember torely on God in everything you do”S. Chanza, Medical assistant……………………………………………….Case ReportsBurkitt’s lymphomaFour-year-old child with a facial tumourAmuna Akadya Fote is a four-year-oldmale child from Msila village,Mozambique. He was referred fromNambazo Health centre in July of thisyear. He had a history of swelling of theright cheek for two months. It started inMay, with a toothache on the same side.Since then the swelling has been growingprogressively. On admission he wasunable to see with his right eye andunable to eat solid food due to theextend of the facial swelling. No previousmedical history. Received allvaccinationsOn examination:Swelling of the right cheek, hard nontender, irregular in nature, fixed to themaxilla Fit, a febrile, pink conjunctiva.Body weight not taken. Nolymphadenopathy. Clear lungsPer abdomen, no organomegaly.Extremities, nothing abnormal detectedHb: 11.8 gr/dlWBC: 4100/ mm3Diff /Neutr: 53%Lymph: 46%DD/ Burkitt’s lymphomaPatient was referred to Queens CentralHospital in Blantyre for further diagnoses(histology) and chemotherapy (com)Theory Burkitt’s lymphoma (BL).The commonest childhood cancer intropical Africa. There is a peak incidenceat 5-9 years, with a male predominance.…………………………………………….It is endemic in tropical Africa. It occurssporadically in the West. Endemicity canbe correlated with frequent childhoodexposure to an infection with Epstein-Barr virus (EBV) before the age of oneyear. BL also occurs as a complication ofAIDS.Clinical: often presents with tumours ofthe jaw and gastro-intestinal involvement.It grows rapidly to large size with in a fewweeks. Histology shows a “starry sky”appearance (isolated histiocytes on abackground of abnormal lymphocytes).Management: a single dose ofcyclophosphomide, repeated for twodoses beyond complete remission. Ifavailable, methotrexate and vincristinshould be given along withcyclophosphamide (COM therapy). Therates of complete remission are 80-90%.The cure rate is over 50%.……………………………HydrocephalusWorking as nurse in our paediatricward I have seen quite a few patientswith an enlarged head circumference,the medical term is hydrocephalus.Either the child was born with anenlarged head (congenital) or itdeveloped after birth (secondaryeither to meningitis)During the quarter of July-SeptemberHoly Family Hospital has registered fourcases of hydrocephalus of which threewere caused by the child having hadmeningitis and one patient was born withthis affliction (congenital). All thesepatients have been referred to Queen9

HOLY FAMILY MISSION HOSPITALElizabeth central hospital in Blantye,where they were managed because itwas beyond the therapeutic possibilitiesof this hospital.……………………………Clinical manifestation of the referredcases1.Accelerated rate of head growth2 Sunset eyes (downward deviation ofthe eyes)3. Bulging anterior fontanelInvestigations done1.Lumber puncture was done to analysethe cerebral spinal fluid. And those whohad their cerebral spinal fluid analysissuggestive of meningitis were firsttreated and then referred to QueensWanting to know more abouthydrocephalus, I did some research:Hydrocephalus is the accumulation of thecerebral spinal fluid (CSF) in the brainmeninges either caused by blockage ofthe ventricles, post meningitis or inabilityof the arachnoid villi to absorb the CSFPathophysiologyIn the brain there are two ventricles,which are found in two hemispheres, andthese are right and left lateral ventricles.the third ventricle passes through theforamen of Munro. At each ventricle thereis a network of capillaries called choroidplexus. These capillaries receive bloodfrom arterioles in the pia mater andsecrete cerebral spinal fluid in theventricles. Each cerebral hemispherecontains a lateral ventricle, which isconnected to the third ventricleby foramen of Munro, and the thirdventricle connected to the fourth byaqueducts of Sylviu. Once cerebral spinalfluid is produced in the choroid plexus itdrains through the two lateralventricles and passes through theforamen of Munro to reach the thirdventricle and finally to the fourth ventricle……………………………which carries it to the subarachnoidspace where it circulates and getsabsorbed by arachnoid villi Cerebralspinal fluid is produced at the rate of20mls per hour and the whole of it issupposed to be absorbed.Causes of hydrocephalus1.Inability of the arachnoid villi to absorbthe circulated cerebral spinal fluid2.blockage of the cerebral spinal fluiddrainage in the subarachnoid spaceeither in lateral ventricles or fourthventricle3. Post meningitis blockage by pus in thecerebral spinal fluid4. Congenital; a child may born withabnormality either in the absorption orstructure of the ventriclesManagement of hydrocephalus1. CT scanning to detect any defect orblockage, malformation2. Aspiration of fluid from the anteriorfontanel to analyse for bacteria and casts3. Ventriculoperitonial shuntingMr. R. Chinzu, NMT10

HOLY FAMILY MISSION HOSPITALPoetryLoveWhen it comes, will it come with out awarning?just as I am, picking my nose?Will it knock on my door in the morning?or tread in the bus on my toes?Will it come like a change in the weather?Will its greetings be courteous or rough?Will it alter my life altogether?Oh… am just, but afraid.Will you experienced good friends tellme?Will my entertainment not being stolen??But just tell me the truth about loveMr. S. ChanzaTime to laugh“Chisomo”A clinician tells three-year-old Chisomothat he has a running nose. Chisomoreplies angrily:“Where is it running to? My nose is justwith me”. Mr. S. Chanza, Medical assistantFurious teacherA teacher was dictating notes to hisclass. At the end of a paragraph hedismissed the class for time was over.The next day the teacher asked his classwhere they had stopped. One pupilquickly stood up and answered theteacher “we stopped at full stop, Sir.” Theteacher got angry and sent him out of theclass.Mr. Namalawa, Senior Accounts AssistantHotel experienceA certain man went to a hotel with hisson. Upon arrival at the hotel theyordered rice and an egg each. Whileeating, the son noted that there was achick in his egg and informed his fatherabout it. The father replied: “just eat itquickly, if the waiter sees it, he willcharge us extra”.Mr. Namalawa, Senior Accounts AssistantMerry Christmas & Happy New Year!!11