Author Archives: M Silvestri

About M Silvestri

Mara, who believes the media should serve as a catalyst for social change, recently completed her Bachelor of Arts in Global Studies and Communication Studies from Wilfrid Laurier University. Mara has been involved with Journalists for Human Rights prior to being hired for her position in Malawi, she was the president of the Laurier jhr student chapter for two years and always dreamed of getting involved with the organization in an overseas capacity. Mara has published numerous pieces in The Cord Weekly and Blueprint Magazine. She will be working as the Rights Media Print Intern at the Daily Times Newspaper in Blantyre, Malawi.

Firsthand research and experience with the Malawian health care system

“Take a deep breath. Another one, and one more…”

Those were the last words I heard before I couldn’t fight the anesthetic anymore and I was fast asleep.

I recall questioning whether this was really happening. It was just a couple weeks prior that I began working on an article that explored the capacity of Malawian hospitals to accommodate serious illness and medical procedures. So far my findings had not been encouraging, so I had the worst of thoughts running through my head as I was being rolled into the operating room.

In one particular interview with a medical intern, I was told that it is not common for most hospitals to have back up generators. If a power outage occurs, there is a chance that patients who rely on the use of power-driven machinery may not be able to survive. Knowing this alongside my other worries, I was deeply afraid of how successful the surgery would be.

When I woke up, the pain in my torso hit me immediately, as the nurses told me it would. It was so widespread I couldn’t detect the precise location of the incision.

I knew one thing was for sure: my appendix was no longer inside me. It was sitting in a jar, in front of me, labeled “Mara Silvestri, Room 9A” as if it was considered just another body part by those who removed it. For me, it was monumental.

Just hours before, I learned I had appendicitis. Within a five hour span, I was diagnosed and under the knife, without much time to consider my health care options because appendicitis needs to be treated immediately in order to avoid a burst appendix.

As someone who squirms at the thought of blood or needles, I had faced my biggest fear by undergoing an emergency appendectomy. The appendix that sat in front of me symbolized a triumph.

Lying in the hospital bed with my expat crew surrounding me, the first thing I wanted to do was look down to see the size of my scar, but even with remnants of anesthesia clouding my judgment, I knew I wasn’t brave enough to see it.

I couldn’t help being curious. Despite the tears flowing down my face pre-surgery, the doctor was candid with me and refrained from sugar-coating the situation.

“If the appendix has perforated and caused internal problems, we will need to operate further. I’m going to make the scar below your belly button instead of to the side so we can expand it upward accordingly, in case we open you up and find internal problems,” he said  as he motioned his hand up his chest and to his chin.

All I could imagine before surgery was coming out with a scar that spanned the length of my upper body.

I was lucky, I had the appendectomy before any serious complications occurred and the scar is only two inches long, I’m told (I still haven’t looked beneath the bandage).

Prior to that day I had met with multiple doctors who all told me the problem was my kidney. At that point, kidney complications seemed like a relief to liver, gall bladder or appendix complications. After asking around to gain knowledge of who the more experienced doctors in town were, I sought another medical opinion. I was told the problem was indeed my appendix, but by that point the diagnosis was becoming easier to make as the pain I was experiencing was increasing and I was in agony.

“Don’t worry, God is with you” I was told over and over again by doctors, radiologists and fellow patients.

How could I not be worried? My family was tens of thousands of miles away and I have a history of breaking into tears at the slightest of medical worries. I bawled when my dentist informed me I needed my wisdom teeth taken out- and that was at a clinic that was fully equipped, being performed by a doctor I had known since my adult teeth first grew in.

To sit in a hospital bed under a malaria net, with some of Malawi’s most common critters under the covers with me (cockroaches), being served a meal that I am sure consisted of chicken feet, caused me to be very concerned about how my recovery would progress. At one point, the nurse spotted the critter that was crawling about my bed and said “looks like you are not alone!” but this wasn’t the company I envisioned at my bed side.

Furthermore, the hospital I was in does not possess an internal communication system between rooms. There was no button for me to click in order to notify the nurses I needed their attention. The only thing remotely close to that was the radio behind my bed, which fell out of the wall when we tried to use it. This is one of the reasons I was so grateful to have friends I had made here by my bedside.

My stay in the hospital, and my experience with the Malawian health care system made me appreciate the access that patients in countries such as Canada have to a variety of specialists, surgeons, general practitioners and medical facilities.

The hospital I was at was a private hospital in Blantyre, yet it was still under staffed. There were times when I needed my IV changed, required assistance getting out of my bed, or needed another painkiller injection, but nurses told me they were busy with other patients.

I had a great support system to care for me in the days leading up to my dad’s arrival, but I was very happy to have a comfort of home at my bedside as my father walked into my recovery room and greeted me by telling me that he was there to care for me for the next week.

This experience marked an extreme moment in my internship that was already defined by extraordinary moments. Some may call me crazy for not racing back to the comforts of home at a time like this, but even in my post-op state, I’m eager to recover quicker so I can walk around Blantyre again and hear “hey sister” being yelled in my direction on my way to work. I’m also looking forward to once again hearing the sounds of my coworkers greeting me good morning at the beginning of another adventurous work day. It is all part of Malawi’s charm.

And with this, I can safely say that when in Malawi, expect the unexpected.

World Press Freedom Day event reveals media freedom in Malawi has a new landscape

Media freedom in Malawi has been commonly deplored, but amidst the political transition that brought Malawi its first female head of state last month, Her Excellency Joyce Banda, media freedom is beginning to take an unfettered shape.

The topic was denounced at a UNESCO funded event held by the Media Institute of Southern Africa (MISA) Malawi chapter in Blantyre last week, in commemoration of World Press Freedom Day on May 3rd.

The event was titled “Media Freedom and Freedom of Expression in Malawi: The Role of Human Rights Defenders in Promoting the Rule of Law and Constitution in Malawi,” and a debate ensued as NGO workers, journalists, academics, and government officials who sat on a panel discussed the topic.

“The defence of human rights is about informing people on time, about surveillance…. it is about evaluating the performance of all authorities responsible for our social welfare… and it is also about the most important thing which is advocacy” said Emmanuel Kondowe, acting deputy executive secretary for Malawi National Commission for UNESCO, as he asserted that true and accurate information is only possible through free media.

Kondowe futher expressed that the media is at the forefront of defending the aspirations of Malawians, defining the media’s role as “drawing attention to human rights infractions.”

“[The media] has the power to reach out to the masses and influence opinion, as well as foster change,” said Edith Kambalame, the features editor at The Nation.

Kambalame also introduced the view that change can also be fostered on an individual level as “every Malawian is a human rights defender” and the other panelists unanimously agreed.

“We have the right to defend our own rights apart from somebody else defending for us” said Margareth Ali, vice chairperson of Human Rights Consultative Committee.

Media freedom in the past fell privy to scrutinization as panelists and audience members alike reviewed the media landscape that existed under the power of past president Bingu wa Mutharika’s regime.

“The new government is only a few weeks old, but with the previous one, we were facing many difficulties” said Ali, referring to organizations that were condemned for helping the media.

“Again, events in our recent past attest to this. Journalists have been attacked by their fellow citizens and not least by some sectors of society who are charged with protecting the sanctity of life including the lives of journalists,” said Kondowe in reference to the harassment journalists have faced.

In response, George Pemba, Regional Information Officer for the South, spoke on behalf of the government in order to proclaim change.“You may agree with me that the human rights defenders including the media were not free enough to express themselves or disseminate information,

“[Now,] the freedom is there and present, particularly with the coming in of this new government. You may recall when the new Minister of Information was being sworn in, the head of state indicated that what she would want to see and hear is the truth and only the truth that has to be given out to the public.

“This is an indication that government is more than ready to make sure that human rights, especially media freedoms and freedom of expression are upheld in this country.”

Francis Chikunkhuzeni, lecturer of  Mass Media and Society at Polytechnic, sent a message to all journalists and human rights defenders in regards to a way forward.

“We should be very optimistic, but cautiously optimistic because change is usually gradual. We are not going to reinvent our practices overnight.”

Growing mental health awareness in Malawi calls for more trained medical professionals

About half of the world’s population resides in a country where there is one psychiatrist or less to serve 200,000 people on average, according to the World Health Organization (WHO).

However, in Malawi, there are only two psychiatrists and two psychologists who are registered with the Medical Council of Malawi and serving a country of over 13 million people.

Without access to trained mental health care professionals, the mental health issues facing Malawians remain largely untreated and access to mental health facilities with trained professionals is arduous.

“The situation for mental health in Malawi is something that really requires a lot of attention,” says Dr. Chiwoza Bandawe, one of the registered clinical psychologists in Malawi, on the topic of the 1 to 6 million psychologist to patient ratio.

Until the field of mental health started growing, Bandawe speaks of his experience being the only clinical psychologist in Malawi for about 10 years upon his return to Malawi in 1995 from studying at the University of Cape Town. He attributes the lack of psychologists in the country to the lack of attention mental health previously received.

The current state of mental health is expected to change as Bandawe adds that the Malawian government has recognized mental illness in the Essential Health Package which “will help tremendously towards putting mental health right in its necessary spotlight.”

Henry Chimbali, Spokesman for the Ministry of Health in Malawi, told The Daily Times that government is adapting to the growing needs for mental health treatment.

“Mental health is one of the priority areas that have been included in the new health sector strategic plan and requires more attention than before,” he said.

Chimbali, however, suggests mental health still requires adequate budget allocation by government. He claims an assessment made in 2008 on funding to the sector found that only 0.9 percent of the total health budget was assigned to mental health.

Faced with scarce resources and a growing need for treatment, two of the country’s main forces behind mental health, Dr. Felix Kauye and Dr. Chiwoze Bandawe both agree that tremendous challenges remain which must be overcome in the field, beginning with addressing the need for more mental health professionals.

“There are a lot of challenges which I face in my career. The main challenge which I am currently facing is the workload,” says Kauye, who is one of the country’s two registered psychiatrists and also holds the title of Director of Mental Health Services at Malawi Government.

His skills are so highly relied on that his role within Malawi is increasingly more multifaceted. Kauye undertakes clinical work at Zomba Mental hospital, where he has four business ward rounds and one academic ward round in a week. He is also a clinical lecturer for the College of Medicine and involved in the training of post graduate students who are training to be psychiatrists. Additionally, Kauye is the head of the management team of Zomba Mental Hospital and is involved in the administration of the hospital.

But his role still does not end there, “Lastly but not least, I am involved in the drafting and implementation of national mental health programs like integration of mental health in primary care in Malawi and supervision of district mental health services,” says Kauye.

Bandawe’s responsibilities are just as demanding. At the present time, Bandawe is employed by the College of Medicine as the Dean of Students. He says his challenge, like other mental health care professionals, is not being available to as many people as he would like.

“.…I hardly see clients or patients at Queen Elizabeth Hospital and the need for psychologists is growing. People are coming to realize and appreciate the need for speaking with a psychologist,” he says.

Bandawe sums up the current problem of lack of qualified staff by saying that “there is a growing recognition and appreciation, so the challenge is as that recognition and appreciation grows, so do the demands on me grow. It becomes quite taxing at times.”

He attributes this, in part, to the fact that “the government has been so caught up with infectious diseases, which are important, but mental health has never been considered a priority,” he says.

Even without the resources to conduct community based data, Kauye is aware of the causes of psychological distress, as “the proportion of people who suffer from mental illness does not differ across cultures.” These causes include genetic factors, physical illnesses like HIV, daily life events like loss of employment, giving birth and substance abuse.

Kauye explains that there is currently a severe shortage of mental health professionals in Malawi and Bwaila unit in Lilongwe is currently run by nurses with no clinician working there. This affirms the WHO research finding that nurses represent the most prevalent professional group working in the mental health sector.

The nurses at Zomba Mental Hospital were unavailable for comment, but Kauye says, “With the shortage of staff and poor district mental health services, the team works under a lot of pressure because if we do not treat and discharge our patients quickly, the hospital becomes overcrowded and difficult to manage.”

This is particularly important in the cases where there is an over reliance on the tertiary hospitals since district hospitals are in poor condition, increasing the strain on the professionals in these settings.

Bandawe suggests that there are posts in the government for psychologists, but training and filling those posts have not been a priority. He attributes that lack of response to the stigma associated with mental health, a stigma that means those who suffer from mental illness are often ostracized from society and fail to receive the care they require, according to WHO.

“When most people talk of mental health in Malawi, they usually refer to people with severe mental illness who are in most cases unkempt and disheveled,” but mental illness has many faces, Kauye says, and this is just being realized.

Both doctors suggest that this stigma be addressed through creating mental health education and awareness, which is one of the methods that will enable every individual’s right to enjoy the best attainable state of physical and mental health under Article 16 of the African Charter on Human and Peoples’ Rights.

With the Malawian government seeking solutions to mental health care issues, there is a new hope that the future of mental health in Malawi will bring about positive change and the perceptions surrounding mental health will adapt to the growing need for mental health care professionals.

Not skirting around the issue: Malawian women take on gender norms

Three thousand women were leaping out of their seats and waving their hands in the air amidst a chorus of cheers. A continuous line of speakers were taking center stage at HHI Multipurpose Hall, advocating on the topic of women’s rights.

It was Seodi White, a social development lawyer and Director of Women and the Law in Southern Africa, whose words prompted the first bout of cheers from the crowd.

“I felt devastated as a woman, as a citizen of this country, and I know many women felt the same,” said White.

The January 20th event was held in response to vendors who were unclothing women who wore trousers, leggings and miniskirts in the streets of Mzuzu, Lilongwe and Blantyre earlier that week.

It remains a daily challenge for a Malawian woman to exercise her fundamental freedom of equality outside the walls of an organized rally like this, despite the many voices of women who were not backing down to the injustices forced upon them at the time of the event.

Particularly in the formal sector where the inability of government to enforce Article 2 of the African Charter on Human and Peoples’ Rights- which entitles all to the freedoms of the Charter regardless of sex- leads women to take the initiative on enforcing their own rights.

According to Marcel Chisi, The National Chairperson at Men for Gender Equality Now, this problem is a result of a lack of agency in decision making, “There should be a working environment that ensures that women should be able to make decisions, regardless of the levels of structure. In Malawi, the male managers and administrators always dismiss women of their opportunity to speak.”

Sellina Nkowani, a sub-editor at Blantyre Newspapers Limited speaks of her experience facing gender-based challenges in the newsroom, and explains that women have always been regarded as the weaker sex and as a result, “Female views are not taken seriously.”

According to Nkowani, this perception is due to “societal beliefs that we grow up with; the men who are now in the workplace do not treat women differently from how their forefathers did.”

However, perceptions of females in the workplace stem deeper than societal beliefs held by male co -workers, as many women remain largely unaware of their rights. This is a problem that Mary F. Malunga, the Executive Director at the National Association of Business Women speaks of when saying, “In Malawi, most women don’t know what their rights are, so women need to be proactive in the workplace in order to learn. Even if they know what their rights are, they’re not proactive enough and their rights become violated.”

As women take the reigns on altering gender perceptions in the workforce, part of the challenge is eliminating the tendency for outspoken women to be labeled as unsteady and uninhibited by male colleagues: “It’s hard to overcome these challenges because women are supposed to be submissive, talk less and generally respectful of men, something I personally do not agree with,” said Nkowani.

In order to step forward, Chisi emphasized that women who feel their rights have been violated have support systems in place, and that “they should come out and report these abuses to the labour movement.”

In their fight for rights, Nkowani’s words instill responsibility in all women when she says, “No one would fight for women’s rights any better than the women themselves.”