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Jun 22nd 2016

A Visit to the Tisungane Clinic

A Visit to the Tisungane Clinic

Today I spent the morning at Dignitas’ flagship Tisungane Clinic. It is from here that many of Dignitas' accomplishments can be seen. The HIV pandemic in Africa did not enjoy the access to a class of antiretroviral drugs that the developed world has had since 1996. We have converted HIV from a certain death sentence to a chronic disease. Many of us remember NBA star Magic Johnson being diagnosed as HIV positive in 1991 and through the lens of what we had seen in the 1980s felt his fate was sealed. He in the end likely had access to early trials that eventually changed the way the disease was managed a few years later. It became a chronic disease. Unfortunately that success never spread to Malawi and the rest of Africa. Barriers related to cost and integrated primary healthcare meant that it was still 1989 here, although at an incomprehensible scale, involving millions of people.  In 2004 when Dignitas International first started working here, the HIV infection rate stood at 18%, with almost all condemned to progress to full blown AIDS. Today it still stands at 10% but thanks in part to the efforts of Dignitas and with almost 250,000 patients directly now on ART due to DIs efforts, it is a more controlled chronic disease. Like diabetes. Like hypertension. The Malawi Health Ministry has done a terrific job in providing leadership to work in partnership with local expert NGOs and with tremendous support of the  Global Fund to tackle this disease. Of 15 million people living with HIV worldwide a rapidly growing number of people are on treatment.   It is an emerging global heath success story.   I wish there were more. 




Moving forward, in 2014 UNAIDS announced its 90-90-90 goal:  I wrote about it  during the 2014 Give a Day Campaign.  It briefly states that by 2020:

1:90% of all people living with HIV must know their status – this means more HIV tests, particularly in sub-Saharan Africa, where only about half of all people        living with HIV are aware of their positive status. 

2: 90% of HIV-positive people will start and sustain anti-retroviral treatment.

3: Of those on anti-retroviral treatment, 90% will have viral load suppression which will allow them to live productively and reduce transmission




Walking through the Tisungane Clinic one cannot help but be inspired.   Onyx, one of the legion of Clinical officers in this country gave me a comprehensive tour of the facility. There are five levels of caregiver at the facility. The clinic care structure is headed by physician Victor Singano who manages patients directly and oversees 8 clinical officers. They work hard and provide excellent, compassionate care.


 Clinical officer at Tisungane

The nurses (as with everything else in heathcare) form the backbone. The ministry of health provides much support with nursing care. Most well patients just come and get their medications from the nurses at the dispensary.  


We then have HTCs (HIV testers and councillors), trained out of secondary school and able to some simple nursing tasks. Finally there is the patient expert, an HIV positive patient on treatment that serves as a patient advocate. The overall DI reach extends well beyond Tisungane to 170 settings often in very rural locations in the Zomba district.


Tests at the rest of the hospital can run at a snailspace.  At Tisungane HIV testing can be performed and reported in 15 minutes:




Down the hall I met Agnes who helps coordinate the care of TB patients infected with HIV. All very efficient and at a high care level.



Alice oversees the healthcare worker clinic at Tisungane.   Dignitas created a smaller more discrete space for where its own HIV infected healthcare workers can get looked after 


Further, there is a space for the care of antenatal and postnatal HIV infected women.  A major success has been to implement screening every pregnant woman for HIV. Untreated, the transfer rate to the child can range up to 40%. Again, through strong partnerships, the Option B+ program has cut transmission rates to those close to the developed world. Malawi was the first resource limited country that committed to providing life long treatment for all HV+ve pregnant and breastfeeding women. It is massive achievement. Find out more about the Dignitas effort in support of maternal to child transmission (PMTCT) program by clicking here:


At the end of the day what I was again stuck by was the quiet grace and dignity with which most people here live their lives. They dont have much but they are content and greet you warmly.  They teasingly smile when I say "Mulibwanji" (hello) or "Zikomo" (thank you).  I am trying to learn more.   Musician Leslie Feist, a tremendous supporter of DI sums it up nicely in her interview with Matt Galloway last fall. You can find it here:


The emerging success of HIV treatment integration provides a model for how surgical and other neglected diseases should be tackled, HIV is only one disease. Scaled by thousands of clinical entities it seems entirely hopeless but that sort of effort where the larger world comes together to support and fund local healthcare systems in partnership with local NGOs who have expertise on the ground seems like a model to follow. We won’t get there if we don’t think about these things and at least try

We carry on






Posted: June 23, 2016

By: Tom Moore

Impressive effort in the face of it all. Sense a lot of integrity and smiles at the clinic. I notice from the pictures how organized and clean things seem, which I always find a measuring stick no matter
how basic the pursuit. Very positive and up beat.

And the blog is so well done Rajiv, not only the text, but layout and links. At the end of such a day, don't know where you find the
energy !

Posted: June 23, 2016

By: Dr. Errol Superville

I have tremendous admiration for what you are doing Dr. Rajiv.
In the early stages of my medical career, in 1966 while I was interning at St. Michael's Hospital, Dr. Leo Mahoney (our expert breast surgeon) had just returned from a stint in one of the developing countries. I was very impressed by what he had done and thought that some day I would undertake such a task. I became very involved in my Family Practice including Obstetrics and raising our family of 2 girls and 2 boys that I never got around to fulfilling that goal of helping out overseas. Now that I am retired from medicine, I am afraid I have 'missed the boat'. I am delighted that people like you exist; do keep up the good work. My prayers are with you.

Posted: June 24, 2016

By: Carlene Ledwidge

I am amazed the amount of services covered over there, and so many
dedicated people.Your work is appreciated i am sure.
Good job guys.98C

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