Posted by: rhoban | March 16, 2009

Day 15 – Next generation

STI Clinic

Clement Mapanje

Clement Mapanje

On the Sunday I was in Lilongwe, I swung by to interview Clement Mapanje, one of the clinic’s senior staff.  He was there to do some work, and do some studying (he’s working on a masters in public health from the London School of Tropical Hygiene and Medicine).  The clinic was strangely quiet.

But Monday through Saturday, it fairly bustles with activity. There are always people sitting on the benches outside, waiting to be seen, and at least 60-70 patients get seen and treated daily.  Many patients come before sunrise to get in the queue to be seen.  Because if they arrive later than 8 am, they often have to return another day.

UNC researchers working at the STI Clinic have done seminal research into HIV.   In today’s story, Irving Hoffman mentions one – the study finding that having a sexually transmitted infection makes it easier to give and get HIV.  That study was a groundbreaker in the 1990s. Since then, people at the STI clinic have done studies on nutrition and HIV, on improving detection of HIV in patients, they’ve helped the Malawian government get a better handle on how many people in Lilongwe have HIV… the list of studies literally stretches for pages and pages.

Today’s story focuses on the STI clinic and research being done there.

Patients wait to be seen at the STI clinic in the morning

Patients wait to be seen at the STI clinic in the morning

Training the next generation of Malawi’s health leaders.

While in Malawi, I met a number of people who had trained at UNC or who had received further training because of UNC. You’ll meet some of them in this  story.

In the past, many countries have depended on expatriate medical professionals who come for several years and then go – with little continuity of management or projects. But what countries need is local expertise.  And the key to insuring a successful future for health care in Africa is training the next generation of health care leaders – doctors, nurses, public health experts – who will stay and build health systems.

One of the ways that UNC has worked to build that kind of capacity in Malawi is by training people, getting them involved in research and exposing them to their American peers.  Currently there are several Malawian students at the Gillings School of Global Public Health, and several more have graduated and returned to Malawi.  Others have been recommended by UNC for fellowships through the Fogarty International Center – part of the US National Institutes of Health.

Linda Kalilani in front of her office in Blantyre

Linda Kalilani in front of her office in Blantyre

One of those is Linda Kalilani who’s now an associate professor at the College of Medicine in the southern Malawian city of Blantyre after receiving her doctorate in epidemiology from UNC.  The school is in the process of building a school of public health – literally and figuratively.  Buildings are going up, personnel are being hired, students are being accepted for study. Right now, public health students are distance learners who spend several weeks a year on campus, and spend the rest of their time in their jobs around the country.  About 30 young people from Malawi are entering the program annually.  Every summer, professors from UNC travel to Blantyre to teach classes in epidemiology and grant writingStudents from UNC go too – it’s a way for them to get exposed to public health issues in the region, come up with proposals for future research, and develop relationship with their peers in Malawi.

The future School of Public Health in Blantyre

The future School of Public Health in Blantyre

Kalilani and others say that continued engagement from UNC gives them an incentive to stay at home in Malawi –, because they can continue doing research, stay intellectually engaged, and continue to build academic careers.  In turn, they’ll be in Malawi to train the next generation, and build the intellectual caliber of the entire health care workforce.

This billboard is a common sight.  It encourages people to treat nurses and midwives with respect... so they won't emigrate.

This billboard is a common sight. It encourages people to treat nurses and midwives with respect... so they won't emigrate.

Continued association with UNC also helps someone like Kalilani, or Dr Dan Namelika at Kamuzu Central Hospital, or Dr Sam Phiri at the Lighthouse materially.  Getting involved in research projects means that they get written into grant proposals – and that means they receive a stipend to supplement meager government salaries at home. It’s enough of a financial incentive so that skilled medical and public health personnel are less tempted to leave the country.

And after returning home to Malawi with a doctorate from UNC someone like Kalilani almost instantly becomes one the country’s public health leaders. That’s an incentive too.

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