Went on a field visit to the district of Dowa Monday! Only a 1-hour drive, which apparently is nothing compared to getting to most field sites in Malawi. As we left Lilongwe, the city transitioned into mud huts, goats running everywhere, and the road became a bumpy dirt path. We pulled into the Dowa District Hospital, a sturdy yet sparse place (hard to believe this is the place most people are lucky if they can get to).
We met with the District Health Officer (the head honcho of the place, with a sleek wooden desk and mosaic tile floor) and the management team. Then we met about 30 of Malawi’s community health workers for a training. The basic idea of community health worker is that many common illnesses are fairly easy to diagnose and treat, so in a setting where specialized doctors and even nurses are in short supply, you can train people with basic education to be that first point of contact between the community and the health system. (Side note: If you want to read a really inspirational story about an Indian NGO that uses community health workers, click here. This story is what got me interested in community based health.)
In Malawi, which has one of the biggest shortages of health workers in the world, organizations are catching on that the community health workers can address many causes of illness and death. So their responsibilities include everything from education on clean water, to giving kids medicine for pneumonia, to visiting pregnant women at home before and after they give birth. That last task is what the training was about, showing them how to correctly fill out a form for each woman they visited. They’re supposed to see if there are any danger signs in the mom or baby and if there are, they instruct the woman to go to the health facility. The community health workers here are actually probably being asked to do too many things at once: on top of all their official responsibilities in communities, the district health management try to get them to help out with facility-based work!
During the training, we heard the sound of the patients singing!
Next we headed to a place called Dzaleka, which is a refugee camp for about 13,000 people from the Democratic Republic of the Congo, Somalia and elsewhere. (But it’s more of a long-term settlement area so there were houses instead of emergency tents.) We did the same training for the community health workers there.
During the break, I was wandering around and met a girl named Grace from the DRC; she and her family have lived at this camp for 10 years. She and her friend took me into the camp itself, which was like a mini city/village. It was getting dark so I had to go back soon, but got a brief glimpse into life there.
What struck me during both trainings was how attentive and engaged the community health workers (CHWs) were, despite the fact that they were literally crammed into a small room, with benches but no desks, no fancy powerpoints or even visual aids. When the power went off, the rhythm didn’t waver; they laughed about it and quickly moved on. Afterwards, we gave a few of the CHWs a ride home; one lived almost 30 minutes away by car; they told me if he’d walked home it would have taken him 3 hours! And it was already nightfall; he would have joined the lone figures slowly travelling the roads on foot or bike, miles and miles from anything. And there are apparently hyenas in this area! (Wasn’t hard to imagine on that dark dirt road, I felt like we were on a nighttime safari looking for lions.) But the main point was: that CHW had walked 3 hours to the health facility for the training that afternoon! And all he’d gotten was biscuits and a soda when he arrived. It reminded how in the U.S. we have so many comforts in a meeting (individual ergonomic chairs, AC, specialty coffee and catering, fancy presentation graphics), and when any one of them goes awry, we get quite irked and our attention span shortens. Note to self: remember this next time I’m in that situation!
We found a little place for dinner, and finally got to try nsima, the staple food of Malawi! It’s basically patties of cooked corn flour, eaten with a chicken or beef sauce. Abandoning my vegetarian tendencies, I dug in. The Malawians laughed at how I was getting the sticky nsima all over my hands as they deftly rolled it and dipped.
Then off to sleep under a bed-net canopy at a little lodge, my heart filled with the image of SO MANY STARS speckled throughout the thick band of the Milky Way.