The Experience of a Lifetime: an Elective Rotation in Malawi, Africa

“Africans bend what little they have to their will every day. Using creativity, they overcome Africa’s challenges. Where the world sees trash, Africa recycles. Where the world sees junk, Africa sees rebirth.” -Erik Hersman

For the first time ever, this past spring Cal Poly started offering the option for dietetic interns to complete their elective rotations internationally. Dr. Peggy Papathakis, a Cal Poly professor and Fulbright Scholar, presented our program director Kati Fosselius with the idea of bringing two Cal Poly dietetic interns to work with her in Malawi on a grant. Dr. Papathakis has worked extensively abroad throughout her career; recently, she has been living and working in Malawi as an RD for several months on her Fulbright. In exchange, two dietetic interns from Malawi would come to Cal Poly the following year for a rotation in California. Kati and Dr. Papathakis worked tirelessly to make this opportunity possible.

I wanted to go to Malawi to experience a different culture and gain a new perspective on how practicing dietetics is different in developing nations, so naturally, I jumped on this opportunity. I knew that it would be filled with unexpected challenges, and that I would be uncomfortable at times, both physically and mentally, but above all, I wanted to keep an open mind and learn as much as possible. A few weeks later, Dr. Papathakis emailed me telling me that I was selected (along with fellow intern Kelsey), and so it began!

Week 1: Project Peanut Butter (PPB)

After 30+ hours of travel time, we arrived in Blantyre, Malawi. My first week was with PPB, a nonprofit organization that runs many studies and projects related to malnutrition in several countries in Africa. The team produces and distributes a fortified peanut butter in order to address poor nutritional status among young children. I worked with the clinic team, so my first few days in Malawi were spent in rural malnutrition clinics, where I took children’s measurements such as mid upper arm circumference, height, and weight. We also collected urine and stool samples for one of the studies. Clinic days were usually pretty busy, but I enjoyed the work and loved getting to know the other volunteers better during our down time. Many of the volunteers had been working in Malawi for months, so I was able to learn more about the culture and lifestyle of Malawians by listening to their experiences as well.

For two nights, I stayed with other volunteers at a lodge in a rural village that was several hours from the city of Blantyre. Blantyre is a city, so there are many more amenities than in the villages, like clean tap water. In the village, we typically didn’t have running water, definitely didn’t have warm water for showers, had no wifi, and lived in much dirtier areas. I literally watched women carry huge tubs of water on their heads from the borehole to pour into a tank that was then connected to my room so that I could take a very brief cold shower. I had to brush my teeth with bottled water for my own safety and shared my tiny bathroom with a few lizards, spiders, and other creatures. I’m grateful that I was able to live that way, even if just for a few days, so I could ever so slightly relate to the way that others in the area lived. Even then, I’m positive that my living arrangements were nicer than most.

Week 2: Queens Hospital

My second week was spent at Queen Elizabeth Central Hospital, which is a 1000+-bed public hospital in Blantyre. Since Queens is a public hospital, their patients don’t have to pay anything (except for special labs or tests that need to be sent out), which is amazing, but they also have limited funding and resources since the government determines their budget. The conditions at public hospitals are typically much poorer than the private hospitals in the area. Dr. Papathakis and I worked in the pediatric ward there, which was particularly exciting for me because I did not work with pediatric patients during my clinical rotation in San Luis Obispo. We saw patients in the medical bay, burn unit, oncology, surgery (at Mercy James, a ward funded by the musician Madonna), and more.

I had many unique patients that I could not have even imagined having in the US. One of my patients was the second-ever patient on TPN at the hospital (the solution is all donated, since it’s so expensive); the guidance that Dr. Papathakis and I provided was appreciated. The patient had Burkitt’s lymphoma and very little usable bowel after several surgeries, so it was essential that she received parenteral nutrition. We also monitored and adjusted her oral diet to minimize stoma output. The entire hospital relies on paper charts instead of the electronic medical records that I’m accustomed to. There was definitely a learning curve, since reliable information was not as readily accessible, but we navigated this challenge by increasing face-to-face interaction with nurses to learn more about patients’ conditions and nutritional statuses.

We also worked closely with the wonderful foodservice team throughout the week. Queens does not have a dietitian on staff and the country as a whole only has eight registered dietitians. Dr. Papathakis usually sees patients once a week or when referred, but much of the nutritional burden is placed upon the foodservice department. Foodservice staff will assess if certain patients need to be put on the “high protein diet,” based on their condition/disease state, which includes additional milk and egg (as well as beef if available). The kitchen and its equipment were in incredibly poor shape and they didn’t even have a working refrigerator. The staff is constantly learning and genuinely want to help the patients even with their limited resources, which is really inspiring to see. During this week, I helped Dr. Papathakis set up a GoFundMe to raise money for kitchen equipment, and she has recently begun purchasing new pots that will help the kitchen with their work greatly.

Week 3: Permaculture

For our final week in Malawi, we traveled from Blantyre to Lilongwe, the capital of Malawi. This week was centered around permaculture and the intersection between nutrition, sustainability, and agriculture policy. Our first stop was at Never Ending Food, where we were introduced to permaculture by Kristof, who is an expatriate who has been working and living in Malawi for many years. Permaculture is difficult to sum up in a few words, but it involves utilizing resources and space efficiently when designing a garden. The placement of each plant variety is done with intention and purpose, so that all features of the garden are working synergistically. Instead of planting an entire plot of land with maize, which is a local staple, Malawians can diversify their crops using permaculture principles.

We spent time on permaculture farms, learning from expatriates and locals alike, and stayed at Permaculture Paradise Institute in Mchinji for the majority of the week. It was nice to return to a simpler way of life on the farm, where we were away from technology and could enjoy each other’s company over dinner and Malawian board games. I learned about the resistance to permaculture in the villages, because it can be seen as strange or unorthodox, though there are some who recognize how beneficial it would be for the malnutrition issue if more people practiced permaculture.

We also took some time to meet with local agriculture and nutrition officials. Both the agriculture official and nutrition official had similar things to say about barriers to diversifying diets of Malawians – much of it had to do with mindset, attitudes, and culture, rather than an actual lack of knowledge or food. We often heard how Mchinji is the food basket of Malawi because they produce so much food, but people are selling it and using the money to buy maize and other household necessities instead of eating it.

What now?

Our three weeks in Malawi flew by, and Kelsey and I were both sad to leave, but immensely thankful for this opportunity. After graduating from the Cal Poly internship, I drove across the country from California back to Vermont (in eight days!), where I am now living. I’ve been studying for the RD exam, applying for jobs, and taking some much-needed relaxation time. Recently, I started working part-time as the breakfast chef of a local boutique bed and breakfast. I’m eternally grateful for the experiences that I’ve had over the entire internship, but especially for the unique perspective that working globally has granted me. I plan to do more global work in the future, though for now, I’m sticking around the East Coast for my first job as a registered dietitian.