Malawian healthcare workers are facing challenges from all sides. More than half of healthcare facilities in Malawi are without handwashing facilities, almost two thirds have no decent toilets and almost one fifth do not have clean water on site.
With cases of Covid-19 in the country continuing throughout the year, staff are working through the pandemic without a basic first line of defence against infection.
For midwives and those involved in maternity care, this absence is frightening. Without water, toilets and soap, health centres, the very places which are supposed to keep mums and babies well, become breeding grounds for the rapid spread of infectious diseases.
Globally, one million mothers and new-born babies die from infections soon after birth each year. This is a tragedy that could easily be prevented with something so simple – soap and water.
In the run up to this year’s three-day World Health Assembly, which is scheduled to end May 26 in Geneva, WaterAid spoke to health workers, patients and families in about the challenges of keeping mums and babies safe in this environment.
Ntchisi is a rural district in the central region of Malawi. There are four health care centres: Ntchisi District Hospital as well as Kangolwa, Mkunzi and Khuwi health centres.
None have adequate water, sanitation or hygiene facilities. Mothers and babies are at risk of catching and spreading infectious diseases – and staff are struggling to keep the environment clean.
WaterAid and the Wimbledon Foundation are working together to bring clean water, decent sanitation and good hygiene to these four healthcare facilities in the Ntchisi District – a change which will impact 300,000 people.
But there are almost 2 billion people being put at risk every day across the world, because they go to work or seek care at a hospital or clinic without these fundamental services.
Chrissy, a health attendant at Khuwi Health Centre, has to collect water four times a day from community boreholes, 300m away from the health centre. The boreholes are crowded, and she has to either spend time queueing, or fight her way to the front of the line, explaining that it is for the health centre.
She worries that when she leaves the hospital to do this, she is leaving her colleague (one nurse midwife) alone to look after a number of mothers and babies. This means that some are left on their own, and at times when both the baby and the mother require urgent care, one or the other loses out. On any maternity ward, any moment can be critical.
She said: “The time we leave the hospital to fetch water can literally mean the difference between life or death for women and babies.”
Even though the health centre staff know how important handwashing is as a first line of defence against Covid-19 and other infectious diseases, there simply isn’t enough water to make this happen, or to keep the surfaces clean in the hospital.
Chrissy said: “…during this time of COVID-19, we have been trying our best to make sure that water is available for people to wash their hands before getting any medical attention, but we just can’t keep up with the huge number of people. It is important to keep the surfaces of the hospital clean so that we don’t become a conduit of spreading the virus.”
Khuwi Health Centre attracts a lot of people due to its location, alongside the main tarmac road to Ntchisi District. But the centre bears the scars of somewhere that has, for a long time, struggled with water, hygiene and sanitation issues.
In the maternity ward, women who have no other way to clean themselves once they have delivered a baby have resorted to cutting away pieces of the mattresses (there are only two) and using these pieces as sanitary pads.
Kangolwa Health Centre’s busy labour ward, not far from Khuwi, delivers 40-60 babies every month. Unfortunately, there is only one working toilet for the entire labour ward and this is often blocked. Only one woman can wash in the bathroom each day as it fills up with water and blood.
Some mothers are asked to walk to the other side of the health centre to use a shared bathroom for relatives who are caring for patients at the hospital. This bathroom is often blocked too.
Steria, community midwife at Kangolwa Health Centre says: “Imagine asking a woman who has just given birth to walk all the way to the other side of this facility with blood dripping all the way. “It is heart-breaking, but we just don’t have any other options.”
Loveness’s one day old grandson was born at another healthcare centre in the region. To help her daughter recover, Loveness wants to prepare food and drinking water for her at the health centre’s kitchen but without clean water nearby, this is difficult.
She said: “For the past three days, we have had challenges accessing water. Especially here at the kitchen, there is no running water. “Imagine having to walk several times in a day to fetch water not just for drinking, cleaning plates, pots and others eating utensils not forgetting water for bathing and cooking for both myself and my daughter, but also fetching water for everyone who is here at the hospital.It is not easy.”
One in three healthcare facilities globally do not have readily available access to handwashing facilities and almost half of healthcare facilities in the world’s poorest countries have no clean water. Without these bare essentials, new-born babies are needlessly at risk from infections and diseases.
Community midwife technician Eunice is adamant that hospitals without running water and decent hygiene pose a threat to public health: “We need thorough handwashing in our line of duty. With no water, we can’t wash our hands. We are at great risk as health workers, not forgetting the patients we have to attend to. “Instead of patients getting help from this clinic, they are getting infections. Simply because we have no running water. “Water is life. Without it, we are doomed.”
Data shows that globally, a staggering 1.8 billion people are at greater risk of contracting COVID-19 and other diseases, simply because they use or work in a healthcare facility which lacks basic water services. In the twenty first century this simply shouldn’t be and needn’t be the case.
Last December the WHO estimated that to bring clean water, handwashing facilities and decent toilets to the health care centres in the poorest countries would cost just $3.6billion – which equates to around an hour and a half’s worth of what the whole world spent in a year on the Covid-19 response.
It’s time to make this investment.
*Dennis Lupenga is Voices from the Field Officer at WaterAid, based in Lilongwe, Malawi.