Malawi's Warm Heart

5 November 2012

Malawi's “Warm Heart of Africa” slogan is no mere words — it is evidenced in the most unlikely of places — particularly its paediatric and gynaecologic oncology hospital units and rural hospitals.

Malawi has a disease burden characterized by a high prevalence of communicable diseases, maternal and child health problems, in addition to an increase of non-communicable and tropical diseases. With an HIV/AIDS prevalence of around 12%, Malawi has successfully implemented nationwide access to free antiretroviral therapy (ART) and more than 50% of the 270 000 people that need ART now receive it. Concurrently, cancer has been growing at an alarming rate affecting over 14 000 Malawians every year. Kaposi sarcoma, a cancer associated with HIV infection, represents one of the most prevalent cancers in Malawi.

In an effort to address the cancer burden, the Malawian Minister of Health in January 2012 requested an imPACT Review. The imPACT Review is an IAEA service that provides a multi-disciplinary, comprehensive assessment of a country's cancer control capacity and needs, and is implemented under the Joint WHO–IAEA Programme on Cancer Control. From 8-12 October 2012, the imPACT Review mission team visited sites throughout central and southern Malawi to collect information and observe the health care system where it directly diagnoses and treats patients. The mission team was comprised of experts nominated by the World Health Organization (WHO), the International Agency for Research on Cancer (IARC), and the IAEA's Division of Human Health. The imPACT Review was funded by the IAEA Peaceful Uses Initiative (PUI).

Of the four tertiary (central) hospitals in Malawi, Queen Elizabeth Central Hospital (QECH) in Blantyre is the largest. One of the sites visited was the QECH's gynaecology unit where a room full of women anxiously awaited treatment. The gynaecologic oncologist at QECH faces an increasing number of women in the midst of their reproductive years who seek medical advice and treatment for cervical cancer. Sadly, many women often arrive to the hospital in advanced stages of disease when a reduction in patient pain and suffering is the only treatment, and cure is not an option. In Malawi more than four women die of cervical cancer every day.

Cancer treatment in Malawi is further limited due to the lack of radiotherapy in the country, as very few patients can afford to pay out of pocket or get on the government sponsorship list for treatment abroad. Encouragingly, the Malawi Ministry of Health is planning to address this gap with plans to introduce radiotherapy facilities at the Central Hospitals.

The imPACT Review mission report to Malawi will provide recommendations to guide the establishment of radiotherapy facilities integrated into a structured, comprehensive national cancer control programme. The IAEA, through its technical cooperation project MLW/6/003, will assist Malawi with the establishment of the Lilongwe cancer treatment facility.