Soon after 8am on the 4th February, 2002, the group climbed into the Land Cruisers and set off for Mangochi. It is about 300 kms. from Lilongwe, with a good stretch of road (called the M1 – shades of England’s first motorway??). The road had many villages and markets in operation along the way – and picture stops were a mandatory.
Despite the overcast and sometimes rainy weather, the scenery was spectacular, with hills rising almost sheer form the lush green valley floor. At one point, the Mozambique border runs along the road, allowing free passage between the two Countries. On the Mozambique side there were still many ruined houses and other deserted buildings, relicts of the long Civil War in that Country.
We stopped near Nadzanale (?) to visit the market, and later at Ntcheu to get some refreshments. Digestive biscuits, potato chips … and South African beer!
Around Balaka the M1 veered towards Blantyre, and we followed the M8, a less well made but still tarmac route. We dropped down from the plateau towards the Lakes, and the entire trip took us almost 5 hours. Fortunately, the group enjoyed the time as we could use it in getting to know each other better, and in talking the issues.
We were also able to learn more about the country from our guides and drivers. That is, when we were not listening to Robert’s Country and Western and Reggae tapes….
Despite its spectacular scenery by the lake, with Mozambique’s hills in the background, Mangochi is actually one of the worst hit areas of Malawi. It has more poverty and higher HIV incidence (probably over 20% versus the 15/16% National average).
Perhaps surprisingly Lake Malawi doesn’t help – as it harbors diseases (e.g. Bilharzia), has been over fished, and, with the influx of tourism from across Malawi, has a thriving sex industry.
After lunch, and arriving very late with profuse apologies, the group visited the Mangochi Save the Children office. There is a large staff at work in Mangochi District (up to 85) although most are usually in the field. Joining the Save people were representatives of the local District Government Office, the Education Office, and the Health Office.
First was an informative and insightful review of the COPE program, given by Patrick, Save’s District Coordinator. Without repeating the principles here, a couple of thoughts struck home. There is no point trying to get people to be careful about contracting HIV if they have too much spare time (and thus frustration).
Part of COPE is designed to keep kids busy! Getting kids who have dropped out of school to join Youth Clubs is one approach. Peer pressure is also a wonderful tool. Another critical aspect it to build a multi-sectoral approach, with Government Departments, local Community Chiefs and businesses – so that the messages are interlinked and reinforced. Save estimates that in 2002 the COPE programs should reach about 50% of the 800,000 total population in the Mangochi District.
Jimmy, the CHAPS District Coordinator told how COPE had evolved over time in this District, extending into a full scale “Life Initiative”. Key items are to be a supporter and partner for Government HIV / AIDS programs, rather than a stand alone program implementer. This of course means CHAPS must help to build capacity to deal with the issues via ongoing health training. Building on the “Life” theme, CHAPS also supports the District in preventing parent-to-child transmission of HIV, an increasingly serious issue. A particular concern is how to handle transmission via breast milk. Of course, insufficient coverage of HIV testing also gets in the way.
Finally, CHAPS is working on education to get the facts out about all sexually transmitted diseases (rather than some of the folk lore). This includes special efforts to teach girls how to better control a sexual encounter, use condoms etc, and how best to encourage Communities to distribute condoms. One barrier is that condoms cannot be distributed at schools.
Douglas told us about the HIV Education Programs in Primary Schools. A start point has to be getting the Community sensitized to the issues and the facts – making Community Leader’s pivotal players. An essential first step is to baseline the sexual practices amongst the population – and it was pointed out that the average age of sexual initiation in Mangochi is 11 years old (and can be only 10 years old). Perhaps a little surprisingly the girls become sexually active before the boys. It is also clear that children’s sexual practices (and abuse levels) vary according to whether they are two parent, single mother or single father homes.
The team is currently working on how best to use the data to develop the optimum teacher training program with which to go to scale. Rob (a teacher himself) made the excellent point that the teacher’s own behavior strongly influences the kids future activities. In fact, this makes some teachers reluctant to teach the subject, as they know their behavior is found wanting. Unfortunately, it was also pointed out that some 20 teachers a month die of AIDS in Malawi every month. This is not only an issue in HIV / AIDS education, but in Malawi’s overall educational development.
Next was the School Health and Nutrition Program, presented by Mary M. The programs are all implemented by teachers in the schools, so Save is essentially a resource and capacity builder. The program learns from other successful programs around the world – but has to be tailored for local diseases such as Bilharzia along the Lake shore, including annual health checks. Save promotes the use of vitamin A at school, and is now broadening this scope to the general Community.
The program also encourages Communities to provide First Aid kits to all schools, in particular to help prevent malaria which is still a major killer.
Inevitably, the program also deals with sex education. This includes the peer pressure on children to have sex, and the practices and “data sharing” in kid’s sexual education from traditional leaders. In Mangochi District, this education is carried out be semi-professional initiators outside the home, and could happen as young as 7 or 8 for boys (girls are more likely at puberty or just before marriage). There is then of course ongoing talk back in the Community, in which the children are encouraged to follow traditional sexual practices.
Unfortunately if anything the age of sexual debut is dropping, and it is clear that it is difficult to discuss and change the education / initiation issue with these traditional Communities. This all may well be highly inappropriate in an HIV dominated world…. although the opportunity to use the traditional process to impart modern knowledge is a real one. The Positive Deviance technique (which identifies the “successful” kids in an otherwise “unsuccessful” group – a tool pioneered in Vietnam) is one method being employed.
Finally, another Mary (Mary K) talked about the Youth and Adolescents reproductive health program – which we will learn more about in the coming days. It is called Nchanda ni Nchanda in Malawian, and covers about 60,000 young people a year.
With lots of thanks for a very energetic and informative discussion, the group parted ways, and set off back to the Nkopola Lodge.