Summary Report of Summer International Education and Community Needs Assessment in Malawi Between August 24 and September 2, 2013
Haeok Lee, PhD, RN & Teri Aronowitz, PhD, FNP-BC, Nursing Department
Goal 1: Transdisciplinary, Transnational and Transcultural (TTT) Community Needs Assessment Focused on Prevention of HIV, HBV, HCV, and HPV in Malawi.
Goal 2: Educating nursing students and nursing faculty at DNC in the areas of Health Assessment and Community Based Participatory Research
Country for the Study Abroad: Lilongwe, Malawi
Malawi is located in Southern Africa; the British established and ruled Malawi in 1891 until its independence in 1964. The population is 13,603,181 and about 85% of the population live in the countryside, monthly house hold income is less than $30, typically from corn and tobacco framing. The country is presently experiencing increasing corruption, population growth, environmental issues, and the spread of HIV, HBV, and HCV.
Site for the Study Abroad: Daeyang Nursing College (DNC) and Daeyang Luke Hospital (DLH)
DNC and DLH are located outside of Lilongwe, the capital of Malawi by Miracle for Africa. The current CEO of the hospital, Young Shim Baek, is a medical missionary who has been working in African for the past 20 years. The hospital is currently under operation and serving an immediate catchment area of 70,000 people. In a region where illiteracy and poverty levels are very high, DLH serves under -privileged population and provides essential health services. DLH has 200 beds, however, the census could be as high as 400 depending on the season of the year. The hospital also offers mobile clinic to reach those left vulnerable without an access to adequate medical care. In a region where illiteracy and poverty levels are very high, DLH serves under -privileged population and provides essential health services. The hospital also offers mobile clinic to reach those left vulnerable without an access to adequate medical care.
DLH operates a research center for AIDs and Tuberculosis. HIV-positive patients receive antiretroviral therapy. The progress of each patient is carefully monitored and recorded for further analysis. Infants and children are given tuberculosis vaccination to reduce prevalence of the disease.
In October 2010, DNC had an opening ceremony of its Nursing College (DLC) with the Malawi president. Dr. Susie Kim, the principle of DNC, is Dr. Lee’s mentor and has worked with Dr. Lee focusing on heath disparities and global nursing education over the last 30 years.
Below are the Fact Sheets Concerning the HIV, HBV, HCV, and HPV Health Care Crisis in Malawi:
1. In Malawi the HIV prevalence is around 10 to 14.2 percent, rising to 28% in urban areas, whereas in Kenya the prevalence is 6.2 percent and in the U.S. it's 0.7 percent.
2. HIV/HBV and HIV/HCV co-infections are as high as 20.4 percent and 5 percent respectively and co-infected individuals have much higher mortality rates because of increased toxicity from HIV treatment and are more prone to opportunistic infections to be the leading causes of mortality.
3. AIDS is the leading cause of death in the 20-40 age group (NAC, 2002) including health care workers in Malawi.
4. The time and transmission routes are different between individuals in Western countries and in sub-Saharan African countries: The majority of HIV and HBV infections occur among adults in the U.S. whereas children are infected from mother to child (vertical) transmissions in Malawi.
5. Average life expectancy at birth in Malawi is 49 years, Kenya 63 years, while in South Korea and the U.S. it is 79 years.
Shortage of Health Workers Crisis including Nurses:
The HIV, HBV, and HCV epidemic in Malawi has placed additional strain on the health care systems as more than 50% of inpatients have an HIV or HIV related diagnosis which contributes to the health care professional resource crisis.
1. Health care delivery system consists of government facilities, Christian Health Association of Malawi (CHAM), and some private for profit providers.
2. Nurse-to-population ratio is approximately 3:10,000 compared to 53 for South Korea, 98 for U.S., and 319 for Norway.
3. Physician-to-population ratio is approximately 2 physicians per 100,000 people compared to 14.1 for Kenya, 180 for Korea, 279 for the U.S., and 606 for Italy.
4. An estimated 50% of nursing positions are unfilled (MOHP, 1999) and the reasons for the shortage of health workers are:
a. High rates of absenteeism due to illness and death: The impact of HIV/AIDs is serious and it is estimated to be the cause of 19-53 percent of all deaths of government health employees in African countries
b. Fear of HIV infection: nurses are leaving the profession (Aitken and Kemp, 2003).
c. International migration of health personnel to better paid countries, including the U.K. and U.S.