Communities along the northern shoreline of Lake Malawi bury the dead in their own backyard, underscoring an unbreakable bond between the living and the dead.
This mystical fondness was pronounced when Silas Ngwira took us to a rocky graveyard behind his home in Khondowe, Nkhata Bay North.
“Here lies Mary Banda,” he pointed at a mound of soil and rocks. “The pregnant woman died of treatable complications due to poor transport.”
Banda, who died aged 20 in July this year, was a victim of a poor access to life-saving services in the lakeshore strip which depends on risky water transport.
During the visit, her grandfather took us to her tomb because he was at pains to explain her death and that of the unborn baby.
“This grave,” he whispered, shaking his head. “This is what transport challenges have done to me. My grandchild should have been alive today if we had a proper water transport system and phone network.”
The mountainous area along the continent’s third largest freshwater lake is accessed by water transport only.
Equally cut off from the country’s road network are Ruarwe, Usisya, Thoto, New Salawe, Tchalo, Zunga and Mlowe.
In the final months of her pregnancy, Banda went to live with a relative near Khondowe Health Centre to lessen the burden.
But this meant nothing when she suffered life-threatening complications which needed specialist treatment at Mzuzu Central Hospital (MCH).
“We were told to foot the cost of transportation because the health centre had no boat ambulance. We couldn’t even wait for MV Ilala, a ship which travels once a week. It was an emergency,” Banda explained.
The poor family hired a boat to Usisya, where they would connect to Mzuzu by road.
“We spent all day looking for K15 000 for the boat in various village banks. We departed for Usisya around 11pm and arrived around 1am,” he recalls.
Unfortunately, they had to wait nine hours for an ambulance from Mzuzu, over 60 kilometres away.
“It arrived around 8am and the pregnant woman arrived at MCH very weak. It was too little too late. We lost both the mother and the unborn,” remembers Ngwira.
Khondowe Health Centre nurse and midwife Lupakisko Mkweche says poor transport and phone networks endanger lives of patients and pregnant women.
“We have problems to connect with referral hospitals when we need an ambulance to be on standby at Usisya,” she says.
According to Mkweche, pregnant women constitute almost 30 percent of clients referred to MCH.
For the past three years, four women had stillbirths due to delays caused by poor transport.
“Due to transport problems, most pregnant women referred to higher hospitals end up with stillbirths and fistula,” she explains.
Nowadays, she advises pregnant women to move closer to MCH or Nkhata Bay District Hospital before they are due for delivery.
“We are afraid of losing them. With transport challenges, it would be disastrous when there are complications,” says Mkweche.
Poverty forces constrained women to deliver at Khondowe.
Mkweche says government needs to address transport challenges by offering the remote community a boat ambulance.
“We also need phone networks to quickly communicate with referral hospitals in case of emergencies,” she says.
Sub-Traditional Authority (S-T/A) Kondowe asked for a better road to connect Mlowe and Usisya. This will wean people from slow and unsafe water travels.
According to Malawi Health Equity Network (Mhen) executive director George Jobe, the deadly gaps in Nkhata Bay North constitute a wake-up call for government to revisit its investment in the healthcare sector.
“When planning for health, especially ambulances, government and district councils should not use the one size-fits-all procedure because places along the lake need boat ambulances,” he says.
Jobe is concerned that Malawians in hard-to-reach areas, where quality health services are scarce, are denied the life-saving interventions by government.
“In case of outbreaks, such areas may also be heavily affected,” he says.
Interestingly, Ministry of Health (MoH) spokesperson Adrian Chikumbe says government is aware that some populations in tricky terrains remain marginalised and excluded.
The Malawi Health Sector Strategic Plan II (2017-2021) promotes universal health coverage as advocated for by the United Nations.
“With decentralisation, district councils are empowered to realign their priorities with the strategic plan. Wherever resources allow, the Ministry of Health will continue to support needy councils in areas that need huge funding allocation,” says Chikumbe
Nkhata Bay district health office spokesperson Christopher Singini says the district has a rundown boat that operates between Ruarwe and Khondowe to refer cases to Usisya.
“We have allocated some funds to repair it,” he says. “Even if the boat were operational, the district would need more support to address challenges in referring cases from the lakeshore areas.”
There is no boat ambulance operating between Usisya and Nkhata Bay.
“We need a bigger boat for that stretch because it is a long a distance,” says Singini.
There is an overland ambulance which operates between Usisya and Mzuzu in the dry season only.
The district health office suspends the ambulance during rainy periods because the tricky earth road is muddy and dangerous.
“We really need a boat ambulance to operate from Usisya during rainy days,” says Singini.
Ngwira and his neighbours want a break from digging graves for the pregnant women dying due to the long wait for safer transport alternatives becomes a depressing song—dirges. n