Oct 19 - The Malawian Rollercoaster

The Malawian Rollercoaster

October 19

Life here seems to fluctuate from despairing over the multitude of problems and frustrations, compounded by the inability to do anything about them, to feeling as though you need to be here and ‘save the world’ for the rest of your life.

The despair
Robert, a new Dutch paediatrician who started recently, was on a Moyo ward round with me learning the ropes. Wanting to help in some way that is currently not possible, he offered the idea of simple things such as an electrolytes machine for the children as part of the project that has brought him to Malawi. I thanked him for the enthusiasm and ideas but then informed him of the sheer number of kids that this would require blood tests for, the reagents that we would then not be able to afford, the absence of anyone available to service the equipment when problems arise, the number of nursing and patient attendant staff required to take these regular blood tests, and the lack of good therapeutic measures to act upon all but the most basic of problems from the changes we detect. Although a wonderful idea, the support that would be required for such a process is far beyond simply providing a machine that looks lovely and gives a few useful answers to begin with (in saying this, the use within a very limited number of patients with specific problems, or stylizing the tests in the setting of a study to correlate with future clinical practice would certainly be useful).

This I guess raises the problems with a lot of donated goods and monies. Much of the well intentioned pieces of equipment require reagents that we cannot afford or sometimes cannot even access, they often require support staff in the form of laboratory analysis, servicing and repair that we have no money or training for, and they may not even be compatible with other equipment to run it, meaning it lays idle as we await further parts. As a great example we currently have no less than fifteen oxygen concentrators (the portable machines which provide oxygen to unwell patients in hospitals where oxygen piped through a central means is not available) that sit dorment in our maintenance department with no one capable of fixing even the smallest problem. They are all invariably made by different manufacturers and often with different electrical inputs, meaning even if we did have a knowledgeable repairman, the parts would have to be sourced from multitudes of varied companies.

Then there is the donated money. This often comes with the caveat that it be spent in a certain fashion. This can either be with the requirement that the product or service it is intended for come from the donor country itself, giving no long term gains economic development, training or education to local providers, or that the money be spent in certain areas that have no relevance to the true shortages that currently exist in service provision given the lack of consultation with ground level service providers to ascertain their true needs.

Then there’s the immeasurable problem of donor funding in the form of NGOs, religious organizations and other such benevolent bodies who come to the country with their own agenda, not linking their ideas or implementation with existing or competing interests, either government or external. This means massive duplication of services, fractured training and knowledge, disproportionate aide to certain areas and none to others and, most discouragingly, lack of long term sustainability as one project finishes and another simply reinvents the wheel. I don’t disagree that the country needs external funding and skills at present, nor that these organizations are worthwhile and important – heaven knows, the place would simply collapse without them – but there’s surely a better way of going about it… and if you have the answer, please let us know!

Of course none of this is helped by the nepotistic, self-indulgent, corruption of the government (and Malawi is one of the less corrupt on the continent) that manages to continually channel money into the wrong hands, mismanage responsibilities external funders place on them and, unbelievably, withdraw service provision to areas that are being externally funded despite these initiatives often only being short term undertakings, thus leaving the system shot with holes afterwards. Then finally, there’s the attitude of a small number within the community who see this entire process as a good excuse to exploit the system and make money.

Saving the world
Yet not all is despair. Very commonly, admittedly not quite as often as the frustrations, we are encountering inspirational people who seem to make being here a pleasure, and even make you feel like what you are doing is never enough for the plight of the country. Two of those people are fellow paediatricians (amongst other roles they have), Liz Molyneux and Robin Broadhead. Enjoying dinner at Robin’s house recently we heard many an uplifting story that made us feel quite inadequate in what we were doing here.

Robin himself has been here for the last seventeen years, moving here from the U.K. with the establishment of the University of Malawi. Throughout this time he has been one of the instrumental figures in shaping what is now an internationally recognized teaching institution that is, albeit slowly, shaping the future of Malawian medical practice. He has been a university lecturer, the Head of the Paediatric Department, and is now the Principal of the College. He has lived through the dictatorial years of the Banda government, existed without any family or close friends from home and now sits through the daily frustrations of endless bureaucracy in various meetings, and is still able to look upon Malawi and all her foibles with the most positive spin.

Liz and her husband have lived here for interrupted time over the last 40 years. After initially coming here in a missionary capacity, Liz has taken over the Head of Department position and managed to almost single handedly thrust paediatrics at Queen Elizabeth Central Hospital into a position of international renown in international developing world circles, as well as dropping the admission mortality during the wet season alone from a staggering 18% to now regularly under 5%. This she has achieved with an enviable blend of inexhaustible diplomacy and a passionate devotion to the day to day clinical responsibilities of the department. Her husband, Malcolm, has also headed the majority of the malaria research in Blantyre for the same period of time, allowing Queen Elizabeth to be at the forefront of both research and clinical practice in terms of the malaria pandemic that still to this day claims so many millions of lives every year. And this he does with a wit sharper than many, and a clinical acumen that speaks volumes of his time in the realms of such unthinkable disease.
These are only a couple of examples of such inimitable devotion to what many would see as a sinking ship. Their ongoing commitment to the development of this country makes so many other contributions seem trifle in comparison, yet at the same time motivates you to see through the daily frustrations to the bigger picture, and the small but appreciable difference that you actually can make here.

Oct 13 - Buffalo maulings

Buffalo Maulings and Flaming Sambuca

October 13-14

Lengwe National Park was out getaway for the weekend, down in the south of the country in the lowlands of the Shire Valley (prounounced shee-reh now, although undoubtedly coined by the Brits several decades earlier). We had decided on a nice romantic night away from the fast-paced social scene of most weekends… therefore having our umpteenth flaming sambuca at the Illovo sugar plantation sports club at 2.30 in the morning wasn’t exactly what we had planned.

It all started innocently. A beautiful drive down the Thyolo escarpment drops towards Chikwawa, 40km south of Blantyre. This road is a stunning vista over the low lying Shire valley, stretching as far as the eye can see some 600-metres below, intersected by the snaking contours of the Shire River. Although shrouded somewhat in the mists and dusts that await the upcoming rains to wash them away, the views at every turn are nothing short of awe inspiring.

After driving through the non-descript little market town of Chikwawa, Lengwe National Park sits another 20km south, with the road taking you through the cane fields of the monstrous Illovo plantations to the park gates. The park itself is a comparatively small expanse of thicket and open grassland that abuts the Mozambican border in the tapering southern tip of Malawi. Little known and even less visited, this place is home to a varied animal and bird life which we were keen to have a relaxing look at. Only a few minutes drive along reasonable dirt tracks, Nyala lodge is a relaxed sprawl of rather upmarket air-conditioned rooms then a simple but quintessentially African eating and sitting area complete with bar and restaurant.

After pitching our tent in the secluded openness of the ‘campsite’ under the watchful eye of many a bold vervet monkey, we hit the lounge area for a mid afternoon Green. Now this is Africa: sitting back on sofa chairs as you sip your beer, positioned perfectly only a couple of hundred metres from a rather active hide, or watering hole, as you watch baboons, warthog and guinea fowl meander around the scarce drinking water.

We also got talking to Max, the Malawian-born Italian owner of Nyala, about the recent buffalo mauling we had only this morning heard about. Two days previously Phoenix school – a private primary school in Blantyre – had been on its annual educational safari park field trip. They were here for the night and at the time out on a walk to the main hide, opting not to take a scout given Nyala’s long history of not enforcing the park rules that all walks must be accompanied by an armed ranger. Unfortunately a surly old single male buffalo was also out for a walk to the main hide, and these two parties don’t blend very harmoniously. As the kids came around a bush, they were set upon by a somewhat surprised and therefore spooked animal – and an animal not exactly renowned for its friendliness. One of the teacher’s husbands reacted quickly, and rather heroically, by putting himself in the line of the charge between the buffalo and the children. As the kids scattered everywhere the guy realised that the buffalo was going to batter him and he promptly attempted to run… a little too late. He fell as he turned, probably saving his own life, and was gored on the ground as the charging beast passed him. Having enough time to stand as the buffalo wheeled around, he jumped behind a small tree for protection. With that the buffalo promptly charged again, this time completely uprooting the distracting tree and hurling the guy metres through the air in the process. The guy was then obviously trying to defend himself by kicking out at the animal as he lay on the ground, because the repeated goring of the buffalo’s horns tore shreds of skin and muscle from his inner thighs and lower legs. Having a moment of respite, the savaged guy then managed to clamber under a larger tree with good cover, blocking the line of sight, and with that the enraged beast, a herbivore at heart, lost interest in his little victim and sauntered off to do whatever buffalo do after goring something to within an inch of its life. Twenty minutes later, having been alerted by the returning kids, Max arrived to find the guy, blood everywhere, his belt as a tourniquet around his worse leg, stumbling toward the safety of the lodge. Several hours later he was being attended to at Mwaiwathu Hospital in Blantyre, southern Malawi’s only reasonable private hospital, having survived something that not too many live to tell the tale of, with not a single school kid injured.

With this lovely news to digest, we set off on our own little safari – driving – in our low clearance two-wheel drive Marino, something the roads in this park allow. Now a game drive is good fun even at the worst of times, but there’s something unique about doing it yourself in your own vehicle, adding that extra element of excitement to it all. So for the next hour and a half we crept along spotting countless numbers of nyala, impala, kudu, duiker, warthog and buffalo, along with a fair few impressive birds – the latter we know next to nothing about. The animals, although quite wary of the rather unusual grey beast that we were travelling along in, were often found lingering on the road literally metres in front of us. All in all, a brilliant little outing… and no close encounters with buffalo which was an added bonus.

From here, things turned rather messy. Being the campers we are, not wanting to spend too much on a dinner at the lodge, we had brought our own pasta and red wine. With this in our stomachs we joined the others at the bar… Max and a nice couple we had met briefly at the Lake of Stars weekend. Catherine, a 26 year old American Peace Corps volunteer, is working on environmental sustainability programs in the park and living in the nearby village with no running water or electricity – surprisingly agreeable and not too over the top for your average Peace Corps worker – and Justin, a young South African archaeologist helping to set up an archaeology department in one of the colleges in Malawi. After a couple of drinks we set off in the back of Justin’s ute for the Ntchalo Sports Club, a focal point for many expats around here, located right in the middle of the Sucoma (Sugar Corporation of Malai) sugarcane plantations operated by Illovo.

On the way, with dust swirling around our heads in the open tray, we were treated to a little lesson on the sugar plantations by Max. The 6-carriage long trucks that run 24-7 carting the freshly cut cane to the processing plants weigh in at 14-tonne per carriage when fully loaded. The sugarcane, once it has had its sugar extracted, yields not only ethanol, methanol and glycerol sold for local production, but also molasses to regularly coat the roads and keep the dust down and finally a byproduct that can be burned down and used as fuel. This fuel is then channeled back in for power to run the plant as well as the nearby national park, something which is necessary given Escom’s inadequate power supply from the national grid. Sugar is not the only product of the plantation either, with a few fields being donated to the growing of maize which is used by the government in times of national food shortages (something which occurs all too often here). Although Illovo itself is one hundred percent foreign owned, each arm of the production other than the processing itself is subcontracted out to Malawian companies, meaning that everything from vehicle hire and maintenance through to cane field planting and upkeep is putting Malawians into employment. So all in all, this enormous creation seems to be doing quite a sustainable and commendable job… from what I can gather anyway.

Twenty minutes drive after entering the plantation gates – laying testament to the sheer size of this operation – we arrived at the sports club, a concession to everything foreign. The rest of the night was a series of drinks forced upon us by overly friendly and big drinking South African expats as we watched the English beat the French in the Rugby World Cup semi-final (that is, after we had all finished watching African Big Brother… with Malawi in the final five, who wouldn’t be watching!). By 3am we were once again travelling the molasses laden roads back to Lengwe, somewhat inebriated, having had anything but the romantic night for two we set out for.

Oct 4 - Lake of Stars

The Lake of Stars & Court Cases

October 4-8
Once a year the English-run – thus stratospherically high priced in terms of local affordability – Lake of Stars festival descends upon the Chinteche Inn. This lakeside lodge, set along the idyllic shores of the country’s most impressive natural feature, lies just south of Nkhata Bay in the north. A full three day program of music from Africa, Europe and the U.S. along with debaucherous dancing, drinking and lazing by the water's edge tests even the staunchest of party goers. We therefore thought we had better have a little look at this phenomenon, and with the Mother’s Day public holiday on the Monday tacked onto two days off the previous week we made a real trip of it – our first true holiday from work, albeit only five days. It was also the first chance for our little sports car, the Silver Stallion, to get a decent run on the open road.

Everything began disastrously. Sarah, a New Zealand friend of ours who we had planned to take up in our car, called us the morning we were meant to leave to tell us she had hit a pedestrian the previous night in her own car and would be going to court, thus not able to make it to the lake. We had also planned to stay at Sarah’s folks’ house in Lilongwe that night, so this really threw a spanner in the works.

As it turned out, the previous night Sarah had been driving down Glynn Jones Road, the main road through town, when a drunk local dressed entirely in black decided to suddenly run out into the middle of the road, straight in front of her car. The issue was he that he managed to run out on a pedestrian crossing, making Sarah legally liable regardless of the circumstances. What’s more, Malawian law apparently states that if you mow down a pedestrian on a designated crossing, you are jailed for reckless driving until your hearing can be arranged. Without knowing this, Sarah took the pissed local kid to hospital despite only having run over his foot (he actually jumped up straight away, then the locals with him had said he was fine and that she could just give them money and go – meanwhile some Indians nearby were yelling at Sarah simply to leave because all the Malawians are thieves… a lovely scenario as you can imagine). Using the weight of another friend’s boss, a renowned character in Blantyre circles, Sarah was able to avoid the jail time (the police chief himself was called to smooth things over), and the process of an out of court settlement then began. All a bit of a shakeup for Sarah, and although she wasn’t able to make it with us that day, everything seemed to have worked out alright. Interesting how even though this guy was completely hammered, it was the driver who would be paying the penalty.

Having decided against staying at Sarah’s place in Lilongwe we then lumped ourselves on another friend, Amy, who was also planning to come along to the lake after a night in the capital. Cue the next disaster. Half way to Lilongwe, all going smoothly along the M1, we came across a broken down car… Amy. Why is it that every single person’s car in this country seems to be a moving disaster zone – must be the age of most vehicles I presume. Anyway, she had overheated and was now stranded, and although we offered to help out, another friend was arriving soon to apparently to give her a hand. Although I’m not sure what she was thinking when she simply told Amy to leave her car on the roadside and jump in with her – I could see her car being stripped in seconds leaving out on the middle of the highway here. By the time we arrived in the capital, having stopped off for a few beers at a cute little bottle shop along the way to help us through the day, Amy was still stranded on the side of the road just north of Balaka, almost 200 kilometres away. She finally got a tow-truck to bring her back to Blantyre, picking her up at 6pm after having stood on the side of the road for the last 3 hours (not sure where the hell her other friend went?). So now she was on her way back to Blantyre and we were in Lilongwe without any accommodation, having travelled several hours out of our way to come here!

After swinging by Sarah’s house to grab a tent for her, we found Amy’s house (no thanks to her directions) and rolled up at her gate. Ten minutes later, without even being told we were coming, her guard had handed over the house keys to some complete strangers and we were safely inside, for all he knew trashing the place. When Peter and his car full turned up we made seven in total, a little surprise for Amy’s housemate when she turned up later that night! Either way, with a nice meal in an Italian restaurant and then a few beers listening to Asif practice his set for the following night (he was DJing at the Lake of Stars), all was forgotten. Certainly an interesting start to proceedings.

The following day was a little better, making good time up to Chinteche, with a quick stop in a beautiful little local restaurant in Nkotakota complete with personal curtained pagoda and delicious cheap food.

Then the fun began! Three days of solid partying with the stunning backdrop of the lake to complement the whole picture. There were two stages: a main one mostly for live bands and late night DJs, then Harry’s bar, a smaller venue with a non-stop string of more house-oriented tunes. We spent our nights flitting between the two, dancing the night away between long waits through insipid service at the single bar for our large mugs of beer. Daytime was mostly spent recovering while we lapped up the sun… and then convincing ourselves to do it all again the following evening. We slept gingerly under the shade of trees, lounged on the beach between dips in the beautiful fresh lake water and dined on very non-Malawian greasy burgers and pizzas (not much choice I’m afraid). A weekend of complete hedonism – great fun, but I think we’re both very happy that this thing only runs once a year.