PIH Patient Turned Staffer Pays it Forward in Malawi

The sun beats down on the red tin roof of Dambe Health Center in Malawi, boiling the concrete entrance step. Across the threshold, a dark, cool room overlooks tree-scattered hills and plumes of blue smoke rising from unseen villages.

Inside, staff members have installed the last examination bed, connected the electricity, and turned on the water. Wooden benches now wait expectantly for patients, who will arrive when the facility opens this month.

“It’s going to be busy. A lot of people are sick in Dambe,” said 47-year-old Steve Mtewa, the PIH infrastructure manager who led the clinic's construction.

The 6-foot-tall man with a closely shaven head, collared shirt, and warm eyes has fond memories of Dambe. His grandparents used to live here, and he visited them during school holidays.

It’s also where he came to die nine years ago with a severe form of meningitis.

Searching for care

Dambe is a region in Neno District, where PIH, known locally as Abwenzi Pa Za Umoyo, has worked since 2007. The area sits atop a mountain near the border with Mozambique and has a population of 14,000. Life is not easy here. Most people are subsistence farmers, relying on good weather to feed their families. Housing is modest; a family of seven is likely to live in a mud hut. Getting ill is possibly the worst challenge people face because reaching clinics is time-consuming, costly, and an arduous journey over mountainous terrain.

Mtewa knows better than most what people in his community face when they’re sick. He became ill in 2007 and tried for months to find proper treatment. He was working outside the country at the time, and when he didn’t get better his friends, fearful he would die away from his family, brought him home to Malawi. They first took him to a hospital in Mwanza, a district next to Neno.

“It was a nightmare,” said Mtewa. The facility was filthy, had no medicine, was more likely to make him sicker, and was nowhere he wanted to stay.

So his mother cared for Mtewa at home instead. When he grew stronger, he traveled with her to a clinic where she worked in Neno. Although he regained some weight, his condition eventually worsened. His final option was another hospital, in Neno Boma, the district’s town center. Exhausted and with the previous hospital visit fresh in his mind, he refused to go.

“It was a fight,” he said. “I told them, ‘I don’t want to go there. I just want to die here.’”

Mtewa does not remember how he reached Neno District Hospital—much of his sickness is a blur—but once there, he couldn’t believe he was in Malawi. The hospital, supported by PIH, was a small, three-room building staffed by a doctor and a couple of nurses. It was stocked and clean. He was given a bed, put on effective medication, and immediately started getting better.

He was discharged after a month, but returned regularly for checkups. He was nothing like the skeletal man lying in bed weeks before. At each appointment, Mtewa said, staff stopped what they were doing and exclaimed to each other, “‘Come and see Steve!’”

A new start

After getting to know PIH staff at the hospital, it wasn’t long before Mtewa was invited for a job interview. He was selected to be PIH’s pharmacy coordinator in February 2008 and managed stocks of medicine in the hospital’s warehouse.

Three years later, PIH promoted Mtewa to manager of the infrastructure team. He had a lot to do and work stretched beyond normal hours. PIH was building another hospital and revitalizing 10 public clinics in the district.

“Neno has changed so much,” said Mtewa. “There are houses everywhere. Because of Partners In Health, it’s growing fast.”

Mtewa played a big role in this growth. He led several building projects, including a maternity ward near the hospital, where pregnant mothers could stay before and after delivering their babies. And then in 2013, he managed his most personal project back in Dambe.

Building a mountaintop clinic

That year, the need for a health center in Dambe suddenly became urgent. After agreements between the government and two other clinics in the region expired, the two clinics began charging patient fees. With an average income of 84 cents a day, residents simply couldn’t afford between $1 and $3 for an appointment and medicines. Patient visits plummeted by 70 percent.

Neno District Hospital was still a free option, like it had been for Mtewa, but it was too far away for most people. And during the rainy season, mud made the road impassable for vehicles. Those journeying on foot were stopped by an overflowing river.

“You can’t cross here,” Mtewa said, gesturing to the same road from a PIH truck. “On this side, there are all clinics that charge,” he said, pointing to the surrounding hills of Dambe where residents would be forced to remain until the rain dissipated.

“The situation demanded drastic action,” said Luckson Dullie, PIH’s executive director in Malawi. “For the level of poverty in that area, fees were an immediate barrier to care.”

Mtewa was charged with coordinating efforts among contractors and teams. He discussed the potential new clinic with Dambe community members. PIH staff knew he was the right man for the job. “Steve understands from a different perspective how far Dambe is,” said Dullie. “It’s a project he oversaw from inception.”

PIH partnered with Construction for Change, a Seattle-based nonprofit with the mission of increasing access to health care, education, and economic growth in under-resourced communities. Deerfield Partnership Foundation also provided vital support.

It was not an easy task. Tons of heavy equipment had to be hauled over a battered, barely existing road to the top of the mountain. When it rained, it was impossible to continue. When it didn’t rain, there was no water in Dambe for construction. It had to be transported bucket by bucket to the site from a nearby river.

Construction of Dambe Health Center under way in the mountains of Neno, Malawi. Photo by Tyler Weinbrecht / Construction for Change

 

Two years of slow progress eventually yielded a 13-room clinic with staff housing, a borehole to supply water, a generator for electricity, a delivery room for expecting mothers, and a postnatal ward.

It is a great achievement for PIH and the Malawian government, with whom the organization collaborates on all its projects.

“Dambe Health Center will be a source of joy for the people in Dambe and Neno as a whole,” said Dr. Lawrence Nazimera, the Neno district health officer. “The facility will serve numerous people who have been denied quality and equitable health services due to long distances and geographical constraints.”

Nazimera and PIH staff hope the clinic will not only meet the needs of Dambe residents, but serve as a model for providing comprehensive and high-quality primary health care in Malawi. Its construction, the partnerships created in the process, the community-wide collaboration, and its all-round success will stand as proof for building many more like it. The government’s goal is to ensure no Malawian lives more than 5 miles from a health facility.

“Dambe has helped us redefine quality and what is possible in these settings,” said Dullie.

Mtewa is already thinking about what’s next. He envisions more staff housing at the Center and more rooms at Neno District Hospital, among other ideas. There is a great need for health care in these remote Malawian hills he calls home. Right now, though, he’s proud of this project.

“It’s going to save a lot of people,” he said.

Partners In Health staff move equipment into Dambe Health Center in Neno, Malawi. The new clinic will provide health care to nearly 30,000 people. Photo by Lila Kerr / Partners In Health