Tuesday, August 31, 2010
Sunday, August 29, 2010
Maketa
It always rains in Maketa. Maketa is a neighborhood located on the outskirts of Blantyre, the main commercial city that should be the capital of Malawi but isn’t. I confess to having a morbid fascination with this place, which only increased the evening that Clifford, my driver, and I were late driving back from the deep south. While stuck in traffic going up the steep hill to the plateau on which Blantyre is located, he suddenly turned to me with an anxious look (extremely atypical for this very laid back man) and said “Quick, lock the doors.” Our doors are never locked. He has never again made the same request.
Ok, I exaggerate when I say that it always rains, but even when it doesn’t, it is a dark, densely populated area with no trees, the existing ones having been chopped down for firewood long ago. Maketa is marked by the abject poverty of the hopeful who have moved here from around the country in search of a better life. Urbanization and slum sprawl is new to this country where 80% of the population is farmers living in rural areas. Incorporating large numbers of the poor into rapidly expanding cities is about as successful here as it is elsewhere in the developing world.
On one side of the street are all of the major businesses: the Hip-Hop bottle store where they sell greens (Carlsberg beer—how did Denmark corner this market?), several Rasta themed shops with diverse services that range from barber and beauty shops to cell phone ‘top up’card centers (where you can buy credits for cell phone service for as little as 50 kwacha, I usually buy 1500 kwachas worth of credits when I buy) to the inevitable woodworkers shops, whose major source of income is from the niche market of coffin sales. I monitor one particular vendor of coffins quite closely because it is shocking the turnover of stock. They always seem to have new coffins for sale, elegant in style and unique in design.
Then there is the other side of the street in the half mile or so that comprises the street front of the neighborhood, which radiates both up and down the hill in hand made brick and corrugated tin roofed splendor. God is present in quick flashes beginning with a traditional Christian church, which is flanked by a good sized mosque, which is adjacent to an off-shoot, loosely Christian church of the more humble that has branches throughout the south.
There is hope here, but it is a hope against the odds. I feel like witness to a traffic accident every time I drive through the place, yet I cannot seem to take my eyes away.
Ok, I exaggerate when I say that it always rains, but even when it doesn’t, it is a dark, densely populated area with no trees, the existing ones having been chopped down for firewood long ago. Maketa is marked by the abject poverty of the hopeful who have moved here from around the country in search of a better life. Urbanization and slum sprawl is new to this country where 80% of the population is farmers living in rural areas. Incorporating large numbers of the poor into rapidly expanding cities is about as successful here as it is elsewhere in the developing world.
On one side of the street are all of the major businesses: the Hip-Hop bottle store where they sell greens (Carlsberg beer—how did Denmark corner this market?), several Rasta themed shops with diverse services that range from barber and beauty shops to cell phone ‘top up’card centers (where you can buy credits for cell phone service for as little as 50 kwacha, I usually buy 1500 kwachas worth of credits when I buy) to the inevitable woodworkers shops, whose major source of income is from the niche market of coffin sales. I monitor one particular vendor of coffins quite closely because it is shocking the turnover of stock. They always seem to have new coffins for sale, elegant in style and unique in design.
Then there is the other side of the street in the half mile or so that comprises the street front of the neighborhood, which radiates both up and down the hill in hand made brick and corrugated tin roofed splendor. God is present in quick flashes beginning with a traditional Christian church, which is flanked by a good sized mosque, which is adjacent to an off-shoot, loosely Christian church of the more humble that has branches throughout the south.
There is hope here, but it is a hope against the odds. I feel like witness to a traffic accident every time I drive through the place, yet I cannot seem to take my eyes away.
Friday, August 27, 2010
Thursday, August 26, 2010
Nsanje world reprise
Utawaleza. It even sounds beautiful, rainbow in Chichewa. I really thought I would see a rainbow today. Even though it started so brightly at 6am, alas it became cloudy as we headed west into the higher mountains of Limbe. We drove through cloud pockets on our last tour of the deep south, but the stunning vistas that I remembered as we headed down the steep swerving road into Chikhwawa were completely obscured. However, it is a bit nerve wracking during the steep descent to see how easily it would be to accidentally fall off the cliff, through a loose turn of the wheel or to avoid a child jumping out of nowhere, perhaps it was for the best. Even so, I still thought I deserved a rainbow, which failed to materialize.
I kept my camera in my lap anyway waiting for stunning images to suddenly burst through the clouds and then as we hit the lower Shire valley, I hoped for intriguing shots to compose themselves in the flat boring landscape anchored by the highway to nowhere that no one is allowed to drive on but that is beloved by the local people for walking, cycling, and driving their cattle. The highway that is also known as ‘the future hope of Malawi!’
After our four and a half hour drive to the very, very tip of Malawi, we decided to treat ourselves and actually visit the much heralded inland Nsanje port, gateway to the future (everything is in the future here in Malawi). Goats and heavy earth moving equipment aside, it looks nothing like the photos featured in the serious faced president’s billboards announcing Malawi’s entrance into the twenty first century. One wonders where those photos were taken. Given the small crew working and the complete lack of water anywhere near the pier-to-be, it may be the 22nd century that the future will actually kick in.
After this brief respite from the car, we reluctantly climbed back in (also after meeting a self proclaimed wise man ambassador recently released from the Zomba Mental Hospital—the only one of its kind in the country—who was eloquently in search of funds for nourishment.) An uneventful three hours later found us in the bustling trading center of Chikhwawa with the man whose computer I had infected with a virus so terrible the he lost everything when his computer inevitably crashed. Guilt was doubled when I had to confess that after numerous hours at the task I have yet to be able to successfully download the promised free antivirus program shareware on to a CD. It really shouldn’t be this hard to do! All was forgiven however, because he had neglected—this one time only!—to back up his files which I gladly shared with him.
Today’s memorable sightings included: two(!) Obama ‘Yes we can!’ salus (the cloth that women wrap as skirts) and one salu that placed a huge eye on a woman’s butt, (So good!), a goat teetering on the very top of a tall ant hill, the tastiest leaves on the tree still out of reach, God is the way shopping center, a few miles without a person in sight, new Malawi flags—though only posted in places the President had visited today.
Two brisk hours later, when we were almost back home in Zomba, a thin watery stalk of rainbow appeared inexplicably and accompanied us until the sun set over the mountain.
I kept my camera in my lap anyway waiting for stunning images to suddenly burst through the clouds and then as we hit the lower Shire valley, I hoped for intriguing shots to compose themselves in the flat boring landscape anchored by the highway to nowhere that no one is allowed to drive on but that is beloved by the local people for walking, cycling, and driving their cattle. The highway that is also known as ‘the future hope of Malawi!’
After our four and a half hour drive to the very, very tip of Malawi, we decided to treat ourselves and actually visit the much heralded inland Nsanje port, gateway to the future (everything is in the future here in Malawi). Goats and heavy earth moving equipment aside, it looks nothing like the photos featured in the serious faced president’s billboards announcing Malawi’s entrance into the twenty first century. One wonders where those photos were taken. Given the small crew working and the complete lack of water anywhere near the pier-to-be, it may be the 22nd century that the future will actually kick in.
After this brief respite from the car, we reluctantly climbed back in (also after meeting a self proclaimed wise man ambassador recently released from the Zomba Mental Hospital—the only one of its kind in the country—who was eloquently in search of funds for nourishment.) An uneventful three hours later found us in the bustling trading center of Chikhwawa with the man whose computer I had infected with a virus so terrible the he lost everything when his computer inevitably crashed. Guilt was doubled when I had to confess that after numerous hours at the task I have yet to be able to successfully download the promised free antivirus program shareware on to a CD. It really shouldn’t be this hard to do! All was forgiven however, because he had neglected—this one time only!—to back up his files which I gladly shared with him.
Today’s memorable sightings included: two(!) Obama ‘Yes we can!’ salus (the cloth that women wrap as skirts) and one salu that placed a huge eye on a woman’s butt, (So good!), a goat teetering on the very top of a tall ant hill, the tastiest leaves on the tree still out of reach, God is the way shopping center, a few miles without a person in sight, new Malawi flags—though only posted in places the President had visited today.
Two brisk hours later, when we were almost back home in Zomba, a thin watery stalk of rainbow appeared inexplicably and accompanied us until the sun set over the mountain.
Sunday, August 22, 2010
GREEN MAMBA!!!
I blame it on Irene. Today is Irene’s birthday, so of course Africa had to give her a gift. Irene is from Denmark and, as a product of her upbringing, she has developed a list of things she would like to see—and photograph—as proof and remembrance of her visit here. Snake is on the list. There are very few snakes in Denmark. Therefore, Irene doesn’t have a full appreciation of snake-ness. Personally, I would be extremely content to never see another snake for as long as I live.
I was in the lead acting as guide because I had walked part of the trail on the top of Zomba Mountain before and it was new to everyone else. There were five of us walking happily along. I was talking with Raquel, the nurse from Brazil, though I cannot for the life of me remember what we were talking about. (At this point I must note that I am glad I am a loud person. Snakes do not like loud people.) In mid-sentence I’m sure, we both stopped walking shocked at the three foot ribbon of bright green across our path that suddenly raised its head into strike position. In all fairness to Mr. Green Mamba, he briefly tasted the air with his tongue as he lifted his head even higher and pulled it back in final readiness because he realized that he was less than a foot from being attacked as well (not really, but we are both much tall than him—even in strike position—so the misunderstanding on his part is quite understandable after all).
His quavering tongue was the last thing I saw. Both Raquel and I did what any rational person who has the utmost respect for highly poisonous snakes would do, we turned around and ran like crazy in the opposite direction. Only Irene ran forward with her camera, bitterly disappointed that the snake had had the very same reaction as we did and slithered quickly down along side the misleadingly western appearing creek that the trail follows.
Now you know why there are no pictures for today. Only five witnesses who live to tell the tale. Green mamba. Oh yeah.
I was in the lead acting as guide because I had walked part of the trail on the top of Zomba Mountain before and it was new to everyone else. There were five of us walking happily along. I was talking with Raquel, the nurse from Brazil, though I cannot for the life of me remember what we were talking about. (At this point I must note that I am glad I am a loud person. Snakes do not like loud people.) In mid-sentence I’m sure, we both stopped walking shocked at the three foot ribbon of bright green across our path that suddenly raised its head into strike position. In all fairness to Mr. Green Mamba, he briefly tasted the air with his tongue as he lifted his head even higher and pulled it back in final readiness because he realized that he was less than a foot from being attacked as well (not really, but we are both much tall than him—even in strike position—so the misunderstanding on his part is quite understandable after all).
His quavering tongue was the last thing I saw. Both Raquel and I did what any rational person who has the utmost respect for highly poisonous snakes would do, we turned around and ran like crazy in the opposite direction. Only Irene ran forward with her camera, bitterly disappointed that the snake had had the very same reaction as we did and slithered quickly down along side the misleadingly western appearing creek that the trail follows.
Now you know why there are no pictures for today. Only five witnesses who live to tell the tale. Green mamba. Oh yeah.
Friday, August 20, 2010
Thursday, August 19, 2010
Happy signs!
The witch doctor is IN!!! I'm taking advantage of the mysteriously well functioning telecommunications system to post lots and lots of photos! Happy viewing! More thoughts anon...
Tuesday, August 17, 2010
!Viva Espana!
Partied the other night with MSF-Barcelona at their goodbye party to Malawi. We danced until midnight. I’m really going to miss those ladies. They definitely know how to have a good time!!! I now have hundreds of picture from the party, since the camera was passed hand to hand and people were just clicking away. I’ve posted a few choice samples. Check out the guy in the red t-shirt
I was laughing at myself when I stepped outside of the open air thatch roofed bar where we were dancing and walked down to the shores of the Shire River. There were bats, hundreds of them, swooping low and accurately. I don’t know why they freak me out so much, since they were hungrily devouring a principal nemesis here in Africa: mosquitos! Yet, because I have not yet been vaccinated for rabies, I am a bit cautious because bats are notoriously infected. I’ve heard that their bite is quite gentle and almost unnoticeable, despite what many vampire movies would have you believe.
I left Liwonde very early the next morning to go to Mulanje. Because it was a Sunday morning and we were so sick of the music that we’ve been playing day in and day out, much of which was also featured at the party (P-squared from Nigeria mostly—excellent stuff!), we decided to listen to the radio. Sunday in a conservative religious country (more on this in a later post!), what does one hear? Sermons? Good guess, but not right. No, it’s time for Rap Jesus. Jesus is my bro and I’ll never ever lose him... It was a hip hop self promotion (by the DJs) extravaganza, with a little country and western Jesus music to round out the hour.
Somehow, don’t ask me why, something along the drive triggered Thoreau in my mind: He who travels alone travels best. I had no idea when I read him as a teenager that I would need to be a lifetime traveler. Now I know. I remember being excited and frightened at the force of his convictions (and his austerity, which I confess to not mimicking!). I don’t actively feel that force in my life, though do confess to being passionate about the issues important to me. Perhaps that was the point after all: Live life faithful to one’s self and one’s beliefs. I’m there.
(Photos may be later...Malawi telecommunications strikes again!)
I was laughing at myself when I stepped outside of the open air thatch roofed bar where we were dancing and walked down to the shores of the Shire River. There were bats, hundreds of them, swooping low and accurately. I don’t know why they freak me out so much, since they were hungrily devouring a principal nemesis here in Africa: mosquitos! Yet, because I have not yet been vaccinated for rabies, I am a bit cautious because bats are notoriously infected. I’ve heard that their bite is quite gentle and almost unnoticeable, despite what many vampire movies would have you believe.
I left Liwonde very early the next morning to go to Mulanje. Because it was a Sunday morning and we were so sick of the music that we’ve been playing day in and day out, much of which was also featured at the party (P-squared from Nigeria mostly—excellent stuff!), we decided to listen to the radio. Sunday in a conservative religious country (more on this in a later post!), what does one hear? Sermons? Good guess, but not right. No, it’s time for Rap Jesus. Jesus is my bro and I’ll never ever lose him... It was a hip hop self promotion (by the DJs) extravaganza, with a little country and western Jesus music to round out the hour.
Somehow, don’t ask me why, something along the drive triggered Thoreau in my mind: He who travels alone travels best. I had no idea when I read him as a teenager that I would need to be a lifetime traveler. Now I know. I remember being excited and frightened at the force of his convictions (and his austerity, which I confess to not mimicking!). I don’t actively feel that force in my life, though do confess to being passionate about the issues important to me. Perhaps that was the point after all: Live life faithful to one’s self and one’s beliefs. I’m there.
(Photos may be later...Malawi telecommunications strikes again!)
Friday, August 13, 2010
The Chinese in Malawi
It sneaks up on you. I didn’t really notice it at first, especially since I have not seen one Chinese person since I entered Malawi. But they are everywhere. I think it really hit home when Clifford, my driver, decided to teach me Chinese to while away the hours on one of our very long drives (having given up on my linguistic ability to learn Chichewa, the language spoken by the majority of Malawians), My favorite phrase over which the two of us had an excellent chuckle: Tora! Tora!—Hurry up! Yes, that goes over well in theAfrican context.
It was then that I started keeping my eyes open, I began to see Chinese characters on trucks and buses. I saw the Jian Ching shop along the M1 highway in one trading center that was almost too small to have a name. It wasn’t too small for Jian Ching, however, because they had done so well with the original shop that they were compelled to open a newer, bigger, more brightly colored annex at the other end of the trading center (ie, four doors down from the original). Then of course there is the enormous Wu Lian just opposite the traditional market and overlooking the highly garbage encrusted section of the Lilongwe River. It stands perched haughtily on the hill in its bile green concrete splendor dwarfing the thatched roofed market structures that scream temporary but have probably been there since long before Wu Lian.
My favorite Chinese investment, however, is the new highway to the inland port in Nsanje—Malawi’s gateway to the future! (All of the billboards featuring His Excellency the President tell me so! I digress.) Like most southern parts of any country, Nsanje currently has the reputation of being backwards and uncivilized. Perhaps sleepy may be the more diplomatic term. But, man, when that highway is done, things are going to be mighty different! The technological masterpiece is well under way. Every engineer in Malawi is working on various parts of the highway that is ruler straight, despite any deviations thrown up by nature, with numerous gullys dug under the highway at regular intervals and supported with huge cement tubes to accommodate the regular flooding that makes the soil so perfect for sugar cane, rice and bananas. It is indeed a marvel, unlike the bumpy and sinuous dirt road that parallels and sometimes crosses the hallowed highway, which begins innocuously enough with the sign: Roadworks next 84 kilometers.
Soon the super highway will connect the new inland port located on the southern most point of Nsanje on the Shire River that meanders through Mozambique to join the Zambezi River that at long last empties into the Indian Ocean and ultimate prosperity for all Malawians! Except that not that many people live in Nsanje or in adjacent Chikhwawa (don’t you just love to say that name? Chikhwawa!), which has a road that unfortunately makes the 84k of detours look (and feel) like a walk in the park. Hmmm, this does not bode well for all of those trucks laden with goods coming up from the inland port to improve daily life in south central Africa. But wait, what about that steep mountain range shooting up from the valley just ahead--the one with the single lane road where the few trucks that dare struggle both up and down (and up and down—it is a mountain range after all). Quick! Bring back those Chinese engineers to blast some tunnels right away!
NB: The Chinese are pretty much singlehandedly in charge of the telecommunications infrastructure in this fair country. Please address all complaints for my current inability to upload photos directly to them. I’ll keep trying, but for now you’ll have to bear only with my words...
It was then that I started keeping my eyes open, I began to see Chinese characters on trucks and buses. I saw the Jian Ching shop along the M1 highway in one trading center that was almost too small to have a name. It wasn’t too small for Jian Ching, however, because they had done so well with the original shop that they were compelled to open a newer, bigger, more brightly colored annex at the other end of the trading center (ie, four doors down from the original). Then of course there is the enormous Wu Lian just opposite the traditional market and overlooking the highly garbage encrusted section of the Lilongwe River. It stands perched haughtily on the hill in its bile green concrete splendor dwarfing the thatched roofed market structures that scream temporary but have probably been there since long before Wu Lian.
My favorite Chinese investment, however, is the new highway to the inland port in Nsanje—Malawi’s gateway to the future! (All of the billboards featuring His Excellency the President tell me so! I digress.) Like most southern parts of any country, Nsanje currently has the reputation of being backwards and uncivilized. Perhaps sleepy may be the more diplomatic term. But, man, when that highway is done, things are going to be mighty different! The technological masterpiece is well under way. Every engineer in Malawi is working on various parts of the highway that is ruler straight, despite any deviations thrown up by nature, with numerous gullys dug under the highway at regular intervals and supported with huge cement tubes to accommodate the regular flooding that makes the soil so perfect for sugar cane, rice and bananas. It is indeed a marvel, unlike the bumpy and sinuous dirt road that parallels and sometimes crosses the hallowed highway, which begins innocuously enough with the sign: Roadworks next 84 kilometers.
Soon the super highway will connect the new inland port located on the southern most point of Nsanje on the Shire River that meanders through Mozambique to join the Zambezi River that at long last empties into the Indian Ocean and ultimate prosperity for all Malawians! Except that not that many people live in Nsanje or in adjacent Chikhwawa (don’t you just love to say that name? Chikhwawa!), which has a road that unfortunately makes the 84k of detours look (and feel) like a walk in the park. Hmmm, this does not bode well for all of those trucks laden with goods coming up from the inland port to improve daily life in south central Africa. But wait, what about that steep mountain range shooting up from the valley just ahead--the one with the single lane road where the few trucks that dare struggle both up and down (and up and down—it is a mountain range after all). Quick! Bring back those Chinese engineers to blast some tunnels right away!
NB: The Chinese are pretty much singlehandedly in charge of the telecommunications infrastructure in this fair country. Please address all complaints for my current inability to upload photos directly to them. I’ll keep trying, but for now you’ll have to bear only with my words...
Thursday, August 12, 2010
Monday, August 9, 2010
Chambo--the best fish in the world!
Actually, I am inclined to agree: a nice light firm fish with an excellent taste and no fishy scent to follow! Yum!
Guess which is the MSF senior staff meeting and which is the fish purchasing extravaganza. It was too much fun watching one of the MSF guys and my driver selecting fish and negotiating the price. It was like they were buying diamonds! But they did have the happy fish vendor deliver the diamonds to the truck--all the way in the back of the truck, since the thought of 7 silver fishies floating in the back seat on a warm winter's day was just the slightest bit unappealing...
(Pix to follow possibly since Malawi internet is really acting up this morning!)
Ok still not pictures! Maybe later.
Guess which is the MSF senior staff meeting and which is the fish purchasing extravaganza. It was too much fun watching one of the MSF guys and my driver selecting fish and negotiating the price. It was like they were buying diamonds! But they did have the happy fish vendor deliver the diamonds to the truck--all the way in the back of the truck, since the thought of 7 silver fishies floating in the back seat on a warm winter's day was just the slightest bit unappealing...
(Pix to follow possibly since Malawi internet is really acting up this morning!)
Ok still not pictures! Maybe later.
Sunday, August 8, 2010
Epidemiologists without borders—one step closer!
What exactly am I doing here in Malawi? Let me tell you!
One of the major roles played by MSF in this emergency mission is to help establish a viable system of complete data collection for the measles outbreak (in addition to all of that medical stuff, I mean). All health facilities and hospitals are visited at least once per week. At each site, the data are copied from the patient register books on to a special reporting sheet for epidemics (this one is measles, next one cholera?). At some health facilities this is standard practice, at others people have never been trained so we showed them how. So far, so good.
The next step is to collect the data and bring it back to a central location for data entry. Easier said than done. Do you know how much fuel costs here?? Yes, yes mighty expensive! As long as MSF is out in the field doing case management of the measles cases, we collect the line lists as well. MSF then hires data entry people to enter the line lists of measles cases in order to be able to document the extent of the outbreak and to be able to effectively evaluate the impact of our vaccination campaigns—at least in the districts where MSF is working: 12 of 28 districts.
Near the beginning of the epidemic it was decided that it would be useful to the Ministry of Health if MSF would collect data even in the districts where we were not directly working as well. Although there have been some ummm shall we say challenges, it’s nothing that a little visit to the District Health Offices (DHO) can’t clear up. This turns out to be a doubly good move, because as I may have mentioned in the past, internet access and connectivity is not yet state of the art here in Malawi. Therefore, a major challenge is getting the data all in one place in a timely fashion.
(I know, I know, control your excitement, epidemiology is just so gripping!) Actually I have to say that I am having a wonderful time criss crossing the central and southern part of the country with my fearless driver, Clifford (in the yellow shirt), spreading epidemiology cheer wherever we go! I have to confess that it wasn’t always like this. It turns out that some people are not totally enamored with data. Can you believe it?!? They don’t love to collect the data from the field and they really don’t love entering data into an excel spreadsheet. The saddest thing of all is that this is where the whole thing ends (for the most part). Come on! Now is when it gets exciting!! No wonder they didn’t love data until I came along!!
With a simple flip of the autofilter switch amazing things can happen with the data! At every DHO, I do a little presentation with data, charts and tables—their data, their charts, their tables—and people are amazed at the things they can do once they have the knowledge and the technology. Often at the end of the bumpiest, dustiest roads is a person yearning to learn the joys of data analysis, (though many are unaware of this yearning until the end of my presentation). A most popular use of data that is intuitive to most DHO personal is the fact that they can now document their need for additional resources. Knowledge really IS power! To be fair, almost everyone has mentioned that the basic template that I have provided them for the measles outbreak can easily be altered for other epidemics that will sadly come along and keep the people at the DHOs perpetually busy throughout their careers.
To my never ending delight, after my trainings, I have had several requests for additional epidemiology training. To that end I have developed an epidemiology toolkit that I will distribute (along with free antivirus shareware!!) on my next round of visits to the DHOs.
What do we want?
Data!
When do we want it?
Now!
Why do we want it?
To get more money!
What?! Really, why do we want it?
To improve the public’s health!
Long live epidemiology.
One of the major roles played by MSF in this emergency mission is to help establish a viable system of complete data collection for the measles outbreak (in addition to all of that medical stuff, I mean). All health facilities and hospitals are visited at least once per week. At each site, the data are copied from the patient register books on to a special reporting sheet for epidemics (this one is measles, next one cholera?). At some health facilities this is standard practice, at others people have never been trained so we showed them how. So far, so good.
The next step is to collect the data and bring it back to a central location for data entry. Easier said than done. Do you know how much fuel costs here?? Yes, yes mighty expensive! As long as MSF is out in the field doing case management of the measles cases, we collect the line lists as well. MSF then hires data entry people to enter the line lists of measles cases in order to be able to document the extent of the outbreak and to be able to effectively evaluate the impact of our vaccination campaigns—at least in the districts where MSF is working: 12 of 28 districts.
Near the beginning of the epidemic it was decided that it would be useful to the Ministry of Health if MSF would collect data even in the districts where we were not directly working as well. Although there have been some ummm shall we say challenges, it’s nothing that a little visit to the District Health Offices (DHO) can’t clear up. This turns out to be a doubly good move, because as I may have mentioned in the past, internet access and connectivity is not yet state of the art here in Malawi. Therefore, a major challenge is getting the data all in one place in a timely fashion.
(I know, I know, control your excitement, epidemiology is just so gripping!) Actually I have to say that I am having a wonderful time criss crossing the central and southern part of the country with my fearless driver, Clifford (in the yellow shirt), spreading epidemiology cheer wherever we go! I have to confess that it wasn’t always like this. It turns out that some people are not totally enamored with data. Can you believe it?!? They don’t love to collect the data from the field and they really don’t love entering data into an excel spreadsheet. The saddest thing of all is that this is where the whole thing ends (for the most part). Come on! Now is when it gets exciting!! No wonder they didn’t love data until I came along!!
With a simple flip of the autofilter switch amazing things can happen with the data! At every DHO, I do a little presentation with data, charts and tables—their data, their charts, their tables—and people are amazed at the things they can do once they have the knowledge and the technology. Often at the end of the bumpiest, dustiest roads is a person yearning to learn the joys of data analysis, (though many are unaware of this yearning until the end of my presentation). A most popular use of data that is intuitive to most DHO personal is the fact that they can now document their need for additional resources. Knowledge really IS power! To be fair, almost everyone has mentioned that the basic template that I have provided them for the measles outbreak can easily be altered for other epidemics that will sadly come along and keep the people at the DHOs perpetually busy throughout their careers.
To my never ending delight, after my trainings, I have had several requests for additional epidemiology training. To that end I have developed an epidemiology toolkit that I will distribute (along with free antivirus shareware!!) on my next round of visits to the DHOs.
What do we want?
Data!
When do we want it?
Now!
Why do we want it?
To get more money!
What?! Really, why do we want it?
To improve the public’s health!
Long live epidemiology.
Friday, August 6, 2010
A world of Maureens!
Who knew that the two places in the world to find the most Maureen's are Ireland and Malawi! There are Maureen's everywhere! Needless to say, everyone knows my name.
I have to say Viva MSF Espana!!! I was hanging out with the Spanish contingent the other day. Walking home from the district hospital what to my wondering eyes should appear but an MSF van with HUGE speakers blasting dance music!! Every kid in the neighborhood was there and soon their mothers joined in too. Party on in Malawi!! Everyone needs a dance break. The little girl in the pictures is, of course, Maureen. When the kids found out my name they searched for my name's sake. It turns out that there's at least one in every crowd.
Monday, August 2, 2010
Rats vs. bugs
Last night we had a lively discussion about which is worse to encounter--usually at unexpected moments. Of course we had the tales of rats as big as cats, spiders as big as birds, in your shoes, and the occasional snake and what kind of snakes really do live in Malawi--a puff adder was recently spotted stretched across the road. When the MSF clinician asked the people walking on the road to kill it, they said 'No way!'since it was probably the spirit of someone recently deceased. But I digress. After the debate on rats v bugs the subject was put to a vote. I of course voted for rats as the more nefarious creature having recently witnessed a rat death in this very house. Ok in the interests of full disclosure, I admit that when I learned there was a rat in the bathroom I ran (did not walk) to the other end of the house. Later, Florencia the magnificent, our nurse from Kenya who did battle with said rat, exited triumphant from the bathroom, rat in one hand, broom weapon in the other.
Last night there was the most GIGANTIC wasp tangled up in my sheets. As soon as I managed to dislodge it, you know I pulled down that mosquito net!!! I am currently reconsidering my vote.
Last night there was the most GIGANTIC wasp tangled up in my sheets. As soon as I managed to dislodge it, you know I pulled down that mosquito net!!! I am currently reconsidering my vote.
Sunday, August 1, 2010
That is NOT a boulder
I saw a hippo today! No make that two and a whole herd of elephants. A very exciting day at Liwonde National Park. Directions were quite limited, but then again so were the roads. Just as we thought we were hopelessly lost and weren’t quite sure what to do, the road ended at the promised Mvui Lodge. It turns out that the directions are to go back the way you came. This time we saw a LOT more elephants and both Joe and I jumped out of the car to take pictures, much to the consternation of the driver who kept whispering as loudly as he dared ‘Get in the car! Get in the car!’ because he didn’t want to frighten the elephants into stampeding—as if they would with a with a crowd of four wheel drive vehicles watching and the elephants all protected by the sheltering trees. No these munching elephants were settling in for the evening and we all left long before they even considered wandering away from their ideal glen.
Imagine if you will, the long ride into the unknown along white then red then black bumpy roads over questionable bridges, the occasional warthog glancing up, uncountable antelope like creatures: some big and bushy with horns, some dark with a white target on their butts with horns, some orange and jittery with horns, all viewed accompanied by the dulcet tones of the darling of Malawi: Celine Dion!! Our driver is possessed of the complete Celine collection all on well loved cassette tapes. My favorite (on fifth hearing) was her duet with the long dead Frank Sinatra. Frankly that dead-alive duet thing freaks me out a bit, but it is a Sunday and I forgive a lot on this day of the week.
Imagine if you will, the long ride into the unknown along white then red then black bumpy roads over questionable bridges, the occasional warthog glancing up, uncountable antelope like creatures: some big and bushy with horns, some dark with a white target on their butts with horns, some orange and jittery with horns, all viewed accompanied by the dulcet tones of the darling of Malawi: Celine Dion!! Our driver is possessed of the complete Celine collection all on well loved cassette tapes. My favorite (on fifth hearing) was her duet with the long dead Frank Sinatra. Frankly that dead-alive duet thing freaks me out a bit, but it is a Sunday and I forgive a lot on this day of the week.
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