Rural Health Workers Haven’t Lost Hope. Nor Should We.

Samuel Naluso is one reason I have such a heart for local health centers and the people who staff them. A 30-year-old nurse, Samuel is the lead — make that the only — health professional at the rural and remote Majete 1 Health Center in southern Malawi. He sees more than 100 patients a day, by himself, and they come at all hours.

And yet, Samuel keeps on — as he has for the past four years. “The people here need me,” he says.

Samuel’s clinic is so remote that he has a hard time getting supplies. The government’s central pharmacy will often deliver his monthly allotment of medicines to a less remote center, a 22-mile drive away on bad roads. Samuel has to pick them up. He makes the same trip to collect his monthly salary.

And yet, he keeps on, saying humbly, “I think I am making a difference.”

Add to all of that this list of frustrations: a donated ambulance sits unused with grass growing through its hubcaps because it can’t handle the rugged terrain, and the health center has no access to fuel anyway; his only motorbike sits in a storeroom without a back tire; a gas cylinder that powers a cooler to keep vaccines cold is empty and he hasn’t been able to get a new one.

And yet, he keeps on. God bless him.

During my visits to rural health centers in Malawi last week I met many health workers like Samuel. Andy Mwafongo, a medical assistant at the Mbonechela Health Center, sees as many as 200 patients a day — by himself. Malaria, malnutrition and diarrhea lead his case load. Josephine Masache, a medical assistant at another health facility, serves a bigger population but does have some help: two nurses. The day I visited they added 200 names to their malaria registry — 200 people diagnosed with malaria in just one day.

Local clinics like these are a critical link between health services and the community. For families, they are the first line of defense against illness and disease. For expectant mothers, they can be the difference between a healthy delivery and severe complications. And for sick community members, they are the key to recovery. These clinics are, however, almost always understaffed, underfunded and under-resourced. If not for the heroic work of dedicated health workers, they would quite literally go under.

Throughout my 25 years of involvement in global health, I have found that when these local health centers function well — when they provide quality treatment services along with health education — the people they serve don’t just have better health outcomes, they have a better shot at a productive life.

In the global health field we aim to strengthen the capacity of health workers and the centers where they work. I traveled to Malawi to look for new opportunities for us to serve. I certainly saw them.

Unfortunately, I also once again saw too many well-intentioned attempts to help that, for a variety of reasons, didn’t work out. At another health center I saw a rain-capture water system doesn’t actually provide water because it was never completed. At another, an eye-clinic-in-a-box delivered three years ago that was never used and is now infested. And at yet another facility, a well-built maternity center that has never served a single patient.

As we in the global health community work to help these health centers, we must remember aid, however well intentioned, must meet real needs with solutions that work. Otherwise, what’s the point? These health workers have a tough enough road already.

Andy Mwafongo is happy to have electricity at his health center in Mbonechela. He should be. Many others do not have it. But the electrical current does not do him a lot of good because, as he tells me with resignation in his voice, he doesn’t have light bulbs.

And yet, Andy keeps on. And so should we.