Makhanga, East Bank: Bat Guano, Give Us Some Mops
In the morning I ran up the steep hill behind the lodge until I reached the top of a ridge, running into villagers young and old carrying heavy loads downhill to sell at the market. After my run the rain came in torrents, the roof of the lodge leaked directly where I sat for breakfast, dripping water on my head. Just as quickly it started, the rain stopped but the road had already become muddy.
I thought nothing could top the appalling conditions that I have seen in the health centers that I visited so far. I was dead wrong. Makhanga does not even have a sign to indicate that it is a health center. As soon as we walked into the first room which looked like an ante-room to the pharmacy, we were confronted with huge gaping holes in the ceilings which were moldy and brown with water damage and an overpowering smell of bat guano permeating the air. Water puddled on the floor from the rain. The nurse mid-wife showed me the cause of the ceiling damage. A tree had fallen on the roof a year ago, bent metal roofing with a gaping hole was the result. The district is aware of it but this could not be fixed because of a lack of funding. In fact the district health team comes quarterly, takes notes of all the deficiencies and at the end informs the health center that there is no money for repair.
Someone stuffed a roll of paper through a hole in the ceiling while another taped a square piece of board in a gallant attempt to pluck the hole while in other areas the staff just gave up and stripped the ceiling altogether. In the maternity ward the sterilizer was just a container sitting atop an old hotplate with wires sticking into the plug. Like Tengani, this place has a donated sterilizer which has a plug that does not fit the wall socket.
In the Labor and Delivery Room, a woman was groaning in labor, cervix dilated ready to give birth to her fifth baby and she did deliver a 3.4 kg baby boy. Because there was no light bulb in the post-natal ward, she would be spending two nights in the dark unless her family brought in some candles. Like all the other centers, the consultation rooms were always littered with trash, papers, and stacks of frayed registration books not put in any orderly fashion, empty boxes and bottles spilled on the floor. No one bothered to clean up and there was always an excuse as who was the last person responsible for creating the disorder. Perhaps it was the full moon or the bat guano, I just lost my patience today and decided to talk to the person in charge and asked him who was responsible for tidying up the mess after an ART session. He indicated the clerks were and that I should talk to them myself. But then I said, “Aren’t you the one in charge?”
He had seven cleaners for this health center and yet the place did not seem to be dusted or emptied of trash. The In-charge said, “We have no mops! Just give us some mops and we’ll clean” I replied, “But you don’t need a mop for the general cleaning up.” There had been a eight-month discussion of swapping the bigger HIV testing room with ART room. The HIV testing counselor was reluctant and the issue went as high up as the District Medical officer with no resolution. The exam table donated by MSF sat in the HIV testing room because the ART room was too small for it. The HIV testing room was also filled with trash and cluttered with unusable furniture or horded items that someone thought would be needed in the future. I asked to speak with the testing person and the “In charge”. When we finally sat down together, the In-charge began first by complaining to the counselor regarding the trash in his room. The counselor quickly placed the blame on the volunteers who helped with HIV testing. When I asked if he would be willing to swap room with the ART Clinic, he replied, “We could discuss again with the District Medical Officer.” I said, “Isn't this an internal issue that could be resolved between the two of you without involving the higher-ups?” As I said that a chunk of termite nest fell from the ceiling behind where I sat, narrowly missing me. Miraculously, he amicably agreed with the stipulations that MSF moved the shelves from the ART room, fixed the broken lock and the non-working sink. As we walked out, he pointed out the ambulance which had not worked for a year and needed “a very small part” for its engine. I nodded but did not promise anything. As I looked up the ceiling there were at least three supporting beams which were either broken or were just hollow shells, the inside had been completely eaten by termites. Just before we left, a cleaner appeared with a bucket and a mop cleaning the floor of the HIV testing room. In the afternoon I went hiking the hills to clear my mind of the clutter of the day and to get rid of the smell of bat guano in my sinuses. John the driver was talking to a villager and told me he would follow me soon. On the way the villagers asked me where I was going in Chichewa, I pointed to the top of the hills. One could almost imagine the fall foliage of New England with the clumps of orange and green trees on the hills. After I hiked for almost three quarters of an hour the route sloped downwards and cognizant of waning sunlight I began to head back running downhill and spotted John who gave up on catching up with me and had turned around heading home. The villagers had pointed to him where I was hiking. Far below us we could see the Shire Valley.