Hospital Attendant Saw Decades of Neno Health History

Over seven decades in Malawi’s Neno District, Rosemary Mapemba not only has witnessed transformative changes in health care and quality of life, but also has been a daughter, a mother, a grandmother, a Partners In Health patient, a much-loved PIH hospital attendant, and, now, finally, a retiree.

The last of those things is the only one that makes her sad.

“The government said I’m too old,” the 68-year-old Mapemba said with a rueful smile in October, via Skype, referring to national employment regulations. “I need to work again.”

Mapemba’s desire to continue working is all the more impressive when you consider her commute. She was a hospital attendant at Neno from 2008 through 2016, working for Abwenzi Pa Za Umoyo (APZU), as PIH is known in Malawi. She walked to and from work every day, up and down the mountains between her home—in a village named George 2—and the Neno hospital, about five miles away. The trip took her at least two hours each way. That meant she spent four hours walking every workday, for nine years. Through rugged country. Usually alone.

But it didn’t mean she showed up late.

“She was often the first one at the office, at 7:30 a.m.,” said Stephen Po-Chedley, a volunteer medical informatics advisor at Neno from 2013 to 2014. “We would shuffle around every morning to get out of Rosemary’s way, because she took great pride and was stubbornly persistent in her work, and wanted to make sure everything was cleaned every day.”

Mapemba’s work went well beyond cleaning—she made sure patients had basic needs, kept hospital offices supplied with materials, helped the information technology team handle requests, and more. Her diligence and sunny personality made Mapemba a favorite not only among Neno staff, but also within the larger communities around the hospital and George 2. Mapemba said simply, “I made a lot of friends.” But that doesn’t tell the story of someone whose retirement drew such a broad response—several current and former co-workers were eager to talk about her—and who is a living history of health care in the region.

Mapemba was born on Sept. 28, 1949, in the Nanzanga area of Neno District. She spent much of her childhood in Zambia and suffered full-body burns there, she said, in a fire that killed hundreds and hospitalized her for more than a year. Mapemba returned to Malawi and Neno District in 1964, shortly after the country’s first president, Hastings Kamuzu Banda, had come to power.

Health services for Neno District were based in a police station back then, Mapemba said, before a more formal health center was established in 1978. She recalled how people in the Neno area often would go into forested areas to find plants they used as natural medicines, such as tree roots that functioned “the same as quinine” and were used to treat malaria.

Mapemba said people who were very sick eventually were able to go to Mwanza District Hospital, about 30 miles south, but transportation remained scarce with just one ambulance.

“In those days, health care wasn’t good,” Mapemba said. “Even if you went to the hospital, the providers were not available.”

She said the availability of medicines also was hit or miss—“Sometimes you could find it, and sometimes not”—and did not improve after Malawi’s first multiparty presidential elections in 1994.

Mapemba has witnessed generations of change in health care. She gave birth to two of her four children, for example, at hospitals in Blantyre, Malawi’s second-largest city. She delivered her third child at a Red Cross building in Neno District, and her fourth at the regional health center. Two of her 15 grandchildren, though, were born in the new maternity ward at Neno District Hospital.

And earlier this year, one of her grandchildren received malaria treatment known as artemether-lumefantrine, at Neno.

Mapemba said the years have brought broad changes to the community, including a market and more streetlights, along with Neno District Hospital itself. PIH opened the hospital with Malawi’s Ministry of Health in 2007.

“Now, the hospital is good and the doctors treat us well,” she said.

Mapemba experienced that treatment firsthand, after she became so sick in 2006 that nobody would bring her to see doctors.

“They were all waiting for me to die,” she said.

Mapemba’s daughter eventually brought her to PIH’s health facility in Neno, where APZU’s first executive director, Dr. Keith Joseph, and his team diagnosed Mapemba with HIV. They started her on antiretroviral therapy, and suspected she was battling tuberculosis, as well. The timing was fortunate—PIH began working in Neno in 2006, the same year she fell ill.

There were no x-ray facilities in Neno yet, though, so Joseph accompanied Mapemba to Mwanza District Hospital, where she was diagnosed with TB and began treatment for that, too.

Mapemba said she also was struggling with hypertension at that time, but began recovering on all fronts in 2007. About a year later, she started her job as a hospital attendant—helping people at Neno, rather than the other way around.

Po-Chedley said Mapemba didn’t speak much about the hurdles she had faced in her life.

“I was aware of some of her health challenges and we discussed them, but she never really framed them as grand challenges. I think she was modest in that sense; you knew she worked hard because you could see it, not because Rosemary told you,” Po-Chedley said. “Rosemary had pride in working with APZU, and I hope she knows how important she was to the incredible work PIH does in Malawi.”

Po-Chedley added that Mapemba, “was a constant, positive, persistent, and hard-working source of inspiration.” She routinely called him “achimwene,” or brother. Mapemba often called long-term expatriates at Neno achimwene or “achimwale,” which means sister. Po-Chedley said that even though she speaks English, Mapemba tried to teach her foreign co-workers a little Chichewa every day.

Beth Dunbar, former director of monitoring and evaluation for APZU, said the same, noting that Mapemba would greet her every morning with, “Mwadzuka bwanji abwenzi?,” which translates to, “How did you wake, friend?”

“I’m sad that she’s retiring; she’s always a happy presence,” Dunbar said in October, sitting next to Mapemba on the Skype call.

Mapemba was reserved and spoke quietly on the Skype, belying the gregarious nature that’s evident in co-workers’ stories, and in photos of her with family and friends. But she smiled widely when Dunbar turned to her and gave a compliment that undoubtedly is felt by many.

“You took good care of us,” Dunbar said.