News flash: men prefer having sex to raising healthy kids!

Or, at least in Malawi, some men do. In a report a few weeks ago from the Daily Times, which I read bemusedly (humor over tears is my frequent approach here), the practice of spraying DDT in homes for malaria prevention was discouraged because it led to reduced sex drive among men.

There is a current ban on DDT in Malawi, so this article is rather mute. However, I guess some men got wind that health experts are trying to lift the ban as DDT has been shown highly effective in reducing malaria when sprayed (in low concentrations) on the walls of homes - check out an older CDC article here.

Malaria is a huge problem here. I don't know how many men die of reduced sex drive, but an estimated 12,000 people die of malaria every year in Malawi, most of them children.

Now, if you reject DDT use for its destruction of the environment or its general toxicity, I am fine with that. But, if you refuse to use DDT to fight malaria because you might have libido issues, I am slightly sickened.

And, that is why I need a vacation (and why I eat Pepto like candy).

Namibia, here we come! Happy holidays and Happy New Year to everyone!

One step forward, two steps back

One of Malawi’s (and the world’s) toughest obstacles in the fight against AIDS is that some HIV-infected individuals do not want treatment or seek treatment too late. The reasons for not wanting, or delaying, treatment are of course complex and multifaceted. I do not pretend to understand them all. But, some of the most common reasons are: 1) denial about being infected even after a positive test; 2) fear of disclosing HIV status to someone (you MUST bring a guardian to get HIV treatment in Malawi - more on this later); 3) lack of desire to take life-long meds; 4) believing that you only have to start meds when you are really sick – a time for some that is always in the future. There are hundreds of other reasons why people do not start, or remain, on treatment.

Still, a man died from TB today in the hospital –his lungs were so bad that people described the Xray as “looking like corn in the lungs.” He had started TB treatment 3 days previous. He also had AIDS but was not yet on treatment. He had tested HIV positive months, if not years, ago. Clearly, it was too late by the time he got treatment.

This situation is not unusual -- it happens dozens of times every day -- and almost 70% of people in Malawi with TB are also HIV infected. However, this case was different: the deceased man’s brother runs an HIV clinic in the capital.

Now, if even the close family members of Malawi’s best trained and most motivated AIDS clinicians can die from accessing treatment too late, what does that mean for others? I know it is not the clinician’s fault in any way. But, in the abstract, this shows that the challenge of getting people into treatment, and into treatment on time, is not as simple as increasing knowledge about HIV and TB or improving access to care. As all of us in this profession understand, we have a long way to go in winning this battle. Sometimes, it feels like the war has barely started.

Puppies 1, Horton 0

And they call it, "Puppy Love"....

What NOT to do: Tips for interviewing in Malawi

Yesterday, I helped interviewer 4 candidates for an upper level financial management position at my organization. The evaluation panel consisted of 3 people: the Executive Director, the head of the Board of Trustees, and me. After 7 hours of torture, and one possible candidate, I have some tips for future interviewees:

1. Please spell check your cover letter and resume. If I am editing while reviewing your materials, I am clearly distracted from appreciating the contents.

2. Please come on time. 30 minutes late for a casual dinner? Fine. For an interview? Forget the job and go home. I know you did not tell your boss you were looking for a job, but can’t you make up a funeral or a bank errand and get here on time?

3. On the flip side, please do not come 3 hours early. This seems over eager and desperate.

4. Please dress for an interview. I know that folks here are poor. But, if you want to be in charge of millions of dollars, you have to look like you don’t immediately need money for work clothes. Wearing a pink striped shirt, red tie, and jacket made for someone 100kg larger than you will not inspire confidence from our donors.

5. Please do your homework. If you are asked what you know about the organization, please do more than read the Mission Statement off the wall in front of you. Please at least peruse the website. Please do not say, “I don’t know much.”

6. Please limit the length of your answers; be concise. This is especially important when the interviewer says, “please tell me briefly……”. The 15 minute regurgitation, verbatim, of your resume is not appreciated.

7. Please speak up. There are only 4 of us in the room, seated around a small table. If I cannot hear you, I will make up what you are saying, and you will not like it.

8. Please know the job you are interviewing for. When you give lengthy examples of your experience in agriculture and church organizing as the reason we should hire you as our finance manager, you are not doing yourself a favor.

9. Please refrain from drawing repeated attention to your distance education MBA from Somalia. I think I can print out that same certificate myself.

10. And, when someone asks you for your salary requirements, it is not advisable to say, “the higher the better.”

There are two places like home

Ever feel like life’s roller coaster is moving faster than the speed of light? I could swear that I was just in the States for a visit, but it also just feels like a sweet, sweet dream. Did I actually get to see my friends and family? Did Red dog and I snuggle for 9 solid nights? Did I really eat all that??? Seems it happened, and I have some photos to prove it.

Despite the 67 combined hours in transit, it was blissful to be home. I got in some good time with my STL friends, spent lots of quality couch time with my dog and family, and even managed to get some exercise between mouthfuls by playing Wii, ping pong, and jump rope with my nieces and nephew. I received an original tri-color masterpiece from my 3-year old niece, and my 97-year-old grandma was able to enjoy the holidays with us all. My mom and I managed to avoid almost all seasonal craziness by shopping only (yet repeatedly) at the 3 local grocery stores and Target, and my dad led us in our annual pilgrimage to a labor art show. Jon joined me in STL after spending some time in VA and NC, so we got some (not too bored) board gaming in with the whole family to boot. I even played 3 whole games with barely a pout. A new record!

For Thanksgiving, we had snow! Eating those lovely white flakes was calorie free and delightful. Dinner, also delightful, was slightly sturdier. I had Quorn meatless cutlets, roasted root vegetables, vegetarian dressing, some asparagus, and apple pie. Snicker, you may, but it was heaven to me. Jon devoured the meaty treats with the rest of the carnivorous family. There was plenty of wine and Wild Turkey (not kidding) to go around. Red enjoyed her role at cleanup, just resting her head on my grandma's lap, ever hopeful for something dropped. Other edible excursions included multiple Thai food stops, Vietnamese, and BBQ for Jon (while I ate sweet potato fries and Diet. Dr. Pepper). You know it’s love when a vegetarian suffers a meat eater dining on ribs… extra credit for that!

Then, with bellies full, and bags stuffed to the gills with more food and some toiletries, we left STL for our adventure back to Malawi. With a brief stopover to see my favorite roommate in Johannesburg, we were back home in Malawi. Greeted by a secure house and well cared for puppies, it felt good to be home. It also felt great to be home in STL just a few days ago. Which one is really “home”? I’ll take both, thank you.