Chisi Island on Lake Chilwa is home to over 5 000 Malawians who have to board canoes to access social services across the waters. EPHRAIM NYONDO visited the island and explores the challenge of maternal health in the area.
One needs K400 to pay for a canoe and sail from the sprawling Kachulu Beach to Chisi Island on Lake Chilwa.
Being an inland lake, the waters are dark, smelly and unsafe. On a windy day, the fury of the waves sways the canoe.
“Sailing during the night is more challenging. The waves are usually strong and, just a few weeks ago, we lost two people after their canoe, which carried 15 people, capsized due to waves,” says, John Muliya, one of the boys whose business is to ferry people across the waters.
According to Davison Liimbe, a health surveillance assistant (HSA) on the island, a pregnant woman from Ntchelero, one of the 17 villages in Chisi under Traditional Authority (T/A) Nkumbira, started experiencing labour pains one afternoon.
“She was then brought to the clinic,” he says.
Chisi has one health centre. It does not have a resident nurse. Nurses exchange after serving for a month. But there is a local woman who volunteers as a mid-wife in cases where a nurse has left and the other has not yet arrived.
Fortunately, says Liimbe, there was a nurse the day the woman in labour came through.
“The problem is that we do not have space at our health centre for pregnant women to wait for their due time. As a result, they wait at their homes. This means pregnant women are forced to walk miles or hire bicycles to the health centre when their time is due,” says Liimbe.
It is a small health centre with three rooms: the registration room, treatment room and a small room where patients rest. These rooms are so close that discussions in one room are heard in the other. Thus, the question of privacy while giving birth at this health centre is non-existent.
“Looking at her condition, the nurse could not let her return home. As such, she was made to wait in the room where patients rest after treatment,” he says.
The woman came with three relations, including her sister Loveness Chapola.
Chapola says they waited outside until the sun set.
“As we stood waiting, we saw a number of patients waiting outside because the waiting room was occupied by my sister,” she says.
At around seven o’clock, continues Chapola, the nurses came and helped the woman deliver a baby boy, but her journey was not over.
“The nurse surprised us when she said our relation had twins, but the other baby was failing to come out. She said we need to rush with her to Matawale Health Centre in Zomba for help,” she says.
Dazed, Chapola’s fears were not the 30-kilometre journey from Kachulu Beach to Matawale, whose road is narrow and bumpy. Rather, it was the 30-minute sail from Chisi Island to Kachulu.
“My first question was: Where, at this hour, do we find a canoe? Even if we find it, how safe is it being a windy night, which increases the waves?” she says.
After hours of questions and searching, they found a canoe.
“The winds that night were not too violent. In the middle of the sail, my sister started to sob in pain. We travelled without the nurse because we were told the ambulance from Matawale would come with a nurse. We started helping her while the canoe continued to wobble on the waves to Kachulu,” she says.
Chapola says when they finally reached Kachulu, the baby had been born, but it only survived a few minutes.
After the incident, they sat at Kachulu Beach waiting for the ambulance. Worried that hours were passing with the new mother crying in pain, they informed the nurse at Chisi Health Centre who advised them to return there.
“So we sailed back and my sister got post-natal treatment at the health centre,” she says.
According to Liimbe, stories of pregnant women giving birth in canoes, and sometimes dying in their homes, are common on the island.
“This is a small island that should not be witnessing these challenges. What we need is a maternal waiting ward and, at least, an engine boat to connect us to better health centres in cases where they is a referral,” says Liimbe.
In terms on internal travels, adds Liimbe, people here have their own methods; for instance, using bicycles and carts, to ferry pregnant women to the health centre in time.
The Women’s Legal Resource Centre (Wolrec), with support from Tilitonse Fund, is implementing a project on the island aimed at sensitising local people to demand redress from government through local leaders such as chiefs and development committees.
Wolrec programme officer Gift Mauluka says local people need to be aware of their rights and should be able to demand them.
“What we do is to challenge the people to understand that they have a right to good health. However, these rights need to be demanded because, if they do not do that, they cannot enjoy them,” he says.
As part of the project, Wolrec has advised people to mould bricks and, then, ask government to help them construct a maternal waiting ward.
The organisation has also called on the chiefs to regularly meet officials at district level such as their district commissioner.
Mauluka advised the villagers that they have a right to hold peaceful demonstrations should their demand for rights are not met. Through the project, which is being implemented by Worlec and Youth Net and Counselling (Yoneco), the capacity of community members to demand essential public services from duty bearers in Zomba and Phalombe districts has been enhanced.
Malawi is still struggling to reduce maternal deaths. According to the 2010 Demographic and Health Survey (DHS), 675 out of 100 000 women die while giving birth in the country