Otilia Haule, a resident of Lupingu village in Iringa’s Ludewa district considered herself lucky having gone to deliver her first child at the Ludewa district hospital by car. She got a lift from an NGO vehicle that happened to be in the village at that time.
Expectant mothers in Lupingu village, especially first time mothers and those expecting their fourth and so on child are advised to deliver at the district hospital in Ludewa town, 45 kilometres away.
Because of the poor road in Lupingu, transport is a very big problem. Six months ago before the Lupingu Dispensary’s only ambulance was grounded, expectant mothers and children under five referred to the district hospital used to get a free ride there. Other patients used to pay between 35,000/- and 40,000/- as fuel contribution.
The ambulance used to serve other villages on the shores of Lake Nyasa in the Southern highlands. Today women and patients referred to the district hospital have no choice but to walk the 45 kilometres to Ludewa hospital, a journey that takes two days. If not admitted, seriously sick people or mothers who have just delivered walk another 45km back home.
The nurses at Lupingu Dispensary usually advise first time mothers or women expecting their fourth and so on child to deliver at the district hospital for fear of complications likely to happen in such births.
Madeline Mapunda and Mary Kayombo are the nurses at Lupingu dispensary. They advise women to set off at between 32 and 38 weeks into the pregnancy. They don’t have facilities to handle emergencies at the dispensary and thank God that those who start their journey to the district hospital early normally get there safely.
The lucky ones like Otilia either get a lift from people with cars who visit the village for various reasons or from the Catholic priest’s car though once in a while.
The village’s only Toyota Escudo vehicle charges 10,000/- fare can not be relied upon, especially in emergencies. First, the majority Lupingu residents can not afford the 10,000/ fare and 150,000/- to hire it during an emergency. The vehicle also only sets off for Ludewa when it has enough passengers. Because of the bad road, no one is ready to send their vehicles to Lupingu for transportation.
“The transport problem affects everybody here. We are four nurses at this dispensary and we normally have to go to Ludewa to get our salaries. But all of us can’t go to town at the same time. We do so in turns,” says Mapunda.
When they miss the priest’s car, they also walk the four days journey to and from Ludewa. The exercise to get money from the bank takes a week which affects services at the dispensary.
The first day of the journey to Ludewa ends at a village called Nindi. This is where patients and expectant mothers from Lupingu spend the night before proceeding to Ludewa hospital.
“When people get to Nindi village, they ask the locals there to host them for the night and proceed with the journey the next morning,” says Otilia.
Victoria Kiowi, a mother of four walked the same route from hospital back to Lupingu just two days after giving birth by caesarean. She could not afford paying 150,000/- to hire a car back to the village.
“The village dispensary’s ambulance has been grounded for a long time. We therefore have no choice but to trek for two days to get to Ludewa district hospital,” says Victoria.
Lupingu ambulance’s driver, Faraja Chipungahelo, who is currently jobless says 3,000,000/- is needed to buy spare parts for the vehicle.
The Village Executive Officer (VEO) for Lupingu, Yusuph Lukuwi says four villages in Lupingu ward are affected by the ambulance problem.
“You cannot believe it that we don’t have any means of communicating with the outside world right now. It is like we are in the jungle. The road is very bad and we haven’t had communication services since April. We are forced to walk to the next village in order to get mobile phone network connection,” the VEO says.
The majority Lupingu residents consider themselves as having been dumped long ago by their representatives in Parliament who never visit them after getting their votes.
The transport problem not only affects expectant mothers and the seriously sick but people living with HIV/AIDS too. Victoria Haule, 38, is a mother of two living with HIV/AIDS. Haule, who is a member of the Service, Health & Development for People Living Positively with HIV/AIDS (SHDEPHA+) says HIV positive people in the village are tired of having to walk the long distance to Ludewa to get Anti-retroviral drugs (ARVs). This she says could see a drop in the adherence rate if quick measures are not taken to address the situation. Some people are dropping out as a result.
Haule wonders why the government does not take services near the people. They need ARVs at their dispensary to save them the 90 kilometres journey to and from the district hospital every month.
“We face serious problems in our village. First, we do not have good roads, we cannot even communicate with people outside this village unless we go to Ludewa. The government needs to consider helping us by bringing us social services to this village, says Haule.
The Acting District Executive Director for Ludewa, Brown Kilanga admits the existence of the ambulance problem. He said plans to repair it are underway.
“The vehicle needs to be thoroughly checked and a lot of money is needed for this,” he said.
In 2009, President Jakaya Kikwete promised to improve health services in the country including bringing services closer to the people.
Speaking to the then Finland President, Mary Robinson at the state house in Dar es Salaam, the head of State said; “Our goal is to improve health services, improve hospitals, dispensaries and existing health centres, build more and make sure they are within five kilometres ...closer to the people.
Three years have passed and Lupingu residents are still waiting for the promise to be fulfilled.
Deogratius Filikunjombe, the Ludewa Member of parliament promises the problem will soon become history as the Tanzania Roads Agency (Tanroads) has agreed to upgrade the road to Lupingu.
The villagers can’t wait for the day when they will be relieved of the transport burden.
Although the president’s promise to bring health services closer to the people is welcome, the health facilities need to be fully equipped as far as staff and facilities are concerned so that people don’t have to be referred to the district hospital unnecessarily. But if needs be, then transportation need not be a problem. Roads need to be in the required standard and health workers need to be motivated to attract them to work in remote areas.