Mary runs the palliative care team at the government hospital in Blantyre. It is often very sad and really puts other minor difficulties in life into perspective. However, we can give support and time to explain things to children and their families, and relieve pain and other distressing symptoms, and this meets a real need, and does feel very worthwhile. She mainly works in the mornings when the children are at school.
James is running the Malnutrition unit, one of the largest in Africa, which has received a lot of media interest in view of the food shortage and HIV/AIDS in Malawi. He has been trying not be the media face for malnutrition in Blantyre but recently when the Malawian registrar did not turn up, he ended up being interviewed on camera. As a bonus Mary managed to get Obi Wan Kenobi’s autograph for the kids, as Ewan McGregor came round the unit as a UN ambassador. We also had the World Food Programmes ambassador, a Jordanian princess visit after Christmas. Who said the work is not glamorous? – although the media attention has been an additional burden to the unit timewise.
Sadly the malnutrition uni is very busy, and about 20% of those admitted die, with about half the 1,500 admissions each year infected with HIV. We expect many more admissions in the coming year as last year’s harvest failed, and malnutrition in the population is high. The positive side is seeing 80% of children recover, and increasing numbers of children with HIV are now able to start antiretroviral treatment [ARVs], with good results. Resources are always a problem, with basic things often running out, and with patients two to a bed and sleeping on the floor at this time of year as the unit is full [60 children currently on the ward]. Nurses are a scarce resource, many sadly recruited out of the Malawian health service as salaries are low. Many are in the UK, but who can blame them when on a basic salary of 11,000 Kwacha a year [£500], which even with allowances is still less than £1,000 pa. Staffing generally is a major difficulty, the malnutrition unit has only 2 permanent government nurses, the rest we try to raise charitable funds for, or get research staff to help out clinically. James is also on call for paediatrics, and has teaching and research responsibilities in Community Health, Nutrition and Paediatrics. There is a relatively new medical school here, through which Malawi hopes to generate the next generation of doctors, and who will require postgraduate training, ideally predominantly in Malawi, as when sent to the UK for training few return.
The contrasts of being here are very great. We live in a nice house with quite a few mod cons, which do work most of the time, and a big garden with many fruit trees. The kids go to an international school [which follows UK SATS and GCSEs] where they mix with the privileged sector of society, yet we both work amongst the poorest of families and with very sick children. The contrast between our basic but comfortable home and lifestyle and the poverty and suffering of our patients can be very challenging at times. However we do obviously have a responsibility to our own kids’ health and well-being, and for us to be able to work here we need them to be secure and happy and able to fit back into the UK education system when the time comes.
We would appreciate prayers for our health, and the health of our car, which has had a more troubled few months than we have.
James, Mary, Thomas, Samuel, Rosie and Jonathan Bunn
A Letter from Malawi
James and Mary Bunn