Wearing the Cap and Gown

With training from UNC, nurses fill a critical health care need in Malawi

By Saumya Ayyagari (’11)

HIV/AIDS is wreaking havoc on Malawi. In this land-locked, mostly rural country of 10 million people, 15-17% of the adult population is infected with HIV. Not limited to the physical health of those who have the disease, the impact of HIV reverberates throughout all levels of society. Ironically, one of the sectors most adversely affected by the pandemic is the health care system.

zimba, ndovie and maseko smile and pose in chapel hill

From left: Chifundo Zimba, Maggie Ndovie, Bertha Maseko

UNC has been delivering clinical care in Malawi for two decades. At UNC Project-Malawi, HIV keeps the waiting rooms full and the clinics and hospitals short-staffed. On any given day, one out of five people is out of the office because they are sick themselves, taking care of a family member who is sick, or attending a funeral, said Cheryl Marcus, BSN, who is clinical research director of the AIDS Clinical Trials Unit at UNC and often travels to Malawi.

“AIDS has crippled a lot of middle management across the board in Malawi,” Marcus said, because the disease has affected so many in their peak productive years. And this, combined with the out-migration of trained workers—so-called “brain drain”—Malawi’s health care system is woefully insufficient. Malawi has a physician-to-patient ratio of one per 100,000.

The Institute for Global Health & Infectious Diseases (IGHID) is committed to addressing these challenges and building capacity in the region. The UNC AIDS International Training and Research Program (AITRP) program, for example, has been providing HIV/AIDS research training to scientists in Malawi and Cameroon for 11 years. Participants in the AITRP program must return to their home countries to battle the epidemic, and graduates of the UNC AITRP have become government leaders and policy makers, directors of public health programs, and academic faculty who are themselves training young HIV researchers in-country.

IGHID is now collaborating with the UNC School of Nursing to create training opportunities for nurses employed at UNC Project-Malawi. This past summer, three Malawian nurses came to Chapel Hill for advanced training. Chifundo Zimba, BSN, Bertha Maseko, RN, and Margret “Maggie” Ndovie, BSN, were selected to complete the practicum on physical assessment and clinical trials and receive additional instruction from faculty at the UNC School of Nursing. Their training was supported by grant from the NIH Fogarty International Center, which also supports the AITRP.

Maseko, Rhonda Lanning, and Ndovie

Before arriving in Chapel Hill, the nurses prepared for their lectures and practicum at UNC Project’s satellite health sciences library. This library provides an invaluable service to faculty, students, and trainees at UNC Project, in addition to the local health care community, and is another example of how IGHID is working to build health systems in Malawi.

When they got to UNC, the nurses completed the lab and clinical research requirements, final practicum, and final exam under the supervision of Rhonda Lanning, MSN, RN, a clinical instructor in the school of nursing. At the end of the two weeks, Zimba, Maseko and Ndovie were awarded certificates for physical assessment and clinical trials courses.

All three of them first became interested in nursing because they were enchanted by female nurses’ white caps and gowns. But it was a personal acquaintance with the health care system that really got them hooked. “When I was in grade eight, I had a fracture on the tibia and my grandmother brought me to the hospital,” Ndovie recalled. “What interested me the most was that you treat the patient, and he is up the next day saying, ‘Today, I’m OK.’” Maseko had close relationships with nurses who cared for her when she was young, and these experiences inspired her to pursue a career in nursing.

The nurses’ experience in Chapel Hill was positive and eye-opening. “[The instructor] has been so friendly,” Maseko said. Ndovie was both surprised and honored that people treated them as colleagues, and it didn’t matter where they came from. This “attitude of teamwork” is something Ndovie hopes to share with her colleagues back home.

In fact, Zimba, Maseko, and Ndovie were eager to return to Malawi and put their new knowledge and skills to practice. Zimba, who plans to teach in Malawi, wants to teach other nurses how to do the kind of thorough physical examination and assessment they observed at UNC. “I will never forget the skills Rhonda has taught me,” Zimba said. “I will use them to assist the general public that I am going to serve at home.”

Although Zimba, Maseko and Ndovie—not to mention their patients in Malawi—are the real beneficiaries of this exchange, UNC has gained something as well. “Everyone who met [the Malawian nurses] and interacted with them was touched by their humility and courage,” said Gwen Sherwood, PhD, RN, professor and associate dean for academic affairs in the school of nursing. “They were beacons of inspiration, spreading hope to all who had the pleasure of being in their presence.”

IGHID intends to expand the UNC-Malawi nursing training program over the coming years. As early as fall 2010, one of these nurses may have the opportunity to begin a master’s degree program in nursing leadership at UNC.

This item originally appeared in the April 2010 issue of “Global Health Matters,” an online publication of the NIH Fogarty International Center.