In the country where Lucy Mkandawire-Valhmu was born, her research helps women who are close to death. Many are relatively young and dying of AIDS or cervical cancer in the small, rural villages of Malawi, where support systems are strained or scarce.
“We are trying to find ways that palliative care can be done in a cost-efficient way,” says Mkandawire-Valhmu, an associate professor in UWM’s College of Nursing. She adds that the Malawi government wants to strengthen home-based care services, but it’s challenged by an already-overstretched health care system and an ongoing shortage of providers.
Africa’s AIDS epidemic hit Malawi hard. Mkandawire-Valhmu says that in some communities, 26 percent of the population is HIV-positive. HIV prevalence is higher in urban areas, but the epidemic is complicated in rural areas by issues such as poverty, lack of education, challenges to health care access, food security issues and gender inequalities.
The burden of care for stricken women often falls on the family’s children, particularly girls. “They drop out of school,” Mkandawire-Valhmu says, “and this perpetuates the vicious cycle of illiteracy and poverty among women there.”
One recommendation from Mkandawire-Valhmu’s research: Allow existing health surveillance assistants, who are trained community health workers, to monitor and ensure the comfort of palliative care patients and perhaps administer some medications. Right now, she says, end-of-life patients from rural areas must travel long distances for medication.
Where communities are very strong and there is less stigma toward AIDS, Mkandawire-Valhmu has found that dying women have more mental and physical support. “It might be as simple as a neighbor fetching water,” she says, “or bathing the 3-year-old.”
Mkandawire-Valhmu works with organizations like Tigwirane Manja – which means “let’s hold hands” in the local Chichewa language – to research the dying women’s experiences and look for community-based help. She has included UWM nursing students in her research efforts, most recently on a trip in January 2018.
“Simply by playing with these women’s children,” Mkandawire-Valhmu says of the students, “they are providing some support.”