Brumfield, Sarah

School of Public Health



Malawi-Improving measurement of HIV-related mortality during population-based surveys in African countries

I chose to stay in Malawi as long as I could before I needed to be back on campus. I had lived in Malawi for two years as a Peace Corps volunteer and had grown to appreciate and love the culture and the people. This time around, I got to see a new part of the country, the Northern Region, right on the lake shore. From the guesthouse, I could see the beach and the lake stretching out as far as I could see. Weekends were primarily filled with swimming in the clear blue water and watching movies with the barmen at the local beach restaurant. I did get to travel a bit to see the legendary Likoma Island, but I found that I missed the people at my site when I was away and preferred to spend as much time at home as elsewhere.

I worked on a research project that had been established in the late 1970’s to address leprosy. Since that time, the project has expanded its scope, and have even performed a yearly census of the study area for several years. I found that people working there to be very motivated and was excited to learn from them. The colleague that I worked closely with was constantly willing to answer any of my questions. During daily tea breaks, I got to know some of the other people working there. They were happy to teach me the local game, bao, and share doughnuts, or mandasi. After work hours or on the weekends, I would find them at the small local bar on the beach ready to chat away into the night hours. Walking between offices, the receptionist would offer boiled cassava or bananas, accompanied by a short conversation.

My closest relationship was formed with the housekeeper who worked in my guesthouse. I was exploring the local area one day and happened upon her house. After that, I spent at least a few hours most weekends at her house, playing with her dogs and helping peel cassava. No visit to a Malawian home is complete without a meal of nsima, maize porridge, and some relish to accompany it. The family enjoyed showing me how to cook nsimaand laughing at my inability. However, the housekeeper would be away from work frequently for a two or three days at a time. When she was working, she would complain about pain in her legs. She lived uphill from the guesthouse, which exasperated her troubles. I would often find her sitting in the kitchen waiting for bread to bake to take the stress out of her legs. Visits to the local hospital were not helpful. There are often shortages of medicine or clinicians in rural areas. In addition, she complained that it was difficult to get help on a weekend, since the clinic workers were not happy to be working during that time. Having a full time job, this made getting care difficult for her. As a person with a job and an employed husband, her situation is a bit easier than others who live in rural Malawi. The village I lived in as a Peace Corps volunteer was 10 km away from the nearest health clinic. Medicine is expensive and hard to come by. It is difficult to watch people suffer from pain and illness of treatable diseases. Some even die when they cannot make it to care in time. This is part of the reason that I am motivated to work in public health and to continue working in the developing world.

After my initial two years and the few months I spent there this summer, I consider Malawi as a second home. The culture is very welcoming and I feel more than comfortable there. I would like to pursue future opportunities in the country or elsewhere in sub-Saharan Africa. If I was able to partake in a similar experience again, I would sign up without hesitation.


Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

August 2019



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