THAT each hairpin bend on the rubble road leading to the hospital in Livingstonia is labelled with a number says something about the challenge its ascent by vehicle or foot can be. The ill and injured who take this twisting, turning route up the precipitous escarpment from the shores of Lake Malawi can count down the turns, Bend 10, Bend 11, Bend 12, longing for the ‘Bend 20’ that is its last, for someone to say they are nearly there. Such is its condition that the ten-mile distance takes at least an hour of lurching and rolling by jeep or ambulance. For some women, the journey is done while in labour, perhaps delivering on the way. For others in severe pain, or the delirium of fever. Most who make the trip will testify that it is the bumpiest road they have ever travelled. But at the top is relief. For there, on the plateau sits what has to be the most remote fully-working hospital in Malawi, one of the poorest countries in the world.

When you arrive at the doors of David Gordon Memorial hospital, you can’t help but wonder why anyone would put a hospital in such a seemingly inaccessible location. But there is history behind this, and sense. There’s a reason why, over a century ago, Scottish missionaries, lead by an Aberdonian doctor Robert Laws, settled on this plateau high above the lake, naming their community after the great Scottish explorer and missionary, David Livingstone. Other places closer to the lake, previously chosen for their missions, had been beleaguered by malaria – at Cape Maclear, for instance Laws suffered 15 attacks in a few months. But, here, at this altitude, away from the water, the disease was not so much of a problem. Though each of the wards here hang with nets, the mosquitos are few here.

This remarkable hospital, built in 1910, is is one of the health facilities supported by EMMS International, an Edinburgh medical charity which has brought me here, and who are funding, among other things a new boat ambulance to help the medical staff reach patients in the most remote villages along the shore of Lake Malawi, as well as palliative care projects and training. In Malawi, cancer diagnoses have more than doubled in the last decade. By 2021, an estimated 180,000 patients and their families will need palliative care, and, across Africa, cancer cases are expected to grow by 400% in the next 50 years. Yet here, palliative care is embryonic.

What’s striking if you spend any time with this palliative care team, as I did, is that it takes a particular type of medical worker to work here, in this hard to reach place. Some staff don’t last long. But others dig in for the long haul. Kwezi Gondwe for instance, a warm-hearted, laughter-bearing nurse, who has been here for thirteen years, raising two children here, and who has been through the grief and hardship of losing a husband to blood cancer. He was ill for over eight months. “I know what it is to care for someone who was dying. Whenever I see people taking care of their relatives, I’m with them.”

Or there’s nurse technician Chawanangwa Smith Beza came here, from Mzimba, a little further south. “This place has many challenges,” he says. “The road network is very bad. But sometimes to help others it takes a sacrifice of somebody. I told people that I will stay long. They say, ‘No, you can’t stay long.’ But I say, ‘I have the passion of helping people who are living in areas where most people run away from them.’” He was offered a very well-paid job elsewhere, but he said, he recalls, “No, money is not the first thing in life.”

Beza wears a t-shirt saying Give Me Morphine For My Pain. Increasingly access to the drug is considered, by organisations like the Palliative Care Association of Malawi, a human right, yet, sometimes, he says, there are long-term shortages in supplies of it. “We ran out some time back," he says. "For six months we didn’t have morphine. It was a problem even in big hospitals that they did not have morphine available. Of course we can give other painkillers. But morphine is the strong opiate of choice."

It's with Gondwe and the team's chaplain, Reverend Kenneth Muyika, that I set out to take a trip down to the lake and along the shoreline, to witness some of the further challenges of remote healthcare – delivering to those communities that live not just ten miles of hairpin bends away from the hospital, but also several hours by boat. The journey begins with the long descent, bend by bend, counting down from twenty. Often the team go out on motorbike, though in the rainy season is frequently prevented by the treacherous nature of the road.

We pass, as we descend, a broken down vehicle, brimming with passengers at the side of the road, snagged on its way up. It’s a frequent occurrence, Muyika observes.

“If you have a woman in labour travelling up here," he says, "often by the time they get to the top they have had the baby. This kind of road, brings it on. Some deliver the baby on the road.”

A new road, it's widely thought, would make a huge difference to the hospital's ability to deliver care. "They are constructing a new one behind there," says Muyika, "but it will take time. One day. One day.”

"Two bridges" a local tells me is what the road would cost. And two bridges is the kind of daunting cost that gets too easily shelved.

At the bottom of the escarpment, sits the vast blue expanse of Lake Malawi, so huge it looks endless, with waters that seem irresistible, but which come with a warning for swimmers, since they carry the disease-carrying parasite bilharzia. Two boatsmen have brought a wooden dinghy for us to board to the water’s edge. We are told that both of the hospital’s boats are being repaired, so today we are hiring one from some locals.

The waters we glide across are dotted with fishermen in dug-out canoes. Here, along the shore of the lake people have subsistence lives, selling fish and living off a diet of mostly cassava, which is all that grows along here. En route we pass a small boat laden with passengers, so full it's hard to believe it still floats. One such vessel, Muyika explains, overloaded with more than seventy people from an Easter Day service, capsized. It was a local tragedy. Many died.

Our destination is the village of Tcharo, inaccessible other than by boat, and five hours walk from the nearest road. From the shoreline there it is just a small distance up into the village where one of the team's patients lives. Cancer has arrived in these villages – a strange, and to many of them bewildering disease, which appears new and unknown, not part of their local histories.

80-year-old Kesnary, who sits on the stoop of her small home, has cervical cancer and is suffering from bleeding so copious it sometimes leaves her weak or unconscious. Frequently cervical cancer is linked with HIV and affects young women, but Kesnary does not have the infection. Her husband passed away some years ago, so she is now looked after by her daughter and her brother-in-law.

“I am very worried,” says her brother-in-law. “Because this is the first person in my family to have this disease. We had a woman in the area who passed away of this two years ago. We never used to see this. When she sees one is passing away automatically she becomes afraid that this very same thing will happen to her. We try to comfort her because she has got so many worries. Just pray. God will help you.”

Their biggest problem, he explains, is their inability to afford the drugs – and it’s when she doesn’t have the drugs that her bleeding gets worse. “Sometimes we don’t have any money. Sometimes instead of having the drugs for a month we just have two weeks, and they are run out. So for weeks it is a problem. We get money through fishing. We just fish. We sell our fish, and then maybe we have enough money to buy the drugs.”

Food is also a problem for these villagers. Some days she eats little. Her diet is mainly nsima, a kind of porridge, occasionally baby fish, and this is the dry season so even the cassava has dried up. Her illness is also taking a strain on the wider family. Kesnary’s daughter left her husband temporarily in order to look after her mother. She sometimes walks for six hours over the hills along the coast sometimes for supplies.

We make that same distance in two hours by boat that afternoon. Further back along the shore is another of the team's patients, Malaika, a young man, just 36 years old, who lies on his bed barely able to move, afflicted by a pain so great he can hardly bear people to touch him. He is HIV positive and last year was diagnosed with tuberculosis and took treatment for it, but, he says, he believes he must now have some other disease.

He has been unable to eat for weeks. “I think this is the second or third week of eating only porridge and nothing sometimes. Nothing today I didn’t take it. Now it will be the third week. I am losing appetite. And now I discovered that I only cough when I wake up.” He twists uncomfortably under his sheet. “The whole of my body here: if someone touches me it feels very painful.”

He cannot even bear to let his mother help him bathe. “No, she can’t even touch me. It is so painful. I wash only with a towel on my own.”

9% of the population of this area are HIV positive. This isn't as high as some areas of Africa – for instance Swaziland, whose rate is 27%. What they call, here in Malawi, a "sensitisation" campaign is working. New infections have dramatically declined. But the toll is still there. Many still suffer and many, if they are not tested and put on drugs early enough, still die. Last year there were 24,000 AIDS-related deaths in Malawi.

Not all of the community that the hospital serves resides down by the lake. Some are up on the plateau, and it’s one of these families that nurse Chawanangwa Smith Beza takes me to. Down a dirt-track road, in a tiny hamlet next to a small banana plantation, lives a family unit we visit here tells a wider story of life in rural Malawi. Here, in this household, live 74-year-old Loveness with her 85-year-old husband Jackson, and her 19-year-old grand-daughter Rabekah, a recent divorcee, who fled domestic abuse, along with her son. All are surviving off the meagre sales they make from farming bananas at a subsistence level.

Loveness, however, has cervical cancer and is now experiencing frequent pains and dizzy spells. Currently she has no drugs for her pain. Last week, her codeine ran out, and she can afford no more. “We are subsistence farmers of bananas. We sell our bananas along the road, and whatever money we get we buy some drugs. With the money I have I can’t afford my full prescription, so I just get as many tablets as my money will pay for. Then I have to come back home, get the bananas, sell them and hope to get enough money to finish the prescription. Because of the weakness, though, I am not longer strong enough to go and sell the bananas. "

The family, here, are struggling in so many ways. Rabekah and her son arrived at her grandparents' door when she was fleeing domestic violence. “The third month after I gave birth to our son,” says Rabekah, who, pink-haired and beautiful, looks far too young to have gone through all she has experienced, “he started beating me. One day he tied me with a rope on the neck and he said he wanted to kill me. I was admitted to the hospital because of my injuries.” Like many young women in Malawi, where child marriage is common but illegal, she married early, and was a teenager when she had her first child.

Her grandfather Jackson, at 85 years old, also has health problems, though he still talks with a vibrant smile. He can no longer really eat, he says. “They cook me food but I sometimes vomit. So they make me porridge. I drink that. I don’t know why I vomit.” He still, he says, makes the walk down the escarpment road, though, to sell bananas or get what they need. “There are short cuts,” he tells me, “from bend 1 up to bend 20.”

Jackson’s own grandfather came here, he tells me, in the time when the missionaries arrived. “He found a job there. That’s why we live just nearby. He worked with Dr Laws, as a messenger.” He also tells a story of the poverty and struggle of life in those hills before their arrival. “Before they came here, we were very poor. We had nothing to cook food, no matches, no fire. We ate fruit from the trees. We are now better off. The Europeans abolished the slave trade. People from Tanzania bought many slaves from here.”

There are many stories told around here of the arrival of the missionaries. Almost always they are positive – even if the British colonial government itself is often criticised. They got rid of the slave traders, people say. And to some extent that is true. It was David Livingstone pioneered that fight against the chiefly Arab and Swahili-run East African slave trade.

It’s also possible to see the impact of their religious mission almost everywhere in the religious texture of this very Christian country. Here belief is deeply written into every aspect of life, from the shop signs with names like God Knows Butchery and Up Up Jesus hairdressers, to the frequent prayers. In the town Robert Laws' former home, now a museum, still stands, a stone house which could have been transplanted from the Aberdeen that Laws grew up in.

What EMMS is doing here, and the work of the hospital in Livingstonia, can be clearly traced back to the arrival of those missionaries, and to David Livingstone, who was one of the organisation's early members. It’s a chapter of that story, but also of something wider. It’s part of a contemporary struggle to deliver what the people in this remote place, where less than 1% have medical insurance, and across Malawi, need. "What has motivated the setting up of the palliative care team?" says Chawanangwa Smith Beza. "It’s the pain endured in the past. Many people were dying and suffering in silence when we can do something for them."

EMMS international is currently running Every Life Matters, a fundraising campaign backed by the UK Government, which will match donations from the public, pound for pound.