Nursing in Malawi

I accompanied the medicine writer, Christine Gorman to Malawi in Southern Africa in August 2008. Christine was a Nieman Fellow for Global Health Reporting at Harvard University . There is a tremendous and growing shortage of doctors, nurses and other health care workers worldwide. Malawi, a small, land-locked country in southeastern Africa, has just one doctor per 50,000 people one of the lowest levels in the world. While nurses are trained every year, some leave the country annually to seek employment in other countries. We tried to tell the story of what Malawi is doing to hold on to its nurses and what their lives are like. Beyond that, I photographed the world around me.

The Hospitals

"One hospital we visited, the Embangweni Mission hospital compound consists of several dozen terracotta-brick buildings and outer buildings surrounded by a terracotta-brick wall. Although the staff have told the community they need to keep the chickens out, there always seem to be a few hens clucking about on the grounds. Currently, Embangweni has about 130 beds plus mats for about 60 expectant mothers. Each inpatient, however, is typically accompanied by at least one and often two or three relatives. On average, the hospital has about 4500 to 5000 inpatient admissions each year and three times as many outpatient visits. That's not counting all the folks seen by the health centers and the mobile clinics. Being admitted to a hospital alone is practically unheard of. For one thing, there is no facility to serve meals, so relatives bring food and water (there is a bore hole on the compound). Nurses hand over pills to each patient's caregiver or guardian and watch as the medicine is swallowed with water drawn by the caregiver. As odd as the system seems, it works. Given the personnel shortage, it would be criminal to try to keep friends and relatives out. Its hospital policy to let one guardian sleep on the floor next to each patient. Others sleep outside the compound in the guardian shelter. Moms sleep with their children in the beds on the pediatric ward. Children six and up are admitted to the adult wards which isn't ideal and the Embangweni staff know it. There are plans for a new ward for kids 6-to-13 years old provided funding comes through, etc." -Christine Gorman

Mobile Clinics

"Just back from three hours on bumpy, dusty roads into the hills right on the border with Mozambique. What a blast and am I ever glad I don't have to do that every day! We packed into the back of an ambulance with Matilda Nyambo and her team from Neno District Hospital and climbed up a rocky, dusty road to the hillside village of Chilimbonde in the Dambe Traditional Authority. Seems every nurse who goes on a mobile clinic is part actress and Matilda is no exception. I enjoyed watching her engage the group of 100-plus women and children and listen to them laugh at some of her pantomines.

Of course every good act needs an opener; there was singing and a lecture on the use of bed nets to prevent the transmission of malaria. Because the bednets are donated they can only be given to mothers with children under the age of a year. And yet, everyone seems to want them.

Already many people lined up in different areas under the trees. One section for weighing babies, followed by the delivery of World Food Program soya flour and palm oil. The women stretched a cloth out on the ground, a bucketful of meal was placed in a heap on the cloth and then a large cup full of oil was poured into the center of the meal, everything then wrapped up and carried home that way." - Christine Gorman


Traditional healing still competes with modern medicine in Malawi. These are witch doctors, photographed through the car window because the driver thought it was dangerous to get out.

Death in Malawi

HIV, lower respiratory infections, and malaria are the three leading causes of death. AIDS alone kills eight Malawians every hour the primary cause of death among adults in Malawi, and a major factor in the country's low life expectancy of just 43 years. HIV is still a taboo subject in many communities within Malawi, and discrimination is common. As a result, few people living with HIV make their status known, many have difficulty discussing the subject with their families, and some support groups do not meet openly. The man whose funeral I attended, at the request of the hospital gatekeeper, may or may not have died from AIDS; it didn't seem appropriate for me to ask.

Malawian Nurses At Home

Cities are much livelier and more appealing places than Malawi's remote rural areas, so nurses tend to prefer working there. To lure them away from urban areas, rural hospitals offer amenities like subsidized housing. These communities of nurses and their families give a snapshot of reasonably comfortable middle-class life in one of Africa's poorest countries'a striking contrast to the images of death, disease and despair that lead many Westerners to think that's all there is to Africa