Thursday, 25 February 2010

Fair's Fair

Went to an event this evening and met a Fairtrade certification officer named Diane. She comes from Ghana and is travelling in Europe during Fairtrade Fortnight telling what difference receiving fair prices for products really means. She comes from a pineapple growing area and the fair income recieved from selling these fruits benefits the workers on the plantation and thier communities. It has enabled one community to install a stand pipe for fresh water, a lavatory block and a school room. And that is only the 'tip of the iceberg' of change for the better.

Fairer prices for milk in this country are still desperately needed. I attended the 150th anniverasry celebration service of the Royal Agricltural Benevolant Institution earlier this week and learned of the help that this excellent organisation can give to our farmers. One farmer who had to give up his dairy herd and then his milking goats because more money was needed to increase numbers, was helped by the RABI with a grant to retrain as a heavy goods driver. This enables him to earn extra money while continuing to farm on a small scale.

Perhaps Great Milk Debates are called for once again.

Sunday, 14 February 2010

The Ministry of Food

Just over a week after returning from Malawi and the atmosphere of the country and the memory of the people I met are still very much with me; perhaps they will never disappear.

The daily struggle of many in that country to provide food for themselves and their families was also with me early last week when I found myself at the Imperial War Museum for the opening of its latest exhibition "The Ministry of Food".

How did our grandparents' and some parents' generations find enough food to eat in a beleaguered country and yet remain healthy enough to withstand the deprivations? Well, it's all there - this delightfully direct and nostalgic exhibition tells us what to do; there are many lessons in domestic science and gardening that we can learn today which would help us all to fulfill the criteria of home grown, locally produced, sustainable and healthy food. And it could mean no bananas.

No war time history of food would be complete without the WI, of course, which provided the willing and able workforce to produce tons and tons of jam from the fruit grown in this country. Canning machines from the USA were provided by government to 500 WIs so that jam could be canned and stored for distribution around the country. The sugar was also provided. I wouldn't be surprised if there is still a canning machine hidden somewhere in several federations still. The one on show is loaned by Buckinghamshire Federation.

Guests at the exhibition opening sampled mock goose and mock cream as well as uniform sized potatoes stuffed with stilton as well as potatoe biscusits. Being a child of the 50s I was brought up with mock goose and mock cream both being familiars in my mother's repetoire menues.

In 1939-45 the people were told to keep calm and carry on. A maxim to be followed still I think.

Thursday, 4 February 2010

It appears the WI arrived in Malawi at a most auspicious time, just as President Bingu was elected to the Presidency of the African Union. This afternoon he returned home to much pomp and ceremony. Of course, his Vice President was there to greet him; The Right Honourable Joyce Banda, African Union Goodwill Ambassador for Safe Motherhood. I could not see if she was still wearing her WI brooch during the ceremony on tv, that she immediately pinned to her beautiful bight blue and white dress when I presented it to her this morning.

A meeting with this lady would brighten any day. She sees every glass half full rather than half empty. Maternal mortality rate has decreased since 2004 even though Malawi has the second highest death rate in Africa. But she begins with hope, the hope of saving more lives. As a wife and mother from a Malawian village, in her combined roles, she is determined to not only give the issue of maternal health high priority in government but she is also doing her job understanding completely the many difficulties women may have during pregnancy and childbirth.

At the meeting with her we told her of all we had seen and heard in the last 3 days; the issues of decision-making within the household, that the birth is imminent, the broken down bicycle ambulance, the lack of space and care when a woman gets to hospital and the abrupt ending of the funding for nurse midwife training. She was more than familiar with all we said and explained how she had set in motion programmes to teach the leader of a village the necessity for women to go to hospital as soon as possible in order to avoid complications, and that she should be helped to get there and cared for generally. This change of culture has already made an impact on maternal mortality numbers but there is still some way to go. When the women do go to hospital in time for the birth, sometimes 4-6 weeks before, there is nowhere for her to stay because the holding shelter is already overcrowded. Mrs Banda issued a plea for more holding rooms like this and at the same time, more midwives. As the funding for training has come to an end she wonders if there could be a sponsorship scheme to train the young men and women who would come forward but cannot afford the three thousand five hundred pounds required for the three year training. She genuinely seemed as bewildered as everyone else we had met when it came to the cutting of funds. She concluded by saying that overseas aid is still crucial to her country, thank you and please keep it coming.

After the photo session I invited the Honourable lady to become an Associate member of the WI to which she replied, "Yes, please".

Before our conversation with Mrs Banda we had met the Minister for Health who told us quite categorically that of course he knows the situation with maternal mortality was bad but it is getting better. He too is grateful for the aid that comes but also asks for its continuation. We raised issues of women's decision-making power, transport, enough and adequate hospitals and the lack of midwives. The majority of health aid comes from DFID (the UK Department for International Development)and we were left in no doubt that they hope after our election this will continue.

During a final meeting with DFID they explained that the allocation of the aid they give is determined by priorities set by Westminster. The current budget is 75 million pounds with plans to increase it to 80 million next year with maternal health being one of their top priorities. Crucially, we hope that after the election it will still be a priority for whichever party is in power. However with climate change impacting communities here and now, a budget must also be allocated to address these challenges, while keeping their committed funds to achieve the MDGs.

After all we're learning about the Millennium Development Goals and gender equality being vital to achieving each and all of them it was disappointing to say the least to learn that gender was not on DFIDs priority sheet which they presented to us, and when questioned about this they referred to one or two unnamed projects. We had hoped to see a stronger commitment to gender equality from our government.

So the trip is over; we have met some wonderful and dedicated people to whom the issue of maternal mortality is so important. Malawian people are so friendly and caring and they have been so pleased to see us. They say it has been an honour but I would say quite the contrary as we have been completely honoured to meet them in their beautiful country. We felt the welcome from "The Warm Heart of Africa".
The WI is coming home both informed and inspired as well as humbled.

Wednesday, 3 February 2010

A Journey to the interior - down desperate roads, across fields of puny maize, to meet a family beleaguered by HIV/Aids. Husband and wife and youngest son of two years all need ARVs every month. Mister was very ill but there is a marked difference now since receiving the drugs. His wife and son appear well. To collect these drugs for all three at once (which thankfully does happen now) he must walk back the way we came in our trusty 4x4, then pay the sum of $2 for the bus to take him to clinic.

This family live in abject poverty. Their food yesterday, some maize, of which there is enough left for today, was earned from a day's work in someone else's field.

A volunteer community worker, Ruth, who goes to five outlying villages over a two-week period and whose job would be eased if she had a bicycle, is seemingly this family's only hope at the moment. Her enthusiasm and her care of these people and obviously many more, really is a beacon of hope. This does remind me of our great organisation and all the voluntary hours that we put in.

This afternoon we visit the National Organisation of Midwives where its deputy, Harriet, reiterates the despondency they all feel at the abrupt halt in funding from government for training nurse/midwives. There are currently only 25% of the needed midwives in Malawi. Also their problem in retaining the midwives is many-fold, not least the high-risk aspect of their jobs as many have contracted HIV themselves. Also their fears around housing, electricity, transport and providing schooling for their own children. Solar powered electricity is part of the answer, as we saw at the health clinic on Monday did sport one of these, and the clinician had the best house in the village.

All this may go if maternal health isn't prioritised in the next health SWAP - more on this tomorrow.

Tuesday, 2 February 2010

2nd February

Another day, another destination within this beautiful country. This morning we set off to visit one of Oxfam's projects which addresses the issue of HIV/Aids in a remote rural area but one that also is concerned with maternal mortality.
On the way we pass by huge tea plantations. We see a sign which reads "You are entering a child labour free plantation"! We see the tea pickers with huge baskets on their backs picking the shiny fresh green leaves of the tea we so love to drink. They truly are huge baskets. Pickers seems to be all men or all women but not both together.

Now we take a right turn off the main road and encounter people everywhere at a roadside market but only a few yards further on we pass Thyolo hospital sporting the sign on the gate "This is a Child Friendly Hospital" with a painting of a breast feeding woman at its side. A left turn past the hospital and we are on a dirt track which passes through an extensive tea plantation, "owned by someone in the UK" we are told. It is gated and we have to pass through with the permission of the two guards. Right in the heart of this plantation is our destination. The road is tortuous, and driving in anything other than a 4 wheel drive vehicle would be unhealthy never mind uncomfortable. We pass people gathering macadamia nuts from the many trees on the way.

As we arrive in the village we are greeted by many, many children all waving and smiling and a group of women welcome us with song. We are ushered into a low, darkish, building where seated in a line are the people who are in involved in the project. The welcome is delightful and long and everyone is applauded for their position and for what they do. The village head man gives an address and then the officer with the community based organisation working with Oxfam gives us a full run down of statistics and people in the HIV/Aids programme. Finally we come to the issue of maternal mortality and the women in the group begin to speak. One of them was a Traditional Birthing Attendant who is no longer allowed to work according to a government directive. And in his final address the village leader states categorically that there will be heavy penalties imposed on anyone continuing to work as a TBA. We are told later that the TBAs had only received basic training and would often take on more complicated births than they were able to cope, resulting in high mortality rates.

However, one of the main difficulties for pregnant mothers in labour is the ability to get to the hospital. The nearest is only 3 miles away, we passed it, but the road is so treacherous no pregnant woman, nor one in labour, should look at it let alone drive down it. The only mode of transport is a bicycle with a stretcher attached. One man says it is dangerous for the men to ride this bicycle down that road, especially in the dark night because that is when most women go into labour!

Unfortunately, the bicycle is no longer in working order, the back tyre needs attention and we are told later, when viewing the famous bicycle, that the last time it was used the poor lady lying on that stretcher died before she reached the hospital.

Transport is not the only difficulty when it comes to giving birth. A second problem is the question of who takes the decision that the woman should go to hospital and when. It is usually the husband and if he is not there, waiting can be too long and too late; at the same time no one else in the village might know a woman is pregnant - witchcraft of old is still thought of and not knowing whom might be your enemy causes you to hold your tongue! A third difficulty is that very often when a woman does reach the hospital ready to give birth there is no one to attend to her.
One broken down bicycle for the women of 11 villages. It is sad!

After handing out WI pens we move on to visit another hospital with a maternity wing.
Also the site of a college of midwives. This is St Joseph's hospital, a hospital set up in the 1950s by the Catholic Church. We meet one of the two doctors who works there; his colleague is GP trained. In the welcoming group there is also the chief nursing sister (both a nun and a nursing sister).

Here, women from a designated area are treated 'free of charge' and their particulars on the relevant form must come with them to be passed to the government who will then pay the costs. Any woman from outside the area would be treated but payment would be expected. Dr Banda who trained in tropical medicine in the west tells us he came back to work in Malawi because he wants to help those less fortunate.

We are shown the maternity wing beginning with the check in room and the delivery suite. Our standards at home seem sky high in comparison! Then we go to the ward where tiny newborn babies lie in the middle of the beds with their mother. They are to stay for several hours only and while they are there their families must feed them. There is a compound outside the ward where families stay.
With the rain finally falling we are shown across the yard to the school of midwifery where Rose, the principal tells us that in the third year they have 54 pupils but in the first year the have only 3. This is because the government has withdrawn funding as of September 2009. Now students have to pay their own fees. This means that would-be students have to find over 1,000 pounds per year. They cannot do this. Speaking later with 4 third year students, two of them, young men of 22 and 21, tell us that they wanted to be midwives because they wanted to do something to stop the deaths of mothers and babies, wanting to help those less fortunate and one whose twin brother died of asthma who wants to be able to help avoid such deaths. The three year course qualifies them as a general nurse too.

The day is over. We drive back in torrential rain - thank goodness, the rains will help the maize to grow. May it pour all night.

Monday, 1 February 2010

Hello Malawi!

31st January 2010

Hello from Malawi!

27 hours of travel and we arrive in Blantyre. The Sunbird hotel awaits at the end of our 4 hour road journey from Lilongwe, passing through the most deprived and poorest of areas. Of course, the heart is tugged by barefooted, beautiful children in rainbow hued clothes and young women holding out bowls of their home-fried insects which come with the rainy season to sell to passing travellers. Yet we all thrill at the sight of artistically piled turrets of tomatoes, potatoes and mangoes in the roadside markets.

Maize is planted in every available space within the deep orange earth of the lush green landscape which reminds me of the Brecon Beacons - without the gorse. And the villages of grass roofed huts speed past as well as hundreds of rectangular buildings - homes, looking as if deserted but not so; and there is the very odd smart one too. But everywhere, familiar signs - "Blueband, the spread" and "OMO for good dirt" Incongruity and beauty - an adventure waiting.

1st February 2010

We hear it is snowing back home but here in Blantyre it is very warm and humid and before long it is HOT. Our day begins with a visit to the Oxfam office, just beside the hotel. We are given a brief overview of the work it is carrying out and hear of the earthquake that struck Malawi in December- 6.3 on the Richter scale. Malawi is used to dealing with flood and drought but earthquakes of this magnitude is new. 3,000 people are in camps and house rebuilding is desperately needed.

We learn that the rate of HIV/Aids is still very high here but that it has fallen from 14% of the population affected to 12% as antiretroviral drugs are now available and free. This and a lot of education has helped the situation and continues to do so.
But we also learn that 1 in every 100 women still die in childbirth and this is the crux of why the WI has come to Malawi.
Maternal mortality is an issue within Millennium Development Goal no 5 - Female Health. So we set off to a village where we are to meet pregnant ladies. We are so graciously received with the sleeping mat put down on the bare earth for us to sit.
Our hostess has 3 little boys, the youngest not much more that a year old and baby number 4, whom she hopes will be a girl, is due - she does not know when! She goes to a hospital close by every month, but she has to take a taxi as she is still breast feeding her baby and walking is not easy. For a fee she could go to a nearer hospital.
She wants no more children after her baby is delivered and will take contraceptive advice after the birth. She didn't want her husband to know. We are invited into the family hut which is pitch dark even when our eyes become accustomed to it. We are told her older child sleeps with the grandmother across the way. Very happily the family pose for photographs.

A very short walk to another village and we are introduced to a second lady, a first time mother of 18. She brings out the upholstered dining chairs on which the men usually sit as well as the sleeping mat. I sit on one of the chairs with our hostess. She seems somewhat bewildered by the whole process of maternity but is glad that she has learned what it all means from the health worker in the hospital as she had been frightened by what she had learned of giving birth from the women in her village. When asked what her hopes for her baby might be she said first that she hoped it would be a boy and that he would grow up to be a male nurse. She had hoped to be a nurse herself but had to leave school, having reached Grade 5 only, when she became pregnant and married. Perhaps she will return to education one day. I hope so.

And finally today, off to a Health Centre proudly welcomed by the Health Worker and his caretaker/assistant. Daily 500 patients are expected and received - and treated. A few patients were in the waiting area - an open-sided room with hard benches. One small boy looking unwell was led from the surgery by his mother. We were told that now is the time when there is much Malaria. Mosquito nets had been given out in the past but this year they had not. To this health centre people come for diagnosis of HIV/Aids but they are treated at the hospital some distance away.
Everyone seemed so very pleased to see us and were happy to welcome us into their homes and work place. The day's excursions felt positive - but where we found ourselves was remote by our standards and there are people living in far more distant places who do not have access to much healthcare at all and certainly not anti-natal or post-natal services.

There is one exciting thing I have to tell you - we have our first WI in Malawi! Well, not strictly, but in one village, with the dedication and foresight of one man in a voluntary capacity, he has set up a place for the women, with their children, to go. This group were saying that they have time to meet together and they want to talk about all sorts of subjects, but they need a leader. Needless to say, I easily identified the president and the committee! And through the translator it was felt that the WI model was for them. Who knows where this might lead but if the structure of the WI can help these women find their voice then no one is happier than yours truly, Ruth