"When can we start messaging?"

Back row, Left to Right: Harold Malanga, Benedict Mgabe, Zakeyo Kaphanthengo, Joana Chimphanje, Pascalia Chiwinda, Moreen Phiri, Verona Kapagawani, Baxter Lupiya
Bottom row, Left to Right: Dickson Mtanga, Grace, Alex, Rosemary Bernado

I have to believe today's events were endowed with the elements of a promising beginning. The first phones are in the field! Before I get too ahead of myself, let me explain what's put me in such an optimistic mood.

We called the chairs and vice-chairs of the volunteer committees (Community AIDS Committee, Village AIDS Commitee, and the People Living With HIV and AIDS [PLWHA] support group) for a meeting at 9 am this morning. The came in together, some on bikes, most on foot. Considering that some traveled over 50 miles (that's most definitely an underestimate), this was quite the event.

I had been up since 6:00, testing phones and FrontlineSMS, and I was eagerly awaiting the group - equipped with Cokes, Fantas, lemon cookies and a broad smile.

We met in the old Nutrition Rehabilitation Unit, which had been stocked with assorted chairs. After everyone sat down, the hospital's matron greeted the group. After making sure each of the CHWs could understand slow English, she opened the meeting:

I know that times are difficult, but we must make improvements step by step. Do babies just start to run? No, they start just sitting. Then, when they see something beautiful, they wiggle their stomachs and arms, trying to reach for it. Soon, they can crawl; then they start walking. We can take steps forward, together. This is a pilot - we are learning new vocabulary today, too! You are the first to do this. It is not enough to try. We must do it.

After that poetic introduction, the matron told them they'd be receiving cell phones. This news was greeted, almost immediately, with cheers and applause.

The matron handed the ecstatic audience over to Alex and me, and we explained how to operate the phones (Alex is a male nurse, who works within the Home-Based Care program). I had every single ounce of the audience's attention, as I started, "First, just open your phone!"

*A disclaimer: That's Alex's handwriting.

We had an outstanding time teaching the CHWs how to use the phones. It started with group chants of, "Messages! Compose Message! New Short Message!" The majority of the CHWs hadn't texted before, so we spent some time teaching them - by the end of the session, each of the health workers flawlessly typed 'St. Gabriel's Hospital,' apostrophe and all.














After a few hours of rigorous concentration and seemingly inexhaustible patience, we took a break for snacks. During break, we discussed logistics.

The CHWs all claimed to have access to electricity. It seems that most will have to pay 10 kwacha (a few cents) to use the nearest electricity hub. When it's necessary, they (or someone from their village) will travel to the hospital to recharge the phone, free of fees. This isn't altogether rare, as the CHWs often accompany patients to the hospital.

After the matron and Alex explained baseline expectations for communication, the CHWs took over the meeting. Pascalia and Verona, the two Community AIDS Committee chairs, were especially emphatic. Pascalia stood, declaring, "The hospital does what it can to help the volunteers. We must do what we can to work hard. Remember, just because we are the ones who came to the hospital today does not mean the hospital loves us more than the others." Verona responded, looking straight at me and pumping her fists, "I will work much harder!"

The frequency and type of communication the CHWs will maintain with the hospital will depend on the program the CHW is enrolled in. For example, those involved in TB drug adherence monitoring will alert the hospital when a patient is deviating from a regimen. Similar expectations were agreed upon for the ARV monitors. Home-Based Care volunteers will be messaged when a patient needs to be traced or if a follow-up is needed. Those involved in organizing peer support groups will use the system to coordinate meeting times and locations. With any luck, and plenty of commitment, they'll be a working network of CHWs, with St. Gabriel's Hospital as a coordinating agent.

















Before leaving, the group sent a sample text to the hospital's number, and we showed each CHW their respective message as it popped up in FrontlineSMS. It was an animated scene, for sure. I recorded some of their information (name, number, village, and respective program), checked their starting units, and let them loose on the catchment area.

Needless to say, I'm looking forward to tomorrow, and the possibility of the first messages trickling in. With a smile on her face, Verona asked me, "So, when can we start messaging?" A few of the CHWs joined me in responding, "Now!" As they started home, I could see they were exchanging phone numbers.