Malawians face a daunting HIV epidemic and high rates of infant and maternal mortality, while quality care is scarcely available or unaffordable for most people. Those who can pay for treatment are often unable to reach clinics, especially over mountainous terrain and barely passable roads in remote areas. In the rural, southern district of Neno, where Partners In Health has worked since 2007, “remote” definitely applies. Patients sometimes ford rivers to reach a health facility. In the rainy season, from November to April, staff often have to use a dune buggy to reach clinics. The geographic challenges have fostered a model of integrated care, in which clinics offer treatment for many conditions—not only HIV, but also hypertension, diabetes, malnutrition and mental illness, for example—so patients can make the most out of lengthy trips or rare visits.
