LOOK: The absence of radiotherapy in Malawi leads to a large number of patients being sent to palliative care

Doctor’s Without Borders (MSF) palliative care clinical officer Yamko Jere (left) examining patient Kelitha Chidothi (centre) with the help of palliative nurse Christopher Chalunda (right). Picture: Zodidi Dano

Doctor’s Without Borders (MSF) palliative care clinical officer Yamko Jere (left) examining patient Kelitha Chidothi (centre) with the help of palliative nurse Christopher Chalunda (right). Picture: Zodidi Dano

Published Jun 11, 2021


Seated on a reed mat with her swollen legs alleviated on a pillow peeling a full bowl of pod peas, 56-year-old Kelita Chidothi details the aches and pains she feels as she clings to life while fighting a battle against cervical cancer.

Chidothi, who is from the Chileke District, has cancer that is at an advanced stage, stage 4.

The mother of two, who is being cared for by her 64-year-old sister and niece, weighs just a little bit more than 20kilograms. This has decreased from when she weighed 40kgs in March this year.

Video: Zodidi Dano

Chidothi’s tumour has grown so much that it presses on her pelvic. Her legs are swollen because she cannot walk and fluids are clotting on her legs instead. Her right eyelid has an inflammation, but she says it is not painful.

As doctors examine her feather-body seated in an upright position, Chidothi has moments where she closes her eyes and slants to the side as if she were to sleep.

Her tiny one-room home has been divided into two. It has no windows, a door that can’t close and the severely ill woman sleeps on that same reed mat on the floor on which she is seated.

Picture: Zodidi Dano

Doctors say they have been struggling with Chidothi’s weight even giving her plumpy nuts, therapeutic foods that help people with malnutrition.

Explaining her medical history, Doctors Without Borders (MSF) Palliative Care Clinical Officer Yanko Jere said Chidothi was diagnosed in December 2020 after numerous visits to local health facilities with complaints of bleeding, vaginal discharge and pain.

“Chidothi’s case is similar to that of many women who are not properly diagnosed at local health facilities. Women sometimes go to herbal centres or health facilities and are given a misdiagnosis, such as being treated for a Sexually Transmitted Infection instead,” he said.

Jere said lack of awareness of cervical cancer in Malawi is a big problem.

“Awareness is not as robust everywhere among health professionals. Most workers in small health centres are not trained on the screening of cervical cancer,” he said.

Cancer is the first leading cause of death in Malawi, at around 35 %. Cervical cancer accounts for 10% of those deaths.

Each year, about 4 163 women are screened for cancer and of those screened 2 879 dies of cervical cancer.MSF Palliative Care doctor Camille Desforges said 40% of the cervical cancer patients screened annually were referred to palliative care almost immediately after diagnosis.

Video: Zodidi Dano

“The gap caused by the lack of radiotherapy is challenging, We have high surgery numbers,” he said.

Malawi does not have radiotherapy equipment nor the manpower to manage the treatment. MSF had planned to transport and pay for a selected number of cervical cancer patients to travel to Zambia, Lusaka, to get treatment for six weeks.

Desforges said if radiotherapy was available in Malawi then some lives could have been saved. He was not able to give an estimate of how many of those patients could be treated.

Picture: Zodidi Dano

At the moment, palliative care has 210 active cases but annually they get 400 to 500 palliative care patients. Currently, 35 patients are on home-based care where they are unable to come to the hospital and are visited by doctors in their homes. Chidothi is one of them.

“Palliative care is end of life care and symptom management, the main goal is to improve the quality of life of a patient living with a life-threatening disease,” he defined.

Apart from giving medical advice and treatment, one of the palliative care responsibilities is to offer support to families.

Malawi is a poverty-stricken country where people survive from eating Nsima (maize meal, peas and vegetables grown on the farms. Protein is hard to come by. MSF assists with providing food packages, transport fare and mental support.

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