We had an opportunity to go on our first mobile clinic this week, to the farthest post no less, a village call Dzama. It is about 19 km from the hospital, which driving over unpaved, dirt roads, translated to 45 minutes of  a very bumpy car ride. We left around 8 in the morning to arrive eventually at a school house to a long line of already waiting women, pregnant or with children. While it was impressive that the hospital makes an effort to reach villages as far as possible, it is noteworthy still that some of mothers had to walk 5km to get to Dzama.

There are two separate procedures for pregnant women and women with children under 5. For pregnant women, they first need to be weighted and the number is then recorded in their health booklet. The mobile clinic offers tetanus immunization for the mothers, so if they need it, they then go to the immunization station. All pregnant women are tested for HIV using the RAPID test that yield results in 15 min. St.Gabriel’s is very active in PMTCT and if the mother is discovered to be positive, she is referred to the hospital for counseling and treatment. As I rotated amongst the stations, I was surprised that at the immunization station, we had a supply of syringes that are automatically set to certain volumes to prevent an overdosage, sort of like the dosing kit we brought.

For the mothers with under-five children, they are first lined up outside beside a tree where their babies are weighed. The method is a little awkward but fast; normally, the children are slung on the mother’s back in a backpack fashion. To weigh the children, the sling is shrugged off and then hooked onto the scale hanging from the tree, like weighing a pack of meat. The weight is then tracked on the health card that has a trajectory indicating the ideal range of weight the baby should be at certain ages. Extremely malnourished babies are counseled and referred to the hospital. Children are also given the polio, DPT and measles vaccinations in addition to the oral administration of BCG.

The services offered are obviously very basic, but they are focused on two important factors impacting fetal mortality in Malawi. Vaccinations are the most cost-effective global health intervention while PMTCT is essential in ensuring the health of all babies given the relatively high HIV rate in Malawi. Traveling on the road to this remote village, the landscape really gave a perspective of how hard it is for healthcare to reach the entire population of Malawi. There are small villages, usually made up of a circle of huts with bricks and thatch roofs, scattered kilometers apart. Everyone is either riding bicycles or walking; there is no sign of paved roads or cars. On the way back, we picked up mothers on their way walking to the hospital on a journey that would take a car 30 minutes to travel. Malawi is truly still a very rural country, which makes even the simplest intervention like the services offered by the mobile clinic important and of high-impact.