Likoma's overwhelmed health heroes

 

A healthy nation is a worthy nation. To Alesi Nkongolo, Likoma seems to have slightly over a dozen of skilled health workers who are sacrificing their chances for the wellbeing of 10 433 people in the two-island district.

Unfortunately, the health workforce’s motivation to triumph where their colleagues fear to tread are being constrained by abundant setbacks, including irregular supply of vital supplies, due to the on-and-off condition of the islanders’ most reliable transport—MV Ilala.

"The hospital here has selfless workers who always try hard to help us to stay alive, but sometimes they cannot do anything because of the shortage of drugs and essential equipment," said the 61-year-old mother of six who has been complaining about unrelenting chest pains for six months now.

Despite presenting herself for check-up at a time some Malawians seemingly think hospitals are exclusively for the critically sick, she left St Peter’s Hospital devastated by medical advice to go and always drink a lot of water—thanks to the breakdown of the healthcare facility’s sole X-ray machine five years ago.

"My body aches and I feel somebody is playing with lives. How do you convince people to stop wasting time with herbalists when a hospital hardly provides proper check-ups, diagnosis and treatment?" she wondered.

Hers is a request for reliable provision of essential supplies, not contempt of the three midwives and 14 nurses-cum-midwives at the 52-bed hospital.

On Likoma’s twin island, Chizumulu Health Centre has two nurses only. This in some way confirms a statistic in a 2009 sector wide study jointly conducted by the Ministry of Health and its financing partners, which showed that 44 percent of the country's health centres do not meet minimal staffing requirements of two nurses plus two medical assistants and one environmental health officer.

To save and serve

HOSPITAL ADMINISTRATOR VUMA

St Peters Hospital administrator Francis Vuma confirmed that the X-Ray has been awaiting repairs for half a decade.

However, the protracted glitch is just a glimpse of the problems affecting the delivery of quality healthcare services at the facility, which sees about 200 patients a day.

"St Peters targets about 10 000 people on Likoma, but almost seven in every 10 patients treated at the hospital are Mozambicans or Tanzanians who usually come in critical condition,” said Vuma.

The official said this exerts pressure on the skilled health personnel at the life-saving institution designed for at least five clinical officers and 18 nurses-cum-midwives.

Putting the scarcity in perspective, Vuma said: "The workforce constitutes a sharp rise from five nurses five years ago, but we are struggling to reach the required minimum staffing levels due to sudden resignations and refusal of deployment.

“Some skilled personnel are put off by transport woes and high cost of living on the island as basic goods are scarce and expensive. Prices can double up when Ilala breaks down."

Even the district health officer Dr Solomon Jere lives in Nkhata Bay ostensibly because there are no houses and structures for his office ever since Likoma was separated from Nkhata Bay in 1999. EVEN district council offices are housed in confined buildings formerly belonging to Chitukuko Cha Amayi m’Malawi (CCAM).

When asked what keeps them happy to serve a health post some shun in preference for better conditions at Nkhata Bay and other parts of the mainland, some of the health personnel were candid in their response.

RASHID: WE PAY HIGHLY

Apart from the primary calling to serve and save lives, St Peters guarantees us chances for further training as well as free housing, water and electricity," said clinical officer Leonard Rashid, who has been on the isle since 2006.

Having worked at Ekwendeni and Embangweni CCAP hospitals in Mzimba before joining Likoma in 2006, Steven Phiri, 28, affirmed: "Health work at Likoma entails paying excessive costs for goods and services which our classmates and colleagues access freely elsewhere."

Apart from the hardships and increased workloads, the health personnel have to endure spectacles of people dying or returning empty-handed due to what Vuma termed chronically erratic availability of essential drugs, particularly antiretroviral (ARVs) and medicines for non-communicable diseases such as diabetes and high blood pressure.

“Due to the scarcity of ARVs, two people living with HIV are compelled to share a bottle meant for one,” said Phiri.

PHIRI: DRUG SHORTAGES DISCOURAGING

Lapses in ARV dosages could result in patients developing resistance to drugs and vulnerability to graver ailments such as TB. The hospital, with no isolation ward for TB patients, faces the urgency to bolster its staff as a new government policy recommends door-to-door treatment of the disease right in their communities.

Other challenges include regular breakdowns of an ambulance as well as stock-outs of drugs and other medical shipments which hit a fatal height when the Ilala’s trips are discontinued.

Apart from Gabriel, a missionary vessel anchored at Nkhata Bay jetty, the hospital relies on Ilala to transport critical and emergency cases that cannot be treated or operated on at the hospital.

The disappearance of the vessels leaves them reliant on boats with no facilities for transporting patients and fragile drugs and reagents.

Although the health workers conduct caesarean childbirths and other operations at the hospital, Vuma cited as a major blow the absence of an expert to administer painkillers and other relevant dosages to patients going under the knife.

They currently rely on a relief anesthetist who plies between Nkhata Bay and Likoma.

Beating the odds despite the bottlenecks, the hospital is making inroads towards closing the gaps in the country's bid for Millennium Development Goal (MDG) six: Combating HIV and Aids, malaria and other diseases by 2015.

As the clock is ticking, the nurses, clinicians and midwives are playing a leading role in administering antiretroviral therapy (ART), awareness, prevention of mother-to-child transmission (PMTCT) and HIV testing and counselling (HTC) in communities.

DRUGS A RARE RESOURCE

As caregivers, they are also frontline soldiers in fighting malaria by providing health education on prevention measures, especially effective use of insecticide treated nets. Their strides have resulted in traditional leaders banning the use of mosquito nets for catching
and drying usipa fish effective last month.

Likewise, the traditional leaders have imposed fines on couples who give birth at home. The hospital staff feels the grass-root intervention will help improve maternal health and reduce mortality rates currently estimated at 675 deaths in every 100 000 live births by ensuring that every baby is born at the hands of skilled attendants.

Most of the women who die while giving birth are Mozambicans who report late to the facility, according to Vuma.

Although only four of the midwives-cum-nurses are female at St Peter’s, pregnant women say it does not affect them as even the men handle their conditions with care, compassion and respect.
The success stories and challenges in Likoma call for more human resources in rural setting where 80 percent of Malawians live, yet only 30 percent of health staff work there.