DUKE - FAMILY HEALTH INTERNATIONAL SUMMER 2006
PILOT PROGRAM IN MALAWI
By: Cynthia Binanay
July,
2006
This summer, the Hubert Yeargan Center piloted its first summer internship
program in partnership with Family Health International's (FHI) Country
Office in Malawi. We had two outstanding candidates join the Malawi
office, Jing Luo, recently graduated and enrolled in medical school
for the fall (and also a photographer), and Dan Englander, a public policy
major with a special interest in health policy. During the course of traveling
to several of our sites in Africa few weeks ago, I had the rare privilege
of visiting them in Malawi and evaluate how they and the program were
going.
During my brief stay, the students and I made home based visits with a nurse and clinician (similar to a physician assistant in the US) from an HIV Treatment clinic, one of FHI's "Implementing Partners." The roads were so bad; cars were unable to get close enough to the homes. We parked our vehicle and then hiked along dirt paths into the "town," the nurse carrying a heavy bag of "supplies," the clinician armed only with a stethoscope. The nurse had hand picked the folks we were going to visit, because typically clinicians are only out in the field a couple days a week; the rest of the time they are treating patients back at the clinic.
The first house we entered was made of cement blocks with a tin roof, a couple holes in the wall for windows. It was dark as we climbed up some boulders to enter and we could only make out a curtain hanging up in the middle of the room to divide the space. But as our eyes acclimated, we saw a bundle of dusty covers in the back of the room on the dirt floor. There was an old woman there; at least she looked old, weathered by a hard life. Her daughter, who was introduced as her caretaker, could not have been older than 15. The patient was emaciated, wracked by TB and HIV, and some other unknown infection. She had been given an antibiotic earlier in the week, but clearly had not been taking it appropriately. Her daughter caretaker already had two children of her own to take care of and had forgotten to make sure her mother got her pills.
We saw three other patients that morning, each more worrisome than the next. One that was particularly troublesome was a young woman who was pregnant, had HIV, and had developed paraplegia, unable to move her lower limbs, barely able to sit independently. There was a question as to whether the woman had a brain lesion as a result of toxoplasmosis, a secondary infection to HIV. The doctor thought she needed a CAT scan to diagnose the problem and hopefully initiate proper treatment. Although the government now provides free antiretroviral medication for HIV, and the nurse and clinician can visit the patient at home, patients must provide for their own transportation to either the clinic or the hospital for evaluation. For many, this can be an insurmountable barrier.
Later in the afternoon, we ventured into rural Malawi. Out here, there
are no doctors visiting the patients, only nurses and community volunteers.
As we arrived, there were a group of women dressed in brightly colored kangas
sitting under a tree. I thought they were having a meeting but was informed
that they were community volunteers waiting for us. They greeted us with
clapping and song, eagerly welcoming us, shaking our hands while singing.
They led us along grassy paths amidst mud huts, fire pits, "latrines", and
maize fields and before we knew it we had scores of children of all ages
following us just like the pied piper. They were dusty from head to toe,
barefooted and clothed in torn and tattered clothes, but had the brightest
smiling faces. They ran along beside us, waving, wanting to get close or
hold our hands, and when we took the camera out to take their pictures they
danced and pranced, eager to get our attention. They were a cheerful distraction
from the real purpose of our visit.
Both FHI's Country Director and I were so impressed with the work our students accomplished during their stay in Malawi and the seriousness with which they approached each day. It was obvious that the experience was making a significant impression on how they would view their future career choices, strongly influenced by a desire to include service for the disadvantaged as a major component of their work. In particular, it reaffirmed the value of providing such opportunities for undergraduates so that we can capture their attention and "light their fire" during the formative career development years.
Two Duke undergraduates worked in Malawi as Duke University - Family Health International Fellows during the summer of 2006.
To view their blog, click here...