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Endemic/epidemic disease | Natural disaster

Malawi experienced the most severe floods in living memory in 2015; 176 people were killed and over 200,000 were displaced. Doctors Without Borders (MSF) responded with a five-month emergency operation in the south of the country.

MSF mobile clinics provided 40,000 outpatient consultations, distributed relief items such as water treatment kits or mosquito nets to over 13,000 households and a total of three million litres of drinking water. The latter intervention helped contain a cholera epidemic that had flared up in neighbouring Mozambique and spread to Malawi: 279 cases were recorded in MSF-supported facilities in Nsanje and Chikhwawa.

HIV care

Despite significant progress in prevention in recent years, an estimated one million people are still living with HIV in Malawi and only half of them receive treatment. The health authorities have launched an ambitious plan to accelerate the fight against the disease, by increasing the resources allocated to it and focusing on assisting the most vulnerable and hard-to-reach people, such as sex workers.

The four-year handover process that started in Chiradzulu in August 2014 continued, and is due to complete by mid-2018. In this district, MSF supported more than 33,000 HIV patients, of which 18,800 are enrolled in the so-called ‘six month appointment’ schedule, whereby stable patients attend a consultation only twice a year. This not only benefits patients, but also reduces staff workload, allowing them to focus on more complex cases.

MSF has implemented viral load point of care in seven of the health centres, facilitating rapid access to viral load measures to confirm suspected treatment failures. MSF is advocating to keep decentralised point of care in areas with high prevalence like Chiradzulu district.

In December, MSF finished handing over the HIV project it had been running for 18 years in Thyolo, to the Ministry of Health.

In Nsanje, MSF continues to supervise the implementation of the policy to put all HIV-positive pregnant and breastfeeding women on antiretroviral (ARV) treatment, regardless of their clinical status, to prevent transmission of the virus to their babies. This year, the Ministry of Health requested MSF’s support to launch community ARV groups too. The handover to the ministry of the programme to integrate HIV and TB treatment project has started will be completed in 2016.

MSF also continued a three-year project in two of the three central prisons in the country – Maula in the capital Lilongwe, and Chichiri in Blantyre. The aim of the project is to adapt models of care to reduce HIV and tuberculosis (TB) transmission in these severely overcrowded environments, by increasing diagnostics and access to treatment.

The ‘corridor’ project continued in 2015, offering testing for HIV and other sexually transmitted infections to truck drivers and sex workers in Mwanza and Zalewa, near the border with Mozambique. The team also worked over the border, along the busy route between Beira and Tete.

Health Inequalities

Health advocates, including Doctors Without Borders (MSF), are expressing strong reservations about a proposal by Malawi's Ministry of Health to establish paying wards in district hospitals across the country.

Members of Malawi’s Universal Health Coverage (UHC) Coalition say there is a strong risk that patients who pay will get prioritised over those who cannot afford to. They argue that this attempt to generate more money for the health sector will only further escalate health inequities in Malawi.

Emergency activities

In April, following an outbreak of xenophobic violence in South Africa, MSF supported the Ministry of Health to offer medical and psychological care to 3,831 Malawians, most of whom had been forcibly repatriated. Three months later, MSF organised mobile clinics in the village of Kapise, near the border, for Mozambicans fleeing sporadic violence in Tete province. The influx of refugees continued into 2016.

First person story:

Berita Tcheleni welcomed her newborn baby girl in the most difficult conditions: 13 days after the floods, Berita gave birth in the isolated village of Makhanga with the help of MSF nurse Clive Kasalu who had just arrived by helicopter. Makhanga is only reachable by the air since the floods on January 9th. Photo: Rowan Pybus.

“I was eight months pregnant when the floods hit, and we had to spend four days on top of a tree until the water receded. Then, on 22 January, I felt that the baby coming. We went to Makhanga clinic, but it was closed because it had been completely destroyed by the floods. There was no one there to help; our village had become an island completely cut off from the rest of the country. I was told to wait, that a helicopter was coming, that it could take me to another clinic. Fortunately, when the helicopter arrived, it brought with it someone from MSF to help us and my baby girl was born.”

No. staff in 2015: 586 | Expenditure: €9.0 million | Year MSF first worked in the country: 1986