BREAKING BOUNDARIES

Mulanje Mission Hospital (MMH) is an innovative new unit that opened its doors in January 2023 where OT, Sally Feyi-Waboso and her ophthalmologist husband, Andrew, are working collaboratively in offering ophthalmology and rehabilitation services. The new unit has seen OT breaking boundaries and doing eye assessments like visual acuity assessments, biometry and keratometry for preoperative cataract patients.

Dr Arie Glas, the medical director at MMH, had big dreams and plans for the hospital when he identified the need for eye and rehabilitation services. Dr Glas approached and secured funding from The Carmellia Foundation, Christian Blind Mission (CBM) and others to create a purpose-built unit for the new services.

A chance introduction saw Dr Glas inviting Andrew and Sally to advise and help set up the eye and rehabilitation units respectively. In April 2022, when Andrew and Sally visited MMH, the building still had no roof and completion seemed a long way off but with persistence and determination, the building was completed and handed over by the contractors in December 2022.

In December 2022, MMH advertised locally for the role of rehabilitation technician (RT) and after shortlisting and the interview process, Eunice Mcheka was employed and now works with Sally in the new rehabilitation unit.

The new unit opened its doors to patients in January 2023 with an official opening planned for 2 March 2023.

Mulanje Mission Hospital

The hospital is situated in Mulanje, a densely populated district in the southern region of Malawi.

It was originally located on the slopes of Mount Mulanje (to avoid the attention of the slave traders) but in 1928, after the abolition of the slave trade, MMH was moved to its current location, approximately 10kms from the original site.

MMH is a 220-bed facility that provides a full range of medical, surgical, and paediatric services. The hospital together with the local district hospital serves a population of approximately 800,000 across 72 villages.

Patients access the hospital from over the border from neighbouring Mozambique for outpatient, in-patient, non communicable diseases (NCD), and HIV/Aids services.

Rehabilitation Work

According to The Population and Housing Census (2018), in Malawi there are 1,734,250 persons living with disabilities, representing approximately 11.6% of the total population of people over five years of age.

The need for improved rehabilitation services in Malawi is well recognised as The Human Resources for Health (HRH 2030) highlighted that Malawi is among the 57 countries with a crisis in human resources within health and that the health sector in Malawi has a critical shortage of trained rehabilitation healthcare workers.

Occupational therapy is in its infancy in Malawi with no in-country training and fewer than 10 OTs in a population of 19 million. This collaboration further illustrates the versatility of OT in a developing world setting.

Eye Work

It is estimated that the number of cataract operations per million population per year (CSR) in Malawi is 268, one of the lowest in the world (Seva.org).

With less than one ophthalmologist per million population, five optometrists and seven allied ophthalmic health personnel per million respectively, any collaboration is welcome.

The eye unit has just recruited three nurses currently receiving local eye training.

A clinical officer (CO) is currently being trained in cataract surgery in Tanzania. He will complete his training in 2024 and return to the unit. The opportunity for ‘on the spot’ visual rehabilitation input is enhanced by having the rehabilitation team involved in eye care visual assessments. This is an often overlooked, life-enhancing intervention for the significant minority for whom no curative treatment is available in Malawi.

The new unit is unique in that it offers rehabilitation and eye services in a place where the rehabilitation staff have acquired new skills in order to support the eye unit. Sally and Eunice regularly engage patients in eye assessments including visual acuity, keratometry and biometry.

For more information on the work Sally is doing at MMH please email: ot4sally@gmail.com