Late last year, Khadija Bakali was expecting her third-born child. She is 21 years old and, just like many girls in Mangochi, she started bearing children at the age of 16.
She has had three pregnancies but says the third one left her with painful memories.
Khadija, for that is her surname, stays in Nkata Village, Traditional Authority Jalasi, in Mangochi District. The closest health facility to her village is Jalasi Health Centre located 20 kilometres from Nkata Village.
On average, it takes about 150 minutes to walk on foot from Nkata to Jalasi Health Centre. Those who use bicycles take about an hour because the area is partly hilly.
This presents a challenge, especially to pregnant women, who have to visit the hospital frequently to access antenatal services.
One September morning, Khadija started feeling labour-related cramps. Knowing that she was due in October, Khadija, accompanied by her sister and mother, went to have a medical checkup at Jalasi Health Center.
Around 9am, when they arrived at the hospital, relief was the prevailing emotion, especially because they arrived in good time.
Little did she know that her arrival at Jalasi health facility would mark the beginning of the pain she is feeling today.
“When I gave my health passport to a health worker, she looked at it and turned it back to me, telling me that I was not supposed to be at Jalasi but Mangochi District Hospital,” Khadija says.
Immediately after that, the health worker walked away without hearing from them again.
“Because I was in pain, I followed her, begging her to assist me. I knew I was supposed to go to Mangochi, according to their instructions, but I could not go that time because I was in pain and I knew that I was not due,” Khadija explains.
Somehow, Khadija knew that she was in trouble.
As they continued negotiating for treatment, one of the medical personnel came forward and ordered them to leave the hospital.
The trio obliged, and walked towards one of the trees outside the hospital. By this time, Khadija knew, from experience, that she was going through labour pains and she was to deliver a premature bay at slightly above seven months.
Although she was ordered to travel to Mangochi District Hospital, she not offered any means of transport; meaning, she would have to make do with public transport.
“Under the tree, I started delivering a baby. Men and children who were going to the hospital, and those who were just passing by, could see me in my situation. Others mocked me as they took out their cell phones and started taking pictures of me,” Khadija narrates.
At this moment, her sister and mother used their wrappers to form a cover for her to deliver in “private”. Some concerned women joined them to assist Khadija to deliver outside a public hospital she was denied access to.
Half way through the delivery process, one of the female medical personnel at the hospital shouted at the women who were assisting Khadija, instructing them to bring her inside where she would finish delivering.
“We told them we could not manage to do that because the baby was still coming out. Instead, she came and helped the women to move inside, with the baby half out. But while inside, I was left alone to deliver without their help,” Khadija’s sister says.
Immediately after delivering the baby, Khadija was told to go to Mangochi District Hospital where she was supposed to meet doctors.
However, the hospital did not offer her transport to the facility.
Instead, Khadija and her mother jumped into a commuter pick up. It took them close to two hours to arrive at Mangochi Boma.
By the time they arrived at the hospital, Khadija had lost the baby. Today, Khadija blames the hospital for subjecting her to treatment which, she says, led to the death of her child.
Cases of this nature are not new at Jalasi Health Center. When they visit the facility, some pregnant women say they are forced to pay K7,000 as a contribution to buy mattresses for the labour ward.
However, no official receipts are issued upon payment.
Women that have no money are denied entry into the hospital. In some cases, others are detained or their properties such as cell phones are confiscated until K7000 is paid.
Both Traditional Authority Jalasi and Mangochi District Health Office spokesperson, Harold Kabuluzi, confirms to have received complaints related to patients’ treatment at Jalasi Health Centre.
“We have received reports from concerned members of the community. However we cannot take action before concluding investigations into the matter. At the moment, Mangochi District Health Office management is engaging the communities to establish the truth of the matter,” Kabuluzi says.
Malawi Health Equity Network Executive Director, George Jobe, expresses shock that some people in rural areas continue to face abuse at the hands of medical personnel who are supposed to assist them.
Jobe asks the Ministry of Health to thoroughly investigate the Jalasi incidences and find a solution that will unite the hospital staff and the community.
“Health rights are very important. We do not expect anybody to be denied these rights for reasons that are not in line with the Republican Constitution. We regret the treatment the Mangochi woman was subjected to,” Jobe says.
In Malawi, only 46 percent of the people live within a five-kilometre radius of a health facility. But, despite most public health services being free, there are often costs associated with transportation to and from a facility that limit access to health facilities for ordinary Malawians.
In addition to that, shortage of qualified medical personnel is said to be contributing negatively to maternal and infant mortality as most health worker are overworked.
Sadly, this has the potential of forcing women such as Khadija to avoid delivering at a health facility, which is against the government policy of encouraging every pregnant woman to be attended to by a skilled birth attendant.
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