IT'S a steep climb through a warren of stone shanties to the house where Cynthia Evance lives.

With their brightly painted exterior walls, you could be forgiven for thinking the houses here were in a Spanish Andalucian village rather than an African slum community called Chilobwe overlooking the Malawian city of Blantyre.

In Chilobwe's narrow alleyways the swarms of grinning, boisterous children are a disarming distraction that leaves me unprepared for the sight of fourteen-year-old Cynthia as we enter the dimly lit ramshackle interior of her family home.

The young woman is lying on the floor propped against a chair with a tattered foam mattress behind her head. In Cynthia's nose and mouth is a feeding tube and occasionally she groans and saliva flows from her lips on to her chin.

Four months ago it was all so very different. Back then, Cynthia was walking and talking. Then the sepsis set in, followed by a series of infections. Meningitis came next, resulting in neurological damage. Cynthia was born HIV positive in this, a country with one of the highest rates of HIV/Aids in the world.

The room in which she spends nearly all her time now has a few sticks of furniture, and in one corner sits a roughly hewn wooden chair improvised for cerebral palsy sufferers. "We use the chair to give her some relief from the pressure sores after lying on the floor and to protect her when we have to spend time out doing chores or selling small food items from a stall that gives us a little money," Cynthia's mother tells me.

The prognosis for Cynthia is not good and right now the priority for her mother and siblings is to provide her with the best quality of life they can in the most trying of conditions in this impoverished community.

Helping them do this is the Scottish-based international healthcare charity, EMMS International. Founded in 1841, and formerly called the Edinburgh Medical Missionary Society organisation, it counts David Livingstone among its earliest members. Today, here in Malawi, EMMS' partner organisation is the Palliative Care Support Trust (PCST) that provides home-based care for patients like Cynthia and many others suffering from similar medical conditions.

For most of us, the term palliative care might be quite alien, but the chances are we will have a family member or friend diagnosed as terminally ill or in need of specialist care resulting from a painful, debilitating condition.

Just a short drive from the Chilobwe neighbourhood where I met Cynthia and her family sits the Queen Elizabeth Central Hospital in Blantyre, where the PCST has one of its clinics.

Here, medical director Dr Cornelius Huwa introduces me to 12-year-old Pilirani Shadi and her mother Alisaneti. Mother and daughter had journeyed 125 miles from their home town of Nsanje - which sits near the border with Mozambique and is known as the hottest place in Malawi - to the hospital here in Blantyre.

Pilirani's condition had worsened more than two years after she first experienced pain and swelling in her neck back in 2012. At the time her mother, like many in rural communities in Malawi, had sought out a local traditional healer. His use of crushed herbs applied to Pilirani's neck only exacerbated her pain and condition, and it was decided then that they would need to make the journey to Queen Elizabeth Central Hospital. Two things now occupy the mind of Alisaneti.

"I'm worried about her sickness and whether it will be cured," she tells me, knowing now that following a biopsy her daughter has been diagnosed with lymphoma, a cancerous tumour on her neck.

"I'm also worried that we have come from far away and for what we thought would be a short time but now it has been very long, a full month, and we are unprepared for such a stay," Alisaneti says.

Their problem is not uncommon, with many patients like Pilirani having to leave their remote communities in search of treatment in the city. Behind them they often leave other children or dependents who have to fend for themselves, putting even more emotional and economic strain on families.

So bad is Pilirani's condition now that she can barely speak, though still insists she misses school and playing with friends. In the fortnight before we talked she had been receiving chemotherapy. For now, mother and daughter sleep in the hospital, complaining that what food the government-run facility provides is not enough for both. I ask Alisaneti how long they are prepared to stay.

"We will stay as long as it takes, it is her only hope," she replies, as a weary Pilirani rests her head in her mother's lap.

And so for the time being it is up to the PCST to provide the help this little girl and her mother so badly need.

According to Huwa, children account for 20% of its case load and the need is far greater than the capacity the clinic can support. Some 500 children have passed through the PCST's care and up to 40 youngsters continue to arrive every month before being diagnosed and receiving palliative care. Some of these sick children survive for three to four years, though 30% are lost in the first few months.

It is this combination of the work done at Queen Elizabeth Central Hospital and the benefits of the home-based care programme patients like Cynthia receive that make such a difference to the quality of these youngsters' lives. In undertaking this invaluable work, PCST faces a range of problems, many of which stem from deeply ingrained cultural attitudes in Malawi.

Among these, Huwa says, is "late presentation", whereby people only go to the doctor when they have pain that has become intolerable. Some, due to lack of education, remain convinced that the hospital's inability to find a cure results from a curse and so they have no option but to return to traditional healers whose "treatment" either exacerbates or gives rise to further medical problems.

One male patient I encountered while in Malawi had stopped off while en route to hospital for a consultation with a traditional healer. The man, who was later found to be HIV positive, was given herbal and other treatments for leg sores that caused serious bacterial infection and subsequent major tissue loss.

Just how lacking proper palliative care (PC) is for people in Malawi can be summed up by some shocking statistics. Not only are only two oncologists and no radiotherapy available in the country, but less than 5% of people with cancer receive chemotherapy.

For the staff who work at the PCST, breaking the news to those afflicted is also never an easy task. Huwa, who trained in Malawi, had no plans to go into PC, but changed his mind after doing

postgraduate work on HIV/Aids.

"My eyes were opened and it became evident there was so much work to do on PC," says the man now recognised as the first doctor in Malawi to do provide such care properly.

"One of the things I learned early on was that doing a proper

assessment of the patient and their loved ones allows us to find the right approach when it comes to telling the family. Some of these people would go crazy without the support we give them," he insists.

The work that he and his PCST team do is pioneering in terms of its implementation in rural Malawi. Through time it has increased the quality of life for thousands of people with terminal conditions including cancer, TB and arthritis - often linked to HIV infection, which affects about 10% of Malawi's population.

To this end, the Edinburgh-based EMMS International charity is currently running what it calls its Sunday's Child appeal.

This appeal aims to raise more than £600,000 with the support of the UK government's Department for International Development (DFID). Money raised will be match funded by DFID, effectively doubling any sum raised.

"In countries where there are few or no palliative care services available it is often left up to female family members to look after ill relatives. This limits chances for girls and women to complete their education or find a job, and creates a cycle of poverty that is difficult to escape," says International Development Secretary Justine Greening.

"By matching pound for pound all public donations to EMMS's Sunday's Child appeal, we can train health workers in Malawi to provide support for more than 40,000 people, many in need of round-the-clock care. That means relatives can return to school or to work and ultimately have a better future."

Scotland has long had a close affinity with Malawi and the work on palliative care by EMMS International continues in that vein.

It is generally recognised that relief from suffering is a human right.

Palliative care is part of that process. More than anything it is about adding life to days, not just days to life.

Making a gift to the Sunday's Child appeal

You can relieve pain and take away fear by helping to improve end-of-life care in Malawi. Your donation will be doubled by the UK Government's Department for International Development, helping even more people in desperate need. Making a gift is easy using any of the options below:

Text Sunday to 70660 to donate £5

Online: To donate online go to

Post: To donate by post, make cheques payable to EMMS international, and send to EMMS International (Sunday Herald), 7 Washington Lane, Edinburgh, EH11 2HA.

Telephone: Call EMMS International on 0131 313 3828.

Texts costs £5 plus network charge, EMMS International receives 100% of your donation. Obtain bill player's permission. Customer care 0131 313 3828. EMMS International is a charity registered in Scotland No SC032327. A company limited by Guarantee Registered in Scotland No SC224402. Registered address above.