Handouts won’t sustain hospitals

Through transformative partnerships, a surgeon in Nkhata Bay is turning around an idle valley into a food basket to ensure patients and inmates do not starve anymore. JAMES CHAVULA writes.

On a rainy Tuesday morning, we bumped into two prison warders walking in the corridors of the new Nkhata Bay District Hospital. They were not sick. Rather, they were all smiles.

“We need 100 sacks,” one of them told Dr Albert Mkandawire. “We have brought 50 prisoners and they are expected to fill a 50kg bag each. We’ll bring 50 more people tomorrow.”

This growing season, the inmates and warders have been a common sight at the new hospital.

Midway through the new hospital’s corridor, the prisoners were shelling maize in an expansive restaurant. No storeroom could contain the heaps of cobs, bragged Mkandawire.

Prisoner warder Julius Kawonga could not hide his joy.

“We are expecting between 400-450 bags,” he projected.

The district’s hospital and prison, two of the most constrained institutions, expressly refuse to go down on their knees begging for food.

“Handouts will not sustain any institution. We have to do something to lessen our shared problems,” said Mkandawire in an interview.

He cites the fear of encroachment and the trimming of funding from Treasury as the main drivers of the initiative.

When the project begun, admitted patients were receiving one meal a day, down from three. The starving patients, who need adequate nutritious food while taking prescribed drugs, became depressing human faces of a countrywide health crisis.

By July last year, government almost halved funding to district health offices and hospital administrators mostly discontinued provision of meals to inpatients and trimmed ambulance services.

Reports of doctors sending SOS were rife as activists took to the streets to protests against the worsening situation which threatened access to quality healthcare among the rural majority with few if any alternatives.

The crisis culminated to Nkhata Bay DHO getting almost K115 million a month, down from K138 million.

Despite the slump in funding, Mkandawire and his workforce expressly refused to starve the patients and staff members on duty while the hospital has nearly 25 hectares lying idle just outside the fence.

It was against this backdrop that the surgeon, in consultation with officials at the prison, agricultural development office and Nkondezi Research Station, resolved to dedicate almost five hectares to maize and pigeon peas.

“The land had been lying fallow and villagers were encroaching. We asked ourselves: Why can’t we utilise the land to lessen our problems?” he explained.

To meet the labour demands of the project, the hospital officials approached the prison services and in-charge Steve Malishe was game as the congested correctional complex which takes up to 200 inmates was also grappling with food shortage.

The two institutions eventually signed an agreement to share the yield equally.

The harvest sharing deal clearly exemplifies the power of partnerships in transforming constrained institution, which was appreciated by former Minister of Information Jappie Mhango.

When he visited the hospital early this year, Mhango told health administrators: “Instead of complaining, you need to borrow a leaf from what is happening in Nkhata Bay and come up with innovating ways of feeding your patients.”

The minister’s remarks was hugely misconstrued, with cartoonists and critics portraying him as a no-brainer who envisioned patients working on the said hospital farms.

But the backlash did not dash Mkandawire’s zeal. He was concerned by the shocking situation patients were going through.

“The burning issue was: How do we feed our patients? This is the question I had since I moved from Mangochi to Nkhata Bay in 2013. When I arrived here three years ago, the patients went seven months without food,” he stated.

Equally affected is the health workforce. They no longer receive meals since the expiry of funding Norad was injecting to supplement their food budget.

The support only caters for electricity and water bills. Relocation to the new hospital, whose outpatients department is almost the size of the old hospital, has further stretched the district health office’s thin budget.

The office expected the mid-year budget review meeting of Parliament to hike their monthly budget by K25 million (about $37 404) to cater for the greater needs of the vast hospital, but legislators looked away in silence.

Now, the trimmed funding has to cater for overhead costs of a swelling security force, increased staff and cleaners of the massive corridor, numerous glasses and other facets of the new hospital.

Besides, there are nutritional needs of the patients who have to do with two meals a day.

“Already, we are not feeding them enough. These are not square meals. The meals are monotonous, just maize and beans,” Mkandawire said.

The patients deserve a balanced diet comprising fruits, vegetables and other food groups, says district nutrition officer Jason Chigamba.

Chigamba’s office is in talks with some partners to establish vegetable and fruit gardens within the hospital premises. They prefer calling it permaculture.

This will complement the existing diet.

“We are talking about dietary diversity because a diet without fruits and vegetables is not complete,” he said.

As the negotiations continue, Mkandawire and his team are already talking about winter cropping.

Currently, discussions are underway on whether to divert the nearby Kalwe stream or install a solar-powered system to pump water into the nearest reservoir tank for irrigating the crop fields.

“We are looking at viable water sources because buying maize from Admarc in Mzuzu is not sustainable,” Mkandawire says.

Presently, government spends about K400 000 (about $598) to procure maize, K200 000 (about $300) on beans and about K320 000 (about $478) on salt, cooking oil and sugar to feed 110 patients at Chintheche and 150 at Nkhata Bay.

If sustained, the project will lessen the food budget. Most importantly, it shows adversity is not the killer of human innovation.

In every difficult situation is potential value. Like Mkandawire, strivers and overcomers believe this, then begin looking for a silver lining to every cloud. n