NKOLE NKOLE, Limulunga
THE a gravel road, which is eventually taken over by thick sand, causes the Toyota Hilux transporting us to Kaate area to skid and bounce.
Our driver does his best to navigate the thick sand, which is a challenging terrain even for an off-road vehicle.
Accompanying me on the trip to Kaate is Limulunga District Administrative Officer (DAO) Mubiana Ngenda and district health director at the Limulunga district health office Douglas Singini.
One of our first stops is at the Ikwichi health post, where patients who were attended to in the early hours of the morning got discharged by noon.
The patients often get to the health facilities very early in the day after walking from their villages in the early morning hours to avoid the sweltering heat of the afternoon.
Our final mission is to get to Kaate, where a brand new hospital is being constructed for Limulunga district.
At the Ikwichi health post, the only remaining outpatient is a young expectant mother who is resting on a mat and in care of two elderly women who accompanied her to the health post.
To get to the health post, they walked at least six kilometres in thick Limulunga sand, a journey which is hazardous to someone in the expectant mother’s condition but which must be made all the same.
“Traditional home births have been outlawed in the district to curb maternal deaths and encourage expectant mothers to access safe maternal services at government-established health facilities,” Mr Ngenda shares with me.
For specialised services, locals have to travel as far as Mongu to get treated at the Lewanika General Hospital.
A survey done by the Japanese International Cooperation Agency (JICA) shows that most of the areas in the district are covered in terms of health facilities.
What is however a need at the facilities in the district is a boost in staffing levels. The completion of the Limulunga District Hospital where works have currently stalled will offer the opportunity for specialised services to be offered to people in Limulunga through the hospital.
However, access around the district is still a major challenge due to the poor state of roads. The Mongu-Limulunga road for one, is in a deplorable state yet is the main road leading into the district.
During the rainy season, frontline health workers often face the dilemma of transporting patients to health facilities across flooded areas.
When the floods are full, three of the district’s health facilities are accessible by boat, but as the water begins to recede at the end of the season, boats are unable to reach health facilities.
With the help of the department’s partners, some health facilities have ox carts which are owned by the communities and used to transport patients to access points where patients can be picked up either by vehicle or by boat depending on the season.
Dr Singini says as one of the newly constituted districts, Limulunga bears many of the health characteristics as those recorded in Mongu district.
Because Limulunga is a rural district, many places are remote but the department has made a lot of strides by heightening surveillance around the district to reduce any risk of outbreaks.
The HIV prevalence in the district was quite high in recent years at around 15 percent in all people that were being tested.
Through deliberate efforts by the district health office, this rate has drastically reduced from 15 percent to 1.8 percent.
“We can say that we have reversed or we are approaching a reversal of the epidemic,” Dr Singini says.
Hamoya Hamweene, a registered male nurse at the stage two Limulunga Rural Health Centre, says previously Limulunga residents would have to travel all the way to Mongu to access ARV medication before an ART clinic was opened in Limulunga.
A more recent development happened in 2017 with the centre receiving medical equipment that has now made it possible for CD4 count and other blood tests to be done at the health centre.
Before this development, blood could only be collected in Limulunga and was later sent to Lewanika Hospital in Mongu but this time, tests are done right in Limulunga.
There were a lot of determinants driving up the epidemic. The main one was that very few people in the district had access to HIV testing services.
What the Ministry of Health did to overcome this was to increase access to testing services for people within the district.
It also used lay members of the community or lay counsellors to sensitise communities on HIV.
People who were infected and were not on treatment posed the highest risk of spreading HIV but with increased testing, they have been able to go on treatment to reduce their viral load, making them less infectious.
“For HIV testing in the community, we are being assisted by organisations such as the University of Maryland, which is going in the community for door to door testing,” Mr Hamweene shares.
Maryland conducts what is called index testing. When someone at a health facility is found HIV AIDS positive, they follow that individual up to their household, where family members aged 15 and over are also tested.
Having identified the key populations that are potentially infectious and have the economic means to travel to different places within and outside the district, the district health office has been able to control new infections.
Some of the district health office’s biggest partners have been the President’s Emergency Plan for Aids Relief (PEPFAR) and the Centre for Disease Control (CDC) as well as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Health Organisation (WHO) and UNICEF, who are sponsoring various facets of HIV management.
In conquering rural attitudes regarding health, the department has had to design interventions tailored to suit the rural setting by engaging directly with the rural communities through neighbourhood health committees.
“That way they feel engaged,” Dr Singini says. “They are seeing government spending on them and in those settings we are able to share information as well.”
Other diseases the district is grappling with are malaria, respiratory and diarrhoeal diseases.
There has, however, been a reduction in malaria cases due to interventions by the department through its community, based volunteers, who not only test but initiate treatment upon a test emerging positive.
Malaria remains common, especially in those aged under five years old.
The supply of bed nets in many parts of the district and increase in coverage for indoor residual spraying are also helping in malaria control.
Dental care has also been a challenge in the district, with locals unable to afford the regular replacement of toothbrushes and the purchase of toothpaste.
This is evident through outpatient visits for abdominal complications since the inability to chew food can lead to indigestion.
Last year in September, the Ministry of Health erected a prefabricated structure which now houses medicine in Limulunga that is accessed by facilities even outside Limulunga.
It is hoped that the completion and opening of Limulunga District Hospital in Kaate area will sustain a healthier population that can contribute to the overall growth and development of the district and make it a greater force to reckon with in Western Province in the coming years.
NKOLE NKOLE, Limulunga