The big cracks in the walls of the building that houses the maternity unit are the first thing that catches one’s eyes when one gets to Masenjere Health Center. Inside, the antenatal and labor and delivery rooms are cordoned off as unsafe and the postnatal ward now is antenatal and labor and delivery as well. The ominous cracks in the walls and floors which at some places are buckled look like an earthquake has struck. Given the extent and the proximity of the cracks to the postnatal unit, one wonders why it is not condemned. I was told that the plight of Masenjere had been widely publicized in the news in the past and I have seen pictures of the cracked walls posted in some other health centers.
The ART Clinic is in the second building and unlike Sankhulani, it is spacious. Unfortunately it is filled with trash piling up on the floor and on top of MSF-donated exam table. MSF has also recently delivered a bookcase, table and chairs. Apparently my team visited it last month and addressed the trash issue and took it upon themselves to clean it and there seems to be no impact. The TB Clinic is not much better. It is covered with so much dust that it looks as though it has not been dusted or cleaned in a long while. The other issue that disconcerts me is the proximity of the TB Clinic to the HIV Clinic, perhaps they are run on separate days.
A sixteen-year-old girl came with her guardian yesterday. Her parents died when she was a baby and since then she continued on HIV medications till three months ago, although she and her guardian did not know that she had HIV infection. This was never disclosed to her. I find it hard to believe that a sixteen-year-old would continue to take medications without asking what they are for. There are disclosure procedures formulated by the HIV/AIDs Unit and only trained counselors are allowed to do the disclosure which is done in stages. This patient was retested and confirmed positive yesterday and learned for the first time that she was HIV positive; she had been so distraught that she refused to resume her medications. As we left the East Bank I felt like we are swimming upstream against a whole slew of obstacles that seem quite insurmountable except perhaps the simple problem with outfitting the ART Clinic in Sankhulani, but even that I am holding my breath to see if it will be easily and readily accomplished. With the visit of Masenjere, I have now visited all fourteen health centers at least once since I arrived. The worst health care center in terms of physical conditions is Masenjere and a close second is Makhanga, the bat infested center. In the stretch between Nchalo and Bangula, there seems to be more aggressive tree chopping and the trees are barren or if there are leaves they appear shriveled. The land is dry and dusty and without much tree coverings it appears desolate and baked, the landscape resembles the northern part of South Sudan. The aggressive deforestation through random cutting as well as burning also seen in the mountainous areas on the way to Thyolo, not only makes the mountains look bare but probably is not too kind to the environment. One could only hope that some programs of replanting and education will be introduced to slow down this devastating process.