Moderator champions 'life-changing' health programmes in Malawi

The Moderator of the General Assembly has been appointed the ambassador of a Christian healthcare charity which supports work to improve lives in one of the poorest regions of the world.

Lord Wallace said he is delighted to help promote EMMS International which funds two programmes at Mulanje Mission Hospital in Malawi, which is run by the Church of Central Africa Presbyterian (CCAP) – a Church of Scotland partner.

Malawi Youth club
People watch a youth club play which focusses on sex education messages. MMH/EMMS

One is a teenage pregnancy prevention programme and the other is focussed on improving palliative care, tuberculosis screening, and water and sanitation facilities at rural health clinics in the southern part of the African country.

Lord Wallace had hoped to be in Malawi to visit the Church's partners in person this month to offer encouragement and prayers but the trip was cancelled due to the ongoing COVID-19 pandemic.

A series of online meetings have been arranged instead and this week he met with EMMS International's team including CEO Dr Cathy Ratcliff, and Mulanje Mission Hospital's medical director, Dr Arie Glas, and his wife Dr Lisanne Glas to learn more about their important, life-changing work.

He described the programmes as "tremendous" and said he hoped that church members would consider donating money to help the Edinburgh-based charity continue funding the programmes.

Originally established in 1890 by Scottish missionary Rev Robert Cleland, the modern-day hospital has 230 in-patient beds and serves 72 villages, providing primary health care for 92,000 people.

Lord Wallace Malawi Zoom meeting
The wonder of modern technology - Top/L-R Dr Arie Glas, Dr Lisanne Glas, Mary Robertson, EMMS Director of Fundraising, Dr Cathy Ratcliff, EMMS CEO and Director of International Programmes, Jennie Chinembiri, Africa and Caribbean Secretary of the Church of Scotland, Rev Fraser Macnaughton of St Magnus Cathedral in Kirkwall, Orkney, Lord Wallace, Lady Wallace, Cameron Brooks, CofS Communications.

Malawi has one of the highest teenage pregnancy rates in the world with 141 births per 1,000 which is three times higher than the global average.

Linked to teenage marriage, the pregnancy rate in 2019 was 20.6% but the crisis has worsened during the pandemic and the rate increased to 41% in 2020.

School closures with no remote learning alternative and rising unemployment are two factors that have likely led to the sharp increase which poses serious health risks for young mothers and their babies.

The age of consent in Malawi is 16 and people cannot legally get married until they are 18 but the law is poorly enforced and according to children's charity, UNICEF, 46% of girls are married when they are underage.

Initiation rituals

Girls are under put under pressure to be sexually active as young as 11, and are then forced to drop out of school and get married when they become pregnant. Many lose hope of living independent lives and are trapped in a cycle of poverty.

Launched nearly a year ago, the objective of the programme is to reduce teenage pregnancies, lower HIV rates and increase provision of sexual reproductive health education among teenage boys and girls.

Lisanne explained that the level of knowledge of sexual reproductive health is generally low in Malawi, particularly among youngsters, older people generally do not openly discuss contraception and it is usually men who control whether condoms will be used during intercourse.

She added that 57% of girls go through traditional initiation rituals when they start menstruating and are encouraged to have sex at an early age.

Future for girls Malawi

Lisanne, who along with her husband is originally from the Netherlands, added that young people are often left confused due to conflicting messages about sex promoted by people from different sections of the community including the church.

"This is a very complex problem with many different aspects and needs a holistic and culturally sensitive approach to address," she explained.

"Making a difference will cost a lot of time but we believe that we can definitely make a change.

"We have established mentor networks to train role models for girls and boys so they can provide leadership to help protect girls' rights and to show girls where they can get contraception if they decide to have sex and how they can say ‘no' if they don't want to.

"We have introduced youth-friendly health services with specially trained staff to provide advice and support in a safe place and sex education has been introduced to schools, partly communicated through plays."

The programme provides financial support for 60 girls to enable them to continue their education after giving birth and vocational training opportunities for a further 60 girls so they can learn skills to make a living.

Lisanne said: "The programme has led to more awareness and we have community dialogue with village headmen, parents and church leaders to discuss the issues and the problems they are facing.

"We train leaders on sexual health education and discuss how we can change the initiation rituals to promote sexual health education and speak with one voice together."

Life saving

Lisanne said older men and boys are trained to be mentors and role models to try and change attitudes towards underage sex and address issues like inequality and gender-based violence.

"It has been received very well and men and boys want to be more involved and are really open for discussion and I do think that things are changing," she added.

EMMS International, which has a vision of ensuring that all people have access to good quality and dignified healthcare, says £13 trains a traditional counsellor to defend girls' rights through the pandemic and beyond.

And £40 helps healthcare workers reach one school with potentially life-saving information on sexual health while £105 funds education or vocational training for a girl or a young mother, restoring her hope for the future.

Lisanne says there are signs of breakthrough with lower numbers of teenage pregnancy cases but it is too early to be certain and EMMS will conduct an evaluation of the programme in April.

Arie, who also a degree in water management as well as medicine, gave a presentation on the Mokwanira Programme which aims to be a model to deliver key elements of Malawi's national community health scheme.

It also features work to ensure a sustainable and green future for Mulanje Mission Hospital

Arie said: "The Malawi government is currently not providing minimum standards to patients in the rural health centres and co-ordinates very poorly.

"A programme like Mokwanira is very popular in the community as it creates tangible change."

Water for Mpala Health Centre
People draw water from a pump for Mpala Health Centre. MMH/EMMS

Arie said a needs assessment carried out at 20 rural healthcare centres in November 2020 showed that the situation was "appalling" and much worse than he and his colleagues thought it would be.

"Most facilities did not have a proper water supply and most of them had very run-down toilets and latrines so can you imagine if you don't have running water, how can you stop Covid, how can you advise people to wash their hands?" he asked.

Arie said progress has been made under the programme to make improvements to five health centres including installing new plumbing, solar pumps, water tanks and toilet facilities.

Modernisation

A new tuberculosis screening programme to improve diagnosis has been established and work is continuing to expand it as well as palliative care services.

Arie said the mission hospital was working to becoming more self-sufficient by increasing local revenue and reducing costs and dependence on external funding.

A third water borehole has been drilled to increase the water supply, the book-keeping invoice system has been digitised and extra solar panels have been installed to generate more electricity.

Solar power Malawi
Vital signs monitors are powered by solar power at Mulanje Mission Hospital. MMH/EMMS

Speaking after the meeting, Lord Wallace said: "Mulanje Mission Hospital is one of the longest standing partners of the Church of Scotland and members up and down the country follow and support its good work carried out in Christ's name.

"Whilst it is disappointing not to have been able to visit the hospital in person, it was wonderful to spend time with Arie and Lisanne on Zoom."

"It was absolutely fascinating and eye-opening to learn about the tremendous work EMMS International and Mulanje Mission Hospital is doing to address rates of teenage pregnancy and build infrastructure to support vitally important rural health clinics.

"This work has been made possible through the financial support of EMMS International, a charity for whom I am an ambassador."

Thembe Health Centre Malawi
Dr Arie Glas explains the situation around Thembe Health Centre

Lord Wallace said he was pleased to accept the invitation because there are always new challenges which demand action and support.

"EMMS International's imaginative initiative to bring church leaders and local chiefs together to seek to change mindsets among men and boys is just one project worthy of support," he added.

"I look forward to continuing my association with EMMS after my term as Moderator finishes in May"

Historic partnership

Dr Ratcliff is also EMMS International's Director of International Programmes.

"We are delighted to have the support of our new ambassador Lord Wallace, together with his wife, Rosie," she added.

"Their voices are much needed to highlight the inequalities and daily challenges that girls face in Mulanje District in Southern Malawi, one of the poorest districts in the world.

"The Church of Scotland has historic and strong links with Malawi, and we value its compassionate and prayerful partnership with EMMS International over many decades.

"The Moderator will speak out on behalf of girls and women in Malawi and lend his voice to our campaign with Mulanje Mission Hospital to create a climate of change that would see girls leading the way in building stronger, healthier lives for themselves, their families and their communities."

Lord Wallace of Tankerness
Rt Hon Lord Wallace of Tankerness QC has been a Kirk elder since 1981.

Lord Wallace said there are many links between presbyteries and congregations in Scotland and counterparts in Malawi.

"Orkney Presbytery's link with Thyolo Highland Presbytery and the support given through local fund-raising to facilitate vital projects, such as water bore-holes is just one example," he added.

"I hope congregations will be encouraged to continue such support as the need is all too evident.

"What was apparent from the presentation is the importance of good governance and due diligence carried out in partnership between EMMS and Mulanje Mission Hospital to ensure that financial support is spent in the most appropriate way to maximise impact on vulnerable people who need help the most.

"I wish Arie and Lisanne and all their colleagues at the hospital well with their life-changing work and our thoughts and prayers are with them."

Lady Wallace took part in the Zoom call on Tuesday as did the Moderator's chaplain and minister, Rev Fraser Macnaughton of St Magnus Cathedral in Kirkwall, Orkney.

Jennie Chinembiri, Africa and Caribbean Secretary of the Church of Scotland and a trustee of EMMS International, and Mary Robertson, its Director of Fundraising, also took part.