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Health care in Malawi is a challenge for doctors
Aug 18, 2007 By: Dr. Steve Russell(Originally published Sept. 13, 2005)
MALAWI, AFRICA - The coughs and moans of sick children and emaciated young men echo off the bare cement walls of the waiting room at St. Luke's Hospital. A wooden bench scrapes the floor as another weary mother takes her seat, her baby peering over her shoulder with sunken eyes and chapped lips. The aroma of congested humanity hangs heavily in the air -- the sweat of hard labour, the smoke from distant cook fires, and the unchecked odour of clothing worn days in a row.
I'm sitting in a wooden chair in the spartan doctor's office, observing Dr. Helena Jellema, a Dutch doctor, as she takes a history from a young man through an interpreter. We met early this morning as Brian Payne (from Ross Memorial Hospital in Lindsay) and I delivered four boxes of donated medications. Our boxes contained approximately $11,000 worth of new drugs to combat infections and malnutrition. But what at first seemed like a significant donation was soon dwarfed by the mountain of problems we saw in the clinic.
Dr. Jellema strains to understand the frail young man. He is 28 years old, married with three children, and he complains of abdominal pain, chronic diarrhea and weight loss. His cheek bones jut through his wasting skin, and his eyes are sunken. This is his first visit to a doctor. After a thorough history and physical examination, the doctor concludes he has advanced AIDS. I look for surprise in his eyes, but all I see is resignation. I suspect he already knew his fate before we started.
For years, AIDS has meant certain death in Malawi. Shame cloaks the victims with such despair that they seldom leave their huts once the disease starts to devour them. The man before us carries heavy burdens on his bony shoulders ¡ª he is a father, a husband, a farmer, and a son to his aging parents. The devastation of his deadly illness will affect so many lives that depend on him for survival.
But rather than talk of a gloomy prognosis and untimely death, Dr. Jellema opens the doors of hope. She invites this patient down the hall to an HIV-testing counsellor and writes a prescription for anti-retroviral drugs (ARVs) that will start next week.
"I'm looking forward to seeing him again," she says as he shuffles out of the office. "Within a month, these patients walk back in like they are new people. They gain weight, they regain their energy, and they are back to work. It's like they are raised from the dead."
The Lazarus Effect, they call it. Her face beams as she calls in the next patient from the jammed waiting room. "It's the most satisfying work I have ever done."
In fact, there is an air of optimism in the clinic, despite the overwhelming burden of HIV/AIDS in Malawi. In the face of an epidemic affecting almost one-quarter of Malawians (30 per cent of urban adults), the government is developing a strategy to fight back. Several clinics have sprung up across the country to provide voluntary testing and diagnosis, and then prescribe ARV drugs at no cost to the patient. The government, aided by international donors, is footing the bill, somewhere under $400 CDN per patient per year.
For individual patients, the results are astounding. In a country where the average life expectancy has plummeted to 37 years old, people are surviving into their forties. They must stay on their drugs for life, but the clinic staff tell me with the proper counselling, and follow-up by volunteers in the villages, the rates of compliance with the drugs are very good. People realize the medications are life-sustaining.
Dr. Kevin Bezanson, a general practitioner from Kitchener, set up the HIV clinic in one of Malawi's state hospitals. His organization, Dignitas International, has trained hundreds of volunteers from the surrounding villages to monitor and support treatment for AIDS victims in their homes, a responsibility that overwhelmed the few doctors and nurses available.
"What keeps us going is what we see happening," says Dr. Bezanson, as we shovel in mouthfuls of maize with our fingers at a local dinner party. "We are seeing lives being transformed."
The country is starving for trained nurses and doctors. With a population of 11 million people, Malawi has only 50 physicians. By contrast, Ontario's 12 million residents are served by 24,000 doctors. The only medical school in Malawi just boosted its enrollment to 40 students per year, but many graduates leave the country for the UK or North America, following generous offers of wages and a lifestyle far beyond what they can expect in Africa.
One of the Malawian doctors who stayed is Dr. Carlos Varela, a tall, soft-spoken young man I met in Lilongwe. He is intelligent and articulate, and committed to his countrymen. "This is where my family is," he says, shrugging his rounded shoulders matter-of-factly. "They depend on me."
He works six days per week as a general practitioner and surgeon/obstetrician, earning only $100 CDN per month, plus a housing allowance. He dreams one day of training in orthopedics, hoping to be the first native orthopedic surgeon in Malawi.
As I tour the dark, dingy halls of his hospital, peering in packed ward rooms, occasionally seeing two patients in a single bed, I marvel at his tenacity. His is not an easy road to travel, but he feels a calling to stay and serve his people, even under such harsh conditions. And, I have learned, this is an attribute that so many Malawians share. A willingness to stay and tough it out, a dogged determination to work through difficult problems, and little in the way of complaining or bitterness.
He excuses himself as he shakes my hand with his big, powerful grip. "Sorry, everyone (on staff) is on my neck, asking where I am." He smiles shyly and glances at the ground. "It was good you could come and see what it is like in our country. I hope you will remember us."
For sure I will, I think as I rub my hand. And so Carlos goes off to work in his world, and I will soon return to work in mine. But we have shared a connection, and our lives have brushed up against one another, even for a brief visit. And that is what will sustain my memories of Carlos and the others we met in Malawi. Our lives are connected, and even half a world of geography can't change that.
