Friday, July 31, 2009
Thursday, July 30, 2009
I forgot how clumsy I am in Malawi. The main problem is that my bike is still too tall. I told KASO to get me the shortest bike possible, but it seems they are all one size fits all. Even with the seat at the lowest level, I have to find a hill to prop myself up to get on the seat. I've finally given in and taken Charles' lead on one footed run-jump, swing one leg over. It works, but makes for a wobbly start. Getting off is even funnier, if there’s no hill to be found, I basically just tip over and fall until one of my feet hits the ground. Today my wobbling intersected with a van's illegal u-turn and I t-boned it, oops... Luckily we were both going slowly, so no harm done (well, it's possible that I may have dented the van, that could have been why the driver was yelling at me). It was absolutely my fault, I had ample warning to know that the van was turning….but just couldn’t seem to get control of the bike. The volunteers yelled at the van driver for quite some time until he (and all of his many passengers) apologized profusely to me. They are terribly protective of us, making sure we don’t get hit by cars and staking out the markets so they don’t charge us too much because we are white, for example. I honestly feel like a small child….but they don’t seem to be judging, just laughing when appropriate. Back to the clumsy biking, I have also already hit so many rocks that I had a flat tire yesterday. Two 20 cent repairs and a $2 tube later, it was all better.
Today we met an unexpected challenge when we tried to do the familiarization and sensitization at Malembe village. When we arrived at the center, there were very few people. The ECD coordinator explained that one of the village headman (a leader above several chiefs and below the traditional authority in rank) had passed away yesterday. Tragically, a small child had drowned in the river on the same day. So, most of the chiefs and adults of the community were at the funeral. We continued with the program as planned for the people who were in attendance, but will need to return on Sunday to make sure we have reached enough community members. Fortunately, Malembe is one of the closer villages.
Today the Health Sciences Research Council met in Blantyre in order to review our proposal. We should hear the results by Tuesday……
Today we met an unexpected challenge when we tried to do the familiarization and sensitization at Malembe village. When we arrived at the center, there were very few people. The ECD coordinator explained that one of the village headman (a leader above several chiefs and below the traditional authority in rank) had passed away yesterday. Tragically, a small child had drowned in the river on the same day. So, most of the chiefs and adults of the community were at the funeral. We continued with the program as planned for the people who were in attendance, but will need to return on Sunday to make sure we have reached enough community members. Fortunately, Malembe is one of the closer villages.
Today the Health Sciences Research Council met in Blantyre in order to review our proposal. We should hear the results by Tuesday……
Tuesday, July 28, 2009
Muddy in Kuilani Village
Today we biked into Alton's home village, Kuilani. He was so proud to show us where he was from and to introduce us to a couple of his children and the nearby chiefs. It took us like an hour and a half to get to the village when they thought it would only take 45 minutes. Part of the problem was that when we stopped at a gas station all of the "white people" (Tiane and Kim included!) took the opportunity to use their indoor plumming. When we came out, the researchers were all saying tiene, tiene! Let's go! They didn't mean to make such a logn pit stop.... On a side note, tiene sounds a lot like Tiane :).
When we arrived at the village, we approaced our first roadblock, a pit of standing muddy water. Mmmmm. Tutu (Tiane's aunt, ie: Kim, ie: Momma), crossed with no problem, so I followed right behind. My tires got stuck and I fell right into the mud. I laughed hysterically and made my way out of the sticky mess. The volunteers were all very concerned about me. I said let's just keep going, was gonna hop back on my bike and just be muddy till I dried off. But they insisted on cleaning me. One of the villagers ran very quickly and brought a bucket of water. Alton and Maria took off my chitingi and proceeded to bathe me. They were so sweet, even scrubbing my behind (I was still wearing jeans!) and taking my shoes off to wash my feet. It was very embarassing because all the kids from the village crowded around to see this azungu get a bath. The whole process required a second bucket of water. When we got to the center, one of the ladies took my chitingi (then Maria dressed me in her own) and washed it. Magically, an hour later it was clean and dry and ready to go! We can't figure out how they clean things so fast here...
Theh community meetings have been going wonderfully. Yesterdays was expecially exciting since it was the first one. At least 100 people greeted us as we rode in, some older boys took our bikes for us and they sang a song to welcome visiters. Both yesterday and today we toured Early Childhood Development (ECD) program building. We met the chiefs of the nearby villages. The meetings were extremely well organized (thanks to Alton and Jonathan). The volunteers each took a piece of the project to explain (purpose and goals, voluntariness, confidentiality, no benefits for participation), allowed the ECD coordinator to make an introduction, and took questions and answers. Here are some of the questions:
Will you continue the research if there is a funeral?
What if a child is approaching 6 years, will he be researched?
Are there going to be injections?
Will you suck the children’s blood?
Will the results be given to the families involved?
The chiefs said they would bring Gule Wamkule out of the jungle so that we could see them. This was actually a very funny discussion today. The volunteers told the people that we had been briefed on Chewa culture (wearing chtingi’s, learning to say Muli Bwanji, being fearful of Gule Wamkule), but also mentioned in a joking manner that we were really hoping to see the Gule Wamkule (means big dance, youtube it!) The chief today was a little upset that the volunteers didn’t warn him, or he would have set up a dance for us. So, they have arranged for it to happen on Saturday.
I have been very neglectful in expressing how much fun we’ve been having along the way. My friend Maction in DC was very kind to us and arranged for us to meet some of his good friends in and around Lilongwe. His friend Time Fatchi met us here at Korea Garden Lodge for coffee last Thursday. He then took us to a wonderful Reggae concert on Saturday night. A local band, the Black Missionaries, were planning and it was extremely fun! We danced for a few hours and some Malawian girls taught us local dance moves.
Sunday, since we had the day off, we went to Salima. There was a big craft market so I bought some earrings and a couple of baskets. Spent a lazy afternoon at Livingstonia beach. I couldn’t believe how beautiful it was. You could see the Tanzanian mountains on the other side of the lake and it was so windy that there were actual waves!
Hahaha, the lights just went out….guess I’ll save my battery.
When we arrived at the village, we approaced our first roadblock, a pit of standing muddy water. Mmmmm. Tutu (Tiane's aunt, ie: Kim, ie: Momma), crossed with no problem, so I followed right behind. My tires got stuck and I fell right into the mud. I laughed hysterically and made my way out of the sticky mess. The volunteers were all very concerned about me. I said let's just keep going, was gonna hop back on my bike and just be muddy till I dried off. But they insisted on cleaning me. One of the villagers ran very quickly and brought a bucket of water. Alton and Maria took off my chitingi and proceeded to bathe me. They were so sweet, even scrubbing my behind (I was still wearing jeans!) and taking my shoes off to wash my feet. It was very embarassing because all the kids from the village crowded around to see this azungu get a bath. The whole process required a second bucket of water. When we got to the center, one of the ladies took my chitingi (then Maria dressed me in her own) and washed it. Magically, an hour later it was clean and dry and ready to go! We can't figure out how they clean things so fast here...
Theh community meetings have been going wonderfully. Yesterdays was expecially exciting since it was the first one. At least 100 people greeted us as we rode in, some older boys took our bikes for us and they sang a song to welcome visiters. Both yesterday and today we toured Early Childhood Development (ECD) program building. We met the chiefs of the nearby villages. The meetings were extremely well organized (thanks to Alton and Jonathan). The volunteers each took a piece of the project to explain (purpose and goals, voluntariness, confidentiality, no benefits for participation), allowed the ECD coordinator to make an introduction, and took questions and answers. Here are some of the questions:
Will you continue the research if there is a funeral?
What if a child is approaching 6 years, will he be researched?
Are there going to be injections?
Will you suck the children’s blood?
Will the results be given to the families involved?
The chiefs said they would bring Gule Wamkule out of the jungle so that we could see them. This was actually a very funny discussion today. The volunteers told the people that we had been briefed on Chewa culture (wearing chtingi’s, learning to say Muli Bwanji, being fearful of Gule Wamkule), but also mentioned in a joking manner that we were really hoping to see the Gule Wamkule (means big dance, youtube it!) The chief today was a little upset that the volunteers didn’t warn him, or he would have set up a dance for us. So, they have arranged for it to happen on Saturday.
I have been very neglectful in expressing how much fun we’ve been having along the way. My friend Maction in DC was very kind to us and arranged for us to meet some of his good friends in and around Lilongwe. His friend Time Fatchi met us here at Korea Garden Lodge for coffee last Thursday. He then took us to a wonderful Reggae concert on Saturday night. A local band, the Black Missionaries, were planning and it was extremely fun! We danced for a few hours and some Malawian girls taught us local dance moves.
Sunday, since we had the day off, we went to Salima. There was a big craft market so I bought some earrings and a couple of baskets. Spent a lazy afternoon at Livingstonia beach. I couldn’t believe how beautiful it was. You could see the Tanzanian mountains on the other side of the lake and it was so windy that there were actual waves!
Hahaha, the lights just went out….guess I’ll save my battery.
Sunday, July 26, 2009
Final preparations
So much has happened since my last update I don’t even know where to start. So far, the project is going remarkably well. Each time I meet with the team from KASO I am astounded at the enthusiasm, dedication and resourcefulness of the volunteers. This is simply the most incredible group of people I have ever worked with.
Friday we met for the third time with two main objectives 1) for the KASO researchers to give feedback on the questionnaire after spending some time analyzing it question by question the previous afternoon and 2) for training on anthropometric measurements (how to weigh and measure the heights of the preschoolers).
To my surprise, they were also ready to present to us a detailed work plan. Alton, the director of Early Childhood Development (ECD) had already booked a community meeting at each of KASO’s five centers to be held one per day during the coming week. During the past few months, Richard (the director of KASO) has been working closely with the board of trustees and the parent’s committee in developing the project. So, the members of KASO as well as the local leaders are all supportive and welcoming of our research. The community meetings will serve several purposes: 1) to explain the purpose of the research 2) to familiarize the community with the azungu (white people) who will be visiting the villages 3) to emphasize the confidentiality of the interviews so that people do not follow the researchers or crowd around the homes where interviews are taking place (this is directly related to number 2 because last time I was here people flocked around the home based care (HBC) visits that were taking place just because they wanted to look at me). I am not exactly sure how these meetings will work, but will find out tomorrow!
At our meeting Friday I also wanted to show the volunteers the WHO growth charts for the standards for ages 2-5 so that they could see how we would use the data to interpret nutritional status. Charles, a primary school teacher in Mangochi, popped up and gathered a chalkboard and some chalk to make sure that the other researchers fully understood how to read the graphs. He was fantastic… I just sat back and smiled :).
Interesting cultural side note: when referring to anti-retroviral (ARV) treatment, people say they are “topping off.” Like when “topping off” or adding minutes to their cell phones, people have adopted the terminology to refer to adding minutes to their lives when they take their pills.
Saturday was children’s corner, an activity that I also helped with when I was here three years ago. I was once again completely amazed at the progress KASO has made. In 2007, Unicef provided some training about organizing activities at the center. Now the program is very well organized. A youth committee is in charge of organizing the activities and the kids each choose which they would like to do. This week the choices were: drama, traditional dance, art and HIV/AIDS discussions, to name a few. The younger kids can choose from a different set of activities: reading, imaginary play, nature, math and manipulatives and music. Other areas of focus are spiritual growth and nutrition. The last activity of the day was lunch.
Although resources are very limited, KASO is doing an incredible job of reaching the children in the community. The volunteers are proud of what they are doing and truly put their heart and souls into the programs. Can’t wait for tomorrow!
Friday we met for the third time with two main objectives 1) for the KASO researchers to give feedback on the questionnaire after spending some time analyzing it question by question the previous afternoon and 2) for training on anthropometric measurements (how to weigh and measure the heights of the preschoolers).
To my surprise, they were also ready to present to us a detailed work plan. Alton, the director of Early Childhood Development (ECD) had already booked a community meeting at each of KASO’s five centers to be held one per day during the coming week. During the past few months, Richard (the director of KASO) has been working closely with the board of trustees and the parent’s committee in developing the project. So, the members of KASO as well as the local leaders are all supportive and welcoming of our research. The community meetings will serve several purposes: 1) to explain the purpose of the research 2) to familiarize the community with the azungu (white people) who will be visiting the villages 3) to emphasize the confidentiality of the interviews so that people do not follow the researchers or crowd around the homes where interviews are taking place (this is directly related to number 2 because last time I was here people flocked around the home based care (HBC) visits that were taking place just because they wanted to look at me). I am not exactly sure how these meetings will work, but will find out tomorrow!
At our meeting Friday I also wanted to show the volunteers the WHO growth charts for the standards for ages 2-5 so that they could see how we would use the data to interpret nutritional status. Charles, a primary school teacher in Mangochi, popped up and gathered a chalkboard and some chalk to make sure that the other researchers fully understood how to read the graphs. He was fantastic… I just sat back and smiled :).
Interesting cultural side note: when referring to anti-retroviral (ARV) treatment, people say they are “topping off.” Like when “topping off” or adding minutes to their cell phones, people have adopted the terminology to refer to adding minutes to their lives when they take their pills.
Saturday was children’s corner, an activity that I also helped with when I was here three years ago. I was once again completely amazed at the progress KASO has made. In 2007, Unicef provided some training about organizing activities at the center. Now the program is very well organized. A youth committee is in charge of organizing the activities and the kids each choose which they would like to do. This week the choices were: drama, traditional dance, art and HIV/AIDS discussions, to name a few. The younger kids can choose from a different set of activities: reading, imaginary play, nature, math and manipulatives and music. Other areas of focus are spiritual growth and nutrition. The last activity of the day was lunch.
Although resources are very limited, KASO is doing an incredible job of reaching the children in the community. The volunteers are proud of what they are doing and truly put their heart and souls into the programs. Can’t wait for tomorrow!
Thursday, July 23, 2009
Day 3.....
Today the KASO staff and volunteers continued to amaze me. They were so happy to see Tiane and I in the morning and ready to get to work as soon as we arrived. Today we spent on procedural and ethics training. The ethics training was easy because all of the volunteers are well-aquainted with issues of confidentiality and sensitivity due to the nature of their work with HIV and AIDS. I would mention an issue and they would run with it in discussions. Same with the procedural issues, they really strove to understand the meaning behind each of the items on the interview questionnaire and to seek out ways of approaching various subjects in a culturally sensitive manner. For instance, the volunteers perceived the question of head of household education level to be extremely personal because people in the villages are realizing more and more the importance of receiving formal education. The volunteers have a keen sense of the importance of presentation when approaching all of these issues, especially those related directly to HIV and AIDS.
So, basically instead of doing the "training" I had anticipated, we ended up facilitating a meaningful and productive discussion and brainstorming session the heart of which was truly led by the volunteers. Tiane and I left KASO early, around noon, in order that they would have time to discuss in even greater depth each question. We will reconvene tomorrow morning to make final alterations to the questionnaire and to talk about our plan of action (practicing and piloting the questionnaire, holding community meetings to announce the project, and work schedule for after we receive National Health Sciences Review Board approval).
Yesterday KASO gave us an orientation to their programs and services. I was so impressed with how much things have evolved since I here 3 years ago. They now have a much larger early childhood development component (preschool and feeding programs) and a new youth outreach program to name a few.
One of my favorite parts of our discussions so far was when we asked for cultural training. They mentioned a few important points such as the need to always wear chitingi (traditional skirts) into the villages.
So, basically instead of doing the "training" I had anticipated, we ended up facilitating a meaningful and productive discussion and brainstorming session the heart of which was truly led by the volunteers. Tiane and I left KASO early, around noon, in order that they would have time to discuss in even greater depth each question. We will reconvene tomorrow morning to make final alterations to the questionnaire and to talk about our plan of action (practicing and piloting the questionnaire, holding community meetings to announce the project, and work schedule for after we receive National Health Sciences Review Board approval).
Yesterday KASO gave us an orientation to their programs and services. I was so impressed with how much things have evolved since I here 3 years ago. They now have a much larger early childhood development component (preschool and feeding programs) and a new youth outreach program to name a few.
One of my favorite parts of our discussions so far was when we asked for cultural training. They mentioned a few important points such as the need to always wear chitingi (traditional skirts) into the villages.
Tuesday, July 21, 2009
First day in Lilongwe!
We arrived in Lilongwe today! Richard (the director of KASO), Charles (the head researcher from KASO) and Essu (our driver) picked us up at the airport. I asked them to make a detour to KASO so I could show Tiane and Kim where we'll be working. It was exciting to see that things have improved a bit. KASO has a new sign and all new buildings. When I was here in 2006, there were two small buildings, one for operations and one for the pre-school programs. Now, there are three larger ones: a dining room/kitchen, a preschool building and a building for general activities. They have also changed the color scheme from white with blue trim to dark green. I'm really excited because one of the volunteers I worked with last time, Jonathan, will be helping with our project.
They dropped us off at Korea Garden Lodge in area 3, one of the nicer areas of Lilongwe and where a lot of government agencies are located. The room is huge, it’s basically a bedroom/kitchen/living room all packed into one.
We were actually supposed to land in Lilongwe yesterday, but our flight left DC late and then we missed our connection in Addis Ababa. So, we ended up staying in Ethiopia for the night. As soon as we landed in Ethiopia I got sick. Really sick….I’ve been doing oral rehydration therapy all day (drinking lots of gross sodas) after passing out on the bathroom floor last night. I don’t feel great, but I’m better now that we’re in Malawi.
Aside from my sickness, it was neat to be in Ethiopia for a day. The airline put us up in a hotel and gave us three meal vouchers. It’s the rainy season in Ethiopia, so during the day there were major downpours. We decided to stay in and have $9 massages instead of trekking out in the rain. Before dinner we walked around a bit. I’ll post some pictures if I can manage to keep the internet up long enough.
Tomorrow we have an orientation at KASO. They’ll introduce us to their programs and mission and will provide some cultural training. We’ll also go over some logistics for the project.
We’re waiting to begin our study until we receive approval from the National Health Sciences Research Council. They meet on July 30th. So, we’ll have lots of time to plan and prepare before we start collecting data.
On a side note, Richard told us today that KASO received a grant to fund transportation of children from home to Baylor University’s pediatric AIDS clinic. They require monitoring and evaluation in order to demonstrate effectiveness. It looks like one of the first uses of the data we collect might be to serve as a baseline, as far as the numbers of kids on anti-retroviral treatment, etc.) for the transportation program.
They dropped us off at Korea Garden Lodge in area 3, one of the nicer areas of Lilongwe and where a lot of government agencies are located. The room is huge, it’s basically a bedroom/kitchen/living room all packed into one.
We were actually supposed to land in Lilongwe yesterday, but our flight left DC late and then we missed our connection in Addis Ababa. So, we ended up staying in Ethiopia for the night. As soon as we landed in Ethiopia I got sick. Really sick….I’ve been doing oral rehydration therapy all day (drinking lots of gross sodas) after passing out on the bathroom floor last night. I don’t feel great, but I’m better now that we’re in Malawi.
Aside from my sickness, it was neat to be in Ethiopia for a day. The airline put us up in a hotel and gave us three meal vouchers. It’s the rainy season in Ethiopia, so during the day there were major downpours. We decided to stay in and have $9 massages instead of trekking out in the rain. Before dinner we walked around a bit. I’ll post some pictures if I can manage to keep the internet up long enough.
Tomorrow we have an orientation at KASO. They’ll introduce us to their programs and mission and will provide some cultural training. We’ll also go over some logistics for the project.
We’re waiting to begin our study until we receive approval from the National Health Sciences Research Council. They meet on July 30th. So, we’ll have lots of time to plan and prepare before we start collecting data.
On a side note, Richard told us today that KASO received a grant to fund transportation of children from home to Baylor University’s pediatric AIDS clinic. They require monitoring and evaluation in order to demonstrate effectiveness. It looks like one of the first uses of the data we collect might be to serve as a baseline, as far as the numbers of kids on anti-retroviral treatment, etc.) for the transportation program.
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