In a country with just one doctor for every 62,000 people, GP Katrien Deschamps is playing a vital role in Malawi’s healthcare situation. As one of just two doctors working in a district hospital in the north of the country, she’s undertaking life-saving clinical work and at the same time passing on invaluable skills to health workers at all levels.

Background
Although VSO usually focuses its efforts on training and improving organisations’ structures, the severe shortage of doctors in Malawi means we are currently recruiting for doctor roles while local staff are trained.

Twenty-nine year old GP Katrien Deschamps is one such doctor. She is based at Rumphi District Hospital in the north of Malawi. Rumphi is a small rural town, 65km of steep winding roads and rickety bridges from the amenities of Mzuzu, the region’s capital. With its rusting ambulances, over-crowded wards and severe lack of staff, the hospital struggles to serve the thousands of patients who might travel for days to get there.

‘The whole healthcare system in Malawi is very understaffed, with so very little nurses, very little clinicians, very little of everything in general,’ says Katrien. ‘So that’s why along with my fellow volunteer Andrew, I’m the most senior person in Rumphi District Hospital. Until we came there were no doctors here.’

Work on the ground
Like many VSO volunteers, Katrien stepped back and spent the first few months of her placement building a picture of what was happening and working out where she could make the most impact. Naturally expectations were very high when she arrived. Her Malawian colleagues thought she would be spending all her time doing surgery. ‘But I’m a GP, and I’m not trained to do surgery,’ explains Katrien. ‘At first that was quite difficult for my Malawian colleagues, because they think if you’re a doctor you do surgery. So it took a little while to tune in a bit, find out what they expected and what I could offer them.’

Katrien immediately recognised that she could make a big impact in areas that didn’t require surgical skills. ‘There are so many more things to do here than just surgery – so many children in the paediatrics’ ward, in the male and female wards, so many aspects of daily care that need improvement. There’s a whole hospital to cover – any hospital in Belgium or the UK would have 50 doctors, here it’s just one or two, so you have to specify what you can do. For me, that’s mainly paediatrics, because that’s what I have the most experience of.’

Impact
Before Katrien and Andrew arrived at Rumphi, lives were being lost simply because doctors were not on hand to treat patients and ambulances were not available to transfer them to the central hospital. But VSO has changed that. ‘Since the VSO doctors came we are not referring many patients to the central hospitals,’ says Bernard Chavinda, the district health officer. ‘We are now able to manage these patients here because of the expertise of the VSO doctors. This has reduced the transport costs to the central hospitals. It has made a big difference to us here.’

Though Katrien’s is primarily a clinical role, she incorporates training colleagues into her job at every opportunity. ‘We are doing a lot of training outside the day-to-day clinical work. Andrew and I have introduced a blood bank system, and right now I’m in the middle of training on ECG. The government gave all the district hospitals ECG machines but nobody knows how to use them because it’s not part of their basic clinical officer training. So I started lessons on Saturdays in how to use the ECG machines, and how to handle the patient if they find abnormalities.’ Katrien is also organising training in neonatal care for nurses. ‘I think small things like this can bring a bit of sustainable change, so it’s useful that I’m here.’

Clinical officer Wizo Chilongo agrees. ‘A lot of improvement has taken place since Dr Katrien and Dr Andrew came here. They had the idea that at the end of every month staff should meet, and that improves our skills and our working relationships. For the patients we just used to write on pieces of paper and then leave them on the table, and then you’d look for the paper the whole day and not find it. But now we have patient files where we keep all the notes. So we are learning a lot from them. We wish they could stay longer because we’re used to them, they are part of us.’

More doctors needed in the future
VSO needs more GPs to work in district hospitals all over Malawi. Katrien is keen to reassure doctors who think Malawi is too much of a challenge that they really can make a difference. ‘You’re not going to change the world working for a few years in a developing country, but if you help just one patient each day or pass one little thing on to a nurse or clinical officer, you’re doing something – you’re helping healthcare in Malawi.’

Impact

• Thanks to VSO doctors, staff at Rumphi District Hospital can now manage more patients there rather than referring them to the central hospital. This saves transport costs – and lives.
• As a result of a blood bank set up by VSO volunteers, Rumphi District Hospital now has an efficient blood transfusion system.
• Patient notes are now filed, enabling staff to work more efficiently.