Prior to the advent of HIV, the healthcare system in Malawi was severely challenged; with its arrival, it has been brought to its knees due to a shortage of health workers
TWENTY YEARS after the first World Aids Day, Aids seems to have gone off the radar in the West due to developments in drugs and treatment. But it is still the disease claiming most lives in the developing world. We just don't see it because it is not on our doorstep.
Last week, in one of the worst-affected countries in the world, Malawi, I sat with a young woman who gave birth to her baby, on to a stone floor, unassisted. The baby was stillborn. A few hours later this woman gathered up her small bundle of belongings and headed home, a two-hour walk. The staff, all three, were so overburdened that no one had time to talk to her.
She was gone before anyone noticed. There is no facility for these women to grieve. They just walk home and life, in whatever form, continues. In addition, these working conditions are utterly demoralising for the staff and are partly responsible for the 60 per cent midwife vacancy level at this hospital.
In the same maternity hospital it is estimated that 30 per cent of the women presenting for delivery are HIV positive and have not had access to treatment. HIV is major contributory factor to maternal death. A HIV positive expectant mother is twice as likely to develop complications as a woman who is negative. When a mother is HIV positive, she can pass the virus to her unborn child through pregnancy or breastfeeding. This results in 30,000 babies being born with the virus in Malawi each year. The fact that this transmission is preventable through treatment only makes this figure more tragic.
Giving an expectant mother anti-retroviral drugs by the 26th week of pregnancy can almost eliminate the risk of the virus being transmitted to the baby. These anti-retroviral drugs are free, but only 20 per cent of HIV positive expectant mothers have access to the treatment.
Malawi is a landlocked country in southern Africa and ranks among the most densely populated and least developed countries in the world. With the majority of people living on less than $2 a day, life is a challenge. Travelling around Lilongwe, the capital city, and its rural surroundings, one is struck by the sinister poverty, with lack of healthcare being a major contributing factor. According to official figures, 15 per cent of the population is HIV positive, however, speaking with hospital staff and healthcare professionals, it is estimated to be considerably higher.
Prior to the advent of HIV, the healthcare system in Malawi was severely challenged; with its arrival, it has been brought to its knees. While many people have received treatment, the majority of those in need have not been reached. Efforts to increase access to treatment and to maintain and improve the quality of care are being hampered due to the acute shortage of health workers. It has been recognised for some time that this is greatest obstacle to healthcare delivery in many African countries and is contributing to unnecessary illness and death. In Malawi there are only two doctors and 56 nurses per 100,000 patients.
Travelling around district healthcare clinics surrounding Lilongwe, this shortage of healthcare workers is a stark reality. So many people are ill and awaiting treatment but in the majority of clinics there are no doctors and very few qualified nurses. Many people walk up to four hours to the nearest hospital; for the most part these individuals are very ill.
In Lilongwe, hospitals are severely overcrowded with many patients sleeping on bare mattresses on stone floors. In some cases, patients sleep on balconies open to all the elements including severe cold and heavy rain. 80 per cent of the patients are young and in the final stages of Aids. The level of illness among the patients is overwhelming. You would never see such illness in western hospitals as treatment is available at the early stages.
The central maternity hospital was built in 1939 to facilitate 4,000 annual deliveries. There are now 12,000 births with three fully qualified midwives and two obstetricians. To place this in context, there are 9,000 annual births in the Coombe University Hospital with 18 obstetricians and 130 midwives.
These scenes are repeated all over East and Central Africa, as a country with a very high level of medical and nursing expertise we need to respond. With such overcrowding and lack of skilled healthcare workers it will come as no surprise that Malawi has the highest level of maternal mortality rate in the world for a non-conflict country.
Despite all this, the spirit of the Malawian people is extraordinary. When you meet them you would never guess the sadness that lurks beneath. What strikes you most is their ability to smile, their ability to access inner resources, the resources that facilitate survival. But poverty is exhausting; you can see it in their eyes though it is worn with an unconscious dignity.
There is an urgent need for those of us in countries with developed healthcare systems to respond to these wonderful people. To start with, measures need to be taken by donor national and international entities to retain skilled health care workers and to attract new staff by increasing salaries, improving working and living conditions, as well as providing access to treatment and health care for the workers themselves. Many young doctors and nurses have been lost to the pandemic or are wrestling with the virus in the course of caring for patients.
This year, on the 30th anniversary of the Universal Declaration on Human Rights, much greater strides are required from the international community to make this declaration a reality for those who need it most. While we have our difficulties to worry about, we cannot let these people feel alone. We are connected to each other now more than ever.
• Mary Donohoe is founder of the Rose Project whose programme in Lilongwe in Malawi includes a maternity hospital, due to open next spring; a clinic for healthcare professionals, opening in May; and a new programme designed to prevent HIV transmission from mother to child. Further information from www.roseproject.org