Death and squalor still stalk maternity wards promised Scottish aid

THE babies, lying swaddled beside their mothers on the floor, are small and pale. Mattresses are stacked in the corridor and the windows are cracked. The midwives are on 24-hour shifts and look exhausted.

This is Bottom Hospital, now known as Bwaila Hospital. Two years ago, Jack McConnell paid a visit and was so shocked that he pledged money on the spot to help. The First Minister said the future of the hospital would be his number-one priority.

Mr McConnell may have succeeded in raising the profile of Malawi in Scotland; £6.6 million has been spent there and the new Executive has pledged a minimum of £3 million per annum to the country. Yet just £10,000 of direct funding from the Executive has gone to Bwaila. In 2005, it had four gynaecologists - now there are two.

Malawi still has the worst maternal mortality of any non- conflict country in the world. In Bwaila hospital, a mother dies every week - and as the central hospital in Malawi's capital Lilongwe, its record is better than the country's rural centres.

On a normal day at Bwaila, there are just three midwives on duty, one clinical officer and one doctor - for up to 40 births. If there are complications, there is just one theatre, and the woman who is waiting will lose her baby - or could die herself.

There is no pain relief in labour and sometimes not enough for post-Caesarean section patients. Women deliver their babies on beds covered in a plastic sheet and there are no towels or sanitary products. There are few cots so most babies lay beside their mothers. Those needing extra warmth are transferred to the "kangaroo care" unit, where the child is strapped to the mother's bare skin in the hope of survival.

To Dr Tarek Meguid, one of the two gynaecologists at Bwaila, it is an infringement of human rights to have women deliver in such conditions. "Most of my doctor friends in developed countries have never seen a maternal death in their lives," he says. "Here we see a woman die every week on average.This is an injustice to these women."

There is no doubt Scotland has helped alleviate the problems. As well as the £10,000 - to build a private area for HIV/AIDS counselling - £360,000 has been spent training more than 700 midwives across Malawi in life-saving techniques. Dr Meguid is grateful, but also a little frustrated at the speed with which governments can help: "They [the Scottish Executive] have 100,000 ideas from 100,000 people and do not know where to spend the money. This is a human-rights violation of unimaginable proportions."

In the end, it was the generosity of the people of Scotland and philanthropist Sir Tom Hunter that gave overworked hospital staff the hope they needed to go on. Sir Tom paid a visit, and pledged a new hospital.

Following an appeal, supported by the Executive, the Scottish public raised more than £300,000, matched by the Clinton Hunter Foundation. A £770,000 hospital is set to be finished by the end of next year.

A Scottish charity also funds 24-hour anaesthetic cover for the hospital and fundraising is collecting money for a support centre for healthcare staff. But the healthcare crisis in Malawi is one of almost unimaginable proportions, with underlying problems that will take decades to fully address.

In one of his first speeches as PM, Gordon Brown said the crisis in countries like Malawi - which has 250 doctors to 12 million people - was one of the biggest challenges to meeting the G8 goals set in 2005. His government has pledged £70 million to Malawi in aid in the last year.

A large proportion of this is going into a long-term programme working with the Malawian government to improve the health service, including boosting nurses' salaries by 52 per cent and increasing training capacity by more than half.

The Executive is also helping healthcare training but it is the help of ordinary people that is really making the difference. Voluntary Services Overseas is recruiting volunteers from Scotland to help Malawi's health services and took The Scotsman around hospitals to see the scale of the problem.

Immediately, we found a mother mourning her dead child in the waiting room of Kamuzu Central Hospital. The seven-year-old boy died of malaria on the way to hospital; if he had made it 12 hours earlier, doctors could have saved him.

Malawi has just one doctor to 50,000 people, compared to one to 350 in the UK. In Kamuzu, the main hospital for Lilongwe, there are 20 doctors for 600 in-patients and about 300 outpatients daily. By comparison, in the Royal Infirmary in Edinburgh, there are 800 doctors for an 827-bed facility with 260 outpatients daily.

At district and central hospitals around the country, we saw similar scenes. At Zomba mental hospital, we met the only psychiatrist in Malawi, who does his best to look after 200 patients with old anti-psychotic drugs and electroconvulsive therapy.

VSO volunteers work in all these hospitals, but while charities battle to get Scottish healthcare workers to go to Malawi, Malawian staff are going to Britain. The irony is not lost on Martha Mondiwa, acting registrar of the Nurses and Midwives Council of Malawi, who said the country has lost 700 nurses to the UK and other countries, a huge proportion in a country where just 2,000 nurses are educated to a senior level.

The Malawian government is desperately trying to train more nurses and is introducing a bond to keep them in the country. Mrs Mondiwa said nurses need much more money as well as support in housing and educating children: "The government needs to do something. Otherwise they will wake up tomorrow and find all the nurses are gone."

This is perhaps no surprise when wages are as low as £50 per month, even after the recent pay rise. Most nurses are forced to work 24-hour shifts, to support families which often include orphans and other dependents.

Back at Bwaila Hospital, midwife Loveness Chikalamo, 42, is into her second of three back-to-back, eight-hour shifts. She will be paid less than £3 per shift and on a wage of 20,000 kwacha or £70 a month, every penny counts. Like most nurses, she supports nieces and nephews as well as her own five children.

She is motivated by a clear sense of duty. "I would earn more in the UK," she said. "But who would look after all the women and children here?"
AGED 6, BUT SHE MAY NOT LIVE PAST 15

MERCY Mwale is six and hides her missing teeth behind a shy smile. She is a serious girl dressed in ragged clothes. She goes to nursery school, often walking the 20 minutes along a dirt track alone, and helps her grandmother with her chores, even though she sometimes has a bad cough.

Like one million children in Malawi, Mercy is an AIDS orphan. She is HIV positive and will be lucky to live to 15. Her grandmother, Olive Ngwira, 52, took in Mercy and her brother Mapopa, 12, after their parents died. It is a typical modern family unit in Malawi, where 14 per cent of the population is infected with the virus and there are 84,000 new orphans every year.

Ms Ngwira speaks of the loss of her children to the "new disease" in hushed tones, but clearly loves Mercy and Mapopa: "It is a privilege to have them. Whenever I come home, they run out to give me a hug."

Mercy tested positive at three after visiting a local health clinic with a bad case of shingles. She is now on antiretrovirals (ARVs), taking half a tablet twice a day. The medicine to help the immune system costs 50 kwacha or around 12p a month, a huge amount for Ms Ngwira and her husband, who barely survive on subsistence farming.

All over Malawi, families face a similar challenge as the AIDS pandemic takes its toll - yet things are improving. At Gleneagles in 2005, the G8 agreed the target of universal access to HIV/AIDS prevention, treatment and care by 2010. Progress is being made, thanks in large part to the generosity of the Global Fund for AIDS, malaria and tuberculosis supported by Bill Gates, the billionaire founder of software giant Microsoft.

The number of people tested in Malawi tripled from about 150,000 in 2002 to 440,000 in 2005, while the number starting on ARV treatment has increased from 4,000 in 2003 to 100,000 in June 2007. However, new infections are estimated at 90,000 per year and coupled with the shortage of nurses needed to give out ARVs, it will be a massive challenge to achieve the G8 goal.

There is also concern that the focus on HIV/AIDS and ARVs is taking staff and funding away from primary healthcare for preventable diseases.

Many argue a more sustainable way to tackle AIDS is giving sufferers the best possible quality of life through better healthcare and nutrition and providing support within communities.
'PEOPLE SAY YOU GO TO HOSPITAL TO DIE BECAUSE SO MANY DO NOT SURVIVE'

IN FOUR years as a midwife in London, Debbie Connor had never seen a woman die in child birth. In six months in Malawi, she has lost two patients. The 29-year-old, from Kilmarnock, came to Malawi to return to the basics after becoming disillusioned in Britain. She trains midwives in health centres which are often low on basics like gloves and aprons. "A lot of people believe you go to hospital to die because so many people do not survive," she says.

Debbie trains midwives in programmes aimed at giving children born to HIV-positive mothers a better chance of survival. Although the programme will ultimately end in more orphans, she is passionate it is a good thing.

"You can't sit there and say: 'I could do something to stop you dying, but I am not going to'," she says. The Malawian government has stepped up the number of midwives in college and Debbie admits the level of training is not very high - but if she can help just one midwife perform better it could save a number of lives in the future: "If one student does something right without being told, you think 'Wow'. It is whether it continues - we wait and see."

Carol Carson, 51, from Perthshire, was treating mostly diabetes in Scotland brought on by the excesses of the western world. In Malawi she is treating malnutrition, malaria and TB. She says nothing could have prepared her for the under-staffed hospitals she would see in her work as a nurse trainer in Malawi.

The pair are among 100-plus volunteers working for Voluntary Services Overseas in Malawi. With £100,000 funding from the Scottish Executive, NHS Scotland is the only healthcare service in the UK to keep jobs open and pension payments ongoing for nurses and doctors who volunteer with VSO. Over the next two years 20 volunteers will be sent out to Malawi under the scheme, but VSO want it to be extended.