Reflections from Malawi

Dr. Vanessa Kerry, CEO, Seed Global HealthBlog, Malawi

Commitment. Engagement. Resilience. Perseverance.

These words describe the ever present – and necessary – qualities of the doctors, nurses, and midwives who are working to improve the health and wellness of their communities in the countries where we partner.

Last month, I had the honor of visiting several of our partner sites and colleagues in Malawi. We city hopped, from south to north, to see incredible care in action: the pediatrics ward at Kamuzu Central Hospital, where even under a seemingly-overwhelming patient load, each colleague went above and beyond their responsibilities to ensure children were swiftly and fully taken care of; bednets over almost every patient at the regional hospital in Mangochi; a nursing student delivering an outstanding presentation on the post-operative care of a patient at Mzuzu; and systems of organization across facilities that reflected not only smart design, but pride and purpose.

We also saw the very real challenges that we know persist, even in a global era of technological advancement. There’s not enough infrastructure in many facilities. Wards are open, concrete rooms lined with beds on thin metal frames. Monitors are rare, wheelchairs are creatively fashioned from lawn chairs, and patients often wait to be seen on mats on the floor. There are often not enough beds, so adults sleep on the floor kids will pile in 4 to a bed in the pediatrics ward.

But what was also so evident was the need for people. I was awestruck as colleague after colleague shared with me their lists of responsibilities. A single nurse may need to care for 30, 40, even 50 or more patients on a grueling, 15-hour, overnight shift. As those children rest many to a bed, their vital signs must be monitored – but how do you do that for so many? To quote one pediatrician we met, “donors and others want to send equipment and stuff, but what we need are people.”

I walked the wards feeling profoundly grateful and optimistic from the tireless dedication of our partners. And it’s both outrageous and unacceptable that patients in Malawi do not have access to the same quality of care we see here. It is not for lack of vision or effort. The leaders of our partner teaching facilities are living our shared mission every day and have leveraged the partnerships they have to do what they can and to improve patient outcomes. But the fact of the matter is that Malawi, the tenth poorest country in the world, experiences a different standard of care from what we experience in the United States.

The enthusiasm and dedication to eliminating the discrepancy between these two standards of care persists, and is embodied by the people we are fortunate to collaborate with across Malawi. It is embodied in our Malawi Country Director, Bridget Malewezi: she not only understands the Malawian experience, but she sees every angle of the visiting educator, counterpart, government, or even patient perspective in enabling the success of Seed’s work. It is embodied in our government partners, including Minister of Health and Population, Atupele Muluzi, who is profoundly and publicly committed to the success of a teaching and training model. And it is embodied in the local clinicians who embrace the opportunity to learn, always seeking what is best for their patients.

On this trip, I had a rare moment of evaluating a single patient alongside one of our clinician educators and his students. I was briefly pulled out of “listen and learn mode” and back into “doctor mode,” hearing through my stethoscope for the small hints her body would give. Our educator then pulled out of his pocket a small, handheld ultrasound device, and we were suddenly able to see inside her – a window into her illness. The ultrasound in our educator’s hands was a transformative tool for her diagnosis and management, but it also was a powerful tool for teaching. For one brief moment, I felt as though I could have been either in our ICU at home, or in Malawi. The gap in care closed for the millisecond before we had to acknowledge we needed medicine, laboratories, and a heart monitor.

It was a poignant, tangible reinforcement for me of what we need to do. And we will. Slowly, deliberately, and in partnership. Alongside our colleagues in Malawi, Seed is and will remain committed to moving us closer to that single, high standard of care that all people deserve.