Malawi should own the war on HIV or...

As part of World Aids Day coming up on 1st December, here is an issue Malawi should sit and listen to.

Emily Banda [not real name] is about 55. A grandmother of six, she had three children who are now dead, leaving her with the burden of looking after the grandchildren.

 Her skin is close to her bones and her eyes beam from deep inside her skull. It is a familiar story—Banda is HIV positive.

Gogo Banda flanked by her two friends - Whats their future?  

“I loved my deceased daughter so much that I cared less about her ailment and in the process of taking care of her during her sickness, I contracted the virus,” said Banda.

She discovered her condition after illness would not leave her a few months after burying her daughter. She is now three months on anti-retro-viral therapy (ART). She is not fully used to the drugs and she is feeling the effects of the powerful medicines.

Banda sits in a hut in Lilongwe’s Area 21 flanked by three other women who also carry the HIV virus. The reason their faces brighten up is that the life-prolonging medicines give them hope that they will see another day at least.

That could all change after 2014.

A crucial donor who buys most of the anti-retroviral drugs (ARVs) for Malawi will no longer do so after 2014 and unless Malawi identifies another donor or buys the ARVs herself, HIV and Aids will ravage people such as Banda and take an enormous toll on the impoverished nation.

The revelation has been discussed in a resource mapping document prepared by the Ministry of Health and Clinton Health Access Initiative titled HIV Funding in Malawi: Key Findings from Resource Mapping, published on 18 September this year.

“55 percent of HIV funding in Malawi is at risk with the Global Fund grant ending in 2014,” warns the document.

The report says although the current grant will end in 2014, Malawi will have access to two years of funding that will maintain drug purchases for all existing patients which will allow for continued treatment, but with limited chances of being increased.

Banda and the other women that I assembled in Area 21 are worried by the spectre of a potential scaledown in the distribution of ARVs.

“ARVs gave us hope; we are now able to do manual labour to take care of our families because ARVs give us strength. Cessation of HIV funding would be killing the Malawi nation because we are not alone, there are many of us,” said one woman who does laundry in people’s houses for a living.

Another woman pointed to her pregnancy, saying despite having HIV, she can afford to bear a child because of the drugs.

“Recall the deaths that used to be there in the late 90s. ARVs give us a reprieve. If they stop giving people ARVs, the number of orphans will rise sharply. Imagine, we are already unhealthy with ARVs; how will life be without them?” she said.

The woman added that without drugs, stigma will come back as it will be easy to identify those with HIV.

Martha Kwataine, executive director of the Malawi Health Equity Network, says it is time Malawi put ARV purchases in the budget.

Kwataine - lets act with speed

“The government must start with the forthcoming 2013/14 national budget to allocate resources for ART. That will be a way of weaning ourselves from donors. If we can start by allocating say K5 billion in the 2013/14 budget, that would go a long way than leaving the whole game to donors who sometimes impose unrealistic conditionalities to their aid.

“It’s high time Malawi began to show its commitment to allocating resources for ART,” said Kwataine.

Board chairperson of the National Aids Commission (NAC) Mara Kumbweza-Banda played down the gravity of the situation, saying Global Fund is not the only partner supporting Malawi in HIV interventions.

“Even if Global Fund withdrew today, we will be able to manage. We have other strong partners such as the United States Government, CDC and others,” said Kumbweza-Banda.

Kumbweza-Banda - Not worried

However, she acknowledged the need for Malawi to avoid relying too much on donors. Kumbweza-Banda said a resource mobilisation strategy is being drafted to that effect, but could not divulge details, saying the information will only be available when the strategy is ready.

She said independence cannot come overnight, arguing that Malawi is making strides in the fight against HIV and Aids.

Out of the $354 million (about K114 billion) that was channelled to fight all diseases in the 2012/13 financial year, 60 percent went to HIV. That is a staggering $212 million (about K70 billion).

The $212 million, which comprises money from the Global Fund, Health Resources and Services Administration, and UNAIDS, among others, will shrink to $117 million next year, $84 million in 2014-15 and remain the same $84 million in 2015-16 following the decreases in funding from Global Fund and others.

According to CHAI (clintonfund.org), the average cost of treating an HIV patient for one year in Malawi is $200 (K64 000).

Negotiating the cost of giving life Joyce Banda's way

Felicia Yohane has sired four babies in her life, two of those did not live to celebrate their first birthday, two are living and now that she is 7 months pregnant, she is very aware of what can happen to her expected baby.

Felicia lives in one of the 197 villages that look to Lumbadzi Health Centre for assistance, she has to walk a long distance of about 2 hours to come to the health centre. And she is not alone; the hospital sees 160 maternity deliveries per month, 10 waiting cases per day and hoards of pregnant women coming for neo-natal care, that is the attention given soon before delivery.

Felicia’s pillar, Lumbadzi hospital however has only thirteen beds in the small maternity wing that has no waiting area, the 13 beds therefore service those that have delivered and those about to. It’s a case of hard rock and place because the next nearest health centre is 15 Kilometres away from Lumbadzi.

Felicia in a one on one with a nurse

The situation at Lumbadzi is just the summit that is visible; the real mountain spans across Malawi, almost all health centres in the country face what Lumbadzi health centre faces.

Out of every 100,000 women that give births in Malawi about 700 of them die in the process, this is high by all means, in Estonia out of the 100,00 only two women are expected to succumb.

Felicia’s deceased little ones are also part of a bigger nationwide problem, 80 babies die out of every 1000 before they complete their fifth year. She lost her babies at four and nine months and the worry for her next baby is written all over her baby face. 

Since Joyce Banda assumed real power after the death of Mutharika in April this year she instantly leapt to highlight the plight of the mothers and infants. If Bingu sang food security and green belt, Banda’s song is from the safe motherhood studio.

She set up her Presidential Initiative on Maternal Health Safe Motherhood. Though difficult to separate it from the politics that accompany its activities, the initiative is breathing in new life into the fight against preventable deaths of women and children around the pregnancy and birth period.

Misozi Jimusole is the Initiative’s media and advocacy officer. I asked him why women need to be given priority.

“Women make 52 percent of our population; they contribute the most to the country’s output its only fair that they should be safe guarded. In safeguarding women, we will also be advancing towards Millennium Development Goal number five.

“The role of women cannot be overemphasised, in any country excluding women from development means that nation cannot develop, including women and having a healthy involved female population means more development,” said Jimusole.

Felicia braves the October heat to travel to the hospital, she knows what dangers come with shying away from hospital; the rest are not that informed.

Jimusole said some women discouraged by distance, cultural beliefs and illiteracy go turn to traditional birth attendants who have little real knowledge about pregnancy complications and motherhood best practices, and he says this exposes mothers to all kinds of risks including death.

While 71 in every hundred women go to the hospital, about 29 seek the attention from traditional birth attendants, who obviously cannot perform a caesarean section and will be quick to point to witchcraft for simple complication.

Children born in the hands of traditional birth attendants are also likely to miss out on vital immunisation given to the baby in the early days of its birth, if the mother looses too much blood during the birth process there is little the attendants can do apart from watch the new mother die. 

But with only thirteen beds there to accommodate 160 women all in a month, it might not be culture or illiteracy that might be  forcing women to go deliver at home and this is what Banda’s Initiative is aiming to tackle.

“The Initiative wants to construct maternity waiting shelters to ensure close monitoring of pregnant mothers and encouragement to seek quality maternal care at public health facilities to avoid complications arising from giving birth at homes,” said Jimusole

And its not just talk.

It is also seeking to replicate its Mulanje feats in Dowa, Balaka, Karonga, Mchinji and Lilongwe and in Ntcheu. Lumbadzi will also get a shelter and funds are reported to have already been secured.

In the drive to attain an almost zero maternal mortality rate, infrastructure is on one hand, the other hand includes human resource, if all the women can decide to come deliver in the hospitals are there enough trained minders? 

At our case study health centre at Lumbadzi there are 13 qualified nurses to mind not just the maternity wing but the whole hospital such that the 160 or so pregnant women have to see the same people that people with Malaria have to see.

President Banda’s other goal in the initiative is to try and beef up the numbers of these minders. In a slow but significant move, she has already identified 200 young women, 10 from several districts have been identified to start midwifery training.

“The project aims at increasing numbers of skilled and trained midwives. Maternal and neonatal rates are still high not only due to lack of sufficient health personnel but also untrained traditional birth attendants. 

“We also want to build capacity of community midwives to promote health seeking behaviour and attitudes of the communities towards family planning, reduced pregnancy, delivery complications and encourage girl child education,” said Jimusole.

Again, having trained personnel and building is never a guarantee that the village folks will flock to get expert care. In Malawi missionaries came with life saving drugs but the population took years to accept modern medicine, some still have not.

Jimusole said the third goal of the initiative is just that, trying to win over communities and to do that chiefs must be target. 

“In order to achieve the effective access to maternal and neonatal health care, Community mobilization and training to the chiefs and their subjects is of paramount importance. There is lack of knowledge on how to handle maternal and neonatal health care so chiefs as opinion leaders are good targets in accelerating behaviour change.

Felicia mounts the scale to check her pregnancy progress

“The chiefs promote cultural habits that influence health seeking behavior and attitudes of the communities towards family planning, pregnancy and delivery, preserve women dignity by stopping defilement, and other forms of violence that make women insecure and unstable in their lives,” said Jimusole.

One of the chiefs who is well won over to the side of progress in Inkosi Kwataine, he says his area of jurisdiction is on its way towards decreasing mother and infant deaths by employing a simple trick which he is now campaigning for.

“Local documentation of pregnancies will erase many problems. Chiefs will be cable to track the progress of the pregnancy and ask if the mother-to-be has gotten a vaccine, where she plans to go for delivery and to push her to go to the hospital when her time is near,” said Kwataine.

Hebeli Honde was also at Lumbadzi Health Centre when Nation on Sunday visited, she hails from kwa Chiponde and is only 18. She has never given birth before, she will do so in 3 months all factors constant.

Jimusole: Aiming for MDG number 5

“I cannot go trust azamba (traditional birth attendant), it’s my first time and I want all the attention, I will come wait here when I am in my advanced stage,” said Honde.

Joyce Banda knew that with her influence business people would be ashamed to ignore her initiative, already big companies have donated to the Initiative. And so far that is what is funding the Initiative.

Naturally big businesses cannot spend on causes without brands and the Joyce Banda trick is working, mothers have hope...the only question is how long will it take and what happens when Joyce Banda leaves power?

 

Honde sits among her mates possibly sharing stories of what labour feels like, it easy to see fear in her eyes. Her fears can easily be reality if no one springs to action to help address the current situation.

Fighting HIV one family at a time

Twenty seven years of HIV and the nation is still buckling under the weight of the pandemic, by December 31 fifty thousand fresh Malawians will have contracted HIV despite the various interventions that are being implemented…there is one intervention, however, that looks like it’s the panacea the nation has been waiting for.

The Kantuwanjes  -  enjoying their hakuna matata married life

 Jonas Kantuwanje, 44, teaches standard three at Mdeka Primary School, some thirty minutes outside Blantyre city, in his spare time he plays technician and fixes radios and televisions that people bring to him, as he works, his young wife Brenda, 22, potters about and the new-born baby in the house serves as an icing to the harmony.

Kantuwanje’s first marriage collapsed years ago and when he thought of remarrying his prime worry was HIV, back in his youth days the pandemic was not as menacing as it is today. He went on to marry Brenda anyway. 

Meanwhile Brenda was also wary of the same worry as her new man. For a man with two children coming to her, she could easily be an innocent victim of HIV.

“There was this silent tension in the house, each one of us silently worried and wondered if the other had HIV,” said Brenda.

Kantuwanje said that he knew that he could get tested at Mdeka Health Centre but the distance, and the fact that sometimes there were no test kits at the health center made him lazy.

Then came the light.

Dapp field officers counsel teens at Mdeka before testing them for HIV.JPG

From the blue, the group village headman, GVH Kabano called a meeting and announced that there would be HIV testers and counselors going round the village to provide what both Brenda and Jonas secretly wanted.

“They came to our house, counseled us and told us of the benefits of knowing our HIV status. We agreed and we were tested. It was a big relief to finally clear the mist between us. You see, after I knew that I was HIV negative I would never dare go out to another woman, I want to keep my status the same so I can say the testing made me responsible,” said the husband.

The wife also beamed and says that the two now live happily because there are no doubts. Well, no wonder a child soon appeared in the family.

The people that tested the Kantuwanjes were field officers from DAPP. Yes you read that correct, DAPP. It stands Development Aid from People to People and not sellers of second hand clothes. Of course, they do sell second-hand clothes but they do many other things too.

The programme that saw the Kantuwanje’s get tested in their backyard is called Total Control of the Epidemic. It is bankrolled by the National Aids Commission (NAC) and the United states Department of Agriculture. 

The field officers go door to door registering people, mobilizing each individual to an individual decision on HIV prevention and ultimately an HIV test.

Madalitso Chimtengo is one of the fifty field officers that DAPP employed for the door to door HIV testing and counseling exercise. He was assigned to test 4000 people in several villages in traditional Authority Chigalu’s area which occurs in Blantyre North. He gallops from one village top another on his mountain bike.

Chimtengo starts by noting that since the programme started three years ago, there is a visible behavioural change as those that have been tested are now responsibly living.  Already out of the about 3600 he has tested only just above 50 have HIV.

I asked him how he manages to beat the strongly held fears about HIV testing and go on to test people in their homes.

“Well, firstly, chiefs rallied the people and told them that we would be going around and again we do not go with the message of testing, we go and ask the people what they know about HIV, if they know little we tell them what they don’t know and then we tell them the benefits of getting tested.

“There is little rejection; the response was actually overwhelming such that it is the HIV test kits that ran out while people still wanted to get tested. If this was a country-wide programme HIV would be contained quickly,” said Chimtengo.

Already at Mdeka Primary School where some field officers had set up a testing booth, children as young as 8 years had to be chased off the queue of those wanting to get tested, its like testing is the new cool thing.

Asked if testing people in the villages is not going to fuel stigma, Chimtengo contests and reckons that it in fact normalizes knowing ones status and bolsters openness on HIV questions.

Chimtengo - There is Behaviour change.JPG

Chimtengo bemoans the lack of condoms in rural areas, the lack of test kits as some of the things that stand in the way of the programme. 

Florence Longwe coordinates the programme for DAPP and reckons that the approach works because of its personal nature.

“The HIV and AIDs discussions are taken at a personal level and issues are not generalized. Hence individuals open up on what HIV and AIDS issues are directly affecting their lives.  In a mass media there is no personal dialogue where one can freely open up issues which are affecting them.

“TCE programme sees family as an important entry point for preventions, for stopping stigma and discrimination and rallying support for positive living for those on treatment. It is reaches out to people at their own convenient time and at the same time also those who find it difficult to go for such services due to transports or distance restrictions,” said Longwe.

She said the door to door makes it easy to reach men who usually do not go to clinics to get tested. Out of the tested in the TCE pogramme, 46 percent are men. 

 The project also has potential to reach more married couples who are the main culprits in the spread of HIV today, it difficult to find couple together unless they are at home. Again couples who are HIV negative or think they are because they don’t fall sick will never go to a hospital for HIV testing a gap that the TCE programme effectively fills.

And it is not just testing and counseling.

The project was phased out on October 31 but the Chimtengo said its effects will ring and stick around forever. Each field officer has trained volunteers in the villages who will take over the counseling in prevention, nutrition for the infected and the follow ups on all the rest.

For every HIV positive person, the field officers organised two family members who are supposed to check on the infected making sure that they faithfully adhere to their Anti Retro Viral drug dosage. Some members are trained in vegetable production while some were given heaps of shoes and the returns from the shoe sales are meant to economically help the infected. 

Gift Chitukula another field officer who also has tested over 3000 villagers proudly  declared  that he does not have more than 200 on his list that have HIV and this apparent low prevalence of HIV excited T/A Chigalu.

“I think the fact that we have been speaking and prioritizing HIV and testing has made people start to actually listen and change their behavior, already some bad cultural practices that fueled HIV have been eliminated, we have even banned overnight Kitchen top-ups which were new platforms of immorality,” said Chigalu.

Dapp field officers counsel teens at Mdeka before testing them for HIV.JPG

The programme is also being implemented in the low income areas of Blantyre and Thyolo. It was rolled out in 2007. There are about 25 field officers and each is supposed to test, counsel and follow up on 4000 people in three years. 

That is first to register and know them, then to counsel and or test then check of them later to make sure that those without the virus do not get it and that those with the virus do not spread it and are living healthily.

The Kantuwanjes can now enjoy peaceful sleep and as the Chimtengos and Chitukulas pack their utensils and leave T/A Chigalu’s area, the onus is on the community (over a million reached so far) to keep the sanity that the TCE programme brought.

Garani MW 1 (The HIV Herb, As seen in Nation on Sunday) is now available to the public

After writting about the herb in The NAtion on Sunday, i had to switch my phone as folks called asif i was Jeremiah, well...Jeremiah has agreed to come public and if you want the herb, here is where you will find the herb...this according to Jeremiah...

I am far from the marketing officer/ salesman, infact i refused to give out Jeremiahs contacts even when very important people including my bosses wanted, they too say folks have been caling them like crazy....you want the herb? here is how you are going to get it....

Mzuzu- call Eliza at 0999361237/ 0884981702

Blantyre -go to Trade fair stand number 41B or talk to Godfrey on 0888333912

Zomba -call 0884403363

Lilongwe – In Area 2 just behind Bottom Hospital, behind K-99 Shop there is a green shop with a red ribbon appropriately named “Garani MW 1”

Remember you will not buy the drug unless you are visibly HIV positive or you have a referral letter from a VCT centre or Hospital.

The Price has been adjusted to K5000 as a control measure.

Inquiries about the drug shoudl go to garanimw1@yahoo.com but should be copied to (one word:) mutafire [at] facebook.com

Malawi on brink of HIV cure

Owner, government locked horns on patenting

Only WHO can certify it – Shawa

Gambia’s President Yahya Jammeh, Mchape and a thousand other traditional doctors have claimed that they can cure HIV but they ended up drawing public wrath, the story of one woman however is likely to be a big topic on the tables of those who say HIV has no cure because her herb can actually make HIV disappear.

Gloria Jeremiah has not advertised her herb, she has tried to engage government to have the drug certified so that Malawians with HIV can get cured but for some reasons nothing has happened since 2009 when the authorities were approached about this herb. The herb was discovered in 2007 and she verified it in 2008.

"Preliminary analysis was done at Chancellor College's Chemistry department under
Professor Saka with the consent of the Office of the President and Cabinet, Nutrition, HIV and AIDS .The herb was also given to Malawi Pharmacy, Medicines and Poisons Board for analysis. Preliminary results found three major moieties (parts or functional groups of a molecule) in the powder which need to be further identified," said Jeremiah in an interview.

Jeremiah - Pioneering the herb

Jeremiah said things got tricky when some authorities demanded that she reveal the name of the tree from which she gets the powder so that it can be fully analyzed before it can get certified and patented.

Permanent Secretary on HIV and AIDS in the Office of President and Cabinet Dr Mary Shawa admitted taking the medicine to the Poisons Board and said it is necessary for the tree to be made known to government before it can be certified.

"When such discoveries are made they have to go through several stages; we need to name it as a country, the next stage is to subject it to testing and processes before we can send it to World Health Organization which is the only body that can certify it," said Shawa.

Shawa said that the drug is actually one of the priorities on her desk and that she actually called Jeremiah to talk about the issue, she however said the deal hit rock bottom when it came to the legal part where Jeremiah insisted on patenting first before the tree could be revealed.

"Once the name of the tree is revealed, we could lose our intellectual rights and it’s why we insist on patenting first before anything like revealing the tree can happen," said Jeremiah

Jeremiah has since engaged a Malawian and foreign doctor to help her with the patenting process. Away from the legal hustles, the concoction continues to sell in silence. Many people that get "cured" fail to come out for fear of discrimination. News of the herb is spread by word of mouth.

"I have seen a few people who used the herb and their problems and symptoms disappeared, mind you am not saying cured, it disappeared and hid the HIV," Said Shawa.

Shawa said it’s difficult to say for certain that one is cured of HIV because even a prolonged intake of the ARV's can hide the virus; she warned those taking the herb to continue taking their ARVs.

Asked if she knew that the delay in making the herb certified means that many people that could have gotten cured are dying, Shawa said she is aware and said it’s why the drug is on her priority list.

"We want the herb, but the owner is uncomfortable with property rights, that’s where we stalemated,” said Shawa.

The herb which is known as "Garani MW 1" was discovered by a man from  Lilongwe who was shown the herb in a dream in 2007.He was HIV positive and was on ARVs from 2005 up to 2007. He got 'cured' after taking the medicine. The man has been tested several times for HIV and is still HIV negative.

The Herb in its Packed and Powder Form

The man, after being rebuffed by some authorities, contacted Jeremiah who works at a Health Office in Lilongwe and has pioneered the medicine since. The man chooses to remain out of the limelight but if the herb is patented, he is and will remain the owner.

 Jeremiah challenges any authority to bring an HIV subject for testing and says the herb doesn’t clash with other medication and that the
only side effect associated with the herb is an increase in appetite levels.

"I delayed coming open about the herb because I wanted to have ' tangible scientific evidence ' and  I was afraid that it could affect my studies but since I am finishing my masters this year, I feel this is the time," said Jeremiah who is also an alumni of The Malawi Polytechnic, Environmental Health graduate.

The full course of the medicine is three teaspoons of the powder taken over a period of 3 days repeated after two weeks form the same pack.  The herb which is in powder form is supposed to be put in porridge without sugar or salt. The herb is sold at K4000 a pack and this is all it takes to
 make the HIV disappear within or even before 18 months.

Jeremiah Shows her med to the Camera

For independent proof one retired senior government official speaking on condition of anonymity revealed that he took the concoction three years ago and has been HIV free since.

“Its contingent but it works, I am living proof I quit taking my ARV’s over two years ago. I think if you believe in this medicine, it works...but don’t mention my name, ay?” Said the source.

A Turkish Doctor (Not real nationality) is also in the country to help with the patenting and from the trials she conducted; she expressed hope but said there is a long way to calling it an absolute cure. She gave the medicine to 18 HIV positive people and from the preliminary results released last week 10 tested HIV negative the others are still under observation and treatment.

“There scientific evidence that the viral load is reduced drastically especially during the first three months after taking the herb. A number of patients that took the herb last year have viral loads below 50 copies per Millilitre of blood, this is great because such people are leading a normal life and doing their usual businesses,” she said.

She said to determine if the person is completely free of HIV,, there is need to use the DNA screening method. She also was pessimistic about WHO accepting her results because “so far regarding the ‘HIV end game’ the results are inconclusive,” she said.

“I am mindful however that many lives could be saved right now by this herb with the current scientific data we have.” 

It will take months before the herb can be patented, and even years before it can be certified, meanwhile people are out there dying.

Climate change issues vital in HIV fight - Livingstonia Synod

The Livistonia Synod Aids Program (LISAP) says fighting climate change is important in containing the effects of HIV/Aids.

LISAP Director, Mphatso Nguluwe, said this at a planning and review meeting the organisation had at Sambani Lodge in Nkhatabay on Thursday.

“We have planned to venture into dealing with climate change this 2012. Issues of climate change have a direct effect on HIV/Aids, for example lack of rains due to climate change mean there will be food insecurity. HIV/Aids patients need good nutrition to live longer and thus climate change can drastically affect them,” said Nguluwe.

Nguluwe also revealed that her organisation has planned to work to fulfilling the National Aids Framework which includes issues of support, care and prevention.

LISAP is a branch of the Livingstonia Synod that was established to tackle issues of HIV/Aids in the synod's domain.