Published: May 4th 2009March 31st 2009
Nurse Chiundira performing pre-test group counselling in Makala village.
A lot has happened since I last wrote. The project has progressed, local colleagues have come and gone, the weather and environment has changed and, as always, I have learned new things.
The project is progressing by leaps and bounds. We started with visits to 9 communities in November but, after a fair bit of research into local prevalence rates, many visits with village chiefs, coordination with hospital volunteers, and advertising (posters, word of mouth, announcements in local churches etc.) we have now doubled that number. Our schedule is constantly changing as we try to make space for visits to new villages and more frequent visits to areas where we have experienced high turnouts. During a visit to a health center in Nkhwazi earlier this week we performed our highest number of CD4 tests so far - 40.
We have found the responses from the various villages to be extremely varied. We receive a warm welcome from most villages (from the chiefs and villagers alike) but not such a warm welcome from others.
Although the chief of Kachete was happy for us to come, and told us he would do everything he could to get a good turnout
In the shade of some beautiful trees in Makala village
(including arranging a village meeting for the morning of our visit, without telling people that we were coming), word got out and the villagers revolted. They told the chief that, if we came, he would be the only one getting tested because they would refuse. When you see the respect that most people have for their chief, for them to go against his wishes is quite significant. It’s really a shame because, when testing was done in anti-natal mothers living in Kachete in the past, one in three was found to be HIV positive. All we can do now though, is give it some time and hope that their attitudes change.
So, we erased Kachete from our outreach schedule and replaced it with the nearby village of Liwinga. In complete contrast to Kachete, the response was absolutely overwhelmingly positive, in both the number of people that turned up, and the warmth with which we were received. Due to it being a ‘pilot visit’, we went in the afternoon, following a morning clinic in another area. We arrived at 3 p.m. to be greeted by the village headman, two community volunteers, and the head of the Village HIV/AIDs committee. They
rang the church bell and within half an hour we had a crowd of people. Following group counseling, HIV testing began. The chief and his 2 wives volunteered to be tested first. With myself doing registration (sex, age, marital status and results are recorded for national statistics) and our nurse, lab tech/phlebotomist and one of the hospital volunteers all taking samples at the same time, we were able to test almost 80 people before the sun went down. People were still arriving but we had to turn them away. No electricity is not exactly conducive to testing. We now have a second, all day visit scheduled. Apparently some of the local girls are going to do some traditional dancing for us, and a chicken is going to be cooked up.
I believe that some of this good response was due to the village chief, his relationship with the villagers, and the villagers’ relationships with each other, but a significant amount of it was due to the hard work of that particular hospital volunteer, in coordinating with ourselves and the locals to arrange everything perfectly (including the timing and the buildings that we would use). Their work can really make
We have recently added quite a few villages to our schedule. We set up outside chiefs’ or volunteers’ houses, churches, school buildings or just any isolated buildings that can be found. The days can be much more interesting than when we’re testing at ‘health centers’ (having nowhere near enough resources to meet the definition of a health center in the western world). Apart from finding myself in some absolutely beautiful areas, I usually come home from a days work with a gift of some kind - a bag of pumpkins, pumpkin leaves, maize or zipwete (look like spiky cucumbers, taste part cucumber part watermelon!). I have also named a pig (Chiyembekezo, or ‘hope’). Hope has subsequently had 8 babies.
I mentioned that the weather and the environment have changed since I last wrote. It having not rained much recently at all, we yesterday decided that the rainy season was ‘officially over’. Of course it then rained all night long like never before. As far as crops go though, the maize is almost ready to harvest, there are pumpkins galore (I personally have been gifted with 8 this week) and the tobacco has hit the Lilongwe auction
floors. I have an interesting story relating to the tobacco industry. One day last week we were pretty much wrapping up one of our clinics when we were informed that we should not shut down our instrument as it was very likely that we were going to be seeing quite a few more patients. It turned out that the police had escorted 12 ‘night nurses’ (prostitutes) to the clinic to be tested. Apparently, they do this at random times. It being the time of year when there are a number of men who suddenly find themselves ‘rich’ following the selling of their first tobacco for the season, they decided that this was a good time to do a sweep through the local bars, find these girls, and give them the opportunity to be tested. Out of the 12 girls, 8 turned out to be HIV positive. Upon receiving positive test results, one girl called a friend on her cell phone and said ‘apparently I am going to die already’. It is heartbreaking to see how the disease is still sometimes received as a death sentence. With optimal Anti-Retroviral Therapy, the prognosis of HIV-infected patients is substantially improved and long, productive
Chaponda pinning a poster to a tree
In a village near Ming'ongo health center
lives can be led. 5 of the 8 HIV reactive girls opted to have CD4 tests done that day to check the current status of their immune systems.
Even my colleagues have changed since I last wrote. I have been working with 13 people on our local mobile team here - 4 clinicians, 4 nurses, 4 lab techs and a driver. One clinician recently moved to the U.K. to begin a course in Public Health at Leicester University and one lab tech moved to southern Malawi to take up a government position (a requirement due to the government funding he received for his schooling). Other current hospital employees will be replacing them. The clinicians, nurses and lab techs work one at a time, on a rotating basis. Each day there is a different dynamic depending on who is there. It’s interesting because we visit so many places that everyone compares where they have and haven’t visited and are jealous of certain places (the busier places, the more scenic rural villages and the places where they can say they have been to Mozambique or Zambia). It’s only our driver and I who have been everywhere.
Unfortunately we have also
suffered the loss of a wonderful woman - Mary Kaludzu. Mary worked as a nurse at St Gabriel’s for over 20 years but passed away due to breast cancer. Mary was the nurse who was originally going to be working on the project with us. I sadly learned of the traditional Malawian ways of saying goodbye to someone through goodbyes to Mary. St Gabriel’s is a small, close-knit community, and everyone will miss her very much.
There’s so much more I could say and so many more stories to tell but I’ll finish here for today. Hope all is well,
P.s. The next time I write I hope to give you an update on project numbers, tell you about the celebration of 50 years of St Gabriel's mission hospital (May 9th) and fill you in on the Malawi presidential elections (to take place on May 19th), the preparations for which would be hard to miss around here these days.
There are more photos below