Pontoon boat.
The only way to cross the Kafue River to get to Chiawa is by a pontoon ferry

Zambia elections 2011: Making health a priority

The Zambia general elections will be held on 20 September to elect a president and representatives to the National Assembly. Civil society organizations in Zambia have identified the elections as an opportunity to ensure key health issues are a priority during the upcoming elections. This has been done successfully in various African countries, most recently in Malawi.

Chiawa Rural Health Center

Chiawa district lies between two mighty African rivers – the Kafue and the Zambezi. The village overlooks the banks of the Zambezi, with Zimbabwe visible on the other side of the water. A small herd of elephants graze at the riverside, buried up to their massive tusks in lush greenery. This may sound like an African idyll but life is hard in Chiawa.

The elephants often destroy the villagers’ crops and vegetable gardens and when the floodgates of Lake Kariba are opened, their fields are submerged and their harvests lost. For subsistence farmers losing a crop means going hungry until the next harvest, leaving few resources to spare when an overburdened health system cannot help them.

Giving birth can be deadly

Mary Sakala is the headwoman of Chimanga Village in Chiawa. “I am responsible for the wellbeing of all 105 households in my village, and I am really not happy with the health center because they don’t have enough medicine or staff,” she says. “There is just a nurse and a clinic officer and they have to go all the way into Kafue each month to collect their salary, which means they are away for 4 days. If someone is sick in that time, then we have a problem. Recently a woman gave birth when the staff were away, and then started hemorrhaging while she walked to Chirundu, which is our nearest town, 36 km away. There is no transport and no taxis in this area. She died.”

Getting to and from Chiawa is no easy feat. The only way to cross the Kafue River is by a pontoon bridge, designed to float cars and trucks across the water (and this is one place where the term “crocodile infested” is not hyperbole). Villagers can hitch a ride on the pontoon ferry for free, but it only crosses when transporting a vehicle that can pay the 68,000 Kwacha (US $14) fee. Sometimes a truck can be hired from a neighboring area but that costs about 70,000 Kwacha (US $14.50), in addition to the pontoon fee.

“Last night we were lucky,” explains Sakala. “A 19-year-old woman gave birth but then she started having hallucinations. The clinic here didn’t have the means to help her so we had to get her to the hospital in Chirundu. But we have no cars or buses here as we are far from town. The clinic staff walked to the main road and managed to flag down a car. That driver was kind, and he came to the village to fetch the woman and then drove her to the hospital. That was very lucky because not many cars use that road and most people who drive by don’t stop.”

“Our MP is useless”

The government recently abolished user fees in rural Zambia in an attempt to ensure more people could access health services. Unfortunately the Treasury did not allocate additional budget to make up this shortfall.

“They may have scrapped user fees,” exclaims Sakala, “but it makes no difference: they didn’t have medicine before and they don’t have it now. The only change is that now you don’t pay to go to the clinic, and only then find out they have no medicine to give you. As an elderly woman it was difficult for me to pay that fee.”

Sakala feels ambivalent about the upcoming general elections. “Our MP is useless. He made promises to get us to vote for him, but he hasn’t done anything for us. Our politicians only come here when they want our votes.”

Not enough essential drugs

Rosemary Chimwanga, midwife and nurse at Chiawa Rural Health Center, cares for five-year-old Zezai Gubo.

Rosmary Chimwanga, midwife and nurse at Chiawa Rural Health Center, has worked for the Zambian Ministry of Health for 24 years. She says the system is deteriorating.

“It is getting worse in all ways. Firstly, we don’t have enough essential drugs or antiseptics. They deliver drug kits but often items are missing. Up until 2005 we used to get everything we needed in those kits. But this morning I delivered a baby and didn’t even have basics like cotton wool. I’ve spent the last three years working in a teaching hospital in Lusaka but now that I am back in a rural health center I can really notice this problem. We don’t get the injectables we need, such as Diazepam. When I had a patient who was convulsing I had to give her the drug in tablet form which causes a delay in response.”

As we talk there is a disturbance from the nearby ward, where Zezai Gubo (5) has been admitted with cerebral malaria. She is having convulsions and has ripped the drip out of her arm. Chimwanga moves quickly to soothe the child and calm her mother, but has no gauze or cotton wool to wipe up the blood oozing from around the drip needle. She has no choice but to wipe it with a cloth, something she feels is unhygienic and unprofessional.

“Secondly, we don’t always get the money to maintain and keep the clinic clean so we can’t buy things like Cobra [floor polish] and Jik [bleach]. We used to spend the user fees to buy those cleaning supplies. The scrapping of user fees has led to us seeing an increase in the number of patients but the budget is the same. In fact, sometimes they even reduce the budget when they run short of funds. We have two wards here but we can’t admit patients overnight as we have no budget to feed them. This is a problem because we do have patients who should be admitted because the hospital is far away and transport is expensive.”

How to get nurses to work in remote areas? Running water would be a start

Chimwanga explains that is very difficult to get young nurses to work in a rural health center where there is no electricity and no running water, and very little in the way of recreation or social activities. “We need to train and hire nurses who have a passion for rural health,” she says, “but we also need to ensure we provide more incentives to retain staff. I am not just talking about allowances for working in remote areas, but also incentives like running water and a flush toilet. There is no bank here, so I have to go into town each month to get my salary, and that also costs me money.”

The clinic and its staff and patients rely on a nearby borehole for water and pit latrines for sanitation. The latrines are, of necessity, situated a slight distance away and a trip to the bathroom during the night can be dangerous, with elephants and hippos and grazing in the area which is close to the river. It is easy to see why young nurses might be reluctant to give up the comforts of city life.

“When I deliver babies I put water in a bucket and have to wash my hands in that between deliveries. Running water is the kind of incentive rural health workers need.”

Text and photos: Nicole Johnston/Oxfam

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On the Global Health Check blog: Making free health care work for all Zambians: will this election deliver?

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