Unexpected challenges of success through medical excellence


The work of Partners in Hope is supported by SIM Malawi project MW#96853 Medical Discipleship and Spiritual Ministry

In this second of four articles about Partners in Hope Medical Centre, we look at the medical side of the work. A new Medical Director, longer opening hours and a sharp increase in HIV/AIDS patient numbers are just a few of the things which have had to be managed in recent years

Managing change has required a significant amount of time and effort in the last few years at Partners in Hope Medical Centre (PIH) in Lilongwe. In terms of the medical side of the work, much of this change is being managed by a new Medical Director, Dr H Sigauke who, himself, has only been in post full-time since March 2018.

“I joined Partners in Hope in 2014  having spent six years working at the Adventist Hospital in Blantyre,” said Dr Sigauke.

Ward rounds:  Partners in Hope Medical Director Dr H. Sigauke checking in on a patient

“I responded to an advertisement and felt that PIH was a place where I wanted to work as I saw what the management team at that time wanted to achieve. I was appointed Medical Director designate in November 2017 and was then appointed full-time when the previous director, Dr Barrett Jones, returned to the USA.”

PIH was founded in 2004 by SIM Malawi missionary Dr Perry Jansen. He acquired a semi-derelict former medical warehouse and transformed it into the hospital we see today. In terms of medical provision, PIH has three main patient areas.

The largest is the free Moyo (Chichewa for ‘Life’) clinic. This is open to members of the community who can come in for HIV or TB testing, and sees an average of around  140 patients every day.

The second area is the  Dalitso (Chichewa for ‘Blessing’) outpatient clinic. The third area is the  Thandizo ( Chichewa for ‘Help’) in-patient ward. Patients using the Thandizo and Dalitso facilities are charged for the services, and this money goes towards subsidising the free Moyo clinic. Moyo patients who get admitted into Thandizo pay a subsidised low bed fee.

In addition, PIH also runs the USAID-supported programme, EQUIP, which is designed to enhance diagnosis and care of HIV/AIDS patients.

The scope of the Medical Director’s work is wide and diverse. As well as being a member of PIH Executive Leadership Team, the postholder is also responsible for the nursing, clinics, pharmacy, laboratory and Tigwirane Manja services, with all section heads reporting to him. In addition to all of this, Dr Sigauke is designated as the ‘United Nations Consulting Physician’ for PIH, although some changes are being thought about in this area and more doctors are being trained to handle this responsibility

One of the things Dr Sigauke has introduced, and one of the major aspects of the recent changes at PIH, is 24-hour opening. Previously, only patients in the  Thandizo ward had 24-hour care; all other parts of the Centre closed overnight.

“I felt from the outset that 24-hour opening was essential for the development of PIH,” said Dr Sigauke.

“People get sick at 3am just as they do at 10am. The problem was that if they came outside the then opening hours they may well be turned away by the security guards. When I was being considered for this job I said that I wanted to see PIH open 24 hours a day and, from the day I took up this post full-time, that is what has happened.”

Patient care: Even the most straightforward procedures are carried out with great care and concern for the patient

Moving to 24-hour opening has meant that staffing levels have had to be considered. For some areas, locums have been brought in, while in others, staff are paid overtime. In addition to the locums, PIH doctors are also on call should the need arise for them to have to attend during the night to help out or to advise on a difficult case.

But it is not just the patient areas that are now open 24 hours a day; the laboratory, pharmacy and radiology departments also have to be staffed in order for tests, screenings and medicines to be available to patients at all times.

At a time when the World Health Organisations (WHO) is looking to eradicate HIV/AIDS by 2030, one startling statistic that is coming out of PIH is an over-60-per-cent increase in HIV/AIDS patient numbers in the last few years. Numbers have gone from around  7 500 a few years ago to over  12 000  now for both Moyo and Dalitso Clinics. One of the reasons for this sharp increase means that PIH has had to face unexpected challengs because of its own success’.

“Part of the eason for the increase in numbers is that PIH strictly applies the ‘Test and Treat’ programme,” said Dr Sigauke.

“This means that everyone who is tested at PIH and tests positive for HIV/AIDS automatically goes on to a treatment programme after appropriate counselling . As a result of this, we are finding that people from outside of our catchment area are using the addresses of friends or relatives inside the area in order to be eligible to  register at the Centre for testing as they know if they test positive they will get treatment. As a result, our numbers have gone up, but we have a significant number of people in treatment, and that is good.

“The WHO aspiration is a noble one but may be problematic to achieve. What we are hoping will have a greater impact is the ‘90.90.90’ programme which UNAIDS together with the Malawi Government has introduced and which we operate.

“What this programme sets out to achieve is that 90 per cent of people who  are HIV positive should know their status. Of them, 90 per cent should then be placed in treatment. Finally, 90 per cent of  those on treatment should have a supressed ‘Viral Load’ [this is a measure of the number of viral particles present especially the number of HIV viruses in the bloodstream]. Patients are encouraged to stay in  counselling and adhering to their medication. I feel that this programme will have a significant impact on reducing HIV/AIDS in Malawi,” he said.

To help improve the testing régime at PIH, pre-fabricated testing facilities are being constructed on site. Working in conjunction with the Centre for Disease Control in the USA, these facilities will greatly improve the workflow for testing and will also release space in other parts of the Centre for development into other uses.

Despite the fact that he is new to the post of Medical Director and is already handling a raft of changes that have impacted PIH, Dr Sigauke is determined that PIH will continue to build on its already considerable reputation.

“As we move forward there are changes that I want to see come on board which I am sure will help not only PIH but also our relationship with our partners,” he said.

“In addition to my medical qualifications, I also have an MBA and so bringing the business side of my training to work with the medical side will be important. From a business point of view, I think it is vital that we are able to continue functioning at all levels, even if a particular post holder is away from the Centre. People fall ill, need to take holidays, have to attend meetings and conferences, so it is crucial that we have people ready to step into their shoes to ensure the Centre keeps running. I am doing this with my own rôle as UN Examining Physician.

First contact  View from above of the Reception Desk at Partners in Hope

“My workload has increased since I took over as Medical Director, so I think it is important that other people be trained to be able to carry out this important rôle if I am not available. I am encouraging other managers to have a well trained ‘deputy’ as well.

“Another area in which I am working with the Executive Director is to get Memorandum of Understanding (MoU) documents finalised with all of our partners. At present, our relationship with many partners is on a handshake or on a Gentleman’s Agreement basis and I think that MoUs will strengthen our links and bring benefits to both sides of the partnerships.

“On the medical side, we have introduced a physiotherapy unit which operates a few times a week. I should like to see that develop more.

“We are also looking at introducing an operating theatre, further to expand the scope of the services we can offer at PIH.

“There has been much change and there will be changes still to come but over the next 12 to 18 months these changes and processes will be complete, or will on their way to completion, and we will have in place what I call a ‘textbook organisation’ which is stable in a business sense and offering first-class medical and back-up facilities,” he said.