Christmas Babies

Several weeks ago this tiny baby boy was brought into the hospital by the local police dept, having been dumped at a nearby business centre, crying his eyes out but soon quieted by a slurp of formula milk. Since then 'Moses' has grown considerably and consumes a good quantity of milk and loves to be taken for a lullaby walk around the busy Maternity dept, usually by one of the student nurses. It is interesting to see the large men with a tiny baby rocking in their arms.

Moses has been donated several clothing items (having arrived naked in a rather dirty cloth) by the nursing students Scripture union. Incongruously, one of the little 'T' shirts says 'I love Mummy and Daddy'. Where are Mummy and Daddy? We will never know and nor will Moses.

Just recently, on boxing day (the day after Christmas) Moses has been joined by another tiny baby, also crying for a slurp of milk, duly quieted by the appropriate drink. He was brought in by the local police having been left on the doorstep of a local clinic. The local Social welfare dept have been looking since the arrival of Moses for a place in one of the orphanages throughout Zimbabwe, with no luck: the orphanages are brimming, under staffed and under resourced. If Moses ever finds himself in such an institution he would have to wait awhile for his slurp of milk, while here at Murambinda he quickly gets his demand, thanks to MSF and their willingness to help the hospital with formula for the needy children.

BUT how can we continue to manage? We are already having to care for this patient on intravenous quinine, this mother delivering twins, a wasted patient staggering through the hospital door at midnight… Moses and his companion must move on, much as we love them.

What of the desperate Mums that felt the only way forward for themselves and their babies was to leave them and hope they would fall into good hands? How many babies have not fallen into good hands? Did these Mums forget to take precautions? Could they not afford precautions? Were they forced into unwanted sex? And the Dads? Moses certainly is a beautiful baby, and a good baby, what his parents are missing! What lies ahead for him? Maybe he will part the seas, maybe a miserable infanthood of wet nappies and hunger?

Zimbabwe is not an easy place to find your way if you live on the edge for whatever reason, but Farai, the tall nursing student, who lovingly walks up and down with Moses says there is much to be said for Zimbabwe.

Rabies Story

Time for some more Murambinda news.

On call last night I was asked to see six patients, who had been bitten by a puppy who in turn, had been bitten by a ‘mad’ stray dog the week before. That both the dog and puppy had been killed and that rabies is endemic certainly indicated the need for vaccination.
The patients, two mothers and four children, had traveled some 80 kms from a neighboring district, to seek medical care the main component of which was the anti rabies vaccine.

When I had to say “Sorry the hospital has no rabies vaccine,” one of the mothers broke down crying, explaining that their limited funds could not take them to other hospitals, that may have the vaccine. The nearest hospital was over 100kms away. Furthermore, given the rabies vaccine shortage in the country there was no guarantee the next hospital would even have the vaccine.

It was decided to admit all the patients overnight and to try and see if there was vaccine at any of the other hospitals. There was no vaccine at any of the other hospitals! The local private surgery had vaccine, but at Z$ 23,000/vial, [each patient needs one vial immediately then two more at later intervals. There was no way these patients could afford this amount. A doctor in public service earns only five times this amount!
What to do?

I could only think about it, while busy sorting out patients with arm fractures. Then Munyaradzi from the OI clinic, called to say his brother, a young trainee doctor, had visited the area and would like to see the hospital. Munya had also just overheard the rabies vaccine dilemma, and said “but the OI clinic has rabies vaccine in their dispensary”. Hurrah!
Good coincidence, and six happy patients

Interview with Sister Rumbanduro

Interview with Sr. Rumbanduro, Sister in Charge, Maternity Department
By Kirsten Scott

Sr. Rumbanduro went to the World Aids Conference, held in Toronto from the 13th to the 18th of August. She was funded by the Friends of Murambinda Hospital. She presented a poster presentation on the 16th entitled “Working in partnership to enhance care and treatment of HIV infected persons – an example in rural Zimbabwe”.

What were your impressions of your trip and the conference?

It was the first time to travel by air and also my first visit to North America so it was very exciting. The airport in Toronto was very big and busy and it was surprising to see that there were very few people in the streets, unlike Zimbabwe.

At the conference itself, Bill and Melinda Gates donated US$500 million to the global fund to fight HIV/AIDS, TB and Malaria. Bill Clinton put in an appearance at the question and answer session. I was impressed that the treatment of children with HIV was a major topic of discussions and talks. It seems like it had been sidelined in the past and it was high time that it became a major focus.

One of the things that impressed me the most was the number of famous people including those in power who came out publicly to talk about their HIV status. As someone living with HIV positive I have sometimes found it difficult to tell other people about my status. Seeing so many people talking openly about it inspired me and helped me to see that I should not be afraid of disclosing my status to my work colleagues and friends.

I was saddened that the price of ARV’s (anti-retrovirals) is still very high and that there seems to be no promise to lift the patent on the drugs despite many people campaigning for the cause. There was a big demonstration by some people from India against the continued use of the patent.

Was there anything at the conference that you particularly disagreed with?
One thing that I was not happy about was that some leaders from Southern African countries were not present at the conference. They did not even send representatives from government health departments. The leaders met daily to discuss the way forward and it seemed silly that those from the countries hardest hit by the epidemic were not present for the discussion. In order for us to really solve the problems relating to HIV/AIDS it is necessary to have political involvement and support. Leaders from developing countries in South Africa should meet to campaign for cheaper ARVs.

It also seemed problematic that most of the research presented was done in developing countries by people from developed countries. I think that it would be better to empower researchers in the developing countries.




Do you think that you will change anything about your daily practice now that you have been to the conference?

I will definitely think more about the issue of mother to child transmission of HIV. Before I went to the conference I was happy to just give nevirapine monotherapy to babies of HIV positive mothers. Now I would like to make a register of all HIV positive mothers to ensure that their children are followed up and put on ARVs at 18 months if they are still positive. The maternity department at Murambinda could do this in conjunction with the opportunistic infections clinic. I also realised that nutrition was an important part of HIV care. Although nutrition is not a substitute for ARVs it does help to stave off infections. Food security is critical for survival in people living with HIV/AIDS.

What else did you learn at the conference?

-I was interested to hear that a certain donor agency had funded special nursing homes and clinics for children with HIV in 10 African countries. Surprisingly, Zimbabwe was not one of these countries, despite being one of the hardest hit by the epidemic. I thought that this was probably for political reasons.

-It was also interesting to see how people with HIV/AIDS are cared for in Canada. They had a special lounge where they could meet to share their experiences and were provided with free (nutritious) food. They seemed to spend most of their time discussing every day events and not focusing on HIV. They also received excellent health care and support.

-I also feel that a healthy, well educated workforce is important for any organization to survive or develop. People often delay seeking treatment because they are afraid of losing their job, or they are too proud or they are scared of the stigma of HIV. Better education and clearer work policies would help to encourage people to be open about their status.

-I also felt empowered by the conference: I met so many other people who were living with HIV who were healthy. Some of them had been near death before starting ARVs and I felt like we shared a common experience. It boosted my morale to see so many HIV positive people making a contribution to the care of other people.

Is there anything else you would like to say?

I would just to say that I was so proud to be chosen to go to the conference. I never dreamed that I would be given such an opportunity and I am incredibly grateful to Dr.Monica, Sr, Barbara and the Friends of Murambinda Hospital for helping me to make the trip to Toronto a success.
If funds are available I would like to subscribe to the International AIDS Society so that we can update our practice in Murambinda in line with advances in global research.

Kirsten's first impressions

18/08/06

My name is Kirsten Scott and I am a visiting medical student from Kings College, London. I grew up in Harare and although I have been out of the country for seven years I still feel as if Zimbabwe is home. At this very moment I am relishing my good fortune at having found myself in Murambinda, despite the power cuts, lack of luxuries and dearth of traditional distractions.

It was a string of coincidences that lead me to Murambinda. The hospital or its staff kept appearing in my life until I eventually emailed “Dr. Monica” to see whether I could pay the hospital a visit in my capacity as a rather inexperienced (but keen) medical student. I first heard of Murambinda two years ago when helping with a fundraising event in Edinburgh: the hospital was one of our chosen charities. Barely a year later, as part of my job as a carer to the elderly, I looked after a man whose granddaughter had worked at Murambinda. He was full of admiration for her and seemed to think that she had fallen in love with Zimbabwe through Murambinda. At any rate, she didn’t seem to be in a hurry to return to the UK. As if I hadn’t heard enough about Murambinda, I then went to a meeting of Zimbabwean doctors where I heard a presentation from the Friends of Murambinda hospital. All these tales coalesced in my head to produce an image of a utopia – a hospital managing to survive despite the economic and political problems besetting health care in Zimbabwe. Having organised my visit, one of my TB lecturers used Murambinda as an example of a rural TB treatment program. It seemed as if everyone knew about this tiny little hospital in rural Zimbabwe. I couldn’t wait to get there.

Now that I have been here for a day and a half, I have formed multiple first impressions. What struck me most was that the whole establishment was awash with smiles: nurses’ smiles, cleaners’ smiles and even incredibly ill patients’ smiles. In the course of my first day I saw a caesarean section, a finger amputation, a birth by vacuum pump, a lumbar puncture, a wrist fracture, TB, HIV and countless patients on wards some of whom were still managing to smile despite the fear and desperation in their eyes. I knew that HIV and TB were a major problem in Zimbabwe but such factual knowledge didn’t change my surprise (or horror) when confronted with the actual situation.

All the blankets are holy (probably in more than one way!), the theatre gowns faded and the corridors still haven’t shrugged off an air of the 70’s – but everything seems incredibly clean and absolutely nothing is wasted. Many NHS hospitals, despite their chromy shine, look a lot dirtier.

At the moment, I am perfecting the art of standing by feeling useless and ignorant – hopefully a skill I shall be able to jettison as time goes on. I am in great awe of all the staff here who seem to be able to deal calmly with absolutely anyone (and their injuries) who walks through the door. I hope I will be able to take some of that calm with me when I leave.

Transmission hiccups

Murambinda news has experienced hiccups in transmitting news, the version of Windows 98 on the hospital computor seems unwilling ,unable to accept and transmit 'Murambinda news' but kindly a good friend with much up dated soft ware has offered to help.

Still the over reaching problem of hyperinflation continues to hamper health care at the hospital and in the 27 peripheral clinics, essential medicines even simple analgesics are 'o/s' outof stock at the clinics, the hospital somehow manges to keep extremely minimum stocks of our own 'essential list of 100 drugs' available [Zimbabwe Essential drug list is 350].

We manage through generous help from partnerships developed since the late 90s, 'Friends of Murambinda in England', 'Friends of Murambinda in The Netherlands' University of Bordeaux, MSF-Lux. for which we are very grateful.

This is not to say the Government of Zimbabwe via the Ministry of health is not supporting us, the MoH pays our salary bill and without that we would not manage.

So what do we do with all this help and input, provide primary and secondary health care as the District hospital for Buhera district, with focus on maternity care and HIV/AIDS/TB but of course provide other basic health care for Malnutrition, Malaria, trauma, [amazing how many broken arms we see!] hypertension, diabetes, the disabled, the mentally ill.

More next time if the rather convoluted transmission works, we are looking into getting Windows XP Professional, money needed!

A Blog from Murambinda

I have decided to share news about Murambinda, through this medium.
Murambinda is a busy district hospital in Zimbabwe, struggling like most institutions in Zimbabwe but still finding the way forward particularly in the fight against HIV/AIDS, together with our partners, MSF Lux, University of Bordeaux, the Friends of Murambinda [England], and Stighten Vrienden Murambinda [The Netherlands].
I am a senior doctor at Murambinda and have some twenty years of my life working at Murambinda, and still remain inspired by the community I work for and the staff I work with.
I am currently on a two week break thus do not have the very latest, but wanted to get started on communicating this way with the help of a friend.
More news coming.