We traveled to Tengani again today to observe their ART Clinic but it turned out it was not an ART day so we traveled further north to Phokera, a relatively new health center built in October 2006 by “Press” donor. It has the usual OPD, ANC, ART and Maternity Ward. The beds in the maternity ward look comfortable with cranks that make the beds adjustable. Already there are signs of poor maintenance; termites have begun to build their nests on the wooden beams.
The OPD consultation room is spacious across from it is the exam room. I asked permission to look at it, it was locked; a bad sign, it could only mean one thing: physical exam is not done routinely to warrant it being free and open. When the medical officer finally found the key to open it, the exam table was squeezed in a corner obviously not used very often and there were two tables keeping it company, boxes and papers were piled on top of these; the exam room is slowly turning into a storage or clutter room.
Outside the ART room is a narrow corridor also acting as the waiting room for the patients, dark, dingy and congested. The ART room itself was crammed with furniture: a humongous desk took up center space where the medical assistant presided with papers and bottles of ARVs on the table top. The table took up so much space that the exam table given by MSF sat in the ANC room next door. Like many health centers we visited, the medical assistant had two patients sitting in front of him to be seen at the same time, again without regard to privacy and confidentiality which is the first requirement of the dictum of the Ministry of Health of Malawi for HIV care. The chair prevented the door from closing so the patients waiting right outside were within earshot of what was being discussed. Our suggestion was to use a smaller desk and rearrange furniture to accommodate the exam table. With him sitting behind such a big desk it was a great deterrent for him to even reach over to look at his patients.
Some other donor has built a new building next door which will be used as a laboratory, the hope is to build additional buildings to make Phokera a hospital for this area, I was told. I can’t help but compare the healthcare facilities from what little I saw in South Sudan, Malawi has a lot of help from many donors and they have many health centers (with maternity unit, a must for a nation that tops the fertility rate of Africa) which are solidly built and but poorly maintained. South Sudan on the other hand, at least in the places I went, does not enjoy health facilities that are close to the inhabitants, hence the mobile clinics that we ran. They are far behind Malawi in that respect. It would be a tremendous loss if Malawi does not keep these places up to continue providing reasonable care within reasonable distance for their citizens. The so-called “Difficult-to-reach-area of East Bank” is difficult for us to reach because of the washed-away bridge but the inhabitants could still reach their health center except in severe floods. The Makhanga health center with its bat-infested and damaged ceilings, hollowed beams will soon cease to exist and sealing the fate of the villagers to travel a long way to the next health center.