The DREAM centre of Mthengo wa Ntenga, on the outskirts of Lilongwe, the capital of Malawi, is situated in the heart of vast territory dotted with many small villages that are very poor and completely deprived of health centres.

Many of our patients cover long distances on foot to come to us (the cost of transport, wherever minibus services are available, is in fact prohibitive, given that fuel costs as much as it does in Europe). But patients anyhow strive to come because they have found great hope in us. Stories are beginning to spread through the villages, of sick people who have started to live again thanks to antiretroviral treatment. Moreover, the fact that more than 70 children have been born healthy within the programme of vertical prevention is really good news for people who seem to have been forgotten by everyone.

 
The mother of Phemphero (his name means “prayer” in Chichewa, the language of Malawi) is one of many women who travel a long way. In order to get treatment for her son, she leaves a day early from her village, walks for 20km and stops to spend the night somewhere half-way through the journey. She starts walking again early the following morning to reach the largest centre from where she can take a minibus that will bring her, on time, for her appointment with the doctor and delivery of medicine. So far, this woman has not missed a single appointment, her child is well and it could be said that Phemphero is really an answered prayer, thanks to the faith and constancy of his mother, as well as her joy and the joy of all those who love them.

The road is long for Janete too, who lives in Mozambique on the border with Malawi. One day, she crossed the border to go to Dedza township, and an acquaintance noticed sores on her skin caused by Kaposi’s sarcoma. The acquaintance told her she had also been there, but now she was undergoing treatment at the Mthenga DREAM centre and she was well… And so Janet decided to come to us. She found our centre, started therapy and since then she has not missed a single appointment, although she has to walk for five hours to reach us.

These stories of great dedication and hope but also of considerable difficulty and toil raised questions for us. DREAM aims to create a model characterized by access to treatment, even and especially for people living in rural areas, who are already at far too much of a disadvantage in many aspects (and we should not forget that this is the prevalent reality in Africa). Faced with all these stories, we started to offer treatment and vertical prevention services at the Dzoole health centre as from October, precisely to facilitate access to antiretroviral treatment for as many people as possible.

The Dzoole area covers dozens of small villages inhabited by around 30,000 people including 8,000 who are minors aged 15 years. Visiting some of our patients who live there through the home care service, we had the opportunity to observe conditions in this area and to get an idea of prevalent needs. However, we decided to meet the village head several times, as well as those running the health centre and maternity clinic, to better understand, from what they said, the life and needs of these people, to agree together about the modality of our intervention.