Archive | June 2010

Malawi Day 8: Refuse Stealing

I had the incredible fortune to run into the “Refuse Stealing Band” or the “Kukana Kuba Band” on the way home today. I still haven’t figured out if they are the “Refuse Stealing Band” as in, they refuse to steal, or whether they are the “Refuse Stealing Band”, as in a band that steals refuse (note: it has been since confirmed that the meaning is the former). I had heard stories of young bands that fabricate their own instruments out of wood and wire to create Malawian music, but tonight, I was lucky enough to find one. I have attached a picture of these two guys from Ndirande, which is a densely inhabited urban slum area north of here, but an upload of the incredible video footage will just have to wait until I have a proper internet connection. I can only hope that I will have the chance to see one of these “jazz” bands again soon.

Malawi has a long tradition of music, largely unknown to the rest of the world and, like other countries, it has a wide diversity of musicians and styles. This type of band, possibly pioneered by the legendary blind jazz and blues performer Alan Namoko Band in the 1970’s, is known as a “jazz” band, although quite unsimilar to that which is known as jazz in the US. Malawian musicians such as these two have little resources to buy instruments so they must fabricate their own from whatever materials are available. But what they lack in material resources they more than make for in precisions. The string player spent no less than 3 minutes painstakingly tuning his intrument, indicating that the construction and design of his bass/banjo/drum is deliberate and calculated. I am unaware of the creative process that goes in to the music itself and suspect that much of the music is either borrowed or inspired from other people in the genre, but the result is mindblowing in my opinion.

In true Malawian style, the music is quiet and unassuming, but incredibly complex and textured. The audio on the video I took simply does not do the band justice. I wish that someone would bring these guys or bands like them to the states so that all could experience it. In an alternate life, I would have loved to explore and document this country’s musical heritage, but, fortunately, others have taken the initiative to scratch the surface. Malawian music is available for purchase here. I’m also willing to share what I have with whomever might be interested.

Malawi Day 7

I’ve spent the past days with mzungu, watching soccer on big screen tvs in bars and eating far too much in a country where tons of kids don’t get enough protein to be able to develop well enough to survive past their fifth birthday. It’s a rather odd feeling. I feel no guilt; that’s a pointless venture. But although Malawi’s economy is the second fastest growing in the United States and the quality of car and buying power of many Malawians has expanded even in the twelve months that I’ve been related to this country, there is still much work that needs to be done to balance out the incredible inequality that exists here. Hanging out in places where people spend the equivalent of a months wage for an average Malawian in a minute and watch sports without power outages in an English speaking environment just strikes me as surreal. Most mzungu never pick up the local language. It’s easy to see why.

There has been an outbreak of measles in the Machinga District, north of here and toward a large nature reserve on the banks of Lake Malawi. It is likely that, despite extensive vaccination efforts, the conditions were right to facilitate spiraling measles transmission in children. In America, we have to presnt detailed and exasperated arguments to get partenst to properly vaccinate their children. In Malawi, mothers line up eagerly in the Machinga District Hospital to get their children vaccinated before the worst can occur. The Malawian government is unable to provide resources for this impoverished population. Doctors Without Borders has set up a temporary vaccination site and is furiously trying to keep pace with the incredible demand by vaccinating more than 2.5 million children throughout Malawi

Machinga district Hospital appears to be an excellent facility for reproductive health, advertising proudly that it is a hospital for healthy babies. By all appearances, they struggle to provide as quality of service as they possibly can and look to be well outfitted. However, a walk around the compound provides a look into the incredible challenges they must face there.

The TB and AIDS wards appear packed to the gills, and incredibly ill patients walk about the compound aimless and clearly exhausted from fighting the specters of disease and physical debilitation. I spot what appears to be an ancient woman who is likely not but 50, give me a glazed look before she hikes up her skirt and urinates, standing, not but 10 feet away from me. Perhaps this is common practice here in rural Malawi and my wealthy sensibilities are merely unused to what could be a full natural human behavior, but after a litany of ill children, ill parents, TB patients and human suffering that desperately collects about this overworked facility, I can’t help but think that this is the true cost of disease, poverty and poor distribution of worldwide resources, the cost of human dignity and self determination.

It does not make me feel the fake guilt that we are trained from birth to feel. It does not make me feel sadness or pity, but it does anger me that in 2010, at a point where portions of humanity are living wealthier and healthier than any other time in human history, that a combination of bad governance, lack of development and use of available resources and the surrounding spectre of an environmental climate that favors the circulation of infectious disease at the expense of human health is allowed to continue. Of course, it only strengthens my lean toward atheism. If there is a god, then he must truly hate his most faithful of sheep.

Full time residents who likely work at the facility appear to have reasonably good accommodations, ancient solar power units adorn the houses and music emanates from inside, indicating that all is not unwell. Technology is not completely unknown in this end of the world, and those who have it and the education necessary to keep it, can at least somewhat shield themselves from the worst. One has to remember, however, that the residents of these dwellings are those who fight the hardest fight every day, often at their own expense. I’ve met a number of doctors here and don’t think that I’ve met a smarter, more dedicated lot. It can be said that they have gone a route that is lucrative here in cash strapped Malawi, but I am positive that these people put in more than their allotted number of hours. In the end, they don’t make even as much as a full time convenience store worker in the US and work twice as much, under the most challenging of conditions. No wonder Malawi has an incredible problem keeping doctors and nurses in the country. The situation is improving, but this country of 15 million people still has less than 250 doctors in the entire country. One can hope that the expanding economy will encourage more physicians to stay and offer promising students the opportunity to obtain training. All is not bad.

Malawi Day 4: Mount Mulanje

I skipped day 3 since nothing worth noting on this blog occurred. I’m losing track of the days anyway. On what I think was day 4, I went with some colleagues from the Malaria Alert Centre on a climbing expedition to Mount Mulanje, which is about an hour and a half southeast of Blantyre and close to the Mozambiquan border. Mount Mulanje is notable for being the highest mountain in all of Malawi and one of the highest mountains in Africa. Sapitwa is the highest peak of Mount Mulanje at over 3000 meters. “Sapitwa” literally means “don’t go there” in Chichewa. Several hikers have died or disappeared hiking it and their bodies were never found. Malawians will consistently warn you that evil spirits reside on Sapitwa and will predictably tell you “don’t go there”, hence the name. Hence, not wanting to encounter evil spirits, we opted for the friendlier second highest peak, “Namasale”.

Our first stop was to the Forestry Reserve office, who graciously allowed us to leave our vehicle parked there while we hiked the mountain. Mount Mulanje is not only a beautiful hiking spot, but is also the home of the Mulanje Cedar tree which can be found nowhere else in the world. Mulanje Cedar’s rarity along with its sweet and pungent smell make it highly prized for furniture, wood carvings and artwork around the world, and thus a target for poaching. Samson, who heads this particular Forestry Reserve station,kindly showed me a warehouse filled with milled Mulanje Cedar boards and saws that had been confiscated from local poachers.

Notice the lack of glass in the buildings. Recently, a group of angry poachers attacked the Forestry Reserve buildings and shattered all of the glass windows and trashed the place in addition to beating the workers to get them to stop their control efforts. The impoverished Malawian Government is unable to provide security for the Forestry workers, who are the target of poor locals trying to get by through illegal means, which will eventually endanger the entire area in the long term. It’s remarkably similar to rural logging areas of the US who see the Federal Government as standing in the way of profits for the sake of seemingly unimportant environmental reasons.

Like all of Malawi, deforestation is threatening the entire area, which provides a home for Malawi’s countless bird, animal and insect species, in addition to controlling deadly mudslides and erosion. To respond to this desperate need to maintain forest stability and replenish deforested areas, the Forestry Reserve routinely plants cedar and pine seedlings throughout the area. Samson demonstrates the staging areas for planting seedlings and the results of an experiment to introduce a new species of pine to the area for erosion control but notes the difficulty in planting and maintaining the forests. The Forestry Reserve workers face incredible challenges both from the local residents and from the fragile ecology of the area but they are dedicated to the area and to the forest.

The amount of plant diversity on Mount Mulanje is staggering. Every kilometer or so, we passed through a completely different ecosystem, from grass lands to temperate rainforests to bamboo forests. Although there was no indication of a large variety of mammals, we did see droppings from mountain goats and rabbits. Our guide indicated that leopards live in the region, but others in the parted noted that there was little evidence of their existence here. The only wildlife we did happen to see was a large baboon crossing a stream on the way back. The oft celebrated Malawian bird diversity seemed to be represented only by a few pier crows and some small sparrows. It is possible that we were merely in the wrong area to see animal life, but what lacked in mammals and birds, was certainly made up for by plants.

On the plateau, us ueber-riche mzungu stayed in a camping house that the Forestry Reserve rents out to visitors, while the Forestry workers sleep in traditional Malawian huts outside. I slept on the porch just because. The mountain is so high up, that it breaks the migrating clouds and induces rainfall onto the slopes, providing water to the entire plain below. At night, when clouds pass, the winds hurl and water droplets cover everything in sight.

The hike up the mountain wasn’t nearly as bad as I imagined. Some areas were nearly vertical, but most of the walk was fairly flat. Fortunately, the igneous rocks are rounded and easy to scale. After some time, we made it to the top, but unfortunately the view was spoiled by a evil cloud that appeared right as we reached the summit of nearly 2600 meters. The way down was much worse than the climb up, but it went quick and was even more beautiful than the way up. Hopefully, I will have a chance to do it again. Below is a picture of me reincarnated as a member of Foghat along with our guide, Peter. Peter was a fantastic guide and effortlessly climbs the mountain, in contrast to us weak mzungu.

As an aside so that I never forget, I had an incredible conversation with him about “witchcraft planes”, which transport Malawians to distant locales at night, but which often crash into houses and kill people. Witchcraft legends persist all over SSA, and Malawi is no exception. Peter does not believe that there are any evil spirits on Mount Mulanje, but he did note the uselessness of the witchcraft planes in that they only fly at night, while Air Malawi flies in the day, serving more people. This may be fortunate given the witchcraft planes’ poor safety record. While I doubt that Peter believes in withcraft planes, his animated conversation on the subject along with his extensive knowledge of the mountain and all of its wildlife and plants was unforgettable.

Addendum: Mount Mulanje legends

Mentioning the first highest peak, Sapitwa (lit: “Don’t go there”), to Malawians will elicit a flurry of mysterious stories and ghost legends. Stories which everyone, except the people who work on the mountain, believe are completely true. The stories are mostly similar, but have some interesting variations, given me reason to be skeptical as to their veracity. Here we go:

1. If you go to Sapitwa, you will find a bowl of cooked Nsima. If you eat it, you will die.
2. If you go to Sapitwa, you will find a bunch of bananas. You are free to eat them. However, if you take some to eat for later and put them in your bag, you will find them to be mysteriously gone.
3. If you go to Sapitwa, you will find several servings of food, as if prepared for many people. If you eat one, you are ok. If you try to eat more than one, you will become lost and die.
4. If you go to Sapitwa, you will find food and alcohol. If you eat the food, you are fine, but if you drink the alcohol, you will fall asleep and die.
5. If you go to Sapitwa, you will camp for the night. Tall men with long hands and faces will walk up to you and ask for food. If you give them some, they will leave quietly. If you do not, they will return while you are sleeping and kill you.
6. If you go to Sapitwa, a man will approach you as you are walking. He will offer you food. If you accept kindly you will make it to the top. If you refuse, you will get lost and die.

Malawi Day 2

This country is in full soccer fever mode. The power keeps going on and off almost hourly because the entire country is watching football on TV or listening to it on the radio, creating an incredible drain on the power grid. I passed by a wooden shack in the Blantyre Market here today where you could sit with other soccer fans and listen to a Chichewa broadcast of the Argentina – Korea game for a mere $.25 and the place was packed to the gills. Everywhere you go, all anyone wants to talk about is the results of the previous day’s games and it’s not hard to get minutely updates of the status of whatever game is going on. I am normally not a sports fan, but the enthusiasm here is infectious.

Last night, my friend Henry invited me to a local bar to watch the South Africa – Uruguay match, which led to an embarrassing loss for South Africa, almost as bad as the punishing results of the Swiss – Spain match earlier in the day. Aside from the game and the raucous support of the local Whitey’s for Uruguay’s team, I had the opportunity to eat an excellent dish of marinated cow’s hoof, apparently a Malawian delicacy and the first proudly “Malawian” food that I feel that I’ve eaten so far.

Coming with us to see the game was Henry’s younger brother from Zimbabwe, Godfey Macheso. “Brother” is used very liberally here, as they would actually be cousins in our world. Apparently, the Bantu languages do not make the distinction, and cousins are brothers, and uncles and aunts are mothers and fathers, making the southwest African family a connected and complicated group. This, of course, goes a long way to explain the incredible societal complexities of African cultures, where an age old tribal and village awareness leads to a deep and multilayered fabric that connects everyone, for better or worse. I am even impressed at how Malawians who I had only a small amount of contact with, remember my name like yesterday and readily recollect even mundane events that we shared together.

Godfrey. Godfrey is a young Zimbabwean political activist, who has recently been forced to move to Malawi. The bankrupt Zimbabwean government of Robert Mugabe has discontinued support for college students in Zimbabwe, and requires that students pay more than $1000 US per year to remain, an incredible sum for even the well off in SSA. Godfrey protested through online blog posts against the government’s spineless unwillingness to invest in its own future and against Mugabe’s crony government. He found himself arrested and tortured in a Zimbabwean prison as a reward for his online willingness to exercise his human right to speak out against a miserable and backward totalitarian government.

My exchange with Godfrey reminded of the extent that politics pervades throughout African cultures. In contrast to countries like the United States, Africans that I have met consider themselves to be deeply connected to their countries, much akin to connections to their complex families or home villages. No one here can say that they are unaffected by politics and everyone, in any situation will freely express complex and nuanced opinions on the wide range of political problems these countries face. Malawian political conversations are extremely civil, with each side making sure that everyone’s opinions are heard and understood. In America, we treat politics as a taboo subject to avoid argument and conflict. Here it is assumed that everyone will at least give others a chance to be speak. Most educated people here are invested in their countries and do not have the option of retreating into fantasy or of packing up and leaving to go somewhere else. Everyone wants to see their nation develop for the benefit of the nation as a whole, as the welfare of the state implies the welfare of the people. Unfortunately, leaders on top, like Robert Mugabe, only seek to exercise control and show wide displays of power and wealth, at the expense of African people.

Malawi Day 1

The arrival to Lilongwe was welcome but uneventful. The driver, Patrick was there to pick me up from the airport and take me 5 hours south to Blantyre because Air Malawi’s planes are grounded due to a failure to pay their lease. The road trip along the main highway of Malawi is long, but it affords me a view of the gorgeous (albeit treeless due to massive deforestation) countryside and of rural life in Malawi. In a country of 15 million people living in a state the size of New Jersey, you can expect that there is not any large space of land that doesn’t have at least one community of people.

99% of the vehicles in Malawi (and perhaps all of Africa) are bought used from Japan. Combine a 100,000 mile vehicle with the decaying condition of the now overused roads, and you have one beat to shit car. While passing through Zomba, one of the rear wheels of the truck came flying off and shot 50 feet into the air. Our good fortune allowed it to happen in the middle of a city and at night. If it had been the day, someone would have certainly been killed by the flying wheel. Had it been on the “highway”, we would have certainly died, as these drivers like to do almost 90 on the worst roads imaginable, past hordes of bicycles and goats that constantly wander into the middle of the road.

In an incredible African moment, 20 guys came out of the nearby truckstop and jacked the truck up on pieces of cement and managed to reattach the wheel armed with nothing but a crowbar and a rock. We had to cannibalize the lugs from the existing wheels, leaving us with a wheel held on by only three lugs on less than ideal posts. The trip that would have taken an hour, took us 6 as we could only do about 5 miles an hour all the way back. All the while I was praying that we wouldn’t be stuck in the middle of nowhere, having to wait until the next morning for a ride.

Every two kilometers or so, we had to stop and tighten the lugs to keep the wheel from falling off again, and every time we’d stop, drunken soccer fans would wander out of the darkness like zombies to see what we were up to, all to the soundtrack of the World Cup blaring out of an ancient TV speaker. One gentleman, drunk off his ass, decided to demonstrate his knowledge of English obscenities while I took care to keep an eye on the starving dog wandering up to see if we had any food. Patrick would make sure to stop in areas where we would have limited contact with zombies, but, as I mentioned before, there are people in every corner of Malawi. After about 10 repeats of this situation, we finally made it to Blantyre and I was able to call my three day trip over.

One thing I had forgotten, is how every conversation, no matter how mundane or serious, is punctuated by incredible laughter amongst all parties. In 10 hours all the way back to Blantyre, in what should have been an event for serious concern, I don’t think there was more than 10 minutes where someone wasn’t laughing hysterically.

On the way, we stopped through Patrick’s wife’s home village where he is building a home. Apparently, Malawian men must build a home for their wives in the village of their mothers in law as a condition of marriage. This is in addition to the home that they must build in their own village and the home that they must maintain in the city to be able to work. So Patrick must have three homes on one salary. He proudly showed me his brick home, and explained that he made all the bricks by hand, as all Malawians do and then paid $80.00 to have a brick mason put them up. 20 children from the village came out to see probably the first white guy they had ever met and proudly practiced their english. This is an absolutely incredible place, full of vast quantities of human kindness and warmth. Malawi is truly deserving of its name, “The Warm Heart of Africa.”

Malawi Day 0

Just preparing to leave the US for Malawi is an incredible reminder of how wealthy developed countries really are. All electronic items must be bought here, books and research resources must be prepared and you have to bring your own personal pharmacy, because little of these items are available for any small cost in a developing country. Agreeably, medicines are available, but I would rather not risk Indian made pharmaceuticals nor the health system here. This is, of course, a majorly hypocritical attitude as people there don’t have much choice, but I do. That’s pretty much the crux of being from a wealthy country: we have choices and options and should be thankful we do. There are people in the US who believe that our freedom emanates from a particular political system we have. Our freedom is a result of our incredible wealth. It could disappear in instant is we suddenly became a poor country and one look through the history of the United States can provide insight into how it was in a time when we weren’t so wealthy. I can only hope that one day, all people in the world (and even in the US) will be so fortunate.

I traveled through Amsterdam to change planes, had an exquisite cup of coffee (I forgot how good European coffee is) and marveled at the selection of excellent English books available in the airport. The Detroit Airport Border’s stock Sean Hannity and Glenn Beck books in their non-fiction section, Amsterdam stocks books on complex European politics and narratives about human rights and world economies. The downside to widespread literacy, free markets and large book chains is that the less insightful (trying to avoid the word “moronic”) become a market for books.

The plane to Johannesburg was filled with Chilean soccer fans, most which didn’t appear to ever have been on a plane before. 10 hours to Johannesburg was filled with soccer chants and generally high spirits, which was noisy but completely awesome. It made me even sadder that tickets to all the games were pretty much gone, unless you by them from third parties in South Africa. The 2010 World Cup is a big deal for Africa. South Africa gets to show the world that they are on the way to becoming a developed nation, despite their incredible social and economic challenges, and all Africans can beam with pride that the world’s most popular sport is being hosted in an SSA country. This would be equivalent to having Mississippi host the Super Bowl. Hopefully, it won’t be the last time and that either Botswana or Kenya is able to host the games someday.

Either way, the incredible influx of visitors to SA must be an incredible boon to their troubled economy. It can also be a way for the world to look past the problems to see a country doing the best it can. My generally cynical and skeptical attitude toward South Africa certainly changed in the 20 hours I was there. It’s clear from interacting with South Africans that, in contrast to Malawi for example, violence pervades every facet of life in South Africa. It reminds me so much of New Orleans. People are generally as friendly as they can be, but guarded and human relationships, particularly between the haves and the have-nots are complicated and troubled. However, despite the hardened demeanor of it’s citizens, the World Cup can do wonders to generate some local pride.

Plus, the Germany – Australia game was awesome not to mention a North Korean goal against…. Brazil???

WHO and Big Pharma Scandal

Recently, I was sent an article on a set of reports sponsored by the Council of Europe regarding the WHO’s handling of the H1N1 pandemic. The same article, written with bigger words, appeared in the British Medical Journal. The article, as written, accuses members of the WHO of receiving massive kickbacks from pharma companies to construct a false pandemic in order to generate billions in profits from the sales of vaccines and anti-viral medications. Specifically, three scientists at the WHO responsible for drawing up guidelines advising governments to stockpile medications had previously received compensation from private pharmaceutical companies, (Roche and GSK) for other, unrelated consultancy work. It appears that the WHO damned these three scientists by not openly providing conflict of interest statements to the general public. The WHO maintains that it keeps confidential conflict of interest statements on file for all members of a meeting to discuss vaccine usage in pandemics. The WHO has since released a document recognizing the inadequacy of its present protocols for public disclosure.

I found this interesting and it brought the whole conversation home:

“Dr Arnold Monto was the author of the WHO annex dealing with vaccine usage in pandemics. Between 2000 and 2004, and at the time of writing the annex, Monto had openly declared consultancy fees and research support from Roche and GSK. No conflict of interest statement was included in the annex published by the WHO.”

Dr. Monto is a faculty member of the School of Public Health at UM. Knowing Dr. Monto, I find it highly doubtful that he was receiving large kickbacks from pharmaceutical companies to fabricate a pandemic to increase his pocket book. In fact, Arnold Monto’s consultancy for GSK can be known from a simple Google search! The BMJ reports that he received $3000. yes, $3000. Not $3,000,000. $3000. Dr. Arnold Monto and a fabricated global pandemic can be bought for the paltry sum of $3000.

The otherwise somewhat reliable Washington Post has taken purely circumstantial evidence and reported it as damning fact, generating fodder for every brainless and fanatic conspiracy hack on both sides of the politically extreme spectrum. Basically, the “evidence” supporting a conspiracy, is akin to saying that I am a tax evader because the UM knows all my tax information, yet does not release it to the public.

The report from the Council of Europe was engineered by a MP Paul Flynn, who conveniently keeps a regular blog where he has posted articles that call into question his own claims, prompting one to wonder if he actually reads what he posts. Indeed, the man even seems to be willing to ride with the anti-vac batshit brigade:

“In Australia there are claims that the flu vaccines are causing fits in young children. The swine flu vaccine had limited trials and GSK wanted the Polish Government to take responsibility for any adverse reactions. They refused.”

It is clear that not only is Mr. Flynn’s ability to read the English language in question, but he is also deficient in his understanding of influenza and influenza vaccines. He repeatedly notes that “only” 18,000 people have died. Of course, he does not specify whether this number is world wide or in the UK. He conveniently fails to mention that that is 18,000 above the regular number of influenza related deaths in addition to ignoring that much of that 18,000 were children and young adults. On top of that, he fails to present any number of hospitalizations due to H1N1, which, again, would be above and beyond the number due to regular seasonal flus. To make things even worse, he fails to recognize that his “small number” would be much bigger without large scale immunization strategies. Perhaps, he should go back in time, stop the H1N1 vaccination programs from occurring and then go and tell all the parents of all the extra kids who died that it was all a hoax.

I write this, not in defense of the WHO, but in criticism of the ubiquity of uninformed and preposterous popular news articles regarding influenza and vaccination programs. I am not for a second going to deny that the WHO does not have connections to pharma and that the potential for corruption does not exist. I am positive that decisions made at the WHO are made with pharma companies in mind and some level corruption does, in fact, exist. However, the manner in which Mr. Flynn and company try to suggest a large level conspiracy smacks more of ignorance that whistle blowing.

Corruption between big pharma and health organizations should be rooted out where necessary but the relationship between pharmaceutical producers and health providers is admittedly complex. One cannot exist without the other. However, I also believe that the H1N1 pandemic has the potential to present a significant threat to the health and welfare of all susceptible people and, given it’s predilection to hospitalize and kill the young and healthy, health organizations and governments should maintain exceptionally high levels of vigilance to safely minimize morbidity and mortality. The greatest failing of the H1N1 campaign was that not enough people died in the developed world to satisfy the general public. If millions had, in fact, died (as in 1918), then we would be seeing people like Mr. Flynn happily patting himself on the back for a job well done. However, in public health, particularly in vaccination programs, success is measured by nothing happening.

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