Monday in Malawi

This week jump started at 7am on Monday morning as Jeffrey and I piled into a vehicle packed with seven other Clinton Foundation staff heading out to rural health facilities scattered about the rural district of Machinga in southern Malawi for another days work. We arrived at a health center around 9:00am, and by 10:00am Jeffrey and I are in the middle of a counseling session with our supervisor, two “Expert Clients” (Clinton Foundation-trained HIV/AIDS peer counselors), and an HIV positive woman who had just returned to the clinic to receive her test results to determine if she was eligible to start treatment for HIV.

As the counseling session unfolds, I learn bits and pieces of this young woman’s life as Jeffrey translates her story. She is 22 years old and HIV positive. She already has three children- ages 9, 5, and the 3 month-old she is currently carrying on her back. She started walking from her home at 4:00am this morning to arrive to the clinic by 8:00. She had learned of her HIV status when she tested HIV positive during an antenatal visit for her most recent pregnancy. She is married to an older man, and he refuses to get HIV tested. She has not told him about her HIV status because she fears he will abandon her. He doesn’t even know that she or the baby is taking any medicines. I almost have to take a step back to realize where I am. This young woman is telling her personal story, but it is echoing of the stories that I have heard in news stories, in books, in movies or in articles so many times.

By the end of the counseling session, she is crying, and I can’t even come up with words to provide any comfort- let alone in Chichewa (the most common local language in Malawi). And unfortunately, this is the story of so many women in Malawi. Thankfully, this woman had the courage to come to the health center and to take medications to prevent HIV transmission to her 3- month-old child. So far, the baby is looking very healthy, and we are all hopefully she will be HIV negative. Thankfully, this health center has Expert Clients who can help support and counsel this woman throughout her efforts to keep her baby healthy and her struggles to disclose her status to her husband and convince him to come for testing. Many woman and children in Malawi do not have access to these kinds of services. This was just the first patient we saw that day; there are many others waiting on the benches of the clinic, each with their own story.

Jeffrey and I are going to be spending a major portion of this year supporting the Expert Client Program, which is what led us into that counseling session on Monday morning. The goal of the Expert Client Program is to engage and train people living with HIV/AIDS to be role models, counselors, and mentors (Expert Clients) in order to increase the enrollment of HIV positive individuals, especially HIV positive mothers and children, in care and treatment while maintaining the same level of healthcare workers in an overburdened healthcare system. These Expert Clients are mothers and caregivers themselves who exemplify positive lifestyles, strong adherence to treatment plans, and have been trained by Clinton Foundation in HIV/AIDS education and peer counseling. Expert Clients work in their own local health clinic M-F during clinic hours and spend their days doing one-on-one counseling sessions with HIV positive pregnant women and mothers, mother and caregivers of HIV positive children, and even HIV positive children. The Expert Clients help patients navigate the health system and ensure they receive the care and treatment they need. In the past, as many as 50% of clients are lost between testing and enrollment on treatment!

Jeffrey and I are going to be acting as program managers, doing everything from assisting in the design of the reporting system to visiting the Expert Clients at their sites and helping to build their capacity to act as mentors and counselors to helping the program expand to more clinics. I’m excited, overwhelmed, and already diving in! Here we go…