The mission hospital at Embangweni provides the only medical care within its catchment area, which contains approximately 90,000 people. The hospital was established early in this century and is a positive force for providing care for both the body and the soul. The Christian emphasis is evident everywhere: from daily 7:00 am chapel to prayer offered before the start of each surgery.
The hospital is partially supported by the Presbyterian Church USA. See their link for some historical background.
Compared to American health facilities, conditions at the hospital are
minimal. The only electric power comes from solar panels which feed into
large storage batteries. Within the administration building, there is usually
enough power to run the internal phone system (used mostly to call doctors
to nighttime emergencies) and a computer and printer. Power also serves
the operating theatre for lighting and the x-ray and ultrasound machines.
The wards, pharmacy and chapel have no electricity. There is diesel back-up
available for the generators during the rainy season when solar power is
limited. The hospital also has the world's first solar sterilizer. A solar
still produces distilled water for use in this sterilizer.
The Embangweni hospital is arranged in a campus-type layout, with separate
buildings for each type of problem or group of people. There is a maternity
ward, a men's ward, women's ward, pediatric ward, tuberculosis ward, a
surgery theatre 
and
a nutritional rehabilitation unit (NRU). The administration building, chapel
and pharmacy/out-patient building complete the campus. There is a total
of 120 beds, but the actual patient census often exceeds that. The NRU
actually has no beds; mothers and babies sleep on bamboo mats spread on
the concrete floor. Outside the hospital wall is an area for "guardians"
to cook and sleep: the medical staff does not provide patient care here.
Each patient is accompanied by a family member who cooks and feeds the
patient, attends to their daily care needs and generally keeps them comfortable.
Since patients tend to stay for long periods of time (weeks or even months),
this places an incredible burden on the family member who must be gone
from the home.
Much of the hospital's work is concerned with children and maternal
care. 
The
public health nurses struggle in outlying clinics and villages to encourage
child spacing. This is very difficult due to a high infant mortality rate
and the culture which places a high value on large families and where taking
of multiple wives is not uncommon. Poor overall nutrition affects maternal
health, with the result that many babies are born with low birth weights.
The hospital encourages mothers to stay at the hospital until the baby
reaches a weight of 2 kilograms and uses a system of "prizes"
given to graduating mothers as a way to reach that goal. We were able to
bring a number of quilts donated by Girl Scouts and Colorado quilters which
were being used as prizes; other items include lengths of cloth, knitted
or crocheted layette items and the like.
If the baby survives the first months of infancy, numerous problems lie in wait and contribute to the 30% mortality rate. Malaria is often deadly to children under 5 years; older Malawians have built up an immunity. They still get malaria, but it usually does not prove fatal. A project is presently underway to encourage families to buy and use bed nets for young children. Children are immunized against common diseases, but problems with vaccine and administration frequently makes immunization unreliable. A measles outbreak in May, 1997 lead to a re-immunization program for all children under age 10. Cerebral meningitis is common; chronic ear infections lead to deafness in many children.
The problem of poor nutrition is rampant. In the hospital's Nutritional Rehabilitation Unit, mothers live with their malnourished children and learn how to provide more nutritious food. A large part of the problem is the preferred diet of nsima, a thick corn porridge. While very filling, nsima provides limited nutrition, with the result that children develop kwash --- malnutrition from lack of protein, although basic caloric intake may be adequate. NRU grows a demonstration garden containing soya, beans and other vegetables; maintains a small goat herd for milk and raises rabbits and chickens as a source of protein. When mothers and babies graduate from NRU, they are given vegetable seeds to grow at home.