Nassie Kasiya, a resident of Blantyre, Malawi who travelled to Kenya to seek treatment. [Courtesy]

Imagine you are living your life, healthy and steady. Nothing out of the norm. Then one day you are diagnosed with cervical cancer. Normally, we strive our best to seek appropriate treatment to better ourselves. Unfortunately, it was not a choice for these two women. Chimwemwe Chiduleni and Nassie Kasiya, are from Malawi, a South-eastern Country in Africa.

In Malawi, Radiation therapy is currently unavailable. Radiation therapy is considered to be the first-line treatment for cervical cancer.  According to the World Health Organization Report, Malawi's health system ranks number 185 out of 190.

“People in this country think that, once you have been diagnosed with cervical cancer, you will not be cured, and they continue talking among themselves about how this disease is very dangerous. Once you have cancer here, you mend your affairs waiting to die,” says Chimwemwe Chiduleni, a mother of two children in Ndirande, Blantyre.

“My daily routine has been affected by this disease, often I wake up feeling weak and in pain. Back and hip pains, and my work has to be put on standby,” adds Chimwemwe as she cleans her compound.

For the 49-year-old Nassie Kasiya, a mother of three, In Blantyre-Malawi, the situation is not different.

“When I was diagnosed with cancer, I was so stressed. I depend on small-scale farming as a source of income. I won’t have enough food to last this year because I’m not farming due to this disease. This sickness has brought my activities to a standstill,” Narrates Nassie. 

Malawi, a small country in Southern Africa, has the fourth-highest percentage of people living in extreme poverty in the world. According to the World Bank, more than two-thirds of the population lives in extreme poverty, almost all of whom rely on small-scale farming for their livelihoods. 

Cervical cancer is the fourth most common cancer among women worldwide and, despite being preventable, detectable and treatable, it kills hundreds of thousands of women each year, with an estimated 604, 000 new cases and 342,000 deaths in the year 2020, globally.

In the landlocked country of Malawi over 4,000 Malawian women fall sick with cervical cancer every year. With 2,905 deaths due to cervical cancer in 2020. 

“Besides finding out that there is a treatment, I also now know that this disease is not contagious, it is curable,” says Nassie confidently, as she displays her expertise after researching.

About 70 per cent of Malawian people live on less than USD2 a day. With many Malawians being poor it is but a dream to afford the traveling and treatment cost to other nearby countries. The lucky ones find their way to non-governmental organizations, like Doctors without treatment, to sponsor their treatment journey.

“Currently patients that come to us for initial consultations, out of them 50 per cent or more arrive with a stage that is already too advanced to be treated either with surgery or with a combination of chemotherapy and surgery. So, we have no options to cure those patients, because the Only way to offer them treatment is to send them for radiotherapy, which is not available in Malawi, says Sylvie Goossens, Former MSF Project Coordinator Cervical Cancer Project.

The patients are then forced to be referred to countries that offer a viable mode of treatment. In this case Kenya.

“Since October 2022, we decided to work on a system where we could refer the patients out of Malawi, to get access to radiotherapy, which is basically their only option of treatment,” says Goossens.

“When it was confirmed that I was on the list to go for treatment in Kenya, I told my family. My family embraced the good news, just as I did. When I think about the journey I must take from Malawi to a foreign hospital, I am not worried. However, I know that I will miss my family since I will be away for six weeks,” says Nassie

“When I was told that I would be going to Kenya, I was very happy, but at the same time I got nervous because I am leaving my children behind, some of them are quite young. I was a bit worried, because I support other members of my family. I am the firstborn daughter, so I’m responsible for supporting the rest of the family,” says Chimwemwe.

As humans we strive to survive, the Malawian women have no choice but to leave their loved ones and seek treatment. And so the Journey to Kenya starts for the selected 50 women.

“What matters to me the most is I am going somewhere where there is the possibility for me to be cured from this Disease and that is the one wish I have had since I got sick. A lot of women in the past have died prematurely because they never had this privilege,” says Nassie.

“Because we came to know each other, due to having the same disease, we have been supporting one another to not lose hope. Through the encouragement we’ve given to one another, I overcame my fears and was determined to go to Kenya and receive the treatment,” says Chimwemwe. 

One might ask why is the Malawian Government letting its citizens seek treatment elsewhere. Well, upon speaking to Dr Samson Mndolo, the Secretary for Health in Malawi, he acknowledged the lack of radiotherapy services in Malawi.

“It is true as of now Malawians go outside the country for conditions that need radiotherapy. They go to Kenya, Tanzania, South Africa and some as far as India. The good news is that the National Cancer Center in Lilongwe is about to be completed and within the first quota of 2024, it will be functional. Also a Private Facility is opening in Blantyre. So until the two will be functional, Malawians have no choice but to seek treatment elsewhere. I can’t deny, it is the 22nd century yet our healthcare system is still not resourceful,” says Mndolo, the Secretary for Health Malawi.

“My first night when I had just arrived here was very good. I was happy that my journey from Malawi to Kenya was successful. It’s actually the first country outside Malawi I have visited,” says Chimwemwe upon arriving in Kenya.

According to Epicenter MSF Malawi, the high prevalence of Human Immunodeficiency Virus (HIV) in addition to human papillomavirus (HPV) infection puts Malawian women at higher risk of cervical cancer.

“What has been proven to eradicate or significantly reduce the occurrence of the disease [cervical cancer] is the HPV vaccine. But in Malawi, it’s not available even to young girls. Screening is also a challenge because of the resources and treatment options available.

‘The unavailability, or unequal availability, of treatment options also drives how much you can do and what you can offer to patients,” says Dr George Chilinda, MSF surgical oncologist at Queen Elizabeth Hospital- Blantyre.

And the journey to betterness starts. A six-week thorough treatment program for the Malawian Women.

“I don’t have any worries in my mind. I am just filled with joy because the treatment process has started. Imaging has been done. Blood samples have been collected and we are being examined,” says Nassie.

“We all have one goal and we are there for one another. That is if one woman is sick or vomits, then one of us takes care of her with no problems,” adds Nassie

“I don’t have any doubts or fears because this is what I have been looking forward to. The program was explained to us in Malawi. That we are going to get physiotherapy and also, they are going to use a certain type of light that will burn cancerous cells, among others,” narrates Chimwemwe.

“When we go for radiotherapy treatment, we lie on a bed and there’s a machine that goes round and round on us mainly focusing on the Lower part of our abdomen and hip area. And after five to ten minutes of exposure to this machine, the operator releases us for that specific day to go and rest,” says Chimwemwe

“Is that all? I asked, “yes,” he said. I expected that the electrical equipment would be hot, with a burning sensation,” recalls Nassie

“I’m feeling side effects which are normal to experience. I can already feel a bit of change in my body and I hope that everything continues like this and will be all with me,” adds Chimwemwe.

When they return home it is a relief for these cancer survivors, at least they have received vital treatment in the fight against cancer.

“I had given up on life but now I am hopeful. I can continue building my house and working,” says Chimwemwe Chidulani

These are only 50 women who benefited from this project. For many in Malawi, radiotherapy treatment is but a dream.

In the fight against cancer, a journey fraught with both resilience and despair, the absence of accessible radiotherapy treatment in Malawi casts a shadow of profound hardship.

Imagine facing this uphill battle, only to be met with the harsh reality of inadequate treatment options.

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