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'Malaria is a thing of the past' - Kamwi

By Paul T. Shipale

Question: Cde Kamwi, what strategies has the Ministry of Health and Social Services used to almost wipe out malaria in the country?

Answer: At independence in 1990, we were faced with a devastating malaria epidemic, never to have been registered. We checked the records from the defunct administration, the so-called Department of Health. They had some good records, but they had never registered such a worst malaria epidemic. That was the situation. At that time, I was a young man with a national diploma in public health.

I was tasked to tackle malaria control. I was appointed Chief Health Inspector for the four northern regions, called North-West Health Directorate. With the help of the World Health Organizatio, WHO, we put in place a multi-sectoral approach. We had to confront the adult mosquitoes.

Our main stay was using indoor residual spraying, using 75 percent DDT water-able powder, targeting the roofs and the walls. We were not spraying outside. At that time, we had malaria vectors. These are anopheles gambiae, anopheles funestus and anopheles arabiensis. WHO gave us the technical support. The newly established SWAPO Party government provided the resources to fight this epidemic.

I was charged with that programme. By the end of May 1990, we brought down that epidemic. Since then, I was identified to go and study at the University of Liverpool. When I came back, I was tasked to set up and manage the National Vector-born Disease Programme, primarily to fight all vector-born diseases. I was tasked to come up with a national policy for malaria control programme. That policy, as you see it today, went through my hands. That policy has only been amended twice.

I came up with a formidable team. We covered all malaria areas in this country. That is the whole northern part of Namibia, plus the Central Region, Otjozondjupa, and now Omaheke. We faced this disease head-on. In 1991, Namibia's first Minister of Health, Dr Nickey Iyambo, decided to reward me. Through WHO, I received my Fellowship Award to go and study, specializing in malaria. When I came back, I put more fire. I had a team that listened and worked with the sole objective to see to it that we eliminated malaria from Namibia. That was my objective.

Let us look at the data. In 1990 alone, malaria killed 7000 Namibians in the whole country. In the North-West Health Directorate alone, malaria killed 5000 people that year. At that point too, we registered 400 000 clinical cases of malaria. That data is with us. Because of hardwork and commitment, responding to what we fought for, the intended objective had been met.

In 2001, countrywide, outpatient malaria cases was 521 067. By 2010, we brought that figure to 22 359. Those are the cases that went through laboratories. Those are outpatient malaria cases. In 2001, malaria admissions in Namibia stood at 41, 636 down from 400 000 cases at independence. By 2010, we brought down that 41 000 to 1 505. Who was coordinating? Nchabi Kamwi.

I was identified by Founding President, Dr Sam Nujoma, who appointed me as Deputy Minister of Health and Social Services. I still maintain that I am not yet done with my intended objective - that is to eliminate malaria in Namibia by all means.

Question: Cde Minister, where do we stand now?

Answer: Remember that we had over 7000 deaths caused by malaria in 1990. By 2001, we brought that figure down to 1 747. By 2010, we brought down deaths due to malaria to 45. Where do we stand today? Last year, 2012, we managed to bring down deaths due to malaria to four cases countrywide. With regard to clinical cases, we brought them down from 521 067 at independence to 3 163 in 2012. With regard to malaria admission cases, there were only 50 confirmed malaria cases in the whole country last year. That is no mean achievement.

But, again, if you check the history of these 50 cases, they were imported cases. Even the four cases of death I have earlier mentioned were imported from Angola. Let us look at the vectors. We had anopheles gambiae, anopheles funestus and anopheles arabiensis. These are major ones and very lethal. Where do we stand today? Do we still have these killer mosquitoes in this country? I am saying no. The answer is no. We don't have them anymore. I hold my Phd in malariology. I did my research on malaria in Namibia, the whole country.

I recall in 1998, I was with Dr Abraham Mzavaa, who was one of my external supervisors for my Phd. We were doing what we call "knock down," which meant you closed down all the windows and sprayed, checking all the vectors.

We went to Omahenene in Omusati Region in 1998, we looked around in several huts. There was not a single vector mosquito we could find on the Namibian side, not a single one. We could not find a single anopheles gambiae nor a anopheles funestus. We had a few anopheles arabiensis. That was then. As we speak today, we no longer have malaria vectors in this country other than imported ones. Even those ones are a few and far between.

Question: Where do we stand as a country in the Southern African Development Community, SADC, as far as malaria is concerned?

Answer: These are major achievements par excellence, well documented not only in Namibia, but also by WHO. This means we are serious. Now, regionally, our neighbours have been following these achievements. Five years ago, WHO was looking for countries to be earmarked for malaria elimination. In SADC, eight countries were identified. Four for a total malaria elimination, and another four to follow. That is what is now termed the E-8 malaria elimination.

Question: Which are those countries?

Answer: They are Botswana, Namibia, South Africa and Swaziland. These four countries are looking at total elimination. The other four are Angola, Zambia, Zimbabwe and Mozambique. In SADC, the chairmanship of any SADC structures rotates. But this is not the case with the E-Eight. What I am telling you now is a very interesting picture.

The first meeting was held here four years ago. Obviously, as a host country, we had to be the Chair. We had experts from as far as San Francisco in the US and WHO. We served our term. Two years ago, we went to Botswana for the E-8 countries' meeting. We were to hand over the chairmanship to Botswana. All the E-8 member states refused. They insisted that Namibia should still be the Chair. Don't ask me why.

We argued and asked why Namibia? In SADC, the Chairmanship rotates! Why only Namibia? This matter was left to the main body to make a decision. The health ministers met in Mozambique. I did not attend that meeting. My Deputy, Cde Petrina Haingura, went.

What happened? They still unanimously said Namibia should continue to be the Chair of the E-8. A year ago, we went again to Polokwane, South Africa, for the E-8 summit. It was the same thing. The summit unanimously said that Namibia should continue to chair the E- 8. Obviously, South Africa, could have become the Chair.

South Africa is a giant. They could have taken the Chair. This time it was unanimously decided that the Headquarters of the E-8 should be in Namibia, and not in Gaborone, Botswana. And the Chair? Namibia again. The whys are in the documents we produce and how we have managed to bring down malaria in this country. Our neighbours are impressed. Just look at how our graph has moved down dramatically, from close to 2 000 malaria related deaths in 2001 to just four in 2012.

This is what we are capable of doing. This is not just Nchabi Kamwi. This is teamwork. I have been at the steering of this exercise, entrusted to me and my team by the Namibian government. I remain extremely grateful to both Founding President, Dr Nujoma, and President Hifikepunye Pohamba. I am also extremely grateful to Dr Nickey Iyambo and Dr Nestor Shivute. They did all they could for me to be what and where I am today.

Last year, I received an invitation from Harvard University that I was one of the health ministers who was identified for a Harvard Ministerial Leadership Award. I must admit it came at a wrong time. It came at a time when President Pohamba had appointed a Presidential Commission of Inquiry on the Public Health Sector in Namibia. I declined that offer. I kept quiet. They wrote two letters. I did not respond.

The third was a telephone call from Harvard University, telling me that in May 2012, I would have gone to receive the award. I turned it down. This year they came in persons, and extended an invitation to me to go and receive the Award for my contribution to improving the health system in this country, starting with establishing the National Malaria Vector Disease Control Programme. This includes HIV/AIDS and TB.

Question: Some people and newspapers have been calling for your sacking. They have called you one of the "most useless ministers" in government. With all these impressive achievements noted not only in Namibia, but outside Namibia as well, what is your pick on such people? How do you feel when you are described like that?

Answer: You are right. I have been called all sorts of names. This year, I was privileged to head the Namibian delegation to the World Health Assembly. This is where the entire member states of the WHO meet. At that Assembly, Namibia was elected in two major bodies for the first time.

The first one was the General Committee, which is like parliament. On the last day of that week, the Assembly met to elect member states who should serve on the Executive Board. Namibia was one of those countries elected to serve in the Executive Board.

This was for the second time during the course of my eight years as Minister of Health and Social Services. It is unusual for a member state to serve as an executive board member within eight years two times. It is unusual, but it has happed because of our indicators.

Two weeks ago, Namibia was invited by the US Secretary of State, John Kerry. President Pohamba permitted me to go. I was the only minister from Africa who was invited because of the excellent indicators from Namibia. Again, I recall, last year, for the first time in this country, the first ever internationalist, Director General of WHO, to address our Parliament, Dr Margreth Chan. She informed the Namibian people about the quality leadership of President Pohamba, whose Health Minister was a shining star.

When we went to the WHO Health Assembly last year, she repeated her words. She visited several countries, but she singled out four, which included Namibia. At the World Aids Conference last year, I sat there and listened to the US Secretary of State, then Hillary Clinton, singling out Namibia. But as I listened, I knew back home it was not all well. When they are talking so bad, internationally, people see what we are doing. They look at the indicators. But some people can be jealous. In Oshiwambo you say, "Ondumbo nayise," "Jealous must die." Let us support each other. It is for the betterment of the country. Do you still see convoys going to cemeteries on a daily basis? It is no longer the same.

The situation has changed. We have significantly brought down malaria deaths in this country. It is not Kamwi who is saying this. It is the data, the figures, the indicators. It is pure jealousy when they call me names. True, we have challenges in this country, but they are not insurmountable. There are people who talk out there, criticizing us for not doing this and that. Yes, it is their democratic right to criticize.

One day, I appeared on One- On-One on the Namibian Broadcasting Corporation, NBC. Today I want to respond. One of the silly questions the moderator asked me was: "What do you say, with so many deaths, people who are dying in front of your eyes?" He went on to mention names. Sometimes it is painful when people do not know. That is why I always say to my team, forgive them, because they do not know.

He went on to mention the names of those who had died, some of whom I knew the causes of their deaths. It was very unethical. You don't ask a person to reveal the cause of death of a person without the consent of family members. One of those he mentioned died from AIDS, full blown out. I know. When a womb becomes so defective, and such person came so late, you try all your best. Then this person dies, must we say this person died from AIDS? Is that ethical? It is unethical. He even showed me some photos of babies who had died at birth.

We have maternal and neonatal deaths in this country. I took over this Ministry when AIDS was at its peak. That explains why it was so high at that time. There were even attempts to move this programme to the Office of the President or the Prime Minister.

But thanks to the wise leadership of President Pohamba, he refused. When I took over, maternal death ratio was 449 per 100 000. Where do we stand today? It has come down to 108 per 100 000. Our latest quarterly report shows that maternal deaths have decreased from 118/100 000 to 100/100 000. If anyone says, Kamwi, why is he still there?

I am saying it is unfortunate. My prayer is he or she should be forgiven for his or her sins. Internationally, the recognition is there. The world recognizes what we are doing. If we can manage to do this much with so little, and there are people who do not appreciate this, my good Lord, may you forgive them.

This is the best that we can do under the circumstances. We cannot be compared with private hospitals. Ours are public health institutions. We do not have the financial means. The know-how is there, but the resources are not enough. With the little that we have, we are able to showcase internationally. When my term is over, I will leave this Office as a happy man. When I look back, we have built more primary healthcare clinics than at any other point in time since independence.

We have renovated health infrastructure than at any other time of our independence. I am most grateful to the team that I work with. My Deputy, Petrina Haingura, my Permanent Secretary, Andrew Ndishishi are doing their best. So are my advisors and the entire management team.

If I had been given a man like Andrew Ndishishi right from the beginning, we would have gone a long way. He is one of the best managers in this country. He is hands-on. I am also most grateful to the spray men and women out there who have managed to wipe out malaria in Namibia. It is not only malaria. We had polio in this country.

We wiped it out too, under my leadership without external support, apart from technical support from WHO. Plague (Okatumba) devastated villages in the northern regions, killing people. Do you hear it today? We no longer have it in this country. To those who say I am doing nothing, I say "May the living God forgive them." I am sorry that some people have died during my tenure of office. It was not our own making. We have done our best.

There are some cases of negligence. In any system, they are there. But they are dealt with as such. My appeal is this. When Namibians criticize, please, blanket criticism does not help. Let us be more specific and more genuine.


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