Nothing, not even long illness, prepares Senior Group Head Chiponde of Machinga District for the moment the life of one of his subjects ends.
That is why, whenever a pregnant woman from his area pays K10,000 to bus or taxi drivers to take her to Namwera Health Centre— which is the only option, really, because Chiponde Health Centre just a stone-throw from his village has no maternity wing— he only hopes for the best.
But the best has become hard to come by these days because, often, when the road from Chiponde Trading Centre to Liwonde Trading Centre descends to Namwera Health Centre roughly in-between, the cross of hope tumbles into that of hopelessness.
“Just two days ago, we lost a woman and her child to death. Because we do not have a maternity wing at Chiponde Health Centre, which is the closest place we have, pregnant women have to take the long, arduous and expensive journey to Namwera Health Centre, where such services are provided.
“Most often, despite the good intentions of the medical workers there [Namwera Health Centre], and despite that medical services are provided free-of-charge, our women die. Sadly, cases of death of new-born babies are common. We are tired of this. The painful part is that, while people in other parts of the country enjoy free access to health services, our women pay K10,000 in transport costs from Chiponde [Trading Centre] to Namwera Health Centre,” Senior Group Chiponde laments.
Inadvertently, Namwera, where Namwera Health Centre is, has become a ruined cross-section between life and death, at least to Senior Group Chiponde’s subjects.
Actually, when the Namwera Health Centre doors open for the pregnant woman from Chiponde, Senior Group Chiponde fears for the worst. It is as if the doors were a mantrap, taking people in without no intention of letting them out.
Senior Group Chiponde often stands close to the road at Chiponde Trading Centre and gazes down the tarred road, in Namwera’s direction to be specific. He cannot help it when one of his subjects heads in the Namwera Health Centre direction.
Often, death puts a full stop to all his labours of hope and love because, sadly, some of his subjects die in the course of giving birth or in the course of travelling to Namwera Health Centre to deliver babies.
Ironically, the traditional leader says all these problems— which is basically one problem; namely that of preventable deaths of pregnant women or their new-born babies— are preventable.
“Very preventable, indeed,” he says, before delving into the issue that has given him a headache for years on end. It was his headache. It is his headache. It may be his headache in the foreseeable future.
“You see, when [former president Bakili] Muluzi opened this [Chiponde Health Centre], I and my subjects hoped that we would soon have a maternity wing. But trouble soon arose when the earmarked piece of land became embroiled in a dispute.
“A private house was constructed on the spot we identified as suitable for a maternity wing and, even after Senior Chief Jalasi intervened, things did not change. Lawyers for both sides have been discussing the issue and I understand that when money amounting to K10 million will be paid to compensate the individual, we can start thinking about [construction of] the maternity wing. That is what we have been looking forward to: the finding of an amicable solution to the issue,” he says.
So, until that day, the journey that costs poor, hapless women K10,000 will remain a bitter pill they cannot afford not to swallow.
When, as happens sometimes, the bus arrives at Chiponde Trading Centre from Mangochi Boma, it will always leave for Liwonde filled with vendors, fish sellers, meat sellers, chips sellers, grocers, office workers, medical personnel and, of course, Chiponde pregnant women on the way to Namwera Health Centre.
That means transcending areas of two legislators: Ishmael Grant represents Chiponde and surrounding areas in the august House; Lilian Patel is the lawmaker for Namwera and surrounding areas.
However, to concerned women such as Fatuma Mzeremu, 45, Chiponde and Namwera are not domains of two legislators; they are the crossroads between life and death.
“To us, women, we do not look at who represents which area. We look at which area gives us another chance at life. Like everyone else in this country, we want to live; we want to lead healthy lives; and we want to come back to full health when we fall sick,” she says.
But that is not always the case when one of the women in Senior Group Chiponde’s area falls sick.
Death is the certain case.
And one of Senior Group Chiponde’s subjects, Elias Andwatch, is not impressed.
“Why should our women die in the course of giving birth? Why? Let those responsible for service provision in the health sector come to our rescue,” Andwatch says.
Matias Nyale is equally concerned. He says Chiponde is a land so full of contrasts, in terms of weather, that banking on Namwera Health Centre is always a gamble.
Sometimes, he says, Chiponde gets so hot that a pregnant woman is more likely to succumb to dehydration. Under such circumstances, a careless chicken that lays its egg on the soils of Chiponde risks getting it soft-boiled within seconds.
“And you tell me that, when the temperature is at its most extreme, a pregnant woman should be on the bus, or crammed taxi, on the way to the hospital in Namwera? No!”
“At other times, temperatures in the area plummet, such that a pregnant woman should be buying warm clothes instead of searching for money to pay for transport to Namwera,” he says.
However, while Senior Group Chiponde’s subjects decry rising costs of transport, which pregnant women have to incur on the way to give life at Namwera, other community members in Mangochi are looking for alternative means of transport.
In fact, they seem to have discovered that death, the robber of daily breath, has slower days, too; days so slow that a bicycle can travel faster than death itself.
That is why they have learned that bicycles can be used as ambulances. All such people do is attach a cart to a bicycle on death’s slower days, load the pregnant woman or sick person before the condition worsens, and cycle faster than death to the nearest health facility.
Most often, the sick end up getting into the warm embrace of medical personnel, instead of falling straight into the hard, cold jaws of death.
Sounds strange? This knowledge has been widespread in Malawi, from the days of the ox-cart, when pregnant women, the seriously ill, among others, depended on community goodwill and human-animal (donkeys/ cattle) relationship to tame death.
The Centre for Reproductive Health (CRH), a department at the University of Malawi’s Chancellor College, was one of the first institutions to buy into the idea.
A pilot project on bicycle ambulances was born in Makanjira and Nkumba areas in Mangochi. This was time, in early 2000s, when well-founded fears about high mortality and morbidity rates animated the nation.
At that time, according to the Demographic Heath Survey of 1998, at least 894 women had to die from pregnancy-related complications out of 100, 000 births.
A study which the Ministry of Health conducted in a period of five years (between 2009 and 2013) indicates that the most common cause of maternal mortality were hemorrhage (22 percent), preeclampsia (13 percent), cardio-vascular disease (10 perent) and embolism (9 percent).
Today, only less women are dying but health rights activist Maziko Matemba says “every life counts”.
May be Senior Group Chiponde and his subjects can mobilise themselves and, while waiting for a solution to the maternity wing issue, utilise bicycle ambulances.
Meanwhile, Ministry of Health spokesperson Joshua Malango has said maternal health is at the heart of the Ministry of Health’s work, and efforts are being made to make services available all people all over the country.
To Chiponde’s subjects, however, such services may come lives too late!