Mulolo River was rowdy and enraged the day we visited Masenjere Health Center in T /A Mulolo Nsanje. Too grim for us to cross; yet, less grim than the situation women giving birth at the clinic endure.

Every step into the river was like a sharp needle piercing through her heart which made her angrier as she pushed all manner of debris downstream. The raucous sound from the raging water was enough to make even the fearless being shudder.

A woman selling vegetables and with a baby carefully strapped on her back, told a story of a pregnant woman who almost got swept away as she tried to cross the river to Masenjere clinic.

Her story was corroborated by Ian Kalonga a Medical Assistant and In-charge of Masenjere Health Center.

This is just one of the many hair-raising stories that people especially women in Masenjere tell to those who care to give them an ear. Milole, is just one of the many rivers they must wade across to get medical attention.

The dark, cracked walls

“My greatest fear is not the rivers we cross, but the health facility we go to. One day we will be buried alive in this clinic. It’s just a matter of time before these walls fall on us,” said 29-year-old Elizabeth Khembo, a mother of three but has given birth five times: two died.

On May 6, 2012, in a dark cracked walled and mosquito infested tiny room of Masenjere Health Center, Khembo gave birth to her latest bundle of joy, a baby boy.

Nine months down the line, she still has vivid memories of what she called “the hell” she went through during pregnancy to her delivery.

“I and my baby slept on the cold floor of the clinic’s verandah after I gave birth. There are no enough rooms at this clinic,” she said.

Poor care at the hands of the health care givers, to delivering on the cold floor and sleeping with her newly born baby on the mosquito infested verandah of the clinic, are just but a few of the many problems she could afford to share.

Almost everything at Masenjere Health Centre is gloom and doom. The only reassuring thing is that at least there are health workers willing to help the community unlike some health facilities such as

Chang’ambika in Chikhwawa District which has been closed down because there are no health workers willing to work at this rural and hard to reach place.

President Joyce Banda in her speech late last year after laying a foundation stone at Chembe Community Ground in Mangochi reiterated her commitment to the promotion of Safe Motherhood. One thing that was salient in her speech is the need for health infrastructure development especially in rural areas as this is a key element in the promotion of safe motherhood.

In her words: “My government is committed to ensuring that most facilities that are far away from referral centers should at least have a maternity clinic to promote safe delivery in our communities.”

However, clinics like Masenjere pose a great danger, not only to the women and other patients but to the whole Safe Motherhood initiative.

The cracked walls could best be described as the holes that are making it impossible for the full circle of safe motherhood initiative to hold together.

Ministry of Health spokesperson Henry Chimbali, said the ministry is aware of the condition of Masenjere Health Centre and the planning team will assess it.

“Our planning team will assess what it will take to renovate it or construct a new one. We are treating this matter with urgency,” Chimbali said.

But, somehow, just mending the cracks is not enough as there seem to be a horde of problems that need to be addressed before we can sing a sweet song of victory.

This is something that Khembo, a standard 5 dropout, agrees with. She is certain the initiative will yield nothing if women continue to face the problems they are facing, and if clinics such as Masenjere are still left unattended to.

“This clinic is a danger to our lives. When you are in the labour ward, we get more worried looking at the cracks on the walls, penanso osamva ululu wakubereka (we are more worried of the cracks in the walls that sometime labour pains seem bearable).”

Her friend Rhoda Willard, holding her four months old baby born on October 28, 2012, has a chapter to narrate in the sad tale.

After two days at the clinic, she was finally referred to Fatima Hospital which is 14 kilometres from Masenjere. The ambulance was there but it had no fuel.

“I almost died. Safe motherhood is not possible here because we have a lot of problems at our clinic,” Willard said adding:

“There is no water at the clinic. After giving birth we bath in Milole River. It is very embarrassing. I remember soon after giving birth, I was weak but had to go to the river to bath. I tripped and almost fell.”

There are big see-through cracks on the walls of what used to be the labour ward.

Kalonga said the ward had to be closed and they had to turn the post natal into a labour ward, which has rendered the center to have no postnatal ward.

“You can’t go there. It’s about to collapse. Women with their newly born babies sleep outside on the verandah where they are not protected from mosquitoes and the cold weather. This is the reason why we send them home as soon as they give birth. There is no space to keep them here for a few days of observation,” said Kalonga.

Could this be the other “hell” that Elizabeth talked about?

The “new” labour ward is a small dark room with only two beds with navy blue mattress covers. Nothing illuminates the room. It is as dark as the future of those giving birth in it.

“We only attend to two women at a time. If it happens that there are three women one of them will have to deliver on the floor,” said Kalonga

Without electricity and running water, the only bright things in the room are the three red 20litre plastic buckets put under the beds—used for storing water.

This is despite the fact that some shops and a few houses nearby have electricity. Kalonga said that the Solar Power panels they were using broke down long time ago.

Lucky are those who deliver during the day because Mother Nature provides them with light.

According to Elizabeth, if nothing is done about the situation at the clinic, Safe motherhood initiative will only be a thrilling talk show and a brilliant idea but only on paper.

Human resource challenges

With only two nurses, one medical assistant to cater for a catchment area of 15,000 people and an average of 100 patients a day, Masenjere Health Center presents a perfect example of one of the perennial problems facing the health sector in Malawi.

The problem is worse in rural areas where medical personnel shun the places because of lack of basic amenities.

The few that have been deployed in areas such as Chang’ambika Health Center in T/A Mlilima in Nsanje District have since left, leaving the clinic without any health worker save for a guard and ground labourer who are trying to keep the place alive.

Kalonga and colleagues, who describe their job as a calling, have a daunting workload. Failure to give quality health care is attributed to the fact that the few workers available are always overworked.

“We do not have a work schedule. Every day and every hour is work time. It’s just the three of us. We do everything and anything. Often times I work from morning shifts and straight into the night shift then morning shift again. I can’t remember the last time I went on leave. We are overworked,” said Kalonga.

Medicines sans Frontieres (MSF) a, medical humanitarian organisation working in over 70 countries worldwide including Malawi, has been supporting Ministry of Health in the provision of health care to reduce HIV and TB related morbidity in Thyolo since 1997.

However, after observing that lack of human resources for health continues to be one of the key challenges in their projects,particularly in implementation of ART and Prevention of Mother to Child Treatment (PMTCT) a critical component in the drive to safe motherhood success, MSF-B has offered a total of 10 scholarships to residents of T/A Mulolo in Nsanje and T/A Chapananga in Chikhwawa Districts.

The scholarships which cover full tuition and residential cost of MK650, 000 per year, aim at training community members who in turn will work in their communities.

According to MSF Head of Mission in Malawi Rodd Gerstenhaber, MSF hopes their scholarship initiative is a sustainable long term contribution to increasing the number of health workers and improving their retention.

“All Malawians should have equal access to quality health care no matter their income and location,” he said.

A 2011 United Nations Fund for Population Activities (UNFPA) report on the State of the World’s Midwifery highlights the fact that the shortage of human resources is critical and staff turnover and attrition in rural areas in Malawi is high.

The cracked walls, human resources shortage, lack of as well as shortage of health resources such as drugs, poor road infrastructure are but a few barriers to safe motherhood.

If government and other stakeholders won’t intervene and fail to mend the cracks and make the walls hold together not only at Masenjere Health Center but in the whole health sector, safe motherhood initiative will remain, what Khembo said, a thrilling programme but just on paper.

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ZIMENE MUMAKONDA

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