Malawi
Map of Malawi
Malawi by the Numbers
| Population | 12.1 million (UN, 2003) |
| Healthy Life Expectancy at Birth | 34.9 |
| Percentage of Population Under 18 | 52% |
| HIV Prevalence (adults 15-49 years, 2001) | 15 |
| Under-5 Mortality Rate | 197 per 1,000 children (almost 1 in 5) |
| Percentage of people who must travel over half an hour to collect water | 43% |
| Estimated number of people living with HIV/AIDS (end of 2001) | |
| Adults & Children (0-49 years) | 850,000 |
| Children (0-14 years) | 65,000 |
Health Information
15% of adults in Malawi are HIV-positive, one of the highest rates of infection in the world. Even though antiretroviral therapy (ART) to treat HIV/AIDS has become more affordable, officials in Malawi are struggling to bring treatment to the 170,000 people who need it. Human resource shortages remanin a worrisome barrier to fighting HIV/AIDS as doctors and nurses leave their posts to work in other countries. In a recent piece in The Lancet (an international medical journal), reporters noted that:
“all policy makers we interviewed in the four countries [Malawi, Mozambique, Swaziland, and South Africa] no longer regard financial resources as the main obstacle for scaling up antiretroviral treatment in the short term. Instead, they see the lack of health workers as the single biggest constraint. Tackling the issue of human resources for health is of paramount importance not only for achieving the 3 by 5 goal but also for the survival of these countries’ health systems in times of AIDS.”
Health worker shortages are not only hurting HIV/AIDS treatment programs, but also make health care less accessable to all in need of medical treatment. Many health workers leave public and rural positions in order to work in HIV/ AIDS treatment programs, making brain drain a local and international phenomenon.
Dr. Paul Farmer discussed the need to address overall health care issues in addition to AIDS related problems in a July 14, 2004 article in the New York Times:Dr. Paul Farmer, an American renowned for his treatment programs in rural Haiti, said international projects intending to help poor countries should pay heed, as Mozambique does, to the need to integrate AIDS treatment with overall health care.
"When you're in a clinic in rural Haiti and someone comes in with a broken arm or in obstructed labor, you can't say, 'Sorry, we only do AIDS prevention and care,' " said Dr. Farmer, a Harvard professor. "The massive loss of life due to H.I.V. disease is only one symptom of a very sick world in which hundreds of millions are going without any modern medical care at all. Addressing AIDS properly offers a chance to set some of this right.”
The Malawian health system is struggling to treat all those in need of medical care, HIV-positive and otherwise. With severe human resources shortages, only so much can get done, only so many lives can be saved. Many lives are lost or shortened because there are simply not enough people to get the job done. Adopt a Doctor is working to improve the situation by funding doctors in underfunded, understaffed positions like those in public and rural settings.
News Articles
• “Shortage of African Doctors and Nurses: We Must Support Primary Health Infrastructure” (Washington Post op-ed)
• “Brain-drain highlighted at AIDS conference” (The Nation, Malawi's daily newspaper)
Health Reports
• "Scaling up access to antiretroviral treatment in southern Africa: who will do the job?”
Links
Malawian Poems
Our Doctor Mr. Ligomeka
from Skipping Without Ropes, Jack Mapanje
Our Doctor Mr Ligomeka(in memorium)
I do not know why you return today
shouting at Mikuyu Prison guards that
you wish to detect the effect of fansidar your
WHO brand of malaria tablets on your patients,
‘Open the gates for Mapanje!’
when the timid prison guards bring
me to your Sick Bay you demand privacy
‘So I can have a proper look at his abscess!’
and as they reluctantly retire we have a soft laugh -
how nervously the idiots accept doctors’ orders!
But you have come to tell me the story of my death,
you clarify, ‘The nurses at the General are grieving
your death which some authority has devised,
I came to verify for myself, now that I know, I
will march you to the full view of the General!’
How you plan to preform this feat bemuses
but the message is clear,
when another bout of chronic malaria strikes
I must not be excited about
the new brands of quinine the prison offers
they could be poisons
Besides Martin Kanyuka, stonent, colleague, brother
has just been accidentalized,
‘What I detest most is why they refused to let
me do the post-mortem when they said it was
just another accident!’
When you name three other university friends
disappeared in my short absence
my voice falters fearing,
‘Won’t you too vanish if they discoverthe tricks you perform for us in prison?
’My dear doctor, you came to serve us
after inveterate wars for our medical liberation,
our appeals had flown to the freedom lovers
of the globe through friends, dedicated strangers
and official bags before you were offered to us,
the weeping blisters and thick boils you exploded
on our grois and between our buttocks
could not have been for nothing
how could we have dremt them up
with buttocks already inured beyond baboons?
Do you recall the bones that clinked
squatting before you and the eyes
deep in drooping sockets pleading
for your prescription of valiums
to manage Mikuyu’s sleepless nights?
And that smelly lump of nsima you
extracted frin CheJumo’s ears was
no mean madness, CheJumo frankly
sought to protect his ears from the tyrant’s
tedious tles that had damned him here!
could he have invented delirium
for cheek, cheer, valiums?
So when we hear you too have been
disappeared today we are not suprised
but pray that wherever you are you might
still shelter the patients of the Sick Bay
of the prison you have left behind.
Author’s note:
The only clinical offier from Zomba General Hospital who had the courage to accept treating political prisoners at Mikuyu Prison when others did not dare for fear of being imprisoned too; Ligomeka was special because he fearlessly helped us communicate surreptitiously with the outside world; nisma is the staple meal of Malawi made from maize flour which is cooked into hard porridge.
Mapanje was imprisoned in Malawi for four years without charge under the dictaroship of hastings Banda.
A Death Song
(Birimankhwe maso adatupa ninji?
Kwathu maliro
M’samaseke ana inu:
Kwayera mbee, mbee, mbee.Ine n’dzachoka pam’dzi pano.
Mutsale mumange pam’dzi pano.
Taonni pakhomo pangapa:
Payera mbee, mbee, mbee.)
1
Chameleon, why are your eyes swollen?
There’s death at home.)
The Chameleon was wrong.
The tear-stricken, swollen,
swivelling eyes did not see
the lizard still scuttling
on the potsherds of Kaphirintiwa;
survival song as she burst open
to give birth to laughter, song and dance.
Yes, the locusts came
and joined the army worms
and the monkeys in the middle
of the maize, bean and ground-nut gardens;
but the west brought AIDS
and hybrid maize to replenish
the ravished sturdy local stock.
The east brought yaws too,
in nice neat rice packets,
and the media promised us
another bumper harvest because
of the prevailing peace and prosperity.
2
(Look at my homeland;
it’s empty, empty, empty)
The Chameleon was wrong.
The homestead was not really empty.
Some zombies were left,
in spite of their deafness.
The ndondochas* wailed at night
despite their tongues being cut off.
They were not yets completely dead.
Yes, carloads of souldmet their sticky end
sat the end of the line.
However, the survivors were permitted
to attend the funerals and burials
under careful supervision.
3
(I shall leave this village;
you stay behind and build this village.)
The Chameleon was wrong.
The answer was not to abandon the village
as rats do a sinking shipor fleas a dying hedgehog.
Exile, pretended, genuine,
or self-imposed, is not the answer
to the holocaust or the apocalypse.
Yes, we seek new homes every day,
the old ones no longer habitable.
We hunt for new myths everywhere,
the ancient ones defaced or defiled.
However, recycled myths or homes
are better than nothing,
they are all we have left.
4
(Do not laugh, children:
it’s empty, empty, empty.)
You are wrong, Chameleon.
Just look at the survivors:
How many Nyanjas did not hurtle
headlong into Chingwe’s Hole?
How many Ngonis did not
partake of the kalongonda**?
How many Chewas were not
crushed at Mpata-wa-Milonde?
How many Kafulas did not
suffocate in the Bunda caves?
Yes, you are wrong, Chameleon.
Just count how many delayed
their deaths in spite of the lizards message.
Look how laughter, song and dance
still rebound against the rock of Kaphirintiwa:
We are still alive!
*ndondochas — zombie. It is believed that owner of the zombies resuscitates the dead, cuts off their tongues, maintains them in this life-in-death state to do different chores for him, for example, working in his gardens at night. He keeps them wailing in packs like a dog with its puppies.
**kalongonda — type of large wild bean, poisonous when eaten without having been cooked for a very long time.
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