“WE really believe God’s called us to be there. It’s His work. We need to be faithful and try to bring the Gospel to bear, and show by example how things should be done.”

It’s that faith that sustains Church of Scotland world mission partners David and Rebecca Morton through the frustrations of working at Nkhoma Hospital in central Malawi, where they provide healthcare for a population of around 425,000 people.

The American couple with Scottish ancestry have been at Nkhoma since 2009, having previously run a small hospital in Uganda from 1985-1998.

The work involves a lot of hats: David is consultant physician, deputy medical director, head of finance and leads the HIV/AIDS programme at the hospital. Rebecca has helped establish a more accurate, more sophisticated records system for the hospital and has also assisted a Dutch volunteer to set up a care centre for vulnerable infants and children with no-one to look after them.

While he doesn’t mince his words about the financial mismanagement and corruption in the African country, which he describes as ‘a disaster’, David says there have been considerable successes.

“The financial management of the hospital is on a much more solid footing now. On the medical side, I was able to establish a chronic disease clinic (and) we were able to upgrade the laboratory and then we were able to get more staff and recruit more Malawian physicians. Also through partnerships in the USA we have been able to expand the chaplaincy programme by adding four chaplaincy assistants and integrating spiritual care, and presenting the hope of the gospel of our Lord Jesus to our patients.”

“The project which is particularly successful is the cervical cancer programme, funded by the Scottish Government and partnered with Scottish health professionals through the Edinburgh Global Health Academy. Malawi leads the world in both rates of cervical cancer and rates of death. There are a number of factors for that – one is poor screening, and another is we did not have the facilities to eliminate pre-cancerous lesions.

“Through discussions in Scotland and providers here they suggested we consider a different model called thermal coagulation, which had been used in Scotland. It took a little bit of convincing the national programme to allow us to use it, but now it has been approved and has solved the problem of not being able to treat the pre-cancerous lesions.

“We developed a training manual with our partners that’s with the World Health Organisation now, and we hope it will be incorporated into their guidelines for how cervical cancer should be treated in Africa.”

He also points to a successful malaria programme, and says they have expanded training for Malawian medical students and a new postgraduate family medicine residency programme, particularly for the rural areas ‘where 70 per cent of people live but most doctors don’t want to go’.

However, it’s clear that the job brings with it serious frustrations, particularly working with a government which David says ‘has lost international donor confidence and funding due to corruption, and seems out of touch with the majority of Malawians who are poor and living in rural areas’.

“Through a service level agreement (SLA) with the government an agreed set of conditions are covered (for free treatment) with an agreed reimbursement rate per condition, and we submit invoices listing every single person we treat. In June 2015, after not paying us since February 2015, they told us they had no money so we weren’t going to get paid. We were owed about £30,000, maybe more, and it almost bankrupted us.”

Another problem, he says, is the persistent belief in witchcraft, especially in rural areas. “I treated a pastor who didn’t think he was going to get better because he said he killed a bird in his house and believed it to be an ancestral spirit which then caused his illness.

“That’s where the church needs to have a voice, to proclaim the Gospel that Jesus is Lord and that we serve one another. Our prayer for our work here, as echoed in our Lord’s Prayer, is that through us and Nkhoma God’s kingdom come and will be done on earth as in heaven”

While visiting Scotland at the end of last year, David wanted to thank the presbyteries of Lewis and Gordon, which the Mortons are partnered with through the World Mission Council. “The support we have received from the two presbyteries is incredible. They pray for us, they communicate with us, they are concerned about the work and they help financially. The churches have been incredibly supportive of us.”