Feature story |

MSF Clinical Officer Olesi Ellemani Pasulani's reflections on AIDS treatment in Malawi

“How can you go back to rationing access to care?”

The scale-up of antiretroviral therapy (ART) in recent years, backed by solid funding commitments has given millions of people in poor countries a new lease on life. People mired in poverty and living in underdeveloped rural areas have a reason to rediscover joy and live more meaningful and full lives. This is the case for tens of thousands of people living with HIV/AIDS in Malawi’s southern Thyolo district and the healthcare workers who treat them.

Olesi Ellemani Pasulani, an MSF clinical officer at the Thyolo District Hospital, shares his experience and observations from the last five years.

“I can remember what the situation was like before we had ART in 2003. We could only offer people voluntary HIV testing and counselling. We could only promote the use of condoms and distribute them, we could treat other sexually transmitted diseases. We had a lot of patients in homes who were on palliative care due to terminally ill conditions. There were very few people that came forward to be tested for HIV, because there was not much we could do without ART. It was like a death sentence to test HIV positive,” Olesi says.

Health care workers were left disheartened because they could only deliver home-based care, simply being able to offer treatment for chronic illnesses and providing end of life care to patients. Olesi explains, “You could just take care of them, and wait for the day that they would die. It was really hard, because you could see how people were broken down by the knowledge of being HIV positive. That era was really hard for healthcare workers and it de-motivated you completely.”

Thanks to an MSF and Ministry of Health developed model of care, the ART scale-up in the Thyolo district in 2003 turned around thousands of lives and entire communities by providing universal access to treatment across the district. By the end of 2008 the number of people on ART had increased even further and now in 2009 universal access is maintained.

“Now people living with HIV/AIDS have courage, there is light at the end of the tunnel for them. There is hope among people in the villages. You can see the difference that you as healthcare worker make in someone’s life thanks to ART. We would see a patient that was bed-ridden earlier, and they would start ART. When you meet them again six or seven months later in the market or on the street, they are completely changed. They have joy.”

The threat of the early retreat of HIV/AIDS funding and the dire impact it would have on patients’ lives across the most affected areas of sub-Saharan Africa is something that worries Olesi and his colleagues.

“It is important to continue with ART and increase it even more. How can you go back to rationing access to care? It is a right to life. If treatment is threatened it will mean we go back to a situation worse than before ART. It will also damage the relationship of trust that communities have built with healthcare workers over the years,” he says.