UK’s Guardian online media raises red flags on Malawian expectant mothers at risk due to lack of anaesthetics for Caesarean operations

*Patients reported to be travelling long distances fail to access Caesarean operating theatres in half of hospitals are shut down

Maravi Express

UK’s Guardian online media has reported on Monday, November 22, that almost half of Malawi’s district hospitals have closed their operating theatres due to a dire shortage of anaesthetics.

The online report by its Malawian correspondent, Charles Pensulo in Lilongwe, quotes doctors as saying “maternity care has been affected by a lack of drugs”.

It goes further to say surgery, including Caesareans, has been cancelled and patients needing emergency care have been moved hundreds of miles around the country.

The report further quotes Anaesthesia Association of Malawi as describing the situation as “an emergency”, saying 11 of the country’s 28 districts had run out of drugs.

The Guardian says the Anaesthesia Association demanded answers from the Ministry of Health and a meeting with the Central Medical Stores Trust (CMST), which buys and supplies drugs to all public hospitals.

Joel Moyo, president of the association, is quoted as saying the safety of expectant women faced with complications during their labour was a big concern.

“One of the drugs that is not available is thiopentone, which we use in surgery, especially for women who are convulsing during delivery and also those who have high blood pressure.

“This [drug] has not been in the country for a year. We asked [the CMST officials] why it has not been available and it was attributed to logistical issues,” Moyo is quoted as saying.

He adds to say that they had been improvising by using second-line drugs, although that was not recommended.

“We thought, ‘maybe next month things will change’, but this has been going on for a year now. But when members said that they don’t have suxamethonium, that’s when we raised a red flag. That drug is supposed to be in a [operating] theatre all the time.

“Without it, then the theatres have to be closed. You can lack some drugs, but when we don’t have this, then there is no theatre.”

Moyo is further quoted as saying he had received worrying reports that some pregnant women who required emergency surgery were at risk as district hospitals had to refer them to central hospitals where the necessary drugs might be available.

The Guardian report further says Malawi’s health system faces immense challenges, from lack of equipment to a severe shortage of qualified staff.

“Poor working conditions, including low salaries, have led to health workers seeking better-paid jobs outside the country or with non-governmental organisations.

“People, including pregnant women, have to travel long distances to reach their nearest clinic or hospital.”

It goes further to quote 72-year-old Patrick Chithumba from Mulanje, that he has been waiting several years for treatment for a painful bladder condition.

And that when Chithumba was finally given a date for surgery earlier this month, his siblings and six children pooled their savings to pay for his transport to the hospital — some 225km away but when he arrived, he found the surgery had been cancelled due to the lack of anaesthetics.

“I am much traumatised with this,” Chithumba is quoted as saying. “Apart from the money that we’ve spent, I am in pain and my children have to take me to the local community clinic to be checked, but the help is not enough.”

The report says new private clinics have sprung up across Malawi, profiting from the shortages by catering to those who can afford their prices.

Quoting Dr. Victor Mithi, president of Malawi’s Society of Medical Doctors, he is reported to have said the lack of anaesthetics was the “tip of the iceberg”.

“It is very concerning because you can’t do an operation without these drugs and the fact that we don’t have them speaks a lot as to how our healthcare system is organised and governed. Some of the procedures are a matter of life and death,” Mithi told the online.

“For instance, if you have a pregnant woman who you need to operate on and you don’t have these drugs, you can either lose the woman or lose the baby, and the decisions are made in haste.

“This is why we’re worried and we hope the government will be able to chip in and help us as fast as possible.

“These are not the only drugs not available in hospitals,” Mithi is quoted as saying, adding that medical centres had been running out of supplies in many areas.

“People don’t really speak about this,” Mithi reveals. “Sometimes patients accuse us of not properly attending to them. But this is because we’re not supplied with the proper working materials.”

The online quotes CMST spokesperson, Herbert Chandilanga as saying suppliers were struggling to secure stock from India and China amid “a logistics scramble worldwide”.

Minister of Health, Khumbize Kandodo Chiponda, is quoted as saying government planned to improve funding of the Central Medical Stores, which she said owed medical suppliers more than K19 billion (£17.2m).

She told the online that CMST had out-of-date drugs worth more than K2 billion that “may have been procured by the previous administration”.