Visiting 16 patients scattered among the rural hills of Malawi not once but twice a day, every day? "No problem!" says one village health worker.


Briston and his trusty bike

Every day, Briston Threemunthu rises before the crack of dawn, climbs onto his trusty bicycle, and pedals down a narrow dirt path to visit his first patient.

As a village health worker with Abwenzi Pa Za Umoyo (APZU, PIH's partner organization in Malawi), his job is to visit HIV patients twice each day to monitor their health and help support the intensive regimens needed to treat the disease. But the visits often call for more than just monitoring medical needs. "I visit them, chat, share ideas, remove stress, encourage them that [even if they] are sick, it doesn't mean the end of life."

Briston's route currently includes 16 patients in the rural, mountainous district of Neno. "Other [CHWs] may have only six patients. But it is no problem. [My patients] all know me well. They all chose me to be their village health worker. I cannot deny them. That's why I have so many," grins Briston. "It is no problem," he repeats, smiling at the black mountain bike that is one of the keys to his ability to care for so many patients, some who live as far as five or six kilometers away from each other. Although APZU currently employs a cadre of nearly 300 village health workers, Briston is unfortunately one of the few with access to a bike.

But the bike is only part of the equation. The other part is Briston's own dedication. The path he travels down is full of rocks and potholes that fill with water and mud, requiring him to get off and carry the bike on his shoulders for part of his route. In the rainy season, he sometimes must leave the bike at home and do his rounds on foot, which takes about twice as long. Every evening, he repeats his route, checking in on each patient one more time before returning home to his wife and their two-month-old baby. Even though it sometimes means returning home well after dark, he is careful to give all of his patients the attention they need. "Every round should be exemplary," he insists. Plus, each patient is more than just a patient-they are his neighbors. "I am assisting my brothers and my sisters," he says. "As long as I'm assisting them, there's no problem and they are getting well, and I am happy," he smiles. "No problem."

[posted June 2008]