Tag Archives: health

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.

A Balancing Act

By Eloise Sheerin (Trinity)

The beauty of harmony

The beauty of harmony

At home in Ireland I would consider myself to be someone who is a very good judge of character and sincerity. Here I am not so certain. I find myself struggling with contradicting thoughts. It is natural to want to think the best of people but I have found that sometimes this is seen to be naive. I am constantly switching from each extreme of the spectrum. Either I take someone to be genuine and sincere or I am constantly searching for the ulterior motives behind someone’s facade. It is proving hard to find a neutral position.

I feel naive and over optimistic when at the positive end of the spectrum. It is easy to get lead astray into difficult situations when your assumptions were wrong. When we were doing a health meeting in the Chilanga Court I was excited, hopeful and optimistic. I thought everyone understood the approach of Praxis Malawi and how we were trying to empower the community to take matters into their own hands and work together to better their community. We are not here to provide immediate relief but support and long term sustainable relief. We were talking of exchanging knowledge on sexually transmitted infections and family planning. The discussion was in depth and riveting and everyone seemed to be reading off the same page. I felt the empowerment, felt by what I thought was the whole group, but I soon found out that not everyone felt this way. A man came to us and asked us for aid now. I wanted so bad to help him now and give him whatever he needed to get his problem sorted. By doing this I know I am just feeding into the oppression and culture of dependence so evident here. I felt deflated as I dropped my guard and demonstrated naivety.

You can learn to grow a thick skin here.

This kind of experience forces you into a cynical and untrusting frame of mind. I find myself at times expecting that people are lying to get something from me. I start to think that any gesture that appears to be a friendly, nice gesture is just a game to get some prize. I have been pleasantly proved wrong in my thinking thankfully. When visiting the school for the blind, we were warmly welcomed and invited back in the afternoon to observe a choir rehearsal. On returning, the children had changed into nicer clothes and the performance was so breathtaking and moving that I will never be able to forget it. Even while I was sitting watching and listening to this heartfelt and moving exhibition of the magic music can bring to your soul, I was thinking ‘oh sugar’… here comes the request for money. For the last part of the performance, before the electricity cut out and the class was dismissed, I was thinking up possible ways in which they were going to approach us about money or charity. We had deep discussions with the teachers and principal following and not once did they expect or ask for anything from us. Instead they completely understood the approach we had. They discussed how they feel their method of teaching visually impaired students wasn’t adequate for some students who had learning difficulties also. A suggestion was made that they contact the school for learning difficulties and exchange knowledge. They were shocked at how they hadn’t considered this before and wanted to ‘buy’ the idea from us. We assured them it is free and to take initiative and use it. We found out yesterday that they already had a meeting and it was successful!

These experiences boost your trust in humanity. I get a boost and I am back to naivety and over optimism, then I get a blow and I am back to being negative and cynical. This process is cyclic. The problem I have is remaining somewhere where I am prepared for both scenarios. Finding a harmony, like the voices of the school choir. A neutral! I assure you, I am working on it!

The Realization

By Dale Perks

Busy days

Embracing the moment

We have been here already 3 weeks and I have had the opportunity to listen, observe, engage, and collaborate with various individuals from this village and nearby villages. Sometimes these experiences have left me feeling happy and enriched, as well as sad, discouraged and even overwhelmed.

Previously, I thought that perhaps I would be more immune to culture shock, due to my ‘mature’ age and  my exposure to large amount of suffering from  having practiced 27 years in the field of nursing….but I I realized that I could not have been more wrong! Culture shock is something that is very real and I am not “immune”. During the first weeks I enjoyed the bliss of the honeymoon stage and bathed in all the interesting sounds and sights, and I experienced feelings of awe and joy. Regardless of some of the difficult situations that I was observing, being among the people of this village, especially the children and women, made me feel so renewed and inspired. I also found myself acting in the role of “the nurse”,  as I would be back home, and started caring for those who showed up on my door step in need. There wasn’t a day that went by that I didn’t have to pull out my first aid kit, or go into my stash of over-the –counter medicines, or pull out my stethoscope, or listen to someone story about their health issues. The villagers had figured out that I was a “nurse” and suddenly I became the “go to” person” for all kinds of health issues, which ranged from cold symptoms, stomach aches, arthritis, tooth aches, swelling of the eyes, minor cuts and scrapes, blisters, and sprains. Unfortunately, my role here, is not as the acting nurse for the villagers nor the neighboring villages. I think part of my falling into this nurse role was facilitated by my eagerness to relieve suffering of those around me and instinctively providing care for others…something I do so naturally back home and without a thought, and which gives me a sense of making a difference in this world. In reflecting about all of this, and after having some discussions with Dr. Stonebanks and Dr. Sheerin, I realized that I needed to take a step back. Making a difference here is all about putting in place practices that are meaningful to the people and which are sustainable. This kind of approach is in line with Praxis Malawi, which is different to most NGO approaches, and which is an important realization. I will still continue to be “mama Dale” to the students, but as hard as it is for me to step back from the nurse role in the village, I must redirect my energy to the goals of this important project.

Another realization is that I sometimes feel that I am bouncing back and forth between various stages of culture shock, namely disintegration and reintegration, and this can be frustrating at times.  With our last road trip to Zambia,  I experienced an array of emotions. It also triggered many thoughts and comparisons between the people of Makupo, or my ‘home away from home’ and the Zambians working in Zikomo lodge. Fortunately, I am surrounded by some very bright leaders and students, and with sharing of ideas and observations, this helps to anchor me and renew my faith in our work. As an aside, the experience in Zambia was truly amazing, especially seeing all of the wild animals, including zebras, elephants, giraffes, and many others, in such close proximity and within their natural habitats.

On a final note, as a health care professional, being present in a region where there are so many health needs and competing priorities, is rather challenging. However, I try to keep in mind that every human being deserves to be treated with dignity, respect, and equality, and with this in mind I can keep moving forward, regardless of the challenges. I know the road may be rocky and not so straight, but I am not afraid to take the path. Also, working with some exceptional and creative students, along with brilliant and dedicated professors who have a clear vision, has also helped me to move forward.

I look forward to the remaining weeks, whereby our health team and co-learners will be collaborating on several health initiatives, including the distribution of village first aid kits,  providing a workshop to villagers regarding family planning and STI’s (sexually transmitted infections), facilitating the creation of an inter-village health committee, and work related to some education around disabilities and inclusion.

Furthermore, some dialogue has begun about the future health clinic, which will eventually be built within the campus, and will play an important role in providing healthcare and health promotion for villagers in the Chilanga region. I look forward to sharing all of the news about these projects to all of my family and friends back home who are also supporting Praxis Malawi at a distance. Your support is really important to all of us!

 

Muli Bwanji

By Shayla Baumeler (Mount Allison)

The smiles are contagious

The smiles are contagious

The warm heart has truly exceeded my expectations. All of my preconceptions of the country have either been confirmed or denied in the most positive way possible. When we arrived at Makupo village, the children greeted us on the street and ran alongside our bus until we parked in front of the building which we would be calling home for the next five weeks. The villagers gathered around our bus as we all offloaded. The children danced and the local women sang in Chichewa, the vernacular language of Malawi. The locals acknowledged us one by one with the phrase “Muli Bwanji,” meaning “how are you”. I attempted to respond in their language, but inevitably struggled.  Even so, I was graciously accepted.  At the risk of sounding cliché, it was an unforgettable experience.

Within the past few days, I have seen immense progress in every capacity. Our Praxis Malawi team began as a number of individuals, but now resembles a family. Our research projects have developed in a similar manner; we originated with personal goals, but we are now working as a cohesive unit, using collaboration as a method to maximize impact. An important factor of the Praxis Malawi initiative is the use of co-learners. These are individuals in Makupo Village and the surrounding communities that are interested in one of the realms that are being pursued, and wish to contribute to the development of that component. This premise emphasizes the importance of a reciprocal relationship, with ‘teaching’ and ‘learning’ occurring between all participating parties.

Yesterday, we had the opportunity to gather with our designated co-learners. Dale and I met with Grace and Lonjezo, both of which are Makupo villagers, and commenced our research on the condition of local health. We spent hours discussing a variety of prominent local health needs including Malaria, Diarrhea, Coughing, Parasites and Malnutrition, just to name a few. Near the end of our conversation, we touched on a few sensitive topics, the last of which was rape. We were told that rape of women is suspected to be a very common occurrence in this region, yet it is rarely reported. A recent case, reported on the radio, consisted of a six-month-old baby girl being raped by an older relative of her family. In any context, this kind of action is unacceptable, but I found myself extremely alarmed by the news of this six-month-old girl. This was not out of ignorance; instead, it was because of my observations of the Malawian people. I respect the nature of the relationships that I have witnessed while on the ground. There is genuine devotion to family and siblings. There is immense support between neighbors and community members. There is hospitality beyond belief.  There are many qualities of the local Malawian society, which I truly admire, but this story, among others, has emphasized the need for modifications of the current system.

With this in mind, I think that my time in Malawi will prove to not only enhance the development of the Chilanga region, but also my own knowledge and hopefully the communities that I return to in Canada. The concept of a co-learner has never been so clear. Malawians have much to learn from Canadians, but the opposite may be even truer. No one person is ever perfect and the same goes for countries, regions and communities. Whether we care to admit it or not, we all have something to learn from one another and there is always room for growth.

Research Journey

By Barbara Hunting

Naomi June 13

It’s all about education

First something to tickle your funny bone; experiential learning (life) happens. Let me share an amusing event from this morning, I woke up and as usual I went to leave my room and the door would not open. (Wed. June, 12, 2013) I am staying with a villager and her daughter and her daughter and I attempted to open the door; the door would not open. I went to the window and saw no one as it was early. I went back to the door and rattled the handle some more. Ruth heard me! She asked me to drop the key and pass it under the door; I told her the door was not locked. We both laughed.  I asked her to try the handle and she did; it opened.  The mechanism on the inside of the door had worn out.  I did have a moment of panic because the windows have bars on them, so there was no escape route.  I have found that an essential part of field work is humor.

Research journey; I am impressed with my research participants!  I am using photovoice technique (participants take pictures, then interpret the pictures) [see C. Wang, 1999, C. Mitchell, 2011] while co-constructing a health policy dialogue with the research participants in the Kasungu region of Malawi.  What excites me about using photovoice technique is that the participants become empowered to narrate their health concerns and issues.

Without revealing too many details, I can explain that in this rural area of Malawi there are many concerns related to health and this year, while doing my doctoral research, I have the opportunity to take the community health concerns to the next level and begin to co-construct a health policy dialogue.  It is a request that has been made by the community. I have worked with senior and junior populations (in Canada) to bring them together around creating awareness about HIV and AIDS.  I came to this project due to my interest in experiential learning and collaborative classroom projects.

Discussions around themes of health concerns lead to the challenge of representing ideas through pictures.  I arrived with a collaborative project and the participants have enhanced my abilities of interpretation. These participants continue to amaze me.

Dialogues emerge from the photos that are taken in workshops, then pictures are chosen by the group and then a focus group discussion begins.  After this focus group session, there are separate interviews to capture any concerns that could be more personal and not shared within a group.  The groups are all asked to reflect on a space to hold a photovoice exhibit where all the groups will see all of the photos and captions.  The main focus is to examine and capture health concerns and create awareness possibly to new audiences and co-construct a greater awareness about health in the everyday.

That’s it for now!  More from the field soon!

BaaBlah (Barbara Hunting)