Rural Health Centers (RHCs) are the most remote location and bottommost tier for healthcare in Malawi. They are often staffed by one Clinical Officer, a nurse or midwife and HSAs (Health Surveillance Assistants). RHCs do not admit patients. RHCs do not have the capacity for surgical intervention and focus mainly on primary and outpatient care and obstetric care (deliveries). The way the healthcare system works here is if there is a complicated case that presents at an RHC, they are referred to a Community Hospital (like Kabudula Community Hospital!). Community Hospitals then refer to District Hospitals who refer to Regional Hospitals.

Malembo Rural Health Center (brick building on left) and cold storage pharmacy (white structure on right).

Malembo Rural Health Center (brick building on left) and cold storage pharmacy (white structure on right).

Kabudula Community Hospital has 8 RHCs that refer to it plus its own community that uses it directly. Its catchment area (area surrounding the hospital that includes RHCs that refer to it and communities where their patients come from) is over 350,000 people.

Ambulance used to take patients to Kabudula Community Hospital.

Ambulance used to take patients to Kabudula Community Hospital.

Yesterday, the GHFs went to Malembo Rural Health Center, one of the 8 that refer to Kabudula Community Hospital. We asked our friends at Kabudula for the directions. We were told it was about 35 KM past Kabudula on the tar road, easy enough right? There are no road signs so once we passed Kabudula we reset the odometer on the dash and started paying attention for a health center. We had to ask for directions 4 times. I wrote the directions down for future use and they are as follows: 28 KM past Kabudula turn right on dirt road (pay attention once the odometer’s at 26KM!), (road might not be passable during rain, and be mindful of the crops on either side) turn right at first t-junction and pass through market place (market place identified by minibuses waiting to load to go to town, and about 3-5 corner shops), turn right at carpenter’s stall (blue stall on right past marketplace) and health center is adjacent to soccer pitch.

Maternity ward in Malembo Rural Health Center which houses two beds.

Maternity ward in Malembo Rural Health Center which houses two beds.

We had a wonderful visit with the Clinical Officer and other staff in which we talked about the services they provide and gathered some information for our needs assessment. When we arrived, both of the waiting rooms were overflowing waiting to see the Clinical Officer but the staff was making good use of everyone’s time by conducting community trainings about cholera with the waiting patients (which is an issue more now during rainy season). There was an overall sense of calm and peace at this health center, even though there was as many as 75-100 people waiting to be seen. The hospital staff was so warm and friendly, and the health center was well kept. We really enjoyed our visit with them!

By focusing our interventions at Kabudula Community Hospital AND the catchment area, we are offloading the burden of cases that Kabudula must see and hoping to lessen the burden all the way up the healthcare chain. We are looking forward to visiting the other Rural Health Centers in the coming weeks!