Water for dinner was boiling on the stovetop at Nanniver Makusa’s house when the lights went out again. That is not an unusual event in this community, a compound carved out of rutted dirt streets, about 10 miles outside Lusaka, the capital city. Makusa turned away from the bubbling pot to light a candle. That’s when her son Chimuka, who at four seemed to be getting a little bigger and quicker everyday, decided to follow her. In the dark, he stumbled into the stove. Scalding water poured over his chest, shoulder and arm.
There is no taxi, no minibus to be found here after nightfall. There also is no hospital.
“That is the tragedy of this community,” Foster Chileshe, who lives around the corner from the Makusas, said later.
Chileshe is a nurse who has spent the last 10 years turning the front of her family’s home into a clinic, and that is where Makusa ran that night, her wailing child in her arms. Chimuka became Chileshe’s 81st new patient this year.
Two days later, Makusa was smiling, her son sulking as he braced for his next injection of antibiotics—he had already had two a day since the night he got hurt.
“It really does sting,” Chileshe said.
That is about the worst of his problems now, though, she added. Without medical care, he could have gone into shock that night. The burns that peeled the top layer of skin from his chest and arm could have become infected.
A nurse who has seen the results of obstacles between health care and the poor in this country since 1989, Chileshe knows well the way treatable injuries and illnesses can become deadly. Her mother, who had died on the way to a clinic five miles of broken road from her home, inspired her efforts to start the neighborhood clinic.
“It bothered me. Death comes for everyone,” Chileshe said. “When it comes, it comes. But maybe, if she had gotten there sooner, she wouldn’t have died then.”
When the government health system, which she worked for then, reorganized and reduced staff in 2000, Chileshe took a buyout and used the money to start renovations for the clinic. Today, the clinic’s certification hangs on the wall of a tiny reception room. A canvas sling dangles there to weigh neighborhood babies. She does that for free, monthly for all new babies. An examination room is stocked with emergency drugs—antibiotics, anti-seizure medication. She hopes to turn a storeroom into a pharmacy.
When the money ran out she took a job with ZAMBART, (Zambia AIDS Related TB Project) and saved some more.
Through a visiting volunteer she met a woman who gave her money to buy a van—which she uses at times as an ambulance—and equipment.
She lives with the family in a crowded couple of rooms behind the clinic. Seven people—Chileshe has no biological children but is raising nieces and nephews—come and go when they are not in school, and help out. Her niece, who is a nurse, and a nephew, whom she raised as a son who is studying nursing, pitch in. Two “health officers”—the Zambia equivalent of physician assistants—alternate shifts to help out. Her logbooks show that she sees about 25 patients a week, 82 new patients this year.
Many of her patients have HIV-related illnesses, she said. Some have sought treatment from traditional healers before coming to her. All, she believes, are people who couldn’t, or wouldn’t receive medical care otherwise.
“They fear queues,” she said, referring to the long lines at government clinics. The nearest government clinic is more than three miles away. They also fear being referred to the large government hospital in town—because the time and expense of travelling to follow-up care would make work impossible.
She is hoping longtime AIDS activist Winstone Zulu, her friend and patient, will help her put together a proposal to secure a source of reliable ongoing funding, but he has been sick.
In the meantime, she charges for her services—at 25,000 kwacha, about $4 a visit. She lets patients owe her, if they don’t have the money on hand, but still it bothers her to charge at all, because she believes that keeps people from coming.
“Only a few can afford to pay,” she said. “The people I serve are poor. So it comes back to the same thing. The people who need care can’t get it.”