British doctor reveals hospital’s quick action saved hundreds of lives in Malawi

Dr Jamie Rylance calls on high-income countries to help distribute vaccines more fairly

Hundreds of lives were saved in an African country suffering from a dramatic rise in Covid-19 cases after medical staff helped deliver a million-litre oxygen tank.

But people in Malawi are still braced for thousands of deaths because they are unlikely to be immunised for at least a year.

Doctors and nurses are also battling Covid without adequate PPE and no vaccinations as they look after wards being filled by very sick patients, many suffering from the coronavirus variant first discovered in South Africa.

Since early January, there has been a fivefold rise in Covid in Malawi, with an official figure of 28,000 infections, although there is substantial underreporting of cases in the largely rural country of 19 million.

Wards are now overflowing with Covid patients, but thanks to a quick-moving partnership between the Malawi Ministry of Health and the Wellcome Trust health charity, many lives at the main hospital in the second city of Blantyre have been saved.

While plans had been put in place by the Ministry of Health, Dr Jamie Rylance was among the team of doctors who realised that as Covid was a respiratory disease, a good supply of oxygen would be vital to keep patients alive. Like many African countries, Malawi’s medical centres spend large amounts buying oxygen so the hospital decided in March last year to quickly try to build the its own supply.

With £2 million ($2.7m) in funding from the Wellcome Trust, the hospital was able to install an oxygen plant that provides one million litres a day, helping patients who would otherwise struggle to breathe.

"One of the great things last year was having a bit of buffer before Covid hit to get the oxygen plant in, so now even for the sickest patients it will look after 60 or more at high oxygen flow rates," he told The National. "It's been brilliant and I'm sure it's saved hundreds of lives but, even so, today we are running out in terms of capacity, because there are so many people and they need so much oxygen."

The Queen Elizabeth Central Hospital in Blantyre, like many others across sub-Saharan Africa, is desperately short of equipment. It was hit by a wave of infections, largely coming from migrant workers returning home from South Africa at Christmas. It is also the rainy season, so people are huddled together at home.

With few infections over summer it seemed that southern Africa, with its youthful population, had largely escaped Covid unscathed. But the current wave has claimed both young and old.

“I’ve seen a lot of middle aged and younger people die of Covid here,” said the doctor, from Liverpool School of Tropical Medicine.

Anecdotal evidence also suggested that it was predominantly overweight people who required intensive care beds. “I don’t yet have the evidence to back it up, but in our hospital we are seeing a different demographic of people to our normal patients,” said Dr Rylance, 44.

“There are many more obese people in our Covid wards, much more diabetes and much more hypertension. I think it’s a class thing, an inversion of what you might expect in other places. This is more affecting middle class, wealthier Malawians who, for whatever reason, have high availability of calories and sugar. But we’re in a pretty good situation compared to other places in Malawi, just because we have that oxygen tank.”

Dr Rylance, who has worked in Malawi for eight years, admits to some anxiety about the high exposure there is to the virus working on Covid wards without a vaccine or adequate personal protection equipment.

“Many of my co-workers worry that they haven’t been vaccinated and clearly everyone would like to be. I do feel that I am more at risk here than in the UK practising medicine, partly through the PPE issue and partly because of the levels of community transmission. I don’t think there’s necessarily any point in being anxious but I guess you feel it occasionally.”

Dr Rylance also said he feels “inequity, not for yourself as much as just for the country in general” in not having any vaccines available.

A health worker dries decontaminated nasal prongs and oxygen face masks at Queen Elizabeth Central Hospital in Blantyre, Malawi on Saturday, Jan. 30, 2021. Malawi faces a resurgence of COVID-19 that is overwhelming the southern African country where a presidential residence and a national stadium have been turned into field hospitals in efforts to save lives. (AP Photo/Thoko Chikondi)

Asked if he thought many people will die in Malawi because they haven’t been vaccinated he responded, via Zoom: “Yes, I’m sure they will. You can’t put a number on it but many are dying in rural communities.” He has heard accounts of similar situations in nearby countries such as Zambia, Zimbabwe and Kenya.

Their only hope is getting some form of vaccine but they are resigned to African countries being at the end of a long queue.

“My best guess is that it will be European summer, July time, before we see anything here, and that will be just for frontline staff.”

He has called on high-income countries to work more closely with the World Health Organisation’s Covax initiative, which is aimed at giving fair access to vaccines globally.

“I think these governments need to have now an explicit discussion with their populations and with other governments about how they will redistribute vaccines to people who need at least as much but have much less,” he said.

“There’s no real animosity towards the West, it’s generally a resigned shrug. This has happened many times in Africa, with many different health emergencies.”

With his hospital overflowing with patients, sick people have been put in tents on the front lawn while staff have learnt to adapt PPE to keep them safe.

“We have an entire laundry service in reusable gowns, which has worked really well,” the British doctor said. “And of course it’s local and a little bit more sustainable and has reduced the environmental waste.”

The hospital has innovated extensively to combat the shortages, using a 3D printer to make face coverings and eye protection. “The PPE supply is very intermittent and it does point to a fairly precarious position from our point of view,” he said.

Dr Rylance is supporting the Bump It Forward campaign, whereby people can help by donating the equivalent cost of their vaccine to help people in poorer countries be immunised.