A Training Hospital for Central Africa
John & Rachel Woodfield, (NZ Treasury, December 2006)
The Open Brethren (CMML) mission work in central Africa covers an area approximately the size of the South Island, including eastern Angola, northwest Zambia, the south of the Democratic Republic of the Congo (DRC) and Northern Zambia. This work began over 100 years ago, and has resulted in over 2000 churches being established as well as many schools, clinics and hospitals.
The medical work provides a practical demonstration of God's love, and has helped the witness of the church for many years. It has also given the people a positive alternative to traditional medicines and the use of witchcraft. A series of hospitals were built, and many of these are continuing to provide essential medical care today. In North West Zambia there are four hospitals at Chitokoloki, Chavuma, Loloma and Kalene and clinics for maternity care such as Dipalata. In Northern Zambia there is a nurse-run hospital at Mambilima and a large clinic in Lwela. .Medical mission work in Angola and DRC has been compromised by civil war, but in spite of this the work has gone on. Hospitals in Congo include those at Kasaji and Mulongo and nurse-run hospitals such as Katoka and Luanza. Plans are underway to reopen a clinic at Kavungo in Angola.
The geographic area covered by CMML is in a 'remote part' in each country, and has received little investment in infrastructure (see Murray Stevenson's letter, October 2006 Treasury, p26). There are many small villages, subsistence agriculture and an HIV rate of around 10%. Mission hospitals and rural health clinics are providing an essential service which would be unavailable should they close. Medical work continues to provide an open door for sharing the gospel to patients and families. A recent conference in Johannesburg of Christian brethren church leaders from seven African countries emphasized the need for an ongoing medical work. They requested the continued support of Christians from traditional missionary sending countries to provide staff and some financial resources for mission healthcare.
Currently, CMML medical work is approaching a crisis. Problems with national poverty, a challenging working environment, malaria and HIV are not the primary reasons for this. In Zambia, 90% of medical graduates in the last twenty years have left the country, with many moving to South Africa or the United Kingdom. Registered nurses are also leaving the country, and many of the remaining health professionals are ill or have died from AIDS. There is also a problem recruiting expatriate doctors and nurses due to changes in medical training. Whereas 25 years ago medical training equipped doctors with the broad practical skills, (eg: general medicine, obstetrics, and basic anaesthetic and surgical skills), needed for an African hospital, now training is more theoretical, and practical skills are developed in a specialty area. Many of the current medical and nursing staff are approaching retirement and replacing them will be very difficult.
During our time in the United Kingdom we discussed these problems with a number of interested people and groups. It was felt there was a need for a training hospital in central Africa, to enable doctors and nurses, (from either Africa or western countries) to receive the practical training required to equip them for work in a rural African hospital. Echoes of Service recommended Kalene Mission Hospital for redevelopment as a training hospital. By providing trained staff to other medical facilities in the broader area, the aim is that the redevelopment of Kalene should benefit all.
Kalene Mission Hospital
The Kalene area is in the top left hand corner of Zambia, and borders Angola and DRC. The hospital has approximately 180 beds and provides inpatient and outpatient services including maternity, surgery, paediatrics, infectious diseases, malnutrition and general medicine. The centenary at Kalene mission was celebrated this year and the current hospital facility was built in the 1950's. The hospital is partly funded by the Zambian government and by Echoes of Service UK
The Kalene area combines a number of advantages. The hospital is close to the Zambezi river, and from 2007 will be provided with reliable 24 hour electricity as a result of the Zengamina hydroelectric project (see October 2006 Treasury, p14). The hospital is in a good geographic position to help the medical work in Angola and DRC and is central to the Lunda tribal area. There is space to renovate and expand hospital buildings and a nursing school facility is on site. Sakeji primary school is about 20km away.
Medical work at Kalene has faced difficulties in recent years, including chronic staff shortages, lack of building maintenance and poor staff morale. The upgrade to a training hospital will require a major effort, both in terms of the hospital facility and in establishing a team (doctors, nurses, administration, and maintenance) to take the work forward. Christian service agencies in the UK, including Echoes of Service, Brass Tacks and Medical Missionary News are committed to this and will provide practical and financial support.
Four practical steps to developing as a training hospital
The redevelopment plan can be summarised in four stages.
1) Reliable 24/7 electricity supply.
This will be provided by the Zengamina hydroelectric scheme and will reduce the reliance of the mission on diesel generators. Building this project has had a very positive impact in the community and is making excellent progress.
2) Renovation of the hospital.
Brass Tacks (www.brass-tacks.org.uk), a mission building and maintenance group, (similar to Mobile Mission Maintenance), has had a team of 28 people putting in 200 working days on site from May to December 2006. They have begun the hospital renovation. The first phase includes the construction of new toilet blocks, extensions to the plumbing and drainage system, roof repair, and rewiring the hospital for 24 hour electricity. Good progress is being made. Medical Missionary News (www.mmncontainers.com), a missions supply organization have sent 20 foot containers of medicines and building materials to Kalene and will help with purchasing new medical equipment.
3) Establishing a medical team.
The current staff at the hospital include GP, Dr Vivian Davies (Wales), Dr Jeff Mortelmans (Belgium) and three nurses, Alice Turner (Canada), Helen Hindson (Northern Ireland) and Rachel Reed (Australia), a midwife. There are three recently qualified Zambian registered nurses and a number of general Zambian staff. We will be joining the team in May 2007. John is a General Surgeon, and Rachel a hospital pharmacist. Dr Peter Gill (UK), an orthopaedic surgeon, is planning to move to Kalene, but does not have a definite starting date. There have been a number of enquiries from others, and in the last few weeks we have received news of a newly qualified doctor from DRC who will come to Kalene for additional training in 2007.
Central to the plan for training nurses is the reopening of the nursing school. The government have inspected the school, promised some funding, and requested it be reopened to train Zambian enrolled nurses (ZEN). A two year course for approximately 20 nurses is planned. Other mission hospitals and clinics would be able to send students to be trained as enrolled nurses, who would then return to the referring hospital/clinic after completing the course.
Training of qualified doctors, clinical officers and nurses from African and 'Western' countries would be based on an apprenticeship model. It is envisaged that staff would come requiring training in particular practical skills, such as obstetrics or surgery. They would have the opportunity to learn these skills in a supportive environment and with appropriate supervision. When competency was achieved, the worker would move on to the hospital or clinic they were planning to work in.
With the other medical and nursing staff at Kalene, we are looking to establish a team of committed doctors and nurses willing to serve the Zambian people by providing medical care and training others. There are exciting opportunities to strengthen the witness of local churches and improve the delivery of healthcare in this part of Africa. Progress is being made. There are opportunities for any doctor or nurse interested in serving the Lord in this way. The most pressing needs are for an administrator, a nursing tutor to help in the nursing school, a midwife, a further doctor (especially someone with anaesthetic skills) and a maintenance person. We are also keen to hear from people interested in receiving training for medical work in Africa.