Trustees Julia & Karen (centre back) with medical staff at Mtendere
Trustees & Staff

The Health Centre is located in the west of Dedza district in the central region of Malawi. It has the highest catchment population in the district of 48,985 with additional refugees from the border country, Mozambique.Despite such a large catchment population, Mtendere Health Centre has a critical shortage of technical staff. Infant mortality rates are 104 per 1000 live births respectively. (In UK 17 per 1000). Life expectancy is 36.3 (UK Life expectancy 78)

Sr Florence
Sister Florence

Sister in Charge is Sister Florence Kankota. The nearest hospital with a doctor is 30 kilometres away but it takes an hour and a half to reach it on dirt roads. These are often impassable in the time of the rains.The Health Centre offers similar facilities to Nhkamenya (but more limited) and runs 14 Outreach Clinics which are attended by families from 38 villages. They run vaccination programmes ,ante natal clinics and under 5 clinics with distribution of antibiotics and anti malaria drugs etc to the children.

Medical Officer at Outreach Clinic
Medical Office at Outreach Clinic

There is no laundry and no laboratory. It doesn't have a Nutrition Unit (NRU) to check for malnutrition and provide pregnant mothers and children with vital food supplements and vitamins. At the moment, with a good harvest, there is not an immediate problem.

Sister Florence said that if this situation changes as it did in the 2003 famine (and provision of food is always precarious as it is dependent on so many factors such as weather, soil degradation etc) they will have a major crisis on their hands.

HIV/AIDS (Top page)

Sister Florence said that she is aware of well over 100 HIV positive patients locally (and many more are sure to be infected but have not been tested). At the moment she can give them very little help.

The Government have provided her with HIV/AIDS Testing Kits and Antiretroviral drugs (donated by the Global Fund and other organizations)) but not the personnel , the salaries to train health workers, or the facilities to run the programme.

This involves educating the local community leaders and going out into the villages with trained staff to test patients and distribute the life saving drugs.

She also wants to start the crucial PMTCT (Prevention of Mother to child transmission) programme and invite pregnant mothers for testing & treatment with the dose of nevirapine that they so desperately need to protect their infants from infection. She simply does not, at present , have the personnel to do this. The situation is extremely urgent.

An admirable Spanish charity, "Africa Directo", has just built a Voluntary Counselling and Testing (VCT) Centre, where HIV patients can recieve treatment and support.

THE WARDS. (Top page)

Mother & baby ward
Mother & Baby ward
Conditions are very sparse although the walls are brightly painted, mosquito nets are provided and the atmosphere is as cheerful as Sr Florence and her colleagues can make it. Sr Florence said that the Medical council came and were very critical of the beds The paint is flaking off so badly that they are a source of infection .
Women's ward
Maternity Ward
Disintegrating foam mattress
Old Mattress

They urgently need bed linen. At the moment they usually put the next patient straight in the same bed as the recent occupant without changing the linen as long as there is no visible sign of dirt. Sister Florence has no alternative as she says they have no spare clean linen sometimes. The babies sleep in the beds with their mothers . They do not use cots.
Sheets and pillow case : Price : £550 US$1093
Many of the mattresses were not even plastic covered, just disintegrating pieces of foam.
The provision of washable mattresses that can be quickly wiped and disinfected is another priority: for 20 mattresses Price: £400 US$200
We saw the delivery room and she told us they do not have an oxygen concentrator for new babies: price for this : £1070 or even a basic resuscitator: Price : £210 US$ 417

One nurse there at the moment had been sucking out new born babies mouths by giving mouth to mouth resuscitation. (Very dangerous given the prevalence of HIV) This nurse had last worked in a refugee camp in a war zone so was used to emergency methods.


Medical Officer & mothers in outreach abtenatal clinic
Medical Officer & mothers

Everywhere in rural Malawi there are Traditional Healers and Traditional Birth Attendants , (TBAS). They are much respected by the local population.

Sr Florence is trying to create good relations with all the local chiefs. She knows the chiefs' backing is needed to help persuade the people to come to the outreach clinics. There they will receive ante natal checks and crucial treatment and testing for HIV/AIDS.

The Government is also encouraging traditional leaders to convince people to go to outreach clinics and not to rely primarily on traditional methods.

"People tend to listen much more to what their traditional leaders tell them than anyone else. Chiefs must therefore tell people the importance of coming to hospitals with problems affecting their health."

(excerpt from Trustees' report)

Sr Florence (left), Traditional Birth Attendant & Angels Trustee, Julia Cussins
Traditional Birthing Assistant

"We stopped at a hut where some births take place.

We met the TBA who delivers the babies who don't make it up to the clinic and saw the birthing hut where she does it. Neither things particularly reassuring

Basic WC & Placenta Pit
WC Placenta Pit

The hut had two dirty little rooms and a basic table with a box of mystery bits of metal at the end of the bed. There is no running water though apparently the bore hole is not far away. A basic toilet and placenta pit were near by.

The TBA had recently had a disaster when the baby died before birth and had to be dismembered and removed from the mother without anaesthetic. There are obvious problems with such dangerous methods, unsanitary conditions and the spreading of various infections particularly HIV/AIDS .

Sister Florence does her best to instill basic "safe practice" in these conditions. "The best solution is for the women to get to the clinic before they give birth but obviously this does not or cannot always happen."

Another major hazard is the lack of transport for getting patients from the TBA's home to hospital when a crisis arises. All too often the situation is beyond help.

MEDICINES (Top page)

Under Fives Clinic
Under 5's Clinic

Mtendere Health Centre receives no money for medicines for children under 5 years of age. The supply is always uncertain.

  • There is a perpetual shortage of drugs, IntraVenous fluids, gloves, disinfectant & antibiotics for under 5 year olds.
  • Price for 6 month supply £8,100 US$ 16105

There are many pneumonia cases in the rainy season when babies are strapped to their mothers' backs as they work in the fields in wet weather. Malaria (a constant scourge) still kills more people generally than AIDS.

  • The costs are low: e.g. IV fluids cost less than £1 per litre and Quinine costs for 1000 tablets only (£30).

EQUIPMENT (Top page)

An ultrasound scanner was requested as a priority. The scanner would enable serious problems to be diagnosed before they got to the crisis point. The nearest ultrasound is in the capital, Lilongwe. (bearing in mind that caesareans etc cannot be done at Mtendere). Price : Ultrasound scanner, printer and paper £6713 US$13347

Many patients are very reluctant to go to Lilongwe for an examination because although they are taken by an ambulance from Dedza, they are not transported home and must make their own way.

All too often this is too expensive for them, and a bewildering and frightening experience. They do not know the capital, Lilongwe ,or where to catch a bus in the city and are stranded. Therefore, if they are referred for an appointment they often refuse to go.


Sister Florence desperately needs funds to train personnel to implement the crucial new Government PMTCT programme (Prevention of Mother to Child Transmission).

MO & Group
  • Just one dose of neviropine to an HIV positive mother in the late stages of pregnancy and one dose to the newborn child can prevent the baby from inheriting the HIV infection.

Anti retroviral drugs are now provided free to the Government by the Global Fund and others. This is a tremendous advance in the treatment of HIV. It is not a cure but it can prolong life and for many, if diagnosed early, can contain HIV/AIDS as a medical condition instead of an automatic death sentence.

  • This is a message of hope that mothers need to hear and be encouraged to come forward for HIV testing in time for the treatment to be effective.

Sister Florence believes that a comprehensive programme of HIV counselling and testing must start with educating the rural community in her catchment area on how best to prevent transmission and mitigate the terrible consequences of AIDS.

Ten Intensive Outreach Training Programmes aimed at "200 Custodians of the Community": Chiefs, Political and Religious Leaders, Teachers, Traditional Birth Attendants, Healers and Health Care Workers will be taught to provide vital information on basic essential "Safe Practices".
They will also learn how to recognize the clinical manifestations of AIDS so that they can urge people to seek treatment without delay.
Free and open discussion will help put an end to stigma and fear and encourage positive behaviour changes in their society.

Trustee Julia Cussins at an HIV/AIDS testing clinic
Julia at Clinic
FACTORS contributing to spread of HIV transmission in Mtendere:
  • Increased number of marriages without knowing HIV sero status.
  • Lack of community awareness and involvement in HIV prevention & mitigation
  • Inadequate resources for HIV prevention & mitigation
  • HIV infected mothers transmitting to their children during pregnancy,
  • Increased premarital & extra marital sex
  • Poverty
  • Deliveries by unskilled personnel

CHALLENGES : (Top page)

  • Lack of permanent transport for HIV/AIDS education programmes A car needs to be purchased. (a four wheel drive))
  • Inadequate HIV/AIDS Counsellors: only one is trained
  • Lack of male involvement, especially in PMTCT services: only pregnant women are tested
  • Inadequate food integration for HIV/AIDS positive patients, especially pregnant women and the very sick.


PRICE: £12376 US$ 24607



Sister Florence

We asked Sister Florence what her biggest problems were (apart from the under funded AIDS/HIV programme) and she said that the water tank for the hospital and the pump are completely inadequate and cannot keep up with the demand . Frequent power cuts mean that if the water tank was empty the pump would not work and they could not refill it. They urgently need a generator for these occasions to ensure that the hospital has a constant supply of running water.

Sister Florence (left) and the tottering water tank. It is rusting and in a state of disintegration and often out of action during the frequent electricity cuts


  • Cost of building generator house, ground work, cable connections & supply diesel generator: £9136. US$ 18149
  • Cost of supplying water tanks, towers, pipework etc: £6891 US$ 13698
Outside Laundry at Mtendere


THE LAUNDRY (Top page)

The hospital laundry consists of one tap and two concrete slabs on which clothes and bed linen are scrubbed . This is out in the hospital grounds underneath an extremely rickety tin shelter. It is shared by all the patients, and the guardians who care for them.

A very small water tank attched to it, frequently runs dry. In the rainy season there are no facilities for drying sheets and clothing .

Plans have been drawn up to build a simple laundry (under cover with hand basins)that would serve staff and patients alike, giving shelter to the guardians from sun and rain and providing an area where sheets etc can dry during the wet season.



Crumbling laundry at Mtendere

Much time and effort is spent by the guardians and their families in fetching cans of water from the pump for cooking and washing for themselves and for their relatives in the hospital.

If the hospital water supply were to be modernized, there would be no need for this heavy work to be carried out, much of it, by very small children.

There is no doubt that the provision of a proper water supply would do an enormous amount to make life easier and far more hygeinic for staff and patients alike.

(Top page)

At the water pump Water babes

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