One year down

Two months ago my colleague's wife died. She was 28, had given birth to
their first child in January, and died of anaemia. She was not an
uneducated village woman, but degree holding, smart, funny, and
overjoyed with her new daughter. Up until this year I had never heard of
anyone dying of anaemia, yet here it seems that everyone dies from it.
Iron deficiency is the main cause of anaemia in developing countries,
and there are as many as 56% of pregnant women who are iron deficient in
this part of the World.

Iron deficiency reduces work capacity, and therefore reduces development
potential, increases susceptibility to infections like measles and
malaria, increases the risk of maternal mortality by six times, and
leads to suboptimal mental development. In the West we don't even think
about it.

Not that I've checked, but I imagine UK flour and bread is fortified
with iron, as in many developed countries the governments have ensured
that iron deficiency won't halt a country, like it has here. Iron isn't
the only micronutrient halting the progress of Malawi: iodine, vitamin
A, niacin, thiamin and vit C play their part too. At least here all salt
must be iodised by law - but the storage of salt in the sun means that
most of the time the iodine has evaporated before it enters the body, or
it comes over the border from Mozambique, where iodizing salt isn't
enforced. The economic implications of malnutrition are staggering:
populations working at 50% capacity, high infection rates due to poor
immune systems leading to costly medication, high maternal mortality
rates, and in a country with a high HIV rate like Malawi a good diet can
drastically halt the transition of HIV to AIDS by decades, and
complement Anti-retroviral Therapy, making ARVs more effective and
reducing the side-effects (fortified supplementary food to ART
beneficiaries is another WFP programme). Food fortification is the
cheapest, most extraordinarily successful way of improving the health of
populations, and this should be a right, not a priviledge.

The only reason this is coming up now in an email after nearly a year of
being here is that I've just finished a week long training on nutrition
needs in emergencies. This is the last of a batch of WFP trainings, and
focused on ration content, ration size, and meeting the nutritional
needs of the most vulnerable during crises. As ever by the end of the
training I fail to understand the attitude to food in the UK. Certainly
since September I've seen my fair share of children with severe wasting
and stunting and some horrific kwashiorkor cases, where the child's face
is so swollen with fluid that they can't see. Yet despite this, and the
previous trainings from WFP on nutrition, this latest course has struck
home much more intensely the very basic nature of development that we're
dealing with. Food is so fundamental, so essential, and totally
devastating when lacking. In the UK there is just so much; you can
choose between different types of bananas and apples, a multitude of
breakfast cereals, a plethora of biscuits, and yet still people are
unhappy with their relationship to food. There are such enormous
advantages in the UK, and such basic lacks here. And yes, it is utterly
pointless going on about Western guilt mentality, but does anyone
realize how lucky they are for more than a fleeting 10 seconds when
walking down the aisle of Sainsburys? I struggle with this enormously
because I complain just as much about the lack of yoghurt, cheese, fish
and jam here, and wish there were more regular food supplies in the
shop, or at least more exciting cooking ingredients. 95% of this country
spend 97% of their income on food. In the UK it's something like 12% of
income.

If I ever write a book about here it will be on the drivers, one chapter
on each of them. There's Pashani, my favourite, who is always on time
(not Malawian time), always asks about my sister in China, and starts
every sentence with 'ah..Hezil...no,' and gets particularly passionate
about my lack of a brother. Pashani is the driver who recently prevented
us ending upside down in a ditch when we had a blow-out tyre while
driving at speed on a deserted bit of the M1 in the North. Joyce, the
only female driver, is extremely intimidating with 4 children (by three
different men), and 6 nieces and nephews she also looks after. She is
vast, with rapidly revolving hair styles, and you don't want to cross
her. The drivers are never just drivers: they all have about 10 acres of
land under cultivation, one has a mini-bus, and Hastings sells his soya
to Unilever. When it comes to unknown territory they are all fearless:
never tell a WFP driver that perhaps the road isn't too good, as they
will always want to try it out. This has resulted in me getting stuck on numerous occasions, watching from the sidelines as a gleeful driver dons overalls and tries to yank
the vehicle out of a mud-bank.

Edward, the youngest driver at 28, is a bit cool. He wears bright
striped shirts with white collars and cuffs, and has a thing for Nelly
Furtado. He always beams with bashful pride when you comment on his
choice of shirt. We were in Ntchisi one day going round health centres
with the District Nutritionist, Albert, who is also 28. The journey
started off from the boma in silence, then Nelly Furtado came on the
tape and Edward turned it up and said to Albert that this was a really
hip song. Albert nodded in a kind of cool, understanding way. This broke
the ice. After rewinding and listening to the song another three times,
Edward offered Albert his newspaper in an off-hand, not really offering
sort of fashion. It was brilliant. By the end of the trip they were firm
friends, talking about women, football, the crazy politicians in the
country, and Nelly Furtado. I really love these trips, sitting in the
back of the pickup, getting my spine contracted with every bump, and
waving back to the children walking along the side of the road.
This last month I have been spending a lot of time with the drivers due
to a two week evaluation of the emergency supplementary feeding
programme: a week in the Central and Northern region, and a week down
South with Roger, the Norwegian nutritionist at UNICEF, where we crammed
five districts into five days. The last evening of the mission was spent
playing snooker at the local bar in Phalombe (a relatively new District,
still connected to the main road by a 1.5 hour dirt-track journey) where
I teamed up with the very drunk District Nursing Officer (DNO) and beat
Roger and his partner - an even drunker District Head of Police. Only on
trips with Roger can I enter a local bar, and even then you can see all
the drunken men looking slightly uncomfortable as they stagger to stand
up in shock as two muzungos
(foreigners) arrive. Still, my snooker playing has improved immeasurably
after some handy tips from the DNO. These trips are exhausting, both in
the planning and the execution: 6am to 6pm most days, extremely bad
roads, mice-infested accommodation and health centre after health centre
where either the staff have decided not to show up at work that day, or
where syringes litter the floor and no one seems to care. There are, of
course, exceptions, and some of the Health Surveillance Assistants
(HSAs) I interviewed were inspiring and hugely committed to improving
their knowledge about effective nutrition interventions. One health
centre in Ntchisi has the most beautiful nutrition education garden,
which the health centre staff maintain and fund themselves. As most of
them earn $80 a month, their dedication is quite spectacular.
When planning the methodology for the programme evaluation I wanted more
than anything to interview beneficiaries to find out whether they knew
why they were receiving food. Interviewing beneficiaries is a first for
me, and certainly a first for this programme - which hadn't been
evaluated before.

Unusually at one health centre in Phalombe a father - not a mother - was
there with his daughter. At the end of my questions he asked what was
the point of supplementary feeding if his daughter (aged 2.5 years)
weighed 8.2 kg at the beginning of the programme and weighed 8.2kg now?
I was a bit lost for words; how do you tell a father than 90% of
non-responders are HIV positive? Nearly 1 in 3 malnourished children are
HIV positive and nearly all non-responders. HIV is everywhere, not least
on the M1 just outside Blantyre where there is an enormous sign stating:
'AIDS is real, It is not witchcraft.'

At Ndamera Health Centre in Nsanje the HSA replied to my question about
how we could solve malnutrition long term without food aid by saying:
'A thing seen by my eyes can be remembered, but a thing done my by hands
becomes part of me,' and while he was referring to nutrition education
and kitchen gardens, for me this rings true in so many ways concerning
my time here so far.

This first year is coming to an end now, and there are so many lessons
learnt about the realities of being an aid worker, and so much more to
learn (my Chichewa can still be classified as basic). Sorry Chris for
abusing your email, but you put things much better than I ever could, so
please forgive the quote: 'Partly, your work becomes just that - not
saving lives, not exciting-every-day tasks with your merry gang of
superhero colleague-friends, but work, a job which you do, desensitised
to its real meaning; knowing the world is far more populated by number
crunchers than by development zealots, and knowing this isn't an all-bad
thing... and when you do think about it, you're making it so that people
can move up from a miserable to a meagre existence, and it's rather
depressing.'

This is something we talk about a lot here, especially when it comes to
relating this life with the one back in the UK. We get asked how life is
in 'Africa?' and have to resist the temptation of saying that we have no
idea what it's like in the northern countries, or over in the west.
There is no saving of millions of lives going on, no Mother Teresa mass
acts. Instead there is a normal job, and lots of valuable work done from
the number crunching side as well as the not-strictly-number-crunching
side: writing monthly NRU admissions analyses, composing programme
evaluations, writing the bi-monthly country nutrition food distribution
plans, the dreaded Monthly Consolidated Output Report, disseminating
ideas about food diversification, constant monitoring of the programmes,
exasperation at the Ministry of Health, and really countless, endless
meetings where the agenda isn't followed and you leave not having a clue
about what was achieved or the next step. But these things contribute to
so-called development: tiny chippings away at the gruesome poverty which
doesn't seem so gruesome anymore, a worry in itself.

Having been counting the days till I go to the UK for a month's home
leave, I'm now not so sure. There is so much I've learnt this year and
so much I have grown to love. The humour here is fantastic with comments
about breasts the size of pawpaws (during a breast milk lecture), a
comparison of women and cows ('but we are all animals after all' shouted
one guy) and when the facilitator of a recent workshop on the
Accelerated Child Survival Strategy said that Malawi was a very
peaceful, stable country, three people from the Ministry of Health
heartily chorused, 'at least we've achieved something in 50 years.' Even
this is incomparable to the hysterically funny Advanced Security in the
Field training, after which I can now identify different land mines and
how to cope in a hostage situation. The training was conducted by an
Angolan former Army general, who had a map of Angola tattooed on his
bulging bicep, and had difficulty controlling a bunch of WFP staff who
found innuendos in everything he said in his heavily accented speech. My
car maintenance skills have improved beyond belief (fan belt /tire
changing in the dark/jump starting a battery), and I could write a
recipe book on 101 things to do with a squash or pumpkin. Lilongwe is a
small, pretty, fairly planned out town, with five shops, seven
restaurants, and the famous Chameleon which plays jazz on Sunday
afternoons and 80s disco music on Friday nights. There's not much else.
Every international is on the Lilongwe google group (it really is that
small), and in the course of two months you'll see the entire muzungu
population at the Thursday night film showing, held on a projector at my
friend Matt's house. It's a content life, wholesome, immaterial, all
ages mixing together, but slightly dull. I like the simplicity and the
values but hate the lack of anything to do and the cliquey muzungu
groups. While this is an isolating experience in many respects, and
there have been some very difficult, frustrating, gloomy times, I feel I
know Malawi from Chitipa to Nsanje by the position of over 500 health
centres, by the dirt-road shortcuts, and by the shapes of the mountains,
and for all the faults of WFP it really is my family.

So to finish with a saying from Ntolo in our M&E unit, which he says
when I scream at yet another driver overtaking up a hill/round a bend
and nearly hitting us head on: 'TIA':
This Is Africa.

I'm back in the UK this Wednesday.

School Feeding photos (from Ntcheu)

While this might look like an ad. for a WFP catalogue, this is in fact mouldy Corn-Soya Blend (CSB), which had to be destroyed.



A good example of food diversity...lovely yummy fruit.

A finger print from a school feeding recipient, as she picks up her take-home ration.

Taking the rations home.

Nell's nocturnal visitor (a story from the sticks, direct from the horse's mouth)

‘On Tuesday night I went out to eat dinner with my neighbours. I was out until around 9.30pm, which is a late night for me in Ntcheu. I should note here that it has been getting cold at night, and so therefore I have not been opening the windows, or leaving the doors open for any length of time, other than to enter or leave the house.

Upon returning to my house I made tea for my night watchman, Earnest. We had a disagreement since I told him I would be deducting money from his wages if he continued to come after dark. Despite this we said good night on good terms, and I slept peacefully at 10pm.

At 10.55pm I was awoken by loud noises coming from the kitchen. There was a crashing of pots and pans as they fell to the floor. My thought was that intruders must have entered the house. I was terrified. Somehow I summoned the courage to pull on some clothes and grab my keys. Then I made a run for the door. Upon leaving my bed room (it was dark) I felt something slap me in the face. I kept running and realized that there was some kind of large bird circulating in the hall. I saw that it was an owl. I fumbled with the lock and the bugler bars until I escaped from the house and shouted for my night watchman, Earnest. He was no where to be found. I shouted and shouted but he didn’t come. I did not know what to do, but I was not ready to confront the creature alone. I called for my neighbours and they came together not believing that an owl could be inside my house. We put jumpers and blankets around our heads to protect them from the bird’s attack. My neighbours approached the bird with a broom and a mop. Thankfully it panicked and flew through the open door. All of us were terrified.

My neighbours told me that owls in Malawi are associated with witch craft. None of us could explain how or why the owl had entered the house. Some suggest that it may be linked to the disgruntled watchman, and that the watchman transformed himself into an owl. In fact, nearly everyone in Ntcheu believes that the owl was an evil presence, and was the watchman in another form. Many people have come up to me to express their regret at the evil owl. The watchman later denied all knowledge of the incident. He claimed to have been present the whole time, but we can safely say he was not… in his human form.’

(Nell works for WFP as a Food Aid Monitor in Ntcheu district, two hours by car from Lilongwe, and two hours from Blantyre. This weekend she escaped up to Lilongwe, fleeing the owl and the disgruntled night watchman.)

9 months in.

I was extremely tempted to scrap the below email, carefully written on Saturday, and write about the mountain we climbed yesterday. It is a beautiful mountain, called Mphunzi, and like all the mountains in Malawi is a very funny shape, mainly rock, sitting just behind a CCAP Mission church and health clinic (which does supplementary feeding). It was a straight up the side kind of hike, a break at the top for fruitcake, and a rather scary descent before the trip back to Lilongwe on Ali’s Djibouti 10-seater overland truck.

Anyway, this is not going to be about the mountain, or the rock paintings that were up there.

This last month I was back in the field to my old haunts in the Lower Shire (shir-e): Nsanje and Chikwawa. I realize that being ‘in the field’ is a little odd as an expression, especially as it refers to anything outside Lilongwe. But for the Lower Shire it holds some truth; halfway between Blantyre and Nsanje the tar road stops and the driver announces with a smirk ‘now we’re really in the field.’

Nsanje is little more than a one-street-wonder, positioned by the enormous River Shire, which floods with depressing regularity, stuck at the bottom of a basin that makes up the Lower Shire, a mere 30m above sea level. It really is as if Nsanje and Chikwawa were dropped off the side of the great cliffs of Blantyre. In Nsanje there are a few NGO district offices, the District Assemblies building, District Hospital, District Education Office etc. In fact there are more buildings declaring it a District capital than there are people. This district has the highest rate of malnutrition in the country, the highest temperatures, highest humidity, highest percentage of malarial mosquitoes, prone to famine and drought and lacks a proper road to connect it to the rest of the country. If something goes wrong in the country, it will probably happen in Nsanje.

However, the town has another, more positive, claim to fame: it’s Port – the President’s vision of the future, but as yet no more than a signpost, and an official looking building with a guard situated on the banks of the Shire. On the strength of the promise of the Port a baker arrived in December 2006, and Mr Singh is a bit of a legend among people who go to Nsanje. My two friends who live down there, VSO doctors, (the only doctors in the district) have had their lives revolutionized by him. Now not only can bread be bought, but raisons and peanuts, and the odd beef sausage. Considering you can’t buy eggs all the time, Mr Singh and his little raison buns are a bit of a miracle.

The point of the Mission to Nsanje was to investigate the possibility of changing the way we do food distributions for the nutrition programme. At the moment WFP delivers directly to health centres on a bi-monthly basis. This is extremely expensive because the tonnage for Assistance to Malnourished Groups (AMG) activities is small, and only 3tonne trucks are needed. In April this year the trucking company refused to take the food for AMG activities, saying that the quantities were ridiculous and they’d rather be sacked so they could go and haul tobacco around the country. It was a bit of a disaster for us and put our critical food distributions behind by a month. Understandably we won’t be using this truck fleet again. For 4 months of the year when the rains come to Nsanje the roads also vanish, making deliveries near to impossible. Yes, of course we pre-position for the rainy season, and send food for 3 month periods, but it’s still a challenge. I had heard that the RUTF (ready to use therapeutic food) supplied by an NGO for the OTP (out patient therapeutic care programme) was being delivered to this Nsanje district hospital, and then Ministry of Health was distributing to health centre themselves. So, I thought maybe we should look into this, as perhaps MoH could do the same with out food, especially considering a possible phase out of WFP in the next 10-15 years.

The first evening down there I had dinner with Isobel and Berndt, the two doctors. Isobel has just been made DMO – District Medical Officer, and responsible for all clinical medicine in the district. Typically, as is happening in Lilongwe at the moment, the power cut for three hours (6-9pm), so we fried eggs on a fire outside, with mosquitoes sticking to our sweat from the 30 degree heat. These two do an extraordinary job, especially considering the lack of resources in Nsanje. Isobel does everything from surgery to district level policy and staff supervision. The stories they tell are enough to make you never want to need very basic health care, not only in Nsanje, but also in the rest of Malawi, and chatting with them is always a bit of a horror story.

Of course, no visit to a district would be complete without checking on the WFP supported NRU (nutrition rehab unit). The NRU in Nsanje is attached to the paediatric ward, and the smell wafting up the corridor as we approached was not very nice. This NRU had been highlighted at the last TNP (Targeted Nutrition Programme) meeting, which is a monthly meeting of the key stakeholders in nutrition in the country (usually about 10 of us). Nsanje NRU had been reporting a death rate well above the SPHERE standards we should be meeting. Because of this, the supporting NGO – Concern World Wide – have been doing a careful supervision of the NRU for the last month, and while the death rate has decreased from 65% to 30%, it’s still way above government and SPHERE standards. One child I had been discussing with Isobel the previous evening had a 25% chance of survival. It was a re-admission, with severe wasting and quashiokor, and had gone into spasms in the arms. The main problem was that the child will have been like this for at least at least two weeks. And here’s the main problem with everything health related: late presentation.

So the conclusions of the mission?: next year the MoH could probably take over a third of our deliveries to health centres, especially the difficult to reach ones, providing we do a needs assessment next December and they put the cost implications in their District Implementation Programme (the famous DIP). Moderate cost reduction for us, capacity building for MoH in Nsanje, and with any luck better, and more timely food distributions in AMG activities.

There’s been a lot of traveling this month. On Friday I returned from a really fantastically motivating conference, where we were coming up with a national communication strategy for Accelerated Child Survival and Development. About 20 of us, mainly from Unicef with District representation, spent 4 days in a beach resort in Mangochi thrashing out ideas and slogans, key messages and prioritizing high impact interventions at national and district level. It was exhausting, but so good to be part of something broader than just food aid. I came back from the four hour drive from Mangochi bouncing into our house telling Anna, my housemate, that I want to work for Unicef – despite having spent the last six months slandering their every move.

Anyway, it’s the weekend now and it’s time to close. I am half way through painting the kitchen cupboards blue, as far removed from their prison-like dark grey as possible, and I have a rehearsal to get to for the concert in two weeks time. If any of you know the Poulenc oboe sonata or Grovlez sarabande then you can empathise with my fears of a complete screw up on the night in question. Have a good month!

A ramble

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.

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.

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.