Airports were finally opening and COVID testing was now available to Canadians. Should our family return to Malawi? In the months I spent fighting COVID alongside other nurses in Canada, it seemed Malawi had been relatively spared. So we boarded a plane back to Malawi, arriving January 6, 2021, after 10 months in Canada. I was offered the first dose of the vaccine the day we left but couldn’t squeeze it in before our trip to the airport. I didn’t think it would matter because throughout December there had been few to no COVID cases reported in Malawi. My second chance for the vaccine would be when it arrived in Malawi the second week of March, and by then everything had changed.
Ten Months Earlier: Leaving Malawi
After almost two years of living and working with Serving in Mission (SIM) in the capital city of Lilongwe, Malawi, we had only four days to pack and move. It was March 2020: the COVID-19 pandemic was brewing and the Malawian airport was rumoured to be closing soon. Before leaving, we did everything we could to prepare the missions hospital we work at to be ready to face an impending disaster. I met with the ministry of health to liaise between them and our missionary medical facility. How would our HIV population fare against a health crisis like COVID?
Malawi has one of the highest HIV prevalence rates in the world. Over 1.1 million of its 18 million population live with this endemic disease. The first ICU in Malawi was only formed in 1990 and the total ICU beds pre-pandemic was 25. Only seven of those had ventilators. We all wondered what would happen as the virus hit Malawi.
Malawi’s borders and airports shut down two days after our flight out. God miraculously provided a home for us in Vancouver. I ended up working in two different emergency rooms. It was like whiplash. I went from an environment with few resources to one where people threw them out. From a place that was scrambling to find Personal Protective Equipment (PPE) to get ready for impending disaster, to a place that had new gowns for each and every patient interaction. I often struggled watching supplies go to waste. Should I dig extra unused equipment out of the trash to take back to Malawi? Even worse, I saw a population of people who didn’t realize the wealth they had and were anxious that it wasn’t enough. It hardly seemed proportionate.
Malawi and COVID in 2020
Malawi was one of the last countries in the world to report a COVID case, perhaps because of the lack of access to testing. According to the Malawian Medical Journal, in April 2020 only 20 people a day could be tested.The “first wave” was moderately small. The closed borders slowed the perpetual movement of people across Malawi’s porous borders between surrounding nations like Tanzania, Mozambique and Zambia. By early June, only 14 testing sites were set up in Malawi and only one-third of the 255 health facilities in the country had any oxygen supplies at all. We watched with bated breath from Canada.
Amazingly, though the Malawian government announced a 21 day lockdown to start on April 18th, the citizens of Malawi fought the ruling and on the 17th of April, the high-court barred the lockdown. Using democratic means, they went to the courts to overturn the governments demands for a seemingly impossible set of rules. With a GDP per person of only $389 a year, making Malawi the second poorest country in the world, we were relieved that our Malawians brothers and sisters would not be prevented from doing small business and getting crucial access to food and resources. Strategies used in other parts of the world for virus containment would almost certainly cripple the Malawian economy and population.
As the months continued things seemed to go back to normal, as our colleagues remaining in Malawi would tell us. Churches reopened, and for a nation that looks to education for the future of its largely young population, there was a collective sigh of relief when schools did as well. In the short period of time between March and October, without schools, teenage pregnancy and child marriage rates skyrocketed. According to Oxfam, a 35% increase in pregnancies of girls between the ages of ten and 19 were reported between March and October as girls were prevented from going to school.
Quarantine as anxieties rise
Arriving back in Malawi on January 6, 2021, we started our 14-day quarantine anticipating the joy of re-uniting with colleagues and friends and going to church. Six days later we started hearing the reports: the number of COVID cases was doubling every four to five days. COVID arrived with repatriating Malawians from South Africa. On January 12th, two prominent Cabinet ministers died on the same day causing a new state of panic in the country. Within days the numbers climbed to over 1,000 new cases a day. Thirty percent of the total cases since the start of the pandemic arrived in January. We heard updates from colleagues at the hospital as staff started getting sick, as a COVID treatment tent was erected outside, and as oxygen supplies and PPE began to rapidly decline.
We completed our quarantine when anxieties were at a record high. It seemed I was meant to fight the pandemic on both sides of the globe. The government declared a state of emergency and closed schools again on February 8. I started to work alongside my colleagues in our COVID tent. We have an outdoor nursing station, a donning and doffing tent, and a patient treatment tent. The rainy season can make this outdoor nursing a messy work. It’s not remotely pleasant at nighttime with mosquitoes, leaking ceilings and power outages. During the day, we limit how much time we spend in the tent – donning and doffing carefully, only going in to see the patients a few times a day. We have to get creative about grouping our tasks together to limit patient interactions, without compromising nursing care. I am thankful that patients are usually required to have “guardians” with them. This means a family member or friend acts as a personal care attendant to the patient and stays with them at all times. The risk to that one family member is high, but it helps limit the movement of multiple people in and out of the tents all day.
When I started working, the fear was palpable. Was our protection adequate? My husband and I wondered what would happen if I got sick or if our kids got sick. Medical evacuation has changed indefinitely. We started seeing firsthand the reality that whole Malawian families were being devastated by this illness. Patients would come to us having lost spouses and siblings and cousins all within days of each other. Patients were dead upon arrival or dying quickly after presenting with symptoms. Their oxygen requirements were impossibly difficult to meet with the main and only oxygen supplier in the country running out of supplies. In a culture that rallies around each other in death, Malawians are being prevented from attending funerals and practicing traditions because of the reality of such quick losses. I could sense the secondary trauma among my colleagues.
Having recently fought tampered election results through democratic and legal means, having survived Hurricane Idai floods, famines and the horrendous reality of the HIV pandemic, Malawians have proven yet again their resilience.
In another positive by-product of the pandemic, corruption is being flushed out in new ways. Large amounts of donated money were mis-managed, allowing the government to have clear reason and opportunity to eliminate corruption. It fired a large part of its COVID task force when it was evident they could not account for their why their funds had not led to increases in oxygen supplies and PPE to the desperate health facilities. This is a win for Malawi as they can see in real time how prevalent the mismanagement of healthcare funds is.
Further, the government opened a stadium treatment centre and new companies have arisen to meet the demand for oxygen production. This can only be good news for this country where so often lack of oxygen causes HIV patients with conditions like PCP pneumonia to die. Though there are few statistics available yet, the spike in COVID proved what the WHO recognized was true in Malawi: this country has made remarkable improvements in the diagnosis and treatment of HIV patients over recent years. There has not been a disproportionate number of HIV patients suffering with COVID. Malawian HIV sufferers are getting the HIV care they need in order to have strong enough immunity to protect against the reality of COVID.
As with the rest of the world, the economic and social impacts of this disease remain to be seen. With schools still struggling to open as teachers strike because of their lack of protection in overcrowded classrooms, and teenage pregnancy still on the rise, how will Malawi rebound? With young business owners struggling to cross borders and import products from South Africa and Tanzania, and college classes unable to run virtual classes because of expensive and poor-quality internet, how big are the setbacks?
With the amount of transitions our family has undergone, through every rise and fall of COVID numbers, we have seen God’s faithfulness. So it is with Malawi. This resilient people is seeing decreasing COVID numbers for the first time in two months. God is in this country and as her people call upon him in new ways, we all wait to see the hand of God.
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