Table of Contents
Excerpts from the
Annual Report 1999
The aim of Livingstonia Synod Health Programs is better health for the communities we
serve and a clear Christian Witness to the love of God.
History and Location
Embangweni Hospital is a 134 bed hospital located in the southern part of Mzimba
district in northern Malawi. Its catchment area is bounded by the Zambian border on the
west and south, the M-1 highway (main north-south road in Malawi) on the east, and by
Moses Chilenge and Emazwini villages to the north. The hospital serves a population of
about 100,000 people, with referral cases often coming from much further away,
including Zambia. It also operates remote health centers located in Kalikumbi, Mbiri, and
Mpasazi, though the latter was closed during much of 1999. Travel throughout the
Embangweni region can be difficult, especially during the rainy months, November to April.
The only access to the M- 1, a distance of 30 km, is by either the Jenda or Perekezi
Forest dirt roads. While the terrain surrounding Embangweni is best described as flat
savannah, it is a beautiful area, situated at an altitude of 4,000 feet.
Work to establish Embangweni Station, formerly called Loudon, was begun by Reverend Donald
Fraser and his wife, Dr. Agnes Fraser, missionaries of the Free Church of Scotland, at the
end of the 19th century. Clinical work by Dr. Fraser, a friend of Dr. David Livingstone,
began in 1902. In 1926, under the direction of Dr. W. Turner, the facility expanded to
become a rural hospital. Additional buildings were constructed in 1924 and 1940; a
maternity ward was added in 1966. During the 1970s, the hospital doubled its size from 38
to 77 beds. Then in 1989 under the ministry of Dr. Kenneth and Mrs. Nancy McGill, the
hospital greatly expanded its facilities and its services to include separate buildings
for maternity, pediatrics, male and female general care, as well as a small operating
theater for limited surgeries and caesarian-section deliveries.
With a population nearing twelve million people, of which 85% live in rural areas,
Malawi is one of the worlds poorest countries. In the northern region, where
Embangweni lies, population is less dense than to the South, but it faces many of the
population pressures consistent with underdeveloped countries. Population growth,
estimated to be about three percent per year (fertility rate of six children per woman)
represents too many children born to women at too early an age, too late in life, or too
close together. Another critical related problem is that most of the suitable land
is already under cultivation. Reliant on rain-dependent crops, not only for subsistence
but also as a means to hard currency, Malawians grow maize, tea, coffee, tobacco, cotton,
and groundnuts. Tobacco remains the major export crop, accounting for 85% of export
income. GNP per capita remains at less than US$170.
The lack of enough food and lack of nourishing food contributes to a high morbidity and
mortality rate among children. Almost half of children under the age of five are stunted
in their growth, suggesting a high prevalence of malnutrition. The maternal mortality rate
in Malawi, according to WHO/UNICEFs 1990 report, is 560/100,000 live births. Child
mortality (under five) and infant mortality (under one) rates remain among the highest in
the world, at 217 and 137/1000, respectively. Simply put, one in four children do not live
to the age of five.
Life expectancy at birth is down to 41 years, principally due to the outbreak of HIV/AIDS.
There are an estimated 710,000 people infected with the virus, a national infection rate
of close to 15 percent (WHO 1998). At Embangweni hospital, it is believed that one out of
three patients treated is affected by HIV/AIDS.
Literacy in Malawi is low. About half of all women (perhaps 80% in rural areas) are
functionally illiterate or have not attended schools. About 70% of the men are literate,
though only about 4.5% of those attending primary schools are able to continue on to
SOURCE: UN AIDS/WHO Epidemiological Fact Sheet -- Malawi, 1998
Overview of Hospital and Health Center Services
Embangweni Hospital and its Health Centers, including their out-patient care and
maternity wards, continue to be busy. In 1999, the hospital, in conjunction with the
Health Centers, provided 36,613 inpatient days, 36,452 outpatient visits, and 8,325
well-child and antenatal visits with 1,647 children delivered. In the surgical theater,
there were over 1,000 major and minor surgical procedures performed. The hospitals
health care services are led by a combination of two to three expatriate doctors and two
Malawian clinical officers, as well as a cadre of skilled medical assistants, trained
nurses, and additional trained allied workers, who together direct a dedicated hospital
and its three health centers staffs, bringing the total number of workers to over
130. Based on reputation, the hospital remains incredibly busy. Given its remoteness, as
well as the many transport hardships encountered by Malawians in accessing services, wards
are often near capacity.
In addition, health services go to the people. Important outreach deliveryoccurs in 16
village centres who are served by mobile clinics. Immunizations (over 30,000) and growth
monitoring, family planning and contraceptives distribution, antenatal visits for pregnant
women, malaria prevention (bed net programming), and the Drug Revolving Fund (distribution
of five different drugs for simple ailments, collection of payments, and purchase of more
drugs for more distribution), make up important Primary Health Care (PHC) programming.
Networking through community health committees within each of these centers is the system
for dissemination of health information to whole groups of people in our catchment area.
Trained traditional birth attendants provide the final extension of health workers.
In addition to the outreach services, essential Primary Health Care (PHC) work at
Embangweni includes malaria, tuberculosis, and AIDS Control programs and the Nutritional
Rehabilitation Unit (NRU). Between eight and nine thousand meals (malnourished children
are served six meals a day) are provided to women and children staying in the NRU for
ongoing treatment of diseases of malnourishment. A demonstration garden, showing the best
agricultural practices, provides the harvest to be used by the home craft workers for food
and instructing mothers on diet, nutrition, and food preparation.
To keep the Station operational, an impressive Projects Department works hard to maintain
facilities, including staff homes, and to oversee new capital projects. Importantly, it
also oversees the Shallow Wells program, in cooperation with Marion Medical Mission who
has helped build over 1000 wells for people of Malawi since 1991. Knowing first-hand the
relationship of good health and clean water, this station is proud of this public health
intervention so generously supplied by churches and workers from the US.
From clinical officer to village health committee member, a model of integrated health
care has been effected at Embangweni, inspired by vision of Gods love and healthy
people, with the hope that Malawians will be empowered to take responsibility for their
own health and the development of their communities.
Specific Services Provided
|Male and Female Ward|
|Premature Baby Care|
|Select Surgical Services|
|Primary Health Care|
Top Five Inpatient Diagnosis By Ward
||-Complications of pregnancy
Continuing with its goal to attract Malawian clinical and medical officers, 1999
brought to Embangweni two outstanding Clinical Officer interns: Lillian Gondwe and Kennedy
Chirwa, both graduates of the Malawi College of Health Sciences in Lilongwe. Well trained,
both are able to provide top quality in- and out-patient care, as well as provide
obstetrical care, along with some surgeries. In addition, Embangweni Station continues to
be staffed by four medical assistants, including those in-charge at our remote Health
Expatriate physicians include Dr. Neil Kennedy (Sara and Ben) from Presbyterian Church of
Ireland in his third year; Dr. Martha Sommers from Presbyterian Church USA in her second
year; and Dr. George Poehlman (Betty) also from Presbyterian Church USA, arriving in
October. In November, Dr. Cosimo Storniolo (Meredith, Ninah, Sarah, Norah, and Baby
Isabella) completed their three year term in Embangweni, returning to the US.
We were very pleased to receive five fully qualified, newly graduated Malawian Enrolled
Nurses! Midwives to our staff in 1999. Other new staff members include: new pharmacy
assistant, new laboratory assistant, new dental assistant, new UN AIDS volunteer, new
assistant environmental health worker in PHC, new station Maintenance Officer, and two new
Primary Health Care
Activities of the Primary Health Care Department remain central to community health --
the hope for sustained changes in the health status of Embangweni Stations people.
Led by Joyce Ngoma and assisted by Jodi McGill, MN, MPH, program development
continues and program activity is monitored. Impact of programming in PHC is easily
recognized -- when the communities are ble to take charge of their own health!
An overview of PHCs 1999 calendar describes the myriad efforts of this Department to
improve the health of Malawians: In January, Joyce went for a three day Traditional Birth
Attendant supervisory training. Global Health Action visited to discuss future
programming with PHC . . February found Joyce co-facilitating Training for Transformation
for Synod hospitals, training she received the previous year through Global Health Action
of the US. Drug Revolving Fund volunteers from communities received four day training . .
In March, in-service training for homecraft workers who direct the activities of
the Nutritional Rehabilitation Unit started. Hoping to improve the cognitive
development of children "shut down" by their malnourished state, they explored
"crafting" and use of visual stimulation . . . .In April, Drug Revolving Fund
training continued with workers learning more about simple ailments that can be diagnosed
and treated with simple drugs at home in the community. Insecticide Treated Materials (MM)
training took place over six days within the month....
Health Surveillance Assistants were brought in during May for briefing.... With crops
planted and harvest underway, June, July, and August saw increased community Training For
Transformation for villages throughout our catchment area. The hope is to empower
communities, through community leadership, to take charge of its peoples health.
This kind of health effort, at the moment, is our best tool in disease prevention
and control of the spread of HIV/AIDS HIV workshops were conducted in surrounding
communities focusing on HIV counseling training. In October, a full month was devoted to
training 17 Traditional Birth Attendants for improved monitoring of prenatal status of
village women as well as improved methods in labor and delivery. Breast Feeding refresher
courses were available to all the community support groups.... Margaret Sinumbe, a UN
volunteer AIDS worker, arrived for a year stay to help in the expansion of AIDS community
trainings . . . . In December, training of volunteers in remote villages who monitor
growth of children was conducted. Additional trainings included neonatal resuscitation for
In addition to these efforts, which are designed to encourage sustainable,
community-generated and community based programs, work at Embangweni Hospital remains
constant. There are family planning services to oversee, both at Embangweni, at health
centers, and remote sites; there is the Synod-wide initiative, Malaria and Mosquito Bed
Nets program, intended to aid in the prevention of malaria-laden mosquito bites and
reduction in cases of malaria, still the leading cause of death in children; there is the
ongoing Baby Friendly Hospital exclusive breastfeeding program, a WHO/UNICEF initiative,
to reduce the high rate of infant diseases and perinatal mortality due to gastrointestinal
diseases. The important network of 16 mobile clinic continues, each a half-day to full-day
event, that includes a health talk followed by visits with antenatal mothers and children
under five. Children receive their vaccinations and have their growth monitored; mothers
learn family spacing options and receive help in birth control. Finally, the work of the
Nutritional Rehabilitation Unit/Food Program continues to reduce the suffering of little
children. Over 9,000 meals were served to malnourished children, referred to NRU
from their villages or by medical staff. The NRU demonstration garden, which provides
lessons in agriculture and food for patients, doubled in size, and the goat population,
whose milk serves as an alternate protein source, also increased. An agri-forester was
added to our part-time workers to help in reforestation efforts around the area, as well
as promote programs of food security.