Macha Hospital - A Beacon of Hope

Macha Hospital was originally started as a Mission Hospital by the Brethren in Christ Church in 1906. It is located on a high arid savannah in south-central Africa. It has grown substantially over the century and now contains 208 beds plus numerous outpatient services serving approximately 140,000 people scattered across a large rural area of southern Zambia. Its patients are overwhelmingly poor with little or no income, living as subsistent farmers in small groups dependent entirely on the fertility of the soil and whims of the weather. Consequently, it is impossible to charge enough for hospital services to sustain the expenses of running the complex. Malaria is a large problem during the wet season. AIDS is a growing and major concern, but with Macha being certified as an Antiretroviral Clinic there is evidence that people now see hope and are more willing to confront the disease.

Has the hospital helped to reduce illness? Yes. Incidences of malaria have dropped significantly, leprosy has declined to the point that it has become a rare disease, neonatal typhoid is no longer common, and death from measles, which used to kill approximately ten percent of those infected, is now unusual.

The first thing that one needs to do in order to understand Macha is to erase the mental image of a North American hospital. Macha is different. It is rural. At the end of a two-hour, bone-jarring, teeth-rattling, auto-suspension-ruining, tire-destroying ride you turn off the dusty road into the Macha Hospital compound. The compound is split by a dirt road with the hospital complex on the right and staff housing (local housing is not available) and nursing school on the left. All the buildings are made of local hand-made mud brick that are very close to the same color of the earth. The building roofs are normally of corrugated asbestos sheets with their aged and dark-grey waves running perpendicular from the peak to the eaves.

All the buildings have ice-rink-smooth concrete floors that seem to command rubber suction shoes for traction. Wearing socks on these floors is a high-risk endeavor so one either goes bare foot or wears shoes inside. With so much dust from the ground, wearing of shoes inside tends to leave dusty imprints as one meanders through the building.

The hospital buildings are sometimes connected by concrete walkway paths from one building to another. The sidewalks lie within sections of hard red earth covered with a dusty powdered-cinnamon topping that puffs up in little smoke signals with each step. There has been no rain from May to September. Many trees have lost their leaves and their bare, black, bony branches reach up to the relentless sun begging for water from the cloudless sky. At this time of year there are numerous ground fires set to burn off the high lifeless grasses that are the only reminder that this parched land can and does sustain much life. The flora comes alive again each year during the wet season in November through March. The trees burst forth with flowers and leaves while the red pan earth gives birth to the green grasses, cultivated fields, and other plants that sustain the lives of browsers, grazers, carnivores, and humans.

The Macha complex is a rough collection of buildings with special purposes such as the Antiretroviral (ARV) Clinic, the administration building, the operating theatres, the pharmacy, etc. Each building has its smooth concrete floor held in place by smooth concrete walls that are normally painted one of many shades of blue or green. Lighting is sparse and electricity is intermittent. Precious water is used for drinking and human needs and sparingly for the cleaning of floors and walls.

The main hospital is comprised of a long building with the women's ward on one end and the men's ward on the other. The section in the middle is for nurses' stations, waiting room, cleaning area, etc. Each section is approximately one third of the whole. As you walk into the dark hallways your senses adjust to the new surroundings. From the blinding sunlight, your eyes adjust to the diminished light. From the comfortable dusty smell of the outside, your nose begins its adjustment to the eclectic combination of antiseptics, burns, bleach infection, sweat, humanness, and sickness. It is not an uncomfortable odor; it's just an unusual olfactory assault that takes getting used to.

In a culture that values community over privacy, there are no private or semi-private rooms. There are beds placed side-by-side around the walls with patient's feet pointing towards the room's center. Each bed is full. Relatives sit beside and sometimes sleep beneath the patient's bed. Even in this open-ward situation there is very little cross contamination between patients. Illnesses include malaria, meningitis, broken bones, burns, the occasional cancer, Karposi's sarcoma, tuberculosis and a variety of other AIDS-related diseases. Women patients with nursing babies continue their maternal duties in the hospital regardless of their illness. The pediatric section, for patients less than six years old, is in a separate building.

The operating theatres are simply rooms with an operating table in a rather square room (approximately 15 x 15 feet) with shelves around the walls that hold a variety of operating tools. The ominous operating bed is in the center. The Spartans would have thought these conditions were Spartan. Surgeries are scheduled for specific days if possible. With the shortages of pain relievers, time, and doctors, surgeries are done quickly, efficiently, and frills-free.

On the hospital campus there is a bakery with two-brick wood-fired ovens where bread is baked once or twice per day. There is a small police contingent in a building that houses a small office (12x14 feet), small reception room (12x14 feet), and a small jail (you guessed it-12x14 feet). When asked what the most common crimes were, the local constable replies that stock theft (rustling) is top of the list followed by assault and petty theft. When we were there they had two prisoners-one accused of arson and the other of theft of an electric fencing generator.

The most modern looking building on the campus is the community center comprised of a library, gift shop, theatre, and Internet café. It stands out because of its white paint and new sign. The community activity center provides a service to those in the compound to provide some relief from the normal ascetic atmosphere.

There is also a generator building that houses two large generators that kick in on occasion when the local power goes out.

The Macha Malaria Research Center buildings are located on the complex. The newness and funding by Johns Hopkins Hospital gives these facilities an obvious appearance of high status compared to the hospital which is funded by the Zambian government, church contributions, and small philanthropic organizations such as HelpMercy International, Inc.

Just outside the hospital complex is a place called the Area of Many Fires where relatives of inpatients can stay until their loved one is returned to health or dies. This is simply an open area where people generally sleep on the ground and cook on the many small fires. Just next to that are stalls of commerce where local entrepreneurs sell everything from chewing gum and bottled drinks to clothes, grass sickles, and other necessities of life. The hospital has spawned a community that also includes a vibrant church life. The local hospital chaplain is very active and can be seen preaching to groups of people in the waiting room as they prepare for their medical or dental procedure. Counselors work with people who have tested positive for AIDS in order to provide comfort and instruction regarding the handling of such a disease.

Macha Hospital is more than a hospital-it is a community of interdependent relationships that grow out of the hardships of life. It is people serving those in dire need. Macha is a beacon of Christ's love in the middle of poverty and spiritual and physical need on a high arid savannah of South Central Africa.

Women's Ward at Macha during visiting hours