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MSF in Malawi, 2012
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HIV/AIDS is the main cause of death among young adults in Malawi – those who should normally be the most productive age group in the country – according to national surveys. Doctors Without Borders/Médecins Sans Frontières (MSF) has been adopting a range of approaches to improve access to treatment for people with the disease and one program has expanded, while another is on track for handover to the Ministry of Health.
Patient Numbers Increasing in Chiradzulu
Antiretroviral (ARV) treatment was introduced in the HIV progra in Chiradzulu in 2001. Implementation of the recommendations for care that the World Health Organization set out in 2009, including starting ARV treatment earlier, has meant that the number of patients has grown: in 2012, MSF had about 33,860 HIV patients, 80 per cent of whom were on ARV treatment. Some 2,600 pregnant women received prevention of mother-to-child transmission (PMTCT) services. Such large numbers mean models of care must be simplified, but without sacrificing quality. Some tasks have been transferred from doctors to nurses, so that services can be decentralized to health centers. At the 10 centers where MSF works, teams offer antenatal care to pregnant women, including PMTCT, counseling and also integrated care for people co-infected with tuberculosis (TB), so that patients can obtain all their treatment at one facility. Furthermore, people who are in a stable condition need only attend appointments every six months: this has reduced the burden on both the patients and medical staff.
Preparing for Handover in Thyolo
Around 48,000 patients have begun ARV treatment at the HIV program in Thyolo during its 15-year history. All 24 sites in the district currently offer comprehensive HIV care, including PMTCT option B+, which puts pregnant women with HIV on lifelong ARV treatment. The objective now is to hand over all basic services to the Ministry of Health by the end of 2013 so that MSF can focus more on technical support in specialist areas such as diagnostics, including early infant diagnosis, and integrated HIV and TB care. With MSF’s support, 30 students were enrolled in the Malamulo scholarship program, which trains young people from rural areas in health professions, on the condition that when they qualify they return to work in rural areas of Thyolo district for five years. Supporting HIV care in Nsanje and Chikhwawa An MSF team has been supporting an innovative nationwide mentoring program in Nsanje and Chikhwawa. Mentoring staff as they implement new clinical guidelines should help improve patient care. MSF also assisted in infection control and pharmacy management.
Kingston, 25 years old and studying for a diploma in nursing and midwifery, sponsored by MSF.
When I was 15, my sister fell sick and we took her to Thekerani hospital. The queue was long and there was only one clinician. We arrived at 7 am and my sister died right there in the queue at 2 pm. It was very difficult to understand.
The death of my sister was due to the shortage of healthcare workers, and
I decided to become one.
At the end of 2012 MSF had 770 staff in Malawi. MSF has been working in the country since 1986.