It’s amazing how quickly one’s world can turn upside down. I went from feeling ecstatic about my job to resigning in a matter of weeks. I had a moment of clarity the other day and realize that the time has come for me to leave Malawi.

(Reuben’s brothers and sisters)

The window for finishing my PhD is rapidly shrinking and it’s imperative that I complete my doctorate before beginning my next adventure.

(M’bangombe Health Facility – site visit looking at EDS)

Interestingly enough, my projects are going exceedingly well – so I can depart this beautiful country feeling great about my accomplishments.

(Health Passports – bar code is part of EDS)

We’ve managed to secure over $2 million dollars (with an additional $1 million base funding per year) for the national roll-out of Electronic Data Systems for ART. And we’ve been working closely with consultants from I-TECH, WHO and the University of Oslo to design technical specifications of a central repository which will be housed within the Ministry of Health; to explore innovative ways to link research to practice; and to build capacity for informatics professionals in Malawi.

(Senga Bay)

We’ve successfully incorporated Health Management Information Systems (HMIS) as a top priority area into the Partnership Framework – a collaborative agreement between the US Government and the Government of Malawi which defines goals for the framework and sets the stage for a process to define the specific work of the partnership framework implementation plan. This level of accountability is paramount for the long-term success of HMIS in Malawi.

(Consultants from I-TECH, University of Oslo and College of Medicine)

We have been pursuing public-private partnerships with the telecommuncations industry to ensure widespread internet connectivity; and we are in the process of upgrading the current, District Health Information System (Access-based) to the latest Web-based version (OpenMRS). This upgrade will also serve as the basis for a national indicator repository – which includes a GIS component to map HIV services and to conduct geospatial analyses.

(Another trip to visit our wood carvers in Senga Bay)

Furthermore, we are in the process of setting up a national patient data warehouse in order to track patient transfers and to increase data reliability (off-site back-up). This entails the need to explore national patient identifiers.

(Sunset in South Luangwa)

In terms of M&E, when an ART patient defaults it is difficult to discern whether the patient has died, has transferred to another facility or has simply stopped taking treatment. Unique patient IDs will help answer some of these questions as patients move from one facility to another. And unique patient IDs will help facilitate continuity of care.

(Hippos)

For instance, we have separate registers for HIV Counseling and Testing, Prevention of Mother to Child Transmission (PMTCT), TB/HIV, ART, etc. Unique patient IDs would help strengthen the linkages across these program areas.

(Ground Hornbills)

In addition, HIV counseling and testing is currently anonymous – meaning that if a patient is HIV positive, once they leave the testing facility there is no way to follow-up these individuals to ensure that they receive adequate care. As such, we are in the process of changing policy from anonymous to confidential testing. HMIS will play an integral role in achieving continuity of care as we follow patients from the time when they first test HIV positive to when they qualify for starting antiretroviral therapy.

(Pride of lion on night drive)

Chancellor College in Zomba recently started a Masters program in Informatics – and I’m proud to say that nineteen students have enrolled in its first year (which just started in June). We are working diligently to identify hands-on projects for these students where they can gain the skills and knowledge needed to become leaders in this field.

Finally, what I am most proud of is the development of the National Data Standards Technical Working Group, a direct outcome of the standards workshop that I conducted last fall. What started out as an amorphous concept (most Malawians had no idea what I was talking about when I discussed the importance of national standards) has now blossomed into a sizable Task Force, complete with three sub-groups (Data, Security and Architecture) and a formal governance structure (we report directly to the M&E Technical Working Group – who reports to the SWAp – the sector-wide approach – otherwise known as Global Fund or the pooled donors).

Our last standards meeting had unprecedented crowds (standing room only at the Ministry of Health’s conference room), proof that Health Information Systems is emerging as a top priority in Malawi. Hopefully there is enough interest, momentum and expertise in this area that my Malawian counterparts will keep the ball rolling. I worry that some of this work may come to a halt with my departure, but believe too many people are involved with this process for it to ever completely fade.

(Mumbo Island)

I feel great knowing that I have been the driving force that has ensured that HMIS stays on the political agenda, and that HMIS has become a major part of the partnership framework. Now that it’s an official part of this binding collaboration, there will be more pressure to ensure that these projects succeed.

(Cape Buffalo)

I have mixed feelings about leaving this country. I love Malawi, the work that I have been doing, and the friends that I have made along the way. I’m beyond heartbroken about leaving my dogs – they mean everything to me. And I worry about the financial security of my staff.

(Hippo)

When I told Elizabeth (my housekeeper) that I was leaving (in essence, that she would be homeless in one month’s time), the look on her face was haunting.

(Lioness on the prowl)

She found the strength to leave her husband (who was not only HIV+ but also taking on additional wives) and the will to take her children out of that environment and into the city. She moved to Lilongwe from the country, sleeping wherever she could until taking refuge into my home. She’s been with me for over two years – and I consider her a dear friend. I will do everything I can to find her a new job.

(Elephants)

Now that I know I’m leaving, I’m trying to see as much of this country as possible. I ended up going back to South Luangwa (my fourth trip to this game park) for the fourth of July – and I must say, had the best safari experience of my life!

(Warthog)

On our night drive, we came across a leopard in the daylight and a pride of ten lions out on the prowl only to be thwarted by a herd of angry elephants who chased them away. Exciting stuff.

(Reuben’s Family)

And I made it back to Cape Maclear to visit Reuben’s family (and to give them more money for his schooling). I’m hoping to make a trip to Zomba to see Reuben one last time before I leave.

(Havent and Reuben’s Father holding up their big wad of Kwacha)

Finally, I should be back in Austin, TX by mid-August. I don’t have a place to live and desperately need an address to ship my belongings! If you know of anyone who needs a roommate or that has a rental property for a short-term lease, please keep me posted.

(Safari Beach Lodge)

Sending much love,
Amy