Highway M-1 snakes across the level surface of the Lilongwe Plateau. A little way south of the capital city of Lilongwe it begins a slight roll as the road surface moves closer to the southern end of the Great Rift Valley. As it crosses the river that divides the Lilongwe District from the Dedza District, the highway begins the climb into the mountains that surround the Dedza Trading Center. Curves caution the driver to the slow down, and mountain crevices beckon the careless driver to serious injury or possible death. Guard rails are seldom seen and remembrance of those who have died along this stretch of road remain in the hearts of those who loved them.
Deadly Stretch of Road
The seriousness of this stretch of road and its high accident rate is not lost on the doctor sitting across the desk. The concern seems to etch itself deeper into his forehead as Dr. Thomas Clayhon Salim responds to a question about the preparedness of this heath care facility in the case of a critical road accident or emergency. "We are the only facility in the region and we are not at all prepared," he responds sadly. "We have no equipment or supplies to handle these kinds of problems even though we have a
staff of doctors that stand ready to do the job."
The Staff is on Call
His response is surprising and unexpected, and it is unlike the response usually received from medical professionals in most outlying hospitals. Usually they point out that they have neither the equipment, nor the trained staff to handle the cases that need a trauma or critical care unit. In this case it is not a matter of staffing. It is a matter of not having the building and the equipment. The staff is here waiting.
The Dedza District is positioned in the very center of the country and the hospital is located on the northwest side of the Dedza Trading Center not far from M-1, the main highway through the nation. It is a community not unlike large numbers of African trading centers all over the sub-Sahara. Humanity spilling out over a very compressed land mass, tiny shops that vie for attention along a pot holed, dust filled, narrow street, and the tiny overfilled, under-equipped, one story hospital that hides in embarrassment behind the long brick fence. 
Thousands of Patients
This hospital serves a geographical area of 668,571 people, plus "a large number of people from Mozambique who come into Malawi from just across the border to obtain heath care", reports Dr. Salim.
No Critical Care Unit
The doctor lists 33 health care facilities in the District, including 11 church related facilities, 20 government heath centers, one government rural hospital, and one mission hospital. The district sits pre-cautiously atop this feeder system where any case that cannot be handled down the line in these other facilities ends up in one of the 250 beds at Dedza. The doctor is quick to list supplies and equipment unavailable or in short supply in their facility. "No equipment to test for diabetics, no ability to test kidney and liver functions, no ability to do A.R.V. tests, short of bed linens, beds, mattresses, all types of delivery supplies, gurneys, back table supplies, rubber gloves. We need them all. We have no ultra sound and no CT scan. We have 68 beds in pediatrics, 20 in
OB and the rest are general. Everywhere we are short. If there is a major accident along the highway there is no high dependence or critical care unit. They must go to Lilongwe and this can take up to 11/2 to 2 hours to get them into Kamuzu Central Hospital. This is far too long if they have been badly hurt," the doctor noted.
After punctuating the need for a critical care unit the conversation moves to the needs in order to complete the facility.
Finding a Way
At the top of the agenda is a building to house the equipment, beds and patients. It will need to be next to the present surgery theater. During the conversation Dorothy Kamalizeni, a District Nursing Officer sits next to the doctor, and they both become caught up in the excitement as the dream for a critical care unit begins to take shape. Various ideas come into focus, and a concrete proposal begins to form. The concept is for the medical establishment to seek the help of the business establishment to join the Town Council and the Traditional Authority to gain community support to insure the construction of the building. When this begins to move forward the Malawi Project will seek the needed equipment and supplies to make the new building into the medical care unit.
While these ideas are being discussed and the plans being formulated, just a little over a mile away, traffic linking the highly populated southern region with the central and northern regions continues to rush past the Trading Center. It is on a road through the mountains that is far too narrow, with curves far too sharp, and mountain ravines far too steep and deep. Everyone knows it is just a matter of time before another major road accident occurs, an ox-cart or ambulance comes from a remote village with a critically ill person, or a mother and baby fight for survival as a birth goes bad in the maternity part of the hospital. Dr. Salim is hoping the new building will be completed before more people die because the hospital does not have adequate care for them.