Westgate Medical Practice, Dundee
Sam is a trainer on the national vocational training scheme for practice managers in Scotland. He is interested in healthcare provision worldwide, especially in Malawi. Sam's main hobby is public speaking and he is an active member of Dundee Speakers' Club
In April 2005, Pam Wilson, a district nurse attached to my practice, went on secondment to Malawi, or "the warm heart of Africa" as it is referred to under the auspices of the Voluntary Service Overseas (VSO) Scheme. Pam took up the post of a Clinical Nurse Tutor at the Malawian College of Health Science in Zomba, in the southern region of Malawi.
To set the scene, Malawi is a landlocked country in southeast Africa. It is bordered by Zambia to the northwest, Tanzania to the northeast and Mozambique on the east, south and west. Malawi is among the world's least developed and most densely populated countries. It has a low life expectancy, high infant mortality and a high prevalence of HIV/AIDS.
While in Malawi, Pam sent us regular email updates of her work, which were promulgated to all members of the team. As a Scottish general practice, we felt we had a moral responsibility to ponder for a moment, consider our options, and try to do something practical to help make the relationship between the people of Malawi and the people of Scotland more equitable. We considered a range of options and decided to follow the World Health Organization mantra to "think global, act local". Our global mission was to help our healthcare colleagues in Malawi, and our local task was to find a clinic to twin with.
Finding a twin
Dr Ron Neville, one of the partners at Westgate Medical Practice who has led this project from the outset, being the first person from the practice to visit Malawi in 2007, had a contact there who proved invaluable in helping us find a twin. Pam met with the contact and, after visiting a series of clinics in Southern Malawi, together they chose Zingwangwa Clinic, which serves around 126,000 people in a township adjacent to Blantyre, to be our 'twin'.
The clinic tries to manage a full range of health conditions, but in a resource-poor environment and – to our amazement – without resident medical staff. Compare that with us here at our practice in Dundee, adjacent to a major teaching hospital serving an urban population of 10,500 patients, with eight medical partners and a full range of nursing, support staff and equipment, utilising IT to the full.
By embarking on this route we were following in the path of many Scots before us, as the people of Scotland and the people of Malawi have established many links – through churches, universities and schools – going back to the time of David Livingstone, a Scottish missionary and one of the greatest European explorers of Africa.
Having found ourselves a twin, we thought it would be worth considering taking the twinning concept a stage further.
In 2006, we applied to the Scottish government's International Development Fund. The objective of our bid was to build two-way educational, medical, nursing and patient group links through a sustainable model of clinic twinning between Scottish general practices and Malawian clinics. We were delighted, if initially somewhat surprised, to receive a grant of £94,000 over three years to take forward our plans.
We thought the idea of twinning Scottish GP practices and Malawian clinics would give healthcare workers in both countries the opportunity to share experiences and help each other on an equal and equitable basis. Rather than follow the traditional path of fundraising for hospitals, orphanages or non-government organisations, we opted for a low-key approach to establish people links first, and see how we could help each other. We planned to proceed slowly, respecting local traditions, to build a dialogue between healthcare workers in Scotland and Malawi in a long-term, sustainable way.
Initially, we set ourselves a somewhat ambitious target of twinning 20 Scottish general practices with 20 Malawian health clinics. However, it soon became clear that this was not going to happen, so we revised our goal to twinning 10. A project manager was appointed in both Scotland and Malawi to move the project on.
Accordingly, a network of 10 Scottish practices and Malawian clinics were then established, and dialogue between the clinic pairs began. Through a contact, we found out that Glasgow City Council had 30 personal computers they no longer required that they were prepared to make available to the project. For our twin at Zingwangwa, we procured a laptop and digital camera to facilitate communication. Our team were delighted to receive emails from their Malawian colleagues. For many in Malawi it was the first email they had ever sent.
In 2007, Sylvester Chawala, the Project Manager in Malawi, visited Scotland and addressed the annual Scottish Practice Manager Networking and Learning Conference. Apart from the cold weather conditions, Sylvester enjoyed his time in Scotland and witnessed the huge differences in the two healthcare systems. Visiting our practice, he attended a 'patient involvement' group meeting and was surprised at the contribution the patients make to the overall running of the practice.
In May 2010, I had the pleasure of spending educational leave in Malawi to see for myself how our funding had been used and to observe at firsthand the challenges of providing healthcare in the country. I was accompanied on the trip by Pam Wilson and Marion Foster, a manager of a practice in Perth, itself twinned with Matawale in the Zomba District.
At each of the sites we visited, we could not fail to be overawed by how the staff met the challenges on a day-to-day basis. From a patient's perspective, the first challenge they face is the journey to the medical facility. This can be a 2-3-hour trek on foot.
On arrival, the patients are processed through a registration desk (no self-check in here). They then wait in turn to see a clinician who updates the 'health passport' (a written record of healthcare that the patient brings each time they visit a clinic or hospital for treatment) of each patient seen. The patient is then required to register any medication prescribed before collection from the clinical pharmacy.
In the waiting room, while the patients wait to be seen, staff promote health advice in the form of song-and-dance routines, as the photograph illustrates (this is not something we have tried in Dundee as yet). When the patient has been seen, their long journey home begins again.
During a normal day, the clinicians will deal with a huge numbers of patients with an extensive range of medical conditions such as malaria, anaemia, chest infections and many HIV/AIDS-related conditions. While we were in the country there was an outbreak of measles, and emergency clinics were being held to vaccinate the children.
We were impressed with how, despite their extensive workload, clinicians everywhere we visited made time to make us welcome and show us around their facilities. We were mindful of the time we were taking up, but they politely insisted that they would take time out to meet us. In each of the facilities we visited, internet facilities had been set up. It was reassuring to see the PC being utilised to the full, as this was one of Dr Neville's prime objectives at the outset of the project.
During what proved to be an action-packed nine days, we caught a snapshot of life in a medical facility in Malawi. We could not fail to be impressed by the enthusiasm, dedication and commitment of the staff, despite the conditions they had to endure and the excessive workload they faced from start to finish of their shift.
Now that the official funding has been utilised, it is going to be up to each of the 'twinned' practices to maintain their links. At Westgate we have made a commitment to fundraise to keep the link going, and a number of events are planned for over the summer. These include a sponsored walk in the beautiful Angus glens and a 'Zumba' session (a Latin-based dance fitness programme) in the health centre. Email links and the use of 'blogging' on the website www.malawiclinics.org will continue.
More recently, on 16 March this year the twinning project was one of eight chosen to be presented to Her Royal Highness, The Princess Royal at a Scottish Malawi Partnership conference in Edinburgh. (The Scotland Malawi Partnership – see Resource – was formed in 2004 to promote an informed, co-ordinated and effective way for individuals and organisations to be involved in Malawi.)
Her Royal Highness seemed impressed by the concept underlying our project and was keen to hear how it had benefited staff in the clinics in Malawi. Obviously, it was a major honour for our project to receive such high-profile publicity.
On a daily basis, as we grapple with the latest changes in the NHS, it is all too easy to take for granted the high standard of care patients in the UK receive from the majority of primary care providers. Until my trip to Malawi, I thought that we worked hard, but, having witnessed firsthand what our counterparts in Malawi have to contend with on a daily basis, we really need to put our working life into perspective.
My colleagues at Westgate have found the whole experience rewarding and if, having read this article, you think this type of project is something you would like to get involved with please feel free to contact us. During my life I have had the pleasure of being involved in a number of innovative projects but the Malawi twinning is somehow that bit more special, and we aim to maintain our links with the "warm heart of Africa" for many years to come.
Scotland Malawi Partnership