Cathy Ratcliff, Director of International Programmes for EMMS International, discusses how EMMS’s Department for International Development (DFID) funded project Chifundo (Chichewa for “Compassion”) is “pivoting” to COVID-19 activities.
As COVID-19 turned into a global pandemic, and as Malawi wondered what to do about this emerging crisis, DFID was quick off the mark, asking us: what would EMMS like to change in our project Chifundo that DFID funds, to “pivot” it to COVID? Once our five partners in north, central and south Malawi had worked out what they wanted to change, we asked DFID, and DFID quickly approved these requests.
EMMS has been developing palliative care in Malawi for ten years, and our Chifundo project (Chichewa for “compassion”) involves a network of 30 health centres and hospitals, spread right across the country and including at least one facility in each of Malawi’s 28 districts. Chifundo includes particularly rural and hard-to-reach facilities and all 4 of Malawi’s Central Hospitals. So far, we have helped 20 of these 30 health facilities to reach the exacting standards of the African Palliative Care Association.
EMMS specialises in palliative care, for which there is a vast need in Malawi, because of the stage the country is at in the HIV pandemic and also in its development. Because of these two factors, Malawi has high incidences of cancer and Non-Communicable Diseases. Little did we think, though, when developing this expertise in Malawi to cope with the HIV pandemic that our work would also be good preparation to help Malawi cope with a Coronavirus pandemic.
Adapting to COVID-19
Our work in Chifundo has just over a year left to run. Our partners’ main concern when wondering what to do about COVID-19 was to ensure they could still complete the project. They still want to get all 30 health facilities to the required standards of palliative care, with pain-relief drugs, spiritual and social care, nutritional support, and plenty of home visits. Ultimately, they want to ensure they are still able to help and care for patients and families and to ease their distress at a supremely difficult point in their lives. As such, we are making changes to pivot Chifundo to COVID-19.
We are adapting our vital and specialised work of rolling out palliative care, looking after palliative care patients while keeping them safe from COVID-19, and helping our extensive network of palliative care centres to play their role in preventing COVID-19. At the same time, partners are preparing to deliver palliative care to families affected by COVID-19. The changes cover our five partner organisations, the health centres which they are mentoring, and the palliative care departments of the four Central Hospitals.
These changes include providing Personal Protective Equipment (PPE – face-masks, goggles, gloves, re-usable gowns and rubber boots), and hand-sanitiser, buckets and soap for the 30 health facilities. They include training staff to prevent COVID-19 and to handle COVID-19 cases. They include training communities in social distancing and hand-washing to prevent COVID-19, along with hand-wash kits to help them do so.
To the 8,000 or so palliative care patients currently enrolled in Chifundo, our partners will give larger quantities than usual of pain-relief drugs, to help patients and their families to remain longer than usual at home without visiting a hospital. We shall give some healthcare staff mobile phones so that many patients can still receive phone consultations from hospital staff. . Those families in greatest need will get extra food, soap and buckets.
Some of our partners’ staff will be working long hours in triage centres or in COVID referral hospitals, and Chifundo will now help them with transport while public transport is much reduced. We will also provide mobile phone time for consulting with palliative care patients remotely, fuel for travel to visit people suspected of having COVID-19, and internet access for office staff to work from home. There will also be changes in EMMS’s management of the project, as we cannot travel to Malawi and management of the project now takes more of our time.
Supporting frontline services
Given Malawi’s current need in the face of COVID-19, and the fact that Chifundo partner Palliative Care Support Trust has staff in Queen Elizabeth Central Hospital and Mzuzu Central Hospital, we will be providing equipment to two Central Hospitals. EMMS aims to fund six oxygen cylinders, pressure gauges and oxygen concentrators, and extra beds, trolleys, infrared thermometers and hand-washing stations for the High Dependency Units in these hospitals. Some will also be of use in Mzuzu Central Hospital’s Screening, Triaging and Treatment centre.
EMMS’s long-term relationships with our partner institutions and with their staff have given us unique opportunities to respond, with donors’ help, to this unprecedented situation in Malawi. Our partners in Malawi will continue to travel to improve palliative care country-wide while taking care of their own safety. They will continue to respond compassionately to the needs of patients. They will now also help staff and communities understand how to stay safe from COVID-19. And they will be able to play a central role in Malawi’s response to COVID treatment, prevention and care.
We are grateful to the UK government’s Department for International Development for their ongoing support of the Chifundo project and for their willingness to see the project adapt to meet Malawi’s current needs. Along with donations from our Emergency Appeal, this allows our partners to respond to this global pandemic in ways that are appropriate for their communities.