Chilombwe HIV/AIDS Activities: June 15

On Monday, June 15^th, we travelled an hour and a half to the shores of Lake Malawi, to a village called Chilambwe. We were destined to see an HIV testing center, anti-retro-viral (ARV) dispensary, hospital, and school. But first, we had to get there!!

This panorama shot shows the view of the gathering villagers of Chilambwe from our table of honor!

Our driver Jonathan skillfully guided our van down a paved road we have travelled many times in the short time we’ve been in Malawi. Then, we turned down a dirt road, and then another, and then another, each progressively worse. Eventually, we ended up on nothing more than a trail through the bush, with grass all around us taller than the van. Seeing how thick the grass was, we asked our driver what sort of animals lived in the area. He replied that just last week a woman had been killed by a python when she climbed on top of a rock in the dense grass to try to obtain better cellular service. It was on top of the rock that she met her demise.

We travelled through some of the most difficult terrain I’ve ever driven through, with boulders sticking out of the road all the way across, with the only way through over the top. Up and down we went, over teeth-rattling terrain, crossing rickety old bridges made out of simple, thin lumber supplies. We were brought to an abrupt halt by a bridge that had been destroyed by floodwaters earlier this year. We had no choice but to proceed, across the river bottom and through the flowing river, which was quite small and calm due to the dry season (thankfully!).

We asked our driver if he travels this road often, to which he responded yes. It turns out that he is the one sent out as an “ambulance” driver to the hospital. Mzuzu has the nearest main hospital to Chilambwe, so any serious medical conditions require transfer to Mzuzu. There is no ambulance service here, so sometimes in the middle of the night Jonathan will have to make the arduous journey to pick up a gravely ill patient. He is the one sent because the hospital is run as a partnership between the Diocese of Northern Malawi and the Malawian government. Jonathan is employed full-time by the Diocese to do that sort of work, as well as drive people like us around.

Soon, sights of beautiful lake Malawi graced the horizon, indicating that we were close to the village. When Katherine and I arrived at Chilambwe, we were greeted by Fr. Edward. He is in charge of a parish of around 1200 villagers, and volunteers at the hospital and HIV testing clinic. He would be our guide around the village for the day. First, we went to the HIV testing clinic, where we were ushered into a room with 6 women, Fr. Edward, and a male nurse. The nurse explained to the women what was going to happen. Then Fr. Edward and the nurse donned gloves and drew blood from the fingertips of their first patients. After changing gloves, they proceed with the next patient, repeating for the last two. The nurse also distributed female condoms to the women, and explained how to use them and the importance of doing so. These women that we saw were all pregnant; the clinic especially encourages pregnant women to be tested so that if they test positive special precautions can be taken with the fetus while in the womb and when the baby is being born. However, all women and men are encouraged to be tested regularly, especially if they are at risk.

Since the HIV test takes 15 minutes to produce results, we walked across the hall and spoke with the nurse who distributed ARVs (antiretrovirals) to the patients who test positive for HIV. She explained the different forms of ARVs that are given to different patients: babies, children, and adults. The drugs are provided completely free of charge, as is the testing, by the Malawi government. The patients have to return to the clinic each month, however, to obtain more drugs and to be counseled on proper hygiene so that the virus isn’t spread to those around them, along with how to best live their lives so that the medications will work, such as limiting the use of alcohol. Usually, patients at risk for secondary infections are also given a free supply of antibiotics to take.

We then returned to the testing room to examine the test results. One of the six women had tested positive according to the results. A follow-up test would be performed shortly, the nurse said, to confirm the results. At that point, drug therapy would begin immediately if HIV is confirmed. On the ride back to Mzuzu, I remarked to Katherine what a privilege it was to experience the testing along with these women. They allowed us into what could be a life changing moment in their lives. In the U.S., this experience would likely have never occurred for us as undergraduates, and certainly not by simply waltzing into the room as we did.

After leaving the HIV testing clinic, we proceeded out to what appeared to be the center of town. There, what appeared to be nearly 500 students from the primary and secondary school were gathered, along with church members, medical staff, and school staff for a performance on HIV/AIDS. It turns out that these topics are discussed regularly in Malawian schools: sex, pregnancy, condom use, HIV, AIDS, rape, prostitution, etc. It was wonderful to see both students and adults talking so openly and eloquently about such important topics. We heard poems from students, testimonies from HIV positive men and women, songs from church ladies, and a skit. Katherine and I were treated as visiting U.S. dignitaries, and were seated in proper chairs at a table covered with a white tablecloth amidst everyone else sitting on the ground, on benches, or on tree stumps. It also seems that this entire little assembly/menagerie of performances was put together just for us. What a terrific honor!!

Next we went to Fr. Edward’s home, where all of the village leaders, including the head teacher, nurses, village headman, along with Katherine and me, were treated to a lunch of “local chicken” (aka the chicken pecking around under your feet a couple hours ago!), rice, and cabbage, typical Malawian cuisine. After finishing our lunch, we were sent off, again as visiting dignitaries with a gift of a wooden globe carved by a local artisan. What a wonderful learning adventure and cultural experience in Chilambwe!

The male volunteer nurse taught Derek and me how he conducts HIV/AIDS screenings when he is at the clinic by a finger prick method.

Father Edward also volunteers at the HIV clinic and helped to perform the screenings while we were there.

The test strips shown are all negative (one red line) except for number 3, which is positive (two red lines).

The Chilambwe chapter of the Mothers' Union performed many songs, dances, and even a skit for us.

The primary school choir

A few men from the parish performed a comedic skit for us to encourage nondiscrimination against HIV/AIDS positive community members!

From left to right: Mothers' Union Representative, Parish of Chilambwe Secretary, Head of the Home Care Ministry, Katherine, Derek, Father Edward, Father Edward's Wife who is also part of the Mothers' Union

Malawi Facts

(Katherine and Derek)

Bananas-sold by the bunch! Malawians like them yellow, but Derek insists on eating the green ones!

This weekend, we had the privilege of having dinner with two of the diocesan workers: Bernard Mainga, the Secretary of the Anglican Diocese of Northern Malawi, and Betha, the coordinator for diocesan women’s organizations. We have really enjoyed spending time with our new friends and learning more about life in Malawi. For this post, we hope to share some of what we have learned with you via list.

1. Minimum wage for a laborer in Malawi is 550 Malawi Kwacha PER DAY (approximately 1.20 USD).

·         2. Primary and secondary school is not compulsory. Public primary school is free, but neither public nor private secondary school is free.

·         3. Marriageable age for a Malawian woman is 18, though many marry illegally at an earlier age. Dowries are common practice in northern Malawi though not southern.

·         4. Men and woman are viewed as equals by most Malawians.

·         5. In some areas of northern Malawi, men can have more than one wife.

·        6.  It is always banana season in Malawi!

·         7. Malawi has a suitable climate for growing nearly every crop:

°         Rice

°         Corn

°         Sugar cane

°         Wheat

°         Bananas

°         Papayas

°         Avocado

°         Mango

°         Tomatoes

°         Cabbage

°         Potatoes

°         Sweet potatoes

°         Coconut

°         Oranges

°         Onions

°         Peppers

°         Egg plant

°         Peas

°         Green beans

°         Cherries

°         Apples

°         Sorghum

°         Cassava

°         Pineapples

°         Coffee

°         Tea

°         Tobacco

°         Cotton

°         Peanuts

°         Okra

°         Rubber

°         All varieties of fish and meat

·         8. Malawi has its own electricity grid and doesn’t connect with any other country. It produces mostly hydroelectric power.

·       9.  You must buy electricity units in advance of using any electricity in your residence/office/etc. so running out is common. (Rather than using and then paying a bill.)

·         10. Malawi does not produce a drop of oil. All oil is imported.

·         11. Lake Malawi is known for a type of fish called Chambo. Chambo is also the name of the boat we will ride to Likoma Island.

·         12. Many roads in Michigan are equally as bumpy as Malawian roads. Pot-holes…

·         13. Malawian women carry their babies on their backs by tying them there with a piece of colorful cotton cloth while they work.

·         14. Malawi suffers from “brain drain,” a common phenomenon in developing states whereby young people leave the country to study in another state and then do not return to work in their home state.

·         15. It is common for Malawian children to live with their parents until the age of 26.

·         16. Malawians are a docile people and do not participate much in political activism.

Saturday Orphan Feeding Program: June 13

(Katherine)

The Anglican Diocese of Northern Malawi’s home parish, St. Mark’s Mzuzu, runs a feeding program for orphans in the city. Every Saturday morning, children between the ages of 0 and 18 years flock to the church hall for fellowship, a hot meal, singing, and skills training. Derek and I walked from our guest house around the church to the hall where the feeding program takes place and were greeted by the several women in charge. Everyone immediately welcomed us and threw us into the challenging work of cooking for the 250 children they serve. After hearing that program funding comes from an Anglican parish in Montreal, Canada, we were quite impressed by the balanced meal the funds provided, along with the many supplies for skills training. However, the love and care of the community toward the children, who have lost everything and who struggle to survive day-to-day, impressed us most.

Let us describe the meal the women showed us how to prepare. Standard Malawian fare consists of a small portion of meat and vegetables along with a large portion of starch, either corn meal or rice. Today, the children received nsima (pronounced seema), a sticky corn meal paste, along with a piece of chicken, cabbage and tomato relish, and a banana. Before the meal though, while it was cooking, we served the children tea and bread as a snack. 

Though the portions were large for the children, nearly every child of every age consumed every morsel, reassuring us of their need and physical hunger. Derek and I really enjoyed helping, as we learned how difficult cooking traditional Malawian food is! The nsima that is eaten twice a day is heavy and must be stirred frequently. Since we were preparing such large quantities, you can imagine just how big the stirring spoons were—almost as tall as I am!

While the meal cooked and each of the women contributed to the preparations, Derek and I bounced around—cooking, observing, talking, and laughing—enjoying the time we spent in such a welcoming environment. One of the women showed us around the hall, well actually outside of the hall, where volunteers teach the children how to knit blankets and sweaters, sew aprons and clothing, and make tin items such as pans and cooking burners. These skills may be the most important part of the Feeding Program’s ministry since they will help the children obtain employment and discipline. All materials the children produce are sold in the market and the proceeds are used to buy more supplies to maintain the workshops.

(Derek)

One thing that struck both Katherine and I was when a middle-aged lady called off each orphan’s name from a list; this allowed them to come receive their meal, and to mark whether they were present. What each name represented, it occurred to us, was, in all likelihood, two deaths from HIV/AIDS or malaria. And to think that this feeding program at St. Mark’s represented a small fraction of the number of orphaned children from these terrible illnesses in Malawi, and from Africa as a whole. In the US, when we hear of someone being an orphan, I am willing to bet that he/she is not an orphan because of these diseases. Rather, they are probably an orphan because of cancer, an automobile accident, murder, etc. 

Derek and I liked serving each child tea (with milk and sugar) and bread before getting started with the cooking.

Some of the children write poetry on these Saturday mornings while they sit together outside the church.

We have noticed that both boys and girls usually have shaved heads, so we have trouble telling who is what gender. 

Everyone thought Derek and I were VERY funny while we tried scooping out the heavy nsima into the serving pots. Nsima is sticky when it is first cooked, but once it is scooped out, the portions magically do not stick together.

The older boys work under the supervision of a tinsmith, making pots, watering cans, and cook stoves.

This is a knitting machine which reduces the time needed to make one baby sweater, complete with socks, pants, and a hat, to one hour!

The sewing brigade makes pants, shirts, pjs, aprons, dish cloths, and also mends clothing.

The completed meal! (Nsima is the white stuff.)

Malawi Water Project: June 11 and 12

We have arrived in Mzuzu, Malawi!

Today, our first full day in Mzuzu, Derek and I jumped right in to our work with the Anglican Diocese of Northern Malawi (ADNM). The diocesan secretary, Bernard Mainga, has planned a wonderful schedule for us: one week here in Mzuzu surveying ADNM activities, then 6 weeks on Likoma Island in Lake Malawi working at a secondary school and a hospital, and our final week back in Mzuzu to finish up our time with ADNM.

Derek and I began our work here by serving ADNM’s partner, Malawi Water Project (MWP). MWP is a nongovernmental organization that works throughout Malawi to increase safe, clean water access among the local people and receives its funding from an organization in Canada. The Mzuzu MWP group works just outside of the city in Malawi’s beautiful northern mountainous jungle region. The primary method of doing this is by building and providing biosand water filters from local materials and installing them in people’s homes, usually to serve 5-20 family members. The typical, well-cared-for filter can last up to 16 years.

ADNM provides (pays for) a local project coordinator, Esau, to coordinate MWP’s work in Mzuzu and the surrounding area. Our driver Jonathan drove Esau, Derek, and me to the factory site where MWP builds biosand filters, about a 30 minute ride from the city. When we say factory, we use the term not to describe the type of building, but rather, the type of work done, construction of a product. The building is a small brick pavilion sharing the land of a demonstration garden also run by ADNM. While there, we met the garden’s proprietor who briefed us on the garden’s purpose. He said that the garden was constructed in 2002 in response to famine in Malawi to teach local farmers how to use maintain the land and improve productivity. But, since 2013, the garden has lacked funding and so has been all volunteer run, meaning the classes it previously hosted are no longer possible.

Before the work of the day began, Esau introduced us to the four main employees of MWP Mzuzu. All four people—two women and two men—are locals who live near the factory which adds to the project’s sustainability and reputation for using local knowledge to improve access to clean water. All MWP chapters work in a team model, and Mzuzu is no exception. Esau explained that the women work as Community Health Promoters, traveling to the nearby villages and teaching about health, hygiene, sanitation, and water. Key to success of the whole project, these two women work tirelessly to help community members understand why water filters are necessary for their families. Due to their work, the demand for biosand water filters is increasing exponentially and has exceeded supply.

The men employed by MWP are biosand water filter construction gurus. Each and every filter—all 216—that MWP Mzuzu has installed has been built and installed by the two men we had the privilege of meeting. Also, after installation, the men have a 90 day follow up program, visiting households several times during that period, to ensure the proper operation and use of the filters.

Our work with the Malawi Water Project consisted of building two bio-sand filters. For now, this is the maximum number that they can build per day, since they only have two molds. Another mold is currently on order from Zambia, which will allow for a weekly production of 15 filters, up from the current 10, which is the normal M-F production. First, the molds must be fastened together, using bolts, which are tightened using hand tools. No power tools here! A plastic is tube is run from the “spigot” portion of the machine down to the bottom of the filter, where the water fresh and clean after being filtered. The weight of the water above, combined with gravity, allows the water to flow from the bottom of the machine up to the spigot. Then butter is applied to allow the cement to easily slide out from the form when it is done. Butter is used as a lubricant since these will come into contact with drinking water. The making of the cement comes next.

The concrete mixture is mixed completely by hand using shovels. The local river sand is first sifted by hand to sift out any rocks, after which it is measured and placed onto the outdoor mixing slab. Then the cement itself is measured. This is followed by sifting of local rocks of ½ inch size, which are then placed in with the other ingredients. This is all stirred together in preparation for the addition of water. Water is supplied using a large cistern, which during the rainy season is filled with rainwater from the roof. Right now, however, is the dry season, so local villagers are employed to haul water the approximately 1km from a stream to fill the 2000 liter tank. Then the mixing begins, after which the concrete is poured into the forms, compacted, and allowed to sit overnight.

The following morning, we returned to continue our work. We began to undo the nuts and bolts holding the forms together, and lo and behold, our filters were still intact! After a bit of minor cosmetic work to fix a few small cracks, we allowed the forms to dry for about 30 minutes. At this point we filled them with water, which will remain there for several days. This is to ensure that the drying process wasn’t too rapid such that they would crack.

After our work at the factory was complete, we went to a nearby home to install a previously constructed filter. The filter is installed by putting larger stones at the bottom, followed by successively smaller stones, all the way up to sand that is almost like dust. This combination of materials allows the filters to catch most contaminants, including bacteria we are told. I can attest that I saw muddy water poured into the top and crystal clear water emerge from the spigot! On top of the filter sits a diffuser that the unfiltered water is poured into. This diffuser has tiny pin-holes which sprinkle the water into the filter machine so as to not rush in when being dumped, which would disturb the sand and stones. Once a certain level of water is reached in the filter machine, enough pressure will be generated that fresh, purified water will be forced through the tube and out the spigot and into a waiting pot or bucket below. This entire process is, of course, meant to mimic the filtering action of the earth when rain infiltrates the ground and percolates through.

We were told that the bio-sand filters can filter water for up to 15 years, depending on the amount of use they get. At that point, all that needs to be done to restore the filter to operation status is to remove the filter materials and either discard them and insert fresh materials or to wash the existing materials. The bio-sand filters are designed to provide enough drinking water for up to 20 people. Their flow rate is at least one liter per minute, which is not too bad considering what we are working with. The total construction cost of these filters is around 500 Malawian Kwacha, which is only a little over $1 USD. What a small price to pay for a device that can potentially save lives, and at the very least significantly improve the quality of life of its users for over 15 years undisturbed, with no electricity needed, only some sort of a water supply such as a well borehole, a river, or rainwater. Homeowners are not charged for these particular devices, since the Malawi Water Project is a non-profit organization. All supplies and labor costs are paid for by outside donations. Employees of Malawi Water Project told us that some for-profit companies in Malawi charge homeowners up to 10,000 Malawian Kwacha, or over $23 USD, a hefty sum for Malawians.

In the MWP training center

Sifting sand

Mixing the cement for the molds

Derek enjoying raw sugarcane! It really is quite good!!

Katherine trying to peel the sugarcane of its bark via the African way. We think this must strengthen the teeth and jaw!

Meeting James, the director of the demonstration garden

Using a device to remove the inner mold on day two of the project. This requires quite a bit of force to break the seal between the still wet cement and the metal. The man on the left is our driver, Jonathan, who takes us wherever we need to go.

Removing the outer molds

At the installation, washing the small stones in preparation for placing them inside the mold. The residents are watching intently as their new filter is prepared.

The village children were very excited to greet their visitors!

Finished filters at the factory waiting to be installed

Katherine hauling a mold

Filter sitting in its new home

Sprinkling the rocks into the filter 

The home where we installed the filter

Katherine helped install the filter by holding the baby...

Adding water to the newly installed filter

It works!

Measuring flow rate

Flushing out sediments before residents can consume the water

Community Health Promoter conducting an interview with the 18 year old resident and mother. The interview consisted of asking about previous water consumption habits, illnesses, knowledge of clean water importance, water-borne illness. As described in the above paragraphs, the CHP and installers will return to the home to conduct follow up interviews to ensure everything is going smoothly. Katherine and Derek will do this within the next few days.