Revolution!!!!

There have been many highlights for me in the last two weeks. One: last weekend Friday 11th Feb., I went with Elleana and my Boss and the Boss of my Boss to Lilongwe for a conference/meeting of the Association of Malawian Midwives (AMAMI). That was so inspiring!

The long journey there was totally worth it (also a highlight), I think by now (or how the Malawians would say: as of now) you must have realized that I just love to go on the roads in Malawi through the lush green maize fields with its beautiful landscape and scenery. Especially the way to Lilongwe from Blantyre is wonderful as you travel along mountains, through rich valleys and little villages with markets bursting with fresh fruits and veggies. thanks to the rainy season! When the bus stops you will always have a gathering of women and kids selling bananas, cassava, tomatos, soft drinks, airtime, and snacks like samoosa or chips. It is always a busy pile of people. The women carry their goods on the head, the young men and kids theirs on the shoulder and you can just lean out of the window and take what you want. First product then money is the rule and if you´re smart you have the right change otherwise you might pay more then you wanted. It is quiet hectic because everyone wants to sell something and it gets really complicated when besides the big bus also a minibus is stopping at the same time. I love to just watch the scenery, the shouting and selling and bargaining. That’s how you learn it best..

Lilongwe was as always relaxing, Elleana and I stood with Mark, my Bosses in the hotel. The meeting was fantastic! We had several presentations and a long plenary discussion about what goes wrong and what goes right in Malawian’s midwifery. Even the Minister of Health (Prof. David Mphande) was there to talk about how serious the government and the president take the issue of health. “The situation in Malawi is unacceptable” was one of his statements. How important it is to reach the Millennium development goals (i.e. maternal and child health, universal education, combat HIV/AIDS, gender equality, end poverty and hunger) is self speaking, all in all they want to improve the Malawian health sector with special focus on the education of health professionals (lack of skilled nurses, midwives and doctors is a major problem here, they just don’t get trained well). I didn’t know before that the first lady is the coordinator of the safe motherhood initiative and puts a special focus on family planning as well as preventing early marriage and alternative health care techniques. I think that’s quite liberal and regarding family planning one of the key points (together with education) to improve the situation here. There´s just simply not enough food, water, money, teachers, doctors or future objectives especially for all the children here plus because of HIV and tuberculosis there are so many orphans who never have a chance. It is alarming and the only key is family planning and education I think. Sounds tough but 5 kids in a family have more chances then 10, that’s a fact.
Under the motto: Malawi needs more midwifes now than ever before the plenary discussion was held. This bit was the most interesting one I think. All the midwives, if working at the bedside or as lecturers or in administration were pointing out problems, solutions, things which go well and things which go wrong. The motivation and attitude of the midwives especially in the district hospitals and health clinics seem to be a major problem. They are deaf and blind and don’t say a word, the picture of the 3 monkeys (one holding a hand over his mouth, the other over the ears and the third covers his eyes) came into my mind. While women are bleeding, delivering, dying midwives are sleeping, chatting or are simply not on duty. It is crazy, they just look away! Stories were told about cleaners delivering babies because there was no midwife, women and babies are dying because situations weren´t taken seriously or weren’t realized. It makes me really sad. They are numbed by all the terrible things they see every day, and angry that never anything changes. It is one way of dealing with this to react like the monkeys, just shut yourself out. So it was even more motivating to see the midwives on the meeting being dedicated, enthusiastic and act as role models for the new generations. It is important to have these ones on the wards, to benefit them, point them out and let them be an example! Especially one midwife really inspired me, Lennie Kamwendo, she has been working as a midwife in Blantyre for more than 30 years, never gave up smiling, never gave up trying to improve, always asking, always positive. She was teaching at the Kamuzu College of Nursing in Blantyre, one of my colleagues was one of her students. She wrote a book (Sexual and reproductive health, what you always wanted to know) I so have to get that! I am thinking of asking her to talk in front of the students here, I think that would be really inspiring for them. They haven’t seen anything else but the Malawian way, they don’t know how the labour wards look like in Germany, never experienced the work of one to one attendance of midwives like in Dublin, they just don’t know it better so maybe she can tell them what best they can make out of this. It is not all about high standard equipment, fancy beds with aroma therapy and harmonic colours and pictures of waterfalls on the walls. I think it is about the attitude, the smile of the midwife, the commitment and dedication to her work, her passion. Lennie I´m sure can tell us all a bit about that, to keep on smiling and being friendly when all around you women and babies are dying even though you try the best you can. She is a real midwife, an inspiration! I see if I can get in touch with her. It´s time for the Malawian midwives to stand up and change all they can to improve this situation.
Unfortunately I didn’t bring my camera to the meeting so no pictures, sorry, but I try to get some send out to me so maybe later.

That evening El, Mark and me went to see the Black Missionaries in the Shak, and besides that the new volunteers have arrived! About 10 of them were at the concert too, they seem really nice! Unfortunately no one of them is coming to Blantyre. So I´m not the newbie anymore :)
We had a good night out with a lot of reggae and all the rest of it. The next day we travelled back to BT and I chilled the rest of the weekend with spending Sunday at the pool in this French place again. Nice!

This week then started quite busy for me with teaching every morning big lessons like the whole physiology of labour and puerperium. It is really getting into detail with four different stages of labour and then all the physiological changes after the baby is born. Interesting but time consuming! For me it is a good review and refresher, and now with a few years of practical experience it all makes so much more sense than when I did my training. Midwifery is definitely more practical experience and understanding of the individual woman than only the theory of how the baby winds itself through the pelvis and what can all go wrong. With my last lesson about psychology of labour I could round this theory up easily, is it not all about the approach and the attitude in the individual situation? I think psychology is 70% of our job and we don’t even know so much about it, only through experience. It is so interesting! I really start to enjoy this whole teaching thing!

But behind the walls of our college grounds people seem to not enjoy the teaching thing at all. This week were big demonstrations from the students of polytechnic and accountancy taking place.

Their book and study material allowances have been reduced by 25% now they are on the street. They have blocked the highway, thrown stones, damaged cars.
The police was answering with tear gas and clubs. Unfortunately our college is positioned pretty unfortunate between the highway and the other college so all the tear gas has also blown into our offices and lecture theatres so a smaller panic started with students running and screaming and even collapsing. Nikki and I had to flee in the bathroom to wash our burning eyes and mouths with water, man that shit hurts!!!!

The revolution of the youth is spreading over Africa! Of course it is not as serious as the rebels in Egypt or Tunisia but is it not also the government of Malawi which cuts the costs and closes the eyes while the president Dr. Bingu wa Mutharika drives around on evacuated highways with 5 Hummer cars and all police to protect him. What is he so afraid of? He builds big inland ports but doesn’t have the infrastructure, he sends out the Minister of Health to talk to us about reaching the MDG´s but closes down hospitals and colleges in the same time. So much has to change on this continent and first of all the leadership! It´s time to think liberal, the progress of time never stops and Africa is still stuck in the past, with old traditions and beliefs. Of course these shouldn’t be forgotten, traditions are important and hold us together but it is never healthy to close your eyes, shut your mouth and not to listen to anything else. I think Egypt is a good example; hopefully many countries will follow to finally be free, competitive and (real) democratic. I´m sure the problem with oil we´re facing and maybe even the peace between west and south, Jew and Muslim will then much easier sorted out. Think of John Lennon! Imagine!

last days with Andrea and back to daily life in Blantyre

It has been a while! It is already weeks ago that Andrea has left and I miss her still! Every now and then I find a little piece of paper with a little nice sentence on it, she hid them all around the flat and I still haven´t found them all. Our last days we spent together just flew by so quick, especially because I had to be back at work and we only had the evenings together.

I think she made the best use of her time checking out Blantyre´s stages (unfortunately the only one you can find is damaged with a broken roof since 2 years and no money to be repaired), sights and even went with a friend to a primary school a bit outside of Blantyre.

Of course we also met our Israeli friend Orr again for some drinks in Doogles and had great fun just the two of us cooking Nsima and watching movies. It were some great last days and I miss her terribly! Its unbelievable how fast 5 weeks just flew by. We traveled together to Lilongwe and saying good bye at the airport wasn´t easy as we both know it will be a while until we meet again. But she loved Malawi and maybe can come back again next winter. We even met a German midwife at the airport also going to Addis Abeba so at least she had some company.

After that I spend another day in Lilongwe with Mark and my volunteering friends based there. We had movies and Pizza, just the right recipe to make me feel better, Mark is so much fun its impossible he wont make you laugh. Sunday I made my way back to Blantyre together with Raz who was also in LL to visit his brother.

And then just after another week of preparing lectures and getting the final timetables and preparations ready, the students FINALLY arrived!! 50 of them, men and women, all of them quite motivated and interested. So finally my real job here started and I already had two lessons with them, they seem to be really nice! I started off with a few really boring topics like History of midwifery and legal/ethical issues and then an exciting one: sexuality. But they really worked with me and seemed to enjoy the lessons as much as I did. So all being nervous for nothing (as always) I actually start to really like this teaching business 
This week I will start teaching some more interesting topics: physiology of labour! I can´t wait, I love this topic! So I hope they can take over some of my enthusiasm but of course it is really a different thing looking at what you teach and then the reality of it. I think it is quite a difficult one to give them on the one hand all the information about for example pain management and one-to-one care but then on the other hand knowing in reality there is no way they can put this into practice. The question is, should I still teach them about it or just don’t waste too much time about practices they will probably never come across. I think it is still good for them to know at least what could be done, especially the midwife-client relationship and the one-to-one care! In the end no matter how busy it is and how understaffed the hospital is, still it is each of their own responsibility to give the best care they can and have a good relationship to their clients. The situation is horrendous as it is already why making it even worth by acting like a brick stone when it comes to interpersonal skills. Hope I can get this point across..
I read an article in the nuisipepala (newspaper in Chichewa haha) the other day about how the Nurses and Midwife Council of Malawi now started to close down Health Clinics and wards and even Colleges because of lack of accommodation, hygiene, equipment or low work standards. I´m not sure what to think about that! I mean in the end it is the government´s responsibility to provide all these basics but on the other hand I think it is good that the council starts putting up stricter rules for standards, work environment and education. But it is always just the tip of the iceberg which is paid attention to, the real problem for me seems to be the culture and beliefs of most of the Malawians and of course the lack of education which brings a problem in understanding the whole picture and also in developing higher standards. In the hospital I think this can only start changing when people realize that it´s not only money and working hours which make them suffer, no it´s also the patients who don’t give feedback. They never complain! So there is no conversation between patient and care giver and with that you can never develop any further. Yeah one problem leads to the next and it will for sure take a few more years for Malawi´s health and education sector to reach some goals and make some obvious difference. But raising awareness is the first step in the right direction, on any topic you want to think of. As soon as you know that there´s something wrong there is no turning back or ignoring the problem. For me that’s one of my aim, to make the students understand that they are the ones who can make a change!
But enough about problems, what else happened in these last few weeks?

Today Ash is moving in with me and Janet, yesterday was his leaving party from Ntcheu and it was a good party! Bob Marley´s birthday and dancing to reggae tunes under the stars in his garden, how much nicer can it be? I even came across a bottle of JURA whiskey, guess who I was reminded of?
But I am so jealous, these Malawians and their dancing skills, wow! No matter what song, there´s always someone having the best fun dancing with one leg up, ladies shaking their round bums and men starting the craziest moves across the dancefloor. The longer the party the wilder it gets but it always looks as they´ve never done anything else before! Its amazing!

Friday was world cancer day and Nikki, me and some of our collegues together with a lot of nurses and doctors went to a procession up the highway with one truck in the front loaded with older ladies who were singing and booty shaking to the rhythms of drums. In the end of this march of maybe 200 people and their banners, another car with speakers on the roof, playing Michael Jackson´s “heal the world” over and over again. So loud you could hear the song throughout the whole town and Limbe I´m surre! The walk ended with a few speeches and prayers from cancer survivors and of course a lot of dancing again. There´s this dancing group from the hospital, I´m telling you these ladies have rhythm! Out of any topic they make a song, teaching about cancer or how to prevent it, what the symptoms are and what the methods are which can be used to cure it. This all in a song, together with dancing and drums, I think its fantastic! The best way to raise attention. We even saw an acting group and although I couldn’t understand any it was hilarious to just listen to the melody of this language with all the “eeeeeeeeeeeeeeeeeee´s” and “iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiieeeee´s” and “aaaaaiiiiiiiiiiii´s” I love it!
But the highlight of these last few weeks was definitely yesterday!

On my way from Blantyre to Ntcheu I accidently met a german couple in the minibus who told me that they are working in a missionary orphanage not far from Ntcheu and they invited me over to have a look and get to know their work. Of course I went, on the back of a motorbike, down the dirt track a good bit up the hill to my new german friends. It is amazing what they have started in a few years, of course there are a lot of orphans around and their aim is it to give them the possibility to go to school, maybe a training afterwards and be taken care of.

They more or less live on their own expenses, they have cows for milk and pigs for meat, maize for Nsima and vegetables all around. They even have a little health clinic and just started on a project to care for babies who´s mother had died during childbirth to give them the food they need and support the father and the rest of the family. In a country where only really rich people can afford to feed their baby with formula (what they by the way love to do just to show how rich they are) it is dramatic when the mother dies during labour. This baby will starve to death because there is no other possibility for a poor family to feed it. They cant afford formula now normal cows milk nor sugar or anything. So all they could feed would be water and maybe tea or a mix from maize flour and sugar cane if they´re lucky. I think it’s fantastic these people want to start this project! The other idea they have is to provide some sort of further education to the orphans once they´ve finished their school. In one hall which was just built a few month ago was a lot of furniture building equipment, even real machinery and proper equipment to learn how to build furniture and work with wood and iron. Amazing! I really enjoyed my visit there and will definitely come back some time. Besides all these wonderful things they do it was great to meet some more Germans and I´m sure we´ll keep in contact!

So that was pretty much all about the time since my last entry. I keep you posted.

Hanna