{"id":2364,"date":"2026-04-25T09:19:44","date_gmt":"2026-04-25T13:19:44","guid":{"rendered":"https:\/\/geiselmed.dartmouth.edu\/cghe\/?p=2364"},"modified":"2026-04-28T16:07:32","modified_gmt":"2026-04-28T20:07:32","slug":"holistic-approach-in-malawi","status":"publish","type":"post","link":"https:\/\/geiselmed.dartmouth.edu\/cghe\/2026\/04\/25\/holistic-approach-in-malawi\/","title":{"rendered":"Meredith\u202fSherman, MED \u201928, shares how a holistic approach to health and healing fostered mutual understanding during her time in Malawi"},"content":{"rendered":"

by Meredith Sherman, MED '28<\/em><\/p>\n

\"Innocent
Photo courtesy of Meredith\u202fSherman,\u202fMED\u202f\u201928.\u202fDuring her 2024 Fulbright fellowship, Research Technician Godfrey\u202fMvula trains her in wet lab techniques while they develop a gene deletion assay at Kamuzu University of Health Sciences in Malawi.<\/em><\/span><\/figcaption><\/figure>\n

During the Center for Global Health Equity Co-designed, Community-based Internship, I partnered with a team of researchers and public health clinicians in Malawi focused on understanding emerging threats to malaria<\/a> control. Championed by the Malawi National Malaria Control Programme, our work evaluated the effectiveness of rapid malaria diagnostic tests (mRDTs) in the Southern Region. Gene deletions in the parasite that causes the deadliest form of malaria, Plasmodium falciparum<\/em>, enable these parasites to go undetected and untreated. To address this concern, a research team led by Dr. Karl Seydel at the Blantyre Malaria Project began investigating parasitic gene deletions affecting malaria infections in Southern Malawi.<\/p>\n

\"Meredith
Photo courtesy of Meredith\u202fSherman,\u202fMED\u202f\u201928. Innocent\u202fJackson (L), Lawrencia Mbera (C,) and Patricia Mawindo(R)\u2014Meredith\u2019s research teammates\u2014pose after a successful sensitization meeting in Zomba, where Innocent improvised a sheet as a makeshift screen.<\/em><\/span><\/figcaption><\/figure>\n

According to the 2024 WHO Malaria Report<\/a>, there were 6,378,000 cases of malaria in Malawi. In 2021, 262 million mRDTs were distributed by National Malaria Programmes worldwide, and over 13 million mRDTs were used in Malawi. This makes the reliability of mRDTs a serious concern, both in Malawi and in malaria-endemic countries globally. Parasites with deletions of Plasmodium falciparum<\/em> histidine-rich proteins 2 and 3 (pfhrp2\/3<\/em>) have become increasingly prevalent, and these genes encode proteins detected by the most widely used and sensitive mRDTs. As of 2024, more than 42 countries have identified pfhrp2\/3<\/em> gene deletions. Individuals infected with these abnormal parasites could be missed for treatment, resulting in increased morbidity and mortality.<\/p>\n

Ask<\/h2>\n

Through funding from the Fulbright Program, I was fortunate to begin work on our project in 2024. Building on preliminary research conducted by Innocent Jackson, a student in the Medical Laboratory Sciences training program at the Kamuzu University of Health Sciences who joined our team, we designed a cross-sectional, multisite surveillance study informed by the WHO template for detecting pfhrp2\/3<\/em> gene deletions. We began field data collection in March 2024 at twelve health centres in two districts in Southern Malawi: Blantyre and Zomba.<\/p>\n

\"Sensitization
Photo courtesy of Meredith\u202fSherman,\u202fMED\u202f\u201928. Many sensitization meetings were held in Health Centre waiting areas, whose walls are painted with pictograms that promote key health messages\u2014like encouraging breastfeeding.<\/em><\/span><\/figcaption><\/figure>\n

Working closely with the Ministry of Health and the District Health Officers (DHO) for Blantyre and Zomba, our research team implemented a thorough surveillance protocol. After obtaining approval from the DHO and the Malawi IRB, the first step was to hold a \"sensitization\" meeting with each health centre team. These meetings included introductions, a presentation of our project's rationale, questions and suggestions from healthcare professionals, a discussion on how our team could integrate with theirs for our data collection, refreshments, and conversation.<\/p>\n

Explain<\/h2>\n

Implementation hurdles required flexibility in our original protocol. We had proposed using two different diagnostic tests at the point of care\u2014an mRDT and microscopy\u2014to identify infections that were concerning for parasites with gene deletions. Our intent was to compare these tests and identify participants whose malaria infection was detected on microscopy but not on mRDT, a 'suspicious' combination. However, microscopy was not available at most rural health centres. As a result, we needed to significantly over-screen participants and perform microscopy later at the hospital lab in Blantyre.<\/p>\n

\"Health
Photo courtesy of Meredith Sherman, MED '28. The Health Centre labs\u2014where staff warmly welcomed Meredith's team\u2014allowed them to examine samples, even a live Schistosoma egg under the microscope.<\/em><\/span><\/figcaption><\/figure>\n

Despite an initial target sample of 720 participants, we ended up screening over 1,600 community members. In addition to the increased time in the field, we also faced resource constraints. The cost of the study far exceeded what we had anticipated, and we scrambled to put together additional funding requests. As the season progressed, malaria transmission declined, resulting in lower screening numbers and more field days. Navigating these limitations was illustrative of the practical realities of research outside a lab setting. The Center for Global Health Equity Internship supported my continued work with our research team, which focused on data analysis and manuscript development.<\/p>\n

Feelings<\/h2>\n

This experience profoundly shaped my career passions, my understanding of the world, and my sense of self. The privilege of working on this project and living in Malawi was transformative. My colleagues pushed me to expand my worldview, challenging me to think differently and holding me accountable to step outside my comfort zone.<\/p>\n

The sensitization sessions, held before we began work at each health centre, were among my favorite parts of the project. As advocates for their communities, the health centre workers posed insightful questions and provided thoughtful feedback. These sessions also gave us an opportunity to raise awareness about the problem of gene deletions in malaria control. Many health centre workers were already aware of gene deletions and believed addressing them was crucial. They were excited to participate in our project. Speaking with healthcare workers on the frontlines of caring for malaria in an endemic region gave me insight into the realities of care in lower resourced environments. The resilience, selflessness, and grit of these clinicians, working tirelessly to keep their communities healthy with limited tools, are extraordinary.<\/p>\n

\"Main
Photo Courtesy of Meredith Sherman, MED '28. A main passageway at Queen Elizabeth Central Hospital in Blantyre. QECH is the largest hospital in the southern region and the location of the Blantyre Malaria Project, the site of Meredith's research group.<\/em><\/span><\/figcaption><\/figure>\n

Driving many hours a day to rural study sites with my colleagues, we had conversations about differences in American and Malawian educational approaches, our lives, and political events in both the US and Malawi. A simultaneous source of stress and humor was frequent police roadblocks, which my coworkers supported me in navigating. Our research nurse, Patricia, helped me see how one might view the function of politics and government in a society with less stability. Her pragmatic and candid approach was enlightening, teaching me that a law is only as effective as its enforcement. As a political science major, I valued the opportunity to learn about the lived realities of a distinct political regime. Patricia's approach to life did not hinge on idealism, which allowed her to interpret daily events with clarity.<\/p>\n

The sheer resourcefulness of my colleagues and of other Malawians who supported us along the way left me in awe. From building a lab outside on a plastic chair under a tree to fashioning a tool from a pipe to fix a blown tire, the ingenuity of my coworkers and community members, especially under high-pressure circumstances, was estimable. Rapidly disappearing daylight and crowds of a hundred patients waiting to be tested left them unfazed. I can only hope that some of their composure and conviction rubbed off on me.<\/p>\n

I am profoundly grateful to my Malawian colleagues and to the community members who taught me so much and challenged me to become more receptive, thoughtful, and humble. Zikomo kwambiri (Thank you very much)!<\/p>\n

Findings<\/h2>\n
\"Godfrey
Photo Courtesy of Meredith Sherman, MED '28. Godfrey Mvula, Jomo Banda, and Meredith setting up the thermocycler for their PCR experiments.<\/em><\/span><\/figcaption><\/figure>\n

We still await the outcome measures of our project. Even so, learning how to carry out a research project from design to implementation to dissemination has been incredibly instructive. The numerous ethical questions we faced became some of the greatest learning opportunities of the project. Working with community health leaders and navigating their perceptions of our research team was an unexpected lesson, one that taught me the crucial importance of learning from community stakeholders. By following my colleagues' lead, I limited inevitable blunders.<\/p>\n

Future<\/h2>\n

My time in Malawi has reaffirmed my goal to pursue collaboration and learning in lower-resourced contexts throughout my career. On the first day of recruitment for our study, an elderly gentleman and his wife consented to participate. His wife was affected by kyphosis and was blind. Her husband had bilateral above-the-knee amputations and used his hands to remain mobile. Together, they were surviving in one of the five poorest economies in the world. The callouses on his fingers were so thick that we had to prick the back of his hand for malaria testing. Having this small window into their lives made me view the context of our work, and the broad scope of malaria's burdens, with a renewed seriousness.<\/p>\n

While I am passionate about doing what I can to advance the fight against malaria, my time researching the disease has also exposed me to the limitations of individual effort. Driving our research team down dirt roads, working to integrate with the health centres on arrival, and reflecting on our experience as a team have helped me understand what research is really about: shared pursuit fueled by communal passion.<\/p>\n

While research is crucial to advancing care and can improve lives in a powerful way, our day-to-day work also showed me the importance of taking a holistic approach to health and healing. Moving forward in my career, I consider pursuing mutual understanding to be among the most valuable parts of the drive for systemic change.<\/p>\n

This experience has given me a new perspective grounded in humility, teaching me to listen first, ask questions, and communicate respect. As we recently heard in a global health session at Geisel, one of Paul Farmer's core principles for engagement was \"accompaniment.\" As I progress in my career, I hope to embody this principle and walk with patients and peers in our shared pursuit of greater health.<\/p>\n

Check out Meredith's research on cerebral malaria in Malawi, published in The American Journal of Tropical Medicine and Hygiene<\/em> on June 3, 2025, entitled: \"Intravenous Fluid Bolus Resuscitation Increases Mortality Risk in Malawian Children with Cerebral Malaria.\"<\/a><\/p>\n

\"The
Photo Courtesy of Meredith Sherman, MED '28. The beautiful Southern Region of Malawi! The drives to the rural Health Centres were another highlight of the team's fieldwork.<\/em><\/span><\/figcaption><\/figure>\n
\"Meredith
Photo Courtesy of Meredith Sherman, MED '28. Meredith hikes Mount Mulanje in southern Malawi near Blantyre, a UNESCO World Heritage Site.<\/em><\/span><\/figcaption><\/figure>\n","protected":false},"excerpt":{"rendered":"

by Meredith Sherman, MED ’28 During the Center for Global Health Equity Co-designed, Community-based Internship, I partnered with a team of researchers and public health clinicians in Malawi focused on understanding emerging threats to malaria control. Championed by the Malawi National Malaria Control Programme, our work evaluated the effectiveness of [\u2026] <\/p>\n

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