When Clement Mandala began losing weight in 2003, he did not realize it could be a sign of an underlying health problem. It was his uncle who encouraged him to visit the hospital, a decision that would change his life.
At the hospital, Mandala discovered that he had diabetes. He suddenly faced the reality of living with a chronic condition that would require daily medication, dietary changes and regular medical attention.
“There was nowhere to run to, so I accepted my condition,” he recalls.
Over time, diabetes affected different aspects of his life, including his relationships and sleeping patterns. One of his continuing challenges is taking medication every day.
Although maintaining a daily treatment routine can be difficult, Mandala says he remains committed to taking his prescribed medicines and attending diabetes clinics as advised.
He has also experienced comments from people who tell him what he should or should not eat. While such remarks may be well intentioned, they highlight the need for greater public understanding of diabetes and more supportive attitudes towards those living with the condition.
His experience has taught him that managing diabetes requires more than changing one’s diet. It demands consistent treatment, reliable information, regular medical check-ups and support from family and the wider community.
Despite his commitment to treatment, accessing medicines has not always been straightforward.
“Many times, there are no drugs at the hospital. Drugs at the hospital are expensive,” he says.
When medicines are unavailable at public health facilities, patients may have to seek them elsewhere, sometimes at prices that place considerable pressure on household finances.
For Mandala, the cost of treatment affects the entire family. Money that could have been used for other household needs must sometimes be redirected towards buying medication.
His family has also adjusted its meals to accommodate his dietary needs. These changes demonstrate the practical and financial effects diabetes can have on everyday family life.
Mandala identifies his family, particularly his spouse, as one of his greatest sources of support. Their encouragement has helped him navigate the demands of living with a chronic condition for more than two decades.
However, he recognizes that not everyone has the same level of support or the financial means to obtain medicines when they are unavailable at public hospitals.
More than two decades later, Mandala, who is the president of the diabetes Association of Malawi (DAM), is drawing on the experience to advocate for a better care for people leaving with diabetes. His concerns extend beyond managing his own health to the availability of affordable medical care and public awareness particularly in the rural communities.
For people in rural communities, the challenges can be even greater when appropriate diabetes services are far from home.
Mandala believes that bringing diabetes clinics closer to rural populations would help more people access diagnosis, treatment and follow-up care without facing unnecessary barriers.
Mandala’s experience has shaped his work as President of DAM, where he advocates for greater awareness and improved services for people living with diabetes.
Through the association, district-level committees linked to hospitals help raise awareness about the condition and encourage communities to seek reliable health information.
However, Mandala believes that misinformation, medicine shortages and the cost of treatment remain significant barriers to effective diabetes care in Malawi.
He wants to see essential diabetes medicines consistently available in hospitals, more healthcare workers trained in diabetes management and greater investment in services for people living with the condition.
He is also calling for diabetes clinics to be extended to rural areas, helping reduce the distance patients must travel to receive appropriate care.
For Mandala, awareness and access to treatment must go hand in hand. People need to understand diabetes, but they also need healthcare facilities that can support them after diagnosis.
His own diagnosis followed unexplained weight loss, which prompted his uncle to encourage him to seek medical attention. His experience highlights the importance of taking unusual changes in the body seriously and seeking professional advice.
Diabetes does not always cause obvious symptoms, particularly in its early stages. Appropriate screening and medical assessment can help identify the condition, while a healthy lifestyle can reduce the risk of type 2 diabetes. For people already diagnosed, following professional medical advice, taking prescribed medicines and attending regular check-ups are important parts of managing the condition.
The Ministry of Health says it is working to expand access to diabetes and other non-communicable disease services.
Hastings Chiudzu Chiumia, Assistant Director of the Non-Communicable Diseases and Mental Health Division at the Ministry of Health, says the government is implementing the World Health Organization’s Package of Essential Noncommunicable Disease Interventions (WHO-PEN).
The programme integrates the management of common conditions, including type 2 diabetes and hypertension, into primary healthcare. According to Chiumia, WHO-PEN is being implemented in 300 health facilities against a target of 450.
The government is also implementing PEN Plus, which strengthens the management of severe or complicated non-communicable diseases at district hospitals. Chiumia says the programme has reached 15 hospitals against a target of 30.
These initiatives aim to bring services closer to communities and reduce unnecessary referrals to central hospitals.
However, Mandala’s experience highlights the importance of ensuring that expanded services translate into reliable access to affordable medicines, trained healthcare workers and consistent follow-up care.
A call for a future where patients receive the care they need
Since his diagnosis in 2003, Mandala learnt to live with diabetes while navigating the practical and financial demands of treatment. Today he draws on the experience to advocate for health care systems that supports people beyond diagnosis.
His journey demonstrates that diabetes care goes beyond telling people to eat healthily and exercise. People living with the condition also need affordable medicines, accurate information, emotional support and accessible healthcare services.
Mandala wants people newly diagnosed with diabetes to understand that the condition can be managed with appropriate medical care and consistent support. He also wants communities to replace stigma and misinformation with understanding.
His appeal extends to government, healthcare providers and communities: invest in diabetes services, ensure essential medicines are available and bring care closer to the people who need it.
More than two decades after learning he had diabetes, Mandala continues to advocate for a future in which people living with the condition in Malawi can access affordable medicines, reliable health information and consistent medical care, regardless of where they live or their ability to pay.
By Monica Chinyama Lipiya