On my way to a maternity health care facility in one of Malawi’s most deprived districts, Ntchisi, I tried to stay level headed. If I was scared, how did the women I was about to meet feel? This was not my first time seeing the horrors of Malawi’s health care system but it was my first experience staying the night.
You might wonder why I would choose to spend the night in a hospital without electricity, running water or toilets? Simply, I wanted to be able to empathise on a deeper level with the work I was doing in Malawi. While I acknowledged I would never be able to fully grasp the gravity of the situation, I became increasingly uncomfortable with my own complacency. It is too easy to switch off to those who do not have a voice, so by placing myself directly in the situation, I was confronted with it. I could not change the channel, turn off notifications or look away.
Globally, Malawi has one of the worst maternity and neonatal mortality rates. This is primarily due to infection, a critical shortage of health workers, medical provisions and long distances to health care facilities says Dorothy Ngoma, president of the national organisation of nurses and midwives of Malawi. According to WaterAid, 56 percent of healthcare facilities have no hygiene facilities, 63 percent do not have adequate latrines, and 17 percent do not have clean water. The distance between home and healthcare facilities often push expectant mothers to stay at the facility for extended periods, despite the lack of basic amenities, as well as access to trained health care assistants. Consequently, the expectant mothers have few options but to bring a family member as their guardian. This guardian acts as their advocate but also carries out basic care like preparing food, collecting water and maintaining basic hygiene levels. While essential for patients, the guardians are doubling the strain on an already struggling service, as they also require access to the basic amenities and shelter, which is haphazardly provided, if at all.
We pulled into Chinguluwe Health Centre just after 6pm, although the sun had just set, it was pitch black. I was greeted by the only community midwife, Martha Njinga. My attempts at greetings in Chichewa (the language of Malawi) eased some of the tension in the air before we began a torch-lit tour of the maternity ward. There were 3 rooms: the delivery room, the bedroom and a washroom. The delivery room had two beds, a sink without running water and a single lamp. The bedroom was a large room with 6 beds and several sisal rugs laid out on the floor. The bright chitenges (traditional cloths won by women) brought some colour to an otherwise dilapidated looking room. Due to the lack of running water the bathroom had been abandoned, leaving outside as the only option for going to the toilet.
As we made our way to the guardian centre, about 100 meters from the main building, I could hear the rhythmic patter of footsteps and singing. Upon entering the room, I saw at least 50 women packed in a tight semi-circle singing traditional Chichewa songs while two heavily pregnant women danced in the middle.
Once the singing and dancing ended, silence washed over the women, a stark contrast to the joy of just moments before. We made our way back to the main bedroom, for what I expected to be a sleepless night ahead. There were about 35 women and only six beds, which went to the most heavily pregnant women. For the rest of us, whatever space we could find was our bed for the night. I tucked myself away in the corner, laying my sisal rug and chitenge under one of the beds, dreading that I might need to pee in the night.
During the night, Brenda Manuel was brought in from one of the neighbouring villages, she was already in labour, but experiencing complications which meant she had to be anaesthetised. However, Lidocaine the drug needed for this had run out on Tuesday, so she had to be sutured without. There was a collective sigh of relief when we finally heard the first cry of the healthy newborn baby. Njinga informed us that Brenda was lucky and recovering well. Many have not been. There are approximately 634 cases of maternal mortality for every 100,000 live births according to the World Health Organisation (WHO). Although, maternal mortality rates have actually fallen in the last two decades from approximately 950 deaths per 100,000 live births which is due primarily to charities encouraging and educating women on the benefits of delivering at a health care facility. The Malawi health system is struggling to adequately accommodate all its patients. Chinguluwe Health Centre is the epitome of this, with a catchment area of about 22,500 people, it only has two nurses, two medical assistants and one senior health surveillance assistant.
Conflict with the surrounding community is further exacerbating the lack of amenities. Every morning the women are blocked from collecting water from the only borehole in the village. The government is obligated to pay for its maintenance but have failed to do so. The community have taken it up and feel they have the right to stop the women collecting water. Further issues with sanitation and hygiene are increasing the likeliness of illness and disease spreading. The WHO estimates that around 16 percent of maternal mortality cases are due to infection, particularly sepsis, which could be entirely preventable if proper hygiene facilities such as pit latrines, showers and better medical waste initiatives were provided. Chinguluwe does have sterilization equipment but because of very frequent power outages and generator breakdowns, they often cannot be used.
Given this conflict with the community, the morning quickly became quite contentious. As usual, the women were stopped from collecting water, but this time they had a foreigner to advocate for them. At first, I was uncomfortable using my privilege to leverage a community into letting the women access the borehole, but this was the only option we had and the difference between having and not having water was far greater than my unease.
As someone who is living in the UK, it’s not often that I interact with human rights issues on such a deep and personal level. I was afraid I would not be able to handle the gravity of the injustices I witnessed. What I now realise, is that it was a privilege to be let in on something which causes such great pain and suffering.
Often, we are so focused on the negatives of a situation that we forget to look for the joy. In this statement, I am not attempting to minimise the suffering of the expectant mothers, but I want to highlight the pure drive and tenacity the women of Malawi have for changing their circumstance. This duality between fear and pain and joy and determination was not necessarily what I thought I would find, but why I took part, to gain a better understanding and empathy for a people and an issue that I knew nothing about before I travelled to Malawi. It is what I now do with this knowledge that counts.