When my family first moved to Prince George, we had a hard time finding a family doctor. In fact, it took us several years, even though my husband has diabetes. My husband didn’t mind; he doesn’t like going to the doctor.

But I was on a medical mission. I interrogated acquaintances at parties and tracked down their physicians. I cold-called medical offices from the phone book.

A doctor filling in at a drop-in clinic briefly considered my request to take us on at his family practice. But then he shook his head. “You should have stayed in Quesnel,” he admonished me. “You had a doctor there.”

The Northern Health Authority has a “Doctors Accepting New Patients Hotline” for Prince George. But when I phoned, a few years ago, not a single doctor was listed. Last month just one was named on their recording.

Still, if you want to experience a real doctors’ shortage, head to Malawi, in East Africa.

That’s what I did, on a journalism fellowship to report on poverty and development issues. And here’s what I found out:
-Northern BC has about one family doctor for every 1, 200 patients.
-Malawi has about one doctor for every 100,000 patients – even though many of those patients are suffering from life-threatening illnesses like HIV/AIDS, malaria, pneumonia, and tuberculosis.
-Their average life expectancy is 40 years. As a 40-year-old Canadian visitor, I had already outlived half of Malawians.
-Malawi is one of Africa’s poorest countries, and one of the least developed in the world. Two-thirds of Malawians live in poverty.

But that’s just statistics. It’s not the whole story.

Malawi’s capital city is a strange mix of shiny new gas stations, tiny maize fields, concrete strip malls, and village-like townships, with long stretches of wild, green, beautiful bush in between. In old-town Lilongwe, a crippled man wearing shoes like mittens crosses the road on hands and knees.

In the market near the mosque, young entrepreneurs are selling tires, deep-fried maize balls, blue plastic bags, Kenyan paintings, gas coupons, and ground nuts. Aid officials roar by in a big SUV, small green guavas rolling along the dashboard. Huge roadside billboards encourage abstinence – or advertise cell phones.

I’m heading out to a publicly-funded health clinic, in a rural neighborhood. Outside the Area 18 Clinic, a weary older woman sits on the ground with her daughter and newborn grandchild. The grandmother calls me over and makes frantic motions towards her mouth.

Like many people in this hungry season before the maize harvest, she needs food. I offer her the gluten-free power bar I brought from Prince George, and some crumpled Malawian kwacha bills.

Inside, a line of people sit on a concrete bench in a dark hallway, waiting for medical help. But there’s no medical doctor working here. The patients are waiting to see a man who calls himself “a doctor by Malawian standards.” He’s a Clinical Officer, one of the people who form the backbone of this country’s health care system.

Kedson Masiyano was trained in a four-year Clinical Officer diploma program to do everything at this clinic. And that’s exactly what he does: he’s a surgeon, emergency doctor, therapist, pharmacist, family physician, social worker, and midwife, all combined in one small, vibrant man.

Masiyano is 34 years old. He’s been doing this work for years. He says that at times he sees 250 patients in a day. When he can, he takes the time to talk with them about their lives, since he believes pills alone can’t solve every problem. He’s on call all day and all night, every day and every night.

“If I get four hours of sleep, I have slept quite good,” he says with a smile. “The patients, they keep coming.” Last night he was called in twice. He has a contagious laugh, and a propensity to giggle that hints at just how sleep-deprived he is.

Masiyano lives with his wife and three children in a small brick house just metres away from the clinic. The rent is deducted from his salary, so he takes home about $170 (Cdn) a month. He says it’s not enough money to send his children to a good school, but insists the money isn’t so important.

“You are happy to help people,” he says. “The important thing is when someone who is about to die gets better.”

On my first visit to the Area 18 clinic, Masiyano showed me the clinic’s tiny inpatient wards
with a sense of frustration. He was wearing a white lab coat and spotlessly clean shoes,
but the wards themselves were bedraggled, even besieged.

In one room, thieves had slashed through window screens meant to protect patients from malarial
mosquitos. They’d stolen a fire hose, window glass, and curtains donated by the Lions Club.
They’d made off with mattresses from the hospital beds. Fortunately, the maternity ward was so
busy that women in labour had kept the mattresses underneath them pinned firmly in place.

Masiyano was angry about the damage, but thieves were not the only problem. The clinic
frequently runs out of drugs and supplies, including antibiotics. “The drugs are not here, so we send patients to the main hospital,” Masiyano explained. “And then the hospital sends them back to us because they don’t have the drugs either.”

Even when drugs are available most patients can’t afford them, especially during the hungry
season before the harvest. “How could they buy the drugs?” Masiyano wondered. “They have to
think of their stomachs.”

Faced with these difficult working conditions and low wages, many health professionals are
leaving Malawi’s public health system. Some join private clinics. Most leave their impoverished
country to emigrate to the United Kingdom. One report suggests there are more Malawian
doctors working in Manchester than remain in Malawi.

It’s part of a global trend that worries the World Health Organization (WHO). “Increasing numbers are joining a brain drain of qualified professionals who are migrating to better-paid jobs in richer countries,” says WHO Assistant Director-General Dr. Timothy Evans.

“The shortages are most severe in sub-Saharan Africa, which has 11% of the world’s population, 24% of the global burden of disease, but only 3% of the world’s health workers.” In a report released in April, the WHO fretted that Malawi was just one of 36 sub-Saharan African countries with a severe shortage of health workers.

And that shortage is causing a lot of misery and death. According to WHO, these staff shortages are “impairing the provision of essential, life-saving interventions.” The number of women now dying in childbirth, for example, is on the rise in Malawi. The country’s maternal mortality rate is now among the worst in the world.

So what can be done to stop the hemorrhaging of Malawi’s health care system?

Malawi is urging wealthy countries like the UK to provide compensation for luring away African-trained health care workers. Some countries are already sending money to top up the salaries of health professionals who remain in Malawi. Some aid groups are trying to reverse the brain drain by sending foreign doctors and nurses to fill the vacancies in Malawi, and to help train more local staff.

And then there is Kedson Masiyano, soldiering on at the Area 18 clinic. On my second visit, I interrupt his lunch. He tells me he was called back to work three times the night before. He’s weary, but still gracious, and he takes me to meet his newest patients in the women’s ward.

A badly beaten woman lies on a bare bed, without mattress or sheets. She was attacked last night outside a bar. A good Samaritan found her on the road and brought her here.

She has head injuries and is hooked up to an I-V, but there’s no one at her side to take care of her. Every hospital patient in Malawi is supposed to have a “guardian” with them – a friend or family member. The guardian does what the clinic’s small staff can’t – feed and care for the patient, and wash their clothes and bedding.

This patient, frets Masiyano, has no one. She is a “bar girl,” who works in the sex trade. Masiyano is trying to find her brother.

In the next bed there’s another patient with no guardian, but this woman also has a small child with her. Masiyano says she’s a banana seller from the south, far from her home and family. The woman is asleep or unconscious. Her young son, no more than two years old, sits silently at the foot of her bed. He looks terrified.

The boy’s mother has malaria. Often deadly, it’s one of the most common diseases encountered here at the clinic because many people cannot afford the few dollars it costs to buy a mosquito net.

Masiyano himself had malaria as a teenager, and the care he received moved him to become a Clinical Officer. He says his passion for his patients was inspired by one of his medical teachers. This was a doctor so loved and respected that when he got older, his patients still came to him for medical consultations.

“Think of this,” says Masiyano with a smile. “They came to him for advice, even on his death bed.”

Doctor Shortage Statistics

Northern B.C. life expectancy77 years
Malawi life expectancy40 years

Northern B.C. has about 252 family doctors for 300,000 people.
Malawi has about 120 doctors for 12 million people.
Canada has about 64,454 doctors for 31 million people

Northern B.C. has about1,190 patients per family doctor
Malawi has about 100,000 patients per doctor

Northern B.C. will have24 doctors/year graduate from the Northern Medical Program
Malawi has20 doctors/year graduate from the country’s only medical school

Statistical Sources: Northern Health Authority, World Health Organization, Malawi Public Health News, VSO. Note: Different sources list the number of doctors in Malawi as between 100 and 137.

Betsy Trumpener was one of 5 BC journalists awarded a CIDA/Jack Webster Foundation Africa Fellowship to report on poverty and development issues. She traveled to Malawi in February.