Reflections and rants on my one year anniversary with Malawi

Is this an occasion for celebration or consternation? That is the question! As I swiftly approach my 1-year mark in Malawi and at the HIV/AIDS clinic in which I work, I’ve been taking some time to reflect. Actually, the malaise that settled around me like warm blanket forced me into this meditative state. In a vicious cycle reminiscent of Groundhog Day, or like a bad tune (Les Mis’ “On My Own” anyone?), I have been having these recurring thoughts: Why I am here? Why do I work here? Why do I stay in a country and in a career field that is always a mix, but never a balance, of pleasure and pain? I haven’t even been writing in my Oprah-circa 1996-inspired gratitude journal (the horror (on many levels))! To exorcize these demons, I’m writing some of my thoughts down here. It’s not so much to soothe myself as to give my thoughts a place to reside other than on constant-repeat cycle in my head.

To be clear: I love what I do. But my work place has its consistent challenges. First, as I’ve noted before, sharing an office with anywhere from 3 to 8 Malawian colleagues means no head bashing stress release, no mental-health skype calls, no secret shopping during work hours, no naps! Plus, I’ve come to recognize that although I value working in a foreign NGO, not having any other expat colleagues (other than Jon) is really limiting as far as enjoying work and feeling like there are people with whom to commiserate. [Note to self: I will not work in an organization overseas again if I am the only expat staff: I require outlets for sarcasm and comic relief!]. Unlike graduate school or my previous jobs , there is no flexibility. Everyone here figuratively clocks in and out, in part due to a previous employee who was “working from home” in Zanzibar. To rub salt (and oil) in those wounds, I eat the same lunch every day at the clinic “cafeteria”: greasy rice, greasy greens, fried cabbage, and 2 boiled eggs. I stare sadly at my plate every day before applying copious amounts of hot sauce and mindlessly chewing…

The hard truth is that this job can often feel thankless and stagnant. My boss and colleagues sometimes thank me and appreciate my work. Things are also improving, albeit at a glacial (sustainable?) pace. But, the reality is that as an “adviser”, I cannot (and should not) take credit for positive changes. To the contrary, it is my job to build capacity (i.e., not take credit) and stand in the back while others move forward. It is gratifying to see improvements and know that I “facilitated”, “motivated”, “encouraged”, and “other buzz word-ed” these changes. But, sometimes (frequently) it’s like I am a ghost writer or speech writer: I have literally heard my colleagues say something in a meeting repeated, almost verbatim, from something I previously suggested. Yes, yes: imitation is the highest form of flattery, and blah blah blah. But, it’s tough (and contrary to my nature, maybe human nature) to be a technical advisor, and not get that sense of accomplishment that comes from putting your name on something or leading a successful project start to finish.

And, there continue to be infuriating things about working in HIV in Malawi. Although they allocate about 12% of their total budget for health (not too shabby), only 1% goes to HIV-related programs (for 12% HIV prevalence). The other HUNDREDS OF MILLIONS of dollars needed to care for over 300,000 people on antiretrovirals comes from donors like you/we tax-paying Americans and our European friends. The result of this generosity is a feeling, a nagging feeling, of growing dependency and entitlement, rather than pride resulting from hoped for increases in Malawian capacity and quality of care. As an example of the unexpected gains in inefficiency and graft, the Malawi national drug storage facility (Central Medical Stores) is a laughing stock: their inability to manage or distribute any drug led the donor community to create an entirely parallel system of HIV-related commodity distribution (all AIDS drugs, malaria nets, etc.). This second system goes against the golden rule of development: Do strengthen existing systems; do not create parallel systems! Of course, it is hard to manage drugs when the apparent purpose of Central Medical Stores was to fill the coffers of its directors! I cannot help but feel dejected by the unknown, but significant, proportion of folks who work in HIV to have a donor-funded car, a donor-funded training, a donor-funded job. It’s like my colleagues and I put all our 10 fingers in the dike, but 8,257 holes remain leaky with hundreds of folks just watching (and waiting for someone to pay them, aka “train them,” to help)! Still, thankfully, mercifully, the majority of our work colleagues actually want to be do their jobs well and the organization, as a whole, does an excellent job. Hallelujah for a reminder of what quality services, in really resource constrained settings, can accomplish! [repeat to myself, repeat to myself].

It sounds unpleasant, but I’ve made some lemonade out of these lemons. Earplugs are my new best friend and lifesaver! Work hours from 7:30 to 4pm makes mornings early, but late afternoons at home with Jon on the porch [wine in hand, fresh tomatoes, balsamic vinegar, and crackers in mouth] are wonderful. And, if I really think about why I took this job, when else am I going to be completely immersed in a foreign NGO, gaining remarkable and under-appreciated insight into AIDS in sub-Saharan Africa? Maybe I will value working in my pajamas more when I get home, therefore enjoying my next job? In other encouraging steps, not only have I learned to be audibly enthusiastic about exchanging eggs for beans when available (YES! Bean Day!), but the cafeteria recently started making me bacteria-laden fresh salad and boiled greens – a work coup with a moderate side of intestinal distress. I also found a way to diplomatically get myself included as an author onto several of those papers and presentations I “supported”, and I spearheaded 3 projects which I firmly believe will leave the organization better than when I found it. Yeah for relatively-sustainable change!

Those of you reading, or still reading, might think me depressed. I actually think not (and it is not denial). I think that it is desperation. Desperate to get over the 1-year hump. Desperate to make new friends to fill the void left as old friends move to new posts. Desperate to make an impact and not feel like these 2 years are for naught. And the thing is: I do like it here, I do love my work, I do make friends easily, and I do actually think that I am “fostering positive change” (bonus jargon points!). But, I also do hysterically, ravenously, need a vacation before I chew my nails down to the knuckle with angst. April 30^th cannot come quickly enough! I’ll see many of you during our 2 week Bar Mitzvah/Peace Corps reunion/wedding (not ours) whirlwind of a USA visit. Others, 2012 is just around the corner! And, some days (like today) it cannot come soon enough…