Tiffany and Jasper

July 26, 2010

Tiffany and Jasper, two Rice University students on Beyond Traditional Borders internships, have been busy for the past seven weeks here at St. Gabriel’s. They have tackled several projects including testing the reliability of a salad spinner adapted as a centrifuge, and a water purification system for the mobile clinics.  One of their biggest projects has been to develop a training program for the support groups for People Living with HIV/AIDS. The training program focused on business – the concepts of debt, savings, loans, keeping records, and developing an action plan. Angela, the coordinator here for the Village AIDS Committees, followed their lesson plans and taught over 100 participants – each attending two half-days of training.

They have done a great job – developing a PowerPoint, handouts and lesson plans in Chichewa translated by Angela, providing snacks for the participants, and really putting a lot of thought into making the information relevant to the people here. They hope the project can be sustained by continued education, business development and even micro-financing. You can read all about their projects in detail at http://malawi.blogs.rice.edu/

I thought I’d share some of the picture from the training. Many of the people attending are also volunteer Community Health Workers who know my son Josh who set up FrontlineSMS:Medic (http://medic.frontlinesms.com/ ) cell phone network between the volunteers and the hospital staff. It was fun to see them again, and find some of them even wearing their FrontlineSMS:Medic buttons!

Tiffany helping training participants learn to keep accounting records

Jasper helping at the training

A training participant

The afternoon training group

Jasper and Tiffany registering participants

Evidence of a successful training session - lots of empty Fanta bottles and cookie wrappings

Laughing with Benedict, one of the Community Health Workers

A Community Health Worker wearing a FrontlineSMS:Medic button

And another!

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One of the ongoing projects of the Rice University global health bioengineering team is the development of backpacks that meet the needs of those providing health care in resource-limited settings. St. Gabriel’s has partnered with Rice in developing a backpack meeting the needs of the nurses who provide community health outreach services. The backpack contains everything a nurse would need to provide care on a home visit – vital sign monitoring equipment, basic bandages, medicines, urine strips, oral rehydration instructions, and much more. I am certainly not the backpack expert – but my daughter is. She brought the first Diagnostic-Lab-In-A-Backpack to the Baylor Clinical Center of Excellence in Lilongwe for field-testing by the doctors two years ago. When she showed the backpack designed for physicians (with a microscope and centrifuge) to Alex, the home-based care nurse coordinator at St. Gabriel’s the idea for a Community Health Outreach Backpack started. The need for such a backpack was confirmed after seeing Alex’s worn cardboard box strapped on to the back of his motorcycle with shredded bicycle tires strips. So, she and the design team at Rice went to work. They developed a prototype of a Community Health Outreach Backpack that was field-tested last summer. After gathering feedback from the nurses using the backpack, the design team made modifications, put together 14 of them, and shipped them to St. Gabriel’s. Here, they will be continually field-tested.

It is amazing to see how the Community Health Outreach Backpack is working in conjunction with a new model of care here at St. Gabriel’s – a very well coordinated palliative care unit. Patients from the hospital wards or the community can be referred to the palliative care unit. There, a team of trained professionals provides care for the patient as well as support the caregivers. It has been incredible to be a part of this resource for those caring for the chronically ill, or dying family member. The community outreach aspect of the program is the link between the families at home and the resources of the hospital.

Alex, the home-based care nurse, and a nursing instructor from Mzuzu using supplies from the Community Health Outreach backpack on a home visit

A nursing instructor from Mzuzu taking a patient's blood pressure using a cuff and stethoscope from the Community Health Outreach backpack

Organizing pills in the back of the community outreach van with supplies from the Community Health Outreach backpack

Low-dose aspirin packed and ready to be given to the caregiver for the patient


Coming to the hospital

July 21, 2010

We take emergency services for granted – the ease with which we get emergency help just by dialing 911 is something we expect. Not so here. If you are very fortunate, a pick up truck with a mattress in back will bring you to the hospital. Also, if you are lucky, you can come in the back of a motorcycle outfitted for transport. A third way would be to come in a stretcher, pulled by a bicycle. All of these ways of travel here are called “ambulances”.

Actually, transport for medical care is a huge issue here in Malawi. The most common way of getting to the hospital is by being carried on someone’s back. People also ride on someone’s back on a bicycle. Ox carts bring many, as well as personal vehicles. At a gathering of physical therapists last week, this issue was of importance to the therapists. They are becoming more actively involved in disseminating public health messages – including the importance of not moving people who have sustained a suspected back injury in an auto accident.  Many of these people have spinal cord injuries that are worsened by being transported in the back of an old Toyota Corolla!

Because of the lack of emergency transport, people have understandably taken the responsibility upon themselves. A friend was taking a taxi somewhere (on a long trip). The taxi hit a woman on the road. The woman was injured and needed transport to the hospital. The taxi driver asked my friend to get out of the taxi, and wait. – he would be back. He proceeded to take the woman to the hospital, and then returned for my friend, three hours later. Yes, to deliver her to her destination.  Imagine.

Pick-up Ambulance


Motorcycle Ambulance

Bicycle Ambulance

Ox Cart Transport

Ox Cart with patients

Nyau meets Taylor

July 15, 2010

The Nyau is a secret association of dancers who wear masks so that no one knows their identity. The word “Nyau” refers to the association, the dancers, the masks as well as the dances. The Nyau have been adopted by some neighboring cultural groups, but are described as the heart of the Chewa identity – of the traditional culture of central Malawi.

In order become initiated as part of the Nyau, you have to be a man of mature age. They perform their dance at funerals and at the traditional ceremony of initiation of girls. At a funeral, they are important for interceding for the spirit of the deceased. In general, children are very afraid of the Nyau. Several years ago, we gave a stuffed teddy bear to a friend’s child, and he was scared of it because it looked like a Nyau.

A village chief had passed away at the hospital, but they Nyau were not allowed on the hospital grounds. So, they were dancing in the nearby village. Taylor, a paramedic from Chicago, came across them on a run earlier in the day – just imagine Taylor running along on a dirt road (in the middle of nowhere) looking up at these guys with masks. It was a friendly, albeit somewhat unsettling, encounter!

Nyau

Taylor

In the market

July 13, 2010

I shop at the market in Namitondo – the village near the hospital – at least once a day. Over the years, it has really expanded. The first year Elizabeth and I came to Malawi, five years ago, we found only bananas and tomatoes for fresh food. Every year, I see more variety. This year, I have found tomatoes, eggplant, snap peas, green beans, carrots, green peppers, hot peppers, potatoes, cassava, sweet potatoes, avocados and even okra (if you like okra!). The vegetables are sold by the pile. Tiffany and I bought a pile of sweet potatoes (7 huge ones) for 50 kwacha (30 cents). Two sweet potatoes were all we needed for dinner, so we gave the others to friends in the village. Feeding seven people for 30 cents. The bananas are deceiving – even though they are discolored on the outside – they are always perfect inside. The banana man appreciates the frequent business.

The banana man

Bananas ripening under a leaf pile

A woman selling vegetables

Tiffany (a Rice University student) and a woman carrying water near the market

Faith and Grace

July 11, 2010

Their pictures tell it all.

Faith is a resolute, feisty girl who has been the motivation for her father to persist as he struggles to recover from Guillian-Barre Syndrome. She is wise beyond her years, understanding what her family has endured over the past three years. Soon after her first birthday, Faith’s father became ill – first thought to be malaria, then meningitis. Following his illness, he became unable to move his arms and legs. He became so weak that he almost stopped eating because he had difficulty swallowing. His illness interrupted an opportunity to study accounting in the UK – certainly was a cloud over a soon-to-be bright future. Faith has seen her father learn to feed himself, sit, stand, and now walk with help. She is now ready for Standard 1. The look in her eyes tells me she is ready for more than that!

Faith

Grace is a bundle of smiles and part of a large village family that values education. They are struggling to send every child to school. She plays, though, carefree, giggling and holding her ground even with the older kids. My dad would call her “a tough cookie”. I have watched Grace grow up from a four year old, to now, one of the top of her class in Standard 2. It is wonderful to return to find her thriving in Namitondo.

Grace

There have been many changes at St. Gabriel’s since last summer – a new operating room, a digital imaging machine, a new sterilizer, a new surgical ward in a renovated wing, and a new Family Care Center with an Electronic Medical System for the HIV/AIDS services.

Alexander is the coordinator of Home-Based and Palliative Care in the Family Center. He works together with Grace to provide care management for People Living with HIV/AIDS. With his jolly demeanor, caring approach, and open mindedness, he is a catalyst for new ideas and innovation. The following are pictures of Alex and Grace using the new Electronic Medical System (OpenMRS) in the Antiretroviral Treatment Clinic. I am not the expert, but I understand the system was developed at St. Gabriel’s through an organization called Baobab. Just by looking at the pictures, it is hard to believe they are taken in a rural village in Malawi. It is amazing to see the technology implemented and the benefit to patient care.