Debriefing & Farewell dinner 9/10 – Departing thoughts as we leave Malawi 9/11

On Friday four of us from the GAIA-US and three from the GAIA-Malawi office spent most of the day de-briefing and going over next steps, questions small and large and discussing our intervention strategies. In short, our current areas of emphasis are enabling us to impact thousands of the poorest of the poor in remote rural areas unserved by other NGOs. Our signature Village program is empowering women in desperately poor villages to help others in the community as caregivers for HIV+ villagers and the many, many orphans who have been left as a result of the extensive number of deaths in the current parental age group. The training and education provided by GAIA has become a vital part of the villages. We saw this so clearly when the hundreds of villagers showed up to greet us singing GAIA gratitude songs and speaking of their specific reasons for appreciation. Whether for having been tested for HIV, receiving care themselves or for the orphans they care for in the form of kits, school fees etc., being trained in a skill or as part of a village health committee etc., etc., these villagers see GAIA as a God-send for helping them take steps toward health and hope for well being in the future. At the same time, the three mobile health clinics we now deploy in the Mulange district are serving more than 125,000 patient visits. In this meeting we all computed our cost to be approximately $2/visit for patients who otherwise would have to walk many, many miles to district government clinics which we have been told are often short of necessary medicines. Women in neighboring districts whom we met at CBOs we visited asked us when we would bring mobile clinics to their areas while others at different CBOs wondered the same about their villages within the Mulange district.

The difference GAIA is making in the Malawi healthcare structure with it’s nursing scholarships which boost the nursing force in the country is significant and will be even more so as we roll out the USAID grant which has recently been approved to provide even more scholarships, HIV training, BEmONC training and triage in conjunction with UCSF School of Nursing. This major program expansion along with the clear room for growth in GAIA’s existing Villages program and Mobile Health Clinics makes clear the need for our continued push to find the resources required. Similarly, the capable and hard-working GAIA staff is continuing to see areas for improvement and development which make our programs even more effective and responsive the the specific needs seen in the villages. It is also clear that here is considerable expansion capability in the densely populated areas contingent to our current villages, not to speak of needs which could conceivably be addressed in other districts down the road. With funding, the demand for addition Mobile Health Clinics, costing roughly $375,000 each, all-in for 5 years of service, would justify a multifold expansion of the current clinic program. On so many fronts there is so much we can do.

I awoke for the last time this trip to the Muslim call to prayer from a nearby mosque, the neighboring roosters and the smell of gum tree fires burning along every roadside and from kitchens everywhere in the area other than the relative few that have electric stoves. We thank the dear Malawians who run our guest house and head to the airport. Relatively well-off neighborhoods distinguished by their walled homes and security guards give way to less affluent but still urban clusters of homes down long dirt roads off the paved road to the airport. Then the communities along the road begin to look more like the rural villages where there is no electricity or running water and simple dirt floors. Even in Blantyre, we experienced electrical outages and most of one day without water. The farewell dinner we held for staff at the nicest hotel in town on the last night was missing 6 of the invited staff from Mulange who could not come because there is fuel shortage in all of Southern Malawi this weekend due to road problems which have reduced normal traffic to a trickle…

We take off toward Johannesburg looking through skies thickened by smoke from open fires burning wood, so much wood that the landscape below seems mostly to be dry, red soil – deforestation is evident and will have further impact on the country’s ecosystem. I feel sad to be leaving despite being excited to get home to see my wonderful husband and family whom I have been missing. There is maybe a sense that you can help these people who have so many basic needs if you are here in the country but leaving is turning your back on them. It is, of course, not the case but still I feel a pang. We have met so many people who opened their homes and hearts to us and greeted us with such joy and hope despite their own person pain on so many levels. These fine people love and care and work hard to help each other in their communities. How much we can learn from them and how much we can help. Even the smallest effort is a blessing begun which can expand to who knows what ultimate benefit.

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Malawi College of Health Sciences & Chigodi Women’s Center of Blantyre Synod – 9/8 & 9/9

For today’s trek to the Malawi College of Health Sciences, we were hoping to see some of the GAIA nursing scholarship recipients – a visit which had been inspiring to those on the last GAIA trip here who had seen young women who had been shy and timid orphans literally transformed into capable nurses with practicing certificates which would have been unthinkable without GAIA’s help. We were led to an administrator’s office and in the end it seems there was a mis-communication. Most of the students were on holiday and indeed there was uncertainty about the college’s financial status and whether or not it was going to be brought under the wing of the University of Malawi as had been rumored but not confirmed to them. It is early September and the College has no certainty of it’s budget for the upcoming session which begins in Mid-October. We couldn’t be too surprised given that we are from California where we seem to have a difficult time getting even the funding for elementary and high school education funded until the last minute year after year…

It was a disappointment but our first… We diverted to the best hotel in Blantyre where we sat in the lounge with cokes and used remaining internet minutes processing emails we had been otherwise unable to access for a number of days.

The next morning, we set out in the direction of the Zomba district and stopped in rural Blantyre at the Chigodi Women’s Center (“mvoma” – for some reason the Chichewa word stuck in my brain). We were greeted by Miriam, a preacher in charge of the Blantyre Synod of the Presbyterian Church’s Women’s Desk which oversees activities throughout the Synod. The facility we visited was on the side of a hill with a lovely view and had been donated to the Presbyterian church in 1967 by a Scottish woman. The various meeting and boarding rooms are used for training of women’s programs and such and was administered by a woman named Regina. She explained their work which involved training caregivers and women’s desk heads from 640(!) congregations throughout the area. Much of the training has to do with orphan care, setting up feeding centers, and HIV testing and care for HIV+ villagers which is relatively new since the sin attached stigma has evolved to an attitude of the need to deal with the pervasive prevalence of this AIDS pandemic.

We were welcomed by the women training in the adjacent room who sang us in and where we went through the usual formalities of starting with prayer and introductions. We asked each other questions with interest on both sides. Two of the women mentioned that they knew of GAIA’s mobile health clinics in their regions and were hopeful that the program might be expanded to include their areas. They prayed again and then sang us along our way.

We toured the grounds, saw a training class of women learning about nutrition and IGAs (income generating activities – mostly sewing projects) which can help them raise funds for their volunteer work. We then walked down the hill to a church where the local women’s group was in the midst of one of it’s 2 days of feeding orphans from the neighboring village. The children sang “We are walking in the light of God” as we approached – love that song 🙂 and we were warmly greeted by them and the 5-6 village volunteers who use their own personal funds for this feeding program. Here they pointed out that they used an outdoor “kitchen” which was unusable when it rains and hence there is no feeding program on those rainy days. Also they feed the children in shifts since there are insufficient bowls to feed the 50-60 orphans at the same time. Since the children had been waiting for us before they ate, we encouraged them to carry on with their meal of likuni phala enriched porridge for the children who gratefully lined up and ate. The women explained to us that this was not only food for these children but also a welcome break from the deplorable living conditions from which they come. The women said that we would not like to see the houses where these children lived or particularly the latrines. The children are nonetheless amazingly able to smile and enjoy having the azungus take their pictures and show them the images on our cameras.

Day after day in varying places the same story again and again – so many orphans in such need and thankfully at least some in the communities with compassionate hearts to give them some support, however small. These communities are all poor but clearly the Malawian way is about helping those in the community in need even if you are in need yourself.

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Microfinance in Thyolo District and a primer on Freehold lands – 9/7

We head east and then south this morning toward Luchenza in the Thyolo district where GAIA’s micro finance program is headquartered. Again vast tea plantations along the way but more about that later. We arrive at GAIA’s local office, a simple but adequate facility, where the friendly micro finance staff brought us up to date on our work in this area. There are maybe 4 other micro finance entities at work in the district but GAIA distinguishes itself by its willingness to not only go to remote villages which require quite a long travel time form Luchenza but also, and importantly, to lend to not the “productive poor” but to women of dire poverty who have no business acumen whatsoever and indeed did not even know that such a thing as a loan to a woman might even be a possibility. So the GAIA microfinance program, run by a Malawian with experience in Malaysian micro finance, has been established with particular care and focus on the screening and training that is required to make for a successful program starting from such a base of inexperience as is represented by the women who eventually come to make up the lending groups to which loans are granted.

After going through details of the actual practices of our program, we drove about 45 minutes down a bumpy dirt road to arrive at a former MSF site now vacated where women from 3 of the lending groups greeted us with song. Their voices were lovely with very nice harmonies which I hope to have caught in a transferable way on my iPhone’s voice memo application! We made our way inside with the 23 women still singing and then went through introductions on both sides as well as a welcoming prayer.

A spokesperson for the women explained how they had come to be involved with the program – a few of them had actually come down to Luchenza to inquire – and then gave details of their training and how their groups operated. From her speech and subsequent short speeches by 8 – 10 of the other women, we learned that they were using the loan funds for all sorts of projects including brewing local beer, selling tomatoes, bananas, chitengas (sp?), groceries, and produce plus one piggery. Most moving were the descriptions from these now empowered women about what a difference this had made to their lives – one expressed gratitude and awe that GAIA had actually lent money to those others consider as “useless”… Another said, ” we were in the dark and now we are. In the light”… These women expressed from such a sense of strength and belief in themselves how their lives had changed. They have built homes, been able to pay school fees – even for private school in one woman’s case, been able to buy a bicycle for transport to the hospital for medicines for her medical condition which she could not otherwise have done, and even one woman has purchased a cell phone which enables her to conduct her trading business more effectively.

What particularly differentiated this group of people who have received support from GAIA is their own very clear sense of accomplishment that has resulted from their having received a loan, worked hard to make profits, and repaid a loan. Two of the women specifically commented on the fact that their husbands were also engaged in their work and helped with buying goods for resale or working in the garden. Many commented that their husbands now paid more attention to them, were more loving and were not wandering. This is also not insignificant in our battle against the spread of HIV where the fact that the men in this culture are prone to multiple sexual partners is a constant threat to efforts to reduce infection rates.

Our time with the micro finance groups ended with our country director encouraging them to continue the good work they have started as a way to bring themselves out of poverty. His message was that often people are trapped in poverty by their own lack of belief in their ability to escape it. He gave the analogy of a dog chained to the tree by the home each day when the family left so that he would not wander. One day when the family would be gone for the day, they left the dog unchained so that he could wander for water and such. When they returned, however, they found that the dog had spent the whole day in his usual spot by the tree. So it is with many in poverty who do not realize that they are indeed free to escape it if they will but do so.

These brave and newly empowered women sang us away with a GAIA song they had created for us – it was beautiful!

We had lunch we had brought seated on benches in the GAIA office back in Luchenza followed by a walk through the local market. We bought a few fresh vegetables for our dinner salad; one of us bought an ensema stirring spoon; for my part, I was tempted by a carved wooden bowl perhaps made for pounding grain but the 400 kwacha ($2.67) price was clearly exorbitant since it should have been kw 150 a 200 so I passed – would have been tough to fit in my suitcase anyway! Hmmm, that was only a little over $1…

On the way home, we passed the beautiful expanses of tea fields with occasional large tracts of untilled land laying fallow and then a small grouping of 1 to 5 houses randomly placed in the midst. So the freehold land taken over by the British was planted with tea and cannot be used by the local people. A few people here and there refused to move their homes – hence the occasional isolated home(s). It is not clear to which chief these people would be subject. Then there are the unused tracts of land owned by a now absent British landholder. These freehold lands are off limits to the local villagers in neighboring villages who often have insufficient land for their own sustainable farming. If they encroach on these lands they will be subject to ejection and worse, prosecution if the owner or his representative returns. In the Mulange district where village populations are dense as we have seen, the government has relocated people to Mangochi, northeast of there to lands purchased with global fund moneys. The people are displaced from their homeland, valuable funds used for the effort and those now living in Mangochi have extremely limited water supplies, insufficient some would say for living and farming. These attempts to rebalance the population distribution will be increasingly difficult in a country where the birth rate is now 5 children per family and will continue to put pressure on land use.

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Misango Village Mobile Health Clinic & Nsoma+Kanyandula+Mphuchika Villages (St Luke’s) 9/6

Eight of us drove again toward Mount Mulange including an Ethiopian pediatrician who was mostly raised in the US, studied at UCLA and is now taking some time to travel in Malawi and Ethiopia and perhaps elsewhere to also work in clinics where she may be needed. We got lost on the way to the mobile health clinic at Misango because a bridge was out and the diversion was not at all marked but the silver lining was that we drove through a very remote and densely populated area of 16 or so villages where apparently not many azungo (white people) travel and we have never gotten so many smiles and waves, even from adults and adolescents, and the children were absolutely beyond ecstatic and excited and frantically waving while jumping up and down as if they just could not get enough of seeing our unusual skin.

We finally made it to where the clinic was operating on a Monday in a small church with concrete floor and built in benches where again the people welcomed us with song although relatively few sang as most were simply amazed and not to speak of not feeling well. Some had begun walking from their homes at 4:00am and had been waiting since 6:00am for the medical staff. We all went inside the church and were introduced with Bill making a short speech about our wish to be their sisters and brothers and that we wished them well. We then split among a few who sat with the medical officer, a few with the 2 nurses who were entering medical data in each person’s medical passport and the government and clinic records using carbon paper (!), and then a few were writing down people’s stories with Alice interpreting.

The nurses explained what they were giving to the patients and we could see each small plastic bag marked with the medicine’s name and a visual of how often they are to take it as marked by boxes showing morning, noon, evening sun and the moon. Apparently, many people come to the GAIA clinic because the government clinics are more often out of the medications and also require a long walk. ARVs must still be secured from the government clinic which is a very long walk away taking maybe 2(?) hours or a Kw 250 but otherwise, the people prefer the mobile clinic.

The very small children still in their mothers’s infant sling were terrified of us since our skin looked so pale. One child looked at us twice and burst into frantic crying which made the mother laugh and she could only appease him with her breast. Others were less vocal but still did not like our looks!

After an hour at the clinic where about 25 villagers were seen by the MHC staff, we left and actually found a wood fired pizzeria with delicious pizza in a close-by town. Then we went back by the tea plantations from a few days ago to the 3 villages supported by St Luke’s parish in Darien, CT. Again we were sung and danced into a gathering where we were seated in front of villagers, this time the caregivers and orphans from 3 villages recently added to the GAIA villages program. Most of the 296 orphans who inhabit these 3 villages seem to have been there as well as their 105 caregivers, 2 coordinators and hundreds of other villagers of the 6,398 populating this area.

The program to which we have become accustomed unfolded with opening prayer, introductions of the chief and of the Americans, heartfelt thanks of a grandmother who GAIA has helped support the orphans she cares for, and AIDs patient who is grateful for the support, and 2 dances, the second of which we were encouraged to join which we did! The chief of one of the villages, a wise woman, gave a well thought out speech about how glad they are that GAIA is now there since they saw our work in the neighboring villages and feared we would never come but here we finally are! The villagers laugh and clap when we really get into it as one foe our group does very well – it is a wonderful way to enjoy each other cross-culture through dance requiring no verbal communication!

After the program closed with a prayer, we went to visit a home based care patient, a mother aged 38 with 4 children, one of whom is still nursing. Her husband left her with the 4 children when he found out she was HIV+, he would not get tested, and she struggles to feed the family despite some help from her sisters. She has a bad case of kaposi’s sarcoma which is especially bad on her right leg and causes her much pain. Despite this, she feels that she is better now that she is on ARVs from the government clinic. She shared her story with us willingly and we asked her many questions – her life is very, very hard. Before GAIA she had absolutely no support with feeding and meds.

Our senior staffer, Alice, then took a few of us to Ester’s home as I had requested if we could possibly see the inside of someone’s home including living area, bedroom, storeroom, adjacent kitchen and bathing area. Ester, a widow of several years, was thrilled to show us her home which was all dirt floors, well swept to a hard pack in order to keep dust down, and all in all well organized with her few belongings. The inside is very dark as there are no windows but it was fresh and tidy. The bathing area was brick lined with woven privacy walls and a large bucket for water. 2 toothbrushes were stuck in the woven siding for easy access! The kitchen is separate so there is no smoke inside. The smoke from the kitchen fire escapes through the door and 2 small open spaces in the hut wall when she cooks with her pot resting on rocks.

This was an emotional day as the remoteness of these villages meant that so many were exceedingly poor and yet needing to care for so many orphans left with no one. Also the unfamiliarity of the villagers with azungas (white people) and even the relative progress outside of their remote village felt especially desperate and deeply sad. The 4 americans in our car fell into a deep sleep on the way home – it was a lot to take in and difficult to make sense of it all in the context of the modern world from which we come.

We arrived back to the Assemblies of God guest house for creative vegetarian chili prepared by 2 of our group along with salad – in bed before. 9:00 for a sound sleep…

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Blantyre – Open Arms orphan care 9/4

With a local visit today we got to sleep in a bit since we left at 10:00 rather than the usual 8:00 – a nice reprieve! All of the GAIA staff and Sally Rankin from UCSF International Nursing program were meeting with the USAID representatives regarding details of a recent grant to GAIA for nursing scholarships and training in field maternity training. The rest of us went to the Open Arms Infant Home in Blantyre which is supported by various church and other groups in the UK as well as GAIA through it’s small grants program. This is an extremely well run care facility for about 50 children mostly under 2 who have been abandoned, or left without a mother due to death in childbirth or other illness – frequently AIDs, by a family member who cannot care for such a young child for whatever reason. The home maintains contact with remaining family members if known who visit the children when they can during their first 2 years when they are cared for by Open Arms, well nourished and given immunizations. At the age of 2, the children are healthy and able to return to their village with the relative who has been visiting over the years. To transition them, the relative comes and lives with the child in a house on the Open Arms campus that is just like a village home where the child and their relative bond for 1-2 weeks and the child adapts to a similar environment to the one in which he will be living once he leaves.

There are here also older children still at the facility who have no known relatives – currently numbering 10. They are cared for until either adopted by someone living in Malawi (per adoption laws dating from 1948) or sent to a Foster Home, of which OA has purchased 5. These homes are cared for by 2 women who can bring 2 of their own children and then adopt 4-6 foster children as their own for life. These homes are financed by various groups or organizations mostly in the UK.

OA also endeavors to find “nurseries” in the villages to which their children return, so they can be a feeding center, insuring that 60 children get at least one good meal a day. While OA provides food (probably Likuni Phalla) for 60 they are well aware that these feeding centers end up supporting considerably more children than that. If there is no nursery available, OA will build one either through specific funding or through J&J which sends employees to Malawi for this purpose regularly. One nursery was set up 3 years ago with solar electricity costing $1,600 which provides for 4 lights and a mobile phone charging station very successfully.

It is the director’s opinion that the number of abandoned children is increasing in Malawi. The reason has to do with the increase in mental illness among the child-bearing population and the social breakdown there that is resulting from the loss of so much of the parent population to AIDS over the last few decades. Fewer of these orphans are dying of AIDS than in the past due to the availability of ARVs for children which is at least one positive development.

The lot of children across Malawi is not really improving much if any and so the outlook feels bleak to this ED. There are simply too many children to be cared for and too few people available. Moreover, crises like the current measles outbreak are devastating with considerable under-reporting of the actual number of people affected, in this case the number of children who have died. He is aware of district health clinics that have been unable to diagnose the measles even in the midst of this outbreak with the result of may children dying needlessly.

This visit was informative though heartbreaking in many ways. At least the orphans lucky enough to end up at OA are as well cared for as could be reasonably expected. For our part, we enjoyed romping with the 10 older children, singing, throwing the ball and generally feeling the warmth of their smiles despite the tragic circumstances of their lives. I left with the image of Emmy forever imprinted in my mind, the feel of her earnest hand holding mine, her adorable engagement with “head and shoulders knees and toes…” and my hope that our little time together will leave her with a sense of my caring rather than the disappointment of yet another adult who has abandoned her…

We lunched at Ryall’s, the nicest hotel in Blantyre, went to Lambett’s to buy chitenga (like sarongs) fabrics, went back to pull together our day and then dined at 21 Grill, the nicest restaurant in Blantyre which is at Ryall’s where Andy, GAIA’s local data researcher, and his lovely wife and 1 1/2 year old joined us for dinner. We are driven back through the security gate and “home” by the wonderful GAIA staffers, Austin and Daniel.

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Mpala school and Nsona Village 9/3

We headed out this morning in 3 SUVs as we had the 10 of us plus Jones Laviwa, GAIA’s outstanding Country Director, as well as Alice Bvumbwe, Chief Staffer in Blantyre and Gertrude Chipungu, Chief Staffer in Llongwe as well as 2 drivers, Austin and Daniel. Our first stop was the GAIA office which has been built in the past year, has covered spaces for 5 vehicles, a round thatched Malawian equivalent to a gazebo plus unused land within the fenced-in property now owned by GAIA. We will see the interior another day.

We head east again toward Mount Mulange but after 45 mins turn right through the tea fields on a dirt road toward Mpala. Along the way are groves of trees planted by the tea plantation owners as a way of insuring they hold their adjacent properties by impending the villagers from building houses there. After a long drive through well maintained tea plants, all hand picked and irrigated with sprinklers, we begin passing by the now familiar huts of the villagers with thatched roofs and end up on the Mpala school property. We are welcomed into the one school block (room) of the existing 7 that has desks. In the other blocks, the children sit on cold concrete floors during the winter.

The purpose of this meeting is for the Hamels Foundation, represented by Heidi, to discuss with the Mpala chiefs and the head of the current Catholic school (taught by teachers who are not necessarily Catholic sent by the Malawian government) as well as some of the teachers the school renovations and additions that the foundation is committed to funding with GAIA’s support. Currently this is a primary school only and serving 2,400(!) students with 18(!) teachers. With only 7 classrooms, one of which has a leaking roof, most of the classes are held outside without even a chalkboard. The message delivered graciously by Heidi, Bill and Jones was that GAiA and the Hamels Foundation are not bringing Mpala a gift but rather are partnering with them for the benefit of their children. The details of what exactly is being proposed were laid out by Heidi who asked for input from these leaders and made it clear that this is their community project that once complete must be something with which they are all pleased. Jones did a beautiful job of encouraging them to give honest feedback about what exactly they want giving the analogy of the uselessness of a Muslim taking pork offered to him and then throwing it away – it certainly makes much more sense for him to be grateful for the offering but turn it down. Thus this school project will only make sense if it is what the community actually wants, will use to it’s fullest, maintain it and be proud of it. With a very open exchange then, some details were decided about staging, timing, location of different pieces of the project etc. to everyone’s satisfaction. In the end, the head of school and the principal chief expressed their gratitude and spoke of how fast the word would travel through their villages and how excited all the people would be to hear it. It was a fascinating interaction with a successful outcome for all sides and all the more interesting because of the poise and engaging spirit that Heidi, a 29 year old slightly built blonde American, displayed addressing a room full of Malawian men and only 2 Malawian women.

We toured the run down grounds including an old teacher housing structure that has been out of use for a long time and left to the termites who have built numerous mounds inside. Before leaving, Shirley had a group of 30 os so Malawian children dancing with her – great fun – and then the two of us helped some of the Malawian women turn a merri-go-round type of pumping structure which pumps water for the villagers – also fun and a but of a workout!

On the way back out to the main road, we stopped at a carpentry shop which housed a youth club project run by a young man named Victor who proudly showed us the furniture the group had made. This youth club is one of the activities sponsored by GAIA which trains the youth in a skill they can have for life while building their self-confidence in so doing and keeping them focused on a useful endeavor which diverts them from other trouble an adolescent might get into, all of which plays a role in reducing the potential for HIV transmission.

Back in the cars and shortly we come to the village of Nsona, which is part of a cluster of 3 villages in their 3rd year as GAIA villages. Here we are again sung and danced into a gathering under eucalyptus trees where we are seated in the front row while 700-800 villagers are seated and standing in a circle in front of us. A ceremony similar to the one the day before unfolds with one of the GAIA caregivers as MC, a prayer, introductions of chief representatives and the US visitors, a speech by Bill encouraging testing and treatment as necessary for pregnant women, and a speech by an HIV+ man who spoke about the importance of coming to grips with the disease in terms of being tested and then getting on ARVs which give you back your life in the event you have contracted the disease. A grandmother then spoke in great detail about how grateful she was for the support GAIA had made available to her grandchildren. There were dances by adolescents and then the 50 or so caregivers, all in white blouses, entered the circle singing praises to GAIA and how they did not want us to leave and then, of course, they pulled the visiting American women into the dance – we did our best and certainly entertained them for all sorts of reasons, no doubt!

Back to the Assemblies of God for a meal of leftovers and a good night’s sleep, at least until the 4:50am call to prayer from the neighboring mosque and/or the cockadoodledoos of the neighboring roosters!

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Mulanje District – Moloza mobile clinic and Village of Duswa 9/2

An amazing day! We headed east from Blantyre and once outside the city saw more and more of the rural scenes that paint the Malawian picture:
– an old woman leaning on her hoe in a small plot of land that is now well hand- furrowed
– a river below a bridge we’ve crossed with 50 or so women and children washing clothes
– a never ending stream of bicycles mostly being used as transport for huge bundles of sweet potatoes, bananas, long stripped trees, thatch, bed frames, charcoal (illegal but widely sold everywhere), firewood, bamboo…
– women with enormous plastic bins balanced on their heads or sacks of roots or suitcases…

We turn off the paved road about an hour from Blantyre onto a red dirt road at the end of which we find the Muloza mobile clinic parked at a small church. The GAIA staff and the maybe 200 people gathered for consultation at the clinic sang us to the site! I am realizing looking back that other than the GAIA staff, the people there singing to us were ill and there for medical help and here they are gathering the energy after what may have already been a long walk that morning to sing US welcome – I am even more humbled now than I felt then. Once greeted, the health clinic staff got to work inside the church, and we observed. There was pre-natal counseling behind a curtain in the main room which was maybe 20 X 50 with wooden benches on which the waiting people sat with only the light from concrete blocks with holes that are clustered as “windows”. In another area, a nurse dispenses medications that the medical officer has prescribed. While waiting, there are lectures to educate those attending about HIV, being tested, getting anti retrovirals (ARVs), prevention etc… Three of us stood in a side chamber, perhaps what might be the sacristy, where the medical officer who completed med school at he Malawi School of Medicine, analyzed patient symptoms, read test results which they hand carried in with their medical record book, and prescribed medicines and care. This most compassionate and kind doctor saw 2-3 patients every 5 minutes or so. He explained to us what he was seeing as their symptoms and test results as he worked with each patient and then what he prescribed. The most common positive test result was malaria for which the doctor would prescribe a 3 day medicine regime which amazingly arrests the disease. Apparently this is a relatively new med made from a Chinese (?) tree abbreviated LA which replaces SP – fansadar which was the prior med. Apparently, the GAIA clinic carries the new med which is not necessarily available at the government health clinic, hence the popularity of the GAIA mobile health clinics.

Other patients were suffering from opportunistic diseases which come with AIDS, as well as diarrhea, skin rashes, fevers, eye and ear infections etc… The doctor encouraged HIV+ patients regarding dealing with their status among spouses, encouraging testing etc… All of this so gently handled by the doctor and the patients clearly so relieved to be at the clinic, and we as visitors are taking pictures and asking questions and trying so earnestly to convey our compassion as we hear each one’s story. What noble and courageous souls look at us with such depth of presence as they take their medical books and prescriptions our of the room.

Near the end of the hour, we hear our fellow travelers leading the children old enough and not too sick in a round of “head, and shoulders, knees and toes; knees and toes…” They are thrilled and try to partake though we all wish the language weren’t a barrier…

We leave as I think what a blessing it would be for all the world to have such a kind soul as this doctor we have seen so quickly assess each patient and handle his counsel with such care.

PS Of interest was the fact that a fair number of the malaria tests were not readable, so the doctor was forced to decide if he gave another or just prescribed based on symptoms – a trade-off considering costs, time and patient interaction. Similarly, in this remote area, the blood pressure cuff was broken and the doctor was forced to assess with incomplete information. These are just examples from 1 hour of observation showing the types of issues that the rural medical clinics must deal with each day.

We traveled back along more red dirt roads to the village cluster at Duswa where a throng of 500 – 600 people awaited us under a grove of tall eucalyptus trees and began singing and dancing toward us as we got out of our SUVs. Astounding! It was overwhelming to say the least. This was a gathering of people from 15 of the GAIA villages. We were seated in the front row of chairs set out for the occasion with 10 of the represented villages’ chiefs seated behind us – one a woman. One of the GAIA caregivers, Jean, acted as MC to a surprisingly hushed crowd given the fact that at least half were children. We were welcomed heartily and asked ” to feel at home” and then one of the other caregivers was asked to lead us all in prayer – a long prayer in Chechewa which grew faster and faster as she progressed and ended in “amen” which we all repeated. Then all the Chiefs were introduced which brings a special slow clap from the crowd for each. Other villagers were introduced and then Bill was asked to introduce each of us – regular clapping after all non-chief introductions. Bill made a special point of saying that we all were honored to be here as sisters and brothers to all of the villagers.

The well planned program then included a singing of the national anthem by a young choir all dressed in simple uniforms holding their hands over their hearts. There were testimonials by several villagers and caregivers thanking GAIA for our help in supporting their villages, especially the orphans, and one of the HIV+ villagers encouraged others to be tested as he had because with the new meds one could still have hope for the future. There was a dance by the adolescents singing a song about AIDS and then a drama which emphasized the importance of orphan girls getting their full education rather than being married off immediately. The next dance was by a larger number of villagers accompanied by enthusiastic singing of a song which thanked GAIA for our support and then all the female visitors joined in the dancing as best we could which brought much giggling among the villagers as they watched us trying to keep up – very fun! The program ended with a prayer and then we took pictures of the children, showing them their images on our camera screens to their absolute delight. We have become accustomed to this and love entertaining them as such although at times their persistence and closing in closer and closer to the camera becomes a bit claustrophobic! As we approached our cars to leave, the caregivers again began singing a song about GAIA and their gratitude for our work.

I now really understand at least part of why GAIA’s village model is so effective in educating about and de-stigmatizing AIDS… The fact that GAIA’s dedicated caregivers teach the whole community these songs which become a part of their village life means that the messages therein are heard, learned and remain a part of their very own local culture. These are not messages from outsiders that are simply preached and then forgotten but rather are from people in the villages themselves who learn about how HIV is spread, how it can be prevented and what to do if you have contracted it or think you may have and then not only tell this to their fellow villagers but incorporate the messages about what they have learned into their daily work and even the village songs.

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