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!
Fun fact: I’ll get to celebrate Independence Day again when I land, as July 6th is the day Malawi attained independence from the British in 1964.
I’m about to leave New York for Johannesburg (kind of can’t believe a single stretch goes that far), with the volunteer IDs, some kwacha, a $60 unlocked droid phone that will work on the global network, all the luggage I could carry and then some.
Wish me luck getting myself and all my stuff to CLI without any huge hiccups! Thanks for everyone’s sweet well wishes I’ve received in the past week or so, can’t wait to get to work and share it all with you.
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:
Coffee. 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 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.
I’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.
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!
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!
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.
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!
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.
Thanks for all of the support you’ve all shown me already, and for any new supporters reading this now!
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.
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.
Lets visit the numbers:
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.
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!
Every Master of Public Health student has to complete a practicum project. For mine, I knew I wanted to go abroad again, and the project requires me to work more hands-on in the health work than my Peru visit allowed.
In April of last year (yes, before my trip to Peru) the Child Legacy International team made a visit to Ohio State to talk about their wellness center and other services provided to rural Malawians. They shared their plans to open a new maternal ward and illustrated the need–Malawi has high maternal and infant mortality rates, even compared to their neighboring Sub-Saharan countries.
I got in touch with their Ohio State partner and asked how I could contribute to their work for my practicum. The stars aligned then, and their biggest need (that I could help with) happened to be related to maternal health. They needed a maternal death audit system to assesses their services and the care provided to mothers and their newborns throughout their catchment area of 20,000 people across 68 villages.
So it’s been a year working on and off (though more ‘on’ recently) to develop a surveillance system that can help us learn more about what happens when a mother dies from childbirth or when her neonate doesn’t survive. This data is collected routinely in western health facilities and used frequently to improve care practices and identify risks. Collecting and analyzing this information for the MWC catchment area will allow the quality of care to improve for their community as well.
I’m looking forward to sharing more with you as the project approaches and then will post stories from the field. I leave in early July for my 4-week trip.