Working in St. Gabriel’s Hospital in rural Namitete, Malawi, I quickly began to appreciate the unpredictability that surrounded me. In a country where 550,000 children were orphaned by AIDS in 2005, one can imagine irregularities dominating health care environments. However, in the month I worked in Malawi, I was overcome by the constancy of one volunteer’s commitment to his community AIDS and Home-Based Care programs.
Dickson Mtanga (photo, right) was first trained as a volunteer by St. Gabriel’s Hospital in 2005, and neither his life nor the lives of those around him have been the same since. Open about his HIV-positive status, he is employed by his own good will – receiving no monetary compensation for the 10-20 hours of work he sets aside from farming each week. Each day I spent at the hospital further confirmed my initial inkling – Mr. Mtanga is the model community volunteer in a dire health situation.
Roaming the wards each day, I would find Dickson sitting with one of many patients. His exact relationship to the patients always was variable, but there was an overarching theme – Dickson was there to help. His volunteer time is split between two positions, one within the Home-Based Patient Care (HBPC) program, and the other as an Antiretroviral drug-adherence monitor. Accompanying each position is a record book, which extensively documents his patient interactions and is checked regularly by hospital staff.
In his rural village, he’s organized a volunteer committee of 30 members. At their bimonthly meeting, they have general discussions and often very organized agendas (e.g. logistics of visiting extremely rural patients, building new latrines, and accumulating gifts for those who are ill). Dickson heads the committee, and reports to the hospital as a community health leader. The word ‘community,’ in this instance, is certainly not to be taken lightly – Dickson travels to over 50 villages to see patients, serving around 2,500 people.
The service Mr. Mtanga is providing to his fellow Malawians fills a void created by the harsh relationship between distance and stunted means of travel. He refers about 20 patients per week to the hospital, many of which are a 5-hour walk from St. Gabriel’s, the closest patient care (photo, right).
One day in Male ward, he was intently watching a physical therapy session with a man who’d just had a stroke. He told me he’d take what he’d learned with him as he aided a new stroke patient in a nearby village. Dickson knowingly supplies a link between the brilliant physicians at St. Gabriel’s and communities full of those in need. Even those diagnosed at the hospital – especially those who are HIV-positive – count on him for support.
Dickson understands that HIV/AIDS is a very real and serious threat to his community. That’s why he is so unyielding as an Antiretroviral (ARV) drug adherence monitor. His records are impeccable, and his outlook on the program similarly positive. When I sat down with Dickson, he stressed the program’s efficacy, “Overall, [the adherence pattern] is pretty good. Things have changed, and things are still changing for the better. In the past, too many people were dying.” A large component of his meetings with those on ARVs is his infamous ‘positive story.’ According to Dickson, the bottom line of his story is, “Follow instructions, and you can live. In the past, there was a stigma – people were keeping to themselves and not revealing their status. Now, when reactive, we encourage him or her that it’s not the end of life.”
With over 1 million Malawians living with HIV/AIDS, the message has to be clearer than ever. Community health efforts, personified by Mr. Mtanga, represent the keystone in St. Gabriel’s efforts to preserve the Malawian family in the face of HIV/AIDS. The more Dickson Mtangas there are to support Malawi’s community health efforts, the easier it will be to combat such a formidable opponent. His message to the international health community is equally simple and true – “Everybody in Malawi has to take a role, take part in the HIV/AIDS program. We can change Malawi for the better.”
Josh Nesbit, Stanford University
