Likoma’s referral system on deathbed

Death in itself is a painful experience. But death of a 12-year-old person is even more painful, particularly if it happens in circumstances that could be avoided.

People of Chiwoko Village in Traditional Authority (T/A) Mkumpha on Likoma Island live in pain. Just a fortnight ago, they watched a 12 year-old boy, who fell from a tree wailing in deep pain. He died while on referral to Nkhata Bay Hospital from St Peter’s Mission Hospital on the island.

“As a hospital, we tried to save the boy from death, but lack of a proper referral system let us down,” says Likoma District Health Officer Dr David Sibale.

According to the deceased’s father, Cassim Mashapata, the boy fell off from a tree, around 3pm on October 22 and was immediately taken to St Peter’s Mission Hospital. However, due to the severity of the fracture, the hospital referred him to Nkhata Bay Hospital.

Unfortunately, when they reached Jalo, the departure point for MV Ilala on Likoma, the ship had just left for Nkhata Bay Port.

“We tried to persuade the Ilala crew to return and collect the boy. However, our request only hit a snag. The crew said they are not allowed to return once they have started off,” explains Sibale.

He adds that they arranged a private boat to carry the patient and catch up with the ship at Chizumulu. At around 6pm, says Mashapata, the journey continued from Chizumulu towards Nkhata Bay, but the MV Ilala, which has become too old for the lake voyages proved unreliable for emergencies.

Sibale says while on the cruise, they realised the deceased was becoming more breathless and gasping.

“At this stage, he required oxygen, but there are no portable oxygen concentrator machines in Likoma. He also required suctioning out secretions, but it was not possible due to lack of a suction machine,” says the DHO.

It was a painful moment for Mashapata to see his son dying just metres away from Nkhata Bay Port.

“We found an ambulance ready to pick the dead body to the Nkhata Bay Hospital mortuary,” said Mashapata amid tears.

The boy’s incident mirrors the challenges people living along the lakeshore and on islands go through during referrals to district hospitals.

Sibale says Likoma only refers about three cases to Nkhata Bay Hospital every week and they continue to experience such incidents.

Away from Likoma, last week, another boy from Chizumulu Island also died on the way to Nkhata Bay Hospital on referral after doctors suspected he had an internal bleeding, having fallen from a mango tree.

The Nation has also established that people living on islands struggle to ferry  dead bodies to the islands from mainland. The readily available private boats cost as much as K450 000.

Searching for answers

Sibale says the Anglican Church on Likoma has a speed boat, but lack of resources to meet the costs of hiring derails the island’s ambition to save every life on referral.

“We are suggesting having an independent trust fund to be used during emergencies and in the long run buying the DHO’s office a speed boat. There is also need to equip St Peter’s Hospital with an X-ray machine besides equipping the laboratory,” says Sibale.

He adds that they are working on improving staff and ensure that review meetings are held periodically to assess the effectiveness of the referral system from time to time.

Recently, Red Cross Society of Malawi bought a speed boat to be used for emergencies on Chizumulu and Likoma islands, but Sibale says: “We have no information on how that boat is supposed to operate here.”

MV Ilala Captain Daniel Ngwira says the locals should not bank their hopes on the ship for emergency referrals because “it is not for emergencies, but a passenger vessel.”

“Unless there is a victim on sight, that’s when we are allowed to intervene,” says Ngwira.

Locals believe that the island has all these problems because Likoma does not have a district hospital as St Peter’s is regarded a community hospital.

In the face of these problems, islander Harry Utonga proposes upgrading the mission hospital or construction of a district hospital.

Ministry of Health spokesperson Adrian Chikumbe admits the referral challenges and says there is need to strengthen and sustain the referral system between Nkhata Bay and Likoma, including all those cut off from the mainland by water. He, however, laments poor funding.

“The ministry had a water ambulance, but I don’t know if it is still functional because it is quite costly to travel between Likoma and Nkhata Bay. However, it is government’s wish to make sure that everybody else is served regardless of where they are, but we are constrained at the moment in funding,” he says.

Chikumbe says for an area to have a district hospital, a number of factors are looked into and these include population and distance to the next hospital. However, he says low funding levels could also be a setback in making sure that the area has a district hospital. n