Yes, I will answer to the name, “Cow.”

Today, President Bingu wa Mutharika is getting married! As the celebration is right down the road, I walked down a few minutes ago just in time to see the groom’s pre-wedding car (and ~30 accompanying vehicles) enter the grounds. I snapped a quick photo of the car – festooned with ribbons and traditional cloth created with the couple’s photo. The streets around Lilongwe (at least the ones for his procession) are newly tarred, blooming flowers line the road, trash is cleaned up, and it looks lovely. It also likely cost a small fortune for Malawi, but everyone likes a party with an international who’s who of politicians and dignitaries. I saw license plates from as far as Rwanda, a multi-day drive, and I saw Robert Mugabe's motorcade pass as well. Obviously, I was not invited; instead, I am a shut-in for the morning due to traffic and security.

Almost two weeks in, and as you would expect, my Chichewa pronunciation is deplorable (but hopefully improving). I am sure that people find my current attempts at greetings and repeating people’s names amusing. In response, I feel only slightly guilty for commenting about some people’s difficulties trying to say my name. For context, the letters “R” and “L” are pronounced similarly and often written interchangeably by many Malawians (immature expats smirk when recalling news of the election on the radio or TV). So, here I must answer to a name that sounds, most unfortunately, like they are calling me “Cow.” You can imagine the impact on my self esteem. Moo.

Despite my newly-acquired bovine status, work is going well. I’ve been shadowing coordinators and department directors learning about Lighthouse’s testing, treatment, and care programs for HIV and TB. It is incredible to briefly observe what these professionals encounter repeatedly every day. For instance, I sat in on an afternoon with a nurse during follow-up ART (anti-retroviral therapy) visits. These typically-quick visits are used to resupply individuals with their meds, verify pill counts to gauge adherence, and inquire about side-effects. She saw over 20 patients the first hour: 3 children under age 6; 5 adolescent girls; 1 teenage boy; and adult men and women of all ages. Complicated cases were referred to an on-site clinician (equivalent to a physician assistant). By the time the 4th young girl, age 14, walked in, I thought I would cry. It is not that I don’t know about the high HIV prevalence among adolescent girls (up to 5x the rate for adolescent boys), it’s just the overwhelming difference between reading the statistics and seeing the individual faces. To cover my face for a moment, and suck back tears, I glanced at one young woman’s chart: she tested HIV+ at age 16, already at WHO stage 4 (translated: fairly close to death) and weighing 28kg. Now, 3 years later, she is asymptomatic, 58kg, and looks beautifully healthy. The miracle of ART!!! For another much-needed dose of optimism, you should read about one of Lighthouse’s most amazing accomplishments: the adoption of an electronic data system (which we still can’t do in the States) . It makes me feel very lucky to be a part of this place.