Visit to a health centre at rural area

I hopped on this trip with a new friend, Umar. We met randomly at the staff canteen when he took interest in my plate of nsima – actually I had no choice as that’s the least expensive option when I had no more than 500kc! (well not to say I don’t like nsima I quite like it too)
He had arranged everything so it’s great that I just followed. It’s my wish to see all levels of government health facilities though it is not in my research agenda. I simply wanted to see things with my own eyes though I probably can’t use them as my research data.
That’s a rural area we were going into. After 2.5 weeks in Malawi, there wasn’t too much shock that would really strike me. Having seen how a ‘shop’ is like at rural areas, I would imagine a health centre is something like a small outlet with very small scale of operational facilities.
Hmm but no – it’s much impressive than the picture I painted myself through literature. And I must say it was better than some Klinik Kesihatan we have in Malaysia. I don’t mean better in facilities wise, but the programmes they run were really good. Every morning they run special clinics e.g. HIV clinic, ante-natal clinic, supplementary feeding programme, family planning, etc. And in the afternoon it’s general OPD. However emergency OPD is open at all times.
When we arrived, there was a HIV clinic running. The room was crowded with patients. I was speaking to a community nurse (while Umar was doing his research bit with the Health Surveillance Assistants) who led me into the HIV clinic. They usually see approximately 200 HIV patients every Tuesday morning – screening, prescribing ART and co-trimoxazole prophylaxis, checking ADRs, referrals if necessary. I saw 1 clinical officer, 1 nurse and 1 clerk were working. It felt quite strange to walk through the very crowded room – to come so close in contact with HIV positive patients. Not to say I hadn’t worked with HIV patients in Malaysia but squeezing yourself through these patients really made you come face-to-face with your fear of getting so close with them. I must confess I had this fear – though very unlikely, not sure if there’s somebody who was mad at me for whatever reason and could just give me a little scratch or needle prick or something.. paranoid me.. tell me who is not paranoid the first time you come to a country you haven’t been, come in close contact with patients who carry fatal disease that is communicable.. but of course I pretended to be such a professional ‘tourist’ (that’s another thing I felt so bad about myself – especially when I took a picture! But how do I tell the world what’s happening in Malawi without pictures?!)
There is also a ward in this little health centre that admits post-natal mothers. I asked how many babies are usually delivered in a day – the community nurse said oh many.. 2 or 3. Then she led into the ward to see the mothers. There were 4 mothers with their babies – most of them were young.. 18 with her first born; 24 with her 4th child; 29 with her.. (forget); and the oldest one was 44 years old with her... 13th baby!! She was advised by the nurses not to have any more babies. And again the nurse told me about the government plan to encourage people to have no more than 4 children. Seems the people get the message across very well. Everybody is talking about it.

There’s also a special site for donor-sponsored project for testing efficacy of Fansidar in pregnant women. Again it reminded me of what I had seen at Queen’s and the conflict behind – though the nurse-in-charge did say they (she and the research nurse) worked ‘hand in hand’. The world can never be fair, no matter how people claim that’s ‘ok’, as long as we do not own the same. I felt myself exploiting the research site sometimes – no matter what you generate from this site it’s going to be novel and you can publish something about it. You think my project is helping Malawi? No – I think Malawi is helping me. It’s them who enrich me, I’m just a little nuisance disturbing other people’s busy workflow most of the time..

Another interesting thing I saw was the food distributed for supplementary feeding programmes. Peanut butter with ‘added medication’ (I think perhaps fortified with vitamins and minerals and some other nutrients, not medication..) called ‘Chiponde’ is given to malnourished HIV patients. It looks just like any other peanut butter at the supermarkets (see picture). The nurses said it’s more salty than ordinary peanut butter. Hmm. I actually felt like trying (well I feel like trying everything the local people do at all times.. including putting a huge bag of rice on my head) but of course it really is a sin to take even a wee scoop isn’t it..

I’ve also spoken to one of the HSAs. Ohh I read a lot about them in the literature so coming face-to-face with them was really an exciting experience. I asked what he did and whether he liked his job. Ok here proved my assumption wrong again: I thought most HSAs do not speak English (as Umar said he needed to get translator to speak to them), do the job part-time and half volunteering for the job, and do mostly surveying task as the title suggests. But no they’re doing so much – going from house to house, knocking on every door on the village he’s in-charge of (there’re about 1000 people in the village he’s in-charge of). He is giving education about how to use toilet, how to keep food clean in the kitchen, how to make sure water is clean, importance of using washing line (and not to dry your clothes on the ground), checking on malnourished patients, watching out for diseases e.g. cholera, malaria (then do referrals if necessary).. now you could see how uninformed the people living in rural areas could be – we’re now talking about keeping the most basic standard of living. It’s so important to get most people into at least basic education otherwise we have to use a lot of resources just to teach people how to live and care for themselves. Oh yes and coming back to the question whether Mr HSA is happy with his job: he grinned happily and said yeah everybody calls him doctor, doctor! I asked if he would like to go for further degree to become a doctor, he quickly said yes of course he sure can do it. I bet if he were to be born anywhere else in the developed nations, he would most probably have no problem at all becoming a doctor. This guy is intelligent (from the way he responded to questions), speaks perfect English, ambitious, held high self esteem – the only thing that keeps him from moving forward is just lack of opportunity. The same goes for the community nurse I've spoken to – I told her sincerely I was really impressed at how good the job they’ve done as community nurses. And I told her she’s equally good, if no better than, any nurses I’ve met in Malaysia or in the UK. And I really think. She knows her job well. She did 3 year training for nursing then 1 year for public health. She knows what to look out for the patients, how to manage drug stock, how to run different clinics, why it is important to do certain things.. if you assume health workers at community level are less competent than their colleagues at higher level of the healthcare system – here proves your assumption wrong again (I’m critiquing my little undeveloped brain here..). In fact it’s even more important to train really competent people at community level because that’s the first line, and the most cost-effective way to curb diseases. Only if you are well trained you know what’s important to the people. It’s not just about the technicality in delivering tasks e.g. giving injections, it’s about TAKING CHARGE of people’s health! So for those doctors, pharmacists, nurses out there who think clinical specialisation is the only way to prove that you are clever that’s a huge mistake – working with people requires equal or even bigger brain capacity!