Lives in Limbo: A tale of the crisis facing eSwatini’s ostomates

By Nokukhanya Musi 

When 46-year-old road accident survivor Mkhulisi Masina* wheels himself across the small bedroom he now rarely leaves, his greatest fear is not pain or paralysis—it is the soundless leak that signals his colostomy bag has failed again.

The stoma on his abdomen, an artificial opening created after he broke his spine along the Manzini–Mbabane highway, has become a daily battle for dignity. 

“I deal with leakage that can cause unpleasant odours, and it sometimes damages my skin,” he says. 

Masina is one of hundreds of people in eSwatini living with ostomies—medical conditions that require a colostomy, urostomy or ileostomy pouch to collect body waste. But in a health system buckling under chronic medical shortages, the simple plastic-and-adhesive pouch that keeps these patients alive has become a rare commodity. 

After being discharged from a private hospital where supplies were always available, Masina now relies on public hospitals that frequently run out. His family carer travels monthly to Mbabane Government Hospital to fetch his pouches—and increasingly returns empty-handed.

Interviews and field reporting by Inhlase reveal that eSwatini’s ostomates face a silent but devastating crisis: a nationwide shortage of colostomy, ileostomy and urostomy bags that forces patients to reuse worn-out pouches, improvise with plastic bread bags, or go without altogether. 

Masina’s case is not an exception. Recently, another ostomate made headlines when she posted on social media pictures of how she has resorted to using bread plastic bags as his colostomy bags. She glued and taped the bread plastic bags to the abdomen due to the shortage of proper colostomy supplies in the public health facilities. However, this was met with deafening silence from civil society and government, aggravated by the conspicuous mainstream media’s inattention to the ostomate’s predicament. 

A 28-year-old Thulile Shongwe from the Mbikwakhe area in Matsapha underwent an ostomy surgery at the Mbabane Government Hospital. She cannot afford the colostomy pouches, as a pack of 10 costs around E1,200. After complications from cervical cancer treatment, Shongwe has gone public appealing for assistance in purchasing the necessary but costly colostomy bags.

The consequences are severe—skin infections, odour leakage, social isolation, and a collapse in mental well-being. Yet despite the public outcry generated when another ostomate posted photos of using improvised plastic bags taped to her abdomen, the government has offered no clear response, and the mainstream health system remains unable to guarantee the most basic supplies for some of the country’s most vulnerable patients.

“The frustration can be overwhelming, especially since colostomy supplies are expensive and often out of stock. It feels like the government does not care, which leads to feelings of depression. It’s painful when the supplies don’t work effectively; it can lower your self-esteem. It’s hard to be yourself when you’re constantly worried about how you smell,” Masina laments.

Reached for comment, Swaziland Democratic Nurses Union (SWADNU) secretary general, Mayibongwe Masangane, points out that the shortage of colostomy bags has been going on for a long time in the country. He says the absence of colostomy bags makes it difficult to keep the patient clean and the patient’s surroundings. He blames the ongoing shortage of colostomy supplies on the poor procurement system.  

“Some patients may buy the bags from private healthcare facilities. Due to the limited resources, they keep them beyond the desired period compromising prognosis by the breeding infections. Fixing the procurement problem may save the situation,” he says.

In an attempt to understand the supply-side challenges with the supply of the critical colostomy bags, this reporter interviewed ASD Medical General Manager Trevor Mdziniso who noted his company had established relationships with multiple manufacturers to alleviate the problem. 

“We have made arrangements to establish business relationships with more than one source of colostomy bags. This diversification strategy is vital, especially given the challenges faced in the public healthcare sector, where supply shortages can disrupt patient care,” he says.

In response to key concerns in the healthcare sector about affordability, Mdziniso notes that ASD Medical employs a systematic pricing algorithm to keep costs manageable. “Our pricing is determined solely by the cost of bringing goods from our suppliers,” he says. 

However, Mdziniso acknowledges the competitive landscape. “We don’t deal directly with patients; we work with organisations like pharmacies, clinics, and NGOs. Public health facilities often offer subsidised products, making them more affordable compared to private options.” 

ADL Medical recognizes that many ostomates lack knowledge on proper use. 

To address this, they provide patient information leaflets with their products, ensuring healthcare workers educate patients effectively. 

Inhlase contacted the Ministry of Health multiple times to gather information on the current state of support for ostomates. However, Communications Officer Nsindiso Tsabedze said there is no comprehensive data on the number of patients in the country using colostomy bags. When queried further about the ministry’s initiatives and programmes to support ostomates, he was unable to provide concrete answers. 

Dumsile Ngwenya, the Programme Manager of Eswatini Cancer Network (ECAN), acknowledges that, while the organisation has historically focused on breast and cervical cancer, it currently has limited information and experience regarding support for clients who use colostomy bags. 

The lived experiences of the four ostomates serve as a powerful reminder of the human cost of healthcare shortages in eSwatini.   

The overlooked shortage of colostomy pouches in the public health system is not only confined to eSwatini. It is also a widespread issue in South Africa, according to Faizel Jacobs, the founding member of the South African Society of Stomates (SASS), a nonprofit organisation for ostomates across Southern Africa which facilitates a “holistic” approach to ostomy patient care by bridging the gap between the private and public sectors whilst advocating for the rights of fellow ostomates throughout the country. Patients in both countries face significant challenges in accessing colostomy bags, resulting in a dire need for intervention from their governments.

Inhlase caught up with 36-year-old South African cancer survivor Itumeleng Morole from Katlehong, Gauteng, whose life changed dramatically after a stage-4 anal cancer diagnosis in 2021 led to a permanent colostomy. She says living with a stoma is inherently challenging because “people think we stink because we live with something they know little to nothing about,” a misconception that fuels isolation and despair among ostomates. She explains that although a stoma saves lives, stigma and discrimination often follow, leaving many ashamed, fearful and cut off from friends, family, and communities.

As founder of the Ubunye Ostomates Foundation, Itumeleng advocates for awareness, reliable access to supplies, and emotional support – needs especially urgent in eSwatini and South Africa. She envisions health campaigns in schools and workplaces to normalise conversations around ostomies. “Because it is said that we stink, we often don’t want to be seen outside, leading to depression and suicidal thoughts,” she says.

Echoing Itumeleng’s words, Masina identifies a need for systemic change in the traditional attitudes towards ostomates, calling on the eSwatini government to prioritise colostomy supplies to ensure they are available in all hospitals and clinics across the country. He further calls for community support. He complains that community members tend to isolate ostomates due to the unpleasant odours. 

“People should not discriminate against those like me; understanding is essential, without requiring any special treatment. Family plays a vital role as well. Support—whether physical, emotional, or psychological—from family is crucial. It depends on the people around you. Most people are beginning to understand and society is changing, but some stereotypes still linger,” he states.

Information gleaned from the International Ostomy Association (IOA) shows that the critical shortage of colostomy bags cannot be overlooked in eSwatini. With the escalating burden of diseases and injuries, colostomy care has never been more vital. The ostomy causes include, among others, colon cancer, colorectal cancer, bladder cancer, rectum cancer, cervical cancer, prostate cancer, Crohn’s disease, polyps, accident and unwanted surgery. 

The Global Cancer Observatory ranks eSwatini among countries with the highest cervical cancer incidence rate in the world. It puts it at 84.5 per 100,000 women and is significantly influenced by the high burden of HIV. This comes at a critical period of rising cancer rates and shortage of colostomy bags, further exacerbated by the resource constraints attributed to the trend of low health budgetary allocations over the years. 

According to the Ministry of Health Annual Budget Performance Report for the Financial Year 2024/25, the supply chain for medical commodities remains inadequate, resulting in inconsistent availability of essential supplies including colostomy bags. It also notes frequent shortages of critical medications and medical supplies, impacting treatment availability. 

The report states that cancer patients in eSwatini face significant challenges, including rising incidence rates, limited access to care, and strained healthcare resources. An inconsistent supply of chemotherapy drugs and essential cancer treatments limits the effectiveness of care for cancer patients, as well as a need for specialised services.

The scarcity of resources impacts not only physical health but also fosters emotional distress and stigma. Many patients rely on these colostomy bags for their daily functioning and quality of life. Without them, individuals face significant health risks.

Masina observes: “Availability of colostomy bags at affordable prices is essential for those of us living with this condition.” 

*Not his real name