Saturday, 25 July 2009
Having spoken so much about blind children in Malawi and my field tips in the rural areas in line with VISION2020 requirements ,which now has its own blog that i will talk about later ,
I am attempted to talk about the Euro link –the train that takes coaches, cars with passengers inside from one side of the tunnel to the other side but I am afraid that people will look at my blog and laugh at me as to why am amazed with this. But let me explain then maybe you may not laugh.
Having been born in Malawi and brought up there , in a rural area called Ezondweni in Mtwalo ,Mzimba we were so much used to seeing cargo ( a few pieces of firewood or a few bags of maize) been carried on an Ox-cart driven by two fat bulls and we could admire how they managed such a lot of work .But recently when I arrived at the French English border by Euro line ,I was told that we would while still on the bus go on the train and that this train would take 20 of such buses with 60 people in each and cruise at 120 km per hour to cross the tunnel .For once ,my simple arithmetic told me that the weight of one bus and passengers was around 10 tonnes and that the weight of 20 buses would be around 200 tonnes .So how could such a big and long train be able to carry such a large cargo and still cruise.
I was on the coach and saw it being driven into the bigger train ,and in front of us there were several buses . Eventually the train closed, and there were announcements that all the buses had to have their engines switched off and hand break on ,and that crossing over the tunnel would take around half an hour while cruising at 120km/hour .
To cut the story short I ended on the other side safe, one by one the buses started coming out of the train and when our bus was out the driver started the engine and off we went.
I have been on a ferry before in Mombassa, Kenya but I tell you this is nothing compared to the Euro Train. Up to now we are still using oxcart in my village, hence this was a good surprise. And when I finally saw tower Eifel ,I knew I was finished .
The trip gave me more reasosns to continue fighting for blind children in Malawi.
Should we still be using oxcart in Malawi ?
Do you agree that I should have been surprised?
Who would think someone would want to pretend that they are me and even try to post blogs on my site on my behalf .And what would be their motive behind all this be?
These are the questions I am being faced with but it is true that someone has attempted to hijack my blog and post articles which would not be my favour. Defamation of my character is a possible reason for their attempt.
My advice is that if you see a blog with blasphemous words (uttering bad names /things against god) or swearing words on my site, know that the blog has not been posted by me and contact me immediately to remove it from the site .Blasphemy and swearing are not in my character , and I would not want to be associate with such words .
Today I did come across evidence that someone is tampering with my blog and have reported to the responsible authorities.
Honestly, Blogging is free, why can’t you just create your own blog if you are not happy with what I write .Alternatively, why bother reading my blog when there are so many things out there to be done.
The blog is here to say even if it doesn’t please other people. Anyway, am sorry, it was never meant for such a purpose.
On another note, some days are not meant to be good. In addition to being hijacked on my blog Imagine recently I was charged one Euro (approx 1.4USD) to use a toilet in a shopping mall called PRINTEMPS in Paris, France. I asked where I could get a free toilet to wash my hands and I was told forger it, it doesn’t happen in Paris .So I reluctantly paid and decided to spent a substantial amount of time in the toilet ,to get value for my money .
Life is much simpler there where there is less technology and development like rural Malawi ,thus why I am going back to the field in Mangochi next week.
What do you say?
Wednesday, 22 July 2009
Health surveillance assistants (HSAs) implement the bulk of community health projects in Malawi; and they do a good job if trained properly and given the appropriate incentives . I can help in organising such trainings if need be.
Challenges involve motivating them to continue doing the work in the community; and providing adequate supervision.
In Zomba district, one particular group that we trained did extremely well in identifying many children from their communities with eye problems.
There is a World Health Organisation document which talks about guidelines for incentives for health workers, and I am currently studying it to find out which ones can be available to motivate the HSA’s
Without HSA’s ,I believe the health system at community level would collapse in Malawi .But can HSA’s do everything and do it well? Have you heard about Task shifting? If not ,that will be the subject of my next blog. Have a good day.
Did you want to comment?
Thanks for your enquiry .I will be lieing if I say as eye doctor I know everything about eye diseases and community health workers. If I did, I wouldn’t still be studying in London trying to get more skills. The truth is that my expertise is limited to eye diseases in the tropics and also to those affecting the poor people. Please do not ask me things that are beyond my capacity like requesting whether I can do laser eye surgery on you.
And I am not the only Ophthalmologist or the cleverest one in Malawi .there are many colleagues who have better skills than me, and I continue learning from them.
I can also not give the accurate information about other diseases like HIV and malaria in Malawi. There are other people who have expertise in this area and I would be willing to direct you to them.
But if you want to know about blind children in the rural areas of Malawi and how community health workers can be used to find them, am willing to share with you my experiences .
Monday, 20 July 2009
I must admit I know Malawi very well especially the rural community.
In response to the question most people have been asking me, YES I have been to all districts in Malawi and have slept in many substandard rest houses that most of you reading this blog would never ever dream of visiting .The outstanding ones that I remember are the Nsanje discovery lodge –where a night in an ensuite was only costing USD 7 but you could not get water from the tap. Surprisingly you were woken up at 5 am only to be told that water was available for bathing .I have also being to Karonga , Chitipa .Most of these arrears were visited while I was conducting eye outreach camps and operating on people with cataract in the field .
In addition and as part of work and continued medical education , I have visited some countries outside Malawi, viz : Zimbabwe ,Mozambique, Zambia ,South Africa, Botswana,Kenya, Rwanda, Uganda, Tanzania ,Egypt, Australia ,UK , Argentina , Brazil, India ,Switzerland ,Holland , Germany ,France .
I speak Swahili which I learnt in East Africa (Kenya) when I stayed there for 3 years.
I have vast experience in community health programmes.
Of all the places I have been to, my best moments are when I am in the rural community in Malawi dealing with local people at that level. I also had a very good time in Rwanda when I was involved with the trachoma survey.
Ready to hire me for an assignment in Malawi or elsewhere .
I had had several informal requests as to whether I could get involved in other health related projects in the community .The recent email from Domasi Zomba invites me to visit a community project dealing with HIV/AIDS and help build capacity .
One fact I can clearly state is that I am neither a donor nor a supporting funding partner. Infact I am looking for people or organisations who can contact me to give me tips of how to convince some donors or individuals to give money to me to help the poor blind children in Mangochi.
For certain of you have some monies and want me to assist you in setting up community projects or coming up with monitoring and evaluation indicators , I am nore than happy willing to assist you. Much as I focus in blind children ,I am more than available to be involved in any community health projects especially those that involve training of health workers and volunteers.
For those NGO’s interested to know about my detailed experience in working with health workers in the community, email me and I will get back to you . If you have a proposal send it to me then I can look at it and advise. If you have an idea send it to me then maybe we can develop the community proposal .
I have been involved in community projects in Rwanda, Mozambique , Tanzania and Zanzibar in addition to the many I have done within the country and I am more than available to go to new areas or countries. I can be involved in the designing , implementation and evaluation of the programmes .
I cant just leave without thinking about the community .
What do you say?
Ignorance is a disease; lucky enough some of us know and acknowledge that we suffer from such a disease. For once I wish I was a writer, but I know I am useless when its comes to putting words on the paper .If I did not how to write I could write a few books about all these ideas I have in my mind, books such as “guidelines for training health workers in Malawi”; “Eye diseases and their prevention in Malawi”; “How to make money while working for less hours ” and many other books.But God did not bless me with such talent ,so everytime I decide to start writing a book I write a paragraph and my head goes blank. As an alternative I have ended to writing blogs –which I still do not do well. But why is this the case ? You see I am always in the field seeing and experiencing all these things, and I tell myself when I get home I will write them up but I don’t.I wish I could be at least a better blogger ,if not a writer .Has this got something to do with my origin or culture?
Is there anyone there who can give me good tips ? easy ones and not referring me to books and blogs to read .Sorry I do not have such time. Unless your blog is talking about blind children ,or poverty in the rural villages in Malawi ,I am unlikely to read it.
I will be waiting for your email .Right now in my head I have all these wonderful ideas about what could be done to the primary health workers in Malawi but cant just spell them out .On the contrary I have noted that when it comes to going to the filed to do the work I am the one who packs the bag first .Its a pitty that so much is done ,but only the tip of the iceberg is reported.
Any suggestions on what could be done ?
What do you say?
I should have joined “Muhlako wa Alomwe” because I know that unless I am seen at such gatherings, my hard work and sweat is not going to yield anything in the next 5 years. Rumours say that members of this group can perform well as managers in various capacities in Malawi , but membership is very strictly restricted .
Having been frustrated that I can not join such a beneficial group I have decided to show my face at “Friends of Mzimba Heritage” whose membership am told depends on whether you consider yourself or your parents to come from Mzimba.Well I was born there ,so am qualified to be a member .I need to be noticed at this time and everyone must know my name and that am a doctor ;This is incase this group also gets the same powers and privileges to be board chairmen and directors ,I should not be forgotten to be given such a post.
We are meeting at Michiru for lunch one Sunday afternoon and about forty people have gathered here .The chairman welcomes us in Tumbuka (I am told he is the professor and vice chancellor of the Catholic University ) and asks us to introduce ourselves in Tumbuka as well.
When a man named Dr DD Phiri rises everyone applauds and I ask them why ,am told he is the one who started the association and that he has published over 18 books and a million articles .They ask me that didn’t you see him getting the national achievers award on Televison Malawi during the celebrations day? The name person to be introduced is the so called lady whose career as a professor of law in Zambia was interrupted by being imprisoned together with the husband and sons and that the husband died in jail. She runs an NGO and am told she also got the medal at Celebrations day. In absentia but also recognised is the lady called “Rose Chirambo” who am told is dead but was the first female minister under the first Ngwazi regimen.
Then comes a list of all the prominent people in town who are here, Chief Executive of X,Y, Z and MD’s of P,Q.
And then there is this “bayethi”-all of us standing up and clapping hands to who? I am told the man is Inkosi Mabulabo even though he looks younger than me .
Its my turn and all of a sudden I am tongue tied .I thought I was going to be noticed as an important person but there are too many here so I introduce myself as Mr Kalua ,also from Mzimba and working at the hospital and luckily enough no one bothers asking what I really do .I know I take care of blind people but in this gathering that role is unnoticeable.
I have learnt one thing in this meeting; there are already too many people from Mzimba with positions in Blantyre that even if the opportunity presents that they have to chose some directors, my name would still not be considered. For once I wish I was a Lomwe ; surely I could have been going to the embassy .
I am told the Mzimba heritage welcomes everyone so you are free to join. As you can see my late grandfather is seated at his house in Mzimba so I cant deny my roots .
What do you say?
Sunday, 19 July 2009
Following the recent bad experience I had with the training of HSA’s in Mangochi (see my previous blog), I have taken a few days off to sit down and reflect on what went wrong and how I can improve the trainings. I also want to explore how I can best disseminate this information to other people who may be interested in training such cadres in Malawi. Well this will give me a good break about communities in Malawi and the blind children.
Remember I am an addict to travelling and indeed by Malawian standards (even by some Afican Standards) I have travelled a bit compared to the average globe trekker.Look at me in the picture taking at my home village.
Well I have not been to Europe for some time now and this being summer I have decided I will make a trip to France and visit Paris .I am not how to get there but having obtained my Schengen VISA I should be on the move anytime .
Who knows I may send a blog from Paris, otherwise I will blog after that .
Any advice on where I should and should not visit in Paris?
Are you involved in training Health Surveillance assistants (HSA’s) in health projects in Malawi? Do you have evidence based facts of their success in implementation after training?
I have just returned Mangochi where we trained a group of 30 HSA’s from Mangochi Zone and another group of 30 volunteers from Chilipa Zone where I faced major challenges with the HSA’s .Relax and I will share my experiences with you.
Having trained HSA’s in Mulanje and Zomba (a total of over 300) I thought with my vat experience, the training in Mangochi would be smooth. I had overlooked a number of issues which I would advise any one willing to train HSAs in Mangochi to seriously consider before rushing doing anything. Mangochi district ,in Southern Malawi is 190 km from Blantyre and has the beautiful Lake Malawi on one part of it and lake Malombe on the other. Lake Malawi has various tourist resorts and Hotel and the environment is very friendly .I stayed at the mini Martins Lodge
The district though very rural has various health research projects including the College of Medicine department of community Health and the Malawi Liverpool Welcome Trust. Most of the community projects involve training and using HSA’s
HSA’s take the invitations to attend the trainings as a privilege and look forward to the financial incentives that are associated with the training.
Some HSA’s claim from Mangochi that in order to win to win their favours and loyalty some NGOs pay them an allowance of up to USD 50 per day despite the government lunch allowance being USD 7.
We thought we had done our assignment well ;had talked to the responsible officers and agreed we would give an allowance of USD 7 for the one day training but in addition we would provide drinks and snacks .As a background in 2007 I had done a situation analysis in Mangochi on why HSA’s despite working in the community were not involved in identifying children with eye problems .I spoke to a group of representative HSAs (20 in total) and they all indicated what they lacked was the skill and if trained they would be willing to do such a job. So this training was organised as part of my study and in response to the findings .We conducted the first training to a group of 30 Volunteers from a different area on day one ,gave them the allowances and snacks. During day 2 we arrived at a different place to train HSA’s ;started the training but noted that the participants were not attentive. In probing why ,we learnt that they wanted to know how much money they would get at the end of training ,and whether we had brought t-shirts and other incentives for them. After explaining that we would only give USD 7 as per what volunteers got the previous day, the whole workshop turned into chaos with the HSA’s threatening to boycott the training and forfeit the highly needed skills if they did not get all their monies .
So how did it all went at the end ? Not very well – I sustained a few emotional bruises .I would like to write a whole blog about this –when I am better.
For now you can gues!!!!
Have you experienced difficulties in conducting training? What did you do? Or are you just interested to comment.
If you are an NGO or an individual interested in community health issues, you probably be wondering how much impact the role of community health workers have in improving the health of Malawians. In particular to this cadre are the so called Health surveillance assistants (HSA), who are said to be the backbone of the health system in Malawi .HSAs are employed and paid by the Ministry of Health. But what skills do HSA’s have to implement health care; and if trained do they actually do their work.
There are currently an approximately 12,000 HSA’s in the Malawi public service ,as a result of the recent scale up (2007) with almost half employed by the ministry of Health under the Global fund and other funding parteners and the rest through normal employment. HSA’s are responsible for implemented most of the health initiatives in the community, and for disease surveillance .By education ,the newer HSA’s have reached at least high school (Form 4) ,while the order groups may have not been very educated .HSA’s only undergo a 3 months training in Preventive, Diagnostic and Curative measures and upon completion they become experts in all community diseases .
With all the community interventions in Malawi relying on HSA’s ;is there evidence that HSA’s have contributed to the reduction in morbidity and mortality of the common Malawians .What are the implications and limitations of using HSA’s in health programmes ?
A look at the maternal, mortality figures in Malawi indicates that Malawi has the highest mortality rates (1120deaths per 100,000 mothers delivery) despite the many health promotion messages being spread by HSA’s. Many causes of these deaths are attributed to low levels of maternal care.
Unicef States of the world children 2009 that over a period of 16 years (1990 and 2006) of intensive community programme interventions, Malawi has only managed to reduce under five mortality by 40% and that the main causes of deaths still remain preventable at the community level. HSA’s are taught the integrated management of childhood infections (IMCI).
Since 2007 I have been involved in training HSA’s in identifying blind and visual impaired children in rural communities in Malawi; and have been comparing their performance with a matched group of trained volunteers .
I have very interesting results –which will be published later ,but certain issues desrve to be mentioned at this stage.
I have noted that most NGO’s and government institutions assess the outcomes of HSA’s training through reports submitted to the interested parties ,and that rarely do the trainers observe and access the skills attained by HSA’s after the training. I have also noted that most HSA’s rate the trainings based on the amount of subsistence allowance received during the training, and not on the skills attained. The mismatch in expectations between the trainers and the HSA’s has more than often resulted in not having proper measures to measure the outcomes of trainings .
In my next blog I would like write about what incentives HSA’s have mentioned to be being necessary for them to do the work ; and whether when given such incentives they have successfully accomplished the desired tasks. I will also be introducing the tracking tools that we have developed to assess whether HSA’s are doing their work and the incentives that we give. In the picture I am listening to a group discussion by HSA’s from Zomba. The forms we have devised can be used for any time of training and I will be more than willing to share with you.
Are you involved in training HSA’s in health projects in Malawi? Do you have evidence based facts of their success in implementation after training?
Or do you want me to share our results with you? Or are you just interested or want to comment.