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When I think about the treatment I got from the doctors in Neno, I am so happy because at that time I didn't know if I would live this long.

Meet Nimiya 

Nimiya Ziwoya is a 40-year-old woman living in the rural district of Neno in Malawi. When Nimiya was seven months pregnant, she noticed that her legs were swollen and she was finding it difficult to breathe. She then went to the local hospital, where she was referred to Neno District Hospital, which is supported by Abwenzi Pa Za Umoyo (APZU), PIH’s sister site in Malawi. At Neno Hospital, Nimiya learned that she that one of her heart valves had been severely damaged by rheumatic heart disease. She would need life-saving surgery to repair the valve, but this type of surgical care is not available in Neno or anywhere in Malawi. Nimiya was able to get government support and travel to India to get the surgery she needed.

What Nimiya’s story teaches us

Rheumatic heart disease (RHD) is caused by a strep throat infection, which progresses to rheumatic fever and can eventually become RHD if untreated. The initial infection can be cured easily by penicillin if diagnosed and treated in time. When left untreated, these infections can lead to RHD, a condition that often requires surgical intervention for patients to survive. RHD predominantly affects children and young adults in lower-resource settings and rural communities.

When Nimiya first began to feel unwell, she was not able to work. Nimiya explains, “I was failing to take a pail to fetch water, I was failing even at going to the maize hill, I couldn’t go.” As subsistence farmers, both Nimiya and her husband work all year to be able to provide for their family. With one less person working, the financial impact of Nimiya’s condition would have been catastrophic to her family.

Although Nimiya was able to obtain surgical care in India, it is an expensive and risky choice for families and governments to make. The provision of specialized surgical care to treat conditions such as RHD should be available closer to families like Nimiya’s, and must be an essential component of countries’ efforts to progress towards universal health coverage. A lack of qualified personnel and appropriate equipment too often leads to unnecessary premature death, predominantly among the most vulnerable populations.

Nimiya no longer struggles with major complications and is now able to work in her field and provide for her family. She visits the hospital monthly to receive warfarin injections and regular check-ups.