Cyclone halts health services in Phalombe district

Every health facility guarantees its surrounding population access to quality treatment and care within reach, but Gladys Enoch returned home gutted on a stormy Friday when her baby was hit by high fever.

The woman with a feverish one-year-old baby on her back could not hide frustration as she exited the Phalombe Health Centre, which was flooded after Cyclone Freddy hit the district on Monday, March 13 2023.

"I came here because my son  Honest's body temperature rose dramatically the previous night and he has been shivering and vomiting, but we are going home without any assistance. The health centre has been closed due to severe destruction caused by flooding," she narrated, calming the weeping baby.

Gladys's frustration mirrors the plight of about 52,000 who depend on the devastated health facility, where volunteers from surrounding communities were seen clearing the knee-high silt using shovels, hoes and wheelbarrows. 

Nearly six health centres in Phalombe, a southwestern district along Malawi's border with Mozambique, were hit hard by the rainstorm, floods and mudslides.

The muddy flood soaked and silted all rooms alongside medicines, patient's files, furniture as well as resident health workers' homes.

The facility was closed indefinitely two days after the tragedy struck on Sunday around 3 AM.

This has left the old Phalombe district hospital deserted with just a security guard watching over the soaked remains in mud-filled rooms and a senior health surveillance assistant  signposting to the nearest healthcare centres.

Now desperate clients like Gladys endure extra costs to travel about five kilometre to Holy Family Catholic Hospital where those without referral letters pay or make a 15 km trip to the new Phalombe Hospital at Migowi Trading Centre. A return trip to the latter destination costs about MWK 3,000, enough to buy three meals for her family of five.

Gladys lamented: "People here are suffering untold hardship due to the disruption of health services by severe floods and mudslides that followed three days of relentless heavy rains. 

"With no health workers and medicines in sight, I have to make the hard choice between buying un-prescribed medicine from a local drugstore or going to the distant hospital. Either way, I have to spend the money that I can use to feed my family." 

The path of destruction is vivid at the hospital ripped by murky floodwater following severe flash floods and mudslides from a neighbouring hillside that wiped out people, homes, crops, livestock and invaluable goods in Bokosi Village at its foot.

The misfortune left the health workers overwhelmed by dead and injured persons from disaster zones and a certainty to temporarily close the facility because the environment is no longer favourable for their lifesaving work, says Director of Health and Social Services Dr Sam Sibakwe.

"Had you come on a normal working day, you would have found 100 to 150 people waiting for care in the outpatients' department, no less than 10 pregnant women waiting to give birth in the labour ward, five to 10 with newborns on their beds, some 200 people waiting to receive HIV treatment and 70 women with children aged below five waiting to get routine vaccination and nutrition screening. But all this suddenly stopped when Cyclone Freddy struck the facility," says the district's top medical doctor.

According to Sibakwe, the busy health facility serves more than 50,000 people in the vicinity, including the worst-hit Bokosi, where mudslides from nearby mountain ripped homes in its way.

"The devastation was terrifying and all services have been disrupted because the floodwater, debris and mud from the mountain destroyed everything, including essential drugs and medical supplies. Even the health workers are traumatised having lost their property, suffered injuries and been displaced by the floods," he said.

The halting of healthcare delivery has pushed patients and pregnant women into financial hardship due to long travels to nearest facilities and medical bills outside the public healthcare system.

"We have a service-level agreement with Holy Family Mission Hospital, but our patients require a referral letter to get assisted free of charge. Sadly, the health workers who issue, sign and stamp the letters are not available because their houses are no longer habitable," he says.

The financial distress is visible as the security guard and community health worker send back about 35 people a day, mostly those who cannot afford the travel and medical costs elsewhere.

According to Sibakwe, children aged below five are highly affected due to disruptions in routine immunization, nutrition checkups and other services offered in these specialised clinics. 

"We are under pressure to reopen the health centre, but it will not be easy. This is a daunting task and the price is huge. We have to clear the debris, renovate the buildings and procure new furniture and replenish medicines and medical supplies," he says.

The loss and damage has been worsened by thieves who looted doors, frames, mattresses, trolleys, buckets and other supplies.

To mitigate what could become a long wait for restored services if not urgently supported, Sibakwe appealed for urgent assistance to launch mobile clinics that bring services closer to affected communities.

Health services have been paralysed, so we call on partners to support us to provide mobile and static clinics close to affected communities. We need more clinicians, nurses, community health workers, vehicles, fuel and medical supplies so we can go to places hit hard by the disruptions caused by the cyclone," he says.

And Gladys can only hope her most trusted and accessible health facility will reopen sooner than later.

"The longer the reopening of the facility, the more people will die of treatable diseases at home, the more pregnant women will give birth without the help of skilled hands and children will miss on vaccines that protect them from deadly diseases prevented by immunisation. We need urgent support so we can continue to get vital health services within reach, not after the long and costly trips."

In response to the damage caused by Cyclone Freddy, UNICEF has supported the Ministry of health with mobile clinics and transport for health workers to help them reach vulnerable communities with health services.