Over the weekend I stayed in Limbe, next to Blantyre and on Monday I traveled south to the East Bank to meet my team who traveled north.Blantyre is abloom with lovely Jacaranda flowers.Unlike the last time we were at the East Bank this time we traveled for an additional 18 km on a very bumpy road up the mountains to Therkerani in Thyolo to stay in a MSF guesthouse.There is no running water and the strong woman housekeeper fetches water starting around four in the morning. I have a mortal fear of latrine but the latrine here is surprisingly free of odor.
In the morning I ran up to the peak, the morning sun came up around five much earlier than in Nsanje. But before then around three thirty in the wee hours of the morning till five, a persistent and annoying announcement for passengers to Limbe designed to keep everyone awake kept me up. By then it was so bright that any hope of dozing off to sleep evaporated. Already many of the villagers were up and about, women fetching water from the borehole, men firing up their tower of bricks…
Sankhulani has an ornate globe as its water tank sitting prominently on top of its building. Ironically this health center has functioned without water for three years. Only part of the solar panels works; there is light in the maternity unit but the solar panel that works the engine that powers the pump for the water does not. It has not been fixed for that many years. If a woman comes to labor and delivery, her guardian will be asked to fetch water from the borehole. At one end of the maternity unit, there was a distinct odor of bat guano.
A bed was prominently placed in the room for the Antiretroviral Treatment Clinic (ART), on it were strewn with patients’ files, a medicine cabinet, a non-working sink and two chairs donated by GOAL, an NGO in Ireland; a very spartan set-up. The medical assistant saw patients in this room. MSF donated an exam bed which languishes in the Antenatal Clinic because there is not enough space for it. Yet this clinic was deemed in the graduation phase of the site assessment of the mentorship program in the last quarter. How on earth did that happen? Sankhulani means choice but the healthcare personnel running this clinic have not much choice.
Part of my team was visiting Makhanga, the bat infested healthcare center. I visited it last month and at that time they agreed to switch ART room for the more spacious HIV testing room. Unfortunately no progress has been made; it has been a contest between the Ministry of Health maintenance and our logistics to see who blinked first while I suggested that MSF should just go ahead and move the shelves as requested before anyone had time to change their minds. Changed their minds they did and now it seems that the higher-ups in the Ministry of Health are involved and are against the switch, arguing that HIV testing also needs a big room. MSF loves to end a meeting by asking for the Way Forward, this feels like the Way Backwards as this problem was listed a priority to be solved in the annual report of 2012 and now nine months later it remains unresolved.
A small woman with a baby swaddled in a tchenje sat bolt upright waiting patiently to be seen. It appeared that she just had her fourth baby at home, not sure if she was assisted by an attendant. Despite that she did not look tired. At the Antenatal Clinic all mothers-to-be are taught to have a new razor and a clean thread handy at home in the case of home delivery. The women here not only have to earn a living the hard way but also to be able to deliver their own babies. Sankhulani has a population of 7700, close to 50% are under 15 years of age and about 18% below 5 years, villages full of very young people.
Earnest came to talk to me while we were waiting for our transport. He volunteers at the center two to three times a week as a HIV tester and counselor and helps his wife at the farm two days a week. His wife as he puts it is a farmer working six days a week in the field. He married when he was twenty-two and his wife was seventeen; I forgot to ask him whether he had to pay a dowry. She was taken out of standard three to work as a domestic help, a common practice for young girls to end their schooling. He went to school till Form Four but failed his Malawian Certificate of Education (MCE) and did not have money to repeat the two years to retake his exam. They have four children, the youngest is two months old and he said that “his work” is done. They are considering family planning and surprisingly he said he is considering kuseka (vasectomy) as he thinks his wife should not be the one to undergo any procedure. He is somewhat forward thinking although his wife continues to be the major bread winner of the family.
The medical assistant runs the clinic this week as the two nurses are away, one on leave the other is taking a training course in “Long-lasting methods for family planning”. The HIV counselor spoke to Earnest that they should be prepared to provide basic medical care for the patients who do come despite the absence of the other staff.
In the afternoon we crossed four railway tracks to the Ruo River, one of which is still working; a train runs from Limbe to Makhanga once a week. In the distance a herd of cattle crossed the tracks probably returning from the Ruo after a drink.
The Ruo River looks deceptively tame now with several rivulets divided by rocks and elephant grass but during the rainy season it covers all the rocks and forms a big roaring river. Children, all boys, romped in the water to get relief from the heat.
During the night I tossed and turned mulling over the problem of the ART Clinic in Sanhkulani. In the end I decided to forward a request to build a single shelf for the files, replace the bed with the exam table; donate a small table for patient’s consultation and a bucket with a spigot for hand washing. Voila you have a functional clinic! I shall wait and see how long this would take to happen.