Malawi is a small landlocked country in central Africa, sharing borders with Tanzania, Zambia and Mozambique. The Great Rift Valley runs through the country, in the basin of which lies the 365 mile-long Lake Malawi. From 1891 the land that is now called Malawi was known as the British Protectorate of Nyassaland. It gained independence in 1964. Its leader after independence was Kamuzu Hastings Banda whose one-party rule was tightly controlling. The first multiparty elections took place in 1994, and since 1995 the country has had a democratic constitution.

Malawi is a densely populated country where most people live by subsistence agriculture. 85% of the population is rural, and have been severely affected by several years of poor harvest and drought. The country’s main export is tobacco, which it sells as leaves, rather than in processed form. 70% of the country’s export earnings come from tobacco, which makes the whole country vulnerable to fluctuations in the global price of tobacco which has been falling, and the global tightening of restritions on tobacco consumption. As a result, the country is heavily dependent on aid for its social spending.

Many households in Malawi are poor; four in five households live in residences with floors made of earth, sand or dung, and 89% of households use wood or straw for cooking. There is a great difference in living conditions between urban and rural areas. Whereas 30% of urban dwellings have access to electricity, only 7 % of rural households do so. Surrounding the major cities of Lilongwe and Blantyre are extensive slum areas, where housing conditions are poor.

In 1994, the government introduced free primary education. This has, in subsequent years, led to an increase in enrolment in primary education for both boys and girls. Now 86% of children complete primary education, though girls drop out sooner than boys, often because of domestic responsibilities.

Child mortality is high, at about 86 deaths for every 1000 live births, and life expectancy is only 50. This is low because so many children die early in life. HIV affects 11.9 % of the population, with higher rates in urban than in rural areas. 70% of adult patients in hospital beds have HIV. The disease places a huge burden on the economy, as young adults are infected in their prime. The country does have a programme for offering anti-retroviral treatment, but accessing this treatment is difficult for people who live far from health facilities and must give up productive farming time to seek health care. Other illnesses often accompany HIV, and tuberculosis (TB) is particularly common and disabling.

I was in Malawi for 5 months in 2007, with my wife. Whilst she undertook health related research, I carried out a photographic project for a Malawian non-governmental organisation called the REACH Trust. The REACH trust researches issues about equity and access to health care for the people of Malawi, particularly related to services for TB and HIV. My role was to help the organisation to develop an image database which it could use to illustrate and publicise its work.

Many of my photos document the health system and the informal, community based structures that support it. In particular, I spent much time with a community based organisation called Paradiso whose volunteers supported patients with TB and HIV in their homes. These volunteers are called ‘home based carers’ and are a critical link in the care system in resource-poor setting such as Malawi. They visit patients in their homes, remind them to take their tablets, and provide community education through music, dance and drama about health issues, gender-based violence, the dangers of alcohol misuse and so on. Their work is voluntary, and they weave it in and out of their busy lives. Solidarity amongst the home based carers gives them the energy and companionship to carry on.

In addition to my project for the REACH Trust, I worked as a volunteer in a primary school in one of Lilongwe’s slums called ‘Area 56.’ The school was a ‘private school’ where, for a fee, children could attend classes of 40 or so children, rather than classes of 200 children as in the state schools.

As well as supporting the teaching,I took a strong interest in the life of the slum population, getting to know the rhythm of the community and its activities, and the many resourcefully ways the community members found to make ends meet. Again, my photos document this experience.

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