Makunduchi is located at the south eastern point of Zanzibar and is home to approximately 12,000 people who survive on fishing and farming. It has one primary school and one secondary school. Despite its beauty, Makunduchi sees very little tourist activity compared to other villages on the eastern coast of Zanzibar, such as Jambiani and Paje. However, it is famous for its four day Mwaka Kogwa festival which takes place in July.
In 2007, Makunduchi Cottage Hospital was staffed by an Associate Medical Officer, a Clinical Officer, and 13 nurses, but no doctor. Much of the hospital was dilapidated, outpatient services were disorganised, and in-patient bed occupancy was very low indeed. There was no access to blood transfusions or caesarean section. An ambulance and a fuel allowance were provided by the Health Service Fund (Danida) so that critically ill patients could be transferred to the referral hospital in Stone Town a couple of hours away.
HIPZ joined forces with Zanzibar’s Ministry of Health in 2007 in order to strengthen and improve upon the existing infrastructure and healthcare services which are provided by Makunduchi Cottage Hospital and the surrounding Primary Health Care Units (PHCUs). The first step towards achieving these goals and objectives was creating and supporting a strong hospital management team, which now works closely with its staff members, forming a cohesive and functional team. By building a durable and resilient structure for a management team, HIPZ aims to create a lasting and sustainable impact on accessible and adequate healthcare in the southern district of Zanzibar.
In order to provide accessible and properly administered healthcare to the people of Zanzibar, it is essential to gain the trust and confidence of the local community. This is a central aspect of the HIPZ paradigm for sustainably transforming the healthcare provision in Zanzibar. By working closely with local staff, HIPZ volunteers are able to form long-lasting and trusting relationships. These well-trained and informed staff members, along with the Makunduchi managerial team, are able to connect with the community members and collaborate with them in order to determine their needs.
Since 2007, Makunduchi Hospital has attained an improved standard of clinical services and facilities including a Primary Healthcare Unit and a Maternity Unit which were built by HIPZ. The hospital now has robust management and financial systems in place along with a functional ambulance service, eye-care service, X-ray and basic ultrasound services and now has the skills required for emergency obstetric care and minor surgeries.
KEY PROJECTS AND IMPROVEMENTS:
Training of an Anesthesiologist:
HIPZ supported the training and certification of an anesthetist in order to further the theatre’s capacity for surgeries. This allows community members to receive relatively simple treatments close to home rather than traveling over an hour to the main city of Stone Town.
Theatre development, minor surgeries and caesarian sections:
The Makunduchi theatre is now well equipped, sanitary and functional for weekly surgeries that take place on Thursdays. Makunduchi staff have the ability to perform surgeries for hernias, appendix removal, and other minor surgeries. In addition, emergency C-sections can be performed.
Outpatient Department and Triage:
HIPZ helped design a second building which now serves as Makunduchi’s outpatient department in order to deal with the increase in outpatient numbers. Since 2007, the number of patients seen daily has increased to an average of over 100 outpatients.
In addition, a triage system was implemented in February of 2016 in order to improve patient flow while decreasing average waiting times and helping staff to quickly identify the most unwell patients.
Maternity Pick-Up Services:
This is a free service that is provided to all pregnant women in labor who need help getting to the hospital quickly. Before this service, many women were forced to wait for public transportation while in labor in order to reach the hospital, which could take hours depending on the time of day and would increase discomfort and distress.
With the help of Reyhana and ZIDO (Zanzibar International Development Organisation), Makunduchi has been able to recently renovate its inpatient wards. In July 2016, the children’s ward was officially opened and both the emergency room and two women’s wards started renovation in August of 2016.
In addition, 19 new inpatient beds were donated by ZIDO. These beds have the ability to incline, which allows patients to sit up comfortably: this is especially important for those suffering from respiratory and breathing issues.
In July of 2016, The Rotary Club of Zanzibar organised a fundraiser for Makunduchi Hospital in order to raise money for essential new equipment. By the end of this fundraising process, the Rotary Club will manage to raise thousands of dollars to help support hospital improvements.
Weekly Clinics at Makunduchi:
Hypertension, Diabetes and Psychiatry clinics take place on a weekly basis and provide the community with a consistent and reliable service that provides them with personal care and counselling.
FUTURE WORK AT MAKUNDUCHI:
Sustainability, sustainability, sustainability! Everyone works extremely hard to make sure our projects and improvements are long term solutions, not short term.
Even though Makunduchi has seen great improvements over the last decade, we are not finished. There are still improvements to be made and new projects to be implemented:
Makunduchi Hospital staff are working on how to get a new incinerator since the current one is extremely old and out of date.
Keeping a Clean Hospital Environment:
Makunduchi is also looking to build a fence around the hospital perimeter in order to keep out unwanted animals such as chickens, goats and cats. These animals, especially the chickens and cats, will walk into the hospital, its offices and even the wards that are housing sick patients. They contribute to a dirty and unsanitary hospital environment.
Filling in the Gaps:
With Makunduchi Hospital’s growing capacity and ability, more patients are reporting to the hospital when they feel ill. Due to this increase in patient attendance, Makunduchi is understaffed and over worked.
The managerial team is constantly requesting new staff members from the Ministry of Health. However, the staff accommodations are in need of some repairs and there is a hope that more housing units can be built for the new staff members which are being requested.
Makunduchi staff are always looking to keep their skills up to date. Every Friday at the morning hand-over meeting, there is a weekly teaching session led by a local staff member. They take turns each week and refresh the other hospital employees.
In addition to these weekly sessions, staff members are also attending external trainings to improve their skills. Some future training sessions they want to focus on are those regarding maternal care and neonatal resuscitation.