First Day in the Field!

After exactly a week of orientation, today was my first day in the field. Lectures on PMTCT, the organization we're working for, and monitoring and evaluation (M&E) were brought together as my partner Arthur and I accompanied staff members on two site visits in Lilongwe District.

Our first stop was the Area 25 Health Center, one of the many government health facilities located throughout Malawi. Although not large by Western standards, the outpatient facility provides many services through its under 5, maternity, postnatal (after pregnancy), antenatal (ANC, during pregnancy), antiretroviral treatment (ART), family planing, and outpatient departments/wards. Area 25 H.C. is a high volume facility facing the same challenges as many hospitals here: drug stock-outs and, relevant to our project, HIV test kit stock-outs. As space is a challenge, our organization houses its own activities in a UNICEF-donated tent on the grounds of the facility. 

Area 25 H.C. has six community health workers (CHWs) whose daily tasks are numerous. Each day, they provide a relevant health talk (often at the ANC) when other organizations are not giving one, conduct group pre-test counseling inside the tent, walk the mother over to the HIV testing and counseling (HTC) center, and provide 1-1 counseling based on HIV test results with the woman and, when possible, her partner. They facilitate support group sessions once a week, discussing a relevant issue suggested by the women and also serving a nutritious (and educational) hot meal. The CHWs also interact with return client mothers who are coming in for a check-up or receiving their medications. 

 M & E Coordinator outside the health clinic

Our second stop, Chitedze Health Center, was almost opposite to Area 25 H.C. A densely-populated space was replaced with a low-volume site, requiring only two CHWs for our program. Nested within the government's agricultural headquarters, Chitedze H.C. provided a small room for our program. The CHW's tasks are quite similar, although they expressed that there is very strong collaboration with the health facility's medical staff. 

On the way to Chitedza

At both sites, I had the chance to ask several questions to really get a feel from the women what their experiences working in the field are. As my Chichewa has not yet progressed, Delia - Regional Manager - translated that some of the challenges faced include: retention of women after HIV testing (due to long waiting times), disbelief of HIV status resulting in refusal to return to the facility and get proper medical attention, and getting monthly PMTCT data from the health facility as required for documentation purposes by our organization. 

What surprised me most in asking about the challenges was that none of the CHWs complained about the task of collecting data. These women are required to document their daily activities on several tools, including an education notebook, a general registry (Antenatal/Postnatal notebook), and a support group notebook. Moreover, they have to translate this information to a logbook, individual daily tally sheet, and a site-specific daily/monthly tally sheet. While the information is very useful from  an M&E perspective (thus, making my job a lot easier!), there are often problems and inconsistencies in implementation. Instead of describing these notebooks as tedious or arduous, Madaritso, site coordinator at Chitedze, actually suggested that they have been helpful in continually monitoring her site's success. It has even encouraged charting progress on a monthly graph. 

Charts documenting the program's progress at Chitedze Health Clinic

When asked why she became a CHW, Grace, a second-year mentor at Area 25 H.C., echoed the sentiments of the other employees, responding that she successfully completed a PMTCT program and wanted to help others. Singere, the site coordinator, emphatically described that by encouraging other HIV-positive mothers, she is able to encourage herself. My morning in the field (which included playing with a little girl named Jennifer) was the highlight of my time here thus far, and a reminder of why I chose this path. These women CHWs and the mothers they assist are not just women living with HIV, they are women "living positively."  

Area 49, which we passed along the way