Malawian Toilets
Hey folks. I hope everyone is doing well. Congrats to everyone who is expecting bebe’s. there must be something in the water back home! ;) Just got back to Lilongwe. I spent the last week in the Northern part of Malawi on a field trip, conducting monitoring visits for some of CPAR’s projects. It was great to get out of the city, and back into the bush. Part of my job is to do periodic reviews of the projects, suggest improvements, and help the field staff find solutions to unexpected issues. However, as most of my time is spent at CPAR’s country office in the capital city, it is easy to become far removed from the realities of rural Malawian life, and the projects on the ground.
Our first task was to assess a water and sanitation project which is being implemented in 20 villages, targeting 6000 people. The purpose of the project is to provide access to clean water and to impart proper sanitation practices in order to reduce the fatal yet common diseases of typhoid, cholera and diarrhea. I love the water component of these projects. They are simple, and it brings huge changes to a community. Previously women had to walk between 2 – 5 kms to fetch the family’s daily bucket of dirty water from a muddy stream. Now, there are more than 50 clean boreholes strategically situated no more than 1km from each household provided a closer and cleaner water source. The sanitation aspect of the project is trying to get each household to build a pit latrine (i.e toilet), and getting people into the habit of washing their hands. Previously, the common practice was to use any bush, and to clean their hands on the grass. Surprisingly, this is the most difficult part of the project as it involves changing habits. So we spent two days driving off road to the most remote areas, walking through villages (while avoiding bushes), taking pictures of people’s toilets, and asking them about their personal hygiene practices. It’s kinda crazy trying to get people to do simple things such as washing their hands after toileting and before eating, considering it is something they’ve never really done before. While the people were amused to see the “white” (aka brown) girl walking around their village taking photos of toilets, I found it shocking to see how people live in such poverty. Even the differences between these rural villages and Malawian towns are incredible. Not to mention Malawi compared to the rest of the world. Yet, it is also completely humbling to observe the work ethic, strength and dignity of the people as they go about their daily lives filled with hardships. Attached are some photos from the trip!
Cheers,
Tess
Tales from the Medical Volunteers....
Although I work for “Canadian Physicans for Aid & Relief” there is nothing medical about the organization. Although the NGO did start with Canadian doctors coming to Ethiopia to do medical relief, over the last 15 years it has evolved into a community based development organization focusing on health related issues like water, sanitation, nutrition, etc. However, there are quite a few ex-pats here working within the health system in different capacities, and their stories about their daily work make my challenges and frustrations seem trivial. While Malawi is lacking in most professional capacities, the lack of professional health care workers is a serious problem. There is a medical school here, yet roughly out of the 20 doctors that graduate a year, about 17 of them end of working abroad (so I have been told). To compensate for the lack of doctors, Malawi employs “clinical officers” which in my understanding is someone between a doctor and a nurse. A lot of the gap is generally filled by foreign doctors who do 1 or 2 year terms in Malawi.
Patrick, a young doctor from Germany is finishing his residency in Internal Medicine back in Europe. Here, he has reluctantly become the country specialist in internal medicine. Erwin, a Filipino pediatrician gets stuck time and time again performing complicated surgeries with outdated medical equipment. Ryan, another Filipino guy we know works as a lab tech at Kamuzu Central Hospital, which is the main hospital in Lilongwe (the capital city). Basically his job is to teach the Malawian lab techs improved methods on running a hospital lab. Every time we see him, his stories blow me away. Last time we saw him, he told us that one of the clinical officers was having trouble getting a blood sample from his patient. Frustrated the clinical officer went to Ryan asking for help, telling him that he tried drawing blood 5 times, and couldn’t get any. Ryan goes over to talk to the patient, and discovers that the patient was dead. As Ryan says, “it’s kinda hard to draw blood from a dead guy”. You may wonder how this minor detail may of slipped by the clinical officer. Yes, we wonder as well. Another day, Ryan tells us that a 13 year old girl comes in and is diagnosed by a different clinical officer. The diagnosis: “mass in stomach”. As Ryan has never heard of this strange tropical disease before, he goes to see the patient himself. He takes one look at her, and puts his stethoscope to her stomach. His diagnosis: “5 months pregnant”. How that one slipped by the trained medical professional, is also beyond me. Some of his stories are more disturbing like the wrongly assembled asthma machines which end up sucking out air, instead of pumping in oxygen asphyxiating the patient, or the clinical officer who refused to believe him that a pregnant patient with blood type A should not be given a transfusion of blood type O, and only taking his word for it when faced with 2 fatalities the next morning. Sadly, there is no accountability here, and death is such a common event, that most times questions are not even asked.
My colleagues father in-law unexpectedly died of malaria a few weeks ago. Funerals are so common here, not surprising with the state of their health system, and where the average life expectancy is 36 years old. I was discussing this issue with another co-worker today, and when I remarked that we don't have malaria in Canada, he asked me what diseases Canadians generally die of. His question caught me off guard, because I really didn't have an answer. I know that the number one killer in Canada is heart disease, but that doesn't usually manifest itself till past 65. Cancer is another common killer, but is not as commonplace as malaria, cholera, TB or HIV/AIDs. Seeing that I didn't really have an answer beyond old age, he rephrased his question, and asked me "okay…then what do children die of in Canada?" I know that roughly 20% of kids in Malawi don't make it to their 5th birthday, but I have never heard of a child in Canada dying from any commonplace virus. When I told him that children in Canada don't usually die unless they have been in an accident, or had a congential birth defect, he was shocked, and looked at me disbelievingly. Canada, he said, “must be like a dream.”
So perhaps “Canadian Physicans for Aid and Relief” should get more involved in direct health care. Or perhaps we should continue to support all the other medical NGO’s, faith based medical relief groups, and volunteers like Ryan, Erwin and Patrick that really use their talents and gifts on the frontlines of this medical crisis. Or even, if you have some time, throw some prayers this way for the countless silent victims that die without any questions ever being asked.
Regards,
Tess
(of course, as most of us spoiled foreigners live the ex-pat life, I guiltily admit that we all have expensive health insurance that provides us with over the top prime medical care administered by European / American doctors….and air evacuation coverage in case we don’t find it cushy enough…so no worries for us…. But do worry for the average Malawian…….)
