Raising a child ought to be a joyous moment for a mother. Surprisingly, mothers on Likoma and Chizumulu islands, including those living along the shoreline of Nkhata Bay District, dread the moment.
It is not that they do not care about the children. Rather, it is because they are usually afraid that the children would not survive beyond their fifth birthday due to lack of operational boat ambulances to refer patients to the next level of medical care.
Ellen Makwinja, 27, and her newborn baby survived about nine hours aboard the MV Ilala. The Chizumulu island resident was referred to Nkhotokota District Hospital for further attention instead of Nkhata Bay Hospital, which is nearer as there was no readily available transport. The Ilala was heading south.
“We had no choice, but to take the longer route,” says Christina Bookani, one of the two guardians of the mother, who could not talk during the interview.
Bookani says they rushed to Chizumulu Health Centre the day Makwinja complained of labour pains.
“We arrived at the health centre around 6am. Makwinja endured labour pains until 9pm. The same night, we were referred to St Peter’s Hospital on Likoma after officials noted some complications,” explains Bookani.
She says they were forced to arrange a boat to take them to St Peter’s Hospital, a trip that takes about eight hours. Bookani says they arrived at the hospital in the early hours of the following day and the patient was taken to the theatre. Luckily, she says,Makwinja went through a normal birth delivery.
“However, the baby was born with gastroschisis, a condition where a baby is born with intestines out and required further medical attention,” says the guardian.
Generally, patients from Likoma are referred to Nkhata Bay District Hospital but on this day, there was no ship to Nkhata Bay as the Ilala was heading towards Nkhotakota.
Bookani says St Peter’s Hospital did not provide them with a boat ambulance to Nkhata Bay such that they were forced to board the passenger ship to Nkhotakota.
The Anglican Church, which owns St Peter’s Hospital, has a speed boat that ferries patients to Nkhata Bay District Hospital, but is not always available due to logistical issues, according to Likoma district health officer (DHO) David Sibale.
Such circumstances have left patients from the islands and lakeshore area on the verge of dying from treatable conditions as they spend hours on the ship on their way to referral hospitals. The patients also dig deeper into their pockets to meet travel costs.
Bookani says they spent K12 390 for the three of them to travel on the Ilala to Nkhotakota District Hospital.
“We borrowed this money from friends on Likoma. We don’t have any relative or friend in Nkhotakota and we had no food or extra money to meet additional costs as it was an emergency,” says Bookani.
Likoma safe motherhood coordinator Atusaye Kaonga says unlike in the past when the district had several cases of maternal deaths during the tedious journey across the lake to referral hospitals, they are yet to register one this year.
He reveals that most of the maternal deaths registered between 2015 and 2016 came from Mozambique.
However, Kaonga admits that there is a challenge of transport when cases are referred to Nkhata Bay Hospital.
“The ship to Nkhata Bay takes about four to five hours, but a speed boat can only take about 45 minutes. We really need a boat ambulance otherwise the situation is not safe for expectant mothers,” says Kaonga.
Pregnant women in Nkhata Bay, particularly those from the lakeshore areas, share the same story. Thoto in Nkhata Bay north, for example, is accessible by water transport only.
Boats operating between Nkhata Bay Boma, Thoto and Usisya are usually available at odd hours. They start off from Usisya passing through Thoto to Nkhata Bay Boma between midnight and 6am.
They go back late in the evening. This means patients waiting to be referred to Nkhata Bay Hospital which is roughly 40 kilometres away from Thoto and 60 kilometres from Usisya, have to wait for the night rides.
Lucky Kaunda from Mlenda Village, Traditional Authority (T/A) M’bwana is one of the victims of the poor referral system in the district.
She started off from Usisya around 6am with her nine-month-old child, who was referred from Usisya Health Centre. Kaunda says she spent K5 200 on transport and lodging on a round trip to Nkhata Bay Hospital.
Nkhata Bay DHO spokesperson Christopher Singini admits that the district does not have a boat ambulance. As such, he says, those who opt for water transport do it at their own peril and cost.
He says the DHO has a motor ambulance stationed at Usisya to refer cases to Nkhata Bay hospital.
Ministry of Health spokesperson Adrian Chikumbe admits the referral system on the lake needs to be strengthened and sustained to save mothers needing assistance.
However, he says, issues of funding are a major setback in making sure that everybody is served regardless of where they live. n