Esther Nkolimbo is a widow whose life keeps falling apart in the face of the hunger crisis that has gripped her village on the outskirts of Balaka Town Centre.
Her home—a flat sodden site surrounded by scantly-dressed crop fields—typifies wretched lack.
A small house with a sparse grass thatch sitting on baked clay walls marred by soot is all her family has for a kitchen, a living room, a bedroom and, sometimes, a bathroom.
Thin verandas become handy when it rains. Those lining the front part of the house limitedly allow her to cook for her family while at the back, her children have found convenient spots when they want to take baths.
“My family is struggling,” Nkolimbo laments. “My brother used to help me but he passed on recently.”
In her condition, it is required that she goes all-out to ward off opportunistic infections but it does not always work.
The smoke that drifts from her wood-laden fireplace hardly ever escapes into the open atmosphere in front of her house without some getting into her body.
Along the way, respiratory infections regularly attack her and threaten to weaken her immune system which is being protected by the medication she is taking.
“But I am not taking my medication according to the prescriptions anymore,” Nkolimbo reveals, a sad smile flitting across her face as she blankly stares at the sunset, a glorious conflagration blazing with reds and oranges.
For 16 years, she has devotedly taken her medication every evening until November last year when the worst hunger crisis hit her family. Now, her life is being dashed by a threat in her fold.
“Without proper food, it is difficult to take my medication. When I do that, I wake up in the morning feeling weak and dizzy such that I cannot even do household chores,” Nkolimbo explains, sighing hopelessly.
An advocate of diversified prevention methods, beyond treatment, Ulanda Mtamba, states that treatment and good nutrition go hand in hand.
She says inadequate nutrition affects drug intake and adherence.
“In the process, the efficacy of the treatment is also compromised. Taking drugs requires some minimum food nutrients. Even basic drugs like painkillers require food,” Mtamba says.
She also reckons that despite that women constitute the largest chunk of smallholder farmers in Malawi, they are often thrust onto the periphery of decision making when it comes to what to do with the harvest.
This, Mtamba says, leaves them struggling and those on treatment often bear the biggest brunt.
“Men can have other ways of meeting their nutrition needs. Women, who are often in charge of household activities, do not have such opportunities. That is why the epidemic continues to bear a female face,” she adds.
Nkolimbo recalls the benefits of adhering to treatment recommendations which she says are there for all to see in her life.
Seven years ago, she gave birth to a baby boy who, till today, remains bubbly and buoyant despite that he has a heart problem.
“Because I adhered to instructions regarding my medication, my son was born without any problem. Of course he has a heart problem, but that is all,” Nkolimbo says.
Still, the single mother is troubled that skipping her medication due to hunger may eventually give room for more opportunistic infections which may soon incapacitate her.
Already, she is struggling to find money for travelling to Queen Elizabeth Central Hospital in Blantyre about 130 kilometres away where her son’s heart condition is supposed to be checked by doctors once every three months.
“I have to work in other people’s farms to find money. It is not always enough. When I am weak, I cannot do anything and end up missing my son’s appointments with the doctor,” she narrates glumly.
As Nkolimbo battles her own challenges, she wishes her son lived a restful life.
But he is often in pain and she has to be by his side during such moments—and always.
“He cannot even go to school. Perhaps, if he can get better, he will start. I don’t want him to find himself in this same poverty when he starts leading his own self-reliant life,” she states.
Yet, she cannot evade the far-reaching consequences that the hunger crisis in her household has on her and her son’s future.
She has on several occasions listened to messages on the dangers of skipping one’s medication but insists that in her current state, she has no choice.
“I am not just speaking. I have experienced it. I have had terrible problems after taking my medication on an empty stomach. Is there anything else I can do?” she queries rhetorically.
While experts state that most forms of treatment do not need any food interactions or requirements, they also agree that some medications need to be taken with food to be most effective.
Researchers Sera Young and three others clarify that food insecurity is emerging as an important barrier to adherence to care and treatment recommendations.
Adults, pregnant women, child and adolescent populations are all drawn into this picture.
“Food insecurity, when people do not have physical, social and economic access to sufficient safe and nutritious foods that meet their dietary needs and food preferences for an active and healthy life, is emerging as an important barrier to adherence to care and treatment recommendations,” the researchers conclude.
They further put forward that adherence to treatment is critical for reducing related deaths and that non-adherence is the most consistent predictor of development of drug resistance and progression to ‘big diseases’ and death.
And for Nkolimbo, these threats are lurking around.
“Those on treatment must not default on treatment even when they feel they are fine. Now, we see that those other big diseases are coming back. We are now seeing a lot more sick people,” says Patrick Mangochi, a medical doctor at Médecins Sans Frontières.
He further states that ‘several other’ diseases such as tuberculosis and meningitis caused by various parasites are coming back.
And Nkolimbo has to balance the comfort of today and that of the future.
“It is difficult to stick to treatment when you have all these problems. For tomorrow, we will see what it brings,” she says, staring once again at the last gasp of the sun’s beauty before it dips below the horizon.
And she is not alone.
Many more women in her village are skipping their medication because of insufficient food.
“I have stayed for a week without eating proper food in line with my treatment. Because of the food crisis, I cannot faithfully take my medication,” says 56-year-old Nora Chimbalanga.
She further states that the food aid that comes in her village often ends up in the hands of those already better-off leaving those in search of some power to soothe their frail souls in the cold.
“Our leaders know who needs the support most but they divert it to those they love, leaving some of us on treatment suffering,” she charges.
Her home is draped with an air of sullenness.
She has been on medication for close to two decades and knows very well the implication of defaulting.
Information about the required food groups has also sunk into her heart but it does not help much in the hunger situation that is threatening gains registered in fighting the epidemic.
“My biggest fear has been opportunistic diseases attacking me because of failure to consistently take my medication. I know that I am supposed to take it for the rest of my life.
“But in my poverty, it is difficult to manage that. It appears some illnesses are for the poor. We fail to do many things to keep ourselves on our feet,” Chimbalanga laments, her face scarred by anxiety.
She reveals that in her poverty, she manages to get some food after working in better-off people’s farms despite that the food falls short of meeting the minimum nutrition standards for any human being let alone those in her situation.
“We are in trouble. We are living dangerously. I pray that a time will come when my life will be moderately normal,” says the single mother of three.
Village Head Matchingo, who oversees a small location next to Zam’mimba Village, concedes that in this part of Malawi, those on treatment face several problems which jeopardise their efforts to remain strong.
He perfectly understands their situation—he is one of them.
“Treatment works well with good food. But there is severe hunger in Balaka and those of us taking our medication have not been spared,” he says, a distant detachment registering in his eyes.
Staring at the lush crop fields in the vicinity of his house, the local leader is hopeful that soon, his people will have some nutritious food that will help them retain their health.
One thing he is so sure about is that the dream will not be actualised in two days.
It is this common fear sweeping across poverty-stricken households with members on treatment that strikes Nkolimbo about what would become of her health—and her life—the following day or week.
“My son needs me. He has a heart problem. No one else can take him to the hospital,” she says as she lifts the seven-year-old cheerful boy into the warmth of her bosom. Nothing has ever affrighted her like this hunger crisis.