Nurses of the World: How a Malawi Nurse Defied Expectations to Pursue Her Calling

Editor's Note: This piece is part of a series highlighting the vital role nurses play in health care systems around the world. Look out for more stories on nurses from Partners In Health (PIH) sites in the weeks leading up to International Nurses Day on Tuesday, May 12.

When Chisomo Kondowe arrived at the Mulanje Mission Hospital in Malawi to begin her nursing career, she thought she knew what to expect.

Kondowe had dreamed of becoming a nurse for years, undergoing skepticism from her family-who wanted her to pursue law-in addition to the intense coursework and preparation required to enter the field.

Soon after Kondowe started, the hospital matron, one of the senior leaders of the hospital, took notice of her. She saw Kondowe's potential and quickly promoted her to nurse in charge, which meant Kondowe would be running the maternity ward almost immediately out of nursing school.

She was 22 years old.

Kondowe was thrilled and excitedly accepted.

"I think (the hospital matron) understood me well," Kondowe said. "I was young and I was willing and I showed enthusiasm into taking up that role."

But it soon became one of the "hardest and most challenging" experiences in her professional career.

Despite her initial eagerness about the role, Kondowe hadn't had formal leadership training and was learning her new position while already working in it. She felt immense responsibility to care for the mothers and babies in her unit.

To make matters worse, some of the older nurses talked poorly about her because of her age.

"I had nurses who were older than me who undermined my leadership, who would look down upon me," Kondowe said. "Who even coaxed the mothers saying, 'No, she's too young to take care of you.'"

But Kondowe refused to give up. She stayed and learned, growing into the leader the Hospital Matron always saw in her.

Now, decades later, Kondowe has brought her passion and experience of being a nurse leader to Abwenzi Pa Za Umoyo (APZU), as Partners In Health (PIH) is known as in Malawi, and has helped to transform care and passionately serve the country's children.

Kondowe "Heard the Calling" of Nursing

Kondowe's father did not want her to be a nurse.

"He kept on saying, 'It's a low paying job. You will be forced to be taking care of all your relatives.'"

But when Kondowe's grandmother got sick and she began caring for her, her passion for the profession only grew. Kondowe helped her with her medication, eating, walking, or even just sat by her bedside. Over time, Kondowe watched her grandmother grow healthier. She imagined being able to provide the same consideration and care for all patients, even ones who were not her relatives.

Rather than pursuing law, as Kondowe's father hoped she would do, Kondowe applied to nursing school. She felt that being a nurse was "embedded" in her.

"We always said if you're becoming a nurse, you must have heard the calling of becoming a nurse," she said. "You just didn't walk into nursing, but you actually had a call upon your life that you're going to be a nurse."

It's been decades since Kondowe was a nurse in charge at the hospital in Mulanje. Over the years, she was promoted to Antiretroviral Therapy (ART) Coordinator and eventually Hospital Matron-taking over the role of the person who once saw potential in the 22-year-old Kondowe.

Her work in nursing has taken her to different countries, including South Sudan, where she was an international registered midwife for a project aimed at reducing maternal and neonatal mortality in the country.

Then, in 2021, she joined APZU as a pediatrics nurse mentor in Neno District. Kondowe helped run APZU's newly established Pediatrics Development Clinic (PDC), a unit focused on providing comprehensive medical, developmental, and nutritional support to high-risk infants and children under 5 years old.

Chisomo Kondowe at the five-day Partners In Health (PIH) Nursing Education Workshop held in Blantyre, Malawi. Joseph Mizere / PIH

"One of the biggest changes that I really appreciate was removing the stigma," Kondowe said. "There was a lot of stigma around women having children with disabilities, women having children with complications, and how much of the time they were discriminated in our community. But when PDC came, there was a lot of change: women would come out openly, women would invite other women to the program."

The initial goal was to enroll 100 children in three years.

At the end of the first year, there were more than 300 children involved with PDC. Over time, with nutrition support, physiotherapy, and tailored treatment for the specific needs of the patient, children were able to be discharged back into the community.

To date, more than 950 children have enrolled.

"That's why I have so much attachment to the PDC," Kondowe said. "Because it's something that we saw how it started, and the steps that were added to the program, and how it grew to become what it is today."

"Why Am I Jumping?"

Throughout Kondowe's career, her leadership has sometimes brought challenges-but always with the best interests of her patients in mind.

Early in her career, before Kondowe joined APZU, she was a nurse in the maternal ward of a different hospital. There was a patient who had been in labor for a long time, and Kondowe was growing concerned. When she told the doctor, he kept encouraging her to "wait one more hour," Kondowe recalled.

She pushed back, even though she worried the decision would be unpopular, because she knew the mother needed treatment immediately.

"At first I thought I would get in trouble for that," she said. "But I said, 'No, let's get in trouble for the safety of this mother and her baby.'"

They both lived.

Kondowe said the interaction-though tense at the time-set a precedent for the hospital. Higher standards were set to ensure doctors were capable and willing to do work the right way.

In the next year, the hospital reported zero maternal deaths-an incredible achievement, especially given that Malawi's maternal mortality rate is at about 225 deaths out of every 100,000 births. That's over 13 times the amount in the United States, which is at about 17 deaths per 100,000 births.

Kondowe learned to trust herself and push back for her patients, even if it was hard. She recalled a lesson a teacher gave on the first day of nursing school, which she has carried with her ever since.

"She came and then she asked us as a class, 'If somebody came to you and said, "Jump," what would you do?' Most of us answered, 'I would jump.' And she says, 'No, no, no. That's not how you bring about change in any place or in any profession, especially nursing. Because if somebody came to you and said, "Jump," you should be able to ask them, "How many times am I supposed to jump? Why am I jumping? What is the outcome of the jumping?"'"

Chisomo Kondowe (right), assists beneficiaries at Neno Community Hall in Neno. Families affected by food insecurity received bags of maize, cooking oil, and beans. Joseph Mizere / PIH

Kondowe hopes to see more nurses becoming empowered and innovative-which is one of the reasons she was drawn to join APZU later in her career. She took notice that the CEO of PIH, Sheila Davis, is a nurse, in addition to noticing the amount of grants and fellowship opportunities supported by PIH to expand nursing leadership training and growth.

Kondowe is passionate about connecting nurses to one another and creating spaces for them to support each other.

"Because of being mentored at a younger age, I was able to motivate others to say, 'It's not about how old or how young or where you are coming from, but it's what you can bring out from what is being put before you.'"

Two years ago, she was promoted from pediatrics nurse mentor to primary health care manager at APZU. She spends her days in Neno, working to strengthen health systems with patients at the center of all decision making.

Now, every day, she lives her "calling."