Posted by Sara Marshall on 11 June 2012
Action Meningitis, our pilot initiative in Africa, has launched its first phase and I had the opportunity to visit Blantyre, Malawi for a week.
Action Meningitis will break down barriers to meningitis treatment, improve healthcare delivery and treatment rates, and ultimately save lives of Malawians affected by meningitis. We are working with Health Care Workers to improve early recognition of meningitis and other bacterial infections by using mobile phone technology. Action Meningitis will also provide community awareness messages and symptoms information to the general public, particularly for mothers and care givers of young children, through a national radio programme. Bicycle ambulances (ambi-bikes) will also be provided to key community groups to help transport people to health centres.
I had never been to Malawi, the heart of Africa, but my previous work in Namibia and South Africa did give me a sense of familiarity being back in Southern Africa- beginning with the small international airport situated outside of the capital of Lilongwe. The new Project Manager, Thomasena O’Byrne, is based in Blantyre, managed to make all the arrangements for me to get to Blantyre. I was picked up at the airport by a man holding a sign with my name on it, who then quickly drove me to the coach in Lilongwe just in time to get on the last coach to Blantyre. During the four hour drive I was able to see more of the country as we passed fields, mountains, villages, trading centres, markets and towns along the highway. I was greeted by Thomasena and her friends on my arrival, who then drove me to their house, and my house for the week.
I stayed with Thomasena and her family in a Gogo’ s (Granny) house next to a main house where her friends live. They have a maize meal operation, growing maize and grinding it into meal, so we were woken to the sound of the mill each morning and often saw people sifting and sorting corn kernels. We ate our breakfast and dinner as a family in the main house, with wonderful African food – and Thomasena’s friend, Patience, even baked a breakfast marble cake at 4am for us! The house has running water, but it’s really cold, so someone boiled water for us each morning to use in our bucket bath (literally bathing out of a large bucket).
Thomasena and I had a busy week meeting with partners from the Malawi-Liverpool-Wellcome Trust (MLW) and the Queen Elizabeth Central Hospital in Blantyre. Thomasena works from the MLW building and introduced me to some of the researchers, as well as the Director, Rob Heyderman, who MRF has worked with for many years, the Programme Manager, Danielle de Clercq, and our primary researcher for the project, Nicola Desmond. We had several conversations with Nicola about the project evaluation, which she is designing following her research project on treatment barriers that led to the Action Meningitis initiative. I also met with clinicians Professor Elizabeth Molyneux, Dr Queen Dube, and Dr Mac Mallewa and who are conducting a meningitis research project funded by MRF, and Tamara who is working with the health radio programme. It was great to meet all of these people in person and to get a better idea of their roles in research and at the hospital.
We then visited two Primary Health Clinics in the Blantyre area, in Mpemba and Zingwangwa. Mpemba was more rural, with a fair amount of people waiting in a queue to be seen by the clinicians, however they got through the queue fairly quickly. We were able to speak with the Clinical Officer managing the clinic, as well as a Medical Assistant, nurses and Health Surveillance Assistants who travel between the villages and the clinic focusing on prevention. They explained their roles, how the clinic works and some of the challenges they face. Transport is a factor in getting to hospital since they are further from the city, and the minibus taxi stops only on the main road to Mpemba. To get from the clinic to the main road people have to ride on the back of bicycle taxis, called kabazas. The health care workers also pointed out that they are really busy keeping up with all the patient’s needs and working in under-resourced conditions. The clinician in charge is trying his best to improve the services they provide, but there are still children who arrive at the clinic with serious illnesses and who don’t always get to the hospital in time.
The clinic in Zingwangwa is more urban and was a lot busier, with people queueing from the building up the staircase and onto the road. They weighed all the small children before they went into the waiting area and checked their symptoms briefly. The waiting room was full of adults and children, and every so often a health care worker would call up a group at the front of the queue, which brought on a mass stampede through the entrance to the clinic where they had get in a queue again to be seen by the clinicians. Since the health care workers were very busy, we could only speak to a few of them for a few minutes, but they were helpful in answering our questions. They have similar challenges with a shortage of personnel to manage and treat all the patients, and getting people to the hospital quickly.
After the clinic visits we realized that the health care workers are doing their best with what they have and are still trying to improve quality of care, but resources are limited. Identifying the sickest patients and making sure they are seen by a clinician and referred to hospital is a major problem as there is no formal system to ensure that critically ill patients are prioritised. The triage system used in hospitals has not been introduced in primary clinics yet.
After getting a better picture of the health system and how the clinics work, we had to go to Lilongwe for a meeting about the mobile health (mHealth) technology available to use in the project. Luckily, Thomasena’s friend Charles was nice enough to drive us there and ensured our safety despite a brief encounter with a mini-tornado beside the highway!
There are other mHealth projects running in Malawi, which is encouraging to know, but none are focusing on urban health clinics in Blantyre. We found out that it’s possible to add applications to phones by adding a thin chip to a SIM card and placing both in the phone. The application can be accessed as part of the mobile companies services – imagine! It’s really quite simple, but makes a big difference once it’s used to improve things like maternal health or determining the nutritional status of children... or identifying severe illnesses like meningitis.
After an enlightening and brilliant visit in Blantyre- with warm sunny days, fresh bananas, new Fanta flavours and great hospitality- it was time for me to leave. The Malawian people were very friendly and welcoming during my stay, and by the end of the week I had an adopted Malawian family! It is very exciting to be part of the start of the project, and to see first-hand how the project can really help identify sick children more quickly and raise awareness about meningitis. I’m looking forward to the next few months as the project begins running in the clinics, and I will post more updates as we go!