Yesterday evening the power was out for longer than usual, so we watched an episode of the American television show “My Super Sweet Sixteen” on a laptop. Among other things, it made me reflect on a conversation we’d had with Sister Justa over lunch.
Storm warnings, voting information, and disease outbreak protocols are all critical pieces of our health and civic system at home. At home, I can access any of them through what right now seems like an unlimited number of communication mechanisms.
I can see that this kind of information does get disseminated here, but it’s hard for me to discern how. How does someone 100 miles away know that they are within the catchment area for St. Gabriel’s? How do they know who is running in the upcoming elections and how to vote? How do new outpatients know what days of the week the HIV clinic accepts new patients? How does everyone know who Barack Obama is?

Most people who work at the hospital get their national and global news from television. The hospital has one receiver that plays in multiple locations on the grounds, so they see BBC news when it’s on at the hospital. Some people have televisions and receivers at their homes, and if they understand the languages they can watch the African news before the Malawian news. Malawian news focuses mostly on the government and President Banda. Very few people have dongles or laptops to access the Internet.
St. Gabriel’s, with its huge catchment area, does a remarkable job keeping its furthest reaches in touch. A big element of that is the volunteers, who, despite recent cutbacks, keep the clinicians here in touch with patient needs and act as deputized representatives of the hospital where they can. There aren’t always enough supplies to go around, but at minimum they can give their information and expertise.

Another big element of communications is tradition and word of mouth. A worker from the hospital, Gift, showed us his home and introduced us to his family yesterday (Check Liz’ blog for pictures!) While we walked, we asked him the same question that confused us before: how did he know so much about President Obama? He didn’t really have an answer for us—only that everyone knew. While that was the starkest example of a bit of information that’s simply known around here, it seems that direct resource communication accounts for many of the linkages that make things run around here.
Direct communication increasingly relies on cell phones. It’s an oft-cited statistic that more people in Africa have cell phones than toilets, and Namitete seems to be no exception. In fact, SMS Frontline, an SMS-based health reporting service, was developed by Josh Nesbit at St. Gabriel’s. Alex, who coordinates the volunteer program, communicates with everyone by SMS. Most people here have a cell phone, even though many have never left Lilongwe District.

Here at St. Gabriel’s, morning report seems almost exactly parallel to rounds at home. Outside the hospital gates, though, patients communicate in a world of ways I don’t yet know about or understand. People like Alex and Josh Nesbit are doing really innovative work bridging the two systems to improve health care—I’m humbled to get to see it in action.