The bitingly cold weather on the rising hills of Chididi area in Nsanje south west is not some peculiar phenomenon in June.
Even when it is unsparingly hot at the district’s main town and surrounding places, Chididi has remained adamant in its fidelity to chilly climate.
In the frigid elements along the rutted and snaky road that connects the hilltop location and the town centre, a woman lost her baby while delivering outside a hospital, in the hands of a helpless mother-in-law.
“It happened in the eighth month of my pregnancy. I never expected I would be due that time, so when labour pains started, I was home,” Frida said recently at her home about half a kilometre (km) from what was supposed to be her family’s nearest clinic.
She had no money for hiring a car and opted for a motorcycle, which is cheaper.
Just about 10 minutes into the journey, she felt unusual contractions, an urge to visit the toilet and her waters breaking.
Squeezed in between the bike rider and her mother-in-law, the expectant mother declared they were too late to reach Nsanje District Hospital some 20km away.
“My mother-in-law was shocked; in fact, she was confused,” Frida admits while pressing her right palm down her pale face.
She recalls that as she wobbled into a roadside rocky setting with scanty undergrowth in her mother-in-law’s tow, the motorcycle rider turned his eyes away to give them some privacy.
In a few minutes, a bouncing baby boy was born, exposed to the biting weather of Chididi hills and the absence of warm garments that would mollify the little one’s body from the mist of the amniotic fluid.
He could not make it beyond that first wondrous cry that often signals that a new-born’s respiratory and circulatory systems are making a successful transition to life outside the womb.
“It was a painful moment for me. For once, I thought I was dying too. The whole thing felt unreal, but I later came to terms with it,” Frida says.
She declares it may be the last time to conceive again due to struggles she has to endure throughout a pregnancy while on treatment.
Frida realised she was HIV positive when she got pregnant with her last child—who could not make it—and believes she might have contracted the virus after her two daughters’ births.
“They were born negative. I tried as much as possible to faithfully take my medication so that my third baby would also be born negative. I am sure he was,” she says, wiping dust from photographs of her two daughters taken during their baptism.
The first part of her story epitomises what several other women eating for two in Chididi experience in their poverty and the absence of a public health facility.
In the hilly section, a small building which is supposed to be a rural clinic, perched above the dirt rocky road, lies almost abandoned.
In under a year, construction was supposed to be completed and the facility properly staffed with workers and equipped with diagnostic, therapeutic and preventive apparatus as envisaged.
“But four years later, what we have is just an unfinished building. So women, frequently deliver on their way to Nsanje District Hospital because the nearest health centre here is a paying one,” says Mike Thole, chairperson for a development committee for the village where the clinic project is.
Thole harks back to Frida’s case which he concedes could have been avoided if she had accessed a health facility nearby.
He has records of dozens of other women who delivered in the roadside bushes on their way to the hospital or at home after failing to reach the facility in time.
The local leader is concerned that widely promulgated efforts of ending preventable deaths of new-borns and to reduce neonatal mortality to at least as low as 12 per 1,000 live births are being thwarted by familiar and long-standing challenges.
Malawi’s maternal mortality rate stands at 349 deaths per 100,000 live births, according to the latest data from the Ministry of Health.
“Well, there are people behind those figures. Those are human lives. As they say, a life lost is one too many. To avoid these preventable deaths, people at Chididi mobilised sand and bricks for the clinic project.
“They are still waiting while our women are delivering in the bush and sometimes lose their babies because they can’t afford to pay at the nearest health centre,” Thole laments.
The target of ensuring universal access to sexual and reproductive healthcare services is also being frustrated by the absence of a government clinic in Chididi since the area’s creation.
It is worse for those seeking family planning services as the nearest Christian Health Association of Malawi-run health centre does not offer such services.
“The health centre is run based on doctrines of the church that owns it and they cannot give us contraceptives,” says Amina Katungwe, a resident of the hilly area.
She reckons that government-owned healthcare facilities are flexible in terms of young people accessing sexual and reproductive health services and rights.
“Here in Chididi, we are left behind. We badly need a government clinic. We are no lesser human beings than our friends who easily access healthcare services within their locations,” Katungwe charges.
As she strolls around the structure which is without window panes, a cement floor and plastered brickwork—basic elements to be done before the final fittings—the 22-year-old is worried villagers’ efforts to mobilise the initial chunk of construction materials might turn out to be in vain.
Malawi Health Sector Strategic Plan II, spanning 2017—2022, states that government is committed to ensuring that people in Malawi attain the highest possible level of health and quality of life.
“This will be achieved by ensuring universal coverage of basic health care which is the obligation of government according to the […] Constitution,” a foreword to the plan declares.
There is an admission in the document that despite that there was a steady decline in maternal mortality ratio at the time of developing the strategy, the proportion remains one of the highest in Sub-Saharan Africa.
Frida is grateful she did not lose her life when giving birth to a baby she could not breastfeed beyond his life’s first two hours.
“But I know of a woman who lost too much blood after delivering in the bush on her way to the district hospital. She did not make it,” she says, gazing at her daughters’ glossy portraits.
Under the preceding strategy, Malawi is said to have made substantial gains in reducing under-five mortality and infant mortality.
But to those who have lost their babies at birth, the pain is never placated by the said gains, Thole says.
Nsanje District Council Health Committee chairperson, Felix Round, admits that most people in the district’s remotest locations are struggling to access health services within reasonable distances.
For the clinic at Chididi, Round says all the council can push for is resources and staff placement once construction has been completed.
“It is a concern that people in several areas of the district fail to access health services within a radius of seven kilometres, which is the requirement,” he says.
The project was commissioned by then-member of Parliament for Nsanje South West, Joseph Chidanti Malunga, who did not make it at the 2019 parliamentary elections.
Apparently, the contractor only took the construction works to where the money he was given could take him.
Locals who are expected to seek services from the hilltop clinic say they have been promised construction will be completed soon so that they can narrow down the distance they cover to the nearest public clinic.
“We do not take part in discussions at the council but we have been assured that soon materials will be made available for the construction to be completed,” Thole says, his voice tinged with cynicism.
Even an update from Chidanti Malunga’s successor, Eurita Ntiza, seems to cast a cloud of doubt on the possibility of Chididi residents accessing healthcare services at the clinic any time soon.
While she insists that works will resume “soon”, the legislator says the council will only release money from the Constituency Development Fund, where her predecessor had also sought the resources, once local leaders at Chididi formally seek the support.
In the meantime, poor seekers of healthcare services from Chididi continue to cover about 25km to the district hospital where they sometimes do not even find medication.
“It is worse for us women. We don’t know when that light our counterparts elsewhere see will shine on us,” Friday says desolately, her voice tapering off in the cold ambience of her home on the slopes of the rock-strewn knoll.
Alick Ponje is a features writer at The Times Group. He graduated from the University of Malawi with a bachelor’s degree in education, majoring in literature in English. Follow him on Twitter @aponje