Live Below the Line Challenge for Malaria No More 2014

Tomorrow I’ll be living on £1 a day for all of my food and drink as part of a global challenge, Live Below the Line, to end extreme poverty.

Live below the line

My brother, Joe, caught malaria while we were living in Malawi, but fortunately he recovered after being given the right treatment. I’m doing this challenge so that other children can also receive life-saving treatment for malaria. No parent should lose their child to a disease that is easy to prevent and costs £1 to treat. Malaria is a leading cause of child deaths and poverty in Africa, but together we can make malaria no more. You can sponsor me by donating to Malaria No More here.

This is all of my food for the week, which cost £4.82.

photo-17

I bought a bag of pasta for all my lunches, a bag of rice for my dinners, 2 tins of tomatoes, a tin of tuna, a tin of kidney beans, a tin of sweetcorn, and a packet of mushrooms to mix together with the rice and pasta. I also bought a tin of peaches and a pot of natural yoghurt for puddings and a bar of chocolate, and I shall be having a pitta bread for breakfast with a free egg from our chickens. I’ll only be able to drink water as I didn’t have enough money for tea or milk. Unfortunately I couldn’t afford any fresh fruit as they only sell packs of 5 or 6 which cost too much. I think I’ll have plenty to eat, but it will get pretty boring. At least it’s only for 5 days though…

Live Below The Line Fundraising Challenge 2014

Next week I will be taking part in the Live Below The Line Fundraising Challenge again and I will be living off £1 a day for 5 days to help raise awareness about people around the world living in extreme poverty. This is what I did last year:

live below line receiptlive below the line meal

 

 

 

 

 

I will also be trying to raise money again for my chosen charity, Malaria No More, to try to get more bed nets in places like this hospital in Malawi below: http://www.impatientoptimists.org/~/media/Blog/Other/J/JP%20JZ/545141534656c71c18b2b_jpg_autocropped.jpg

When I lived in Malawi and visited people in hospital there it was very rare to see any mosquito nets, even in the maternity wards. My brother caught malaria while we were living in Malawi, but fortunately he recovered after being given the right treatment. I’m doing this challenge so that other children can also receive life-saving treatment for malaria. No parent should lose their child to a disease that is easy to prevent and only costs £1 to treat.

Malaria is a leading cause of child deaths and poverty in Africa, but together we can make malaria no more. If you would like to donate and help prevent malaria, please visit my Live Below the Line page here.

 

Latest research on the long-term effects of malaria

Chris Moxon, clinical lecturer at Liverpool University, has just published a study in the Journal of Infectious Diseases that shows there may be a link between repeated bouts of malaria in children and a greater likelihood of them becoming ill later in life with other illnesses like cardiovascular disease (read more in this LSTM article).

This is because their blood vessels become inflamed when they have malaria, and they may remain inflamed throughout their life making them leaky and susceptible to blocking with fat. He suggests the possibility of treating the children with statins in the future to help reduce the inflammation, and prevent further disease.

I was particularly interested in this study which was carried out on 190 children in Blantyre, Malawi, because I used to live there, and my brother also caught malaria while we were there.

 

Malaria nets are not always effective

In the Lancet medical journal a couple of weeks ago, scientists said that mosquito nets are not effective for people who work or sleep outside at night, in countries where malaria incidents are at a low level. I agree with their findings as, when I was living in Malawi, we had security guards who worked outside our house all night. While we were asleep under our mosquito nets, they were walking around the garden being bitten by mosquitoes, and at risk from malaria.  Many men in the cities in Malawi work as night guards for families and businesses, and they can’t be protected like most people. It is a fact that malaria-carrying mosquitoes are most likely to bite people between 10pm and 5am in the night, so if you sleep under a net your chances of catching malaria are greatly reduced.

image from http://www.todayifoundout.com/wp-content/uploads/2010/08/mosquito_malaria.png

This BBC news article suggests other ways people could be protected is to treat hammocks or clothing with repellants. I think it is really important to research new ways of preventing malaria, like finding a vaccine or genetically changing mosquitoes, if malaria is ever going to be totally eradicated. Until then, we must make sure governments give the Global Fund enough money to keep providing treated bed nets and quick diagnosis tests for all the vulnerable people living in malarial countries.

Living Below The Line Press Release by Malaria No More

The other day, Malaria No More sent me this press release that they have written about me and Jeremy Lefroy ‘living below the line’. 

Staffordshire MP and sixth form student live below the poverty line on £1 a day to save lives from malaria

7th May 2013: How much change can you make from £1? This is the question that Jeremy Lefroy, MP for Stafford and Megan Owen, a sixth form student, are asking themselves as they live on a budget of £1 a day for all food and drink for five days.

They are taking part in Live Below the Line – an innovative campaign to fight extreme poverty. It challenges the public to get sponsored to cut their spending on food and drink to just £1 a day. This budget is a daily reality for the 1.4 billion people around the world who are forced to live below the poverty line every day, for absolutely everything.

Jeremy and Megan are doing the challenge in support of Malaria No More UK as they have both experienced the devastating impact of the disease while living in Africa. Jeremy caught malaria twice during his 11 years working with smallholder farmers in Tanzania (1989-2000) and Megan’s brother suffered from malaria when her family spent five years in Malawi (2008 -2012).

This experience shaped their personal and professional directions on returning to the UK. For Megan it has fuelled a keen interest in tropical medicine and she hopes to become a doctor. Jeremy, who was elected to Parliament in 2010 and has retained a strong interest in African issues, he sits on the influential International Development Select Committee and Chairs an active All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases. It was in this guise that he invited Megan to speak at a meeting the group organised at the Houses of Parliament to mark World Malaria Day on 25 April. 

Megan says: “I wasn’t sure what to expect when I arrived at the Houses of Parliament, but I was warmly welcomed by Jeremy, and he asked me to speak first. There were many people attending the event, including MPs and global health experts, and the theme of the evening was the World Malaria Day theme: ‘Invest in The Future: Defeat Malaria’.

Jeremy adds: “It was our privilege to welcome Megan. Her own story takes us beyond the statistics and speaks volumes about the daily impact of malaria in Africa. She saw her brother suffer and mercifully recover from malaria thanks to swift treatment. We want this to be the case for families across Africa. No parent should lose a child to a preventable disease that costs £1 to treat”.

Jeremy and Megan have since pledged to Live Below the Line. The challenge is in its third year in the UK, and growing strong with almost 5000 people registered so far, raising over £400,000 for charities, including Malaria No More UK. The charity works tirelessly to save and protect millions of lives from malaria, a preventable disease that remains a leading killer of young children in Africa.

Jeremy is doing the challenge one day a week due to his parliamentary schedule, with one week down and four left to go. He reflects: “I wanted to take the opportunity to experience life with my choices totally curtailed – the daily reality for 1.4 billion people today. The challenge also gives a timely excuse to raise awareness about a cause close to my heart – malaria. It is unacceptable that this preventable disease still claims the life of a child every minute and we need to do all we can to sustain support to save the lives of the most vulnerable”.

Megan completed her challenge during the Live Below the Line week from 29 April – 3 May. She says: “I was really surprised at how much I could get for my money, although I wish I could have afforded more fresh fruit and vegetables. I missed drinking a cup of tea! But the time goes quickly and it is a great opportunity to raise awareness about malaria – a disease that is, not only caused by poverty, but causes poverty”.

Money raised for Malaria No More UK will be used to help save lives in Africa, where most deaths from malaria take place and where the disease is an ongoing contributor to the cycle of poverty, preventing children from going to school and workers from earning a living.

www.livebelowtheline.org.uk

My World Malaria Day Presentation

APPMG meeting - Megan with Jeremy Lefroy

On Tuesday evening I travelled down to London to give a presentation about malaria to the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases (APPMG), in Westminster. The event was organized by Jeremy Lefroy, chair of the APPMG, to mark World Malaria Day on 25th April.

I first met Jeremy, when I went to Auschwitz with the Holocaust Education Trust, in February, and I discovered that, like me, he had spent time growing up in Africa. I wrote to him a few weeks later, asking him to continue to support the UK’s commitment to help halve malaria deaths in at least 10
 of the world’s most affected countries by 2015, and to support the Global Fund to Fight AIDS, TB and Malaria. It’s already saved almost 9 million lives, but 
desperately needs topping up if it’s to continue its vital work.

I was delighted and surprised to receive a reply from the Secretary of State for International Development, as well as an invitation from Jeremy to speak about my experience at the APPMG World Malaria Day event in Westminster.

I wasn’t sure what to expect when I arrived at the Houses of Parliament, but I was warmly welcomed by Jeremy, and he asked me to speak first. There were many people attending the event, including MPs and global health experts, and the theme of the evening was ‘Invest in The Future: Defeat Malaria’.

I talked about my own experience of malaria, when I was living in Malawi, and about my brother, who contracted the disease, despite the numerous efforts that we took to protect ourselves. Luckily, he was fit, strong, and had access to a private hospital where he received quick, life-saving treatment and was able to recover. But unfortunately 1,500 children still die every day from the disease, even though it’s both preventable and treatable. At the moment, the best prevention for children is to sleep under an insecticide-treated bed net, which can be bought, delivered and hung for just £5. However, I feel that, until there’s a vaccine to totally eradicate the disease, children are going to continue to slip through the net, and even one child dying from malaria is too many.

The next speaker was Dr Rob Newman, Head of the Global Malaria Programme, at the World Health Organisation (WHO), and he gave an overview of malaria today. Other panelists included Dr. Shunmay Yeung, deputy director of the ACT Consortium and a clinical senior lecturer at the London School of Health and Tropical Medicine, who talked about diagnostics; Dr Tim Wells, Chief Scientist for the Medicines for Malaria Venture (MMV), who discussed progress on drug discovery; Dr David Kaslow, director of PATH Malaria Vaccine Initiative (MVI) who talked about new technologies on the horizon; and Dr Kolawole Maxwell, director of the Malaria Consortium Nigeria Programme who focused on implementation of his programmes on the ground.

I was incredibly honoured to take part in such an important evening, and I hope that my small actions might go some way to helping there be malaria no more.

You can support Malaria No More by going to my Just Giving page.

 

Roll Back Malaria "World

Roll Back Malaria World Malaria Day 2009

Letter to Jeremy Lefroy

I have written this letter to my local MP, Jeremy Lefroy, asking for his support in ending malaria. You can Add your voice too, by writing to your local MP. 

Dear Mr Lefroy,

It was really interesting to meet you when I went to Auschwitz last
month, and to hear about your time in Tanzania. As you know, I’m in the
sixth form, after which I’m hoping to study medicine.
I was first inspired to become a doctor after my younger
brother, caught malaria in Malawi. I really admire the doctors
I met out there and the vital work they do, despite the country’s
poverty and difficulties. Now I’m back in England, I’m raising
awareness and money for ‘Malaria No More’, through my blog about my
journey from Malawi to medical school:
http://medblog.medlink-uk.net/megsjourney/.

I think the UK’s commitment to help halve malaria deaths in at least 10
of the world’s most affected countries by 2015 is so important, and I
would love it if, like me, you could support this amazing commitment
and ensure that it’s backed with sufficient funding. My brother was so
lucky; he was fit and healthy and had access to a private hospital
where he was given life-saving treatment, and was able to recover
quickly. Unfortunately, 1500 children are still dying every day from
malaria, even though it’s preventable.

There’s been amazing progress made in the last 10 years, with deaths
from malaria cut by over 25%, but I don’t feel that this is enough.
Although the UK has played a leading role in reducing malaria, if we
don’t do more, then malaria could rapidly rise again. It would be great
if you could join me in calling for action now, to make sure that this
doesn’t happen.

If you could pass this email to the Secretary of State for
International Development, I’d like to ask her to redouble UK efforts
against malaria, including support for the Global Fund to Fight AIDS,
TB and Malaria. It’s already saved almost 9 million lives, but
desperately needs topping up if it’s to continue its vital work.

I believe that defeating malaria would be the greatest humanitarian
achievement of all time, and it is achievable, with enough money and
the right leadership. Ending deaths caused by malaria is very important
to me personally. I know that millions of children die because of the
disease and, without the right care, it could easily have been my
brother.

Thank you for your support,

Megan

Interview with Professor Neil Kennedy

Professor Neil Kennedy is Professor of Paediatric medicine at Queen Elizabeth Central Hospital and Malawi College of Medicine in Blantyre, Malawi. He and his family lived over the road from me and my family for 4 years, and he has very kindly answered my questions for this blog.

Me: What’s a typical day like for you?

Professor Kennedy: Long!

0700 – 0800: Office and emails.

0800 – 0900: department handover meeting. We hear what’s gone on the night before, discuss difficult cases

0900 – 1200: ward rounds or clinic work. Here, that means seeing perhaps 40-50 children some mornings. We always have students with us when we work on the wards, so I do a lot of teaching – medical education is an apprenticeship. Most of my clinical work is in general paediatrics, but I have a specialist interest in paediatric cardiology (I run the only kids’ heart clinic in Malawi) and in child protection work.

1200 -1330: lunch (on occasions) or more usually some sort of meeting – a journal club or a university committee

1330 – going home time: varies a lot between teaching, working on research, administrative duties (I’m head of the dept), writing grant proposals or seeing specific sick children.

Me: What’s the biggest challenge that you face at the moment?

Professor Kennedy: Lack of time to do all that needs doing. Government is often out of cash for basic treatments.

Me: What is the most rewarding part of your work?

Professor Kennedy: The amazing variety and the opportunity to make a difference in the lives of the children we see and the wider community. Last week, I met the President as she opened our new centre for abused children. I got a phone call from a mum in Northern Malawi to thank me for getting her child sent to India for life-changing heart surgery. I worked with a donor to gain funds to train another 8 specialist paediatricians for Malawi (we only have 16 now – just over one per 500,000 children!)

I would like to thank Professor Kennedy for his interesting answers to my questions. I hope he inspires you as much as he has inspired me to become a doctor.

Comparing work experience in Malawi to work experience in England

 I have written this article, for the doctors who kindly allowed me to shadow them last week, comparing my work experience there with my work experience in Malawi. 

Comparing work experience in Malawi to work experience in England

I am in the sixth form, and I’m hoping to study medicine after my A levels. I was first inspired to become a doctor, after my younger brother caught malaria, in Malawi, where I lived with my family for 5 years. Even though Malawi is a very poor and underdeveloped country, he was quickly diagnosed and treated, and soon recovered. I really admire the doctors and nurses who work in Malawi, in spite of many difficulties, so after my IGCSEs, I spent a few days working in a diabetes foot clinic in a city government hospital there. More recently, I was also lucky enough to spend a week in England shadowing Dr Dhrubo Rakhit, a consultant cardiologist, and other doctors. I thought it would be interesting to compare what I learnt there with my experiences in Malawi.

It was an early start on my first day in England; at 8:00am I went on a surgical ward round, seeing patients who had come in over the weekend. The variety of patients with such different illnesses was fascinating, and I was interested to see how the doctors explained what was going on to them. All the nurses and patients were very friendly and eager to chat, and I tried to make myself useful by changing bed sheets and cleaning.

It was a different world from the hospital in Malawi, where the wards are much more crowded and many patients have to lie on the floor between beds, and even out in the corridor because there aren’t enough beds for them all. Each patient also has to bring a relative to stay with them to do all their cooking, washing and cleaning, as there aren’t enough nurses to cope with all the work.

In England, the hardest part of the first day was towards the end when I went with the consultant surgeon to talk to the wife of a patient in Intensive Care. The consultant explained that the patient was likely to die quite soon, because all his organs were failing. He said that the patient was very sick and had only about a 1% chance of recovery. It was heart-breaking to see the patient’s wife cry, and I’m sure that these conversations are the hardest part of being a doctor, and will never become easier. The consultant taught me that it’s important to be clear and honest with the relatives, but sensitive too. 

On my second day of work experience, I was in Cardiology, where most of the patients I saw had been admitted to the coronary care ward during the night. It made me realise how rapidly patients are treated, and I was surprised at the number of patients seen each day. After the ward round, I watched a patient having an ultrasound scan of the heart, to look at how it was functioning. It was fascinating to look at the images of the heart, and to learn about all the different things that can be seen on the scan. The Cath Labs were also very interesting as I could see the patient’s heart on the screen and the doctors explained to me what was happening and where the narrowing in the arteries were. I watched a few patients have angiograms, during the afternoon, but one patient had so many blockages in their arteries that the doctors couldn’t put in any stents.

meg southampton 3

I thought that the angiograms were very clever and useful, because the doctors could look at, and operate on, the heart, without being too invasive or causing the patient much discomfort, which really benefits the patient. The doctors told me about open-heart surgery, which has higher risks because they take veins from the leg to put in the heart, so that blood can bypass the damaged artery.

I was impressed with the technology used in England, which was much more sophisticated than any of the equipment available in Malawi, where the doctors have to rely much more on their clinical skills to diagnose patients. Although they have an MRI machine in Malawi, the power sometimes goes off for up to a week, and although the hospital has generators, there are often huge fuel shortages, so the generators don’t work either. It also takes a long time to import spare parts, so if a machine breaks down it can’t be fixed for a long time, sometimes years. 

On my third day, I went to listen to Dr Armstrong give a lecture about chronic kidney disease. The lecture was very interesting and I was pleased to find that I could understand a lot of it.  It was a really valuable experience, because not only was I able to see the university, but I could imagine what it would be like to be a student there. After the lecture, I returned to hospital where I spent the morning in an Adult Congenital Cardiology Clinic. I shadowed a registrar, who kindly explained to me about some congenital heart defects.

The next day Dr Rakhit took me on a 3-hour ward round, followed by a cardiology meeting where the doctors presented and discussed unusual case studies. Although it was the same coronary care ward, all of the patients we saw were different to those we had seen before, as it is run so efficiently. I found these ward rounds really interesting, because there is so much to learn and discuss, including the history of the patients, their diagnoses, and plans for tests and treatments, and it is all done so quickly.

I was also lucky enough to meet some medical students and chat with them about their time at the Medical School and their experience in the hospital. They are all enjoying the medical course, which they say is very integrated. One of the students told me that she thought the best doctors are also excellent teachers. I think that this is very true, because doctors not only have to teach other doctors and students by giving presentations, but they also have to explain their diagnosis and treatment clearly to their patients.

This is much harder in Malawi, where the language barrier can be a problem. Many patients only speak Chichewa, the local language, and the British doctor I shadowed needed a translator. It’s so much easier to gain a history and diagnosis if the patient can speak good English, which is a more developed language than Chichewa; for example, there are more words in English to describe different types of pain. It’s also difficult to describe to the patients how and when to take their medication, as some patients don’t have clocks, so the doctor has to tell them to take their medicine when they wake up or go to sleep.

In England, I especially enjoyed watching the transesophageal echocardiograms (TOEs). The doctors sedate the patient, then they put a probe down the patient’s oesophagus, to get a very clear ultrasound scan of the heart. Most of the patients’ hearts were normal; however, one patient had a serious bacterial infection in their aortic valve, which had been replaced, and the infection had spread into their blood, which could cause serious complications.

meg southampton 2

After watching the TOEs, and learning more about the echo tests and structure of the heart, I saw a stress echo test. The patient had to stress their heart by exercising on a treadmill, and then get off and have an ultrasound scan of the heart straight after. This was then compared to an ultrasound scan of their heart at rest, so the doctor could find out whether the heart could function under stress.

Finally, I spent some time in a Cardiovascular Outpatients Clinic, with a doctor and a specialist nurse. The clinics are different to the ward rounds, because the doctor has more time to see each individual patient and treat them. The patients who came in had many different heart problems; a couple of them had prosthetic valves. I listened to their hearts and I could hear their metal valves, which made clicking sounds. Quite a few patients had been referred to the clinic, because of chest pain, but their ECGs showed normal heart rhythms and their echo tests were normal. However, some of the patients were diagnosed with heart problems, after being tested and were given treatment.

In Malawi, I also spent time in an outpatient’s clinic. Most of the patients came into the diabetes foot clinic with foot ulcers, which can be dangerous as they can become infected easily. Many of the patients had walked miles to get to the hospital, in broken flip-flops, which didn’t help their feet at all, and it would take them hours to get to the clinic to get their dressings changed, or be checked up on. Quite a lot of the patients needed to have amputations because their ulcers had become badly infected. I went onto one of the wards to see a diabetic man who had just had his leg amputated, and I checked his blood sugar levels.

A major problem with diabetes, in Malawi, is the lack of awareness. In England, there is a lot of education about health, so most people know about diabetes and it’s easy to look it up on the internet, but in Malawi it’s a lot harder for people living in rural villages. Many people don’t know that they have diabetes because hospitals are few and hard to get to. A lot of the work that they do at the diabetes clinic is raising awareness about diabetes and educating the patients about how to look after their feet and keep them clean to prevent infection. They advise about what shoes to wear; preferably ones that have thick soles and don’t rub, although many patients just can’t afford them, so they end up having to have an amputation. However, people are generally very positive and the patients often sing and dance to show their appreciation to the doctors and nurses, who have to make the best out of what resources they have, and just get on and do the best they can. It certainly made me appreciate how lucky we are here, to have free access to excellent health care, and one day maybe I’ll return to Africa, as a qualified doctor myself so that I can help to make a difference in the hospitals there.

I enjoyed every minute of my work experience; it has strengthened my ambition to become a doctor, and made me more passionate about following a career in medicine. Before my work experience, I wasn’t sure what it was like to work as a doctor under the NHS, but now I feel that I have a realistic insight into what the job involves at different stages in the profession. All of the doctors, nurses and staff were so friendly and made a real effort to make sure that I was enjoying my work experience and understood everything.

I would especially like to thank Dr Rakhit & Dr Armstrong, for arranging my work experience and for looking after me so well.  I would definitely recommend it to anyone thinking of going into medicine, and I’m looking forward to returning in the summer.

Interview with Dr Sue Heyes

Dr Sue Heyes is a British doctor, who spent a year working in the diabetes clinic in Queen Elizabeth Central Hospital, Blantyre, Malawi. I was lucky enough to spend time shadowing her last summer, and she has kindly allowed me to interview her for my blog.

Me: What was the biggest challenge that you faced working in Malawi?

Dr Heyes: The biggest challenge that I faced working in Malawi was two fold really. One was having so few reliable clinical tests available to help in diagnosing patients.  The other was not having enough basic drugs available to treat the commonest illnesses.

Regarding the clinical tests available, the hospital had lots of fairly up-to-date machines for performing tests, but they often didn’t work because they needed a new part which was unavailable, or the reagents were out of stock for the blood and microbiology testing.  For example, for a few weeks there were no tests available for diagnosing HIV so that meant that patients could not be started on their HIV drugs because it was essential to have a positive test result before starting treatment.  Also, we not infrequently ran out of processing chemicals so that X rays could not be developed so no X rays.  Most of the time there were not the reagents for the machine which checked for electrolytes (a test of kidney function) so there were no results or more commonly they just could not be relied on…  The test results for TB often got lost and had to be repeated several times before a result was available…… Getting lymph node biopsies done and getting a result,  to distinguish between TB and lymphoma, was so difficult to organise….The MRI scanner needed a spare part so was not in use for a few weeks while they waited for the part to arrive and the machine to be repaired… I could go on and on, but you can imagine how difficult this made things.  In the UK, we rely on test results so much in making our diagnoses, so in Malawi I had to relearn my clincical skills and start to rely on them for diagnosis.

Regarding drug supplies there did not seem to be a problem with supply of drugs for TB or HIV treatment.  However there were severe shortages of almost all other drugs.  Twice during my year in Malawi we had no long-acting Insulin  (the commonest treatment for Insulin treated diabetes ) available for several weeks.  There was no good alternative available.  Some people were given quick acting Insulin as an alternative but there is a much greater risk of low blood sugar levels with this and consequently, sometimes death.

In addition, we sometimes for a few weeks, did not have the antibiotics needed to treat the commonest bacterial infections, eg bacterial meningitis, pneumonia, non-typhoid salmonella and even malaria.  These are very common in patients with HIV and will often cause death in these patients whose immune systems are so damaged. 
One of the worst things, though, was the lack of available painkillers, both  mild and strong ones. Mostly the only painkiller available in the short term was paracetamol.  Good painkillers were available for patients who had a confirmed terminal illness through Tyanjane, but generally on the wards there were very few available.  I ended up having my own supply of painkillers which I gave out on the wards as necessary. To me it is bad enough that we did not have the right drugs to treat the patients with, but it seems unacceptable that we were not at least able to keep our patients comfortable and allow them to die as comfortable a death as possible.

Me: In the UK everyone thinks of AIDS or malaria when you mention Africa, do you think diabetes gets forgotten about, and how could awareness be improved?

Dr Heyes: I do think that Diabetes gets forgotten about when thinking about Africa. I believe that over the next 20 years, it is going to become a huge public health issue, as an increasing cause of illness and death.  It is obviously important to raise awareness of diabetes, both its prevention,diagnosis  and treatment available, in Malawi.  However, having seen the scourge of HIV at first hand, I can completely understand the priority given to HIV awareness in Malawi at the moment when health care resources are so scarce.  HIV predominantly affects young adults in the age 20 to 40 age group who tend to have young children and families to look after where as most people with Diabetes tend to be in an older age group, so again, much as I, as a diabetes specialist, would love to see Diabetes having a higher profile, I can understand why HIV takes priority.

Interestingly, it is now known that some of the drugs used to treat HIV increase the risk of  developing  Diabetes, so therefore actually increasing education about the prevention of HIV, would also impact to some degree, the incidence of diabetes in the developing world in the future!

Me: What was your most rewarding experience working in Malawi?

Dr Heyes: Regarding rewarding experiences in Malawi, there are two which stand out in my mind.

One was looking after a young man with HIV and paraplegia (loss of any power and sensation in his legs and lower back).  He and his 2 younger brothers had been orphans for many years (probably due to HIV) and R was the breadwinner while his brothers finished their schooling.  They were all very bright boys and the youngest brother wanted to go to medical school to train as a doctor.  R was looked after in hospital by his middle brother M who had left school but was unable to get a job because he was caring for R.  Over a few weeks it became apparent that there was no hope that R would ever recover from the dreadful pressure sores he had developed on his bottom and hips (because he had no feeling below the waist).  I was able to help M to come to accept that his brother could not get better and was going to die and I was responsible for his care when he died peacefully in hospital, with his family understanding that this was  inevitable.

Subsequently, I was very pleased to learn that M had been successful in getting a job as a translator at QECH (the hospital where I was working) which hopefully will be his first step on the employment ladder and means that M is now able to financially support his family.

The other rewarding thing about my time at QECH (Queen Elizabeth’s Central Hospital, Blantyre) was the development of a diabetes foot clinic which had open access for any diabetic patients with foot problems, in the out patient department which ran weekly .  This is the only diabetic foot clinic in Malawi and had not existed before 2012.  We were able to offer education regarding the prevention of foot ulcers in diabetics, as well as providing good  multi -disciplinary treatment for pateints with ulcers, to help the ulcers to heal and to prevent subsequent amputation which is an all too common consequence of foot ulcers in sub-saharan Africa.  During my time there, the Orthotics department made their first pressure-relieving insoles to be worn in shoes, to off-load pressure areas in a patient who had had recurrent foot ulcers over many years.  And it was wonderful to see some of the ulcers that I had treated actually heal and not need those amputations (from which there is such a high mortality in Sub saharan Africa).

I would like to thank Dr Heyes for taking the time to answer my questions in such depth.