Drowning the horses

You know the expression: You can lead a horse to water, but you can’t make it drink. For hundreds of years, people have been saying something very similar, so I feel some sense of camaraderie as I live that saying. For 16 months, I’ve been holding the heads of an entire cavalry of horses under water, and still most of my “horses” are parched and thirsty. Some take tiny sips now and then. Some will not open their mouths. Few quenched their thirst. It just makes me want to scream! Do you not recognize this as water? Are you not thirsty? Do you think that water is bad for you? Are you waiting for me to open your mouth, spoon in the water, and help you swallow??? Maybe I need to use feeding tubes?

But, really, this work is frustrating. And, I am running out of ways to maintain my mantra, “I love what I do; I love what I do; I love what I do” without cracking myself up (or just mentally cracking)! It’s not that I actually don’t like what I do, it is that the ratio of work that I am *supposed* to do and *want* to do is decreasing while the work that I am *doing for others* and *outside* of my interest/experience/job description is increasing.

Today, however, I am in a happy place: I am working from home! The protests that served as an excuse to stay home never did materialize, or they have not materialized as of 10am. Here, it is just me and my laptop, and we are working away – getting more done in an hour than I might be able to do in a whole day with the usual distractions that come with working in an office of 6. Clearly, this hour I am taking a break...

As I noted last week, there is something energizing about heading into the home stretch. I can see the light at the end of the tunnel, both from a professional and a personal perspective. At work, I’ve started implementing a new type of tough love. In my first 6 months, I learned a lot and did some. In my middle year, I kept learning but I did a lot. Now, in my last 6 months, it is time to pass on the teaching and stop doing. I’m more confident in saying no to new projects; more firm in my insistence that I will help strengthen an existing draft versus write a draft; and, I’ve become better about openly criticizing things that I know do not work while still maintaining, I think, enough diplomacy to be constructive not hurtful.

On the personal side, there is still much to enjoy in Malawi, as I wrote about before. But, let’s be honest: there is much more to enjoy elsewhere. As I tick the days off my calendar, push for completion of my final work projects, and start considering all the choices and possibilities after leaving here, I am finding a new happy place. It’s not just the happiness that comes with leaving here (although that is OVERWHELMING); but it is also the quieter the happiness that comes with appreciation for where you are – the birds, the elephants, the blooming trees, the hands-on work, the remaining shreds of romanticism about ex-pat life.

Oh happy place: how nice to see you! I hope not to lose you again.

On having 6ish months left…

Oh, to even write that feels like a miracle!! 6 months? That is no sweat! I feel like I could do 6 months in Sudan, even though I would rather not. Sudan has petrol and coca-cola at least. Anyway, in honor of what I will call my growing “exit attitude”, I thought I would reflect on the good things that are preventing me from jumping ship these last 6 months. I think that the reasons for giving up and leaving would be too lengthy for a blog post. Plus, I don’t want to be glass half empty all the time...

So, in keeping with my tendency to write lists, I will summon the positive energy buried inside to think of 10 convincing reasons to stay here for the next 6 months, 5 personal and 5 professional:

5 reasons to stay for fun:

1. Lake of Stars, the enormous music festival held on the shore of Lake Malawi, is the end of this month. It will be 24 hours of music on the beach for me although for others it is more like 72 hours. Still, better than nothing. And, even I can stay up for one great night of dancing!
2. My parents are coming in October, and we have a great vacation to the lake and a safari in Zambia planned! That will be fantastic to see the lions, leopards, and elephants with my folks. Then, they go on to Cape Town where I will live vicariously through them for 3 days.
3. I am going home for Thanksgiving in November for 10 days. That will be an incredible break and respite -- getting the final energy boost needed to complete my contract!
4. I already have fun Christmas plans for the lake – even taking a whole day off! I’ve never been up to Nkata bay, but there's a lakeside bungalow and 3 whole nights to enjoy diving among cichlids and drinking up the relaxation!
5. I finally made some new friends, and I am thrilled to spend some time with them over the next 6 months of volleyball, hiking adventures, and neighborhood potlucks. Glad to have some new people to make this place enjoyable.

5 reasons to stay for work:

1. My SMS (text messaging) for direct provider to patient communication system is slowly taking off. We (plan to) use the system to text message antiretroviral treatment (ART) patients who miss their appointments to remind them to come back for their meds.
2. We are also starting to message patients who have not yet started ART (pre-ART), but who are eligible to start. If they get the message, it will bring them into care earlier, which is better for their health.
3. The TB/HIV electronic data system should be working in the next 2-6 months, one of my most exciting lasting legacies for the clinics. This will put my organization’s electronic system light-years ahead of any now used in the USA , and it is truly an achievement that has been in the works for 16 head-smashing-against-the-wall months.
4. I just finished a set of tools for the Ministry of Health to help them monitor the roll-out of a national clinical mentoring program – pretty exciting to have some influence at this level. Hopefully, the monitoring and evaluation tools will let us show the positive influence of clinical mentoring for improving the quality of patient care.
5. And last, but definitely not least, patient mapping is under way! Within 6 months, we should have maps of all patient neighborhoods so that we can make better, and more persuasive, presentations and advocacy efforts in the future about where are patients come from and the health centers that they attend.

No petrol = creatures of habit

The one-week lapse in petrol shortage is officially over. Although I filled both our cars to the max (with no waiting!), it seems that many people did not. The lines around town today were back with a vengeance. I am safe for another couple of weeks. Jon's car is full too, and as he is in the States for the month, I have an excellent backup supply. He might even have fuel when he returns. Plus, I looked at our storage shed today, and no one has stolen our jerry can of fuel. I can breathe a short(lived) sigh of relief.

So, without much mobility, we've been hiking to the top of the same local mountain at least once a month. We usually go with our friends, Mike and Hillary -- two fellow hikers and cooks who make living here fun. Nkhoma is not so tall, but it is steep, involves a few hour return climb, and is just 40 minutes from Lilongwe, making it highly geographically desirable for a morning trip. We always pass tons of folks with anything and everything on their bicycles, including goats (sorry, goats!) and baskets. The mountain is currently up in smoke ('tis burning season), but before it was on fire, it was covered with lovely wild flowers. At the top, we always take a few minutes to picnic and take in the view. Not the most amazing place on earth, but a great way to spend the day with good friends. Again, it's the small things that you savor and that keep you sane.

It's lonely at the top

A few weeks ago, the supposedly-democratic leader of an African country that we shall call, Iwalam, dismissed his entire 41-member cabinet. All gone. Dissolved. The office of the president is now in charge. And, there is no constitutional time frame by which the president has to fill these posts.

I could be wrong, but "government" suggests something plural to me. One individual tasked with heading all branches of government and all Ministries sounds like a different word, a word that I will let you fill in yourself. Others around here are also beginning to lose patience, calling for swifter measures to fill an increasing chasm of leadership. There are droughts, fuel, forex, food shortages, HIV, closed universities, poor schools, bad roads, etc., to deal with. Plus, there is a shortage of plain non-fat yogurt that NO ONE SEEMS TO BE ALARMED BY BUT ME!!!!

Let’s gossip about sex!

One of my favorite radio shows of all time is “This American Life,“ typically hosted by Ira Glass. Last week, the show was about gossip. The major story, the 2^nd segment, was about gossiping about sex and HIV status in Malawi. My undergraduate Advisor, Dr. Susan Watkins, and her team from both Penn and UCLA are interviewed. It’s fascinating and crushing all at once – I was sad to hear the story end. You should catch the show while it is still available free as a podcast. You can hear it here.

Like most people would say, gossip is often cruel and unfounded; spreading gossip if often harmful and malicious. However, in practice, it is often juicy and (maybe I should not admit this) fun. Here, gossip is a favorite pastime of both expats and locals, especially when it is not about you and not hurting someone you know and love. In Malawi, the show notes, gossip about HIV can be both positive and negative (pardon the pun). By revealing someone’s HIV status, you might be protecting a friend from acquiring HIV from a partner who is known to be HIV positive. Or, by revealing someone’s status, you might outing them to the community or spreading false rumors about their status, a crime which actually carries a penalty (perhaps theoretical, but still important).

Anyway, whatever your stance on gossip, I think you would enjoy the show. It is some interesting insight into life in Malawi and into the continuing barriers that reduce effective HIV prevention. Let me know what you think!