Burch Fellowship Scholar – Burn Prevention in Malawi

– written by Marissa Bane, Health Policy and Management student and Burch Fellow

As a burn survivor, I had dreamed of working at the Kamuzu Central Hospital (KCH) burn unit in Lilongwe, Malawi for several years, and I was finally able to go this past summer as part of the Burch Fellows Program. The burn unit was founded in 2008 through a partnership with UNC Hospitals to help improve outcomes for burn patients. Because the unit is relatively new, they had no knowledge on burn prevention in Malawi, and they did not have the resources to research and fund a program. At first, I did not understand why it was important to research burn prevention strategies in Malawi. In the United States, we already know how to prevent burns – for example, we know not touch a hot stove or let children near a pot of boiling water. However, if we tried to implement our burn prevention strategies in Malawi, most would be completely useless and even confusing. The challenges Malawians face regarding burns are very unique, and burn prevention strategies need to be relevant to them.

Open flames are the cause of the majority of burns in Malawi.  Marissa's project aimed to educate Malawi's citizens on fire safety and burn prevention.

Open flames are the cause of the majority of burns in Malawi. Marissa’s project aimed to educate Malawi’s citizens on fire safety and burn prevention.

With the help of UNC surgeons, I created and translated a 35-question survey that was asked to the parent of each child at the burn center under eight years old. Prior studies have shown that children bear a disproportionate share of the burn injury burden, which is why this specific age range was chosen. The goal was to understand how serious burns occur for children, as well as the environment surrounding the accidents. To do this, it was important to assess other factors potentially affecting the burn accident, such as underlying health problems and bad weather. The survey consisted of five main sections, which included basic demographics of the burn patient, socio-demographics of the patient’s primary guardian, cooking style in the home of the patient, child care in the home of the patient, and information about the burn accident.

Marissa with a family in Malawi.

Marissa with a family in Malawi.

We discovered more than half the burns were cooking-related. Further, most people in Malawi are dependent upon fire for survival. They use open flames or unsafe traditional stoves several times a day for light, heat, cooking, bathing water, and manual labor. At the time of the burn, only 23 percent of mothers were with the patient. Further, 22 percent of patients had no one looking after them when they were burned. There were several other discoveries that were found to be extremely helpful when considering burn prevention in Malawi. Information collected from the study should be used to help create effective burn prevention strategies for those in sub-Saharan Africa, which is why I plan to present my findings from the study at Harvard University’s 2015 National Collegiate Research Conference, as well as produce a publication under the guidance of UNC surgeons.

I loved my time in the beautiful place I now call a second home. I learned so much during my time in Malawi and built some amazing friendships. My heart was broken by the poverty, especially the failing health care system. And while I know my research will not change everything, my hope is that I can change the life for at least one person. As a burn survivor, I know the pain and hardship a burn produces. Therefore, if I could prevent the burn of just one Malawian, I would consider my research a success. They call Malawi the “Heart of Africa,” and I now know why. I will never forget the people I met and the experiences I had.

Community-Based Research: An Approach, not a Methodology

On November 7, the Office for Undergraduate Research and the Carolina Center for Public Service offered a workshop on Community-Based Research (CBR). Dr. Beth Moracco from the Gillings School of Global Public Health talked to over 50 students about what CBR is and what it isn’t, why it’s an extremely important and relevant approach to research, and the challenges involved in doing CBR. She was also clear that there are research projects and situations where CBR would not be appropriate or effective. CBR is not about getting feedback on something you’ve already decided to do or findings you’ve already developed.  It is about “conducting research with people, not on people.”Moracco agenda

Dr. Moracco learned some of the basic principles embedded in CBR, like mutual respect and listening to community members, during her time as a Peace Corps volunteer. Other principles of CBR include engaging multiple stakeholders in all phases of the research, shared decision-making, commitment to long-term relationships and more. CBR believes in “bidirectional” learning–both the researchers and the community have knowledge and should learn from each other; however, it’s also necessary to acknowledge power and privilege differentials. CBR is rooted in an ethos of social justice; it makes explicit its goal to engage in inquiry and discovery that results in social change for the good.

Conducting CBR is not without its challenges. It is time-consuming to build relationships and trust with communities. There can be conflicts between the researchers’ agendas and the needs and desires of the community members — and community members themselves may differ on what takes priority or has the most salience for their lives.

Dr. Moracco traced the history of the development of participatory research and CBR and noted that increasingly funders expect CBR approaches to research questions; CBR can also help build capacity and develop the sustainability that funding agencies demand. Although the gold standard of CBR is to involve the community from the very beginning of the project, it is also possible to employ CBR in specific aspects or components of a project. Dr. Moracco said that you can use CBR “anywhere or everywhere in the research process.” She shared many examples from her own research experiences, both locally and globally, as well as telling us about CBR projects undertaken by students in the School of Public Health. According to Dr. Moracco, there is a substantial body of evidence demonstrating that interventions and policies developed using CBR are more effective.

Thanks to everyone who attended the workshop and to our colleague Dr. Beth Moracco for taking the time to share her knowledge and expertise.