Malawi’s village health heroes

In remote villages hours away from Malawi’s cities, community health workers are saving the lives of small children in makeshift outdoor treatment areas.

Amidu Malope (37) sits under a tree with a wooden table by his knees. A malaria-testing device shows two bright lines running vertically down a screen. The lines mean that Malope’s previous patient – a four-year-old girl – was just diagnosed with malaria. A baby wriggles restlessly in her mother’s arms in front of him. They’re waiting to see whether this six-month-old will also test positive.

In this small village called Thipa, Malope is a bit of a hero-and he knows it. He volunteered as a community health worker in 2001 and when he realised that he could help people, he was inspired to go for further training. He finished high school but has no tertiary education. Instead, the government provided general and then specialised primary care training for him to treat people. His patients are aged from neonatal to five years old.

“We were the first group doing drug distribution to people in the village. It made me think I could help people,” he says.

In Malawi, workers such as Malope are called health surveillance assistants (HSAs) and the United Nations Children’s Fund (Unicef), which provides supplies to these assistants, has said they are one of the reasons child mortality has dropped by two-thirds from 244 deaths for every 1 000 live births in 1990 to 68 in 2015.

The HSAs report to health centres-small clinics dotted around the country. It is from these health centres that Malope obtains supplies such as vaccines, medicines and testing devices. Through the HSAs’ work, which is recorded in large books handed to the healthcare centres, government can track which ailments most commonly affect children and how often they become ill.

Siyeni Phiri has walked 5kilometres from her village with her daughter, four-year-old Ruth, strapped to her back. Ruth is tired, quiet and listless. Before Malope pricks her finger to take a blood sample for a malaria test, Ruth already knows what’s coming and begins to cry.

Her test is positive. In addition, she has pneumonia. Malope watches Ruth’s stomach rise and fall for one minute as she breathes. He counts 55 breaths. She’s breathing faster than the normal 40 breaths a minute. Malope makes the pneumonia diagnosis and gives her a chewable tablet called Coartem to treat the malaria. Her face grimaces at the taste.

In order to obtain the pneumonia medicine, the timer he wears round his neck, malaria pills and other necessities, Malope has to cycle 27km to the closest health centre. He carries his load of supplies in a backpack. Vaccines that need to stay cold are kept in a cooler-box tied to his bicycle with a rope.

“In the rainy season, the river overflows and it becomes impossible to get to the health centre,” he says.

Phiri was born in Malawi but moved to Zambia with her aunt. The aunt left her in a village and, before she knew it, Phiri was married at the age of 12. She thought being married would help her survive but after her husband violently beat her, family members in Zambia sent her back to Malawi, fearing he would kill her. She returned with six children.

She sits on a mat, watching as Gladys Mwale and her six-month-old baby Judifi wait to see whether the infant’s malaria test will be positive. It’s negative, but Judifi still has to take medicine for pneumonia.

Mwale also married young. She is now 22 and has two children, the eldest aged three. She wants her children to have the education she could not have, but poor healthcare can affect education prospects too.

Chanthunthu Primary School, located further north in Chanthunthu Village, is an extreme example of this. The learners aged six to 18 go to the HSA near the school for care. If the HSA is not around, they walk 18km for medical help. The impact of this lack of access to healthcare on their education has been dire.

When Malope started out as a volunteer, he had no bicycle. Once the government employed him, he could cycle for supplies. The Malawian government is now working with Unicef to open a corridor that will allow drones to deliver blood testing devices and provide Internet connectivity to communities in need, such as Chanthunthu Primary School.

“It will help us a lot,” Malope says. “It will save us time to collect medicine. We can say it is a big relief to us.”

Like many other HSAs, he treats his patients under a tree. When the weather is bad, he is able to see patients inside the home of the chairperson of the village clinic. What makes Malope particularly proud is the way local communities have helped the HSAs.

Every clinic is managed by village committees led by a chairperson. They communicate to the HSA how residents feel about their work.

“It helps us because they see this as theirs. That’s why the communities construct structures for us. They see the clinic as their own,” he says.

There are 2 020 people in the village where he looks after children’s health. He sees each of them as being his responsibility.

“I’ve helped a lot of people, I’ve saved lives, so I feel proud,” says Malope. n