Body in Motion

To walk in another’s shoes
September 5, 2009, 8:00 am
Filed under: development, health, malaria, poverty

I recently found myself in a village on the doorstep of a community health worker with two colleagues, a Malawian and an expat.

We found a woman and her two children in the house, the younger of whom was of indeterminate age, a sure sign of malnutrition and growth stunting. These children have an eerie look about them: a larger head with an older face upon a tiny wiry body. This child was 2 1/2 but probably weighted what most one-year olds do. We were told the child had been in and out of the nutritional rehabilitation program multiple times. The child was the last in a line of 7 or so children and the father had died the previous year. No, we were assured, the mother tested negative.

The community health worker believed the child had malaria. The nearest health center with drugs to offer was 15km or a two-hour walk away. There is no motorized transport in this tiny village, only a 20-minute drive from the main road. A bicycle taxi would have cost 500 Malawi kwacha or $3.50.

Community health worker bike

Community health worker bike

The mother opted to sit in the dark cool of the community health worker’s house.

My colleagues and I drove away.

Among us, the Malawian has what most of us would call a desk job, though make no mistake of how integral she is to all that we do. The expat is more of an old hand at what life and health looks like out in the bush. We sat in the car, rehashing the situation.

“If that were my child,” says the Malawian, “I wouldn’t care if it were a 2-hour walk. If my child needed care, I would go.”

“It’s not that simple,” says our bush-hand. “It looks as if that is a problem mother. Plus it’s not just the walk – she will have to carry the child there and back herself.” There are structural issues. What will it cost the mother to go, even if the medicine is free? Will she not be able to collect firewood for the evening? Will she have to bring her other children with her on the walk? Did the nurses yell at her for her stunted baby the last time she went?

“Besides,” I say, “I don’t think the child has malaria.” It’s dry season and we are high above the lakeshore. In fact, many studies have shown that only 1 of every 2 people treated for malaria in sub-Saharan Africa actually test positive for the parasite. Malaria is a catch-all for any unexplained fever.

“I would still take my child,” insists the Malawian. “In my village [where her family is from; she grew up in town], the community would organize men to go with her, to carry the baby.”

I listen to my colleague carefully.

There are two truths before me: 1. My colleague and I have a more common perspective than she shares with a villager, despite their nationality; and 2. Structural issues, lack of malaria and all, if it were my baby, I would walk too.

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Heartbreak and Hardship
May 16, 2009, 11:46 am
Filed under: africa, development

I was in South Africa recently, preparing for a site visit to a school for disadvantaged children. We were warned ahead of time that the school was heart-breaking. The group going to the site was from across Africa with a few Asians thrown in for good measure.

When we arrived at the site, we were stunned. We found ourselves at a rural school, K through 9, occupying an old house. There were a few containers for overflow classes, and literate but unqualified teachers. The children were fed lunch each day and sat for their national exams at the end of the school year.

Heart-break? We looked at one another. The children before us all wore shoes, there were no distended bellies or hair singed orange from lack of nutrients.

We shrugged. This school looked no worse than what we saw in the places we had come from – even those from outside of the continent.

As I looked at the school children who walked a dusty hour to school in the cold South African winter and probably had little at home to keep them warm, I wondered if our collection definition of heartbreak had become so inured to hardship. We were a group of development workers who considered hardship and marginalization to be the norm.

Two days later, we drove through Mamelodi, Pretoria – a township for poor blacks in the apartheid era, now a mixture of up-and-coming neighborhoods mixed in with shantytowns that stood blatantly in the face of economic development.

On the left, the road was lined with small sturdy middle class homes, clothes lines hung heavy in the morning sun. Garages and staff quarters behind, paved driveways leading behind their modest brick compound walls.

On the right, clothes dried against the tin walls of shacks that looked as though they would survive a serious wind gust but for the shack next door propping each one up like a line of dominoes. Only there weren’t lines, there were muddles of shacks built illegally on the dry South African dust.

The Gini Index ranks South Africa as one of the most disparate countries in the world and it isn’t hard to see the contrast for yourself. The South African malls peddle designer clothes, shiny housewares and bold cinemas just 20 minutes from landfills where shantytown residents comb their neighbors’ trash, looking for anything that might be worth a few rand.

It is still difficult for me to call that rural school heartbreaking. There are reasons that school had children from Malawi and Zim and other countries throughout the region: South Africa has an economy which trundles along fairly well in comparison to its neighbors; and that is why people come to SA. To find opportunity which eludes them in their homelands. Despite South Africa’s race riots last year, the influx continues.

What I find heartbreaking is that native South Africans live in dust and squalor across the road from their compatriots with a house, a car and a holiday once a year.

Perhaps us development workers aren’t as jaded as we think – but it’s not so much an absolute that rattles us – rather it’s the contrast of desperation in a middle income country where the tax-collecting government promises so much more than it delivers.

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Malawi Annals
March 30, 2009, 6:32 pm
Filed under: culture, development, elections, Malawi, malawian culture, politics

The Afrobarometer has just released some new data on how Malawians see themselves, their government, the state of the country and their political system and it’s pretty telling.

A quick peek at the new survey data shows that Malawians overwhelmingly see government as their parent – not their employee, that over 70% of those surveyed believe the government has the right to close a newspaper, that 74% claim to have voted in the last presidential election and that food supply is the biggest problem Malawians think is facing the country. And if you want a sneak preview of May’s elections, most say that if the elections were tomorrow, they’d support the incumbent, Bingu wa Mutharika. They’ve even given him an 83% approval rating.

Having lived here for some time, I am not too surprised by these survey results but they do seem to highlight the influence of the early direction a young democracy takes in its development.

Kamuzu Banda, Malawi’s first post-independence leader, did his best to set the stage for many of these beliefs. A 1964 Time article on the fledgling leader, just 9 weeks into his thirty-odd year term as President for Life and Ngwazi (Great Lion), alludes to a ban of public meetings (remember when I mentioned this as the reason that Lilongwe is so spread out?), Banda’s invention of himself as a father-figure to the country, and his autocratic leadership style. Let us not forget: this is the man who banned television.

After an entire generation and then some grew up with these beliefs, it is any wonder that 73% of Malawians believe that the government shouldn’t allow contrary views to its own?

With the elections scheduled less than two months off, it’s worth taking a breath to ask how democracy shapes itself. The root of support for the current president isn’t much of a secret. Malawians list food shortages as their biggest concern; Mutharika started a fertilizer subsidy program that has kept Malawi stocked in maize, the main staple, with enough to left over to keep the export market going and a healthy stream of forex coming. Most people believe the elections will be reasonably free and fair which leads one to believe that Malawians will get the president the majority of them elect.

While support for a politician across regional and tribal lines may be something relatively new around here, it doesn’t mean that a maturing African democracy will look much like what we see in the Northern Hemisphere. Fifteen years into a multi-party democracy doesn’t provide a lot of history to stand on and many Malawians are still displeased by the way primaries were set up for parliamentary and local elections. This year’s presidential race aside, over 70% of Malawian believe it’s difficult to have their voices heard outside of an election year (though I would guess most Americans would say the same).

What’s telling is that 30% of Malawians believe that the country should try another form of government. Banda may have fought hard to keep China out of Malawi, but today’s government has welcomed the Chinese with open arms and coffers. In the post-Cold War era, the lines drawn in the sand between friend and foe look are a different shade entirely.

Chances are, Malawi will continue down the road with some form of democracy -hopefully guided by Malawians themselves- though this Westerner struggles to understand how a democracy with a populace that doesn’t believe in freedom of thought will achieve what its citizens strives for: food security, a water supply, an end to poverty and economic development.

Coffin Row
November 21, 2008, 6:29 pm
Filed under: development, HIV/AIDS, lilongwe, Malawi, poverty

There is a place in Lilongwe called Coffin Row. Headstones with plastic flowers encased inside are displayed on the side of the road outside shops. When life expectancy for Malawians is around 50, the coffin business is a thriving one. One in every eight children dies before his or her fifth birthday and about 14% of Malawians are HIV positive.

It’s easy to see how hope gets lost. A church sign along Coffin Row cries “Winners’ Chapel: Home of Breakthroughs!” and I wonder how many people stop there on their way to find a coffin. Does that stop increase the odds of extra years before they themselves become the object of a coffin search? Do they realize their alcohol abuse and promiscuity deliver them closer and closer to the door of “Heaven-bound Coffin Parlour”? Or are they simply reminded of the beneficence of the creator, who will be waiting with open arms on the other side of the light?

Winners' Chapel

As I pass the House of Respected Last Homes, it seems the plastic flowers protected from the elements, enclosed in a tombstone, have a longer chance at longevity than that those who are alive in this country. In a malnourished country where billboards promote “Energy Coffins – 24 hrs!” and margarine as an energy source, that which should sustain us seems a mockery of a healthy life.

Energy Coffins

Living in a place where mangoes rot on the ground while children suffer from Vitamin A deficiencies pokes even further at the bitter irony of looking life and death in the face at every turn. Perhaps I’m due a visit to the Winners’ Chapel.

October 3, 2008, 5:07 pm
Filed under: colonialism, culture, development, drc, music, roads, travel

When the Malawian dust alongside the road fades to the Mozambican, it’s hard to notice the difference. But as soon as you pull into Mocuba, the first town on the Mozambican side of the border, the mud road widens into a dilapidated boulevard and the once-graceful Colonial Portuguese buildings lean their roofless walls into one another. Only the cathedral survived the war in-tact.

Mozambique is like a cross between Lebanon and Congo, with trees growing tall out the tops of long-abandoned buildings amongst the empty remnants of a polished town. The fingerprint of post-Colonial war is the common thread, with handicapped children playing the parts on this mock-up set of a thriving settlement.

Once you reach the coast though, all bets are off. The Mozambican character is so unbelievably unlike the Malawian. For as much as the war played a role in this place’s development -or lack thereof- the Mozambicans are full of life, music and style. Both men and women wander the streets on a night out with a background of Portuguese dance music lulling the body into a smooth glide over the customary jaunt.

The war feels farther away here though supposedly there are still landmines in the surrounding hills. There is a generation who missed school and literacy rates are staggeringly low.

That being said, Mozambique has one of the fastest growing economies in the region. With broad freshly-tarred roads expanding before the eyes, you can’t help wonder what the Malawians have against street lamps that the Mozambicans don’t.

It’s a whirlwind of cultural collision;, making it difficult to believe two places could share such a lengthy border. But Lake Malawi, the pride of the western shores, is hardly heard of in Mozambique, where the Indian Ocean glitters for over a thousand miles. It’s hard to say what has formed the diverging character of these two neighbors: the sea, the Colonial powers that occupied them (a culture of modest tea-drinking Scottish missionaries versus one of stained glass cathedrals with Mediterranean wine), or simply the innate differences that form the character of two siblings, close in age but nevertheless, far apart.

The dust of the road crossing back into Malawi obscures the lingering taste of fresh prawns and it’s not long before the smell of the sea is gone from the nostrils. It’s only the fingerprints whose touch remains, with a Cathedral standing tall, amongst the battery around it.

The Face of a Dollar a Day
April 6, 2008, 4:27 pm
Filed under: africa, bednet, children, cholera, development, driving, health, malaria, poverty, roads, water

Since I was little, Sally Struthers has been asking us to sponsor a child somewhere in the world who is living on less than a dollar a day. I’ve been working in Africa for the better part of the last ten years and have become accustomed to what I see in the village -where most African still live- that once made me stop and think. Six year olds taking care of two-year olds. Kids running around with swollen bellies full of parasites and orange-tinged hair – a sure sign of malnutrition.

In the countryside after the rains, the fields are full of green green crops and overripe mangoes lie rotting on the ground, and I can’t help but wonder how people here can be so poor. The soil is volcanic and fertile. But it’s malaria season, flooding has brought cholera to the surface, and bridges to health centers have washed away only to be rebuilt after an interminable period of time.

Here in Malawi, 133 of every 1000 children born dies before they turn 5. Amazingly, this figure is down from 189 deaths in 2000. Forty-six percent of children are stunted from malnutrition, and only 64% make it through enough school to considered be literate. Over half of Malawians live on less than a dollar a day.

I was in the bush last weekend, face to face with a young man speaking decent English with a good head on his shoulders. He has 2 small children, his wife has passed away. His salary comes out to a bit over a dollar a day, making him just slightly better off than many others in the village. But averaged across his small family of 3, he and his little boy and girl are each living on about 35 cents a day. Even if his kids don’t go to bed hungry, any extra cost -a minibus ride to the health center, a few secondhand clothes- will seriously set them back.

Progress is made slowly, but today out of each thousand born, 56 more children than at the beginning of the decade make it to their 5th birthday. Each step, however small a stride in keeping those most vulnerable alive, is bringing us closer to a world in which a child can grow up to earn more than a dollar a day.

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Malaria makes the Big Time
February 2, 2008, 11:11 am
Filed under: development, foreign aid, health, malaria

For those of you who have been following along at home for some time, you probably already know that I’m a malaria geek. So when a new report hits the media with a lovely tale of how malaria is on the run in this part of the world, it’s really pretty exciting. In Rwanda, malaria deaths have dropped more than 60% in a few months, just by those in a position to do so making sure that enough mosquito nets and effective malaria treatments drugs reach the population.

Malaria has received more attention and consequent funding in the last few years than in has since the failed global eradication campaign of the 1960s and ’70s. The efforts of the Roll Back Malaria Partnership, Global Fund for AIDS, TB and Malaria, the World Bank Malaria Booster Program and the President’s Malaria Initiative have mobilized incredible resources and political support to half the burden of this disease.

Battling malaria should be a simple issue. The politics are not as controversial as with HIV/AIDS, the technical issues are less complicated than TB, and there are more resources available than clean water has. As the report says, all we need to do to get mosquito nets and treatment drugs to those who need them most: kids under 5.

I can tell you from first hand experience that this small feat is not quite as straightforward as it sounds. Even with the wealth of global funding available, there is often still not enough money to go around. It’s only recently that the mosquito net manufacturers have been gearing up their production facilities quickly enough to respond to the need for product. The new artemisinin-based antimalaria drugs need to be stored at cool temperatures – much cooler than health centers in the tropics where electricity is a constant challenge.

I spent most of my days trying to find a way to make things happen, whether it be ensuring that trucks have fuel to carry drugs to where they need to be or working with the Ministry of Health to determine which drugs to order in the first place. At the end of the day, it’s hard to believe I’ve accomplished more than a few sent emails. But reports like this one are enough to make one believe that baby steps will take you where you’re going. It just takes patience.

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