Today marks exactly one month after I left home. Since I have so many briefings and materials thrown at me, I feel I am still learning and with fourteen health facilities to cover, I have not visited them all. There is nothing much to do in Nsanje so I took a long walk alone along the Shire River into the farms this past Saturday afternoon, bringing a folded umbrella with me just in case I chanced upon a crocodile. A few words of greetings in Chichewa seemed to bring up smiles from the locals and enthusiastic response. Many women were doing their laundry the hard way on the banks and drying them on the rocks. Water hyacinths glided swiftly with the currents.
Lulwe Health Center is to the south-west part of the tip of Nsanje and is situated high up on the mountains, also called “a difficult to reach area”. The cruiser had to climb steeply at some spots over rocky terrain. Lulwe belongs to CHAM (Christian Health Alliance of Malawi) and charges a fee at the clinic. As with centers that charge a fee, it is clean and better maintained. A mid-wife at the Ministry of Health Makhanga Health Centre in the East Bank, the health center that smelled of bat guano, wished that his center could also charge a small fee so they could use the funds for maintenance. However he knew that none of the politicians would agree lest they were voted out of office.
A woman who gave birth to her ninth baby three days ago at Nsanje District Hospital, her last because she had her tubes tied, hitched a ride with us. Some of her older children were already married. She was sitting on the ground at the hospital gate and when she learned she could ride with us, she gathered her belongings tied up in a bundle, her basin and her swaddling baby and ran with such energy you would not think she just had a baby. One wondered how she was going to make her way home up the mountains in Lulwe 40 km away.
Lulwe nestles on the slope of the hills with more mountains in the distance and Nsanje sits in the hazy, flat, hot valley. Mozambique is just a stone’s throw away. This is a small center with few patients, a very civilized pace. It has the necessary maternity unit where a woman just gave birth this morning. Being up in the mountains and cooler in temperature, all the babies here wear a warm knitted hat.
A thirty-year-old man started taking HIV medications a year ago and his weight went from 42 kg to 70 kg in a matter of months. However recently, he developed a cough and his weight has slowly decreased to 56 kg. The health center treated him with some antibiotics but there was no improvement. He had a sputum sample that did not show TB, a second sputum had not been obtained. The next facility is Nsanje District Hospital, far away from here at least on foot. That is where he could get a chest x-ray, yet the Gene-xpert machine (a special machine to test his sputum for TB) was out of commission at the time. I asked the HIV/TB integration service person to look into his case. I was told that the national guideline frowns upon empiric treatment [starting treatment before a firm diagnosis is obtained.]
An eight-year-old boy with wide-open eyes could not take his gaze off me; evidently he had not seen a foreigner before. He was sick a few months ago with fever and diarrhea and his mother brought him to Mozambique to see “an African doctor” or a traditional healer. Apparently he was cut in the arms with a razor blade by the healer but continued to do poorly. At Nsanje District Hospital he tested positive for HIV but his mother was negative. He started on HIV medications after his diagnosis. Today they retested him and again he was positive. Did he get his HIV infection through the use of an infected razor? He was started on HIV drugs a few months ago but failed to return for refills till today .
In the afternoon we left the remote but temperate Lulwe heading to the hot valley of Nsanje.