Engendered Discrimination

UNICEF routinely conducts city-level health surveys in various developing countries, such as Malawi, called the Multiple Indicator Cluster Survey, or MICS.  The MICS focuses on indicators related to maternal and child health, including fertility, child mortality, nutrition, child health, environment, reproductive health, education, child protection, and HIV/AIDS and Orphanhood.

A finding that struck me from the survey conducted in Blantyre, Malawi concerned HIV-related stigma and family dynamics.  It reported that 68% of women compared to 36% of men would want to keep it a secret if a family member had HIV.  In the discussion, they mildly conclude that women are more discriminatory than men when it comes to stigma and discrimination of HIV.

I disagree that women in Malawi are more discriminatory.  From my research on gender in Blantyre and the observations I made during my limited experience there, I think there is an alternative reason for why women more than men would want to keep it a secret if a family member was infected with HIV.  Women to me seem more socially connected, more relational with their neighbors, friends, and other mothers, in very personal and familial social networks: the neighborhood, the local church, their children’s schools, the market.  In this sense women seemed to be more tightly woven into the fabric of other people’s lives.  So something like stigma against a family member who has HIV is more damaging, more threatening, more immediate to a wife or a mother in Blantyre.

Women then, are not more discriminatory.  Rather, they are more affected, threatened, or harmed by discrimination from their community.  The conclusion drawn from the MICS seems to conflate women being more discriminatory with women being more susceptible to discrimination.

A bogy of the mind

“We tell ourselves that pestilence is a mere bogy of the mind, a bad dream that will pass away. But it doesn’t always pass away and, from one bad dream to another, it is men who pass away.”
-Albert Camus, The Plague

Last weekend my internet and cable went out in my apartment, so I spent most of Saturday and Sunday lying on the couch with the windows open, reading The Plague. I have to write an essay for my Ethical Issues in Public Health class on the “strengths and weaknesses of utilitarianism and contractarianism or rights theory in public health ethics,” built around a reading of one of several books, of which I chose the novel by Albert Camus. This isn’t the essay… just a story and some thoughts…

Shortly after I returned home from Eldoret, a street boy I knew was killed. He was traveling between Eldoret and Nairobi, presumably in search of greater economic opportunity in the big city. As many street children do, his mode of travel was to hang onto the undercarriage of trucks carrying goods between these two urban centers. The roads are bad enough that trucks travel slow enough such that street children can hang onto the chassis for a few kilometers, hop off when they grow tired, then climb back on to travel further down the road. Somewhere along the road, he lost his grip. Caught under the wheels, he was killed instantly. A mere street boy, he was quickly forgotten. An orphan of poverty, in search of money, food, friendship, and family… the road cut short his journey. He was 12.

Shortly after Christmas, as the world began a new year, violence erupted on the streets of Kenya. Poverty, tribalism, corruption and shattered hope created the context for killing. Former neighbors turned into enemies. Historical tribal tensions were re-ignited under a new pretext of politics, burning violently to the surface. “The whole country was on fire” several of my friends told me, recalling the horrifying months of January and February. Poverty, the pit holding the fire, quickly deepened.  In total, 1,133 Kenyans died and thousands are still displaced, living in camps.  Blood stained many hands.

Many of us subscribe to utilitarianism superficially. The greatest good for the greatest number. It sounds very appealing. But would you allow a single person to die in order to save ten? Instead we believe ourselves to be inherently worthy and equal as individuals, regardless of our “utility”, everyone sharing a right to life, to prosperity, to well being, to health… And releasing us from egoism, we live within a social contract. It is not only our own right that we must ensure; we have a responsibility to ensure that other’s rights are upheld as well. By upholding each invidual’s right to life, and recognizing we are inextricably connected to every other person in this world, we collectively share the moral burden of ensuring every person’s rights, without having to sacrifice anyone…

Kenya is a poor country, with a tenuous, and short, history of democracy. There is much work to be done with big development strides to make, and with this comes the possibility for great hope and achievement upon electing a new president, and also the bitter anger and sense of betrayal if the democratic process is taken away from you. In Kenya, there are bad roads, unregulated laws, families living without enough to eat, children out of school and out of home, living a life on the streets in search of food, income and meaning. Born into circumstance, as we all are, the boy who died was living the reality of having to travel between Nairobi and Eldoret hanging onto the undercarriage of trucks. Because of this, he died. I knew him, interviewed him, talked with him, have his picture on my computer. You are now reading about him. He, and others like him—other street children in Eldoret; the poor, the marginalized, the vulnerable, the oppressed, the unlucky no matter the geography—are our responsibility. We abide, or must abide, by a social contract that both guarantees and takes responsibility for their rights… to life, to prosperity, to well being, to health…

Poverty is not a bogy of the mind, not a bad dream that will pass away. It is our responsibility. Indeed, men are passing away because of it.

in my name end global poverty

Isn’t it cool that ending global poverty is now cool?!?!

Be the Generation

Sky 1 – Glue Kids of Kenya

When I was in Eldoret, a crew from Sky1, a news channel/service in the UK, came to do a piece about children displaced after the post-election violence. The British NGO, Save the Children, is working in Eldoret to this end. What Sky1 found was the large population of street children in Eldoret, making their way through life on the streets, heavily addicted to glue, marginalized, impoverished, vulnerable, without education or family support. The name they used, “The Glue Kids”, kind of makes me cringe — b/c I have pictures of most of these kids on my computer, along with their personal testimonials, and tried all summer to know them by name, as real children — however, it is wonderful that a news agency like this has shown concern and is spreading the message to the world that these children exist and need our help.

Please look at these PICTURES from Sky1

And watch this video of Ross Kemp, Sky1 broadcaster, bear witness to the situation of street children in Eldoret, Kenya.

A Safe Place to Sleep

Between 20 and 30 street children wait patiently for me each morning. I wake up early, take a bicycle taxi into town, stop by the supermarket to buy bread, butter, milk, sugar, and tea, then walk to the Ex-Street Children Community Based Organization where we serve breakfast and interview each street child as part of my research study to learn first-hand about their backgrounds, survival mechanisms, drug use patterns, and perceived barriers to leaving the streets. Many come to the office day after day, know me by name, some even meeting me half way to help carry the grocery bags. Others are new faces, recruited by their street peers to come receive a free breakfast, play checkers, do puzzles, draw pictures, and share their life stories with the hope that someone, finally, will do something to help them and their families. We conducted 70 interviews, without a single refusal, and as a result came up with a fairly comprehensive picture of the causes and consequences of street life in Eldoret, Kenya.

By partnering with this community based organization to conduct the research, we created a safe place for street children to come off the streets each day. This in and of itself may have been the most important conclusion of our study–the very simple realization that street children NEED a safe, physical space OFF the streets, where they can eat, play, share their stories, interact in a positive social environment, escape stigmatization, discrimination, and abuse, access services… even just have a place to sleep.

Coming back to the office from a meeting in town one afternoon and witnessing these children laying underneath the table, sleeping peacefully on top of each other, I was overtaken by the importance they placed on having a safe place off the streets where they could come to escape the harsh realities of their daily existence.   The near unanimous answer to the question, “What is the hardest part of living on the street?” was, harassment and abuse by police, and beatings and theft from the older street boys.  Street children are quite possibly one of the most marginalized and vulnerable populations in the world, and although they are absolute masters of survival, they are still children who need protection and support.  There are 150 million street children worldwide, a couple thousand in Eldoret, and nothing has proven to me more that they need our help than this picture, taken long after breakfast was served and our interviews were completed. Walking away from this non-verbal scream for help, can no longer be an option.

Glue

“To feel high”; “to be able to sleep outside”; “to get happiness”; “to feel warm during the cold, especially at night”; “to not feel so hungry”; “to forget my problems”; “when someone does something wrong to me to have no fear and fight”; “to relieve stress and anxiety”; “to have courage to rob someone”; “because my friends influenced me”

Asking street children in Eldoret the question, “Why do you use?” these are several of the more common responses I get.  Their drug of choice?  Huffing glue.  And although I haven’t fully completed the analysis, of 50 street children I’ve interviewed, I would say only about 5 said they don’t use glue.  Nearly all started using glue immediately when they came to the streets, and most use every day, all day.  They buy the glue from cobblers or small supply shops in town, and a whole days worth of glue costs 20 shillings at most (about 30 cents).  Street children may lack obvious material needs and basic human rights – food, clothing, shelter, education, and health care – but their addiction to glue makes the seemingly simple provision of these lacking needs very difficult.  In my mind, and the mind of many others I’ve talked to here, drug use among street children represents the single biggest barrier to finding lasting solutions.

Here’s a verse from a great artist on a great album that says some very poignant and relevant things about drug addiction.

“He said, nobody else ever loved him / that’s why he get high enough to go touch the heaven’s above him / vividly remembers every pipe every needle that stuck him / every alley he ever slept in every purse that he snuck in / every level of hell he’s been to and the one that he’s stuck in / the one he can’t escape, even though it’s of his own construction / maybe you can’t relate, maybe you one of those that just doesn’t / maybe he doesn’t care, loves to allow these demons to come in with No… Intruder… Alert”
-lupe fiasco (Intruder Alert, from The Cool)

Kambi nguruwe

The pungent smell of chang’aa stings my nostrils as we push back the lace cloth covering the door. Inside a large bucket sits on the only table, from which 10 shilling cups of the home-brewed maize liquor are served; served to men who waste their days sitting and drinking to complete incoherence and oblivion; served by women who make their living brewing, hoping to earn enough at the end of each day to feed their children, and if they’re lucky, send them to school. This area of Langas is called Kambingurewe, kambi- meaning slum or village, and -ngurewe meaning a place where pigs are kept. The name seems ironically fitting. It is a large brewing area, where woman after woman brews and sells chang’aa, and in two consecutive rooms of one of the long, mud-wall rental houses, two single mothers qualify to participate in my research study. They qualify because both have children in their household who rather than going to school, go to the streets.

“I don’t know why they go to the street” both mothers tell me when I ask them the “Why” questions. They explain that there is enough to eat at home and primary education is free in Kenya. Indeed, there is enough food at home—both mothers are HIV+ and poor, and are therefore receiving food from AMPATH’s nutrition program. And indeed, primary education is free in Kenya, but the uniforms are not; neither are the books, the pens, the notebooks, the exam fees, the registration fees, sometimes not even the desks. But there is a more pervasive, and much more obvious reason why these children are on the street—the youngest son of one mother, and 4 younger siblings of the other sister who is head of the household, and a mother of a young baby herself. And that reason is continuing to sting my nostrils. The environment these kids have grown up in is simply not the kind of environment where one can have a pleasant, normal childhood, going off to school each morning and returning home to do your homework each night.

Should the mothers be blamed for raising their children in a “bad” environment? I find it extremely hard to place any sort of blame on people attempting to survive in extreme poverty. These mothers, supporting 10 and 6 in their respective households, wake up every day to begin brewing so that they can earn a couple hundred shillings. Their biggest expense is paying the almost daily bribe to the different police officers who come each day. Brewing chang’aa is “illegal” in Kenya, but the police manage the brewing areas in the slums more like personal businesses. The police come so frequently that each woman in the area takes her turn paying the bribe by borrowing from the other women, and then pays them back throughout the week, or just loans the money when it is someone else’s turn to pay the bribe.

We had to arrive early to conduct the interviews because by late morning the women were busy serving chang’aa, and we’d rather avoid questioning by drunk and stumbling old men. Although it was before 10am, as we were conducting the interview in the second home, a man walks in looking about 70 but probably only 50, cigarette in his hand, eyes glazed, wanting his first 10 shilling cup of the day. I was nearly sick to my stomach. The smell was overwhelming. The old man wanting this nasty alcohol was overwhelming. The mud floor, single bed, tattered mosquito net, few scattered dishes and dirty cooking pots were overwhelming. The small baby, half-naked, unable to breastfeed because his mother was HIV+, likely to grow up in this same environment where 4 of his older siblings had “chosen” life on the streets over life at home and in school was overwhelming. The man was told to wait, crushed out his cigarette on the floor, turned and ducked out the door; I regained focus and resumed the interview.

During the first interview, the older sister to the mother waked in briefly to say hi, and we learned that she too had a boy who went to the street. I was no longer surprised. She lived about 10 feet around the corner, and was also a brewer. We went to visit her after finishing the two interviews and began chatting about her son who was now a street boy. In the middle of our conversation, one of her young daughters, still clad in her school skirt and sweater, poked her head in the door and hurriedly chattered something in Swahili. At the end I picked up the word “polisi” and realized many of these young children act as scouts for their mothers’ illegal brewing business. Immediately, the mother jumped up from her seat, and with no goodbyes, no words, no nothing, she rushed into the kitchen and began frantically covering sufurias filled with chang’aa. Samuel, Virginia, Veronicah, and I all looked at each other wondering what to do. “I’m not dealing with the police,” Virginia said to me. “I’m not either,” I quickly returned. And with that, we jumped up and walked quickly out the door, and out of kambi nguruwe.

Division of Labor

A single mother sits quietly on the thin foam mattress of her bed, breastfeeding her small baby. Rain pings on the rusty tin roof overhead, and the dampness begins to seep in through the cardboard covering the inside of the mud walls and up through the dirt floor below. She has two other children, boys, age 10 and 14, but they are not here during the day. It’s a Wednesday, but they’re not at school either. They have a more important responsibility: food. The division of labor in this household is, sadly, not too uncommon. The mother, baby on her back, finds work where she can, washing clothes for slightly “wealthier” families living in this urban slum. Maybe she can find work 3 to 4 days out of the week, and maybe she can earn enough to pay the 500 shilling ( $8 ) house rent at the end of each month. That is barring any extraneous expenses, such as medical bills, new clothes, supplies for the baby… anything. Her boys take care of food for the family. They leave at 6AM each morning for the streets, to beg and to collect scraps of plastics and metal for recycling, which they turn in for 40-50 shillings, so they can feed themselves, and then bring home whatever food and money they can to their mother in the evening. One meal a day is all they can afford. And despite free primary education in Kenya, the mother can’t afford the uniforms, the registration fees, or the school supplies. Her boys are what UNICEF classifies as “on” the street children. They leave for the streets in the morning, but return home to their families at night, and compromise around 2/3’s of street children in Eldoret. The fourteen year old tells us, “Who am I, the father?” The division of labor is harsh… but real.

The Story Workshop

One of the more innovative organizations I met with in Malawi was an NGO called The Story Workshop. They used the radio as a way of raising awareness on a variety of social and cultural issues, including gender-based violence (GBV), which led me to their office situated a short drive from the center of Blantyre. The Story Workshop utilizes the local village and area development committees (VDCs and ADCs) to form “community listening clubs” to which they distribute free radios. In a country with 35.9% illiteracy and the majority of families unable to afford a TV, radio is the most effective mode of mass communication. The Story Workshop employs writers and producers to create dramas based on actual situations gathered by project officers who make regular visits to the communities. “Actual situations” include, for example, cases of husbands abusing their wives; sexual harrassment of young school girls by male teachers; or young women forced into prostitution, early pregnancy, and often disease due to economic circumstance. I was interested in the content, and costs, of such a program for my job; but I was more intrigued by the concept. A very simple and powerful one. Use “real-life” stories to convey a message, raise awareness, and create meaning… hmmm… sounds familiar.

So I tell you that story to tell you this story.

The other focus group discussion I held was with a group of older women just outside of Blantyre, mostly widows in their 40s and 50s, who had been trained and received microfinance loans to start their own businesses from a Malawian organization called the National Association of Business Women (NABW). They were entrepreneurs of small businesses ranging from selling mandazis and doughnuts to raising cattle for dairy to buying staples such as cooking oil, sugar, and salt wholesale in town and then selling them individually in their own communities. My questions revolved mainly around the specifics of the business training they received, how they utilized and interacted with the “market” in Blantyre, how their lives had improved and changed since starting their own businesses, and the major challenges they faced, as entrepreneurs, as women, and as women entrepreneurs. One of the biggest challenges the women spoke of was now being considered the “breadwinner” in their family and having to provide for more than just their own children, including sisters, nieces, nephews, cousins, and orphans. The profits of their small businesses were supposed to help lift them out of extreme poverty but instead were being stretched thin across needy, but often demanding, family members. “It’s our culture,” Sophie, the project officer for NABW told me.

A sign I saw hanging in a house just outside of Eldoret last year while making home visits to families caring for orphans. Telling, very telling.

A couple weeks later, I’m cooking dinner in Eldoret, Kenya with my two very good friends Ken and Samuel. Samuel is a high school teacher who lives with his wife Regina, a nurse, and their two month old baby. Samuel comes from a family of 11 and Regina from a family of 7. Of the 18 sibling in those two families, Samuel and Regina are the first to graduate from college. And because of it, they are the first all their siblings turn to in times of need. A teacher and a nurse make a modest living in the States, and make just as modest a living in Kenya. But to their family members… they are educated, they have stable, professional jobs, and they are more or less perceived as being wealthy. “I thought with the new baby, they would back off a bit,” Samuel told me. “But no,” he laughs. “We are trying to save, have future expenses to think about, such as his education, medical bills.” He sighs, and chuckles, “It’s the African way.”

“Africa’s communal culture” appears to be a double-edged sword.

Culture or Consequence…part 2

Last week I had the privilege of conducting a focus group discussion with 16 women living in the impoverished township of Ndirande, just within Blantyre’s urban district. These were typical Malawian women… most were married with husbands working low-paying, unskilled or semi-skilled labor, while a few were widowed or abandoned; all had several children, and several had another on the way; none worked outside of the home, yet all filled their day with caring for children, caring for their husbands, caring for their home… selflessly caring, pretty much, for everyone but themselves; all were friendly and welcoming, loving to their children, and laughing with each other. We sat in a big circle in the dirt between two of the cramped houses in this expansive, but crowded urban settlement. The focus group was mainly centered around the challenges these women faced, and nearly everyone shared harrowing stories of discrimination–from their husbands, from the job market, from the “culture”, from everyone. With my job, I have found myself immersed in the plight of women in this country, and learning about discrimination, and outright violence, these women face every day, has, at times, made me utterly ashamed to be a man.

And of course, I’ve thought how a country, or a continent, could treat over half of its population so badly? Many, including myself sometimes, are quick to write this off as simply “Africa’s patriarchal culture” … a long history of cultural oppression and disempowerment that has socially constructed the roles of women to be bound to child-rearing and domestic responsibilities. But that surely can’t be the final explanation, can it? We can’t move forward with gender equality if we are resigned to the fact that the source of inequality is simply entrenched in the culture. Cultural values, norms, and roles cannot transcend basic human rights.

So I asked these women, as my final question of the focus group, “What is the root cause, or source, of gender discrimination in Malawi?”

The answer came without hesitation … uphawi. Uphawi is the Chichewa word for poverty.

Gender discrimination, gender-based violence … culture or consequence? To these women, who experience it every single day, it is a consequence of poverty, hardship, selfishness, and competition for scarce resources. And again, I ask, what exactly is the difference? If there is an anthropologist reading out there… please enlighten.

Culture or Consequence?

One of the millions. A boy at the Village to Village Community Orphan Care Project in Domasi, Malawi

Last summer, as I made home visits with community health workers to households caring for children orphaned by AIDS, I reflected on “Africa’s communal culture.” I remember a particular day in which we visited 8 homes, caring for a total of 56 orphans. And I remember Virginia and Veronicah, two of the most amazing community health workers, saying to me half jokingly about how we could literally go door to door in the communities surrounding Eldoret and find orphans in nearly every home. We were laughing at the prospect of going door to door only because we were ankle deep in mud from rains nearly every day for a month, and we had spent the entire afternoon that day, and the one before that, and the one before that, simply making follow up visits to families needing medical care, nutritional support, or help paying for school fees and uniforms for their children. However, I knew, and they certainly knew, that we indeed could go door to door visiting new families, and it certainly was nothing to laugh about.

Spending the summer thinking about and addressing the needs of children orphaned by HIV/AIDS, I always felt a shred of hope at the end of the day when I reflected on the communal nature of the Kenyan (and I think many African) people. I was literally seeing a single disease kill an entire generation, and leave the next uneducated and jobless. However, were it not for all the grandmothers, aunts, and neighbors, millions and millions of children would be homeless. Literally, millions. What if this was America, I thought? Would orphanages be as common as Starbucks? Who would take care of all these kids? I actually had the thought that if this horrible tragedy was to happen anywhere in the world, Africa at least had a culture of sharing, of providing for and helping relatives no matter what, of sharing with your neighbors whatever is needed… and ultimately, of taking in and raising children whose parents have died.

Jump to one year later… I’m here in Malawi, standing at the bar of the Blue Elephant after watching the opening matches of Euro 2008 with my friend Hans, a medical student from Holland working here in Blantyre at Queen Elizabeth Central Hospital. He has traveled extensively across Africa (he and four friends actually rode motorbikes from Holland, around West Africa to Cameroon, and then from Uganda to South Africa, in five months!), and I think in the context of talking about our travels, we got talking about the orphan crisis and I made a comment something along the lines of, “thank god for the grandmothers, aunts, and neighbors… thank god for Africa’s communal culture… I hate to think of what would happen if there wasn’t this safety net for these orphaned children… the one saving grace I suppose.” He nodded and agreed partially, but then asked me what I meant about the “communal culture.” It was a bit loud, and at first I thought it was just the language barrier between Dutch and English, so I tried to explain what I meant and relayed to him my experiences from last summer working with these families. “I don’t know if the communal nature is necessarily culture,” he said. “I think it’s more of a consequence.”

A consequence… yes… of course. A consequence of poverty. People who are poor share and look after one another out of necessity… as a means of sustainability and survival. In the “West”, we have constructed other safety nets and support structures, such as pensions and nursing homes and life insurance. Here however, humans, and not institutions, comprise the fabric of these safety nets.

Really, I’m sure it’s a bit of both… the network of “mothers” who care for this generation of orphans is both a product of culture, and a consequence of poverty. And really… what’s the difference? How much of “culture” is really just a reflection of a country’s economic and social conditions?  Maybe I’m conflating terms?  Maybe I’m debating semantics? Culture or Consequence? Whichever… in the face of tragedy and hardship, the way in which I’ve witnessed people caring for one another is remarkable.

A day or two…

Despite my promise that I would not write this blog as a daily activity journal, i thought i’d give a bit of “a day (or two or three) in the life” … need to catch up a bit, so if you can stand an erratic, stream-of-consciousness sort of post, hopefully i can fill you in on some of my activities and other interesting insights…

Thursday 5/29

meeting with the District Community Development Officer (district level of Ministry of Gender, Child Welfare, and Community Services), which was several kilometers out of town, in a completely run down, un-electrified building (interesting what you can discern about priority from the status of a gov’t or organization’s building) … make some phone calls to schedule/reschedule meetings… buy some more phone credit from one of the hundreds of women selling Celtel and Telcom mobile phone units all over town (mobile phone service here is beautiful in that it’s readily accessible and affordable to just about everyone, but damn, it gets really expensive when you actually need your phone to make calls on a daily basis)…return to Kabula Lodge, hang out w/ the other expats, mainly medical students, doctors, and a couple researchers here for a couple months or more from the UK, Holland, Spain, and Belgium… power goes out (which it does almost every evening) … draft emails in Word to send tomorrow … power comes back on, make dinner – vegetables and rice – with whoever else has ingredients to share that evening, or whoever went to the market that day…

Friday 5/30

Drop off some info at the Blantyre City Assembly… try to meet with someone in the Social Welfare Office, but she is busy dealing with the crisis affecting Malawians in South Africa, although says she’ll compile some reports and budgets for me next week … go to the ATM at the bank (cash economies are a pain!) … have a very productive meeting with the director and projects officer of an NGO called PACENET (Pan-African Civic Educators Network) who are doing a lot of great work promoting women’s involvement in Malawian politics and local decision-making bodies … go out to dinner with some friends, then head to a local bar/club called Chez-Ntemba for a night of live music, including Malawi’s most famous musician, Lucius Banda, who interestingly enough, was a former politician (MP) and spent some time in jail for speaking out against the current administration (for which he wrote a song, “Cell 51″). Malawian politics…. that’s another post.

Saturday 5/31 – Tuesday 6/3

Take a minibus to Zomba, about an hour outside of Blantyre … buy some peanuts from one of the many hawkers who flock the minibuses at every stop, selling oranges, bananas, eggs, peanuts, green beans, tomatoes, soda, biscuits, and airtime for mobile phones…

stay with my friend Jenn who lives in Domasi, a rural village outside of Zomba, where she is an English Language Fellow for the U.S. State Department teaching at Domasi College …

Jenn in front of her house on the Domasi College campus

hike Zomba plateau on Sunday, and take in the beautiful view, but also witness first hand the deforestation that is depleting Malawi’s trees and keeping girls from school who carry huge bundles of wood on their head home to their families several days a week (wood is still the primary fuel source here) …

The “Queen’s View” on the top of Zomba Plateau. Pictured are myself, Jenn’s best friend Deliwe, her brother Mavuto, and our guide, Adam

Bringing down a load of timber…most likely illegaly… from the forest on Zomba Plateau

Monday collected a HUGE amount of data from the National Statistics Office (NSO) which involved a stop at the headquarters office, a trip up the road to the NSO library, back to the headquarters office, across the street to the demography department, and then a ten minute car ride to an employees house to get some “personal copies” of surverys he had (classic!) … all morning Tuesday in the University of Malawi Centre for Social Research resource library …

One of the many old colonial building in Zomba that combined with the large trees, mountain, and university, give the town a very homey and cool vibe. In this case, the building has been converted to the National Statistics Office Publications department and library.

stroll through Zomba’s market (the cleanest and most well organized I’ve seen in Malawi), waiting for photocopies of hundreds of pages of reports, articles, policies to be made … drive back to Domasi, drink some beers and play Bow (a traditional Malawian game) with Jenn and Deliwe … wake up to the barking dogs and rooster who starts crowing incessantly at 5:30am … eat breakfast … run some errands with Jenn, including the ATM (again!), store to buy water, and a stop at a tailor where her and Deliwe were getting a dress made (actually a woman’s house who supplements her income working at the University library by making dresses and hospital nurse uniforms, as well as baking wedding cakes – I’ve found most women here who have “day jobs” still supplement their income with a side business or two) … drive back to Blantyre … eat incredible Indian food for lunch … have a meeting with the director of the Malawi Law Society to discuss gender issues from a legal perspective and any legal provisions/aid specifically targeting women… chat with friends back at Kabula… pull the mosquito net down… sleep.

Malawi’s Human Rights Activist

Last Tuesday I had the great fortune to meet with one of the foremost human rights activists in Malawi, Mrs. Emmie Chanika. First as a nurse for the Red Cross, and currently as founder and executive director of the Civil Liberties Committee, she has worked tirelessly promoting human rights in Malawi for over 30 years, covering everything from women’s rights and empowerment, gender-based violence, prison reform, political activism and constitutional rights, water and sanitation, and poverty alleviation.

As I sat waiting to meet with her, she was in the midst of instructing her staff to call a press conference in response to the Malawians harassed, abused, and killed in the horrific acts of xenophobia happening in South Africa. Then she turned to me and I described to her the research I am doing and the information I am trying to collect on gender issues in Blantyre. To my delight, she started talking… and I just sat and listened. I can’t capture this two hour conversation in words, so I’ll leave you with just a few “sound bites.”

“There is money in the third-world, it is just mishandled. We are not a poor country. Africa is not a poor continent.” ex) On opening day, the “Shoprite” (Malawi’s biggest and nicest supermarket) in Blantyre made 12 million kwacha (1 US dollar = 140 Kwacha).

“If women raise issues, stand up for their rights here in Malawi… the response is, ‘Doesn’t she have a man to control her? Doesn’t she have babies to take care of?”

“HIV/AIDS…it came…and we start politicizing, saying stuff like it’s a white man’s disease…So what! If you get shot, you don’t scream who shot me! You get to the hospital!”

A few years ago when a girl in Blantyre was raped in the streets by several street vendors, Mrs. Chanika led a march against violence… some other street vendors came to her office and said “if you have that march, then you will see!” Emmie said, “then I will see!” … and led the march.

“My passion is housing. I think dignity starts with where a person sleeps.” (speaking of some of the horrid living conditions in the urban locations surrounding Blantyre).

“The problem with being an activist, is half the people think you’re mad!” (laughing)

One of the most common, and beautiful, scenes in Malawi… and I think probably in all of Africa. If this doesn’t speak to the need for activism and advocacy for human rights, I don’t know what does.

An article on domestic violence in Malawi where Mrs. Chanika shares some important insights about how to reach rural women via awareness campaigns.

An interesting, and telling, article about dispossessing widows in Malawi, in which Mrs. Chanika (as well as Mrs. White from WLSA) is quoted.

For those of you in New Haven, Mrs. Chanika is being presented a Human Rights award at the Yale School of Nursing on June 19th, 2008.

Women and Water

“There is no greater gender issue than water,” Mrs. Seodi White, National Coordinator for Women and Law in Southern Africa Research Trust, told me. “If only Malawi paid as much attention to women as it does to roads, we would be getting somewhere.” Malawi’s roads are indeed quite impressive, with most of the major tarmacs free of potholes, and even “robots” (i.e., traffic lights) at several of the major intersections in both Lilongwe and Blantyre. Water is a gender issue primarily due to the time burden it places on women, who are largely responsible for fetching water for the family each day, in addition to doing the cooking, cleaning, and washing, all of which require water. The time spent procuring and using water by women in Malawi is time not in school, time not earning money, time not at a health centre, time not…anywhere, except at the local well, or stream, performing one of the daily tasks required to sustain their families.

On the road home from Mt. Mulanje, women pumping water at a well. I saw three wells on this one-hour drive, each one surrounded by one or more women filling buckets with water.

Picture taken by my friend Lidwein, a medical student from Holland. As we were walking towards Mt. Mulanje we passed over a bridge and in the stream below were a group of women washing clothes.

Two years ago, while living in the village of Naitiri, in western Kenya, I spent a day with the public health officer visiting several local water springs. Hidden between maize fields, nestled in valleys, or underneath groves of palm or acacia trees, water springs are always located at the end of a narrow, well-traveled footpath. I remember that day we visited nine local water sources, two of which were protected, leaving seven unprotected and therefore unfiltered and contaminated with bacteria, chemical run-off, and animal waste. One water source may provide water to 1,000 or more people. Quite possibly the cruelest consequence of this harsh reality is that too many HIV-positive mothers are forced to decide between breastfeeding and possibly transmitting the virus to their newborn, or mixing formula powder with contaminated water, risking dysentery, typhoid, bilharzia, cholera, or other water-borne, diarrheal diseases that account for 18% of the under-five mortality worldwide (UNICEF State of the World’s Children 2008).

Near the rural village of Naitiri in western Kenya, a primary school girl carries water home to her family

Generalizations and Ruminations

There are a few things on which I must reflect, or ruminate, before I go any further with this blog.

Writing/Blogging…I am writing this blog to share and inform; connect people to information, ideas, problems, and solutions; and to invite comments, questions, and criticism. Writing this blog took some serious convincing and urging from friends, and I admit, I experience some serious inner tension both about what I write, and how I write it. So, who am I writing this for, or who will be reading this? I’m partially writing for myself, simply to process and to write. Some who read this are very educated and very experienced friends and colleagues of mine, many of whom have tremendously more experience than I in issues such as global health, economic development, and working in resource poor settings and developing countries. Other readers may have no such experience, and for whom I hope this blog can be a window, albeit a very small one, into the gross inequalities that exist in the world today. Still others will fall somewhere between these two groups, all with different backgrounds, viewpoints, and frames of reference in which they will process, interpret, and create meaning out of what I write. I was advised by a very excellent professor and treasured mentor of mine, that a I have to “earn the right to give my analysis and meaning through the ethos of my writing.” So the best I can do is provide a realistic description of what I see, hear, and experience, and attempt to create a picture of life or situations in Malawi and Kenya as respectfully, concretely, and richly as I can.

Generalizations… I received a wonderful and challenging email from a friend that spurred me to think harder about what it means to generalize… in this case, to generalize about “Africa.” Africa is a continent, and certainly, there are vast differences between, say, northern and sub-Saharan Africa, western and eastern Africa, Kenya and Malawi, even Nairobi, Lilongwe, Blantyre, Eldoret, and Naitiri. What’s more, several of my dear friends are African, and I agonize over the fact that I, a westerner, am often writing about the struggles and challenges facing their continent, as if I know something. I too, worry that generalizing, for example using “Africa” to refer either, to the situation of a specific country, city or village, or to the situation of extreme poverty in the developing world as a whole, “is reductionistic to the complexities” of these situations, and has “simplified the issues of poverty and structural violence into a single catch-all where in fact they have numerous manifestations, each requiring a tailored solution.” Generalizations can at times, simplify and belittle, but I also think they can have the power to unify and uplift. So instead of using the term “Africa” to speak of Malawi or Kenya, Blantyre or Eldoret, maybe I ought to go the other way and just use the terms “world” or “earth”???

Poverty… Is it ethical to compare settings of extreme poverty? A year ago, the ethics of this question never even entered my mind, and in fact, I was quick to compare. I had lived for a little while in a rural village in Kenya, and then later had worked in the urban slums, so thought I had a basis for comparison. In the rural areas, I saw people eek out an existence on subsistence farming, on which their families often could not subsist; I saw people miles away from access to markets, health care, and information. In the urban areas, I saw mothers caring for their own children, and their sister’s orphaned children, on unskilled, casual labor that rarely provided a daily income enough to feed their children, or pay for school uniforms; I saw families literally sleeping on floors turned to mud by the rainy season, unable to afford mattresses or new roofs to keep out the rain; I saw children living with no place to play, amid cramped and insanitary living conditions. But when a family is living on less than a dollar a day (the current definition of ‘extreme poverty’) how can we say that one is worse or better than the other? How can the rural poor be worse, or better off, than the urban poor? Hunger is hunger. Unclean water is dirty, disease-causing water. No access to, or money for, health care is sickness, not health. Lack of education simply leaves one uneducated, uninformed, and powerless. The list goes on… but could there possibly be a value assigned to whether or not this poverty existed in a rural area or an urban one? Or in Malawi, Kenya, Africa, India, Bangladesh, Mexico, Rio de Janeiro, or south-east Asia for that matter?

While there are many ways in which to be very rich, there are only a few in which to be very poor.

Thank you for reading.

If you’re in the mood for something a bit lighter, have a look at these Ruminations for a guaranteed out-loud laugh. (‘sup Rome! thanks for putting me onto this guy years back… hilarious)

Malawi and HIV/AIDS

Friday I had a meeting at the National AIDS Commission of Malawi, housed in a beautiful, albeit ridiculously out of place building in Lilongwe that is made entirely of green glass. The NAC was established by the Malawian government in 2001 to provide overall leadership and coordination of the national response to HIV and AIDS. “The Commission was established following Government realization that the response to the HIV and AIDS pandemic required a multi-sectoral approach and interaction between HIV and AIDS and broader issues of population, economic development and management, social service provision, culture, community development, human rights, and gender.”

The meeting itself was with the Director of Policy and Programmes, and although short and not really that productive, I did get the opportunity to spend about an hour and a half in their Resource Center where I had access to a wealth of information on HIV/AIDS in Malawi generally, and for my purposes, several documents and reports about gender and HIV/AIDS in the country. Here’s just a few basic facts from the Malawi HIV and AIDS Monitoring and Evaluation Report 2005-2006:

• 14% of the population aged 15 – 49 years is infected with HIV, totaling about 1 million cases in the country; AIDS ranks as the leading cause of death among the most economically productive age group (20-49)
• HIV/AIDS has caused a major human resource crisis in Malawi, like in many sub-Saharan countries; for example, between 1999-2005 over 6,000 teachers in Malawi died of AIDS
• It is estimated that there are about half a million orphans as a direct result of AIDS deaths, and slightly over a million orphans total in the country
• Only 5% of HIV positive pregnant women in the country accessed Nevirapine for PMTCT, of which a single dose to mother and newborn can decrease the risk of vertical transmission by 50% (see the original HIVNET 012 trial in Uganda if you’re interested)
• Only 14% of Malawians had ever been tested for HIV in 2004; thankfully, that number is steadily increasing
• Only about 30% of those who need treatment are on ART (anti-retroviral therapy), although this is reported as one of the higher coverage rates in southern Africa; the coverage rate for children however is tragic–25% of those who need ART are children aged 0-14, but only 6% of children are receiving it
• Women are nearly 4 times more likely to be HIV positive than men

My work this year is on a much more policy/structural level compared to my work/experiences in Kenya the past two summers, so it’s hard to tell what’s actually happening “on the ground” … but from this perspective, I am impressed with Malawi’s response to HIV/AIDS. Their National Action Framework 2005-2009 is very comprehensive, and reading the M&E report, they are definitely getting started on just about every initiative/problem/correlate of HIV/AIDS given their limited resources and economy. A long way to go, but it seems hopeful.

And although there are certainly still huge walls of stigma and discrimination that must be torn down, the level of awareness, advocacy, activism, and yes, hope, does seem apparent. As I was out for a walk today, I strolled past this huge stadium up on a hill, and although I could only see the outer brick wall, I knew something was happening. I went in to check it out and sure enough, I caught the tail end of the International AIDS Candlelight Memorial 2008, sponsored by the Global Health Council. The crowd was almost entirely women activists/advocates and late primary / early secondary school students. The motto of the event was “Never Give Up, Never Forget”

Friendly business

Bridge connecting the markets in Lilongwe, Malawi

Wyson Titus is a good businessman. Walking towards Old Town in Lilongwe, Wyson said hello and started strolling along side of me. We chatted a bit, about where I’m from and where he was from, and I learned that he was an “artist” who sold postcards mainly to tourists. He grew up around Blantyre but came to Lilongwe about four years ago for better economic opportunities (interesting in that Blantyre is known as the economic capital of Malawi, while Lilongwe is the political capital). Anyways, he finished secondary school in Blantyre, then got a job as a petrol station attendant. Now, he earns about the same amount or a little more selling postcards in the city, and is able to send a little money home to his brother who is taking care of their sister’s three orphaned children. We kept chatting as we strolled along the road, and met up with two peace corps volunteers from Namibia who were looking for a bus to Mzuzu. We walked over the main bridge crossing the river and up the hill past the large mosque, where several times a day, even over the bustle of the city, I hear the serene, humming music of the call to prayer. It is serene and beautiful and calming. After seeing off the PCVs he showed me where the buses to Blantyre left from and what a fair price would be (800 kwacha = $5.50), as I told him I’d be heading down to Blantyre next week. Then he took me in the market and we winded through the narrow alleys between stall after stall of spare automotive parts, tools, nuts, and bolts, then rounded a corner and were suddenly surrounded by stalls of fresh fish, meat, vegetables and ground nuts. We exited the maze through the clothing and music section and emerged back on the main street of town. We continued walking and chatting, and went to the other market in town. The man-made bridges seen connecting the two sides of the market cost 10 kwacha to cross… “everyone finds a way to make a little money” he told me. After about two hours of walking and talking, he asked me to look at his postcards. At this point, I was happy to buy a couple. And even after the sale, we kept walking and I called him out on his good business model. Most of the other hawkers selling postcards, paintings, carvings, and other curios are very forward and although friendly, still a bit aggressive. He just laughed, and had clearly figured out a way to make a bit of money himself… not just selling postcards, but also by being friendly and taking the time to show us around town.

pamoja.

Blantyre Big Bullets vs. Lilongwe Silver Strikers

Today I happened to catch the launch of the 2008 TNM Super League, Malawi’s professional football (soccer) league. The match was between the Blantyre Big Bullets and the Lilongwe Silver Strikers, which hail from the two largest cities in the country. How about those names?!?! Hilarious.

The match was packed with hordes or people and I was standing, wedged in at the back row of fans encircling the stadium seating, which proved to be an unfortunate position as I checked my pocket after the start of the second half only to realize my cell phone had been pick-pocketed… sucks. With no taxi numbers, I left a bit early to catch a minibus home before dark, with Blantyre winning 1-0. Glad to see the game nonetheless.

Homo Urbanus

Last year marked the first time in history that the majority of the world lived in a city or town. Humans are no longer a rural species, and every day at least 190,000 people are added to urban areas. But of the greater than 3 billion urban dwellers, at least one billion live in a slum.

Here is an excellent essay I found last year in PLoS Medicine about slum health, which aptly cites the definition of a slum as an area of “concentrated disadvantage.”

Homes I visited last year in Langas, outside of Eldoret, Kenya

The tin roofs of Kamukunji, outside of Eldoret, Kenya

My contact, the Millennium Cities Initiative social sector specialist here, is the lone UN-HABITAT officer in Lilongwe, the UN’s human settlements program that is charged with providing “shelter for all.” They have several initiatives dealing with the urbanization, and by extension, the urbanization of poverty. I am excited to be involved in the start-up of the Millennium Cities Initiative, the urban counterpart to the Earth Institute’s Millennium Villages project (UN Millennium Project), working for solutions in urban development.

Urbanization, in my mind at least, represents peoples’ search for something better. People tend to migrate into cities or towns from rural areas in search of economic opportunities. And in my limited experiences in Africa, I think urbanization is generally a good thing. However, I’ve also seen some pretty dire consequences of urbanization, particularly the rise of slums and the birth of street children, not to mention problems with water, sanitation, pollution, crime, and disease. It worries me that with urban development, poverty in some countries may in fact get worse before it gets better…

pamoja

In Kiswahili, pamoja means together.

Together, we can accomplish anything. Alone, you, or I, can accomplish very little. True in just about every domain of life, but particularly salient, necessary really, for work in global health and development.

The title comes from three motives: 1) It’s Swahili, a tribute to Kenya, my first introduction to and love of Africa; 2) I’ve probably written thousands of papers in my academic career and I’ve never been able to start a single one of them without a title–I just can’t do it, some sort of mental block or something; 3) the meaning seemed to fit.

I begin this blog as I begin a summer job with The Millennium Cities Initiative of The Earth Institute. I’m conducting a gender-based needs assessment and costing analysis in the city of Blantyre, Malawi in order to determine the specific needs and costs of interventions that will promote women’s equality and empowerment, and ultimately to attract foreign direct investment that will enable the city of Blantyre to achieve Millennium Development Goal 3: promote gender equality and empower women. Basically, I’ll be meeting with people in government ministries, non-governmental organizations, community organizations, women’s rights groups, hospitals, schools, etc. to gather information about gender issues (read: women’s inequality) in Blantyre.

I’ll be in Malawi until the very end of June, then I travel back to Eldoret, Kenya to continue my work with street children, building a team of colleagues to begin working towards solutions for street children in Eldoret, and to conduct an ethnographic/qualitative research project with street children and their families that will ultimately inform the development of these programs/solutions.

I’m hoping this blog will “accomplish” several things. First, and a bit selfishly, it allows me to process and write about my experiences, without daily journaling, because journaling is boring, constraining, and just kind of sucks (if this ever begins to read like a journal… first I did this, then I did that, etc, please tell me). Second, I hope to share, inform, and educate in the small way that I can, about the tiny sliver of “global health and development” within which I’m working, and about the wonderful people I meet and places I see along the way. Third, I hope this blog can connect–people, places, ideas, information, problems, and solutions. We are truly part of a singular human race, and together…

In some Swahili dialects, particularly Sheng,which most of my Kenyan friends speak (but not in pure, formal Swahili as I’m told by my Tanzanian friends), pamoja is used to end a conversation, as in pamoja–”we’ll be together again”. So with that…

pamoja,

merc.