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VISIT BY FRIENDS OF MURAMBINDA (FMH) HOSPITAL TRUSTEES MARY MILLER AND CAROLYN RIGBY, WITH SUPPORTER BETH KIRBY Friday 28.2.20 Mary and Carolyn arrived Nairobi via Schiphol early morning then flew onto Harare arriving tea-time where we met Beth Kirby a colleague of GPs John and Anne Connolly former doctors at Murambinda Mission Hospital (MMH) who has just finished her master’s degree in Public Health and joined us for the trip. Saturday 29.2.20 After a night in a small hostel we walked to a local supermarket to buy food for our stay as we were unsure of its availability in Murambinda. We had brought a lot of staples with us and found the supermarket well stocked but empty of customers most likely due to prices being not dissimilar to the UK. We were picked up just after lunch, arriving MMH about 6pm. There were lots of potholes on road and a toll just south of Harare, also 2 police roadblocks but we were waved through. Administration Building, Murambinda Mission Hospital Sunday 1.3.20 We attended church at 8.30 which was much enlivened by a very energetic priest giving an interactive sermon on the temptation of Eve- much laughter and other people having their say. We sat on the back row and had intermittent translation by two lovely ladies who laughed and chatted through the service but clearly took their religion seriously. We had to introduce ourselves and then were “exposed” with lots of thanks as we’d put US$ in the collection (the amount was announced!). The highlight was the singing and the gorgeous babies and children. At the end the choir gave a recital of their competition entry from the day before where they had come 6th. It was truly exceptional. We met many old friends and made a lot of new ones. MEETING WITH DR. KWIRI, DISTRICT MEDICAL OFFICER After lunch we then met with Dr Kwiri the District Medical Officer (DMO) and Hospital Superintendent who very kindly gave up his Sunday afternoon for us as he was off to Mozambique for a cross-border conference about Coronavirus. He has been acting Provincial Medical Director since January which necessitates 2 days a week in the provincial capital Mutare 200 km away so he is very busy doing his own DMO work in reduced time. From him we learned • There are another 2 doctors besides himself along with a clinical officer (like a very advanced nurse practitioner). He feels doctor numbers are less important than their commitment to the work but he ideally feels MMH needs a DMO and 3 doctors (plus another 3 at the larger health facilities in the district which he does not have). His main aim is to retain the doctors he has as they work as an excellent team. • There are unlikely to be any newly graduated (post foundation) doctors coming for their rural practice placement any time soon because of the delay to their studies due to the strike last year and because they are choosing not to get their open practice certificate which is unnecessary for working overseas or for private practice. • Outpatient numbers are down due to transport and user fee costs being beyond the capability of many • Clinically malaria is reduced (poor rains over the season) but recent late rains have caused a spike. There were only 2 cases of multi-drug resistant TB in last year though TB rates are up. And they have very good treatment completion rates. Malnutrition is currently low (good support from donors after Cyclone Idai) but with an expected poor harvest will likely go up unless ongoing support is forthcoming. Births are up, many coming from outside the district. HIV rates are mercifully down, and they only test high risk cases routinely. Anthrax is up as poor animal health. We thanked Dr Kwiri sincerely for his exceptional hard work and for his help with elective students. He explained that he had been brought up in a rural farming area and is committed to helping the people of rural areas. VISIT TO MUSASA PROJECT We then went for a walk and met an old friend Farai Bishi on his way to the women’s refuge- they regularly use him as a volunteer driver. It is called The Musasa Project. There is a very young counsellor and support worker called Lisa who showed us around and there was an assistant house mother on duty for the weekend. There were 8 bedrooms sleeping 2-3 girls some who are only in their very early teens looking after their babies. Some of the girls as young as 6 had been sexually abused or subjected to violence or severe deprivation. One young woman had physical disabilities The Musasa Project provides a safe place and emotional and legal support. We noticed the complete absence of possessions or toys but there was a very calm atmosphere and they were all very welcoming. Monday 2.3.20 The traditional welcome at morning prayers at 7.30 was as always a very special occasion. The matron Sr. Silindiwe welcomed us. We introduced ourselves and then after songs and prayers and a reading we had the usual shaking of hands from all the staff and lots of hugs. MEETING WITH SR. FILLYS MADZIYA, LCM Head of Missions After this we met with Sr Fillys, the newly appointed Mission Director. She kindly explained her role. She has been appointed to integrate the vision of the Little Company of Mary with that of the hospital and hopes to attend to the holistic and spiritual needs of the patients and staff alike. She wants to ensure that for all patients their care is as dignified as possible and that their spiritual needs are catered for. She plans to liaise with other denominations. She hopes to find a place for a chapel where patients can sit and find peace in prayer. The priest still attends weekly and visits all wards and the morning prayers moves around the hospital. For the staff she wants to foster a workforce that is well-motivated and supported. She has a vision that the Murambinda ethos will be instantly recognisable in all the staff no matter where they may end up working. She hopes they will create a healing environment which be supportive to all, patients and staff alike. She wants a social space for staff where they can recharge their own energies and plans to have motivating pictures and messages displayed throughout the hospital. She hopes that this will help everyone cope with the pressures they are under. This model is already underway in Australia and other places. She is very appreciative of Mary (Miller) and her husband John staying in Zimbabwe throughout all the problems around the 2008 election and subsequently. We spoke briefly to Mrs Natale at CARC (the Child and Adolescent Resource Centre) which supports children and young people living with HIV, as she was going out on an outreach project to support female care givers by training them in chicken management, financial affairs etc. Empowering women is their aim. We heard about Lewis a recipient of CARC’s fabulous support who is now at university studying psychology and is due back to help CARC during his placement year. Mrs. Evelyn Natale, CARC Coordinator MEETING WITH MR. MUDZI, Donor Funds Secretary We then met with Mr Mudzi our donor secretary to discuss current challenges as he sees them. He sees the priorities for funding as hospital repairs and renovations, incentives and groceries (10l of oil and 10kg rice and sugar per quarter). They plan to renovate the Matumba (waiting mothers’ shelter) by turning the cooking area which is underused into another sleeping quarter and making a much smaller cooking area outside in a shelter- this has been surveyed by the district engineer and is not thought to be a high cost project. They really want an isolation ward and a new service vehicle- they plan to auction the existing one. Solar lighting is also sorely needed-half the hospital is on solar power, but the batteries aren’t working in maternity and children’s ward so they need new ones or repairs. LCM are funding this. The x-ray machine and autoclave still need mains electricity but of the generators used to power these during a power cut one needs servicing and the other needs repairing. The borehole has a solar pump to use when the electricity is off as no water can be pumped from the river. MEETING WITH SR. TAWODZERA, Sister in Charge We met Sr Tawodzera- she is the assistant matron and is the acting matron when Sr Silindiwe is unavailable. She is also nurse in charge of gynae and female ward. She attends the exec and advised them on the clinical areas and takes the minutes. She manages staff shortages and absences and liaises between the doctors and nurses. She feels that medical equipment is well resourced, but the hospital infrastructure is getting very old and the hospital needs constant repairs: painting and floor tiles. For her the number one priority is pharmaceuticals. The non-monetary incentives (groceries) are very welcome. She feels an isolation ward is a priority but wonders where it can be built. She has worked at MMH 31y. MEETING WITH MRS. CHIPANGA, HSA Mrs Elizabeth Chipanga is the Health Services Administrator (HSA) and a very busy lady. She is currently preoccupied by the RBF (results based funding) in clinics- she must visit all 33 clinics every quarter to monitor their activity and support them in administration.

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