work work work?

Mid November already, and I can say that already I feel sufficiently baked from the sun. Just this week, a slight wind has blown in, doing what little it can to keep us all slightly cooler in the sweltering heat. However, the aluminum roof on my house click click clicks constantly from the sun and what little respite is given from the wind is compromised by the extremely loud banging of tree branches falling on the roof, day and night, and the dust that sticks to my sweaty body. Yet, my house is becoming my home, my surroundings more and more familiar, and the people of Kalimira are becoming used to the Azungu woman living in their midst. Lately, instead of being asked if I cook nsima at home or being told I must speak Chiyao, villagers have come to me asking for medical advice and medicine; neither of which I have much to give.

I think most people within the vicinity think I am a doctor, or at least a nurse. Last week I was in the Park and talking with one of the staff members who, upon learning my name, promptly called me Doctor Chloe (a title I was sorry to have to deny). Later that same week, I was asked if my husband in America was a doctor; a question whose response could be approached from so many angles that I was initially flabbergasted. And so, as there has been a request for information about my “work,” I will honor it by devoting this blog to what I have been doing in Africa besides sweating, battling ants and spiders, and not speaking chiyao.

I have already been in Malawi for almost five months; three of which have been spent in the village. Next week, I will return to Dedza for In-Service Training, a two week training on what to do with the information we have gathered about our villages. So it seems, this is a perfect time to write about my activities, as I am already reflecting on the information I have gathered and what my next step will be.

Mornings are spent at the health center, observing, manning the registration book, chatting with the staff, and warding off attempts to teach me how to give shots to the Under 5 crowd (no thanks). My observations have been surprising, frustrating, and intense at times, and have really given me an understanding of the challenges Malawi faces not only in terms of providing proper diagnosis and care to its people, but also how the information is received, processed, and used by consumers. Women are being sent away with no contraception, including condoms, because they are unable to remember the date of their last period (which shouldn’t be surprising in a culture where people don’t even know their age, let alone the date of their last menses), patients are brought in after months of suffering and only when it is too late to save them, and the most basic medicines are unavailable even when people do come in (for example: a terrible case of pink eye developed in my neighbor just last week and despite my advice to go to the health center and to NOT touch her eyes, there was no medicine available at either of the two closest health centers and now, even though it has cleared up for her, the rest of the children in the house are currently suffering from varying stages of it). All of these problems seem inordinately out of my league.

Besides observing at the health center, I have also met with the local chiefs, some of the leaders of local committees, and interviewed community members to gain an understanding of the specific problems faced within my local community. Writing up the interview questions, translating them into Chichewa and then trying them out to see if they were even understandable was a challenge. I quickly discovered their answers lacked the depth of critical thinking I was expecting (even with the chiefs) and some of the questions, especially a few I was particularly interested in hearing what people had to say about, weren’t even answerable. However, interviewing was a valuable exercise that really put me in my place, so to speak, in terms of what people are (and are not) thinking about, their values, and how they are perceiving the world around them. Overall, I suppose when your main concerns are the location of boreholes, transportation (by bike) to the nearest health center, and elephants trampling your crops (and kids), there is not much extra time for contemplating such worldly matters as the state of foreign aid in Africa, the presidents stance on resuable energy, and developing a support group for survivors of relationship abuse (especially since there seems to be a unanimous belief that there is absolutely no violence in the community).

Finally, I conducted a PACA (participatory analysis for community action) meeting under a mango tree in front of Kafulafula school. I invited about twenty people with the intention I would split up the group into men and women and conduct the activities in separate groups who would then come together to present and discuss their conclusions. However, in reality, eleven people showed up and so I quickly readjusted our activities. First we did a community mapping activity to get an idea of what the area looks like; where the boreholes, schools, roads, football fields, maize mills, community based organizations, etc are. We created a map for each of the three villages represented by the group; Tambala, Maselema, and Kalimira. It turns out that as a new person to the community, I remembered places that the others had forgotten. After that, we created a seasonal calendar, charting out weather patterns, agricultural patterns of planting and harvesting, disease cycles of malaria, cholera, TB, and colds, major holidays, when people have more money, less food, and a lot of time. At the end, I asked what people had learned from this exercise. One man said he didn’t realize there were some communities with more resources than others and another said he didn’t know that diseases came and went according to patterns; two pretty significant things to come out of a meeting, I think.

And so, now it is time to put all this information together, sort through it, and see what can be done; an admittedly daunting task, all things considered. All together, community members expressed a pressing need for a borehole, followed by a bike ambulance. Additionally, and I think it goes without saying, most people wish there were more opportunities to earn a living, though given the chance, the likelihood of them taking advantage of an opportunity is questionable. Overall (and this is definitely subject to change), I think key areas of focus for the next two years are going to be education about nutrition, contraception, using locally available plants as natural medicine, and growing kitchen gardens to supply food for families. Also, I am interested in exploring IGA (income generating activity) options for the women of the village; perhaps baked goods to sell on the road, peanut butter, etc. I would like to start a women’s group at the school to sort of channel all this information through, as I believe the women who would attend such meetings are the ones who would be more apt to influence others.

Lastly, I want to take advantage of the time women and patients are waiting to see a doctor at the health center to educate them; basically using the health center not only as a place to receive medicine and weigh babies but as a learning center. Training the HSA (health surveillance assistants) will be key, as well as creating interesting and informative posters. Lessons won't always have to be scheduled, mostly impromptu on an as needed basis (the need being all the time, I suppose).

Phew! Now that I have just outlined it all out, I feel a little more prepared to write up my thoughts in a more official document. Obviously, there is no shortage of work to be done, however, I must admit to feeling incredibly overwhelmed by the outrageous amount of opportunities I could take advantage of. I think creating goals and a structured plan for the next year will prove useful as a reference to me; someone who needs a little structure to keep me on track. However, I also hope the Peace Corps will provide some useful tools for me in terms of a jumping off point.

Although I am feeling overwhelmed, it is one that presents a challenge, rather than a wave a despair. I am still so content and happy to know I am Malawi, doing what I have thought about for a long long time and the challenges I face seem, for the first time, to be of the “real world” nature. Even as I jump around shaking ants off my back after foolishly leaning on a tree crawling with thousands of them, listening to the hoots of the amayis and knowing I should feel embarrassed, I am know I am where I am supposed to be.

sending you all my love, all the time. and sorry for the long post this time. you asked for info about work, and info you got!

P.S. Check out what the spiders at my house (which aren’t actually spiders) look like. Some poor fellow out of his mind seems to want to keep one in his aquarium when all I want to do is run away from them. http://www.faunaimportuk.com/caresheets/cswindspider.htm