In January 2006, the Trust Board of University Hospitals Coventry and Warwickshire NHS Trust (UHCW) supported a proposal to establish a formal link with two hospitals in Nkhotakota, Malawi for a minimum of five years. The primary aims of the link were to provide support to the specified hospitals by the provision of training to local health workers and provision of specific items of equipment. Funding for the link was to come from charitably raised monies.
The UK government actively promotes links between NHS organisations and developing health economies to provide medical assistance in a variety of ways. The NHS benefits substantially from the training opportunities and breadth of experience on offer in international work in which healthcare professionals are either involved on their own initiatives, or through their employers.
Malawi is one of the countries that is the focus of the UK government, as it has a substantial HIV problem and a significant shortage of health care staff. The Tropical Health and Education Trust (THET) have been commissioned by the government to oversee and provide guidance to health links. Health Link Malawi is operating within the framework and guidelines set by THET.
Links allow NHS staff to contribute to the improvement of healthcare worldwide, whilst continuing to serve their own communities. Links motivate staff, enlarge their experience, sharpen their skills and thus help to retain them within each country’s National Health Service: the benefits are clearly felt by both English and overseas partners. Participating in a health link provides the opportunity for UHCW staff to work in a different healthcare environment as part of their continuing professional development.
Benefits of this include:
- Broaden horizons and learn from a different culture
- Professional development of staff as develop skills from: i. New pathologies ii. Teaching and leadership iii. Adaptability and ingenuity iv. Demanding and different responsibilities
- Renewed motivation and fresh perspective
- Retention and recruitment
- Participation in a significant humanitarian project
- Greater appreciation of the needs of developing health economies – cultural and economic factors in health
- Corporate social responsibilities
- Research opportunities
Details of partner organisations Health Link Malawi was established by UHCW, but aims to incorporate all health care providers in Coventry and Warwickshire. The link is focused on a town called Nkhotakota, situated 200km North East of the capital, Lilongwe, on the short of Lake Malawi, about mid point from North to South of the country. It is a small town of around 200,000 and its economy is agriculture. It is notable as the setting for the negotiation between Livingston and the African tribes in 1861 which effectively ended Slavery.
It is served by two hospitals: St Anne’s Hospital (mission/church foundation) and District Hospital (government foundation). Both of these hospitals also serve rural health clinics. Health Link Malawi aims to support the provision of health care in all of these forms.
After much deliberation and consultation, it was agreed that the most effective and manageable way to run Health Link Malawi was as a charity in its own right. This involved registration with the Charity Commission of England and Wales. Trustees for the charity were agreed along with a governing document. Health Link Malawi’s registered number is 1117624. In April 2006; a steering board for Health Link Malawi was established to manage the strategy; direction and operational requirements of the link. The membership of the group was designed to reflect the various needs of the link: clinical; nursing; publicity; previous experience; finance etc. Following establishment of the link as a formal charity; this group evolved into a formal sub-committee of the Trustees with delegated responsibility to make decisions on behalf of the Trustees within the parameters set to them.
A group was established to focus on fundraising for the link. This included some enthusiastic and valuable contributions from a wide spectrum of staff within the Trust. A number of good ideas have been generated and some money has been raised. All the staff involved are doing so on a voluntary basis and it has been felt that the resource and drive has not been sufficient to follow through as well as might have been hoped by all concerned. The nature of this group is due to be reviewed by the Health Link Malawi Trustees at the end of March 2007.
Equipment from Walsgrave and Coventry and Warwickshire Hospital The move to the new University Hospital provided the link with a unique opportunity to identify hospital equipment that was fit-for-purpose but not transferring to the new hospital. In conjunction with St Anne’s Hospital; the Steering Board agreed a list of equipment that would be of most use to the hospitals in Malawi. This included hospital beds; anaesthetic machines and surgical instruments. This equipment was shipped in a container provided at cost by TNT.
Ambulance The first request from St Anne’s hospital was for an ambulance to assist primarily with bringing pregnant women into the hospital from the rural areas. Women are otherwise dependent on public transport and help is often too late by the time they arrive at the hospital. In partnership with Land Rover; Health Link Malawi was able to commission and raise funds for this purpose. Partners who supported the purchase of the vehicle include Skanska; Innisfree and PMA. The vehicle is due to arrive in Nkhotakota in April 2007.
In summer 2006, a small delegation from the Trust travelled to Nkhotakota in order to: Meet staff and scope facilities; Discuss clinical priorities and training needs; Review other ways to support health services; Conduct risk assessments and understand how to prepare for staff placements; including clinical; cultural and accommodation issues. This visit was essential in forming the direction of the link and ensuring that appropriate measure were put in place to support staff participating in a placement.
The first clinical team to deliver training and share skills with frontline staff was an obstetric based team. This involved two midwives and one consultant in February 2007. The staff who participated in this clinical placement found it extremely challenging; both personally and professionally. They were able to provide some support and training to health workers and assist with frontline care. Feedback from this visit will be crucial for shaping and maximising on future placement opportunities.
Portable ultrasound machine UHCW has asked its private sector partners to support Health Link Malawi; primarily through the provision of funds for the ambulance. Rather than do this, GE Medical wanted to donate a piece of equipment. The steering board advised that a portable ultrasound machine would be the most useful piece of medical equipment. This was donated by GE and delivered to St Anne’s Hospital in February 2007 as part of the obstetric team visit. Health Link Malawi intends to provide ongoing training and support in the use of this machine.
Partners Health Link Malawi is building support from the local area as well as other organisations that are involved in similar work. These include: THET, Scottish Executive, Coventry Evening Telegraph, NHS Warwickshire, Coventry PCT
Three further clinical placements in 2007 to build on each other: May – Respiratory and Diagnostic focus; July – Mixed to include paediatrics and obstetrics; Autumn – to be confirmed; Build on links with NHS Warwickshire and Coventry PCT; Develop links with nursing/medical schools; Raise funds; including hospital ball; Review nature and remit of fundraising committee.
Dr Keith Struthers
University Hospitals Coventry and Warwickshire NHS Trust
Executive Suite, University Hospital
Mr Emmanuel Pemba
St Anne’s Hospital and Nkotakota District Hospital
PO Box 52
Tel: 00265 1292 335