Nurses' Nutrition Training

The nutrition training for the community nurses here in Thyolo finished on Friday. It was two sessions each a week long. We split it up because we couldn't take all of the nurses away at once because then there would be no one to deliver care to the clinics. Both weeks of the training were funded by a grant that I received from Peace Corps. Although I submitted all of my paperwork back at the beginning of December, because of the holidays and other delays the actual funding proposal wasn't submitted until about 2 weeks before the training. The money was supposed to come the week the training started. The planning committee and I decided to go ahead with the training in anticipation of receiving the money in good time. Unfortunately it took almost 3 weeks for the funding to come through, which meant that money for the entire training didn't come until it was almost over.

So what was the money for? We some was for stationary supplies like folders and pens for the participants, some was for food supplies for a cooking demonstration. The bulk however was for per diem for the trainers, the drivers and the participants. It was a little stressful to have to ask people daily to be patient and to guarantee that the money was coming. It was such a relief when it was finally here. I was discussing my experience with a friend who works for Medecins sans Frontieres who basically organizes trainings and has been doing so for the past 9 months. She said that my experience is actually quite typical and that sometimes participants or even trainers stop coming if the per diem doesn't come in time. Fortunately only 2 participants stopped attending but for reasons other than funding.

The next step is to complete a month's work of monitoring and evaluation. Each participant will complete a short form for each outreach clinic they attend to indiciate whether or not they delivered the information they learned about nutrition education and nutritional assessment to the patients. From these forms we will be able to determine if the training was effective in the short-term.

It's been a while so I thought I would write a brief update. I've been busy working on the nutrition training. It's scheduled to happen next week and the first week of February. The grant proposal was approved and the funding will be coming. Unfortunately, we probably won't receive the money until after the training has started. It's okay though because the important supplies are stationary for the participants and facilitators and most of these will be taken from my office or else bought on credit.

Speaking of buying on credit, I decided to try to buy some folders and pens for the participants on credit. I wasn't sure if it would be possible but I figured I'd give it a try rather than just sit around and have to stress out during the training. There are 2 stationary stores in town but I only knew of one so I didn't bother to price check. I went into the store and explained my situation but I didn't do a really good job because they kept asking me "who sent you". I know they just wanted to know what organization I was representing so they could know if the person was reliable or not. But it still sounded like I should have come with a secret password.

The owner said he doesn't usually give things out on credit but I left him my contact details (including where I work) so he can come find me if he so chooses. The money is scheduled to come in next Monday or Tuesday so I plan on going back to his shop as soon as it does.

We were hoping to have a guest facilitator from USAID to help deliver the curriculum but unfortunately this was not possible. So now we're trying to find someone here in town to fill in. We already have 2 facilitators so the third would just make the workload easy (which is important) but it will not make the training impossible to carry out.
We
It's been raining for a couple of months now so the crops are really tall. I'm always amazed by the speed with which corn and other crops grow. It's so fast that you almost forget what the landscape looked like during the dry season.

The CBO mapping is going along. Not as fast as it could but not as slow as it could either. We've managed to contact about 20 organizations out of the 200 that are known to exist in the county. We'll keep at it and maybe we'll finish by the time I leave. One of the biggest road blocks is that our office does not have any funding (other offices received funding but not the office of the District AIDS Coordinator where I work). So we don't have money for fuel to drive to these places or phone cards to call them.

Other than that, not much is happening right now.

Happy New Year!

I haven't written in a while because not much was happening at work. Actually all of the government offices shut down from Christmas Eve until today so even if I had gone to work I wouldn't have had anyone to work with. Well, the hospital and the prison were still functioning but not at full capacity.

I just found out that the grant that I applied for last month was accepted for the full amount. : ) This is great news since we're scheduled to hold the training at the end of this month. I'm really excited to see this project come to life. I hope that the nurses who are participating enjoy the training and are able to use the information that the facilitators deliver.

The National AIDS Commission asked all the District AIDS Coordinators (DAC) to conduct mapping of all of the HIV/AIDS stakeholders in their respective communities. The Thyolo DAC and I have been working on the mapping for our district since last month. We have the survey ready and we're scheduled to go into the field this week to deliver them to some of the organizations. I found out that Medecins sans Frontieres (and NGO operating in the district) has also completed a mapping of the HIV/AIDS stakeholders in the community. This made me wonder how many other organizations have done a similar task. So I asked the DAC if we could have a district-wide meeting to find out what other organizations have conducted similar mapping activities and any suggestions or resources that could be shared. Hopefully we can have that meeting this month or next.

It hasn't been very busy here at the Assembly lately. The frenzy of planning World AIDS Day is over so people are relaxing a little. The DAC and I have been planning to conduct some field visits to area Community-Based Organizations, Faith-Based Organizations, Non-Governmental Organizations and Youth Groups. We have two motives for these visits. One is to have all of the HIV/AIDS stakeholders in the District (so that would be all of the organizations I just listed above) complete a survey indicating what activities they do. The other reason is to do GPS mapping. The first purpose is fairly easy and we will probably be able to complete it within a matter of months. The second purpose is proving a bit tricky.

The National AIDS Commission (NAC) has asked all of the District AIDS Coordinators to use GPS mapping to find out the location of all of the HIV/AIDS stakeholders in their respective districts. This is a great idea, however, not all districts have access to a GPS device, and even if they do not all of them have someone available who knows how to operate it. Also, there are almost 200 different stakeholders in Thyolo and I'm sure it's something similar in all of the other districts. So that means that it will take a lot of money to provide fuel and per diem for the people conducting the mapping. As I mentioned a while ago NAC doesn't really have any money so they are not a realiable source of funding.

To futher complicate the issue, there is currently a fuel shortage in Malawi. I was told this is due to a lack of foreign currency in the banks. I think that means that they use the foreign currency to buy fuel from other countries. So no money = no fuel. And no fuel means that we cannot go into the field. I did submit a budget to the District Commisioner (DC) to cover the cost of fuel and per diem for us to visit a few organizations. The DC accepted the budget, so now we just wait for the fuel shortage to end.

I finally submitted the grant for the nutrition training. We are hoping to have it in 6 weeks so hopefully it will be approved either before Christmas or right after. The training will be for 2 weeks: the last week of January and the first week of February. We will then monitor the nurses to see if they actually practice the techniques they learn in the training. They will fill out a short monitoring tool after each field visit and at the end of each week I will collect the forms and enter the information into a database. This will be done for only three months. Well, at least I will only be collecting the information for 3 months because I need to wrap up the grant before I leave in August. I will leave the database and all of the information with MSF and the district hospital when I leave and if they want to continue collecting data they can.

Right now everyone at the Assembly is waiting for the President to declare the offical government dates for the Christmas holidays. I guess people don't really know the dates of their vacation until right before it happens. It's kind of like a Christmas surprise. But it makes it difficult to plan travel, etc. I won't be traveling far this year, just a 30 minute bus ride away to a friends house. We will make Christmas cookies, watch movies and sing Christmas carols together. Delightful.

World AIDS Day

Today is World AIDS Day. The DAC office is hosting (maybe sponsoring?) 2 events in the district - one at the prison and one in a town about 25 minutes down the tarmac road. I say that maybe we are funding the events because, as of today we still have not received the money to cover the function from the national office. Each district is doing its own thing to fund (or maybe not fund) WAD events. Here in Thyolo the District Assembly loaned us the money and we will pay them back as soon as we receive the money.

I decided to attend the function at the prison since I didn't think I'd really be any help at all at the other event since there were so many people going already. The event was scheduled to start at 9:30 am with a Solidarity Walk (similar to a 5k or other walk but much shorter - maybe 1/4 mile). But, most events here don't start on time so we eventually began the walk at 10:30 am. It was really good: people held signs up talking about this year's theme: Universal Access and they were singing songs about getting tested and taking ARVs. Then we made our way into the prison.

I feel that I should describe the prison first before I talk about the function. It is a small white building bordered (but only in the front) by a flimsy barbed wire fence. It's near where I work and in fact I walk by it every day. This was my first time to go inside though. I was told by one of the officers that there are currently 172 prisoners - 2 women and the rest men. The 2 women were able to sit on a bench on the porch of the prison because they were only 2 and there isn't a women's ward. The men on the other hand were all crammed into 5 cells - meaning about 35 men lived in each cell. I don't know the area of the rooms, but I'm sure they either slept right next to each other or on top of each other. Not very sanitary or mentally helpful.

I asked the prison HIV/AIDS Coordinator if they were thinking of expanding the prison but she said that due to lack of funds that would probably not happen. I was also told that there are only 2 bathrooms and 2 showers for all 170 men. I asked if they were given food and she said yes, but only once and day and it was probably just nsima (a paste made from corn flour and water) and beans. She said that sometimes the families of the prisoners brought them food, but they'd have to travel to the prison and sometimes they lived very far away or they might not have the money to buy food.

The 5 cells are spread out around a small open air courtyard. Some prisoners spend their whole sentence (months or years) in that small space and are never allowed to leave. Other prisoners who have almost finished their sentences are allowed to leave the prison to do manual labor for other government offices or officials. (For example, a group of prisoners came a month ago and chopped down some trees in the District Commissioner's yard - also my yard.) So they live a very hard and very confined life.

After the Solidarity Walk we went to the prison where the function was to take place. There was a giant tarp spread out on the ground of the court yard for the prisoners to sit on and chairs set up for the invited guests (i.e. the important government officials and village chiefs). Although it is the rainy season, it hasn't rained in a few days so it was HOT. This was especially true in the sun where all of the prisoners were sitting. No one complained though and they really seemed to have a good time despite the sun beating down on them.

There were speeches discussing this year's theme - some people talked about getting tested, others talked about taking ARVs if you are positive, others talked about getting tested with your partner. Very good stuff. There were also several sketches, songs and comedy routines all talking about this year's theme. Two people gave testimonials, but since it was all in Chichewa I don't really know what they talked about, but I'm assuming it had something to do with how HIV affected their lives.

The function was over by 1pm and as the invited guests left, the hired DJ played music for them so they could dance. During the entire function, staff members from the district hospital were providing HIV testing for the prisoners. I asked if they could get tested whenever they wanted and was told that they could, provided there was an officer available to escort them to the hospital to get tested. In her speech, the head officer at the prison asked the hospital to provide them with a trained counselor on a regular basis so that all prisoners who wanted to get tested would be able to.

I'm really glad that I was able to attend this event and that I was able to learn what life was like for prisoners here in Thyolo. The request for HIV counselors and testing got me thinking that maybe the DAC and I could find some way to train counselors for the prison, maybe members of the prison staff. I asked the prison HIV/AIDS Coordinator about the training and she told me it was 3 weeks long - shortened from 6 weeks. Wow, that's a long training and an expensive one, especially if the trainees get per diem. But maybe we could find some money somewhere. I also thought about the fact that so many of the speeches stressed the importance of proper nutrition but most of the prisoners only ate one meal a day. There are some organizations here in Malawi that provide food for school children, maybe they'd be interested in starting a program with the prison.

World AIDS Day Planning

The past few weeks have been focused on planning the World AIDS Day (WAD) events here in Thyolo District. We started planning at the beginning of this month and will hold the activities on December 1st. Although it is a worldwide event and most occur on December 1st, sometimes due to the arrival of funding, people's schedules, etc, the events are held after December 1st. And, I learned here in Malawi that WAD is actually the start of a year-long series of events (if money and time allow) to commemorate that particular year's theme. So WAD actually goes from December 1st of one year to November 30th of the following year. This year's theme is universal access to testing, care and ARVs.

Unfortunately, at least here in Thyolo, the only variation in the planning activities is the theme, the rest of the event is the same. Since the DAC office has not received funding from the national office (or maybe this doesn't even matter) in a year and a half, we are using the budget and format for the WAD event planned for last year. As far as I know, the event actually did occur last year. In any case, the national office has issued a checklist to each of the districts in the country with the activities that should occur in their respective WAD events. So, like all the other districts we will have traditional singing and dancing, skits, poetry, speeches from invited guests - all related to this year's theme.

One of the largest portions of the budget for this event and most other events, training, etc is that set aside for allowances (or per diem). So, for our WAD event we will be inviting important guests such as the Members of Parliament for each of the 5 constituencies in the district, the village headmen, the traditional authorities and the chiefs. We will pay them an allowance to attend and will also ensure that they have the best seats and get the best food.

We will be holding 2 events on December 1st, and possibly 2 or 3 more later in December, January or maybe not at all. The 2 events on WAD will be held at a town about 10 minutes drive from the town proper and at the district prison. Since it is the rainy season we will be borrowing some large tents (like the kind they use for weddings and other outdoor events) to protect the performers and the invited guests. Unfortunately the area where we will hold the event in the prison is too small to comfortable contain a tent, so if it rains I guess that we will just have to (hopefully) postpone.

Other than WAD, I'm still slowly working on the grant for the nutrition training. Hopefully I can get it submitted and approved by mid-December. We want to hold the training the last week of January and the first week of February of next year.

There was a reseach dissemination day (similar to the internship conference at the College of Public Health) this past Saturday. I was surprisingly really excited to go. I didn't realize how much I enjoy research, statistics and data until I came here and started working on this grant. The idea behind the day was that so many government and NGO employees working in Thyolo attend national and international conference where they share research and data gathered in the district. This information is rarely shared on a local level, so the District Health Officer and one of the doctors at MSF decided to create a forum to share such information. It was really interesting and nice to learn what other people are doing in the district.

A day in the life

A few people have asked about my daily life here so I thought I'd just write it in my blog. I just want to give a disclaimer though: this is only my life, it is not the life of a typical Malawian because I am both wealthy (here, anyway) and white.

I wake up at 5 am to Lucy running circles around my mosquito net. I don't let her inside the net with me because she would attack me all night long. It's just getting light outside and the sun shines bright pink and yellow above the perpetual fog that appears every morning here in Thyolo. I get up and walk out the door to go on a walk through the hills and tea estates that surround my house. I stop first to pick up a rock to threaten my landlord's dogs because otherwise they would surround me barking.

My walk can either be peaceful or a lot of mental work. It's beautiful here so it's always relaxing to wander the dirt roads passing by brick houses and corn fields. However, I am white so I stick out like a sore thumb. The word for white person in Chichewa (the language spoken in most of Malawi) is mzungu. So the children stand at the side of the road staring or waving and shouting mzungu! mzungu! Older people will ask "Mwaduzka bwanji?" which means "How did you wake up?" and I reply "Ndazuka bwino, kaya inu?" which means "I woke up well, how about you?" to which they would reply "Ndazuka bwino". Sometimes, there are a lot of people so I have to greet lots of people or else just say "Zikomo" which means many things, among them "thank you", "excuse me" and I guess "hi".

After my walk I make breakfast which is not very Malawian but an idea I got from a fellow Peace Corps Volunteer. I make warm chocolate milk and then soak a bun in it (they call it an "Obama" I don't know why. There are also buns called "Bin ladens" because they're really hard to find). I used to each a porridge called likuni phala made from soybeans, peanuts, beans and corn. But the chocolate milk and bread is so much better. Anyway likuni phala is often used with nutritional rehabilitation for children and PLWHAs.

After breakfast I take a shower using a bucket and a cup to pour water on myself. I have a bathtub but often the water isn't working. Sometimes I don't have water for days at a time. My landlord's wife told me it was really bad last year and there was one time when they didn't have water for 3 months. It's been fairly reliable recently (knock on wood). Also sometimes the electricity goes out, like it did last night. Then if i want to eat I have to use a small metal stove and cook with charcoal (which is illegal here by the way because of the impact on the environment, but what are people supposed to do for cooking when there is no wood?)

Then I go to work. If there is no electricity it is a little harder since a lot of my work now involves computers. If there is electricity I might go to the computer room at the Assembly (yes we have one!) and check e-mail. Or I'll go to the District AIDS Coordinator office and wait for my counterpart to show up. I made a calendar for us to use last week. The idea is we'll use it to let each other know what our plans our and if we plan on going out of town. I wasn't sure if he would like it but he loved it and called it "best practice". I thought he might just be humoring me but when I went into the office yesterday he had written his schedule for this week into the calendar. Sometimes I go to meetings either with the nurses at the hospital to plan the nutrition training or with the District AIDS Coordinating Committee to plan World AIDS Day or with the statisticians at MSF to gather data for the grant proposal.

I go for lunch around 12. If I need to buy food then I just go over to the open air market down the road. Some vendors have stalls, some sell on the ground (I suppose it has something to do with what they can afford). There are people who just sell vegetables; people who sell meat; people who sell home goods like candles, soap, lotion, matches, sugar, batteries; people who sell clothes; people who sell sheets, table cloths and curtains; people who sell shoes; people who sell plastic ware like buckets, plates and cups. It's a small market and I have my favorite vendors for different items so I usually go to them and haggle to get a good price. Sometimes they give you a "prize" at the end like an extra tomato or bun because you are a good customer or they want you to become one.

Then I go home to make lunch on my hot plate. After I go back to work around 2pm and do one of the activities I mentioned above. Sometimes I have Chichewa lessons so I have to take a minibus (a 16-passenger van that is usually packed to more than full capacity) 5 minutes away to Thyolo Secondary School. We meet in one of the classrooms: a mid-sized room with windows in a larger concrete building. Thyolo Secondary School is actually a nice school (I think built with outside funding), but I think the schools here are generally better than the ones in Togo. Bigger, cleaner, better stocked.

I usually go home around 5pm. I've been just making dinner and reading in my house, but it's getting lonely just talking to a cat. So I have the number for my landlord's wife and if I want to hang out with them I'll just call her and she'll send someone to come get me. All of this would not be necessary if they didn't have the 5 beasts of the apocolypse they call dogs. I typically go to bed around 9 or 10pm.

Weekends are a little different. I do laundry on Sundays, visit friends, stroll around the market, go to Blantyre. But that's basically my life here.