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Eye Care In The Wake Of A Storm

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The newest outpatient clinic at Mulanje Mission Hospital (MMH) in Malawi opened March 2 with a celebratory welcome dance—and rightfully so. Construction on the eye, rehabilitation, and dental facility had taken 15 months. During the process, hospital staff educated themselves on new equipment and administrators developed ways to optimize the clinic’s workflow. The facility was now complete, and the staff was ready to see patients. 

When the ceremonial opening arrived, local television and radio stations announced the new medical services across the 800 square-miles of Mulanje District. The media presence, however, did not capture the scope of the clinic’s significance—this would be after the disaster that struck ten days later. Cyclone Freddy 

Cyclone Freddy had already taken out parts of Madagascar and Mozambique when it made its final stop in Southern Malawi on March 12. By then, Malawi’s wet season was nearing its end and bodies of water were closing in on full capacity. The storm showed no remorse—six months of rain were cast over the region in a span of six days. 

In a country already knocked down by the worst cholera outbreak in history, the damage was nothing short of catastrophic. Wind and water washed away entire villages; falling rocks and debris rendered farmland useless. Three-quarters of Mulanje District’s maize crops—almost ready to be harvested—were destroyed. Bees, goats, and worst of all, people went missing in the storm. 

President Lazarus Chakwera called for two weeks of national mourning in the storm’s wake. By the end of the month, the country’s death toll had risen to 676 people. Chances of finding the more than 500 people who remained missing were slim. 

Amid the chaos and destruction, MMH had managed to stay open, having only suffered minor damage in the storm. The new eye clinic continued its outpatient services and surgical procedures. Patients arrived for services just days after the rain subsided, despite widespread devastation across the district and the surrounding areas. 

Identifying Healthcare Needs 

Studies estimate that cataracts are responsible for nearly half of all blindness in adults ages 50 and older in Southern Malawi, yet most of these patients have not undergone effective surgery to remove them. With roughly 1.4 ophthalmologists for every 1 million people in the country, Malawi has far from the number necessary to address the population’s unmet eyecare needs. 

Cataracts have caused blindness in 5,000 people in Mulanje District alone, according to an estimate from MMH. With the new eye, rehabilitation, and dental unit open, MMH has started to crossing names off that list —despite not having an ophthalmologist on staff. 

A grant from Brother’s Brother Foundation provided funding for MMH nurses to undergo training in intraocular surgical techniques led by ophthalmologists at Zomba Central Hospital. Afterward, nurses returned to MMH, where they performed the hospital’s first cataract surgeries alongside Dr. Owen Kanazawa and his medical team from Zomba Central Hospital. The program is a reflection of Malawi’s overarching strategy to use “task switching,” teaching lower-level healthcare workers how to fill more specialized roles, as a way to mitigate the consequences of the country’s health worker shortage. 

Less than three weeks after the eye unit opened, MMH staff saw over 200 outpatients and completed 45 eye surgeries to remove cataracts, lower eye pressure in patients with glaucoma, and treat other ocular conditions. The hospital performed patients’ initial surgeries for free and did not turn anyone away because they could not afford treatment. 

Responding to Cyclone Freddy 

While MMH’s eye unit was busy caring for an influx of patients, other hospital workers addressed crises the Cyclone Freddy’s aftermath. A primary care team assessed the community’s damage and needs—nearly one thousand homes and more than 2,000 toilets collapsed in 34 villages, leading to the establishment of 130 camps in schools and churches throughout Mulanje District. More than 6,000 people living in these camps were pregnant women. 

Brother’s Brother Foundation provided a grant to MMH to support relief efforts in Mulanje that began immediately after the storm ended. 

The hospital provided food and medical care to seven refugee camps that housed a total of 1,600 people—a quarter of whom were children under the age of five. MMH sprayed camps to prevent malaria and combat bed bugs, and treated water with chlorine to prevent the spread of waterborne illnesses. 

Phase two of the disaster response focused on rebuilding in a way that prepares the district for future disasters, began on May 15th and is set to last until the end of the year. Plans include training 500 farmers in climate smart agriculture, assisting 400 households with construction materials, building over 1,000 toilets and replanting more than 20,000 trees. 

Although Mulanje’s journey toward stability will not be easy, MMH’s recent work offers a glimpse of the triumphs that could lie ahead. The hospital’s quality score improved by 65% since 2021, a significant step toward achieving its goal of becoming an accredited health facility by 2028. Dr. Andrew Feyi-Waboso, a consultant ophthalmologist who visited MMH, said the hospital is “set to make a big impact on the fight against avoidable blindness not only in Mulanje, but in Malawi.” He thinks the hospital can have a self-supporting sustainable eye unit in the next two years, pending the addition of an optometrist and an ophthalmologist. In the meantime, Brother’s Brother Foundation will continue to support MMH’s eye unit by providing the hospital with a shipment of ophthalmology equipment and medical supplies. It will be one of more than a dozen shipments BBF has sent to MMH since 2015.

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