MediServ Week Preparation- Operating Theatre

Part of the team installing new sockets!

Part of the team installing new sockets!

Our team will be arriving in Malawi in less than a month! We are still hard at work on the ground with Kabudula Community Hospital preparing for a busy week.

Over a year ago, there was new theatre equipment donated to Kabudula, but the electrical sockets were not the right shape to use them. We looked around for adapters but couldn’t find any that fit, and there was no solution besides changing the outlets, so we started to facilitate progress towards that.

We met with the anesthetists at Kabudula, the Lilongwe District Health Office and also found a great technician who had some great ideas to solve the problem permanently. Ultimately, a modern Malawian outlet and a new South African outlet were installed at each site in the theatre to accommodate equipment from all sides of the operating tables. Having both outlets there will allow all equipment to be used as the plugs come in both styles.

Anesthetist Clinical Officer Wells said “Wow! This is a great development. We have been trying to do this for over a year! Thank you so much, we are so proud of this work!”

New sockets!

New sockets!

MediServ Week Preparation- Updates

We are still busy on the ground getting ready for the upcoming MediServ Trip!

Patient Recruitment: Recently, our on the ground staff visited the Rural Health Centers within the Kabudula Community Hospital catchment area to meet and schedule surgical patients to been seen by our team during the upcoming trip. There were so many patients that came to be scheduled! We have very high aspirations to see as many patients as we can. We are also working towards making sure that surgical cases are seen after our trip is over by Kabudula staff and other Malawian clinicians we are partnering with.

Equipment Installation: Ultrasound, x-ray and anesthesia monitors have all been installed at Kabudula recently. A few months ago, we discovered that Kabudula has many new equipments that had not been in use because they had not been installed yet due to lack of space or consistent utilities, amongst a few other reasons. We are happy to hear that some of these machines are up and running!

Kab Clinician, Patrik, preparing new anesthesia monitor in preparation for MediServ!

Kab Clinician, Patrik, preparing new anesthesia monitor in preparation for MediServ!

Bat Infestation: A few months ago we described the situation at Kabudula whereby the Under-5 clinic ceiling collapsed. We connected with another organization in Malawi, African Bat Conservation, to help Kabudula control this issue. Over the past few months, we have been working closely with them to try and eradicate the bats from Kabudula Community Hospital in a responsible way. After preparations, they are going to being their work at the hospital!

MediServ Week Preparation- Equipment

The “Hot Cot” station at Nkhoma Private Hospital

The “Hot Cot” station at Nkhoma Private Hospital

We are busy making sure that the equipment at Kabudula Community Hospital is ready for our MediServ Trip.

Last year, operating theatre equipment was donated to the hospital from another partner, but has not yet been installed because, at the time of donation, Kabudula was struggling with a consistent water supply. We are working closely with this partner and the government to make sure that it is installed in time for use during our trip and after.

We are also working to provide the neonatal department at Kabudula with new equipment that they will become comfortable using in conjunction with our visiting neonatologist. We call these “hot cots” and they are wooden boxes with a series of light bulbs that produce heat from below to keep premature babies warm and prevent hypothermia. Although people often assume that Malawi is always warm, we are entering our cold season and it can get fairly chilly at night.

Factory made equipment can be expensive to procure, install and maintain. We found out about these incubators, made from local materials, from Nkhoma Private Hospital which uses them regularly. Nkhoma has created a top of the line neonatal department in just 5 years. They are guiding us on this project. Our goal is to have one incubator made for Kabudula Hospital before our trip.

Kabudula Community Hospital is ready to handle surgical cases on their own, they have the necessary resources when it comes to equipment. However, the remaining gap is staff training and experience, which is something we will provide during our trip!

MediServ Week Preparation- Patient Recruitment

Last week, GHF Angela traveled to all 8 Rural Health Centers that are part of the Kabudula Community Hospital catchment area to begin the patient recruitment process for the surgical aspect of the Mediserv trip.

For our previous trips, a lot of our patients came from the community that was directly surrounding Kabudula Hospital. We want to ensure that patients further away from the main hub that is Kabudula, that do not have access to these services are being recruited and told about the program, so they can be treated also.

At each health center, she met with the Clinical Officers there who are responsible for running the clinics. She introduced the Mediserv trip and to ask if the Clinical Officers were already aware of patients that could use our services. Angela also met with the Health Surveillance Assistants (HSAs) that each health center has. HSAs are responsible for encouraging healthy behaviors throughout the communities and linking patients with the health centers and care. HSAs from these health centers will help us to find patients in their communities and make them aware of the screening day we will have at each health center. Together, the HSAs and the Clinical Officer at each health center will help us find patients in their communities who need surgery.

We’ve found that patients often struggle the most with transportation (view our previous posts about traveling to the rural health centers from Kabudula describe what it is like for us.) We want to come to these patients to make sure that they aren’t missing out on a treatment that they could need, because they can’t get there or haven’t heard about it.

In May, we will host screening days at each of these health centers, where we will sign them up for treatment days at Kabudula during the Mediserv trip.

MediServ 2019 Prep!

In June 2019, a medical team from AHA will be traveling to Malawi for another Mediserv trip!

Every time we have MediServ trips, we look for ways to improve them and have a larger impact. This trip will be our most innovative and far-reaching yet! Similar to last trip, we will have a surgical, dental and training aspect to the program and this time we are adding a maternity/pediatric aspect as well! The overarching goals of our trips is to provide access to healthcare to hard-to-reach patients but also participate in an exchange of skills with Kabudula Community Hospital and other partners so all clinicians participating in the programs (visiting and Malawian) leave with improved capacity to treat their patients long after the trip.

Our staff on the ground have been working very hard to make sure that everything our team will need is prepared. Over the past few months, we have been working hard with our partners at Kabudula Community and the Ministry of Health to meet their needs. They are also helping us with the trip logistics which include patient recruitment, equipment preparations and the program plan.

We were recently approached by a general surgeon at Kamuzu Central Hospital about the possibility of our surgical team visiting them to help train intern surgeons on a specific type of surgery. By doing this, we will reduce their backlog and also have the opportunity to help train surgeons at the largest hospital in Lilongwe.

Preparations for a trip like this take a lot of work and collaboration within Malawi and the US, we are excited to see everyone’s hard work pay off and see the impact we can have this year!

Tropical Cyclone Idai

In the past two weeks, Malawi has been hit with flash floods as a result from Tropical Cyclone Idai. There were two waves of flash floods due to the cyclone leaving many casualties in its’ wake. All AHA employees are safe and uninjured. Some of our Malawian staff has suffered house and property damages that were able to be fixed.

Most of the impact was in the southern region, where houses were washed away, roads and bridges collapsed and lives were lost. The effects of the flooding in Kabudula community were minimal compared to other regions and communities that were devastated. As with any unforeseen circumstance, even minor incidences such as this cause families to suffer because they are already struggling to survive financially, many times depending on one person’s income to support extended family.

Similarly, when someone falls sick in a family and needs surgery, it takes everything the family has just to get them to the hospital for help. Even if they do manage to get there, they often find the public hospital is under-resourced. Private hospitals have more resources but are unaffordable for village residents. This is where our organization comes in, to support the public hospital to be better resourced to handle day to day activities, provide care to hard to reach patients and support when unforeseen events occur.

The cyclone has affected Mozambique and Zimbabwe also, with a death toll climbing close to 1,000. Our partner organization, World Altering Medicine, often helps Mozambican residents receive surgery at Nkhoma Private Hospital through the Watsi program.

News updates of Cyclone Idai can be found via all major news outlets.

Traveling to Chilobwe Rural Health Center

Our team of three (our two Fellows, Carolyn and Angela and a Research Assistant, Gabriel) visited the last three rural health centers yesterday. The intention was for the entire team to visit all of them together, but due to rainy season, hazardous road conditions and lack of a 4x4 vehicle the plans changed.

The road to Nambuma Health Center

The road to Nambuma Health Center

 We set off from Lilongwe on the way to Nambuma Rural Health Center. The health centers we have visited are within about 40 KM in all directions from Kabudula Community Hospital. The road to Kabudula from Lilongwe is all paved so it is never an issue for us to get there. All the rural health centers are not off paved roads so to get there we must take dirt roads/paths. Currently it is the middle of the rainy season, so the conditions on these paths are sometimes impassable. Nambuma Health Center is about 40 KM on a dirt path off the main road. At first, it was not a big deal, we were doing fine, but the road kept getting progressively worse. After for what felt like 30 minutes, we did not see any town or health center in sight. We looked at the odometer and we had only gone 5 KM! We were concerned we would get stuck and turned back to find the main road and make a new plan.

We now needed to split up to make all our appointments with the health centers. We went to Kabudula to leave our car and organize rides on motorcycle kabazas (taxis). Angela and I went to Chilobwe Health Center together.  

Tobacco leaves drying in the town where we stopped for fuel

Tobacco leaves drying in the town where we stopped for fuel

From Kabudula, Chilobwe is about 20 KM which is SUPPOSED to take about 45 minutes, but the ride there took about 1.5 hours. Angela’s kabaza ran out of fuel about a quarter into the ride, so we had to stop off in a small village to find fuel. The village we stopped in is technically still Kabudula but a suburb or region of it. We just made friends and chatted and waited for her driver to use a borrowed bike, ride to the neighboring suburb and buy fuel.

 We were back on the road after 20 minutes and about 10 minutes later my kabaza ran out of fuel! So, Angela’s driver had to go back to the village we just came from to buy more fuel for my driver. We got off and walked a little bit and found some shade while we waited. Finally, we were all back on the road. The conditions were concerning but easily passable on a motorcycle.

We finally made it to Chilobwe Health Center and met the staff there. It was a great visit, we were energized by the dedication and hard work of the team. They were so welcoming. We found out that clients who seek treatment come from a radius of up to 25 KM from Chilobwe, and there is only one clinical officer for this area. This clinical officer has worked closely with his community to set up village clinics throughout the catchment area that are ran by Health Surveillance Assistants where people can pick up medication when they are not able to reach the health center. Chilobwe Health Center does not have a maternity ward, so they cannot have deliveries there. Pregnant women from this area have to organize their own transportation to Kabudula to give birth.

On a tour of Chilobwe Health Center

On a tour of Chilobwe Health Center

We took a tour of the health center but had to cut the meeting short because we could tell the rain was coming soon. We can tell from the temperature change (it gets really hot and humid) faster than we can tell from the sky that the rain is coming. Our drivers could tell too so we booked it back to Kabudula. I bounced around like a Ping-Pong ball on the back of the motorcycle over the uneven dirt paths dodging other bikes, animals and people for 45 minutes. I couldn’t even move that night I was so sore.

All in all, it was a great experience. It highlights the fact that we transportation from rural villages that seek treatment at Kabudula and even the rural health centers is extremely difficult. We had the resources to use kabazas, so it was ‘easy’ for us to get there. This can be almost impossible for many people who live in these areas. And this is just to get to Kabudula. If someone presents with a complicated case, needs to be seen by a medical doctor in Lilongwe and if they are able to afford it, the journey could take an entire day. On top of this, many diseases are worse during the rainy season (mosquitoes are more prevalent, which means more malaria, waterborne diseases are also more common) AND it is considered ‘hungry season’ because almost everyone is subsistence farmers and are waiting for the harvest to come. We hope our work and experiences can highlight the difficulties many Malawians face in seeking healthcare.

Main entrance of Chilobwe Health Center

Main entrance of Chilobwe Health Center

Visit to Malembo Rural Health Center

Rural Health Centers (RHCs) are the most remote location and bottommost tier for healthcare in Malawi. They are often staffed by one Clinical Officer, a nurse or midwife and HSAs (Health Surveillance Assistants). RHCs do not admit patients. RHCs do not have the capacity for surgical intervention and focus mainly on primary and outpatient care and obstetric care (deliveries). The way the healthcare system works here is if there is a complicated case that presents at an RHC, they are referred to a Community Hospital (like Kabudula Community Hospital!). Community Hospitals then refer to District Hospitals who refer to Regional Hospitals.

Malembo Rural Health Center (brick building on left) and cold storage pharmacy (white structure on right).

Malembo Rural Health Center (brick building on left) and cold storage pharmacy (white structure on right).

Kabudula Community Hospital has 8 RHCs that refer to it plus its own community that uses it directly. Its catchment area (area surrounding the hospital that includes RHCs that refer to it and communities where their patients come from) is over 350,000 people.

Ambulance used to take patients to Kabudula Community Hospital.

Ambulance used to take patients to Kabudula Community Hospital.

Yesterday, the GHFs went to Malembo Rural Health Center, one of the 8 that refer to Kabudula Community Hospital. We asked our friends at Kabudula for the directions. We were told it was about 35 KM past Kabudula on the tar road, easy enough right? There are no road signs so once we passed Kabudula we reset the odometer on the dash and started paying attention for a health center. We had to ask for directions 4 times. I wrote the directions down for future use and they are as follows: 28 KM past Kabudula turn right on dirt road (pay attention once the odometer’s at 26KM!), (road might not be passable during rain, and be mindful of the crops on either side) turn right at first t-junction and pass through market place (market place identified by minibuses waiting to load to go to town, and about 3-5 corner shops), turn right at carpenter’s stall (blue stall on right past marketplace) and health center is adjacent to soccer pitch.

Maternity ward in Malembo Rural Health Center which houses two beds.

Maternity ward in Malembo Rural Health Center which houses two beds.

We had a wonderful visit with the Clinical Officer and other staff in which we talked about the services they provide and gathered some information for our needs assessment. When we arrived, both of the waiting rooms were overflowing waiting to see the Clinical Officer but the staff was making good use of everyone’s time by conducting community trainings about cholera with the waiting patients (which is an issue more now during rainy season). There was an overall sense of calm and peace at this health center, even though there was as many as 75-100 people waiting to be seen. The hospital staff was so warm and friendly, and the health center was well kept. We really enjoyed our visit with them!

By focusing our interventions at Kabudula Community Hospital AND the catchment area, we are offloading the burden of cases that Kabudula must see and hoping to lessen the burden all the way up the healthcare chain. We are looking forward to visiting the other Rural Health Centers in the coming weeks!

Back to Nature at Kabudula Community Hospital

Kabudula Hospital staff hastily cleaning up the ceiling collapse!

Kabudula Hospital staff hastily cleaning up the ceiling collapse!

Bats have taken over the antenatal department at Kabudula Community Hospital! Apparently they had been nesting between the roof and ceiling of the building which houses the antenatal clinic, ETAT, dental department, and vaccination clinic, but remained unawares for quite some time.

The collapse aftermath.

The collapse aftermath.

A few weeks ago, the entire roof over the antenatal waiting area collapsed! The feces produced by the bats had built up on the ceiling for so long, that the sheer weight of it caused the entire ceiling to fall through in one unforgettable moment. (Luckily, no patients were affected, as it was almost after hours).

The following day was spent sweeping up the bat feces and carting it off in sack bags to be sold for manure. The staff at Kabudula was working very hastily to clean up the mess and return to business as usual. They are also working to ensure this does not happen again.

Oftentimes, patients in Malawi have many barriers to obtaining healthcare. They don’t have a mode of transportation themselves, or money to take a bus to the healthcare centers. They don’t have resources to afford a hospital stay (family lodging, family and patient food). They are unfamiliar with the healthcare system and don’t know how to properly navigate it, including many not believing that their condition can be treated, or providers in rural areas not having the resources to do so. They are unsure if they will have to be referred to a large hospital, which would mean further transport, longer stay and less familiarity with the system. They are unsure if they will need to purchase medicine, which they may not be able to afford. These are only a few examples on top of the fact that there is only about 1 physician per 1000 citizens in Malawi. The ceiling collapse can be thought of as a metaphor for healthcare access here in Malawi where so many small things compile to prevent a Malawian from obtaining care. We aim to prevent a collapse by reaching patients where they are and addressing these barriers to care.  

Being a Patient at Kabudula Community Hospital

Imagine being a patient at Kabudula Community Hospital…

When someone falls sick in an African village, the family must find money for transportation to the hospital. They may reach out to other family members or sell a goat or some chickens to find these funds. Once the patient leaves home, he/she may begin by walking several kilometers to a dirt road. If the patient cannot walk, he/she may be carried on the back of a bicycle. Upon reaching the dirt road, another option for transportation may include riding on the back of a motorcycle to the main road. At the main road, the patient may be able to board a minibus for the final part of the journey to the hospital.

At the hospital, there is usually a long line of patients waiting to be seen, having started lining up since the early morning. These people have all been awake since before sunrise, having had to fetch water and start a fire for morning baths before leaving home. Whenever villagers travel anywhere, such as to the hospital, they bathe meticulously and dress their very best. No one seems to mind waiting for several hours to see the doctor – children play together and families chat in the waiting area as the day proceeds. No one comes to the hospital alone – every patient is escorted by at least one or several family members for support, and mothers generally carry small children on their backs everywhere they go, so it becomes a family event. The extra support is necessary, however, because if the patient is admitted to the hospital for an overnight stay, the accompanying family member is responsible for caring for most of the person’s daily needs. This presents another issue of lodging for family members – it is too far for them to travel back and forth to the hospital each day, and the hospital only has space for patients. So, family members set up camp just outside the main area of the hospital, where you will find many people cooking, washing dishes, washing clothes, and generally camping out for whatever length of time their relative remains a patient in the hospital.

Since individual records are not kept on file at hospitals/clinics, patients carry a “health passport” book with them whenever they go to the hospital. This is a small paper booklet about the same size and shape as a regular passport. Every patient must have one, and this is where the doctor records notes and writes prescriptions.

Most of the common illnesses presented at Kabudula Community Hospital are readily treatable by the clinicians on staff and the availability of essential medicines from partners like Access Health Africa and World Altering Medicine. However, patients with more serious conditions or complications are referred to hospitals in the capital city, which presents further issues regarding travel and transportation logistics. In addition, these referral hospitals are often over-crowded and under-resourced, making it difficult for everyone to access timely and quality care. We are working together with staff and partners at Kabudula Community Hospital to increase its capacity so that more patients can access the care they need.

Thanks for supporting us to make a difference in this community!

Small but Strong

Working as a Global Health Fellow with Access Health Africa (AHA) and World Altering Medicine (WAM) has allowed me a new perspective of what a non-governmental organization (NGO) can do and provide in the global health field. Compared to aid organizations that most people are familiar with (Unicef, USAID, Partners in Health) AHA and WAM are smaller, but no less capable of providing quality services. I came to this realization recently while in a meeting with these implementing partners who are all working to address the issue of cervical cancer throughout the country.

Malawi has the highest rate of cervical cancer in the world (75 per 100,000). Cervical cancer is entirely preventable but about 63% of women who develop cervical cancer in Malawi die from it. “Screen and Treat” is a proven intervention to diagnose cervical cancer and treat it at an early stage. Currently, the Malawian government has started to roll out a program to provide screen and treat equipment and training to all rural health centers in the country. Many large organizations are helping the government roll out this program country-wide. Until screen and treat becomes widespread allowing cervical cancers to be treated at an earlier stage, there is going to be a great number of women who need advance treatments including surgical intervention (radical hysterectomy).

There is currently a backlog of women in the central region of Malawi (where we mainly operate) that need radical hysterectomy. We were first made aware of this backlog through our partners at Nkhoma Private Hospital, where we run the Watsi program that funds surgeries. AHA and WAM are interested in addressing the issue of cervical cancer, so we set out to explore potential options of maybe helping rid of the backlog. Through the process of making connections with government officials and other organizations who are working to address this issue in Malawi, we were invited to partake in a task-force that consists of many large organizations and the Ministry of Health to gain a better understanding of the work that is already being done here.

The first task-force meeting that we attended, I was completely intimidated by the names and organizations around the table to the point where I didn’t think we even belonged. The information gathered was invaluable and when the time came to introduce ourselves, we simply stated who we were and that we were interested in learning more about the work that was being done already. Immediately after, we were told that there are many organizations (with large budgets and teams) that are working on up-scaling the screen and treat option and there is a great need for implementing partners to help with advanced treatments (like radical hysterectomy).

I couldn’t believe it, this is something we have already developed a proposal to do, help rid the surgical backlog! Here we were at this meeting, the whole time I was thinking, “there is no way that our smaller organizations can possibly fill any gap that is not already covered by large-scale implementing partners,” to be proven completely wrong. Our organizations CAN fill the gap and so much more.

This experience offered me the opportunity to reflect and really think about the strengths of our organizations. In this example, we have expertise and interest in an area that is not covered by other large organizations (access to surgery). We also have taken the time to build partnerships with the communities we serve and focus on providing access to health in conjunction with community members and clinicians there. Being a small organization offers us the opportunity to have more personal relationships with other organizations (such as Watsi) through which we can all work together to provide services because they are able to put a face to the organization and trust us to get the job done. These personal relationships also make our current programs more successful because we have boots on the ground working hand in hand with our Malawian community partners. We may be ‘small’ but our reach is far.


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Kabudula Community Hospital... an overview

On a tour of Kabudula Community Hospital

On a tour of Kabudula Community Hospital

Written by GHF, Angela

A lively community hospital serving a large rural population, Kabudula is the hub for health services in this area. While the hospital does not charge fees, patients often struggle to pay for transportation to reach there, and family members face challenges regarding lodging and food.

In partnership with World Altering Medicine, we help stock the hospital’s pharmacy with medication when the system experiences shortages, so that patients receive the care they need no matter what.

The cold-storage pharmacy

The cold-storage pharmacy

According to a community member interview, the hospital is mostly adequate in the basic services it provides, and most of the departments are equipped and staffed, with just a few areas for improvement. X-ray equipment is available, but there is no radiographer on staff.

The operating theatre

The operating theatre

Surgical equipment is also available, and it is utilized for C-section deliveries, but not for other surgical procedures. Cervical cancer screening is promoted, but treatment is not available on location. We are conducting a needs assessment of the hospital to better inform future programming and how partners can bring resources together to address these gaps. Improving healthcare at the level of the community hospital is very important in this area because patients who are referred elsewhere may never get helped due to over-crowding at the final referral hospitals or transportation challenges in getting there.

A patient being treated in the current trauma room

A patient being treated in the current trauma room

We are currently in the planning process for building a new emergency department at Kabudula hospital, in partnership with World Altering Medicine. The current “trauma room” is too small to even fit a bed or stretcher inside!

Newly built Mangochi trauma room

Newly built Mangochi trauma room

The need for emergency services has increased with the improvement of the tarmac road through Kabudula, bringing more vehicle accidents. We have chosen a spacious building site just inside the gate of the hospital campus, and we are modeling the design from a recent addition to the Mangochi hospital for the same purpose.

Staff and patients alike look forward to Access Health Africa’s annual “surgical camps” at Kabudula, where visiting surgeons come and perform minor surgeries on needy patients while training the local clinicians on these procedures. We hope to continue improving the partnership with Kabudula hospital through ongoing programming with the assistance of Global Health Fellows on the ground year-round. Please continue to support these promising initiatives!

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An Afternoon in Lilongwe

Written by Global Health Fellow, Carolyn

My co-fellow, Angela, has been living in Malawi for almost 3 years and I have now been here for 3 months. I have been so grateful to Angela that she has taken the time to show me around and share with me some of her favorite spots in town! When we have free time and some extra pocket change, we like to spend the afternoon shopping and having lunch.

GHF Angela crossing the footbridge at the market.

GHF Angela crossing the footbridge at the market.

Today I wanted to have a new dress made out of the local fabric, chitenje. So we started off by going to the largest market in the country which is within walking distance of our office. The market is so big and has different sections for clothes, electronics, produce and other businesses on both sides of a river. Usually we can quickly run there after a day at work for produce but to shop for fabric we have to cross a foot bridge which spans the Lilongwe River. To cross the bridge it costs 50 Kwacha (~7 cents) and this money pays for continued maintenance of three foot bridges. Crossing the bridge, you’ll often see workers in the river washing clothes and shoes to sell second-hand. We had to weave through many stalls (Angela said “just keep turning left and right until you find a clearing”) to find a small alleyway where chitenje is sold. These can be used as wrap skirts, which we often wear when we work in Kabudula or Nkhoma or used to make dresses. Two meters of chitenje (enough for a wrap skirt or short dress) costs about 3000-4000 Kwacha ($4-5) depending on the quality.

A chitenje shop in the market.

A chitenje shop in the market.

After picking out the fabric, we went to the tailor who is conveniently located tucked behind the produce section of the market. I just decided to have a short dress made and also have the tailor alter another dress I had made for work. He will have both of these things finished in 3 days time. Depending on the complexity of the dress or outfit, prices can vary and are always negotiable.

I needed to buy some produce from the vegetable market for dinner. I got onions, green beans, tomatoes, potatoes and plums (just now in season and unbelievably delicious!) for 2500 Kwacha (~$3.50). I often buy avocados, bananas, apples, sweet potatoes, peppers, zucchini, cucumber, oranges, mangoes, plantains, lettuce and other local greens, pineapple and watermelon. Prices are negotiable and depend on the seasonality of the produce I’m buying but there is so much available.

Shopping in the produce market (with super cool AHA tote bag in hand).

Shopping in the produce market (with super cool AHA tote bag in hand).

One of mine and Angela’s favorite places for a nice lunch is the Lilongwe Wildlife Sanctuary which also has an amazing cafe. At the conservatory you can take a tour and see the animals (monkeys, crocodiles, owls, snakes and others depending on what they may be rehabilitating) and also walk along their nature trails. The cafe often hosts fundraising events and is a nice place to enjoy a working afternoon over coffee or lunch. I am a member of a book club and we have our meetings here too!

A view of the market.

A view of the market.

These are some of the typical activities Angela and I both enjoy to do together and alone in which we able to get a taste of Malawian culture and Lilongwe culture in the meantime. Lilongwe is a robust city with so much to do, this is only a taste.

*This picture of the market is to show these little fish called bonya which do not smell nice and there are always bags of them on minibuses to places far from the lake, especially so on our rides to Kabudula! The smell bothers me so much that when the minibus drivers see me coming, they always reserve the front seat for me so I can have the window and fresh air.


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A Week in the Life of a Global Health Fellow!

Our Global Health Fellows (GHFs) are hard at work on the ground in Malawi! A typical week for them looks as follows:

Monday and Tuesday (Lilongwe): The GHFs usually work in the office on Mondays and Tuesdays, organizing their tasks for the week and attending meetings. Currently they are involved with many on-going projects and are working towards developing new ones, building partnerships and expanding the scope and reach of Access Health Africa and World Altering Medicine.

Recently they are working closely with Kabudula Community Hospital, the Lilongwe District Health Office and the Ministry of Health to conduct a needs assessment of the Kabudula Hospital to determine the direction of future programs. This project will span many months and takes a lot of community outreach. Planning alone for the needs assessment has taken a few weeks and has included multiple meetings with their community partners at the hospital, Ministry and District Health Office officials, who have granted their full support to continue.

The GHFs have also started to explore the possibility of addressing the issue of cervical cancer here in Malawi. Cervical cancer is the leading cause of female cancer in Malawi. In the central region on Malawi, there is a backlog of women who require radical hysterectomy via surgery, a potential intervention point for the organizations. AHA and WAM are working to expand their partnerships in Malawi to help address this issue and having boots on the ground is making this possible!

Nkhoma Hospital where we help facilitate access to surgery for patients who would not otherwise have it.

Nkhoma Hospital where we help facilitate access to surgery for patients who would not otherwise have it.

Wednesday (Nkhoma): Every Wednesday, the GHFs travel to Nkhoma Hospital from Lilongwe (about an hour drive) to meet, interview and follow-up with patients who are funded through a program called Watsi, and organized on the ground by the GHFs. Watsi is a crowdfunding platform that provides fully funded surgeries to economically needy patients. It’s a great opportunity for GHFs to meet the patients we are helping and see their reaction to finding out the economic burden of a life-altering surgery is lifted from their shoulders. The GHFs are responsible for submitting the patients to the online Watsi platform. Through this service, we are able to provide $7,000 a surgery a month!

Thursday (Kabudula): On Thursdays the GHFs travel to Kabudula, a community where they have many ongoing projects and are focusing their needs assessment. In the morning, they usually meet with hospital staff to talk about the needs assessment. They also will check in with the pharmacy tech, whom they work closely with to provide essential medicines to the hospital on a monthly basis. The hospital is in need of many medications, including antibiotics, anti-inflammatories and especially pediatric forms of common medications.

A Kabudula Community Hospital Clinician treating a patient in the current trauma room.

A Kabudula Community Hospital Clinician treating a patient in the current trauma room.

They have also started a proposal to build a Trauma Center at Kabudula Hospital. Currently, the hospital only has the space to house their entire trauma unit in a small room, not large enough to fit a patient bed. Hopefully, we will be able to provide a Trauma Unit that can house all of the equipment, patients and staff that is necessary at Kabudula Hospital.

After all tasks are completed at the hospital, the GHFs head to the Kabudula Secondary School to meet with their community partner there, a teacher at the school. With her, we are able to provide 50 scholarships to Secondary School students every year through our KEEP program. Students are chosen based on economic need and commitment to their education.

They also attend the Girls Empowerment group organized at the school every Thursday that includes over 100 girls in secondary school and covers topics such as career guidance, relationships, reproductive health and hygiene and peer counseling.

KEEP students participating at the student/parents meeting

KEEP students participating at the student/parents meeting

Friday (Lilongwe): On Fridays, the GHFs are usually busy wrapping up their tasks for the week and often includes things like purchasing the essential medicines to be delivered, research for the needs assessment, cervical cancer issue and trauma proposal, reaching out to potential partner individuals and organizations to expand the organization's scope. Sometimes, meetings are held on Fridays with partners in Lilongwe, including the Ministry of Health and the District Health Office.

Saturday (Kabudula): Once or twice a month the GHFs spend Saturday in Kabudula to work with community members who are unable to meet during the week. Recently, they are gone on home visits to help choose KEEP scholarship students and hosted a meeting with all of the KEEP students and parents.

Keep on the lookout for more detailed updates of the programs that Access Health Africa and World Altering Medicine are running!


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Surprise on a Home Visit

By Carolyn Schafer, AHA/WAM Global Health Fellow in Malawi

During our past surgical trip, I was responsible for helping to organize the surgical patients, interview them and discharge them. During this process, I got to know some of them well, and was fortunate enough to see them before anesthesia and after surgery, when they were anxious, excited and then thankful for a successful operation. Knowing that our patients were coming from a very large catchment area, including some villages that are hard to reach, I was not sure if I would ever see some of them again.

Riding on the back of a kabaza down a road some of our surgical patients walked to be treated by our surgical team.

Riding on the back of a kabaza down a road some of our surgical patients walked to be treated by our surgical team.

A few weeks after the surgical trip, I was with one of our community partners, a teacher at the Kabudula Secondary School, conducting home visits for students we will sponsor this coming school year through our partnership with World Altering Medicine. I met the teacher at the secondary school and we proceeded via kabaza (bicycle with a passenger seat on the back, my first time riding one!), to a remote village to meet a student and his family. The ride was about 20 minutes through the countryside on a dusty road.

Along the way, I was casually waving and greeting everyone we passed, and I saw one of the mothers of a young female patient we operated on during surgical week! She started laughing, waving and yelling to get my kabaza to stop. I recognized her instantly and hopped off to greet her. She gave me the biggest hug, high fives and a handshake and through laughter and mixture of English and my own broken Chichewa, I asked how her daughter was doing.   

Coletta (right) our patient, and her mother (left).

Coletta (right) our patient, and her mother (left).

Her daughter is 14 years old and had a ganglion cyst on her wrist. She said she has healed fine and is pain free! Before her surgery, she was unable to complete her housework because the pain was too bad and had the cyst for 6 years.  Her and her mother walked to Kabudula Community Hospital along this dust road 3 different times to see our surgical team. I walked it back from the home visit, and it was not an easy journey, it took over an hour with no respite from sun or dusty wind.

I couldn’t believe that I saw one of our patients’ parents from surgical week, and the fact that she recognized me, embraced me the way she did and again thanked me for our services, was such a highlight of my time here. She was beaming.

(Written by Global Health Fellow, Carolyn)


Introducing Carolyn, Global Health Fellow!

Carolyn Schafer is a Global Health Fellow working with Access Health Africa and World Altering Medicine based in Lilongwe, Malawi. Carolyn's fellowship started as of August, 2018. 

Hi! I am so excited to be working with Access Health Africa and World Altering Medicine as a Global Health Fellow. I am coming to Malawi from Cleveland, Ohio. I earned my Bachelors of Science in Biology from Saint Mary's College (Notre Dame, IN) and went on to receive my Master's in Public Health from Saint Louis University where I concentrated in Global Health and Epidemiology.

I have worked and lived abroad many times over the past few years in South Africa, Belize and most recently Burkina Faso where I was a Peace Corps Volunteer. This is my first time in Malawi and I am very excited about the work that AHA and WAM are doing and how I can create a lasting impact with both organizations.

Over the next year I hope to improve upon the many amazing programs that these organizations are making possible. My goal is to create sustainability through the monitoring and evaluation of these programs and by working with our Malawian community partners.

Since being on the ground in Malawi, I have created all of the data collection instruments for our Medical/Surgical trip that is beginning August 17 and will run through August 25. I have been working closely with Angela, the other Global Health Fellow to finish any logistical tasks needed to prepare for the trip. I have also met with all of our community partners throughout the country and am excited to work more closely with them. I am excited to use my skills and build upon new ones through this Fellowship and the programs that AHA/WAM have already created.

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Surgical Week Wrap Up

Today wraps up our week in Malawi which has by all accounts been a huge success.  Dr. Henson and myself were able to exceed our surgical case goal with over 60 procedures performed in just 5 days.  This volume could not have been accomplished without the excellent planning of the AHA staff, exceptional OR personal and assistance of the Kabudula staff.  Power outages and limited supplies were daily challenges that required creative problem solving.  Head lights and generators were a most to keep the day moving.  Operating in Malawi has been a chance to step outside of my comfort zone and learn how to work with the resources at hand. 

 The opportunity to provide care for many people has been the highlight of our experience.  Regardless of the country, surgery is a scary event for patients.  The language barrier made comforting and reassuring patients a challenge, especially in our pediatric patients.  Despite their anxiety, the Malawian patients showed a strength not commonly seen in the United States and trusted that we would fix their ailment.  The hardest part of the week was turning patients away simply because there was not enough time in the day. 

So, as our week ends it has been an honor to be a part of the Access Health Africa team.  Our team quickly formed a small family.  Our days have been filled with work in the village followed by eating dinner while drinking local beer and chatting in the evening.  The group will be missed but not forgotten and we leave planning to return in the near future.

 

Thank you to Dr. Sean Martin, one of our volunteer surgeons for writing this blog! 

CPR/BLS Training in Ukwe, Malawi!

(Written Tuesday, August 21, 2018) What an amazing training experience today, in the village of Ukwe, Malawi! The participants from the women’s/children clinic were both receptive and excited to learn the components of C.P.R. The initial apprehension quickly turned into enthusiasm. Practicing the steps of B.L.S. and working together  demonstrating how to save a life, gave participant confidence that each of them is capable of making a positive impact in an emergency situation. The instructors and interpreter all agree that the knowledge gained will be an asset to this rural community.

Thank you to Dr. Francine, our volunteer CPR/BLS Trainer for writing this blog!

First day in the OR!

This trip has been an experience like no other (this coming from someone that has never left the U.S. before). Mostly, I’ve felt completely out of my element. It’s been a hard adjustment, but it has been one of the most rewarding experiences of my life. I’ve really enjoyed learning about Malawian culture and spending time getting to know our team. We spent the weekend screening patients for surgery and getting accustomed to our new surroundings.

Today was the first day of surgery. I work as an operating room nurse, so being in the OR felt like home. Our team consisted of 2 surgeons, 1 CRNA, 1 surgical tech and 1 OR nurse. The staff at Kabudula worked along with us, so we were able to see their methods in the OR. The schedule started out with 8 surgeries. With added on cases, we did a total of 12 surgeries. We worked non-stop all-day, taking only a moment to grab a snack or water. We didn’t mind the hustle and bustle because we were so absorbed in our work. Overall, the day was a great success. The dental team saw 70 patients and the CPR class had 47 attendees. After today, I am so excited for the days ahead. We have an awesome team doing some majorly awesome things here in Malawi.

Thank you to Allyson, our volunteer operating room nurse! 

Surgical Team Arrival!

Day 1: August 17, 2018

As the plane landed in Lilongwe, Malawi I felt every emotion, especially pure excitement.  Walking down the steps of the plane, looking across to the airport buildings, I spotted the Access Health Africa sign hanging from the banister and saw the AHA Fellows waving. Finding 6 large duffel bags of medical supplies and 3 small suitcases amongst 300 people’s luggage was actually much easier than I thought. All bags were present and accounted for so off to the customs officer to have the bags checked.  We were extremely blessed they didn’t confiscate any of our bags.  We had two very friendly ladies, Carolyn and Angela, waiting on us from Access Health Africa to welcome us and take us to the house.  After loading all the bags on top of a 15 passenger van we headed to the house.  It was a 30 min ride on the opposite side of the road and CRAZY driving but we made it safely.  We spent the next hour or so unloading and organizing all the things we needed to make our week doing surgery a success. We took a trip to the grocery store to purchase snacks.  I was amazed that the grocery store was not much different from the ones in the US.  Great pizza was served from a local Malawi pizza restaurant.  We were advised to stay awake until 9:00 so we would be able to sleep all night due to the time difference.  So after checking in back home I took one of the hottest showers I have ever had and go into my bed surrounded by the mosquito net and fell asleep.

 

Day 2: August 18, 2018

The alarm goes off at 7:30 and it’s time to start day 2.  After everyone fixed themselves breakfast and got dressed we left for Kabudula Hospital.  It was a 45-minute drive, and a CRAZY one.  Some of the road is paved, some are not. On the drive we did get to see different villages where the homes were built of self-made bricks and mostly straw roofs.  After arriving to Kabudula hospital we started the pre-op process.  We split up into vitals, anesthesia approval, examination by the doctor, and surveys.  After having their vitals and anesthesia work up, Dr. Henson and Dr. Martin did an exam and decided if the patient was eligible for surgery.  We saw 18 patients and scheduled 15 for surgery, a very successful day.

 

Day 3: August 19, 2018

In the morning, we packed the van with enough supplies to accomplish 2 days of surgery and headed to Kabudula Hospital to pre-op more patients.  We saw 19 patients but scheduled 15 for surgery.  Some of us went to the maternity ward to see if there were any patients in labor.  Its not like laboring at home.  These ladies are lying on a cement floor in active labor and not making a sound.  After they get to a certain point in labor they are moved to the delivery room where they lay on a delivery bed but it is far from the luxury beds in the US.  There is one nurse to take care of the laboring mother and the baby.  She is responsible for all laboring patients.  Today there were 3 in labor and 2 in active labor.  We also went to the pediatric ward.  There were 12 patients.  It is the family’s responsibility to take care of their child while at the hospital. After setting up the OR for our day tomorrow we headed back to the house.  Tomorrow we have planned for 8+ surgeries, wish us luck!

 

Thank you to our wonderful surgical tech, Tyra for writing this blog!