Twice the pain: Case of patient guardians


By Isaac Salima:

It is around 4:30pm and, soon, darkness will overcome the light of day. For many people, it is time to rest.

However, for guardians at Queen Elizabeth Central Hospital (Qech), it is just the beginning of another long night of anxiety and uncertainty.


Apart from worrying about the health of their loved ones, they worry about their own welfare as a majority of them have no idea about where their next meal will come from.

A case in point is Cecilia Stefano, who was referred to Qech from Mulanje District when her daughter developed complications on her leg. As the two of them wait for the day surgeons will operate on the leg, they endure another ordeal; hunger.

The maize flour they brought along to Blantyre for food has run out, leaving the two of them stranded. It is their worst nightmare.


“After the flour and money I had got finished, my colleagues were sharing me some food. Unfortunately, I could not get in touch with some relatives back home because their phones were unavailable. When I managed to talk to them, they sent me K4,000 which I unfortunately lost,” Stephano said.

Worse still, some patients who come alone from health facilities located far and wide face a double tragedy: they have to serve two roles of patient and their own guardian, often without hope of when they will be treated as well as their next source of food.

Carlos Zolemba exemplifies this situation. Referred from Nsanje District, he found himself in the position of both patient and guardian after he developed sores on his throat.

He was told that he would see a doctor after two days. Nursing empty pockets meant he could not afford to generate money for transport to go back to Nsanje, and, as such, decided to stay put at the hospital.

“I had not yet been admitted to the hospital, meaning that I had to look for my own food. When you come to the hospital from rural areas like in my case, you have to have money for transport and food. Unfortunately, for a person like me, it is not easy and this is a situation I am in. it is my hope that I will be assisted within a short period so that I can go back home,” Zolemba said.

The agony, frustration and helplessness echoed in these voices could just be the tip of the iceberg. Many faceless and voiceless people that find themselves serving the role of guardian in central hospitals nationwide could have problems far much worse than these.

The country’s referral hospitals offer food rations to patients only, leaving guardians to fend for themselves.

The problem has been compounded by the introduction of Covid-19 measures at Qech; which means guardians have to find places they would spend the night at. Contact with other people has to be minimised.

No wonder, these people seek refuge in the guardians’ kitchen built at the facility. This is their temporary home as they wait for the day when, by God’s grace, their loved ones would be discharged from the hospital.

Of course, the place was not meant to be a rest house hence it has no beds and beddings.

Well, what can the cashless, often hopeless, guardians do? They can only wait for the day hunger may finish them off. Worse still, they may simply fall prey to mosquitoes that transmit malaria, after enduring the mental torture of sleeping on the floor.

“I came here in June with my sister who is sick and I have been sleeping on the floor using this wrapper to cover myself. Nowadays, we are not allowed to sleep in the patient wards,” Janet Soni, who was also referred to the hospital from Nsanje District, said.

To make things worse, the guardians, most of whom are women, do not even know when their loved one would be discharged from hospital.

Meanwhile, health rights activist Maziko Matemba has called on the government to offer guidance on the issue.

“Malawi is different from other countries because our guardians, most of them, come from poor families and require to be supported with food rations. However, government needs to come up with a clear guidance on how we can manage our patients with guardians. Are the hospitals supposed to support the guardians? If not, what guidance can be given?” Matemba said.

According to Ministry of Health statistics, as of 2008, the health care provider to patient ratio was 1:2,771 and the physician to patient ratio was 1:50,000.

With the apparent problem of shortage of nurses, physicians, and clinical officers, hospitals are severely understaffed and ill-equipped to provide adequate patient care.

It is a fact that Malawi’s public hospitals cannot do without guardians.

However, Ministry of Health spokesperson, Joshua Malango, said their primary focus is on patients.

“We recognise guardians as people who are there to assist our health workers in taking care of the patients but we are obliged to give food to patients not guardians,” Malango said.

It must feel like a huge burden to serve as guardian in winter when almost everyone wants to tuck themselves in a warm place at night.

Sadly, this is the situation countless guardians will be in tonight. To worry about their loved one’s health condition is torture enough, but sleeping on a cold, biting floor is akin to being punished for expressing willingness to care for a patient one cares about.

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