This is a rural mission hospital, with a 90 bed facility, caring for people of all faiths or none. The hospital is in a large complex with a secondary school, a farm and two primary schools. It has a catchment area of 34000 people, mainly subsistence farmers and their families living well below the poverty line.
In common with all rural hospitals it has no doctor and no surgeon. It has Clinical Officers and qualified Nurses, som eof whom are Midwives. Sister in Charge is Sister Margaret Nyirenda

The hospital provides basic treatment and care for maternity and medical problems. The main areas of care are:

Sr Margaret
Sister Margaret
  • Ante/postnatal care
  • Treatment for malaria, diahorrea, cholera, pneumonia, TB, men/women/paediatric etc
  • A Treatment Centre for Malnutrition
  • Vaccination programmes against measles, polio & other diseases
  • Voluntary counseling and testing for HIV/AIDS (VCT) which includes Educational programmes. But there are no VCT centres at the hospital at the present time.
  • HIV/AIDS treatment which includes the vital Prevention of Mother to Child transmission with the new drug, nevirapene.
  • Just one dose of nevirapine 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.
  • 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.

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.


Mobile Clinic queue
Mobile Clinic Queue

These mobile clinics visit the people in the outlying districts who cannot get to the hospital due to severe transport problems. The hospital uses its one reliable ambulance to reach them.

The Clinics provide:

  • Ante natal checks for pregnant mothers
  • Vaccinations for children
  • Malnutrition checks for the under 5s.(weighing and distributing of vitamins etc)
  • Distribution of malaria tablets and iron tablets (always in short supply.) The iron tablets are needed because of the high incidence of anaemia, this, Sr Margaret tells us, is linked
  • to AIDS.
  • HIV/AIDS testing & counselling
HIV/AIDS Testing Clinic

There are over 300 registered HIV patients at present being treated in the Outreach Clinics and many more left untreated because they have not come to the Clinic for testing.

They are either unaware of their condition or too afraid of the prognosis to find out. The stigma of HIV is such that all patients are called by numbers, never their names.



TRANSPORT: (top page)

Bull Ambulance

All critical patients have to be referred to Kasungu District Hospital (50 kilometres away on rough roads), where there is a doctor who can diagnose conditions, or else they are sent to the capital, Lilongwe, where they do have some of the very few surgeons in the country.


Transport is extremely difficult, especially during the rainy season when many of the tracks to the villages are virtually impassable. Some patients are brought to the hospital in bullock carts (see left)) having travelled for hours. Many patients die before they get there. The hospital has one reliable ambulance from which it transports patients to the District Hospital and from which it also operates its numerous Outreach Clinics for patients who live too far away from Nhkhamenya.

LAUNDRY AND LAB: (top page)

Bull Ambulance

The hospital has a simple laundry (sheets and clothing can be handwashed in basins), a basic dental unit where visiting dentists come every quarter, (see below right) an under equipped premature baby room and an inadequate dispensary. The baby room has no incubators or resuscitating equipment. Just two warming boxes with lamps, similar to seed propagators. Hot water bottles are used to counter the electricity shortages which regularly occur.


They also have a tiny laboratory with 1 basic microscope and an ancient centrifuge. The Laboratory technician, Stephen Phiri (see left in the lab), longs for better qualifications (3 year diploma course) facilities and equipment. He needs to be able to test in situ for TB, etc . At present he has to send the samples away to be tested and patients have to wait several weeks for their results. This is particularly dangerous for mothers and small children. They then have to make a second journey to the hospital which they can ill afford and they frequently do not come back. When they finally do, it is usually too late.

MATERNITY: (top page)

Bull Ambulance

Sister Margaret told us that they have approximately 80 deliveries per month. Up till 2005, infant mortality in Kasungu District was the highest in Malawi. Over 1000 deaths per month. Things are slightly better now. There are no cots for the babies. Many mothers from the villages can come to the hospital up to a month before giving birth and they bring up to five female relatives or "guardians" with them. As is the custom, these guardians do all the washing of the patients, the laundry and cook their food on small wood fires in the compound.
They sleep under the beds in the wards in the rainy season and the babies sleep in the beds with their mothers. There is one bare room with straw matting, a "dormitory" area for expectant mothers and their guardians who sleep on the floor or else in the corridors.(see left)


Conditions at Nhkhamenya are extremely cramped, partly due to the hugely increased number of patients presenting with HIV/AIDS and related illnesses.
When the rains come, the discomfort, the difficulty of transport and the problem of adequate shelter for the "guardians" cannot be overestimated.
The Outpatients waiting area is far too small. There is room for only 15 people.(see right)
There are approved plans to build a new outpatients department, dispensary & laboratory which will alleviate the present overcrowding. There are no funds for this at present.


Operating Theatre

Sister Margaret, newly appointed Sister in Charge, highlighted the problems she has with HIV related illnesses and the ever present scourge of malaria. However she stressed her greatest concern was for mothers needing emergency caesarean sections and other life saving surgery.

At the moment, in a crisis these mothers have to travel more than two hours over rough roads to the district hospital in Kasungu. This is a potentially lethal situation for both mothers and their babies, especially during the rainy season. Sister Margaret showed us a building she inherited when she came a year ago.

This is a new complex consisting of an operating room, recovery ward and offices for medical staff . The construction was paid for by a generous grant from the Beit Trust. (see left)

At present it cannot be used.

  • It does not yet have the resident trained medical personnel to perform the necessary surgery
  • Although the construction is complete ,the building is not quite ready for occupation.
Boxed Equipment


A certain amount of work needs to be done on the interior (all the carpentry, tiling and plumbing in the operating room and recovery ward etc and installation of simple air conditioning.) Angels International has been asked to fund this.

There is also a considerable amount of operating theatre equipment donated by several charities some time ago. (see right) All of it is in good condition and waiting to be put to use.


TRAINING : (top page)

Sr Margaret (centre) & Staff
Operating Theatre

Sr Margaret needs to train one Medical Assistant for upgrading to Clinical Officer to perform caesarean sections, hysterectomies, repair of uterine ruptures and other surgical interventions .

She also needs to train a Clinical Officer to administer anaesthetics, mainly epidural . In addition she needs trained nurses to give proper post operative care in the new sterile conditions. This will help the many mothers who have travelled miles to get to her.

With approximately 80 births per month there are frequent complications such as uterine obstructions and infection requiring emergency surgery. Also, nearly 50% of births take place in the villages with the assistance of "Traditional Birth Attendants". She often has to deal with the aftermath when the birth has not gone well and mother and baby are brought to Nakhamenya when they are critically ill.

These are the acute cases she deals with and her absolute priority is to reduce the high mortality rates that are now prevalent and create a safe environment for mothers and their new born infants in her care.

The completion of this Operating room and recovery ward, combined with the training of the medical personnel will completely revolutionize the treatment of all mothers and babies in Sister Margaret's catchment area. Undoubtedly many lives will be saved. We can all see that it makes absolute sense to complete this project as soon as possible.

OUR TWO YEAR PLAN for 2008-2009: (top page)

Trustee Karen Roberts with Sr Margaret and Staff
Trustee & Staff
  • to finish the interior of this building turning it into a basic operating unit: £3776 US$ 7456
  • to complete a recovery ward for mothers and newborns : £3897 US$7697
  • to sponsor training of a Clinical Officer to perform Caesarean sections & other surgery: £1250 US$2468
  • To sponsor additional training of nurses to assist the CO:. £750 US$1481
  • To sponsor the training of an anaesthetist: £1500 US$2962
  • To purchase specific equipment including an autoclave and ultra sound scanner: £12533 US$24754
  • To sponsor training for a laboratory assistant (to diploma level:) £2,500 US$4939


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