A 'golden gap' in Malawi to build a health service

THE songs ringing from the corrugated iron roof sound melodic enough, but the message is deadly serious. These women at a health clinic in Malawi are singing about the dangers of unprotected sex in a country suffering an AIDS epidemic.

It is all very different from a waiting room in Dundee, the usual environment of Pam Wilson. But this 46-year-old looks perfectly at home in the Matawale health clinic in southern Malawi. In fact, as she bustles around the centre to check babies are being weighed correctly, or to supervise students counselling pregnant HIV patients, she looks quietly proud.

Wilson arrived in Malawi to train nurses with Voluntary Services Overseas (VSO) in April 2005 and immediately met Jack McConnell, the then first minister, on his first official visit to the country.

Two years later, McConnell is due to become British High Commissioner for Malawi and Wilson is due to see her first set of students graduate. In the intervening two years, both Scotland and Wilson have had an impact on the small African country.

The Scottish Government has pledged at least £3 million to Malawi every year through the international aid budget, of which most goes towards health. In the last handout, £100,000 was invested in a partnership between VSO and NHS Scotland so that health boards can pay the pension contributions and keep jobs open for staff willing to volunteer. Now the charity is expanding its programme in Malawi and more Scots volunteers like Pam Wilson are needed.

Wilson is typical of VSO volunteers today. Although the charity was set up for young people, the average age is now 44 and you are just as likely to see "golden gappers" as gap-year students on the wards.

After 24 years working in the NHS, Wilson joined up looking for a new challenge. "I had been working for the last 16 years as a district nurse in Dundee and I was not stretching myself. I needed a complete change and VSO was certainly that," she says.

At home she treated 12 to 15 patients a day for conditions associated with Western living, such as diabetes and high blood pressure. In Malawi she found herself treating conditions such as malnutrition and tuberculosis that have been virtually wiped out in the West.

"The death rate is shocking," she says. "In two days we had five child deaths which were preventable in one district hospital."

The district nursing sister found herself working in hospitals where patients are forced to sleep on the floor because of a lack of beds, and even the most basic drugs or equipment is hard to come by.

However, she says, her time as a district nurse has kept her well prepared.

"Hospital nurses who have everything to hand at home often find it very hard when they come out to Africa where there is no equipment, whereas I am used to adapting to the circumstances and using the resources I have," she says.

VSO carries out a thorough assessment of all volunteers to make sure they are ready for a change in career and lifestyle, including interviews with family back home. Volunteers are also given extensive in-country training. However when half the population are below the poverty line and traditional beliefs in witch doctors persist, there is always going to be an element of culture-shock.

Wilson has adapted well. Living costs are provided by VSO and she stays in a simple bungalow in Matawale with electricity - though there are frequent power cuts. Her leisure activities include travelling to Lake Malawi in a pickup truck or playing golf on the local course - when the goats don't get in the way.

Work includes demonstrating treatments to students on the wards and teaching in the classroom. The Department for International Development are working with the Malawian government to increase the number of nurses by increasing training capacity by more than half.

However, in the meantime, hospitals remain chronically understaffed with up to 100 patients to each nurse. This is where Wilson comes in - though she is not just a stopgap. The founding principle of VSO is to be sustainable, and the senior nurse is in Malawi to teach the nurses of the future so they can pass on their skills.

"Students are keen to learn but it is difficult for them to put it into practice because of a lack of resources. We have been able to give them more teaching on the wards and increase confidence," she says.

Wilson had taught student nurses on a one-to-one basis at home, but as a clinical instructor at the College of Health Science in Zomba, she finds herself taking classes of 60 or more. "When I arrived in Malawi I'd never taught in a classroom before, and I'd never used PowerPoint for giving a lecture. I'm now quite comfortable doing both.

"I'm really enjoying teaching the students in both the classrooms and in their clinical placements where I can see them improving the care given to their patients," she says.

Wilson will now take these skills and experiences back home to Scotland. But, more importantly, she has passed skills on in a country desperately in need.

She has also raised money to buy maize for the local community during a famine and used a £5,000 humanitarian health fund grant from the Scottish Government to buy equipment for the college, including laptops and privacy screens for the practical rooms.

When she leaves, the good work will continue, as she has helped set up a three-year project to twin 20 UK GP clinics with 20 health centres in Malawi. The scheme aims to share knowledge between Malawi and Scotland and has been given £94,000 by the Scottish Government.

After such hard work it will be hard for Wilson to leave, she says and she has extended her stay in order to watch the first students she taught in 2005 graduate.

"I wouldn't have missed that for the world," she says.

• To find out more about volunteering with VSO go to: www.vso.org.uk