Crisis looms at St Gabriel’s Hospital

Up to 250 000 lives that depend on St. Gabriel’s Hospital in Namitete, Lilongwe, are at risk as the hospital’s donors pull out at the height of administrative malaise.

Apart from the rural people living in communities surrounding Namitete, the hospital also caters for patients from other districts such as Mchinji, Dowa and the capital city, Lilongwe.

At the centre of the looming crisis is the manner in which gastroenterologist Dr. Athanase Kiromera, considered by the hospital’s leading donors as an effective administrator for the facility over the past 17 years, was fired—apparently without giving reasons.

This has prompted donors such as Norway, University of Toronto (Canada) and The Diana, Princess of Wales Memorial Fund, to freeze funding.

They question the motives of the remote owners of the hospital, Carmelite Sisters of Catholic Church based in Luxemburg, in ridding the hospital of a professional who was behind most of the projects at the facility.

Among other services, the hospital serves 5 000 pregnant women per year and 14 000 children who attend under-five clinic each year.

While St. Gabriel’s Hospital is under Lilongwe Diocese of the Catholic Church, authorities there have not investigated the matter.

But Ministry of Health principal secretary Charles Mwansambo recently wrote the diocese, asking for an explanation although the ministry refused to be dragged into the matter during an interview this week.

Christian Health Association of Malawi (Cham), under whose umbrella St. Gabriel’s Hospital falls, has just started investigating the issue.

Weekend Nation understands that Dr. Kiromera, one of the only two gastroenterologist Malawi has had over the years, has since left the country for his home country, Burundi, following his sacking.

The other gastroenterologist is Professor Jack Wilima of Mwaiwathu Private Hospital in Blantyre. A gastroenterologist specialises in the treatment of patient conditions affecting the liver, intestine and pancreas.

Racism allegations

In an interview last week before flying out of Malawi, Dr. Kiromera confirmed to have been fired, but blamed it on racism “because there is nothing professional they can point at as my crime.”

The problems started when Dr. Kiromera crossed paths with a German surgeon only identified as Dr. Heim after two white interns alleged that the German had sexually abused them.

Kiromera confirmed confronting the surgeon over these allegations. He claimed he got no support from both Lilongwe Arch Diocese and Carmelite Sisters in Luxemburg who fully sided with the accused.

When contacted, Hans Goetzeke, who heads the charity in Luxemburg, said in an e-mail response on Tuesday this week: “I have received your mail and I would like to let you know that I will visit Malawi from November 18 to November 23 and a personal meeting could be organised during that time. In the meantime, I would propose that you contact the Archbishop of Lilongwe who is well informed about the Kiromera case.”

Lilongwe Archbishop Ste Marie was unable to respond to our questionnaire on these matters sent to him on Monday.

Norwegian Ambassador to Malawi Asbjørn Eidhammer, whose country is among the donors outraged by the likely collapse of essential services at St. Gabriel’s and fears for the community there, expressed concern over the Namitete developments.

“Hearing what has now happened at Namitete Hospital, with the danger that important partners are withdrawing, is of great concern to anyone engaged in improving health services in the country. I am sure that the relevant authorities will look into the matter to find out what has happened, and take whatever measures are required to rectify the situation,” Eidhammer wrote in an e-mailed response to our request for comment.

He said having followed developments at St. Gabriel’s hospital for 12 years “as many others, inside and not least outside of Malawi, I have seen the hospital being transformed into what is one of the very best hospitals in the country.”

“It has attracted engagement and support from prominent medical institutions abroad. Some very interesting projects have been implemented in the district, engaging the local population in a unique way, and establishing palliative care which is an example to other health institutions in the country,” said Eidhammer.

Norway is heavily engaged in the health sector of Malawi, supporting government health budget as well as Cham, by contributing funding to the running of the hospital.

Another St. Gabriel’s donor, Princess Diana of Wales Memorial Foundation, has said it will not renew its support when the current programme ends in December this year.

University of Toronto has terminated its relationship with St. Gabriel’s. The relationship saw the hospital benefit from free services of family doctors sent from the university on rotational basis.

Effie Blythe, communications manager for the Diana Memorial confirmed a long relationship with St. Gabriel’s hospital.

“The Diana, Princess of Wales Memorial Fund [the Fund] first awarded St. Gabriel’s Hospital a grant in 2006 and an additional grant was awarded in 2009. Both grants were given to the hospital to support its work to increase the provision of palliative care in the Namitete region,” she said.

On the other hand, Dr. Katherine Rouleau of University of Toronto wrote: “We have terminated our relationship with St-Gabriel’s Hospital.

“I have no doubt the patients of St-Gabriel’s will suffer on account of his [Dr.Kiromera] departure and echoes from the community already confirm that the quality of care has deteriorated since he left,” said Dr. Rouleau.

“From where I stand, this is what I can attest to: I am certain that Dr. Kiromera did not commit any wrongdoing towards the hospital or the Namitete community that would warrant his dismissal. I believe that his unique set of skills, qualities and aptitudes were largely responsible for the quality of care delivered at St-Gabriel’s hospital over the past nearly two decades,” she added.

To her, the dismissal of a medic who has been responsible for the growth of St. Gabriel’s Hospital is “fundamentally one of faulty governance and stewardship”.

Money offer for resignation

Dr.Kiromera was fired on June 28 2012, a week after Goetzeke offered the medic 100 000 euros (around K43 million) to resign, which Kiromera refused “because I was not told the reasons.”

Weekend Nation has seen protest letters donors have written to Mother General, head of the Carmelite Sisters.

Dr. Katherine Rouleau, director of the Global Health Programme at the University of Toronto, wrote on July 19 2012, saying “we are concerned about the impact this dismissal will have on the availability and quality of care for patients served by St. Gabriel’s Hospital”.

“The termination of a relationship between St Gabriel’s Hospital and some of its academic partners such as the University of Maryland in the wake of Dr.Kiromera’s departure, and the resulting decreased number of visiting medical staff, will likely further deprive the local community of the much-needed resources.

“This will add to the already substantial loss of resources created by the departure of Dr.Kiromera,” she said in her letter to Luxemburg.

St. Gabriel’s Hospital has been without a board of directors to oversee its governance structures since 2010, leaving the situation vulnerable to manipulation.

The congregation, Carmelite Sisters, established a board of governors for the hospital to, among others, discuss and resolve any question of policy necessary for the running of the hospital.

Archbishop St. Marie dissolved that board in 2010 and its replacement has never met to this day, leaving all board roles in the hands of remote owners in Luxemburg.

During the past years, the hospital has attracted international attention for the quality of work done in HIV and Aids prevention and care, an area Carmelite Sisters support.

Cham head of human resource Collins Jambo confirmed that they have started investigating the matter to get to the root of it and see if they can bring partners to a discussion table to resolve the matter.

Ministry of Health spokesperson Henry Chimbali said: “The issue of firing medical personnel at a Cham facility is not part of Ministry of Health.  Our relationship with Cham facilities is on service level agreements in the provision of care and also in other areas provision of salaries.”