Posted by: rhoban | March 17, 2009

Day 16 – Why Malawi matters…

So what’s UNC doing in Malawi anyway? And what does it get in return?

Throughout my trip to the UNC Project, I kept asking the same question, why should Malawi matter to North Carolina?

When I posed the question to Irving Hoffman, he mentioned the humanitarian aspect of what UNC does in Malawi… clinicians employed by UNC all spend part of their time providing patient care, and that to be in Malawi is the ‘right thing to do.’

However, I know that people in North Carolina might be saying, “Why aren’t they doing this stuff at home?” And… “why aren’t these people spending time and money back in the US?”  I put these questions to both Irving Hoffman and to Francis Martinson. Here is the synopsis of what they said:

Girls pump water at a well in Dzama Village donated by UNC staff members

Girls pump water at a well in Dzama Village donated by UNC staff members

Essential research

All the practitioners at the UNC Project are quick to point out one basic fact – if you want to research malaria, you have to be where people have malaria, if you want to study HIV, you have to be where lot of people have HIV. I haven’t even touched on diseases such as leishmaniasis or schistosomiasis or sleeping sickness.

For the past four or five decades research into diseases that effect tropical countries, or poor countries has been slim at best. Once colonial powers left places like Asia and Africa, they stopped studying them. Why bother? Their people were no longer being affected.

Add to that the market model of pharmaceutical research: most drug executives believe (rightly) that there’s no lucrative market for drugs they might make to fight these diseases, so they didn’t do it. To whit, not one new medication for tuberculosis has been brought to market since the early 1960s. Only one drug for sleeping sickness has been created, but it’s only available because it’s also quite good at removing unwanted hair. Yet pharmaceutical manufacturers spend hundreds of millions of dollars to create drugs for… what, erectile dysfunction???

For years, we neglected these diseases – at our peril. Tropical countries are great places for microbes to evolve – for any number of reasons, from weather, to close contact with animals, to poverty. Now that we’ve ignored ‘poor people’s diseases’ such as tuberculosis, we find that they’ve evolved into ever more deadly forms, such as extensively-drug-resistant TB.

Lab worker Creto Kanyemba holds up a bacteria sample

UNC Lab worker Creto Kanyemba holds up a bacteria sample

UNC researchers are doing work on essential problems – malaria, HIV, tuberculosis, nutrition. Their results get used both here and in the rest of the world. That’s a win.


Working in Malawi provides a place for training health care professionals from both Malawi and the US. American researchers get opportunities to do basic research on problems that matter to millions of people. Researchers in Malawi learn to become better researchers, so they can partner with others to answer some of those pressing problems. And the opportunity to do research at home means they’re more likely to stay there.

On the clinical side, the world is getting increasingly small and diseases are getting better at getting around. It’s only 20-some hours to fly from Malawi to the US. And lots of travelers come back to the US after having acquired a disease in another country even before they feel sick. It’s a good thing that some of the practitioners at area hospitals can recognize something such as malaria, or schistosomiasis if they walk into a clinic with symptoms. In 2006 (the last year for complete data), 1500 people in the US were diagnosed with malaria. And just this past week, the CDC reported on a patient who acquired a form of simian malaria while traveling in the Philippines.

My co-worker Leoneda Inge can tell you something about that. A few years ago she was asked to mentor a young woman at the annual meeting of the National Association of Black Journalists. When she arrived, the girl complained of flu-like symptoms. Leoneda accompanied her to an emergency room where they sent her back to her hotel, telling her she had the flu. No one took a basic history to discover that the girl had recently returned from a summer working in Namibia.

Two days later, Leoneda took her back to the hospital. The girl was admitted and never went home. She died of multi-organ failure, resulting from of case of malaria that was recognized too late.


People in North Carolina who might wonder why their tax dollars go to Malawi, might surprised when they hear this next fact. UNC actually comes out ahead from running these projects.


Entrance to the STI clinic at Kamuzu Central Hospital

Entrance to the STI clinic at Kamuzu Central Hospital

It turns out almost all the money for research and patient care at the UNC Project comes from research grants, not from UNC, or North Carolina tax dollars. According to project director Francis Martinson, as money makes its way to Malawi from the Gates Foundation, or the Elizabeth Glaser Pediatric AIDS Foundation, or the National Institutes of Health, between 30-40 percent of it stays in Chapel Hill in the form of administrative overhead paid to the University (that’s standard for grants handled by the university). So, in effect, UNC makes money by running the project in Lilongwe.

And the whole operation in Lilongwe costs a whopping $8 million a year – to provide tens of thousands of patient encounters, train dozens of health care workers, prevent thousands of cases of HIV, treat tens of thousands of patients with malaria, TB, HIV and other diseases and employ more than 300 people.

So, between the money, the training opportunities and the research opportunities, UNC does pretty well from being in Lilongwe.


Finally, this wasn’t something Hoffman or Martinson said, but something I observed, during this trip and during all of my other tenures abroad. People in other countries really want to get to know Americans, and are actually rather surprised when they do.

While I was in Malawi, I took several hours out to visit with the family of one of Hoffman’s employees. He and I sat in the couple’s house, had lunch and chatted (Hoffman, the man and I, the wife spoke no English).

I had brought some balloons with me. I took out a bag, and blew several up. Then the man’s wife, their daughter, son and I batted the balloon around and giggled for about 45 minutes as Hoffman talked to the father. When we left, the kids wrapped themselves around me for hugs. I got a big hug from the wife too.

UNC Project health educator Chimwemwe Buwalo with children at Dzama village

UNC Project health educator Chimwemwe Buwalo with children at Dzama village

Tell me those kids won’t grow up with a good impression of Americans, even if they never meet another. Take my one afternoon and multiply that by all the encounters UNC researchers living in Lilongwe have with Malawians.

Way back at the beginning of this blog, I cited an article that posits the thesis that controlling neglected tropical diseases is key to US foreign policy. One can argue that it also serves us for countries not to be as grindingly poor as Malawi. People become less desperate, less sick. Their region becomes more stable. They become better trading partners. They don’t try to emigrate illegally. And they support us when we need it. It’s a win in every direction.

A VW bug made of beads at the market in Lilongwe

A VW bug made of beads at the market in Lilongwe

And a final thought…

One of the enduring impressions I’ve taken away from Malawi and Zambia is of all the clever people I met there.

In the markets, I met clever local people making wonderful art and utilitarian crafts out of virtually nothing. At the UNC Project researchers and local staff were ingenious at making due with limited resources, and at writing research grants that would also provide for tens of thousands of episodes of patient care. The leaders at the UNC Project, or at Malawi Children’s Village have been patient and careful in their planning, eventually scraping a few dollars here and a few there to build an enduring infrastructure for care.

A wheelchair assembled from spare parts and cheap porch furniture
In Zambia: A wheelchair assembled from spare parts

So much unrealized potential exists in places like Malawi and Zambia, but it gets mired down because of the overwhelming poverty. If only people there could turn their creativity to something more than the day-to-day scraping by to survive, how much better off the whole world might be.

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