Reaching the Last Mile: Health Delivery on Mazongozi Island, Malawi
Have you ever thought about living in an area which is 30 kilometers away from the nearest health facility? Have you ever thought about living in the hardest to reach areas across the world — on islands, up hills, and beyond roads where vehicles cannot go? Have you ever imagined living in an area with no electricity and perhaps not even a borehole for drinking water? For many of us who live in cities, towns, and other urban places, we can’t imagine this in any real way. Some of us are so privileged that we sometimes even choose to neglect services that are available to us for various reasons.
When I joined the public health sector in 2015, I was privileged to work with Blantyre Institute for Community Outreach (BICO), a local eye health nongovernmental organization (NGO) in Malawi. I had a chance to travel to a lot of places throughout the country as we were doing research, and one place that left an impression is Chitsa village on Mazongozi Island in Chikwawa district in the southern part of Malawi. Mazongozi, surrounded by the Shire River and its subsidiary rivers, is a group village headman with 11 villages under it. It is under the traditional authority of Makhuwira in the district.
We traveled to Mazongozi via water, using a dug canoe, locally known as “ngalawa.” On the way there, I thought about all that I had heard about the island and tried to ignore my fear of water. As it was my first time to travel on water, it was not easy. The journey of fewer than 10 minutes was full of prayers and screaming, but we finally crossed the Shire River from a village around Nchalo Trading Centre to Chitsa village.
The land at Chitsa is fertile and there is a lot of food. This is likely one of the major reasons why the settlers do not want to leave, despite their lives being in jeopardy from the frequent floods in the district. The residents live in two types of houses —during dry season, they live in houses built with brick foundations. During the flood season, they move into suspended houses built with a permanent wood foundation and reeds.
It is not easy to access education at Mazongozi, as there is only one primary school on this island. The school only has classes up to seventh grade, and, as such, children on this island can only study up to seventh grade. Those privileged to have a relative living elsewhere usually take advantage of the connection to further their studies. There are very few available healthcare services, and the local system is not equipped to deal with an outbreak or a serious emergency. Access to clean water and sanitation systems is another challenge on the island, as there is not even a single borehole. People drink from unprotected dug wells. If you asked for water to drink, you would surely be surprised by its color. Only about 20% of the households that were visited in June 2017 in Mazongozi had functional pit latrines.
Accessibility to the mainland is also a challenge, but one with a potential solution. The width of the river we crossed to get there is between 30–50 metres, and a bridge would greatly increase ease of passage there. However, constructing a bridge is not a popular idea. It would mean eliminating the source of income for the canoe operators who make around MK50.00 per individual and give a share of these profits to the village chief.
As a Global Health Corps fellow, I am working towards the objective of building the movement for health equity around the globe, so I am very concerned with social justice. We have made a lot of progress in access to basic social services in some areas of Malawi, but thinking of Chitsa makes me realize there is still a lot of work we need to do to eliminate disparities.
“It is the responsibility of every citizen to take part in the development of his or her own community, and to play his or her part to protect and uphold others’ rights.”
We need to work to ensure that national and local policies promote equity, and we need to think about how we can sensitize residents and local leaders to consider the possible long term benefits of building a bridge. We also need to educate rural Malawians so they are aware of their rights and the possibilities for creating change within their own communities. It is the responsibility of every citizen to take part in the development of his or her own community, and to play his or her part to protect and uphold others’ rights. Access to health and education are not just human rights, but they are needs for every human. Let us act accordingly.
Mumderanji Balakasi is a 2017–2018 Global Health Corps fellow in Malawi.
