Time is moving quickly

By Dr. Lynda Wilson

Left to right:  Mary Anne Shannon, Rachel Rodriguez, Ellen Chirwa, Lucky Muhango, Caroline Chitsulo, Lynda Wilson, Tuli Soko, Immaculate Chamangwana, Rose Nyrienda, Simon Ntopi, Fannie Kachale

Left to right: Mary Anne Shannon, Rachel Rodriguez, Ellen Chirwa, Lucky Muhango, Caroline Chitsulo, Lynda Wilson, Tuli Soko, Immaculate Chamangwana, Rose Nyrienda, Simon Ntopi, Fannie Kachale

Whew! The week has flown by! The classes with the PhD students are so invigorating…this week they asked me to do an extra class as we didn’t have time for all of the students to share the homework that I had assigned to them last week: writing a draft problem statement and also completing a summary table for a quantitative research article critique…It has been so exciting to hear their research ideas taking shape, and I know that they will truly make a difference to health care in Malawi!

It has been fun this week getting to know three nurses who have arrived in Malawi this month for their one-year assignment with the new Peace Corps Global Health Service Partnership Program (http://www.peacecorps.gov/volunteer/globalhealth/). This is a one-year program in which nurses or physicians spend one year in Malawi, Uganda, or Tanzania teaching to strengthen nursing and medical education. There are four nurses working at the University of Malawi KCN, two on the Lilongwe campus (where Deb Walker is working), and two on the Blantyre campus (where I am). The nurses on the Blantyre campus include Chirly, a 27-year-old nurse from Nashville who will be working in community health, and Jan, a 61-year-old nurse from Montana who will work teaching medical-surgical nursing. They are working in the clinic and hospital for the first month to have an orientation experience and get their Malawi nursing licenses and it has been eye opening…Chirly helped to deliver four babies on her first day of orientation!

The shortage of nurses and other health care workers and facilities and equipment is sobering here. There are often not enough beds so patients are placed on mattresses on the floor…their bed identification numbers have an “F” on the end (e.g. Bed 51F)…Every day I am reminded of how fortunate we are and how much we often take for granted.

A long-time friend of mine arrived last night from London. Ros Lowe has been Chief Executive of the Health Visitor Association in England, and also retired as a Chief Nurse for a major National Health Service Trust…she will spend the last week with me in Malawi and is eager to learn about nursing and health care here.

Today we are off for a weekend holiday at Bushman Baobobs – to go on safari and sleep in chalets with no electricity! Check it out at http://www.bushmansbaobabs.com. Debbie Walker took the bus to Blantyre last night from Lilongwe so will come along, and our friend Rachel Rodriguez (the American nurse who is teaching here in the graduate nursing programs), will be our driver and guide. I will send photos next week.

In today’s photo of the PhD students you also will see Dr. Rachel Rodriguez, Dr. Ellen Chirwa (the Vice Principal of Nursing at KCN in Blantyre and also Coordinator of the PhD program), and Mary Anne Shannon, one of the Peace Corps Service Corps volunteers from Lilongwe who will be teaching medical surgical nursing, but who is sitting in on the PhD classes for these next two weeks to get oriented to that program in case she is needed to help with that program during the year.

Hope all is going well in Alabama!

Advertisements

Along the journey there are mountains

By Dr. Deborah Walker

Mountains of all types and sizes on this trip…we all face them – we all climb them at one point or another.

walkerblogpic1_8-12

Preparing to lecture

One very small mountain for me this week (in comparison to everyone else’s) – I had to prepare and deliver a lecture on breast cancer. Seems pretty straight forward, since this is what I do and have done for the past 15 years, right? Not so much. How do tell someone screening for breast cancer could save your life, when there are no mammogram machines around? How do you teach someone self-breast exam, when fear is in control? How do you tell someone there are some options, when they really have no access to them? I gave the lecture. I would like to think that we learned from each another.

walkerblogpic2_8-12

Francisco and I on the drive to Blantyre

Friday I headed south to Blantyre. Everyone tells me that it is 3.5 hour drive. The many times that I have traveled this way, I have yet to make it in 3.5 hours. We left at 11:45a and made it at 5:15pm. You have to go over and through mountains, through congested villages and markets and through multiple road blocks. But we (there were 5 of us) made it. One gentleman in the car with me was Francisco, a 23 year old, 4th year nursing studewalkerblogpic38-12nt. We had plenty of time to talk about nursing and all of the mountains that he has climbed. He is the first of 6 children in his family, so he has a lot of responsibility. He was telling me that he is the first in his clan to attend college, but he hopes his brothers and sisters follow in his footsteps. He is interested in pediatrics, but really he doesn’t get to choose where he works when he is done. The government usually “post” nurses in various clinics when they get out of school, wherever the need is greatest. He would like to eventually end up back in his village. He told me about life in Malawi and was a great tour guide throughout the trip. Thanks Francisco for a fun trip and making the time go quickly!

I met up with Lynda Wilson in Blantyre for the weekend. We were able to do some sightseeing on Saturday. We went to Mulanje Mountain and did some hiking with a tour guide Alex and our driver Richard.

One of the steep hills I had to climb

One of the steep hills I had to climb

walkerblogpic4_8-12

I made it!

 

We were told that the hike up the mountain to the waterfall was about 45 minutes. That is 45 minutes Malawi time. (Lesson here: always double the time). Anyway, it took quite some time and up some treacherous terrain. We made it!! It was so worth it! The beautiful views of the Malawi landscape and the tea plantations along the valley were breath taking. The pictures don’t do it justice!

Chombe tea fields with Mulanie Mountain in the background

Chombe tea fields with Mulanie Mountain in the background

walkerblogpic10_8-12

A few children from a village…they love to get their picture taken and then see it on the screen! We had fun!

I made it back to Lilongwe after a busy morning in Blantyre on Monday (only 4 hour trip this time).

I took some pictures around town…the flowers are just beautiful, so I can’t help but to take some pictures. No one seems to know the names of them though…maybe a green thumb reading this can help me out with the names?? Anyway, enjoy the photos….more later!.

Best Bananas EVER! Only 25 cents for this bunch. They are so sweet!

Best Bananas EVER! Only 25 cents for this bunch. They are so sweet!

walkerblogpic8_8-12walkerblogpic9_8-12

Wonderful opportunities and adventures, despite connectivity issues

Dr. Deb Walker and Maria Chikalipo, KCN maternal-child nursing faculty member

Dr. Deb Walker and Maria Chikalipo, KCN maternal-child nursing faculty member

By Dr. Lynda Wilson

Thursday August 7 started with a wonderful opportunity to participate in a case review conducted by the chief nurse of the pediatric unit at the large Queen Elizabeth Hospital, along with about 25 nurses from the hospital pediatric and emergency wards, and also with several of the pediatric nursing faculty and students from KCN. They reviewed a case of a child who was admitted last Sunday with pneumonia, and identified the positive aspects of the care that had been provided, as well as areas where care or communication might have been improved. It was great to see the passion and dedication of so many nurses as they problem-solved to figure out ways to make the system better so that they could provide quality care, despite the limited resources here.

I had some discussions with Ellen Chirwa about a proposed new PhD program in collaboration with the University of Zambia and Zimbabwe, which will be supported with funding from NORAD, the Norwegian Aid agency. I spent much of the rest of the day trying to work with Charles, the Information Technology administrator for KCN, to put the quantitative research course I had prepared onto their online Moodle platform…There was no electricity at the school of nursing yesterday or today so we went to the Leslie Lodge where I am staying. Although I had electricity, we discovered that the system doesn’t work with the internet service provider they have at Leslie Lodge…We then went to a restaurant which has wifi with a different service provider – that doesn’t work either! We called the university and learned that the electricity is back on so back we went with high hopes…only to find that the entire system is “down.” I am advised to try again tomorrow, so fingers crossed!

Dr. Lynda Wilson and Dr. Deb Walker

Dr. Lynda Wilson and Dr. Deb Walker

Unfortunately, Friday there was still no luck with getting the online “Moodle” platform to work, so I wasn’t able to help put the research course on Moodle. I spent much of the day reading and grading master’s students’ papers for the ethics course, helping Ellen who is overloaded with work and grading! It has been interesting reading the students’ views about different ethical issues here (abortion and providing contraceptives to teens are the most popular topics). Deb Walker, my UAB nursing faculty colleague, came down from Lilongwe to spend the weekend with me and we planned a great adventure on Saturday. We also had a lovely visit with one of the KCN maternal-child nursing faculty members, Maria Chikalipo, who stopped by for afternoon tea (see photo below). Maria was one of 12 Malawi global health fellows who came to UAB for a 2 week workshop on interprofessional education that was supported by a grant from the U.S. State Department in 2012. She has invited us to her village home on Sunday for dinner and we really look forward to this!

View of Mount Mulanje from a distance

View of Mount Mulanje from a distance

What an adventure! Saturday Deb and I left our hotel at 9 am with our KCN driver, Richard who drove us about 60 km to beautiful Mulanje Mountain Forest Preserve, in the southern part of Malawi. Here is what Wikipedia says: (http://en.wikipedia.org/wiki/Mulanje_Mountain_Forest_Reserve) “The mountain is composed of syenite, quartz-syenite and granite rock materials. This forms a massif of approximately 500 km2. The surrounding Mulanje mountain is characterized by densely populated plains situated at 600m-700m above sea level. From the plains, it rises abruptly to high plateau basins at 1800-1900m surmounted by rock peaks to its maximum attitude of 3002m above sea level, Sapitwa Peak. In fact the mountain is the highest both in Malawi and South Central Africa. The structure and altitude of the mountain have led to the development of a unique climate for the area, which is characterised by high rainfalls from November to April. This climate favours the development of unique ecology of rare and endemic life forms which contribute to the massif’s high biodiversity. Mulanje is south of Blantyre.”

Dr. Lynda Wilson buying vegetables for dinner at market near Mulanje

Dr. Lynda Wilson buying vegetables for dinner at market near Mulanje

The drive to Mulanje is majestic … at the base of the mountain are verdant green tea plantations…we learned that the famous Chobe tea comes form this area in Malawi. The photos show the views with the tea plantations at the bottom of the mountain.

Women carrying wood down Mount Mulanje

Women carrying wood down Mount Mulanje

We first took a short hike on a trail behind the Kara Omula lodge where we passed several women carrying BIG and very heavy loads of wood coming down the mountain (most of them barefoot)…. We also passed some mean with machetes going up the mountain to cut reeds that are used for making thatched roofs on the houses.

Children playing in village near Mount Mulanje

Children playing in village near Mount Mulanje

 

Richard, our driver, had heard of another lodge with good hiking nearby so we drove down a very BUMPY dirt road and after nearly 30 minutes came to the Likhubula Lodge – we decided to have lunch and then hike with a guide to see a waterfall that we were told was only 45 minutes away…Once we learned that lunch would take 40 minutes to prepare, we decided to do the hike before lunch. Our guide, Alex, led the way up, up, and up a steep mountain path…After about 1 ½ hours (not 45 minutes!) we arrived at an incredibly beautiful waterfall. The hike was well worth it, and Deb and I slept very well last night!!

 

Exploring Blantyre and getting to know KCN’s PhD students

By Dr. Lynda Wilson

wilsonblogpic1_8-6It has been a wonderful first three days here in Blantyre, Malawi! I arrived on Sunday, August 3, and was greeted at the airport by Dr. Ellen Chirwa Mbweza, Professor and Vice-Principal of the University of Malawi Kamuzu College of Nursing (KCN). Dr. Chirwa directs the PhD program that I will be teaching in while in Malawi.

Dr. Chirwa and the KCN driver, Mr. Daruni, took me to the Leslie Lodge, a delightful Bed and Breakfast, where I will make my home for the next 3 weeks. Here are some photos of my new home. I have a nice room with a small kitchen where I can cook dinners if I like, and even a private courtyard. There is a small antelope on the grounds of the lodge so I really feel like I am in Africa!

blantyremarket6I spent Monday getting to know the town of Blantyre – visiting the market, shopping for groceries, and walking to the huge 1300 bed St. Elizabeth’s Hospital which is only a 20 minute walk from the Leslie Lodge. I am attaching some photos below of the market and the hospital grounds,. I was especially interested to note that there is an entire unit devoted to Kangaroo care for preterm infants!blantyremarket2blantyremarket11

Tuesday was my first day with the group of seven PhD students at KCN. I participated in the qualitative methods research course that is being taught by Dr. Chirwa and Dr. Rachel Rodriguez, an American nursing faculty member who came to KCN two years ago on a Fulbright grant, and decided to stay! She has been hired on a 2-year contract at KCN to help to teach in the MSN and PhD program! The students are fantastic – they include six nurses (the Chief Nurse for the Ministry of Health, the Chief Nursing Officer for St. Elizabeth’s Hospital, the head of the Reproductive Health Unit at the Ministry of Health, a Community Health Clinical Officer, two nursing faculty members, and the chief nursing officer for a district hospital in northern Malawi. The focus of the PhD program is interprofessional collaboration and education, and many of the students are interested in developing research that will focus on strategies to enhance interprofessional collaboration and thereby improve health care. It is exciting to be a part of this program in some small way! I am attaching here a photo of me with the seven students, taken outside of the new campus of the KCN in Blantyre. It is a lovely campus with views of the nearby hills and mountains from the windows. It feels like a nice place to learn!

wilsonblogpic7_8-6On Wednesday (today) I taught the first class in the quantitative research methods course that I have developed in collaboration with Drs. Chirwa and Rodriguez. The time flew by and I felt that we had only scratched the surface before it was time to head to lunch! The students are on campus for the first four weeks of the semester, then go back to their homes for the next 10 weeks, and finally return to campus for the final four weeks of the term. As a result, we are trying to cover as much of the content as we can before they leave so that they will have the basis for completing the assignments for the semester!

wilsonblogpic5_8-6I spent the afternoon meeting with Dr. Chirwa who coordinates the World Health Organization Collaborating Center on Interprofessional Education (IPE) and Collaboration, (IPC) at KCN. We discussed the objectives (or terms of reference for the center) and worked on drafting a report to summarize the many accomplishments to promote IPE, including the development and launching of the country’s first PhD program in a School of Nursing! It is an honor to be working here with such a group of dedicated professionals!

 

 

“Laundry” list of activities

By Dr. Deborah Walker

ta da!

ta da!

I am getting settled in my quaint set up, feeling quite domestic as well. I have gotten the mosquito net set-up down to an art; I can do it in 5 minutes now, instead of 30.

I have hemmed some pants, cooked what I thought were English peas. They looked like peas, but didn’t taste or cook like peas- and took forever! But it was filling. I did my laundry today (by hand!)(in the tub!). They smelled fresh, probably because they still felt quite soapy. After hanging out to dry for most of the day, they smell like a mix                                                                between floral soap and smoke from                                                                area fires.

"clean" laundry

“clean” laundry

I have also set up a nice obstacle course in my place, for a “gym like” effect.   A chair for dips, mat for sit-ups and push-ups, etc., let’s see how long that lasts. Ha!

I have met some interesting people here at the “Titanic”, a man that works for UNICEF from West Africa. He kindly took the picture below of me, once with my phone and once with his camera. Several people just passing through, but individuals from all over, mostly doing relief effort type work.

Me, waiting, and waiting, for my transport.

Me, waiting, and waiting, for my transport.

Anyway, I have been busy preparing a lecture and activities for the “workshop” on Principles of Oncology Nursing and Palliative Care. I will do this twice, once in Lilongwe and once in Blantyre. KCN has invited the area hospital nurses, students and faculty. So preparing something for such a broad audience is a challenge. But I am SOOOO up for it! Cervical and breast cancer are such a burden here in Malawi…so I think for this time around I am going to briefly cover cancer basics and then talk about breast cancer and the need for early detection. Often women here cannot go for “screening”, like we can with getting mammograms. So the principle of early detection through self-awareness/self-breast exam, etc. and knowing what to look for are sooooo important. I will let you know how it goes.

I hope to travel some this weekend, so hopeful for some animal pictures soon. For now I leave you with this lovely picture right outside my room.walkerblogpic4_8-6

 

Getting started

By Dr. Deborah Walker

walkerblogpic1_8-4

Patio Workstation

I met with faculty at KCN this morning to discuss the next 3 weeks. Looks like I have a busy time ahead. I will be doing half day workshops in both Lilongwe and Blantyre presenting on oncology and some palliative care. I am so excited! This time I assured them I would provide breaks. ☺ We will be including nurses and other hospital staff for these workshops in both cities, so I am really looking forward to interacting and identifying other areas of need. I will also be working with faculty as they make plans for their new curriculum to start next term. They would like me to be present to make sure oncology is represented and integrated! I couldn’t be happier! Yippee!

This afternoon I did some grocery shopping and headed back to the residence. I am trying to get in the time zone. I came home to a bed made and mosquito net put up….so nice. If they only knew though, it took me 30-45 minutes last night to get the net just the way I liked it. Oh well, practice makes perfect! I will do it again.

Beautiful Africa

Beautiful Africa

It is winter here (yes, they have a winter of sorts) so highs are 70’s, nights are 50’s, it is a bit chilly at night and in the mornings (not quite as hot as the sun as I mentioned earlier, although it feels hot sometimes). It is so refreshing and nice to be able to do work outside as I prepare for the weeks ahead.

More in the days ahead…

And so the journey continues…

walkergraphic1

By Dr. Deborah Walker

I left August 1 from Birmingham, AL to head back to Malawi for another 3 weeks to work with faculty at Kamuzu College of Nursing. So excited to be going back! This time a friend and colleague (Lynda) joined me for part of the flight. We traveled together from Birmingham to Johhannesburg, South Africa, and spent the night.Screen Shot 2014-08-04 at 9.13.47 AM

 

We had time to go to the gym, answer emails, chit chat and I even did a little Facetime with my husband, Eric. (The world seems so small sometimes with technology). Lynda and I parted ways this morning. she will be in Blantyre and I will be in Lilongwe.

walkergraphic3Now, after two and a half days, I have finally arrived at my destination. I was greeted at the airport by my friend, Christina who is from Malawi, and works for 100x Development in Montgomery.She is working with teams (healthcare and education) from the US who stay at Mtendere Village where I usually stay AND where I want to bring a group of students next summer (to find out more about the study abroad, email me). This time I will be staying at a different place, closer to KCN in Lilongwe…I was a little nervous, but I think I am going to love it here.   I am staying at the Titantic, which is ironic since there is no water to be found for miles (it is dry season), and it is as hot as the sun. But it is lovely. Very peaceful. Tomorrow I start at KCN.