Dr Mercy Mkandawire has travelled the world in search of knowledge, but she got her most memorable lesson as an intern in her birthplace, Kamuzu Central Hospital (KCH) in Lilongwe.
The kidney doctor says nothing shocks her anymore, but fondly recalls a patient who shocked her in an inspiring way—a patient admitted to a khonde of a crowded male ward.
Said Mkandawire: “He had HIV and advanced cancer. He was lying there as if he was dying. In my mind, I had written him off. But a consultant I was working with said, lets give him the prescribed treatment. To my amazement, the patient responded so remarkably to medication. Within a week, he was well enough to go home. This taught me never to give up on patients, but to be a doctor who gives them a chance and fight for their life.”
Laying foundation
Mkandawire, who helped set up Namibia’s kidney transplant programme, is one of Malawi’s four nephrologists.
She has a particular interest in kidney transplantation.
In December 2024, the Ministry of Health hired her to lay the foundation for Malawians to get quality kidney treatment, including kidney transplants, locally.
This may appear daunting in a country where KCH and Queen Elizabeth Central Hospital are the only public healthcare facilities that offer dialysis, artificial kidneys that remove impurities from blood when an inborn pair collapses.
However, she has accumulated the know-how and experience since 2006 when she graduated from the University of Malawi’s College of Medicine, now Kamuzu College of Health Sciences.
Mkandawire studied for a specialist degree in internal medicine at Witwatersrand University in South Africa. In 2016, she completed a fellowship in nephrology at Belfast University in the UK.
Her day-to-day work at KCH entails providing dialysis for inpatients and outpatients with curable acute kidney injury and chronic kidney disease.
“We also run a small transplant clinic that provides treatment, care and support for people who have undergone kidney transplants and kidney donors. We provide post-transplant care for them, addressing issues that they may have encountered.”
This gives a glimpse of her strides to domesticate kidney transplant services.
Looking forward, she says: “We hope that the small transplant clinic we have started will grow and a culture of kidney donation will become widely accepted and sought after.
“Our general renal replacement therapy only involves haemodialysis at the moment. When a renal transplant clinic is eventually well-established, end-stage kidney disease patients will access reliable treatment right at our doorstep.”
Community health campaigner Maziko Matemba says it is sad that only two public hospitals in the country provide dialysis at a time kidney disorders are rising in both rural and urban communities.
“All essential services like dialysis machines need to be functioning and accessible for Malawi to achieve universal health coverage [ ensuring everyone gets quality life-saving without suffering financial hardship],” he says.
Permanent solution
The Ministry of Health handed the specialist a three-year contract to pave the way for the rollout of kidney transplants in the country, according to Principal Secretary Dr Samson Mndolo.
He states: “Dialysis is just a stop-gap measure, so we need a permanent solution. The permanent solution for chronic kidney disease is a transplant, but this will take years. We want the renal transplant specialist to be guiding us.
“For now, we need to have reasonable dialysis services to keep our clients alive while we are thinking about the long-term solution…which will take years.”
Currently, people in Malawi get kidney transplants abroad, a setback to the poor. The cost varies from $40 000 in India to $200 000 in the US, draining scarce forex.
Those who cannot afford international medical trips queue for years to get State-sponsored air tickets. Hundreds die without accessing dialysis in the two overwhelmed public hospitals, which maintain long waitlists for their aged machines.
Mkandawire leads 13 nurses and one medical officer in KCH’s 12-bed dialysis unit.
She is concerned that patients keep dying of treatable kidney disorders while waiting for the ‘artificial kidneys’.
“We just need to enhance our dialysis services. Access needs to improve. We need more dialysis machines and more dialysis sites so that patients get the service when they require it,” she says.
Mkandawire and her team also run a general kidney care clinic where over 500 walk-in clients receive dietary and nutrition counselling.
She hosts continuous medical education talks every two weeks, ensuring staff and medical students keep up with emerging knowledge and current dos and don’ts.
Despite low healthcare spending amid a high disease burden, the nephrologist remains steadfast in her line of duty—especially the challenge to roll out kidney transplantation.
She says: “Apart from my passion, my choice to specialise in this field was partly motivated by the fact that we had no nephrologist in Malawi, so the service gap was huge. I saw an opportunity to make a difference in my country.
Sweet home
For Mkandawire, ‘charity begins at home’ is part of her creed.
“Having gathered knowledge and skills in parts of the world where some people looked down on me, maybe because of my colour or because I’m skinny, returning home to serve my people was always part of the plan for me,” she says.
She exemplifies a growing cadre of kidney experts earmarked to conduct transplant kidneys in collaboration with urologists, general surgeons, anaesthetists and specialist nurses.
Said Mkandawire: “This is something I’m personally aspiring to, though it won’t happen in the immediate future. We have basic human resources in the country and more is being developed. Getting them to collaborate with other centres well established in kidney transplants—like the International Society of Nephrology and other partners—would be a good start.”
