"The journey continues," Gilford Mphugela said, sinking back into the driver seat of the Toyota Land Cruiser. He had spent the past 75 minutes skillfully navigating treacherous mountain roads, where torrential rains had cut deep ruts that threatened to swallow the truck’s wheels. The six Partners In Health and Malawian Ministry of Health (MOH) employees crammed in the back of the vehicle cracked jokes and shared laughs along the way, but when the vehicle tilted or the tires spun on a steep incline, everyone held their breath. In the weeks prior—during the peak of Malawi’s rainy season—the vehicle had gotten stuck several times on this same road and the team had to turn back. But today was hot and dry, ideal for the Nsambe mobile clinic to reach patients in Chawe, among the most remote regions PIH works in Malawi.
Before reaching Chawe, though, we had to make a pit stop at a small health facility run by the MOH and Christian Health Association of Malawi (CHAM). Here we picked up Elias Issack Okhoma, a health surveillance assistant working with the MOH. He piled a few boxes of vaccines into the back of the truck then wedged his way into the last remaining seat. The journey continued, as Mphugela promised, across another bumpy stretch. Mphugela worked the clutch as the truck climbed the winding path, his feet dancing across the pedals with the grace of a NASCAR driver. He pointed out the window toward a lush range of mountains, noting that we were near the border of Mozambique. A few huts specked the ridgeline, otherwise brush and tall grass dominated the landscape in every direction.
After another 20 minutes, a small hollowed-out brick building came into sight. Outside, a crowd of approximately 200 mothers and children milled about. As the truck rolled to a stop, everyone merged into a snaking line. The team unloaded the truck and swiftly set up shop in the building. Inside, each member of the mobile clinic was responsible for a small station serving a very specific function, from patient registration to vaccine administration to HIV testing and counseling.
“Our mobile clinics are designed to offer general consultation for all type of diseases in adults: antenatal services for pregnant women; immunization and growth monitoring for children under 5; family planning for women of childbearing age; HIV testing and counseling; malaria rapid test; and typhoid rapid test,” explains PIH/APZU Clinical Director Dr. Junior Bazile.
Aaron Mapwelemwe, a PIH/APZU pharmacy assistant, provides antimalarial medication to a mother and her child at the mobile clinic in Chawe, Malawi. In the rainy season, cases of malaria soar.
PIH’s Malawian sister organization began running the current version of the mobile clinic to Chawe at the end of October 2013. While there is the small health facility operated by CHAM and the MOH in the region, not all patients can reach it or afford the nominal consultation fees—200 Malawian Kwacha (approximately 50 U.S. cents). Though it’s a small sum, it could mean the difference between receiving health care for the poorest and most marginalized patients.
The mobile clinic to Chawe, which goes out every Tuesday, is always a mix of PIH and MOH employees. It has helped deliver care to more than 2,100 patients since it began operating at the end of October 2013. “Partnering with MOH has been key. Because we are here to support and supplement the MOH, we want them to take the lead in such activities and we can help in identifying, filling, and fixing the gaps,” Bazile says.
The mobile clinic has helped deliver care to more than 2,100 patients since it began operating at the end of October 2013.
Mobile clinics are only one part of the primary health care services to which all Malawians are entitled. They complement our strategic objectives of delivering health care, accompaniment, and socio-economic support to people in their communities and providing technical and financial assistance to MOH. They help link other active case-finding efforts carried out by village health workers and clinicians to the Neno District Hospital.
“We have been conducting mobile clinics in collaboration with MOH since we started operating in Neno,” Bazile says. “However, the weekly mobile clinics in Chawe have opened our eyes to how great the needs of the community are, and they have enabled us to go one step closer to the poor in that neglected part of Neno District.”
Elias Issack Okhoma, a health surveillance assistant working with the MOH, prepares to vaccinate a child during clinic hours in Chawe, Malawi.
After a few hours of steady work, Aaron Mapwelemwe emerged from the brick building and took a seat on the edge of the road. The sun was directly overhead, baking the dirt surface. “This program, this mobile clinic, is a relief to the community. Without this program people would have died. Some patients have to walk hours to get care at the district hospital,” he said, gesturing toward the mountains and a narrow dirt path. “They might sleep on the side of the road at night or take a short cut through the wilderness. There are ferocious animals out there. And the people are already sick. With this clinic, everyone is free to access quality health services.”
Mapwelemwe is a pharmacy assistant who’s been working with PIH/APZU since 2007. Within the mobile clinic, he’s responsible for stocking and dispensing an array of medications, from hypertension and epilepsy drugs to antimalarials. On this particular day, Mapwelemwe has dispensed several packets of antimalarial drugs—during the rainy season, malaria rates soar in PIH’s catchment area—and medication for children with persistent coughs.
All said, 195 patients were seen by mobile clinic staff that afternoon.
The line of mothers and children dwindled. Mapwelemwe’s bags and boxes of medications were packed into the back of the truck. We all squeezed into our seats. And once again Mphugela was back at the helm, ushering us down the same rutted road.
For Mphugela and Mapwelemwe and all the other staff who venture out on mobile clinics each week, the journey continues.