It is 22:00 hours on a rainy night in December and a health worker is beginning to enjoy his sleep after a tiresome day.
Suddenly, he overhears a knock on his main door but ignores it. He was in a deep slumber compounded by a long working day.
But the irritating knock continues until he finally wakes up; it turns out that it is Chimatilo Health Post’s watchman.
The watchman has come to inform him that there is a very sick patient seeking his help at the health facility which is 100 metres away.
Without asking many questions, the health post Medical Assistant (MA) Stanley Banda gets ready and rushes to the facility.
Even though it is rainy season, he does not bother to put on proper, closed shoes; he goes in his slippers.
“My job is about saving lives and not minding my dressing, especially at night,” he says.
According to Health Advisory Committee (Hac) members, Banda often interrupts his sleep to attend to patients. He says at times this happens three times a night and he does not show defiance.
Chimatilo Health Post is located in Traditional Authority (T/A) Sawali over 10 kilometres away from Balaka Boma.
In the middle of the night, Banda switches on a torch to see his way through as well as to see where to record the patient’s symptoms in the health passport. He has used this torch for only one month as he initially used a paraffin one.
The ceiling of the facility is dilapidated and has become a haven for bats which constantly disturb him when assisting patients at night.
Patients are also feeling the pinch of lack of other basic facilities at Chimatilo Health Post. There is no proper toilet where they can relieve themselves as they wait for treatment. There are two pit latrines which are full and do not have doors for privacy.
The health post is situated in a remote setting. Banda’s house does not have electricity and running water either. The pit latrine and bathroom are outside the house.
His house is so basic. It has a sizeable sitting room, a bedroom and a storeroom.
There are no social amenities around where he could go and relax at times like his counterparts in the city. If he wants such, he has to use a bicycle taxi and travel over 10 kilometres to Balaka Boma.
“I have no chance to have lots of time to myself. I was the only one working here until November 2016. There are always people in need of assistance,” he says.
Banda is serving an estimated population of 15,869 and assists an average of 100 people per day.
The facility’s Hac Chairperson Enock Mawenda says Banda works as if Chimatilo Health Post were his own.
“He is our saviour here. He is unlike his predecessors who had a tendency of closing the clinic at 4:30 pm daily and never opened it during weekends. They also used to shout at us if we came here in the night with a critically ill patient,” he says.
Traditional Authority (T/A) Sawali says she is proud of Banda.
“He seems to have a passion for his job. This profession is a calling and they get many blessings if they deliver as per the vows made,” she says.
The T/A believes that hard-working and self-less people like Banda need to be motivated because it is difficult for health workers to live in the conditions he endures.
But the situation is the opposite at Kwitanda Health Centre in the same district, where communities are complaining.
During Christmas festivities, the health centre was closed for a week. Patients went untreated while others walked a distance of over 10 kilometres to receive treatment at Chiendausiku Health Centre.
Vice-Chairperson for the facility’s Hac Rose Mwanyali says the medical assistant always claims that he is attending meetings at Balaka District Health Office (DHO) and he reopens the facility on Tuesday at around nine or 10 am.
She says the facility has three nurses and the MA. But in the absence of the MA, the nurses do not diagnose the patients.
“The medical assistant rarely wakes up in the night to assist patients,” she says.
Some Balaka DHO officials say Hac of the area raised the issue at one of the meetings on December 24 2016 and the issue was referred back to the Hac to handle before taking any disciplinary action.
“It appears Hac of this area didn’t know that they are empowered to question the MA’s actions. They were advised to first talk to him, if it fails, they should make a report to the DHO for further action,” one official says.
But District Medical Officer (DMO) for Balaka DHO Dr Leonard Chafewa says his office is not aware of the issue.
“At every facility, we have a committee that looks into discipline of health workers in line with the civil service’s rules and regulations. So the ombudsman of this health facility hasn’t reported anything of this sort to us,” he says.
However, The Daily Times has learnt that this issue is widespread in most health facilities of the district but the DMO’s office ignores it because the MAs in question accepted to work in hard-to-reach areas, where most health workers refuse to go.
Efforts to speak to Kwitanda Health Centre’s MA proved futile as he could not be reached.
Executive Director for Focus Kossam Munthali asks for deliberate policies to motivate young health workers working in the rural areas like Banda of Chimatilo Health Post.
“The Hacs are working for the good cause of the people. They should keep checking on the attitude and performance of the health workers. If they note some strange behaviours like that of MA of Kwitanda, they should report to authorities for appropriate measures to be taken before lives are lost,” he said.
Malawi medical journal of June 2016 says motivation of health workers is a critical component of performance and is shaped by multiple factors.
It says human resources for health shortage remain a key challenge to the aspiration of achieving quality universal coverage in Malawi.
Sustainable Development Goals (SDGs) aim at ensuring healthy lives and promoting the well-being for all at all ages is essential to sustainable development.
One of the targets of the goals is to substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and Small Island developing States by 2030.