June 4, 2007

Well it’s hard to believe that I’ve only been here three weeks to the day. I’ve gained vast knowledge in a relatively short period of time.

My job continues to amaze me – challenging yet rewarding. My predecessor has set the bar extremely high and is very well respected both personally and professionally. As such, I am truly grateful to have had this time with her in country (she leaves Friday for Kigali, then off to Mozambique). She’s played an integral role in transforming the HIV program here in Malawi. Unfortunately, the CDC is going through some major transitions (we’re getting ready to lose three out of five staff) and until they can hire replacements, I am basically all they have. Not to mention, the remaining staff will be out on leave throughout the months of June and July (poor planning if you ask me!)…Thus, these next few months will be interesting to say the least. Fortunately, they’re flying in short-term support from Atlanta – but the institutional memory will be gone.

Many of you have asked specifically about my job, so I’ll try as best I can to describe all the responsibilities/projects that I have acquired. First and foremost, I am tasked with writing PEPFAR’s Country Operating Plan (COP). As some of you may know, President Bush just signed phase II of PEPFAR (the President’s Emergency Plan for AIDS Relief) and has pledged $30 billion dollars over the next five years to AIDS relief in Africa. Malawi is trying to position itself to receive a substantial increase in funding – so there is a lot riding on this COP report. The reporting process itself is tedious and covers all USG (United States Government) Programs, meaning I am coordinating partners from USAID, CDC, Peace Corps and the Department of Defense. For those of you who thought PMATS was complicated (the program management and tracking system I helped develop for the Texas Department of State Health Services), the COP Guidance manual alone is several hundred pages long – and that’s just to explain HOW to enter into the reporting system. Needless to say, I am getting to know all the partners (including Save the Children, PACT, JHPIEGO, BRIDGE, NAC, etc.) and familiarizing myself with their work in HIV. Over the next few weeks I will be meeting with each partner to discuss target setting and activity narratives.

During my first week on the job, we had an all-day retreat (at the very same lodge MADONNA stayed at when she came to adopt her son) in order to strategize how we wanted to prepare for this year’s COP. I am the Strategic Information (SI) lead and will play an essential role in monitoring the HIV/AIDS program – which has been divided into five main priority areas (Strategic Information – including Surveillance and all M & E Activities; PMTCT & Pediatric AIDS – including infant diagnosis, community and facility PMTCT; Integrated care and treatment – including ART, HIV counseling and testing, TB/HIV & Palliative care; Prevention – including A/B/C & Blood Safety; and Systems Strengthening – Lab facilities and supply chain management). As the SI lead, I will be actively involved in all aspects of monitoring and evaluation activities across all program areas.

I’ve been working with the Ministry of Health, Lighthouse, UNICEF, and various other partners to revise/update their national registries (including ART, PMTCT (Prevention of Maternal to Child Transmission), Antenatal Care, & HIV Counseling and Testing). This will have an enormous impact on M & E activities at the national level! We’re also in the process of revising Malawi’s health passports. Unlike health records in the states that are often kept in a doctor’s office, all Malawians carry a health passport. This way they can go from clinic to clinic and physicians can have an idea of their health history. Anyway, much dialogue was centered around possible repercussions of including a stamp in a passport that may reveal one’s HIV status. One needs to be extremely sensitive around issues that my stigmatize individuals. As a result, R (reactive) and NR (non-reactive) are used to indicate one’s HIV status.

Another project that I am excited about is EDS, or electronic data systems, for ART. I am providing technical leadership as well as coordinating the pilot and roll-out of a national EDS system. As hundreds of thousands of people begin antiretroviral therapy, it is imperative to not only have a reporting system in place that can monitor dispensing of drugs, but also measure adherence to various regimens. As ART scale-up continues, it is important to collect critical indicators as early warning signs of drug resistance.

In addition to these two major projects, I am working within the Ministry of Health and NAC (National AIDS Commission) to improve routine data collection systems for HIV/AIDS services – including M & E tools, supervision and training. I am also providing input on M & E issues of national relevance (e.g., situational analysis planning, retention in care, operational research).

Finally, much of my job pertains to system strengthening and capacity building.

I will gladly provide more details as I learn more about the specifics. Regardless, I marvel each and every day about this fabulous opportunity to truly make a difference.

On another note, my world is about to change! I will be receiving Internet at my home next week. And I am in the process of purchasing a vehicle. Transportation and the ability to get online at night will make all the difference. I’ve been incredibly lonely since I arrived….my days are busy but my nights are quite empty. Andy won’t arrive for three more months – which is too long! We’re hoping he can come earlier but I’m not going to get my hopes up. I’m also waiting on my container….which will also take three months. So until then, I will continue to live in my big empty house.

I had a chance to go hiking over the weekend. I spent the afternoon with friends in Dedza, climbing Mphunzi. The hike itself was beautiful but a little more intense than I had anticipated. I could do without the steep inclines (even more frightening on the way down). However, I absolutely love going through the small villages along the base of the mountains. The people are so friendly…always a joy!

Ok, I’ve written enough for now. Please continue to write. I’d love to hear from you!

Amy