Sunday, November 16, 2008

Ulusaba Safari Day 1!

Hey yall-
I've posted pics from my first two game drives on my Picasa website. Check'em out!
Chase

Thursday, November 13, 2008

Photos of Lake Malawi

Hey yall-
well, today is my last day in malawi--I depart for Johanesburg for an overnight stay, and then it's off to Ulusaba Reserve in Kruger National Park, in the northeast of South Africa, for safari. I'll be sure to take lots of pics, especially of the Big 5! For now, enjoy some pics from Salima, a small town on the coast of Lake Malawi, as well as a few from the countryside. Hopefully these capture some of the sights of villages and towns that i saw along the roads of Malawi; they are posted on my Picasa website (link below).
I'll write soon, but for now, I hope all are well.
Love,
Chase

Sunday, November 9, 2008

Community Gardens

Nutrition and Garden Program (Posting Date 11.9.08)
Part of the education Partners in Hope (PIH) provides their patients involves nutrition. The idea is a simple one: the more healthy patients will survive longer on HIV treatment. Upon intake to PIH, patients are evaluated for the need for HIV treatment with anti-retrovirals (ARVs). But prior to starting ARVs, all patients undergo two counseling sessions: a course on ARVs, and a course on Healthy Living. Included in the Healthy Living course is a session on nutrition and gardening. This session is a hands-on demonstration that teaches patients about the fundamentals of nutrition. The session is conducted at PIH’s own Community Garden, in front of the clinic building. The nutrition session uses the example of the Malawian house as a model or analogy to nutrition. For example, the “bricks of the house” are the equivalent to protein gained from eating meat, and “vitamins” are equivalent to the mortar that holds bricks together. Since most Malawians do not read, or at least don’t read well, a diagram of the house and the 6 nutrition groups (the 6th being water) is used to communicate the teaching points. This diagram is hand-drawn, and is displayed inside the demonstration house (see picture in photo album titled “Nutrition Program”).
After hearing about the fundamentals of nutrition, patients then learn about farming for sustainability by touring PIH’s community garden, complete with house, outhouse, and kitchen (all are separate brick units). Majority of Malawians (over 80%) live in rural areas and are subsistence farmers; consequently, most of the 88% of unemployed Malawians are, in fact, working every day to survive. The main crops include maize, pumpkins, and some fruit, like watermelon. Unfortunately, these crops are seasonal, and are only planted after the rainy season, which starts in another 2-4 weeks. Malawian farmers will cultivate these crops, and only these crops, and will live off these crops for the remainder of the year. They do not plan any crops that provide a continuous, staggered harvest, or anything that reintroduces nutrients to the grossly overused, nutrient-poor soil, and use only synthetic fertilizers. So depending on the harvest of maize, pumpkin, and the occasional fruit, it is either feast or famine…literally. Given this non-sustainable pattern of farming, the PIH program attempts to train patients to plant staggered harvests, to use their soil and resources wisely, and to grow plants that have multiple uses. Teach a man to farm, and he farms forever.
The idea of multiple uses for one plant is key to improving the ability of Malawians to become self-sustaining. This is a culture that recycles everything. Except for plastic bags like the ones from our grocery stores, almost everything has multiple uses or lives. From tires to logs to plastic water bottles, Malawians are very resourceful and use what they’ve got on hand. Using this practice already engrained in the daily practices, PIH is trying to expand this concept to farming by introducing the concept of Plant Guilds. Plant Guilds are groups of plants that, when planted together, have multiple, symbiotic uses. For example, in one area near the house, one can plant a tall fruit tree (ie: mango tree) that provides shade for the house and surrounding plants, and fruit for the household. The tree’s deep roots help draw water and nutrients from the lower layers of soil, and the trunk of the tree provides a stand for fruit-producing vines, like tomato plants. Next to the tree and tomato plant would be various plants that produce pretty flowers for decoration but also fruit or edible leaves or roots. And legumes are then planted to provide ground cover and help reintroduce valuable nutrients like nitrogen into the ground. The flowers provide areas for bees and other insects to help pollinate plants, and a small pond (usually made out of a small, plastic jug or bucket) sits in the middle of this guild and provides a home to frogs that control plant-eating insects. Again, multiple uses for one object—in this case, plants. I wonder what US farmers are doing. Do they use plant guilds? Are they planting staggered crops and finding multiple uses for the same plant? What about at home, in our own gardens? Are we thinking sustainability, or are we too short-sighted and plant only for the season?
After this session, we went out to a local “urban” village (? shanty town, ? slum) to see a successful farm. About 5 minutes north of PIH, on the way to the heart of Lilongwe, we turned off the main road and onto a dirt road with numerous, steep potholes. We traveled slowly through the village, through the market teeming with people selling goats, chickens, fruit, and phone cards (people may not have money for food and housing here, but they all have a cell phone). Traveling through this village, the biggest issue regarding health and nutrition was this: the idea of a nutritious garden was great, but whereinthehell are patients going to plant a garden in this urban village? There are simply too many houses placed close together to provide any space for individual gardens; perhaps a community garden would work, but you need a very large one to provide nutritious food for all the people of these villages.
We passed a rock quarry, a home-based care center (? equivalent to nursing homes), and many Malawian children who all ran after the jeep, shouting “Azungu!” (white person). After a few turns, and traveling down a narrow road, we eventually reached a house with two men playing a board game. This was the home of the PIH patient, and his successful garden. We met the patient, and he allowed us to tour his small garden. It did, in fact, use the principles of Plant Guilds, using trees, legumes, and ponds, although most of the garden was prepared for the upcoming crop of maize that would be planted in a few weeks. I don’t know how successful his garden is, but the folks at PIH are very proud of his attempt to practice these principles. And I don’t know if any of the patients located in the surrounding rural villages are planting a garden based on the PIH training, or do they simply do what’s been done year-in and year-out.
So the quest for adequate nutrition for HIV+ patients is ongoing. You can see that nutrition for the poor is a huge issue, regardless of whether you live in the developed world, or a resource-poor country. And although fast food has not really made it to Lilongwe, it has to other areas of sub-Saharan Africa, including South Africa, which means that it will come to Malawi soon. And with the arrival of the “western diet” comes all of the ill effects—worsening hypertension, obesity, high cholesterol, and diabetes. Malawi currently does not have the infrastructure to provide rudimentary care to its people; it fails miserably to provide maternal and perinatal care, and is trying desperately to scale up its HIV programs. So how can Malawi possibly care for diabetes, hypertension, high cholesterol, and obesity?
On a positive note, the trip to the village ended on a high note. Upon getting out of the truck, we were greeted by dozens of local children who were very friendly, and wanted to interact with the Azungus. They greeted us with smiles, shy waves, curious stares, and a smattering of “hello’s” and “good morning’s” in English; I replied with what little Chichewa I know. As a side note, I’m not sure why the kids weren’t in school—they may have been on break for lunch, or something—but in Malawi, school is free for all kids, with school sometimes consisting of a blackboard outside underneath the shade of a tree. Anyway, the kids followed us around, keeping their distance, but after we finished our tour, I went up to many of them, saying hello, and giving them Hi-Fives and hand shakes. And then I took out my camera…and the kids went crazy!!! They all wanted their pictures taken, and I was happy to oblige. Gathering them all together was a challenge, as they all wanted to be in front. I was finally able to get most of the kids to stand still for a minute so I could take a few pictures, and they all got great joy out of seeing themselves on the camera screen afterwards. As did I.

Saturday, November 8, 2008

More Photos


Hey yall-
I've added new photos: One from Nthanje Outreach Clinic (a prior posting), one from the Nutrition and Farming course at PIH and local Area 25, and one from our dinner at Anna's last night. I've added captions, so hopefully you get a sense of what's going on.
Stay tuned, as I should have a couple of postings this weekend, now that I've got a free minute to write.
Love to all,
Chase

Tuesday, November 4, 2008

Safari Photos


Hey yall-
I've posted a few random safari photos, as well as a few from my trip to Zomba Plateau, all from this past weekend. They aren't labeled or organized--i'll try to do that later--but at least you can take a look at some of the amazing things i saw. The link for the photos is at the bottom of this page.

i'll post some stories from the safari later, but the highlight (and fright!) of the trip was when 2 elephants decided to have a midnight snack right next to my cabin!! Needless to say, I didn't get much sleep that night!

Chase

Thursday, October 30, 2008

Nanthanje Outreach Clinic

Nanthanje PIH Outreach Clinic (Posting Date 10.30.08)

I wanted to take a few minutes to reflect upon the Nanthanje clinic we went to on Tuesday morning. We all met at PIH, and after morning chapel, 6 of us piled in a jeep and drove ~20 minutes outside of town (I still haven’t figured out which direction is North!). Within 5 minutes on the road, we were in rural Malawi—there are certainly no suburbs here. We would pass several small villages, which usually consisted of a few round mud huts with thatched roofs, maybe a central kiln/brick stove, and usually a few random farm animals, mostly goats, wild dogs, and chickens. Often there were women cooking, and small kids following their parents around; occasionally a man or a child would pass by on a bicycle. While we were on a highway that was paved, all of these villages were surrounded/accessed by roads. Often, “minibuses” would stop on the side of the road at these villages and pick up a traveler or two.

We arrived to Nanthanje by way of a dirt road with very large “potholes”—worse than what you see in any city with a winter. Upon arrival, we parked beneath the lone tree in the medical complex, which consisted of three small brick buildings with windows and cement floors, along with one area for expectant mothers. Outside the first building, which was the primary care clinic, there was a line of about 20 mothers and children, all in beautiful traditional African prints wrapped around their waist, or around their backs with their children secured firmly. As a side note, the men dress much more western than do the women, except for businesswomen, who dress particularly modern, with pantsuits or suits with mini skirts and high-heeled, pointy toed shoes. But back to the clinic….

After getting a quick tour of the complex, we split up into teams, with Eri and I shadowing two of the clinical officers, people who are 1 level below physicians (maybe the equivalent to a nurse practitioner) but with a great deal of clinical and surgical expertise (ie: COs do deliveries, C sections, hernia repairs, numerous procedures, and run many of the clinics). Jessica, one of the Mzunga (white) nurses from PIH, and Anna, another nurse from PIH, checked in all the HIV patients, and ushered them to benches outside the exam rooms. Patients were seen in order, and the whole visit consisted mostly of an evaluation of the patient’s HIV history, their compliance with medications, and investigation into any recent complications. Because the volume was so high, rarely did we have time to do an exam, talk in detail about the psychosocial aspects of their disease, or do any meaningful amount of documentation. Instead, patients were often given refills of their medications, and their clinical status was documented in their health passport—a paper book about the size of a passport, that contained brief notes from all their clinic appointments. We had one patient with a new cough and a right upper lung consolidation on exam, and began treatment for pneumonia; we asked her to submit a sputum sample for the evaluation for tuberculosis, a diagnosis much more likely in her compared to community-acquired pneumonia. But other than this one patient, most of what we saw was fairly straightforward rural HIV medicine. That is to say, we don’t have the means to do CD4 counts frequently, and these patients in the rural clinics rarely ever have a viral load or HIV genotype done (both of these tests we would use frequently in the States to adjust treatment regimens). Now this limitation is mostly from a resources standpoint—Malawi simply doesn’t have the means to pay for these tests. In addition, Malawi only has medications for 4 types of HIV regimens. You see, HIV care is often like a buffet of food—you pick 1 or 2 meds from category A, add another from category B, and if they are doing poorly, add something from category C or D. Not so for Malawi. Currently, the Ministry of Health only purchases drugs for 4 regimens. Everyone gets the first line regimen called Triomune (a combo of three drugs); if patients develop side effects, or intolerance of the medications, they are switched to one of two alternative first-line regimens (1a or 1b), or if they develop resistance (virologic failure), they get placed on the second line treatment. There are no more options should someone develop bad side effects or fail the 2nd line treatment, which often happens over time, and especially if patients take their medications inconsistently. And unless you can find someone or some company to make a significant financial contribution, this will be the protocol for the next many years (probably through 2010).

In total, we saw approximately 30 patients that morning. We actually brought patient back with us to PIH for further evaluation, as she had developed a very bad skin rash to one of the meds in Triomune, a very common reaction requiring a change in medication. Because the local clinic did not carry this alternative therapy, she had to come to PIH for the medications, a trip that will be very difficult for her to do in the future, as it is several miles away, and she has no money for the bus. Talk about access to care…

Well, it is off to Mvuu camp and the Shire (pronounced Shear-ray) river safari, where we’ll see hippos, elephants, crocs, and lots of rare birds. In fact, over 260 species of birds live in the Liwonde National Park, where Mvuu camp is located. This camp is run by Wilderness Safaris, a group in Africa that is dedicated to keeping the wilderness of Africa pristine, while also reinvesting the proceeds from the organization back in the local community. For example, they built a school for the local children outside the Liwonde National Park. I’m sure it’ll be a blast, as long as I keep my hands inside the boat, and I hope to have many great photos to share. I’ll write more soon, and will try to post this weekend about the experience. Until then, be well, and have a great weekend!



Chase

Tuesday, October 28, 2008

First Photos

Hey yall-
I just added a few photos of my journey on Picasa. You can always find the link to the photos at the bottom of the blog, but here it is anyway: 
http://picasaweb.google.com/chasecoffey

Had a really good day today, going to Nathanje, a medical and HIV/AIDS clinic about 15 mins outside Lilongwe. It was absolutely amazing!! Mud huts with thatched roofs, goats and roosters wandering, villagers looking at the strange people from the city, but especially me; it was what I imagined rural Africa would be. I'll write more about this later tonite and post it soon--for now, though, I need to brush up on my anti-retroviral medications.

I was able to get some great photos, but sadly, I don't have the cord to connect the camera to the computer! But I'll definitely share those later.

Love to all, and feel free to share the link to the blog or photos!
chase