I am currently sitting in Zurich Airport, waiting for my third and final flight of the long journey back home to New York. Where did the time go? I cannot believe it has been over 7 weeks since I first arrived in Malawi for my LiA with Partners In Health. I have learned so much during this experience and in this post I hope to reflect a bit on my experience this summer.
So much has happened this summer, so here's a little recap:
1. I helped to implement 16 new community sputum collection points in Neno District.
This involved...
- Helping to plan and schedule trainings for community health workers (I did not conduct the trainings because they were in Chechewa, but I helped to plan and make sure they actually happened)
- Requesting, acquiring (from the warehouse), and distributing supplies to 16 sites all across the district. These supplies included tables, chairs, sputum bottles, masks, gloves, soap, basins, masking tape for labeling, chlorine for cleaning and all the proper monitoring tools such as reporting forms and registers.
2. I designed 2 studies and wrote up proposals that will be submitted to the Malawi NHSRC this week!
Both Studies aim to determine the impact of new diagnostic programs on TB case notification rates in Neno District.
- One study focuses on use of an ultra-portable X-Ray (UPX) equipped with Computed Aided Detection (CAD) for TB screening at the primary healthcare facility level. It will use an interrupted time series design and measure case notification rates for 8 months before the UPX program and 8 months following the implementation of the program.
- The other study focuses on the Community Sputum Collection points that I helped to implement. This study will employ a mixed-methods approach, utilizing both qualitative and quantitative methods. The qualitative portion involves focus groups and key informant interviews with community health workers. The data from these focus groups and interviews will be used to design a community scorecard that can be used by those running the CSCPs to evaluate their location's performance, identify challenges, and make concrete, time-bound plans for improvement. The idea is that including the community health workers in both designing the scorecard and evaluating themselves will create a sense of social accountability and agency within the community. The second part of this study will be an interrupted time series study that will measure case notification rates over 8 months to determine if the usage of the scorecards results in a continuous trend of increasing case detection.
While I will not be in Malawi for the data collection stage of these studies, I will still be involved in data analysis, design of the scorecard, and writing the manuscripts from back in the US.
Being on the ground was crucial to the design of these studies as it helped me see how systems actually functioned in order to create a design that is both practical and useful. I am excited to see these two programs unfold over the coming year!
3. I gained clinical experience!
- I shadowed Dr. Dimitri Suffrin as he cared for confirmed and presumptive TB and HIV patients at Neno District Hospital. Additionally, as part of this, I helped track down data (everything is on paper, so sometimes getting all the pieces to understand the whole picture requires a bit of searching and running around).
- I attended morning handoff every morning in the Hospital. Handoff is when doctors and nurses from every ward report on statistics and special cases currently in the hospital. These meetings gave me insight into both the types of cases and issues seen in the hospital and into discussions as clinicians weighed what the proper plan of action would be. Once a week, we would do grand rounds, which was the same except we moved around the hospital to the different wards as we discussed cases.
4. I designed a flowchart tool to standardize the care of patients screened by the mobile X-Ray in the district hospital.
5. And last, but definitely not least, I met so many AMAZING people. Malawi truly lives up to its nickname: "The Warm Heart of Africa". I am so grateful for all the new friends I made, and one thing this trip taught me is the incredible power of breaking bread with others. Cooking and eating together is such a powerful way to overcome cultural and socioeconomic barriers and to show everyone that they are seen and valued.
I will, of course, share more when it comes time for our Laidlaw Conference this fall, but for now here are a few pictures from my time in Malawi.
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