Monthly Archives: June 2014

Of Monsters and Men

By Dr. Fintan Sheerin

24th June 2014

Blog 3 redAs I think of yesterday, I am reminded of the title of one of Morrissey’s songs, November Spawned a Monster. For me it might be better titled Monday Spawned a Monster! I am not sure, though, who the monster is and whether it is one of the actors in the events of last night, or the underpinning structures which form the background for our actions as health professionals.

The day started well, with three of us visiting a school in Kasungu and meeting with special needs teachers who maintain a resource room for children with disabilities. The meeting was positive and we were made very welcome. It was notable that, although the resources are limited, the teachers work with an enthusiasm, knowledge base and dedication that are admirable. Indeed, the lack of resources is a problem everywhere and, in anticipation of this, Dale and I had brought four large suitcases of medical supplies, many of which, whilst officially past the ‘best before date’, remain viable and usable for many more months. As health care professionals, we are very aware of this fact but note that, despite this, these are routinely discarded to waste in our own countries. The decision whether or not to bring them was essentially a dilemma as I had wondered whether expecting Malawian people to use items which were not deemed usable amongst our Western populations was in some way devaluing the former group. In the end, knowing that the supplies were still safely usable, I decided that the need of the local Chilanga people took priority and met with the ethical principles of non-maleficience (do no harm) and beneficience (actively do good). And so, following the meeting at the school, Dale, Eloise, Suzanna and Shayla visited a designated clinic in Kasungu and delivered the medical supplies in the presence of a large number of local people and health care professionals. It was clear, from their invited tour around the clinic, that resources were indeed scarce and that these materials were a considerable addition to the empty shelves in the treatment room. Following the handover, the girls left feeling very positive. As we returned to Makupo village, the positivity of the morning was tinged with a sense of uncertainty as all afternoon meetings had to be cancelled on account of a local funeral.

Out of the depth I cry to you… (Psalm 130)

The uncertainty reached a nadir of negativity in the late afternoon following a telephone call which left me feeling utterly devastated. A medical official in the clinic contacted us to say that they could not use the ‘expired items’ and asked us to come and collect them. It had been clearly indicated that the medical supplies were beyond their ‘best before date’ but this man indicated that he was worried about the risk to his job if such items were found in the clinic. So, in the face of having no resources, it was deemed appropriate to refuse recently expired but viable resources! In real terms, this could be the difference between a person bleeding out from a wound or being in a position to stem the bleeding! I don’t know, but this did not make sense to me and the central issue influencing this decision appeared to relate to the need to protect one’s back and not to the saving of lives. It led me to question where Hippocrates’ medical imperative of non-maleficience and that of beneficience were in reaching the outcome of this decision. Have we reached the point whereby the protection of the professional and institution is considered to outweigh that of protecting the person? In the light of this event, I found myself at the lowest and most emotional point on this Malawian trip, such that I became very angry and tearful as disbelief and disillusionment grew.

In reflection today, this is not a uniquely Malawian problem but may be emerging here due to globalising commercial and professional forces which are recreating here what is already extant in our Western countries. Thus, in Ireland, the fear of litigation and allegations of professional misconduct have increasingly become the context within which health care is being provided with the need to assign blame when something goes wrong. This is reminiscent of the infamous medical model in which the person, as human being, is reconstructed and objectified as a patient, bereft of his/her identification as a human being. Illich has written extensively about this in his books, Disabling Professions and Medical Nemesis, and has suggested that this objectification of the person creates dependence, disempowerment and loss of individual identity: dehumanisation. This is the result of the development of a bureaucratic approach to health care which, he has further posited, is essentially a major iatrogenic (physician-originating) threat to health. It may be considered that this is evidenced in the creation and maintenance of a small elite of powerful professionals and a much larger mass of disempowered people: oppressors and oppressed.

Redemption

Despite the negativity that characterised the earlier part of the evening, there was to be yet another twist in the emotional rollercoaster. One hour later, we were approached by another medical doctor who shared our view on the medical supplies and who expressed a desire to obtain them so that he could use them to treat local people in his own clinic. Whilst his actions, in many ways, countered the gloom of the previous hour, there remained in me a disquiet which is leading me to explore and challenge the roles that each of us play in sustaining policies and practices which lead to waste in our countries: both material and human.

Feeling Optimistic

By Rita Morley (St. FX)

Praxis Malawi Chilanga campus

Praxis Malawi Chilanga campus

Today I just have to say that, despite the many set-backs and tough learning curves throughout this trip, recently I’ve been feeling quite optimistic. Even though we still have time left to go here in Malawi, I can’t help but feel that our group is already making progress. Perhaps this feeling will be a fleeting one, but nevertheless, I’ll use it to fuel my work ethic as long as it lasts. It’s funny though – even as I mention this optimism, I am a bit suspicious of it, as though it could just be the bliss that comes along with ignorance. Maybe the only reason I’m content for the moment is that I’m not working hard enough or that I don’t see the big picture well enough. How do I know that my perspective of myself within the overall vision of Praxis Malawi isn’t skewed?

However, while this bit of scepticism does manage to seep its way into my thoughts, I do trust in the leadership of our group. Dale, Fintan, and Dr. Stonebanks have all exceeded my expectations in their roles as teachers, leaders, and mentors. I’m not sure if I’ve ever felt so supported by a team of educators before and perhaps that is one of the reasons I’ve been feeling optimistic. In fact, it may not be so much external context which has promoted my positive outlook, as my own shedding of self doubt. Our teachers here on this learning experience have really shown faith in my abilities and ideas which has provided encouragement for the continuation of my work here in Malawi.

There are bound to be other conflicts and set-backs during the remainder of our Praxis Malawi visit, but for the moment, I’m going to ride this wave of optimism.

Looking Back and Gazing Forward

By Dr. Christopher Darius Stonebanks

cds_fanon_blog 3 (2)

cds_blog_3 red (1)

During my latest stay on mount Livingstonia, I had the chance to spend some quiet time and do things I otherwise have never been able to do during my last five (or is it six?) times at the magnificent Lukwe Lodge. In many ways, this chapter of Praxis Malawi represents many firsts for me. This was the first time I did not climb Mount Kasugu with the students, nor did I go to curios with them either, or even walk up to the top of Livingstonia to see the town. That crazy town at the top of a mountain that, to me, has always represented the madness of colonialism as I try and imagine Dr. Laws convincing the Malawians that building a mission at the top of the mountain is a sound idea. I get the escaping mosquitoes and malaria in the higher altitude and all that, but I still would have loved to be there when the local Malawians turned to each other and said, “Is he serious? Did he just say we’re hauling all the materials up the mountain??”

In any case, at this point there’s been enough of a relationship built with community that these sorts of excursions, like the hike up Mount Livingstonia, essentially run themselves and risks have been minimized through the experiences of trial and error. So, this time I hung back and had the time to do things I otherwise never have the chance to do; like take a nap in the sun, read a book, look at the landscape, observe some amazingly colourful butterflies, and investigate the workings of the compostable toilets. Okay, the last part was not that wonderful, but it was informative to the planning of our Campus. I don’t often get the time to read in Malawi. The first few trips usually involved packing a quantity of books that only made sense if my destination was for a conference on “coffee connoisseurs and speed reading”. Add to that my choice of books; not a single piece of fiction, but a stack of academic writings that I was sure to catch up on and revisit, but never do. Sure, who wouldn’t want to ruin a beautiful Malawian sunset while slogging your way through the uncooperative translation of Max Weber? Perhaps the original German writing is more enjoyable, despite the fact I don’t understand German, eh? Nowadays, I have learned to put a bunch of books on kindle so as to save luggage space on all the books I am guaranteed not to read.

There aren’t really many of those deep reading periods for someone coordinating a trip like this. You don’t get to have many quiet moments where you simply get “to be”.  There’s always something that needs to be organized, someone who needs to be reminded of coursework objectives, community meetings to attend (or reschedule and reschedule and reschedule…), finances to be reorganized so we have enough fuel to get the bus back to the airport, and a million questions to field. On this morning, however, the students went up the mountain with a for-real-certified guide, and I was alone to reread Frantz Fanon’s (1961), The Wretched of the Earth.

It’s been many years since I had first read Fanon’s book; in fact, it was probably at the end of my undergraduate years and more than likely a book that I picked up to have the appearances of being interesting when I sat around a campus café or bar. “Can I have a large cappuccino to go along with my book that clearly shows how smart and deep I am? Can you see what I’m reading?” I do remember it coincided with Gulf War One, and Fanon’s analysis of the oppressed Arabs of North Africa was particularly pertinent to me in those days. Even then, I wondered how such an influential book failed to make any kind of connections in any social justice circles in regard to action to a growing human tragedy, beyond the giant papier-mâché manikins of a distorted President Bush (senior), blowing whistles and banging drums at anti-war protests. Years later and Fanon’s book is still relevant … but what has changed? Frustrated, I put Fanon’s book down and ordered a cup of coffee, once again looking over the lush, green valley and trying to capture some of the peaceful moments I had lost when I decided to reread the book. And there “he” was on the cover of Fanon’s 2001 version of The Wretched of the Earth. Wearing old, worn and tattered clothes, emaciated “he” sits on the floor in some common outdoor space, looking away and simply waiting in anguish. I don’t know him, but I realize “he” is still everywhere in Malawi and, again, nothing has really changed.

On this trip of firsts, I try and remember “him”, and as we drive from Livingstonia and back to Kasungu, I see “him” everywhere. Of course, I haven’t just seen “him” through the window of a moving vehicle; I have met “him” as well. We have sat, and talked in brief exchanges, but “he” knows more about me, because this isn’t a first encounter for “him” either. “He” knows I will go somewhere else, perhaps somewhere on the side of a lush, green mountain and take the time to order a coffee and ponder over “his” picture. Even when we look for optimism and, I see “him”. The Chilanga community has already started moulding bricks as part of their “fair labour” contribution to the Campus, with the faith that this effort can turn into hope for their children, and it appears that there “he” is again. I want to believe this time I am mistaken in my recognition of “him”, and for the first time in my years in this area, things are starting to change.

Energy, Rhythm and Song

By Dale Perks

Let the choir sing

Let the choir sing

On Sunday I attended a Presbyterian Church service, for the second time, along with some students and a co-learner from Makupo village. Some of the differences that I observed in comparison to some of the masses that I’ve participated in Canada included the energy that was felt during this celebration, as well as the amazing harmonies that were heard by the many choirs and villagers of all ages who attended the service. I watched the movements of everyone, as individuals swayed, danced, and clapped to the colourful rhythms and upbeat tempos, which made me want to get up from my seat and dance. The people involved with Praxis Malawi know that I love to dance. However, I refrained from dancing and resorted to a mild tapping of my feet, and swaying my body, as I listened to the songs and sang, as best as I could in Chichewa  some of the songs. As a practicing Catholic, I am used to celebrating mass, which generally lasts an hour long, and to my surprised I couldn’t believe how quickly the time passed, even though the service lasted two hours and was entirely spoken in Chichewa.

Another thing that really struck me was the number of choirs that were present during this service. The choir that was nearest to us was a children’s choir, comprised of mostly children who were blind and a few with albinism, which were accompanied by two musicians, including the choir master who played a key board, and a blind man who played the bass. Many of their songs were performed with a similar structure, with either a soloist, or two singers leading the song, which was then echoed by the rest of the choir and congregation. What really impressed me was how everyone knew the songs by heart and sang with such fervour. There was a sense of active and joyous participation, which is sometimes lacking in the masses that I’ve attended back home. When you weren’t expecting it, the minister would announce the name of yet another choir, which would stand up from a different section of the church, and begin to sing in four part harmony, with everyone else joining in. A total of five choirs were present, including several secondary school choirs, and a choir made up of nuns, who appeared to be of various ages, dressed in white with their hair covered in pure white scarves. They too danced and sang with great enthusiasm, which was truly contagious. I was astonished when I found out that there are sometimes as many as 15 choirs that sing in one service in this particular church. The only time I’ve ever witnessed this amount of choirs singing during one service in Canada was during a very special celebration. Back home, there are many churches that don’t even have a single choir to sing during their masses and often the services or masses are much less energetic, with parishioners typically more passive and less expressive in relation to movement.

The most noticeable difference was related to how the woman and men sit in separate sections of the church. As well, during the collection, individuals of specific villages are called upon to give their donations. The music continues until everyone has dropped off their money in a bucket, and then the announcement is made asking for further donations.

All of the moneys are separated and immediately counted, and the amounts that are given by each village are announced publically to the entire congregation, including the amount that was given by me and the students. This was somewhat intimidating, especially since we had no idea that this was going to take place.

Other than the latter experience, it was really special to hear all of the voices, sung in harmony, and to watch everyone engage with such positive energy and with joyful movement. If only some of this enthusiasm could be transferred to some of our masses back home!

 

Home Sweet Home

By Shayla Baumeler (Mount Allison)

Reflecting through a new lens

Reflecting through a new lens

We recently embarked on our first journey away from Makupo village. The crew awoke bright and early in preparation for the long ride to Livingstonia. The battery we use to charge our electronics was dead once again, so we enjoyed some sizzling hot doughnuts under candlelight prior to loading the bus and hitting the road. As we headed north, an eerie mist dispersed as the sun rose over the few peaks that dotted the landscape. A couple quick stops were scattered throughout our nearly five-hour trip before we came to the base of the mountain. I don’t think anything could have prepared us for what we were about to experience next. Our bus began hopping every which way atop the rocks embedded in the dirt road. A number of bends, marked by small wooden signs, indicated our progress up the mountain. Sharp hairpin turns and a narrow path for our vehicle characterized our nearly one hour climb up the mountain. Once we reached our destination, Lukwe Lodge, there was a sense of relief that overcame the bus, and at the same time there emerged a sense of eagerness to explore the grounds. Our group was lead down to the primary lodge structure – a veranda overlooking the entire valley and facing a number of other surrounding mountains. Any description of the view or the emotional response that it produced would not even begin to do it justice.

A mountain top oasis

A mountain top oasis

Our full day away from the village was spent hiking the remainder of the mountain to the town of Livingstonia. It was astounding to see the drastically different lifestyle that residents enjoy atop this elevation. The University of Livingstonia can be found in the town, along with a number of other private homes and lodges for visitors. Life exists and flourishes at this extreme elevation. The radical journey that we had taken hiking the mountain and on the bus the day prior was something that seemed so foreign to me, but is something that these inhabitants have surely done hundreds of times in their life. On another note, the communities living upon this mountain and the surrounding ones are completely self-sustaining. All of their necessities are at their fingertips despite the extreme conditions, which is a true testament to their multitude of skills and ability to sustain all aspects of life.

Despite the amazing experience that we had while in Livingstonia, I think the most impactful portion of the weekend was, ironically, our return to Makupo. Upon our arrival back to the village, I caught myself saying in my head “Yay – I’m home!” I am confident that I am not alone in this feeling. When I really thought about this, it seemed like the strangest concept. I am thousands of kilometers away from “home”, yet I felt this unwavering sense of comfort coming back to Makupo. This speaks volumes, not only the welcoming nature of the local people, but also of the amazing ability of humans to adapt to significant differences in culture. By no means am I 100% integrated into the society, nor will I ever be. I can say, with gratitude, that the Praxis team has become my second family and Makupo, my home away from home.