Peace Corps responses to HIV/AIDS from within

Hi all,
I am back from a long blogging hiatus with a piece that I wrote for Peace Corps' 50th Anniversary. Enjoy!

Peace Corps responses to HIV/AIDS from within

What does the response to the HIV/AIDS epidemic look like nearly three decades into this ravaging disease’s tenure? How can we come from abroad armed only with knowledge of the epidemic and the will to make a difference and translate that into action which leaves a positive impact? These are difficult questions to answer. We have learned from years of experience that there are many development strategies that do not work and some that even become counterproductive, creating dependency on aid or destabilizing local economies. However, we have also seen development programs that give us hope, that originate from within communities and respond to the root causes of our woes. That we all have the ability to make change may be true, but good intentions alone will not suffice. Just as with other development programs, an effective response to HIV/AIDS is hard won and comes from within.

In my brief experience in Malawi working with the Department of Health and Social Services at the Zomba City Council the key to eliciting the answer from within lay in finding those willing to critically assess their role in responding to the epidemic and supporting their efforts. Thinking holistically, my counterpart and I took a closer look at how the department ensures for the delivery of all of its health services. Our first step was to better understand the health and wellbeing of the city’s residents. Moving from anecdotal observations to systematically collected information, we shaped a clearer picture of the health of Zomba City, acknowledging the heterogeneity of the city. From such a perspective, we are able to prioritize improvements in key health services in critical areas of the city and have united with all of Malawi’s urban councils to seek structural changes in local governance, allowing motivated Malawians the opportunity to better serve those in need.

Just as HIV/AIDS destroys the body’s ability to fight off infection and heal, mismanaged and underfunded health systems take away the government’s ability to prevent disease and provide treatment and care for those suffering. Improving health systems is like prescribing ARTs, as it enables the country to regain control and heal itself. In development jargon it is called health systems strengthening. It is the slow and strategic process of realigning the country’s public health services to respond to the HIV/AIDS epidemic and other health challenges. It is not a quick fix, but consistently pursued it is a crucial part of the HIV/AIDS response as well as an important step toward improving the overall wellbeing of Malawians.

I consider it a privilege to have been a small part of this important process in Malawi and it is my sincere hope that Peace Corps Malawi will continue to play its important role, in villages and cities, to promote sound development from within.

Mike Dalious
Peace Corps Response Volunteer 2010-11

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.

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…