Return of the Goalkeeper
Oct. 21, 2008
By Amy Moraczewski -
'Our goalkeeper's back!'
This was the rejoicing proclamation that Josh Nesbit was greeted with when he returned to St. Gabriel's Hospital in Malawi this past summer.
Nesbit, now a senior goalkeeper for the Stanford men's soccer team, arrived at the hospital carrying 100 donated mobile phones. He would train volunteers to use them to alert hospital employees of patients' needs, in an effort to effectively treat a quarter-million patients spanning a 100-mile radius.
Although he was there to provide unprecedented medical care to the surrounding villagers, in the eyes of the Malawians, Nesbit was primarily their goalkeeper. They remembered well that no one scored upon him while he defended the net for the team of hospital workers the previous summer.
'The first couple of days, everyone just knew me as `the goalkeeper,' ' Nesbit said. 'Even more than the work I did, that really solidified my role in the community. I was asked to attend the hospital's board meeting the first day I arrived, and I can't say with certainty that would have happened without soccer.
'They're surrounded by hardship, and I was there responding to that hardship, but it's also important to respond to what they enjoy and maintain that dual role. I wasn't just playing soccer with random people; I was playing with my good friends, my second family even.'
After traveling to Malawi during the summer of 2007 as a general volunteer on behalf of the Children's AIDS Fund, Nesbit arrived home in the United States with a conviction that he needed to return to Malawi equipped with the resources and finances to create a culture of change, a movement toward improved healthcare. Working with Ken Banks, the developer of a text-messaging system called FrontlineSMS, Nesbit established a program that allows communication with the hospital volunteers from rural, impoverished villages up to 100 miles away. After securing grants from the Haas Center for Public Service at Stanford and the Donald A. Strauss Foundation, Nesbit embarked on launching the pilot program.
One of the steps the Malawians have taken toward positive change is through a healthcare initiative involving over 200 Community Health Workers (CHWs). These HIV-positive individuals volunteer to educate their communities, stimulate conversation, and monitor the medications of others who are infected, while providing primary healthcare. Since it is essentially impossible for the three on-staff physicians to treat a quarter-million patients - especially those who are unable to walk 60-100 miles each way - those volunteers are the main source of hope for many villagers.
Unfortunately, lack of transportation and communication makes it difficult to maximize the benefits of the CHW network. Using donated laptop computers and mobile phones, Nesbit spent his first few days in Malawi conducting training of the new system, which allows volunteers to communicate directly with the hospital. FrontlineSMS is now utilized as a tracking tool of drug adherence and HIV-related discussions, as well as a method of alerting the hospital of health emergencies and adverse side effects of drugs.
'Ineyo ndinayenda mapesent awiri sakupeza bwino amenewa ndiavuto lakhasa.'
This message, sent by Zakeyo Kaphanthengo, alerted the hospital that two patients in his village were very sick with cancer. An emergency notification such as this often meant that Nesbit would join Alex, a home-based care nurse, by jumping on the back of a small motor bike for a 60-mile drive, to deliver the necessary medication for patients who would otherwise go untreated.
On one such trip, the patient instructed his wife to fill Nesbit's knapsack with peanuts, gathered from the top of a 10-foot mound in their backyard. While the Malawians may not have much in the way of material possessions, Nesbit discovered their generosity immense in their display of gratitude.
The program relies on the volunteers to provide a connection with the hospital after a patient is discharged, by visiting 10-15 patients per week and sending a message with an update. Nesbit extended the scope by creating a map to track the patients and reach those who missed follow-up appointments. He also set up a system to inform volunteers of the uses and dosages of drugs in their medical kits, by generating an auto-reply with the summary to any message that contains the name of a given drug.
Months after his return to the United States, Nesbit continues to monitor the program from Stanford through constant communication with the hospital staff. In fact, Nesbit sees every incoming text message received by the hospital, through configuration of the FrontlineSMS that enables each message to be forward into an e-mail account.
After the fall quarter and his final collegiate soccer season, Nesbit will return to Malawi to evaluate the progress of the program and help implement any necessary changes. While he will continue his involvement, Nesbit realizes that in order to be effective over time, the ownership of the program must be turned over to the hospital and the volunteers. Meanwhile, Nesbit is initiating the expansion of the program to other hospitals throughout Malawi, as well as rural Kenya, and Mumbai, India.
Not everyone can travel abroad to volunteer, but Nesbit believes everyone is surrounded by opportunities to give back, and to do so can make all the difference in the world. The positive attitudes of those living in such extreme poverty and suffering should give us the courage to face the daily challenges of our own lives.
'Surrounded by abundance, in a place of privilege and health, we're afforded the opportunity to lead just, moral lives,' Nesbit said. 'By doing so, we pay tribute to those who lead good lives in almost impossible conditions.'
No doubt when he suits up in his new shoes and practice gear each afternoon and walks onto the perfectly manicured grass of Stanford's Laird Q. Cagan Stadium, Nesbit is paying tribute to his teammates in Malawi, who are playing barefoot on a dirt field lined in sand.