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Dear Mr President: An Open Letter On The State Of Cancer Services In Malawi

Dear Mr President,

Malawi President Lazarus Chakwera

I know you are doing well and settling in well in your new role as the president of the republic of Malawi. Well-deserved congratulations. I am writing to you not in my official capacity but as a concerned citizen of Malawi and a frontline worker in cancer in Malawi.

I have decided to use the power of social media to get through to your Excellency as I am assured it’s a guaranteed means to reach you hustle free. I am a board-certified anatomical pathologist and epidemiologist working with the University of North Carolina (UNC)-Project Malawi.

I work at UNC/KCH pathology laboratory which is collaboration between the Ministry of Health and UNC. My work involves examining body tissues and fluids for evidence of disease including diagnosis of cancer. I work closely with nurses, doctors including surgeons and oncologists in caring for cancer patients.

What has compelled me to write your Excellency is your kind gesture in supporting Patience Namadingo towards his fundraising campaign to raise MK3 Million to support cancer treatment of William Kachigamba in Zambia. May God bless you abundantly and I wish William all the best.

However, your Excellency, William is not the only person in dire need of cancer care. The reality is that Our fathers, mothers, children and friends are dying of cancer every day due to lack of access to timely diagnosis and appropriate treatment.

Today for the first time, I speak directly to the head of state on behalf of the many disadvantaged Malawians who do not have the privilege of the platform that I have, who do not have anyone to advocate for improvement in cancer care, who do not have anyone to raise funds for their cancer treatment outside Malawi, the disadvantaged Malawian who is on a long Government waiting list to go to India for treatment, the disadvantaged Malawian who does not have anyone kuwaikila line to expedite their referral to India.  These are the people I am bringing to your attention sir.

Your Excellency, I believe you are aware that we have a new national cancer treatment center at KCH premises which opened its doors in Feb/March 2020. I am grateful to the Malawi government for these efforts.

 However, Mr. President, this cancer centre falls short of being a comprehensive cancer center at so many levels. The centre is heavily understaffed, being served by 2 oncologists and a handful of nurses and support staff.

The centre provides limited chemotherapy only as a mode of cancer treatment. There are no radiotherapy services, yet majority of our cancers are advanced and a good number of our patients would greatly benefit from radiotherapy. The centre does not have its own radiology, laboratory and pharmacy departments and relies on the already crippled services at the main KCH.

There is no functional CT scan at KCH, there is no MRI at KCH. How can a cancer centre operate without these very vital services Mr President? Availability of chemotherapy drugs is also erratic with frequent drug stock outs such that treatment protocols are frequently modified to suit what is available.

Regarding cancer diagnosis, this is another hurdle which many Malawians have to navigate your Excellency. There are patient and health system factors that contribute to delay in diagnosis, but my interest in my conversation with you today is on the health system factors which these poor Malawians do not have control over.

Currently Malawi has only 2 public pathology laboratories which again are heavily short staffed ie KCH in LL and QECH in Blantyre. However, it is only the KCH lab that is fully functional and is able to do some limited advanced/special tests above the routine tests.

The KCH laboratory serves both the central and northern regions of Malawi and is staffed by only 2 pathologists and 5 technicians. The QECH pathology lab is currently down on its knees with no resident pathologist and suffers from erratic supply of reagents.

Essentially patients attending public hospitals have no access to cancer diagnosis in the southern region and this is putting pressure on the KCH lab as some specimen come from the South resulting in longer turn around times hence delaying cancer diagnosis.

I am very thankful to partners that have played a big role in collaborating with MOH in building cancer care capacity in Malawi and I am hoping for continued meaningful collaborations.

Cancer care in Malawi is dire state, the challenges are many your Excellency. It is my hope that the few challenges highlighted in here will stimulate your enthusiasm and treat cancer care as an urgent matter in your priority areas.

Best regards

Dr Tamiwe Tomoka (MBBS, MSc Epi, FCPath)

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