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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