Thanksgiving at the East Bank

          A few days ago right outside the gate of Nsanje District Hospital, an old woman, topless with flabby loose breasts, bent down to pick up a mango pit from the ground and promptly delivered it to her mouth to suck it.  A few feet away she spotted a brown banana peel and she picked that up as well.  She was like the many goats milling around there scavenging for discarded edibles.  A frail blind old woman holding a walking stick was guided by a youngster, probably her grandson standing at the door of a store at the filling station hoping to be given something.

This week my team and I are spending our time at the East Bank.  The rain which is expected about now has not come, the farmers are growing anxious.  We stay in Thekarani up in the mountains so the nights are windy and cool. I took a walk our first evening here and lo and behold as my mind was on Thanksgiving I saw three turkeys pecking away by a church yard, the white turkey looked quite ancient. 

Turkeys in Thekerani

          On Thanksgiving morning, children in Thekerani were going to school, many were not in uniform and almost half of the children were barefooted.   Two boys were walking slowly to the market aimlessly obviously they were not going to school.  Another two about fourteen years of age walked with a grown man who carried a sack.  The boys were in shirts filled with holes and shorts that barely clad their skinny bums.  They sat on the curb rather listlessly.  The man reached into the sack and produced two small loaves of bread which he gave to the boys who bit into them slowly.  There was no beverage to wash them down.       

Thanksgiving is a time when we should sit down and count the many blessings bestowed on us: peace in our country, loved ones, family and friends, food, shelter, financial security…I feel particularly blessed when I travel and volunteer in many countries where I witness the daily struggles of the local people for their daily bread, people who are caught up in war and conflict and their lives are turned upside down by them, natural disaster, hunger, famine or people dying because of lack of healthcare.   

            At Great Grand Rounds, we saw a HIV-infected young man who began treatment six months ago came in with signs of meningitis.  He was started on medicines to treat bacterial and cryptococcal meningitis.  He was no longer awake and was drawing on his last breath.  He died shortly after we left him.

            Two people were attacked by crocodiles this past week while fishing in the Shire River.  The man’s arm was injured but he was lucky not to lose it.  However the young lady lost her left arm as the crocodile ripped it off when she reached into the river to catch fish.  A medical assistant estimates that they see about four crocodile attacks a month at the hospital. 

Woman and Crocodile Attack

          As we drove downhill one day from Thekerani to the East Bank, a father frantically flagged us down and asked for a ride to bring his five month pregnant daughter to Thekerani Rural Hospital run by MSF, it meant going back up the mountain from where we just came.  She looked well but he was worried that she was anemic.  She had not had any prenatal care having been hiding her pregnancy from her father as she got pregnant after staying with a friend.  The father was wearing an oversized pinstriped suit, his forehead beading with sweats.  We would bring his daughter and told him MSF restricts us to one accompanying guardian.  Backtracking is not recommended but if we were to go forward she would have to go to Trinity Hospital, a paying hospital.  A few hundred yards later, he yelled out to the driver to stop and apparently another daughter had come from Thekerani to meet them.  She then boarded the cruiser and the father got down, we were under the impression that his home was close by.  Later we learned that father and daughter had walked all the way from Trinity about 15 km to this village to discuss with the man who impregnated his daughter what he planned to do.  As we drove back again we saw him climbing the road towards Thekerani Hospital, still wearing his jacket in the heat.  I felt really bad that we did not realize how far he had walked and he still had a distance to walk to the hospital.  If I had known, I would have broken the rule of one guardian on board.

            Later the same day we took a young woman who was bleeding at her fifth month of pregnancy to Trinity.  Our visit to the East Bank is always filled with surprises.  The bridge that will take us straight to Makhanga in the East Bank within an hour instead of the five hours is still being built and the date of completion has been pushed from November to February.  We drove to see it from the Makhanga side crossing a solid iron railway bridge over the Shire.  This bridge was built years ago and still remains strong. 

The Railway Bridge

The Mtayamoyo Bridge Viewed from the East Bank

          My family is gathering at my son’s place in North Carolina for Thanksgiving.  I was not able to hang out with them on Google video because there is poor intermittent or no internet access in the East Bank.  For a brief moment I was able to skype with them, I was thankful to hear their cheerful voices.    

            This weekend I will gather with Erin and her friends to celebrate a belated Thanksgiving in Blantyre.  Two Thanksgivings ago I was in Dadaab, Kenya where a fellow American volunteer was so lonely for his family that he retired to bed early.  It’s a great blessing to have your family close by and treasure them as much as you can while you have them.

            Happy Thanksgiving!

How the Other Half Lives

         

          Limbe and Blantyre are full of expats. I realized that when we were asked to go to Hillview School, an international school in BCA Hill for their annual Christmas Fair. I was just going to pop in for a little while being more interested in going hiking in Satemwa Tea Estate that morning.  A group of Malawian children stood outside the school fence at the entrance gawking, trying to catch a glimpse of what was going on in the school yard while school children arrived in cars driven by their parents.  I would be one of those kids outside the fence when I was growing up. Somehow I do not remember having been envious of the kids inside the fence or that life had dealt me an unfair fate.  I knew that I had to work hard to change my situation.  Wandering around the school yard filled with festivities, abundance of crafts, gifts, food and drinks and Christmas music in the air, I could not help but felt a twinge of sadness for the inequality of life and the disparity between the privileged expats, well-to-do nationals and the local poor.             

         The day before I walked deep into the BCA or British Central Africa Village right below the BCA Hill, I tried once to penetrate it but was deterred  by a couple of young men right outside a bar from which loud music streamed out.  They looked at me with glassy eyes, having had a little too much to drink.  One of them said it would make him very happy if I could give him money to buy a drink.  I carried no money with me and told him so.  Standing right at the edge of the village prudence told me that I should not venture into it that evening.  I turned around and walked right back up the hill.  This time I walked into the village greeting the villagers in Chichewa and somehow that always brought out friendly responses and I felt safe.  Some people called out,”Mupitakuti?” (Where are you going?).  The houses were small mainly of bricks with worn out stucco, topped with tin roofs. Narrow, rugged roads with sharp stones crisscrossed the village.  Children, most in ill-fitted dirty clothes and some boys with big gaping holes in their shorts revealing their bare bottoms, walked bare foot, unperturbed by the jagged rocks protruding from the road surface.  Women and men sat on the road sides selling produce, second hand shoes and clothes.  Minibuses arrived at the entrance of the village leaving a trail of choking dust behind them.  Most of the land has been cleared for planting. The people of the village are just waiting for the first rain to fall before seeding.

          That week the water main broke and a string of women balancing big buckets on their heads; walked up the hill a few kilometers to the water department to fetch water.  The people living on BCA Hill have huge water tanks and life went on as usual unperturbed by this event.

          The same evening we drove to Thyolo in a MSF minibus to the Thyolo Sports Club.  At the entrance was a group of locals sitting silently at the edge of the road.  Expats and well-to-do nationals drove in for the night was for the celebration of Guy Fawkes Day.  Guy Fawkes was involved in the Gunpowder Plot of 1605 in an attempt to overthrow James 1 for a Catholic monarchy.  However the plot was uncovered. The locals must have experienced this celebration in years past and partook of the festivity as observers outside the sports club.  The kids outside the gate sat on the ground in the gathering gloom quietly while the rambunctious kids inside ran around in the lawn doing what kids should do.  A bonfire was lit as an effigy was burnt.  The evening ended with a display of firework. We the privileged ones left in our cars leaving the locals behind.  I hope we do not take this privilege for granted.

Dog Days

         

Now we are in November which promises to be hotter than October, we are experiencing heat waves of temperatures in the forties degrees Celsius which translates to over 100 degrees F. Last week it reached 108 degrees F. In the office, the electric supply is not powerful enough to work the air condition in the medical part of the building.  While the coordination section enjoys the coolness of the AC, we struggle with two rotating standing fans blowing and circulating hot air at us.  Sometimes not even that as there was no electricity. Sweats trickle down the backs of my legs and I feel like I am in a sauna.  Soon I am sitting in sticky wet clothes literally.  My walks to and from the hospital in this temperature have not been pleasant even the dogs leave me alone having dug themselves holes in the ground for their long lazy naps. Ku Tentha kwanmbiri (It is very hot)

At night my nightgown and the sheets get drenched despite the fan which blows hot air.  Outside however there is always a cool breeze which makes me long to sleep outdoors but that is not possible.  We actually have it better than when I was in Kenya/Somalia when the generator was turned off by nine in the evening and the ceiling fan stopped whirring.  We lay in our beds in our sweats, not a breeze came through the window.  We once kept our door open to let some breeze through but this was met with protestations from the Kenyan men who lived in the same compound with us.  This is a mostly Islamic area. We heard about the complaints through the grapevine not directly from them.  While they could open their door ajar the women could not.

            In the hospital when the temperature reaches above 100 degrees F, the AC ceases to work.  The conference room where we hold meetings is usually flooded with sunlight and Malawians seem to always come very late to a meeting and love long meetings which do not help.  The sweltering heat makes one sweat through one’s clothes and one’s forehead is covered with the wet stuff, throats are soon parched and with no safe water source, some staff go out to buy water.  My bottle of water is hot and the water does not quench my thirst.  After all these years of MSF presence in hot Nsanje, our office in the hospital has no filtered water and I put a mental note to request one for my mentors.

            As we walk out of the office in mid-afternoon, hot sultry air just blasts us in the face and burns our skin, wilting our will to carry on but carry on we must.  

            A local neighboring Malawian boy rigged up a small fan using discarded materials and operated it with the use of a solar panel as he and his friends rested on a mat outside his house.

Neighboring Boys with their Fan

          

This past weekend, our new expat from Argentina who joined us two weeks ago asked one of our drivers to take us to the base of the mountains to Chididi. With this Argentinian expat in Shire House, we are no longer an all women team.  One of the expats from Belgium became ill two months ago and left and so there is a vacated room for him.  The driver took us to the wrong place and some local women told him where to drop us.  We brought plenty of water for it was a hot day and we could not start early because the driver does not begin working till after seven.

            The Australian expat and I took the lead, trailing behind us and struggling were the Filipino and Argentinian, stopping frequently to rest.  This route is apparently the short cut used by the people of Chididi to go to the Nsanje Boma and it traverses over three slopes.  We met many locals who were wondering why we were trekking to Chididi.  The Argentinian off-handedly said,” We are just hiking to Chididi to get a cold Fanta!” The locals do not walk this route for leisure only the Azungus. As a matter of fact the Argentinian being in logistics was planning to build a wading pool in the backyard of Shire House for us to cool off.  He was hoping to get some timber from Chididi.

            It took us three and a half hours to reach cooler Chididi where the Argentinian negotiated to buy some lumber.  The locals gathered somberly at a funeral service but were distracted by our arrival.  A few boys were catching some giant ants for a snack.  Another driver waited for us by the Chididi Health Center to take us in the cruiser back to the withering heat of Nsanje. I had tried to organize hiking in Mulanje in the past but none of the girls was ever interested. And so I remain the only expat who had climbed Mulanje. I gave the Argentinian a great deal of credit for mobilizing some of the expats to hike and sacrificing their habit of sleeping late on the weekends.   

Boys Catching Insects for Snack

         

           It rained heavily for an hour in the afternoon when the pool was completed and it was partly filled with rain water. The drawback is it blocks the view of the mountains in the backyard. We dipped in it after work for the first time, watching the sunset.  

Our New Pool

In Foreign Land

             Today is my birthday.  I spent a majority of my birthdays in foreign soil but I suppose I can’t really say that since I consider America as my country.  Back in Malaysia at least when I was growing up birthdays were not celebrated.  So I was surprised when my best friend in secondary school gave me a present on my birthday, my first and I turned it down!  Why? My mother often reminded us that we were not to accept anything from anyone unless we truly earned it.  I did not realize that one does not have to earn one’s birthday presents.

             When I came to Wellesley College in the States my very first birthday was lavishly celebrated by the dorm governance and my college “Big Sister”.  She took me to a Bruins game getting the tickets for free by telling them that her “Little Sister” from Malaysia had never been to an ice hockey game. It was during the time when Bobby Orr’s was her worshipped hero.

                Since I started volunteering over the last seven years I spent four of my birthdays in Africa.  The first was in 2006 in Kampala, Uganda when I taught in the Infectious Diseases Institute of Makarere University under the aegis of the Infectious Disease Society of America followed by my time in Masseno, Kenya in 2008 when my housemates managed to bake me a cake.  I did not do anything special on the actual dates but both times I rewarded myself with hikes up Rwenzori Mountains and the Lanana of Mt. Kenya.

Near the Top of Mount Margherita of Rwenzori

At the Top of Mt. Lanana of Mt. Kenya

          My third time in 2011, I spent the day in Marrakesch, Morocco wandering the numerous meandering streets of the Medina with their Berber market or souk.  The square however was still medieval with many depressing performing snakes and monkeys kept in tight cages, never to taste freedom again.  

The Spice Souk

          My fourth time is now in scorching hot Nsanje in the sweltering and withering heat conducting HIV training in a health facility in Ndamera.  Today there is not a cloud in the clear blue sky.  It was a particularly hot stuffy night,night gown was drenched and stuck to my back despite the fan.  I was troubled with my migraine and new muscle ache and bone pain, hopefully they are not harbinger of mysterious illness to come.  Despite all that I went running around five in the morning.  

           Other than hanging out with my kids on Google Plus the weekend before my birthday, and receiving birthday messages from friends and family my birthday passes quietly. Almost everyone in Shire House is away.  Charles sent me a message that it is snowing in New York on my birthday just for me.  I received two letters from Cara, a package from home but alas all the contents were meant for Kuyvina (four cat toys and a Cat Fancy magazine!) and all these took almost two months to arrive in Nsanje. My Wellesley class sent me a greeting with a November picture of Lake Waban, the oak trees only bore sad looking brown leaves reminding me of a somber message on the board in front of a nursery in Westboro: No leaves, No flowers, November (and No Kuyvina to boot and what is a vember anyway?).  Even Kuyvina is away in Limbe to be neutered; Kuyvina Akumwa kuwawa (Kuyvina is in pain in Chichewa)—almost an alliteration!  The Australian expat Mel (who has taken to calling me Dr. Q or mate) and I decided to add Mavuto as Kuyvina’s last name.  It means “trouble” or “problem” in Chichewa. 

Kuyvina Mavuto Resting decadently in My Room

          But then I am not really alone.  There is Roger who slobbers all over me with his tongue when he greets me in the evening.

Roger Greets Me

Blantyre

            I traveled to Blantyre this week for a TB/HIV Integration meeting called by the Ministry of Health (MOH) to discuss rolling out the program to Nsanje.  The person who called the meeting was attending a TB conference in Paris and I was doubtful that this meeting would take place but since we could not reach him I left for Blantyre only to learn that indeed he just landed in Malawi and the meeting would not take place till later in the week.  Blantyre, being in the highlands, is at least five degrees Celsius cooler than Nsanje.  I could not do any of the field work in Nsanje while in Blantyre but there is absolutely nothing I could do about it.

            Blantyre is the second largest city in Malawi after the capital, Lilongwe.  It was founded by the Church of Scotland through missionary work in 1876 and named after the town in Scotland where Dr. David Livingston was born. Dr. Livingston’s missionary work led to the building of St. Michael’s and All Angels Church in 1891 with arches, domes and flying buttresses. Rev. David Clement Scott who managed the construction had no formal architectural training and the church was built with the help of local people with no knowledge of this kind of architecture.  I attended an English church service in Malawi for the first time one Sunday when I was in Blantyre since I have not been able to find a church service in English in Nsanje. I was in awe of the different brick designs and arches in the building. 

St. Michael's and All Angels Church

At the south Side of the Church

     

           Mandala House is one of the oldest buildings in Malawi.  It was built in 1882 with mud, grass and bricks and was then the first house which had another house sitting on top of a house.  Locals came to gape at it and crawled up the stairs cautiously.  It was called Mandala because John Moir wore glasses or Mandala.  John and Frederick Moir, the two brothers who ran the African Lake Corporations, traded in coffee, clothing, ammunition and hardware. It has a shop and an archive library and also a cafe where one could have a light lunch and drinks. 

Mandala House

   

           The National Museum is not much to write home about.  There is an exhibition of the life of Dr. Livingston in the lower section to celebrate the bicentenary of his birth.

The Women Returning Home with their Babies and Bucket of Unsold Food

            In Limbe where I stay when I visit Blantyre, the guesthouse Fargo is on BCA Hill which stands for British Central Africa.  I was given this piece of information by a Malawian man one evening when I took a walk in the neighborhood.  The hill is dominated by nice homes inhabited by expats and rich Malawians including the ex-President all fenced in by brick walls topped with barbed wires and slivers of broken glass, guarded by twenty-four hour security guards and agalu olusa or dangerous dogs. Down in the valley is where the poor locals live in tinned or tiled roofed houses. The houses here are mostly of bricks and not haphazardly patched together with tarp, mismatched corrugated sheets or wood as in the houses in the slums of Kampala or Nairobe .  

           The man waved his hand towards the BCA Hill, " That's where our people go to work."  

            Even years after independence, there are still traces of colonialism in the hierarchical order of the social system here.  All over the slopes of the hills around this region the land has been furrowed and ready for the growing season. Men chip painstakingly at big boulders to form small gravels for sale as building materials to earn a living wage. The disparity between the well-to-dos and the poor is rather stark.  However in my walks I find the locals are always friendly and break into a ready smile with my Chichewa. Around four in the morning the call to prayer arising from the mosque in the valley invariably elicits a chorus of howling from the dogs.

The Valley Below BCA Hill

          

          At the outskirt of Blantyre is the Bvumbwe (Wild Cat) Market where I asked the driver to take me one Saturday morning.  It is a large local market selling produce, meat, second-hand clothes and chtenjis. This is where we get our vegetables which are grown in the cooler region of Thyolo: cauliflower, cilantro, broccoli...which we cannot get in Nsanje and they are brought to us via the weekly transport from Limbe to Nsanje.  In a corner I found a cobbler repairing shoes that had seen their good old days but to the poor they were still salvageable.

Bwumbwe Market

The Cobbler

Malawi Capital Hill Cash Gate Scandal: Mundiepatze Ndalama Zanga! (Give me my money!)

         

             Early this October, the headline on the front page of the Daily News announced “Capital Hill Billion Mess”. It was learned that billions of kwachas had been looted by government officials. The German ambassador warned that the Malawian government cannot blame the computer for corruption; people ran computers and the computers did not commit the fraud and the Malawian people and the donors are entitled to know the truth.  The Malawian government used the Integration Financial Management Information Services (Ifmis), a computer software in government payment system.

            Since then investigations revealed that at least 90 billion k had been pilfered from the Federal Treasury from 2009 to 2012 and the current Vice president is linked to the looting and the past regime is at least responsible for the systematic stealing with at least seven identifiable schemes including paying off companies which did not provide any services, cashing checks without vouchers and cashing large sums without the signing off by senior authorities.  In view of the large sum of money missing from the treasury, IMF has now withheld seven billion k. from Malawi. Some politicians lament the fact that programs which have started will not be able to continue until the latter part of next year because of the withheld money. But what about the harm caused by this looting?

            The news broke while President Joyce Banda of Malawi was visiting US.  She came back and fired her cabinet members.  However it is now emerged as well that since 2012 while she has been President; 20 billion k has also been stolen from the coffer.  A week after the news broke, Britain announced it would send a forensic auditor team to help to identify the perpetrators.  Three commercial banks in Blantyre have been authorized by the Malawian Reserve Bank to honor government checks of any amount which seems a recipe for fraud. It has also come to light that the previous president Mutharika when he came into power in 2004 declared his wealth at 150 million k but when he died of a heart attack in 2012 his wealth had grown to 60 billion k.  He was found to have three bank accounts in Australia, Singapore and the Isle of Man. One wonders when he thought he would have time to enjoy all that with three houses in Singapore and two presidential flats in Australia to boot.  He evidently did not count on the fact that despite all the wealth he was powerless to determine how long he had on this earth.

            Corruption is probably rampant in many Africa countries given the fact that many of them receive huge amount of foreign aids.  People at the government level must be tempted to siphon off large sums of money hoping that their misdeeds would never be discovered.  Or do they feel that they are entitled to some of them? 

            When Malawians are asked what they think about the stealing, they are not surprised but express disgust that hard-earned money of the taxpayers and donors which can be used to improve healthcare conditions and the school systems are pocketed by greedy politicians.  Foreign donors are equally outraged by the news. 

            The newspaper enumerated what the 110 billion kwacha could do for the healthcare sector, agriculture and the school system.  For 110 billion kwacha, 40,000 medical doctors could be trained at the Medical College, 16,500 classroom blocks could have been built so children do not have to huddle under trees to study, 44 irrigation schemes could have been completed within a year.  This last thing is of utmost importance to Malawi given that it still depends on rain-fed agriculture when it has vast supply of water: the lake and the Shire River.  The irrigation scheme named the Green Belt Initiative stalls because of lack of funding.  The food insecurity problem of Malawi could have been solved if indeed this scheme works

            The budget for the healthcare sector is around 48 billion k per year, just about half of what was stolen from 2009 to 2012.  Almost all the healthcare facilities that I visited in Nsanje District are in need of maintenance and repair and ambulances are either non-functioning or in need of fuel for their operation.  The District Health Officer (DHO) of Nsanje District Hospital often has to request fuel aids from MSF. He has been quoted in The Nation as to the fact that 20 billion k could provide all the health services in Nsanje district for 80 years and 110 billion for 440 years. 

The other day after Grand Ward Rounds, one of the medical assistants informed the DHO that they were out of bandages and plasters (Band-Aid in British English, they use plasters here to secure IV lines).  The DHO lowered his head and said,”I suppose we just have to work hard to persuade the patients not to get sick.”

School started during the first week of September, at least half the children walk to school barefoot and many carry no books, and some have only an exercise book in a plastic bag.  In the south parts of Nsanje, numerous students gather around a board under a big tree while their teachers hold classes there.  This week while we drove to Sankhulani healthcare facility, the crowded primary classrooms have no windows; the bricks border the window frames are loosening and falling apart. 

If the politicians had a heart and a conscience they would not have looted the Malawians and endangered their lives because of a half-baked healthcare system or the children which should be the future of Malawi of their much needed education.  We pass schools with NGO’s programs on school meals.  While many NGO’s spend time, effort and money to feed these children at school, the politicians choose to enrich themselves even at the expense of stealing food from the mouths of these children.  

            One seldom sees fat ordinary Malawians at least in the villages, the politicians appearing on the newspapers are often rotund, double chinned, meaty and certainly are by no means starving.  Joyce Banda announced that the country silos are suddenly low or almost empty of maize and the people will be starving.  Emergency measures have to be taken to buy maize from South Africa and Zambia to feed the country.  Did someone also siphon off some maize to feed their bellies?

            The children here sometimes ask, “Give me my money!”

            I reply, ”I don’t have your money.”

            A kid once ran past me and said, “Give me my money buying shoes.”

            I have now learned to say,”Mundipatse ndalama zanga!” (Give me my money in Chichewa).  This often surprises them so much that they just stand there staring at me with their mouths wide open.

            The politicians behave as if the public funds are theirs to take and spend.  Indeed on one of the front pages of The Nation were shown some of the new homes built by the “looters”.  At the same time there was an article where the World Bank was quoted as saying that if US would contribute 4.5 billion dollars to Africa to develop its agriculture and boosts its development and productivity it would solve the hunger problem. It stated that 70% of the African women are in agriculture but they are not allowed to own land because of local customs and many Africans lamentably survive on 1.25 US dollars per day.  Would this amount of money really solve the hunger problem if corruption is rampant?  I rather doubt it.