Posted by: rhoban | March 15, 2009

Day 14 – Creating the Infrastructure

The lab

In order to do good care for patients with HIV, a practitioner needs access to certain information – CD4 counts, viral testing, blood work to find other problems (such as malaria, which I haven’t talked about at all… but is a huge problem, and the UNC Project is doing lots about malaria… but I only had 6 days there!!!).Microscope

Of course, you need the lab if you’re doing research so you can collect and store samples for examination now and in the future.

I got a tour of the lab with the lab’s managers, Debbie Kamwendo and Rob Krysiak.

Debbie’s interesting.  She came to Malawi as a Peace Corps volunteer, met a Malawian man, married and stayed.  She did return to the States to get a graduate degree, but she’s in Malawi for good.  They have children and she’s accepted as part of her husband’s large, extended family.  And… her husband is a regional politician, so she knows everyone.  She’s also a creative problem solver… as you’ll hear during this slide show tour of the lab, here.



You’ll have to forgive my including a slide show on the lab.  Lab teching isn’t a glam job. You’ll never see a TV show about medical lab techs, the way you will about doctors.  Those techs are always peripheral characters in House or CSIBut without thorough and precise work in the lab, Dr. House would get those diagnoses wrong, and the CSI people would never solve a case.

And the lab is also fascinating for the way the UNC Project has found to build this lab… and all the infrastructure in Lilongwe.  According to Irving Hoffman, who’s the international director of the project, they’ve asked for a little money here, a little money there in all of the research proposals that they’ve written.  He says the money for all this infrastructure development happened over years, with an eye to long term planning.  It’s a building task that’s required a lot of patience from him and from the director on the ground, Francis Martinson.  (4:00 audio) 


Francis Martinson, Irving Hoffman and Mina Hosseinipour boogie down at the UNC Project holiday party

Francis Martinson, Irving Hoffman and Mina Hosseinipour boogie down at the UNC Project holiday party

While I’m at it, I want to write a little bit about Irving.

Irving Hoffman is a physician assistant specializing in infectious disease who’s on the faculty of the school of public health at UNC.  He’s been working in Malawi on and off since 1992. Now, he serves as the international head of the project.

I’m going to give some attention to Irving precisely because he’s someone who doesn’t seek it out, and is so self-effacing.  He was my main liaison to the project.  He continually pointed me away from himself, and towards the Malawians doing good work, to the other UNC researchers doing the original work…  But in order for many of these people to do that good work, they need an infrastructure to function within.   In many ways, Irving is the quiet, steady guy with the wrench behind the workings of the project.

And he’s a true believer – he and his entire family.  They spent several years living in Malawi while his kids were in high school, and from the way he tells it, all of them are as invested in Malawi and the success of the UNC Project as he is.

One evening over dinner (and without a microphone), I asked him why he does what he does.   He said (and I paraphrase), “At first it appealed to my sense of adventure.  Then I began to see how much needed to be done and that we could make a difference here.  Eventually, these people became my friends, and I knew I was in it with them for the long run.”

Later, on tape, he changed his answer to something more politically correct (I hate it when people do that).  But Irving, I told you, nothing was off the record!  Here’s what he said (:53):

Infrastructure for a party

The Saturday night that I spent in Lilongwe, also happened also to be the night of the UNC Project’s annual party.  It was similar to an office party in the U S.  Free food and drink.  Speeches from company officers (Irving and Francis) that few people listened to.  Dancing. Celebrating their good work.  People enjoyed the opportunity to watch their bosses make fools of themselves on the dance floor.  And did I mention free food and drink?

lilongwe-131What I found extraordinary was the cheering people did for the project.  They could easily pass for fans at the Dean Dome.  The popping you hear is firecrackers (:38)…

The other extraordinary thing was how proud of what they’re doing everyone is.  And they do have something to be proud of.

Thoughts?  We’d like to hear them.  Contact us at



%d bloggers like this: