Dramatist-turned-marketer Emmanuel Maliro has hiked Malawi’s breathtaking mountains and Africa’s highest.
Not any longer.
Just months after reaching the peak of Mount Kilimanjaro in Tanzania, he embarked on an uphill battle for survival faced by many Malawians with kidney complications.
In 2023, doctors discovered that he was born with one lung and it was failing.
“I thought it was just malaria, but spent three days without urinating,” Maliro recalls. “I knew something was very wrong.”
Check-ups and blood tests showed that creatinine—toxic chemical waste filtered by kidneys—was 10 times higher than the safe limit. In a country with fewer than 10 specialist doctors for kidney diseases and a handful of dialysis machines, his odds looked bleak.
Over 850 million people worldwide live with chronic kidney disease—the eighth leading killer that claims over 3.1 million lives annually, according to the International Society of Nephrology.
The burden is high in sub-Saharan African countries such as Malawi where the majority of patients are diagnosed late and treatment is costly and less effective.
In Malawi, kidney failure is one of the neglected non-communicable diseases and treatment remains exorbitant and scarcely a priority despite the high death toll.
Among others, Malawi lacks a national kidney disease registry, screening programme and a comprehensive awareness strategy.
“It felt like falling off a cliff with no one there to catch me,” Maliro says.
Luckily, a kidney failure survivor helped him find treatment in India.
By then, his creatinine was 35. Dialysis and advanced care saved his life, but doctors said he would need ongoing treatment “likely for life”.
However, what awaited him on his return was far from assuring.
“There was no doctor to attend to my condition. The files from India were barely reviewed. A nurse wrote my name down and I waited. That was it,” Maliro recounts.
In a country of over 20 million, only four hospitals offer dialysis: the State-owned Kamuzu and Queen Elizabeth central hospitals and the privately owned Mwaiwathu and Blantyre Adventist.
Besides, just two district hospitals provide kidney health services—serving only 20 patients per day. The rest are left stranded by geography, poverty or bureaucracy. Meanwhile demand continues to grow due to rising hypertension, diabetes, alcoholism, unregulated aphrodisiacs and over-the-counter drugs.
“Instead of twice weekly, some patients only get dialysis once a week and others skip sessions because they can’t afford transport,” Maliro explains.
Malawi Health Equity Network (Mhen) executive director George Jobe says the life-saving machines should be available “not just in central hospitals, but in all the 28 districts”.
He laments: “We are burying people not because there’s no treatment; but because they were born poor, in the wrong district and without the right connections. It’s unjust.
“We’ve seen dialysis machines at Queen Elizabeth or Kamuzu central hospitals break down, forcing patients to travel hundreds of kilometres to the other facility. This is worsened by incompatible machine brands that don’t allow for parts sharing.”
Mzuzu Central Hospital in the Northern Region has no dialysis machine. This exerts pressure on the public facilities in Lilongwe and Blantyre.
“In the 2025/26 pre-budget submission, we pressed the government to fix this, but urgency is lacking,” Jobe says.
For US-based health communication specialist Laurine Meke, the crisis could be symptomatic of systemic failure and unhealthy lifestyles. It includes misinformation, myths, misdiagnosis and delayed access to medical care.
She says: “Most patients say the same thing: We discovered too late that it was kidney failure.’
“That tells you our prevention system is broken. Families spend more on transport, hospital stays and special diets than they can afford.”
Meke says over-the-counter and expired medications complicate the situation, especially in rural areas where regulation is weak and health facilities far apart.
“We are poisoning ourselves in the name of free trade,” she says. “These damage kidneys quietly over time.”
Dr Jonathan Chiwanda, head of the NCD Unit in the Ministry of Health, says government is reviewing the NCD strategy to put kidney care front and centre.
“However, we must be honest—progress will require funding, collaboration and policy discipline,” he says.
Besides the scramble for the blood-cleaning machines, patients rarely see doctors unless they pay separately and laboratory results often delay or go unread.
In public hospitals, recommended diets are ignored and prison-like meals and unsanitary dialysis wards can worsen the condition.
“There is no dignity in how we treat kidney patients “They die silently—forgotten and uncounted,” says Maliro.
The versatile artist, who co-starred with the legendary Du Chisiza Jnr, first shared his story with The Nation days after music icon Lucius Banda died of kidney failure in South Africa in June 30 2024.
He has become a vocal advocate for change and mass awareness.
“Malawians are sitting on a ticking bomb and hope alone won’t save us. Hope doesn’t clean machines or hire doctors. We need to act—urgently and loudly—because we will continue losing lives if we don’t invest in training, prevention and treatment,” he warns.
Maliro calls on government, the private sector, insurance companies and citizens to invest more in rolling back the silent crisis because “kidney crisis is no longer just a medical failure, but a moral test”.
To him, every death is one too many and it shows how the nation is failing to save its people when it matters most.
“History will remember how we chose to respond—once we knew.”
