The Dilemma of Treating Dialysis Patients in Malawi
Scientists, health professionals and traditional medicine advocates in Malawi are not agreed on the way forward with regards to administration of herbs and other traditional medicines on dialysis-patients.
While some medical experts think the proliferation of herbals is a setback on the fight against the disease, some oppose the thought. Elsewhere, local scientists think it’s time traditional medicines were brought in for scientific trials.
Meanwhile, herbalists argue that growing resistance to traditional medicines is but hangover of imperialism aimed at painting black anything originating from black people, especially Malawi and Africans.
In our special report this week, Western Guta, tells the story of the management of kidney-patients in Malawi public hospitals, a good number of whom are also using traditional medicines.
Twice every week, Mafe Kanyika, has to take a relation, a kidney-patient, to Kamuzu Central Hospital in Lilongwe. This is because it is only at this hospital that kidney-patients can access dialysis treatment.
Kanyika says this is a costly exercise which may have been cheaper where dialysis was accessible in Chitipa, his home district some 600 plus kilometers north of Lilongwe city.
“Our brother is a bricklayer but not working anymore. His colleagues and bosses stopped giving him jobs upon realizing that he is ill. They know he is weak, and cannot be efficiently productive. That makes his situation expensive and worse,” says Kanyika.
It is this predicament that has now forced them to buy and try herbal medicines alongside the dialysis.
The second floor of Kamuzu Central Hospital building has a busy ward on Mondays, Tuesdays, Wednesdays and Thursdays. This is when kidney-patients show up each week to access therapy on the dialysis machine.
On my visit to the hospital, all dialysis machines in the ward are occupied by patient beneficiaries.
The side isle has double the number of patients on queue awaiting their turn on the life-saving equipment.
Dr. Charles Munthali is the doctor-in charge for the ward. He has concerns with increased uptake of traditional medicines and herbals among the majority kidney-patients coming to the facility.
“What have observed something in younger patients that we are seeing. Traditionally or medically what we know is that the common causes of this disease is associated with high blood pressure and diabetes that has not been controlled for longer periods.
“But what we’ve seen and observed in the hospital is that these younger patients don’t even have a history of diabetes or hypertension or high blood pressure. But there is always a history that they have been taking some herbs,” says Dr. Munthali.
Kidney failure is when the kidneys have lost ability to filter waste from the blood. It could be triggered by acute malaria, severe diarrhea diabetes and also uncontrolled hypertension.
The nurses here are trying to cheer-up the patients but clearly the feedback is not what you would expect.
Each of the patients appears deep in their own world of thought. Their bodies appear to be failing them. They look tired and weak. But they also look full of optimism.
But talking to the patients, it is clear they are going through a lot and desiring quick solutions.
We shall call this kidney patient Brazio. He is aged 34 and lives in Area 44 in Lilongwe. Brazio paints a picture of what it feels like when a kidney patient is at their lowest.
“The body says it all, it becomes weak and you feel the urge to go seek medical attention. And if in any case you miss your treatment on the machine, you automatically feel it without anyone telling you,” he says adding “It changes because even from the beginning, you feel and suffer from different illnesses. So you do not feel well at all.”
The head of Kamuzu Central Hospital is Dr. Johnathan Ngoma. He is concerned that most kidney-patients are mixing treatment. They are using herbs, traditional medicines and also scientific medicines and yet others; divine intervention.
Dr. Ngoma suggests scientific trials for the herbs and traditional medicines that are being consumed.
“Whether it is liver or kidney injury, it is dependent on two things. There are other injuries which we call predictable, and there are others we call non-predictable. You know there are already substances where you know that if you take this in large dose, you will damage your body. It is dependent on how your body responds to those substances,” Dr. Ngoma says.
He adds, “So now you’ll notice that there is a proliferation of these herbal medications, most of which might have been tested on other people, other races. Yet you find that most of them which are coming now, might not have been made in Africa.”
The Pharmacy and Medicines Regulatory Authority-PMRA has similar fears. Its Director General Mphatso Kawaye says while the board is not against use of traditional medicine, it has a regulatory task to control uncontrolled advertising and foreign products such as herbs meant for humans.
How is the Pharmacy and Medicines Regulatory Authority working around this problem?
“The main stay in the regulation of traditional medicines is not necessarily in the testing, but in putting in place a proper product registration system that will among other things include putting in place ways of identifying what plant materials these people are using, and also verifying the potential for these plant materials to harm human beings,” Kawaye says.
Chiyambi Mazengera runs an outlet called Umuthi Natural Herbal.
For him, the problem in Malawi is imperialistic. He says people in Malawi trust foreign remedies to illnesses more than local remedies. He insists that Malawi has traditional remedies to all existing health problems.
“We can recommend traditional medicine or herbals because they have no side effects compared to western medicines which others choose to conceal. The problem is that many people western products are the best,” he says.
Proprietor for Chira Ulcer Powder, Kenn Banda, echoes the sentiments. He argues that banning traditional medicines would over-strain hospitals and make people suffer.
Banda says there is evidence that traditional medicine and herbals cure illnesses.
“We’re Malawians and we have grown using these herbals before. So, we are used to get treatment from these and we believe that they help to cure comparing with those hospitals are offering. When they say stop advertising this, stop giving people this, a lot of Malawians will suffer because we’re used to get medication from these and get cured from our diseases,” he says.
Professor Maureen Chirwa is a health expert. She observes that consumption of traditional medicines is more determined by imagination.
Despite being consumed in excess, she argues, the problem cannot be pinned on the medicine. Professor Chirwa agrees that the medicines regulator should step in, although African medicine is traditional medicine
“African medicine is one of those that contributes to the problem because its dosage is not regulated. So, people end up taking it in excess, and that is dangerous to the body,” says Professor Chirwa.
President of the Kidney Foundation in Malawi, Samuel Kumwanje acknowledges that a substantial number of kidney-patients also resort to consuming herbals and traditional medicines.
But for him, society needs to focus on reducing increased consumption of alcohol among young people.
“From the range of 30 to 44 years, there is actually 39 percent of people who are actually drinking, which means there is that risk of people being affected with kidney failure. The challenge is that the content in the traditional medicine and the herbals is not actually clear that you can say it has been measured or scientifically approved, says Kumwanje.
It is without doubt that access to dialysis treatment for kidney-patients in Malawi is a nightmare.
A nightmare because the dialysis machines are too far from patients and at times unpredictable.
Unpredictable because sometimes machine mechanical problems make the inaccessible.
Access to hospital treatment for kidney-patients has generally become painstakingly expensive.
Now unsuspecting Malawians are at the mercy of herbalists, traditional healers and false prognosticators.
The nation has a duty to intervene and ensure that kidney-patients get the best available treatment, away from harmful substances that could make worse their already fragile situations.