Frankfurt, Germany
The final leg – I’m so happy to be going home to see my husband and return to work. There are many people I need to thank for this incredible experience. I must give many thanks to – God, my husband Ron, family, church family, friends, and colleagues. I appreciate your unwavering support and prayers. It will take me a while to process all that has transpired this past month. I am very blessed and I look forward with great enthusiasm what the future will bring and the results of the project.
Thanks to Susan Levings and Eric Davila who have organized and developed the blog site. They have done an outstanding job. This is a wonderful and creative way to share my experiences with the local community and the world. The feedback from readers has been sensational.
Finally I want to say a very special to Dr. Sally Rankin, who without, this project would not be. I thank her for her mentorship and guidance during this process.
It’s 12 noon, I’m back in San Francisco, and Ron is on his way to pick me up. Truly there is no place like home!
Tuesday, July 29, 2008
Monday, July 28, 2008
On My Way Home
Johannesburg, South Africa
Leg two of the trip. The 11 hour flight is hard but I am getting more exciting about getting closer to home. Next stop is Frankfurt, Germany.
Leg two of the trip. The 11 hour flight is hard but I am getting more exciting about getting closer to home. Next stop is Frankfurt, Germany.
Saying Goodbye
Blantyre, Malawi
Saying the final goodbyes was difficult. One of our research supervisors who is Malawian placed his head on my shoulder and said “I have no words”. I had no words either. I just hugged him and said “It’s alright; we will see each other again.” The friendships and collegial relationships that developed over the past 3 weeks are amazing. I worked very closely with the Malawi and US research team members just about every day since we arrived 3 weeks ago.
I am 33,000 feet in the air leaving the beautiful country of Malawi on the first leg of my journey home. It has been an amazing experience and I am grateful for the opportunity to conduct this research project on such an incredible health crisis tropic and to learn more about traditional healers—such an interesting group of health care providers in Africa.
Saying the final goodbyes was difficult. One of our research supervisors who is Malawian placed his head on my shoulder and said “I have no words”. I had no words either. I just hugged him and said “It’s alright; we will see each other again.” The friendships and collegial relationships that developed over the past 3 weeks are amazing. I worked very closely with the Malawi and US research team members just about every day since we arrived 3 weeks ago.
I am 33,000 feet in the air leaving the beautiful country of Malawi on the first leg of my journey home. It has been an amazing experience and I am grateful for the opportunity to conduct this research project on such an incredible health crisis tropic and to learn more about traditional healers—such an interesting group of health care providers in Africa.
Saturday, July 26, 2008
Singing, Dancing, and Preaching at the Pentecostal Church
Chimwankhunda, Malawi
Our morning began early as we set out to attend a 7:30 a.m. service at the Living Waters Church (Pentecostal) in Chimwankhunda. This faith-based organization is one of the five religious groups in our study. Religious organizations are a large part of the lives of Malawians, and it has been an honor to witness the various church services these past three weeks.
When we arrived we found out that an earlier service had started at 6 a.m. We waited outside for the next service scheduled to begin at 8 a.m. The service activities were lively, and the service lasted for almost 3 hours! It was indeed a physical and spiritual workout. There is a lovely young adult choir that stood on its feet most of the service and a lovely women’s choir that delivered soulful songs. There is something about African a cappella singing – it’s hard to describe but the tone is deep and rich and you feel transported back to earlier times. I can just imagine my ancestors singing stories to the village community or teaching songs to young children. There was lively singing, dancing, hand clapping, speaking in tongues, and preaching – all the things I remembered about the Pentecostal services I attended as a child. Malawians are serious about their faith, and the church is a strong influential power and plays a critical role in disseminating information and education about HIV/AIDS to local members. I shall never forget this service. I had heard so much about the church and I’m glad I was able to visit.
The afternoon was spent packing and reflecting more on the past three weeks. At this time my feelings are mixed. I am ready to return home, and I am missing my new friends who I’ve met in Malawi.
Our morning began early as we set out to attend a 7:30 a.m. service at the Living Waters Church (Pentecostal) in Chimwankhunda. This faith-based organization is one of the five religious groups in our study. Religious organizations are a large part of the lives of Malawians, and it has been an honor to witness the various church services these past three weeks.
When we arrived we found out that an earlier service had started at 6 a.m. We waited outside for the next service scheduled to begin at 8 a.m. The service activities were lively, and the service lasted for almost 3 hours! It was indeed a physical and spiritual workout. There is a lovely young adult choir that stood on its feet most of the service and a lovely women’s choir that delivered soulful songs. There is something about African a cappella singing – it’s hard to describe but the tone is deep and rich and you feel transported back to earlier times. I can just imagine my ancestors singing stories to the village community or teaching songs to young children. There was lively singing, dancing, hand clapping, speaking in tongues, and preaching – all the things I remembered about the Pentecostal services I attended as a child. Malawians are serious about their faith, and the church is a strong influential power and plays a critical role in disseminating information and education about HIV/AIDS to local members. I shall never forget this service. I had heard so much about the church and I’m glad I was able to visit.
The afternoon was spent packing and reflecting more on the past three weeks. At this time my feelings are mixed. I am ready to return home, and I am missing my new friends who I’ve met in Malawi.
Getting Ready to Leave Malawi
Limbe, Malawi
The process of saying farewell to members of the research team has begun. The past 3 weeks have passed quickly, and we have completed an incredible amount of work. For me, today was the most restful day of the entire trip. I typed a transcript and some field notes but most of the day I just rested and began to pack my bags for home. There are three of us left, and we spent the time putting the final touches to the remaining work to be conducted by the Malawi research team for the rest of the year. For my project I have interview transcripts that have to be translated into English and typed, which is not an easy task, but I am confident that our research assistants will do a stellar job!
The process of saying farewell to members of the research team has begun. The past 3 weeks have passed quickly, and we have completed an incredible amount of work. For me, today was the most restful day of the entire trip. I typed a transcript and some field notes but most of the day I just rested and began to pack my bags for home. There are three of us left, and we spent the time putting the final touches to the remaining work to be conducted by the Malawi research team for the rest of the year. For my project I have interview transcripts that have to be translated into English and typed, which is not an easy task, but I am confident that our research assistants will do a stellar job!
Friday, July 25, 2008
Celebrating with Roasted Goat, Fanta, Dance
Limbe, Malawi
Today is clean-up day to make sure we have all of our documents on the various computers before we leave for home. I still have interviews to conduct next year, but the plan is to analyze what we have and possibly then modify our questions based on our preliminary data analysis. We have completed most of our interviews of religious leaders and adults living with HIV/AIDS.
We had our celebration party today with our Malawian research team members. A good time was had by all, although it was bittersweet. Eating, drinking Fanta sodas, and dancing. I’ve been craving roasted goat since I arrived in Malawi and today my craving was satisfied. I even had the honor of roasting the meat. Yum! Yum!
Today is clean-up day to make sure we have all of our documents on the various computers before we leave for home. I still have interviews to conduct next year, but the plan is to analyze what we have and possibly then modify our questions based on our preliminary data analysis. We have completed most of our interviews of religious leaders and adults living with HIV/AIDS.
Me grilling goat meat
House where I lived while conducting my research. It was in the Assemblies of God Mission
Assembies of God Mission sign
Thursday, July 24, 2008
The Weaving Factory in Limbe
Limbe, Malwi
Today I typed up a traditional healer transcript that contained a lot of interesting data to process and reflect on. Most of the research team is out today conducting interviews, and the rest of us stayed behind to catch up on our paper work.
During the late morning I paid a visit to the Weaving Factory in Limbe. This is a terrific place. Eighty percent of the employees have some kind of physical disability. This includes being blind, deaf, mute, or have difficulty walking. With their other senses the factory workers are able to create beautiful rugs, place mats, screen printing of T-shirts, dresses, and all kinds of gorgeous products. They spin their own yarn, dye the yarn, and then weave it into rugs, mats, purses, whatever, right on the premises. It was a sight to behold.
Today I typed up a traditional healer transcript that contained a lot of interesting data to process and reflect on. Most of the research team is out today conducting interviews, and the rest of us stayed behind to catch up on our paper work.
During the late morning I paid a visit to the Weaving Factory in Limbe. This is a terrific place. Eighty percent of the employees have some kind of physical disability. This includes being blind, deaf, mute, or have difficulty walking. With their other senses the factory workers are able to create beautiful rugs, place mats, screen printing of T-shirts, dresses, and all kinds of gorgeous products. They spin their own yarn, dye the yarn, and then weave it into rugs, mats, purses, whatever, right on the premises. It was a sight to behold.
Wednesday, July 23, 2008
Who Are These Strangers?
Mulanje and Loundu, Malawi
Mulanje is one of the most beautiful places that I have seen in Malawi. I’ve visited Lake Malawi, which is beautiful, but this area with the famous Mount Mulanje was just breath taking. This region is the home of the tea plantations, so please imagine a green carpet (tea bushes) extending from the road up to the base of the mountains. The tea plants give off various shades of green depending on how the sun reflects back from the majestic slopes. In the distance you can see the tea pickers gathering the harvest with their baskets and tea leave clippers.
We passed the tea factory the employs a lot of Malawians; every morning at the research headquarters for breakfast and during the day we drink the popular Chombe tea, which is grown in Mulanje. When I return to Mulanje I plan to hike up the mountain – I have an entire year to get in shape for that.
Today’s business included interviewing two traditional healers. This is exciting because these are healers from rural villages. Once we were at the main entrance of the village we had to walk about a quarter of a mile to reach our first respondent in Mabuka Village. We met the chief of the village, who is a woman, and per protocol we greeted the village chief and explained to her the purpose of our visit. She was very kind, gracious, and welcoming. I was curious about how she became the chief of the village, and I was told she inherited the position from her uncle. This was surprising to me as we often assume that positions are inherited from parents, but not in this case.
The traditional healer who we met was very warm and open, and the interview went well. We met his wife and a few of his children. The village was very peaceful and serene. The children are running about playing, and they are always very curious when visitors are present.
We then went off to Loundu Village to meet another traditional healer. He welcomed us and invited us to enter his house. He was very gracious and permitted us take photos of his traditional medicine collection, which included herbs, leaves, dried roots, and tree bark. I don’t have names of these medicines but some of the names in Chichewa might come out in the interviews. As we waited outside while the interview was conducted in his house, the children gathered looking as if to ask – “who are these strangers?” The scenic views were spectacular, and there was a wonderful sense of calm and peace in the village.
I am grateful to Alice who is a GAIA regional director, and Edna who is a GAIA village coordinator, for arranging the interviews. Their assistance in this process is what makes our international research efforts successful!
Mulanje is one of the most beautiful places that I have seen in Malawi. I’ve visited Lake Malawi, which is beautiful, but this area with the famous Mount Mulanje was just breath taking. This region is the home of the tea plantations, so please imagine a green carpet (tea bushes) extending from the road up to the base of the mountains. The tea plants give off various shades of green depending on how the sun reflects back from the majestic slopes. In the distance you can see the tea pickers gathering the harvest with their baskets and tea leave clippers.
We passed the tea factory the employs a lot of Malawians; every morning at the research headquarters for breakfast and during the day we drink the popular Chombe tea, which is grown in Mulanje. When I return to Mulanje I plan to hike up the mountain – I have an entire year to get in shape for that.
Me (front row, sitting) with villagers from Mambuka where we interviewed a traditonal healer
The traditional healer who we met was very warm and open, and the interview went well. We met his wife and a few of his children. The village was very peaceful and serene. The children are running about playing, and they are always very curious when visitors are present.
We then went off to Loundu Village to meet another traditional healer. He welcomed us and invited us to enter his house. He was very gracious and permitted us take photos of his traditional medicine collection, which included herbs, leaves, dried roots, and tree bark. I don’t have names of these medicines but some of the names in Chichewa might come out in the interviews. As we waited outside while the interview was conducted in his house, the children gathered looking as if to ask – “who are these strangers?” The scenic views were spectacular, and there was a wonderful sense of calm and peace in the village.
Edna (GAIA coordinator), me, Edgar, and the Chief woman of the village (left to right) with beautiful village children.
Tuesday, July 22, 2008
The Final Stretch
Limbe, Malawi
The research “train” is pulling into the final stretch of our last week here in Malawi. The discussions today with the research team focused on the next steps for the summer and next year for the current project and future projects for which we are awaiting funding. Everyone is busy transcribing interviews from Chichewa into English and then typing the interviews for analysis. We have interviews schedule tomorrow with traditional healers in rural areas.
The time has passed very quickly, but I am thrilled at how productive the data collection has been. We are treading new waters with exploring our sample of traditional healers; the support of the research team with this process has exceeded my expectations!
The research “train” is pulling into the final stretch of our last week here in Malawi. The discussions today with the research team focused on the next steps for the summer and next year for the current project and future projects for which we are awaiting funding. Everyone is busy transcribing interviews from Chichewa into English and then typing the interviews for analysis. We have interviews schedule tomorrow with traditional healers in rural areas.
The time has passed very quickly, but I am thrilled at how productive the data collection has been. We are treading new waters with exploring our sample of traditional healers; the support of the research team with this process has exceeded my expectations!
Monday, July 21, 2008
Eric and Sam
Lilongwe, Malawi
Today is a stay-at-headquarters day dedicated to catching up on paperwork and continuing data analysis. All of the research team members are busy transcribing interviews or typing interviews. We are all either connected to an audio recorder or laptop computer.
The research process is slowing down a little, and we are discussing what will take place when the American team returns to the US and the Malawi team continues with the work.
In the afternoon we are treated to a tour of the Open Arms orphanage. I visited this place in 2004 when I was last in Malawi. The organization accepts children from birth and keeps them for up to two years. Most of the children have lost their mothers, and the goal is to reunite the children with their families in the villages. Most times this works out, but sometimes the children are returned to Open Arms. An outreach program is in place to provide housing and schooling for the orphans who cannot be reunited with their families or adopted.
The care givers are spectacular, and they provide a safe and loving environment for the children to thrive. One way to tell that the children are well loved is that they come up to you with outstretched arms waiting to be picked up. How can anyone resist such an invitation? Once you pick them up, it is very hard to put them down! I was instantly drawn to a little boy named Eric and his twin brother named Sam. I wish I could bring both of them back with me to California. Perhaps another time.
Today is a stay-at-headquarters day dedicated to catching up on paperwork and continuing data analysis. All of the research team members are busy transcribing interviews or typing interviews. We are all either connected to an audio recorder or laptop computer.
The research process is slowing down a little, and we are discussing what will take place when the American team returns to the US and the Malawi team continues with the work.
In the afternoon we are treated to a tour of the Open Arms orphanage. I visited this place in 2004 when I was last in Malawi. The organization accepts children from birth and keeps them for up to two years. Most of the children have lost their mothers, and the goal is to reunite the children with their families in the villages. Most times this works out, but sometimes the children are returned to Open Arms. An outreach program is in place to provide housing and schooling for the orphans who cannot be reunited with their families or adopted.
The care givers are spectacular, and they provide a safe and loving environment for the children to thrive. One way to tell that the children are well loved is that they come up to you with outstretched arms waiting to be picked up. How can anyone resist such an invitation? Once you pick them up, it is very hard to put them down! I was instantly drawn to a little boy named Eric and his twin brother named Sam. I wish I could bring both of them back with me to California. Perhaps another time.
Sunday, July 20, 2008
Off to Church
Chirimba, Limbe, Malawi
This morning we are off to the Presbyterian Church for Sunday morning service. The Malawians are always very gracious when they have guests from America. I sat up in the front area with the pastor, other clergy, and the lay leaders of the church. The service was in English, so it was like attending church in San Francisco. The singing was wonderful and they sang hymns with which I was familiar. A trio of young men sang a couple of selections with taped music, and they were great. After the service we toured the property on which the church is building a new fellowship hall, and they have plans toconstruct a building for the children. This was a prosperous church by Malawi standards, but there is a constant need for resources, mainly money to complete buildings and grounds projects.
The rest of the day was restful, and we planned for the upcoming week. On Wednesday we will go out and try to collect a few more interviews with traditional healers in the rural areas.
I decided in the last week that it would be interesting to collect advertisements from the local news papers placed by traditional healers or people selling herbal products to treat medical conditions, including HIV/AIDS. The process is interesting, and this could be a separate study in itself. So we will see what this activity yields.
This morning we are off to the Presbyterian Church for Sunday morning service. The Malawians are always very gracious when they have guests from America. I sat up in the front area with the pastor, other clergy, and the lay leaders of the church. The service was in English, so it was like attending church in San Francisco. The singing was wonderful and they sang hymns with which I was familiar. A trio of young men sang a couple of selections with taped music, and they were great. After the service we toured the property on which the church is building a new fellowship hall, and they have plans toconstruct a building for the children. This was a prosperous church by Malawi standards, but there is a constant need for resources, mainly money to complete buildings and grounds projects.
The rest of the day was restful, and we planned for the upcoming week. On Wednesday we will go out and try to collect a few more interviews with traditional healers in the rural areas.
I decided in the last week that it would be interesting to collect advertisements from the local news papers placed by traditional healers or people selling herbal products to treat medical conditions, including HIV/AIDS. The process is interesting, and this could be a separate study in itself. So we will see what this activity yields.
Saturday, July 19, 2008
Tracking Expenses
Limbe, Malawi
Today was a low-key day. It’s hard to believe that two weeks have passed, they have very quickly. The data collection process has gone well. I might get a few more interviews with traditional healers next week. I worked on budget issues keeping my Excel spread sheet up to date with the grant expenses. Tomorrow I will be attending a Presbyterian Church service with our friend Alice Bivumbe who is the Global Aids Interfaith Alliance (GAIA) project director for the southern region of Malawi.
Today was a low-key day. It’s hard to believe that two weeks have passed, they have very quickly. The data collection process has gone well. I might get a few more interviews with traditional healers next week. I worked on budget issues keeping my Excel spread sheet up to date with the grant expenses. Tomorrow I will be attending a Presbyterian Church service with our friend Alice Bivumbe who is the Global Aids Interfaith Alliance (GAIA) project director for the southern region of Malawi.
Friday, July 18, 2008
Breakfast at the Ritz
Lilongwe, Limbe, Malawi
The day began with a beautiful English breakfast at Wendel’s, a small piece of paradise tucked away in Lilongwe, and my favorite place to stay in Malawi. We call this place the “Ritz” of Malawi.
After breakfast, we went to Kamuzu College of Nursing to meet with the dean of faculties. She took us on a tour of David Livingstone’s Memorial Clinic, which is run by nursing faculty members. There is a an antenatal clinic, a birthing ward for non-complicated births (However they deliver breech babies, multiple births, vacuum extractions, etc..), an outpatient post-partum clinic, an under-5-years-old clinic, and a primary care clinic for male and female adults. The facilities are beautiful with nice beds, pretty room décor, showers, etc. They are the best I’ve seen in Malawi.
We then went off to see the pediatric HIV clinic, which is part of the Baylor School of Medicine initiative. The facility is 2 years old, and is absolutely gorgeous. I visited the pharmacy and saw a pharmacist providing medication counseling to a mother. During our visit, we saw two pediatricians who completed their pediatric residency training at UCSF, and they were happy to see me and my colleague Ellen. They have been in Malawi for a year working at the clinic.
As we journeyed back to Limbe, we passed several outdoor markets because Friday is “Market Day”. There are crowds of people selling fruits, vegetables, and clothing – lots of stuff. I must say that the fruits and vegetables looked beautiful. It’s all organic! The tomatoes are a rich red and the carrots are bright orange. They had lovely eggplants, onions, peas, green beans – just about anything you could want. Our driver got out, making a few purchases, and I stayed in the car. A mob of people, hoping we would buy something, swarmed the car offering what they had. I was afraid to step out of the car because I did not know how to choose which seller.
The day began with a beautiful English breakfast at Wendel’s, a small piece of paradise tucked away in Lilongwe, and my favorite place to stay in Malawi. We call this place the “Ritz” of Malawi.
After breakfast, we went to Kamuzu College of Nursing to meet with the dean of faculties. She took us on a tour of David Livingstone’s Memorial Clinic, which is run by nursing faculty members. There is a an antenatal clinic, a birthing ward for non-complicated births (However they deliver breech babies, multiple births, vacuum extractions, etc..), an outpatient post-partum clinic, an under-5-years-old clinic, and a primary care clinic for male and female adults. The facilities are beautiful with nice beds, pretty room décor, showers, etc. They are the best I’ve seen in Malawi.
We then went off to see the pediatric HIV clinic, which is part of the Baylor School of Medicine initiative. The facility is 2 years old, and is absolutely gorgeous. I visited the pharmacy and saw a pharmacist providing medication counseling to a mother. During our visit, we saw two pediatricians who completed their pediatric residency training at UCSF, and they were happy to see me and my colleague Ellen. They have been in Malawi for a year working at the clinic.
As we journeyed back to Limbe, we passed several outdoor markets because Friday is “Market Day”. There are crowds of people selling fruits, vegetables, and clothing – lots of stuff. I must say that the fruits and vegetables looked beautiful. It’s all organic! The tomatoes are a rich red and the carrots are bright orange. They had lovely eggplants, onions, peas, green beans – just about anything you could want. Our driver got out, making a few purchases, and I stayed in the car. A mob of people, hoping we would buy something, swarmed the car offering what they had. I was afraid to step out of the car because I did not know how to choose which seller.
Thursday, July 17, 2008
Graduation at Kamuzu College of Nursing
Lilongwe, Malawi
Today I took a side trip to Lilongwe to attend a ceremony for entering nursing students who have received GAIA scholarships at Kamuzu College of Nursing. Being a GAIA Board member, I was happy to attend. The ceremony was beautiful. The young women are all smiles and excited about their new academic journey. The country of Malawi is in desperate need of nurses and all other medical personnel. This is a great way to assist young women who would otherwise not be able to attend nursing school due to lack of funds. The scholarship is for 4 years and the students sign a contract to stay in the country at least for 4 years after graduation.
Lots of important government people attended. The Minister of Health for Malawi was there along with his office; the Vice Chancellor of Kamuzu College attended as well. The auditorium was packed. GAIA President Dr. Bill Rankin gave a few remarks. It was truly beautiful. The Malawi press was present and there was some interviewing and picture taking. There was a reception afterwards - a truly heart warming and significant event.
Not much research done today, but it is because of my association with GAIA that I was successful in getting the grant to conduct my project. Tomorrow we return to Limbe.
Today I took a side trip to Lilongwe to attend a ceremony for entering nursing students who have received GAIA scholarships at Kamuzu College of Nursing. Being a GAIA Board member, I was happy to attend. The ceremony was beautiful. The young women are all smiles and excited about their new academic journey. The country of Malawi is in desperate need of nurses and all other medical personnel. This is a great way to assist young women who would otherwise not be able to attend nursing school due to lack of funds. The scholarship is for 4 years and the students sign a contract to stay in the country at least for 4 years after graduation.
Lots of important government people attended. The Minister of Health for Malawi was there along with his office; the Vice Chancellor of Kamuzu College attended as well. The auditorium was packed. GAIA President Dr. Bill Rankin gave a few remarks. It was truly beautiful. The Malawi press was present and there was some interviewing and picture taking. There was a reception afterwards - a truly heart warming and significant event.
Not much research done today, but it is because of my association with GAIA that I was successful in getting the grant to conduct my project. Tomorrow we return to Limbe.
Wednesday, July 16, 2008
A Gift of Song
Zomba, Malawi
We went to Zomba, and the team interviewed people living with HIV/AIDS. This group is part of my study. I am interested in how their church is helping them access ARVs, if they have consulted a traditional healer for medicines to treat HIV/AIDS, and the barriers they have experienced accessing ARVs.
These villages are also ones that have benefited from Global Aids Interfaith Alliance (GAIA) projects, which include: home-based care for people who are HIV positive or people who are caring for HIV positive family members or friends, orphan care, support for secondary school fees, and income generating activities for the women of the village.
We met a group of women who started a mushroom farm in the village and are now planting maize (corn) to sell for income. Thus far the projects have made good profits, and they want to continue. There were a few of us who asked questions, so it was like a town hall meeting of sorts, run by the women of the village. It was exciting to see the exchange of ideas and the discourse that occurred over the logistics of the projects and the logical next steps. As with all businesses, not everyone involved agrees on each step of the process or in what ways to move forward, so the challenge is to figure out some sort of compromise. A small village in Malawi or a corporate office in San Francisco, the human conflict is the same!
The trip back to Limbe is reflective and quite bumpy. Life in these small townships and villages is so different to what I’m use to in my day-to-day life in San Francisco. The people in Malawi have very little, but they manage to do the best they can.
I end today with the image of the village women singing to us as we left the village. I did not understand the words, but the rhythm was fun and I could clap with them as we walked down the road. It was translated to me to mean “have a safe journey and God Bless you”. How generous of them to leave us with such a gift of song!
We went to Zomba, and the team interviewed people living with HIV/AIDS. This group is part of my study. I am interested in how their church is helping them access ARVs, if they have consulted a traditional healer for medicines to treat HIV/AIDS, and the barriers they have experienced accessing ARVs.
These villages are also ones that have benefited from Global Aids Interfaith Alliance (GAIA) projects, which include: home-based care for people who are HIV positive or people who are caring for HIV positive family members or friends, orphan care, support for secondary school fees, and income generating activities for the women of the village.
We met a group of women who started a mushroom farm in the village and are now planting maize (corn) to sell for income. Thus far the projects have made good profits, and they want to continue. There were a few of us who asked questions, so it was like a town hall meeting of sorts, run by the women of the village. It was exciting to see the exchange of ideas and the discourse that occurred over the logistics of the projects and the logical next steps. As with all businesses, not everyone involved agrees on each step of the process or in what ways to move forward, so the challenge is to figure out some sort of compromise. A small village in Malawi or a corporate office in San Francisco, the human conflict is the same!
The trip back to Limbe is reflective and quite bumpy. Life in these small townships and villages is so different to what I’m use to in my day-to-day life in San Francisco. The people in Malawi have very little, but they manage to do the best they can.
I end today with the image of the village women singing to us as we left the village. I did not understand the words, but the rhythm was fun and I could clap with them as we walked down the road. It was translated to me to mean “have a safe journey and God Bless you”. How generous of them to leave us with such a gift of song!
Tuesday, July 15, 2008
Women Healers and Helpers
Ndirande, Malawi
This is day 2 of interviews with traditional healers. This is turning out to be more productive that I could have imagined. The traditional healers are members of one organization, and the members come from all around the southern parts of Malawi. They have been so gracious and open to talking with us. We were thrilled to meet a traditional doctor today who is a woman. Her interview was done in Chichewa, so I can’t wait to read the manuscript.
I am struck by the poverty in the Ndirande area. The central market place is packed with people sharing the streets with mini vans and cars. As I waited for the interviews to finish I took in the natural beauty of the area. The sun was out, the sky was a great blue, and the white puffy clouds (like balls of cotton) were so close you could reach up and touch them.
To add to all the good things happening today, I met women who serve as traditional birth attendants. They assist women in the villages during the birthing process. The villages are located miles away from the regional hospital, and the regular mode of transportation is walking. So, it is difficult for a woman in labor to walk long distances to the hospital. The attendants are working with the traditional healers to organize themselves and their work.
Today was truly another fascinating day of learning more about the culture of traditional healers.
This is day 2 of interviews with traditional healers. This is turning out to be more productive that I could have imagined. The traditional healers are members of one organization, and the members come from all around the southern parts of Malawi. They have been so gracious and open to talking with us. We were thrilled to meet a traditional doctor today who is a woman. Her interview was done in Chichewa, so I can’t wait to read the manuscript.
I am struck by the poverty in the Ndirande area. The central market place is packed with people sharing the streets with mini vans and cars. As I waited for the interviews to finish I took in the natural beauty of the area. The sun was out, the sky was a great blue, and the white puffy clouds (like balls of cotton) were so close you could reach up and touch them.
To add to all the good things happening today, I met women who serve as traditional birth attendants. They assist women in the villages during the birthing process. The villages are located miles away from the regional hospital, and the regular mode of transportation is walking. So, it is difficult for a woman in labor to walk long distances to the hospital. The attendants are working with the traditional healers to organize themselves and their work.
Today was truly another fascinating day of learning more about the culture of traditional healers.
Monday, July 14, 2008
Interviews at the International Traditional Healers' Council of Malawi
Ndirande, Malawi
Today was an exciting day. We drove from Limbe to Ndirande District.
Ndirande is pretty intense. There are lots and lots of people and narrow dirt roads streets with lots of cars, mini buses, and pedestrians. I don't think I mentioned this before but you drive on the left side of the road, which makes me uneasy as I always feel that we are going down the wrong side of the road.
We arrived at the headquarters of the International Traditional Healers' Council of Malawi at about 9:00 a.m. Edgar (one of our Malawian research team members) and I walked into a small room where we were greeted by traditional doctors and their office staff. The organization was first registered in 1963. The office room is quite small and dark. We spent about 3 1/2 hours interviewing the traditional doctors. I would love to discuss what we were told but I think it¹s best to wait until I get more data. Suffice it to say we obtained a lot of information, and I am flooded with waves of emotion. I was surprised, pleased, curious, scared, and
skeptical all at the same time by what I was told. I interviewed 2 doctors
in English, and Edgar interviewed 2 doctors in Chichewa. All went well, and we have 4 interviews planned for tomorrow. I would say it was a productive day!
Now the next step in the research process is to type up my interviews, at least the ones I did in English, and write up what we call field notes that describe what I saw, felt, and thought about during the process. The interviews conducted in Chichewa need to be transcribed in English and then typed, which is a long and laborious process. Well, as the old saying goes, "no pain no gain" such is the process of qualitative research.
Today was an exciting day. We drove from Limbe to Ndirande District.
Ndirande is pretty intense. There are lots and lots of people and narrow dirt roads streets with lots of cars, mini buses, and pedestrians. I don't think I mentioned this before but you drive on the left side of the road, which makes me uneasy as I always feel that we are going down the wrong side of the road.
We arrived at the headquarters of the International Traditional Healers' Council of Malawi at about 9:00 a.m. Edgar (one of our Malawian research team members) and I walked into a small room where we were greeted by traditional doctors and their office staff. The organization was first registered in 1963. The office room is quite small and dark. We spent about 3 1/2 hours interviewing the traditional doctors. I would love to discuss what we were told but I think it¹s best to wait until I get more data. Suffice it to say we obtained a lot of information, and I am flooded with waves of emotion. I was surprised, pleased, curious, scared, and
skeptical all at the same time by what I was told. I interviewed 2 doctors
in English, and Edgar interviewed 2 doctors in Chichewa. All went well, and we have 4 interviews planned for tomorrow. I would say it was a productive day!
Now the next step in the research process is to type up my interviews, at least the ones I did in English, and write up what we call field notes that describe what I saw, felt, and thought about during the process. The interviews conducted in Chichewa need to be transcribed in English and then typed, which is a long and laborious process. Well, as the old saying goes, "no pain no gain" such is the process of qualitative research.
Sunday, July 13, 2008
Service at Mount Soche Anglican Church
Mount Soche District & Limbe, Malawi
The morning began early. We left headquarters at 7:30 a.m and went to a service that began at 6:30 a.m. at the Mount Soche Anglican Church, which is one of the largest Anglican congregations in the Blantyre area. (As you will notice, we were an hour late.) The service was traditional with lots of prayers and singing, which is always amazing. The women sat on one side and the men on the other. All of the children and youth were seated towards the front. I went to the front to take communion; everyone was warm and welcoming. This was the site for interviews for the larger research project-- which I explained in one of my first postings--so after the service volunteers (local church members) were interviewed by our research assistants. It was a productive day.
The rest of the day was very quiet. I spent most of the time coding transcripts and preparing files for future interviews. The weather has been quite chilly these past few days, so we are drinking a lot of tea to keep warm. (No central heating!)
I spent the evening hours preparing to interview traditional healers tomorrow. We have an appointment lined up tomorrow morning with four traditional healers. Edgar has done a fantastic job. I will do interviews if the traditional healers speak English, and Edgar will do them in Chichewa. With the permission of the interviewees we will record the encounters. There are lots of things to consider culturally as we do not want to unintentionally offend any one. All should go well, and I will keep an open heart and mind to stories that will be shared.
The morning began early. We left headquarters at 7:30 a.m and went to a service that began at 6:30 a.m. at the Mount Soche Anglican Church, which is one of the largest Anglican congregations in the Blantyre area. (As you will notice, we were an hour late.) The service was traditional with lots of prayers and singing, which is always amazing. The women sat on one side and the men on the other. All of the children and youth were seated towards the front. I went to the front to take communion; everyone was warm and welcoming. This was the site for interviews for the larger research project-- which I explained in one of my first postings--so after the service volunteers (local church members) were interviewed by our research assistants. It was a productive day.
The rest of the day was very quiet. I spent most of the time coding transcripts and preparing files for future interviews. The weather has been quite chilly these past few days, so we are drinking a lot of tea to keep warm. (No central heating!)
I spent the evening hours preparing to interview traditional healers tomorrow. We have an appointment lined up tomorrow morning with four traditional healers. Edgar has done a fantastic job. I will do interviews if the traditional healers speak English, and Edgar will do them in Chichewa. With the permission of the interviewees we will record the encounters. There are lots of things to consider culturally as we do not want to unintentionally offend any one. All should go well, and I will keep an open heart and mind to stories that will be shared.
Saturday, July 12, 2008
Our First Interview with a Traditional Healer
Limbe, Malawi
Today we scored - our first interview with a traditional healer! The interview was conducted by Andy in Chichewa, so I have to wait for the transcript to be translated into English. I knew going into this project that this group of interviews would not be straight forward. The reports of the interview were very positive in terms of the information gathered. I will learn a lot from this process with regard to proper protocol when interacting with the traditional healers. For example, all traditional healers are referred to as “Doctor” even though they do not have a medical degree or other professional degree.
Most of the day was spent accessing the internet. We went to an internet café at the airport and one in a very nice hotel called Ryals in downtown Blantyre. The connections are very slow and it is difficult if almost impossible to send large files like photos. It is encouraging that the use of technology is getting easier with each passing year.
Edgar and I plan to set up interviews with about four traditional healers for Monday afternoon. I am very excited and will have more to write on that on Monday.
Earlier this evening I had the opportunity to meet Sister Connelly who I met in Malawi 4 years ago. She is a Medical Missions Sister from the Philippines, and she’s been in Malawi for more than 20 years. Our special connection is that she is a pharmacist, and her area of expertise is herbal and traditional medicines. Seeing her again was a treat! See our picture at the first page of my blog. It was taken in 2004 when I first visited Malawi.
Tonight was my turn to lead the cooking for dinner. I made deconstructed chicken pot pie. The chickens are about ½ the size of chickens we buy at the local Safeway. All of the vegetables – peas, carrots, green beans, and potatoes were fresh and with the homemade chicken stock from the boiled chicken I made homemade chicken gravy. Yum! Yum! I was assisted in this creation by one our research team members Ellen Scarr (School of Nursing faculty) who is an excellent chef in her own right. It was like Food Network comes to Malawi.
Today we scored - our first interview with a traditional healer! The interview was conducted by Andy in Chichewa, so I have to wait for the transcript to be translated into English. I knew going into this project that this group of interviews would not be straight forward. The reports of the interview were very positive in terms of the information gathered. I will learn a lot from this process with regard to proper protocol when interacting with the traditional healers. For example, all traditional healers are referred to as “Doctor” even though they do not have a medical degree or other professional degree.
Most of the day was spent accessing the internet. We went to an internet café at the airport and one in a very nice hotel called Ryals in downtown Blantyre. The connections are very slow and it is difficult if almost impossible to send large files like photos. It is encouraging that the use of technology is getting easier with each passing year.
Edgar and I plan to set up interviews with about four traditional healers for Monday afternoon. I am very excited and will have more to write on that on Monday.
Earlier this evening I had the opportunity to meet Sister Connelly who I met in Malawi 4 years ago. She is a Medical Missions Sister from the Philippines, and she’s been in Malawi for more than 20 years. Our special connection is that she is a pharmacist, and her area of expertise is herbal and traditional medicines. Seeing her again was a treat! See our picture at the first page of my blog. It was taken in 2004 when I first visited Malawi.
Tonight was my turn to lead the cooking for dinner. I made deconstructed chicken pot pie. The chickens are about ½ the size of chickens we buy at the local Safeway. All of the vegetables – peas, carrots, green beans, and potatoes were fresh and with the homemade chicken stock from the boiled chicken I made homemade chicken gravy. Yum! Yum! I was assisted in this creation by one our research team members Ellen Scarr (School of Nursing faculty) who is an excellent chef in her own right. It was like Food Network comes to Malawi.
Friday, July 11, 2008
The Internet Center
Limbe, Malawi
The main mission for today is to get to the Internet Center. Sending email is not as easy as I thought it would be. AT&T does not have a contract in Malawi...a small detail they forgot to mention even though I specifically asked. In defense of Malawi, the country has come a long way. Last year some of the research team members from the U.S. could not use their ATM cards; this year we can.
I stayed at the headquarters compound most of the day. I worked with one of our research assistants Edgar (a Malawian) who is helping me scout traditional healers for interviews. This is not an easy task. In the U.S. appointments for interviews or focus groups are made weeks in advance. In Malawi, this does not happen. You make a phone call and if the person is available that day you can meet. If not, you can arrange to meet in the next day or two. The research recruitment process is a little more spontaneous in Malawi. The key to success here is to be “flexible”.
Malawi lies below the equator and during this time of year we experience about 12 hours of daylight. This is Malawi’s dry season, and so the mosquitoes are not too bad. I am taking my Malarone® (anti-malarial medicine) and sleeping under a mosquito net. The sun is up around 5:30 a.m. and the sun goes down by 6:00 p.m. It is easy to go to bed at 8:30 p.m., but I am wide awake at around 4:30 a.m., then I find it difficult to get up by 7:30 a.m. The mornings are cool and by 11:00 a.m. it can get quite warm. Once the sun sets, the temperature drops. Tonight is the coldest it’s been since I arrived. The winds are blowing strongly, and you can hear the sound of tree branches moving forcefully back and forth. The wind is good as it will blow the diesel and fire fumes away as well as, hopefully, a few mosquitoes. Tomorrow should be a beautiful day.
The main mission for today is to get to the Internet Center. Sending email is not as easy as I thought it would be. AT&T does not have a contract in Malawi...a small detail they forgot to mention even though I specifically asked. In defense of Malawi, the country has come a long way. Last year some of the research team members from the U.S. could not use their ATM cards; this year we can.
I stayed at the headquarters compound most of the day. I worked with one of our research assistants Edgar (a Malawian) who is helping me scout traditional healers for interviews. This is not an easy task. In the U.S. appointments for interviews or focus groups are made weeks in advance. In Malawi, this does not happen. You make a phone call and if the person is available that day you can meet. If not, you can arrange to meet in the next day or two. The research recruitment process is a little more spontaneous in Malawi. The key to success here is to be “flexible”.
Malawi lies below the equator and during this time of year we experience about 12 hours of daylight. This is Malawi’s dry season, and so the mosquitoes are not too bad. I am taking my Malarone® (anti-malarial medicine) and sleeping under a mosquito net. The sun is up around 5:30 a.m. and the sun goes down by 6:00 p.m. It is easy to go to bed at 8:30 p.m., but I am wide awake at around 4:30 a.m., then I find it difficult to get up by 7:30 a.m. The mornings are cool and by 11:00 a.m. it can get quite warm. Once the sun sets, the temperature drops. Tonight is the coldest it’s been since I arrived. The winds are blowing strongly, and you can hear the sound of tree branches moving forcefully back and forth. The wind is good as it will blow the diesel and fire fumes away as well as, hopefully, a few mosquitoes. Tomorrow should be a beautiful day.
Thursday, July 10, 2008
A Day in the Field in the Mulange and Chirizulu Districts
Limbe, Malawi
We were off at 7:00 a.m. to the field to conduct interviews with a group of Malawians who attend the Anglican Church. The villages are located somewhere between the districts of Mulange and Chirizulu. The interviews went well and observing the participants and the surroundings is always an educational and grounding experience, at least for me.
Rural village life is simple but very hard. The poverty is great yet we are greeted with handshakes, smiles, and singing. The study participants gathered at the churches and waited to be interviewed. Prior to the interviews we gathered in the church building that was moderate-sized but was dark (no electricity) and had no seats or benches. There are no glass windows but small holes in the walls that allow in natural light. Once your eyes adjust you can see your neighbor’s face, but you are in the dark. The lay leaders were kind to provide us with benches, but the participants sat on the floor on top of mats. Women on one side and men on the other.
Today is hotter than expected, but there is some relief in the shade with an occasional breeze. Our vehicle seems to be held together by a thread, but it got us to where we needed to go. The backdrop of the area is a picturesque scene of tall mountains surrounding the village with long roads that are very dry and dusty (Red dust covers everything.) There are small brick houses and mud huts with thatched roofs. Outside goats are tied up to small trees to prevent them from wondering off. There are chickens, and a few cows are penned up in the small yards. I saw a few gardens that were well attended and looked beautiful.
Joel, Crystal, and I went scouting for traditional healers. Walking down the village roads we would stop and Joel would ask villagers if they knew where a traditional healer was located. Along the roadside were women and children (preschool age) playing and eating sugarcane. Small girls were carrying water in small buckets on their heads and young men were carrying tree branches on the backs of their bicycles. I saw a little child who was about 3 ½ feet tall carrying sugarcane on top of her head that was twice as long as she was tall. Amazing!
We were off at 7:00 a.m. to the field to conduct interviews with a group of Malawians who attend the Anglican Church. The villages are located somewhere between the districts of Mulange and Chirizulu. The interviews went well and observing the participants and the surroundings is always an educational and grounding experience, at least for me.
Rural village life is simple but very hard. The poverty is great yet we are greeted with handshakes, smiles, and singing. The study participants gathered at the churches and waited to be interviewed. Prior to the interviews we gathered in the church building that was moderate-sized but was dark (no electricity) and had no seats or benches. There are no glass windows but small holes in the walls that allow in natural light. Once your eyes adjust you can see your neighbor’s face, but you are in the dark. The lay leaders were kind to provide us with benches, but the participants sat on the floor on top of mats. Women on one side and men on the other.
Today is hotter than expected, but there is some relief in the shade with an occasional breeze. Our vehicle seems to be held together by a thread, but it got us to where we needed to go. The backdrop of the area is a picturesque scene of tall mountains surrounding the village with long roads that are very dry and dusty (Red dust covers everything.) There are small brick houses and mud huts with thatched roofs. Outside goats are tied up to small trees to prevent them from wondering off. There are chickens, and a few cows are penned up in the small yards. I saw a few gardens that were well attended and looked beautiful.
Our research assistants in the field
Joel, Crystal, and I went scouting for traditional healers. Walking down the village roads we would stop and Joel would ask villagers if they knew where a traditional healer was located. Along the roadside were women and children (preschool age) playing and eating sugarcane. Small girls were carrying water in small buckets on their heads and young men were carrying tree branches on the backs of their bicycles. I saw a little child who was about 3 ½ feet tall carrying sugarcane on top of her head that was twice as long as she was tall. Amazing!
Wednesday, July 9, 2008
Training Our Research Assistants
Limbe, Malawi
This morning the team worked on clarifying the interview questions for the traditional healers and local members living with HIV/AIDS. We are fortunate to have a bright group of research assistants.
This afternoon we conducted a training session for the research assistants who will interview the traditional healers. I gave a brief presentation of the intent of the study and the information we are interested in obtaining from the traditional healers. The process is to read the questions aloud in English and Chichewa and discuss clarifications and to get feedback from the group if the questions make sense to them in English and Chichewa. The process is very helpful, and it ensures as much as possible that everyone is on the same page.
In my mind traditional healers are a mysterious group, possessing a large presence in African culture. This group has not previously interviewed traditional healers, so we will learn a lot as we go along. This is the beauty of qualitative research, meaning we are looking for the stories of the people to help us answer our questions. This is a work in progress, and we will learn new information and rework your interview questions as we go along.
This morning the team worked on clarifying the interview questions for the traditional healers and local members living with HIV/AIDS. We are fortunate to have a bright group of research assistants.
This afternoon we conducted a training session for the research assistants who will interview the traditional healers. I gave a brief presentation of the intent of the study and the information we are interested in obtaining from the traditional healers. The process is to read the questions aloud in English and Chichewa and discuss clarifications and to get feedback from the group if the questions make sense to them in English and Chichewa. The process is very helpful, and it ensures as much as possible that everyone is on the same page.
In my mind traditional healers are a mysterious group, possessing a large presence in African culture. This group has not previously interviewed traditional healers, so we will learn a lot as we go along. This is the beauty of qualitative research, meaning we are looking for the stories of the people to help us answer our questions. This is a work in progress, and we will learn new information and rework your interview questions as we go along.
Tuesday, July 8, 2008
My First Day
Limbe, Malawi
Our official research headquarters is the Assemblies of God Guest House in Limbe, Malawi. It is very large, bright, comfortable, and clean living quarter. Today I met the research team supervisors Joel and Andy and our team of 7 research assistants, all of whom are Malawians. The research assistants are responsible for conducting interviews and then transcribing them into English. All of the interviews are conducted in the native language of Chichewa.
I spent most of the day analyzing interview transcripts and organizing my files for future data analysis. The main objective of this trip is to collect interview data from traditional healers, asking them how they help people with HIV/AIDS access ARV medicines and what “treatments” they recommend for HIV/AIDS, and to examine what Malawians living with HIV/AIDS experience when they try to access ARVs.
Of course not all is work and no play, and since I’m a “foodie” I have to report that my first meal out was Indian food at the Bombay Palace. Very delicious and very inexpensive!
Our official research headquarters is the Assemblies of God Guest House in Limbe, Malawi. It is very large, bright, comfortable, and clean living quarter. Today I met the research team supervisors Joel and Andy and our team of 7 research assistants, all of whom are Malawians. The research assistants are responsible for conducting interviews and then transcribing them into English. All of the interviews are conducted in the native language of Chichewa.
Sally, Sharon, and Andy
I spent most of the day analyzing interview transcripts and organizing my files for future data analysis. The main objective of this trip is to collect interview data from traditional healers, asking them how they help people with HIV/AIDS access ARV medicines and what “treatments” they recommend for HIV/AIDS, and to examine what Malawians living with HIV/AIDS experience when they try to access ARVs.
Of course not all is work and no play, and since I’m a “foodie” I have to report that my first meal out was Indian food at the Bombay Palace. Very delicious and very inexpensive!
Monday, July 7, 2008
We’ve Landed!
Blantyre, Malawi
We have just arrived Malawi and are ONLY 3 hours late. After 2 days of flying and hanging out at airports (Frankfurt, Germany; Johannesburg, South Africa; and then Blantyre, Malawi) I am extremely exhausted, in need of a shower, and excited to be in what I call the “Mother Land” one more time. This is going to be an incredible 3-week journey of discovery both professionally and personally – I can’t wait!
We have just arrived Malawi and are ONLY 3 hours late. After 2 days of flying and hanging out at airports (Frankfurt, Germany; Johannesburg, South Africa; and then Blantyre, Malawi) I am extremely exhausted, in need of a shower, and excited to be in what I call the “Mother Land” one more time. This is going to be an incredible 3-week journey of discovery both professionally and personally – I can’t wait!
Saturday, July 5, 2008
On My Way to Malawi
Somewhere in the Air
I just left San Francisco International Airport aboard a United Airlines jet and am now somewhere high above California as I begin my 36-hour journey to Malawi. I am traveling alone on the first leg of the trip from San Francisco to Frankfurt, Germany. The plan is to meet with Dr. Sally Rankin in Germany, and we will travel the rest of the trip together. Dr. Rankin is the principal investigator of the National Institutes of Health (NIH) R01 parent grant and my mentor, and I am the principal investigator of a 2-year research project diversity supplement grant from the NIH.
The overall purpose of the parent grant is to study the role of 5 religious organizations in Malawi's struggle against HIV/AIDS: Baptist (BACOMA), Muslim (MUWO), Living Waters (LW), Roman Catholic (RC) and Anglican (ANG). My project will look specifically at strategies used by these organizations and by traditional healers to help people living with HIV/AIDS (PLWHA) access antiretroviral (ARV) medicines. I will also look at barriers to treatment and care faced by those infected.
A Bit of Background
A Bit of Background
In order to better understand my reports as I gather data in Malawi, some background on HIV/AIDS in Malawi is in order.
Role of Religious Organizations
The role of Malawi's religious organizations in HIV/AIDS prevention and care is poorly understood within the broader context of Africa's many blended cultures and behaviors. Sub-Saharan African family life and community life are very intertwined with religious life, therefore religious groups, whether they are a fusion of many beliefs or follow a single doctrine, influence HIV-related beliefs and practices.
Religious organizations most often provide the only infrastructures reaching rural areas, where the majority of Malawian people live. Approximately 55% of Malawians are Protestant, 20% are Roman Catholics, 20% or fewer are Muslim, and 5% practice African traditional religions. Religious leaders are frequently accorded respect as opinion-leaders in their communities.
In religious ceremonies, leaders have a public platform from which to challenge destructive prejudices that reinforces stigma, while conveying important information concerning HIV prevention and care. Limited data are available that characterizes how churches provide health information on the care and treatment of people infected with the HIV virus or tangible resources to assist members with costs of transportation, medical care, food, and medications.
The HIV/AIDS Crisis
900,000 Malawians were living with HIV/AIDS at the end of 2003, with 90% of all infections falling within the 15 to 49 age range (810,000 people). The effects of HIV/AIDS on Malawi’s population can be seen in declining life expectancy at birth, which in 2004 was 38 years.
Healthcare and ARV Access
Access to healthcare has impacted the nation’s ability to respond to the epidemic. A 1998 report estimated that 81% of Malawi’s urban population had access to health care services, but only 29% of rural people had such access. A new issue in Malawi is the problem of accessibility and affordability of ARVs that became available during the summer of 2004. Most PLWHA in Malawi are unable to afford medications through private sources and are thus dependent on the free ARVs that are available in 59 hospitals and district clinics. As of July 2005, only 18,000 of the 170,000 HIV-positive men, women, and children who need ARVs are receiving them, primarily through the Ministry of Health’s rollout program to provide free ARVs. In light of the efforts to scale-up distribution of free ARVs, access issues have become an important subject of debate and discussion. PLWHA in need of ARV therapy face the difficult challenge of not having transportation to the hospitals and district clinics that dispense ARVs. Parents who wish to access ARVs for their infected children are presented with obstacles of not having available medications in appropriate pediatric formulations. ARVs that require refrigeration are problematic since 2% of rural households have electricity. Food security plays a significant role because patients often do not have food to take along with the ARV medicines.
Our Project
Within this context, we have set out to learn and describe how religious leaders and traditional healers help people living with HIV/AIDS access antiretroviral (ARV) medicines. This knowledge, in turn, will help to inform future interventions as different groups integrate their activities to help people access ARVs. Ours is a qualitative study using one-time individual interviews. We will be interviewing religious leaders, traditional healers, and PLWHA in rural villages and townships surrounding Blantyre and Zomba, which are in the south central region of Malawi.
Why Me?
Prior to joining the UCSF School of Pharmacy, I worked for 16 years as a clinical pharmacist providing medication information and education to patients in the acute and ambulatory care settings. These experiences then and now have shaped my career goal to become an independent investigator conducting research in the area of racial/ethnic and socioeconomic disparities in health as they relate to medication access and adherence. Currently these topics are of high importance and debate in the United States and worldwide. In 2005, I received a master’s degree in public health, which gave me a broader perspective and understanding of how to provide health information and education to community-based populations and how I as a pharmacist can integrate my unique expertise as a clinician and drug expert in these efforts.
In 2002, I became a member of the Board of Trustees of Global AIDS Interfaith Alliance (GAIA), a non-profit organization that raises funds for HIV/AIDS education and prevention programs in Malawi. We also provide for home-based care for Malawians with HIV/AIDS, orphan care, and women empowerment programs. In my first two trips to Malawi (2002 & 2004) I went in the role of a trustee member. Now in 2006, I am here as a researcher.
Being a part of an inter-professional research team is rewarding. It brings together a variety of perspectives that enrich the research process. I do believe that pharmacists have an important role in assisting patients define and solve problems related to medication access and adherence worldwide. Through this project I hope to enhance my qualitative and quantitative research skills, gain more insight on how to best design and conduct research studied, and eventually develop and test interventions that will improve the processes to access and adherence to medications.
This project is my first opportunity to be involved in international research in Africa. The knowledge we gain will have implications that cross all borders, and I am delighted and honored to be a part of this important work.
I just left San Francisco International Airport aboard a United Airlines jet and am now somewhere high above California as I begin my 36-hour journey to Malawi. I am traveling alone on the first leg of the trip from San Francisco to Frankfurt, Germany. The plan is to meet with Dr. Sally Rankin in Germany, and we will travel the rest of the trip together. Dr. Rankin is the principal investigator of the National Institutes of Health (NIH) R01 parent grant and my mentor, and I am the principal investigator of a 2-year research project diversity supplement grant from the NIH.
The overall purpose of the parent grant is to study the role of 5 religious organizations in Malawi's struggle against HIV/AIDS: Baptist (BACOMA), Muslim (MUWO), Living Waters (LW), Roman Catholic (RC) and Anglican (ANG). My project will look specifically at strategies used by these organizations and by traditional healers to help people living with HIV/AIDS (PLWHA) access antiretroviral (ARV) medicines. I will also look at barriers to treatment and care faced by those infected.
A Bit of Background
A Bit of Background
In order to better understand my reports as I gather data in Malawi, some background on HIV/AIDS in Malawi is in order.
Role of Religious Organizations
The role of Malawi's religious organizations in HIV/AIDS prevention and care is poorly understood within the broader context of Africa's many blended cultures and behaviors. Sub-Saharan African family life and community life are very intertwined with religious life, therefore religious groups, whether they are a fusion of many beliefs or follow a single doctrine, influence HIV-related beliefs and practices.
Religious organizations most often provide the only infrastructures reaching rural areas, where the majority of Malawian people live. Approximately 55% of Malawians are Protestant, 20% are Roman Catholics, 20% or fewer are Muslim, and 5% practice African traditional religions. Religious leaders are frequently accorded respect as opinion-leaders in their communities.
In religious ceremonies, leaders have a public platform from which to challenge destructive prejudices that reinforces stigma, while conveying important information concerning HIV prevention and care. Limited data are available that characterizes how churches provide health information on the care and treatment of people infected with the HIV virus or tangible resources to assist members with costs of transportation, medical care, food, and medications.
The HIV/AIDS Crisis
900,000 Malawians were living with HIV/AIDS at the end of 2003, with 90% of all infections falling within the 15 to 49 age range (810,000 people). The effects of HIV/AIDS on Malawi’s population can be seen in declining life expectancy at birth, which in 2004 was 38 years.
Healthcare and ARV Access
Access to healthcare has impacted the nation’s ability to respond to the epidemic. A 1998 report estimated that 81% of Malawi’s urban population had access to health care services, but only 29% of rural people had such access. A new issue in Malawi is the problem of accessibility and affordability of ARVs that became available during the summer of 2004. Most PLWHA in Malawi are unable to afford medications through private sources and are thus dependent on the free ARVs that are available in 59 hospitals and district clinics. As of July 2005, only 18,000 of the 170,000 HIV-positive men, women, and children who need ARVs are receiving them, primarily through the Ministry of Health’s rollout program to provide free ARVs. In light of the efforts to scale-up distribution of free ARVs, access issues have become an important subject of debate and discussion. PLWHA in need of ARV therapy face the difficult challenge of not having transportation to the hospitals and district clinics that dispense ARVs. Parents who wish to access ARVs for their infected children are presented with obstacles of not having available medications in appropriate pediatric formulations. ARVs that require refrigeration are problematic since 2% of rural households have electricity. Food security plays a significant role because patients often do not have food to take along with the ARV medicines.
Our Project
Within this context, we have set out to learn and describe how religious leaders and traditional healers help people living with HIV/AIDS access antiretroviral (ARV) medicines. This knowledge, in turn, will help to inform future interventions as different groups integrate their activities to help people access ARVs. Ours is a qualitative study using one-time individual interviews. We will be interviewing religious leaders, traditional healers, and PLWHA in rural villages and townships surrounding Blantyre and Zomba, which are in the south central region of Malawi.
Why Me?
Prior to joining the UCSF School of Pharmacy, I worked for 16 years as a clinical pharmacist providing medication information and education to patients in the acute and ambulatory care settings. These experiences then and now have shaped my career goal to become an independent investigator conducting research in the area of racial/ethnic and socioeconomic disparities in health as they relate to medication access and adherence. Currently these topics are of high importance and debate in the United States and worldwide. In 2005, I received a master’s degree in public health, which gave me a broader perspective and understanding of how to provide health information and education to community-based populations and how I as a pharmacist can integrate my unique expertise as a clinician and drug expert in these efforts.
In 2002, I became a member of the Board of Trustees of Global AIDS Interfaith Alliance (GAIA), a non-profit organization that raises funds for HIV/AIDS education and prevention programs in Malawi. We also provide for home-based care for Malawians with HIV/AIDS, orphan care, and women empowerment programs. In my first two trips to Malawi (2002 & 2004) I went in the role of a trustee member. Now in 2006, I am here as a researcher.
Being a part of an inter-professional research team is rewarding. It brings together a variety of perspectives that enrich the research process. I do believe that pharmacists have an important role in assisting patients define and solve problems related to medication access and adherence worldwide. Through this project I hope to enhance my qualitative and quantitative research skills, gain more insight on how to best design and conduct research studied, and eventually develop and test interventions that will improve the processes to access and adherence to medications.
This project is my first opportunity to be involved in international research in Africa. The knowledge we gain will have implications that cross all borders, and I am delighted and honored to be a part of this important work.
Subscribe to:
Posts (Atom)
Posts
