Saturday, July 26, 2008

Mobile Clinic Plus an Odd Comment

4 July 2008, Friday

Happy U.S. Independence Day! Independence Day in Malawi is on Monday, July 7. It's actually July 6 but since that falls on a Sunday, the country is celebrating it on Monday.
Early morning wake-up at 5:15 AM so that we could catch Hilda before she went off shift. Eileen got quite a few photos before it was time to head for breakfast.

Skipped chapel in order to get ready for the mobile clinic with Joyce Ngoma. Left at 9:05 PM. Stopped first at the market in Embangweni to get some supplies. And then drove a good 45 minutes on bumpy dusty roads to Mhalaunda Health Center, where we took on more supplies and a couple more people.

Our final destination was Emazwini—more than 30 kilometers from Embangweni by dirt road. Have a feeling it's closer as the crow flies but then crows don't deliver medicine or examine pregnant women to make sure they're doing okay.

Already many people lined up in different areas under the trees. One section for weighing babies, followed by the delivery of World Food Program soya flour and palm oil. The women stretched a cloth out on the ground, a bucketful of meal was placed in a heap on the cloth and then a large cup full of oil was poured into the center of the meal, everything then wrapped up and carried home that way.

Learned that Joyce did three years training as an enrolled nurse. Spent a lot of time on the maternity ward "catching babies," then did a year's training at the Malawi College of Health Sciences to be a public health nurse.

She has now served as a public health nurse for 10 years. Says that's the only way to find out what people's health is really about—to see for yourself if their water is bad. What conditions in the home are. She also works with the agriculture agents in the area about what is nutritional food. She trained the community health volunteers—and introduced us to them. "They are our eyes and ears and feet and hands," she says.

Depending on which tree you sat under you either got your babies weighed, blood pressure checked, arm circumference measured or soya meal allocated.

Vaccinations happened in one room of medium-sized building. Prenatal checks in another room with two windows. That's where Joyce spent most of her time—and so where Eileen and I stationed ourselves as well. Thankfully out of about 25 or 26 pregnant women, there was only one complication: a woman had had a previous caesarean section and was over due. She will be heading to the hospital tomorrow.

Eileen got some great photographs. One of my favorites was of Joyce listening for fetal heart sounds with an old-style inflexible metal stethoscope. Reminded me of the old movies in which people put a glass to the wall in order to eavesdrop on a conversation in the next room.

Then came the contraceptive clinic. Fewer women were there but nonetheless, they were there. Most apparently got Depo-Provera injections (you get it in the buttocks—who knew?) I later learned that women in this area seem pretty open to contraception after having five children. They also use contraception to time their births so that they won't have a one year old and a newborn at the same time. Usually that means the older child can't get enough to eat because the mother's milk goes for the newborn.
Lunch was about 2:00 PM at the local headmaster's home. Ate rice, cooked mustard greens and a bit of beef. (And, just to satisfy the curious, experienced no ill effects.) Then another bumpy 30-plus-kilometer ride in the back of the ambulance to Embangweni. Bet I sleep well tonight.

An Odd Comment

There's a church group from Massachusetts staying at the Guest House that includes a doctor, a nurse and a paramedic. They're here with World Relief and have brought a lot of medication with them—including amoxicillin, antacids and Bactrim. The physician excitedly told me they were going to an area where no one had ever seen a doctor before. So naturally I asked where and learned they were going to the Mhalaunda Clinic.

My first thought was, well do they really need to see a doctor from Massachusetts? But figured I was just making polite conversation and didn't want to be rude. Besides, I liked the woman. And yet, her comment stayed with me—although I didn't at first realize why. (Sometimes I'm a little slow on the uptake.)

Later realized what it was that bothered me. They were going to a permanent health center that is staffed by a nurse. The clinic is one of four health centers in the Embangweni health system. Patients are referred to the hospital by the nurse. So they do have access to care—whether or not they have seen a physician at the clinic. And in fact, Mhalaunda is one of the closest health centers to the hospital.

(NB: This post was written on site in rural northern Malawi and posted now that I again have internet access.)

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