Rivers provide many communities in Malawi with fish and water for drinking, washing and bathing. But, in Chitipa District, there is a river that does more than that—it serves as a postnatal bathroom. Minutes after delivering, women walk down to the river for the inevitable bath. Sadly, as SAMUEL KALIMIRA found out, the joy of delivering is replaced by the embarrassment of taking a bath with some people peering at the unfortunate women.
Fyness Ng’ambi, 29, from Temwamkondo Village, Traditional Authority (T/A) Mwenewenya in Chitipa District, recalls how some children around Wenya Health Centre peeped at her as she took a bath in Sekwa River.
She had just delivered her fifth-born child. Going to the river, which is a kilometre away from the facility, was not optional.
“After I delivered, I spent 10 minutes to regain energy before I could walk down the river. I was weak but I could not do otherwise. I was supposed to clean myself up.
“I left my baby with my grandmother and walked down to the river carrying a plastic bag, clothes and other necessities, which the nurse used when assisting me,” Ng’ambi says.
The river has served as a ‘bathroom’ for hundreds of women who deliver at the health centre. The river is also the lifeblood of villages through which it passes.
Loveness Simwawa, who is in her 70s and whose house is located about 30 metres from the river, says she sees women taking their post-natal baths, wash their belongings and fetch water for household chores.
“One woman fainted because she was very weak. She was cleaning herself after she had delivered at the health centre. I had to carry her on my back up this difficult terrain to the health centre.
“This is our nearest source of water. We wash our clothes, plates and drink the water after boiling it. But some of our children drink the water before it is boiled,” Simwawa says.
The health centre, which was built in the 1970s, has been operating without running water since 2009, according to community members.
While agreeing with members of the community on the challenges, Wenya Health Centre facility in-charge, Ronex Nthala, says his co-workers told him that the only supply of running water stopped in 2013.
The facility, he says, spends over K20,000 monthly to pay members of the community who fetch water from a borehole located two-and-half kilometres from the facility.
“The district hospital allocates us K20,000 for paying community members who fetch water for us. However, the funds are not enough. Sometimes, we dip into our pockets to pay them. We do that because we don’t want to be spreading infections as we are assisting patients.
“For postnatal women, they don’t have a choice but to go down to Sekwa River,” says Nthala, who is a medical assistant at the facility.
He also laments shortage of staff, saying the facility has 14 health workers instead of the required 44 for a catchment area of 12,000.
The health centre has a nurse-midwifery technician, community midwifery assistant and support staff.
Challenges at Wenya are similar to those of Kapenda Health Centre, which is close to the Tanzania border, a 15-minute walk from Songwe River.
The facility has two qualified nurses against a catchment area of 24,000. As a result, the health centre’s management pays some people from the surrounding communities so that they can fetch water.
Ken Kanyika, a nurse-midwifery technician at the health centre, says working at the facility proves to him that his career is a calling.
“We, sometimes, deliver women on the floor because the room is too small to accommodate more than two beds.
“It takes almost an hour for the ambulance to come and pick up a patient to Chitipa District Hospital. The road is bad and, during the rainy season, vehicles do not get here. People don’t even put on shoes because they get stuck in the mud,” Kanyika says.
He says people in the area use Tanzanian mobile phone network to communicate especially with Chitipa District Hospital, located 35 kilometres away.
Using the neighbouring country’s network is expensive as that amounts to an international mobile phone call.
To make matters worse, the facility also accommodates Tanzanian patients from Lulu, Isongole, Chewo and Itumba areas.
“We are given drugs according to the catchment area we serve and it becomes a problem when we receive more patients from across the border.
“We discovered that Tanzania has no health facilities close to the border and health services are not free-of-charge like in Malawi,” Kanyika says.
Kameme Health Centre in the district faces similar challenges.
Apart from water challenges, the facility has dilapidated guardian shelters, poor toilets and inadequate special rooms for the permission of family planning services, among others.
Shortage of contraceptives for family planning puts more strain on all the three Chitipa health facilities.
Result? On average, the three facilities deliver 50 babies per month.
Senior health surveillance assistants (HAS), Florence Kabaghe and Jimmy Nyondo of Mwamkumbwa Health Post, which is under Kapenda facility in the district, says, in most cases, women fail to access the simple contraceptive method of Depo Provera.
“Medication, for under-five children, such as zinc sulphate [for treating diarrhoea] and tetracycline eye-ointment has not been available for a year now. Oral rehydration salts and others drugs have not been available for a month. We are told they are not available,” Kabaghe says.
However, Kanyika attributes low access to planning methods to limited rooms at the centre.
“We don’t have a special room for the youth to access family planning services and many are reluctant to come because they don’t want to access such services together with their parents,” Kanyika says.
Such a problem is shared by Kameme and Wenya facilities.
But Chitipa District Medical Officer, Easter Chirwa, says the district is doing well in offering family planning services.
“We might not be perfect but we are still trying using our HAS and community-based volunteers who visit women using the door-to-door approach to encourage them to access FP [family planning] services.
“On youth friendly services, we rely on Banja la Mtsogolo which meets them in their respective entertainment places,” Chirwa says.
The 2015-16 Demographic and Health Survey established that 62 percent of married women aged between 15 and 49 in Chitipa use modern family planning methods.
However, Chirwa says the hospital, which has four ambulances, sometimes fails to ferry patients from some health centres in time due to fuel scarcity in the district, which has one filling station and is not stocked throughout the month.
“You know that keeping huge amounts of fuel is not allowed and is dangerous. Therefore, we send an ambulance to Karonga [101 kilometres away] to buy fuel and start attending to referrals from health centres or send them to Mzuzu Central Hospital.
“This is costly and affects our timely response,” Chirwa says.
Chirwa admits that shortage of health personnel affects service delivery in the district, which only has half the required personnel.
“Chitipa is far from the city and even if the government tries to send people here, they do not show up. For example, the number of nurses is less than half [the number of required staff] and this compromises service delivery,” Chirwa says.
She also laments poor funding, saying Chitipa receives K25 million monthly. Such an amount of money, she says, is not enough to buy drugs and other necessities. She says this is the reason some drugs and FP services suffer.
However, on water challenges, Chirwa says some non-governmental organisations have intervened with projects aimed at repairing the water supply system.
Efforts to speak to Ministry of Health spokesperson, Joshua Malango, proved futile as he could not respond to our questionnaire.
But in his statement titled ‘Health in Malawi Beyond 2019’ presented in Parliament on November 19 2018, Minister of Health, Atupele Muluzi, assured that the government would ensure that Malawians have easy access to health service delivery.
Muluzi says the government would address health personnel challenges and other related constraints.
He says the ministry wants to expand service level agreements (SLAs) beyond Christian Health Association of Malawi (Cham) facilities.
“This will ensure [that] we can maintain our commitment to Universal Health Coverage, making sure that everyone can access healthcare services regardless of where they live in the country,” Muluzi says.
Malawi Environmental Health Association President, Kondwani Mamba, laments that the government invests more in curative measures than in prevention programmes.
“We are all aware that prevention is better than cure and we are advocating community healthy interventions so that we prevent cases of avoidable illnesses. This would help decongest health facilities in our country,” Mamba says.
The Malawi Constitution stipulates that every person has a right to access health services.
But the country’s November 2018 Wemos Foundation report paints a gloomy picture of Malawi’s health sector, which has only 0.52 professional health workers per 1000 inhabitants. The World Health Organisation recommends 4.45 health workers per 1,000 inhabitants.
The report shows that the vacancy rate is five times higher in rural and peripheral areas, home to 85 percent of Malawi’s population. Some 29 percent of nursing professionals serve such rural areas.
Sadly, Cham training colleges risk closure due to the government’s failure to fund them for two quarters of July-September and October-December 2018.
The debt has accumulated to over K300 million.
Chairperson of principals of Cham colleges, Esau Kasonda, says the lack of funding has paralysed their operations.
“In fact, many of the colleges are on the verge of closure because we have been affected following the government’s failure to fund us since July. When we wanted to meet officials from the Ministry of Health, we were referred to engage Cham Directorate which wrote the ministry. Up to now, we have not received any feedback.
“I think, at the moment, the government does not prioritise training of nurses. If it were a priority, we could not have been facing such challenges,” Kasonda says.