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Listen to the team from Malawi's first One Stop Centre

Listen to the first-hand stories from Malawians who work in the country's first One Stop Centre for Child Abuse and Domestic Violence.  Aaron Miller provided the training and consulting to make this centre happen, and UNICEF just awarded Aaron a 3-year consultancy to help the Malawi Ministry of Health create a country-wide system of 24 One Stop Centres for Child Abuse and Domestic Violence.


Creating lasting change: The Blantyre One Stop Centre

Gratitude. Pride. Humility. Just a few of the emotions I felt today as I visited for my first time the Blantyre One Stop Centre for Child Abuse and Domestic Violence at Queen Elizabeth Central Hospital in Blantyre, Malawi.

The exam room for children in the Blantyre One Stop Centre

In March 2009 during my first trip to Malawi, the one stop centre was just an idea, a plan by UNICEF to coordinate with law enforcement the creation of a centre to be built by the courts, without involvement of medical professionals.  Upon learning about my trip to Malawi, Dr. Neil Kennedy, a senior pediatric consultant at Queen Elizabeth Hospital, called for a stakeholder meeting which was held during my visit and which changed forever the course of one stop centres in Malawi.  

As the doctors, police, social welfare, and police sat down together for the first time to discuss child abuse, they learned from each other the scope of their work and the daily challenges they face.  And it was Justice Edward Twea, National Chairman of the Juvenile Justice Forum, who said that the doctors are too busy seeing 90,000 children per year in the Emergency Department and thus that the one stop centre for child abuse should be built at Queen Elizabeth Central Hospital.  My jaw almost dropped - it was so exciting to see law enforcement give such a concession to the medical field - more importantly, to provide a health focus to child maltreatment and domestic violence.  After two hours of them presenting to each other, they asked me to talk about my work.  I humbly explained that there's no one way to do this work, and my center was far from perfect, but I told them about my center at Lincoln Hospital in the Bronx.  At the end of my presentation, they said they don't know if they could emulate it exactly, but they'd like to try.  I think they may have exceeded it.

Office for Victim Support Unit Police Officer

The Resting Room, where the client or parent can sleep if they travelled a long distance to the centre.

The Resting Room and each exam room have very nice showers for clients.

One of the two hallways in the L-shaped centre.  The adult exam room is straight ahead; the children's exam room is behind the camera.

The interview room with a two-way mirror.

The interview room as seen from the observation room.  The interviews can be audio recorded and perhaps soon will be video recorded.

That I played even a small role in creating this center - training the staff and promoting a health focus - is very humbling.  It is the passion, commitment, and leadership of the local clinicians that has made the Blantyre One Stop Centre a beacon of hope for survivors of violence.

Why no people in the photos?  I took photos of the centre while Tim videotaped interviews of Tandu, the centre's counselor, and John, the Community Child Protection Worker.  While we were there, a child was brought in who had just been abused.  The team went back to work, and we left to return to Lilongwe.

Creating two more one stop centres for child abuse and domestic violence


December 12, 2013: Participants in the Malawi Ministry of Health Training for new one-stop centres for child abuse and domestic violence in Zomba and Mulanje

Thank you to the Malawi Ministry of Health, UNICEF, the UK Department for International Development, College of Medicine and especially to the clinical officers, nurses, police, prosecutors, social welfare officers and magistrate from Zomba, Mulanje and Blantyre for a very productive 3-day conference at Annie's Lodge in Zomba.  

Each agency gave presentations on the scope of their work and the daily challenges they face, and I gave presentations on the medical diagnosis and treatment of child sexual abuse and how to interview children. The discussions were lively and interactive, and the conference ended with two hours of putting pen to paper to decide on next steps to increase the collaboration between agencies.  The energy and enthusiasm were palpable.

The Ministry of Health wants BRANCH back in February to start doing Training of Trainers.  Exciting times.

Kids at Kamuzu Central Hospital

























Tragedy

Our head nurse had to find the mother and deliver the news: her 8-month-old daughter had died.  We had known for two days that this would be the eventual outcome – she had been gasping for air since arriving to the hospital, and we don’t have ventilators, and her tuberculosis and malnutrition were much too advanced.   When she eventually stopped breathing, I was in my ward, the Emergency Zone:  a parent came up to me urgently and pointed to the ICU, so I went quickly to the unit and led the resuscitation.  She had no pulse, her abdomen was distended, and within a few minutes blood came out of her nose.  She could not be saved.

I looked around to see if the mother had come into the ICU during the code, but she had not.  Our head nurse went and found her, and when they came into the room, the nurse delivered the news.  The mother’s tears quickly became sobs as she leaned over her baby in utter despair.  The people in the hallway and the Emergency Zone looked our way and paused for a moment, realizing that yet another child had passed.  Of the 250 children hospitalized in Kamuzu Central Hospital each day, 3-4 children die each day, so everyone is accustomed to these moments when the ultimate tragedy occurs.  I sit here, crying as I write this, unable to fathom how these parents get through each day.

Looking from 20,000 feet, global child health is moving in the right direction, and Malawi is on course to meet its U.N. Millennium Development Goals for reduction in child mortality.  But this fact is of little comfort to the 10 million children who die worldwide each year, almost all from basic diseases that are easily treated or prevented, like with our patient yesterday.  With all these preventable deaths, it’s easy to understand why so many international organizations focus their resources on preventing and treating infections and malnutrition.  With BRANCH, we’re taking the next step and asking “As survival rates continue to improve, how can we ensure that each child grows up in a safe, stable, nurturing home?"  This question is vital to the 6.8 million children of Malawi and the billions worldwide. 

This first week at Kamuzu Central Hospital has already done much to inform my work in BRANCH about the day-to-day challenges that the medical, legal and social service agencies face in their work to help children.  I look forward to the next 7 weeks and to continuing to learn from my Malawian colleagues about how they want to grow their work to improve the lives of children.


Our first day at Kamuzu Central Hospital

No additional staff joined the strike, but we're still down 4 out of 5 interns.  We have an 11-month-old girl newly diagnosed with diabetes, but we have no dex sticks to check sugars to know if we're giving the right amount of insulin.  We have a 12-year-old girl with Burkitt's lymphoma who will start chemotherapy tomorrow; a 2-year-old with chronic tuberculosis which is causing right-sided heart failure and breathing 84 times per minute; a 1-year-old who was violently shaken and has irreversible brain damage; an 8-year-old girl with rheumatic heart disease who's in heart failure and looked in so much discomfort; and 220 other children being seen by 6 pediatricians and 10 clinical officers.  

I work in the Emergency Zone, the inpatient unit where the sickest children are brought immediately after being triaged in the Emergency Department.  The afternoon became hectic when children started arriving from district hospitals who needed intensive care:  a 14-year-old girl with an abscess on her scalp that drained 1 cup of pus; 2 different children with cerebral malaria who were seizing and comatose; and a few garden-variety pneumonia patients.  The hospital is so crowded that each bed has 2-3 children, and a parent must always be present, because some units will occasionally have just 2 nurses for 120 patients, and the less critical units (malnutrition unit or nursery for "standard" meningitis or pneumonia) have no doctors covering at night.

The agility and dedication of these doctors and nurses was impressive.  I look forward to continuing to learn from them, and I'm excited that UNICEF has put me in touch the doctor who is coordinating trainings for the one-stop centers for child abuse.  But first I need food.  and sleep.  I'm exhausted.


Preparing for a Strike at Kamuzu Central Hospital

Upon my arrival yesterday, I was informed that the staff at Kamuzu Central Hospital - where I'm to begin work this Monday - sent a petition to the government this week, threatening a strike because of the poor conditions at the hospital.

Read the full text of the petition here.

President Banda is still in the process of cleaning up the graft of past administrations, and Kamuzu Central Hospital (KCH) is one of the places still trying to recover.  Various international organizations also withheld their aid when they learned of the graft, and now the situation is even more dire than it had been previously.  Banda took over last year after President Mutharika passed away, and now it's an election year, with Banda running for President for May 2014.

Tomorrow we have a meeting with Dr. Margot Anderson, a pediatrician who has worked at KCH for a year, to discuss the various contingencies for Monday.  The workers have threatened strike in years past, but this is the closest they have ever come, with five of the clinical officers already having stopped, because the money for their housing was withheld and they have no place to live.

Why BRANCH was formed

BRANCH from Aaron Miller on Vimeo.

National District Attorneys Association 1st International Conference on Human Trafficking, Koror, Palau, July 22-26, 2013

test All the attendees at the conference in Palau, including prosecutors, attorney generals, chief justices, chiefs of police, doctors, nurses, and NGO's from Palau, Guam, Northern Marianas, Marshall Islands, Micronesia, and Saipan.

Picking up the torch to combat human trafficking

John, sporting his beetlenut smileJohn Mootmag, JD (University of Hawaii Law School, 1996) works for Micronesian Legal Services in Yap, where he provides free legal services for a wide range of issues, from child custody and employee rights to - now - human trafficking.  I met John on my first day in Yap when I trained 30 police officers on the medical findings in sex trafficking.... and he came with us to Palau for the big human trafficking conference.  

Amid all the convoluted relationships between Yap state government, Micronesian federal government, U.S. governmental funding, and Yap's traditional leaders, John is a kind, steady advocate for those who need assistance.  He is determined to take the momentum from the conference and carry it forward with Elizabeth, Leona, Dr. James Edilyong, Aaron Warren (Attorney General's Office of Micronesia), Johnny Santos (Acting Chief of Police of Micronesia), Bravo (prosecutor in Chuuk) and many others from the Federated States of Micronesia.

Powerful people are involved in human trafficking, so it won't be easy, but they are sincere in their desires and have started crafting their National Action Plan to Address Human Trafficking.