I haven’t been writing as much in Malawi because time just seems to fly here. There is so much to do, so much to experience that I can’t really make myself sit down and write.
So far, to me, Swaziland and Malawi have been two very different experiences. Maybe this is inaccurate on my part as I am comparing a rural Malawian village to the capital of Swaziland. However, I have briefly visited a Swazi homestead and my mind pulls up such huge contrasts. I remember the rolling mountains of Swaziland, imposing compilations of withered granite rocks and persistent greenery. Homesteads perch in this landscape are islands of impressive cultivated land seemingly miles apart from one another. It is a quiet image; I only remember the howl of the wind. Here in Malawi, I am surrounded by sound, music, activity and flat expanses of red dirt. Chickens, goats, cows room freely, offering great amusement to the guard dogs at St.Gabriel who often playfully chase after the goats to nip their tails. I hear the constant chatter of Chichewa outside my window as Malawian woman wearing traditional cloth wraps walk barefoot to the hospital. In the afternoon, the shouts of children asking us to play soccer with them would drown all else. The villages are just teeming with kids, running freely—whether it is school time or not. Malawians love to have big families where there could be as many as ten children whereas in Swaziland, women are embarrassed, if not ashamed, to have more than two or three. The village kids’ favorite activity when they see us is to jump up and down and shout “azungu” meaning foreigner. Then a herd of them—15 to 30 kids—would gather behind us as we walk and follow us to our destination. Foreigners are huge, fun, open-eye, finger-pointing spectacles here, much different from the discreet glances we received in Swaziland. Overall, I think Swaziland is a much more westernized nation where Elizabeth and I have to pay to go to a special cultural village to experience the Swazi old way of living. In Malawi, people embrace and live in their culture, speaking their own language—barely knowing English–, dressed in traditional garments and living life in ways passed down from generation to generation. Their openness of their culture makes us become easily incorporated into theirs.
The Malawian culture is such a friendly one, full of some of the sweetest traditions. I have not been into a village so open to each other and to foreigners. If we do not initiate “Muli bwanji”—how are you—, mothers wrapped with babies on their back and grandmother in head wraps would stop randomly on the street and greet us, maybe to shake our hands as well. It is such a special greeting because they would not ask it to the group but would repeat the question to each person, individually, one at a time. Looking back, it can be a time-consuming process, but really, I love the intimateness of the gesture, the valuing of each person personally. On top of this, Malawians are also very polite. Zokomo, meaning thank you, can be used or heard everywhere. You can pass someone on the street and say Zokomo. There is no excuse me, but zokomo. There is also no “you are welcome”, only zokomo as the response. The decorum of respect to individuals is quite heart-warming; here, people take the time to show a little care and respect to their neighbors and passbyers. Like many traditional societies, relationships are important, as can be seen in introductions. Here, Elizabeth isn’t Elizabeth, but the sister of Joshua (her brother who implemented FrontlineSMS). Mrs.Nesbit isn’t only Casey, but the mother of Joshua, Elizabeth and Daniel. I am not just Yiwen, but friend of Elizabeth and the Nesbit family. Relationships here define a part of you and help others relate to you. What is interesting is that relationships appear to matter more than your social position—your profession, property or education. Although in those aspects, the villagers are mostly homogenous. Almost all families are in some ways subsistence farmers. Even the workers at St.Gabriel who lives in Namitondo have small plots of land they farm for maize and vegetables. Most kids attend primary schools; secondary education requires money and thus is harder to obtain. No one I know has received a college education, whether it is because of money or that most secondary schools do not prepare a student adequately for university. There are technical schools, though, that train people after secondary school in specialty areas such as secretarial work, carpentry, medical assistant and such.
It is not only the Malawians who are especially nice; I have had a wonderful time living with the Nesbit family. I had a wonderful July 9th birthday with them. Despite my being with them almost every minute of the day, they still surprised me with cupcakes they ordered from a neighboring cafeteria and a gift—a beautiful traditional cloth Malawians use to wrap around their waist as a skirt and protective wear to keep what is underneath free of dirt. We shared the cupcakes with our neighbors: three medical students from Luxemburg, an American pre-med student and Joanna who is in charge of the mobile CD4 machine. It was a great opportunity to have a chance to talk with everyone and take pictures of course. Earlier during the day, Elizabeth also personally cooked one of my favorite breakfasts: scrabbled eggs with oven-toasted bread. For dinner, traditionally at home, my mom would always cook noodles for me as noodles signify long life. By pure chance, the dinner Mrs. Nesbit had long ago planned, without knowing the date, was oven cooked ramen noodles with vegetables. The coincidence! It was a great, unforgettable birthday. I am so happy that I had it in Malawi and grateful that I shared it with the Nesbit family and a delightfully unusual gathering of individuals.
I really love the villagers around here and I am comforted that St.Gabriel Hospital is here take care of them. The HIV/AIDS service inspected periodically by the government ministry of health is consistently rated number 1 in the region. HIV is a problem here, but it is not a staggering shock as it was in Swaziland where it seemed like one in two was HIV positive. Especially in a rural areas like Namitondo and Namitete, HIV one of the serious problems next to malaria, tuberculosis and malnutrition but not THE problem. It is interesting to see a slight change in HIV treatment here. In Swaziland, the two popular first line medications are AZT and Nivarapene. Here, AZT is used as a substitute because of its dangerous side-affect of anemia, given the constant danger of malaria here. Moreover, second line drugs are extremely hard to obtain. There are only a handful of patients on it. As mentioned before, the hospital has one of the most extensive community health worker programs I have seen with trained staff going almost everyday to even more remote areas to do follow-up care. I have yet to go on one of these outreach trips because the staff can only take one extra passenger on their motorbikes (!). Elizabeth gets priority because she needs to work on the community health worker backpack, but I hope before I leave, I will get to go on at least one trip. I heard that the motorbike ride is quite thrilling. In terms of lab equipment, the hospital has the capability to run full blood chemistry tests and provide ultrasound, x-ray or microscopy services. However, whether there are enough trained technicians to fully use the capabilities is uncertain. The hospital is constantly making the effort to improve itself. Whereas in the past they had to refer—in essence abandon—patients who needed surgery, whether it is for biopsy, tumor resection or amputation, now they have a retired German orthopedist here to guide and train the surgery department. They have one theatre and will open a new one later this year. Patients being retained in the hospital are already constantly maxing the hospital’s current capacity due to the number of surgery patients. It’s feels great to be here!