Just like soldiers form the bedrock of every king’s power, mobile technology, particularly telephone communication, has become a powerful tool of contact in the country’s public health facilities.
When public health facilities face mobile technology challenges, apart from unrelenting drug shortage, the consequences are dire.
Nthungwa Health Centre in Nkhata Bay, which serves close to 25,000 people, is in such a situation.
Personnel at the health centre named after Nthungwa Hill, located to the east of the facility, have to go almost three kilometres up Phamphala Hill, west of the facility searching for stable mobile phone network.
So they endure the distance whenever they want to call for an ambulance every time there is an emergency or a case to be referred to Mzuzu Central Hospital, the biggest referral facility in the Northern Region.
“Every time there is a maternity case that needs to be referred to Mzuzu Central Hospital, I am supposed to send someone up the mountain to make a phone call, calling for an ambulance from Nkhata Bay.
“The situation is worse at night when one has to climb Phamphala Hill to make that important phone call and make sure the ambulance has indeed left Nkhata Bay to pick up the referral case,” Linancy Gondwe, a midwife at the facility, says.
It does not come as a surprise that the situation at the facility is that dreadful looking at the terrain of its location.
The health centre lies in the centre of four mountains and deep in what is probably Africa’s largest man-made forest, Viphya Plantation, popularly known as Chikangawa Forest.
The facility is also short of rooms to offer satisfactory services.
“Although the facility offers OPD [Outpatient Department] services, we don’t have an OPD structure. Currently, OPD services are being offered from what used to be maternity section’s storeroom which is quite small in size considering the number of people we serve.
Though the Hospital Advisory Committee (HAC) has taken up the task to mobilise people within the health centre’s catchment to construct a new OPD section due to the unrecoverable state in which the old structure is, the situation at the maternity section keeps worsening.
“The health centre is forced to offer maternity services from what used to be a waiting room,” Expert Banda, Hospital Advisory Committee Chairperson at the facility, says.
The maternity wing, he says, also has limited space.
Gondwe says expectant mothers are advised to prepare for eventualities like unavailability of an ambulance in times of need.
“Since the facility is located almost two kilometres away from the road, expectant mothers are asked to keep some money for transport so that they can board a lift to Mzuzu Central Hospital from the M1 Road,” she says.
Nurses do not accompany the referred expectant mothers due to shortage of staff.
The facility has one nurse, a clinician and four ward attendants.
“The fear is that once you leave the facility with a referral, then there will be no one to attend to emergencies,” Gondwe says.
Raphael Chambuluka, who is in-charge of the facility, says combining the maternity and OPD sections poses a serious challenge.
“All the patients sleep in the postnatal ward which is not advisable,” he says.
The health centre’s perils, he says, are worrisome to both staff and patients.
“We get a lot of medical equipment and drugs as a hospital that the storeroom, which used to serve as the maternity wing, cannot hold considering its capacity.
“Drugs as well as medical equipment are being kept even in corridors, which is not safe at all,” Chambuluka says.
But that is not all.
Even HTC services are conducted in an environment that does not offer privacy.
“HTC is being conducted in a room health surveillance assistants operate from, the room is so small that it can hardly accommodate a couple that seeks HTC services from the health centre,” Chambuluka told journalists who were on a tour of health facilities in Nkhata Bay organised by Malawi Health Equity Network (Mhen).
Despite the challenges, Chambuluka says, with the assistance of Improved Service for Aids and Basic Health Care through Empowerment and Local Democracy (Isabel), a project being implemented by the Livingstonia Synod Aids Programme (Lisap), the future looks promising.
“Yes, we don’t have the much needed network, electricity even the space itself is limited but we are hopeful that things will get better. Through the project, HACs and Village Health Committees (VHCs) have been trained in how to indentify challenges, make priorities and engage duty bearers on how to resolve them,” Chambuluka says, recounting the success of the project that is being funded by European Commission through Edinburg Medical Mission Service.
HAC in collaboration with VHC have identified the network challenges, shortage of staff and the need for an OPD structure as immediate needs at Nthungwa Health Centre.
“We are already courting authorities on the need for reliable network in the area. The problem was raised with mobile phone companies but they are yet to look into it.
“The OPD structure is at foundation level following community member contributions and the assistance we solicited from [Grace] Obama Chiumia,” Banda says.
When Programmes Manager, Rosemary Kambewa, says HACs and VHCs that were trained have demonstrated positive results.
“Some committees are playing their role well compared to others. Others, though, are still behind. However, we are overall impressed with the progress,” Kambewa says.
Perhaps Nthungwa Health Centre will shake off its hitches.
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