Environmental health expert makes a difference in Malawi

Dr Tracy Morse - Malawi

She is the University of Strathclyde fellow who has devoted almost two decades to leading vital public health research projects in rural Malawi.

Since 2000, Dr Tracy Morse has managed life-saving projects and led research in the African sub-Saharan country to improve child health through water, sanitation and hygiene interventions to help prevent diarrhoeal diseases.

Tracy, who is based in the country’s second largest city Blantyre, is based in the Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED) at the University of Malawi, a centre built from the partnership between Strathclyde and the country.

Two years

She works alongside a team of academics and researchers to teach environmental health and conduct work in the field. But Tracy, who is bringing up her two children with her American teacher husband in the country, only ever intended to stay for two years.

The 43-year-old, who coordinates University of Strathclyde activities in Malawi and is originally from Aberdeenshire, said: “I came here to complete research for my PhD, but this led on to funding from the Scottish Government’s international development fund, based on our research.

The opportunity to work in public health in this setting is as incredible today as it was 18 years ago, and I’m grateful that I still have the chance to do it with such a great team of people, both in and outside Malawi.”

Among the world's least developed countries with around 85 per cent of people living in rural areas and an economy based on agriculture, Malawi’s population suffers from a number of preventable diseases. One in every five children has diarrhoeal disease at any given time and it is responsible for approximately 11 per cent of under-five child deaths.

Food safety and hygiene play a vital role in reducing and controlling it, but the majority of rural households don’t have running water at their homes, while one third of the population has no access to an improved form of sanitation. With soap also a limited luxury, maintaining good hygiene practices can be extremely difficult.

Changing behaviours

As the national coordinator of SHARE (Sanitation and Hygiene Applied Research for Equity), which works across four African countries, Tracy is leading research on the effects of food safety and hygiene interventions on diarrhoeal diseases among under-fives.

She said: “Our research is focusing on changing people’s behaviours in order to get sustained improvement. We are working with populations who are incredibly poor, so when you are trying to get people to change how they behave you have to look at all their other priorities.

“We can come along with all these great ideas, but a family may be more concerned about having food than whether the food their child has is safe to eat.

“We spend a lot of time understanding the community dynamic and context in terms of who has influence and who mothers and fathers are likely to act on advice from.

“As humans we are all subject to social norms – doing as others do – so if we can manage to shift the normal behaviour to an improved one, then we can achieve sustained changes as a consequence. “

At grass roots level, locals have also been so impressed by SHARE’S work that some parents have given the project the ultimate seal of approval by naming their children after it.

Tracy said: “There are some unusual names here but that was a first, to have two babies called Share.”

Health and wellbeing

The programmes are primarily focused on the United Nationals Sustainable Development Goals to promote health and wellbeing for all ages, part of a collection of 17 global goals set by the UN General Assembly.

The Scotland Chikwawa Health Initiative, for which Tracy was project lead for from 2006 to 2016, is a prime example.

A collaboration between the University of Strathclyde, the University of Malawi, and the Ministry of Health in one of Malawi’s poorest districts, it ran preventative health projects which included research and water and sanitation interventions and disease control and prevention, as well as maternal health.

During seasonal heavy rains, many roads become impassable and due to the area’s remoteness, many women were forced to give birth at the roadside before they could reach medical help.

Tracy said: “We used funding to help build waiting clinics for mothers who were pregnant. They are communal places where pregnant ladies can stay in the weeks leading up to the birth so they don’t have to travel once labour starts.

“We also helped build better housing to ensure there were qualified nurses in place, as these hard to reach areas are not the most attractive area for staff.

“In the past the baby could even end up being delivered by a cleaner or a guard because the nurses were off site.”

 Health workers were also provided with motorbikes to transport vital vaccines and improve access to health care, after a donation from Scotland from Phoenix Honda

Village health clinics, which improved access to under-five growth monitoring and vaccinations and a high dependency unit at the District Hospital, were also built. Many of these were supported by charities and organisations from across Scotland, including FROM Scotland and the SSC (A Club for the Youth of Scotland), who visited and helped do some of the building works.

The project also supports a girl’s hostel at a secondary school in Chikwawa to improve access to education for girls.

Tracy, who is a former Strathclyder of the Year and recipient of a Strathclyde Medal, which recognises people who have made an important contribution to the University values in their work, relationships and achievements, said: “Over the years we’ve done so many different things, we can categorically say that we have improved the infrastructure and access to health services for thousands people across Chikwawa.”

Dr Tracy Morse - the SHARE programme

Tracy, who has five research programmes ongoing until 2022, added: “The communities are very patient and open to being supported but one of the biggest problems is managing expectations.

“We are encouraging people to help themselves wherever they can in very challenging circumstances, and it can take a long time to develop working relationships. But we have built a lot of trust because we spend time with the community itself, as well as community chiefs and religious leaders to explain exactly what the purpose of our visits are.”

Key successes so far have included the learning from the project being fed into the country’s national Community Health Strategic Plan and the scale up of the teams Village Health Committee training toolkit recently adopted by the Ministry of Health.

Tracy added: “My work is very rewarding or I wouldn’t still be here after 18 years. It can be difficult to live and work here – electricity is in short supply and we don’t have it for a third of the week. There are certainly lots of challenges, but Malawi is a beautiful country and I really love my work and the fantastic team that develops, implements and evaluates these programmes alongside me.

“You couldn’t ask for a more rewarding environment to work in.”