Malawi

“Anti-retroviral Drugs and Africa” Sue Makin, MD shares her evaluation of the reality of implementing Bono’s call, “medicines for Africa”. I am working as a Presbyterian missionary doctor in Malawi, a poor country in southern Africa where the prevalence of HIV/AIDS is quoted, by the Malawi Ministry of Health, to be 10% in rural areas and 25% in urban areas. Malawi is slated to receive up to $196,138,500.00 over the next five years from the Global Fund against AIDS, tuberculosis, and malaria. As the Ministry of Health is able to account for the planning and execution of its program against HIV/AIDS, these funds will be released in a staged, yearly fashion.

This paper is being written to expose some of the problems I feel we are facing even as we anticipate the arrival of large amounts of money to aid in alleviating our number one health problem. First of all, there is a tremendous shortage of trained health care providers in Malawi. There is one medical doctor for every 55,000 people in Malawi. There is a severe shortage of nurses, with a 25% shortage in government hospitals and 44% in mission hospitals. There is no end in sight for this shortage, and it may get worse as nurses are leaving Malawi to work in the United Kingdom for better salaries. Secondly, prescribing the anti-retroviral drugs in a safe, scientific, and rational manner requires a level of medical expertise and some medical laboratory services that are not available in the country at this time except in the two largest cities, Blantyre and Lilongwe. Anti-retro viral medicines (ARV's) need to be taken for life. It is difficult for any person to take medicines every day for ten days, let alone every day for a month, or even every day for life. Many of the people in Malawi affected by the virus have a very limited formal educational
background. Explaining and reinforcing the importance of continuing to take the medicine for life will be a very difficult and time-consuming task for the health care providers. Once someone stops taking the medicines that are keeping the HIV virus at bay, so to speak, and allowing the body's natural immune system to function normally, the virus will once again begin to replicate. Even worse, the form of the virus that comes back at this point may be resistant to any anti-retro viral drug available in Malawi. A person who stops taking ARV's can conceivably spread a resistant form of the virus to another person. At the present time in Malawi there are only two combinations of medicines available. There is Duovir, a two drug combination, and Triomune, a three drug combination. If a person has an adverse reaction to either of these two drugs, there is no alternative medicine at this time to give him or her. The only thing to do is to stop the medicine, which means the virus will begin to replicate one again in that person's body.

The ARV's are medicines that can cause some serious side effects such as inflammation of the liver or the pancreas, problems with nerves in the arms and legs, metabolic problems, and possibly a severe rash. If these problems occur then the medicines must be stopped. The people who will need the ARV's will conceivably be provided with the drugs for free through the Global Fund program. However, if these people live in an area remote from the distribution point of the medicines, some of them will not have the resources or the money to find transportation every month to get the medicines. A possible solution to this dilemma would be a get the medicines out to the people, but how to do that would require another layer of health care which does not exist at this time in Malawi. The distribution of drugs for tuberculosis now requires that the client return every month for the anti-TB medication for six months. ARV's are supposed to be for life. These are some of my thoughts about the HIV/AIDS situation and anti-retro viral drugs in Malawi. We must not stop trying to prevent the spread of the virus through information, education, and counseling. The Christian churches in Malawi are being mobilized and I believe that they will become more and more active in the campaign. We still have a long way to go.
Dr. Sue Makin
P. O. Box 126
Chisitu, Malawi, Africa