A group of 100 community health workers gathered at St. Gabriel’s yesterday – from near and far – mostly far. They came by foot and by bicycle from 10, 20, 30, 40 miles away for training in palliative care. They had plenty of Fanta and boxes of cookies common to trainings in Malawi. They also had lots of stories to share with each other, and encouragement for each other. These are the foot soldiers – on the ground caring for people in their communities, voluntarily. Some say they are needed because of lack of resources – not enough doctors, nurses, physical therapists. I say they are much more than just a stand in until resources can be gathered. They are giving the care needed at an individual and community level, with a human approach often lacking in the most resource-rich settings. I applaud them all, and wish we could mobilize such spirit, compassion and commitment on all levels of health care. They all had a chance to watch the video Elizabeth put together on Community Health Workers and projects at Rice University.

As they returned from their lunch break, I caught a few of them singing and dancing in the area outside of the conference room. Mwaiona bwanji palliative care?, they are singing – How do you view palliative care? Chipatala momwemo, the hospital is a part; Suave momwemo, the doctor, Suave, is a part; Matron momwemo, the Matron of nurses is a part, VAC momwemo, Village AIDS Committees are a part. The singing continued later as a break during their training.

100 Home-Based Palliative Care Community Health Workers with the doctor and nurses from the Family Centered Care Unit, St. Gabriel's Hospital

Community Health Workers traveling home...many, many miles, after a day of training



I have spent the week with the first class of physical therapy students at the University of Malawi, College of Medicine. They are the future of physical therapy in Malawi. After teaching this week on the basics of evidence-based practice, I have been inspired. The future is hopeful and bright. The people of Malawi will be in good hands. With only 24 physical therapists currently in the whole country, this class will add 26 more – increasing access to health care, improving the quality of life, and building a future for the profession.

This is a very special group because they are pioneers – the first class of physical therapists, ever, to be educated in Malawi. For seventeen years, a group of therapists in Malawi, committed to starting and school in Malawi, persevered through the challenges. I congratulate them, and admire them for their vision.

The head of the school of physiotherapy is Sylvia Kambalametore. She is optimistic and works tirelessly to provide instruction to students, as well as nurture the growing faculty. I am grateful to her and the Dean of the Medical College for the chance to come to the University of Malawi.

During our classes this week, the students amazed me with their questions and comments. They got involved in group work, raised excellent points in our discussion, and showed me that they are already beginning to use basic principles of clinical reasoning. I thank each of them for their contributions this week.

We also spent time together with Birget Schoenharting, a physical therapist from Germany who is here providing instruction in the orthopedic/sports medicine area. We had great fun exploring our senses and observing our posture in her workshop.

I look forward to the possibility of coming back again next year to continue this instruction, meet the next class of students, and renew my hope for the future of physical therapy in Malawi.

University of Malawi physical therapy students

Physical therapy students working in groups

Sensory awareness activities with the students

Close your eyes, feel the position of a model, keep your eyes closed and put another person in that same position

Another group modeling

Observing posture

A new section of the College of Medicine, view from where I am staying


University of Malawi College of Medicine, a view from the track

I didn’t eat it!

July 26, 2011

Yes, the Malawians do eat mice. They are a source of protein, and I am told don’t carry diseases. I have seen many for sale this year. I am told they are not so bad, but I will never know!

Just pretending....


Mice for sale at the Namitondo market, only 15 cents each


July 24, 2011

Everywhere I go, I am asked, “Where’s Josh?” Usually, they are happy to hear that he is doing well, working hard and sharing what he has learned at St. Gabriel’s with others. The website of the organization he co-founded is http://medicmobile.org if you’d also like to catch up.

Elizabeth and I decided that a new word has been created here at St. Gabriel’s….wheresjosh?

These community health workers were asking “wheresjosh” when I came upon them in the courtyard last week. Two of them, Benedict and Harold, are community health workers from the first pilot group of the cell phone project. A few years ago, Harold took me on the back of his bicycle for an entire day so that I could see what a typical day was like for a community health worker. We biked for hours to see his patients – yes, with a stop at this village so his wife could give me a blanket for some cushion on the trip!

By the way, Josh, you would be most welcome here if you could visit. Sister Annie says you must come again soon.

Benedict, Harold and Rose - Community Health Workers for St. Gabriel's Hospital



Deus and his wife Regina were one of the first Malawians we met six years ago. At that time Patrick was just four months old. Soon, he will be six and will be starting Standard 1. His brother, David, was born this September. Last Sunday during our visit, Elizabeth got a lesson on how to put a child on her back and wrap them in a cloth!

Over the past three weeks, I have worked intensively on the Family-Centered Care Unit (FCCU) at St. Gabriel’s Hospital. This is a palliative/rehabilitative care unit at the hospital with an incredibly committed staff. The FCCU is well grounded in the principles of a family-centered approach. They educate the patient, the family and the community health workers about the patient’s diagnosis and care. Family preferences are respected and avenues for support in the home environment are investigated. With the education given at FCCU, the family makes decisions about the care of the patient – at home or in the hospital unit. My days in the FCCU are about team building and educating through modeling, coaching, and direct instruction.

Last week, I gave a presentation on physical therapy and stroke rehabilitation. As a follow-up, we did a practicum session on some of the common activities for stroke patients on the unit. This week, I gave a presentation on physical therapy and cerebral malaria. Again, as a follow-up, we did a practicum session on some of the common activities for children with disabilities.

These trainings involved everyone on the FCCU staff….the doctor, nurses, nurse assistants, cleaners and even the ambulance driver!

Dr. Gombwa and Comfort practicing range of motion

Two nurse assistants working together

The motorcycle ambulance driver and a nurse assistant

Again, the motorcycle ambulance driver and a nurse assistant

Practicing how to help a patient stand up

A nurse and nurse assistant working together

The home-based care nurse giving instruction

Therapy activities in play with children

Learning how to hold a child for feeding

The doctor learning about positioning for feeding

Who is Disabled?

July 22, 2011

This is the title of a poem that was posted on the wall at the Chimteka Community Center in Chimteka, Malawi. John, the area development manager said a Kenyan nun wrote it. The team working with the children with disabilities at the Center was inspired by her words. I love the way her conversation makes a full circle:

Who is Disabled?

If you fail to see
The person
But only the disability
Who is blind?

If you cannot hear
Your brother’s
Cry for justice
Then who is deaf?

If you do not communicate
With your sister
But separate her from you,
Who is disabled, her or you?

If your heart and your mind
Do not reach out to
Your neighbour,
Then who has the mental handicap?

If you do not stand up
For the rights of all person
Then who is the cripple?

Your attitude towards
Persons with disabilities
May be our biggest handicap,
And yours too.