It took us nearly three weeks, but Sabha and I finally realized that our fellow BTB interns at St. Gabriel’s are just about a 30-40 minute trip down the road. We exchanged Malawi phone numbers and made two very productive trips this week. For our first visit (on Wednesday), Danielle and Alexa showed us the grounds and told us a bit about their daily routine. We were not only able to help take temperatures in the pediatric ward, but we also got the chance to see in the ins and outs of a well-established CHAM hospital (Catholic Hospital Association of Malawi – I’m not entirely sure of the acronym). The hospital staff was more than welcoming and allowed us to take photos so that we could bring as much information as possible back to Child Legacy. We made a list of laboratory equipment that Child Legacy may need to invest in if they are to effectively test for hematocrit, run urinalysis, and test for malaria. We also took into account that St. Gabriel’s is considered to be a district hospital, while Child Legacy is a ‘health center’ – one step down in scale. Child Legacy would need to add male, female, and pediatric wards in order to reach hospital status.

Danielle and Alexa shared with us a lot of valuable information health care practices in Malawi. With regards to maternal health – umbilical cords are commonly cut with string, stirrups are not used for prenatal checkups or in delivery, and instead of incubating newborns they are encouraging women to keep their children close to their chests in ‘kangaroo pouches.’ Alexa and Danielle were also quite stumped as to what the underpads (which were donated to CLI in exorbitant amounts) would be used for. At St. Gabriel’s they simply change and wash the sheets after delivery and neither had ever seen underpads used to stop excessive bleeding. CLI also received donations of patient gowns in large numbers, but apparently patients are never put in gowns at St. Gabriel’s. All of this information will be extremely useful in putting together a revamped list of needed items for Child Legacy to send to Medical Bridges and other organizations that focus of medical donations.

Today we returned to St. Gabriel’s for a meeting with Mr. Alexander Ngalande (Alex), head of the community health outreach program out of St. Gabriel’s. Jeff has expressed an interest in trying to incorporate a community health worker (CHW) into his well repair team. Of course, the level of treatment for sick patients would be limited due to the time constraints of well repair missions. Nonetheless, we thought a discussion with Mr. Ngalande would be the best place to start. While government facilities in Malawi employ Health Surveillance Assistants (HSAs) who serve a similar purpose, the CHW program out of St. Gabriel’s is unique in that they are now utilizing the Rice CHW packs and Frontline SMS (a software that allows for cellphone communication between CHWs and St. Gabriel’s). Alex was extremely welcoming and open to all of our questions about his program and how we might be able to model it at CLI.

Alex first told us that there already about 20 HSAs in Msundwe area and that they could easily be trained to use something such as the CHW pack because they have already undergone the basic HAS training. Alex also offered to recruit several male HSAs from the Msundwe to come with him to CLI on Monday to meet with Jeff and get better acquainted with the Child Legacy and its goals. It was readily apparent that Alex was willing and excited to share his successful CHW program with other areas and health facilities. He also shared some valuable information about the different types of hospitals and funding sources in Malawi – CHAM, government, and private (and sometimes combinations). It is difficult to compare CLI to St. Gabriel’s because the former will be (somewhat) government run while the latter is CHAM. Jeff is hoping to keep CLI separate from CHAM because government funded hospitals are completely free to patients. On the other hand, he also hopes to maintain some control of the clinic (in order to assure quality care) by having a say in the hiring of nurses and lab technicians.

I could go on about the other useful information that Alex shared with us – especially with regards to malaria treatment in Malawi (mostly that the nation is transitioning to LAH for numerous reasons) – but I’ll move on to the other good news of the day. When we returned from St. Gabriel’s shortly after lunch, Karen was also returning from a meeting with the Ministry of Health about the MOU (memorandum of understanding) for the health center. Given the current financial situation in the country, I was half expecting to hear that the government would not be able to provide the funding required to open in the near future. I was happily surprised to hear that the Ministry of Health agreed to the majority of the MOU’s stipulations, including: paying for 3 nurses, consumables, pharmaceuticals, and vaccinations. This is extremely good news. The head minister has also agreed to come visit the site on Monday.

Monday is looking to be a very good day for CLI. We will have the minister of health, Alex and the HSAs, and we have just confirmed that Danielle and Alexa will be visiting that day as well.