Hospitals are places where the sick expect to be healed. But that is not the case in Malawi where hospitals have become death traps. Public health facilities in Kasungu, Machinga and even the country’s biggest referral hospital — Queen Elizabeth — offer no hope to many. The likelihood of contracting disease and dying in these hospitals is very high because the facilities have deteriorated to pathetic levels. SAMUEL KALIMIRA writes:
Malawi’s public health facilities have become a fertile ground for more infections than curative. They have become a death trap with toilets broken, water systems in bad shape and drugs in critical shortage, creating a fertile environment for the spreads of diseases, making them waiting rooms for death amid general human suffering.
We sampled Kasungu and Machinga district hospitals as well as Queen Elizabeth Central Hospital and the situation was the same
At Kasungu District Hospital, for example, patients and guardians at are currently at the risk of contracting diseases due to poor levels of hygiene in washrooms.
Some flash toilets in wards broke down long ago while others do not function properly. When one enters the rooms, they are welcomed by a sight of faeces.
The rooms stink but the patients and guardians still use the toilets because they have nowhere to go.
The worse thing is that toilet doors are not labelled to indicate which section is for women or men and shockingly, some rooms have no doors.
In the alternative, the hospital instructs guardians to bring pales which they use for fetching water at a borehole whenever they want to flash waste down the toilets.
The male ward has a register which ward attendants use whenever they have to announce names and bed numbers of guardians when their [guardians’] turn to go and fetch water from the borehole comes. The water is then kept in one drum positioned opposite the main doors of toilet rooms.
A guardian, Dyna Mwandila from Traditional Authority (T/A) Simulemba in the district, asked the government to renovate the toilets, arguing their current state is compromising healthcare service delivery.
“They shout at us if we refuse to go and fetch water to fill the drum. They wake us up early in the morning. This is a must. If you don’t’ have a pale, you are forced to go and buy one or borrow from your neighbour. Otherwise, members of staff here go bed by bed, forcing guardians to go and fetch water,” Mwandila said.
The only borehole, which was drilled close to the laundry department, is almost always congested.
According to Mwandila, women fight for water because there are hundreds of them, including guardians and pregnant women from the small guardian shelter constructed for the hospital— which is located at Juma Township in the municipality.
Maria Abel travelled all the way from Bua. She said there are always long queues at the borehole, especially in the morning, as well as during lunch and evening hours.
“It is a big problem because water is life; it is a basic need. They encourage us to wash our clothes but you can see how we are struggling to access water from one borehole. It is survival of fittest,” Abel said.
Kasungu District Health Officer (DHO), Dr Emmanuel Golombe, confirmed that there are challenges but said the hospital is trying its best to rectify some of them using funds allocated by the government.
Golombe said the hospital has an allocation of K29 million in the 2018/19 financial year, which translates to K2.4 million per month.
He said the hospital has been failing to renovate toilets at once because of resource constraints.
“We would need some stakeholders to assist us because government resources are not enough.
“Currently, our laundry machine is not functioning effectively, to the extent that we travel to the neighbouring facility [Nkhotakota District Hospital] or Cham [Christian Health Association of Malawi] hospitals to access laundry services. This is costly,” he said.
But the DHO said the hospital’s main challenge is that of power outages. Whenever the Electricity Supply Corporation of Malawi cuts off supply, darkness engulfs wards, forcing patients and guardians to use own torches for lighting.
He said the hospital only uses small generator sets to power paediatric ward, emergency and theatre departments.
“We have a heavy duty genset but we need K2.9 million to fix it. This machine can supply power to the entire hospital but the challenge is that it will need 30 litres per hour to run the machine. This, we feel, is still difficult to run, taking into consideration the allocation we get from government per month,” Golombe said.
He said the hospital could prefer using solar panels for power to the genset because the former is cost-effective.
The DHO also complained about lack of personnel.
Constructed in 1968, and by then it was serving a population of around 100,000, Kasungu District Hospital is now providing health services to about 900,000.
“Some of our team works for 24 hours and they are paid for extra hours through locum. They are working had to meet the demand but we know that this has potential to compromise health service delivery.
“We heard that government will employ some personnel and that is beyond us. We look forward to the recruitment exercise and we believe that Kasungu District Hospital will be one of the beneficiaries,” Golombe said.
Kasungu has 33 health centres and The Daily Times discovered that the entire district has less than 150 health workers.
Kasungu District Council Chairperson, Councillor Greeny Kacherenga, concurred with the DHO.
He said many people do not patronise some health centres in rural areas because they have no qualified personnel.
Kacherenga cited health centres such as Kaphaizi, Chambwe, Kaphyanga and Gogode as some of the facilities that are not helping people despite being located in rural areas.
“Congestion will never end at the main hospital because many of our health centres do provide health services [included in the essential health package and other packages]. Some are no longer working to meet the demand because there are no qualified health workers. Even at our main hospital, we do not have enough personnel.
“The line minister [Health and Population Services] Atupele Muluzi appreciates these challenges because I have briefed him several times. He came here for other official duties. However, nothing is happening on the ground,” Kacherenga said.
He said the district has clinics that need workforce, citing Mzeweza, Kadifula, Chipholi and Chima.
These facilities have been constructed through Local Development Fund (LDF) and stakeholders such as Red Cross and the Catholic Commission for Justice and Peace (CCJP).
This justifies World Health Organisation (WHO) research, which ranks Malawi as one of the countries facing acute shortage of health workers. WHO says patient-to-doctor ratio is at six to 10,000 while nurse-to-patient ratio is at 34 to 100,000.
Some health facilities in the district have also been affected by shortage of some medical drugs and some patients are told to buy the drugs from private pharmacies.
James Phiri, from T/A Mwase, who was discharged on Tuesday, was told to buy Prednisolone and Multivitamin, which is, on average, sold at K900 and K1,800, respectively, per adult dosage, at a pharmacy.
At Machinga District Hospital, there is no reliable source of running water and sanitation is highly compromised.
Walking through the corridors of the facility, one is greeted by an unpleasant smell. Guardians have to fetch water from a borehole to bathe patients and use in the toilets.
The labour ward is the most affected as a woman who has just given birth requires a lot of water to clean herself.
At Nyambi Health Centre in the district, there is no running water and the facility entirely depends on guardians, who fetch water from a nearby borehole, which happens to be used by the surrounding community.
The facility only has one toilet which is used by in-patients (maternity), outpatients and members of staff.
The facility also has a room which is used as a waiting shelter. It is used by women, who use the same toilets. There are no bathrooms for women waiting for their turn to delivery. As such, they use closed toilets as bathrooms.
One woman we recently met at the ‘waiting shelter’ at Nyambi Health Centre, Ruth White, said she felt tortured.
“There are low levels of hygiene and sanitation here. There is only one toilet which caters for staff, outpatients, guardians and us [expectant women who use this waiting room].”
“There is no bathroom for us and we have to use one of the dysfunctional toilets as a bathroom. This toilet smells a lot but I have no choice. I have lived in this condition for a week and some two days,” said White, who was then not sure as to how much longer she would live in such conditions.
The facility is ironically located in the constituency of Muluzi.
Infection Prevention Officer for Machinga DHO, Siphiwe Kachimanga, admitted that Nyambi Health Centre and other facilities in the district face sanitation problems.
She, however, said her office is working on them.
At Queen Elizabeth Central Hospital, probably the country’s major referral hospital, the situation is worse. The facility’s toilets are mostly blocked and they are not as clean as they are supposed to be.
Infection prevention seems not to be a priority as places where there is a high likelihood of infection are not well taken care of accordingly.
For instance, the facility’s theatres are ever busy, so much that there is no much time to sterilise equipment and this puts people at risk of infections. This does not spare the maternity ward and theatres.
QECH Chief hospital administrator, Themba Mhango, told The Daily Times of May 1 2018 that the facility is overwhelmed, adding that, much as the theatres are small and inadequate to accommodate the workload, their
machines are old and experience frequent breakdowns.
Efforts to speak to Ministry of Health proved futile as they could not respond to our questionnaire despite several reminders.
But health rights activist Maziko Matemba said it is regrettable that many facilities in the country are facing similar challenges which government and stakeholders are supposed work together in addressing them.
Matemba, however, said DHOs are supposed to be exposing such challenges at District Executive Committee meetings because the government opted for decentralisation, meaning that it channels funds through district councils.
“Hospitals are supposed to be a place for people to be healed and not where they contract diseases. Therefore, challenges Kasungu District Hospital is facing should be looked after by analysing if the government remits funds to the facility accordingly or if the proposed budget has not been trimmed,” Matemba said.
But Malawi Health Equity Network Executive Director, George Jobe, differs with Matemba, saying the private sector is supposed to intervene through corporate social responsibility roles.
Jobe said health challenges cannot be solved by the government alone.
Patients and Community Welfare Executive Director, Amade Alide, said the government is supposed to prioritise health service delivery.
United Nations Children’s Fund Malawi’s Water, Sanitation and Hygiene (Wash) Budget brief document for 2017-2-18, titled ‘Investing in Water and Sanitation for All Malawians’, notes that 57 percent of healthcare facilities in Malawi are not meeting basic WHO Wash standards
“The government’s financial commitment to Wash falls far short of the eThekwini Declaration which commits African governments to spend at least 1.5 percent of their Gross Domestic Product on Wash,” notes the report. – Additional reporting by Josephine Chinele