Negotiating the cost of giving life Joyce Banda's way

Felicia Yohane has sired four babies in her life, two of those did not live to celebrate their first birthday, two are living and now that she is 7 months pregnant, she is very aware of what can happen to her expected baby.

Felicia lives in one of the 197 villages that look to Lumbadzi Health Centre for assistance, she has to walk a long distance of about 2 hours to come to the health centre. And she is not alone; the hospital sees 160 maternity deliveries per month, 10 waiting cases per day and hoards of pregnant women coming for neo-natal care, that is the attention given soon before delivery.

Felicia’s pillar, Lumbadzi hospital however has only thirteen beds in the small maternity wing that has no waiting area, the 13 beds therefore service those that have delivered and those about to. It’s a case of hard rock and place because the next nearest health centre is 15 Kilometres away from Lumbadzi.

Felicia in a one on one with a nurse

The situation at Lumbadzi is just the summit that is visible; the real mountain spans across Malawi, almost all health centres in the country face what Lumbadzi health centre faces.

Out of every 100,000 women that give births in Malawi about 700 of them die in the process, this is high by all means, in Estonia out of the 100,00 only two women are expected to succumb.

Felicia’s deceased little ones are also part of a bigger nationwide problem, 80 babies die out of every 1000 before they complete their fifth year. She lost her babies at four and nine months and the worry for her next baby is written all over her baby face. 

Since Joyce Banda assumed real power after the death of Mutharika in April this year she instantly leapt to highlight the plight of the mothers and infants. If Bingu sang food security and green belt, Banda’s song is from the safe motherhood studio.

She set up her Presidential Initiative on Maternal Health Safe Motherhood. Though difficult to separate it from the politics that accompany its activities, the initiative is breathing in new life into the fight against preventable deaths of women and children around the pregnancy and birth period.

Misozi Jimusole is the Initiative’s media and advocacy officer. I asked him why women need to be given priority.

“Women make 52 percent of our population; they contribute the most to the country’s output its only fair that they should be safe guarded. In safeguarding women, we will also be advancing towards Millennium Development Goal number five.

“The role of women cannot be overemphasised, in any country excluding women from development means that nation cannot develop, including women and having a healthy involved female population means more development,” said Jimusole.

Felicia braves the October heat to travel to the hospital, she knows what dangers come with shying away from hospital; the rest are not that informed.

Jimusole said some women discouraged by distance, cultural beliefs and illiteracy go turn to traditional birth attendants who have little real knowledge about pregnancy complications and motherhood best practices, and he says this exposes mothers to all kinds of risks including death.

While 71 in every hundred women go to the hospital, about 29 seek the attention from traditional birth attendants, who obviously cannot perform a caesarean section and will be quick to point to witchcraft for simple complication.

Children born in the hands of traditional birth attendants are also likely to miss out on vital immunisation given to the baby in the early days of its birth, if the mother looses too much blood during the birth process there is little the attendants can do apart from watch the new mother die. 

But with only thirteen beds there to accommodate 160 women all in a month, it might not be culture or illiteracy that might be  forcing women to go deliver at home and this is what Banda’s Initiative is aiming to tackle.

“The Initiative wants to construct maternity waiting shelters to ensure close monitoring of pregnant mothers and encouragement to seek quality maternal care at public health facilities to avoid complications arising from giving birth at homes,” said Jimusole

And its not just talk.

It is also seeking to replicate its Mulanje feats in Dowa, Balaka, Karonga, Mchinji and Lilongwe and in Ntcheu. Lumbadzi will also get a shelter and funds are reported to have already been secured.

In the drive to attain an almost zero maternal mortality rate, infrastructure is on one hand, the other hand includes human resource, if all the women can decide to come deliver in the hospitals are there enough trained minders? 

At our case study health centre at Lumbadzi there are 13 qualified nurses to mind not just the maternity wing but the whole hospital such that the 160 or so pregnant women have to see the same people that people with Malaria have to see.

President Banda’s other goal in the initiative is to try and beef up the numbers of these minders. In a slow but significant move, she has already identified 200 young women, 10 from several districts have been identified to start midwifery training.

“The project aims at increasing numbers of skilled and trained midwives. Maternal and neonatal rates are still high not only due to lack of sufficient health personnel but also untrained traditional birth attendants. 

“We also want to build capacity of community midwives to promote health seeking behaviour and attitudes of the communities towards family planning, reduced pregnancy, delivery complications and encourage girl child education,” said Jimusole.

Again, having trained personnel and building is never a guarantee that the village folks will flock to get expert care. In Malawi missionaries came with life saving drugs but the population took years to accept modern medicine, some still have not.

Jimusole said the third goal of the initiative is just that, trying to win over communities and to do that chiefs must be target. 

“In order to achieve the effective access to maternal and neonatal health care, Community mobilization and training to the chiefs and their subjects is of paramount importance. There is lack of knowledge on how to handle maternal and neonatal health care so chiefs as opinion leaders are good targets in accelerating behaviour change.

Felicia mounts the scale to check her pregnancy progress

“The chiefs promote cultural habits that influence health seeking behavior and attitudes of the communities towards family planning, pregnancy and delivery, preserve women dignity by stopping defilement, and other forms of violence that make women insecure and unstable in their lives,” said Jimusole.

One of the chiefs who is well won over to the side of progress in Inkosi Kwataine, he says his area of jurisdiction is on its way towards decreasing mother and infant deaths by employing a simple trick which he is now campaigning for.

“Local documentation of pregnancies will erase many problems. Chiefs will be cable to track the progress of the pregnancy and ask if the mother-to-be has gotten a vaccine, where she plans to go for delivery and to push her to go to the hospital when her time is near,” said Kwataine.

Hebeli Honde was also at Lumbadzi Health Centre when Nation on Sunday visited, she hails from kwa Chiponde and is only 18. She has never given birth before, she will do so in 3 months all factors constant.

Jimusole: Aiming for MDG number 5

“I cannot go trust azamba (traditional birth attendant), it’s my first time and I want all the attention, I will come wait here when I am in my advanced stage,” said Honde.

Joyce Banda knew that with her influence business people would be ashamed to ignore her initiative, already big companies have donated to the Initiative. And so far that is what is funding the Initiative.

Naturally big businesses cannot spend on causes without brands and the Joyce Banda trick is working, mothers have hope...the only question is how long will it take and what happens when Joyce Banda leaves power?

 

Honde sits among her mates possibly sharing stories of what labour feels like, it easy to see fear in her eyes. Her fears can easily be reality if no one springs to action to help address the current situation.

Fighting HIV one family at a time

Twenty seven years of HIV and the nation is still buckling under the weight of the pandemic, by December 31 fifty thousand fresh Malawians will have contracted HIV despite the various interventions that are being implemented…there is one intervention, however, that looks like it’s the panacea the nation has been waiting for.

The Kantuwanjes  -  enjoying their hakuna matata married life

 Jonas Kantuwanje, 44, teaches standard three at Mdeka Primary School, some thirty minutes outside Blantyre city, in his spare time he plays technician and fixes radios and televisions that people bring to him, as he works, his young wife Brenda, 22, potters about and the new-born baby in the house serves as an icing to the harmony.

Kantuwanje’s first marriage collapsed years ago and when he thought of remarrying his prime worry was HIV, back in his youth days the pandemic was not as menacing as it is today. He went on to marry Brenda anyway. 

Meanwhile Brenda was also wary of the same worry as her new man. For a man with two children coming to her, she could easily be an innocent victim of HIV.

“There was this silent tension in the house, each one of us silently worried and wondered if the other had HIV,” said Brenda.

Kantuwanje said that he knew that he could get tested at Mdeka Health Centre but the distance, and the fact that sometimes there were no test kits at the health center made him lazy.

Then came the light.

Dapp field officers counsel teens at Mdeka before testing them for HIV.JPG

From the blue, the group village headman, GVH Kabano called a meeting and announced that there would be HIV testers and counselors going round the village to provide what both Brenda and Jonas secretly wanted.

“They came to our house, counseled us and told us of the benefits of knowing our HIV status. We agreed and we were tested. It was a big relief to finally clear the mist between us. You see, after I knew that I was HIV negative I would never dare go out to another woman, I want to keep my status the same so I can say the testing made me responsible,” said the husband.

The wife also beamed and says that the two now live happily because there are no doubts. Well, no wonder a child soon appeared in the family.

The people that tested the Kantuwanjes were field officers from DAPP. Yes you read that correct, DAPP. It stands Development Aid from People to People and not sellers of second hand clothes. Of course, they do sell second-hand clothes but they do many other things too.

The programme that saw the Kantuwanje’s get tested in their backyard is called Total Control of the Epidemic. It is bankrolled by the National Aids Commission (NAC) and the United states Department of Agriculture. 

The field officers go door to door registering people, mobilizing each individual to an individual decision on HIV prevention and ultimately an HIV test.

Madalitso Chimtengo is one of the fifty field officers that DAPP employed for the door to door HIV testing and counseling exercise. He was assigned to test 4000 people in several villages in traditional Authority Chigalu’s area which occurs in Blantyre North. He gallops from one village top another on his mountain bike.

Chimtengo starts by noting that since the programme started three years ago, there is a visible behavioural change as those that have been tested are now responsibly living.  Already out of the about 3600 he has tested only just above 50 have HIV.

I asked him how he manages to beat the strongly held fears about HIV testing and go on to test people in their homes.

“Well, firstly, chiefs rallied the people and told them that we would be going around and again we do not go with the message of testing, we go and ask the people what they know about HIV, if they know little we tell them what they don’t know and then we tell them the benefits of getting tested.

“There is little rejection; the response was actually overwhelming such that it is the HIV test kits that ran out while people still wanted to get tested. If this was a country-wide programme HIV would be contained quickly,” said Chimtengo.

Already at Mdeka Primary School where some field officers had set up a testing booth, children as young as 8 years had to be chased off the queue of those wanting to get tested, its like testing is the new cool thing.

Asked if testing people in the villages is not going to fuel stigma, Chimtengo contests and reckons that it in fact normalizes knowing ones status and bolsters openness on HIV questions.

Chimtengo - There is Behaviour change.JPG

Chimtengo bemoans the lack of condoms in rural areas, the lack of test kits as some of the things that stand in the way of the programme. 

Florence Longwe coordinates the programme for DAPP and reckons that the approach works because of its personal nature.

“The HIV and AIDs discussions are taken at a personal level and issues are not generalized. Hence individuals open up on what HIV and AIDS issues are directly affecting their lives.  In a mass media there is no personal dialogue where one can freely open up issues which are affecting them.

“TCE programme sees family as an important entry point for preventions, for stopping stigma and discrimination and rallying support for positive living for those on treatment. It is reaches out to people at their own convenient time and at the same time also those who find it difficult to go for such services due to transports or distance restrictions,” said Longwe.

She said the door to door makes it easy to reach men who usually do not go to clinics to get tested. Out of the tested in the TCE pogramme, 46 percent are men. 

 The project also has potential to reach more married couples who are the main culprits in the spread of HIV today, it difficult to find couple together unless they are at home. Again couples who are HIV negative or think they are because they don’t fall sick will never go to a hospital for HIV testing a gap that the TCE programme effectively fills.

And it is not just testing and counseling.

The project was phased out on October 31 but the Chimtengo said its effects will ring and stick around forever. Each field officer has trained volunteers in the villages who will take over the counseling in prevention, nutrition for the infected and the follow ups on all the rest.

For every HIV positive person, the field officers organised two family members who are supposed to check on the infected making sure that they faithfully adhere to their Anti Retro Viral drug dosage. Some members are trained in vegetable production while some were given heaps of shoes and the returns from the shoe sales are meant to economically help the infected. 

Gift Chitukula another field officer who also has tested over 3000 villagers proudly  declared  that he does not have more than 200 on his list that have HIV and this apparent low prevalence of HIV excited T/A Chigalu.

“I think the fact that we have been speaking and prioritizing HIV and testing has made people start to actually listen and change their behavior, already some bad cultural practices that fueled HIV have been eliminated, we have even banned overnight Kitchen top-ups which were new platforms of immorality,” said Chigalu.

Dapp field officers counsel teens at Mdeka before testing them for HIV.JPG

The programme is also being implemented in the low income areas of Blantyre and Thyolo. It was rolled out in 2007. There are about 25 field officers and each is supposed to test, counsel and follow up on 4000 people in three years. 

That is first to register and know them, then to counsel and or test then check of them later to make sure that those without the virus do not get it and that those with the virus do not spread it and are living healthily.

The Kantuwanjes can now enjoy peaceful sleep and as the Chimtengos and Chitukulas pack their utensils and leave T/A Chigalu’s area, the onus is on the community (over a million reached so far) to keep the sanity that the TCE programme brought.

Decentralising Justice: Phalombe Case Study

The twenty or so faces in the room are serious, the mood is tense. Judge George Kulangu sits facing Lonjezo Nkopeka, 14 who insists that he never impregnated Stella Chinkango, 18. Stella however actually tells the court the very date that she had sex with Lonjezo: 25 December and 2 January.

The defendant, fourteen year old Lonjezo is unmistakably his age: He has a baby face and it is only just starting to know adulthood pimples and acnes.

Stella and Lonje listen to 'Judge' Kulangu

He dons a cream shirt that used to be white and can no longer ignore the dust of Phalombe. Behind his shirt juts below his collar, Lonjezo has written ‘DJ. BY,’ not a strange thing for a recent Standard Eight drop out. He is in a jeans a piece of which he steps on as he walks in his flip-flops.

Right next to Lonjezo sits the complainant, Stella. She would pass for age 13 but guess the official story wins. She is clasping a cute and cuddly baby wrapped in several cloths despite the midday October heat. Her breasts are still firm and the baby has made them fuller.

After the facts of the case are presented, and Lonjezo asked to plead, he takes his kinsmen outside and returns to plead not responsible. 

Kulangu then reads from the constitution that according to the law, nobody can force an underage person to marry, he then reasoned with Lonjezo that the son he is turning down might end up as anybody and that he resembles him. 

Apparently touched, Lonjezo asks for another recess and comes back a different person, an elder relative who spoke on his behalf said Lonjezo would financially and materially support the baby but was unsure about the mother since he needs to go back to school.

Stella showed no expression. She was not impressed. She herself and her relatives took their own recess.

 As the trial progressed, the two try as much not to look at each other and instead focus their attention at Judge Kulanga who scribbles some notes as the two parties stated their arguments. Then his phone rings; he has an Orga Family ringtone, so much for a judge.

Well, George Kulangu, 35 is not a judge, he has never been to law school and the building he sits in is not a court. Kulangu is a volunteer, the building he sits in is actually an organisation termed Ufulu Wanthu Community-Based Organisation. (CBO)

The CBO sits at Chiringa in Traditional Authority Nazombe’s base about thirty minutes from Phalombe’s administrative centre. It was built by the community itself with support from Action Aid Malawi.

Kulangu is the director of the CBO and his team see an average of thirty cases per month. He does not get a salary and insists helping the community live in harmony makes him happy.

“We do not pass judgement here, we only counsel – we intend to build not divide people,” said Kulangu.

As Kulangu sits in his ‘court’ Chiringa’s real magistrate court is also hearing cases and it is just 35 meters from Ufulu Wathu. T/A Nazombe’s court is also a stone throw away and yet there seems to be no-one aggrieved or feeling underrated.

“They are helping us with cases, we had an influx of cases and we are working well together and I am not aggrieved because these people are easing my burden,” said T/A Nazombe.

Nazombe also conceded that it is only fair because as chiefs they demand some token to hear cases while at the CBO the cases are heard free of charge.

Ellen Mbulaje who mans the Victim Support Unit Desk at Chiringa Police Unit also hailed the CBO’s efforts and said she sometimes actually refers cases from the police to the CBO. She says since the arrival of the CBO cases of domestic violence have gone down.

One woman to attest to Mbulaje’s assertion is Adalina Tambwali, she told Nation on Sunday that her husband was irresponsible abusive and usually battered her and in some cases would have used knives, mortars to harm her over domestic issues.

“I chased him and he went to Ufulu Wathu to protest, I came and we resolved our issues and after the counselling he changed his behaviour and we are now living happily together, we just had our son. All along we had tried chiefs and elders but they failed to resolve our issues,” said Tambwali

A group of men and women Nation on Sunday talked to pointed at the advantages of going to their own creation (the CBO) by pointing out the weakness of the other justice systems in the community. They said Police demand money to offer bail, they said the court requires a fee to get summons and chiefs also demand tokens.

Ibrahim Nthalika is Action Aid’s programmes coordinator for Phalombe. He said his organisation takes a rights-based approach towards everything it does.

“We mostly work with CBOs, it’s the community that knows their problems well and therefore able to define their destiny and it is proving to be true.

 Ufulu Wathu CBO is working because people trust their own people unlike the civil servants at the court who are taken as elites and there is no imprisonment,” said Nthalika.

Nthalika’s expose explains why the community at Chiringa respect Kulangu and his mates. The CBO’s decision can easily be disregarded but the fact that the community itself created it to handle minor disputes confers salience at the organisation as a source of justice.

Stella came in from her time-out and told the seated that she had accepted the decision but was unsure that Lonjezo would follow through with his pledge. Kulangu asked Lonjezo twice and got verbal assurance. He said sometimes he makes the parties sign for their pledges.

If Lonjezo feels aggrieved, he can go to a real court; after all he went all the way to Phalombe District Hospital to prove that he is not the father of the baby, meanwhile he has categorically admitted that it was him that planted the seed in Stella after all.

The CBO falls under Action Aid’s broad theme of Human Rights and Good Governance, the NGO also supports other causes such as HIV/Aids, women’s rights, Rights to food and education.

Nthalika says the fact that the community took part in the setting up of the primary justice structure means that they own it and likely to sustain it even if the K5 million grants dried up, the CBO will keep grinding.

“We only provide finance and technical assistance, the rest is done by the community,” said Nthalika

Kulangu says most cases that come to his files are those of domestic violence and husbands neglecting their wives after harvesting. With the country struggling with domestic violence where women fail to report cases for fear of losing breadwinners to jail, structures like Ufulu Wathu might just be the panacea.

Kulangu and his team have been trained in proposal writing; paralegal services and only time will tell if what they have in their hands will mean a harmonious future.

As for Stella and Lonjezo and whether their early sexual debut is any hurdle to their future is a story for another day.

Travengelism: honest or sham?

Ever been in a bus that has no preacher shouting next to you, reminding you of the accident that can happen and the hell that awaits accident victim who were unrepented?

Well, in Malawi, almost every bus that leaves Blantyre to Lilongwe ir Mzuzu has such pastors, the guy in the picture is as this moment blaring with his husky voice preaching about Solomom's riches...but there are a few questions that I have for these guys,l.

Why do they only preach in Lilongwe bound buses? surely the people hoing to Thekerani need the gospel too, is it because they are generally poor?

Why do most of these guys mention accidents? is it to threaten the people?

Why do they ask  for moneys? most claim its transport moneys, but if they have no transport, why cant they just preach in their localities? do their neighbourhoods not need salvation?

My verdict is these people are just opportunists, feasting on our fear of dying and knowing that we are going to pass dangerous spots, they use fallacies to threaten people in more fear which then results into more moneys remitted.

They are the same with the African pastors who go establish churches in the UK saying the people there need deliverance when in the African villages they dont have branches of their churches...money is the root of most evangelism.

The guy in my bus just got a handfull of alms and is now dropping off saying 'may the lord gove back what you have given.'

11 villages share a borehole in Ntchisi, Malawi

Rare sight in Ntchisi, a borehole at Kanyenda Village

“I can even say that about 500 people share a borehole here,” said Group Village Headman Kanyenda of Kanyenda Village in the southern part of Ntchisi District. 

He was outlining some development hurdles people of his area are facing during a meeting with the area's Member of Parliament. Water scarcity was top of his list.

In a later interview, Kanyenda stood by his claims and said that he has thirteen chiefs under him, that is almost thirteen villages and yet, he said, they all share one bore hole.

“We have Kakumba River as the nearest water source but it only has water during the rainy season,” said Kanyenda.

Chilapondwa: Problem is indeed big

Asked if he is aware of the development, MP for the area who is also Minister of Agriculture and Food Security, Ulemu Chilapondwa said he was aware of the problem and said he was trying to try to address the problem.

“Most of these boreholes were dug in 2007 under the Integrated Water Development Programme. Most of them are now defunct and most of them were shallow and thus dried up, I am looking at the issue to see what can be done,” said Chilapondwa.

GVH Kanyenda: We have a big water problem

Standing from Kanyenda School and looking eastward, it is easy to see the water problem as the nearest borehole is crammed with about thirty women fighting to fill a bucket. 

The narrow paths leading into villages are also lined with women carrying colourful buckets of water and wandering in different directions.