Thank you very much for this important article on anaesthesia provision in Malawi and Zambia. I forwarded it to colleagues at Chitambo District Hospital, Central Province, Zambia and received this response from one of the Clinical Officers who is also training in Anesthesia at a Zambian university:
"Yeah it really a big challenge for most of district level hospitals in Zambia cause there are very few anaesthetists. And most of the pipo giving anaesthesia in these hospitals are not even trained which makes it even more risky. Anaesthesia is a sensitive profession so there is need to support the program so the people giving anaesthesia are trained from recognized learning institutions. Yes few people are oriented in giving anaesthesia but these people only stick to ketamine and can't give other anesthetic drugs. The other challenge is some anesthetic machines and anesthetic equipment which lack in some of the district hospitals. But with the ministry of health trying to ensure that anaesthesia be among the priority programs am sure in the near future the gap will be closed up. Otherwise anesthesia is a very good profession and each health facility needs at least four anaesthetists as it's focus is about critical care and emergencies."
Fortunately, Chitambo Hospital recently received a donation of a new anaesthetic machine via the Churches Health Association of Zambia (CHAZ) and the United Church of Zambia (UCZ). That is functioning well.
Dr. Jo Vallis, Chair
FRIENDS OF CHITAMBO SCIO, Registered Charity No. SC044337
_Working Towards a Healthier Chitambo District_
Mobile telephone number: +44(0)7791262918
web address: www.friendsofchitambo.org.uk 
Facebook page:https://www.facebook.com/friendsofchitambo/ 
HIFA profile: Jo Vallis is a Medical Sociologist with a general and paediatric nurse/nurse teaching background. She is Chair of Scottish registered charity, Friends of Chitambo SCIO, which supports health projects in Chitambo District, central Zambia: web address: www.friendsofchitambo.org.uk;
Facebook page: https://www.facebook.com/friendsofchitambo
She is Project Lead for a Scottish Government funded project on ‘Strengthening emergency care communications in Chitambo District, central Zambia’, now in its 3rd 2-year funding round.
Jo recently retired from her post as Research Officer within NHS Education for Scotland (NES), in order to continue the work with Chitambo in a voluntary capacity.
Email addresses: firstname.lastname@example.org; email@example.com