Pieter Hugo
Malawi 2003: Tuberculosis and guardian care

27 October - 26 November 2004
The first recorded case of TB in Malawi dates back to 1879 when a missionary's cook was diagnosed with the disease. The first structured TB programme was introduced in 1969 and a national TB register was established. Notifications of TB continue to rise, fuelled by the HIV/Aids epidemic, and it is now estimated that 77% of TB patients in Malawi are HIV positive.

Lilongwe's Bottom Hospital, where some of these portraits were taken, is a ramshackle collection of single-story buildings. Long queues of people, mostly women, many adorned in traditional cloth, stand patiently in line waiting for medicine or a chance to consult with a doctor. Old hospital beds lie outside, rusting in the mid-summer rain. The hospital has a distinctive smell, thick and wooded, damp and generally pungent. One could rudely assert that it is the smell of ill health, that it is a smell that is only vaguely medicinal, and that it is particularly prevalent in the wards but in truth the smell is less threatening than it is unfamiliar. There is a hint of burnt porridge to the odour too, probably due to the fact that many guardians and visitors are allowed to cook food on the hospital premises.

Bottom Hospital is Lilongwe's chief TB treatment centre. Despite the Spartan furnishings and paint-flecked walls, there is a congenial atmosphere, a low buzz of human chatter, patients engaged in purposeful conversation with their guardians. Since the decentralisation of TB health services, conditions in the TB wards at Bottom Hospital have significantly improved. Previously the wards were 200% of capacity, patients housed on the floors, even under the available beds.

These images offer a view of the guardian care programme that encourages relatives and members of the community to provide nursing for TB patients.

These images were taken while on assignment for the World Health Organisation.

Sean O'Toole
For more information contact +27 (0)21 421 2575 or fax +27 (0)21 421 2578 or email info@michaelstevenson.com.

Medisone Baja, aged 19, Bottom Hospital,
Lilongwe, Malawi 2003

Winston Masambo, aged 30, Kumuza Central Hospital,
Lilongwe, Malawi 2003

Tabalure Chitope, aged 30,
and her guardian, Eletina Nedi,
Bottom Hospital, Lilongwe, Malawi 2003

John Muyare, aged 55,
and his guardian, Olivia Muyare,
Kumuza Central Hospital, Lilongwe, Malawi 2003

Chipila Chitukwi, aged 32,
and his guardian, Sara Chitukwi
Bottom Hospital, Lilongwe, Malawi 2003

2003 - 2005 Michael Stevenson. All rights reserved.