Friday, June 5, 2009

Malawi Project Featured in American Journal of Nursing

I am happy to report that a photo-essay about my Malawi project is the cover story for the June issue of the American Journal of Nursing. That great cover photo of Mphatso Nguluwe was taken by my friend Eileen Hohmuth-Lemonick who joined me on my three-month Malawi trip last year.

Mphatso is a great story-teller, who likes to tell her fellow Christians that she is the mother of nine children by eight different fathers. It's a great teachable moment that I wrote about last July.

My project focused on the nursing shortage in Malawi as a kind of a kind of window into how health systems function in poorer parts of the world. Malawi is in the midst of a six-year program to address its nursing shortage by paying nurses more and supporting more nursing education and training.

Part of what I learned in Malawi is how fragmented and overly narrow most efforts at improving health turn out to be. We think that having more drugs or more nurses and doctors will automatically improve conditions without considering the need for better roads, clean running water or functioning secondary schools to make sure those efforts succeed.

Because it's easier to raise money for a single issue--like AIDS or polio vaccines or girls' education, we continue to maintain (and tell stories about) siloed efforts that don't intentionally contribute to broader, more long-term needs like primary care. There was a study about that from the Institute of Tropical Medicine in Antwerp just yesterday in the Public Library of Science.

I don't understand why--if it took me only three months to figure this out--the professionals who do this for a living still can't seem to adjust their efforts accordingly. As the PLOS study suggests, they must already know this. But then, as the saying goes, "It is difficult to get a man to understand something when his salary depends on his not understanding it."

I tried to get at some of these themes with the photos and captions that are part of the AJN essay as well as the supplemental material that is available online. When I suggested to Diana Mason, the outgoing editor-in-chief, that both be made available for free to non-subscribers as well since they reflect on health in the developing world, she readily agreed. Well, as another saying goes (two aphorisms in one post--that probably exceeds the limit), "it is better to strike even a tiny light than to curse the darkness."

Related posts:
Hiding Broken Practices Behind New Catchphrases
At Work with Malawi's Nurses

Update: Related 10-minute podcast with Christine Gorman on the AJN site


Anonymous said...

Christine, thank you for bringing your photoessay of nursing in Malawi to AJN. You are on target with the point about health care professionals not advocating what is really primary prevention (specifically, addressing some of the social determinants of health such as adequate housing, potable water, etc.) because of their self-interests (i.e. their own salaries and positions depend upon perpetuating a narrow biomedical approach to health). As the U.S. focuses on universal coverage, it will quickly learn that we can't (and shouldn't want to) cover everyone for the current model of health care. We must focus on prevention and health promotion. In this country and globally, the socioeconomic disparities must become a priority if we are to promote health. Your work is making more visible these realities. Thank you. Diana Mason

Christine Gorman said...

Thanks, Diana. I just updated with a link to the podcast on Interesting how the various media--audio, video, text--highlight different aspects of the story. A lot more laughter on the podcast, for example!

Anonymous said...

Christine, you ought to consider doing some writing for Asia Chronicle (, especially since Malawi is attracting such diverse investment from Asian interests, both in health care and infrastructure.