My New Obsession

My ex-boyfriend gave me the nickname "foodie" almost exactly two years ago. While I initially hated it (I think I kept hearing "fatty," which no woman wants to hear), it's something I've come to fully embrace during my time here in Malawi. I've started to think more than I ever have before about what I put in my body. And not just calories (although what 20-something-year-old doesn't think about that occasionally) but a lot of things related to food: nutrition, and how to forge a nutritious diet when food isn't readily available; challenges of frequent power outages, and how we plan meals with that uncertainty; and most recently – with my bank account almost empty and payday too far away – the cost and availability of different types of food, and how that affects the decisions we make. 

Check out my next post for thoughts on systematic bias in access to nutritious foods in Malawi!

Watch out Martha Stewart..

My cooking partner-in-crime.

Stuffed peppers (with ground beef and brown rice),
fried plantain, and homemade garlic bread! 

Onion curry meatballs.

Dinner is served!

Supervising Community Health Workers

Last week, I spent four days in the field visiting five different health facilities across the Central Region of Malawi. My organization was doing the first round of supervision since our new community health workers (CHWs) completed training two weeks ago, and it was interesting to see the fruits of the two week training. As I’m based in the monitoring and evaluation (M&E) section, my primary task was to assist in the evaluation of our six different tools that we ask CHWs to collect information on. This largely meant spending anywhere between five and 30 minutes looking through a few of the books and papers with colleagues, checking if all of the information written made sense, if all of the relevant questions were answered (such as: what is woman’s HIV status? Who, if anyone, has the woman disclosed to? How far along is the woman, or how old is her baby? Does she have other children, and know the status of those children?), if data was properly transferred from one book into a cumulative log, and if total numbers were added correctly to represent the number of women coming in each day. While it may seem simple enough to answer these questions, different sites revealed that it will take time for our CHWs to adjust.

Although no two days were alike, the most eventful day had the following schedule:

• 9:00 am: Started off early on a bumpy, dirt road to get to a health facility
  10:45 – 10:50 am: Greeted the head person (often a nurse) of the health facility
  10:50 – 11am: Met with the two to three CHWs at each site, and asking for their feedback on the experience thus far
  11:00 – 12:30 pm: Completed the supervision checklist through surveying the CHWs
  11:00 am – 12 pm: Critically evaluated the different data collection tools used (while other colleagues went through checklist), and providing feedbacks on areas for improvement as well as successes
  12:00 – 12:30 pm: Finished discussion and providing overall comments
  12:30 – 1:15 pm: Traveled back into town
  1:15 – 2:00 pm: Ate a hearty lunch of maize-based nsima, rapeseed mixed with peanut flour, and chunks of beef in a tomato stew
  2:00 – 3:00 pm: Traveled on a dirt road to the next health facility
  3:00 – 3:10 pm: Arrived at new facility, met CHWs, and attempted to carve out a space to sit and discuss.
  3:10 – 4:00 pm: Looked over data collection tools, while Manager went through checklist
  4:00 – 4:15 pm: Provided overall feedback and comments
  4:15 – 5:15 pm: Traveled back into town.
  5:15 onward: Spent time looking for affordable but clean accommodation, ate dinner, and went to bed.

While these routine visits were a great way to start getting involved in the overall management of the organization, they were not without their challenges. In particular, the language barrier was a major issue and so I spent much more time observing than participating (and having a colleague translate bits and pieces for me).

Regardless, the most exciting part was realizing that I've been able to witness a complete process since I’ve been here from my observation of the candidate interviews at a health clinic, to the training of new employees, to the observations of their first few weeks on the jobs. The challenges for these health workers – especially in regards to data collection and managing relationships at their respective hospitals – are many; but the rewards of seeing HIV positive women take ownership of the fate of their peers are equally as great.



Also posted at: http://scoutbanana.org/health-in-africa/from-the-field-supervising-new-community-health-workers/

2 Fun Weekends in Malawi

While the challenges of here life are never-ending, I always manage to carve out some memorable weekends. Since a picture is worth a thousand words, I'll let them do most of the talking...

Two weekends ago, I was a "tourist" in Lilongwe. My friend Emma came into town and we took a tour of the nearby Wildlife Nature Sanctuary. It was surprisingly beautiful and a lot of fun! (And I think our tour guide secretly liked us...) 

This is how our tour started (the guide slammed a gun - yes it's
real - on the table)...

They are being serious.

A hyenas' den. Thank goodness they were fast asleep!

Blood wood tree. It has medicinal value, and really looked like blood! 

We kind of saw a crocodile swimming here!

The beauties of nature.

Me and Emma on a huge rock!
(Does anyone know which type of rock it may be?)

A really cool seed.

Our tour guide really liked us.

I learned that a fig tree is a parasite!

Bamboo in Malawi

Loved the birds nests (right side).

That weekend, I also attended my first Malawian wedding (and I actually knew the bride)! We went for the reception, which we thought would start around 12 pm (so we showed up 30 minutes after). Instead, we were the first ones there! Lesson learned! The receptions here aren't like in the U.S. or even other African countries I've been to, where there's lots of food, dancing, and sometimes drinking. Instead, it's almost more like a show where we're part of the audience, and we get up frequently to dance and donate. Sometimes they provide a snack like a piece of chicken or a donut, but you should definitely come with a full stomach and a full wallet!

My friends (Eric and Emma) and I are the first guests to arrive.
And they told us 10 am...

Here comes the bride...

Bridal party.

Me and Emma. They moved us to the front row on account of
our tall azungu friend. 

The bridal/groom party dance to some Naija tunes!

The bride, Aggie, gets down with her new hubby!

It's not a wedding reception if you don't get up, dance, and give
money...several times...(The secret, I'm told, is to carry small bills).

They asked people from the groom's side to give a special
donation. 

The beautiful bride!!

They asked people from the bride's side to give a special
donation, which I did (left). 

The receptions here are more like a show (with lots of donations!).

Groom and Bride.

More dancing and "making it rain."

This past weekend was Malawi's Mother's Day Weekend, which is actually a national holiday here! With the long weekend, I decided to have one good night out at Harry's before joining some friends on the gorgeous lakeside in Cape Maclear. We spent the first day lounging around by the lake, and I attempted to use the traditional canoe (only fell in once!). We went on a boat ride to an island, bought fresh fish from a fisherman while on the water, and had the most delicious grilled chambo I've had in a long time! And, although travel wouldn't be complete without a few hiccups, we had great tunes, great company, and great fun! This was one of the best weekend's here, and definitely the most breathtaking!

Gecko Lodge, Cape Maclear

Ready to go swimming!

Our attempt to canoe. Our boat was a little off balance so I
gave my inner thighs a good workout while Renee used the
only one-sided paddle we were given to propel us.

My friends Joyce and Renee lounging on the beach.

Gecko.

Sunset. Look at those kids showing us up on the canoe...

It was a good night. 

We visited the island on our boat ride.

A Week (or 3) in the Life of Field Work

The challenge – or perhaps the beauty – of working “in the field” is that no two days are like. Some days are filled with activity, as we travel around to different to different health facilities to interact with community health workers at the site level. Some days are, well, uneventful (unless you count all the social media that I’m able to catch up on). The last few weeks have been no exception.

Two weeks ago, I assisted with a community health worker (CHW) training for 25 new CHWs. Although my Chichewa is still lagging, I was able to supervise the monitoring and evaluation components of the training. One workshop that proved challenging for many of the CHWs was the transfer of information from a case study into the logbooks that data is to be recorded in. This activity is crucial because it will impact the quality of information collected and later used to measure programmatic success.

Last week, I attended Malawi’s 2010/2011 National AIDS Commission (NAC) Annual Review Meeting, which was an enlightening two day conference on Malawi’s national HIV achievements and challenges. Through this interaction, I learned so much about Malawi’s national HIV/AIDS strategy from the major players themselves. I met several interesting individuals involved in the fight against HIV, from NAC officials to consultants, human rights specialists to public health professionals, doctors and business people alike. Having worked with Senegal’s National AIDS agency a few years ago, it was interesting to gain a first-hand perspective of another country’s national response to HIV.

NAC Meeting Day 1

NAC Meeting Display

A skit is performed by a local theatre troop, describing the importance of multisectoral collaboration (a not-so-discrete message to leaders)

Minister of Information Patricia Kaliati receives a donated Land Rover from NAC to use in community HIV sensitization campaign

This week’s excitement involved one day in the field, where I visited three different health facilities to observe and evaluate current data collection and quality. One site had superb data in all six tools that we evaluated; another site revealed a need for more constant supervision and support. CHWs also expressed different challenges they faced, including partnership with the health facility, client volume, and HIV test kit and drug shortages (two serious problems in the response to HIV in Malawi).

The other challenge – or beauty – of this line of work is that schedules are often unpredictable. My attempts over the last 19 years of school to follow a schedule have been put aside, as instead I aspire to learn the art of patience and flexibility. One has to be prepared to attend a meeting with 10 minutes notice, or to spend three days waiting to hear what task is next. I'm not sure what's planned for next week, but it is sure to be another adventure.


Also posted at: http://scoutbanana.org/health-in-africa/from-the-field-a-week-in-the-life/

Lake of Stars: "This is Africa" - Part 2

Although the amazing festival and beautiful lake made for an exciting weekend, the most exciting part was our failed attempt to return to Lilongwe on Sunday morning. While the two other Lilongwe residents intelligently left at the crack of dawn, the rest of us attempted to soak in as much sun and fun as possible, hoping to fill up on positive vibes until the next reunion. So around 11:30 am, as we attempted to depart, the fun – and the reminder of what it means to say T.I.A.: “this is Africa” began…

After checking out of our lodge, we rode to the festival site in the back of our friends’ pickup truck one last time, thinking this would get a quick transfer to the bus station from there. The “quick” transfer translated to a bicycle taxi (manual, not motor) to the main road – encouraged by our friend Dezio – and an one hour ride we hitched in the back of a pick-up truck with 17 Malawians (one of whom essentially straddled me the entire trip), two canisters of fuel, and a rope strung with several fish.

Once we arrived in Mangochi boma, we were guided to the bus stop where expected to easily catch a coach bus to Lilongwe. Two hours later, there was only one minibus whose destination was Liwonde, a town one hour south of Mangochi (and in the opposite direction we were intending to travel). Time was ticking, the sun was waning, and we had no hope of getting to Lilongwe. I desperately tried calling co-workers and my few friends here, and the suggestion was what Leah and I had deduced from our travel guidebook: to give up going to work on Monday and stay the night in Liwonde, home to hippos and lots of wildlife. We agreed we’d salvage the day and make our extended trip into a mini-vacation; the catch was just getting there.

As the two-and-a-half hour mark came around, the bus continued waiting for more passengers. So when our friends, who’d spent the whole day enjoying the festival and the lake, offered us a ride to Liwonde, we decided to take that. We attempted to get our money back from the bus driver, which was an epic failure! The driver couldn’t understand me at first, and then gave me a resounding “no refund” when he did understand, proceeding to raise his voice enough to get the attention of other drivers at the almost abandoned bus station. Two drivers began heckling me (to which I started yelling obscenities and telling them not to touch me), and when Leah tried to descend from the bus, they wouldn’t let her. One grabbed her hand and tried to close the minibus door on her, which resulted in her punching him, and the driver proceeded to enter the driver’s seat and try to drive off. And in the midst of our yelling, I realized that Leah’s bag was in the trunk. My tone completely switched to those congregating around the bus – “please, sir, just help us get her bag” – and thankfully, someone unlocked the trunk so we could grab it before the driver recklessly drove off. We walked as quickly and purposefully as we could to the main road, attempting to hitch a ride to Lilongwe but eventually settling for our free ride to Liwonde with our friends.

And although this would have been a nice end to the adventure, our arrival in Liwonde kept the sense of adventure alive. We decided to splurge for the only hotel whose listed number was in order, a spread known for its view of hippos with its cheapest rooms at US$80 per night (a huge jump from the typical $20 accommodation and a substantial portion of our monthly stipends). But when we saw how dumpty the least expensive rooms were, all we could is laugh. We decided to pay a little more for an upgrade, but the $90 room was covered in cockroaches and ants. We decided to enjoy a yummy Indian dinner at the hotel before heading to a nearby bed and breakfast, where we ended our long day on the riverside drinking Carlsberg and listening to the hippos snoring before retiring to our single twin bed.

The next morning, we hoped to finish our journey with as little adventure as possible, but as luck would have it, the “T.I.A.” weekend was not complete! We enjoyed breakfast on the riverside while watching hippos before attempting our journey back. After 10 minutes, we caught what we were told was the only coach bus to Lilongwe for the morning, along with the 80 or so people already on the bus (half of which were standing in the aisle). We set our backpacks on the floor, created makeshift seats, and tried to ignore the few cockroaches that scuttled by. There was a kind woman who adopted us throughout the journey, ensuring that newcomers didn’t steal our standing space. And eventually, I was promoted from sitting on my backpack sitting on a fuel canister for the remainder of trip.

The day – and the Lake of Stars extended weekend – ended with a fantastic lunch of nsima and beef stew, some fun discussions with the Rastas selling curious in town, an important purchase of Prozyquantil (to treat the Schisto worms I could have contracted from swimming), and – of course – a burger and free beer from, you guessed it, Harry’s bar! All-in-all, it was the best weekend in Malawi thus far. Indeed, “this is Africa.”