Malawi Internship- Week Twelve

While journaling one morning, I looked down at my watch to confirm the date. August 11, 2014. Time is moving quicker than it did ten weeks ago. I examined the sports watch/heart rate monitor I bought for $20 over six years ago. Though retrieved from my Junk Draw of Doom (you know you have one too), this plastic and rubber watch has been incredibly handy throughout my time in Malawi. Why don’t I wear this watch more often, I genuinely thought to myself. Oh yes, I remembered, because I have a super fancy, super shiny designer watch waiting for me at home. Nowadays, fancy watches are no longer used for telling time. Fancy watches are used to signify status. Fancy watches signify wealth. Fancy watches signify importance, as in, “I’m super important and can wear a fortune on my wrist to remind me that I have to be somewhere at a certain time because I’m so important”. Fancy watches tell people that not only are you important, but your time itself is important. Your time is expensive. Fancy watch wearers don’t wait 5 hours at an antenatal care clinic after walking over an hour on a dirt road just to see the one nurse in the village. The one nurse who, one this particular day, neglected to tell the clinician she was staying home even though she lives next door. No, fancy watch wearers don’t wait. Fancy watch wearers have appointments.

 

Fancy watch wearers don’t queue at a borehole to collect water for their homes. They have faucets (that don’t get shut off like they do in Detroit).

 

Kwitanda Borehole_02

Borehole in Kwitanda

02_Waiting at the Clinic in Kwitanda_01

Women waiting at the antenatal care clinic

Fancy watch wearers don’t carry their own medical records on a flimsy paper card titled, “Health Passport”. They have doctors with offices that keep their records for them.Fancy watch wearers don’t walk. They have cars. Really fancy watch wearers have drivers.

Health Passport and Wallet

Woman holding her health passport

Let me be clear. This is NOT a reflection on the burden and/or privilege of First World materialism. This reflection is about stuff. Real stuff. Real stuff like status. Real stuff like access. Real stuff like privilege. Real stuff like choice. Real stuff like survival.My fancy watch is not just a watch. It’s evidence of opportunity. Of possibility. I visited Kwitanda last month. This small impoverished village near Balaka has stuff. It has electricity poles and cables…that aren’t connected to any homes. It has a motorbike ambulance…that doesn’t work. It has health centers… that are understaffed. It has pharmacies… that are out of stock of antimalarials. 02_Ambulance_01 Kwitanda has real stuff, too. Real stuff like lack of infrastructure. Real stuff like scapegoating. Real stuff like indifference. Real stuff like classism. Real stuff like poverty. These things, this stuff, isn’t just stuff. They’re powerful indicators of health status, educational attainment, and life expectancy. Like your zip code in the States, this stuff determines your future. To make it, you need the right stuff. So what should we do? It’s hard work getting people the stuff that they need instead of the stuff that gets our names on organizations and buildings. Hand soap is not sexy. National ID system? Takes too long. Waste management infrastructure? Next! An emergency response system that doesn’t require you to drive to the station to pick up the police so they can attend to your emergency (that is, if you have a car)? Well, that’s just a mouthful. Tablet computers? Yes please! I believe VillageReach, my host organization, has found that critical balance. One of our projects, Chipitala Cha Pa Foni (Health Center by Phone), is an mHealth solution for providing women and mothers with important maternal, newborn and child health information. The project offers two services: a toll free hotline offering health information, advice and referrals and a Tips & Reminders service that sends voice or SMS messages to registered pregnant women, women of childbearing age and guardians of children under one year of age. The Kwitanda Community Health Project, the other Balaka based project, entails a multipronged approach to improving health outcomes in the Kwitanda village through health education in water and sanitation, child health, reproductive health, nutrition, and so much more. VillageReach implements “innovative” public health solutions in last mile communities. “Innovative” is often code for eHealth, mHealth or multidisciplinary approaches. VillageReach does this. But most critically, VillageReach also shows that sometimes the most innovative solution is to simply give people what they need. Sometimes you need a fully staffed hotline that provides critical health information to callers. And then sometimes you just need a razor to cut your umbilical cord. Sometimes you need a text messaging system to encourage expectant mothers to deliver at a health facility instead of at home. And then other times you just need lid on your toilet. At this point in the summer, I am preparing to present on my organizational assessment at VillageReach’s Seattle headquarters. No organization is perfect, but the folks at VillageReach are a hardworking group. As the organization grows, I feel confident that VillageReach will also continue to grow their capacity to provide the right stuff that will truly make a measureable impact on improving health outcomes throughout Malawi.

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