Friends of Malawi: Learn About Malawi: About Malawian Geography

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

Because treatment at district health centers is free, and because most families cannot afford even basic health care items, even the most basic needs are obtained at health centers and hospitals. Ailments like headaches and small burns, which Americans are accustomed to self treating with aspirin and bandages, are usually treated at health centers in Malawi . A large patient base, limited staffing, and limited availability of medicine means that a visit to the health centre can take all day. Compounding this is the limited treatment that is available in Malawi —everything from diagnostic procedures to treatment regimens are 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 local level are rural health centers 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 centers 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 centers.

For illnesses or injuries that cannot be treated at the rural health centers, 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.

However, some illnesses are not treatable even at district hospitals. These patients are 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 . The most expensive of these clinics, found almost exclusively in larger towns and cities, are unobtainable to the average Malawian, but many missions offer fee-for-service clinics in medically underserved areas at more affordable rates.

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 into 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 amongst traditional healers, for example the use of sterile razors for incisions. By 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 to clinics and health centers 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 centers, antibiotics, 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 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.

Healthcare Challenges:

The overall state of health in Malawi is very poor. General poverty and malnutrition, lack of education, and traditional beliefs have all contributed a state of affairs where several diseases are endemic. While programs are in place to immunize children and provide better care for young people, still 1 in 5 children never see their fifth birthday. 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.

It is easiest to look at health issues in four specific areas, although sickness often do 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 in part to the lack of services and the prevailing unsanitary conditions, 1 in 7 (UN statistic for 2000) women die during childbirth yearly. In a country with a high pregnancy rate (where families of eight or ten children are not uncommon), death during labor constitutes a significant risk for women. Efforts to promote family planning are making headway throughout the country, but most families, for various reasons, do not use contraceptives to reduce the number of pregnancies. And of course, young children (who often suffer from poor nutrition and are thus more vulnerable to disease) fall victim to malaria, pneumonia, diarrhea, and other infectious diseases as well as burns from cooking fires.

Environmental health conditions are also poor, adding to the health problems of many Malawians. Basic hygiene practices (such as washing hands in flowing water) and sanitation are 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 may not be 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, and even the availability of fertilizers (on which most Malawian farmers depend but can rarely afford) all have an affect on food security. Many Malawians find themselves with little food during the months of December, January, and February, as their stored foods run out during this time. Over-cooked vegetables, lack of protein in the diet, and scarcity of fruits during particular times of the year also contribute to malnutrition. Vitamin A deficiency and Protein Energy Malnutrition are common among young children, leading to a variety of health disorders and even death. Foods do exist for most Malawians to obtain the proper diet needed for good health, but Western influences, incorrect information, and traditional beliefs limit the foods incorporated into the general diet.

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 that 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 and 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, following cultural norms, go to live with relatives. But many of those relatives are already over-extended—the number of children in need of alternative caretakers has risen too quickly for the extended family networks to be able to absorb them. As the numbers of orphans increases, so do the numbers of street children, begging for food or shelter, living day to day with little hope for a future. AIDS medicines are being introduced to Africa through programs set up by drug companies, but 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.