T-2 days

By this time Saturday I'll be boarding a plane for the first of my three flights. I've presented my work to the MSH team here in Lilongwe, submitted a first draft of my report to them, and will be giving a presentation to the Reproductive Health Unit of the Ministry of Health sometime today (they haven't given us an exact time yet...), so there isn't much more to be done at this point!

Yesterday the power was out for over half the work day, which made things move a little slowly (oh- there went the power just now again!), but Maureen (the other GNU fellow) was kind enough to take me around the city a bit over a long lunch to eat up some of the down time. The city is so spread out! I bought some crafts and was so glad to have here there with me - in the eyes of the people selling, I have huge dollar signs over my head and they were literally chasing us to the car trying to get us to buy their stuff. I'm a bad bargainer to begin with, so it was extra helpful to have Maureen there to give me a sense of what things should really cost.

Turns out I won’t meet with RHU until tomorrow morning – which means I’m free to spend the rest of the day really wrapping up! Tomorrow is a half day at the office (just the morning) and then I’ll pack up and relax!

The beginning of the end...

So here I am, the last work week of my fellowship is upon me. It seems as though the time has flown by, but then again my first day in country feels like it was such a long time ago.

Yesterday I spent the whole day working on the first draft of my final report. I haven't sat down to write for that many hours since working on my thesis at Carleton! It was a long day... but the first draft is done, so now I have a good starting point for finessing the thing :)

Last night I decided to try to see more of Lilongwe and ate dinner in the "city center" neighborhood. By 7pm everything except the restaurant was closed - Lilongwe is really a sleepy town. All the office buildings are in the city itself and homes are on the outskirts, so going to the restaurant at 7:30pm I felt like I was in a cab at 3am. One of the women in the office offered to take me around town tomorrow during lunch, so hopefully I'll see more life in the city then.

Today I'll debrief the staff here (using the PowerPoint I already gave in Karonga - score for recycling!) and possibly the Ministry of Health's Reproductive Health Unit - that may be tomorrow, though. They don't have a whole lot of time booked for me, so I'm not too stressed about it - should just be introductions, key findings, and Q&A - easy enough, right?

My pictures from Karonga can be seen here (even if you aren't on facebook): http://www.facebook.com/album.php?aid=2028055&l=63225&id=19100336

And pictures from Mvuu Camp can be found here: http://www.facebook.com/album.php?aid=2027632&l=5ef1f&id=19100336

Back in Lilongwe

I arrived in Lilongwe Friday evening and have had a restful weekend. Friday was a long day in the car, so I ended up just crashing when I got back to Lilongwe. Yesterday I "slept in" until 6:30am, then had a nice workout and did some work before running some errands and catching up on emails and other personal things.

Today I did a 12 mile run (which wasn't too bad - Lilongwe is cooler than Karonga, but hillier) then spent some time by the pool, which was wonderful. I did some work compiling data and starting on my report and have had a lazy day since, watching movies on TV and reading.

By the end of the day tomorrow I should have a full draft of my report pulled together - another sign that my time here is winding down! In less than a week I'll be back in Boston!

Last field day :(

I have just finished my last field visits. It’s hard to believe that my time in Karonga is virtually up, and that I’m only in Malawi for another 8 days! This afternoon I’m presenting to the District Health Officers here in Karonga, which will be my final outbriefing with them before I head back to Lilongwe tomorrow. After almost two weeks of meeting five new people every day and seeing our work first hand, it’s going to be hard to return to desk work for the next week, not to mention returning to my regular work in Boston. One thing I’ve known about myself for a while, and this trip has only confirmed, is that I like to be on the front lines – it makes me feel like I’m doing the real hands on work, and even though I know things like budgets and logistics are important, it’s harder to get excited about working in Excel for hours than it is to get excited about seeing 50 women show up to a clinic day, ready to start a family planning method. In the end, I know that field work is the direction I want to go in, and the desk work will help me get there someday.

Though I’m sad to leave the work here, I am excited to leave the heat! Lilongwe is hot, but not as hot as Karonga. I feel like I’m in a constant sweaty slime, except for the 10 minutes immediately after a shower. The return of water pressure will be good, too.

So I’ve been delinquent about posting recently – sorry! It’s been a busy few days and the internet connection has been spottier than usual – a blackout yesterday meant that the “fast” internet café wasn’t available, and I don’t want to tie up the internet at the office, which is dial up and shared by three people already – not fair of me to just surf around. Hence, the few days without any news.

The weekend passed well and Monday was a bit of a catch up day. I met with two HSAs, then compiled all the interview responses I had for CBDAs and HSAs and began to pull out some initial key results. I’ll be making a presentation to District Health Officers on Thursday here in Karonga and to the Ministry of Health in Lilongwe next week, so I’m glad I had a chance to start on that before too late in the week.

Yesterday I went to an under 5 clinic day (where all the children under 5 get immunizations, growth tracking, etc) with the project driver. He even got up and talked about the benefits of family planning and demonstrated how to use a female condom (it was pretty funny). Even though he’s not a technical person on staff, he still knows his stuff and wants to spread the knowledge. Pretty cool. Then we met with two CBDAs and two HSAs, and I spent some more time working on compilation in the afternoon.

Today is going to be a busy day, so I don’t know when I’ll post this… I’m going to a clinic day in the morning, then observing Norplant injections, then meeting with HSAs and 4-5 CBDAs, all before 3pm, when we’ll meet people from PSI (one of our partners on this project) to hold a focus group to pre-test a TV miniseries they are working on that deals with family planning and HIV/AIDS. Whew.

This week is a little lighter on running, which is nice. I ran 6 miles on Monday and yesterday was a day off of running in my schedule. During my run on Monday, I passed a man and two women, who all cheered when I passed by, yelling “Excellent, excellent!” It was my greatest running moment here thus far!

The water pressure here is very bad, and especially bad in the mornings and evenings (I usually want to take a shower one of these two times) so it’s been a lot of bucket bathing for me lately. I actually don’t mind it, but I never feel like I’ve gotten all the soap/shampoo/etc off when I’m bucketing. I had forgotten that I tried to turn on the water in the shower last night and forgot to turn it off, because at 3am I woke up to the water running in the shower. It was the best water pressure I’d seen in Karonga! It will be nice to get back to a better shower in Lilongwe on Friday.

Lazy Sunday

Today it is HOT out. I slept in and then went to the lake to sit on the beach, read, and enjoy lunch and a coke. It was really nice while I was in the shade, but the sand in the sun was burning hot! I don't think I got burned, which is good!

This afternoon I'm hiding inside to stay out of the sun. I did some GMAT studying and got a good start on Anna Karenina - I'm enjoying it so far.

I'm also getting over the bit of culture shock I was feeling - any time I hear mzungu I turn and wave hello or goodbye to the kids, and overall the tone of the calls in the street has been a lot more polite than in Latin America. I'll get an occasional rude comment, but for the most part people are respectful. The women here are my favorite - they generally just smile at me and wave. One woman had the most joyful laugh when she say me running - like it was the best thing she had seen in her life. The women who run the guest house I'm staying out have been wonderful, too. They are my trusted advisers on issues like where to get fruit, where to catch the best beach at the lake, and whether or not to accept an invitation to go out (last night, the answer was no - another guest was going to a bar and a club, and I was reluctant, since I didn't know him, his friends, or the places, and my gut reaction was confirmed by Tande, who said that one of the places he wanted to go was pretty rough. I went to bed at 9:30 instead :))

Not so sweet 16

So, I grudgingly did 16 miles this morning... not the best run I've had in my life. It is hot here and I ran out of water 3/4 of the way through my run, so the last bit was painful, but at least it is done.

In other bad news, I have quite the rash on my thighs and a bit of my torso. It's not painful or itchy, which is good, but annoying nonetheless.

On to good news! Obama changed the Bush "gag-rule" on abortion funding: http://www.cnn.com/2009/POLITICS/01/23/obama.abortion/index.html.

Things are going well and the weekend has been relaxing thus far. I finished my book (Three Musketeers) and am moving on to Anna Karenina and GMAT studying - woohoo! Karonga is quiet and even though the guest house I'm at has satellite TV, I haven't really been watching, so I've had time to rest and catch up on reading and podcasts. A uranium mine has just opened here and one of the geologists for the mine is living at the guest house I'm staying at - he said the other night "You have to make your own fun here" and he's right, but I've been succeeding thus far.

I'm about half way through my time here, and I still have a lot of work to do, but feel that I have already accomplished quite a bit. This weekend I'm starting to compile information from the interviews I've done this far, and it is inspiring that the people who are working as CBDAs are so proud to be in that role. It is a leadership role in the community, but few cite that. Many have told me that they feel a responsibility to share knowledge about HIV prevention and family planning. They are confident that using FP methods will help people be healthier, better off financially, and, in some ways, happier. This is the mission that drives them, and they are happy to give their time freely to promote healthy behaviors. Only 1-2 have mentioned that it would be nice to be paid, and others have said that they would like to have more volunteers so they could have more impact or more commodities to distribute.

Friday!

So, the weekend is here! I uploaded the picture of me and the kids to the last post, so check it out.

The last few days have been filled with more field visits. It's been fun to see so much of the district and meet project volunteers. I feel very welcomed, as everyone says that having visitors come to see their work inspires them to do more and lets them know that people are watching and really do care - I feel great that I'm a part of that.

This weekend I'll get a long run in (16 miles - eep!) and visit the lake and a museum where they have dino bones - should be relaxing!

Sorry for the short post!

Jan 20

So, the internet went out with the rain yesterday, but luckily I was able to save this posting. Here it is, a day late!

I was a bit sluggish this morning since I woke up a few times throughout the night last night – once to thunder and rain, once because it was really hot (I think the power must have gone out, since the fan stopped), and a few times because of a mosquito buzzing around my head! We got off to a little bit of a late start this morning, as we took a different route than the Health Surveillance Assistant (HSA) that was riding with us was used to taking. She usually bikes along a path that is not exactly car-friendly, so we got a bit turned around. Nevertheless, we arrived at a health clinic site (the building is still under construction) and found nearly 150 people participating in the event by listening to health education presentations, having their babies weighed, or watching a cooking demonstration.

The HSA, who is an employee of the Ministry of Health and has been trained to give Depo injections, gave a presentation on family planning that used comedy, songs, and drama. One song said that you should use FP to space your births so you don’t have complications in labor and die from a ruptured uterus, because if you die your husband will take another wife and she won’t take care of the children you already have… a bit dramatic, no? She and her supervisor actively used flipcharts outlining each available method (including Norplant, the pill, male and female condoms, tubal ligation, Depo, and natural methods) and even went more in-depth into how the reproductive system works. They gave a lot of detailed information on each method, as the project (and the government of Malawi) are committed to offering all citizens informed choice.

After the education portion, the HSA, a CBDA, and a community nurse went to work! The nurse offered 1:1 counseling for new clients, those who had side effects or problems with their current method, and those who wanted more information about implants or tubal ligation. The HSA gave over 20 injections of Depo (most were returning users) and the CBDA distributed condoms and/or pills to 36 women. It was great to see the team divide and conquer like that!

As things were winding down, I left the clinic and entered a sea of children who all wanted to stare at the mzungo (sp?) – white woman. I greeted them as best I could in the local language and shook their hands as I was making my way to the car. Being on display like that because I come from the US and am Caucasian always makes me a little uncomfortable. I don’t really know anything, and the people who are impressive are those with me, the Malawians who are doing the REAL work. I understand the appeal of a stranger who looks different, though. It was interesting to see personalities at play even though I couldn’t understand the words they were saying – some kids shyly put forth their hands, others pushed themselves to the front, and one kid would just move alongside me and stick out his hand for me to shake every opportunity he got (probably about 10 times in all). I tried my best to catch everyone who wanted to shake my hand, but felt like I was in an unending sea of children – especially when their movement carried me along like I was being pulled by a current! Zina, the district coordinator here, got some pictures that I will post when I have a quicker connection.

Then I met with three different CBDAs to hear more about their work, how it is going, and to see if they had recommendations for improving the program. I was amazed to hear that one CBDA had over 400 clients, another had a youth clientele of nearly 20%, and another had counseled 30 men on family planning. They all were committed to their work, although they are volunteers, and didn’t have too many recommendations for improvement, other than mentioning that they needed an umbrella for the rainy season, honorarium would be nice, or that another CBDA to help them out would be nice.

Overall, it was a productive and inspiring day and I look forward to watching the inauguration tonight! I’m skipping a run to watch it (I think it is worth it, especially since I have a few open days later this week so I can make it up).

Karonga!

I’ve been in Karonga since Sunday afternoon, and am staying in a nice little spot – more of a guest house than a hotel. I had an amazing chicken curry at the “restaurant” last night, but learned that I should order well in advance because it took about 45 minutes to be cooked… since the establishment is rather small, I wouldn’t quite call their food service a restaurant – they have a menu, but it took a few tries to decide on a meal, because the first three things I ordered they didn’t have J. Now I know to ask what’s available right away and just go from there.

I started working in Karonga today. In the morning, I visited an information session that Health Surveillance Assistants (HSAs) were presenting for women on family planning. They were very engaging, singing songs, asking the women questions, and playing with the babies that were there. They discussed the benefits of family planning and asked women for input. The women were eager to share that with FP, they could feed all their children, women could participate actively in the community, budgets could be met more easily, and the mortality rate for children under five drops. They sang songs about how family planning benefits their communities.

After the presentation, the HSAs offered various services – weighing babies, offering FP counseling, and giving vaccinations to babies. These clinics take place once per month and women were eager to take advantage of the opportunity. Some volunteers even prepared a cooking demonstration to show women how to prepare nutritious food for their children.

The downside is that all of this was conducted in the local language, so I had to rely on some translation. However, the general atmosphere and emotions broke through the language barrier, and I was able to tell that people felt comfortable in counseling sessions with the HSAs. It was interesting to me that all the attendees were women and only two people presenting were female – I wonder if the gender issue affects women coming for counseling, but from what I could see it didn’t seem to pose a major barrier. This afternoon I’m writing up notes from my visit, clarifying my schedule for the two weeks I’m here. I hope that soon I’ll be able to explore the town a little bit more and find some restaurants to frequent, markets to explore, and sights to see for the time that I’m here. The internet connection is a bit slow, but I’ll try to be online when I can!

MVUU!!!

My trip to Mvuu Camp in Liwonde National park was excellent! Upon arriving in Liwonde, we had to take a boat over to the camp. We passed throuugh an intense rain shower, which then cleared up and there was a beautiful rainbow. A few minutes later, the boat driver pulled over because he had spotted elephants! There we were, on the side of the water, watching two elephants eat under a rainbow! About 10 minutes later, we saw a group of about 50 elephants, all eating on the side of the water. It was really incredible and makes me want to go on a full safari. We also saw some hippos and crocodiles on our way over to the lodge.

After we arrived, we went on a drive safari, where we saw hippos on land (from far away), impala, birds, and "tracked" elephants... we saw elephant damage all over the place, but didn't have any luck finding them, other than smelling their dung. The ride ot a bit tiring about 2 hours in, as it was pouring, but it was ok nonetheless.

I was traveling on my own, but a group of 7 Dutch med students was there and they invited me to join them for meals, which was nice. It was fun to meet some new people and have a group to hang out with.

This morning we woke up and had breakfast, then went on a boat safari. We saw TONS of hippos, including a baby. At one point we had passed a group of them and all of a sudden our boat motor sounded muffled and the back of the boat raised up. After moving forward a few feet, a hippo appeared from the water - it had been under the boat and nearly tipped us!

Then we had some down time and lunch before heading out. The boat ride back included more elephants and hippos, and I was sorry to leave!

14.5

Today is a public holiday in Malawi and I've taken advantage of the office being closed by sleeping in, visiting the market, reading, and tackling my long run for the week - 14.5 miles. There's no great way to map out distances here (other than that I was told that the airport is 20km away, so I could run out and back for 40....right...) so I've been going by time (10 minute miles, though I usually run faster). I did it, and the run was MUCH better than yesterday's! I stopped half way through to get some water and juice to refuel a bit, and though I definitely got some funny looks, the only bad thing about it was I sweated off my sunscreen early in the run and am a bit red :(

It's been raining off and on throughout the day, which is a nice break in the heat. There's something soothing about reading a book while listening to the rain! Overall, being here has been relaxing, even though I've been at work. It seems like there is a better work/life balance here, especially since people are focused on one project at a time rather than 3-5. They are all dedicated to their work (and I heard a few say they'd be working on some things during the holiday today) but overall there is less stress in the air.

Mulibwangi? Dilebuino (sp?)

Well, I'm back from my first field visit and I've learned four phrases in Chichewa in two days - not too shabby!

I went to Nkhotakota, a district about 3 hours away from Lilongwe, as USAID sent an assessment team there and I accompanied our program staff on the visit. Yesterday we met with the district level family planning advisor and a health facility representative to prepare them for the visit, and today we visited a lot of people - the district health officer and family planning advisor, a villiage chief, a health surveillance assistant, a health facility in-charge, and a community based distribution agent. It was great to see the program in action and to get out to the community to get a better sense of the context the program is working in. Communities are very poor, and many women have over 5 children. The contraceptive prevalence rate in the country is30%, and many districts are much lower (I think Nkhotakota is 12%). Some of the health surveillance (HSAs) have been trained to give Depo injections, and the demand is high. We spoke to one HSA that was trained in December and given 50 doses of Depo. She now only has 4 left! The CBDAs also do HIV counseling and testing, and the one we met today had just started testing on her own one week ago. She has already tested 18 people (all negative so far). What is really amazing is that the CBDAs are volunteers - they get a bike, a polo shirt, and a bag to facilitate their work, but no monetary compensation. It is a position of respect within the community, but still a lot of work!

I have pictures to post, but unfortunately the internet situation here is such that I don't have wireless access. They have hotspots that you have to pay to access, but you can't pay online - you have to buy a prepaid card and enter the code. The hotel says they sell the cards for 30 minutes, 1 hour, 5 hours, and a week of unlimited access, but all they have is the week of unlimited, which is almost $50 and not worth it for me at this point, as I have internet at MSH and will be leaving the city in a few days.

Tomorrow is a national holiday, so I'll get a nice run in and check out the market. I woke up at 5:15 am (ugh) to run today and while I'm glad I did, it was definitely not the best run of my life. It was hot and humid and I ended up taking walking breaks, but hopefully it was just "first run in a new place" adjustment. We'll see how it goes tomorrow!

Friday I'll be in the office for a bit and then head to Liwonde national park to stay at the Mvuu camp, which is a wildelife reserve. Mvuu means hippo, so I hear that I will see hippos, crocodiles, elephants and warthogs! I'm looking forward to it, and in the end it didn't end up being too expensive, so that is a plus. Hopefully I'll get the internet situation figured out soon so I can share all the photos with you all!

Jet lag

Yesterday was a great day in the office. I met the MSH staff and they are taking very good care of me. After the day in the office I went back to the hotel, ran some errands, ate dinner, and worked out at the hotel gym. It's quite a small gym, so I didn't get treadmill time, but got a bike session in. I planned to get up early today to run, so I went to bed right after 10:30pm for an early wakeup. My plans were thwarted by jet lag, though - I tossed and turned a bit, and when I looked at the clock it was after midnight! I saw the clock again at 1:20am, so decided that I needed to sleep in until it was time to go to the office and forget about running for the morning, which was too bad. Maybe I can get it in tonight.

Later today we'll be heading to the Nkhotakota district to meet with a variety of people - staff, volunteers, etc. which will be a great chance for me to see the program in action a bit more! I am looking forward to getting out and seeing more of the country!

It looks like my scope of work is changing a bit - still doing evaluation work, but with a different focus - so I'm reading up on project reports and trying to devise some new questions and approaches. I'm very happy to have the help and guidance of the team here in this process! Hopefully this trip to Nkhotakota will also help me clarify the pieces I'm working on.

I'm here!

I arrived in Lilongwe yesterday after many hours of travel, and it was nice to feel settled in one place for a while, even if it's only for the few days I'm scheduled to be in Lilongwe before heading out to the Karonga district.

I was a bit disheartened last night when I couldn't get the new SIM card to work in my phone and nobody was selling internet access cards on Sunday, which just goes to show how dependent I've become on the internet to be connected to others. Since there wasn't anything I could do to let people know I had arrived safely, I was able to relax with a book for a while, which was nice. My body clock is still a bit off, but nothing a little coffee can't help fix for the time being.

The parts of Malawi I have seen thus far are beautiful! Even in Lilongwe the landscape is lush and green - a welcome change from snowy Boston. From what I've been told, the Karonga district where I'm heading is even more beautiful, so I'm looking forward to that.

Today being my first day in the MSH office, I was just introduced to the staff and will have program briefs and other meetings today. Everyone here is extremely friendly and welcoming, so I'm feeling at ease and excited to refine the scope of my work. I'll be assisting the project in evaluating training they have provided to community based distribution agents who give family planning and HIV counseling and referrals. Program plans have changed a bit since we first discussed my scope, so we'll be tweaking the tools I've developed a bit, but the aim will still be to gather information on how CBDAs are referring and counseling individuals, recording data, and involving youth in family planning activities. The program is very interesting and I'm realizing now just how quickly the four weeks will fly by!

Here I go!

I'm in the airport in Boston, appreciating the free hours before the flight with a book and blogging. After leaving the office I feel relieved knowing that I've wrapped things up about the best I could - there's some liberation in saying "No" that I don't get to experience frequently enough at work, so this has been a nice excuse to do so.

Most of all, I'm looking forward to sleeping on the flight - it's been a long week and I'm ready to relax, even if it is just for the two days that I'm traveling. Monday I'll launch right in to an introduction to Lilongwe and MSH projects in Malawi, and by Thursday morning I'm off to start working! The plane rides will let me sleep, read, and watch TV... luxuries that I don't allow myself too much.

Now I'm off to eat in the one sit-down restaurant in the airport. The one nice thing about having to arrive 2 hours early for international flights is the opportunity it gives you to slow down and enjoy a nice meal and a drink. TGIF!

Packing up!

So, I leave for Malawi tomorrow night! Just one more day of work, contacts to pick up, and then I'm off. Mentally, I'm already there :)