The Blantyre Box

In this country with 7 million children under age 15, there are less than 20 pediatricians.  Ten of them work here at Queen Elizabeth Central Hospital (QECH) and the Medical College in Blantyre, where they are very active clinically and have published much research in the fields of pediatric emergency medicine and infectious disease. 

The hospital has 250 beds for children; however, due to the heavy burden of malaria, HIV, meningitis, malnutrition, and diarrheal illness, there are usually 350-400 children squeezed into the 250 beds.  Pictured here is the Blantyre Box for newborns (which got its name after becoming popular at QECH).  A thin mattress and sheet are placed in the box, and heat is provided by those small white boxes at the bottom, which are simply switches to turn on light bulbs whose heat radiates upward to heat the box.  the plastic cover on top also helps retain the heat.

 

Twelve per cent of all Malawian children die before the age of five.  Before mosquito bed nets were widespread 5 years ago, the mortality rate for all children under five was 25%.  The hospital has no ventilators for patients in intensive care units, and supplemental oxygen only reaches 30% in the oxygen condensers.  The operating room is the only room with a ventilator, and the analgesic medication is provided by a person continuously pumping foot pedals to deliver the medicine.

Fifteen percent of the children admitted to QECH for malnutrition do not survive, while rural villages see 25-50% mortality rates.  Most of the pediatric hospital beds are 5 feet x 3 feet, with two children in each bed, and their mother on their side of the bed.  In a large room of 150 children, with 150 mothers, and beds only 3 feet apart, the challenges of reducing the spread of infections is daunting.  Mothers all sleep on the tile floor by the bed.  For children not lucky enough to have a bed, the mother is given a mattress to place against a wall, where she will stay with her child the entire time.  

My first day visiting this hospital was one of my toughest.  Yet the doctors here show an energy and drive that is very inspiring and made me want to stay to learn more!