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A Decade at St. Gabriel's Hospital in Malawi

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May 16, 2017

Author: Josh Nesbit

In 2008, CEO and co-founder Josh Nesbit launched Medic Mobile's first mHealth project in cooperation with local partners at St Gabriel's Hospital in Malawi. This week he was back at the hospital to share Medic Mobile's latest software and to celebrate what is now perhaps the longest-standing mHealth partnership on the African continent. In the photo above, Community Health Volunteer Benalison Zonse supports home-based physical therapy along with family caregivers.

It has been been nearly eight years since my last visit to Malawi and St. Gabriel’s Hospital in Namitete – and ten years since my first visit. There are changes to report – the road to the hospital is now paved (good news for patients and the bike taxis), the hospital has expanded, there’s now a large Family-Centered Care Unit, one of the lead community volunteers accepted a job at the hospital, and many friends are now working in new positions (and have expanded families).

Remarkably, the text-messaging system connecting the hospital staff and the community health volunteers is still up and running. Perhaps I shouldn’t be surprised.

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Alex Ngalande, pictured above, is the home-based palliative care nurse coordinator at the hospital. He also trains, supports, and regularly visits a network of 145 volunteers in the vast catchment area. Alex goes above and beyond for the volunteers and patients. “Sometimes they joke and call me ‘Senior Volunteer’,” Alex told me. A few years ago, he said, “You have to be empathetic. That means you have to travel together with the family, be part of them, and let them be part of you.” 

Alex’s dedication to this work, eagerness to learn, and creativity in coming up with new uses for communication with the villages are key ingredients for the success of the system here. Alex and the volunteers have used different handsets and solar chargers over the years, and he still has the original phones. He now has updated tools at his disposal, including Medic Mobile’s new software and gateway, shown below.

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The initial idea was to open a communication channel between this referral hospital and villages in the area. We published this study on the impact of this system in 2010, and a case study was featured in this study on mobile health for cancer care in poor countries. After witnessing how this channel has been used for nearly a decade–by a mission hospital with minimal resources– I am convinced this simple use case is an overlooked, important use of mobile phones to improve community health systems. 

The hospital continues to use messaging to check in on patients who miss appointments, target home visits based on symptom reports and requests for assistance, and coordinate meetings. They share tailored, physical therapy plans by SMS when a new patient has been discharged from the hospital. The volunteers also use their phones (all varieties over the years, as you can see below) to coordinate their visit schedules with the hospital and one another, and sometimes travel in groups of two or three to help care for community members.

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Of course, the underlying fuel for this system is the compassion felt and acted upon by the people who are communicating. Volunteers break from welding or farming for a day or two per week to visit and care for their neighbors. One of the volunteers described this as “being supportive of our relatives.” When new services are available at the hospital, the volunteers make sure everyone knows. When a government health worker plans a village clinic, the volunteers make sure their community members don’t miss it. When someone is unsure about a first visit to the hospital, a volunteer accompanies them.

I am privileged to have witnessed St. Gabriel’s Hospital’s service to the community for the past ten years – one fifth of its 50-year history. Their ability to reach and care for people in the last mile of global health must inform broader community health strategies. Their progress inspires us to find and support more coordinators like Alex, and to equip more community health workers like Mary, Baxter, and Benalison.

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Alex Ngalande and Josh Nesbit in front of St. Gabriel's Hospital in May 2017

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