Hills turn into labour wards

IMPROVISED—Postnatal services in progress

Once-upon-a-time Malawians did not have to wait for the government and politicians to offer solutions to public infrastructure needs. Ordinary men and women could construct bridges and health centres in their locations. Somehow, democracy brought with it misconceptions that changed most people’s narrative of development. Suddenly, they waited for politicians to provide everything—including coffins.

However, some members of the community in Nkhata Bay District have realised that politicians and the government cannot be trusted always. They have decided to get dirty for a good cause- -that of constructing a road to connect their area to a health centre so that their women should no longer be delivering in the bush while walking to health facilities.

Samuel Kalimira, in this FRIDAY SHAKER, shares the amazing story of these extraordinary men and women of the lakeshore district.


Jackson Mwakapokera, 37, from Group Village Head Chikaka Madoda, Traditional Authority M’bwana in Nkhata Bay District nearly sheds tears when he recalls how he assisted his wife Lusayo Kalundu to give birth to their fourth born baby in Choma Hill.

Mwakapokera recounts every bit of that dawn.

He said it was around 3:00am on June 12 2019 when their feet could no longer take them to the nearest health facility— Choma.


His wife was in excruciating labour pains and at that time, the nearby bush became the labour ward, of course, without midwifery expertise.

With a torch in Mwakapokera’s hands, Kalundu delivered in the thick of the forest.

“I don’t understand where I got the skill that enabled me to help my wife deliver normally. Sometimes, I think it is only God’s grace. I could not just watch her in pain. I had to help her deliver,” Mwakapokera said.

After the wife delivered, Mwakapokera rushed downhill, leaving her and the newborn in the thick forest, seeking the help of women in the village so that they could help cleanup his wife.

“Later, I rushed down to the village and reported to my sister to assist her with cleaning necessities,” Mwakapokera said.

Kalundu said she did not expect to deliver that time as nurses had, during antenatal examinations, given her three more weeks before the actual day of labour.

Seemingly, there was a miscalculation of the dates; hence, the predicament.

“I started getting labour signs at 1:00am but, due to lack of transport, I thought I could hang on until morning. But at around 3:00am, I failed to hold on and, together with my husband, started off walking to the health centre. I was in pain but with the help of my husband, I climbed uphill. Suddenly, I couldn’t continue with the journey. I sat down near a path and delivered with the assistance of my husband,” Kalundu said.

She is not the only woman to have experienced such a challenge.

Loveness Tembo, 35, who is Mwakapokera’s sister, delivered her twins in the same hill while on her way to Ekwendeni Mission Hospital.

She said this was the case as her family could not afford to hire a taxi at K15,000 to the hospital.

Tembo lost one of her babies a day after reaching the hospital.

“God gave me two but now, I have one. It is painful. I believe the death came because my son was not delivered with the help of midwives,”Tembo said.

The two families were charged K10,000 for not delivering at the hospital.

The sisters are examples of many expectant women who deliver in the bush in Nkhata Bay while others die on their way to Choma Health Centre to access health services.

According to Village Head Chikaka Madoda, since 2017, over 25 expectant women from his village have delivered while on their way to the health facility.

The chief also said since 2017, the village registered three maternal deaths and five neonatal deaths.

Members of the community in Kasasire area say cases of women delivering in their homes and on the way to hospital are common because the area does not have a health facility.

People cover 25 kilometres from Kasasire to Choma Health Centre or 45 kilometres to Ekwendeni Mission Hospital to access health services.

To make matters worse, their neighbouring health facility of Choma is separated by Choma Hill and the road between the two areas is in bad shape; hence, motor vehicles, motorcycles or bicycles cannot access it.

As a result, members of the community carry patients to the facility on improvised stretchers.

Mwabi Mwase, 25, who is eight months pregnant, said it was challenging for her to access maternal services at Choma facility, arguing that footing is tiresome.

“I start off at 6:00am and arrive at Choma at 8:00am and after accessing the services, I walk back home. This takes three hours. There is no option because the road is not passable by vehicles, motor cycle or bicycles,” Mwase said.

The area’s health volunteer, who is also a community-based distribution agent, Andrew Nkhoma agreed with Mwase, saying life was hard for people around Kasasire.

He said a community health surveillance assistant visits Kasasire once a month for under-five clinics and maternal services but the demand for services is very high.

“In a month, the area registers three cases of women delivering while on their way to the hospital and some babies and children die because they lack proper health care,” Nkhoma said.

He said few families access family planning services because many are reluctant to cover the long distance to the health facility.

People on Anti- Retroviral Therapy (ART) too, are, affected by the long distance they cover to get drugs at Choma.

Some people cannot afford to pay K4,000 at Ekwendeni Mission Hospital to access the drug.

“I was supposed to get my drugs at the hospital on August 27 but I am not strong enough to climb the hill down. Five days have now passed with me taking the drug. I do not even have transport to travel to Ekwendeni,” a women on ART treatment said.

She added that 30 women, who are on ART in the area, face a similar ordeal.

To cope with the challenge, they formed a group to be sharing notes and experiences.

Health Minister, Jappie Mhango, said Kasasire might be among the areas that could benefit from 250 health centres which the government would construct across the country.

Mhango said the government would purchase ambulances and allocate them to the new health facilities to ease mobility challenges.

“We are sure that the new facilities, which the government plans to construct in the country, will also benefit people for the said area [Kasasire],” Mhango said.

Kasasire borders Mzimba North Constituency whose Member of Parliament (MP) is Yeremia Chihana whereas Nkhata Bay North Constituency is for Chrissy Nyakanyaso.

The constituents benefit from Choma Health Facility which is in Mzimba North East, whose legislator is Catherine Gotani-Hara. She is Speaker of the National Assembly.

Chihana and Nyakanyaso said they were aware of the challenges which people face in the area but said Roads Authority (RA) has assured them that the road from Kiya via Luhomero to Kasasire would be upgraded.

“I know the challenge and the government, through RA, has planned to upgrade the road. However, I will not comment further because I don’t want to compromise the development by the government,” Chihana said.

But Nyakanyaso said she wants to build a clinic at Kasasire to minimise challenges which women face in the area.

“As a matter of strategy, I will meet the members of the community this week to discuss the matter,” she said.

However, the people of Kasasire cannot wait any longer when their women are still delivering in the bush while others are losing lives.

Tired of unfulfilled pledges and promises by politicians on the road and health centre construction projects, the members of the community have started constructing the road on their own to connect the area to Choma.

The people are using hoes to work on the rocky terrain in a bid to connect the area to institutions such as Choma Health Centre and a community day secondary school.

Group Village Head Kasasire said his subjects decided to embark on the project after realising that expectant women face challenges when walking to the hospital.

“Our women have suffered for a long time. We know that it will not be easy but we have volunteered to construct a road in the hills to connect the area to Choma,” Kasasire said.

He said if they had access to a grader, they would complete the road construction work in five weeks.

But Nkhata Bay District Commissioner, Rodney Simwaka, said the council does not have such a grader, adding that they hire one when there is need.

Simwaka said it might take long before they step in to support the members of the community because the council has not yet received District Development Fund which caters for such projects.

After all is said and done, what 7,000 members of Kasasire community want is either a health centre or a road constructed in the area.

Malawi Health Equity Network Executive Director, George Jobe, said it was sad that some women are not delivering at hospitals, a development he said was undermining the fight against maternal and neonatal deaths.

“The area needs quick intervention because, as a country, we are fighting maternal and neonatal deaths. This cannot only be constructing a health centre in the area but also ensuring that the facility is accessible and has the required health services,” Jobe said.

United States Agency for International Development says Malawi has one of the highest maternal mortality ratios globally, currently estimated at 574 maternal deaths per 100,000 live births.

Despite such deaths, Malawi is a signatory to international instruments making a commitment to providing its citizenry with robust health care.

One of the Sustainable Development Goals’ targets that Malawi has to meet by 2030 is reducing maternal mortality ratio to less than 70 per 100,000 births.

But with some expectant women covering long distances and delivering in the bush, that dream remains far-fetched. Of course, the efforts of the members of community in Nkhata Bay are commendable.

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