Malawi: Daily struggles of the most vulnerable

Videos and Photos18 October 2017

Eleven-year-old G* is living with HIV and has been receiving TB treatment at an MSF clinic.

Alfred Nema, 18 years old, from Ntweya village is living with HIV and TB. In 2016, MSF started the Saturday Teen Clubs space dedicated for adolescents living with HIV. The strategy for the coming years is to integrate medical care for stable adolescents living with HIV including mental health, nutrition, sexual and reproductive health.

Debora Njala, 18 years old, from Chiradzulu is living with HIV and TB and is part of MSF's adolescent clubs in Chiradzulu. In 2016, MSF started the Saturday Teen Clubs space dedicated for adolescents living with HIV. The strategy for the coming years is to integrate medical care for stable adolescents living with HIV including mental health, nutrition, sexual and reproductive health.

Emmanuel is being treated in Nsanje district hospital for advanced HIV and related opportunistic infections cryptococcal meningitis and TB. In this sparsely populated, largely rural area, people living with HIV face many challenges staying on lifelong treatment. Just getting to health centres for check-ups can be costly, time-consuming and difficult. MSF is adapting its support to Nsanje hospital, specifically to deliver a nine-month training programme for health ministry staff to improve diagnosis and clinical management of advanced HIV.

MSF nurse Stonald Shanda provides an HIV test to Seleman Samu, 62 years old, in the HIV testing and counselling room in Nsanje hospital.

Zuze Bingala, 54 years old, has been admitted to Nsanje district hospital with TB and cryptococcal meningitis related to advanced HIV.

Simbazako Thove, 19 years old, who has HIV and TB is prepared for an X-ray in the radiography room, Nsanje district hospital.

Fun time during the "six-month-day meeting" in Mbulumbuzi Health Centre.

Hospital attendant Flonny Hassan serves meals to patients and guardians in Nsanje district hospital. With Malawi facing an economic and human resource crisis, district health budgets have been slashed and referral hospitals like Nsanje are experiencing critical shortages of staff, drugs, power and water. In addition to mentoring and training, MSF is increasing laboratory, imaging and pharmacy support and supplies of essential medicines in Nsanje district.

Mary Dyson (left) 23 years, from Nyambiro, sits with her son in the counselling room.

MSF pharmacy supervisor Simion Laphion supports pharmacy management at Nsanje district hospital.

Selena Bishop from Ng'ombe village, receives her medication at Sorgin Health Centre, Nsanje.

Patrick Chiwanda, 20 years old, who is living with HIV and TB collects his monthly antiretroviral drugs in Milepa Health Centre, Chiradzulu.

Malawi is a peaceful country well known for its beautiful scenery – defined by striking highlands split by the Great Rift valley and the enormous Lake Malawi.

Malawi also has one of the most successful, innovative HIV programmes in the region after being heavily affected by the HIV epidemic in the late 90s.

Yet behind the tranquil horizon, daily struggles loom large.

Malawi faces huge gaps in its health system, with critical shortfalls in funding and a reduced workforce. District health budgets are quietly stagnating – with inadequate funds to pay for essential drugs for patients.

HIV remains the leading cause of death among adults in Malawi. Around 28,000 new cases of HIV are still expected each year. A total of 64,000 AIDS deaths are projected for 2018-2020, two-thirds of which will be among people already taking antiretroviral treatment (ART).

All photos by Luca Sola.

Find out more about MSF's work in Malawi.