Sunday Morning~Blantyre

Sunday Morning~ Blantyre

May 7, 2017

A ndi itana pakalowa njoka; pakalowa mbewa akumba okha~ They call me when a snake has entered; when a mouse has entered, they dig alone. ~ Malawian Proverb

Hi Everyone,

I am back from Lilongwe having had a full few days of research presentations and midwifery energy. The meeting was good. It was a scientific meeting, not an education meeting so the format was different from what I am accustomed to. I was stressed waiting to hear what I was supposed to do, partly because I hate looking like an idiot on a stage and partly because I want this model ward to happen so badly. Not knowing anything about who would be there, what would come of it, the role it might play in the development of this idea, I fantasized that this was our big break. It was stressful.

The meeting was May 3rd to 5th.

Here is the timeline:

April 20th: Abstracts due and submitted.

April 28th (11:29 pm): Email received that abstract will be presented on May 4th with the message: “Format will be sent by May 2nd”.

April 29-30: Prepare presentation that could be either ten minutes or one hour. Waste a lot of time fretting.

May 1st: Try to figure out transportation to Lilongwe on the 2nd or 3rd. Find out we have a lunch meeting with the deputy ambassador on the 2nd in Blantyre. Hope desperately they are driving back to Lilongwe and can catch a ride with them.

May 2nd: (noon): Lunch with embassy people who are not going back to Lilongwe that day. Plan to take the early bus on the 3rd and miss the first two hours of the meeting (reassure myself that it will probably start late and I’ll only miss one hour). Worry I still haven’t received “format”. Learn an architect professor at the Polytechnic may be interested in partnering with us to design the physical space. Feel like God wants this to happen.

May 2nd (2:30 p.m.): Receive phone call while in a taxi in Blantyre saying I will be the first to present from 9:15-9:30, May 3rd, which is tomorrow.

May 2nd (2:36 p.m.): Freak out.

May 2nd (2:48 p.m.): Flail around the office trying to call and email people to get it changed to the 4th as we were originally told as it is impossible to get to Lilongwe by 9:15 the next day. The earliest would be 11:30 and that’s only if the bus doesn’t break down. Am reassured that they will somehow get us on the schedule on the 4th.
May 2nd (2:55 p.m.): Get scolded by fellow volunteer for being “Way too stressed about this.”

May 2nd (2:56 p.m.): Storm out of the office and walk back to Old Town (where I’d just been at lunch; a long walk) to buy two bus tickets for the morning (one for me and one for the volunteer who scolded me), ask for seats not together. Receive a text that I was supposed to supervise students in the nursery that day (first I’d heard of that). Congratulate myself for not screaming.

May 2nd (4:25p.m.) Arrive, sweating, at the nursery to find the students getting ready to leave for the day. The nursery nurse says, “You are late.” I respond, “I know. But only by nine hours. I only just learned I was supposed to be here.” (She doesn’t give a shit. She just had to do my work all day.) Have a quick meeting with the students and tell them I’ll see them there on the 8th. They are all smiles, thanking me. I leave and feel like crap.

May 2nd (5:00 p.m.): Return to the office to give the scolder her bus ticket. Am told she has decided not to go. Tell her she owes me $15 bucks for the ticket. Kick myself that I asked for separate seats as now I would have had two to myself.

May 2nd (5:01 p.m.): Walk home deciding I’m well enough past my hangover to make a gin and tonic to drink while I pack.

May 3rd: Arrive in Lilongwe by express bus at exactly 11:15 a.m. Marvel at this efficiency. Get a cab to the hotel as I have no idea where it is. Discover it is less than 100 meters away and pay the laughing cab driver the 1,500 Kwacha I agreed to. Run into the meeting to hear a presentation on model wards! Realize I have to redo my presentation as the format is nothing like I expected.

May 4th: Get up at 3:45 a.m. to remake my powerpoint.

May 5th: Arrive at the designated meeting place at 7:20 a.m. aware that we are ten minutes early for the march for International Day of the Midwife. Turns out to be three hours early. Enjoy talking with Malawian midwives who are complaining way more than me about how late it is starting.

The meeting turned out to be great. In fact, all of it was great once I got there. It was the Association’s first attempt at a scientific meeting and I thought they did a good job even though it was a bit last minute. The passion and energy was there for sure. It’s hard to keep presentations to ten or fifteen minutes and of course, they all went over. Somehow it worked though (that’s how I feel about most things here). We still got tea breaks and lunch break and everyone got to present. There were three consecutive presentations and then a question and answer period for those three. When I finished my presentation I felt like there wasn’t much of a response. Everyone seemed a little flat, but during the Q&A it was clear there was a lot of interest. The talk the day before on model wards was a study funded by I-forget-which donor and after the grant ended, so did the ward. I emphasized that we are designing this to be sustainable.

There was a lot of discussion about what is happening to the relationship between doctors and midwives here. In the past, the midwives ran the maternity wards and only called for medical help if they needed it. Now with the medical school here, the medical students and residents do rounds twice a day and leave “orders” for the midwives to carry out. They do not stay with the women or even ask the midwives what’s going on. There is an incredible power struggle and the midwives are all frustrated with their lack of autonomy and are less and less invested in asserting themselves. They are poorly paid, have very little time off, and aren’t respected. The midwives at this meeting, most of whom had advanced degrees, were very vocal about that. The proverb speaks to their feelings. The essence of it is resentment for being used in bad times without being thanked in the good times. Snakes are feared here, but mice are a delicacy. Midwives feel they are asked to do all the hard work, but when there is a reward, they are left out.

SEED Global Health, the organization I work with, was a sponsor for the meeting and Bridget, our Country Representative, attended all three days. Bridget is a Malawian physician and went through medical school here. After one discussion where midwives were saying we need to assert ourselves and look for ways to teach the students to do the same, Bridget stood and spoke. She said she had learned so much from sitting through the meeting. She’d had no idea what our education struggles were or how we were undermined by the medical team. She said, “When I was a medical student, I was told to go do rounds and write orders, and that’s what I did. I did not have any exposure to what the midwives were experiencing. I have a whole new level of understanding. It feels to me similar to racial tensions. When there is a power imbalance it is one thing to tell the oppressed to assert themselves, and quite another to have them do it. It’s not easy to bridge that gap.” She said she was excited about this model ward as it is a way to model assertive behavior while providing quality care, and she wants to see it succeed. She said she hopes that eventually medical students can rotate through the ward to learn a different way to practice. She is eloquent and passionate and had everyone rapt. I wanted to kiss her feet.

So, we’re off! Lots of steps and work to do, but so far so good. Meeting with this architecture professor was exciting. He said this is exactly the kind of project the school is looking for. He’s coming over to the hospital tomorrow and I will show him around to give him an idea of what there is to work with. The more partners we have with this the better off our chances.

Speaking of exciting, the first lady of Malawi was invited to close our meeting. After the morning session on Thursday we were asked to leave the room to get it ready for her. This involved bringing in boatloads of greenery and flowers, a velvet draped podium to match the red velvet chair, and microphones and cameras of a much higher quality than the ones we used for the meeting. Red carpets were unrolled along the hallways and swept clean by hotel staff. This took hours. We all could have had an extra fifteen minutes to do our presentations with the amount of time it took just to remake the room. But I was enjoying it. It gave us all time to mill around and chat and do some networking. Security people were all over the place, identifiable by the automatic weapons they had slung over their shoulders. They also had those little earpieces with the coiled wire going down to something on their backs but those were a little harder to see. When she was about to arrive, we were all herded back into the auditorium which looked like a whole new room. About a hundred very scruffy looking people came in and sat up the aisles and in every empty seat. And I mean scruffy, like homeless kind of scruffy. As soon as the royal entourage appeared, all the riffraff stood and started drumming and singing and dancing. I leaned to the person next to me and asked, “Does she travel with these people? Are they hired to do this?” If so, you’d at least think they get some decent clothes and a bar of soap for their troubles. (I was thinking of trump hiring his audiences.) She shook her head, “No, they wait outside anyplace she is supposed to be and come to hear her speak.” I was shocked they let them in, but also thought it was pretty cool.

The first lady of Malawi is president of the organization OOAFLA, The Organization of African First Ladies. She is the picture of grace and charm. She is tall and slender and was wearing an outfit reminiscent of Jackie Onassis, a winter white sheath dress with matching coat, a little retro looking, 60’s style. It was stunning. She wore a gold hat, a huge gold hat with stiff flowers and ribbon. It looked like the whole thing had been spray painted gold. It hid most of her face. She sat in her red throne surrounded by dignitaries from the ministry of health. I couldn’t stop staring at her. There were lots of welcomes and speeches and howling and singing of National Anthems and other songs I didn’t know. When it seemed like everyone but her had spoken, the podium was undraped of it’s red velvet and carried and placed right in front of her so she didn’t have to take a step. She simply stood and was in the right spot. She gave the most thoughtful, and appropriate speech I could ever imagine. She has a lovely voice, soothing and melodic. Really hypnotizing. I wanted her to read me a bedtime story. I’d love a transcript of the speech because I can’t remember all of it or how she worded everything, but the first sentence was “You can’t talk about life without talking about midwives.” I liked that. Another line that struck me was, “No amount of money can compensate you for what you do.” Now, of course those lines would strike me, but it was more than the words. It may be wishful thinking, but I really thought she meant what she was saying. I felt like she was an ally. She said her organization would be a partner, which, is just talk but it was significant and symbolic and I appreciated it. Just the fact that she came was impressive. This was not a huge group. The last census by the White Ribbon Alliance for Safe Motherhood shows that there are just over three thousand practicing midwives in Malawi and to meet the WHO standard ratio for midwife to childbearing women we need 23,000. That’s only 20,000 short. There were probably eighty of us at this meeting trying to figure out how to educate more midwives. We have 2,000 of us at our meeting at home and we’ve never had the first lady come! Anyway, I liked it. The rag tag extras were escorted out and we were told where to gather to pose for a group photo with her. We had to leave our bags in one big heap with two armed soldiers guarding them. We weren’t allowed to take any pictures with our cameras or phones, so I’m hoping I can get a copy of the official one. After the photo op we all lined up along the red carpet and she gracefully exited shaking our hands and greeting us as she left.

Ah. Done with all I had to worry about, I had a relaxing evening and slept well. The 3:30 a.m. rooster serenade didn’t even wake me. I was being collected at 6:30 to meet the group for the march for midwifery solidarity. I love how they organize these marches. People march all the time for one cause or another. It’s so different from when I was here before when organizing a march would get you a lifetime prison sentence. We were supposed to be at the area 25 filling station at 7:30 to begin marching at 8. We would march for a distance of about two kilometers where we would have more speeches and dances before the event ended. Well, we got there at 7:20, beating most of the traffic, and waited an hour before anyone else showed up. Then as midwives trickled in, all wearing the official chithenje of the Association for Malawian Midwives the complaining began about how long it was taking to start. Nine o’clock came and went, ten o’clock came and went, and there was no sign of anyone taking charge. Finally around 10:30, the huge flatbed lorry was heard coming toward us with the “HealthCare Band” playing lively tunes that the women sing at the clinics. There was a big banner on the side recognizing May 5, 2017 as International Day of the Midwife. Then it didn’t take long to get everyone marching in front of the truck lead by a police officer and get on the road. Signs were handed out which read, “Recognize, Reward, Motivate. Midwives.” and “Malawi Needs Midwives Than Midwives Need Her” (I think there was a “more” missing from that one), “Midwives Are The Change And The Future. Malawi Dreams.” , “Midwives Untapped Resource in National Development” (either a colon or an “Are An” missing from that one). Also one that read “Employ More Midwives” and one “Give Us Resources To Work With”. The midwives carried these with pride and danced along to the music playing behind us and raised the signs to every car passing by. It was fabulous. I was honored to be a part of it. It took about forty minutes to go the mile or so to the field where two tents were set up for the speeches. I really don’t know why they chose this particular field at a Teachers College near a primary and secondary school. We were pretty noisy and hundreds of kids poured out of the primary school to mill around and dance and try to get into one of the handbags left on the chairs. One midwife or another was always swatting a hoard of them away. I kept mine over my shoulder so could let down my guard a bit, but there was a lot of swatting going on. There was apparently good reason for this as I watched kids circle the chairs where handbags were, waiting for it’s owner to turn her head. This went on through the speeches until some older kids with tree branches in their hands circled the tent and started swatting the kids until they scattered. Then it looked a little like sheep being herded. The older kids with switches making a wide circle swiping the younger ones as they ran back toward the school. It was actually quite efficient.

After the speeches and songs and poems honoring what we do, we gathered in front of the truck for one last song and we all danced as the band played and everyone (except me, not knowing the words) sang, “You have a baby in your belly, a baby on your hip, a baby on your back, a pot on your head, do you think this is fair?” A little tune promoting family planning by the health care band. I loved it.

Then it was a boxed lunch and a long drive back to Blantyre. I got a ride back in a car returning to the college, which was a treat. I was delivered, exhausted to my door where I could then throw out all the dead rotting flowers on the coffee table that didn’t seem to catch the eye of my housemate.

This week it will be the nursery tomorrow with the students I neglected last week, then an architectural tour. Tuesday we leave again for Lilongwe and a three day meeting for Peace Corps for the end of our year’s service. They are doing it a little early for some reason. Maybe because some people are leaving before the end of June, not sure.

Love to all,