It is hard to believe that I have already been back in the United States for nearly a week! I am tremendously grateful for a productive and highly informative summer in Malawi. I thank my mentors—both those from Rice and the individuals with whom I worked in Malawi—for their patience, support, advice, and kindness. As I look forward to spending the coming academic year in Colombia, I want to write about a few of the wide-ranging lessons that I will take from my experiences in a low-resource setting this summer.

 

First, the tremendous constraints posed by limited staffing must be a primary consideration when pursuing projects in settings like Malawi. The WHO reports that there are only 2 doctors and 38 nurses per 100,000 Malawians. (At this rate, the city of Houston would have just 42 doctors!) This extreme shortage of medical professionals results from cost constraints, a limited national capacity to train a large volume of new staff, and of the large-scale migration of trained doctors to better-paying markets. The medical professionals that I worked with demonstrated a consistent commitment to patient care despite their overstretched schedules. Nevertheless, it was critical to understand the value—and scarcity—of our mentors’ time and ascertain whether our contributions effectively reduced the severity these challenges. In the future, the limited amount of staff time must continue to be a central consideration of Global Health Technologies design projects.

 

Second, the courtesy and respect afforded to Kamal, Teresa, and I inspired me daily. We embarked upon creating an electronic medical records system for St. Gabriel’s palliative care program within the first week of our internship in June. As we refined and adapted DataPall for St. Gabriel’s, we learned of much more widespread need for this type of patient monitoring, data management, and reporting. In July, we traveled to Queen Elizabeth Central Hospital in Blantyre to implement DataPall at Tiyanjane Clinic. The support and attention the staff in both hospitals gave us was humbling. The staff at Tiyanjane connected us with the Ministry of Health in Lilongwe who eagerly agreed to meet with us to discuss the project near the end of our stay in Malawi. The openness of all of these individuals to meet with a team of undergraduates with no obvious medical qualifications impressed me and inspired us to continue to improve and refine our product. I hope to emulate their tremendous openness and respect in my further educational and professional pursuits.

 

Finally, I would be remiss in not acknowledging the warmth of all of the Malawians that I met. Malawi certainly earns its reputation as the “warm heart of Africa.” The driver that drove us to Salima explained that Malawians know well that “a smile costs nothing.” In the face of severe daily challenges, the kindness of Malawian colleagues, friends, and strangers is astounding. I can only aspire to this level of friendliness in my everyday encounters.

 

Thank you to all that made this journey possible. I will be forever grateful for the generosity of the Beyond Traditional Borders program for a wonderful summer.

We traveled to Salima, Malawi on June 26 to visit Ndi Moyo, an innovative hospice facility devoted to providing care for patients with terminal illness. The vast majority of Ndi Moyo patients are cancer patients and over 90% are HIV-positive. Unlike St. Gabriel’s, Ndi Moyo is not a hospital. Rather, it is a standalone palliative care clinic. Ndi Moyo patients visit the clinic periodically for outpatient appointments. Additionally, several days each week, the clinical staff goes to nearby Salima District Hospital to do rounds and see current patients as well as those who would benefit from palliative care. Additionally, the staff members travel to do home-based visits for patients several times per week.

Ndi Moyo offers patients medications as well as homeopathic treatments to address and alleviate symptoms of their respective illnesses. When we toured the small campus, we were stunned by the beautiful gardens where some of the homeopathic treatments are grown. Lucy, the director of Ndi Moyo, served us incredible lemongrass tea made from lemongrass grown in the garden.

We visited on the last Tuesday in June. On the last Tuesday of each month, Ndi Moyo invites patients to come for the day to give their caregivers a much-needed break. In Malawi, the vast majority of day-to-day hospice care is provided in the home by relatives or community members. This round-the-clock care is very tiring and leaves little time for mundane tasks like going to the store or getting a haircut. By providing care for these patients for one day of each month, Ndi Moyo provides support for these dedicated caregivers. On these days, patients assemble in Ndi Moyo’s large open-air dome. The structure provides a large communal area for patients to rest and socialize with each other. Patients passed the day by playing games, watching a movie (a novelty here), and by making beads. The patients seemed to be happy to spend the day in the company of others with similar experiences.

Ndi Moyo boasts a devoted, professional staff. We spent an hour or so talking to the director, Lucy, about her experiences. Lucy’s passion for palliative care and her dedication to her patients inspired me. She lamented the lack of access to and funding of holistic palliative care, particularly for patients with HIV/AIDS. While governments, NGOs, and individuals have devoted vast sums of money to address the HIV/AIDS epidemic, much of this funding does not reach patients who currently suffer from the disease. Certainly, the increased availability of antiretroviral therapy (ART) in resource-limited settings has improved the trajectory of HIV-positive individuals. However, palliative care programs continue to bear the burden of this disease with scarce recognition or financial support.

At Ndi Moyo, we also received some feedback on the InvertaBottle liquid morphine dosing device and were able to solicit the impressions from several current liquid morphine users, thanks to Christopher, the Ndi Moyo clinical officer that I met at St. Gabriel’s. (See Teresa’s blog for more details about this portion of our day.)

We learned so much in our short time at Ndi Moyo. After working so intensively with the palliative care program at St. Gabriel’s, it was interesting to see a model of this type of care outside the hospital setting. We are so grateful for the kindness and generosity of our gracious hosts.

Muli bwanji! Greetings from Malawi!

It’s hard to believe that we have already been in Malawi for almost three weeks. I am so grateful to be here at St. Gabriel’s in Namitete. The staff at St. Gabriel’s as well as the other volunteers welcomed us very warmly and we quickly acclimated to our new environment.

We brought six technologies to St. Gabriel’s that we presented to the medical staff shortly after our arrival. As the internship progresses, I will use this blog to discuss the feedback that we receive on several of these technologies as the summer progresses. (Teresa’s blog has a great description of these technologies.)

Over the past two weeks, we have been working diligently on our first special project—creating an electronic medical records system specially catered to St. Gabriel’s palliative care programs. This assignment has been especially interesting to me as I spent the year working on the morphine dosing project, inspired by last year’s interns’ observations at St. Gabriel’s.

Palliative care aims to improve “the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” (WHO). St. Gabriel’s demonstrates an obvious commitment to palliative care: the Family Centered Care Unit (FCCU) facility is devoted entirely to St. Gabriel’s palliative care programs. Currently, patients receive support from the FCCU through inpatient stays, outpatient visits, and through an active network of several hundred community volunteers who help to facilitate home-based care.

Our assignment, in short, is to design a program through which St. Gabriel’s FCCU staff can evaluate how their services are used and browse patient records as necessary. Over the past two weeks, I have spent many hours inputting hundreds (perhaps thousands) of patient records. In looking through pages and pages of records, I am impressed by the diversity of patients (and families) who use these services. Patients range in age from two to 90 with varied diagnoses. By far, the two most common diagnoses that I encountered in the records were cervical cancer and HIV/AIDS-related conditions (especially Kaposi’s Sarcoma).

The large number of palliative care patients at St. Gabriel’s attests to the value of this type of care. By extending comfort and support (in different forms) to terminally ill patients and their loved ones, the dedicated staff at the FCCU provides a service that is highly valued in many communities in and around Namitete.

We will continue to learn about palliative care in Malawi in the coming weeks as we work to complete this project. Additionally, a visiting doctor from Salima, Malawi came to our technology presentation at St. Gabriel’s and graciously invited us to demonstrate our technologies at his hospital, Ndi Moyo. Ndi Moyo is a hospital dedicated exclusively to providing palliative care services in that community. We look forward to our visit to Salima on June 26!