Friday, October 29, 2010

Palibe Petrol

After a busy and hot week in Lilongwe I woke up anxious to return to Zomba for a relaxing weekend. Then I heard the dreaded words "palibe petrol" (there is no petrol). My ride back to Zomba was in a petrol car, so my plans have changed. I will wait until tomorrow when there is another car heading south that runs on diesel.

Malawi has been experiencing petrol and diesel shortages for the past few months. Added to the electricity blackouts that are occurring almost daily (there is a hum in the background as I type this, a generator running to supply power to the office), it is evident that Malawi is in an energy crisis.

What does that mean for development? Just like my trip back to the south, it is delayed, opportunities are lost and people are frustrated.

Friday, October 22, 2010

Dark Star Safari

I have been reading the book Dark Star Safari by Paul Theroux for over three months now. Theroux was a Peace Corps volunteer here in Malawi during the 60’s, the final years of the British Protectorate. In the book he is documenting his present day travels from Cairo to Cape Town.

Each morning as I wait for my ride to the office, I sit on my front porch, read a few pages and reflect. Theroux is traveling mostly over land to experience Africa some forty years after serving as a teacher in a school near Zomba. His writing is highly critical of both the “agents of virtue” and the state of African development. Constantly questioning the charities running feeding programs and even the work of foreign teachers, he contrasts his memories to current realities, being disappointed by the resulting conclusion that things are worse now than they were then.

As a Peace Corps volunteer, it is not a cheery read. Theroux, turning 60 during his long safari south, is a man torn by his compassion for the continent’s people and his frustrated desire to see things improve. I struggle with his grim assessments and find myself comparing myself to those in his writing. Will what I am doing last? Or is what I am doing further stunting the development of an independent and productive Africa? And on a more personal level, will my compassion only lead to a frustrated and bitter life?

Professionally, it is my responsibility to continue to ask these difficult questions, to evaluate my work with a critical eye. However, I often think that being who I am and having experienced what I have experienced, I have little choice but to continue. I see my happiness in the fleeting moments when I connect with those around me, in the discovery of new places and ideas and I see the contentment I seek which rests in the self acknowledgement of my earnest, if modest, efforts. Though I am uncertain of my impact, I am confident in my good intentions and that is the best that I can go on.

So as I read of a journey south through the heart of Africa, I open my mind and my soul. I listen to the criticisms and doubt. I acknowledge the potential for benefit or harm. Daily I live the pages of this book and share in the experiences of so many others making small steps towards a more just world.

Wednesday, October 20, 2010

Rabies

Why push for health systems strengthening? Because there are not enough Global Funds, PEPFARs and President’s Initiatives to support our vertical response to every preventable or treatable disease out there.


I am glad the readers of this blog probably have no use for the following information. I wish that were the case for everyone.

Rabies is a viral disease that causes acute encephalitis (inflammation of the brain) in warm-blooded animals. It is zoonotic (i.e., transmitted by animals), most commonly by a bite from an infected animal but occasionally by other forms of contact. Rabies is almost invariably fatal if post-exposure prophylaxis is not administered prior to the onset of severe symptoms.

The rabies virus travels to the brain by following the peripheral nerves. The incubation period of the disease is usually a few months in humans, depending on the distance the virus must travel to reach the central nervous system. Once the rabies virus reaches the central nervous system and symptoms begin to show, the infection is effectively untreatable and usually fatal within days.

Early-stage symptoms of rabies are malaise, headache and fever, progressing to acute pain, violent movements, uncontrolled excitement, depression, and hydrophobia. Finally, the patient may experience periods of mania and lethargy, eventually leading to coma. The primary cause of death is usually respiratory insufficiency.

Worldwide, the vast majority of human rabies cases (approximately 97%) come from dog bites. Rabies kills around 55,000 people a year, mostly in Asia and Africa.

Source: Wikipedia @ http://en.wikipedia.org/wiki/Rabies

Grieving

Our differences are so apparent, often intriguing at other times infuriating, it is easy to overlook that they are far outweighed by our similarities. Today I looked into the eyes of another human being and saw them grieving the loss of a loved one. The empathy experienced created a bridge of mutual understanding which made all of our differences seem as they are, insignificant.

And then there was one.

I arrived to Malawi with two fellow volunteers. We actually met in the Johannesburg Airport boarding our flight to Malawi. Mike O. was coming from Albania where he had served in the Peace Corps and then worked for several years with World Vision International. Richard was coming from a freshly completed Peace Corps service in Botswana, where he was working as a district AIDS coordinator. We spent two and a half weeks in and around Lilongwe for an orientation then were sworn in as Peace Corps Response volunteers by the US ambassador. Richard and I headed south to our sites in Blantyre and Zomba. Mike O. headed to the west for his site in Mchinji.

Backing up a bit in the story, I was recruited by the Peace Corps to serve as a response volunteer in Malawi, a job I was happy to take because I wanted work experience in Africa on health systems strengthening projects. Peace Corps was recruiting for 10 response volunteers that they planned to spread out over Malawi in an attempt to support the response to the HIV/AIDS epidemic. They only got three. I chalk it up to a limited pool of qualified candidates and well let’s say life. If you have finished the Peace Corps and have a graduate degree, you are no spring chicken. What you are is in that middle ground between running around and settling down. Mike O. and Richard were already married and a few years older than me. It was clear that we were all looking for something.

Well, a week into our service, Richard flew back to the States for his home leave. Having come straight from Botswana, the Peace Corps gave him a month to go back and catch up with his family and friends before returning to work. After a little delay, we heard that he was not coming back. So then there were two.

Mike O. and I got along great. He is a light-hearted guy that is quick with a joke (that’s what she said, Mike) but who also has a serious hardworking side too. We were the two response volunteers in country, Mchinji Mike and Zomba Mike. We hung out a few times when we were both in Lilongwe for work or a wedding, and we sent text messages, emails and called back and forth a few times.

Unfortunately Mike’s counterpart was a dud and it was difficult for him to get anything moving. The first time around in Peace Corps this would be considered a very normal occurrence and a process of growth for the volunteer as they experienced how things can come to a halt despite our best efforts. As former Peace Corps volunteers, Mike had experienced this already and was not up for a repeat performance. I can’t blame him. As Peace Corps Response volunteers, we expect tangible work assignments and the resources to accomplish them. I got lucky, as in Zomba I found a motivated counterpart and quickly got funding. Mike made the best of his situation for a while, but then made the decision to go home, a decision that I fully support, though I am saddened to see him go.

And then there was one. As the sole survivor of Peace Corps Response Malawi, I have to ask myself what it is that I am doing here. I laugh to think about the old Army commercial’s slogan, An Army of One. In development work, nothing seems more ridiculous than a sole person—especially a foreigner—trying to move seemingly inert government employees and policies and improve the lives of so many. Development is a collaborative process beset with trials and errors. It is a learning process that thrives on communication and good will. And it is a process that needs to reach a critical mass or it will simply stop. As one volunteer, I have to face the fact that it is unlikely that my efforts alone will have a lasting impact on the health and well-being of Malawians.

I need not only to finish my work here in Zomba; I have also to ensure that it is scaled up across the other cities in Malawi. I have to make the case that the urban population’s growth is bringing with it new health and social challenges, and if the government of Malawi continues to neglect the health of its urban residents by supporting a poorly implemented decentralization of the Ministry of Health that favors rural service delivery, urban residents will suffer. My counterpart sees this and is working to change the current structure of health within the government. Peace Corps Malawi is also supporting my efforts to establish an urban M&E system for health, so that the cities can have a better understanding of the health of their residents. And of course we are lucky as there are only four major cities in Malawi, and there is a potential for placing new response volunteers in the other cities in an attempt to roll out the M&E system countrywide.

Will it work? I don’t know, but I am certain that I cannot do it alone. Peace Corps Malawi and the Government of Malawi will need to make substantial investments over the coming years to see this project to fruition. I only hope that I can set them rolling in the right direction.

Labor Intensive Development

There is a crew of men painting a center line down the main road that runs from Lilongwe down through Zomba and on to Blantyre. They have one pick-up truck with a large barrel of paint, some orange cones, paint brushes in varying states of wear, a length of string to make straight lines and small paint buckets made from an assortment of plastic containers. I have seen these same guys working for over a month now painting this one line—sometimes solid and sometimes dotted for passing zones—that stretches on for over 300km. When you see something like this it stands out in your mind and you think about how it is done back home. I think of a high-tech truck that can drive down the road cleaning the area with pressured air and then paint it with a spray-paint gun mounted on the back of the truck. This truck would have some flashing lights and drive at about 10 miles per hour, meaning that two or three guys could accomplish the work of 40 or so in two or three days instead of several months.

There are a lot of us that think sending a truck like this to Malawi would be a good development project. I can see the proposal now—roads painted faster and more accurately, more efficient use of paint, better paint retention time, less traffic obstruction, less risk for road workers, etc… All it would take is the one truck and we would send back reports each month on how many miles of roads have fresh lines to keep the drivers of Malawi safe. Until of course the truck needs maintenance or the spray-paint gun breaks and there are no parts for it in country. The cost of the truck, the shipping costs, the maintenance costs are negligible costs in terms of foreign aid, though combined they could probably pay the current crews wages for the next year. Employing Malawians to paint provides a steady income for the men who would otherwise be unemployed. All of their supplies are available locally and they can adjust their work schedule to the amount of funding annually available for road painting, unlike the high-tech truck which has high upfront costs.

So Malawians should say no to the high-tech paint truck right? Thank the donors for their good intentions but politely decline the assistance. Well, it doesn’t often work this way. Aid is political and often the beneficiaries in the proposal are not the only beneficiaries of the project. Government officials are inclined to keep saying ‘yes’ to aid projects, as those who decline are seen as difficult to work with and may miss the next round of handouts. And though the high-tech truck might not be a good development for the workers, modern equipment is seen as a sign of progress, a sign that the current political party is working for the people. To further complicate the issue, we might discover that the road workers, who were hired out of the capital city and have been living away from their families for months at a time, have a higher likelihood of contracting HIV and spreading it along the length of the main road—Lilongwe to Blantyre.

So do we like a high-tech solution or a labor intensive solution to paint lines? These are the often seemingly simple yet convolutedly complex decisions of development work. As for me, I say stick with the labor intensive method, but hire the men locally and spend a little more on training and safety. All of that to decide how to paint a line on a road, now let’s stop an HIV/AIDS epidemic…

Tuesday, October 19, 2010

Monday Morning

Monday morning rolls around. I wake up with two cups of coffee and head into the office. What to do this week? I have made my annual plan, my monthly plans, and each week I come up with a list of things to do. These plans help to keep me heading in one direction, but they are by no means day-to-day plans. You can’t force things here. It is a game of patience and diligence to accomplish anything. To know the right people, to approach them in the right way, to do so at the right time, and it often seems, to have a bit of luck; this is what it takes to check off each item on the list.

In a resource-starved environment often with under qualified though thoroughly networked staff, round about ways of accomplishing tasks develop that while being foreign to an outsider get the job done. When I get locked out of my office, there is not one person to go to. Instead I ask around until I find someone who happens to have the spare key to the room where the spare key to my office is located. When I am trying to obtain a copy of the reporting forms for health centers, I visit the health centers that refer me to the District Health Office then to the Zonal Health Office then to the central ministry and pick up an additional form or two at each place I visit.

Complicating things, at every step of the way there are three additional tasks that could be taken on. I am working to improve the coordination of the HIV/AIDS response in Zomba City by creating a monitoring and evaluation system that will collect key pieces of information from health providers in the city, which will be later used to make informed health programming decisions. However, right now we are not able to properly administer our bursary funds for orphan and vulnerable children meaning that there are children out there who could be in school but aren’t. We are not providing food supplements to city employees living with HIV which help them take their medications and retain their jobs. And sadly, I have just been informed that one of our secretaries, who has been cooking lunch for me since I arrived, has died from rabies after being bit by a dog this weekend. Apparently we need to revisit our rabies vaccination efforts as well.

In the face of it all, it is easy to understand how people can become demoralized. Some blows can take away your breath while others seem to deprive you of the air around you. However, day by day we make incremental steps towards a healthier Zomba City: by teaching an environmental health office how to use a GPS unit; by encouraging our data entry clerk to submit timely reports even to government agencies that are not cooperative with us; by incorporating rabies control efforts into our M&E system. Though they often do not appear in work plans and are difficult to measure and appreciate, they may be the most lasting efforts we make. They quite literally are the blood, sweat and tears of development.

Thursday, October 14, 2010

Zomba City Council's Website!

Check out the Zomba City Council's website. (where I am working as an HIV/AIDS Technical Advisor)(www.zombacitycouncil.org) It has some nice photos of the city and talks a little about the services that our office provides.

Sunday, October 3, 2010

Expat

“An expatriate (in abbreviated form, expat) is a person temporarily or permanently residing in a country and culture other than that of the person's upbringing or legal residence. The word comes from the Latin term expatriātus from ex ("out of") and patriā the ablative case of patria ("country, fatherland"). This "Latin" term comes from the Greek words "exo" meaning outside, and "patrida" meaning country or fatherland.” (http://en.wikipedia.org/wiki/Expatriate)

Map of Malawi