Public health students go to Malawi, assess problems in care for cervical cancer

Graduate student Sam Rodgers recalled a scene in Malawi that illustrated how fraught with challenges it can be for women to receive proper health care in a nation that, by many calculations, leads the world in cervical cancer.

"We went out on a mobile outreach clinic at a village, and all the patients are lined up getting ready to see us," Rodgers said. "And one of the women cuts to the front of the line. She says: ‘I think it’s going to rain soon, I have to get back home across the river if it rains, it’s going to flood, and I have no way back.' It’s taking into account different things like that we would never think about here in the U.S.”

Rodgers and Stephanie Hernandez, both Master of Public Health students at the Virginia-Maryland College of Veterinary Medicine, went to the African nation of Malawi over the holiday break to help assess the nation’s continuum of health care from home to hospital with a particular emphasis on screening and treatment for the high incidence of cervical cancer, problems exacerbated by transportation and communication difficulties.

As an undergraduate in bioengineering at Virginia Tech supporting TEAM (Technology-Education-Advocacy-Medicine) Malawi, Rodgers had been involved in a collaboration with the Malawi University of Science and Technology (MUST) to make medical devices for hospitals.

Andre Muelenaer, a pediatric pulmonologist and professor of practice in bioengineering and mechanics within the College of Engineering, and his wife Penny Muelenaer, assistant professor of pediatrics at the Virginia Tech Carilion School of Medicine, led the founding of TEAM Malawi.

Undergraduate public health students Jude Sleiman and Grant Soltes were also part of the recent TEAM Malawi mission.

“So while the Malawi University of Science Technology has a great biomedical engineering department, it doesn't have a public health department,” said Rodgers, from Concord, North Carolina. “So the Muelenaers were talking with the vice chancellor of the university, and she brought up a problem that the country of Malawi has with high rates of cervical cancer. The country has tried to make some adjustments and change, and none of it has really worked.

“So MUST asked us to come in and asked us to assess the continuum of care from home to hospital in the country -- how patients will get from these very rural communities of mostly subsistence farmers to health clinics and district hospitals, how they get care from mobile outreach clinics.”

Rodgers’ previous experience with Malawi – a potential opportunity to visit the nation previously had been closed by the COVID-19 pandemic – helped open the door for Hernandez, also.

“I really wanted to participate in this opportunity because of that continuum of care, specifically with women,” said Hernandez, originally of Puerto Rico. “In the community, we found out when we went over there that women hold most of the burden in families. So it was really important for me to really get to see that and experience the culture in Malawi, how that relates to our project and how that relates to the stressors that aren't allowing them to achieve the success that they want to.”

Many of those stressors Hernandez and Rodgers found boiled down to difficulties in transportation and communication.

“A big stressor is transportation, and access to health services,” Hernandez said. “Malawi is a big country with a lot of rural areas, and unfortunately, those areas are sometimes many times hard to reach. And that's something that we, as public health students, we can start the conversation, for sure.”

Rodgers said that because of the distances involved and limited means of transportation, plus the time needed for morning home responsibilities, it was common that for clinics starting at 8 a.m., almost no women would arrive at the clinics until mid to late morning.

Communication is also problematic, not only from health professionals to communities, but even within health systems.

“A trend we saw when we were visiting hospitals is that a lot of the staff members, employees, physicians and such, they were having difficulties communicating within their departments and within different district hospitals,” Hernandez said.

Now back on campus, Hernandez and Rodgers have been at work creating a process map on how to address the problems they found in Malawi. The effort is an integrative learning experience and a group capstone project for the duo in their final semester of the public health master’s degree program.

The first step in addressing the problem, Hernandez and Rodgers propose, is creating an SMS messaging system to create healthy messages about cervical cancer for women in rural communities.

“It's interesting, we found, a lot of these places don't have running water, they don't have electricity, but they all have cell phones,” Rodgers said. “They might not have smartphones, but they have cell phones. They can get text messages.”

Hernandez and Rodgers hope that the messaging can combat rampant misinformation about cervical cancer screening.

The second step is to create an educational module on cervical cancer for health surveillance assistants, who are health workers who live in local communities and often viewed by community residents as the local doctor.

Thirdly, Hernandez and Rodgers want to close the communication gap in hospitals, especially between biomedical engineers and physicians. They want to create an offline web app inventory database for hospitals to be able to keep track of what equipment is available and how it can be used properly.

The experience has also stoked the graduate students’ ambitions for their careers after obtaining master’s degrees.

Rodgers said he is interested in international development. Seeing heart-wrenching scenes in Malawi – the nation was also suffering a cholera outbreak – strengthened his resolve.

“Seeing the challenges that people there have to go through just solely due to a lack of resources, the incredible stress it puts on health care workers there, is very eye opening,” Rodgers said.

Hernandez was taken by the community-based culture of Malawi, where in all settings, there was great familiarity between health workers and patients.

“I really want to be community-based, do community-oriented outreach, any type of outreach programs, initiatives, that's where I want to work,” Hernandez said. “I'm still not sure where or what area yet but what excites me, and I think one of the reasons why I wanted to travel to Malawi, is that this experience really taught me how, as long as there's respect and intentionality in the work that you do, you can really do a lot.”

Written by Kevin Myatt, Writer/Editor for the Virginia-Maryland College of Veterinary Medicine.