By Bob Scott, Retired GP and Tiyanjane Clinic volunteer

AT the Tiyanjane clinic in Blantyre, Malawi, Monday is Kaposi Sarcoma (KS) day and every week about 70 patients arrive for chemotherapy.

KS is a cancer caused by HIV infection which can be cruel in its presentation, with the nose, mouth and legs among sites commonly affected by tumours. Patients with disfiguring facial growths often conceal these behind scarves, while putrid leg ulcers are usually bandaged. Many struggle long distances to be there. Home-made crutches help limping individuals to reach the hospital. If dressings have not been changed for days, clouds of flies herald the unfortunate victims’ attendance.

The severity of the cases is shocking. What is equally bad is that the drug used to treat KS is frequently unavailable. This is not because it is unobtainable or unaffordable; the real reason is corruption.

Analyses by Transparency International show that between 2012 and 2016, Malawi fell from 80th to 120th place out of 170 countries in the Corruptions Perception Index. It is reckoned that around one kwacha in three earmarked for health care never reaches its goal, but is siphoned off for personal gain. Those criminal acts can have life-shortening impacts on individuals receiving treatment.

Nursing staff at the hospital are regularly faced with the unenviable task of apologising to patients for the absence of medication. “We do not have” is their truncated response to the urgent inquiries, “any medicine today?” Disappointment, plus a deep sense of frustration coupled with suppressed anger, is the consequence, on both sides of the consulting table.

However, when supplies of the drug do reach their intended target, the mood is transformed. An amazing rise in spirits then becomes apparent, with light-hearted jokes and a cheerful sense of optimism pervading the room, as veins are identified and skilfully injected.

Such buoyancy is inspiring and testifies to the quality of the professional care being delivered and the endurance of the long-suffering patients. Witnessing this is a humbling reminder that the process of battling enormous odds can be uplifting in its own right. Any sabotage of that stoicism merits harsh retribution.

External donations account for a large part of the country’s budget and projects sponsored by the Scottish Government are of inestimable value to those suffering from serious disorders. It has donated millions of pounds to Malawi, intends to continue doing so and has widely publicised its efforts. This altruism is admirable and few, if any, would grudge allocating a small proportion of their taxes to such worthwhile causes. However, the disturbing scale of corruption in Malawi has received scant attention here. Largesse must be accompanied by close scrutiny and, if necessary, forensic audit. Unfortunately, the ability of organisations within Malawi to achieve that is doubtful.

The Anti-corruption Bureau is the body charged with the responsibility of clamping down on graft, but its record of success is lamentable and in 2015 the head of its Corporate Affairs was murdered. Nor do politicians show any signs of taking steps to improve matters, with an academic in Malawi recently stating: “The current generation of Malawian leaders are beyond redemption.”

Faced with such questionable local supervision, it is up to the Scottish Government to ensure taxpayers’ money is not only well-spent, but that every penny sent from here arrives at the correct destination. If that does not happen, a gnawing suspicion will persist that Scottish beneficence is being short-changed.

Meanwhile, patients at the KS clinic, along with others throughout the country, will continue to be cheated.