Josh Tello, RN, BTM board member, tries desperately to save Happiness, a 5 year old with severe malaria. Despite Josh’s best efforts, Happiness died later that day.
The pediatric wards at St. Andrews and Kasungu District Hospital are filled with malaria patients. This child at St. Andrews was one of the lucky ones who got to the hospital in time to be cured.
Family members wait outside St. Andrews Hospital. They must stay at the hospital to feed their sick relatives and do their laundry until the patient recovers or dies.
Motorcycles are frequently used as “ambulances” in rural Malawi.


Malaria in Sub-Saharan Africa is a big killer of children < 5yrs old as well as pregnant women. It is a disease caused by infection with a protozoan of the Plasmodium genus. By far the most deadly species, Plasmodium falciparum, is all too common in Malawi. The Plasmodium protozoan is transmitted to humans by the bite of a female Anopheles mosquito. Malaria kills by causing profound anemia (the protozaons literally eat red blood cells) and by interfering with microcirculation, thus causing organ dysfunction, especially in the central nervous system. Although relatively easy to treat in its early stages, it can progress rapidly and kill within a few days if left untreated. Access to care is limited in rural Malawi (there is no 911 and there are very few vehicles). Hospitals provide medical care but only that; family members must come to the hospital and stay to feed and otherwise care for their sick relatives, significantly reducing the ability to care for the farm and the remaining family . As a result, a poor subsistence farming couple is likely to put off going to the hospital until a child is very ill; unfortunately, between 1/3-2/3 of such children with severe malaria will die regardless of the treatment instituted at the hospital on arrival. We at BTM have seen far too many tragic child deaths from falciparum malaria at St. Andrews Hospital, despite our best efforts to augment the work of the hospital staff. As a result, we realized that the best way to deal with this horrible disease is to prevent it. In consultation with Peter Minjale, Medical Director at St. Andrews, BTM embarked on an aggressive program of Indoor Residual Spraying (IRS)in 2014. IRS is the preventive measure recommended by the WHO and the government of Malawi. It involves the spraying of a long acting insecticide, alpha cypermethrin, on the inside walls of dwellings and outbuildings twice a year. This insecticide kills mosquitoes when they land on the treated wall after a human blood meal. Since the mosquito is the carrier of the malaria protozoan, the disease cannot be transmitted from person to person if the insect dies. This has proven to be a very effective way to prevent malaria in the area where we work. Learn More Here: Latest Malaria Info (PDF 197 Pages)

Indoor Residual Spraying to fight Malaria in the villages.