This is the journal of Mick’s visit to Malawi and Mozambique, as a Board Trustee of Save the Children (US). The team was looking at Save’s HIV/Aids programs.
The journal is written exactly as it was in 2002, with statistics from that time.
At the time of the visit (February 2002), Malawi was one of the African nations hardest hit by the HIV/AIDS pandemic. Nearly 16 percent of adults ages 15 to 49 – some 800,000 – were believed to be infected with HIV, and a child born then has a life expectancy of just 37 years. Some 275,000 children had been orphaned by AIDS and it is estimated that one in every four children will become AIDS orphans. A World Bank study found that AIDS has wiped out most of the economic gains made by the country since its independence from Britain in 1964.
The crisis is dealing especially cruel blows to these AIDS orphans. They lose the love and support of parents who die of an AIDS-related illness; they are frequently deprived of an education and economic and social security; they are isolated and discriminated against because of the stigma that HIV/AIDS carries; older children often become the sole caretakers of their brothers and sisters; and they are extremely vulnerable to exploitation and sexual violence, thereby increasing their own risk of becoming infected with HIV.
Save the Children had developed the Community Based Options for Protection and Empowerment (COPE). This is a five-year-old program, helping address the basic needs of some 20,000 AIDS orphans in four districts in Malawi: Dedza, Lilongwe, Mangochi, and Nkhota-kota. Save the Children’s HIV/AIDS strategy in Africa called for COPE’s widespread replication and the application of its best practices for other community mobilization programs serving AIDS orphans. Community involvement and self-reliance are at the core of the program, which has been funded by USAID since 1995.
Working with coalitions of local government officials, business leaders and non-governmental organizations, COPE has helped thousands of families to take care of patients living with HIV/AIDS, to meet nutritional, emotional and educational needs of the children, and to improve their long-term financial security.Through COPE, Save the Children had created and are supporting some 200 Village AIDS Committees, which mobilize and conduct care and support activities such as food security, education, and psychosocial assistance for children who have been orphaned by the AIDS-related death of a parent and have been largely left to fend for themselves and care for siblings. Committees also assist families that are caring for AIDS orphans and families that have lost incomes, taken children out of school, or are dangerously close to dissolving because of an adult’s AIDS illness.
- Trains individuals for home-based care of chronically ill patients
- Offers Emotional and social support to orphans and their caregivers
- Ensures the continuation of children’s education and recreation activities
- Provides community-based child care for families of AIDS orphans
- Supplements income through gardening and other small business activities
- Promotes prevention and health safety through organized public events, structured youth clubs and other popular education methods
Save the Children was seeking the resources to replicate COPE in the country’s northern region, where not presently working. Save the Children partners with an NGO already conducting HIV/AIDS programs in the region to maximize the program’s reach by identifying and training local community groups (church groups, youth groups) in the COPE methodology and its implementation.
The Agency had also begun exploring the potential of a “Living University” in Malawi that would train community leaders and HIV/AIDS workers in COPE’s best practices for community mobilization. This cost-effective strategy is based on Save the Children’s groundbreaking Living University model in Vietnam, which is training health workers and community leaders from across the country in our successful child nutrition program and identifying “positive deviance” practices of poor families whose children are better nourished than others.
Elsewhere in Africa, Save the Children has the opportunity to use the current HIV/AIDS awareness and prevention programs as a springboard for introducing COPE. These programs include adolescent HIV/AIDS education and a negotiation skills project for girls in a heavily traveled transportation corridor in Mozambique’s Gaza Province, youth education in high schools in Ethiopia’s capitol of Addis Ababa, and psychosocial activities for some 1,000 orphans at two Ethiopian orphanages run by a colleague organization.
So, the journey began. The British Airways flight (BA65) left London via Nairobi. I was able to meet two of my fellow travellers on the plane – Rob and Marvin. Rob had been to Malawi before with Save the Children, but like me, it was Marvin’s first trip. First impressions on landing were of a green and lush land – although we later learnt that last year was a terrible crop, so there was much hope for a better one in 2002. Passing through customs was an interesting experience, as two flights came together. The rest of our group were on the other one from Johannesburg.
We were met by Justin Opuku, Save’s resident Director. Justin has twelve years of experience with the Agency, originally hailing from Ghana, and arriving in Malawi via many other African countries. His smile and sense of what is right became an instant memory for all of us.
No one wanted to waste time with lunch at the Capital Hotel, so we bundled into a van to visit the markets of Lilongwe. First stop was to see some of the local handicrafts, laid out under protective tarpaulin outside the main post office. Some of the cast of characters can be seen in the first photo album. Whilst a fun time bargaining was had by all, not for the last time we noted that almost one in seven of the people around us would be dying of Aids. A terrible statistic, brought home by meeting mothers and their young children – the mothers hardly older than my youngest daughter.
We went on to the old market, guided by Robert, a new member of the Save Staff. It is a bustling sprawl of people, trucks, goods on blankets on the ground, stores of all kinds and folks just “hanging out”. People were usually excited to have their photographs taken, especially when they could see the instant replay in the back of the digital camera – although once or twice Mick was asked (relatively politely!) not to snap. Again, the humour in the local people was very evident, yet there also seemed a resignation and sometimes a tinge of suppressed aggression in some. And it was rather funny to be told to “move out of the road” by a traffic cop – everyone was doing it, but we seemed to be a particular problematic set of jay walkers!
At US$900 Parity Purchasing Power per head year, this is a very poor country indeed – not least as there are clearly some well to do families in town, which only makes the average income deceptively high. Still, a Carlsberg at 35 Kwacha (about 50c) seemed a welcome afternoon refreshment.
One picture that Mick took will haunt. It is the one above of the young couple. A young man wanted his photo taken with his even younger girlfriend. Superficially just a “happy snap” – but somehow this summed up the relationship of the sexes, with the men dominating and the girls having little choice.
It showed the “Sugar Daddy” culture all too clearly. Whilst not prevalent in Malawi, there is also a belief in some Countries that having a young girl can cure HIV – which only makes the cycle worse, of course.
Most research has suggested that this inter-generational phenomenon has contributed to the spread of the HIV virus – indeed many countries, including South Africa, run public health awareness and education campaigns on the issue.
[2015 note – There is some recent evidence that actually it’s not all a negative – as there is more awareness of the virus threat amongst such couples. But generally the consensus is that it is a rather sad and widespread social trend. The image was originally used by the Guttmacher Institute, in 2005, to head an article on the subject. The article is still online].
The earth is very red, and the overcast skies gave a deep hue all around. Lots to ponder, even on this first afternoon.
Back at the hotel, Justin had arranged a very gracious reception with many of the local NGO heads, some Government leaders and the Lilongwe Save office staff. It is always a privilege to meet the people who actually do the hard work that we just talk about, day in and day out.
Several made short informal speeches on their work. Many themes – the need for better and better education seemed the most pervasive thought from all. Much has been done in the past 2 / 3 years to better arm the population to combat HIV, but even more needs to be done. An inspiring group, and a fun evening.