Health facilities in rural Malawi facing many limitations and challenges By Michael Clout and Louise Hart Day one We’ve had a very positive first day, visiting St Joseph’s Hospital in Blantyre district. We met several patients benefitting from IHP donations, including a woman who was suffering from a cyst. A clinician interpreted for us – and as the woman answered our questions, he decided to change her prescription as a result of new information. We wondered if this was an example of how difficult it is for over-stretched clinicians to make time for in-depth consultations. Another patient we met was HIV positive, and being treated with an IHP antibiotic for an infection. We also spoke with a pharmacist, who (sitting in front of a pile of IHP supplies that arrived two days ago) was pleased to tell us how important donated medicines are for the ongoing work! Day two Despite the 35-degree heat, we’ve had another productive day, travelling to Namulenga Health Centre, 50km south of Blantyre, in the rural district of Thuchila close to the Mozambique border. Public transport in rural Malawi is non-existent, so our host Intercare took us out in an ambulance. With no padded seats – only wooden benches – this was our first experience of non-tarmac roads in Malawi... it was a bumpy ride! Namulenga Health Centre lacks resources and faces many limitations and challenges. For a start, it has no doctors or clinical officers. Instead, there’s a team of six nurses, one pharmacist and one medical assistant (who is two years into training to be a doctor). This team facilitates treatments for a catchment area that covers more than 10,000 people. There are often electricity blackouts, and the centre has no borehole of its own (for water). We were given a tour of the centre’s pharmacy and saw how donations – distributed by Intercare, and including some from IHP (bendroflumethiazide, multivitamins and ear thermometers) – are being stored and used. The level of need was very obvious: this community needs donated medicines. The health centre has no money of its own and receives only limited medicines and supplies from Malawi’s ministry of health, mainly treatments for HIV and tuberculosis. When it can, it does purchase other medicines, but it can only prescribe these to patients who can afford to pay for them. This means that those in the community who can’t afford the cost of medicines – and may need medicines the most – can only be treated with medicines that the centre receives as donations, from IHP and others The nurses introduced us to a couple of patients. One had had a baby two days ago and told us she cycled to the health centre (8km) while in active labour. Another was treated using an IHP-donated ear thermometer. In the afternoon, we met with our partner Project HOPE’s senior technical advisor in Malawi. This provided useful context both to Project HOPE’s work and to the wider healthcare context here.