Nyamithuthu is about 30 km north of Nsanje, 5 to 7 km from Tengani. It sits on the side of a dirt road after we turned off from the tarmac. Because it is close to Mozambique, like Ndamera, it was probably built by UNHCR for the Mozambican refugees as a result of decades of civil war.
The buildings were solidly built of red bricks but because of the lack of maintenance the wooden beams holding the roof are rotten in many places, eaten away by the termites. Before long this will not be a safe place for anyone.
The first section of the building is used by the outpatient department (OPD) which is closed today. It has a consultation room, an exam/dressing room and a pharmacy in addition to the open waiting area, and a public health room. The second building houses the HIV testing room, ART room where HIV patients are seen, an open waiting room and the Antenatal Clinic (ANC) which is also the Antenatal/Labor and Delivery/Postnatal Ward with a total of three beds. Like Tengani, the light fixtures are mostly gone except that each room runs on one florescent lamp, the last one for each room. The sinks all have a problem, no faucet or drain pipe, a bucket is used to hold the waste water. Outside a tap is leaking very severely, clean water is all wasted. All windows have broken screens and some are missing window panes. The walls and doors of the latrines are also broken and no longer in use.
The Maternity Ward is being fixed and that is why the ANC Clinic is used for maternity at the moment. The roof and the beam supports of the Maternity Ward were rotten and infested with snakes and now it has a new roof. Unfortunately work on the ward has been halted and the ANC Clinic is filled with beds for all maternity care.
The nurse was the sole healthcare provider for ANC, OPD and ART when we arrived. The Medical Assistant was out for some kind of training. Because this was a follow-up visit day for the pregnant women, she was able to quickly see them all. She then had to run to the OPD to see the patients leaving the ART patients waiting. My mentors began to see patients at the ART Clinic so they would not have to wait for her. It was not ideal but we were able to have her back for mentoring after she finished with her OPD Clinic.
The large tent funded by UNICEF was used for cholera outbreak two years ago. It still has remnants of the makeshift beds with a hole in the center and instructions for fluid resuscitation. Outside the health center, there was a leaking faucet, precious water streaming out of it at a furious pace forming a large stream overflowing the drain spilling over to the ground.
Again my national companion commented as we were leaving Nyamithuthu, "Maintenance is always the big problem and MSF can’t fix everything.”