It's the biggest and one of the best government hospitals in Malawi, with the country's only medical school attached. But in the main wards, acutely sick men and women lie on mattresses on the floor. Consider them the lucky ones. One or two have only a sheet between them and the concrete.
Privacy is non-existent. There are about 100 patients in an open ward. Relatives camp on the edges of beds, fanning away the flies from the patients. The sick mostly have their eyes closed in pain or exhaustion. Those who do not wear a haunting stare of fearful resignation.
The Queen Elizabeth's pleasant low-rise facade, approached through shady trees and plants, gives no warning of the scale of human trouble within. There are around 10,000 admissions a year, many of them dangerously ill because they do not arrive soon enough - 15% die. It is an enormous challenge needing large, dedicated teams of doctors and nurses. But the Queen Elizabeth is desperately short of those.
It is said there are more Malawian doctors in Manchester than in the whole of Malawi. The vacancy rate for specialist doctors at the Queen Elizabeth - with all the advantages of a medical school attached - is about 60%. There should be 500 nurses, but the hospital has only 200. It loses between three and five each month.
"Most of our doctors and nurses are going to work in the UK," says the medical director, Ibrahim Idana. "The profession is marketable. There is a world shortage of doctors and nurses. Doctors here work for one to one-and-a-half years in Malawi and then they go. If they go for training in a specialisation, most of them don't come back. If they do come back, they work for one or two years and, when they compare the lives of their colleagues in the UK, they resign and off they go."
Money, status and working conditions all compare very badly in Malawi. A doctor will earn around 30,000 Kwacha a month, which is about £150. He can't get a loan even to buy a car, says Idana. "So people say, why do I bother to stay here? I can't have a car or a decent house. The allowance for a house is only enough for a small house in a high-density area, not the suburbs."
The UK has recognised that its hiring of Malawi's doctors and nurses has an impact. It now has a substantial scheme to top up the salaries of those who stay. Idana is not sure it will be enough and he is concerned that the scheme will end in five years' time.
Ironically, the Queen Elizabeth survives on European doctors, some funded by their governments but others working on local salaries for a year or so. They are employed by the medical school to teach Malawian doctors, but spend most of their time treating patients. Joep van Oosterhout and Ed Zijlstra are paid for by the Dutch government, but a change of policy means that this will end in 2007 and neither knows who will fill their shoes after that. There are eight physicians in their department of internal medicine and only one is Malawian.
The nursing shortage is even more acute, says Oosterhout. There may be 70 to 100 patients on a ward, with only two nurses in the day. "In the evenings there is one and it is not uncommon for there to be no nurses present or one nurse to cover two wards."
So the wife or sister, husband or son sitting on the bed, known as the guardian, becomes critical to a patient's survival.
"If you don't have a guardian, your prognosis is much reduced, especially if you are bedridden," he says. Somebody needs to collect your food. Some of the lab test results are brought to the ward by messenger. He calls the name of the patient. A blood culture may have grown some bacteria. It is very important. If you have meningitis you may be drowsy and can't hear," he says. The results need to be attached to the foot of the bed for the doctor to act on. "If you have no guardian, the results won't reach you or will reach you too late."
There are numerous other problems. Drugs are sometimes inexplicably unavailable. Basic operations cannot take place because of a shortage of anaesthetics in some hospi- tals. At the Queen Elizabeth there has been no intravenous penicillin - a very important drug for treating the diseases of Africa - for three months. In one of the labyrinthine corridors, a vast queue has formed for the pharmacy, where out-patients and relatives are waiting to collect prescriptions.
It is huge, but it is silent. People come to hospital more in hope than in expectation. That may be just as well.
