Sunday, February 2, 2014

Mwanza Border District Struggles against Health Challenges

Brown particles of dust run into the clear sky as, on the bare grounds of Nankhubwe Community-based organization in Mwanza West, six under-five children play seek and hide and take turns to run over each other, oblivious of what is taking place in their little bodies. Forty years from now, they may not be there to play.

Most of the people from Chiwembu Village know the ‘truth’ about the children; so, they look at the children with heavy interests, shaking their heads as they go towards wherever their legs or bicycles may carry them. They may choose to go wherever they wish to, but their memories will always bring them back to the spectacle of the children creating fun out of the dust.

The problem lies in telling the children they are HIV-positive. How does a parent inform an innocent-looking three-year old they are living positively with HIV, a thing they may not comprehend?

“It is sad; so sad,” says T/A Nthache of Mwanza. “It breaks my heart to know that they may also get infected with Tuberculosis (TB) as their immune system breaks down.”

Chiwembu Village, where the children stay and play, falls under his jurisdiction. So do Silota, Zilima, Kagulo, Kachipanda. All these villages are now united by the universality of challenges, mostly health related, being experienced by community members.

These challenges, says Nthache, are HIV and AIDS, TB and the influx of Mozambicans who scramble for meager resources such as drugs.

”We are caught in the middle of a complicated web; we don’t know what to do, really, but we are trying. As T/A, I have never tired from mobilizing my subjects against HIV and AIDS, and TB,” adds Nthache.

Mwanza district is itself a web, too. Being a border district, it is a beehive of sexual activity for truck drivers, fueling the spread of HIV and AIDS. Mwanza District Hospital is also a web that seems to be catching more flies than it can hold: people from Senzo and Chitungweni villages in Mozambique scramble for meager medical resources with communities from the district.

HIV and AIDS also seem to have sanctioned the help of TB in a conspiracy against good health, concocting a disaster of twin proportions.

Nthache says, as if that were not enough, people from Chikwawa also find it easier to go to Mwanza District Hospital than Chikwawa. All this against resources designated for a single district.

However, those who pile pressure on the meager resources are those who can walk, or cycle or board Matola. Others are incarcerated by circumstances, and forgotten. Take, for instance, prisoners at Mwanza Prison.

”These people live on one meal a day, a trend that seems to condemn, and discriminate against, those who are HIV-positive to their early grave. It is bad, yet preventable,” says Machilika Matemba, an HIV and AIDS activist from the district.

Machilika is executive director for Mwanza AIDS Support Organization (Mwaso), a humanitarian organization formed by people living with HIV and AIDS. It seeks to promote behaviour change, build hope where only desperation exists, and improve the well-being of those infected by HIV in the district.

Mwaso learned from experience that inmates have no leeway to the hospital, a reality that begins with the prison walls: They are tall enough they hinder prisoners’ view of Mwanza District Hospital.

“It is worse for those (prisoners) living positively with HIV and AIDS. One meal a day is not enough for someone in dire need of nutritious food to boost the immune system. It becomes a multiple problem because, when immunity is weak, TB also comes into play,” says Matemba.

His organization thus established a support project at Mwanza Prison for those who cannot scramble for the basic necessities in the open. HIV-positive prisoners always fight two battles: the one within (HIV in their blood), and that outside (scrambling for a share of medical resources and services at public hospitals).

Mwaso’s nutrition and Stop TB campaigns seem to be working, however. Among others, prisoners grow tomatoes, mustard, onions, cabbages, Lettuce, and ask for sputum examination when they cough for three weeks. This applies to both those living positively with HIV or not.

Already, indicators are that the initiative is raking positive results.

Stanley Mbewe, Senior Superintendent for Mwanza Prison, says the facility has 294 prisoners (as of Saturday, September 5, 2010), 43 of whom are living positively with HIV and AIDS.

“The programme has really helped matters here. The biggest challenge remains the general lack of resources. We need wheelbarrows, raking and splaying materials,” Mbewe says.

Not that the funding Mwaso got from VSO is not enough; it is enough for drawing the battle lines against malnutrition, HIV and AIDS, and TB- reaching the end of the battle line is a multispectral issue.

Geoffrey Kumpama, Clinical Officer for Mwanza Hospital, is one of the people pulling the strings towards the battle line, a better end. He says the hospital has been trying its best to tie the loose ends through the work of Health Surveillance Assistants (HSAs), who he says are well-equipped with knowledge on TB, HIV and AIDS, Malaria, other Sexually Transmitted Infections, and hygiene.

The challenge, as is typical of Mwanza, , comes from Mozambican service seekers.

There are no HSAs on the Mozambican side of the border, making it difficult to trace people with TB, mobilize people to go for Voluntary Counselling and Testing, good nutrition practices, preventing STIs.

Ministry of Health spokesperson, Henry Chimbali, says Malawi and Mozambique signed a bilateral agreement on health four years ago, and that nationals from the two countries are free to access health services in either country.

The challenge, acknowledges Chimbali, is that health services in Malawian local hospitals is free while Mozambique imposes fees on public health services.

"We are working out on how to reach a middle point," Chimbali says.

This, in a way, means that the scale remains unbalanced, and that the negative effects of this still cross the borders into Malawi, in the form of foreign citizens seeking medical help at Mwanza.

But Kumpama looks at the positive side: “The bottom-line is that TB is treatable; those living with HIV can still live long, productive lives; truck drivers can prevent STIs, including HIV and AIDS, by employing preventive measures; and HSAs are crucial in medical service delivery,” Kumpama says.

To which Nthache adds: “United, we can make Mwanza district better. By
this, we mean nutrition-wise, health, education, social-economic
development. It’s all in our hands.”

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