Malawi

A Health Surveillance Assistant offers HIV-Testing and Counseling (HTC) in a Resthouse Room at Sombi

 

Picture trees, water, mountains, mud, birds and fish. This is Lake Chirwa -- the second largest of the five lakes in Malawi and the main habitat of small fish called Matemba. The lake offers a trading opportunity for fishermen from many walks of life.

Lying in the southern region of Malawi, Lake Chirwa is a wetland for people of three districts: Phalombe, Zomba and Machinga. All these people have frequent contact with Mozambique as they lie near the bordering frontiers. The lake lies some 50km from Zomba District Health Office.

If you grow up in places like Kasungu district in rural Malawi, you learn that when your wife is pregnant, you should not have sex outside marriage---because you will lose the “expected gift” through miscarriage. Male promiscuity during a partner's pregnancy is a taboo that many believe will bring a curse on the family.

Patricia Patrick says that after she miscarried in November 2008 “People talked in the village, and people talked within the household. My relatives asked me suspicious questions.” They wondered whether sexual misbehavior by her husband caused the tragedy. She remembers her husband telling his side of the story to prove his innocence, but nobody believed him.

Mother and children, Salima, Malawi, April 2011

Malawi leads the developing world as the first to propose an approach to prevention of mother to child transmission (PMTCT) of HIV that addresses the health of the mother. Recently my MSH colleague Erik Schouten and his colleagues in Malawi wrote a commentary in the Lancet about Malawi’s innovative, public health approach to PMTCT. Malawi calls its model “B+” because it complements the World Health Organization’s (WHO) B option, whereby a mother’s CD4 cell count, a measure of the volume of HIV circulating in her blood, determines her eligibility for lifelong antiretroviral therapy (ART).

In June 2011, the CSIS Global Health Policy Center asked bloggers around the world, Do you think it's possible to create a unified social movement for NCDs, akin to the movements that already exist for individual chronic diseases?  If so, why?  If not, what initiatives can we implement in the place of an effective social movement to move an NCD agenda forward? Dr. Jonathan D. Quick was one of our four finalists.

For three years, Lucy Sakala has counseled people seeking HIV tests at a District Hospital in Malawi. A year ago, she was diagnosed with uterine cancer. She has had chemotherapy and surgery, which are sometimes painful and tiring, but are extending her life.

During the counseling sessions, she sometimes tells her patients about her illness: “I tell them they should live positively. There are several conditions more serious than HIV. I tell them I have cancer. It’s difficult, but I live positively."

The day before she said this, she had journeyed seven hours to the nearest city to see her doctor. He told her he had no more chemotherapy and she must buy it in a pharmacy. The cost was roughly $180. Insurance would only pay half.  The remaining half is a month’s salary, which she didn’t have.

I’d like to call attention to an important set of articles in the recent HIV/AIDS themed issue of The Lancet. Erik Schouten of Malawi Basic Support for Institutionalizing Child Survival (BASICS) has published a commentary (free registration required) about Malawi’s push to be the first country to implement a “B+” approach to reducing mother to child transmission.

Discovering MSH blog series graphicOver the next couple of months, as MSH celebrates it's 40th anniversary, reporter John Donnelly and photographer Dominic Chavez will be traveling to several countries to report on MSH’s work in the field. The stories will go into a book due out in the fall on MSH’s 40 years in global health. This blog entry is a post from the road, to give a flavor of their experiences with MSH staff.

Discovering MSH blog series graphicOver the next couple of months, as MSH celebrates it's 40th anniversary, reporter John Donnelly and photographer Dominic Chavez will be traveling to several countries to report on MSH’s work in the field. The stories will go into a book due out in the fall on MSH’s 40 years in global health. This blog entry is a post from the road, to give a flavor of their experiences with MSH staff.LILONGWE, Malawi – The problem with writing about improvements in Malawi’s health system is focus. There are multiple directions to explore: extending family planning into rural communities, training HIV counselors, the rapid scale-up of HIV treatment, integrating TB services more into the mainstream of health care. At the US Agency for International Development (USAID) mission here, Dr.

Discovering MSH blog series graphicOver the next couple of months, as MSH celebrates it's 40th anniversary, reporter John Donnelly and photographer Dominic Chavez will be traveling to several countries to report on MSH’s work in the field. The stories will go into a book due out in the fall on MSH’s 40 years in global health. This blog entry is a post from the road, to give a flavor of their experiences with MSH staff.

Lucy Sakala at the Salima District Hospital in Salima, Malawi (© Dominic Chavez)

 

It’s common sense that a mother who is on treatment for AIDS, pregnant, has a sick child, and is accompanying a sister debilitated by Tuberculosis should not have to visit four separate service delivery points to receive care. Integrated health services not only make the world a healthier place, but also decrease the burden on health systems.

Integration is a comprehensive approach to service delivery. It is the transition from a vertical or horizontal approach to a diagonal, synergistic approach at all levels of a health system. Smart integration means coordinating disease specific programs (such as HIV and AIDS) with other health programs that have operated independently in the past (for example, family planning) to deliver services at the same time or, more importantly, with the same funding. Integration helps organizations maximize the impact of their health investments while allowing people, information, and funding to flow more easily among collaborating groups and stakeholders. Equally important, integration enables providers to treat the health needs of individuals and families more efficiently---regardless of the initial reason a person seeks care.

This is a guest post from Olive Mtema, Policy Advisor, from the Community Based Family Planning and HIV & AIDS Services project in Malawi. Olive is an employee of the Futures Group.

On March 12, 2011, Muslim Leaders gathered in Lilongwe, Malawi for a conference on Reaffirming Muslims' Positions on Family Planning and HIV & AIDS Issues. The conference was hosted by the USAID-funded Community Based Family Planning and HIV & AIDS Services project (CFPHS) in collaboration with the Malawi Ministry of Health, Reproductive Health Unit (RHU); Muslim Association of Malawi (MAM); and Quadria Muslim Association of Malawi (QMAM). CFPHS is led by MSH, with Futures Group and Population Services International as key implementing partners.

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