Maintaining Community Engagement

When we hosted our first community volunteer meeting back in July one of the strongest pieces of feedback I received was “don’t disappear!” In communities that become subjects of multiple research projects and interventions like CLI’s, it’s important to work with intention to follow through, and illustrate the value these projects bring back–and not just to the PIs.

So, even though the next volunteer meeting occurred sooner than I had planned, I was still happy to hear that Monday’s gathering was well attended, and that our IDs are still being made and new volunteers recruited. The people in our catchment area move frequently, so we anticipated roll over in volunteers who moved out of the catchment area or into a village that was already represented by an existing surveillance volunteer.

Speaking of rollover… our star Health Surveillance Assistant, Lamulani, went off to university! He’s studying medicine and how can we not be excited for that? Luckily, the rest of the HSAs are stepping up and taking care of business. Frank, pictured, is working with fellow HSA Chrispine to continue cultivating this wonderful community dedicated to improving our knowledge about maternal and neonatal care in the MWC catchment area.

Adaptability Training

Got a big surprise on Friday:
Most of the research team including my preceptor Gladson will be in Lilongwe (the capital) for the rest of my time on site. They were able to schedule the training that was pushed back originally, so my relief of having lots of research team availability was a bit premature.

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A Day in the Life

When I’m not running around like a crazy person preparing for a meeting like yesterday’s, here’s what a typical day at the office looks like:


Breakfast with my roommates, Araseli the CLI hospitality manager and sometimes other people on site.IMG_2722

Eggs with beautiful yokes and indulgent toast is the norm.


For those who were wondering, my coffee solution is perfect and is a hit with others on site.

Breakfast is sometimes rushed so we can hop across the site and get to our morning meeting at the clinic.


Clinic and research staff attend to give updates, ask for feedback on upcoming projects, and raise any issues. There’s usually also a presentation. We saw two last week about malaria diagnosis and treatment. I like how the doctors and ‘superior’ staff take time to share what they learn about new standards and best practices with the broader group. For example, they shared doses for children taking first-line malaria treatment with everyone, even though only a few of those present had authority to prescribe.

Last Friday we used this time to get feedback on the volunteer guide, and the project as a whole, from the clinic and research teams.


After the morning meeting we go to the office. It’s simple, I’ll call it an ‘open workspace’ concept with lots of sun. Everyone works diligently, as a group or quietly on their own, until lunch.


Mzungus eat separate from the rest of the staff, which is kind of a bummer. We do benefit from more variety of the kinds of foods we eat, but “doing as the Malawians do” was more of what I expected. I can’t complain though; they just want us to be happy, and the food is great.

IMG_2737Sometimes we are served Malawian food; the main staple being nsima, a white cornmeal kind of dough that you mold in your hand and dip in whatever it’s served with. That is usually “relish” which reminds me of southern cooked greens at home; and then sometimes another version with some kind of peanut flour or paste in it. They call it “peanut butter” flavored.

Everyone in Malawi gets a 90 minute lunch break: it’s actually the law. So depending on the day I check in on things back at the home front (hi ODEE!), take care of things in my room (like cleaning the shoes I filled with dirt on the walk to the market last weekend) or practice some yoga. It’s super sunny, every day this time of year.

Our afternoon at work is our chance to communicate with people in the states so sometimes we do some of that. The other day it took 30 minutes, two computers, and several phones to connect for a conference call which was still off-and-on connectivity that often required transcription on the typing section of skype while my advisor Alison spoke on her end. It’s an exercise in patience.

IMG_2721Otherwise, we just do more of whatever we did in the morning. In the afternoon there are fewer people around, as some staff get assigned to work outside the clinic.


IMG_2760We’ve often come back to the room to find Midnight on one of our beds, which is just like home for me. I recently found out that this was ‘against the rules’ though, oops.

Sometimes we work out before dinner. I’m sharing the room with an agriculture volunteer (Mackenzie) and a student researcher (Julika) and the three of us have done circuit training and running. Malawians, of course, think it’s funny that we exercise. I’m glad we can provide them some entertainment while we get some of that extra energy out from all the eating we do.

Sometimes after dinner we play games like bananagrams or puzzles. Usually we make calls home, do some reading and go to bed early. Like, lights out by 9.

That’s a (week)day in the life for me. It’s a nice routine with some wonderful people and a lot shorter to-do list than at home. I’m learning how to multitask effectively–loading a web page can take dozens of minutes and downloading a device driver has proven to take an hour or two. But with all the progress we’ve made already, I’m feeling confident about having a comprehensive system in place by the time I head home.

Zikomo kwambiri (thanks much)!


Meeting the Volunteers

Today was our big volunteer meeting! 63 of the surveillance volunteers from the villages around CLI came to the clinic. We didn’t have a big enough space for everyone inside so we set up in a courtyard outside the research office.


In the last week I’ve developed a community volunteer guide, which helped explain a little about the project and its purpose, the role of the village volunteers, and important information like contact info on who to report the deaths to. It also defines neonatal and maternal deaths to help them identify what a ‘case’ would be.

Check out the English Version | Chichewa Version

The volunteers got these guides, their t shirts, and volunteer IDs. They also got a round of training from my preceptor and the CLI research lead Gladson. The clinic’s head physician addressed the group as well, expressing his appreciation for the project and their involvement.


As with any well attended meeting, refreshments were served.


I had some really great interactions with our participants, even across the language barrier. It was fun getting to meet them in person after seeing their faces from the ID photos.

Planning the logistics of it all was pretty stressful. For our 1 p.m. meeting, attendees arrived anywhere from 11 a.m. to 2:30 p.m. But overall it was a great opportunity to get everyone together. The volunteers asked thoughtful questions and worked together to figure out solutions that fit their communities.


The HSAs (CLI staff who act as liaisons in the villages) got some great face time with virtually all of the community volunteers for their areas at once, which was valuable too. Despite a long gathering, everyone was in high spirits at the end.


In addition to returning volunteers we also had new participants, so now all of the villages in the catchment area should be covered. I’ll verify when the dust settles and the registration forms are compared tomorrow.


My next step is to take a very close look at what happens after the community volunteer level reporting: how the HSA collects information for the audit, how it’s entered into the database, and how it’s analyzed for applications in clinic decision making.

These are just a few of the photos I was able to snap while helping carry on the meeting. I had a fellow volunteer come take more, so stay tuned.

Tionana (see you later!)


and the work begins

I made it! With almost all of my stuff and almost no plane sleep.

Which meant 11 hours of deep, deep sleep and waking up to the cleaning staff knocking at the door this morning. My roommate and I arrived at the same time and both slept in and missed the daily 7:30 meeting at the clinic. Oops. We’ll have to do the formal intros at tomorrow’s and hopefully everyone will understand that jet lag is real.

Accommodations are very hotel-like; the bathroom is much nicer than my own at home. The staff is amazing, food is great, and the site is gorgeous. I will take a walk around the premises this weekend to better illustrate in photos.


And, there is a cat. A black cat named midnight who follows people around and commands attention like all great cats should. Malawi is known as ‘the warm heart of Africa’ and the people are living up to the name entirely. I am spoiled here.

In spite of my tardiness, I was pleasantly surprised by how productive my first day was. I got to sit down with the Health Surveillance Assistant who is our main connection to all of the community surveillance volunteers. We reconciled some long lists of participants and their villages that had a bunch of disparities. We have almost 50 volunteers trained, photographed and with IDs made!

I also made a guide for the community volunteers that’s more visual and less text-heavy. We’re going to meet with as many as possible this Tuesday so I’ll be preparing for that in the coming days. Another big project that was supposed to be taking off this month was significantly delayed, so I’m very happy to know that getting my work complete is actually feasible and that the people I need to work with have the availability.

Since I’m meeting with volunteers, I need to learn some Chichewa. Greetings aren’t bad:

Muli Bwanji – how are you?

Ndili bwino, kaya inu? – I am well, and you?

Ndili bwino – I am well

Zikomo – thank you

Ndapita – Goodbye

But things get scary pretty quickly:

Ndithandizeni – Help

Sindikumvetsetsa – I don’t understand

So, fingers crossed I understand everything and never need help.


Photos coming soon, I promise. Ndapita!

What I’m Lacking, What I’m Packing

I leave Sunday! The countdown is now less than a week and I’m pulling things together. This is my third international trip and I’m not forgetting all the lessons learned the hard way from my first two:

IMG_2661Coffee. Peru and Uganda both being known for their coffee exports, I thought I’d be drinking some fancy brews, but was woefully mistaken.

In an effort to avoid 4 weeks of instant Nescafe, I’m bringing a disposable pour-over for each day. I think the materials inside the packet are compostable. I found these on Amazon for a fraction of what I pay for coffee here at home. Traveling internationally is always an exercise in flexibility, but I’m giving myself a pass on this one. I think allowing myself a few creature comforts can help me direct my energy on all the other ways I’ll be out of my element.

I’m lucky to have very little to worry about as far as regular medications–just a daily Malaria pill and the typical travelers’ kit of SPF, DEET and ahem, digestive precautions. IMG_2662

I’m going during Malawi’s cool, dry season. Which means fewer mosquitos, so lower malaria risk. It’s also a lot easier for me to stay comfortable and dress conservatively. When you think about going to Africa in July you don’t think about breaking out the sweaters, but that’s what I’m doing as nights will be pretty chilly and days will be in the 70s. In my first trip to Africa I completely underestimated what’s appropriate for dress and was way too casual–this round I’m wearing long skirts and outfits I wear to work now to make a good impression.

volunteer shirtsI’m taking over a bunch of items for the project, too. Including my volunteer t-shirts! I was so excited to get these in the mail last week. It was a much-needed tangible reminder of all the people who are involved in this surveillance system and the impact we can have on maternal health in their community.

These shirts cost 2-3 times what I originally expected to pay for the volunteer incentives, but I’m so happy I was able to get them. They’re really going to help volunteers identify with the project, which is the whole point. I’ve met my extended goal on my fundraising page and that provided me some additional funds for this expense.

*The shirts are also taking 2-3 times the space that my original idea–the volunteer totes–would have taken. Which means I’m looking to borrow a large suitcase. Anyone in Columbus have one they don’t need until August? A BIG one you have to check.

As many projects go, unexpected expenses happen. I wanted to pick up a scanner, for example, so the team members on site can have access to digitizing the audit forms as they’re completed. I’m currently receiving photos of the completed forms taken with a point-and-shoot, and doing data entry from those. This system works in the short term, but should really be improved. So, if you meant to donate to my project and have procrastinated, it’s not too late! At this point, the more I can raise the longer I can support the expenses of my project before they become CLI’s burden.

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I can’t say thanks enough to everyone who has supported me and this project. I’m incredibly lucky to be surrounded by so many great people who have taken an interest and offered to help in so many ways. It’s another motivation on a long list of reasons why I’m committed to perfecting this system while I’m on site. More on that next!

Thank You! + CLI Photos

Guys. You, ahem, made it rain on my birthday. Knowing I’m surrounded by people who believe in me and what I do is the BEST gift I could ask for and I can’t thank you all enough.

Immediate costs of the project are covered, but the longer we can pay our own way in staff salaries and supplies, the better for CLI. They will pick up the expenses when my contributions run out, but that does take away from other funds they would otherwise use to care for the community and execute other important research projects in the catchment area.

So in case you haven’t made it over to my fundraising page yet, I’m keeping it open through this month.

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My advisor took a good hard look at our materials and started asking the what-ifs and other awesome questions that will make my tools more powerful. Grateful for the close look but I have a lot of the more tedious work that’s not so fun to blog about. Instead of boring you to death about my spreadsheets and protocols, I want to tell you more about the site I’m working at, Child Legacy International.

Just from looking at photos you get the impression that there’s a lot going on in this compound in rural Malawi.


First, it runs off of wind and solar power. When you run a clinic and research lab, having consistent power supply is not an option, so they’re building a pretty robust system. When I met one of the founders a couple of months ago,  he made a good point about providing creature comforts as incentives to retain the Malawian staff they train and educate to work at the center. I get it, too–those little things count and you want to have the best people.

Though my project is really focused on work for the McGuire Wellness Center, CLI is way more than just a clinic.


Their compound has farms,


including tilapia ponds that feed staff and patients, then extra go to market for profit to the center


clean water access projects,


below is a photo of the cofounder I haven’t met yet–from what i can see in the photos she walks the walk when it comes to collaborative efforts and i love it.


There’s also a school for young kids, and opportunities for vocational training too.


plus a lab for bio testing, a pharmacy, a research arm, so much!

CLI map

It’s impressive to peruse their photos and see how much they have going on, and to see their plans in the future.


The more I learn about this organization the happier I am to get this opportunity to work with them. I was also glad to see that they’ve earned the highest possible rating by Charity Navigator. It’s another reason why I want to support my surveillance system for as long as possible. The money that’s being put to work by this organization is used where it’s needed and it’s used efficiently.

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Thanks for all of the support you’ve all shown me already, and for any new supporters reading this now!

Supporting my Surveillance System

The surgical theatre was scheduled for its first operation today! I don’t know all the details (ad will share when I get an update) but there were actually two gynecologic surgical procedures planned and they will be the first patients that will stay overnight and be admitted to Child Legacy Hospital. A really big deal for a clinic that for years has only provided outpatient care. Such an exciting time to be prepping for a trip to see it all in the flesh.

CLI operating theatre

My flight is booked, my personal expenses are saved, and now I’m asking for help to cover the remaining project costs.

Since most or all of my community volunteers only speak Chichewa, I’ll be working with a research assistant/translator to help me get around to villages throughout the catchment area and check up on the surveillance system. Everyone on the research team I’ll be working with on site is Malawian, which is another great benefit of working with CLI.

I’m also providing volunteer toolkits, to help the surveillance volunteers in the villages surrounding Child Legacy know they are part of something important and that their work matters. Gladson, my preceptor, let me know that giving them something branded would help make that connection. I’m thinking of giving all of the volunteers their toolkits (manuals, volunteer ID cards, office supplies, airtime etc) in a branded reusable bag that they can then use for other purposes and be reminded of their role.

It’s these remaining project costs that I could use some help with.

I’ve set up a fundraising page to accept donations. Every little bit counts, really!

$5 provides the airtime it takes to supply volunteer with the phone calls they need to report a death in a timely manner. If you donate $5 or more I will send you a photo and some information about the community volunteer who you are empowering to be a part of something, gain new skills and improve maternal care in their village.

If you donate $20, you’ll provide a day’s salary for my translator. If you donate this much I’ll find out what your name would be in Chichewa and report back.

My birthday is approaching and I’d love to dedicate it to this project. Please donate to my project instead of buying me a celebratory beer or a trendy greeting card. It would mean the world to me and it really makes a difference to the volunteers and communities I’ll be working in.

I’ve already received so much moral support from my family, my work family and friends. Can’t thank you all enough for all of the excitement you have shared with me and your encouragement in doing what I love.

Maternal Health in Malawi

Lets visit the numbers:

malawi MMR

The World Health Org has some awesome interactive visualizations of health data, showing maternal deaths per 100,000 live births.

Malawi is at 510.

In case you’re wondering, Is that a lot? Compare it to 28 in the U.S., or 6 in Switzerland.

This means that the risk of a woman in Malawi dying from a maternal-related cause during her lifetime is more than 18 times higher than the risk for a woman living in the U.S., and 85 times that for a Swiss woman.

Even compared to its neighboring countries, Malawi is still behind in maternal health care according to these parameters.

Numbers only carry as much meaning as they can be associated with real people and their stories.

On Tuesday I learned about our first deaths reported by our surveillance project. A mother who, for many reasons including lack of funds for transportation, delivered at home alone. She lost both of her twins within a week of their delivery. She was HIV positive but wasn’t taking the drugs because they made her very sick. Our HSA told her about the CLI clinic and she and her husband did come for a different therapy solution that might not cause so much nausea. We’re realizing it also has the potential to connect community members to the clinic’s resources.

The goal of my surveillance project is to document these circumstances under which mothers and their babies don’t survive. We’ll learn more about these twins’ deaths, but there are already so many obvious fixes to dramatically reduce the risk to mother and child. It is disheartening to identify these solutions after it’s too late. But getting data to illustrate these common obstacles to safe obstetric care will help plan for where new resources can make the most impact, identify training needs, and get facilities across the catchment area communicating with each other.


For so many reasons 510 is more than just a number, and I’m feeling very privileged to be doing the tiniest something about it.

Leg Work Leading Up

Since the maternal ward was scheduled to open sooner than my arrival, the CLI team wanted to launch the surveillance project before I arrived–my advisor was hoping for as early as April. And it kind of did.

I’ve been working since last fall with the team to develop  (several iterations of) the death audit form, a training manual for the village volunteers, a surveillance protocol, a database, etc.

A couple of weeks ago some 30 community surveillance volunteers came to the McGuire Wellness Center to get familiar with their roles in the project and learn about maternal and neonatal mortality. Involving the community is vital for these kind of projects: these volunteers don’t need to know all of the medical stuff, but they are our eyes and ears in the villages.

When any of the volunteers across the 60+ villages hears of a death of a baby or a woman (we give them a wide age range), they report it to CLI. From there, one of our Health Surveillance Assistants asks a few more questions to determine whether this death fits our case definition of a maternal or neonatal death. If it seems to, they head out into the field to get the details from the health care provider and family of the deceased. They complete the audit and take a narrative version of the interviewees’ testimonies.

One tricky part was figuring out how to incorporate an existing audit: the Ministry of Health’s maternal death report. It does exist, but is not shared among facilities, and is not as comprehensive as many of our CLI physicians would have liked to see. I added to the maternal version and included a neonatal section. I also added some questions and did some rewording to apply to deaths that might occur in the community. Our hope is that for the facility deaths, the MOH audit form will already be complete when our HSA arrives, and that the form can be used to cross reference answers we get from the interviewees.

Doing this kind of auditing requires some tact: No one likes to get interviewed on all the things they do wrong. It’s our job to assure the facilities and providers that we’re simply collecting information and are not placing blame or taking any kind of retributory action.

Getting everyone together for a meeting was an exciting first start, and the partners who conducted the training said it was an energetic group. Volunteers have agreed to go ahead and contact their assigned HSA when they hear of a death, but CLI is still translating of the forms I developed. I’ll also be sending over funds for airtime cards for the community volunteers. We’ll continue attracting more volunteers so each village can (more or less) have its own surveillance volunteer. The (kind of) good news is, the maternal ward has not yet opened.

My advisor is traveling to Malawi next month, and she’ll deliver my “volunteer toolkits” that provide each participant an ID badge as a CLI surveillance volunteer, the airtime cards and some other things that will help them feel Official. I hope these tokens and trainings empower and motivate them to take an active role in the project.

Moms in Malawi deserve safe deliveries too! I’m excited to be a part of it and look forward to spreading the good feelings.


I’m knee-deep in the project so am surely missing pieces and parts when talking about it. Would love to receive your questions in the comments below!