By Chrissie Mainjeni, Chiradzulu
Before doctors confirmed she had advanced cervical cancer, commonly characterised by persistent bleeding, Enes Chiwawa first noticed sores on her genitals.
Diagnosed in 2023, the 49-year-old mother of three from Ngumwiche Village, Senior Chief Mpama in Chiradzulu District, had been moving between hospitals for treatment before her care was shifted to a home-based programme.
Chiwawa, who has been bedridden since May 2025, still affords a smile, saying she no longer feels overwhelmed because of the love and support she receives from her family. “Regular visits by a community nurse give me hope and help take life one day at a time,” she said.
At her home, Chiwawa is cared for by three guardians, her two younger sisters and her eldest daughter, aged 14, who dropped out of school to look after her. They take turns nursing her, while her husband and elder brother, Clever, provide for the family.
Clever says his sister’s battle with the life-threatening illness has involved countless hospital visits and sleepless nights caused by pain, placing a heavy financial and emotional burden on the family.
“Looking at her condition, which keeps on deteriorating, we agreed to stick together and stand by her,” he said. “We are also grateful to our brother-in-law for his empathy despite our sister’s condition. It is rare to see such resilience, many would have long left.”
He added that their late mother also suffered from the same disease, but noted that the family is now better informed, as health workers have been engaging and guiding them throughout the treatment process.
Ida Lesteni, Chiwawa’s sister and caregiver, commended the cordial working relationship with health workers, which she says simplifies home-based care. For instance, they are able to determine the gravity of pain felt by the patient by using fingers. She added that through phone consultation with the hospital, they manage to administer necessary painkillers such as morphine.
With much of the finances spent on covering hospital bills, Lesteni said they remain open to financial or food assistance from well-wishers.
According to Ellen Phiri, a Palliative Coordinator at Chiradzulu District Hospital, over 300 chronically-ill patients in communities in the district fail to access medical care due to challenges related to transport and medication.
However, she said the four-month Community Backpack Project, currently being piloted in Chiradzulu, Zomba and Blantyre districts, aims to support patients like Chiwawa — who are receiving palliative care — with essential drugs and food.
Phiri, who is also a community nurse, stressed the need for concerted efforts in providing palliative care through love and support, including procuring drugs such as Bisacodyl 10mg nocte.
Implementors of the Community Backpack Project, Palliative Care Support Trust, say they are targeting 100 patients — 50 adults and 50 children — living in hard-to-reach areas with drugs and wheelchairs in some isolated cases.
Executive Director, Precious Kamange, said with support from Action Medeor German Medical Aid Organisation, they will be providing drugs that are not stocked in the country and source others locally, to manage the life-threatening conditions and to bring hope and comfort to the patients.
Palliative Care expert, Overtone Ng’ambi, emphasised the need for more public awareness and intensive training of health workers who would be able to determine cases and recommend treatment.
He added that district hospitals should also use their community structures to reach out to patients who have mobility challenges.
Ng’ambi, who is also one of the Clinical Officers at Kamuzu Central Hospital’s Palliative Care children’s ward, has encouraged people to offer psychological, social, spiritual and physical support, saying patients are needy and are subject to stigma.
“Let me also appeal to non-state actors to join the government in boosting budgets towards palliative care, to avoid unnecessary stock-outs of essential drugs like Hydroxyurea for treating sickle cell and morphine for cancer patients,” he said.
One of the focus areas of the World Health Organisation in 2025 was to integrate palliative care into national health systems to achieve universal access, emphasising essential medicines, community-based care and multi-disciplinary training to address physical, psychosocial and spiritual suffering.
