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!

Learning By Doing

Replace “being an adult,” with “leading a transcontinental practicum experience project” and this interweb gem has been my life.

Okay, not just Googling, but digging through journals and asking tons of questions. I’ve taken courses about public health in ‘developing countries’ but nothing on maternal health exclusively. So I’ve done a lot of learning by research and doing.

The elements of the project (so far) are the maternal/neonatal mortality audit form, a surveillance protocol, a database with data entry protocol, a volunteer training session and a volunteer manual.

My process for each piece is pretty much finding versions that have already been made (if/when that exists), comparing it to white papers and other peoples’ lessons learned for similar projects, aligning it with best practice guidelines by institutions like WHO or UNICEF, and researching Malawi-specific reports and maternal health projects from the area so I can make sure it’s relevant and appropriate.

I’ve gotten these far enough along to get the project off the ground so we can been able to take in cases (another neonatal death was reported last week). From here I’ll be refining them with experts on site at CLI. My time there overlaps with doctors from Baylor College of Medicine, including an OB-GYN who is living there currently. I’m also looking forward to working along side my practicum preceptor Gladson and other CLI research staff who can help me understand what needs to be done to make sure the tools fit in with the Malawian culture. Finding the right timing so we can respect the traditional mourning period, while getting our data close enough to the event for accurate reporting, is one item on that list.

Taking initiative to learn by doing + research has been difficult at times, but it’s been a huge growing opportunity for me and has been a great exercise for my brain. Now I’m looking forward to perfecting this system and making it run like a well-oiled surveillance machine!

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!