Column: No Substitute for Local Expertise

 

A three year old boy cowers behind his mother, looking up at me with tears in his tired eyes. I quietly greet his mother in Chichewa, the language common to the Southern region of Malawi. It takes time to gain an audience not only with this tiny, frightened child, but also with his mother. I smile, being sure not to reveal my teeth, surely to bring on further tears and sit next to her on the bench in our workspace. She smells of wood fire kitchen smoke and sweat from her 5 kilometer walk to our malaria research center at the District Hospital in Machinga, Malawi.

As I go through the traditional exchange, she seems unsure of me, avoiding my eyes. Her child is gaining some confidence and touches my leg with his hesitant hand, only brave enough to reach my foot. I feel the heat of fever through the bottom of his palm, note his pale mouth. I begin a cursory assessment in Chichewa, querying his mother while stealthy attempting to place a thermometer under the child’s arm. The boy looks at me with a curiosity and bursts into a shy, albeit exhausted smile. That smile is contagious and affects the entire group of women, and laughter erupts through the crowd assembled at the program’s clinic.

The Malaria Alert Center, established in 2001 as part of the College of Medicine, was created to provide a foundation for malaria prevention and control activities involving operations research, monitoring and evaluation, and training of health care workers and medical professionals. From training clinical officers in the proper management of the parasitic disease that sickens 60 percent of Malawians every year, to conducting operational malaria research that ultimately informs policy at the Ministry of Health, the Center functions as a vital tool in an arsenal against malaria.

When I was posted to a newly established field site in 2011, I found an office on the grounds of the District Hospital with basic laboratory capabilities, an expert Malawian staff and an overwhelming number of challenges ranging from scarcity of fuel and electricity to the lack of a streamlined data management system.

The hospital from which our team was to select patients was often out of drugs and insecticide treated nets. The power was fickle, leaving microscopes and equipment ineffective. Women and children would often wait long into the afternoon to be evaluated and prescribed treatment by the hospitals’ clinical officers and nurses. Adherence and follow up was challenging. Despite these issues, the staff of nurses, laboratory technicians and managing physicians at the site was committed to providing quality medical treatment while adhering to the program and study design.

Navigating systemic challenges and incorporating culture into the program’s structure were both priorities for the partner organization providing technical support to the Center. These essential components were seen as integral to the success of the program.

 

Our team scaled up efforts at the site and began an insecticide treated net study, involving 1000 households, a larger team of data managers, enumerators and field workers. We performed an extensive household census, identified community health volunteers in the village and collected information on indicators on insecticide treated net ownership and usage. This was a massive undertaking and required concerted scale up of the site’s capacity.

The Malaria Alert Center team is comprised of driven public health professionals. All of our programming and research focused on resistance management- be it investigating treatment regimes, scrutinizing the vector population or evaluating the efficacy of insecticides. This required extensive local knowledge of the environment, cultural norms and socioeconomic factors present in the population. The expert team tirelessly worked against this seemingly insurmountable, pervasive disease that is potentiated by poverty, struggling health systems and lack of political will.

Solutions and expertise are not solely generated from partners and organizations with large resource reserves and academic powerhouses. Solutions are attained from sustained, collaborative efforts and shared initiative with those closest to the burden of disease. The Malaria Alert Center stands as model progress being achieved by those closest to the challenge.

Because of the compelling efforts of the Malaria Alert Center team, the Malawi College of Medicine is an essential player in the global effort to combat malaria and provide evidence based policy solutions. Change is happening and an expert professional force is evolving here, in Malawi.

For more information on the evolution of the Malaria Alert Center, College of Medicine:
http://www.mac.medcol.mw/ and http://www.cdc.gov/malaria/malaria_worldwide/cdc_activities/malawi.html

 

 

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Kate Dieringer RN, BSN, MPH worked as a technical advisor for the Malaria Alert Center/Centers for Disease Control and Prevention (College of Medicine, Malawi) providing support for malaria programming and operational research initiatives in Malawi. Her background combines global health and emergency/trauma clinical services. She is invested in malaria prevention and control through community based partnerships, as well as health systems strengthening and investment in human capacity. Kate’s scope has focused on Latin America and the Caribbean and Africa regions involving HIV, malaria and maternal child health programming. Currently, she is working with Partners’ in Health Haiti on capacity building and clinical program implementation.