As I continue bringing you stories of women who have suffered various forms of abuse and discrimination due to their HIV status, today we hear from Sara Kanthiti.
Born on March 7, 1967, Mrs. Kanthiti, is married with two children – aged 16 and 5 – all girls.
She comes from Pitala Village, Traditional Authority Mkanda in Mchinji, central Malawi. She is one of the 950 women who have openly declared their HIV status in the district and are doing voluntary counseling and advocacy to combat further spread of the pandemic.
“I tested positive in April 2004”. This is how this woman starts narrating her story. She looks so healthy that one cannot believe she is living with the virus that causes AIDS.
“The district hospital was conducting a campaign to have more people test for HIV. I just took it for granted to have my blood tested for HIV during that time and it turned out that I was HIV positive”, recalls Mrs. Kanthiti about the year that ushered a new era into her life.
“On the same day I was counseled on how to live my life, but they gave me an appointment to visit the hospital so that they could determine the level of my immune system.”
When she visited the hospital she was told that her immunity level was low and she was advised to start taking anti-retroviral drugs so that her body should be able to fight against opportunistic diseases.
Since then she has accepted her status and has gone further to become a volunteer counselor and AIDS campaigner in the district. “My health is good now; I just hear that people suffer from malaria! Not with me”, she says to prove the strength of HIV anti-retroviral drugs.
Institutional militarism or double standards?
However, when Mrs. Kanthiti left her village to stay at the district headquarters in 2009 little did she know that she would face discrimination for being HIV positive.
“What happened was that a traditional leader for our area (Robert 5) told us tell us to register for the subsidized farm input programme.”
“They said those who were to receive coupons for the cheaper farm inputs were the ‘poor of the poorest’, child-headed families and those who have openly declared that they are HIV positive and are assisting in various community work.
“The chief said, because of the work I do, as a volunteer, I was supposed to benefit from the government subsidized farm inputs.”
She registered as one of those living positively.
“But came the day for confirmation, my name was not mentioned despite that the chief had personally came to my house to tell me to register for the programme. I tried to inquire why my name was not mentioned, but I was not given a convincing answer.
“I also showed up on the day people were receiving coupons but, again, my name was not called. When I asked the chief what was wrong, he told me ‘people living with HIV are troublesome’ and that ‘if my name was not appearing on the list there was no need for me to be present there.”
She says this was the worst discrimination, she had seen since coming in the opening to declare that she is HIV positive and suspects her name was only used by someone who stole her coupon.
“I’m healthy, I’m able to cultivate. Government considered my plight and thought I should receive coupons for subsidized farm inputs, so why should somebody who is also being looked after by the same government deny me this right.”
Mrs. Kanthiti says since that time she has never had opportunity to receive coupons for purchasing subsidized farm inputs, adding that she has no hope that people living with HIV like her will be given priority in the subsidy programme just like other disadvantaged groups.
“This year I haven’t also received any coupon. I know I’ll have problems to produce enough maize this year.
“As somebody who is HIV positive, I am supposed to eat frequently. So, how can we eat frequently when we have no fertilizer”, says Mrs. Kanthiti, “At least they should have given us some seed… soya seed to enable us have a nutritious diet. But all this has not happened.”
She says she fears for her health because she has difficulties in finding food.
Ignorance of where to report abuse
When she suffered her ordeal Mrs. Kanthiti says she did not know where to seek assistance on the matter, therefore she never took it any authority that could have intervened.
“We don’t know the meaning of human rights. If there are organizations or people that can assist us, they should come here to educate us on human rights and freedoms”.
Finding the way out
Despite being denied access to subsidized fertilizer, Mrs. Kanthiti has not backtracked on farming, the major source of her food production.
Working with fellow women under the Coalition of Women Living with HIV and AIDS, (COWLHA) she is able to produce organic manure from pigs which the organization’s Mchinji arm is raising with assistance from Action AID Malawi.
She says this is one way of ensuring independence of women living with HIV.
“As members of COWLHA, we want to be independent and ‘make noise’ on own our own. People should know we exist. This year, each one of us contributed MK 50(0.33 USD) and we’ll be able to buy five bags of fertilizer”, she says.
About women’s rights, she says: “In Malawi, women have limited rights because of our culture which says the man is the head of the family. So, everyone the man becomes an important person than a woman.”
A Call for Action
Mrs. Kanthiti says she has leant a lesson that relying on handouts cannot help solve her problems.
According to her there are many organizations claiming to be assisting people living HIV which are highly publicized, yet there are not helping the actual people affected by the pandemic.
“I advise my fellow women, especially those who are HIV positive not to sorely rely on subsidized fertilizer. We should engage into animal farming because, apart from making money after selling our livestock, livestock provide us with organic manure.”
Talking about anti-retroviral drugs, she says the system in Malawi must ensure that people living with HIV are provided with adequate information on the benefits as well as long term side effects of the drugs.
“We need to know for how long we can take a particular drug and when we should change. We just hear that there are second line drugs, we need to know all these things, because when we’re not told and suffer side effects, we may turn against the hospital staff for hiding the truth from us and say that’s why ‘women on anti-retroviral treatment (ART) are abnormally adding weight’”.
Just like Mrs. Ivy Kazembe, we spoke to earlier, Mrs. Kanthiti feels economic empowerment is crucial in making Malawian women independent.
“Sometimes women cling to men that abuse them because they know they’ll have no means of making ends meet when they divorce”, she observes, “If women are economically empowered through small-scale businesses, they’ll be independent”.
___________
My Survival Story on ZODIAK Online is sponsored by the Open Society Initiative for Southern Africa (Osisa).
Tuesday, November 30, 2010
Friday, November 26, 2010
16 Days of Activism: Abandoned because of HIV status:
From November 25 to December 10, every year countries world over observe 16 Days of Activism Against Gender Violence.
As the world take action this year I tell stories of women and young girls who have suffered gender based violence because of their HIV status. Today, we hear from Ivy Kazembe.
Born on November 25, 1969, Mrs. Kazembe, is a window looking after five children. She comes from the area of Traditional Authority Mpama Chiradzulu District. She is currently putting up in Area 22 in the capital Lilongwe.
“My husband died on 20 March 1997 after he suffered from meningitis. After my husband died, I decided to get marry to another man in 2004”.
However, Mrs. Kazembe did not get the happiness she sought in a second marriage as her new husband abused her after realizing that she was HIV positive.
“But because of my status he said, he could not continue staying with me despite that he had made me pregnant. He just left and never come back. Currently, I have a child who is lacking support”.
She confesses that she entered into the new marriage without informing her new husband of her status.
“I know he heard from of my neighbors. You know, there some neighbors who are always speaking about your status”, says Mrs. Kazembe.
She says her new husband went away with all house belongings, including a mattress she was sleeping on when her condition had deteriorated.
“He pulled me down the mat! I felt very hurt and sorry for myself”, says Mrs. Kazembe, “I thought we should have sat down to discuss the issue.”
Mrs. Kazembe, like many other women did not report her predicament to any authority. “Even I had reported I knew, there was nothing that could have been done because no one knew where the man had gone” she narrates her story. “I heard that he died in Blantyre”.
Adding to this Mrs. Kazembe says she feels discriminated when she goes to hospital to receive medication. “We are not treated well. We are told to stay on one side and some people point at us, saying we are HIV positive”, she says.
In her neighborhood she also says some people try to avoid her and her relatives are also not helping her the way she expected.
“You see, I am widow with five children depending on me. Despite having several relatives, I find it hard to take care of the children”, she says, “It’s hard for me to find food and school fees for my children”.
Mrs. Kazembe says she has ever heard that government wants to prioritize women in the subsidized farm input programme, but he she has never benefited.
Currently Mrs. Kazembe is engaged in a charcoal selling business to make ends meet, but she says she does not get enough income from her business to meet all her needs.
She once tried to start pig farming with support from a community based organization called Meaningful Action on HIV/Action Support Network Association, (Masuna) in Lilongwe but thieves pulled her down when they stole the livestock.
The role of support groups
Mrs. Kazembe, nonetheless, points out that the situation has changed significantly compared to years between 2003 and 2005.
“We meet here (Masuna) men and women who are HIV positive and encourage each other to follow good health practices in a bid to sustain our lives.
Working under the Coalition of Women Living with HIV and AIDS, Masuna which was opened in 2005 is also involved in community civic education on HIV/AIDS, farming and orphan care.
All the 63 children under Masuna custody lost their parents due to AIDS relates ailments.
“We have 58 women and 22 men”, says Mrs. Kazembe. “We also assist widows and some other people who came with various problems.
“We strongly urge all our female members to avoid getting pregnant. If a man impregnates a woman who is HIV positive, we regard that as gender based violence”.
According to Mrs. Kazembe her decision to join a support group has helped to transform her life. “I no longer have any worries. I am now confident of my life and I can now relax”, she says.
“I urge my fellow women who have gone through similar challenges to report to relevant authorities. If you don’t they will suffer in silence”. “You can also report to the victim support unit at your nearest police station”, adds Mrs. Kazembe.
A call for Action
In order to improve the welfare of HIV positive women in Malawi, Mrs. Kazembe urges government to create jobs for them and provide them with loans to start up small scale businesses so that we can easily raise the children.
“We need to receive loans and do some business, because, staying idle can also lead us into risky behaviors instead of taking care of our lives”.
“I also would like to urge nongovernmental organizations to continue providing support to women living with HIV so that they can progress in their lives”.
My Survival Story on Online is sponsored by the Open Society Initiative for Southern Africa (Osisa).
As the world take action this year I tell stories of women and young girls who have suffered gender based violence because of their HIV status. Today, we hear from Ivy Kazembe.
Born on November 25, 1969, Mrs. Kazembe, is a window looking after five children. She comes from the area of Traditional Authority Mpama Chiradzulu District. She is currently putting up in Area 22 in the capital Lilongwe.
“My husband died on 20 March 1997 after he suffered from meningitis. After my husband died, I decided to get marry to another man in 2004”.
However, Mrs. Kazembe did not get the happiness she sought in a second marriage as her new husband abused her after realizing that she was HIV positive.
“But because of my status he said, he could not continue staying with me despite that he had made me pregnant. He just left and never come back. Currently, I have a child who is lacking support”.
She confesses that she entered into the new marriage without informing her new husband of her status.
“I know he heard from of my neighbors. You know, there some neighbors who are always speaking about your status”, says Mrs. Kazembe.
She says her new husband went away with all house belongings, including a mattress she was sleeping on when her condition had deteriorated.
“He pulled me down the mat! I felt very hurt and sorry for myself”, says Mrs. Kazembe, “I thought we should have sat down to discuss the issue.”
Mrs. Kazembe, like many other women did not report her predicament to any authority. “Even I had reported I knew, there was nothing that could have been done because no one knew where the man had gone” she narrates her story. “I heard that he died in Blantyre”.
Adding to this Mrs. Kazembe says she feels discriminated when she goes to hospital to receive medication. “We are not treated well. We are told to stay on one side and some people point at us, saying we are HIV positive”, she says.
In her neighborhood she also says some people try to avoid her and her relatives are also not helping her the way she expected.
“You see, I am widow with five children depending on me. Despite having several relatives, I find it hard to take care of the children”, she says, “It’s hard for me to find food and school fees for my children”.
Mrs. Kazembe says she has ever heard that government wants to prioritize women in the subsidized farm input programme, but he she has never benefited.
Currently Mrs. Kazembe is engaged in a charcoal selling business to make ends meet, but she says she does not get enough income from her business to meet all her needs.
She once tried to start pig farming with support from a community based organization called Meaningful Action on HIV/Action Support Network Association, (Masuna) in Lilongwe but thieves pulled her down when they stole the livestock.
The role of support groups
Mrs. Kazembe, nonetheless, points out that the situation has changed significantly compared to years between 2003 and 2005.
“We meet here (Masuna) men and women who are HIV positive and encourage each other to follow good health practices in a bid to sustain our lives.
Working under the Coalition of Women Living with HIV and AIDS, Masuna which was opened in 2005 is also involved in community civic education on HIV/AIDS, farming and orphan care.
All the 63 children under Masuna custody lost their parents due to AIDS relates ailments.
“We have 58 women and 22 men”, says Mrs. Kazembe. “We also assist widows and some other people who came with various problems.
“We strongly urge all our female members to avoid getting pregnant. If a man impregnates a woman who is HIV positive, we regard that as gender based violence”.
According to Mrs. Kazembe her decision to join a support group has helped to transform her life. “I no longer have any worries. I am now confident of my life and I can now relax”, she says.
“I urge my fellow women who have gone through similar challenges to report to relevant authorities. If you don’t they will suffer in silence”. “You can also report to the victim support unit at your nearest police station”, adds Mrs. Kazembe.
A call for Action
In order to improve the welfare of HIV positive women in Malawi, Mrs. Kazembe urges government to create jobs for them and provide them with loans to start up small scale businesses so that we can easily raise the children.
“We need to receive loans and do some business, because, staying idle can also lead us into risky behaviors instead of taking care of our lives”.
“I also would like to urge nongovernmental organizations to continue providing support to women living with HIV so that they can progress in their lives”.
My Survival Story on Online is sponsored by the Open Society Initiative for Southern Africa (Osisa).
Friday, November 19, 2010
Start an Action | Say NO - UNiTE
My Survival Story
A project to air radio programmes advocating for rights women and girls living with HIV and AIDS during the 2010 16 Days of Activism against Violence against Women.
Zodiak Broadcasting Station (ZBS) in conjunction with the Coalition for Women Living HIV and AIDS (COWLHA) - Malawi would like to undertake a series of special radio programmes highlighting the plight of women and girls living with HIV and AIDS as way of making their concerns heard on land ownership; economic rights, domestic violence.
The aim is to raise public awareness and create a forum/dialogue with policy makers and rights advocates to discuss solutions to problems women living with HIV face in Malawi.
A project to air radio programmes advocating for rights women and girls living with HIV and AIDS during the 2010 16 Days of Activism against Violence against Women.
Zodiak Broadcasting Station (ZBS) in conjunction with the Coalition for Women Living HIV and AIDS (COWLHA) - Malawi would like to undertake a series of special radio programmes highlighting the plight of women and girls living with HIV and AIDS as way of making their concerns heard on land ownership; economic rights, domestic violence.
The aim is to raise public awareness and create a forum/dialogue with policy makers and rights advocates to discuss solutions to problems women living with HIV face in Malawi.
Monday, November 15, 2010
VISIT TO KAMUZU CENTRAL HOSPITAL
Located right in the middle of what is called Old Town and City Centre of the capital Lilongwe, Kamuzu Central, is one of Malawi’s three main referral hospitals. Opened in 1977, it was named after the country’s first president Dr Hastings Kamuzu Banda.
The hospital is located in the central region of Malawi, making it the largest referral hospital in the province which has nine districts. According to director of the hospital Dr Noor Alide, the facility serves a population of 5 million in its catchment area.
In short known as KCH, Kamuzu Central is the second largest among Malawi’s referral hospitals – after Queen Elizabeth Central based in the commercial city of Blantyre in the South, Zomba General, in the Eastern Region and Mzuzu Central in the Northern Region.
KCH has many key sections which include the Out Patient Department (OPD), Under-Five Clinic, Children Ward, Maternal Ward, Dialysis Room, Orthopedics, Surgical Ward, Laboratory, Drug and Surgical Stores and Kitchen. There is also a private ward where treatment is provided at a fee.
Recently I had a rare opportunity to tour this vast institution when I joined the country’s newly appointed minister of health, Professor David Mphande. Professor Mphande was on a tour of the hospital on August 20 to familiarize himself with its operations being only about a month-old in office.
Through this trip I discovered that KCH has four main problems: shortage of staff, limited drugs and equipment coupled with an ever increasing number of patients.
Our tour started with the Treatment Room where, we leant about the most common diseases that people seek treatment for at this facility. Here clinical officer Eugene Kaisire told us that malaria, renal failure, congested cardiac failure (CCF), high blood pressure, diabetes, and of late measles as Malawi is one of the many Southern African countries hit by an outbreak of the disease, are the common ailments.
Kaisire said he works for eight hours a day, from 7:30 AM to 4:30 pm. “The problem we face is what we have receive many patients but staff is limited. Kaisire pointed out that the problem is exacerbated by the fact that most of the people that seek medical attention are not necessarily referred district or rural hospitals as it is supposed to be case.
They come direct, jumping the chain of treatment, which requires patients to first be treated at the nearest health centre in their respective communities and be referred to a district hospital or central hospital (regional) depending on the seriousness of their ailment. Once they are here, they cannot be turned back home. “We work even over lunch on a daily basis just to cope with the increasing number of patients”, said Kaisire.
Our visit to the general treatment room was only the beginning of the many problems we were to observe during our tour of Kamuzu Central Hospital. One of the most critical sections of the treatment ward is Dialysis Ward. This is where patients with kidney failure are treated. The four dialysis machines available in this ward are in fact the only functional ones throughout the whole of Malawi. People with kidney failure from all corners of the country travel to this ward to be treated on the machines for four hours, three times a week. Apart from transplant, kidney failure has not other cure. The most appropriate alternative therefore is the use of these machines which filter accumulated waste products of metabolism from the blood of a patient whose kidneys are not functioning properly.
With only four machines this ward has the capacity to handles eight patients a day, said a nurse we found in the ward Jane Rajab.
However, it a direct conservation between the visiting minister and one of the patients who is a member of the Kidney Failure Patients Association of Malawi that revealed insights I never expected:
“I am your child, please, let me die at my own house”, said Ridson Chafulumira.
“The doctor is here. You will get better”, the minister replied apparently not known where the patient was driving at.
“I can’t, you know that kidney failure is not a one day disease, it’s a terminal disease, and this machine is only sustaining life for a few more days, actually” said Mr Chafumira.
“And you want that life to be sustained” said the minister.
“Yes, but while I am at home not here”, responded Mr Chafulumira while laying on his hospital bed.
“But if you go home how do you sustain your life”
“Where?” the patient asked.
“At home”, responded the minister.
“I cannot go home without the machines operational in Blantyre. What I am asking for is the operational of the machines in Blantyre. They have been installed already, but they are taking too long to start operating” said Mr Chafulumira, hitting at the core point of his argument.
“Thank you, we will find out more about that,” said the minister to cut the long story short. “We are praying for you, we are praying for all of you that God should touch you through the medical services you are receiving”, said professor Mphande as he left the room. Being new in the office he had little to say about such a major challenge.
“But God will work through people like you” – these were the last words the patient told the minister before I chipped in to find out more about him.
When I told him that I was George Kalungwe from Zodiak Radio, he was amused and went on to tell me that he has been shuttling between Blantyre and Lilongwe to be put on a dialysis machine for four years – a distance of about 400 kilometers kilometers.
“You might have seen my articles in the paper and heard me on your radio”, he said.
“Are you satisfied with the treatment you are receiving here” I cut him short.
“Let’s not talk about satisfaction here. I am going to be satisfied with these machines in Blantyre, rather than here because Blantyre is my home”, he responded.
From the Dialysis Ward, we continued our tour of KCH by passing through the Female Surgical Ward – 4 A. This room is over congested so much that some patients and guardians sleep on the veranda.
One of the nurses working here Gertrude Nyirenda told me the actual bed capacity of this ward is only eight, but on this day eighty patients were admitted. Nyirenda said one of the measures they are putting in place to deal with the congestion is make sure a patient does not stay long in the ward waiting for surgery. “When a patient comes with a guardian, we tell the guardian to sleep outside, because we cannot accommodate everyone here”, she said, adding that, “We make sure that the doctor sees them as early as possible, so that if surgery cannot be done soon, they can leave and come back on a particular day”.
When we left the female surgical ward we proceeded to the pediatric ward. This is where children between the ages of one month to 15 years are treated. As we visited the hospital 288 children were under the clinicians’ attention. We were told that the figure is almost the same on a daily basis. Ten nurses work in this room for eight hours during the day and 16 hours during the night, said nurse Janet Kadzamira.
In total Kamuzu Central Hospital has a one thousand beds, including those in the maternity wing which has just been extended to include an-all-inclusive pay ward in honor of the late first lady Madam Ethel Mutharika – the Ethel Mutharika Maternity Wing. This ward an internet café and a TV room among other facilities.
To ensure that the all the one thousand patients admitted to the hospital are fed the hospital has a kitchen. All kinds of foods are prepared here, but mostly it is beans, vegetables and msima(a thick porridge made out of maize flour) for patients in the public wards. Those in the pay wards order a meal of their choice.
Explaining the operations here was chief nursing officer Lucy Mkutumura. “There are some patients who are not supposed to eat food with salt or oil, we know how to make it here”, she said adding that, “For those with no restrictions we offer them meals depending on the menu of the day, sometimes we offer them meat...”
The chief nursing officer said the most significant challenge the KCH kitchen is facing is the increase in demand for its services. “The hospital is expanding, but this kitchen has remained the same since 1977 when we opened the hospital”, she noted.
The kitchen has four big electric pots and three industrial cookers. However Mrs. Mkutumura said there are plans to expand the kitchen to meet the growing demand.
The visit to the kitchen was not our last. We still had to see what happens in the laboratory, the pharmacy and surgical storeroom. The KCH laboratory is one of Malawi’s best, according to lab technician Edwin Chitandale. Some of the compartments it has include the Sample Reception, where specimen from patients are received and referred for testing; Safety Cabinet, where testing for contagious airborne diseases is done using vacuum machines and the Tag Room, where TB microscopic is done.
This lab however has only 17 technicians, thirteen short of the required thirty. Apart from shortage of staff, Chitandale said this 24-hour laboratory also faces regular short falls of reagents.
Another section of this lab is the blood bank which supplies patients in need of blood fusion with the precious commodity. Mainly these include accident victims, anemic patients and women in labour wards.
Limited blood supply is the major challenge facing the blood bank. “We are supposed to have at least a minimum of 40 units per day, but most of the times we do not have that”, said Chitandale, “It is our plea to the society that they must change their blood donating habits .When the population does not come to donate we are handicapped”.
Chitandale said the problem is usually worse during school holidays because most blood donors are the youth in the ages of 16 to 18 who are mostly form three and form four secondary students and donate blood from their schools during visits by the Malawi Blood Transfusion Service – a public trust.
With the advent of HIV and AIDS, another important section of this lab is the pediatric HIV testing room where children born from HIV positive mothers that have undergone the process of prevention of mother to child transmission is done. Most of the nine districts of the central region of Malawi rely on this laboratory for pediatric HIV testing for children below six months. With three technicians working on eight-hour shifts, up to a 130 infant samples are tested daily in this laboratory, according to Chitandale.
A major hospital like Kamuzu Central cannot be complete without a pharmacy. This is where outpatients receive drugs on a daily basis. The drugs supplied range from antibiotics to anti malarials. Seniors Pharmacist Macmillan Kondowe said up to one thousand patients receive medication from the KCH pharmacy each day.
Kondowe said, given that this is a referral hospital, the number is too large. “ Actually we should have been getting much lesser than that, but it difficult for us to differentiate who has been referred and who has not”, he said.
After leaving the pharmacy, we entered the surgical storeroom. This is where all non drug items, such as gloves, bandages, clips, and the like are stored.
To deal with theft of drugs and equipment, KCH is implementing a trial system called E-Pharmacy, a short form of Electronic Pharmacy Management System.
“What it is supposed to do is that if one goes through the registration point at the out patients department, they are supposed to be registered and on their health passport book it produces bar-coded label, which includes all your details – your name, sex, and everything”, said another senior pharmacists Albert Khuwi, adding that, “Ideally once somebody has been registered, they go to the clinician, he would also have a screen like this and then after making a diagnosis and a prescription is made out, the prescriber is supposed to enter that information into the machine again and that information on the prescription should be sent to pharmacy, the dispersing area. And then once the dispersing is done the patient is like checked out but the information is kept so that at the end of the day we should be able to check how many, say pain killers, antibiotics, we have dispersed on a particular day”.
“If there is a difference between the amount drugs registered in the machine as having been given out on a particular day and the figures manually recorded in the stores, then people managing the stores can be taken to task”, said Khuwi.
After the health minister professor Mphande finished visiting the hospital, I had the opportunity to interview the director of the hospital Dr Noor Alide. He said the hospital is trying within its limits to address some of the challenges it is facing, but there are other problems which can only be addressed by the government.
He said a system has been put in place to strengthen monitoring of drugs availability and prescribing methods. He added that the hospital has entered into contract with some companies and suppliers so that its equipment is serviced on contract basis. There are also plans to facelift the outlook of the whole three-storey building by remodeling it.
“But for human resource, we really have to depend on the ministry of health just the same as the issue of ensuring that all people that come to access help at the facility are only those that are referred from smaller hospitals” said Dr Alide.
Dr Alide indicated that KCH would also like ask the authorities to allow the hospital to hire staff such as nurses, doctors and clinicians on its own, without going through the ministry of health, saying doing so would help in quickly covering gaps that exists due to brain drain.
Dr Alide revealed that the hospital spends between 8 to 10 Malawi kwacha in hiring additional staff available on the open market to help in delivering effective services.
Asked about tendency of locals who despise hospitals in the likes of KCH to seek medical treatment outside the country, Dr Alide said: “The choice of where somebody gets services is an individual choice. As I have just told you people are bypassing health centres belonging to district health offices coming to central hospital, its their choice, and we cannot stop them from choosing”. “
But what I can say, for sure is that, if there is a hospital here in the central region with specialists and equipment capable of providing quality service then it is Kamuzu Central Hospital. May be the hotel side of the problem is deterring people from coming to access services here, but the staff and quality of service we provide in terms of medical care is of high standard”, challenged Dr Alide.
Being new in cabinet, minister of health professor David Mphande had little to say, other than ‘appreciating the challenges Kamuzu Central Hospital is facing’.
Professor Mphande said he was going to undertake a tour of many hospitals as possible and discuss with stakeholders how some of the challenges can be addressed on long term basis based on a report which he will compile after his countrywide tour of health facilities. “My visit here is an opener to the problems that most health facilities, especially big hospitals like this one, are facing in the country” said the minister.
Nonetheless he said he was impressed with the dedication of the members of staff and the cleanliness of the hospital and concurred with Dr Alide on the need to expand the facility to meet the increasing number of outpatients and those admitted.
…………………………………..END……………………………………….
The hospital is located in the central region of Malawi, making it the largest referral hospital in the province which has nine districts. According to director of the hospital Dr Noor Alide, the facility serves a population of 5 million in its catchment area.
In short known as KCH, Kamuzu Central is the second largest among Malawi’s referral hospitals – after Queen Elizabeth Central based in the commercial city of Blantyre in the South, Zomba General, in the Eastern Region and Mzuzu Central in the Northern Region.
KCH has many key sections which include the Out Patient Department (OPD), Under-Five Clinic, Children Ward, Maternal Ward, Dialysis Room, Orthopedics, Surgical Ward, Laboratory, Drug and Surgical Stores and Kitchen. There is also a private ward where treatment is provided at a fee.
Recently I had a rare opportunity to tour this vast institution when I joined the country’s newly appointed minister of health, Professor David Mphande. Professor Mphande was on a tour of the hospital on August 20 to familiarize himself with its operations being only about a month-old in office.
Through this trip I discovered that KCH has four main problems: shortage of staff, limited drugs and equipment coupled with an ever increasing number of patients.
Our tour started with the Treatment Room where, we leant about the most common diseases that people seek treatment for at this facility. Here clinical officer Eugene Kaisire told us that malaria, renal failure, congested cardiac failure (CCF), high blood pressure, diabetes, and of late measles as Malawi is one of the many Southern African countries hit by an outbreak of the disease, are the common ailments.
Kaisire said he works for eight hours a day, from 7:30 AM to 4:30 pm. “The problem we face is what we have receive many patients but staff is limited. Kaisire pointed out that the problem is exacerbated by the fact that most of the people that seek medical attention are not necessarily referred district or rural hospitals as it is supposed to be case.
They come direct, jumping the chain of treatment, which requires patients to first be treated at the nearest health centre in their respective communities and be referred to a district hospital or central hospital (regional) depending on the seriousness of their ailment. Once they are here, they cannot be turned back home. “We work even over lunch on a daily basis just to cope with the increasing number of patients”, said Kaisire.
Our visit to the general treatment room was only the beginning of the many problems we were to observe during our tour of Kamuzu Central Hospital. One of the most critical sections of the treatment ward is Dialysis Ward. This is where patients with kidney failure are treated. The four dialysis machines available in this ward are in fact the only functional ones throughout the whole of Malawi. People with kidney failure from all corners of the country travel to this ward to be treated on the machines for four hours, three times a week. Apart from transplant, kidney failure has not other cure. The most appropriate alternative therefore is the use of these machines which filter accumulated waste products of metabolism from the blood of a patient whose kidneys are not functioning properly.
With only four machines this ward has the capacity to handles eight patients a day, said a nurse we found in the ward Jane Rajab.
However, it a direct conservation between the visiting minister and one of the patients who is a member of the Kidney Failure Patients Association of Malawi that revealed insights I never expected:
“I am your child, please, let me die at my own house”, said Ridson Chafulumira.
“The doctor is here. You will get better”, the minister replied apparently not known where the patient was driving at.
“I can’t, you know that kidney failure is not a one day disease, it’s a terminal disease, and this machine is only sustaining life for a few more days, actually” said Mr Chafumira.
“And you want that life to be sustained” said the minister.
“Yes, but while I am at home not here”, responded Mr Chafulumira while laying on his hospital bed.
“But if you go home how do you sustain your life”
“Where?” the patient asked.
“At home”, responded the minister.
“I cannot go home without the machines operational in Blantyre. What I am asking for is the operational of the machines in Blantyre. They have been installed already, but they are taking too long to start operating” said Mr Chafulumira, hitting at the core point of his argument.
“Thank you, we will find out more about that,” said the minister to cut the long story short. “We are praying for you, we are praying for all of you that God should touch you through the medical services you are receiving”, said professor Mphande as he left the room. Being new in the office he had little to say about such a major challenge.
“But God will work through people like you” – these were the last words the patient told the minister before I chipped in to find out more about him.
When I told him that I was George Kalungwe from Zodiak Radio, he was amused and went on to tell me that he has been shuttling between Blantyre and Lilongwe to be put on a dialysis machine for four years – a distance of about 400 kilometers kilometers.
“You might have seen my articles in the paper and heard me on your radio”, he said.
“Are you satisfied with the treatment you are receiving here” I cut him short.
“Let’s not talk about satisfaction here. I am going to be satisfied with these machines in Blantyre, rather than here because Blantyre is my home”, he responded.
From the Dialysis Ward, we continued our tour of KCH by passing through the Female Surgical Ward – 4 A. This room is over congested so much that some patients and guardians sleep on the veranda.
One of the nurses working here Gertrude Nyirenda told me the actual bed capacity of this ward is only eight, but on this day eighty patients were admitted. Nyirenda said one of the measures they are putting in place to deal with the congestion is make sure a patient does not stay long in the ward waiting for surgery. “When a patient comes with a guardian, we tell the guardian to sleep outside, because we cannot accommodate everyone here”, she said, adding that, “We make sure that the doctor sees them as early as possible, so that if surgery cannot be done soon, they can leave and come back on a particular day”.
When we left the female surgical ward we proceeded to the pediatric ward. This is where children between the ages of one month to 15 years are treated. As we visited the hospital 288 children were under the clinicians’ attention. We were told that the figure is almost the same on a daily basis. Ten nurses work in this room for eight hours during the day and 16 hours during the night, said nurse Janet Kadzamira.
In total Kamuzu Central Hospital has a one thousand beds, including those in the maternity wing which has just been extended to include an-all-inclusive pay ward in honor of the late first lady Madam Ethel Mutharika – the Ethel Mutharika Maternity Wing. This ward an internet café and a TV room among other facilities.
To ensure that the all the one thousand patients admitted to the hospital are fed the hospital has a kitchen. All kinds of foods are prepared here, but mostly it is beans, vegetables and msima(a thick porridge made out of maize flour) for patients in the public wards. Those in the pay wards order a meal of their choice.
Explaining the operations here was chief nursing officer Lucy Mkutumura. “There are some patients who are not supposed to eat food with salt or oil, we know how to make it here”, she said adding that, “For those with no restrictions we offer them meals depending on the menu of the day, sometimes we offer them meat...”
The chief nursing officer said the most significant challenge the KCH kitchen is facing is the increase in demand for its services. “The hospital is expanding, but this kitchen has remained the same since 1977 when we opened the hospital”, she noted.
The kitchen has four big electric pots and three industrial cookers. However Mrs. Mkutumura said there are plans to expand the kitchen to meet the growing demand.
The visit to the kitchen was not our last. We still had to see what happens in the laboratory, the pharmacy and surgical storeroom. The KCH laboratory is one of Malawi’s best, according to lab technician Edwin Chitandale. Some of the compartments it has include the Sample Reception, where specimen from patients are received and referred for testing; Safety Cabinet, where testing for contagious airborne diseases is done using vacuum machines and the Tag Room, where TB microscopic is done.
This lab however has only 17 technicians, thirteen short of the required thirty. Apart from shortage of staff, Chitandale said this 24-hour laboratory also faces regular short falls of reagents.
Another section of this lab is the blood bank which supplies patients in need of blood fusion with the precious commodity. Mainly these include accident victims, anemic patients and women in labour wards.
Limited blood supply is the major challenge facing the blood bank. “We are supposed to have at least a minimum of 40 units per day, but most of the times we do not have that”, said Chitandale, “It is our plea to the society that they must change their blood donating habits .When the population does not come to donate we are handicapped”.
Chitandale said the problem is usually worse during school holidays because most blood donors are the youth in the ages of 16 to 18 who are mostly form three and form four secondary students and donate blood from their schools during visits by the Malawi Blood Transfusion Service – a public trust.
With the advent of HIV and AIDS, another important section of this lab is the pediatric HIV testing room where children born from HIV positive mothers that have undergone the process of prevention of mother to child transmission is done. Most of the nine districts of the central region of Malawi rely on this laboratory for pediatric HIV testing for children below six months. With three technicians working on eight-hour shifts, up to a 130 infant samples are tested daily in this laboratory, according to Chitandale.
A major hospital like Kamuzu Central cannot be complete without a pharmacy. This is where outpatients receive drugs on a daily basis. The drugs supplied range from antibiotics to anti malarials. Seniors Pharmacist Macmillan Kondowe said up to one thousand patients receive medication from the KCH pharmacy each day.
Kondowe said, given that this is a referral hospital, the number is too large. “ Actually we should have been getting much lesser than that, but it difficult for us to differentiate who has been referred and who has not”, he said.
After leaving the pharmacy, we entered the surgical storeroom. This is where all non drug items, such as gloves, bandages, clips, and the like are stored.
To deal with theft of drugs and equipment, KCH is implementing a trial system called E-Pharmacy, a short form of Electronic Pharmacy Management System.
“What it is supposed to do is that if one goes through the registration point at the out patients department, they are supposed to be registered and on their health passport book it produces bar-coded label, which includes all your details – your name, sex, and everything”, said another senior pharmacists Albert Khuwi, adding that, “Ideally once somebody has been registered, they go to the clinician, he would also have a screen like this and then after making a diagnosis and a prescription is made out, the prescriber is supposed to enter that information into the machine again and that information on the prescription should be sent to pharmacy, the dispersing area. And then once the dispersing is done the patient is like checked out but the information is kept so that at the end of the day we should be able to check how many, say pain killers, antibiotics, we have dispersed on a particular day”.
“If there is a difference between the amount drugs registered in the machine as having been given out on a particular day and the figures manually recorded in the stores, then people managing the stores can be taken to task”, said Khuwi.
After the health minister professor Mphande finished visiting the hospital, I had the opportunity to interview the director of the hospital Dr Noor Alide. He said the hospital is trying within its limits to address some of the challenges it is facing, but there are other problems which can only be addressed by the government.
He said a system has been put in place to strengthen monitoring of drugs availability and prescribing methods. He added that the hospital has entered into contract with some companies and suppliers so that its equipment is serviced on contract basis. There are also plans to facelift the outlook of the whole three-storey building by remodeling it.
“But for human resource, we really have to depend on the ministry of health just the same as the issue of ensuring that all people that come to access help at the facility are only those that are referred from smaller hospitals” said Dr Alide.
Dr Alide indicated that KCH would also like ask the authorities to allow the hospital to hire staff such as nurses, doctors and clinicians on its own, without going through the ministry of health, saying doing so would help in quickly covering gaps that exists due to brain drain.
Dr Alide revealed that the hospital spends between 8 to 10 Malawi kwacha in hiring additional staff available on the open market to help in delivering effective services.
Asked about tendency of locals who despise hospitals in the likes of KCH to seek medical treatment outside the country, Dr Alide said: “The choice of where somebody gets services is an individual choice. As I have just told you people are bypassing health centres belonging to district health offices coming to central hospital, its their choice, and we cannot stop them from choosing”. “
But what I can say, for sure is that, if there is a hospital here in the central region with specialists and equipment capable of providing quality service then it is Kamuzu Central Hospital. May be the hotel side of the problem is deterring people from coming to access services here, but the staff and quality of service we provide in terms of medical care is of high standard”, challenged Dr Alide.
Being new in cabinet, minister of health professor David Mphande had little to say, other than ‘appreciating the challenges Kamuzu Central Hospital is facing’.
Professor Mphande said he was going to undertake a tour of many hospitals as possible and discuss with stakeholders how some of the challenges can be addressed on long term basis based on a report which he will compile after his countrywide tour of health facilities. “My visit here is an opener to the problems that most health facilities, especially big hospitals like this one, are facing in the country” said the minister.
Nonetheless he said he was impressed with the dedication of the members of staff and the cleanliness of the hospital and concurred with Dr Alide on the need to expand the facility to meet the increasing number of outpatients and those admitted.
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