Suffering in the shadow of stretched resources


For James Mathyola, a message about universal access to antiretroviral therapy (ART) is as hollow as efforts by policy and decision makers in trying to mask the massive marks of socio-economic inequalities.

Mathyola grins nervously when asked about the problem facing people living with HIV in his area.

“It is access to HIV treatment services especially ART,” he said with a resigned tone.


Mathyola is 41-year-old and has been on ART since May 2001, a year after he found out he was HIV positive.

Since August last year, Zomba District Health Office (DHO) has not provided outreach clinic services in his area to distribute the life-saving and sustaining medication to HIV clients.

His story represents the anguish of many people living in the nightmarish intersection of fewer resources and inequitable distribution of health facilities and services.


In Chinguma Village—one of the villages in Nsombi area where Mathyola lives — and other surrounding areas, people living with HIV and Aids feel they have been forgotten by their country folks.

“It has been a difficult and long eight months and we are still counting. We don’t know when they (Zomba DHO) will come back to us” lamented Mathyola.

Located in the eastern shores of Lake Chilwa, near the border with Mozambique, the areas of Nsombi, Lungazi, Ngotangota and its communities are paying the heavy price of being on the wrong side of the lake, and the country too.

This runs counter to a call by the 2013 report by UNAIDS titled Access to Antiretroviral Therapy in Africa: A Status Report on Progress towards 2015 targets.

The report states that “all people eligible for antiretroviral therapy, regardless of where they live, have the right to effective and accessible care and treatment services.”

But that is hardly the case with many people on the eastern shores of Lake Chilwa. Many see their right to health fold up and burn in flames of improper care and unavailable resources.

The lack of health facilities in these areas condemns the general population to the perpetual shackles of multiple health risks.

“We do not have a health centre nearby on this side of the lake. What we have are just health posts which are not mandated to provide services like ART,” said Mac Maida, senior health surveillance sssistant at Chinguma Health Post in Nsombi.

He said that the nearest health centre where people can get treatment is Likangala on the western shore of Lake Chilwa. It is almost 55 kilometres away, out of which 40 kilometres is covered on water.

The journey across the lake to the health centre is an expensive one for an ordinary person like Mathyola.

A one-way ride from Nsombi to Kachulu dock on an ordinary engine boat costs K2000. The remaining journey on land transport from Kachulu to Likangala Health Centre costs around K600.

Given the travel time covered on the lake and the erratic schedule of boat rides, it is often impossible to make a return journey on the same day. As such, travellers are forced to spend a night or two waiting for the next ride back home, which means additional costs in terms of accommodation and food.

Sixty-seven year-old Fanny Masharubu from Namalele Village in the same area of Nsombi in T/A Mkumbira occasionally makes it across the lake to Likangala Health Centre.

She is lucky she has the support of brothers who finance her trips to get the ART for herself and her 15-year-old son. But she is still worried with the long journeys that leave her tired and weak most of the times.

“I still wish they could resume visiting us. I understand they stopped because they were busy dealing with cholera outbreaks.

But there are a lot of health problems here, it’s not only about us with HIV,” Masharubu said.

For many of those not so lucky like her, they have been forced to look east for help, the east being beyond the borders in the Mozambican town of Sede.

“Since the time medical help from Zomba stopped coming here, we have been getting ART from Mozambique,” said Mathyola.

Mekanyera Hospital in the border town of Sede is 14 kilometres away, at least a manageable distance for people in Nsombi. But the assist in the east comes at a cost.

“At times, the personnel there are hostile. They shout at us saying we are exhausting resources meant for their people.

Very often, they provide one bottle of ART to be shared by two people,” Mathyola said.

Their situation is not even helped by the fact that access to nutritional supplements, which they could easily get in Malawi, is an outright impossibility on the other side of the border.

Language barrier emerges as another problem the people face in Mozambique. For those not conversant with basic Portuguese, they struggle to communicate their problems.

“We cannot dialogue for a common understanding about our problems. Our predicament is lost in translation and interpretation,” Mathyola said adding that the hostility they encounter hardly discourages them from visiting again since it’s the only option.

Malawi Health Equity Network (MHEN) is civil society organisation that lobbies and advocates for the equitable distribution of health facilities and services.

It said that the situation in most areas along Lake Chilwa denies people their right to health.

“Many people in islands and places along the lake lack access to quality health service because of high levels of inequitable distribution of resources like quality health facilities.

“It is sad that there are places where people cover close to 70 km just to access health services. This is contrary to the predetermined radius of 8 km that one is supposed to cover from home to the next health facility,” said George Jobe, executive director for MHEN.

In the case of Nsombi people going to Mozambique to access health services, Jobe observed that there is always a high risk of Malawian patients being mistreated since they are using resources not meant for them.

“Malawi is complaining that citizens from other countries are putting pressure on its health resources in border districts.

It is obvious our neighbours are complaining the same about our people who visit their health facilities,” Jobe said.

According to Jobe, the sooner the offices of the Zomba DHO resumes outreach clinic services in Nsombi, the faster it can save the lives of many people from various health risks.

Zomba District Health Officer Gift Kawalazira said his office could not provide outreach clinics in the area because it was overwhelmed with cholera response and logistical problems to a number of places along the lake.

“One trip to the other side of the lake requires 200 litres of fuel. We were stretched on resources to respond to cholera outbreak and provide outreach clinics,” said Dr. Kawalazira adding that they will recommence the service by the end of May or June this year.

But people like Mathyola live in a world far removed from the realm of debates on human rights and equality.

“What else can we do? The fate of our lives is in the hands of people in Mozambique,” said Mathyola.

“If there is anyone who can assist, it’s the people in our home country. They are forgetting us.” —Mana

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