ICT 2 – We’re not alone

It seems that we’re not alone. The problems, challenges and frustrations we’ve been facing at Zomba Mental Hospital are similar to those faced by other VSO volunteers all over Malawi. This possibly encouraging message has been the most useful and helpful I’ve taken from ICT2. ICT2, the second instalment of VSO’s In-Country Training, usually lasts a week and is meant mainly for the two-year volunteers, though despite my shorter six-month contract I’m glad I decided to leave the madness at work and come here for two days. It’s been well worth it, and great to meet up with our fellow volunteers again.

P1030579 P1030578 
 
               Mice on Sticks!

  We passed a guy selling these local
  delicacies on the side of the
  road. They are cooked and eaten
  whole. Yes, the fur as well. And the
  claws and teeth and intestines, 
  apparently. Rob, wise as always,
  says I shouldn’t try one – “You’ll die.”

We’re in Lilongwe, and VSO are putting us up at a place called Kumbali Cultural Village, which models itself on a traditional Malawian village set in the bush. We stay in thatched mud-huts, though sleep on regular beds with mosquito nets. DSC_0275 The long-drop toilets are in small mud outhouses just behind the huts, though they have normal-style plastic seats, and there is a satisfying delay between release and splash. The "shower" is a neat cane outhouse, and we must fetch heated water in a bucket from a cast-iron wood-fired boiler, which we slosh over ourselves while soaping intermittently. Meals are served outdoors in the open at large sociable tables, and the food is traditional Malawian fare – though with far more protein, vegetables and probably flavour than would be truly traditional. (A traditional Malawian meal would consist of three large spoons of nsima, the stodgy maize porridge, accompanied by some form of "relish", typically boiled green leaves, beans, or dried fish, or perhaps some chicken or other meat.) There is a thatched conference room, bar, and kitchen. There is no electricity.  Basically, it’s ultra shabby-chic accommodation, loosely based on a Malawian village, amped up for the discerning eco-friendly tourist. All very stylish, organised and possibly fairly pricey. But I’m certainly not complaining.

Sadly, we started the week by saying goodbye to Sue, who has been living with us for the past month, teaching Clinical Officers at Zomba Mental. Sue drove us up to Lilongwe on her way to the airport (back to cold Wales for her), and she, Steph and I had a nice intimate farewell dinner on the first night. I’ve really enjoyed having Sue as a guest in our house, and will miss our talks and morning jogs.

DSC_0278      Evening meal and chatting around the large tables. Bar in background…

Back at Kumbali Cultural Village, there are also numerous TWIMSU’s and TWIMBU’s*, including the massive spiders** which have started to show themselves at night, both in Zomba and here. The only crawly creature of comparable size I’ve seen before is the "koring kriek" (corn cricket), the huge menacingly-spiked beetle-type-thing which fell on Natalie’s head while braaing in the Karoo National Park two years ago. P1030232The koring kriek, however, lumbers along slowly, is essentially harmless and easy to avoid. The large spiders** (update: see this entry) here are quick, ugly, apparently fearless, and according to stories can give a nasty bite. The only photo I have is from the gent’s bathroom in a Lilongwe restaurant. One of them blitzed across a large wooden table where some of us were sitting one night talking, scattering us like skittles. One of them scuttled across the floor in our hut one evening while I was lying innocently reading in bed. It’s so large I actually heard it on the reed mats. After urgently and thoroughly tucking my mosquito net in under my mattress all round, I gave my VSO colleague on the other side of the room clear and detailed instructions on how to get out of bed and kill the monster. It started clambering up her own mosquito net, she screamed but still did nothing to rid us of the beast, saying that I was over-reacting. I slept poorly that night, waking with every noise to check that my net was still securely tucked in and I still had all my toes.

P1030234   Bao board.

Bao is the traditional Malawian board game. A few friendly locals explained the game to me very enthusiastically one afternoon. The aim is to “eat” all the opponents marbles ( or beans), and it gets quite complicated.

As is always the case, the talks and seminars have been of mixed quality, from excellent to boring. Whereas the focus of ICT1 was an introduction to living and working in Malawi, the focus of ICT2 is more about the different areas of VSO’s activities, with the talks from serving volunteers or programme coordinators being the most useful for me. Of course, all of us who arrived together and have now been working for six weeks also swap stories and experiences. It’s also strangely gratifying to see all these English and Irish volunteers enjoying and commenting on South African novelties like Tex Bars and Peppermint Crisps during the breaks – I feel quite proud!

The afternoon session about the VSO Malawi Food Security Programme was moved to the neighbouring Kumbali Lodge due to last minute car battery problems. This lodge is where Madonna stays when she comes to pick up her kids. We didn’t see her, but read in the local papers that she is splitting up with Guy. The Malawian press keeps us up to speed on Madonna. Food Security is about helping to maintain a reliable consistent food supply in a country where 80% of the labour force is involved in very small-scale farming. Although there are some big corporate producers (the tea estates and Ilovo sugar down south, for example) by far the majority of the food consumed or sold here is pooled from the thousands of smallholders throughout the country. Some farmers practice crop rotation or mixing of crops (apparently maize and groundnuts together help each other out), but many do not. The soils are thus being steadily depleted of nutrients, necessitating the recent fertilizer subsidy programme for these farmers for the last three years, which apparently works reasonably. (The volunteers working in HIV/AIDS point out, though, that the distribution of fertiliser coupons, controlled by the local leaders/chiefs, is uneven, and HIV+ people often do not get any. I’ve mentioned such discrimination before here.) Maize, introduced into Africa in the 16th century,and is the staple crop – "the Queen of Cereals" apparently – though like a queen she must be treated just right. Maize requires lots of water, and is not nearly as robust and consistent as the (relatively) native millet and sorghum during dry spells. So why do people insist on planting maize if it is so fussy? The answer is simply that maize, if it gets good rain, has far superior yields compared to the other crops (50% more kg per hectare). But Malawi has only one annual rainy season, and that is not completely predictable, allowing only one or sometimes two crops per year. With irrigation, a VSO irrigation guy told us, they can manage two or even three crops per year, which is a significant improvement. We saw photos of the volunteer working with villagers laying trenches in the mountains, making us medics’ job look positively tame and boring! There was another young volunteer, a business graduate, who is working way up north in an isolated village, helping the villagers turn their tomatoes and peanuts into tomato sauce and peanut butter. A flamboyant Canadian volunteer with a background in the theatre told us how he was helping with chicken farming. This is all fascinating for those of us not involved, and the results seem so tangible and real and immediate (compared to psychiatry), though of course they take time and vision to achieve. It was quite inspiring.

P1030231    Lunch outside Kamuzu Central Hospital. Can anybody spot the problem?

There followed an HIV/AIDS session, and a tour of Kamuzu Central Hospital. A VSO lab technician gave us a whirlwind tour of the lab she was working in there. It looked very good – shiny, clean, modern, lots of machines. But there were some absurdities, which also resonated somewhat with my experience at Zomba Mental. Many basic reagents and consumables for machines were unavailable, often through poor management and organisation at higher levels rather than due to lack of money, and many of the machines were not working due to lack of maintenance. Our VSO tour guide was clearly very frustrated. In addition, donations from external agencies were often expensive and valuable, but largely useless. There was a fridgeful of Salmonella immunoglobulin vials, donated, which in the UK would cost £100 a shot, but would never be used here (though I can’t remember why not). There was a very fancy microscope for looking at Acid Fast Bacilli (TB bacteria) in some special manner, which would be a luxury in many UK labs. Various expensive lab machines had been donated to do various useful blood tests, but the machines were incompatible with those already in the lab, requiring different maintenance, different reagents, different protocols and different consumables and parts. When they stopped working or the supplied bits ran out, they were generally never repaired and left to stand idle. All the while, basic consumables and reagents and spare parts – sorely needed – are frequently not available. So it was a beautiful lab with beautiful machines, but funded incoherently by overseas money, and surprisingly few useful tests could actually be done.

This problem of random donations seems to plague “Development” in many areas, and almost all VSO volunteers have stories of unordered stuff which arrives unexpectedly from an overseas organisation, and is completely useless or utterly inappropriate. At Zomba Mental, there was a shipment of some lab and hospital machines from the Netherlands which arrived on the back of a truck in very large wooden boxes. They were evidently big machines. (There were also some stethoscopes which were eagerly received.) I don’t have the whole story, but I can testify that nobody knew what to do with these unasked-for boxes, so they were unloaded in the parking area in front of the hospital, and to stop them getting rained on, a robust wooden shelter was built over them, complete with four walls and corrugated tin roof. The boxes are still inside (update: still inside four months later). The shelter actually consumed hospital manpower and material – but at least those precious boxes are dry! In a similar vein, Steph and Pennie found a cupboard in the hospital filled with toys and bizarre implements, apparently donated for the children. These had arrived over the years and been securely tucked away in the cupboard, but never used as they were irrelevant to the needs at the hospital. The Occupational therapist had brought out some of the implements to ask what they were used for, assuming that Steph and Pennie would know. In many cases, they had no idea. There were even, remarkably, four adult-size judo suits! Rob and I also heard and subsequently confirmed, with some boyish excitement, that a crate in the ECT suite at the hospital contained a modern EEG machine, also sent recently from the Netherlands. We cranked open the case one afternoon and marvelled at the machine, but of course we don’t know how to use it. Nobody here does. It’s not even really that useful in psychiatry. But it arrived, and some international donors are probably congratulating themselves that they’ve helped the Third World. (To be fair though, a neurologist colleague at Queens Hospital in Blantyre got wind of our donation and is itching to nick it. So it probably won’t be wasted.)

The Ministry of Health in Malawi is aware of these problems and wastages though, and is trying to respond to the gross mismanagement of donor funds and resources (including government spending) with the SWAp Program – Sector Wide Approach – where all money going into health is pooled and spent horizontally where it is most needed, rather than being donated vertically where it might be wasted. This favours mental health apparently, as there are relatively few donors in mental health compared to the more glamorous HIV and malaria, and with the SWAp program we will get a bigger slice of the cake proportional to need rather than fashion. The Chief Government Psychiatrist based at Zomba Mental Hospital, Felix Kauye, is working hard to promote mental health on the government’s agenda.

At the end of the week, some volunteers returned to their placements, perhaps a bit wiser, certainly a bit more relaxed. Some of us, though, looked forward to another week of motorbike training! Whoop! That’s in the next post.

P1030237

*Things Which Might Sting/Bite You
**Okay, as mentioned …here… They’re not actually spiders, but Solifugids, a type of arachnid.

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