Education

A day in maternal ward at Khonjeni

Although there are interventions to reduce maternal deaths, the story on the ground is different. Little or no change at all. Our Staff Reporter ALBERT SHARRA spends a day at Khonjeni Health Centre:

Stella Mchenga (32) of Muwanya Village, Traditional Authority (T/A) Nsabwe in Thyolo swears that unless government brings a public hospital in her area, she will never be pregnant again.

She laments that she went through hell to give birth to her second-born child recently due to lack of health facilities.

A guardian takes water for a bath in one of the pit latrines
A guardian takes water for a bath in one of the pit latrines

In her outburst is a tone of pain and anguish. She says before government banned the traditional birth attendants (TBAs) from helping women in delivery, it took her less than 10 minutes to have a baby from a TBA, whom she claims was accredited and getting support from Thyolo District Hospital.

Mchenga has no kind words for the directive to ban TBAs. She believes the ban was made in haste.

In 2010, government banned TBAs from helping women deliver. Instead, they were to help in facilitating hospital delivery. Today, the majority of pregnant women deliver at hospitals.

Nevertheless, this has bred several challenges such as women delivering on their way due to long distances to hospitals. Some women from Zoa, Sandama and Makapwa walk 20 kilometres to access assistance at Khonjeni Health Centre (KHC).

Paradoxically, Malawi has guidelines on health which state, among other things, that the radius to a health facility should be no more than eight kilometres.

Mchenga says during her second pregnancy, she walked between 15 and 20 kilometres to the facility.

“There is a mission hospital at Makapwa where services are not free. I cannot afford that. Khonjeni is our relief. My labour delayed to three weeks and these are the days I will never forget. We slept on the floor and struggled to take a bath,” she claims.

KHC has that same old story of public health facilities: high demand, understaffing and shortage of basic equipment. Sad tales of maternal challenges are pasted all over in the maternal ward, where only three nurses administer, on average, 25 deliveries per week, according to records at the facility.

We found seven women who had just delivered in the maternal ward relaxing on five beds in the room, four pregnant women were sleeping on the floor in the waiting shelter adjacent to the labour ward and seven others, who included expectant women and guardians, were in the other room.

Moses Chandamale, medical assistant and in-charge of the facility, says on average they have 15 women in both the waiting shelter and maternal ward, excluding guardians.

The waiting shelter is approximately nine by six metres big. There are five beds in it, but without mattresses. The beds have been turned into storage space for suitcase, food and firewood. When asked why not keep the firewood outside, one woman retorted: “People steal here.”

At night, the room is lit by candles brought by the clients.

“The solar panel is down. It worked for a few days upon installation,” says Chandamale.

He reveals that during the night, there is one nurse on duty, who looks after those seeking maternal services. The nurse is also on standby for the outpatient department to help anyone who might come during the night.

The maternal ward building is connected to a solar panel, but only dimly lights up the labour ward because it produces insufficient power.

There is no running water in the labour, maternal wards and the waiting shelter. The only available water source is a borehole some metres away, which is used by the centre and the community.

The nurses are also let down by the poor facilities. Even referring patients to Thyolo District Hospital is a challenge as the ambulance they rely on is undependable as it serves several other facilities under the district hospital. Those referred there mostly use their own transport. Chandamale says sometimes weeks go without drugs and basic maternal health tools.

No wonder, they register high maternal deaths. Between January and June, three neonatal deaths and seven stillbirths caused by birth complications have been recorded.

To take a shower, one has to endure the smell from the pit latrine, which is used as a bathroom. There are no usable bathrooms. The four toilets double as bathrooms.

Chandamale says: “There are two bathroom blocks constructed many years ago, but they are unusable. So the patients use the pit latrines to answer nature’s call and bathing. Those that delivered use one and the other is for those yet to deliver and the guardians.”

We found one woman coming from the ‘bathroom’.

She said: “We make sure the hole is covered by the water bucket. It is hard since the room is small and we need to hide ourselves from passers-by. In the process, the bucket does not cover the pit which makes us endure the bad smell.”

She adds that being a ‘public convenience’, some relieve themselves on the floor. She also revealed that to avoid this, most women take a shower on open grounds during the night.

Chandamale says he has submitted several reports to authorities, but nothing is being done.

Martha Kwataine, executive director for Malawi Health Equity Network (Mhen) is not surprised by the revelations. She blames it on political leadership in the country, saying it lacks focus and concentration on serious issues. She says it is shocking that Malawi should be talking of having health centres without facilities, women taking showers in toilets and walking over 10 kilometres to access health services.

“You cannot get such a situation at private hospitals because the owners have vision and want their clients to get better services. But government takes advantage of the poor to exploit them. How can you expect the policy makers to prioritise public hospitals when they go to private hospitals?” wonders Kwataine.

She also blamed Malawians for not standing up to demand what they deserve and says leaders capitalise on this. She says the country has all the policy that can change the story, but implementation and bad leadership are the greatest problems.

Maziko Matemba, executive director for Malawi Human Rights and Education, describes the situation at the facility as unacceptable and a call for action. He says it is sad that Malawi is still in this few months to the deadline of the Millennium Development Goals (MDGs). He suggests that it is high time the country agreed on who owns what and who must operate other amenities such as toilets in public health establishments.

 

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