This report was prepared by the six University of Maryland (UM) students, one from each of the University's six professional schools in Baltimore, who are participating in an interdisciplinary research project to examine health care access for malaria patients in Malawi, Africa. The slide show below was prepared using their pictures:
Upon arriving in Malawi, our team spent the first two weeks meeting with local health personnel to gain a better understanding of how the health care system operates in Malawi, particularly as it pertains to malaria management. We received a multidisciplinary overview from local doctors, nurses, medical officers, pharmacists, health economists, and lawyers.
These officials work primarily at the local and district level, namely at the Blantyre Malaria Project, Ndirande Health Centre, Queen Elizabeth Central Hospital, Chikhwawa District Hospital, as well as the University of Malawi College of Medicine, the High Court and other institutions.
Through these meetings we began to learn about some of the barriers Malawians face in effectively delivering and accessing health care services, especially in the rural areas. After speaking with local experts, we quickly realized that we needed to adapt and revise the initial version of the survey that we drafted back in Baltimore.
We then spent a few days working diligently through the revision process to assure that the survey reflected our new breadth of knowledge about the health care system here. Having students on the team from different disciplines brought a diverse perspective to the development of the survey as we worked to ensure that it was culturally appropriate, and that it aligned with the research project's main goal to identify where people with a fever go for medical treatment.
We carried out this process in collaboration with Malawian counterparts, who not only provided input and guidance on the survey revision, but also served the vital role of translating the survey from English into Chichewa, the local language. Our Malawian colleagues also were very helpful as we visited the 'mfumu,' or village chief, of each village to seek permission to conduct our survey.
For the past two weeks, we have been conducting the health access and utilization surveys in the Chikhwawa District of southern Malawi, specifically the villages Kandeu, Morgeni, Kapasule, and Lauji. These villages were selected to determine if, and how, people's health care access and utilization differs based on their distance from the Chikhwawa District Hospital.
UM Malawi Interdisciplinary Research Project from UM news on Vimeo.
While everyone in these villages is entitled to receive free government-provided health care at the District Hospital, people face challenges in actually being able to reach these free services. Some of these barriers include long travel times and lack of resources, such as money and transportation. Cars are extremely rare and most people walk but we have spotted a number of alternate transportation types such as ox-drawn carts, and bicycle-taxis with passengers riding side-saddle on the back.
One of our project's more unique components is the method we selected to randomly identify households for the survey. As village maps are not usually available here, we are using a method quite different from those used in the United States. Our survey randomization process uses a UNICEF model: a Coca-Cola bottle (or other soft drink of choice) is spun in the center of the village to determine the initial direction and starting point.
Thereafter, we follow a previously established skip/survey pattern where we visit every other household on that particular path, and stop to spin the bottle again when the path forks. While this process has gotten us more than a few quizzical looks from the local residents, everyone we have met has been so welcoming and friendly, and we have had a lot of practice saying 'zikomo kwambiri' or thank you very much.
Our success to date in carrying out this research has been a true team effort, not only on the part of the entire UM interdisciplinary team, but also in collaborating with Malawian colleagues who conduct and translate the interviews and help guide and introduce us throughout the villages.
We look forward to continuing this project and to ultimately learning what the data will reveal about people's health care access and utilization in the Chikhwawa District of Malawi.
Elizabeth Duke - School of Medicine
Jane Hannon - School of Nursing
Jason Hodge - School of Pharmacy
Angie Larenas - School of Social Work
Lucy MacGabhann - School of Law
Shabnam Mazhari - School of Dentistry