When 19-months-old Baliyasi Samson entered in a ward with his mother Sayankhulana Sakala at Salima District Hospital in the lakeshore district of Salima (90 Km from Lilongwe) in central Malawi his life's thread was hanging on a thin line between life and death. The boy was in a coma but lucky because it had to take a team work spirit and a wonderful skill called triage by health workers at the hospital to save his life by resuscitating him to regain his health.
During Baliyasi’s treatment over a couple of days Salima District Hospital staff provided a strong insight into the intricacies of building a health system bit by bit, and just how vital it is to make sure all those bits were working.
Forty-eight hours after Baliyasi’s parents had brought him to Salima Hospital 28-year-old Sayankhulana was still deeply gripped with trauma by what had happened to her son despite that he was then out of danger.
“On the day before he was rushed to the hospital I thought the boy might have malaria,” said the mother of four children.
Sayankhulana further said her son had a fever and seemed out of sorts.
“In the afternoon, though, the fever subsided; even though he hadn’t eaten in a day and a half, I thought he might be OK. But overnight, he grew hot and agitated,” she explained adding that without delay she and her husband got up at 4 a.m., and walked three kilometers to the nearest health center in the small trading center of Siyasiya.
“At 5 a.m., we arrived at Khombedza Health Centre, and a night watchman called one of the centre’s clinicians, who came down to the centre, examined our child, and recommended that we immediately take him to Salima District Hospital, 30 Km away,” said Sayankhulana.
She and her husband were lucky was because the centre had an ambulance, and soon they were whisked away in the vehicle.
“But at some point, Baliyasi lapsed into a coma and I thought he had simply fallen asleep,” said Sayankhulana.
At Salima Hospital, one part of the system also failed: the driver didn’t communicate the nature of the emergency. But the system had a backup: A nurse performing triage saw the boy immediately.
She called over Rodrick Kaliati, the Emergency Triage Assessment Treatment (ETAT) District Coordinator for Salima, and, after talking with Baliyasi’s parents, he diagnosed the case as severe malaria.
Kaliati, who along with the rest of his staff were trained for five days by Management Sciences for Health in emergency triage, put the boy immediately on oxygen therapy and inserted an IV of glucose to raise his sugar level in his blood. A couple of hours later, the boy regained consciousness in the ward.
“Previously, it was first come, first served,” he said Kaliati of the line of mothers awaiting treatment of their children adding, “There were a lot of deaths in the first 24 hours of admission.”
For over eight years now, Management Sciences for Health (MSH)’s USAID-funded programs have covered a wide range of things: starting in far rural reaches of eight districts in Malawi in building a network of community health care and continuing all the way to the large hospitals in training staff and adding staff in critical areas such as HIV counseling and testing.
MSH Country Director for Malawi Rudi Thetard said the organization with a workforce of 120 and running on an annual budget of $10 million dollars was working very closely with the Ministry of Health.
“We’ve always had a comprehensive approach toward strengthening the rollout of programs. It’s not only about training people, but also about setting up the systems that allow them to work in a sustainable way,” he told a visiting crew of journalists from the US.
According figures for the past five years revealed that during the month of January from 2007 to 2009 roughly two children died every day at Salima Hospital in the first 24 hours.
But during January in 2010 and 2011, an average of less than one child died daily in that time frame since triage training played a major role. The hospital staff was trained in September 2009, and its performance in January 2010 and 2011 showed a major reduction in deaths.
“We were really fed up with these deaths,” Kaliati said adding, “MSH’s training taught us so many new things. ETAT doesn’t draw a line between the nurses and clinicians; we were trained to work together as a team. So when a child in a severe way improves it’s a pleasure to us all. We had just five days of training, but those five days changed us so much.”
Baliyasi was admitted just for four days at Salima hospital before he was discharged and returned to his village.
The boy’s father, 36-year-old Samson Sinoya disclosed that he had great fears about his son’s condition before he was brought to Salima Hospital.
“I thought my son would die. In fact I had already given up,” he said.
Salima MSH District Coordinator Kuzemba Mulenga attributed Baliyasi’s survival to both a triage programme and also other parts of building a system in place.
“Many things had to work,” he said adding that they had to have the drug supply and the equipment in place.
“The District Health Officer had to have put emergency vehicles in the outlying areas, to take that boy into the hospital quickly. And when they got to the hospital, the team there had to act fast, and they did. It’s great,” said Mulenga adding, “Three years ago, that boy would not have survived because the system was not there. Now it is,” he explained.
The success of saving the life of Baliyasi by health workers including nurses using triage nursing skills is just one of few positive stories on Best Health Practices in Malawi’s health sector as a result of well coordinated teamwork and their commitment to professionalism that can save lives of many if fully rolled out in all the country’s public health facilities.
The story even proves that indeed, the strengthening of the health sector including at hospital level the technical knowledge and approach to timely (immediate referral, early diagnosis and treatment) case management was a major contributing factor in saving the life of this 19 year old boy.
Triage system is usually where the severity of patients’ condition is determined and before deciding upon how quickly they need treatment.
Under the system nurses or health workers allocates the patient a place in the queue. In practice most urgent patients are seen first then patients with a stable condition which needs urgent conditions are seen next.
Finally, all the others are seen. It is a highly specialized job, and these people require a great deal of training. Most of them are good at it but some can be spectacularly bad.
Pervasive, chronic poverty has devastated every sector of Malawi for decades—contributing to a faltering economy and applying enormous pressure on an overextended and under resourced government.
Severe food shortages and a lack of access to health services rest firmly and often fatally on undereducated individuals and starving children.
A fragile health care infrastructure is aggravated by the poverty problem and has increased the prevalence of HIV and AIDS, tuberculosis, malaria, malnutrition, and other epidemics.
Malawi has some of the worst health indicators in the world and one of the highest maternal mortality rates in Africa even posing a threat to the country’s policy makers’ efforts to steer the nation towards achieving all Millenium Development Goals (MDGs) aiming at improving lives of majority citizens at all levels by 2015 who are currently suffering from pangs of poverty at all levels.
Since 2003, MSH Programs in Malawi with funding from US Government through USAID have sought to strengthen health care systems, increase disease prevention education, and reduce both maternal and childhood mortality rates through reproductive health and family planning initiatives.
Health education and increased access to fundamental health care in communities remains the focus of MSH’s work in Malawi.
MSH looks forward to collaborating with regional and national institutions, both public and private, to further support health programs and train effective health care leaders.
Collectively, MSH and its partners are striving to facilitate efficient, decentralized management of resources and delivery of fundamental health care services to increase the health of the people of Malawi.
Accessing quality health including emergency services like what happened to Baliyasi is a dream of many in Malawi due to many challenges faced by health workers including nurses.
Just a few weeks for instance, some five innocent souls were rushed to a major referral hospital building in central Malawi with a hope of saving their lives.
However, the sick people returned while lifeless and enclosed in coffins because the people who were employed by the state to attend and take care of them in the building refused to do their job.
Yes! The five patients lost their lives at Malawi’s major referral hospital in the central region of the country [Kamuzu Central Hospital (KCH)] in Lilongwe because health workers denied them the right to access medical treatment.
The workers mainly nurses were only working during their normal hours in protest against the low overtime or Locum allowance pegged at K1, 200 per day and K1, 400 night shift. The nurses wanted instead the money raised to K6, 000 and K8, 000 respectively.
Malawi Government in a statement through Ministry of Health Principal Secretary (PS) Willie Samute however said the demand was too high and unsustainable.
But the PS was further quick to indicate that the state had made recommendations to increase the Locum rates.
Nevertheless such recommendations for adjustment of the health workers’ overtime allowances were only to be effected in the new financial year which was just less than four weeks then.
“Our engagement with them has on these two occasions failed to reach a conclusion that will normalize the situation at the hospital. This has made the situation worse. It’s important to understand that the bulk of the clinical staff shunning Locum is nurses while almost all of them are reporting for normal duties,” said Samute.
The striking health workers had earlier through their representatives presented the Locum matter to the Office of the President and Cabinet (OPC).
In response the Secretary to the President and Cabinet Bright Msaka said Malawi Government appreciates the financial hardships the health workers were going through in the country hence the overtime fees would be raised on July 1 this year.
The response left the health workers pondering amongst themselves on how they were going to make themselves available at Kamuzu Central Hospital (KCH) when they were on off duty to cover the shortage with their little overtime fees.
No wonder that a health worker at KCH disclosed that as a result of the strike over the overtime fees children’s lives were in danger at the time.
“The Children’s Ward also known as the Peadiatric Ward here is literally equivalent to a whole District Hospital since it has three blocks/wards with only 30 nurses in total on duty and they are supposed to be 10 with four on normal duty, six on Locum duty meaning that those six would not be coming for Locum duties. So how do you expect only four nurses to take care of 400 sick children in this ward? Let us just wait and see till July when new Locum fees will be effective,” she said.
Apart from strikes in public health facilities in Malawi in some cases poor delivery of health services to patients has also opened a can of worms for some health workers.
Take for instance, a case of another nurse’s alleged negligence that led to a nurse stationed at Ekwendeni Mission Hospital in northern Malawi, currently battling for her life after an incensed relative to a woman who had just given birth to a still-born attacked her last year.
Presently admitted to Kamuzu Central Hospital (KCH), 25-year-old Grace Chizala revealed that her problem started after she had sand thrown into her eyes by a relative of one of her patients.
"I was on night duty. A number of children were born that night,” she said adding that she heard that one of the deliveries was a still-born.
“I didn't know the details as it was my colleague who assisted in the delivery. In the morning, one of the patient's relatives came towards me and she threw sand into my eyes. Since that time I have been having a series of complications related to the eyes," said Grace.
The nurse looked frail while narrated her ordeal with difficulties. In September last year, Grace went to South Africa for specialized treatment but the problem resurfaced earlier this year to the extent that since then, she has not been able to work.
At one point Grace was also taken to Mwaiwathu Private Hospital in Blantyre however, despite best efforts to find a cure, there has been no improvement in her condition.
An attack on a health worker at Sinyala Health Centre in Mangochi on the other hand also left the facility paralysed without accessing health services for close to three years.
Health workers reportedly fled the Health Centre and were unwilling to go back for fear of their lives.
As a result, residents who were relying on the facility for health services were being forced to travel long distances of about 18Km to get to the next health facility.
“As a result of this situation, the community is being deprived of health services due to very long distances people are covering to get to the nearest health facility,” said Catholic Commission for Justice and Peace (CCJP) Diocesan Coordinator Bruno Banda.
The priest further explained that people cover long distances to seek medical attention to the surrounding health centres of Nancholi and Mkumbe.
Added Banda:"There are health related disasters, even deaths especially of the under fives, pregnant mothers and other seriously ill patients which could have been avoided or reduced with the presence of medical personnel at Sinyala Health Centre."
Mangochi District Commissioner (DC) Thomas Chirwa disclosed that the health personnel fled from Sinyala Health Centre because the communities around the area had a secret meeting where they had planned to stab a Health Assistant (HA) on allegation that he was negligent when attending to patients.
While not condoning health workers including nurses and midwives indulging in acts of negligence at work, National Organisation of Nurses and Midwives of Malawi (NONM) condemned the act of attacks on health workers.
NONM Deputy Director Harriet Kapyepye requested people in the country to follow proper procedures of filing complaints against negligent health workers than attacking them.
"It's not proper to attack health workers. If there are complaints, people have to follow proper channels,” she said adding, “People shouldn't reach an extent of inflicting pain to health workers."
Vice-President also Minister of Health Khumbo Kachali said Malawi Government is aware of the many challenges nurses, midwives and health workers are facing in the course of their work in the country.
“In this regard government will do everything to address the problems health workers are facing in the country,” he said.
The National Coordinator for Safe Motherhood in Malawi Dorothy Ngoma on her part singled out the shortage of nurses in the country as one reason behind the abuse of the few ones in public health facilities by patients and guardians in one way or the other.
“We have situations whereby for instance, four or five nurses taking care of say 200 or 300 very sick patients for 24 hours a day without rest and meeting very little support and that in itself is a form of abuse of nurses,” said Ngoma adding that the practice even compromises the quality of treatment rendered to patients.
“Abusing nurses is not just beating or talking abusively to them as some patients and guardians have been doing in this country but also stressing them with unlimited work pressure without giving them time to rest,” she explained.
Ngoma also expounded that both nurses and patients have become victims of various circumstances especially in public hospitals due to among other things, the same staff shortages.
“We need between 16, 000 to 20, 000 nurses and they need to work on a shift that is, we need four people for one job and it’s expensive but necessary,” she said.
Ngoma was further quick to say that despite that some nurses are naturally unfriendly some act unfriendly unknowingly due to stress and pressure.
“Imagine being attended to a nurse who has been working for 24 hours. She is likely to be rude and angry,” she said.
To deal with the staff shortage problem Ngoma added that Malawi has to take necessary steps.
“First we have to realize the problem exists then put necessary measures how to deal with it. One of the strategies for instance is we should look for donors who should come forward to help us train more health workers including nurses, midwives, clinicians and doctors and put all necessary incentives in place to motivate them at work to prevent them from leaving the public health sector for other so called greener pastures elsewhere,” said Ngoma.
Forty-eight hours after Baliyasi’s parents had brought him to Salima Hospital 28-year-old Sayankhulana was still deeply gripped with trauma by what had happened to her son despite that he was then out of danger.
“On the day before he was rushed to the hospital I thought the boy might have malaria,” said the mother of four children.
Sayankhulana further said her son had a fever and seemed out of sorts.
“In the afternoon, though, the fever subsided; even though he hadn’t eaten in a day and a half, I thought he might be OK. But overnight, he grew hot and agitated,” she explained adding that without delay she and her husband got up at 4 a.m., and walked three kilometers to the nearest health center in the small trading center of Siyasiya.
“At 5 a.m., we arrived at Khombedza Health Centre, and a night watchman called one of the centre’s clinicians, who came down to the centre, examined our child, and recommended that we immediately take him to Salima District Hospital, 30 Km away,” said Sayankhulana.
She and her husband were lucky was because the centre had an ambulance, and soon they were whisked away in the vehicle.
“But at some point, Baliyasi lapsed into a coma and I thought he had simply fallen asleep,” said Sayankhulana.
At Salima Hospital, one part of the system also failed: the driver didn’t communicate the nature of the emergency. But the system had a backup: A nurse performing triage saw the boy immediately.
She called over Rodrick Kaliati, the Emergency Triage Assessment Treatment (ETAT) District Coordinator for Salima, and, after talking with Baliyasi’s parents, he diagnosed the case as severe malaria.
Kaliati, who along with the rest of his staff were trained for five days by Management Sciences for Health in emergency triage, put the boy immediately on oxygen therapy and inserted an IV of glucose to raise his sugar level in his blood. A couple of hours later, the boy regained consciousness in the ward.
“Previously, it was first come, first served,” he said Kaliati of the line of mothers awaiting treatment of their children adding, “There were a lot of deaths in the first 24 hours of admission.”
For over eight years now, Management Sciences for Health (MSH)’s USAID-funded programs have covered a wide range of things: starting in far rural reaches of eight districts in Malawi in building a network of community health care and continuing all the way to the large hospitals in training staff and adding staff in critical areas such as HIV counseling and testing.
MSH Country Director for Malawi Rudi Thetard said the organization with a workforce of 120 and running on an annual budget of $10 million dollars was working very closely with the Ministry of Health.
“We’ve always had a comprehensive approach toward strengthening the rollout of programs. It’s not only about training people, but also about setting up the systems that allow them to work in a sustainable way,” he told a visiting crew of journalists from the US.
According figures for the past five years revealed that during the month of January from 2007 to 2009 roughly two children died every day at Salima Hospital in the first 24 hours.
But during January in 2010 and 2011, an average of less than one child died daily in that time frame since triage training played a major role. The hospital staff was trained in September 2009, and its performance in January 2010 and 2011 showed a major reduction in deaths.
“We were really fed up with these deaths,” Kaliati said adding, “MSH’s training taught us so many new things. ETAT doesn’t draw a line between the nurses and clinicians; we were trained to work together as a team. So when a child in a severe way improves it’s a pleasure to us all. We had just five days of training, but those five days changed us so much.”
Baliyasi was admitted just for four days at Salima hospital before he was discharged and returned to his village.
The boy’s father, 36-year-old Samson Sinoya disclosed that he had great fears about his son’s condition before he was brought to Salima Hospital.
“I thought my son would die. In fact I had already given up,” he said.
Salima MSH District Coordinator Kuzemba Mulenga attributed Baliyasi’s survival to both a triage programme and also other parts of building a system in place.
“Many things had to work,” he said adding that they had to have the drug supply and the equipment in place.
“The District Health Officer had to have put emergency vehicles in the outlying areas, to take that boy into the hospital quickly. And when they got to the hospital, the team there had to act fast, and they did. It’s great,” said Mulenga adding, “Three years ago, that boy would not have survived because the system was not there. Now it is,” he explained.
The success of saving the life of Baliyasi by health workers including nurses using triage nursing skills is just one of few positive stories on Best Health Practices in Malawi’s health sector as a result of well coordinated teamwork and their commitment to professionalism that can save lives of many if fully rolled out in all the country’s public health facilities.
The story even proves that indeed, the strengthening of the health sector including at hospital level the technical knowledge and approach to timely (immediate referral, early diagnosis and treatment) case management was a major contributing factor in saving the life of this 19 year old boy.
Triage system is usually where the severity of patients’ condition is determined and before deciding upon how quickly they need treatment.
Under the system nurses or health workers allocates the patient a place in the queue. In practice most urgent patients are seen first then patients with a stable condition which needs urgent conditions are seen next.
Finally, all the others are seen. It is a highly specialized job, and these people require a great deal of training. Most of them are good at it but some can be spectacularly bad.
Pervasive, chronic poverty has devastated every sector of Malawi for decades—contributing to a faltering economy and applying enormous pressure on an overextended and under resourced government.
Severe food shortages and a lack of access to health services rest firmly and often fatally on undereducated individuals and starving children.
A fragile health care infrastructure is aggravated by the poverty problem and has increased the prevalence of HIV and AIDS, tuberculosis, malaria, malnutrition, and other epidemics.
Malawi has some of the worst health indicators in the world and one of the highest maternal mortality rates in Africa even posing a threat to the country’s policy makers’ efforts to steer the nation towards achieving all Millenium Development Goals (MDGs) aiming at improving lives of majority citizens at all levels by 2015 who are currently suffering from pangs of poverty at all levels.
Since 2003, MSH Programs in Malawi with funding from US Government through USAID have sought to strengthen health care systems, increase disease prevention education, and reduce both maternal and childhood mortality rates through reproductive health and family planning initiatives.
Health education and increased access to fundamental health care in communities remains the focus of MSH’s work in Malawi.
MSH looks forward to collaborating with regional and national institutions, both public and private, to further support health programs and train effective health care leaders.
Collectively, MSH and its partners are striving to facilitate efficient, decentralized management of resources and delivery of fundamental health care services to increase the health of the people of Malawi.
Accessing quality health including emergency services like what happened to Baliyasi is a dream of many in Malawi due to many challenges faced by health workers including nurses.
Just a few weeks for instance, some five innocent souls were rushed to a major referral hospital building in central Malawi with a hope of saving their lives.
However, the sick people returned while lifeless and enclosed in coffins because the people who were employed by the state to attend and take care of them in the building refused to do their job.
Yes! The five patients lost their lives at Malawi’s major referral hospital in the central region of the country [Kamuzu Central Hospital (KCH)] in Lilongwe because health workers denied them the right to access medical treatment.
The workers mainly nurses were only working during their normal hours in protest against the low overtime or Locum allowance pegged at K1, 200 per day and K1, 400 night shift. The nurses wanted instead the money raised to K6, 000 and K8, 000 respectively.
Malawi Government in a statement through Ministry of Health Principal Secretary (PS) Willie Samute however said the demand was too high and unsustainable.
But the PS was further quick to indicate that the state had made recommendations to increase the Locum rates.
Nevertheless such recommendations for adjustment of the health workers’ overtime allowances were only to be effected in the new financial year which was just less than four weeks then.
“Our engagement with them has on these two occasions failed to reach a conclusion that will normalize the situation at the hospital. This has made the situation worse. It’s important to understand that the bulk of the clinical staff shunning Locum is nurses while almost all of them are reporting for normal duties,” said Samute.
The striking health workers had earlier through their representatives presented the Locum matter to the Office of the President and Cabinet (OPC).
In response the Secretary to the President and Cabinet Bright Msaka said Malawi Government appreciates the financial hardships the health workers were going through in the country hence the overtime fees would be raised on July 1 this year.
The response left the health workers pondering amongst themselves on how they were going to make themselves available at Kamuzu Central Hospital (KCH) when they were on off duty to cover the shortage with their little overtime fees.
No wonder that a health worker at KCH disclosed that as a result of the strike over the overtime fees children’s lives were in danger at the time.
“The Children’s Ward also known as the Peadiatric Ward here is literally equivalent to a whole District Hospital since it has three blocks/wards with only 30 nurses in total on duty and they are supposed to be 10 with four on normal duty, six on Locum duty meaning that those six would not be coming for Locum duties. So how do you expect only four nurses to take care of 400 sick children in this ward? Let us just wait and see till July when new Locum fees will be effective,” she said.
Apart from strikes in public health facilities in Malawi in some cases poor delivery of health services to patients has also opened a can of worms for some health workers.
Take for instance, a case of another nurse’s alleged negligence that led to a nurse stationed at Ekwendeni Mission Hospital in northern Malawi, currently battling for her life after an incensed relative to a woman who had just given birth to a still-born attacked her last year.
Presently admitted to Kamuzu Central Hospital (KCH), 25-year-old Grace Chizala revealed that her problem started after she had sand thrown into her eyes by a relative of one of her patients.
"I was on night duty. A number of children were born that night,” she said adding that she heard that one of the deliveries was a still-born.
“I didn't know the details as it was my colleague who assisted in the delivery. In the morning, one of the patient's relatives came towards me and she threw sand into my eyes. Since that time I have been having a series of complications related to the eyes," said Grace.
The nurse looked frail while narrated her ordeal with difficulties. In September last year, Grace went to South Africa for specialized treatment but the problem resurfaced earlier this year to the extent that since then, she has not been able to work.
At one point Grace was also taken to Mwaiwathu Private Hospital in Blantyre however, despite best efforts to find a cure, there has been no improvement in her condition.
An attack on a health worker at Sinyala Health Centre in Mangochi on the other hand also left the facility paralysed without accessing health services for close to three years.
Health workers reportedly fled the Health Centre and were unwilling to go back for fear of their lives.
As a result, residents who were relying on the facility for health services were being forced to travel long distances of about 18Km to get to the next health facility.
“As a result of this situation, the community is being deprived of health services due to very long distances people are covering to get to the nearest health facility,” said Catholic Commission for Justice and Peace (CCJP) Diocesan Coordinator Bruno Banda.
The priest further explained that people cover long distances to seek medical attention to the surrounding health centres of Nancholi and Mkumbe.
Added Banda:"There are health related disasters, even deaths especially of the under fives, pregnant mothers and other seriously ill patients which could have been avoided or reduced with the presence of medical personnel at Sinyala Health Centre."
Mangochi District Commissioner (DC) Thomas Chirwa disclosed that the health personnel fled from Sinyala Health Centre because the communities around the area had a secret meeting where they had planned to stab a Health Assistant (HA) on allegation that he was negligent when attending to patients.
While not condoning health workers including nurses and midwives indulging in acts of negligence at work, National Organisation of Nurses and Midwives of Malawi (NONM) condemned the act of attacks on health workers.
NONM Deputy Director Harriet Kapyepye requested people in the country to follow proper procedures of filing complaints against negligent health workers than attacking them.
"It's not proper to attack health workers. If there are complaints, people have to follow proper channels,” she said adding, “People shouldn't reach an extent of inflicting pain to health workers."
Vice-President also Minister of Health Khumbo Kachali said Malawi Government is aware of the many challenges nurses, midwives and health workers are facing in the course of their work in the country.
“In this regard government will do everything to address the problems health workers are facing in the country,” he said.
The National Coordinator for Safe Motherhood in Malawi Dorothy Ngoma on her part singled out the shortage of nurses in the country as one reason behind the abuse of the few ones in public health facilities by patients and guardians in one way or the other.
“We have situations whereby for instance, four or five nurses taking care of say 200 or 300 very sick patients for 24 hours a day without rest and meeting very little support and that in itself is a form of abuse of nurses,” said Ngoma adding that the practice even compromises the quality of treatment rendered to patients.
“Abusing nurses is not just beating or talking abusively to them as some patients and guardians have been doing in this country but also stressing them with unlimited work pressure without giving them time to rest,” she explained.
Ngoma also expounded that both nurses and patients have become victims of various circumstances especially in public hospitals due to among other things, the same staff shortages.
“We need between 16, 000 to 20, 000 nurses and they need to work on a shift that is, we need four people for one job and it’s expensive but necessary,” she said.
Ngoma was further quick to say that despite that some nurses are naturally unfriendly some act unfriendly unknowingly due to stress and pressure.
“Imagine being attended to a nurse who has been working for 24 hours. She is likely to be rude and angry,” she said.
To deal with the staff shortage problem Ngoma added that Malawi has to take necessary steps.
“First we have to realize the problem exists then put necessary measures how to deal with it. One of the strategies for instance is we should look for donors who should come forward to help us train more health workers including nurses, midwives, clinicians and doctors and put all necessary incentives in place to motivate them at work to prevent them from leaving the public health sector for other so called greener pastures elsewhere,” said Ngoma.
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