More Pictures..............

Some friends and family have requested more pictures of day to day life in Malawi, so here they are:

Sunsets in Mchnji

The boma in Mchinji

Praying to the internet gods on the porch of IKI My frequent showering partner in Mchinji

Kids cooking "chips" sort of fries served with a cabbage/tomato/onion slaw, salt, and peri peri (hot sauce) in a plastic bag - YUM! They are cooked and sold from stalls in the boma and I took the gastronomical plunge the 2nd day I was here.

My favorite tailor in the Mchinji boma. His partner to the right has a machine called the "Flying Dove" which he didn't want me to take a picture of................

Me working outside IKI (its usually too cold to work inside) with some helpers Too cute!

Me trying to get some reading done outside my room but Stinker and Dottie have other plans

Kayesa Inn

More Shameless Promotion of Chiozo's Walk

Because i think he's a fantastic guy and have much respect for his upcoming walk, here are some more pics to promote Jimmy's (aka Chiozo) upcoming walk for poverty.

If you haven't checked out the websites they are:

http://www.dubbinhood.com/

www.soundclick.com/chiozo

What Are Donors Going To Do - Show Up with Their Knives Saying Give Us Your Foreskin?

June 28, 2007

This week I am in Lilongwe at the National Aids Commission of Malawi: National HIV & AIDS Research and Best Practices Conference. It is a gathering of researchers, health professionals, and CBO’s from around Malawi sprinkled with an international presence from Medicines Sans Frontiers, the WHO, MDICP, and some U.S. university-based researchers. Two of the professors (Dr. Susan Watkins [Univ. Penn/UCLA], and Dr. Ann Swidler [Berkeley]) who run the projects I am affiliated with here in Malawi are presenters, along with a couple of sociology graduate students from Austin and UCLA. (Julie would be in heaven here at this conference!) It’s not really my area of research interest but I did have the opportunity to help two of the grad. students get their presentations into shape for public consumption, so I feel I’ve earned my keep.

The highlight thus far was a presentation by Dr. Swidler on “Organizational and Cultural Obstacles to Male Circumcision as a Prevention Intervention”. Dr. Swidler is far and away one of the best presenters I have seen in a long time. Granted the topic itself was attention grabbing, but she held and entertained her audience, and never missed a beat. She presented data from three recent, groundbreaking, randomized controlled trials that unequivocally demonstrated the protective effect of male circumcision on HIV transmission to the tune of 50-75% (Auvert et al., 2005; Bailey et al. 2007; Gray e al., 2007). She then discussed organizational, political, institutional, and cultural barriers to uptake of a prevention intervention that has been proven to be effective. Imagine if we failed to implement the use of some of the vaccines that have effectiveness rates of the same degree?

It was an interesting dynamic, this white, American woman presenting to a room of predominately male Malawians on male circumcision. Never directly saying “look, to not plan to implement this intervention strategy would be ludicrous,” but presenting very compelling evidence and analysis of the barriers and recommending that Malawi and other AIDS-affected countries set their own, HIV prevention priorities and try to do so independent of the influence of donors and international agencies. A difficult thing to do indeed, given the flow of money for HIV prevention in Africa and the depth of the organizational and cultural barriers. She successfully captured this idea of independent intervention planning when she stepped to the center of the room with raised arm and said “After centuries of coming to this continent, taking the people, enslaving them, colonizing, oppressing, and stealing their natural resources, what are U.S. and European based donors going to do? Show up with knives and say give us your foreskins!?” – Not a direct quote, but something to that effect which drove the point home of the immense political and cultural barriers to uptake of male circumcision, and revealed the need for it to be an indigenous based policy if it will work. And to not uptake a proven effective strategy due to such barriers may be a dangerous choice.

A related picture demonstrates some other cultural barriers to HIV in Malawi – this is a sign from Mchinji that indicates news to all of us : There is a curable vaccine for HIV/AIDS!

Translation:

We cure HIV and after that we allow you to go to the MACRO and Government hospitals or VCT center freely.

Let's join hands with the government in the fight against AIDS.

The Omnipresence of U.S. Hip Hop

Just when I thought I had encountered a spot on the planet where traditional cultural beliefs are not influenced by American culture, I went to a Malwian house party and Snoop, Kayne West, and The Game were bumping from the stereo, everyone knew all the words, and we spent the next 5 hours dances to alternating Malawian, South African, and U.S. hip hop.

I’m not sure why I was expecting something else. Perhaps because I was in Mchinji district, which is pretty rural (the Bradt guide doesn’t even mention the town), or perhaps it was because all of the talk of witchcraft (witchcraft and U.S. hip hop coexisting?!). Maybe I was in the mindset that most rural Malawians had little to no experience with the U.S., especially after hearing Alicia (a Jefferson medical student here working in the Mchinji district hospital) explain that she was the new show in town for getting kids on the peds ward to open their mouths for an exam: have a mzungu be the first thing a baby sees when mom unwraps her chitenje and you have an instant wail of fear and a clear view all the way to the vocal cords.

So to realize the level that U.S. hip hop culture has infiltrated the youth of rural Malawi was a bit of a surprise. The music is everywhere, the videos are available via Botswana and South African TV channels that have MTV, and the youth (and the growing Malawian hip hop industry) idolize the American hip hop artists – their dress, mannerisms, hand gestures, and the lifestyles on the videos. I had a typical “SUVs are the spawn of Satan” conversation with one young man who earnestly believes that Malawi needs to get control of its growing populations of vehicles the corresponding air pollution, and use of gasoline but who wants more than anything a Cadillac Escalade like he sees in the videos. I have to admit I was a little crestfallen with the realization that the U.S. hip hop culture was so omnipresent all over the globe.

Now we all know I have nothing against hip hop – the 90’s were my teen years, De La Soul, Tribe Called Quest, Black Sheep, etc. were in constant rotation and I have a lot of favorite current underground artists. I vividly recall getting trouble with Sister Jane when our pom pom squad wanted to use some songs that were “not appropriate” for a Catholic high school. But wasn’t there somewhere on the planet where bling doesn’t rule?

Thankfully I was saved by the people of Kayesa yesterday. During the process of many of us leaving Kayesa for Lilongwe, Mrs. Anderson and her family and staff got together to sign traditional songs – it was a privilege:

TECHNICAL DIFFICULTIES - LINKS COMING SOON

Watch all 4 - you won't be sorry.

Witches Versus American Hip Hop Culture

Witches versus American Hip Hop Culture


The Bradt Malawi travel guide book reports that approximately half of Malawians are Christians, 12% are Muslim, and various other faiths comprise the remaining 38% of the population. The one thing it doesn’t discuss, but seems to have a significant cultural foothold, is witchcraft. One of the men we work with at the IKI research office, Weston, tells me that all Malawians believe that witches (mfidi) are real, that vigilance is needed over small children who are at risk of being taken and inducted into the practice of witchcraft, and that mfidi can and do cause harm to people. Weston says that Malawi also has sing’anga, the traditional herb doctors who villagers see for healing purposes. Some of the sing’anga practice witchcraft as well, a dual role that sounds much like the voodoo priests of Haiti, however most of the mfidi practice in harmful ways only. When I asked Weston if there is a conflict for Malawians who are Christian or Muslim and their belief in mfidi, he looked at me with a bit of surprise and said no, that the belief is a very old one with roots far back in African history. The two beliefs systems exist quite comfortably with dual importance in the life of many Malawians.

The mfidi are a hot topic in Mchinji right now because a school teacher at the secondary school across the road from Kayesa Inn has been accused of witchcraft, of abducting two children (of one of the staff members) one night, and is now in custody in the local jail. The children reported that the mfidi came at took them one night on the “witch plane” but they fell off and were able to get home. The whole school has been in an uproar and we are awaiting news of what will happen to this teacher. It is an unfortunate situation because this teacher has no real opportunity for defense, it seems that once the villagers have decided that the children are in danger, the fate of the person accused of witchcraft is sealed. So very Salem Witch trials!

One other encounter with witchcraft: when Emily and I were in Lilongwe last week, we ran into a group of young hardcore missionaries from Texas (teens and young adults) who were on a two week trip to Malawian to “preach and bring Christianity to the villagers who are lost souls.” I knew I might have trouble navigating the conversation when it opened with: “have ya’ll accepted Jesus Christ into your hearts? Are you believers? Do you go to church regularly?” but Emily smartly nudged me and said yes for us both (she later said she thought that no matter what our personal beliefs, it wasn’t worth the time and energy at that moment to have a discussion about faith/spirituality with this group – we most likely wouldn’t have gotten anywhere and might have received a lot of preaching). We were however, treated to a few stories from their time in Malawi one of which was about preaching against witchcraft to the villagers. It seems they were literally run out of one locality for preaching against witchcraft. They were incredulous that the villagers could hold true to their belief systems in the face of the Christian message they were delivering. I was tempted to start the - traditional cultural belief systems and how it was naïve to believe that they could eradicate this belief system with a quick message about Jesus – but contrary to my true nature :) I kept my mouth shut.

Ok this got long – so hip hop next time!

I Failed My Test of Humanness Today

19 June 2007

I witnessed a fellow human being suffering and I did nothing – I didn’t move one muscle, made no action, voiced no objective. Me, a social worker: "Social workers are sensitive to cultural and ethnic diversity and strive to end discrimination, oppression, poverty, and other forms of social injustice" (NASW, 2000a, p. 1).

I witness suffering at home, the homeless, the poor, the hungry, begging, but I often walk on by without much thought. This was different from that suffering, it was so raw, I was so present, and the opportunity to intervene in a tangible way was so available to me.
And I did nothing.

We were on the way to Lilongwe for a World Bank meeting and Sakala stopped at a gas station to fill up the minibus. I vaguely saw someone come to his window, perhaps to beg for money, hard to see from the backseat. I saw a man who works at the gas station push the person aside and she fell, I think. Then I heard Nicole, who was in the front seat say, almost to herself, “Oh no don’t drag her………..Oh she’s sick.” Her tone was upset, implied the person was not well off, and needed help. Then I saw the man drop the person in a heap on the ground, in the dirt, against a bicycle that had fallen over, in front of a group of young men standing around in the doorway to the gas station building. The girl lay with her head face down, in the dirt, and her chest/back heaved as if she was sobbing.

No one did anything.

The young men all looked at her/ignored her. We all stared from inside the van but did or said nothing. I remember wanting to do something but not knowing what to do – caught up in my own fear, my own inadequacy. Scared to get out, not knowing what was wrong with her, not knowing what the young men would say or do if I, a muzungu approached her, not knowing what she would do, scared because she was “sick” (but not even knowing if she was - it was just what Nicole said - or what sick meant). A man went up to her and tried to give her something, perhaps food? She wouldn’t/couldn’t lift her head. More time passed as we waited for change, it felt like a very long time as we all watched and did nothing.

I did nothing.

Another young man went up to her to try to give her food, it looked like a handful of peanuts. She finally lifted her head, dirt all over her face, mucus coming from her nose. She got up and took the peanuts. She was filthy, with tattered clothes and held one arm as if it was palsied, dragged a foot. She shuffled off, so clearly in need. Desperate enough to throw herself against the side of the van, to beg, to be dragged off, to lie face down in the dirt, to accept a handful of peanuts, to shuffle off with nothing, with us all staring but giving her nothing.
And we did nothing, this group of people here to do research on HIV because we care? and want to help, to make a difference, to end the suffering, to address the multiplicative health issues facing developing nations. We did nothing to help one person who was in immediate need of help, of something, perhaps just a comforting hand and a little money, a sign that another human being cares about her suffering.

We did nothing.
I did nothing.

Ann talked last night about maternal bonding, how perhaps part of the reason that the bond is so instantaneous and strong is related to a mother knowing she is it, she is ultimately responsible for another human being. We talked about this in the context of the literature on altruism, group think, and the individual inclination to help another human being in need. How if you know you are the only one who can help/care for another you will, but once there are others who share the responsibility, we are less likely to act. We discussed this last night! And today the very situation presented itself and we did nothing.

I did nothing.
I failed in my humanness.

Nsima and Goat Burgers with a Side of Goat Kebab

Everyone has been asking me about the food here, so a quick post on what Malawian cuisine.

The main staple for Malawians is nsima, a thick porridge/paste of maize flower that is eaten with every mea. It comes in a sort of patty form, you break of a small piece and use it to dip into the vegetables or meat. Think injera from Ethiopian food but more free form. I haven't quite got the hang of it yet. I'm lucky enough to be staying at Kayesa Inn where we have great cooks. every night there is nsima, rice, greens, usually another vegetable, and chicken. A tomato-based sauces is also served to pour over the rice, etc. Last night however we (well the meat-eaters) were in for a treat. There was a new cook in town and he made goat bugers and goat kebabs. He must be a soul-brother to serge because the kebabs were made on bike spoke skewers. I alomst hit the floor when I saw those - and here I thought we only did that at our house! Needless to say, I had a lot of veggies last night.

There are some things I miss already - like soy milk. There is no milk to speak of in Malawi other than powdered and the occasional milk in a box. Haven't quite worked up to either of those. Also there is no salad to speak of, although I did score some tomatos and cucumbers from the market today.

And there are of course the odd things that you find in developing nations that you can't figure out why they are there and so cheap. For example Irish Gold Butter, why gourmet butter?

and Carlsberg beer, not that I am complaining .

Lilongwe Rastafarians

Jimmy is the son of Mrs. Anderson, the woman who owns the Kayesa Inn in Mchinji. I met him the first night I arrived, sitting in the kitchen of the inn with his fiancé Laia, a rasta herself who hails from Spain, quietly strumming the guitar and singing “Cherry Oh Baby” by Eric Donaldson – needless to say I was hooked! Yesterday we traveled to Lilongwe via the minibus of a friend – 8 of us packed into a space for 6 plus 3 guitars, a few amps, luggage, sleeping mats, etc.

On a side note its amazing what you will do in a developing nation that you would never dream of in the states. I tend to be fanatical about seatbelts, bike helmets, car seats, never packing more people into a vehicle than there is space for etc. I’m sure my hyper-vigilance comes from my trauma social work and Serge’s ER stories. But within 4 days of arriving in Malawi, I have ridden on a bike taxi with no helmet (i.e. a seat on the rack of the back of a bicycle), packed into the bed of a pick-up truck 7 deep, packed into minibuses with way too many people, stuff, no seatbelts and traveled for 1-2 hours so badly cramped I can’t feel my feet. Safe travel is something I take so for granted back home, I rarely worry about my safety on day-to-day transportation. Instead I worry about flying in a plane, or drunk drivers on the Schuylkill. Here, it’s impossible to get anywhere unless you are willing to risk your safety a bit every time you engage in transport. Even walking is a bit hazardous. Any of you who have traveled in developing nations know how crazy everyone drives, using their horns to say a million different things. The road (or walking along side it) is by no means a safe place to be. And yet I’m on it in cockeyed contraptions without much thought.

Back to Jimmy & Laia – we went to their show at the Chameleon Bar at the Four Seasons in Lilongwe (yes even Malawi has a Four Seasons). The show was beyond fantastic – we danced all night to some amazing music. They are both so talented. Check him out (Chiozo is his musician name):
http://soundclick.com/chiozo
Music is not his only passion, Jimmy plans to walk from Capetown to Cairo – yes WALK some 16,5000 kilometers (or 10, 250 miles) to raise awareness for poverty in Africa:
Check out:
www.dubbinhood.com

Malawi Rastafarians

Jimmy is the son of Mrs. Anderson, the woman who owns the Kayesa Inn in Mchinji. I met him the first night I arrived, sitting in the kitchen of the inn with his fiancé Laia, a rasta herself who hails from Spain, quietly strumming the guitar and singing “Cherry Oh Baby” by Eric Donaldson – needless to say I was hooked! Yesterday we traveled to Lilongwe via the minibus of a friend – 8 of us packed into a space for 6 plus 3 guitars, a few amps, luggage, sleeping mats, etc.
Pic of the van

On a side note its amazing what you will do in a developing nation that you would never dream of in the states. I tend to be fanatical about seatbelts, bike helmets, car seats, never packing more people into a vehicle than there is space for etc. I’m sure my hyper-vigilance comes from my trauma social work and Serge’s ER stories. But within 4 days of arriving in Malawi, I have ridden on a bike taxi with no helmet (i.e. a seat on the rack of the back of a bicycle), packed into the bed of a pick-up truck 7 deep, packed into minibuses with way too many people, stuff, no seatbelts and traveled for 1-2 hours so badly cramped I can’t feel my feet. Safe travel is something I take so for granted back home. I rarely worry about my safety on day-to-day transportation. Instead I worry about flying in a plane, or drunk drivers on I-95. Here, it’s impossible to get anywhere unless you are willing to risk your safety a bit every time you engage in transportation. Even walking is a bit hazardous. Any of you who have traveled in developing nations know how crazy everyone drives, using their horns to say a million different things. The road (or walking along side it) is by no means a safe place to be. And yet I’m on it in crazy contraptions without much thought.

Back to Jimmy & Laia – we went to their show at the Chameleon Bar at the Four Seasons in Lilongwe (yes even Malawi has a Four Seasons). The show was beyond fantastic – we danced all night to some amazing music. They are both so talented. Check him out (Chiozo is his musician name):
www.soundclick.com/chiozo

Music is not his only passion, Jimmy plans to walk from Capetown to Cairo – yes WALK some 18,000 kilometers to raise poverty awareness:
Check out
www.dubbinhood.com

16 June 2007: A Swiss Army Knife, Serge’s Well-Stocked Med Kit, and a Minor Procedure

On the night before I left, Serge and I sat on the floor of our room with a bunch of little baggies (about 3 times the size of the $5 & $10 crack rock bags that litter the streets of West Philly), a slew of meds, and other medical supplies. After packing it all up, it seemed like so much to take – when was I going to find a need for Dermabond?! Well my doubts were assuaged last night and we were all thankful for Serge’s thoroughness. Nicole, a PhD student from Austin who is running a VCT component of one of the studies had an old heel blister, that was massively swollen and infected. When she commented to Emily that she was having trouble walking and the pain was traveling up her leg, Emily decided she needed to lance that sucker. Luckily it wasn’t tracking. Iodine, my flame and alcohol sterilized Swiss Army knife, a very brave Nicole, a very apt and steady-handed Emily, triple antibiotic ointment, bandages, surgical tape, and mountains of pus later and our first field procedure was a success. Nicole and Emily preparing for the carnage.

We had spent the day working and then shopping in the outdoor market (picture any outdoor market in a developing nation – expect this one has goats heads hanging from butcher stalls, a liquor store called the Booze Den, and bike seats made from recycled plastic bags for sale.

One of the med students who is here from Jeff purchased a bike for use for the summer but needed a new seat and was over the moon when we found these. She now has a new bike seat complete with girly flowers.

I’m jealous and want very badly to purchase one of the bikes to ride while here. They are the main mode of transportation in Malawi, both personal and public – bike taxis are everywhere. Here are some bike lust pics

15 June 2007: The Mzungu Is Going to the Toilet!

I arrived safely in Mchinji on Thursday afternoon and was met by the project manager for one of the research arms going on here. He ferried me to a bank to get some kwacha (1 kwacha ~ $140 U.S.) and to purchase a cell phone for use while here. 9,000 kwacha for the phone and another 5,000 to “top up” (add pre-paid minutes to the phone) and I was in business for communication both domestically and internationally. I discovered I can text anyone back home for pennies and calls are fairly cheap as well. I settled into the Kayesa Inn in Mchinji, much like where Serge and I stayed in Deschapelles, Haiti at Hôpital Albert Schweitzer (HAS).

http://www.hashaiti.org/

Here however, the concrete floors are washed and waxed every day to a dangerous shine and I’ve almost bit it 10 times over. I’m not sure I will ever get used to the electric shower head, yes ELECTRIC. A mini-heater is attached to the top of the shower head and plugs into the wall; the water travels into the shower head and is heated by the electric coils. There is something very disturbing about standing under a stream of water connected to an electric appliance…………….

This morning we headed to the boma where the markets and the hospital complex are. The office the research project works out a building located on the grounds of the Mchinji District Hospital, and is the headquarters of the Invest in Knowledge Initiative, an NGO that promotes education endeavors in Mchinji. IKI was founded by members of the MDICP research team and has created a research center, funding kids to go to school, the started a public library, and offer professional seminars for community members.

http://www.ikimalawi.org/

IKI headquarters and my working home for the next few weeks.

Unfortunately the internet has been down and I haven’t been able to email/blog yet…….we may try to go pirate the hospital’s signal tomorrow so I can post. I figure after a few days of hard core withdrawal, I will adjust to not checking my email multiple times a day and having any bit of information I desire at my fingertips within seconds. I hoping I get to the point where its liberating, although not banking on it as my online addiction is perhaps as bad as my caffeine one (oh how I miss the Green Line!).

We look like we are working but we are really obsessively checking for an internet signal and cursing the access gods.

The highlight of the day came when a group of us (Americans and Malawians) were working on the survey in the office and Emily (an NP, almost MPH and my comrade from Penn) got up to use the bathroom. This triggered shouts from the group of kids gathered at the doorway watching us and corresponding laughter from the Malawians we were working with. All we could understand was Mzungu or white person. When we asked what was so funny they told us the kids shouted: the Mzungu is going to the toilet! Anything and everything is fair game for the kids to be fascinated/amazed with when it comes to the Mzungus!

The journey has begun

First off - a day hotel at Frankfurt Airport is the way to go!

I decided I did not want to be one of those uncomfortable souls sprawled out on the floor of the airport trying to sleep while maintaining vigilance over my belongings. Despite getting my luggage checked all the way through to Malawi (bonus! was not looking forward to multiple baggage claims/customs/re-checking) my inner bougie was calling for some last minute pampering. Serge will probably accuse me of being a softie, but what girl doesn't love a hot shower and crisp sheets? The Sheraton is attached to the airport, was the perfect place to catch a few extra hours of sleep, and has REALLY good pommes frites.

The first leg of the trip was relatively uneventful, save for some crazy downpours on the way to Newark and me giving up my row of 4 empty seats to a cute 7 year old who really needed to stretch out and sleep.

I'm headed back over to the airport to catch my next flight.

Here are some pics of my kitties helping me pack. Cosmo is a BIG help don't you think?