'medicine in malawi'
a summer of research and adventures

Sunday, July 11, 2010

Resistance to Change

Those of you who know me know that I can be very resistant to change. When my parents wanted to get rid of our 18-year-old worn, stained, crayon-graffitied coffee table I was so upset I insisted they store it for me; it now sits in all of its glory in my living room.  I am still reeling from the change of management in the Health Science Library coffee shop and have resorted to returning home for my afternoon coffee rather than buying the new coffee from the new baristas.

This is all to say that I am sympathetic to individuals and institutions who do not wish to undergo dramatic transformations or systematic restructuring.  Yet one of the most frustrating aspects of working at KCH is the staunch refusal to change inefficient and often broken systems. This has been a common frustration amongst the other medical students working here. Two years ago Mariah implemented a program to help better support the guardians at KCH. When she met with the hospital director this summer he had never heard of this program despite guardians being a constant problem for the hospital.

Similarly, Timica is working in the hospital lab, and planned to spend the summer doing an analysis of whether the lab tests offered at KCH were those that were clinically relevant and assess clinicians’ knowledge of what lab tests are available.  Yet when she arrived it was made clear that the administration was not interested in this study, and moreover was not interested in implementing any changes based on its results.

The study that I am working has thus far been well-received, but I realized on Friday night that my study is a response to resistance to change. One of the UNC undergrads was asking me about my work here, and when I told her that we were investigating alternatives to the DNA-PCR test currently used to diagnose neonates she didn’t understand why an alternative was needed. I explained that the DNA-PCRs take at least a month to get results from the lab, and that a benefit of the p24 antigen test is that it can be done at point-of-care. The student responded by telling me that DNA-PCRs should be able to be done within a week, and she didn’t understand why changes couldn’t be made in the lab to deliver DNA-PCR results more efficiently.

Though I have previously written about this issue in my grant applications and read about it in the IRB proposal this was the first time I really understood the ridiculousness of the situation that precipitated our study. The probability of the hospital lab initiating changes that enable efficient delivery of DNA-PCR results is so low that it is worth immense amounts of time, money and effort to do a new study on a test that will essentially circumvent the lab all together.

Yet even in these frustrating situations I find it a fine line to walk to be honest and critical of the hospital and it’s administration without being ethnocentric and close-minded. How do foreign students and professionals in Malawi work to identify weaknesses and improve on them without undermining the authority of the KCH administration? How do physicians balance the immediate need of patients with the need to respect their Malawian colleagues and create a sustainable system based on Malawian expertise and commitment?

 I think the answer to these questions lies in humility and cooperation on both sides. Just because we have one system in the U.S. does not mean implementing the same system here is the best course of action. Conversely, simply because the KCH lab has followed certain protocols for years and years does not mean these protocols are not without fault.  Yet these lessons are easier said than learned, I will try to remember when sipping my home-brewed coffee at my stained coffee table while the rest of my class enjoys Magical Mochas at the clean linoleum tables of the Friends CafĂ©.

Thursday, July 8, 2010

Promises Fulfilled

It’s amazing how time flies! I realized this morning how long it has been since I last posted and thought it was high time I put some new material up. One of the reasons I haven’t updated recently is that we are now working on study set up which means that I am spending much more time in an office assembling databases and data collection and much less time in the hospital/clinic.  I don’t think my insights on Microsoft Excel and Access are really blog material, so I’ll spare you.

Now that I finally have access to reasonably speedy internet I thought I would take the opportunity to post some pictures, something I’ve been trying to do for weeks, but have been thwarted by poor connectivity.
I don’t have many pictures of people, because I think there are many ethical grey zones surrounding photographing individuals over whom one has power. As an American medical student I am already granted so much access to the people of Malawi, and especially to the patients at KCH, that for the most part I am not comfortable photographing the residents/patients I interact with.

I hope you will enjoy these landscape pictures and pictures of other UNC Project folks.
First, a view from Ntchisi Forest:
The girls from the guesthouse took a day trip to Ntchisi  one Sunday in June. There were gorgeous views from the top (as you can see) and we all had a great time!















Speaking of the guesthouse, here is our happy home:


Now for a cultural lesson....While driving down the highway in Malawi one will often see men in costume running down the road, often with large knives. These men are Gule, members of a secrete society who get together, dress up in costume and masks, smoke marijuana, drinking homemade alcohol and then go from town to town performing dances. They are often hired to dance at weddings and funerals. If you see a Gule running down the road you can pull over and give him several hundred kwacha to dance and let you take pictures. When Mariah, Timica, Rob, Rita and I went to Salima this is precisely what we did. Below, a Gule:


 Speaking of Malawian culture, grocery shopping here is a complicated process involving one or two grocery stores, and a trip to the market where we get all of our produce. The Farmer's Market is one of my favorite summer activities, so it's nice to be able to recreate that here.


 The Lake is a very important part of the Malawian national consciousness. Since arriving I have been asked repeatedly if I have been to the lake, and if I have eaten Chambo from the lake. I have done both, and enjoyed both greatly. More than being a great place to swim and fish, Lake Malawi is the only place in the world where Cichlids can be found. These small flourescent fish are very popular for fish tanks in the States.


 In one of my first posts I wrote about chitenjes; the colorful cloth that Malawian women use as wraps for themselves and to createe slings in which to carry their babies. The marke in Lilongwe has a huge selection of chitenjes, here is a small sampling:

 So, as you can see Malawi is full of many many beautiful things. I hope to get back to posting more regularly and with more pictures (even some with people!) but for now I must say tewanana (see you later!)