Madalitso is an ophthalmic clinical officer and treats eye issues ranging from cataracts and glaucoma to allergies and refractive error. During his weekly trips he sees as many patients as he can during the morning session. He follows this up with home visits to patients who can’t make it to the health centre, such as Winesi, who he met while on an outreach visit and referred for surgery.
Many of his patients live in extremely isolated areas that can only be reached on foot. “I go to the most remote places, even if a car or bike can’t get there and I have to walk,” he explains. “I go to where the patients live, not where a vehicle can get to.”
This on its own is pretty incredible, but Madalitso is also responsible for outreach visits to two other health centres within the Mwanza district, and works four days a week at the district hospital.
In the area where he works, covering more than 45,000 people, Madalitso is the only ophthalmic clinician.
It’s a stressful workload, and has to be balanced with time spent with his wife Bridget, a nurse at Mwanza hospital, and their 18-month-old son Eric. Madalitso (whose name means ‘Blessings’, although his friends call him Mada) also finds time to indulge his other passion: football. He supports the local Blantyre team and is a huge Manchester United fan.
Despite this juggling act, it’s amazing to see Madalitso at work. He gently coaxes babies to look at him and makes them smile. Calm and patient, he takes his time, talking to the patients about how they’re doing. He remembers that one woman had a bad leg last time he saw her and knows she struggles to walk unassisted. He talks people through their upcoming operations, letting them know what to expect, calming their nerves and making sure they understand the course of treatment.
The clinic at the hospital isn’t ideally set up for his work – it was originally intended as a finance office. “It’s very small – it would be much better to have a bigger room. It would also be beneficial to have a surgery room and a ward specifically for eye patients. It would be good to train more surgeons and to have more staff to share my work with.”
While the clinic has its limitations, the outreach work is even more challenging. Even if an area being visited is accessible by car or motorbike, there can be other barriers. “Transportation is an issue,” Mada says. “Sometimes there are problems with fuel. Sometimes there aren’t vehicles to bring patients to the hospital for treatment. For many patients to travel on foot is almost impossible.
“Walking 30km is incredibly difficult, so for me, being mobile and teaching volunteers to do basic care makes it easier. There are public transport options, and motorbike taxis, but a 30km ride one way would cost around 3,500 kwacha (about £5/€5.5). This is much more than most people earn. Most villagers aren’t employed; they just farm to live.”
A further complication is that in some communities, Mada’s work is viewed with suspicion by people who rely on traditional healing methods and don’t trust medical intervention. “I told one cataract patient to come for surgery,” he recalls. “But behind my back, other people from the same village went to tell her not to go, saying that if we do this surgery this lady would go completely blind. So we are still trying to educate people about the cataract surgery.”
The lack of medical supplies is another difficult factor in Mada’s work. During our team’s visit, Mada had to call the staff from a neighbouring district and plead with them to provide eye drops for a man with glaucoma.