Hello all! I made it here to Lilongwe safe and sound on Friday afternoon - but our network went down shortly after, and we were without internet here in the guesthouse until this Monday afternoon.

I spent a night in Johannesburg with Poonam's brother and his family - Poonam, here are two pictures of your adorable nephews, Rithik and Sohan! They were so cute. The next shot is of the South African football (soccer) club, Bafana Bafana...I kept hearing about how they were headed off to a HUGE game in Nigeria, and then I saw them in the airport! I believe they lost the game.

Below that is a shot of Kamuzu International Airport in Lilongwe - definitely nothing fancy - just one terminal and one baggage claim and one customs desk - but it manages to serve the whole country!

I'm living in the UNC Project Guesthouse with my roommate Emily, also a rising MS2 at UNC, a nutrition PhD student named Megan, Dr. Mike Emch from the geography/epi department at UNC, his grad student Caryl and undergrad student Cameron, MPH students Kate and Miriam, 4th year med student Chris...and I think thats it! The guesthouse is well-protected, with hot water and electricity, 8 bedrooms, 2 common rooms and 2 kitchens. Our housekeeper/cook Joyce and house manager/cook Godfrey are here during the week and they take care of us! We also have a goat, Mr. Delicious, who was given to Chris by a patient...who intended for him to eat it, but that didn't happen...so now the UNC Project has a pet. Mr. Delicious is very dog-like...he runs up to greet whomever comes in the gate, its pretty funny. I'll try and attach a photo of him.

So, the last few days...I got my computer configured at the Tidziwe Centre on Friday - thats where all the clinical research projects are headquartered. Saturday the guesthouse group took a long walk up to town to the open market, grocery store, bank (to change USD into kwacha) and to buy cell phones. One dollar is about 140 kwacha - so I'm carrying thousands of them right now. Food (at least at the grocery store) is about on par with how much things cost in the states - bread is a bit cheaper, as are local fruits like banana, papaya, pineapple...and they practically GIVE AWAY the avocados here, which are about the size of footballs! Packaged foods though, like cereal, some cookies, stuff like that, are more expensive, because most of them come from South Africa.

On Sunday a few of us took a walk to the nearby wildlife reserve - which was a bit disappointing, as they were having some kind of fundraising event and were blasting music at the wildlife center. As much as the monkeys and exotic birds love Chris Brown...we didn't see anything.

Monday was my first day at work, I met with Dr. Hosseinipour (Mina) in her office at the Tidziwe Center to talk about my project. Mina is a UNC-trained ID doc, who moved to Malawi 7 years ago for her fellowship and is basically in charge of everything here. I'll explain my project briefly and then probably not say much more about it...

So, basically the UNC Project runs about 12 HIV clinical research projects, and has close to 40,000 study participants. Official WHO numbers put the HIV infection rate at around 15%, although researchers in-country say its probably closer to 30% - in either case, one of the highest infection rates in Africa.

At any given time, close to 10% of study participants are missing study appointments for one reason or another - the Lilongwe population is mobile and some areas are quite transient, many people don't have transportation, they may be too sick to come to the clinic, or they're caring for sick or dying family members. There is a large department of community health workers whose job it is to go out and check on the status of these study participants.

Unfortunately the database that the community department uses to keep track of these clients is very disorganized and not conducive to analysis - so the UNC Project can't gather any good information about why patients are being lost to study. My first assignment is to clean up this database (of about 4000 patients), and then to design a straightforward, check-box form that community health workers can use to keep accurate records on these patients, about why they're being traced, whether or not they found them, and what the outcome was.

The second part of my project will involve analyzing the data for trends in socioeconomic status and level of education, to see if there are particular populations of patients more likely to be lost to study. Dr. Emch and his geography team here are also working with spatial mapping/GIS software to map out Lilongwe, and would like to incorporate that information as well.

When I'm not working on this stuff, I hope to spend some time shadowing in the different departments at Kamuzu Central Hospital, and at the Lighthouse Clinic (the HIV outpatient clinic.) Going from UNC Hospitals to such a resource-poor setting as Lilongwe is such a stark contrast - in a country of 14 million people, there are 140 doctors and 7 dentists. There are 4 times as many Malawian physicians in London as there are in this whole country. Its incredible.

OK well I'll sign off for now and get to work - this database stuff is mighty boring but I'm just glad it'll be useful.

Tsalani bwino, (stay well)

meg


ps. I just realized that my three last pictures didn't upload...I'll post them below...they are of the Lilongwe airport, Lighthouse clinic, and the UNC guesthouse where I live!