Friday July 31st

Yesterday we had a great turnout for our last community meeting. Since a number of KASO volunteers live in Fumbe, the community was eagerly anticipating our arrival. Three village chiefs and a village headman (overseeing a number of villages) as well as many men and women were in attendance. As usual, the KASO team did a fantastic job of covering everything we had discussed –purpose of the study, voluntariness, and confidentiality- (Maria translated as the presentations were made in Chichewa). One aspect of the familiarization meetings that has fascinated me is the genuine interest of the volunteers to make sure that the people truly understand the project. Prior to beginning the community meetings, we had long discussions about presentation. One concern I raised was that people might be afraid of the word “research” and that we might want to use softer language- like “program” or “project” to convey what we were doing. However, the volunteers instead wanted the people to learn that research is not something scary, but something helpful to their community. So, they have taken a lot of time to explain not only what our project is, but to define “research,” dispelling myths that all research involves needles or “blood sucking.” It seems to have gone over really well.
My favorite question yesterday was, “what if a woman is very willing for her child to be researched, but has no child between the ages of 2 and 5, will you still allow her to be included in the research?” Charles answered the question by posing a question back, “If a boy wants to be a part of Gule Wamkulu (big dance), but has not yet reached the age of initiation, can he participate?” He continued with an explanation of why we can only look at kids between 2 and 5, but the comparison worked perfectly. Even in our research group discussions, the answers to many questions begin with “in Malawi, we have a saying….” Such as “you may go to the lake to see the lake, but you may find a hippo.”
I’ve learned tons more in the last week and a half than I did the entire time I was here before. Some of it is cultural, like the way that Malawians cup their hands when clapping for a chief. I am also learning from the way things have changed at KASO over the past few years. As an undergraduate I wrote a paper about the influence of the community mindset (found in most non-western societies in which people think of themselves as a part of a whole, as opposed to the individualistic American mindset in which people think of themselves as the whole) on the HIV/AIDS epidemic. Having heard such sayings as “HIV is in the nsima” I thought that it would be very difficult, once HIV had invaded a community, for individuals to formulate personal health beliefs that allow for the projection of outcomes that are separate from the health of the community as a whole (ie: that even though some neighbors or family members might be infected, they could prevent HIV).
I am very happy to say that I have changed my mind. The people we are working with believe that, as a community, they can stop the spread of HIV. There is a sense of empowerment in these communities that I did not see three years ago. One of the most obvious differences is the number of people who are on ARVs. In 2006, I participated primarily in home based care for people who were so sick that they were home-bound. Now, the number of people who are seriously ill has dropped dramatically. So, people are hopeful rather than helpless. Interestingly, I have heard people argue that access to free ARVs will dampen prevention efforts because people will no longer see HIV as a killer. On the contrary, I see access to these drugs as giving communities a degree of much needed control over the epidemic. Where once HIV was a death sentence, the realization that the virus can be, to some extent, tamed, is allowing for more open dialogue and the perception that health outcomes can also be changed. Of course, this is just my small take on an epidemic that is ravaging a huge proportion of the continent…but I find these to be hopeful signs.