A little embarrassing and obviously unsettling: grownups of both sexes queuing for one flooded toilet and washroom, right in the biggest hospital in Malawiâ€™s capital city, Lilongwe at Kamuzu Central Hospital (KCH).
The situation is dire; in most wards, only one toilet station is working and in some wards, such as Ward 4A, none is running.
Most toilets at the hospital have locked doors, some stringed shut with old cloth, effectively announcing that they are out of service and out of bounds.
The only working toilet in Ward 4B, a male ward, sees female patients and guardians stand in line for the rest room which has one running toilet.
â€œYes, the toilets in the female wards are not working. My patient has to go all the way to 4B. For us guardians, we are better off as we can manage to go down to Ward 3 or the guardian shelter. Itâ€™s a bad set-up,â€ said one guardian who was idling in the corridors of the multistorey hospital.
The running toilet has no water in its cistern; just a constant flow of water that can barely push the contents left by the last user. The only way out is to add to what the last user has left while making sure that the water in there does not splash on you.
The door to the toilet cannot hold shut and just outside there is a sink where women are washing some cloths; no-one seems concerned about the situation and people of both sexes take turns like it is normal.
The floor has about an inch of water flowing from some hidden leaking pipe. Random interviews with guardians show that the other wards also have limited numbers of working toilets.
Hospital director Dr Noor Alide acknowledged that the situation is dire, but said it is only understandable for an institution that has never been rehabilitated since its establishment.
Of course, Alide said, repair works are under way to contain the problem.
â€œWe know about the problem, we told the ministry and they gave us about K70 to K80 million (about $234 000) and a contractor is now on site doing the maintenance,â€ he said.
Health activist Martha Kwataine, who heads the Malawi Health Equity Network, said she was aware of the problem and urged for urgent response.
â€œIn the absence of inadequate hygiene, it could be a breeding place for an outbreak like cholera. Besides that, privacy is compromised when men and women use the same toilet.
â€œAccording to good principles of public health, any dwelling with more than seven people must have an additional toilet. If you calculate the number of patients from the two wards, you should be in a position to get the required number of toilets,â€ said Kwataine
Alide said there is need to educate people, especially those from rural areas, on how to use flush toilets.
â€œThey throw in stones, maize cobs and so many other things,â€ said Alide.
Alideâ€™s words were not just to save his face. In the only working lavatory in ward 4B, someone was dousing his face towel in the cistern and left it there.
Kwataine said the problems at the hospital are a reflection of the problems facing the whole health sector.
â€œConsidering the population boom, Lilongwe needed a proper district hospital in addition to Bwaila to decongest KCH. Thus, the solution may not really be to add toilets at KCH although that is important in the short to medium term.
â€œWhat we need is to ensure that KCH offers those services that it is supposed to offer as a tertiary/teaching hospital. The inefficiencies at the district hospital level translate into low quality of care at the tertiary level including access to services like toilets,â€ she said.
Walking around the hospital, one is bombarded with messages calling for sanitation; one wonders if the people that made the messages have been to the toilets lately.Â