St. Gabriel’s Hospital can be found 60 kilometers from Lilongwe, the capital of Malawi, and serves over a quarter of a million people. With a catchment area of 100 miles, communication is critical for health care delivery at this rural. Patients have to travel miles by foot, bicycle, or even oxcart to reach the hospital, and, Community Health Workers (CHWs) must travel under parallel conditions simply to report patient adherence, seek medical advice, or check a drug dosage.

The target populations for implementation of the Community Health Worker Screening Kit are clinics that utilize CHWs in order to provide healthcare to communities. According to WHO, “among 57 countries, mostly in the developing world, there is a critical shortfall in healthcare workers, representing a total deficit of 2.4 million healthcare workers worldwide.” The 2008 UN report on progress toward the Millennium Development Goals indicates dire need in many public health areas including infant mortality, HIV, and other communicable diseases.

With roughly 2.5 billion individuals around the world living on less than $2.00 a day, the CHW Screening Kit could help bridge the gap between the millions of health care providers in the developing world and these billions of people living in poverty (World Bank 2007). According to the most recent WHO census from 2006, these 2.5 billion people living on less than $2.00 a day are under the care of approximately 22.9 million health care workers (World Health Report 2006). Of these 22.9 million health care workers, only 4.4 million are physicians, and 7.0 million are nurses. Because of human resource constraints, the bulk of health care providers are CHWs, the primary health care providers in rural communities of developing countries and the end-users of the CHW Screening Kit.

The CHW Screening Kit includes several basic diagnostic tools, as well as a glorified first aid kit. The basic diagnostic tools include: a glucometer, pediatric and adult blood pressure cuffs, a thermometer, uranalysis strips, pregnancy tests, a stethoscope, a scale, a tape measure, and a MUAC band. The first aid kit includes: matches, face masks, cotton balls, band-aids, sterile gauze, hand sanitizer, bandage scissors, medical tape, iodine, gauze rolls, alcohol-prep pads, tweezers, and antibiotic ointment. Other tools include: a biohazard bag, a teaspoon, ORS, a swiss army knife, gloves, extra batteries, a notebook, a backpack cover, and a flashlight.

St. Gabriel’s Hospital has three tiers of Community Health Workers. The first, and most highly trained group of CHWs are the hospital nurses. Twice a week, two nurses take a motorbike to outlying communities, in order to continue to establish a relationship between the hospital and the communities. They bring a brown cardboard box of supplies with them. Their supplies include gauze, medical tape, vitamins, Panadol, and several other basic treatment items. The second tier of CHWs includes hospital workers that are not trained in a medical profession. These CHWs include cleaners, nuns, and village role models, all diligently and eagerly edging their way into the medical community. The final tier of CHWs includes all other CHWs – role models in communities, expert patients, mothers, fathers, volunteers. For now, the backpack will be used by Alex – a nurse, the chief HBPC officer, the director of the ART clinic, and the nurse that does most of the hospital’s outreach trips. He will be able to assess which tools are appropriate for CHWs, and which require a stronger medical background. He is excited to begin using it on Friday, and we are excited to begin to get feedback on the pilot of this project.

In the meantime, the Namitete Furniture Factory has begun (and almost completed) work on an incubator prototype. After spending a day gathering wood, and another day building the frame, we will be ready to put all of the pieces of the crib together tomorrow morning. Eric, the carpenter who has been helping us build the incubator, is a kind, gentle man. Perhaps gentle is the best way to describe Malawians. Greeting Malawians reminds me of Paul the Apostle’s subtle insinuation, “Do not forget to entertain strangers, for by so doing some people have entertained angels without knowing it.” (Hebrews 13:2)

Eric whistles while he works, is constantly smiling, will be married next month, and speaks softly to his elderly assistant, who hurries around diligently with his worn-down fisherman’s hat and missing teeth. Places like the Namitete Furniture Factory make you want to pick up a vocational skill.