Fighting kidney disease in Malawi
Mercy Masimo is a 32 year old peasant farmer in Magulugulu Village T/A Malemia in Nsanje District. She talks of how she was diagnosed with kidney disease way back in 2010.
“Actually, I did not know that there is kidney disease until when the doctors diagnosed me with the disease. I noticed some difficulties when I wanted to pass urine. Sometimes the amount of urine was so low and sometimes I could not pass it daily or regularly the way I used to,” she says, adding that sometimes she could feel so weak with some symptoms of malaria.
Masimo says when she went to a hospital, she was diagnonised with kidney disease.
“At first, I was surprised because I did not feel any pain. As if that was not enough, the doctor also said that my blood levels were so low,” says the bed-ridden Masimo.
However, Masimo says it is very expensive for her to access the treatment for her disease in the country. She observes that unavailability of dialysis machines in district health facilities is a huge challenge to her.
Masimo says the situation forced her to travel to Blantyre twice a week to attend the kidney dialysis sessions at the Queen Elizabeth Central Hospital (Qech).
“I have been travelling to Qech since I was recommended to be on a dialysis machine in 2010 because you cannot find such machines anywhere in my district. This is costly because in a month, I spend a lot of money for transport and other expenses.
“I am just a peasant farmer and looking at the weather pattern, I cannot harvest enough to sell to top up my travelling expenses,” says the mother of four.
Masimo, who has no relative in Blantyre, says she sometimes finds an increase in number of patients on the list to access the machine at Qech which forces her to seek accommodation elsewhere, a thing which makes her accumulate some other expenses.
According to reports, at Qech, the country’s largest referral hospital, there are a total of five dialysis machines but they often break down.
Dialysis is the most important equipment in treating chronic renal patients. The machine cleans the kidney enabling it to function properly. It also recommends the amount of toxic materials that have to be removed from the body.
Masimo’s case is similar to many other people with chronic diseases such as renal failure and other kidney problems in the country.
According to the Chief Executive Officer (CEO), for Kidney Research Foundation of Malawi (KRF), Lucy Msungeni , kidney disease is one of the non-communicable diseases (NCDs) in the country which also remains one of the silent killers and a topic that people rarely discuss.
Msungeni says the major common causes of kidney complications include poison such as drug toxicants and snake bites, diabetes disease, malaria and bilharzias. She also mentions anaemia, high blood pressure, loss of weight, low calcium resulting in weak bones (which are prone to breaks in case of accidents) and the amount of urine one passes –as other key factors that influence the emergence of kidney disease.
Currently, Malawi is one of the countries which have no qualified nephrologists hence dependence is laid upon expatriate doctors who occasionally visit the centres. The country spends millions of kwacha to refer patients, mainly those with resources, to countries such as India, Germany and South Africa while the majority of poor Malawians are sent home without treatment where they are suffering and dying a painful death, unnecessarily.
According to the latest findings from the (KRF), the long treatment costs of Chronic Kidney Diseases (CKDs) on an annual basis in terms of haemodialysis and peritoneal dialysis per patient in Malawi is estimated to be approximately US$26,000 and US$65,000 respectively, figures which it says exclude staff costs and additional consumable supplies.
KRF says one available treatment option in the country is dialysis, which it says in itself has also proven to be costly on the part of government and those accessing treatment. The foundation further says alternate treatment such as transplants is virtually non-existent owing to the lack of capacity to manage such options. The challenge, however, it says, the majority of Malawians live below the poverty line. As such, they cannot afford their kidney to be transplanted.
Msungeni says dialysis in Malawi is provided in two types; peritoneal which can be done at home and hospital haemodialysis. However, she says, all patients in the country access haemodialysis with none on peritoneal due to the risk of infection which may be fatal.
Msungeni underscored the importance of why Malawi needs qualified nephrologists: “they will reduce the costs that are currently incurred in sending patients to other countries for treatment. We heard that government sent a total of four people to study nephrology outside the country, but up to now, none has returned yet.”
As if that is not enough, Msungeni says the country has only two government dialysis centres and a private centre, one at Qech, the other at Kamuzu Central Hospital in Lilongwe and a private one at Mwaiwathu Hospital in Blantyre. It is, therefore, clear that kidney treatment in the country is a challenge both to the doctors and the patients.
“Worse still, drugs for treating kidney diseases in the country are scarce and very expensive. Patients would come from other districts when they are due for a check-up, only to find that the type of drug they need is not available. If they are lucky enough to afford it, they will procure the expensive medication from a private pharmacy and are then administered in time, but most cannot afford it and they simply return home,” Msungeni says.
The World Health Organisation (WHO) and other experts recommend that people should also be attentive to warning signs to detect the disease at an early age. It further says along with primary prevention measures; early detention of kidney disease greatly increases chances of successful treatment. Unfortunately, this is not the case with Malawi.
“There is a general low awareness on kidney disease related information. This has created complications of late diagnosis, which coupled with the assymptomative nature of the disease has contributed to late presentation to the hospital for treatment,” Msungeni says.
The ministry of health has acknowledged the importance of addressing NCDs such as renal problems and cardiovascular complications whose burden is growing daily and need a strategic approach for urgent redress.
Dr Beatrice Mwangonde, the director of NCDs and Mental Health Unit in the ministry, says the essential health package conditions of the current health sector plan for 2011 to 2016 includes NCDs such as kidney.
The new 2011-2016 health sector strategic plan (HSSP) has recognised the threat posed by NCDs and will be given special attention. It says NCDs in the country were increasing hence the need to give the burden special attention.
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