PHOTOS: Maternal Health and HIV Prevention in Malawi


Outpatient clinic

Outpatient clinic
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Patients wait for care in the outpatient clinic in Nsiyaludzu

Josie Hollingsworth is a journalism student at UNC. She, along with 22 other students,  traveled to southern Malawi to tell video/written stories of individuals on maternal health. Read about her experience here.

Read more about CARE’s maternal health program
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Lowering maternal mortality is key to overall health in Malawi















By Josie Hollingsworth, Institute of Global Health and Infectious Disease Web Specialist

The most astonishing thing that I noticed while visiting the villages in Ntcheu district, Malawi has been the sheer number of children that live in a single, small community. It is difficult to put into a U.S. perspective, but I found it strange to drive toward a school, passing just a few homes, and seeing over 70 children playing soccer in the field. The average woman in Malawi has five children, a quintupling of the population that has led to problems in providing health care. As a journalism student at UNC, I, along with 22 other students, had been sent to tell video/written/photo stories of individuals who are affected by this scorecard system and the maternal health.

At the end of 2015, the United Nations Millennium Development Goals for Malawi will be assessed. The country is on track to reduce child mortality: the probability of dying between birth and five years. Various programs have reduced the rate from 234 child deaths per 1000 live births in 2009 to only 71 deaths in 2014, on mark to reach 61 in 2015. However, Malawi is off-mark to meet its goal of reducing maternal mortality. In 2004, an average of 984 women died per 100,000 live births. In 2013, the maternal mortality rate in Malawi was 510, far off-mark of the UN Millennium goal of 155 per 100,000 live births. The main causes of maternal death are complications with severe bleeding, abortion complications, pregnancy-induced high blood pressure, infection, obstructed labor and blood clots. Preexisting conditions also accounted for a quarter of all maternal deaths. These deaths indicate conditions of poverty and malnutrition, two important aspects to a healthy pregnancy.

CARE’s maternal heath program that had sponsored my trip asks Malawian communities and families to evaluate the way childbearing and rearing should function. This is a weighty topic, yet I found many communities are beginning to embrace the discussion. CARE’s interface meetings are open to the whole village and surrounding villages and they are well-attended. The one I sat in on in Nsiyaludzu had 800 people in attendance. The meetings are led by a local leader and a CARE worker. The discussion is based around 12 “indicators” that determine the quality of maternal health care at that local clinic. The community ranks transportation to the clinic, quality of care, availability of services, community support of nurse midwives, etc.


A UNC-Project Malawi sign in Nsiyaludzu, Ntcheu District encourages mothers to use antiretroviral drugs to prevent transmission of HIV to their babies


While I was primarily in Malawi in order to research and document maternal health, I found that the legacy of an HIV/AIDS epidemic in Ntcheu remains present throughout all tiers of the health care system. During an interview, a rural nurse said that only about 1% of her patients are unfamiliar with preventing AIDS. I never worked directly with HIV patients or physicians while I was in Malawi. However, HIV prevention and treatment is an ever-present topic in the hospitals, health clinics and maternity wards that I visited as a part of the project. In the photo below, UNC-Project Malawi’s work on transmission prevention through ARVs is being publicized on a poster in the Nsiyaludzu maternity clinic. Family planning in Malawi now means for HIV testing  and prevention, and before birth checkups are becoming more common in Malawi due to various maternal health programs. Visiting Malawi for this maternal health project made me understand the importance of UNC-Project Malawi’s community outreach programs. While research and clinical care of HIV positive patients is vital, so is society-wide improvement of all Malawians’ health and quality of life.

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Becoming Less Super as a Specialist

By David Wohl, MD

David Wohl, MD, traveled to Sierra Leone to care for people infected with Ebola.

David Wohl, MD, traveled to Sierra Leone to care for people infected with Ebola.

There are specialists and then there are the super-specialists. The ‘super’ here should be taken less as a superlative and more as a suggestion of beady-eyed focus and a lack of breadth. Instead of knowing a lot about something special, super-specialists know a lot about a part of that special something. Picture the entomologist whose career has been dedicated to the gut of one particular species of ant, or the historian fascinated by the life of one U.S. vice president. What do you see? Probably someone who is not all that fun to have at a dinner party.

I am a super-specialist. It’s okay, I own it. In fact, I have been proud of it (and I am pretty good at dinner parties). Microbiology and infectious diseases may have been my favorites in medical school, but it was HIV that pulled be over the buggy side. Sure, I dutifully completed an infectious diseases fellowship and every decade I sit for that discipline’s certification board examination. But the truth is I am really an HIV-ologist in infectious disease specialist’s clothing. All but a handful of my patients are HIV infected. The journal articles I actually do read are almost always HIV-related. I attend only conferences dedicated to HIV/AIDS.  Don’t get me wrong, hanging around an ID division, I do pick up some factual knowledge of lesser pathogens such influenza, cholera, and Malassezia furfur. But, what I know of these and other non-HIV germs is not half of what I know about HIV. HIV is what I do.

Well, now it is not the only thing I do. A few months ago, something new started to pull me from the HIV doc ranks. Ebola.

HIV doctor takes on Ebola: it is a story we have heard before and it should not be a surprise. Much has been written about the parallels between HIV and Ebola: uncontrolled spread, fear, stigma, risk. The current massive and unprecedented outbreak has claimed over 8,000 people this year, many of them young. As in the early days of the HIV epidemic panic has replaced reason, lack of coordination has delayed response and all the while people die. It is déjà vu all over again and last August, when the director of Doctors Without Borders called for clinicians to step up to combat a burgeoning Ebola outbreak in West Africa, I applied. All infectious diseases and HIV providers, I felt, needed to at least ask themselves if they could and should respond to the outbreak of Ebola.

Without level 4 pathogen or outbreak response experience, I was not what Doctors Without Borders wanted. But, it turns out this was for the best, as I realized that a better way to tackle Ebola was to apply my clinical research skills – experience honed by my focus on HIV.

Tales of what I have been doing and have seen in West Africa can be saved for another time. As I type while flying back from Sierra Leone, I am wondering how it was that I became so dedicated for so long to one pathogen, albeit the cause of a pandemic that has killed millions and has significantly altered many aspects of modern medicine. Moreover, I reflect on how it came to be that I was pulled from this comfortable orbit by this even more sinister infection. Perhaps it is the particular monstrosity of Ebola that created my urge to respond – just as the swiftly spreading and devastating AIDS crisis of the 1980’s attracted me so strongly then.

Nagging at me, though, is an inkling that there is more to my motivation to respond than the overlap between HIV and Ebola. Can it be that now that HIV medicine has become largely a routine of well visits among people living with undetectable levels of the virus in their blood, when we track LDL cholesterol more closely than CD4 cell counts, that I and other HIV providers are seeking the excitement and novelty we once had? Are we increasingly becoming susceptible to the lure of the next big thing, be that HCV or, for some of us, Ebola?  Our victory against HIV has been accompanied by the loss of intensity that drove many of us to the fight against AIDS. And, so, no wonder that our gaze falls elsewhere.

I have to believe that I am driven toward Ebola by more than some sort of professional mid-life crisis; that my deciding to be involved reflects a commitment to help make things better for those infected and affected by this horror. Yet, I am also aware that why we do what we do is complicated.

I am not giving up my day job and will continue to be an HIV doctor until there is no HIV. Yet, I have to break the news to HIV that I have started seeing another virus. It is scary and wild and thrilling and it is also something I feel I have to do– just like back then, when young men started getting sick and I, along with many others, felt we had to come calling.

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A Mountain of Thanks: Celebrating the African Long Climb Team


The 15-member African Long Climb team poses at the beginning of their journey up Africa’s tallest mountain. The group spent twelve grueling days climbing Mount Kilimanjaro, and raised over $64,000 for IGHID.

Congratulations to the African Long Climb (AFLC) team for a successful climb up Mount Kilimanjaro! The 15-member climb team braved ten grueling days of heavy packs and steep inclines to raise more than $64,000 for IGHID.

The project was the culmination of two years of extensive planning, fundraising and physical training by the climb team — and it couldn’t have been a bigger success.

On June 28, the climbers boarded planes from across the United Kingdom and United States and began their journey to summit Africa’s tallest mountain.

Gene Flood, an advisor to IGHID and a member of the climb team, said the experience was extremely difficult, but rewarding.

“What surprised me the most was how challenging the total experience was,” he said. “Generally speaking, any single day on the trip was not exorbitantly taxing. However, the combined eleven days was a serious piece of work.”

The climb team began each day in the early hours of the morning, with wake up times ranging from two to six in the morning. On top of the early mornings and strenuous climbs, the team coped with ailments like nausea, dizziness and low-grade headaches caused by serious altitude changes.

However, Andy Ballou, an AFLC climber from Chappaqua, New York, said the team’s attitude and camaraderie made the physical challenges less daunting.

“I learned that a group of varied personalities can come together quickly behind a common goal — helping everyone reach their physical and mental limits,” Ballou said.

To keep their spirits up during the climb, the group strapped a small boom box to a backpack, and took short dance breaks along the way. This led the guides who directed the climb to comment on the group’s sense of togetherness.

“Unlike most other hikers who walked silently each with his or her own iPod and earphones, our group had conversations dispersed across the group all day as we walked and listened to the DJ of the hour. Our guides commented that they had never seen a group talk with each other so much,” read a blog post from the AFLC Facebook page.

And the conversation was needed, because the climb became increasingly difficult as the team approached the 19,342 foot summit.

“By the third day on the trail – dust had covered every aspect of our beings. Our muscles were beginning to feel the stress of the long days on our feet. And then there was the issue that all of us knew about, but had no real way of anticipating its effect — the altitude,” read another blog post from July 6.

Finally, after six long days of hiking, the AFLC team reached the top of Mount Kilimanjaro on July 8, and celebrated with tears, laughter and long awaited photos at the summit.

Flood, who climbed with his son, Earl, said the experience was awe-inspiring, and that he’s already looking on to the next adventure with the AFLC group.

“It was definitely worthwhile,” he said. “We had an amazing outdoor experience together, and we enjoyed each other’s company tremendously. Group members are already talking about what else we might do together.”

Flood said he is incredibly proud of the work the ALFC team has done and of the attention it has brought to IGHID.

“I am thrilled that we brought a good number of first-time donors to the Institute and started broadening the awareness of the Institute’s activities,” he said.

The funds the AFLC team has raised will go to support the Institute’s projects across the globe, such as the IGHID Cervical Cancer Prevention Program in Zambia that has screened more than 140,000 women for cervical cancer.

“I view this as a very positive first step to getting the story out about the important work that the Institute has undertaken,” Flood added. “Having just returned from this Kilimanjaro trip, I know a number of us will continue making calls and raising donations for the Institute.”

The team’s fundraising page will be online and accepting donations for the next several months, as they continue to raise money for IGHID.

And on behalf of everyone at IGHID, we would like to thank the AFLC team for all of their hard work over the last several months and their continued fundraising efforts on behalf of global health that impacts thousands across the world. You have all been incredible, and we are extremely grateful.

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Climber Profile: Gene Flood

The following post was written by Eugene Flood, an advisor to IGHID and a member of the 15-person African Long Climb team. On July 10, the AFLC team finished their eight-day climb up Mount Kilimanjaro to raise money for IGHID. 

Eugene Flood (right) poses with his son, Earl, as the pair prepares to embark on the eight-day journey up Mount Kilimanjaro.

I had heard of the Institute for Global Health and Infectious Disease (IGHID) for years through my friends Drs. Ada Adimora and Paul Godley, but I only became intimately aware of it when I was at a birthday party at their house about three years ago.  I was cornered by the energetic and inspiring Institute’s Director, Dr. Mike Cohen.  For those of you who have never met Mike – you need to.   He leads a team of doctors, scientists and caregivers who have tackled some of the world’s thorniest and important medical scourges of our time – HIV AIDS, cancer, burns and clean water.  He speaks at an almost unintelligible rate, and always communicates with total conviction, passion, and engaging humor.  My first lecture under Professor Cohen must have lasted about 30 minutes while partygoers circled around us with food and merriment.  I was totally engaged with my lesson —  I only wish I had had a notebook.  I learned so much. And the learning never stops when you’re around this team.

The issues that the Institute has attacked, such as HIV AIDS, obviously have global importance.  Yet some have taken an especially large toll on the earth’s poorest people.  I have been blessed to have had an exciting career in the global financial markets.  But until now I had never experienced the thrill of hearing the unspeakable gratefulness from a family who still has an HIV-positive loved one alive after ten years because of the care given by the Institute’s doctors.  Nor had I felt the joy of hearing a young boy from a village in Africa tell how he can focus and learn all day in school now because he has clean water and there is nothing moving in his stomach.  Nor had is witnessed the awe of seeing doctors and nurses literally snatch the life of a burn victim out of the jaws of death and lead them back into a functioning existence.

I am so proud to be part of the IGHID team.  As Chairman of the Advisory Board, I tell people everywhere I go about the marvelous work that the team is undertaking.  And I am recruiting new and old friends to come be a part of this journey with me.  The Kilimanjaro climb is the first of many adventures of all sorts that I expect to have as we spread the Institute’s story and gather supporters and funds to continue this glorious work of touching lives and improving the world.

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A look into the climb: Photos from the African Long Climb

On July 12, the African Long Climb team finished their eight-day hike up Mount Kilimanjaro to raise money for IGHID. The 15-member climb team endured treacherous trails and heavy packs as they climbed Africa’s tallest mountain.  The photos below give a glimps into the team’s journey up the mountain.

The team summited the mountain on July 8, after six grueling days of climbing. So far the AFLC team has raised over $60,000 for IGHID. To visit the AFLC fundraising page click here.

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Photo of the Day: Greetings from Kilimanjaro!

Today, the African Long Climb team is scheduled to summit Mount Kilimanjaro! The 15-person team has been climbing for six days to raise money for IGHID projects across the globe. The team is made up of individuals from across the United States and United Kingdom, and so far they have raised over $60,000 for the Institute.

Click to check out their Facebook and fundraising pages.

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The Climb Begins: IGHID’s Kilimanjaro climbers embark

African Long Climb team members Riley Henderson (left), Jared Winoker, Eugene Flood, Jackson Krase, Natalie Rosen and Katie Beiter take a break from climb preparations for a group photo.

Climber Natalie Rosen practices packing her gear up with a climb instructor before the strenuous, eight-day hike. Her father, Brian Rosen discusses climb logistics in the background.

This morning, the fifteen-member African Long Climb (AFLC) team began its ascent up Mount Kilimanjaro as part of a large-scale fundraiser for IGHID. The team arrived in Tanzania on June, 29 and are scheduled to summit the mountain on July 8.

The team will be in contact with IGHID throughout the climb, and the institute will continue to post images and updates throughout the eight-day adventure. To visit the AFLC fundraising page click here.

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Climbing Kilimanjaro: IGHID’s 19,341-foot fundraiser

In just three days, the UNC Institute for Global Health and Infectious Diseases (IGHID) will begin a new kind of project in Africa. On June 29, 15 individuals with no official ties to UNC will board a plane and embark on a 12-day journey to climb Mount Kilimanjaro. And they’re doing it to support IGHID.

The climb team, which consists of six parent child pairs and three of their friends and colleagues from across the United States and United Kingdom, has set a  $250,000 fundraising goal for the project, with the bulk of their funds going to IGHID.

Andy Ballou, a member of the climb team who lives in Chappaqua, New York, explained that the Institute was chosen because of its 20-year commitment to global health.

“We conceived of the climb in the spring of 2012, but the team in its current form didn’t come together until the fall of 2013,” Ballou said. “At that point, the team’s recognized organizer, Scott Krase, suggested that we add a charitable element to the climb.”

Climbers Mikey Ballou, 17,  (left) and Jared Winoker, 18, (right) wear weighted packs and prepare for the eight-day excursion with a four mile training hike.

Climbers Jared Winoker (left), 18, and Mikey Ballou, 17, wear weighted packs and prepare for the eight-day excursion with a four-mile training hike.

“As a team, we considered several charitable organizations, voted and arrived at IGHID primarily based on its 20 year history and commitment to women’s health, clean water, HIV treatment and burn care in Africa.”

Eugene Flood, the only climber with a connection to UNC and an advisor to the Institute, said IGHID’s long history of public service made it an easy choice.

“We all went to different schools, and want to support our schools, but what has captured our attention is the Institute’s commitment to public service,” Flood said. “We’re joining them to be a public service for the world.”

The money raised by the climb will help benefit IGHID projects like the burn unit in Lilongwe, Malawi that treats over 900 burn victims every year, and the IGHID Cervical Cancer Prevention Program in Zambia that has screened more than 140,000 women for cervical cancer.

“I hope this trip encourages the UNC and IGHID community and faculty and alums to see these non UNC and non IGHID people picking up an oar and rowing with the Institute’s mission,” Flood said.

Throughout the climb, the team will be in contact with the IGHID, and the institute will post photos from the mountain, climber profiles and other continued details about the project. The team has established a Facebook page and fundraising site to receive donations, and to keep people updated during the 12-day excursion.

Ballou said the idea for the climb originated during a conversation with Scott Krase, who will be climbing with his son Jackson.

“Scott called me from London, where he and his family were living, and said, ‘I have some friends who’ve climbed Kili recently. Sounds amazing. What do you think?’”

“I basically told him that I was in. And from the way I remember it, there was a palpable silence on the other end, and Scott said, ‘Ugh, I was afraid you would say that.’”

Over the last several months, the team has undergone extensive physical training to prepare for the eight-day climb.

“In addition to hiking and cross training, many of us are training with Hypoxico altitude training systems,” Ballou said. “Basically, some of us are wearing altitude masks while training on stationary bikes and treadmills, or just sitting quietly. Others are sleeping in hypoxico tents.”

“Both devices create reduced oxygen environments, typical of high altitudes.”

Ballou said his son Mikey Ballou, as well as Jackson Krase and Jared Winoker, who are all rising seniors in high school, have been training as well, and can’t wait for the climb.

Flood, whose son is also climbing with him, said he hopes the project acts as an inspiration for the global public health community.

“I am excited and I fully expect that this activity will be an inspiration not only for the Institute, but with the other great teams across the country who are working on these projects,” Flood said. “I hope it inspires people and encourages people to continue working in global health.”

“It’s a great jumping off point for conversation, and it’s a lively way to spread the story of the Institute.”

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Born in Poverty, One Woman Becomes an Agent of Change: Jaussa’s Story

This post was sent in by Janet Fields, a midwife from Raleigh, N.C., who has been working in Malawi at the Fistula Care Center and Malawi Maternal and Neonatal Health Program

Jaussa is training to be a community midwife in Malawi.

Jaussa is training to be a community midwife in Malawi.

In 1981 a beautiful baby girl was born to two impoverished parents in a remote village in Malawi.  The girl’s birth was a source of rejoicing for the whole village, because she was born alive and healthy, despite the lack of a skilled birth attendant at her birth. She was named Jaussa.

Her mother had lost eight previous children, who were either stillborn or died within the first weeks of life.  Three years after Jaussa was born, a sister was born who she also lived.  Later her mother delivered a baby boy, but he died after one week.

This horrific obstetric history left Jaussa’s mother in a deep depression. Her father had been a small businessman, but a terrible accident left him paralyzed on his right side, and he had trouble communicating.  As a result, there was no family income.  Kind relatives gave what money they could to help this small family, but it was hard.  Pretty soon Jaussa’s father began beating her mother, and so her mother left him and returned to her home village with her two daughters.

It seemed that Jaussa was destined to a life of poverty.  But after a few years of primary school, her uncle and aunt stepped in and began paying her school fees.  By the time she was ready for secondary school, her uncle invited Jaussa to move to the city where he and his wife were living, and there she lived throughout most of her secondary education.  Jaussa turned out to be a very bright student who loved going to school and learning. Her favorite subject was agriculture.  Her uncle made it possible for Jaussa to have a chance at a life beyond poverty.

Jaussa had had no specific education or understanding about reproductive health, and at the age of 17 she got pregnant.  Her uncle, who was furious, sent her back to her mother’s village, where she gave birth to a son. There were still no skilled birth attendants in her community;  a family member attended Jaussa at this birth.

When she was 23, Jaussa got married and soon gave birth to a beautiful girl, soon her husband abandoned her for another woman, and she was left to care for her two children and her depressed mother.  Saddened by her inability to find work in the village, Jaussa’s uncle once again invited her and her two children back to his city so that she could complete her education.

With her secondary education completed, Jaussa returned to her mother’s village and tried to find work.  As a volunteer for the Area Development Committee, Jaussa realized that what she wanted in life was to make a difference in her small community.

Jaussa received an invitation to apply for a new midwife education program, an 18-month intensive program that prepares women from the most rural areas for the honorable work of being midwives and health educators in their villages.

Jaussa was accepted into the program and began her education in 2012.  To her great surprise, her class of 25 students elected her as their class president, and she began the role of advocating for her class as the liaison between the administration and the student body.  Her favorite subject in midwifery school was community midwifery.

Jaussa is now preparing for her national midwifery exams.  After qualification, she will be posted, for the first six months, at a district hospital so that she can gain more hands-on experience before being deployed back to her rural community.

She has deep concern for the young girls in her community.  Many of them marry very young, between the ages of 12 and 14.  Few girls are educated beyond the age of 9 or 10. “Girls are for marriage,” the tradition says.  Jaussa would like to be an advocate for change in her community.  Her eyes shine when she describes her dream of being an example to the girls in her community, an example of how one can rise above the poverty and extreme challenges to have a life filled with purpose and meaning. She describes how she will not only be the trained midwife for her community, but also a strong advocate for change in the lives of the girls and young women she will serve.

Increasing the number of trained midwives in Malawi is a critical component of the President’s Maternal Health and Safe Motherhood Initiative, which UNC is helping to implement with funding from the Bill & Melinda Gates Foundation.

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