Thin and lean with the effects of a long ailoment,Trisen Fraiden of Laisen Village in the area of Traditional Athotrity Chapananga in Chikhwawa,Southern Malawi walks kilometer after kilometer in the rainy wether to Gaga Health Centre which is a three hours journey from her village and being in bad health,Laisen will have to travel over four hours to reach the health centre.
While by all means Laisen had all reasons to smile as just within her home area there is a heath centre at Chang’ambika,the health facilty within her home village hasw become a symbol of mockery as it can no longer offer services.

With her level of knowlege,Laisen can not understand why the clinic no longer provides services,as for her,anyone found wirthin the hospital set up is capable of administering medication hence for her the ground labourer and the guard who are the only workers present at the clinic are not doing her community a good service.

After accessing her services she will have to walk back the 10 kilometer journey weak now of hunger as she also confesed of having no food reserves at her home .

While Fraiden just like all residents from her area have to experiences this horrible experince whien they are sick,She still has some reason to be happy as she is assured that she will get quality treatment from Gaga Health Centre as the clinician at the facility has a human heart.

Unlike the many youthful medical school graduates,the Medical Assitant Khwatcha Kabwera Banda believes that the medical proffession is a calling that has to be followed by people that wish to serve the poor desparate populations.
He said in an interview he serves a population of over 50,000 people with assistance of two nurses.

“Ours is a hummanitarian job and I have to persevere the hard working conditions that we face in our service to the community,’’he said.
He however accepts that he serves a large population and with the fatigue he develops after a hard days work,his level of effeciency might be complomised at times.

“This health facility has a population of over 50,000 people and this population addeded to the population coming from the other facilities that have stoped working following staff shortages gives us more work load,”he beamoaned.

He said while the staff at the clinic has managed to attend to the health needs of the people in the area their major worry was the long distances the patients were travelling to reach the facility.

However,Banda is happy when he hears that he might be relieved of the work pressure when the health centre at Chang’ambika might be re-opened following the Medecins Sans Frontieres-Belgium(MSF-B) supported scholarship programme for medical students wishing to serve in hard to reach communities.
According to Rodd Gerstenhaber MSF-B Head of Mission,lack of Humman Resouces for Health has been and continues to be one of the key challenges to be one of the key challenges in the immplimentation of the new Malawi ART guidelines including the promotion of Prevention of Parent to Child(PMCT) and the scalling up of TB care to reach universal access.

“It is immpossible to note that humman resources for health is one of the challenges that Malawi is facing to reach univesal goal to access of health services,and MSF has been comming with incentives to improve the livilihoods of health service workers so that they can remain in the hard to reach areas,”he said.

Gerstenhaber said Retention of skilled,motivated and well trained health care workers is a global problem as many health care workers are reluctant to work in such areas due to poor access of social services..
According to Gerstenhaber Chikhwawa district is not the only district in southern Malawi where patients are travelling long distances to access medical care. Just like Chikhwawa its neibour, Nsanje district is one of the districts where patients travel long distances to access quality medical care.

Melania Mukongwa,community nurse and midwife at Sankulani Health Centre in Nsanje confirmed Gerstenhaber’s assertion to a team of journalists that visited the clinic on an MSF-B supported tour of health facilities in Nsanje and Chikhwawa.
Mukongwa said some of the women at times fail to make it to the health centre and have been reported delivering their children on their way to the clinic.
Mukongwa said while the clinic has witnessed a development in the health seeking behaviour of pregnant women in the area, patients were still facing the law deal of travelling long distances to Trinity Hospital and at times they had no money to pay at the facility following the suspanssion of the service level agreement between the Christian Health Association of Malawi (CHAM) facilty and the District Health Office..

“Pregnant women in our catchment area now understand the importance of attending to neonatal clinics however the long distances these women travel to a health establishment makes it difficult for them to access the service,”she said.

She said following the development some patients have been reported to have derivered their babies on their way to Trinity Hospital which is the .
However Dr Medson Matchaya Distric Health Officer for Nsanje says the situation will soon be resolvede asw negociations are underway to ‘resurect’ the service level agreement.
“The service level agreement has not been terminated,the current situation is that we are still discussing on the modalities of coming back to the agreement as currently we have an un settled bill of K6 miilion at Trinity Hospital,”he said.

However while Dr. Matchaya believes that some of the health problems might be solved in the district,District Health Officer for Chikhwawa Dr. Elizabeth Nkosi believes that Malawi will be proud of having reached the universal goal to health services when each health facility has atleast two Medical Assistants and two Nurses.

“The challenge that we currently have in the country is that health workers attend to many patients as a result of the gaps in the staffing levels,”she said.
She said the MSF-MOH Malamulo scholarships was to assist in solving the Human Resorce for Health challenges that health planners have at district level.
According to Dr. Nkosi the HRH situation in Chikhwawa is pathetic such that some patients from Changoima zone access their services from Mwanza.
Nkosi has since called upon other international NGOs to follow the MSF example as the HRH problem at the countrys hospitals can not be solved by government alone.
However Nkosi advises the young Medical students to have a human heart as the proffession requires patience with the sick.
Registar at Malamulo College of Health Sciences,Paul Moyo said in an interview the MSF-MoH Malamulo Scholarships were unique in that they never required the student to pay any contribution.
“These scholarships are full scholarships where the student just comes at the college as MSF pays anything including the registration fees,”he said.
Amanda Banda Advocacy Officer at MSF-B said her orgnisation stands for equal access to health care and came up with the Malamulo scholarships after noticing the challenges people in the hard to reach parts the orgnisation operates were facing to get medical services.
“We have been working on disaster and have made an impact in the lives of people that were affected by floods in Kalonga,the lower Shire and just recently in Mangochi and Phalombe,however we thought it worth while to train medical workers after noticing the challenges the communities we work with were facing to get healthy services,” sehe said.
MSF is an international medical and humanitarian orgnisation working in over 70 countries world wide derivering emergency medical aid to people affected by armed conflict,epidemics,healthcare and natural or man-made disasters.
In Malawi the orgnisation has been suporting the monistry of health in provission of health care to reduce HIV and TB related morbidity in Thyolo district since 1997 and Chikhwawa and Nsanje from 2011.
Meanwhile the orgnisation says it has invested 84 Million for the training of health care workers that are to serve in the remote hard to reach parts of the three districts.