It is visiting hour at Queen Elizabeth Central Hospital (QECH) and one could easily be confused or lost to get to the patient they want to cheer, especially in wards 4A and 4B.
The beds are so close to each other, there is no privacy for patients and in extreme cases, some patients even sleep on the floor.
Ward 4A is a medical ward where patients whose ailments are under medical investigation and are not known, while others are already receiving treatment. In short, patients with various ailments are just mixed in one ward.
The sight in this ward is not much different from what a majority of public health facilities are like.
Health workers have argued such environments are not conducive for patients receiving critical treatment for Non-Communicable Diseases (NCDs) such as Stroke.
Stroke is a serious, life-threatening medical condition which occurs when the blood supply to the brain is interrupted or reduced. This deprives the brain of oxygen and nutrients and can cause brain cells to die.
Physiotherapist at Kachere Rehabilitation Centre, Veronica Mughogho pointed out that it is hard to effectively manage stroke in such an environment because the patient cannot do anything and needs extra assistance.
“In such an environment, it becomes difficult for a physiotherapist or any health worker to concentrate on a patient… at times, their privacy is not observed. This is the case because other patients and guardians are likely to see when they are being cleaned or turned on the bed,” she noted.
At one point, Chrissy Chiwalo, a Chilobwe resident was in this situation. She happened to be one of the five people that are admitted to QECH with Stroke daily. Such patients are never given a special ward but are mixed with others.
“I just collapsed while taking a bath that is when I was rushed to QECH for treatment. The Magnetic Resonance Imaging (MRI) scan indicated that I had Stroke on my left side and I was referred to Kachere Rehabilitation Centre for physiotherapy after being at QECH for some weeks,” she recalled.
Chiwalo remembers how it all started in 2002 when she was diagnosed with High Blood Pressure and she was advised to have regular checkups. In 2016, she was out in the field on duty (she worked as a nurse for a certain Non Governmental Organisation) with some colleagues and she suddenly felt numb on her legs and neck.
After this mini stroke was successfully treated, the disease re-occurred. This is the time Chiwalo collapsed in her bathroom one morning.
That is when she was treated at QECH’s 4A ward as she awaited to be referred to Kachere Rehabilitation Center for physiotherapy.
“I was told that I might have been at risk of Stroke because I was Obese (weighed 120 kilogrammes and I had BP. But I couldn’t do anything by myself even turning on the bed,” she narrated.
Even though she has always had her close relations to assist her to get well throughout her sickness, her life is somehow incomplete.
“I was fired from work because I was rendered incapable to work. Yet I still have dependants. This meant all the responsibilities automatically shifted to my husband whom I feel is very strained.”
“On the other hand, I have lost many friends.
Very few want to associate with me. At times I can’t socialize with friends at weddings, bridal showers, funerals or other gatherings as I used to due to movement constraints,” Chiwalo said, who claims to have miraculously changed as she managed to resume doing certain chores all by herself after undergoing an intensive physiotherapy.
She advised: “Those that don’t have Stroke yet should take all preventive measures as necessary as possible because our facilities don’t have the capacity to effectively manage the disease yet. Eat responsibly and watch out for the risky factors because prevention is better than cure.
I was told that I have this condition because I have been overweight. Now I have too many restrictions on what to eat and do.”
Chiwalo is one of the few Stroke patients who survived Stroke amid poor health services to treat and care for the patients, especially in public health facilities. Unfortunately, these are the facilities where the majority of Malawians seek medical care from.
A study which Laura Benjamin, Clinical Lecturer in Neurology – University of Liverpool (An Affiliate to Malawi Liverpool Welcome Trust-MLW) conducted revealed that in the last two decades, the number of people with Stroke in Malawi has increased by 14 percent for ischaemic [due to a clot in the brain] and 35 percent for hemorrhagic stroke due to a bleed in the brain].
It established identifying and reducing the prevalence of these risk factors as an important way of tackling the burden of stroke. In United Kingdom, where this has been done, a 12 percent decrease in the number of new strokes has been reported in a similar time span.
It further showed emerging stroke risk factors like HIV infection are prevalent in Malawi, and that there is a higher proportion of young individuals with stroke. In this study, Benjamin found that the chances of surviving a Stroke in Malawi is considerably lower than the global average, and many of the reasons are avoidable, saying one in three people that have Stroke (in Malawi) are young people aged less than 45 years and most of them are HIV positive. “Their survival depends on the stage of HIV and how their acute Stroke has been managed. But two in three patients who develop this complication end up dying within six months here in Malawi due to lack of proper care,” she says.
After noting poor service delivery towards treatment, care and support for Stroke at Queens, a team of researchers from Stroke Service at University College London Hospitals, together with researchers from University College London and University of Liverpool have formed a UK QECH hospital and Welcome Trust partnership. This is aimed at raising $25,000 to $30,000 to construct a Stroke Unit at the hospital.
The University College Hospital’s team has successfully implemented a new stroke model in London. According to background information of the Strategic Plan for QECH Stroke Unit, the disease is number one cause of disability and third largest killer after heart attack and Cancer worldwide and it is now increasing in developing countries like Malawi.
“With infectious diseases being treated better, people are living longer and therefore, exposed to Stroke risk factors such as diabetes and hypertension,” reads the information in part.
It further observes that in Malawi, nearly half of stroke patients will die in six months, and only a third will be discharged from hospital walking.
It is believed that once a stroke unit is in place, there will be reduced secondary infections (especially bladder and chest infections), reduced pressure sores (they would normally lead to infection, increased immobility), reduced length of hospital stay, reduced long term disability and dependency and reduced hospital death rates.
According to the Strategic Plan, the desire is to set up an eight bed mixed unit, on basis of two to three stroke patients per day and an average hospital stay of five to seven days, assuming that a more organized service will facilitate safe and faster discharge for in-patient and outpatient rehabilitation.
Some local clinical staff is expected to be trained and there shall also be an exchange of knowledge between United Kingdom and Malawi multidisciplinary health professionals, and provide a research platform to further develop the knowledge in stroke interventions. Benjamin said: “We are working in partnership with QECH who have provided us with executive support from their senior management team.”
AIDSmap website highlights that smokers and people with High Blood Pressure are at an increased risk of having Stroke. But lifestyle changes can lower one’s risk of stroke. There is need to eat a healthy, balanced diet. A low-fat, high-fibre diet is recommended, including plenty of fresh fruit and vegetables and whole grains. Avoid saturated fats and salt.
It is also important to exercise regularly, maintain a healthy weight, drink less alcohol, stop smoking and the use of recreational drugs such as cocaine, crystal meth, other stimulant drugs and cannabis which increase the risk of stroke.
Goal three of the United Nations Sustainable Development Goals (SDGs) is aimed at ensuring healthy lives and promote well-being for all, at all times. Tackling the Non Communicable disease burden is one of the issues that need to be addressed by all nations by year 2030.