Insights June 2013
Implementing an innovative training and guideline program to integrate HIV/AIDS care with primary care

Our Work in Malawi

Dr. Michael Schull and Dr. Josée Sarrazin

“My work here is research, most of it spent in meetings or behind a laptop, so it does not lend itself to exciting pictures. So I’ll briefly describe the work… I’m in Zomba volunteering as a senior research fellow with Dignitas International. The project I am working on is called PALM-PLUS, and we’re implementing an innovative training and guideline program to integrate HIV/AIDS care with primary care. The issue is that small health centers are staffed by only nurses, medical assistants and clinical officers, with around 50% of staff posts vacant. The success of our HIV/AIDS program working with the MoH means that we have about 12,000 AIDS patients on anti-retrovirals, but to continue to initiate new AIDS patients we must decentralize stable patients to smaller health centers for ongoing AIDS care. The downside is that this creates a new burden on the already over-burdened staff there, and frequently staff may not feel fully trained to care for HIV/AIDS patients. The idea behind our study is to develop and test an intervention, called PALM-PLUS, that targets health centre staff to help them to provide better HIV/AIDS care and better primary care, increase their job satisfaction and job retention, and provide better patient care. PALM-PLUS is a Malawi-specific modification of PALSA-PLUS, which was originally developed by the University of Cape Town, and which was rolled out there in a series of pragmatic RCTs. These demonstrated that PALSA-PLUS provided higher job satisfaction for nurses and better care for patients. We’ve worked closely with UCT to develop PALM-PLUS (the Malawi version of PALSA-PLUS adapted to Malawi’s national medical guidelines, common diseases and resources at health centres). What is particularly innovative is the training model. Our DI PALM-PLUS team includes Sandy Thompson (who’s been working on this for 18 months or more), and our newly hired research assistant Egnat Katengeza. The project is funded by CIDA and the research component by the IDRC.”

The Rainy Season
December 2009 – Dr. Michael Schull shares his experience of the rains in Malawi:

“If November was dominated by the disappearance of diesel (and now petrol too), December has been marked by the  arrival of the rains. After two months of growing heat and humidity, the rains arrived with great relief. I had imagined the rainy season to be wet, humid and dreary, but in fact it is wonderful. The heat and humidity at this time of year are unbearable at times, so much so that one begins to measure it not in terms of degrees Celsius but in terms of how many showers one took that day. Three a day is not unusual for me. The evenings are worse as the house seems to take much longer than outside to cool; many dinners I sit at the table simply dripping with sweat. … But each good rainfall brings about an immediate cooling off that can last from a few hours to a day or so, until the heat begins to build up again. But what is most wonderful about the rains is the transformation it brings about in everything. Fields and hillsides that were brown and dusty begin to show green sprouts within a day or so of the first rains, and now they are lush, and green and beautiful. After the second good rain people plant their maize, and everyone seems happier somehow, especially since so far the rains have been good and the maize is growing taller each day. The air is clear as the rains clean out the dust and smoke, and one can now see mountains in the distance that were invisible before, and the sunsets seem even more stunning.  On top of all that, it’s still sunny most of the time, the clouds form, the rains come crashing down, then it all clears again and it’s back to sunshine and blue skies.”

Taken from the Dignitas Blog:   which includes photos and more 


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