Searching for life in choked health system


Joyce Jackson, 29, is a woman in a stressing situation. In June this year, she watched her life turn worse. Reason: There was no ambulance at a health facility she sought labour services.

“If there was an ambulance at Ngokwe Health Centre or Machinga District Hospital, my baby would have been alive,” Jackson laments.

After losing her baby, Jackson is now battling the embarrassment life of producing an irritating odour due to continuous leakage of urine.


The genesis of her problem rings loud to her memory and, as she recounts the story, one cannot miss the agony in her voice.

“I was pregnant and when signs that I was about to deliver a baby started showing, I went to Ngokwe Health Centre. It was on June 19 this year and I arrived there late in the afternoon.

“In the evening, a nurse helped me but there was no progress. At around 8pm, an ambulance from Machinga came to pick one patient to the district hospital. Because I looked fine, I was left behind,” recalls Jackson, a mother of three who comes from Traditional Authority (T/A) Ngokwe.


However, her situation changed at around 11:00pm. She had developed complications and the nurse on duty told her that she had to be transferred to Machinga District Hospital.

Efforts to recall the ambulance proved futile because officials said the ambulance had already been there and could not go back to pick her.

Apparently, the distance between Ngokwe and Liwonde, where Machinga District Hospital is located, is 111 kilometres.

Her family and friends raised K28, 000 for private transportation from Ngokwe to Ntaja.

Upon reaching Ntaja Health Centre, health workers assisted them by calling Machinga District Hospital again for an ambulance hoping that it would now come after halving the distance.

“But the response was the same. No ambulance. We had to pay K15,000 to get to Machinga District Hospital in Liwonde,” she says.

When Jackson arrived in Liwonde, she was in aggravating pain. The nurses on duty helped her to deliver a baby boy.

Unfortunately, the baby died because of lack of oxygen since it had been in distress for a long time, according to information given to her by the nurse.

It was when she reached home after being discharged that she realised she was leaking urine, a problem which has been there to date.

“I have never sought medical attention because I have been ill since I gave birth,” Jackson narrates.

Jackson’s current condition is called obstetric fistula. According to the United Nations Population Fund, fistula is a hole between the birth canal and bladder or rectum caused by prolonged, obstructed labour without access to timely and high-quality medical treatment.

This condition is one of the most serious and tragic childbirth injuries that leave women leaking urine, faeces or both. It is said to often lead to chronic medical problems, depression, social isolation and deepening poverty.

Thoko Mugomba is the only qualified nurse, midwife and technician at Ngokwe Health Centre and says she feels helpless when faced with a situation similar to Jackson’s.

“Such cases need immediate referral to another hospital but there is no ambulance to assist patients,” Mugomba says.

Machinga District Health Office spokesperson, Clifton Ngozo says the district has four running ambulances that cater for 14 health centres, all of which have maternity sections.

“These ambulances have to respond to all our health centres and it might be that the time they were calling for one, the ambulances were responding to other centres as well,” Ngozo says.

He says Ngokwe has a motorcycle ambulance that can take patients to Ntaja or Liwonde health centres in the absence of vehicles.

Malawi Health Equity Network Executive Director, George Jobe, calls for an increased health budget to ensure availability of resources such as ambulances.

Jobe advises that even in the face of scarce resources, priority should be given to maternal and neonatal cases.

“District hospitals need to do better. In this case, they could have given priority to the mother and her unborn baby so that we continue to make strides in ending maternal and neonatal deaths,” he said.

Health Rights Education Programme Executive Director, Maziko Matemba, says Jackson’s story is a sad tale about the country’s health system that is still grappling with a number of issues.

However, he argues that, much as we expect the ministry to rectify problems haunting the health sector, the responsibility also lies with the private sector and the public in supporting the ministry to address the prevailing challenges.

“Not all of our facilities offer comprehensive maternal care services due to financial and human resource shortages; hence, the need for private sector to be heavily involved,” Matemba points out.

During the commissioning of construction works for Phalombe District Hospital recently, Minister of Health Atupele Muluzi also acknowledged the shortage of ambulances in hospitals in the country, saying government is doing everything possible to curb such a challenge.

There is progress in other areas. Some members of society, including Members of Parliament, are giving a helping hand in procuring and donating ambulances to various health facilities in the country.

But Jackson awaits help to bail her out of the fistula condition. As she weathers through her current situation, one can only hope that rectifying the problem of shortage of ambulances would save scores of women from being thrown into the deep end of fistula problem.

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