Aside from the all the posts about our projects and experiences here, I wanted to devote some of my time to writing about three young Malawians and telling their stories.

 

I met these guys on the way to back to work after my usual lunch break. Starting from the left: Hosea, Mayamiko, and Samson.

Usually I see many high school age students riding bicycles or walking back to Namitando, the village near St. Gabriel’s, on my trek to and from the Gray house. One day a few weeks ago though was a little different. Instead of the usual waves or polite “hello” and “good day”, three students decided to strike up actual conversation with me. Since that day these guys have been taking me out around Namitete and Namitando showing me what life is like for them.

Hosea and Mayamiko both plan to be surgeons and Samson plans to be a lawyer. These goals are nothing new to me.  Frankly speaking, I am an Asian American and stereotypically have been reminded all my life of the value of education. I also grew up in an environment where many of my peers planned on pursuing professional degrees and careers.  Here in Malawi though, these goals are not part of the norm.

Because most of the population ends up entering the workforce after primary school (elementary school), education in Malawi is geared more towards agricultural studies and other vocational training programs rather than professional studies and higher-level learning. This presents severe challenges for students who do not have the resources to attend secondary schools that prepare them for universities.

When I asked how difficult they think it will be to achieve their goal, they all replied tersely, “very difficult”.  Hosea pointed out that they see foreigners as being lucky.

“It is very difficult for people from Malawi to go to university”, he added.

However, Hosea is most likely seen as being lucky by his peers. He lives in the St. Gabriel’s complex because both his parents work for the hospital. Although he is younger than the others, he is surprisingly very fluent in English. He’s also a hooligan. Hosea never forgets to poke fun of his friends and crack hilarious jokes.

Miyamiko and Samson, on the other hand, live in the outlying villages. Their English is choppy, and they understand only small fragments of what I say.

Mayamiko’s father invited me to their home where I sat down to hear what he had to say. Charles used to work at a non profit organization for helping the orphans from the AIDs Pandemic in Namitete. He left recently though because of the misuse of funds he witnessed there; this seems to be an unfortunate problem that plagues some organizations here in Malawi. Like most fathers I know, Charles has very high expectations for Mayamiko and pushes his son to excel in school. He struggles to find work to pay for his son’s education but desperately wants Mayamiko to have a chance at higher education to leave the cycle of poverty here.

The private school the guys attends costs less than twelve dollars a term. The fact that this kind of money is so hard to come by here is so hard to accept. Before I came to Malawi I had heard and read about poverty, but living here has shown me how deeply being poor affects the people of a country.

“It is very difficult to pay school fees because my father died in 2010,” Samson told me. Despite this, it doesn’t seem like Samson is going to give up on his goals any time soon. Among the three, he was the most excited to tell me what he wanted to be in the future; I could tell he had drive and a lot of quiet determination. Samson helps run his older brother’s general shop in Namitando whenever he has free time. When school ends at two in the afternoon he makes the 6-7 km walk back to Namitando to start working until the late evening.  When I visited his shop I asked if I could buy 1000 kwacha worth of airtime for my prepaid Malawian cell phone. He directed me to another shop that apparently has larger airtime cards that I would probably want instead. Samson could have tried selling me smaller cards that would add up to 1000 kwacha like most shop workers do, but he didn’t want to create hassle for me. I still bought a 500 kwacha card from him.

 

Hosea, Mayamiko, and Samson ask me all the time if I want to go exploring the river or climb rocks on hills. My friends and I used to do the same things growing up. Hopping on rocks across rivers and climbing hills we all seem to forget about where we’re from.

 

 

“One time I was with my father here and we saw a monkey!” – Hosea K.

 

District Hospitals:

This last week we were on the road with Sam and MK (from Blantyre) to many district hospitals for the ongoing CPAP project. We scavenged for baseline data to be used on the upcoming study. Getting a chance to leave Namitete and hop around the country was a great refreshing experience. MK has been really great taking out us out to eat at some awesome restaurants in the big cities. It’s kind of nice not having to defeather, gut, and clean chickens for dinner!

Visiting the district hospitals really made me appreciate St. Gabriel’s Hospital. These hospitals seem to be really struggling to keep up with the number of patients they have. Nurses and doctors seem a little overwhelmed and patients fill all the hallways and wards. I realize that there is a serious need for better records keeping in all the hospitals in this country. Currently the health workers use register notebooks that are never consistent and the patient charts are often torn pieces of paper bandaged together. Handwriting is atrocious and accurate summarization of patient information is almost impossible to find. This presents difficulties for the hospitals when they need to report accurate numbers to receive the correct number of supplies and funding from the government and outside organizations.

The problem is multifaceted:

1) Healthcare workers don’t have the time to write detailed notes, too many patients

2) Hospitals don’t have uniformity in their various paper forms

3) Digital records keeping is light years away

4) Staff rotate between wards and specialities

5) More reasons that I am most likely unaware of because I don’t actually work in each of the hospitals every day

 

Fantasy Suites:

Near the end of our week traveling we stayed at a hotel in a small town called Bilaka. We got to stay in Fantasy Suites!

 

 

 

“Do you think they’ve ever washed these sheets?” – Daniel Hwang

 

Backpacks:

On Friday we traveled to many of the outlying villages to meet with the Community Health Volunteers of St. Gabriel’s with Alex, a palliative care worker. These volunteers give up time in their busy lives to receive some basic medical training and to provide care for those in their respective villages. If their patient’s conditions take a turn for the worse or they feel that they can no longer provide the care he or she needs, the worker refers the patient to St. Gabriel’s.

In the past Beyond Traditional Borders had supplied these community workers with heavy-duty backpacks and a variety of medical equipment. Friday’s meetings were for the programs first follow-up. Surprisingly the backpacks from two years ago all seem to be in working condition and still in good use.

Personally, I have been skeptic about the CHW (Community Health Worker) Backpacks. When we packed ten more packs with equipment and supplies during pre-trip days I wondered how this system could possibly be sustainable and therefore effective at all in the long run. When I arrived to St. Gabriel’s and saw the Frankenstein of foreign aid, I categorized our backpacks into jumbled aid.

On Friday’s meetings we mainly listened to the volunteers’ thoughts and suggestions about the backpacks. I was really surprised by how thankful these volunteers were for our desire to have follow-up meetings. They said it showed them that they were not alone and that they had support. Many said they felt empowered and encouraged just by having met with us. One of the groups sang a song of thanks for us at the end of the meeting. (Liz took a great video of it, check out her blog!)

I am still skeptical about sustainability of the actual backpack itself. Volunteers do have concerns about the slowly but surely disappearing medical supplies. The hospital supplies them sporadically due to budget cuts. But I have discovered that the empowerment and encouragement the workers receive from the backpacks and our follow-up fuels sustainability of the community health worker program. Truth is, the backpack is successful in giving the workers their identity but is failing to be really sustainable.

 

 

HIV:

Today Liz and I went into the HIV/AIDS clinic for Children’s Day. Every month children and their guardians make their way to St. Gabriel’s to get ARV refills and general check ups. Many children often come by themselves. Entire families here are affected and ravaged by this virus. Mothers and Fathers die leaving their HIV positive children with aging Grandmothers and Grandfathers.

I worked the CDC donated computer system for the clinic. It was downright depressing to see child after child receive “SEVERE WASTING” warnings as I inputted their height and weight.

 

“They are saying that they feel that they are not alone and that they feel encouraged because you have visited them.” – Alex

 

Frankenstein:

What do you get when hundreds of organizations and various groups with good intentions try to provide aid to hospitals in a developing country?

You get a Frankenstein of some sort. Recently, I went through the hospital storage unit to take measurements of the IV bags used here. I realized that most of the IV bags are donated and are from many different manufacturers. Also, there is no primary type of IV fluid they use for their patients here. They use what they get.

The IV bag measurements I had to make were for a Rice design team back at home. Currently they are busy making final touches to their solution, called IV DRIP, which aims to alleviate the problem of over-hydration in IV therapy. Hospitals here do not have the resources to accurately regulate the amount of fluids administered to a patient. Unfortunately, over-hydration leads to severe complications and death. The case is especially dire for pediatric patients. Most IV fluids are donated and the most commonly available 1L bags are not suitable for children.

Clinicians and nurses here are often reluctant to administer IV fluids because of the constant vigilance and rough estimation needed to provide IV therapy. IV DRIP is a simple, low-cost, mechanical, automatic volume regulator for IV therapy to improve care for pediatric patients in the developing world. (Credit IV DRIP team) The team needs IV bag measurements because of the challenges the Frankenstein of medical aid brings to the problem. The solution must work around the fact that one patient might be using a certain brand of IV fluid and the next will be using another.

The short time I have spent in Malawi has shown me the failures and shortcomings of international aid particularly in healthcare. It’s almost disheartening. From the start of this trip the Malawians have treated us very warmly. They understand we are here to help and genuinely appreciate our efforts. But even though they try to hide it, being courteous as always, I see skepticism in many of the health care workers here. I don’t blame them. Hundreds of volunteers cycle through the country every month, leaving donations and charity that provide immense relief to the system. However, this relief is almost always short lived. Without providing follow up and self-sustainability this relief flickers and dies or leaves a Frankenstein.

There is hope though. Designers of IV DRIP plan to work around disorganized aid. Also, the people we work closely with here at St. Gabriel’s encourage me. The Palliative Care unit almost loyally chooses to use DataPall instead of other available database software because of the follow up we provide. The designers of DataPall really listened to the needs of the unit and created a very customized system that fits the needs of the unit well. As the second round of interns to work on the database, we are providing follow up, and we hope to enable sustainability. The next few weeks we will be building training sessions and manuals for everyday use and troubleshooting of the database.

 

Friends:

The past two weeks have been filled with exploration and friend making. I think these experiences are best told through pictures…

 

 

Last night, we had an amazing dinner at the Grey’s. The evening was filled with good food, drinks, and conversation. Barbecued chicken, steak, and sausage along with so many sides!  Once dinner was served, I let Liz and Hannah do the most of the talking as I inhaled food.

After the dinner we went outside to do some stargazing. I can’t fully explain the experience of seeing the night sky here. The stars blanket the entire sky and the arms of the Milky Way streak across like large brush strokes on a black canvas.

 

“Guys! The curtain’s on fire….GUYS!” – Elizabeth Grace Dunn

 

It’s a week before our team departs for Malawi and we are busily packing and preparing. Liz and Hannah have been hard at work assembling and packing numerous medical supplies and medications for the community health care worker backpacks, while I have been working with the Sphygmo senior design team to build the devices for hospitals in Ethiopia and Malawi.

The Sphygmo device is an affordable automatic ambulatory blood pressure (BP) monitoring device designed to detect irregularities in blood pressure and heart rate in patients. When irregularities are detected, the device notifies relevant health care workers through an LED alarm. In the near future, this device could potentially save many patient lives and prevent complications especially among pregnant women. Currently, many maternity wards in the developing world are bursting at the seams. The few available health workers are spread thin among the many patients they attend to. Sphygmo could hopefully address this strain and keep expectant mothers and their babies healthy.

Below is a picture of a Sphygmo device and its guts taken while I attempt to do some troubleshooting. Special thanks to Team Sphygmo!