Essential Grace Magazine April 2022
1|Essential Grace Magazine
Vol. 2 Issue 9
April 2022
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April 2022
In this Issue … Monthly Theme Stress Awareness Month 2022 Mental Health How does Stress Manifest in Different Age Groups? The Stress Monster; Stress in Children and Teens Health and Wellness Hormonal Imbalance; PCOS PCOS and Hair Loss The Right Way to Manage Stress Resources
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ne cannot think about Malawi without thinking of ‘the warm heart of Arica’. We are known for our welcoming and hospitable spirit, and the way we gout of our way to make visitors feel welcome. We are also known for our resilience in the face of trouble, and we do have a lot of troubles currently. It is not just the global economic crisis at the moment, it is factors such as unemployment, poverty, chronic disease, mental illness, family conflict, crime, toxic work environments, unpredictable weather, and many more. How do we handle the stress and anxiety that seems prevalent due to all these issues? The month of April pays special attention to the theme of stress; raising awareness on the signs and symptoms, as well as how to manage it. There is a growing interest in exercise, gym, body building, hiking, and even cycling amongst Malawians. It is no secret that outdoor activity and exercise are great at combating stress and anxiety. For those who are not interested in vigourous activities, there are plenty of beautiful places to go and get some rest and relaxation, some down time, and some fresh perspective. All these are healthy and pro-active ways to handle stress. An example of a great place to relax is
our cover image for this month that I took in 2021 at Nkhudzi Bay in Monkey Bay, Malawi. One of our strongest tools as a nation is our diversity of culture; cultures which promotes community and a spirit of collectiveness. Let us make the most of this especially when we are under a lot of strain. Instead of keeping things bottled up inside, try to talk to those around you and find the support you need. How do you handle stress? What activities work best for you that others can learn from? Let us know through our social media pages or directly to the editor through essentialgrace@zoho.com Enjoy the read! Julie Soko Managing Editor
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Julie Soko
Mtendere Kishindo
Thandi De Jong
Naomi Msusa
Managing Editor
Sub - Editor
Editorial Assistant
Editorial Art and Design
Essential Grace is a free online publication that is focused of promoting mental health and wellness in Malawi and around the world.
Follow and subscribe to the magazine at www.issuu.com/essentialgrace follow, like, and share on our social media platforms; @EssentialGraceMagazine @essentialgracemagazine.mw 0995 147 290 Comments and feedback on any of our content can be addressed to essentialgrace@zoho.com
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Did you know … Most of our editorial content is contributed by our readers. We welcome your ideas, articles, questions, images, and feedback. Submit your content to the editor at essentialgrace@zoho.com
Special thanks to this month’s contributors: Roshin Ebrahim Chilungamo M’manga
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Monthly Theme
Stress is basically a disconnection from the earth A forgetting of the breath Nothing is that important Just lie down Natalie Goldberg
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What do we know about stress? Stress is the feeling of being under too much mental or emotional pressure. It is your body’s way of responding to any kind of demand or threat. When you sense danger—whether it’s real or imagined—the body’s defences kick into high gear in a rapid, automatic process known as the “fight-or-flight” reaction or the “stress response. The stress response is the body’s way of protecting you. When working properly, it helps you stay focused, energetic, and alert. Pressure turns into stress when you feel unable to cope. People have different ways of reacting to stress, so a situation that feels stressful to one person may be motivating to someone else. Many of life’s demands can cause stress, particularly work, relationships and money problems. And, when you feel stressed, it can get in the way of sorting out these demands, or can even affect everything you do. Stress can affect how you feel, think, behave and how your body works. In fact, common signs of stress include sleeping problems, sweating, loss of appetite and difficulty concentrating. You may feel anxious, irritable or low in self-esteem, and you may have racing thoughts, worry constantly or go over things in your head. You may notice that you lose your temper more easily, drink more or act unreasonably. You may also experience headaches, muscle tension or pain, or dizziness. Stress causes a surge of hormones in your body. These stress hormones are released to enable you to deal with pressures or threats – the so-called "fight or flight" response. Once the pressure or threat has passed, your stress hormone levels will usually return to normal. However, if you're constantly under stress, these hormones will remain in your body, leading to the symptoms of stress
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Stress has the potential to make you ill. If you recognise any of these symptoms, see you doctor as soon as possible. Do not try to ‘cure’ yourself with food, alcohol, or drugs. It will only prolong your stress or make it even worse. Get it seen as soon as possible. Take good care of your mental health.
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Stress in the Elderly Sources of Stress Retirement and the lifestyle changes thereafter, caring for grandchildren, caring for a sick spouse, grief over the loss of friends, spouse or loved ones. Deteriorating physical health, chronic illness, losing independence and becoming more dependent on others. Symptoms of Stress Physical symptoms include loss of appetite, heart palpitations, bad dreams, insomnia, inflammation, aches and pains, joint stiffness – loss of mobility, loss of trust in their own physical ability. Emotional symptoms include increased anxiety, fear, sadness, poor memory, frustration or anger, agitation, hopelessness and sometimes despair. How to Manage Stress Encourage the elderly to share their thoughts, concerns, and feelings. Discuss their coping habits, what works and what doesn’t. Provide room for them to air their concerns regularly and listen with compassion and empathy. Encourage an active social life, socialising with people can be a great tool for fighting stress. Promote a healthy lifestyle, better diet, and relaxation exercises. Some people in their later years find it very difficult to adjust their lifestyle to suit their age. They may become stubborn and insist on doing things the way they used to in their younger years. Encourage a gradual shift in habits, activity levels, and expectations as people get older.
Healthy habits must include exercise, letting go of harmful practices such as alcoholism, smoking, drug use, and unsafe promiscuous behaviour. Encourage them to get new interests such as travel, reading, art, or anything that sparks their joy.
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Stress in Adults Sources of Stress Many adults these days find themselves in many stress inducing situations due to the fast-paced lifestyles in developing and developed societies. The most common sources of stress include financial challenges, looking after extended family, not being able to care for family, family conflict, relationship problems, social media use or overuse, social isolation, toxic work environments, chronic illness or poor health of loved ones, trying to keep up with society standards, unemployment, divorce, being constantly available through technology – no time off, mental illness, and many more. Symptoms of Stress Physical symptoms include loss of appetite, aches and pains, nausea and dizziness, frequent infections such as colds and flu, diarrhea or constipation, low sex drive, chest pains, heart palpitations. Changes in behaviour can include insomnia or over-sleeping, social withdrawal, self-medicating through the use of alcohol, drugs, tobacco, or overactivity. Other symptoms may include sadness, depression, anxiety, isolation, irritability, being easily angered, loneliness, constant worry, overthinking, lack of concentration, poor memory, poor judgment, negativity and pessimism. How to Manage Stress Adults may find it difficult to manage stress in their lives due to having many responsibilities and little time for self-care. Nevertheless, making gradual adjustments to your lifestyle can work wonders. Incorporate exercise into your life, social connection, learn to relax, eat better, sleep better, and become more self-aware. Be willing to access professional help where necessary.
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Stress in Children Sources of Stress Believe it or not, children do experience stress and can also suffer from chronic stress. Stress in children and youth under the age of 20 years can be caused by challenges in social relationships, performance at school, family difficulties such as divorce or separation, identity formation problems, identity confusion, trying to fit in, learning new things, and negative forms of peer pressure. These ordinary life events can become stressful for children because they may not be equipped with the right skills to know how to respond in a healthy way. Symptoms of Stress There are two common ways through which a child can respond to stress; changing their behaviour or regressing. You may notice changes such as social withdrawal, talking more or less, loss of appetite, bedwetting, sucking the thumb, constipation, increase in stomach pain, sadness and crying easily. Older children may begin to abuse substances, to act defiant or rebellious, and exhibit anger, frustration, and impatience. How to Manage Stress Parents and caregivers are responsible for managing their child’s stress levels through several ways. They need to develop and maintain an atmosphere of trust with their child. They need to also promote a caring and warm environment, have reasonable expectations, be flexible in their parenting approach, and to be sensitive to the changes happening around the child. It is also important to build on the family’s strengths in areas such as communication, bonding, and problem-solving styles. Being a present and supportive parent may be challenging, but it is very important in the mental and emotional health of their child.
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Mental Health
How you think about stress can make a big difference. Do not overlook the symptoms of stress, address them in a timely manner. Should you need help in doing so, please refer to our resources section at the end of this publication for contact details of mental health practioners in Malawi.
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The Stress Monster: Stress in Children and Teens By Chilungamo M’mango Young people, like adults, experience stress. Stress can come from a variety of sources including doing well in school, forming and sustaining friendships, or managing perceived expectations from their parents, teachers, or society. Stress is a feeling of being overwhelmed or unable to cope with mental or emotional pressure. It is how we react when we feel under pressure or threatened. In other words, Stress is a feeling of emotional or physical tension. Some stress can be positive in that it motivates better performance, for instance, it may push your child to study more for an exam and pass well. Too much stress, however, has adverse consequences. Unfortunately, adults can sometimes be unaware when their children or teens are experiencing overwhelming feelings of stress. Youth of all ages, but especially younger children, may find it difficult to recognize and verbalize when they are experiencing stress. They are not able to say, “I’m 14 | E s s e n t i a l G r a c e M a g a z i n e
stressed and this is the reason why.” Therefore, their behaviors often signal how they are feeling. As adults, you need to tune into their emotional or behavioral cues in identifying potential problems or stress in their lives. Cues are words, phrases, or actions that are signals for something. So how would you know if your children or teens are experiencing stress? For children, stress can manifest itself through changes in behavior. Common changes can include acting irritable or moody, withdrawing from activities that used to give them pleasure, routinely expressing worries, complaining more than usual about school, crying, displaying surprising fearful reactions, clinging to a parent or teacher, sleeping too much or too little, or eating too much or too little or bedwetting. With teens, while spending more time with and confiding in peers is a normal part of growing up, April 2022
significantly avoiding parents, abandoning long-time friendships for a new set of peers, or expressing excessive hostility toward family members, may indicate that the teen is experiencing significant stress. While negative behavior is not always linked to excessive stress, negative changes in behavior are almost always a clear indication that something is wrong. Adults will want to pay attention to these behaviors and determine an appropriate response or intervention. Sometimes “feeling sick” may be caused by stress. Stress can also appear in physical symptoms such as stomach aches and headaches. If a child makes frequent stomachaches or headaches complaints (when they have been given a clean bill of health by their physician), or if these complaints increase in certain situations (e.g., before a big test) that child may be experiencing significant stress. Be aware of how your child or teen interacts with others. Sometimes a child or teen may seem like his or her usual self at home but be acting out in unusual ways in other 15 | E s s e n t i a l G r a c e M a g a z i n e
settings. It is important for parents to network with one another so that they can come to know how the child or teen is doing in the world around them. In addition to communicating with other parents, being in contact with teachers, school administrators, and other leaders in the community can help parents tap into their child or teen’s thoughts, feelings, and behaviors, and be aware of any sources of concern. Parents, children, and teens do not need to tackle overwhelming stress on their own. If a parent is concerned that his or her child or teen is experiencing significant symptoms of stress regularly, including, but not limited to those described above, it can be helpful to work with a licensed mental health professional, such as a psychologist. Psychologists have special training to help people identify problems and develop effective strategies to resolve overwhelming feelings of stress. If you suspect your child/ teen is struggling with stress, the best starting point is to start a April 2022
conversation about it with them. And If their stress seems to be interfering with their performance at school, their relationships with family and friends, their household responsibilities, etc., that is when you may consider seeking professional help. Take note that Symptoms lasting more than two weeks could be a sign that your teen may have an underlying mental health problem, like depression or anxiety. One of the important things that will help parents/guardians to identify stress in their children or teens is a healthy/positive parent-child relationship. Without this, you may never be able to identify any of these signals of stress in your children. The Parent-Child Relationship nurtures the physical, emotional, and social development of the child. This relationship lays the foundation for the child’s personality, life choices, and overall behaviour. A positive parent-child relationship is a must-have, so learn how to build it.
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Health and Wellness
Stress is a condition that has several negative manifestations on our bodies. The health and wellness section outline one of the conditions closely related to stress in women; PCOS. Should you want to know more about the symptoms and treatment options of this condition, or should you be concerned about your own experiences related to PCOS, please speak to a medical professional near you.
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Hormonal Imbalance; PCOS By Roshin Ebrahim
What are Hormones? Hormones are chemicals produced by glands in the endocrine system. They travel in the blood stream to organs and tissues carrying messages of how to function. Hormones are essential to regulate most bodily processes, so an imbalance can affect many bodily functions. Hormones help to regulate metabolism, blood sugar, growth, blood pressure, reproductive cycles, sexual function, mood and stress levels. Females may experience imbalances in estrogenic and progesterone levels, while males may experience imbalances in testosterone levels. Symptoms The symptoms of a hormonal imbalance vary according to the gland that is affected and whether it is male or female. In women the symptoms most frequently include mood swings, constipation or diarrhoea, irregular menstrual cycle, infertility, insomnia, low sex drive, weight gain/loss, excessive hair growth/hirsutism and pain in the abdomen or back during menstruation. In males the symptoms include low sex drive, erectile dysfunction, loss of muscle mass and thinning of hair. Causes Everyone experiences natural periods of hormonal imbalance or fluctuations at 18 | E s s e n t i a l G r a c e M a g a z i n e
particular points in their lives. But hormonal imbalances can also occur when the endocrine glands are not functioning properly. These glands are used to produce, store and release hormones into the blood. Several medica conditions can impact the endocrine glands. Certain lifestyle habits and environmental factors can also play a role in hormonal imbalances. Medical conditions that hormonal production are:
affect
the
Diabetes, in which the body doesn’t produce enough hormone insulin. Hypothyroidism and hyperthyroidism Hypoglycaemia and hyperglycaemia Pituitary tumours Iodine deficiency Benign tumours Chronic stress Poor diet and nutrition Birth control medications Hormonal Imbalances and Mental Health Mental health is a pertinent part of our wellbeing, wellness does not encompass physical health but also mental and emotional health. Mental health conditions could stem from a hormonal imbalance. Inversely, if you have a April 2022
hormonal imbalance you are more likely to develop mental health conditions. Sometimes psychological symptoms are side effects of a hormonal imbalance and/or treatment.
Hormonal changes in the body often lead to fluctuations in body weight, hair thinning, facial acne and other physical transformations which can lower selfesteem.
Oestrogen is a group of hormones that play a major role in female development. When it comes to mental health, estrogenic is the hormone that regulates neurotransmitters such as serotonin, dopamine etc… which involve mood regulation. That is why fluctuating levels of estrogenic is often associated with mood swings and irritability. Low levels of estrogenic are often linked to lower levels of serotonin, which can cause symptoms such as mood swings, depression, trouble concentrating and fatigue. High levels of estrogenic combined with low levels of progesterone are often associated with depression, irritability, fatigue, memory problems and anxiety.
Hormonal Imbalances and Poly-cystic Ovarian Syndrome (PCOS)
Cortisol - also known as the stress hormone - is involved in the release of adrenaline which produces the fight or flight response. Due to the fast pace of our current society, our bodies are constantly under stress thereby enduring the continuous release of cortisol. Too much cortisol stimulates chronic inflammation throughout the body, a condition which leads to an in increases blood sugar, blood pressure and fat storage. Raised cortisol levels are also related to depression and anxiety. 19 | E s s e n t i a l G r a c e M a g a z i n e
One common health problem that is closely linked to hormonal imbalances is poly-cystic ovarian syndrome. PCOS is a hormonal disorder which among other things causes small cysts to grow on one or both ovaries. People with PCOS usually struggle with their body image and selfesteem. They are three times more likely to experience anxiety and depression as part of the symptoms. Other symptoms of PCOS include infertility, fluctuations in body weight, facial hair, cystic acne, and in some cases the inability to lose weight. The lack of control over one’s health and body can be a frustrating challenge which in itself can lead to anxiety and depression. Poor mental health in women suffering from PCOS can be exacerbated by efforts to minimize or cure some of the symptoms. For example, they may spend thousands on fertility treatments, hair removal treatments, hormone regulating methods, and weight loss efforts, all in the hopes of improving their lives and attaining their goals. Sometimes the physical symptoms of PCOS can make matter worse, having stubborn weight, April 2022
persistence acne, and facial hair can be embarrassing system for a woman. They may try different methods such as caking their face with make up in attempt to hide facial hair and cystic acne. They may replace meals with coffee and water as un-ending quest to be pretty and thinner. Most if the time these efforts may be in vain without the right approach. Doctors often recommend various birth control options for PCOS to help in regulating hormones which may work for some and may not work for others.
focusing on fertility issues. Here, treatment may be to advise the woman to come back when they want to work on conception rather than to help them with all the other symptoms that make up PCOS. All this back and forth, or lack of proper medical care can cause a woman to go into depression and increases stress and anxiety. While some women can get treatment for depression and other mental health initiatives, others may end up with complicated lifestyles, and some to broken marriages because of PCOS.
PCOS may causes excessive mood swings and melt downs, making the person a hormonal mess. Their periods may become irregular with excruciating symptoms, or in some cases stop completely. The pre-menstrual symptoms can also be worse with cramping and nausea leading to vomiting. The treatment process of PCOS takes so long that the person usually gives up. In the chance that a woman with PCOS becomes pregnant, there is a risk of miscarriage, leaving them hurt, lonely and confused because of all the devastating feelings of sadness and loss. Some women dream of being pregnant and starting a family, but PCOS leaves them infertile.
Treatments Hormonal imbalances in general can be treated with the following:
Doctors often have very little useful advice for PCOS probably because they are trained to solve immediate medical issues. Some are referred to fertility specialists where they may end up only 20 | E s s e n t i a l G r a c e M a g a z i n e
Lifestyle change (diet and nutrition changes), physical exercise, weight loss, stabilizing your moods (prescription medication), antidiabetic medication (Metformin), hormone pills (family planning/contraceptive pills) As your hormone levels are stabilized your mental health can follow. Working with the appropriate health care providers in the effort to address the different symptoms of hormonal imbalance can help to bring relief, to implement adequate lifestyle changes, and to improve access to medication and therapies that will help one in taking charge of their physical and mental health.
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Quick Facts About PCOS PCOS is caused by many immature follicles which grow on the ovaries and subsequently cause an imbalance of hormones. This hormone imbalance can cause irregular periods, and can also present problems for a woman when she tries to conceive. If PCOS is not treated effectively, it can also result in some more serious health concerns, for example, heart disease and diabetes. Despite the growing number of women who are being diagnosed with PCOS, there is still plenty of questions within the medical profession as to what causes the condition. Many people believe that the condition is hereditary but, this has still not been scientifically proven. Women who suffer from PCOS may have the following symptoms; difficulty getting pregnant, weight gain, acne, irregular periods, hair loss from the head, excessive hair growth all over the body. Not only do women with PCOS have to deal with these symptoms above, but they are more vulnerable to other more serious health problems later in life, this can include, high cholesterol, depression, and sleep apnea. Unfortunately, there is no known cure for PCOS however, you can manage your symptoms in a number of ways. Work very closely with a physician to manage the physiological challenges you experience including managing your weight. Visit a gynaecologist to manage issues related to fertility and pregnancy, as there may be challenges that they can help you resolve. Stress and anxiety can be very closely linked to PCOS, therefore be mindful how you manage your mental health. Get as much support as possible from those close to you. Invest in a therapist as well to help you through your health challenges.
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PCOS and Hair Loss Many women around the world suffer from PCOS. The condition is usually due to an imbalance of androgens, progesterone, and insulin. Not only does PCOS effect the menstrual cycle, it can have other unpleasant side effects such as acne, weight gain, hirsutism, and hair loss. PCOS hair loss is one of the most common symptoms of PCOS. Of course, the extent varies depending on the individual. So how does PCOS cause hair loss? High levels of androgen (male sex hormones) in men are normal, they usually produce 12 times more of this hormone than women. When this hormone is produced in excess in women, it results in the unpleasant side effects. Symptoms can include shedding that is beyond normal, bald patches that appear on the top and towards the front of your head. Increased breakage, and a dry and itchy scalp that defies your efforts to moisturise. Treatment for this condition can be through the balancing of hormones through hormonal therapy. Although effective in stimulating hair growth and preventing hair damage, hormone therapy can be a long and slow process. Shampoos and conditioners coupled with a good hair and scalp care routine can do wonders to help resolve this process. Invest in products that contain Vitamin B and Keratin, and avoid products that contain sulfates as they tend to dry out hair. Avoid using heated equipment as well as chemical product such as straighteners or relaxers, and hair dyes. These can be really damaging to hair that is already weak and brittle. Taking over the counter supplements to help your hair growth has also been proven to be helpful. Try a combination of Vitamin C and D, Zinc, Iron, Biotin, and Keratin. Don’t forget the most important strategy, reduce stress! Be mindful, and work on your ability to relax and manage negative emotions so that they don’t overwhelm you.
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Treatment Options for PCOS
Steps you can take to help your body heal from the symptoms of PCOS include healthy eating, exercise and losing weight, regulating your blood sugar, reducing your stress and anxiety, taking anti-inflammatory treatment, eliminating toxins, and taking vitamins. Women who are trying to conceive must work collaboratively with a gynaecologist in order to manage their condition.
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The Right Way to Manage Stress We all have different ways through which to deal with stress. Some of these methods work and some make us worse. Dr Scott Dust outlines some coping tendencies that are helpful in properly managing stress. Read the full article at Psychology Today. Problem-Focused Coping Problem-focused coping involves trying to solve the source of the problem. The goal is to stop the stressor altogether. The challenge, though, is that engaging in such behaviors can be hard, timeconsuming, and even introduce new types of stress. Problem-focused coping is a productive, long-term fix, but it takes effort.
Examples Taking stock of the stressful situation and coming up with a plan. Focusing one’s efforts and attention on doing things that improve the situation. Seeking out resources (e.g., people, processes, services) that can help solve the issue at hand. Emotion-Focused Coping
Emotion-focused coping entails managing the emotions associated with the situation. The goal is to minimize the negative physiological and psychological reactions stemming from the stressor. The challenge here is that emotions can be hard to control. It’s worth the effort, though, because you’ll be more successful at problem-focused coping when you’re emotionally balanced. Emotion-focused coping is not a long-term fix, because it doesn’t solve the source of the problem, but it’s an important part of the coping process.
Examples Seeking out social support by finding someone to talk to about how you’re feeling. Pinpointing, out loud or in writing, exactly what emotions you’re feeling. Reminding yourself that you'll be okay, things could be worse, or that you should be appreciative of what you have. Reappraising the stressor as an opportunity to learn, grow, or develop. 25 | E s s e n t i a l G r a c e M a g a z i n e
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Avoidance-Focused Coping Avoidance-focused coping entails distancing oneself from the stressor or the feelings of stress. This is an unproductive form of coping. Unfortunately, people do it all the time. Distracting ourselves from how we are feeling, or refusing to think through how to make things better, only delays the stressor. When it does resurface, it’s typically worse.
Examples Distracting yourself with something pleasurable, like entertainment (e.g., social media), sleep, or substances (e.g., drugs, alcohol). Convincing yourself that everything will be fine and work itself out. Acting as though nothing really happened. Telling yourself you’ll deal with it when the time is right. The Right Way to Cope with Stress Given what we know about stress and coping, here’s what you should or shouldn’t be doing: Don’t avoid stress. If you’re experiencing stress, your brain and your body are trying to tell you something. Avoidance-focused coping doesn’t work. Express your emotions. Seek out people or mechanisms (e.g., journaling, meditation) that allow you to acknowledge and accept your feelings. Emotion-focused coping is part of being human. Let it happen. Start getting organized. Outline the problem, start brainstorming ideas, talk to others to get new perspectives, and then get to work. When it doesn’t work out as planned, iterate, and try again. Problem-focused coping is the primary solution to long-term stress reduction.
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Chitipa District Hospital By now, we hope you are aware that you can access mental health care from all the Central
Resources
Hospitals in the country. Here is something to take note of, before you can get to the Central Hospitals, you need to
Karonga District Hospital Mzimba District Hospital Nkhata Bay District Hospital Rumphi District Hospital
first visit your local District Hospital in order
Dedza District Hospital
to be assisted. This applies to mental health
Dowa District Hospital
care as well.
Kasungu District Hospital
Once you have been assessed, the medical
Mchinji District Hospital
staff (a psychiatric nurse or clinician) will then determine whether you need to be referred to the Central Hospital, which also provides comprehensive care for mental health challenges. Please take note of the list of District Hospitals available in Malawi.
Nkhokota District Hospital Ntcheu District Hospital Ntchisi District Hospital Salima District Hospital Balaka District Hospital Chikwawa District Hospital Chiradzulu District Hospital Machinga District Hospital Mangochi District Hospital
Would you like to advertise your mental health services with Essential Grace Magazine? Get in touch with us for your free offer of mental health related advertising be it for counselling services, support groups, books, upcoming events, and wellness services (e.g. Fitness, massage therapy) 27 | E s s e n t i a l G r a c e M a g a z i n e
Mulanje District Hospital Mwanza District Hospital Nsanje District Hospital Phalombe District Hospital Thyolo District Hospital Zomba District Hospital
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