Student Thesis

In the picture, I (seated far left) engage with people with type 1 diabetes during a focus group discussion in Salima. They share their stories, involvement with, and experience with, the PEN-Plus clinic.

There is a myth affecting young people with type one diabetes in Malawi: "People with type 1 diabetes who do not have children yet will not be able to conceive and birth children." Bright works to hopefully dispel this myth. 

In the photo above, I am with a 20-year-old Type 1 Diabetes (T1D) patient who has not visited the PEN-Plus clinic for three months. (This participant agreed to be photographed, but preferred that his face be blurred for privacy.) He was diagnosed with T1D in 2017 after experiencing diabetic ketoacidosis. His condition shows signs of failing to thrive, with a weight of 25.5 kg (~56 lb.) during this visit. He resides with his grandmother, as his father passed away when he was one year old, and his mother's whereabouts are inconsistent due to her involvement in commercial sex work. Upon learning about his challenging circumstances during data collection at the clinic, we conducted a home visit to understand the situation better. On the right side of the image, there is a clay pot filled with sand, a white container holding the patient's insulin (NHP and Soluble), and an insulin syringe. This is the only place where the patient has to store his medicine at home. 

The image underscores how the PEN-Plus model allows healthcare professionals to establish profound connections with patients and extend healthcare outside the hospital through home visits.

During one clinic visit, a clinician sadly informed the attendees that insulin was unavailable. It was easy to observe the visible disappointment on everyone's faces. While engaging with a guardian of a pediatric patient, Bright learned of the financial strain she faced. She revealed the high cost of insulin, priced at around $30 per vial, yet her ward requires two vials monthly, and she had to borrow money to afford transportation to the hospital. It was distressing to learn that she would have to manage her ward's condition without insulin for another month.

The photo embodies the work in progress of alleviating the suffering of children with type 1 diabetes, sickle cell, and rheumatic heart disease by providing advanced and structured health services. This building is the first ever designed as a designated space for NCD service provision as a secondary care level. 

The picture deepens my understanding of the commitment and collaboration between the Malawi government, Harvard academicians, and other stakeholders in implementing pathways for delivering complex NCD care at the secondary care level.

“You know what, Doc, accessing care here is challenging because we are combined with other people with different medical conditions than ours. Because of this, there are delays in getting the care and our friends do not understand our needs. We would have loved having a dedicated space so that it is only us [people with NCDs].” ~Patient of the new PEN-Plus Clinic

Depicted above is a routine PEN-Plus clinic day at Karonga District Hospital. A PEN-Plus nurse leads a session on diabetes management, foot care, and self-insulin administration. The PEN-Plus clinicians sit in the audience and listen to the health talk.

This photo is the epitome of data collection. While in the field, I enjoy being part of the local team and observing their daily operations in their natural environment. Applying lessons learned in GH 708-Ethnography Methods for Global Health lectures, each day was filled me with new experiences guided by simple questions like: What did I learn today? How different was it from yesterday? What should I focus on tomorrow? 

In my decade of experience in NCD clinics, this was my first time seeing nurses come to the clinics around 05:00 am. When asked, they mentioned wanting to ensure the clinic is set and tidy so that when the patients arrive, they should immediately be assisted and sent home rather than waiting for the clinic space to be mopped. 

"We are not going to be why patients spend their whole day at the clinic." ~PEN-Plus nurse

Above, I am shown fulfilling my mentorship responsibilities at Karonga District Hospital.

The PEN-Plus care model represents an evolving learning journey; exchanging clinical knowledge and skills directly at the bedside enhances the mentor's and mentee's expertise and capabilities.

Read more about the Master of Medical Sciences in Global Health Delivery program here.