A Malawian nurse reflects on BAH’s achievements while urging hospital leadership to review billing practices and ensure daily care reflects the institution’s values of compassion, excellence and respect.

By Namasawani

Blantyre Adventist Hospital (BAH) has long been a cornerstone of healthcare excellence in Malawi. As a Malawian, I take immense pride in the hospital’s growth and its continued commitment to delivering quality and safe care to the population it serves. Over the years, BAH has achieved remarkable milestones, including hosting volunteer medical teams from the United States who provided life-saving surgeries at no cost and making national history as the first hospital in Malawi to perform open heart surgery.

More recently, BAH attained a prestigious FiveStar Accreditation from the Council for Health Service Accreditation of Southern Africa (COHSASA) becoming the first hospital in Malawi to receive this level of international recognition. This achievement reflects a sustained pursuit of excellence, quality improvement, and innovation in patient care.

As a Malawian and a nurse, I celebrate these accomplishments with deep pride and gratitude. However, despite these significant successes, I am deeply concerned about certain billing practices currently in place, which may be perceived as insensitive and disproportionately focused on revenue generation rather than the mission and values BAH has upheld for decades.

While itemized billing is not a new concept and can promote transparency, basic nursing care should never be itemized as a chargeable service. Fundamental aspects of nursing care such as toileting, bathing, feeding patients, changing bed linens, and routine patient monitoring are core responsibilities of nursing practice and should not be billed separately. Patients seek hospital care because they are ill and vulnerable; they come in need of compassion, dignity, and holistic care. Charging for these basic daily activities is not only concerning but also undermines the essence of nursing care.

Of further concern is the reported practice whereby families who choose to assist with basic care activities are viewed negatively, resulting in reduced nursing presence and, in some cases, the absence of essential nursing assessments, an integral and nonnegotiable component of patient care. This raises fundamental questions about patient safety, professional accountability, and adherence to accepted nursing standards.

I would like to give the BAH administration the benefit of the doubt that they may not be fully aware of how these policies are being implemented at the ward. However, if these practices are known and endorsed, they warrant urgent review and revision. While it may be appropriate to itemize supplies or materials used in certain procedures such as during wound care, standard nursing care should never be commodified. This leads to a fundamental question: What, then, is the defined role of the nurse within this care model?

Additionally, physician availability and timeliness of patient evaluation remain a significant concern. Numerous patients report waiting 18, 24, 36, and even up to 72 hours for an initial physician assessment or consultation. Such delays are unacceptable, particularly in a private, internationally accredited, five star hospital, where timely access to medical evaluation is a basic expectation.

I respectfully urge the leadership and administration of Blantyre Adventist Hospital to review these concerns and take corrective action where necessary. Doing so would help restore confidence, safeguard patient welfare, and reaffirm the hospital’s longstanding commitment to compassionate, respectful, and high-quality care. Most importantly, it would ensure that BAH’s celebrated mission and values — compassion, excellence, and respect — are consistently reflected not only in its achievements and accreditation, but also in the everyday experiences of the patients it serves.

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The author, a devout Seventh Day Adventist, holds a Doctor of Nursing Practice (DNP) and works in the state of California, U.S.A.

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