Current State

	A clinic opening in Mtunthama, Kasungu. There are many clinics in Malawi, but few of them are well stocked with medicines or well-trained staff.

Malawi uses a socialized system of health care, with a goal to provide access and basic health services to all Malawians. This is a daunting task, considering 80% of Malawians live in rural areas and the poverty of Malawi limits social infrastructure. However, the Ministry of Health and Population have set up specific systems that are attempting to reach even the most remote areas. In some respects, Malawi has model programs and successes that are enviable in other parts of Africa.

Due to the situation of poverty, even the most basic needs are obtained at health centres and hospitals. While as Americans we are quite used to self-treatment for things like bandages or aspirin, most Malawians seek medical institutions for these items. Compounding this is the limited treatment that is available in Malawi. Everything from diagnostic procedures to treatment regimens are extremely limited and unavailable to most people.

In their efforts to provide health services to all Malawians, the Ministry of Health and Population has set up a three-tiered system. At the lowest level are rural health centres and rural hospitals. They usually serve an area of about 50 villages and 30,000 people. These facilities do not have doctors, but they do have clinicians and nurses. They provide the basic services, including pre-natal and post-natal care, birthing, early childhood care, malaria and parasitic treatments, and treatment for minor abrasions and simple fractures. Health centres also promote prevention and civic education through the use of Health Surveillance Assistants. These people are responsible for teaching better hygiene and health practices in the villages, as well as outreach clinics which provide pre-natal and early childhood care away from the health centres.

For illnesses or injuries that cannot be treated at the rural health centres, patients are referred to district hospitals. There is one hospital in each district in Malawi. These hospitals have more advanced diagnostic equipment, including x-ray machines and blood laboratories. They also have a doctor, and they can provide surgical treatment if necessary. The staff at a district hospital usually has better training, more qualification, and more experience.

One of many orphanges in Malawi. It is estimated that at least half of the orphans at this particular site are HIV positive.

However, some illnesses are still not treatable at district hospitals. These patients are then referred to one of three central hospitals. The central hospitals have the most advanced diagnostic equipment and the best trained health care workers. This is where the highest level of care is provided.

In addition to the social medicine facilities, there are some fee-for-service health clinics in Malawi. These clinics are usually unobtainable to the average Malawian due to cost. They are almost exclusively found in larger towns and cities.

Traditional medicine also plays a significant role in Malawian health care. Proud people with strong cultural roots, Malawians often turn to herbal remedies provided by an “African Doctor,”. Traditional Healers each have their own practices and therapies, and some even incorporate religion in to their work. It is not uncommon to see traditional healers preaching from the Bible while removing spirits from a sick person’s body. The Ministry of Health and Population has tried to encourage safe practices with traditional healers, especially in the form of sterile razors for cutting the skin. Working with traditional healers, rather than trying to dominate them, the Ministry is able to increase outreach for prevention and education, while also learning about important herbal therapies which have helped heal the sick for centuries.

Despite all of these services, it is still often difficult to get necessary health care in Malawi. Transportation is always problematic, and when a person is able to reach a health centre or hospital it is not uncommon to find that here is no medicine. While efforts are made to distribute medicines to even the most promote health centres, anti-biotics, pain relievers, and parasite remedies are in short supply. In addition, the hospitals are over-crowded and sometimes people must share beds or sleep on the floors. Sanitary problems abound at hospitals, and some practices may appear unhealthy by western standards.

However, Malawi has been successful with many of their health interventions. Vaccination programs have been enormously successful, and over 80% of children are fully vaccinated by the age of 5. An emphasis on pre- and post-natal care has helped many women diffuse or eliminate problems associated with childbirth. And family planning programs unheard of 10 years ago in Malawi are making small gains even in rural areas. There are still problems, but Malawi has very specific goals and has worked to develop a health care system to reach everybody.

Health -- Health Issues

Malawi has a very poor state of health, overall. Compounded by traditional beliefs, poverty, and lack of education, many diseases have become endemic in the country. While programs are in place to immunize children and provide better care for these very young people, still 1 in 5 children will never see their fifth birthday. Overall, some statistics place the life expectancy in Malawi as low as 39 to 45 years. HIV, malaria, cholera, various infections, and other illnesses all contribute to this situation of despair.

It is easiest to look at health issues in four specific areas, although sickness does often overlap and even extend beyond these four areas. The first area is maternal and child health. Women often have complications during pregnancy or childbirth. Due to the lack of services, the lack of clinicians, and the prevailing unsanitary conditions, some women will die during childbirth. This is only made worse by the high pregnancy rate in the country. It is not uncommon to see families of eight, nine, ten, or even more children. Efforts to promote family planning are making headway throughout the country, but most women still do not use modern methods to reduce the number of pregnancies. In addition, young children often fall victim to malaria, pneumonia, diarrhea, and other infectious diseases as well as burns from cooking fires.

Environmental health conditions tend to be poor, adding to the health problems of many Malawians. Basic hygiene practices, such as hand washing with flowing water, and sanitation is often lacking. Homes are usually built with little ventilation due to cultural beliefs. And most homes are built in areas without access to running water. While wells, boreholes, and other water sources exist, piped water is a rarity. Because of this, pit latrines are promoted but sometimes are not used or even built. In addition, standing water, particularly in rainy season, promotes the breeding of mosquitoes, increasing risk of malaria and other insect-borne diseases.

Nutrition is a third area for health related issues. Over 80% of Malawians are subsistence farmers and they rely on favorable weather conditions to maintain a year-round healthy diet. Rain, heat, insects, even availability of fertilizers all contribute to food security. Many Malawians will find themselves with a scarcity of food during the months of December, January, and February, as their stored foods run out during this time. Over-cooking of vegetables, lack of protein in the diet, and scarcity of fruits during particular times of the year also contribute to malnutrition disorders. Vitamin A deficiency and Protein Energy Malnutrition are common among young children, leading to a variety of health disorders and even death. Unfortunately, foods do exist for most Malawians to obtain the proper diet needed to maintain good health, but Western influences, incorrect information, and traditional beliefs often compromise the foods that are available.

Lastly, the war on HIV continues to be fought in Malawi. Hardly any country in sub-Saharan Africa has not been affected by this epidemic, and Malawi, too, feels the scourge. Most estimates claim 16 – 18% of Malawians are infected with the virus. The effects are far reaching. The greatest number of those infected are the people in the main workforce between the ages of 18 – 49. These are the people who are running the day-to-day operations of Malawi, and they are dying at a significantly high rate. They leave behind young orphans, who then live with relatives who have already over-extended themselves to care for other family members, according to African family tradition. As the numbers of orphans increase, so do the numbers of street children, begging for food or shelter, living day to day with little hope for a future. Even as AIDS medicines enter in to Africa through programs set up by drug companies, the famous “drug cocktails” which have changed the way we view HIV in the Western world have had little affect on Malawi. Distribution, expense, and the high-maintenance regimen make these cocktails inaccessible to most Malawians. Education efforts for prevention have had a small effect, and attitudes regarding risky behaviors are slowly changing. Still, HIV will most likely continue to affect every aspect of Malawian life for years to come.