MANGOCHI--The tropical September heat in Malawi’s southern lakeshore area of Makanjila in Mangochi district forced 49-year-old Lifa Wile to sag under the shade of a palm tree, 20 metres away from his destination, Mkwanda Health Post.

His feet, painful after a two-kilometre long travel on foot, were also feeling the effects of Lamivudine, an ingredient of the first line anti retroviral therapy treatment regimen prescribed to tame the human immunodeficiency virus that was detected in his body some two years ago. He couldn’t walk any further.

Lifa says he’d sent his wife, Gertrude, to collect the life prolonging drug from the health post, which operates once a week by a volunteer clinical officer, Patrick Msosa, who works for Madina Social Services.

Lifa says Msosa had single-handedly negotiated with the owner of the house to open a health post since the nearest public health facility, Makanjila Health Centre, is situated 36 kilometres away.

He says the other facility, Lulanga Health Centre, which is six kilometres away, is privately owned and charged fees for its services.

“Most of the residents here have for many years depended on fishing in Lake Malawi for their income but due to the dwindling catches in recent years caused…the trade is no longer profitable,” he says.

With little or no income, he the villagers can’t afford medical services at Lulanga Health Centre let alone travel to Makanjila, where a one way journey costs about MK1, 000, an equivalent of US$3 on a push bike.

Lifa laments that for more complex medical conditions a person has to travel to Mangochi District Hospital, 142 kilometres away or hire a boat at about MK2, 000 or US$6 to Senga Bay in neighbouring Salima district.

But lady luck smiled at Lifa and many others as last week Pres Joyce Banda directed that all hospitals in Malawi stop administering ART drugs laced with Lamivudine because of its effects.

She urged doctors to adhere to the World Health Organisation (WHO) recommended regimen.

Fistula

Not far from Lifa’s village, Mary Mdala suffers from fistula and in her case she leaks urine.

According to UNFPA, a UN reproductive health agency, during the second stage of labor, the baby's head presses the soft tissue of the vagina against the bones of the pelvis resulting in an abnormal opening between the vagina and bladder or between the vagina and rectum.

This opening, the fistula, causes constant leaking of urine or feces out of the vagina.

“Despite the fact that the condition is preventable and treatable, it still affects many women in developing
countries every year, yet has been eradicated in developed countries, says the UN agency.

The World Health Organisation (WHO) estimates that there are between 2 million and 3.5 million women suffering with obstetric fistula in the developing world.

The Malawi College of Medicine says Malawi hasn’t collected sufficient national obstetric fistula prevalence data but indicate that the country’s 2004 Demographic and Health Survey (DHS), for the first time sought information on the conditions prevalence.

“An analysis of the 2004 DHS data found a lifetime prevalence of 4.7 per cent and a crude incidence rate of 15.6 per 1000 live births,” says a study by the college adding that data from the same 2004 Malawi DHS estimated a 20 per cent prevalence rate for complications after delivery and that obstetric fistula cases account for 2 per cent of all deliveries.

“A high prevalence of cases were reported in the Southern region (1.9 per cent ) and among the rural sites in Malawi, Mangochi district ranking highest at 2.7 per cent,” it says, explaining that another study reported that there were 29 patients (7.6 per cent) with a combined urogenital and recto-vaginal fistula.

“Obstructed labor was the cause of about 379 fistulas and the remaining 29 were not of obstetric origin,” says the college attributing the problem to the many barriers that the women face before they are able to be seen at health facilities.

“It is highly likely that most fistula cases remain undetected in the community and that the burden is far greater than has been estimated. Information on the prevalence of fistula in Malawi is important as it would indicate the actual extent to which the obstetric services are failing to meet the needs of pregnant women in the country”.

Mary doesn’t know her age but could pass for a 20-year-old. She’s never been to a conventional school. The only form of education she has gone through is the Islamic Madras, where she was taught the principal tenets of the Islamic faith which is the prominent religion in Makanjila.

Mary was once married but her husband left before she gave birth to her first baby who caused her fistula condition.

Malawi has many Marys who continue to suffer during child bearing as they can’t travel far to access modern medical services.

Henry Chimbale, Ministry of Health spokesperson, says government understands the problem and has devised a plan to train post secondary school educated young Malawians in community midwifery for a period of 18 months.

“The approach will address the issue of distance as well as reduce maternal mortality to 675 from 984 per 100, 000 live births,” he says adding that it will increase the access to the prevention of mother to child transmission of HIV, an intervention not found among traditional birth attendants who conduct home based child deliveries
services in the absence of health facilities.

Suffice to say, there’s more to be done to help people like Lifa and Mary who live in rural areas where the majority of Malawi’s close to 15 million people live.
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© The Maravi Post 2012. Reproduction without acknowledgement prohibited

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