Today was a very typical day
I went to the bank at lunch time to pay in a cheque from WFP for travel expenses. All the cheque payment slips had run out (this is the biggest branch of the biggest bank in Malawi), so I was advised to use the cash slips. After queuing for 25 minutes in the ‘deposits’ line, behind a couple of tobacco farmers who had turned up with literally a wad of money which needed counting (the biggest note here is 500Kw – the equivalent of two pounds), the man behind the desk said that I couldn’t pay a cheque in without a cheque slip. I explained the situation, and we came to the compromise that I could cash the cheque and pay it into my account in cash. Later that day I went to the cash point. Now, there are technically four cash points at the City Centre branch of the bank, but usually only 2 of them are working. They also close for two one-hour slots in the middle of the day for maintenance. Of course, there was only one cash point working when I turned up. Malawian cash points are really something else. You really have to be prepared to enjoy the experience, otherwise you’ll end up hitting it. First of all, they are incredibly slow. There’s none of that putting the card in and punching out a pin number. Okay, so technically you do just that, but it’s not exactly instantaneous. The cash point I used had a faulty screen, so when you typed in the amount you wanted, you couldn’t actually see anything, so it has to be done by trusting what you type. That, and the fact the bank won’t let you take out more than 40 pounds.
I actually quite like the National Bank. It has a good logo, a large, glassy, clean building a mere 5 minute walk from Kang’ombe House, and friendly security guards by the cashpoints. However it failed to tell me they were charging me for setting up a bank account, or that there are monthly charges for having a cash card (note, only usable for withdrawing money from another National Bank cash point. The whole paying by a card thing here is completely non-existence, unless you are in the nice travel agent, where you can pay for flights by credit card). I admit, I didn’t ask about the charges, but I still think I should have been told. It’s a bit like the doctor when I had malaria. Such a lovely guy, but he completely failed to tell me the side affects of medication, whether it would clash with anything else I’m on, and whether to continue taking my normal prophylaxis.
But really what am I complaining about. It’s not like the banks in the UK are that great either (sorry Holly).
It’s also a novelty (although not a very nice one) for people to die of anaemia. I was quite shocked about this at first…I mean, how can you die from anaemia. Well, 9 months later and it seems that it’s actually one of the commonest causes of death (after malaria, AIDS and needless road accidents). Laz’s uncle, who went in for an operation for a blocked urethra, ended up dying of anaemia. Ntolo’s wife, who had given birth to their first child 5 months ago, died of anaemia three weeks a go, and the mother of someone who works at our sub-office warehouse, also died of anaemia following a car accident. Yes, it’s quite true: a lot of people die around here (especially in the last couple of months). Apparently there isn’t enough blood, and what there is isn’t too good quality, and most of the time transfusions are done far too late. And that’s the whole problem here: late presentation. This refers to nutrition, education, health, even the current government budget – it’s all prepared, or presented, so late that it doesn’t stand a chance.
Wednesday, May 23, 2007
Monday, May 21, 2007
Please look at the photo accompanying this note. 
On the whole work can be kept to programme matters, on a so-called higher national level. However, last week I was in Nsanje, in the Lower Shire valley down South. Going into the field means something else from the daily grind; direct contact with beneficiaries and health centre staff, difficult conditions, and the face to face reality which is needed to keep enthusiasm for this job, despite it usually leading to depression when I return. The child in the picture is 8 years old, with severe wasting, marasmus on the arms and legs (stick thin), and a very swollen belly, either from oedema or worms, or a combination or all sorts of other things. The child was found by the outreach workers at the health centre, and was asked to come in to be weighted and measured. That was three weeks ago. The child came in with his 12 year old sister, was advised to go for VCT (voluntary counseling and testing for HIV), and referred to the district hospital Nutrition Rehabilitation Unit. This health offers OTP – outpatient therapeutic care – for malnourished cases which have no complications, but such treatment is futile for such a child; he’s just too sick. Afer the first visit to the health centre the child was not taken to the hospital. This is because the father remarried and the new wife is not interested in his two children from the previous marriage. The next time the child was brought to the health centre by the father. The same advice was given. The health centre even provides transport is the father and child turns up ready to be taken to the hospital. I was seeing the child the third time is was visiting the centre. I was standing the storeroom inspecting the CSB mix and checking ration quantities. I looked over at the queue of children being weighed and this little boy stood out like a hippopotamus in a desert. Visibly, the child is extremely sick. I asked what was going on, and why on earth he wasn’t in the hospital. Maggie, the Programme Assistant for Nutrition at WFP, based in Blantyre sub office explained to the father again that the child would die within days unless he took it to the hospital. She pleaded with him, saying that it was his son, and that there were other fathers in the hospital with their children. Even if he wants to take his daughter with him as well, food is provided by WFP at the hospital for the caretaker and any children brought along too. All the time, I was making ridiculous faces at the children, and he barely had the strength to smile, which is such an odd reaction from the children here – usually they are giggling, or hiding their mouths because they think it is rude to laugh so much in front of the strange white girl. After quite a lot of pleading and begging the health centre staff promised they would get the child to the hospital. In reality, I just don’t know. As Maggie said, if the child stays in the village he will die in the next few days. If he goes to the hospital he can be treated, for even if he has HIV there are paed anti retrovirals in Nsanje district, and the boy can grow to be big and strong, an asset to his father. Children like this break my heart, and make me question the benefits of my sort of job. For personal gratification being in an actual health centre would mean more to me, but then having the opportunity to implement at a nation level has its benefits too, they’re just harder to feel.
A classic example of why nutrition education just isn’t working: when I asked why women don’t feed their children an egg every couple of days (very cheap, and nearly everyone has a chicken), Maggie said that traditional belief linked eating eggs to epilepsy, and so no one in the villages eat them. So there goes another easy to eat food, rich in protein, which no one will touch. It takes generations to change culture.
On the whole work can be kept to programme matters, on a so-called higher national level. However, last week I was in Nsanje, in the Lower Shire valley down South. Going into the field means something else from the daily grind; direct contact with beneficiaries and health centre staff, difficult conditions, and the face to face reality which is needed to keep enthusiasm for this job, despite it usually leading to depression when I return. The child in the picture is 8 years old, with severe wasting, marasmus on the arms and legs (stick thin), and a very swollen belly, either from oedema or worms, or a combination or all sorts of other things. The child was found by the outreach workers at the health centre, and was asked to come in to be weighted and measured. That was three weeks ago. The child came in with his 12 year old sister, was advised to go for VCT (voluntary counseling and testing for HIV), and referred to the district hospital Nutrition Rehabilitation Unit. This health offers OTP – outpatient therapeutic care – for malnourished cases which have no complications, but such treatment is futile for such a child; he’s just too sick. Afer the first visit to the health centre the child was not taken to the hospital. This is because the father remarried and the new wife is not interested in his two children from the previous marriage. The next time the child was brought to the health centre by the father. The same advice was given. The health centre even provides transport is the father and child turns up ready to be taken to the hospital. I was seeing the child the third time is was visiting the centre. I was standing the storeroom inspecting the CSB mix and checking ration quantities. I looked over at the queue of children being weighed and this little boy stood out like a hippopotamus in a desert. Visibly, the child is extremely sick. I asked what was going on, and why on earth he wasn’t in the hospital. Maggie, the Programme Assistant for Nutrition at WFP, based in Blantyre sub office explained to the father again that the child would die within days unless he took it to the hospital. She pleaded with him, saying that it was his son, and that there were other fathers in the hospital with their children. Even if he wants to take his daughter with him as well, food is provided by WFP at the hospital for the caretaker and any children brought along too. All the time, I was making ridiculous faces at the children, and he barely had the strength to smile, which is such an odd reaction from the children here – usually they are giggling, or hiding their mouths because they think it is rude to laugh so much in front of the strange white girl. After quite a lot of pleading and begging the health centre staff promised they would get the child to the hospital. In reality, I just don’t know. As Maggie said, if the child stays in the village he will die in the next few days. If he goes to the hospital he can be treated, for even if he has HIV there are paed anti retrovirals in Nsanje district, and the boy can grow to be big and strong, an asset to his father. Children like this break my heart, and make me question the benefits of my sort of job. For personal gratification being in an actual health centre would mean more to me, but then having the opportunity to implement at a nation level has its benefits too, they’re just harder to feel.A classic example of why nutrition education just isn’t working: when I asked why women don’t feed their children an egg every couple of days (very cheap, and nearly everyone has a chicken), Maggie said that traditional belief linked eating eggs to epilepsy, and so no one in the villages eat them. So there goes another easy to eat food, rich in protein, which no one will touch. It takes generations to change culture.
Thursday, May 10, 2007
The return
During pre-departure training one big tip given to everyone was to go away from their overseas placements for a week or so after about 6 months in order to achieve the feeling of ‘coming home’ when returning. It’s a good trick, and it does work, but right now if one more person comes into the office and gives me a hug with a sad, suitably appropriate look, and a ‘I’m so sorry’ comment, I think I am going to crack. I knew before I left that WFP – the good bits of WFP – really are something else. Never have I worked with people I like more, where really everyone has a good soul. Even the security guard on the fourth floor, who I usually avoid, dealt well with a sarcastic reply to his ‘how was the holiday?’. ‘As well as a funeral could go’ I scowled back, and he seemed genuinely nice about it. Saying that, never before have I worked in an organization where family comes first. I don’t think my September 2008 awaiting job in London would look too kindly on me nipping out for a couple of hours to visit my cousin’s daughter in hospital. But I like it. We still get the job done (on the whole), and when Nell walked into our nutrition office this morning to find Laz, Osborne and me having a good chuckle, Laz beamed at her with a ‘welcome to our office.’ These are the things to treasure, especially when I am experiencing post-funeral blues.
On the plane back I got to thinking about the added value of being here. There’s got to be something right, something other than resume related? When I was in Addis I never really thought about added values, it was just as it was, a life. I remember sitting in City Bakery in Addis with my friend Ute thrashing out these issues: will anyone understand this type of work? why should we expect our friends back home to be interested in the minute details of our daily lives and jobs? is it worth the mental isolation if we think what we’re doing is important? will the transience of relationships which are formed have longer term effects? are we missing out on what I sometimes think of as a ‘normal’ life? In Addis I never considered myself to be treading water or putting my life on hold. I was living there. It was a life. I was happy to just be. But here in Lilongwe it’s different. I don’t know if it’s because of the length of time I’ll be here for, or because it is just such a small place, but the feeling of being on hold, of wanting my London life back keeps creeping up on me. When I went back home last week I thought I’d go mad with all exciting food, and decent newspapers. In reality, I didn’t want any of it. What was more surprising was that I didn’t want to talk about my job. My job and my life here are so intertwined that I don’t differentiate. But at home, on the only one occasions someone asked about the job specifics, I didn’t want to talk about it. On the one hand it would be part reeling off statistics and the logistical problems of getting food to 50,000 malnourished children, dumbing it down a little and not using acronyms. On the other hand I could go down the sob story route, about the late presenting quash cases and the use of Fanta in weaning children. Or again, it could be about the frustrations of trying to get things moving quickly when working for an international organsation, how problems repeat offend, how the sheer brick-wall feeling occurs so often that it wears you down, how the physical exhaustion of spending 9 hours in a car 3 days a week wandering around rural health centres can sometimes lead to tears for absolutely no reason. In Malawi I’ll talk about my job until the cows come home. Even to the taxi driver I’ll be expanding on the 6 food groups and the evils of Fanta. But in the UK, I really don’t think anyone is actually particularly interested after the initial and highly superficial introduction. And really, why should they be?
The ever brilliant Roger McGough has some good things to say on this. I’m not in to quoting poetry, but his entire book ‘Blazing Fruit’ could be inserted about now.
So now I have two lives, and while Malawi rubs me up the wrong way more than I could ever imagine there are many things to value too. Post funeral it feels that while death here is so much more common place than in the UK, it seems to mean so much more. I don’t mean to be derisory, but here there is such a dignity to death. Old members of the family are looked after and treasured, not put in nursing homes or farmed out to other paying establishments. There is something quiet, discreet, and meaningful about the way death is treated. I’m not saying that this isn’t the way in the UK, but it certainly feels different here. Maybe it’s the knowledge that here, with the increased religious conviction, there is a confidence that the dead are passing on to somewhere better. What is more reassuring than that?
So coming back to Malawi is a good thing. Good in that it is my home, for now at least. Good that when the taxi came through the gate of 194, Area 15, Dave beamed and clapped his hands. Good that the dresses I bought for Dave’s girls fit. Good that the house still feels the same. When something so permanent in your life goes you think that everything will change. But it doesn’t, and the daily rigours of distribution plans, endless meetings, field monitoring and random chat take over.
On the plane back I got to thinking about the added value of being here. There’s got to be something right, something other than resume related? When I was in Addis I never really thought about added values, it was just as it was, a life. I remember sitting in City Bakery in Addis with my friend Ute thrashing out these issues: will anyone understand this type of work? why should we expect our friends back home to be interested in the minute details of our daily lives and jobs? is it worth the mental isolation if we think what we’re doing is important? will the transience of relationships which are formed have longer term effects? are we missing out on what I sometimes think of as a ‘normal’ life? In Addis I never considered myself to be treading water or putting my life on hold. I was living there. It was a life. I was happy to just be. But here in Lilongwe it’s different. I don’t know if it’s because of the length of time I’ll be here for, or because it is just such a small place, but the feeling of being on hold, of wanting my London life back keeps creeping up on me. When I went back home last week I thought I’d go mad with all exciting food, and decent newspapers. In reality, I didn’t want any of it. What was more surprising was that I didn’t want to talk about my job. My job and my life here are so intertwined that I don’t differentiate. But at home, on the only one occasions someone asked about the job specifics, I didn’t want to talk about it. On the one hand it would be part reeling off statistics and the logistical problems of getting food to 50,000 malnourished children, dumbing it down a little and not using acronyms. On the other hand I could go down the sob story route, about the late presenting quash cases and the use of Fanta in weaning children. Or again, it could be about the frustrations of trying to get things moving quickly when working for an international organsation, how problems repeat offend, how the sheer brick-wall feeling occurs so often that it wears you down, how the physical exhaustion of spending 9 hours in a car 3 days a week wandering around rural health centres can sometimes lead to tears for absolutely no reason. In Malawi I’ll talk about my job until the cows come home. Even to the taxi driver I’ll be expanding on the 6 food groups and the evils of Fanta. But in the UK, I really don’t think anyone is actually particularly interested after the initial and highly superficial introduction. And really, why should they be?
The ever brilliant Roger McGough has some good things to say on this. I’m not in to quoting poetry, but his entire book ‘Blazing Fruit’ could be inserted about now.
So now I have two lives, and while Malawi rubs me up the wrong way more than I could ever imagine there are many things to value too. Post funeral it feels that while death here is so much more common place than in the UK, it seems to mean so much more. I don’t mean to be derisory, but here there is such a dignity to death. Old members of the family are looked after and treasured, not put in nursing homes or farmed out to other paying establishments. There is something quiet, discreet, and meaningful about the way death is treated. I’m not saying that this isn’t the way in the UK, but it certainly feels different here. Maybe it’s the knowledge that here, with the increased religious conviction, there is a confidence that the dead are passing on to somewhere better. What is more reassuring than that?
So coming back to Malawi is a good thing. Good in that it is my home, for now at least. Good that when the taxi came through the gate of 194, Area 15, Dave beamed and clapped his hands. Good that the dresses I bought for Dave’s girls fit. Good that the house still feels the same. When something so permanent in your life goes you think that everything will change. But it doesn’t, and the daily rigours of distribution plans, endless meetings, field monitoring and random chat take over.
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