Life looks normal at Engucwini Health Centre in Mzimba despite the coronavirus outbreak discovered in China last December.
There is no hand-washing soap at the entrance and no one seems worried about the situation.
But Eureta Ngwira, a patient at the facility, wishes there was a bucket where everyone could wash hands when entering or exiting the facility to remove the virus.
“If we have no water to use when taking medicine at the health centre, what about water for washing hands to prevent an outbreak we have only heard about?” she asks.
Ngwira is concerned about government’s disregard of water-stressed rural areas in the fight against the pandemic that has claimed 71 lives from 3 149 confirmed case in the country.
“We don’t have water at the hospital. Even in our villages, water is scarce,” she laments.
Engucwini Health Centre has been operating without safe water for five months since a submersible water pump broke down in February. Health workers, patients, pregnant women and guardians now travel three kilometres to fetch water at a communal borehole in a nearby village.
Clinician-in-charge Bester Zimba says: “This is a huge inconvenience because we spend a lot of time searching for water instead of assisting patients.
“At worse, the hospital operates without water for in-coming patients and guardians to wash their hands.”
Zimba says this has affected the quality of treatment, care and support as well as the fight against coronavirus transmission.
“People just walk into the facility without washing their hands as required by the Ministry of Health,” he says.
The health centre serves a population of 19 600.
Mzimba North District Health Office (DHO) spokesperson Lovemore Kabaghe says Engucwini staff reported the break down in water, sanitation and hygiene problem.
“We are aware of the problem and we sent our engineers to assess the pump, which needs replacement. We are in the process of procuring a new one,” he says.
Water engineer at Water Mission Malawi, Ben Longwe, says the problem is common in rural facilities often shunned by health workers who prefer urban localities.
“The story of rural health facilities lacking safe water is a disaster in-waiting as far as Covid-19 is concerned,” he says. “Clinics are supposed to champion hygiene, but some don’t have water and they don’t clean the floors, furniture or linen.”
Longwe urges the government to urgently fix the water point.
The Nation first reported about water challenges at Engucwini in May, prompting Water Mission Malawi to make the fact-finding trip.
Longwe recommended the installation of a new pump and an overhaul of the whole system.
He states: “Our assessment also reveals that the water needs to be treated so that it is safe to be used for cleaning essential items and people taking medicine.
“We also recommend that there should be one planted in the market area for the benefit of the community. They should be served away from the clinic boundary as a precautionary measure.
Water Mission Malawi promised to provide hand-washing kits for health workers and their clients.
Joshua Mchenga, water, sanitation and hygiene specialist based at Mzuzu University, says the water situation at Engucwini mirrors the potential risk that Covid-19 poses in rural areas.
He states: “Much as Covid-19 has been commonly reported in urban areas, there is a potential risk in rural areas, especially with Malawians returning from Tanzania and South Africa.
“Hand-washing with soap or sanitising hands [with alcohol-based hand-rubs] is essential to reduce coronavirus transmission. However, most rural areas have limited access to safe water and the people cannot afford hand sanitisers. This will make it difficult to manage the outbreak among the rural majority.”
Mchenga is worried that most public health facilities do not have tap water and rely on communal boreholes.
He says the gaps in water and hygiene services leave staff, patients and guardians at high risk of contracting the virus.
“This makes rural health centres potential spreaders of the virus instead of leading by example,” says Mchenga.
As a solution, he urges health facilities to provide low-cost, improved hand-washing stations and hand sanitisers.
“As a long-term plan, government and its partners should provide more water facilities in rural health facilities and communities. Firstly, they can maintain all non-functional water points and then install new ones.”