The Chronic Care Conundrum

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March 18th 2013
Published: August 12th 2013
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Alas, after a very relaxing and much-needed break back in San Francisco, I have returned to Malawi to begin the second half of my post with Partners In Health. My time in SF was mostly spent finishing the last quarter of my Global Health program, which actually provided me with the perfect opportunity to dig deeper into some of the issues that I faced during my first four months here. For my "Communicable Diseases" class, for instance, I focused on the interaction between HIV and PCP (pneumocystis pneumonia) - a common co-infection in HIV+ children; and, in my "Social and Economic Determinants of Health" course, I analyzed the effectiveness of PIH's "POSER" program, which provides economic support to some of the hospital's most at-risk patients.

While I had some mixed feelings about returning to Malawi for the second half of my post, now that I am back I feel a renewed sense of purpose and motivation. Having left and come back, I can actually see some very tangible changes that have occurred in the Lisungwi hospital, the most obvious being the procurement of some much-needed equipment based on a GAP analysis that we performed back in December. For example, all
GHC Fellow Jeff...GHC Fellow Jeff...GHC Fellow Jeff...

...behind the scenes in the pharmacy warehouse.
of the wards now have functioning oxygen concentrators and nebulizers, as well as standing lamps and roof-lights (I still have no idea how patients were examined at night before these lights were installed...). We also procured a new autoclave/sterilizer, which means that the whole hospital no longer has to share the one autoclave that was located in the outpatient dressing room!

Looking forward, it appears that the next hurdle to take-on has to do with the treatment of our chronic care patients (eg patients with heart disease, diabetes, asthma, and mental illness). The biggest challenge surrounding chronic care in Neno ultimately stems from pharmaceutical stock-outs. Unlike the drugs that the hospital receives regularly for many of the region's most common infectious diseases (eg ARTs for HIV, ACTs for malaria, and LA for tuberculosis) - including a monthly consignment from UNICEF - chronic care drugs are often procured locally on an as-needed basis. In order to improve this system, a group of PIH residents from Boston recently instituted a weekly chronic care clinic, whereby chronic care patients come to the hospital one day a week (Wednesday). The justification behind this new procedure is that, by concentrating our chronic care patients to one day during the week, we can more effectively treat them by making sure that we are fully stocked with chronic care drugs on that particular day. Additionally, the clinic will also make it easier for us to track how many chronic care drugs are used per week, thereby improving our ability to predict our pharmaceutical needs and streamlining our monthly procurement process.

While all of this sounds ideal, there will, of course, be some unforeseen challenges in the days ahead. Nevertheless, as the first 'project' of the second half of my stay, I am excited to see how the chronic care clinic improves the functioning of the Lisungwi hospital as well as the health of hundreds of chronic care patients in Neno.

Additional photos below
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(ie family members of patients)

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