Need-Stressing Couched in Gratefulness*

I promise I'll explain the title - in a bit. First, here's a re-cap of some of the week's developments:

Above, I've provided a snapshot of today's activities in the Home-Based Care (HBC) office, the new home of FrontlineSMS and the CHW maps. From left to right - Neggie, a nurse in labor ward; Grace, the hospital's ART coordinator; Alex, the HBC nurse. Neggie showed up at the office with a list of mothers - they were enrolled in the hospital's PMTCT program, but they've failed to report for their 6-week follow up (when blood samples are taken in order to determine the child's HIV status by DNA PCR). Alex is locating the mothers' villages, and reading off the ID numbers of CHWs in their vicinity.

These days, the majority of the patient visits made by the mobile team are responses to SMS requests for immediate medical attention. Still, certain visits are scheduled follow-ups after patients have been discharged. Traveling with Alex, I realized that, at least half the time, the patient is nowhere to be found. Alex now sends a few quick messages to the CHWs overseeing the patients he's planning on visiting, letting them know he'll be stopping by. While he's out in the field, any response from the CHWs is forwarded to his cell phone. This assures that he sees patients who are available - and avoids 40-mile journeys to discover a patient is away, selling maize in Mozambique.

A CD4 outreach initiative funded by the World Bank starts up later this week. They will use the CHW communications network to inform villagers of testing sites and dates - aiming to increase client turnout, thereby bolstering access to the free testing services.

This past Saturday, we gathered the first 30 CHWs for a refresher course - explaining the automatic unit top-ups and the drug keywords (we've already had BB Paint, TEO, Panadol, and Multivitamin info requests). After the session, I video-interviewed four of the CHWs, in English.

I'm leaving Malawi this coming Friday, and when I'm back at Stanford I will be uploading the videos. I'm planning to embed them in individual posts - so you can hear the stories of care from those who have lived them. Their general attitude might be described as thankful, yet realistic about the pressing needs of their families and friends - hence, the title of this post. Malawians are said to spend roughly 10 percent of their waking hours at funerals. The statistic does reflect troubling times - but it also demonstrates the blurred boundaries between family and fellowship. Villages are full of brothers, sisters, and mothers - some share heredity, but all share circumstances. Every text message sent by the CHWs has invited me to appreciate the true meaning and function of community.



*title credit: Maggie Chen