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.

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.

Zomba

This week I was sworn in as a Peace Corps Response volunteer by the US ambassador to Malawi and began my year long service in the city of Zomba. I was excited to hear that I would be moving to Zomba as everyone was saying it was a beautiful place. I also knew that there was a plateau to the north of the city that would be great to hike, bike and climb. (The trout fishing is supposed to be very good also, so come on down dad!) It was the capital city of Malawi during the british colonial rule so there are broad treelined streets, colonial styled buildings and even a golf course that runs through the center of town.

I arrived yesterday afternoon and have not had much time to explore, but I am quickly falling in love with the place. My house is a few kilometers east of the city center in a well planned community called Matawale. It is small house surrounded by a brick wall and has a small front and back yard. I have electricity and indoor plumbing that includes an electric water heater for hot showers! It has a living room, dining room, kitchen, bathroom and three bedrooms. I am working on getting some furniture, but once I do I will be well equipped for visitors. There is even a great view of the plateau from my front porch, which is a great place for the morning cup of coffee.

There was a Peace Corps volunteer living in the house before I arrived, and she had made friends with the neighbors. So the first night I was here 12 year old Kenny came over to say hello and welcome me to the neighborhood. Tonight I was invited over to his house to say hello to everyone. They were all very nice and have lent me a shovel and hoe to work on my garden. Kenny walked me around the block to show me where the local store was located and then over to his aunt's house so that I could see the proper way to plant a garden. I am hoping to get to work on my garden this weekend.

Today was also my first day of work at the Zomba City Assembly. Malawi is working on decentralizing their government by giving more responsibilities to the 28 district assemblies and 4 city assemblies. One of their main roles is to coordinate the country's response to the HIV/AIDS epidemic. I have been placed with the Zomba City Assembly to assist them with their HIV/AIDS strategic planning, coordination of stakeholders and monitoring & evaluation systems. I met some motivated people at the office today that are going to allow me to really enjoy my job over the next year. After only knowing each other for a few minutes we were able to share some of our experiences and analyze some of their current challenges and frustrations. I am sure that it will be a very trying year, but the fact that I am in it with some folks that really care about the work they are doing will mean a lot to me.
The city assembly is near the center of town and right next to the state house. It is situated on the hills coming down from the plateau and surrounded by tall trees. The front steps go down to a small stream running around the golf course. The banana trees and greenery give the place a tropical feel. As I said, it is an easy place to love.

I am hoping to make a trip to Blantyre city this weekend to visit one of my colleagues and buy some things, bike up the plateau and start the garden, so I will write more about this amazing place soon!

The land of acronyms

I am swimming in Peace Corps alphabet soup. Here is a quiz for everybody...
PST
IRC
PCRV
EAP
And some global health soup too...
PMTCT
PLWHA
OVC
MCP

ANSWERS
Preservice Training
Internal Resource Center
Peace Corps Response Volunteer
Emergency Action Plan

Prevention of Mother to Child Transmission (of HIV/AIDS)
People Living with HIV/AIDS
Orphans and Volunarable Children
Multiple Concurrent Partners

And that is just the beginning...