Nurse doing home visitWe enter the house carrying a little red suitcase filled to the brim with painkillers, soap, plastic gloves and other medicine. We duck our heads as we go through the doorpost. The family welcomes us; Muli bwanji?, and guides us to a small room at the back of the house. Sunbeams fall through holes in the wall, leaving little circles of light on the bed. In it lies an old and frail man. He moans, his son informs the two nurses of  his father’s progress. Or is it deterioration? The old man needs to go to the toilet, a painful affair as he has a urinal infection, kidney stones and prostate problems. His thin body is helped up from the mattress that sags like a hammock; supported by son and male nurse he shuffles to the toilet outside.

Upon their return some slow conversation follows –the nurses sit, stare, ask a question, get an answer, sit, stare, discuss, ask a question–. They decide that the man should be catheterised. There are, however, no supplies at the clinic to do this with, so these will have to be collected in a neighbouring town. For now the man gets some more ibuprofen. As I count out the pills one drops to the floor: the bright pink colour seems strikingly out of place in this house where everything is shaded brown and grey.

We move on to the next village (villages seem to consist here of some twenty houses and ten times that amount of children). We make our way to a small adobe house at the edge of the village, and while we walk I’m filled in on the details of this patient’s history. Dutch nurse Thea Ploeg, when starting the home-based care program here in Sengabay, found the woman sitting  on top of a pile of trash and her own faeces. She had suffered a stroke 25 years earlier which not only made her lose her health, but also her dignity because the villagers thought she had become a witch. She was kept in a small room of her house, sitting day and night in darkness with no space to lie down. Her hair, now cut short by the nurses, was then long and wild around her face, her nails had grown to touch her wrists. When found, the woman was cleaned up, provided with a bed, and her family reprimanded for not taking proper care of her. She now goes outside two times a week. Once a month the nurses visit to see how she is doing, they wash her hands and feet, cut her nails.

As we walk into her house I try not to breathe through my nose; the smell in this small space is too oppressive. The tiny, mute woman is hoisted upright by her daughter, looks at us with blue eyes. After a while she apologises for us having to sit on the floor, and invites me next to her on the bed. I move and feel like an intruder in this life that couldn’t be more different from my own. Through the open door I see a group of young children laughing at me.

Nurse cutting the nails of a patient.

Nurse cutting the nails of a patient.

Malawian house.