Reconciling the perspectives of MSF, the Ministry of Health (and patients) on the quality of care during the Covid-19 epidemic in Malawi (2021)
After a mild first Covid-19 wave, Malawi experienced a short but brutal second wave between mid-December 2020 and February 2021, which put a high strain on the Malawian health system, especially in Blantyre district. The only public facility hospitalizing Covid-19 patients for Blantyre district, the Queen Elizabeth Central Hospital (QECH), faced numerous challenges starting with the shortage of staff due to high rate of contamination among health workers, shortage of oxygen, lack of beds, difficulties to organize screening and triage of suspect Covid-19 patients. In addition, it had to cope with a growing distrust of the population toward the health system (accused of deliberately killing patients) which progressively overtook the Covid-19 outbreak as the main public health crisis.
From January 8th onward, MSF responded to QECH call for support with the twin objectives to minimize mortality and maximize quality of life of suspect and confirmed Covid-19 hospitalized patients. Agreeing on a common definition of “quality of care” as well as transforming daily practices proved to be quite challenging. Not being able to implement straight away what they considered as minimal quality standards, some MSF expatriate resigned, while others found their ways to work with their MoH counterparts toward a gradual uplifting of nursing and clinical practices - at the price of uncomfortable work ethics compromises.