By Cassie Farrell Alvin's Guide To Good Business, BBC World, Neno, Malawi |
 Poverty and disease means many in Malawi need urgent help |
The weekly HIV clinic is teeming with patients of all ages, from babies to grand-parents.
A health care worker is questioning one of them about their social and economic background.
He writes down an increasingly grim litany.
Education - none, job - none, children - many, rooms in mud hut - too few.
It is clear that these are people in need.
In Malawi, one in eight adults are infected with HIV.
But drugs alone may not be the answer to this deadly scourge.
Care in the community
In Neno, a remote area in southern Malawi, poverty and HIV are both rampant.
 Edna has created a new life for herself and her children |
There are clutches of straw roofed huts, neglected villages and abandoned crops.
People here are obviously very poor. It is the recipe for a major health crisis, one that is far beyond the resources of the government to cope with.
But in the last three years, they have joined forces with Partners In Health (PIH), a social enterprise dedicated to providing quality health care to the world's poorest people.
PIH believes that social factors are as important as medical ones.
They do not just offer medical care, but practical help as well. They argue that the poor need food, homes, work and education in order to stay healthy, not just tablets and surgery.
This means that a lot of their work does not take place in hospitals, but out in the community.
New life
Edna Joseph was taken in by PIH after she was diagnosed with HIV. Tiny and hunched, she is wasted by the disease and moves with difficulty.
 |  I am so happy not to have to sleep in a house with a leaking roof any more  Edna Joseph |
Seventeen-year-old Edna was married at the age of 13 and has two small children.
Her husband was adult when she met him.
After being diagnosed with HIV and suffering abuse from both husband and in-laws, she was turned out of the marital home.
She returned to her mother's home, but her parents were in no position to support her.
PIH was prescribed anti-retroviral drugs to control the illness, as well as given the food she needed to make the medicines effective.
PIH also built her a tin-roofed house with two bedrooms so she could start to re-build a life for herself and her children.
"When I moved into my new house," said Edna, "I sang a song to say I am so happy not to have to sleep in a house with a leaking roof any more."
Food enterprise
PIH also helps patients get jobs.
But with little formal employment, they have to do this by giving them grants to set up their own businesses.
| Partners In Health Operates health systems in 12 different countries Raises around $65m in donation Serves 2.3 million people Source: Partners In Health |
In a nearby town, a group of 15 women recently set up their own restaurant with the support of PIH.
They are former prostitutes, and all are HIV positive.
The women, all on anti-retroviral medication, wanted a business, not only to provide money to live on, but to give them a sense of pride in themselves.
Good food is essential for HIV positive patients, but the local diet is generally poor.
The staple food is "sima", a maize flour mixed with water.
Its nutritional value is negligible and PIH has started programmes to encourage people to both grow and eat a wide variety of vegetables.
But growing vegetables takes a lot of water, a scarce commodity. One of the projects here failed simply because it lacked a proper well.
Successful business
The restaurant, named Peace, has been a tremendous success.
| Malawi Population: 15,263,000 (est.) HIV prevalence: 11.9% Life expectancy: 52.9 years Source: UN Department of Economic and Social Affairs |
The rota is in place, Florence has a new right-hand woman named Ivy and, most importantly of all, the cooking is delicious.
The women are already turning a profit but their goal is even more ambitious. They want to be self-sustaining by the end of the month.
Soon after that, they hope to see their turnover top $200 a day - a staggering amount in Malawi.
Pride and hope
The investment PIH has put into Malawi has been enormous. They have built two brand new district hospitals equipped with wards and operating theatres.
The money comes from a partnership between Partners in Health and the Malawian government, and the running of the hospital will become the sole responsibility of the government within the next five years.
But the best and the most visible return on their investment is Edna's shy smile.
The medication has saved her life, but her new house, decent food and the prospect that soon she may have a job have given her back her pride and hope.
Alvin's Guide To Good Business, broadcast on BBC World, 12 and 13 March 2010.
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