A common thread running through all causes was identified - that is, the very high level of illiteracy in this group, even for Central Africa.
Malawi AIDS Education Project
MALAWI is not a name, or a place that is in the news press every day, but given this AIDS-sensitive world and age, it should be (click here for map).
What Malawi is, however, is a very small, very poor (the fourth poorest country in the world), landlocked country in Central Africa with a huge population. Dr. Mike Marks spent some time in Malawi recently meeting with health officials and with the deeply concerned staff of Malawi University and Medical School in Blantyre. They described for him a unique problem.
Not surprisingly, this country has one of the highest incidence of HIV/AIDS. Some considerable expense and effort has been directed toward helping to control this health problem. The Dept. of Pediatrics at Malawi University conducted a study into the reasons why the maternal and prenatal mortality and morbidity was so high in this group of young women who constitute a significant proportion of primigravida mothers presenting to the obstetric unit at Montefort Hospital.
A common thread running through all causes was identified - that is, the very high level of illiteracy in this group, even for Central Africa.
Educational materials were developed in local languages and distributed widely to schools and villages. However, this did not have the expected impact on the incidence of the disease. In attempting to analyze the reasons for this, it was finally discovered that the target population, teenage, adolescent girls, had an unusually high incidence of illiteracy - they simply could not read the material. Females are actively discriminated against in third world education systems.
Of the 140 million children in developing countries who are missing out on schooling, two thirds are girls. (UNICEF, 1998).
Not surprisingly, these girls have a higher than usual, even for Africa, incidence of pregnancy, birth complications, deformities, infant mortality - and HIV/AIDS. Therefore the educational program was quickly curtailed and in its place, trained health workers now visit these villages and communities in person, to present verbally, through classes and discussion, the issue of AIDS prevention, maternal and child health.
Thus was born the "The Adolescent Girls Literacy Program" (AGLIT), the new initiative designed to meet this situation. It is a project of Malawi Medical School and the Liverpool (England) School of Tropical Medicines' Women's Health Program, the Bush Hospital Foundation, and MediShare International.
This immediate project directly serves a population of 2000 young women in villages surrounding Montefort Hospital and is partly funded by major donors but as so often is the case, transport is excluded. The villages are frequently many miles (Km) apart, and no transportation is available except for bicycles. Therefore, AIDS workers/teachers must spend most of their time traveling between villages on bicycles - instead of teaching.
The only hospital in the area, the 180-bed Montefort Hospital, is over 100 km, a minimum two hour drive, from Blantyre to the South of Malawi at the bottom end of the Great Rifi Valley. The area is the Shire Valley named after the River Shire that drains into the Zambesi River to the south in Mozambique.
This area of Africa is very hot (38 C. degs. at 8 AM - summertime) and is given over where it is cultivated, to tea and sugar plantations. There is one doctor and 150,000 patients in the catchment area. The hospital has 100 beds. Its OB services, such as they are, are distributed throughout the little hospital. After an on-site visit by Dr. Marks, the Bush Hospital Foundation (BHF), a partner agency of MediShare International, has agreed to pay for the completion of the obstetric wing and renovation of the ante-natal and post-natal wings. A consignment from Direct Relief International, of Santa Barbara, California, will equip the wing (DRI is also a partner-agency).
Given the large geographic area to be covered on a daily basis, and the inaccessibility of many villages to even bicycles, a 4-wheel drive vehicle was requested. Vehicles are usually bought in South Africa and driven to Malawi.
It was proposed that MediShare International donate a vehicle to the Medical School to be based at Montefort Hospital to provide transport for this project. This MARCO-MediShare sponsored Land Rover would be used initially to deliver the project workers to 2000 girls a year in the surrounding villages. It will also double as the hospital ambulance and will be on loan to the university.
This is not only an AIDS Education Program per se. Although this is planned to be the primary initial use of the vehicle, it will be available in the future for a variety of services where transportation, ambulance service, and mobile clinic-use is contemplated or needed.
A surplus military Land Rover with relatively low mileage was acquired in England in the summer of 2000, converted and configured for use as both an ambulance and a mobile clinic as well as for staff transport as needed. BHF-MSI now has nine such vehicles in service in various countries of East and Central Africa, primarily in rural health projects and refugee camps.
Several years of past experience demonstrates that a vehicle can be purchased in the UK from military surplus, then converted, and rehabilitated for approximately $8,000-$10,000. MediShare and Partner BHF, purchases these vehicles and the BHF manages the acquisition, conversion, shipping and delivery to Blantyre, Malawi, in this case, and to other African projects as needed. (Two of our Land Rover ambulance/clinics are being used extensively in the vast refugee camps in Rwanda and Uganda).
In summary, this is a cooperative project among several visible, prestigious, public and private agencies and organizations in three countries and on three continents: the University of Malawi, School of Medicine, the Liverpool (England) School of Tropical Medicine, MediShare International in America, the Bush Hospital Foundation, Jersey Island, UK., and Montefort Hospital, Malawi. This program is clearly defined, easily identified, with a manageable beginning and end.
The program outlined will provide health education, basic health services (such as sickle-call, medical emergencies, inoculations, treatment), and nutritional rehabilitation. The University of Malawi staff and students will develop and provide the educational materials and be the custodian of the MARCO MediShare Mobile Clinic. The BHF is also planning, and will build, equip, and support the 'new' consolidated OB/Gyn unit in the hospital. MediShare acquired the Land Rover which was restored and converted by the BHF and is already on site in Malawi.
In March, 2000, it was learned that the converted Land Rover ambulance-mobile clinic arrived in Blantyre and is now on duty in Malawi. The shipment of surgical/OB medical equipment, instruments and supplies has been shipped to Montefort Hospital and will soon be in use. These include children's vitamins and IV solutions, in addition to an array of medical equipment, instruments and other supplies. The total cost of this portion of the project is $4975.00 and the estimated value of the shipment based on US wholesale prices is $62,000.00.
Both Malawi Hospitals, although nominally government supported institutions, receive very little support from the government and depend largely on charitable contributions. The Bush Hospital Foundation (MediShare's European partner) contributed approximately $30,000.00 so far to this project.
* Dr. Mike Marks is an Honorary MARCO member in private Family Practice in St. Martin, Jersey Island, UK. However, he spends three to four months of each year as a volunteer in humanitarian medical projects in Africa for the Bush Hospital Foundation, MediShare International, the African Medical Research and Education Foundation (AMREF), and in auditing medical projects for Direct Relief International, of Santa Barbara, CA and other US-based medical relief agencies.
May 16, 2001