Tag Archives: malaria

Lucius Dimiano of Kafupa Village.  Roughly translated, "kafupa" means "hard as bone".  Photo by Karissa Gall.

“Mind the gap” – The crippling impact of HIV/AIDS on family composition and elderly Malawians

The old “respect your elders” adage has customarily been an important part of Malawian culture, with the elderly able to depend on the social and economic support of their children and the community.  However, the HIV/AIDS epidemic has had a crippling impact on family composition and tradition.

While the 2012 Malawi Country AIDS Response Progress Report found that from the start of the epidemic the number of deaths per annum had been reduced from nearly 100,000 to approximately 48,000 in 2010, the report also found that the number of children orphaned by AIDS has been on the rise.

Antenatal Clinic sero-surveys (surveys of blood serum) found that the number of children orphaned by AIDS increased from 576,458 in 2010 to 612,908 in 2011.  And with over half of orphans being cared for by their grandparents, men like Lucius Dimiano of Kafupa Village will be celebrating their 70th birthday before that of their retirement.

At 68-years-old, Dimiano is still working three jobs to support six grandchildren orphaned by AIDS.  He works as a guard from 6 p.m. to 6 a.m. at a nearby church, goes to the garden to get maize for his family, weaves baskets to sell at the market and then, does it all over again.

“I cannot sleep, so it’s hard,” Dimiano said.  “As a night guard, I need to always be awake because sometimes there are thieves in the dark.

Still working three jobs at 68-years-old to support six grandchildren orphaned by AIDS, Lucius Dimiano of Kafupa Village demonstrates panga knife techniques he uses as a night guard. Photo by Karissa Gall.

“When I knock off in the morning I go to the garden, when I knock off in the garden I eat and then I start making baskets so I can make more money, but it’s still not enough to care for all six grandchildren.”

In the same township of Chigumula, 55-year-old Mrs. Kandikole has also lost children to AIDS; her oldest daughter passed away in 2005 orphaning one grandchild, and her second oldest daughter passed away in 2010 orphaning three grandchildren.

“I’m the one who’s left looking out for them,” she said.  “And not only those four; I have other grandchildren at my home who have only a mother but not a father.

“It’s very difficult for me to look after these children because I’m very old.  I’m not working,” she continued.  “Things are very expensive here in Malawi.  Food is very expensive.  I cannot manage to buy clothes for them.  It is very difficult for me to take them to the hospital.  To get good medicine, one needs to pay money at private hospitals, but I can’t manage to do all those things.”

Kandikole said she had been working at a nursery school, but had to quit when her daughters died because “(her) grandchildren were alone, so (she) had to look after these children all by (herself).”

She said her husband, 57, is still working as a telephone operator but “he makes very little money.”

“I don’t think he will be able to continue working much longer because he is now 57 years old and his body is very weak.  He is very sick,” she said, adding that they both suffer from chronic bouts of malaria.  “Before, we could manage to do all those things, but not now.”

Without the proper means or support, Kandikole said she “couldn’t manage to send (her) grandchildren to school, because when you want to send a child to school these days, even a government school, you need to buy a uniform, pencils, exercise books and the child needs to eat porridge.”

She said her grandchildren “were just staying at home” until they were accepted at the Jacaranda School for Orphans in Limbe, a free primary and secondary school in Malawi providing education and daily meals to orphans.

“If we did not have Jacaranda, these children would just be doing nothing at home,” she said.  “They go to school without taking anything.  If Jacaranda didn’t provide porridge I don’t know what we could do.  Before, I thought my children would go to school up to college and help their children by themselves.  But their deaths brought everything down.”

The late Nelley Daniel M’maligeni of Che Mboma Village suffered in the same way.

Deaf and blind, M’maligeni struggled to care for herself yet alone her grandson, Vincent, who was orphaned by AIDS.  In March, at the age of 105, M’maligeni passed away and Vincent lost another primary caretaker.

The late Nelley Daniel M’maligeni of Che Mboma Village waits with her daughter-in-law for her grandson Vincent to return from school. Photo by Karissa Gall.

According to M’maligeni’s daughter-in-law, M’maligeni and Vincent had been sleeping in a small hut.

M’maligeni’s daughter-in-law said her family was able to give extra food to M’maligeni and Vincent once a week, but “sometimes it (was) hard because there (was) not enough money.  Sometimes M’maligeni (could) not eat.

“Sometimes we just (bought) panado, because panado is cheap,” she said.

Dimiano, Kandikole and M’maligeni are each representative of the ways that elderly Malawians are struggling to survive in the wake of the HIV/AIDS epidemic.  According to the Catholic University of Malawi’s December 2010 report “Impact of HIV and AIDS on the elderly: a case study of Chiladzulu district,” 59 percent of the enrolled elderly people had difficulty sourcing money for school uniforms, food and hospital bills for orphaned grandchildren; 55 percent were affected through the sickness and death of their children; and 22 percent had to halt their own development to take care of orphaned grandchildren, spending their reserved resources to make the lives of their grandchildren better while impoverishing themselves in the process.

When asked if there can be greater relief for elderly Malawians struggling to care for themselves and their orphaned grandchildren than panado, an over-the-counter pain medication, Finance Minister Ken Lipenga said that government has put in place safety net programmes that target both the elderly and other vulnerable people in the 2012/13 National Budget.

“These programmes are aimed at assisting the poorest in our communities to cope with life,” he said, adding that during the 2012/13 fiscal year  programmes will be scaled up to capture those that may have fallen below the poverty line due to devaluation.

“A total of K27.5 billion has been provided for four programmes, mainly the Intensive Public Works Programme, the School Feeding Programme targeted towards 980,000 pupils in primary schools, the Schools Bursaries Programme targeting 16,480 needy students, and the Social Cash Transfer Programme which will reach over 30,000 households across the country.”

Lucius Dimiano of Kafupa Village. Roughly translated, "kafupa" means "hard as bone". Photo by Karissa Gall.

But until social cash transfers can be expanded to cover the whole country or non-contributory pensions can be provided to ensure income security for the majority of elderly Malawians who have never worked in the formal sector, government will continue to miss men and women like Dimiano and Kandikole who are fighting for the survival of their family and against the intergenerational transmission of poverty, often without sufficient resources or physical strength to do so.

As Dimiano put it: “If I still had children that could help me, I could have just stayed home, but there is no one to help me, I’m only working because of my grandchildren.

“The only ones who can decide if I stop working are my grandchildren.  Maybe they will see that we are very old and cannot work anymore and they will help us.  But maybe they will finish school and go away.

“At the moment, I do not know.”

 

With files from Richard Chirombo.

Malaria: not just a disease, but a way of life

It’s the most dangerous killer in West Africa, the top issue on Ghana’s health priority list, and carries a whopping price tag of up to US$ 60 million a year.  Yet for all the apparent hazards attributed to malaria, the disease is still seen in a relatively casual light in Ghana.

One of the first things people had to say when I told them I’d be working as a journalist here was, “Watch out for malaria!”  Also common were “Have fun, but don’t get malaria,” and the ever-popular “Beware of mosquitoes – they carry malaria.”

Malaria, malaria, malaria.  It seems Canadians can’t escape the idea of it, that mysterious exotic disease that mixes flu symptoms with diarrhea and eventually, if left untreated, leads to death.  It’s the Avian Flu, Black Plague, and SARS all rolled into one, that misunderstood medical monster that all hapless Canadians traveling overseas to warm climates should take the greatest pains to avoid contracting.

Before leaving Canada, my doctor told me I’d be traveling to an “extremely high-risk zone,” and urged me to do any or all of three things: purchase the most expensive of malaria medication; double up on mosquito netting for maximum protection; reconsider my trip.

My colleague at Kapital Radio, Muftaw, saw me writing this post and chuckled.  “I like your headline,” he said.  “Malaria, a way of life.  So true.”

I ended up going with the cheapest medication option known as Mefloquine, a medication whose listed side effects read much like the expected effects of LSD – hallucinations, lucid dreaming, and vivid nightmares.  Personally, I’ve never slept better.

As far as mosquito netting goes, well, I do as the locals do.

“I have a mosquito net,” said Muftaw.  “It’s brand new.  I have never used it.  It’s in my wardrobe.”

Mine too sits at the bottom of my rucksack, unpacked, unused, and ultimately, unnecessary.  I sleep in the comfort of basketball shorts, and really, the mosquitoes have largely left me alone.  They rarely venture indoors anyway.

And as for reconsidering my trip?  Well, it’s too late now, but really, for what reason?  We in North America live in such a culture of fear – of recession, of crime, of people, of spiders, of disease – that we’ve limited our opportunities to experience by simply shutting ourselves into protective bubbles.  I took so many precautions just on malaria alone before I got here, only to find that it’s a commonly contracted disease easily treated at the local pharmacy with medicine.

When I asked him how many times he’s had malaria, Muftaw shrugged.

“Too many to count,” he said.  “I thought I had malaria last week but it turned out to be just a viral infection.”

However, I’ve learned not everyone can afford to be so cavalier.  While most cases of malaria are a quick fix in the cities, there are enormous amounts of people, particularly in the north, without access to proper healthcare.

“It’s a problem, the high risk for those in the rural areas where there are no clinics, no hospitals,” said Dr. Joseph Oduro, Deputy Director of Public Health for the Ashanti Region.  “While we have the medicines to treat it, malaria can be very dangerous if you can’t actually access the medicine.”

Aside from the rare fatality, this danger presents itself in malaria’s long list of side effects, which range from anemia to complications during pregnancy.  Treating the disease can also be a heavy financial burden for many families, who all too often turn to traditional medicines as a cheaper, more familiar option.

“Many people claim they have medicines that can cure malaria, but what research has been done?” said Dr. Oduro.  “People take them and then come to the hospital with many complications.  It’s a real challenge here in Ghana… ignorance is high.”

Another problem is those who rely on traditional medicine also go unregistered in government records, therefore skewing national statistics concerning the disease.  A report released by the World Health Organization announced an estimated 3.7 million cases of malaria in Ghana in 2009.  However, that figure is deceivingly low considering how many cases annually go unreported, and consequently, untreated.  Pregnant women and children under five are especially vulnerable, with UNICEF reporting roughly 20,000 malaria-caused fatalities in Ghana among children under five every year.

The numbers are staggering.  And frankly, avoidable.  While there are dozens of government and NGO malaria-specific initiatives at work in Ghana, the fact remains: malaria is killing people in this country.  ITNs (insecticide treated nets) and anti-malarial vaccines are helping, but more can be done.  More needs to be done.

“It’s a serious threat,” said Dr. Oduro.  “Malaria is the commonest cause of morbidity and mortality in Ghana… it’s a matter of concern for us.”

I could stand to be less dismissive about not using my mosquito net.  Reality is, that net could be saving a life right now.

A poster at the Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR) detailing malaria’s attack cycle

Malawi recognizes World Malaria Day

It’s April 25 and 12 year old Blessings Phiri traveled, by foot for hours from his village to sit in the waiting room of Kamuzu Central Hospital in Lilongwe, Malawi. This time around, malaria has hit him hard.

Blessings experiences the typical symptoms – nausea, headache, high fevers, periodic chills and sweats, muscle aches and a loss in appetite.

“I think that dying is sometimes better than going through this,” said Phiri.

Malawi’s Ministry of Health reports that malaria remains to be one of the key health problems facing the nation. Currently, up to 325 people in every 1,000 Malawian suffer from the illness every year according to last year’s figures.

“It’s the worst feeling in the world,” said Phiri, who sits with his hands covering his face.

Coincidentally enough, April 25 was World Malaria Day. It marked the height of global efforts to build awareness of the mosquito-borne parasitic disease. During this day, the Ministry of Health specifically emphasized to Malawian on the need of using insecticide treated nets to prevent being bitten by malaria-laden mosquitoes.

“I don’t have a mosquito net for my bed. No one in my family does,” said Phiri.

According to UNICEF, many children do not sleep under insecticide-treated nets. If malaria is recognized early, it can be cured, however, UNICEF stated that many Malawians are not able to access treatment within 24 hours of onset of symptoms.

Although malaria is both preventable and treatable, many people in Malawi cannot afford the treatments due to poverty.

The Ministry of Health said that support from development-partners remains a significant resource to ensure access to life-saving and cost-effective malaria interventions.

“Continued investment in malaria control will propel Malawi, a malaria-endemic country along the path to achieve the 2015 Millennium Development Goals, especially those relating to improving child survival, maternal health, eradicating extreme poverty and expanding access to education,” according to the press statement released April 25 by the Ministry of Health.

Millions of lives depend on the strong support and the Ministry of Health is optimistic that living a malaria-free life is an attainable goal.

In the fight against malaria, it’s not just about mosquito nets

The Ministry of Health, in collaboration with donor countries, is working with local volunteers to both distribute mosquito nets and educate the public on how to use them correctly. Photo by Blantyre News Limited.

The World Health Organization (WHO) announced in October that nearly a third of all countries affected by malaria are on the path of eliminating the mosquito-borne disease over the next 10 years.

Malawi is one of them.

Elimination, of course, depends on whether or not current efforts are sustained.

But due to flaws in the country’s healthcare system and, more recently, given the fragility of the global economy, it seems that the fight against malaria is likely suffer a few setbacks in this country.

According to the Global Fund (GF), which is an international initiative against malaria, tuberculosis, and HIV and AIDS, approximately 95 percent of Malawi’s population of 14 million, is at risk of malaria infection. Two groups are particularly vulnerable to the disease: women (51 percent of the population) and children under the age of five (17 percent).

But malaria isn’t just a severe public health problem; it also has a direct impact on the country’s economic and social development.

The Ministry of Health reported that there were over six million malaria cases in 2010. Economically speaking, this means that the country’s workforce lost between 15-25 days of productivity due to malaria alone.

Furthermore, most families spend about 28 percent of their yearly income (approximately CAN$170) to treat it.

Still, experts affirm that progress is being made in Malawi.

The Ministry of Health, with the support of the GF and the President’s Malaria Initiative (PMI) from the United States, have since 2005 distributed across the country insecticide-treated, non-toxic mosquito nets, which have proven to be highly effective when it comes to reducing transmission of the disease, as they can kill mosquitoes for up to three years.

And according to the Ministry of Health, Malawi has seen a 50 per cent reduction in malaria transmission ever since.

Global statistics confirm this positive trend.

The latest report of the United Nations and World Bank supported-initiative, Roll Back Malaria (RBM), reveals that malaria deaths have dropped globally by an estimated 38 percent in the last 10 years, with an impressive 43 out of the 93 countries identified and included in this initiative – including Malawi – cutting malaria cases or deaths by half.

Wanting to continue with this success, Malawi’s Health Strategy Plan for 2011-2016 places malaria’s reduction as a top priority, along with HIV and AIDS.

However, Malawi’s generally underfunded and fragile healthcare system, and the uncertainty of any future external funding from the GF, and donor countries including the United States, the United Kingdom and other European countries, due to the world economic crisis, threaten to make those achievements accomplished so far moot, while putting at risk the implementation of future initiatives and programs.

The Global Fund announced in September that it has halved the estimated amount of money available in its next round of funding, from US$1.5 billion to US$800 million, the disbursement of which has been delayed until 2013.

This is worrisome as the Global Fund accounts for two-thirds of the malaria, tuberculosis and HIV and AIDS response in Malawi, and the balance comes from the donor countries. Malawi has been assured of Global Fund money until about June 2014 but has been warned to look for sustainable financial models to continue its programs.

And while Malawi’s National Malaria Strategic Plan has stated its aim to have 60 percent of the country’s health centres equipped to perform diagnostic testing for malaria, the Global Fund reports that Malawi is far from achieving this goal.

And even where diagnostic testing is available, both laboratory staff and hours are limited, with some facilities seeing more than 200 cases of potential malaria cases each day.

These studies also show that more than half of the patients that tested negative for malaria were still prescribed antimalarials, suggesting that health workers have very little confidence in laboratory test results.

When it comes to malaria in Malawi, significant gains have been achieved and lives have been saved; but without sustained financing to consolidate these accomplishments and enable the continuation of initiatives for malaria treatment and against its transmission, the progress that has been made may quickly backslide.

Preferential treatment v. currying favours

[pullquote]There was about twenty people ahead of me. I took out my book and settled down to wait. One hour passed. Then two hours. Then three. The queue hadn’t moved by a single patient.[/pullquote]

I promised myself I would never knowingly take advantage of the preferential – if not at least differential – treatment foreigners receive in Ghana. Even though I fall into the rather ambiguous category of a dark-skinned obruni, I have, on occasion, been given more attention or faster service than usually afforded to locals. I can’t do anything about it – to refuse would have been rude – but I promised myself I would never illicit any special treatment.
Regrettably, I had to break that promise. I caught malaria despite taking regular medications and avoiding unnecessary exposure to mosquito bites. One weekend, while I was attending a colleague’s wedding, I started feeling especially sick. My temperature fluctuated, my joints ached, I was nauseated and my stomach couldn’t retain any food. Fearing the worst, I called one of my fellow interns’ colleagues at Kapital Radio. He suggested that I get checked, but he advised me to go with a local who knew the ins and outs of the system so I wouldn’t have to wait long to see a doctor.
He didn’t state it explicitly but what he meant was that I should go with someone who could help me jump the queue.
Remembering the promise I made to myself, I went to the hospital alone (My fellow interns Chris Tse and Leah Wong had gone out of town for their mid-internship break).
After asking around, I managed to get to the hospital, find the walk-in clinic, register myself and join the queue to see the doctor. There was about twenty people ahead of me. I took out my book and settled down to wait.
One hour passed. Then two hours. Then three. The queue hadn’t moved by a single patient.

I felt my nausea growing, my stomach threatened another visit to the loo and my fever was back with a vengeance. I glanced over to the man sleeping on the bench next to me – he had been there before I came – and decided I couldn’t wait anymore.

I called another friend who I thought might be able to help. He promptly instructed me to meet him at the hospital where his wife works. Once there, he ran around getting me registered and within twenty minutes, I was sitting in front of the doctor relaying my symptoms. There followed a flurry of activities – a blood test, another session with the doctor, getting my prescriptions – during which I saw my friend speak to this person or that in order to get me ahead of the line at every stop. The whole process took a little less than 3 hours.

As I curl up in my bed feeling calm and medicated, I saw the faces of the people I jumped ahead of. They were all sick and they still had to wait their turn. My stomach churned again with guilt. I reminded myself that I had gotten ahead of the line because my friend had connections at the hospital, not because my skin was a little fairer than the average Ghanaian. There is little comfort in that, but I’ll take it nonetheless.

The waiting room

Falling ill in Ghana is often accompanied by fears of contracting malaria, which accounts for one in five childhood deaths in the country

This is a first. I’m sitting in a hospital lab in Accra, being serenaded by Bollywood music on the radio at 9 a.m. I made it four months in Ghana without visiting an emergency room, but the headache and fever that I went to sleep with the night before were there to greet me the next morning. They were accompanied by abdominal pain and two marble-like lumps in my pelvic area, where no lumps had previously been before. I felt dizzy and disoriented, like being all too present in a hot, sweaty, lucid dream.

Like me, my roommate, upon hearing my symptoms and seeing my general state of confusion, seemed to think that malaria could be the bandit behind my missing bill of health. It was with good reason. I stopped taking my anti-malarial meds a few weeks ago. So here I am, at one of Accra’s more reputable hospitals as a male lab tech drew my blood. I clenched my left fist and turned away as he inserted a needle into a welcoming vein. I’m not a fan of needles, and I really dislike the surgical glove stench of hospitals.

“Are you crying?” asked the lab tech.

‘No,” I replied, rather disappointed by his callous bedside manner. “It’s sweat.”

“Oh, ok,” he said. “Go to the waiting room, I’ll call you.”

I paid 19 cedis ($13 CAD) for my consultation with the doctor, 38 cedis ($26.75 CAD) for the lab tests, and would later fork out 65 cedis ($46 CAD) at the pharmacy. It’s no wonder, at these prices, that many Ghanaians cannot seek medical treatment for malaria, a disease which is responsible for one in every five childhood deaths in Ghana. Ghana’s Health Minister, Dr. Ben Kunbuor, has even noted malaria’s strain on the economy. Fighting the disease accounts for one third of the national health budget. Combating malaria, one of the eight UN Millennium Development Goals, is likely to be unmet by the 2015 deadline, according to the United Nations Development Programme, unless more effort is made to focus on preventative care.

Sitting in a waiting room, knowing that the average Ghanaian suffers from two to three bouts of malaria a year, I began wondering about the ailments of the dozen or so people around me. It was somewhat of a relief, around 5 p.m., when a doctor told me that I had a urinary tract infection.

After several days of bed rest, pills and cranberry juice, life continued as usual. Giggling kids in school uniforms ran by me, on my way to work. Familiar faces in the neighbourhood waved as I passed. Even a lone hen added life to the scenery as it clucked its way across the road. That was until a sedan barreled into it. I guess this chicken crossed the road to cross over to the other side.

It was another reminder of why it’s so important to take time to relax and enjoy life, as Ghanaians so often do. Life can be hard, anywhere, really. But I’m always reminded of how meaningful each breath is when I get sick because I realize that it can be taken away so quickly—by a battered old sedan or a mosquito’s stealth sting.