INTRODUCTION

The Department continues its educational tasks in teaching and training under- and postgraduate medical students, nurses and clinical officers. It runs in-service training courses to all cadres. The Department provides tertiary paediatric clinical care to referred patients from the district, the region and beyond. It also serves as the district hospital for Blantyre District for which it need primary care. The department has provided limited outreach support to the health units in the southern region of Malawi. The department carries out research into locally relevant health problems.

 In December Prof Elizabeth M Molyneux stepped down as Head of Department of Paediatrics and was succeeded by Prof G Tom Heikens, as the third head in the academic departments’ history. We are thankful for Liz all her enduring efforts; she has served the department as a strong and dedicated head, caring keen clinician and educator. Liz here clinical experience has been and will be a beacon for many clinicians. Few have seen the patients mentioned in the textbook of paediatrics so many times and she even have added new patients previously not described.

 Education, teaching and training

The number of undergraduate students has increased and teaching space is at a premium.  The students are each allocated to a mentor so that though their number has increased it does not lead to less personal teaching and contact.

 The increased numbers of undergraduates, interns and postgraduate students have put pressure on the existing teaching space and with the predicted future increase of both under and postgraduate students the present staff and teaching facilities have become inadequate. Presently the Department has its own hand over room in the Academic Annex, 10 staff offices (2 with shared accommodation and one which is turned into a store room), two secretarial offices  and two conference rooms of which one is converted to the office of the postgraduate tutor. In addition we have 2 reasonably well equipped laboratories. The space for the library and offices for registrars, interns, visiting scholars and elective students is presently found in the adjacent Malaria Alert Centre, and is grossly inadequately equipped and terms of space.

 Presently the department has enrolled 8 postgraduate students in its programme of which two complete this year their specialty training in Durban, Africa. Latter two will take the MMed Part II exam in March 2009. There has so far been no dedicated COM budget for these educational activities. 

 De department remains involved in the on the job training of 2^nd, 3^rd and  interns of the Clinical Officers training of the MCHS and assists in the examination of COs in Malamula Hospital. Although there appears to be an MOU between MCHS and COM we do not seem to receive the revenues due for this agreement. It is proposed that the Registrar & Accountant translates this budget in terms of additional FTE for the Clinical Departmental Staff and a fraction for administrative purposes.    

 The department remains involved in ad-hoc educational activities in the form of providing educational staff to courses organized by the DHO, Ministry of Health or UNICEF and NGOs like MSF. The department also participates in the annual course TMIP, tropical medicine in practice. So far there is no COM agreed formal fee structure for using facilities, consumables, equipment and staff; a matter of concern as this would bring income to the department which is vital in our resource poor environment. On this basis the department is building on top of the new Moyo ward facilities an auditorium, a library annex registrar room two conference rooms and office and sanitary facilities. Discussions with the World Health Organization will hopefully be concluded that our department will establish herein a WHO Reference Centre for the Management of Childhood Malnutrition, Childhood HIV and related Infectious.

 Clinical Paediatric Care

Despite the fact that immunisation coverage is good and increasingly bed nets are provided to households in malaria endemic areas the burden of childhood disease in our region is unabated. Fortunately the harvest has been good which gave a reduction in primary malnutrition, however secondary malnutrition mainly due to HIF infection and plan AIDS made that the numbers in our Moyo Malnutrition ward did not fall. 

 As the clinical department fulfils the primary, secondary and tertiary care role in the country for paediatrics our front office our Accident and Emergency Department remains busy and sees together with our Outpatient Services situated in its proximity annually approximately 100.000 sick infants and children. On average every year more than 1000 of these were resuscitated and stabilised in the resuscitation room of the A&E Department,  and  of all seen 23,000 sick children were admitted. Over 1300 were admitted to the short stay ward in the front office, of whom 10% were admitted subsequently to the wards.

 Patients are admitted to one of our 7 wards: Chathinka nursery (40 cots), Kangaroo Mother Care (recently expanded to 17 beds for mothers and neonates), Special Care Ward (50 beds), Nursery (30 beds), Moyo Nutrition Ward (40 beds and being expanded), Medical ward (20 beds), Surgical ward (16 beds), Orthopaedic ward (20 beds) and Oncology (16 beds). There is a 14 bedded research ward that is funded and run by the MLW (Malawi Liverpool Wellcome) team and very sick children are freely admitted there to receive more intensive nursing and medical support. Close to 3,000 neonates were admitted to Chatinka nursery. Close to 1000 children are enrolled in our busy ART clinic. Clinics are held weekly for cardiac problems, sickle cell disease, general referrals, TB, malnutrition, neonates, and follow up oncology patients. Consultations are given on all wards at request and weekly ward rounds are done in the burns unit to help with paediatric nutritional needs, pain control and infection management.

 The acute care wards remain very busy and bed occupancy is higher than ever, especially in the Nursery, Moyo and Paediatric Special Care wards. Services for HIV infected children continue to expand and our ART clinic now runs 3 days a week and staging is done and co-trimoxazol provision is given during all opening hours 5 days a week. The new Kangaroo Mother Care Unit for mothers and their infants has really been a success and offloaded the medium and low care neonatal wards in Chatinka Nursery.  

 Moyo, the Malnutrition unit, far too small for the annually increasing numbers of patients is in the process of being extended. The renovation will greatly improve the ward area and provide on the first floor teaching space as well.

 The four member and doctor-lead Paediatric Palliative Care team has become a well established activity in our wards and is increasingly recognized in the care of terminal AIDS patients, those with malignancies and incurable illness.

 Community Child Health

After waning past outreach activities, mainly focused on training ETAT at 4 District Hospitals, community outreach activities have been established. David Tickell and later Kicky Mittermayer & Loes Tanja started fortnightly visiting the SOS Health Centre in Machinjiri, Blantyre and Neil Kennedy both District Hospitals in Mulanje. Kicky Mittermayer took over from Hannah Blencowe the follow up visits of the Health Centers which started Kangaroo Mother Care.        

 Research

Research is encouraged in the department and all academic staff are actively involved in operational research.  These are listed later.  Close operation with Malawi – Liverpool – Wellcome (MLW) Research laboratories makes much of the research possible. MLW, University of Amsterdam (the Netherlands), University of North Carolina (USA) and the Blantyre Malaria Project (BMP) are involved in on-going studies in the department. 

 Links

Links with research and other academic units, as referred to above, are both long standing and increasing.   

 Increasingly our postgraduate and scientific links look to the South. Links to facilitate our MMed Programme in Postgraduate training in Paediatrics and Mother & Child Health have been developed with the University of KwaZulu-Natal, RL Mandela Medical School, and the University of Cape Town, Red Cross War Memorial Children’s Hospital in Cape Town. This collaboration facilitates increasing contacts with other academic units in South Africa like that of the Universities of the Western Cape, Stellenbosch and Witwatersrand University, Johannesburg.

 Foreign registrars have come from postgraduate paediatric programmes in Australia, the Netherlands, the UK and Germany.

 Birmingham Children’s Hospital UK has continued to hosted registrars, nurses and clinical officers and reciprocally two volunteer Birmingham nurses have worked and taught in our Department for 6 months.

 Departmental staff

Historically the department has been well endowed with visiting or resident staff, not directly employed through the COM. Honorary staff, often posted or affiliated with our COM Research Affiliates, usually serve 30% of their contract in our clinical services. These research links in turn have attracted other clinical researchers who similarly serve in the paediatric clinical services.

 The long term personal affiliation between the Division of Community Health and our department through a clinical paediatric nutritionist posted from the Division of Community Health into Moyo ward and our department came to an end with the departure of Dr James Bunn.         

 Clinical and teaching staff in the department

 Dr Elizabeth Molyneux           -           Professor, Head of Department

Dr Robin L Broadhead            -           Professor, Principal

Dr Geert Tom Heikens                        -           Ass. Professor, Postgraduate Tutor  

Dr James Bunn-                                   Ass. Professor Community Health and honorary member of the Department of Paediatrics (left 15 12 2008)

Dr Michael Mbvundula           -           Ass. Professor (Part Time, and left 31 12 2008)

Dr Neil Kennedy                      -           Senior Lecturer

Dr Peter Moons                      -           Lecturer

Dr Loes Tanja                          -           Lecturer

Dr Kirstin Mittermayer           -           Lecturer (CIM-GTZ affiliate)

Dr David Tickell                      -           Lecturer (left 01 06 2008)

Dr Ivonne Haar                       -           Lecturer (VSO left 01 06 2008)

Dr Trijn Israels                                    -           Lecturer (left 01 06 2008)

Dr Hanna Blencowe                -           Lecturer (Part time, left 01 05 2008)

Dr Marko Kerac                      -           Honorary Lecturer (left 01 05 2008)

Dr Robert Bandsma                -           Honorary Lecturer (left 01 05 2008)

Dr Queen Dube                       -           Paediatrician MOH

Dr Suzanne Anderson             -           Honorary Lecturer

Dr Janell Routh                       -           Honorary Lecturer

Dr Beatriz Larru                      -           Honorary Lecturer

Dr Lloyd Bwanaisa                  -           Honorary Lecturer

Dr Rob Cocke                          -           Visiting Physician

Dr Kondwani Kawaza              -           Ass. Lecturer

Dr Limangeni Mankhambo     -           Ass. Lecturer (presently in Durban)                           

Dr Ajib Phiri                            -           Ass. Lecturer (presently in Durban)

Dr Yamikani Chimalizeni        -           Ass. Lecturer  

Dr Rachel Mlotha                   -           MOH, Registrar

Dr George Chagaluka             -           MOH, Registrar                                 

Dr Mary Bunn                         -           Palliative Team Leader (Part Time, left 15 12 08)

Dr Zoe Palmer                                    -           Palliative Team Leader (Part Time as of 16 12 08)

Dr Ankie Borgstein                  -           Chief Paediatrician MOH, Clinical Lecturer

Dr Samantha Pollock              -           Visiting Physician (left 01 08 2008)

Dr Merel Van Loon                 -           Visiting Physician (left 01 04 2008)

Dr Meta van den Heuvel        -           Visiting Registrar (left 01 04 2008)

Dr JoJanneke Heidema           -           Visiting Registrar (left 01 04 2008)

Dr Andreas Hansmann            -           Visiting Registrar

Dr Ann Kerr                             -           Visiting Registrar

Dr Olivia Swann                      -           Visiting Registrar

Clerical technical and supportive staff

Mrs Rose Kadewa                   -           Departmental Secretary

Mrs Matilda Lali                     -           Data Clerk

Mr Richard Fudzulani             -           Laboratory Technician

Mrs Margaret Zazira              -           Domestic worker

Mrs Grace Jonasi                    -           Domestic worker

Mr Stephen Sadya                   -           Messenger (left 01 10 2008)

Academic staff in postgraduate training overseas

9 postgraduates students and postdoctoral pediatricians are in training in the UK

 Dr Macpherson Mallewa        -           UK  (Postdoctoral training in Paediatric Neurology)

Dr Jailosi Gondwe                   -           UK (MOH)

Dr James Mwenechanya        -           UK

Dr Madalitso Tembo               -           UK

Dr Chipo Chalira                     -           UK (MOH)

Dr Maggie Nyirenda               -           UK (MOH)

Dr Kondwani Kayira                -           UK

Dr Wendy Kondowe                -           UK

Dr Tumpale Mhango              -           UK (MOH)

We have 2 postgraduate students in training in South Africa:

Dr Limangeni Mankhambo

Dr Ajibu Phiri

 Staff who left the department in 2008

 Prof Micheal Mbvundula retired, and Drs. James and Mary Bunn, Dave Tickell, Yvonne Haar, Trijn Israels, Marco Kerac and Hannah Blencowe, Robert bandsma, Meta van den Heuvel, Merel van Loon, Samantha Pollack,  JoJanneke Heidema and Rob Cocke left to return to UK, USA the Netherlands and Australia.

Staff appointments

Drs Neil Kennedy, Kirstin Mittermayer and Loes Tanja joined us as respective senior lecturer and two lecturers. Dr Lloyd Bwanaisa joined as honorary lecturer. Dr Janell Routh joined as paediatrician on behalf of Baylor College, Drs Andreas Hansmann, Ann Kerr and Olivia Swan are volunteer/visiting registrars/physicians.

Academic Programme

 Year I and II

The Paediatric Department continues to give clinical input into system studies by students. Dr Kennedy has assisted the BMS group in introducing Integration in the first years curriculum.

 Year III

Co-ordinator: Dr Queen Dube.  Students spend 6 weeks in the department; they have been divided into 4 groups. The best 3^rd year student in 2008 was Margret Khonga, she had 71.5% overall.

 Year IV

1 student was hosted in the department for its 4^th year research dissertations.

 Year V

Co-coordinators were Drs David Tickell and Kirstin Mittermayer. In the academic year we had a total of 54 students of which 52 passed.

 Dahlenburg Paediatric  and Grace Malenga Prize

This year the best student in Paediatrics, the Dahlenburg price went to Shalom Dunga. The Grace Malenga price for the most enthusiastic and active 5^th years student went to Jenala Njiramadzi; we congratulate both.

 Foreign elective students

The department has hosted 23 elective students this year.

 Clinical Officer training

Weekly formal teaching sessions are given for the Clinical Officers in the department and II and III year students are hosted in the unit.

 Intern training

Twice weekly formal teaching sessions are given for the interns in the department.  Dr Trijn Israels was succeeded by Dr Loes Tanja as their mentor and supervisor. Their programme of training, supervision and mentoring is intensified. 

 Postgraduate training

There are 11 postgraduate students on training schemes abroad.  There are 6 post graduate Paediatric trainees in the department. Two others are completing in Durban for their specialist training. 

 The Postgraduate tutor Prof Tom Heikens was succeeded by Dr Neil Kennedy.  The MMed Paediatric course is taught in modules. Several visiting teachers and lectures have assisted in the teaching. HVO volunteers have taught modules and helped with undergraduate teaching. The Medical Council of Malawi submitted their review and the department has responded and developed a Registrar Handbook compiling/recording all summative and formative forms of assessment.