At breakfast in the hotel we are joined by Alex, a freelance journalist who used to work as a media officer for Oxfam after being a journalist and returned to the third estate a few years ago. (He was once a war correspondent after starting out as an arts writer - interesting career move).
After picking up a local Oxfam co-ordinator, Steve, from a regional office we drive further into the countryside of the Chiradzulu district to visit an Oxfam livelihoods and HIV/AIDS project.
We travel over increasingly bumpy roads that test both the 4x4 and Patrick. We are only 20 km from Blantyre but it might as well be a different plant. There is no air conditioning or internet access here. We are increasingly stared at as the vehicles make their precarious way to a village.
Upon arrival we are been greeted by a group of 20 or so women, dressed in anti-AIDS campaign t-shirts and chitenje, the colourful, sarong-like skirts that most women, especially in the country, wear. (Until quite recently it was illegal for women to wear short skirts or trousers and I have only seen a handful wearing jeans or skirts that do not come down to their ankles).
They are dancing and singing songs warning about AIDS in a way that most Europeans would fail miserably at, but it seems totally at home here. After some minutes the singing ends and Steve translates for us from the commonly spoken local (actually the national) language Chichewa. He, in common with most Malawians, speaks very good English.
The setting is quite formal; we all introduce ourselves in turn before discussing the work that Oxfam has done in the village. When we shake hands many people use the more formal handshake, where you touch your forearm with your spare hand while shaking with the other....
It is the first time that white people have visited the village and we must be the first white that many of the children have seen, which would explain the slightly baffled look on many faces.
But taking pictures on digital cameras that the villages can see for themselves makes us very popular. Initially shy, many of the children become bolder and bolder as we take their picture. One young man who is clearly aware of his good looks cannot be photographed enough.....
At first around twenty odd people have gathered; 30 minutes later it is more like 60, with more women and children than men. The two sexes sit separately. There is a noticeable lack of people in their 20s and 30s, many more people who are too old to have been exposed to AIDS and lots of children.....
Oxfam's work includes food aid in the hungry months, teaching better farm management so food is left over, donating herbicides and pest resistant seeds so work in the field is less labour intensive and giving goats to orphans and other vulnerable people. Many of them are in evidence as we talk.
We later meet two nurses, Toko and Shadwick, who work with Steve on providing local care; vital when the nearest state clinic is about 15 km and an ambulance bike, of which the village is proud but which must be unusable in bad weather, may be the only means of getting anyone to help.
Of their 2001 class at nursing college, half are now working in the UK.. They say they prefer to stay in Malawi and help Malawi but even after the DFID contribution their salary (35,000 kwacha) is around half what they think could constitute a living wage..........
Among others the village has an AIDS committee who work with affected people and those left behind and a home care committee who provide care to those with AIDS and other conditions.
But despite this work and the anti Edzi (AIDS) t-shirts, a real stigma is still attached.to being affected by the virus. When asked how many people present have been affected by AIDS in their families, only six people put their hands up, although Jessica, a member of the AIDS committee, estimates that around half the village may be infected.
The head of the committee Linda estimates that around 30 people a year die in the village. Infection rates are exacerbated by women working for extra cash as sex workers in Blantyre when they visit the town to sell vegetables. In this, a village of. around 800, there are at the last count 52 children orphaned by AIDS. The week before it had been 48.
We meet four such children, four girls aged seven, nine, 12 and 25 at their home. Children are counted as orphans if only the mother dies as property belongs to the women and the father usually, as in this case, moves on. Their mother died of AIDS and their father has remarried in another village and not been back since.
The younger girls are very small for their age and quite grubby, but seem cared for. They are lucky to have their older sister........
There is more singing and dancing as we prepare to leave - we are now running very late - but the joyous mood of this amazing experience fades when out of nowhere a small boy is shoved in front of us. He is grubby, dressed in filthy clothes and is head and face are covered with sores. There is an open wound on his leg and he is hot to the touch.
Pretty much everyone else that we have met looked clean, cared for and well. This is a shocking contrast as this little boy, whose name is Samway, is clearly not being cared for and seems seriously ill. Later we ask Shendra to get Steve to check up on him.....
As if we have not seen enough for one day on the road back to Lilongwe Patrick tells us that we are actually driving next to Mozambique. Although there is a border patrol a few miles on here, there is no fence or wall to mark one country from another...We have to stop and get our pictures taken standing in another country...
Later when we meet Dorothy Ngoma, the feisty executive director of the Nurses Association of Malawi. She explains the truly horrendous circumstances in which nurses often work in rural areas; where there are no doctors and they may be the only member of staff in a district clinic with 100 patients.
They have to deal with all health problems and are expected to be on duty 24/7 by villages who have no one else to turn to, but resources are so scarce that they may not even have gloves to wear on their hands and often have to wear sugar bags for protection while delivering babies........
It is beginning to become clear why Malawi has the third worst maternal mortality rate in the world..
The average length of time to work in such circumstances, with no leave as there is no one to cover, is five years. Dorothy knows of nurses who have worked for 15 years and in one case even up to 25 years in such set ups.....
In the face of such challenges it is unsurprising that in addition to moving to the UK - not now to work in the NHS but for private agencies, often in nursing homes - nurses often prefer to work for private clinics run by charitable or non-government organisations. ....
Dorothy also tells us about 'pertroda', slang for a petrol station that has become the term for nurses working 24 hour shifts. There used to be three shifts but shortages of nurses means there are now two. Working for 24-hour shifts is not allowed, but nurses often move from one ward to another for a different shift or from a private to a government-run hospital.......
Unsurprisingly accidents and mistakes by nurses are common; some are being attacked by the friends and family of patients when they feel their relatives are not getting enough attention....
Karen wants to talk to Dorothy about the outdated, colonialism-tinged attitude to nurse training. Nurse technicians, similar to the former enrolled nurses in the UK,. are paid considerably less than registered nurses even though they are trained for. almost as long and sound just as competent - both must be midwives for instance. The extra years of training needed to be a registered nurse means that there are fewer of them but there is deep protectionism of the system.......
The association has used the DFID initiative to massively increase its membership from 50 to 12,500. Unofficial industrial unrest has also been brewing; the ring leader of a wild cat strike at Zomba Hospital has been summarily dispatched to a Northern district clinic at short notice.......
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