Joe Lusaka is a clinical officer with Abwenzi Pa Za Umoyo (APZU), Partners In Health's sister organization in Malawi. He has been leading the flood response team in the Chikwawa District since the first week of February. We asked him to reflect on his time there so far.
Last month, PIH/APZU offered me the opportunity to assist flood victims living in the displacement camps in Chikwawa District. As a clinical officer with a degree in health systems management, I decided to move to Chikwawa in order to alleviate the disease burden unleashed by the floods, and to bring us closer to making real the human right to health care.
Chikwawa District is located in the southern region of Malawi, 47 kilometers (about 30 miles) from the city of Blantyre. The district covers an area of 4,755 square kilometers and is home to more than 450,000 people. The district’s health system includes a district hospital and 21 health centers, which are arranged in six zones: Nchalo, Chikwawa, East Bank, Chapananga, Ngabu, and Changoima.
Nchalo Township, where PIH/APZU is working, supports a population of 68,671. The area’s primary source of health care is a mission hospital, which charges user fees for most services. Because many people in Nchalo—especially those affected by the flooding—cannot afford even a nominal fee, PIH/APZU’s free clinic provides a vital service.
Clinical Officer Joe Lusaka (Photo: Lila Kerr/Partners In Health)
A typical day starts at 7:30 a.m., when I arrive at the clinic with our team of two nurses and a pharmacy technician. Dozens of patients will be waiting for us, with some having walked from as far as 20 kilometers away (about 12.4 miles). Others are referred to the clinic from displacement camps via PIH/APZU’s community officer, who arranges transportation for them. As we prepare for the day’s activities, a health surveillance assistant from the Ministry of Health delivers a health education talk, including cholera prevention lessons.
Patients then are triaged so those with critical conditions are seen first. The most common issues are malaria, diarrheal diseases, respiratory infections, skin diseases, anemia, musculoskeletal pain, and schistosomiasis (a disease caused by a parasite). We have also seen a number of patients that have suffered trauma because their house collapsed during the heavy rains. Very critically ill patients that require more advanced health technology are referred and transported to Chikwawa District Hospital, which is 27 kilometers (about 17 miles) from our clinic. In addition to treating these conditions, we are screening patients for diseases like tuberculosis, diabetes, HIV, malnutrition, and hypertension. By the end of the day, a nurse and I will have assisted over 200 patients.
In addition to providing clinical services, we are working with local displacement camps and communities to track infectious diseases, such as diarrheal diseases and scabies. Patients with these conditions are logged in a register where we record their basic information and their village. Despite reported cases of cholera in nearby towns and districts, we have so far been fortunate to avoid any cases in the camps and clinic where we are working, and we are continuing aggressive surveillance.
We started monitoring scabies upon hearing that there had been over 200 cases at Chikwawa District Hospital. Flood victims are at high risk for this kind of outbreak because of the high population density and poor sanitation infrastructure at the displacement camps. We started investigating the cause and found out that people in the camps were either not bathing at all or were bathing in the nearby stream. A local sugar company had constructed three bathing sites in the stream: one for men, one for women, and one for children. Unfortunately, that same sugar company uses cattle manure on its nearby fields, and the recent heavy rains caused that animal waste to wash into the streams, contaminating the water that so many flood victims bathe in every day.
We reported these findings to our leadership team, who rushed to visit the site and plan control measures. We have distributed water buckets for bathing and have constructed bathing facilities in the displacement camps.
In addition to providing clinical services, we are working with local displacement camps and communities to track infectious diseases, such as diarrheal diseases and scabies.
Providing comprehensive health care necessitates strong relationships with communities, so we have made a point of introducing our team and our services to nearby villages. During a meeting at Chikwawa District Hospital, I heard that there was an island, Mazongoza, that had not yet been reached by any of the partners working in the district. Mazongoza is the epicenter of flooding in Chikwawa and often relies on a rescue helicopter for evacuation, but some people still call the area home, and it was important that we reach out to them to make sure their health needs are met. The community officer and I decided to take that risk together. The road to the village was waterlogged, so we walked 14 kilometers (8.7 miles) to the river, where we boarded a canoe to reach the island. The area has many crocodiles, but the locals know how to scare them away, and fortunately we didn’t encounter one.
Once in Mazongoza, we learned from the village leaders that people are struggling and that they felt sidelined from the rest of the district. They are drinking untreated water from unprotected wells since they are often cut off from government services, and many of their crops were washed away in the heavy rains. They are now trying to plant rice due to the abundant water. I was touched by our conversations, and felt empathy with them. We weren’t able to promise any specific services, but simply establishing communication with them will allow us to better serve their health-related needs and to act as ambassadors for them in future meetings.
Working in Chikwawa has been challenging, as the work often extends beyond my position as a clinical officer, but I am confident in my ability to serve as a steward to the flood victims, as an advocate for this community at local meetings, and as a leader to my fellow team members. It has been my dream to directly assist the vulnerable people in my country, and I am motivated by this opportunity.
Go here if you would like to support PIH/APZU and Joe Lusaka's work in Chikwawa District in Malawi.