Providing sustainable
medical education and care in African countries.
ameca

DAVID GORDON MEMORIAL HOSPITAL, MALAWI

Medical elective
5.0
  • Lorna Neill reviewed 2 years ago
  • last edited 2 years ago

I spend 6 weeks at the David Gordon Memorial Hospital in Livingstonia, Malawi for my elective. Malawi is the world’s 4th poorest country, with an extremely high maternal and child mortality rate. There is a high rate of HIV/AIDs in the population, and there is a high incidence of tropical diseases such as malaria and TB.

David Gordon Memorial Hospital is a small mission hospital in the village of Livingstonia. It has about 150-200 beds, but serves a population of 450000 from a huge local catchment area. There is a male ward, female ward, paediatric ward and a maternity wing.

Livingstonia is a small town/village built by established by missionaries about 120 years ago on a plateau around 3000ft above Lake Malawi. The population is generally poor farmers and fishermen from villages around Livingstonia, thought the presence of a local university means that a wide variety of patients are seen. Livingstonia as a place feels a bit trapped in time – many of the buildings are left overs from the colonial period of the missionaries. There is only one serviceable road to Livingstonia, which is an unpaved 21 hairpin experience from the lakeshore all the way up the mountain – which takes over an hour to drive, so accessibility is a problem! Most patients are forced to walk or wait to be crammed into the back of the daily ambulance with 30 other people!

Days started at 7am with prayers in the local language Tumbuka. Ward rounds were then conducted 3 times a week in English by the clinical officers or the doctor. Ward rounds tended to last for about 3-4hrs, depending on how many patients were on each ward! The afternoons were then spent in the out patient department, or seeing emergencies or clerking in new patients. On Tuesdays and Thursdays there were scheduled theatre days where we saw total abdominal hysterectomies, hernia repair and abscess drainage! There were also often emergency caesarean sections to watch or assist in.

The hospital has a permanent ex pat Irish doctor, as well as 4 clinical officers and 2 medical assistants. The clinical officers have had 3 years of training but are very competent in treating common diseases such as malaria, and also are trained in surgery. The medical assistants have had 2 years of training and generally were used in the outpatient department taking histories and triaging patients.

We saw a wide variety of diseases while at David Gordon. Many patients had HIV/AIDs, and making sure that all patients who presented to hospital or were listed for surgery were tested was a big priority for the hospital. Unfortunately we saw many patients presenting with end stage AIDs related illnesses, such as PCP or cryptococcal meningitis. Malaria was also a disease we had lots of exposure to, especially in young children, along with severe anaemia. In general the malaria patients were very well treated, but sadly whilst we were there several children died from malaria, often due to presenting too late. We also saw a lot of TB and tropical abscesses – which are often drained and debrided without any anesthetic!

We also saw diseases that we are more used to seeing in the UK – such as hypertension, strokes and cardiac disease. These were the illnesses that made the stark differences between healthcare in the UK and Malawi more apparent – a stroke patient was often just treated with aspirin and some thiazide diurectics – no scanning or clot busting drugs!

We also spent a lot of time in the maternity wing. There were often several women in labour at any time and it was always a very full unit! The unit had a nursery for premature infants, and there was an incubator and the ability to provide feeds via NG tubes, so even premature infants weighing less than 1.5kg did quite well whilst we were there. We occasionally saw babies born with congenital problems or syndromes, such as a Hirschprung’s patient, however these patients needed to be referred to a bigger hospital 3 hours away.

We also saw lots of eclamptic and pre eclapmtic patients in the ward, some requiring emergency caesareans. Unfortunately the nursing staff did not always do regular observations, and this caused some frustration amongst the clinical officers and doctors.

We were also lucky enough to visit some of the out reach clinics in the local community. One visit involved a 2 hr drive, then a 3 hour boat ride to get to a village that is completely inaccessible via road. This was a great experience, and also showed how valuable healthcare is for those who have difficulty accessing it.

As an elective placement David Gordon Hospital was a fantastic experience. Due to the small nature of the village we felt we were able to become really integrated into the local community and know many of the people, as well as learning some of the local language. We were also able to see a wide variety of diseases that we have had little to no exposure to in the UK. It also made us really appreciate the facilities and resources that we have available to us in the UK, and made me realize the importance of taking a history and examination in the absence of any clinical tests. It was also a frustrating experience at times due to the lack of equipment or medication.

I have learnt a lot about the provision of healthcare in an entirely different setting, and have gained some great experiences that I hope will greatly benefit my future career.

  • You must to post comments
DGMH
5.0

I thoroughly enjoyed my time at the DGMH and in Malawi. Throughout my time there I was made to feel very welcome. Malawi really is the ‘Warm Heart of Africa’.

During my time in the hospital I was able to get involved and help in a variety of different ways and situations. I worked on the male, female, paediatric and maternity wards as well as going on outreach clinic visits. I spent a lot of time in the female ward as it seemed to be the busiest whilst I was there. The staff are so helpful and keen to pass on knowledge to anyone who will listen! I was also in a very good position to share the things that I knew. The outreach clinics where an eye opening experience. One doctors clinic could only be accessed by boat along Lake Malawi! I attended morning devotions – hymns, prayers and a small sermon – in the mornings before the start of the shift. This was a great way to get to know the staff and learn about the Malawian culture. I was also allowed to observe some operations – a totally different experience to the UK.

When I had free time I was able to get involved in the local community. I went to church, watched football matches, learned how to cook local dishes etc. at the end of my time at the hospital I spent some time traveling down south along the Lake shore. Lake Malawi is great with clear waters and sandy beaches. I also visited a safari park.

My time at DGMH has taught me a lot about myself and about people. I have been able to develop and expand my skills and knowledge base. I have made lifelong friends in Livingstonia and have been told that I must return!

Whilst there I wrote a blog feel free to check it out – https://crgent.wordpress.com

Claire

Student nurse

  • You must to post comments
holly.whittaker
5.0

I have just returned from my Nursing elective at the David Gordon Memorial hospital and what an amazing experience it was! The hospital was pretty quiet at times and the staffs laid back attitudes to everything made it feel even quieter! The staff are pretty impressive when it comes to knowing what to do, particularly the clinical officers, but lack of resources and funding makes some things pretty difficult. The majority of the nursing staff are untrained but are good at the clinical things, their knowledge is just very limited. Spending time visiting clinics is really good as you get to see what it’s like for people in the really rural area, and some clinics are merely run in the shade rather than in actual buildings! But at least this is giving people access to health care. Unofortunately i never met Lyn as she was back in the UK during my stay, but Penjani was really helpful. If you are looking for a placement that gives you a real insight to rural Africa, but is pretty chilled out, then this would be perfect for you! One word of advice I would give is to be pro active in organising things at the hospital as there is plenty to get involved in just the staff can be a little difficult to get information out of at times! Get involved with OPD, theatre, clinics, community projects and ward work but you really have to organise them yourself as no one will do it for you (I don’t mean this to make the staff sound bad, they are just so chilled out when it comes to organising things, and time-keeping is virtually non-existent!!)

The area that this hospital is in is quiet, very quiet, so it’s better if you are with a friend! It can also be a real pain to get to as it’s based 3000ft above sea level and the roads leading up to it can be pretty bad particularly in the rainy season! But there are things you can do at the weekends, like hiking and visiting other areas in Malawi, that road just makes it a bit of a nightmare getting up and down. If anyone is planning on going to DGMH then feel free to contact me by email: holly.whittaker1990@gmail.com and I’d be happy to answer any questions you might have!

  • You must to post comments
dthurtle
5.0

Superb location for a medical elective. Incredible views and amazin, friendly people. Agree with all Ben has written above. Expect to be asked to provide on call ward-cover through the nights and out-of-hours. A great place to get very involved and yet surrounded by very able medical officers. Would best suit someone with an active Christian faith, with prayers each morning and the opportunity to get involved with the church on the plateau.
Probably the best 6 weeks of my whole medical school experience.
Enjoy!

  • You must to post comments
David Gordon Memorial Hospital
5.0
  • Julia Gasson reviewed 2 years ago
  • last edited 2 years ago

I spent my elective in 2013 at David Gordon Memorial Hospital in Northern Malawi. The hospital has 4 wards (male, female, paediatric and obstetrics), as well as an outpatient department, ophthalmology department and extensive community outreach programmes. My time spent here was a fantastic experience. The hospital staff and local community were all exceptionally friendly and welcoming and also very appreciative of any help that we could offer. This hospital offers a good medical experience with the opportunity to be fully managing patients on your own, as well as offering the opportunity to be involved in surgery and community clinics as much or as little as each student would like. The setting is stunning and offers a good place from which to explore Malawi. Overall, I highly recommend it. Please get in touch if you would like any more information.

  • You must to post comments
tomdove
5.0

This was an amazing elective experience. For anyone wanting to experience a rural African hospital with limited resources who will greatly appreciate and utilise any support you can offer, this is the place! As well as the incredible location, this really will provide a very different experience following training in the NHS system to broaden your understanding and help you to develop resourcefulness in a place lacking in resources! Overall the variety of hospital work, outlying clinics and involvement in this unique community and setting made for a superb elective as a medical student. Personally, this placement gave me far more confidence ahead of my first foundation year as a doctor and I would whole-heartedly recommend DGMH as an elective placement for anyone who is keen for a significant culture change, a varied and challenging clinical experience and an opportunity to serve in Africa.

  • You must to post comments
Benjamin Williams
5.0

I thoroughly enjoyed my medical elective at David Gordon Memorial Hospital and would highly recommend it to anyone hoping to experience a rural African hospital.
The location of the hospital is stunning – set on the edge of the Livingstonia plateau overlooking Lake Malawi.
The organisation of the hospital is mentioned above and all four of the wards can get very busy, though there were times during my attachment where the hospital felt quite quiet. Nevertheless, there was always something to do and all the staff are very keen to develop there skills and knowledge so any visitor would be more than welcome to teach.
The day starts at 7o’clock with prayers and songs in Timbuka followed by a handover in English. Most hospital business is spoken in English although many of the patients will not speak English and nurses and porters are required to translate.
Monday, Wednesday and Friday mornings were ward round days and the theatre lists were mainly on a Tuesday and Thursday. Common operations include bilateral tubal ligations, C-sections, hydrocele and hernia repairs and occasional laparotomies.
Resources are limited and the availability of drugs is a constant problem for the hospital. Only Blood films and Hb levels were performed commonly but there is the capacity to perform more biochemical tests once the personnel are trained in the machinery. X-rays are avaliable but were commonly limited by lack of films.
The staff are very welcoming and guests are encouraged to get involved in the local community. There is currently one long- term expatriated doctor and one nurse working at the hospital.
The hospital is a great location for both electives and for visiting professionals to work. There is the obivious fustrations of African healthcare including limited diagnostics and treatments but the beauty of the area and its inhabitants are sure to make any visit memorable.

  • You must to post comments
ke5g11
5.0

When I arrived in Malawi I was instantly greeted by friendly happy people, which I felt was continuous through my month there. Children as young as 1 year old were walking around the villages without parental supervision and playing in the dirt. I had my aims and objectives on what I wanted to get out of this experience. I wanted to observe and help out as much as I could on various wards around DGMH, but to also learn about the outreach medicine and travelling to local villages to attend clinics. My first day at the hospital began with morning prayers, which was an amazing opportunity to experience as it made you feel that you were in the heart of their culture, as Malawians were very religious. Then it was a stark introduction into the healthcare system within Malawi, as well as orientation around the wards. On first impressions of the wards, I could not believe that it was medicine in its most primitive state being used. Beds were rusty metal framed with what looked like a blanket used as a mattress. I.V stands were non-existent, so they used nails in walls to hold them up. Not every bed had a mosquito net above it, so some patients would have to share beds at night as a way of keeping themselves protected. The drug trolleys consisted of little pots with a worn out hand written sticker on to identify a drug, or if no pots were available, paper screwed up in little balls were used to store medication. The more I saw the more fascinated I became with how clinical medicine is taken for granted in the UK and fortunate we are to have the NHS system in place.
Over the four weeks I was there, I will never forget all the interesting things I witnessed. I got to watch and assist in 11 births, 2 of the babies being named after me, which is an amazing experience and I was very honoured. I also got to witness 4 emergency caesarean sections in which I had to assist on the resuscitation of two new born twins. This was an incredibly scary moment and felt like the longest 15 minutes of my life, but luckily we were able to revive both of them and to this day both are doing amazingly well. I also had the chance to experience the way in which they complete ward rounds, outpatient departments and visits to clinics away from the hospital which gave me the experience to see true rural areas where patients were very sick and unable to receive treatment due to financial circumstances. When working on the wards, I gained knowledge in the way the nurses managed a patient’s care, by assessing a patient, how they took basic observations and how wound care was carried out with the most basic and minimal amounts of equipment. I also would like to think that there were times they gained some knowledge from me and in the way we would do things in the UK. I understood that we obviously have more resources available to us, but the simpler things such implementing a regular turn around chart on a patient who lacks mobility can prevent pressure sores or the use of some wound dressing that they have.
When I wasn’t working at the hospital, I had the chance to do a little bit of exploring of Malawi and whilst doing this, I got to see some amazing and breath taking views of Lake Malawi. The Lake has a gorgeous reputation for its warm sand and its clear fresh water. I never got use to the fact that it was a Lake, due to the size of it. I was also fortunate enough to have met some amazing and inspiring people who I will never forget, as without them my trip would have been incomplete.
Overall, the large amount I was lucky enough to experience has made me develop more as a nurse and as an individual. I’ve learned that there is more to life than money and large amounts of choice at a supermarket. Malawi has taught me the importance of health and how quickly this can be taken away from you. I know I would want to go back to African again, as it feels that a part of me is still out there and I don’t think it will ever come back. People say that you get the ‘bug’ to go back out there, if this is the case, I have a big bug.

I am happy to answer any questions you may have regarding visiting Livingstonia. My email is katespumpkin@hotmail.com.

Thanks

Katy.
3rd Year Nursing Student

  • You must to post comments
Showing 8 results
DGMH.JPG 2 years ago
Showing 1 result
Medical Directory

The AMECA Medical Database promotes opportunities to share healthcare skills, training and expertise between the UK and Africa. Browse the Directory

 

Newsletter

Sign up to receive our online newletter. Content includes:

  • progress on our projects
  • our future plans
  • our travels to Africa