...Given the information; they can make a difference "Health of individuals and communities is largely dependant on their own actions or inactions. People do what they do based on their existing knowledge, beliefs, social norms and expectations.. The key therefore is to build on what people know and provide them with appropriate information and skills," - Paper by Dr. Raj. Arole and Mabelle Arole
The Comprehensive Rural Health Project (CRHP) situated in Jamkhed, a community development block in the Ahmednagar District of Maharashtra, India is the brainchild of Doctor Raj and his wife, the late Doctor Mabele Arole that started in the year 1970.
The project goal was to develop a health programme relevant to the needs and resources of a specific rural area and, amongst their objectives to be achieved in five years were; reducing maternal morbidity and mortality, reducing infant mortality by 50% and reducing the crude birth rate by at least 10 points.
Getting trusted and influential women from within the village who understood the culture and problems of the people to be involved in training programmes on health education, antenatal care, safe maternal delivery, family planning services and other health related issues has changed the health of people living in the village. By involving and working with the community to bring about positive change in health issues, CRHP has been able to reach and far surpass its goals.
A workable and secure network within the community for referrals to the hospital within Jamkhed was set up and serviced by the Arole family who handle any delivery complications and other medical needs of the people in the area. CRHP can now boast about the involvement of the community being one of the reasons why there is a better awareness about health and a very considerable drop in maternal mortality in the project's catchment areas.
Health issues, especially in the developing world are still of concern as indicated by the Millennium Development Goals (MDGs). The health problems that the Jemkhed community experiences are cross cutting and common to many other developing countries, Malawi included.
By involving trusted and influential people in the community, greater awareness about health issues can also be achieved in the rural areas of Malawi. One of the most concerning health issues at present is the number of maternal mortality incidences being recorded in the country.
Well informed community members will gain the trust of expectant mothers and their spouses and can be very useful in bringing about change in the way women view delivery of their babies in the rural settings in Malawi. Informed community members who can explain to both men and women some of the dangers of cultural and traditional practices that greatly impact on maternal mortality will significantly reduce the deaths currently experienced in the country.
Although recent statistics reveal that over 90% of pregnant women visit an antenatal clinic at least once during their pregnancy, the percentage of clinical visits of pregnant women does not correspond to the number of women who deliver with skilled attendants.
There are still a large number of women in the rural areas who deliver with the assistance of a Traditional Birth Attendant (TBA) and follow traditional and cultural practices that can have negative and fatal results.
Malawi is reported to have one of the highest maternal mortality ratios in the world. According to the Road Map for Accelerating the reduction of Maternal and Neonatal Mortality and Morbidity in Malawi - second version for July 2006, statistics are estimated at 1,120 per 100,000 live births, this is an increase in from 620 per 100,000 live births in the year 1992.
A recent report from the Ministry of Health (MoH) also reveals that some of the main contributing factors of high maternal mortality are issues like limited utilization and availability of maternal health care services, shortage of staff, a weak referral system and weak community participation and involvement.
The MoH has taken an aggressive approach to deal with the maternal mortality rates by introducing programmes that are working directly with the communities in the rural areas.
Results from the programmes have made it possible for the Reproductive Health Unit (RHU) of the MoH to identified some of the reason why women continue to use unskilled attendants to deliver their babies. The programmes have also helped by providing a platform for discussion between communities and officials.
Activities done at national level and those done at district level have so far been successful and yielded positive results.
By holding meetings with the people in authority and influence, Safe Motherhood and Neonatal Officer in the RHU Diana Khonje says the meetings within the community have made it possible for relevant departments to address some of the crucial issues concerning maternal delivery.
Tuesday, 4 September 2007
Window of Hope Opens for People Living With HIV/Aids
It is not a hidden fact that Malawi has been badly affected by the HIV/Aids pandemic.
Encouragingly, there are a number of initiatives employed by government and its numerous stakeholders to address this. It is therefore not surprising, that these efforts are bearing positive results and there are signs that things are beginning to change for the better.
Through these untiring efforts, more people are now aware of the disease and new evidence shows a declining trend in national adult HIV prevalence rate in the country. Malawi has a current official rate of 14% prevalence that indicates a decline of new HIV infections.
It is against this background that after noticing the good work the country has done so far and continues to do to fight increased infections that the Global Fund has qualified Malawi to apply for continued funding from the Fund for the Round One grant, under the new funding mechanism called the Rolling Continuation Channel (RCC).
Explaining the qualification of the grant, Chairperson of the Malawi Global Fund Coordinating Committee Randson Mwadiwa said the development has come about due to, among other things the sustained strong performance, evidence of the potential for impact and programmatic sustainability.
"The Global Fund conducted a very extensive review of all Global Fund grants that will be expiring between1st July to 30th September 2008 to determine which country grants would qualify to apply for continued funding under the RCC," explained Mwadiwa adding. "And Malawi's round one HIV and Aids Grant successfully qualified to apply for continued funding under the RCC."
For Malawi to qualify, says Mwadiwa, the Global Fund has noted clear evidence of, or potential for impact of its financial contribution to the national response against HIV and Aids.
He observed the development has also come about because of continued coordination and collaboration amongst the National Aids Commission (NAC), as a principal recipient for the funds, development partners, and all grant recipient and implementing organisations.
"The programmes funded through this grant continue to present convincing evidence of performance, impact, or the potential for impact on the general population; the specific target groups such as people living with HIV; orphans and other vulnerable children; youths; people of the reproductive age group; antenatal attendees; ART patients and TB patients," he said
The Chairperson applauded the Global Fund for the first grant saying has contributed to an increase in the number of people tested for HIV from about 40,000 in the year 2002 to about 1.8 million people at present.
He added that the number of people on the antiretroviral treatment (ART) has increased from 4,000 in 2004 to over 100,000 by June 2007.
"We have also prudently used the funds to scale up Prevention of Mother to Child Transmission (PMTCT) and HIV testing sites throughout the country to 140 and 352, respectively.
"This is why recently, there are more pregnant women accessing PMTCT services and more people testing for HIV. In addition, there has been an increased number of people, particularly, orphans and other vulnerable children that have been reached with financial, material and psychosocial support," Mwadiwa emphasised.
Principal Secretary in the Office of the President and Cabinet Mary Shawa described the development as a relief to the people of this country.
"People have been saying ARVs would end and this in turn would give the country a lot of problems. Obviously this is a welcome development because people were very anxious to know whether the Global Fund would continue," she said. "We will basically continue with what we have been doing so far but we will also look at other areas that need expanding."
On the other hand, the principal secretary advised people to develop a culture of going to the hospital as soon as they fell sick.
"The majority of people take too long before seeking a health facility," she complained. "We need to change our attitude, let us visit the hospital as soon as we feel sick."
Nicholas Chitimba, NAC Chairperson says the country should feel proud because qualifying for the grant has not been easy.
"This is no mean achievement and as a country we have to feel proud. It has not been easy to qualify for the funding. We should part ourselves on the back and continue performing the way we are doing," he said.
Global Fund to fight Aids, Tuberculosis and Malaria approved Malawi's round one HIV and Aids Grant amounting to US$178 million to the National Aids Commission (NAC) over a five-year period from the year 2003.
Encouragingly, there are a number of initiatives employed by government and its numerous stakeholders to address this. It is therefore not surprising, that these efforts are bearing positive results and there are signs that things are beginning to change for the better.
Through these untiring efforts, more people are now aware of the disease and new evidence shows a declining trend in national adult HIV prevalence rate in the country. Malawi has a current official rate of 14% prevalence that indicates a decline of new HIV infections.
It is against this background that after noticing the good work the country has done so far and continues to do to fight increased infections that the Global Fund has qualified Malawi to apply for continued funding from the Fund for the Round One grant, under the new funding mechanism called the Rolling Continuation Channel (RCC).
Explaining the qualification of the grant, Chairperson of the Malawi Global Fund Coordinating Committee Randson Mwadiwa said the development has come about due to, among other things the sustained strong performance, evidence of the potential for impact and programmatic sustainability.
"The Global Fund conducted a very extensive review of all Global Fund grants that will be expiring between1st July to 30th September 2008 to determine which country grants would qualify to apply for continued funding under the RCC," explained Mwadiwa adding. "And Malawi's round one HIV and Aids Grant successfully qualified to apply for continued funding under the RCC."
For Malawi to qualify, says Mwadiwa, the Global Fund has noted clear evidence of, or potential for impact of its financial contribution to the national response against HIV and Aids.
He observed the development has also come about because of continued coordination and collaboration amongst the National Aids Commission (NAC), as a principal recipient for the funds, development partners, and all grant recipient and implementing organisations.
"The programmes funded through this grant continue to present convincing evidence of performance, impact, or the potential for impact on the general population; the specific target groups such as people living with HIV; orphans and other vulnerable children; youths; people of the reproductive age group; antenatal attendees; ART patients and TB patients," he said
The Chairperson applauded the Global Fund for the first grant saying has contributed to an increase in the number of people tested for HIV from about 40,000 in the year 2002 to about 1.8 million people at present.
He added that the number of people on the antiretroviral treatment (ART) has increased from 4,000 in 2004 to over 100,000 by June 2007.
"We have also prudently used the funds to scale up Prevention of Mother to Child Transmission (PMTCT) and HIV testing sites throughout the country to 140 and 352, respectively.
"This is why recently, there are more pregnant women accessing PMTCT services and more people testing for HIV. In addition, there has been an increased number of people, particularly, orphans and other vulnerable children that have been reached with financial, material and psychosocial support," Mwadiwa emphasised.
Principal Secretary in the Office of the President and Cabinet Mary Shawa described the development as a relief to the people of this country.
"People have been saying ARVs would end and this in turn would give the country a lot of problems. Obviously this is a welcome development because people were very anxious to know whether the Global Fund would continue," she said. "We will basically continue with what we have been doing so far but we will also look at other areas that need expanding."
On the other hand, the principal secretary advised people to develop a culture of going to the hospital as soon as they fell sick.
"The majority of people take too long before seeking a health facility," she complained. "We need to change our attitude, let us visit the hospital as soon as we feel sick."
Nicholas Chitimba, NAC Chairperson says the country should feel proud because qualifying for the grant has not been easy.
"This is no mean achievement and as a country we have to feel proud. It has not been easy to qualify for the funding. We should part ourselves on the back and continue performing the way we are doing," he said.
Global Fund to fight Aids, Tuberculosis and Malaria approved Malawi's round one HIV and Aids Grant amounting to US$178 million to the National Aids Commission (NAC) over a five-year period from the year 2003.
Accurate Diagnosis of Malaria
Malaria poses one of the greatest challenges to the health system in Malawi. Those most affected are young children and pregnant women.
It has been estimated that approximately 40% of the mortality rate of children under the age of five years is due to malaria.
Children under the age of five suffer at least 9 episodes of malaria a year while the adult person experiences about 6 episodes of malaria a year.
According to reports, the effects of malaria in the country are enormous. The cost of consultation, treatment and hospital admissions on the health system is high and leads to loss of productivity and earnings for the family.
Having a high mortality rate, correct diagnosis of malaria is essential to quick and effective treatment.
According to the Malawi Medical Journal of June 2006, the majority of malaria diagnosis at primary and secondary level facilities is based on symptoms and treated empirically with sulphadoxine pyrimethmine (SP).
Because of the difficulty experienced in the peripheral health clinics to diagnose malaria correctly due to of lack of equipment and trained lab technicians, treatment is given on the symptoms presented by a patient.
This is preferable to not treating the patient at all or in some cases waiting for the results of blood smears sent to a larger clinic or hospital, which could take time.
However, treating malaria-like symptoms can lead to some misdiagnosis and resistance in the malaria parasites that results in the need for a more toxic and expensive drug to be used to kill the parasite.
The SP drug commonly used these days can, in most cases be purchased over the counter in most grocery stores, even to little shops in the rural areas. This has led to people treating themselves for malaria because of symptoms when in some cases they have an infection of some other kind
*Jessa who works on a farm just outside Lilongwe says when she has a fever (malungo) she purchases SP from a little thatched shop on the road near her home. She says many women can buy the drug from many of the small stalls along the roadside and treat their families without having to go to hospital.
Jessa lives in the village close to the farm and it is evident that this is a common practice among the people in her community.
The concern at present is the resistance of the malaria parasite to the first line treatment of SP.
Several Lab Technicians in clinics visited around the City Centre say the most common form of diagnosis they use is the malaria blood film slide. Using blood drawn from a patient on a glass slide, the slide is placed under the microscope and studied by a lab technician who can identify the malaria parasite as well as other parasites.
"We also do whole blood tests - antigen tests to look for the malaria parasite and this can often reveal the plasmodium falciparum (the most common and lethal malaria parasite in Malawi). This is when the patient is treated for malaria," one technician said.
When asked how accurate the blood film slide is, another technician said in most cases it is accurate but said it could give a false reading for other reasons. "If a person had already taken some malaria treatment, the parasite can in some cases not be seen," she said adding: "Sometimes, the parasite is not seen but we recommend that a person take anti-malaria drug like SP because the parasite might be hiding in the body."
According to Dr Storn Kabuluzi the National Malaria Control Programme Manager, possible misdiagnosis is being addressed by the clinician's diagnosis of symptoms presented by the patient and referral to the lab for testing is done in order to confirm that the malaria parasite is present.
"A clinician will examine the patient then, upon what he sees he will send them to the lab," Kabuluzi says its not so much wrong diagnosis but a resistant of the parasite to the commonly used SP.
The Ministry of Health is currently in the process of working towards introducing new malaria treatment and is expecting to provide training in the proper use of the drugs for those who are expected to dispense the treatment.
It has been estimated that approximately 40% of the mortality rate of children under the age of five years is due to malaria.
Children under the age of five suffer at least 9 episodes of malaria a year while the adult person experiences about 6 episodes of malaria a year.
According to reports, the effects of malaria in the country are enormous. The cost of consultation, treatment and hospital admissions on the health system is high and leads to loss of productivity and earnings for the family.
Having a high mortality rate, correct diagnosis of malaria is essential to quick and effective treatment.
According to the Malawi Medical Journal of June 2006, the majority of malaria diagnosis at primary and secondary level facilities is based on symptoms and treated empirically with sulphadoxine pyrimethmine (SP).
Because of the difficulty experienced in the peripheral health clinics to diagnose malaria correctly due to of lack of equipment and trained lab technicians, treatment is given on the symptoms presented by a patient.
This is preferable to not treating the patient at all or in some cases waiting for the results of blood smears sent to a larger clinic or hospital, which could take time.
However, treating malaria-like symptoms can lead to some misdiagnosis and resistance in the malaria parasites that results in the need for a more toxic and expensive drug to be used to kill the parasite.
The SP drug commonly used these days can, in most cases be purchased over the counter in most grocery stores, even to little shops in the rural areas. This has led to people treating themselves for malaria because of symptoms when in some cases they have an infection of some other kind
*Jessa who works on a farm just outside Lilongwe says when she has a fever (malungo) she purchases SP from a little thatched shop on the road near her home. She says many women can buy the drug from many of the small stalls along the roadside and treat their families without having to go to hospital.
Jessa lives in the village close to the farm and it is evident that this is a common practice among the people in her community.
The concern at present is the resistance of the malaria parasite to the first line treatment of SP.
Several Lab Technicians in clinics visited around the City Centre say the most common form of diagnosis they use is the malaria blood film slide. Using blood drawn from a patient on a glass slide, the slide is placed under the microscope and studied by a lab technician who can identify the malaria parasite as well as other parasites.
"We also do whole blood tests - antigen tests to look for the malaria parasite and this can often reveal the plasmodium falciparum (the most common and lethal malaria parasite in Malawi). This is when the patient is treated for malaria," one technician said.
When asked how accurate the blood film slide is, another technician said in most cases it is accurate but said it could give a false reading for other reasons. "If a person had already taken some malaria treatment, the parasite can in some cases not be seen," she said adding: "Sometimes, the parasite is not seen but we recommend that a person take anti-malaria drug like SP because the parasite might be hiding in the body."
According to Dr Storn Kabuluzi the National Malaria Control Programme Manager, possible misdiagnosis is being addressed by the clinician's diagnosis of symptoms presented by the patient and referral to the lab for testing is done in order to confirm that the malaria parasite is present.
"A clinician will examine the patient then, upon what he sees he will send them to the lab," Kabuluzi says its not so much wrong diagnosis but a resistant of the parasite to the commonly used SP.
The Ministry of Health is currently in the process of working towards introducing new malaria treatment and is expecting to provide training in the proper use of the drugs for those who are expected to dispense the treatment.
Mainstreaming HIV and Aids
Messages and information about HIV and Aids have been disseminated very widely, and as of now, almost everybody in Malawi is very aware of the disease.
Statistics about the escalation of the disease in the country and the world over continue to dominate HIV and Aids headlines continuously.
And, still worrying, are a myriad of social conditions and cultural practices that continue to contribute to the state of the pandemic in Malawi.
Besides, over 20 years down the road since the disease was discovered, many people in this country are still not accustomed to talking openly about sex, the use of the condom as part of safer sex is low and polygamy or multiple sexual partners are common.
High unemployment, poverty, alcohol misuse and gender imbalance put an economic and social strain on vulnerable groups such as women and young people exposing them to risks of contacting the disease as they search for means of survival .
Furthermore, adequate medical care is not available and as such, the presence of HIV often goes undetected until Aids related symptoms are severe.
What is encouraging though, is that the fight for the disease has reached a critical point and a large number of private institutions have joined hands and become partners with government to explore ways to make a difference and stop the pandemic.
One such institution is Voluntary Services Overseas (VSO), an international organization whose main objective is to look beyond HIV/Aids awareness by mainstreaming the pandemic through placement of skilled and qualified volunteers to work with local partner organizations and communities.
Steve Tahuna, VSO Programme Officer argued that the social and environmental circumstances that lead vulnerable people to have unprotected sex thus exposing themselves to possible infections have to be resolved through addressing the causes of poverty and gender discrimination as well as the use of sex as a commodity.
He explained that, apart from emphasizing awareness, people need to be taught how to take full control of their lives by giving them the confidence to know that things can be different.
"The VSO volunteers accomplish this by helping partners identify resources, whether funding and or training opportunities. These volunteers work together with the communities in helping them understand the ways that HIV has an impact on the areas of their work.
Tahuna said VSO also aims at improving the quality and availability of adequate basic services in the fight against the pandemic to improve quality by strengthening the capabilities of the health system resulting in greater opportunity for people to fulfill their rights to physical, mental and social wellbeing.
"VSO Malawi's strategic aim is to assist in the mitigation of HIV and Aids of those infected and affected and contribute towards the reduction in the spread of HIV in the country," he said.
However, Tahuna explained that VSO volunteers are only there to work with support partner institutions and personnel that are already in the field to help identify the key activities that the country must undertake to address prevention, care and impact mitigation of the HIV pandemic.
"Sometimes people feel uncomfortable with the presence of these volunteers, they think they are there to grab their jobs and at times people expect a lot from them thinking they have money," he said. "They are only there to provide their expertise as partners."
There is a need to emphasize the role of stigma and fear of discrimination as barriers to effective intervention and care of people living with HIV.
"But until we call it out, we cannot trigger the intensity of action that is needed to deal with it. Mainstreaming helps to show how we are all involved and all affected by HIV. From that standpoint, we can then identify the key activities we must all undertake to address prevention, care and impact mitigation," according to Director for Southern Africa Aids Information Dissemination Service (SAfAIDS) Dr. Sunanda Ray.
Evolving and sharing experiences can be a valuable source of motivation and learning. This gives individuals a platform for sharing their experiences of HIV and Aids and their response to it in face-to-face conversations thereby giving the people liberty to talk more freely and openly in a personal context.
Statistics about the escalation of the disease in the country and the world over continue to dominate HIV and Aids headlines continuously.
And, still worrying, are a myriad of social conditions and cultural practices that continue to contribute to the state of the pandemic in Malawi.
Besides, over 20 years down the road since the disease was discovered, many people in this country are still not accustomed to talking openly about sex, the use of the condom as part of safer sex is low and polygamy or multiple sexual partners are common.
High unemployment, poverty, alcohol misuse and gender imbalance put an economic and social strain on vulnerable groups such as women and young people exposing them to risks of contacting the disease as they search for means of survival .
Furthermore, adequate medical care is not available and as such, the presence of HIV often goes undetected until Aids related symptoms are severe.
What is encouraging though, is that the fight for the disease has reached a critical point and a large number of private institutions have joined hands and become partners with government to explore ways to make a difference and stop the pandemic.
One such institution is Voluntary Services Overseas (VSO), an international organization whose main objective is to look beyond HIV/Aids awareness by mainstreaming the pandemic through placement of skilled and qualified volunteers to work with local partner organizations and communities.
Steve Tahuna, VSO Programme Officer argued that the social and environmental circumstances that lead vulnerable people to have unprotected sex thus exposing themselves to possible infections have to be resolved through addressing the causes of poverty and gender discrimination as well as the use of sex as a commodity.
He explained that, apart from emphasizing awareness, people need to be taught how to take full control of their lives by giving them the confidence to know that things can be different.
"The VSO volunteers accomplish this by helping partners identify resources, whether funding and or training opportunities. These volunteers work together with the communities in helping them understand the ways that HIV has an impact on the areas of their work.
Tahuna said VSO also aims at improving the quality and availability of adequate basic services in the fight against the pandemic to improve quality by strengthening the capabilities of the health system resulting in greater opportunity for people to fulfill their rights to physical, mental and social wellbeing.
"VSO Malawi's strategic aim is to assist in the mitigation of HIV and Aids of those infected and affected and contribute towards the reduction in the spread of HIV in the country," he said.
However, Tahuna explained that VSO volunteers are only there to work with support partner institutions and personnel that are already in the field to help identify the key activities that the country must undertake to address prevention, care and impact mitigation of the HIV pandemic.
"Sometimes people feel uncomfortable with the presence of these volunteers, they think they are there to grab their jobs and at times people expect a lot from them thinking they have money," he said. "They are only there to provide their expertise as partners."
There is a need to emphasize the role of stigma and fear of discrimination as barriers to effective intervention and care of people living with HIV.
"But until we call it out, we cannot trigger the intensity of action that is needed to deal with it. Mainstreaming helps to show how we are all involved and all affected by HIV. From that standpoint, we can then identify the key activities we must all undertake to address prevention, care and impact mitigation," according to Director for Southern Africa Aids Information Dissemination Service (SAfAIDS) Dr. Sunanda Ray.
Evolving and sharing experiences can be a valuable source of motivation and learning. This gives individuals a platform for sharing their experiences of HIV and Aids and their response to it in face-to-face conversations thereby giving the people liberty to talk more freely and openly in a personal context.
'Report Card' - a FPAM Initiative
Several factors increase girls' and young womens' vulnerability to HIV and Aids. This includes a lack of knowledge about prevention methods, early marriages, lack of economic opportunities, multiple and concurrent partnerships and socio-cultural norms.
Nearly half of the countries' population is under 15 years old and statistics show that the prevalence rate among females aged 15-24 is about four times that of males. The situation puts the lives of girls and young women at risk of contracting the virus and becoming infected.
With this in mind Family Planning Association of Malawi (FPAM) through their umbrella body the International Parenthood Federation (IPPF) recently launched a 'report card' to help fight some of the ills facing girls and young women throughout the country.
FPAM Program Coordinator Mathews Chatuluka defines the report card as an advocacy tool to increase and improve the programmatic, policy and funding actions taken on HIV prevention for girls and young women in the country.
He explained that the report card is the basis of extensive research carried out during 2006 by IPPF, involving both desk research on published data and reports and in-country research in Malawi that aims at providing more qualitative information.
"The report card summarizes the current situation of HIV prevention strategies and services for girls and young women ages 15-24 years in Malawi. Its key audiences are national, regional and international policy and decision-makers, and service providers.
"It builds on global policy commitments, particularly those outlined in the political declaration on HIV/Aids from the June 2006 high level meeting, to follow up on the United Nations General Assembly Special Session on Aids (UNGASS)," he said.
Among other things, explained Chatuluka, the report card would more aggressively promote a positive model of voluntary counselling and testing - one that emphasises the benefits of knowing your HIV status, guaranteeing confidentiality and helping girls and young women cope with the aftermath of being affected.
He said the report card would also strengthen the links between HIV prevention and legal services, "so that, if for example, a woman taking an HIV test reports being raped, she can be referred to a group that can provide appropriate and sensitive legal support."
"The report card would also help in designing programmes that are specifically tailored to young and older men and address their role in supporting HIV prevention for girls and young women," added the programmes coordinator.
"And more aggressively, promote the involvement of men in sexual and reproductive health programmes and facilitate the participation of girls and young women particularly those living with HIV in national planning and programming relating to HIV and Aids including through programmes to build their capacity in areas such as decision-making and public speaking."
UNFPA HIV Coordinator Robert Ngaiyaye said the report card has come at a right time when girls and young women are lacking adequate knowledge about the prevention of the disease.
He said girls and young women lack economic opportunities that are contributing to them becoming involved in sex work at an early age.
"To date despite the high knowledge levels of HIV pandemic in this country only 57.3% state that condoms can help prevent HIV. Teenage pregnancy is also very high to the extent that about 60% of girls get pregnant or have a baby at the age of 19," Ngaiyaye said.
He called on stakeholders to regard the report card as a critical tool to addressing the issues affecting girls and young women.
Ngaiyaye said the report card has come at a time when young girls and women need it the most.
"We need to join hands to address the issues affecting young people. There is a need to intensify prevention efforts," he said.
Minister of Youth Development and Sports Khumbo Kachale emphasised the need for stakeholders in the fight against HIV/Aids to promote educating messages.
The minister also advised youths in the country to put to practice everything they learn about the disease and strive to become role models.
"Let us promote educating messages about the disease and not the threatening ones because if you promote that a lot of youth lose their focus and they stop participating and to the youth out there, take what you learn and apply it to your daily lives. When you do so you become role models in your respective areas," said Kachale.
Nearly half of the countries' population is under 15 years old and statistics show that the prevalence rate among females aged 15-24 is about four times that of males. The situation puts the lives of girls and young women at risk of contracting the virus and becoming infected.
With this in mind Family Planning Association of Malawi (FPAM) through their umbrella body the International Parenthood Federation (IPPF) recently launched a 'report card' to help fight some of the ills facing girls and young women throughout the country.
FPAM Program Coordinator Mathews Chatuluka defines the report card as an advocacy tool to increase and improve the programmatic, policy and funding actions taken on HIV prevention for girls and young women in the country.
He explained that the report card is the basis of extensive research carried out during 2006 by IPPF, involving both desk research on published data and reports and in-country research in Malawi that aims at providing more qualitative information.
"The report card summarizes the current situation of HIV prevention strategies and services for girls and young women ages 15-24 years in Malawi. Its key audiences are national, regional and international policy and decision-makers, and service providers.
"It builds on global policy commitments, particularly those outlined in the political declaration on HIV/Aids from the June 2006 high level meeting, to follow up on the United Nations General Assembly Special Session on Aids (UNGASS)," he said.
Among other things, explained Chatuluka, the report card would more aggressively promote a positive model of voluntary counselling and testing - one that emphasises the benefits of knowing your HIV status, guaranteeing confidentiality and helping girls and young women cope with the aftermath of being affected.
He said the report card would also strengthen the links between HIV prevention and legal services, "so that, if for example, a woman taking an HIV test reports being raped, she can be referred to a group that can provide appropriate and sensitive legal support."
"The report card would also help in designing programmes that are specifically tailored to young and older men and address their role in supporting HIV prevention for girls and young women," added the programmes coordinator.
"And more aggressively, promote the involvement of men in sexual and reproductive health programmes and facilitate the participation of girls and young women particularly those living with HIV in national planning and programming relating to HIV and Aids including through programmes to build their capacity in areas such as decision-making and public speaking."
UNFPA HIV Coordinator Robert Ngaiyaye said the report card has come at a right time when girls and young women are lacking adequate knowledge about the prevention of the disease.
He said girls and young women lack economic opportunities that are contributing to them becoming involved in sex work at an early age.
"To date despite the high knowledge levels of HIV pandemic in this country only 57.3% state that condoms can help prevent HIV. Teenage pregnancy is also very high to the extent that about 60% of girls get pregnant or have a baby at the age of 19," Ngaiyaye said.
He called on stakeholders to regard the report card as a critical tool to addressing the issues affecting girls and young women.
Ngaiyaye said the report card has come at a time when young girls and women need it the most.
"We need to join hands to address the issues affecting young people. There is a need to intensify prevention efforts," he said.
Minister of Youth Development and Sports Khumbo Kachale emphasised the need for stakeholders in the fight against HIV/Aids to promote educating messages.
The minister also advised youths in the country to put to practice everything they learn about the disease and strive to become role models.
"Let us promote educating messages about the disease and not the threatening ones because if you promote that a lot of youth lose their focus and they stop participating and to the youth out there, take what you learn and apply it to your daily lives. When you do so you become role models in your respective areas," said Kachale.
Maximising HIV Test Counselling in STI Services
Integrating HIV Testing Counselling (HTC) into Sexually Transmitted Infection (STI) service delivery has not been successful thereby calling for the intervention of non-medical HIV Testing Counsellors and the Opt-Out Strategy in the country's STI Clinics.
STI patients are at high risk of HIV transmission therefore HIV counselling and testing should be the standard of care for all STI patients; this, according to the National HIV and AIDS policy.
Gift Kamanga of the University of Northern Carolina (UNC) Project at Kamuzu Central Hospital, says STI service providers such as nurses and clinicians do not have enough time to implement HTC adequately in STI clinics.
In this experience, it is clear that non-medical HIV testing counsellors have greatly contributed to the increased uptake of HIV Testing and Counselling services.
Delivering his presentation to this year's National HIV/AIDS Dissemination Conference in Lilongwe, Kamanga emphasized on the importance of providing quality STI services that include the capacity for HIV testing and counselling. The UNC project and Ministry of Health commitment effected the modernization of the entire STI facility at Kamuzu Central hospital that was undertaken in 2005.
Kamanga said the project has since had several improvements and expansion of STI clinical services, which have led to the increase in demand for the services by 46%.
"However, it should be noted that genital ulcers and urethra/vaginal discharge remain significant sexually transmitted infections," he said lamenting that females predominate the STI clinic.
Gift Kamanga advocates that similar clinical settings, with populations of high-risk behaviour such as men and women with high prevalence and incidence of HIV, are ideal settings for HIV preventions programs.
"Programs should include condom distribution, sexual risk reduction counselling, including couples counselling, HIV and Syphilis counselling and testing, partner notification and prompt STI treatment," he said.
However, Kamanga was quick to point out challenges facing the implementation of HTC services in STI clinics saying nurses and clinicians are overwhelmed with routine patient care services hence no proper time is given to concentrate on HTC.
"In addition to that, HTC trainings at the moment do not target the nurses or clinicians in STI clinics hence making implementation of HTC policy not operational," he lamented adding that there is also lack of perceived benefits by STI clients themselves, unlike in TB and PMTCT where HTC is directly linked to instant intervention with antiretroviral therapy.
The need for HTC in STI clinics has been observed by Kamuzu Central Hospital since it went into trials in 2005. KCH STI unit started HTC strategy using one counsellor and by July 2006, they had three.
Since then, nurses and clinicians do testing for HIV and detailed counselling is left to counsellors.
Kamanga said before the deployment of HTC Counsellors there was negligible HIV testing done at the STI clinic and there was less than 10% of new attendees.
"Since HTC Counsellors came in the rate has been increasing to over 60%," affirmed Kamanga.
He therefore called upon Ministry of Health to consider deploying a new cadre of HIV Testing Counsellors in STI clinics across the country to compliment the work of STI service providers.
UNC Project with Kamuzu Central Hospital has further intensified HIV services in the STI clinic by implementing a routine HIV testing through the Opt-Out Strategy in the STI clinic at KCH starting from July 2007.
According to Kamanga, this is a strategy where in the sensitisation process; STI patients will be told that they will undergo an HIV test as part of standard of care but are free to decline if not willing.
Sexually Transmitted infections greatly enhance HIV acquisition and the policy environment in Malawi encourages routine HIV testing for STI clients.
"But not much has happened country wide to make this policy operational in STI clinics," he said.
In the process of the Opt-Out Strategy, STI patients are sensitized on STIs and HIV in the reception area. Then they go for care in the examination room and if they consent, a short opt out HTC and syphilis rapid testing is performed. Then the patient is escorted to a counsellor for detailed post-test counselling. At times patients start with the counsellor for HTC then are escorted to the examination room for care.
On the other hand, the Opt-In Strategy where patients were only asked if they were interested and would be offered the HTC services, had less than 30% uptake thus not giving optimal opportunity for patients to be tested. Nevertheless, Kamanga said the Opt-Out Strategy has doubled the HTC uptake.
This is because messages were refined to reflect clearly the individual health benefits while recognizing patients' rights to opt out.
"Mere emphasis on STI risk to acquiring HIV did not lead to acceptance of HTC but messages for direct health benefit and clear referral mechanism for ART," he said emphasizing that in the course of Opt-Out Strategy service providers should be mindful of preserving patients' rights.
Opt-Out HTC in a busy clinic is possible, according to Kamanga, and therefore all STI clinics should do it. This can be achieved if the Ministry of Health deployed enough HIV testing counsellors in all STI clinics to compliment the work of STI service providers.
STI patients are at high risk of HIV transmission therefore HIV counselling and testing should be the standard of care for all STI patients; this, according to the National HIV and AIDS policy.
Gift Kamanga of the University of Northern Carolina (UNC) Project at Kamuzu Central Hospital, says STI service providers such as nurses and clinicians do not have enough time to implement HTC adequately in STI clinics.
In this experience, it is clear that non-medical HIV testing counsellors have greatly contributed to the increased uptake of HIV Testing and Counselling services.
Delivering his presentation to this year's National HIV/AIDS Dissemination Conference in Lilongwe, Kamanga emphasized on the importance of providing quality STI services that include the capacity for HIV testing and counselling. The UNC project and Ministry of Health commitment effected the modernization of the entire STI facility at Kamuzu Central hospital that was undertaken in 2005.
Kamanga said the project has since had several improvements and expansion of STI clinical services, which have led to the increase in demand for the services by 46%.
"However, it should be noted that genital ulcers and urethra/vaginal discharge remain significant sexually transmitted infections," he said lamenting that females predominate the STI clinic.
Gift Kamanga advocates that similar clinical settings, with populations of high-risk behaviour such as men and women with high prevalence and incidence of HIV, are ideal settings for HIV preventions programs.
"Programs should include condom distribution, sexual risk reduction counselling, including couples counselling, HIV and Syphilis counselling and testing, partner notification and prompt STI treatment," he said.
However, Kamanga was quick to point out challenges facing the implementation of HTC services in STI clinics saying nurses and clinicians are overwhelmed with routine patient care services hence no proper time is given to concentrate on HTC.
"In addition to that, HTC trainings at the moment do not target the nurses or clinicians in STI clinics hence making implementation of HTC policy not operational," he lamented adding that there is also lack of perceived benefits by STI clients themselves, unlike in TB and PMTCT where HTC is directly linked to instant intervention with antiretroviral therapy.
The need for HTC in STI clinics has been observed by Kamuzu Central Hospital since it went into trials in 2005. KCH STI unit started HTC strategy using one counsellor and by July 2006, they had three.
Since then, nurses and clinicians do testing for HIV and detailed counselling is left to counsellors.
Kamanga said before the deployment of HTC Counsellors there was negligible HIV testing done at the STI clinic and there was less than 10% of new attendees.
"Since HTC Counsellors came in the rate has been increasing to over 60%," affirmed Kamanga.
He therefore called upon Ministry of Health to consider deploying a new cadre of HIV Testing Counsellors in STI clinics across the country to compliment the work of STI service providers.
UNC Project with Kamuzu Central Hospital has further intensified HIV services in the STI clinic by implementing a routine HIV testing through the Opt-Out Strategy in the STI clinic at KCH starting from July 2007.
According to Kamanga, this is a strategy where in the sensitisation process; STI patients will be told that they will undergo an HIV test as part of standard of care but are free to decline if not willing.
Sexually Transmitted infections greatly enhance HIV acquisition and the policy environment in Malawi encourages routine HIV testing for STI clients.
"But not much has happened country wide to make this policy operational in STI clinics," he said.
In the process of the Opt-Out Strategy, STI patients are sensitized on STIs and HIV in the reception area. Then they go for care in the examination room and if they consent, a short opt out HTC and syphilis rapid testing is performed. Then the patient is escorted to a counsellor for detailed post-test counselling. At times patients start with the counsellor for HTC then are escorted to the examination room for care.
On the other hand, the Opt-In Strategy where patients were only asked if they were interested and would be offered the HTC services, had less than 30% uptake thus not giving optimal opportunity for patients to be tested. Nevertheless, Kamanga said the Opt-Out Strategy has doubled the HTC uptake.
This is because messages were refined to reflect clearly the individual health benefits while recognizing patients' rights to opt out.
"Mere emphasis on STI risk to acquiring HIV did not lead to acceptance of HTC but messages for direct health benefit and clear referral mechanism for ART," he said emphasizing that in the course of Opt-Out Strategy service providers should be mindful of preserving patients' rights.
Opt-Out HTC in a busy clinic is possible, according to Kamanga, and therefore all STI clinics should do it. This can be achieved if the Ministry of Health deployed enough HIV testing counsellors in all STI clinics to compliment the work of STI service providers.
Rescuing Infants From Tuberculosis
The call to action in Prevention of Mother to Child Transmission (PMTCT) aims to reduce the risk of mother to child transmission of HIV through integrated HIV/Aids education, routine counselling and testing as well as administration of a prophylaxis single dose Nevirapine therapy to mother and infant.
It goes without saying then, that the need to protect infants or the unborn from the possibility of contracting Tuberculosis, including the Multi-Drug Resistant (MDR) and Extremely Drug Resistant (XDR) TB, which is closely linked to the HIV epidemic, becomes of paramount importance.
During the last decade, there has been an increase of TB infections as an opportunistic infection in people with HIV because of their weakened immune systems. This is causing concern in the light of MDR and XDR-TB surfacing because interventions such as the prevention of mother to child transmission of HIV may be challenged where the mother is living with HIV and found with Tuberculosis.
Communications Officer of National TB Control Programme, Henry Chimbali, told Health Check that most healthy people do not get TB unless they are in very close contact with people infected with Tuberculosis as it is spread through droplets in the air.
"The infection of XDR-TB is transmitted the same as the standard TB and could be prevented the same way ordinary Tuberculosis is prevented," Chimbali said.
The international medical humanitarian organisation, Medicines Sans Frontieres (MSF) is quoted by Health Check calling for approaches and new tools to treat multi-drug resistant (MDR) Tuberculosis in Southern Africa.
"MDR, and now XDR-TB, are the tip of an iceberg of failing strategies to control TB," said Dr.. Eric Goemaere of MSF "We desperately need new tools and new approaches and we need them now - we cannot just sit and wait. Despite all the international fanfare created by XDR, efforts to treat drug resistant TB in high HIV prevalence settings are moving at a snail's pace and investments to develop new drugs and diagnostics to improve management of all forms of TB are terribly inadequate. This situation is unacceptable." He said
The World Health Organisation says it is important to avoid prolonged and close contact with a person who has been infected by TB, MDR-TB or XDR-TB in a place that does not have good ventilation and fresh air as one way of protecting oneself from becoming infected with the Tuberculosis.
According to the National TB Control Programme, XDR-TB patients need experts to handle their cases while they are quarantined.
Chimbali told Health Check, however, that any development of TB could be averted if regular TB is treated effectively and if Malawi succeeded in controlling the XDR-TB transmission, then the risk of infection would not be there.
Country Director for UNC Project at Kamuzu Central Hospital, Dr.. Francis Martinson, says there is need for a prophylaxis regimen to protect mother/infant pairs from tuberculosis just as there is a Nevirapine dose to facilitate the prevention of mother to child transmission of HIV.
In this regard, University of Northern Carolina (UNC) Project has embarked on a randomized, placebo-controlled trial to determine the efficacy of Isoniazid (INH), a component drug in the combination of TB treatment in preventing Tuberculosis disease and latent TB infection among South African infants with peri-natal exposure to HIV.
Dr. Martinson told Health Check that the trial would have an initial sample size of 1,300 study participants consisting of 500 infected and 800 uninfected exposed study participants.
"The objective of the trial aims to determine whether INH prophylaxis increases TB disease survival for HIV infected participants; to determine whether INH prophylaxis increases TB infection-free survival for peri-natal-exposed HIV uninfected study participants," said Dr.. Martinson.
"Among both peri-natal-exposed HIV infected and HIV uninfected study participants we are also trying to assess the toxicity and safety of INH prophylaxis."
The fact that once one is HIV positive and having Tuberculosis, one is automatically placed on antiretroviral therapy, puts the mother/infant pair at risk of not accessing medical care if they infect one another and do not get diagnosed in time.
This uncertainty surrounding lives of infants makes it clear that it is imperative for stakeholders to ensure that such cases are identified and assisted adequately in time to save mother/infant pairs' lives and to prevent the spread of both TB and HIV.
It goes without saying then, that the need to protect infants or the unborn from the possibility of contracting Tuberculosis, including the Multi-Drug Resistant (MDR) and Extremely Drug Resistant (XDR) TB, which is closely linked to the HIV epidemic, becomes of paramount importance.
During the last decade, there has been an increase of TB infections as an opportunistic infection in people with HIV because of their weakened immune systems. This is causing concern in the light of MDR and XDR-TB surfacing because interventions such as the prevention of mother to child transmission of HIV may be challenged where the mother is living with HIV and found with Tuberculosis.
Communications Officer of National TB Control Programme, Henry Chimbali, told Health Check that most healthy people do not get TB unless they are in very close contact with people infected with Tuberculosis as it is spread through droplets in the air.
"The infection of XDR-TB is transmitted the same as the standard TB and could be prevented the same way ordinary Tuberculosis is prevented," Chimbali said.
The international medical humanitarian organisation, Medicines Sans Frontieres (MSF) is quoted by Health Check calling for approaches and new tools to treat multi-drug resistant (MDR) Tuberculosis in Southern Africa.
"MDR, and now XDR-TB, are the tip of an iceberg of failing strategies to control TB," said Dr.. Eric Goemaere of MSF "We desperately need new tools and new approaches and we need them now - we cannot just sit and wait. Despite all the international fanfare created by XDR, efforts to treat drug resistant TB in high HIV prevalence settings are moving at a snail's pace and investments to develop new drugs and diagnostics to improve management of all forms of TB are terribly inadequate. This situation is unacceptable." He said
The World Health Organisation says it is important to avoid prolonged and close contact with a person who has been infected by TB, MDR-TB or XDR-TB in a place that does not have good ventilation and fresh air as one way of protecting oneself from becoming infected with the Tuberculosis.
According to the National TB Control Programme, XDR-TB patients need experts to handle their cases while they are quarantined.
Chimbali told Health Check, however, that any development of TB could be averted if regular TB is treated effectively and if Malawi succeeded in controlling the XDR-TB transmission, then the risk of infection would not be there.
Country Director for UNC Project at Kamuzu Central Hospital, Dr.. Francis Martinson, says there is need for a prophylaxis regimen to protect mother/infant pairs from tuberculosis just as there is a Nevirapine dose to facilitate the prevention of mother to child transmission of HIV.
In this regard, University of Northern Carolina (UNC) Project has embarked on a randomized, placebo-controlled trial to determine the efficacy of Isoniazid (INH), a component drug in the combination of TB treatment in preventing Tuberculosis disease and latent TB infection among South African infants with peri-natal exposure to HIV.
Dr. Martinson told Health Check that the trial would have an initial sample size of 1,300 study participants consisting of 500 infected and 800 uninfected exposed study participants.
"The objective of the trial aims to determine whether INH prophylaxis increases TB disease survival for HIV infected participants; to determine whether INH prophylaxis increases TB infection-free survival for peri-natal-exposed HIV uninfected study participants," said Dr.. Martinson.
"Among both peri-natal-exposed HIV infected and HIV uninfected study participants we are also trying to assess the toxicity and safety of INH prophylaxis."
The fact that once one is HIV positive and having Tuberculosis, one is automatically placed on antiretroviral therapy, puts the mother/infant pair at risk of not accessing medical care if they infect one another and do not get diagnosed in time.
This uncertainty surrounding lives of infants makes it clear that it is imperative for stakeholders to ensure that such cases are identified and assisted adequately in time to save mother/infant pairs' lives and to prevent the spread of both TB and HIV.
Rincon ministry aims to raise awareness about Malawi
McEwen, founder of Rincon-based Acts III Global Ministries, in conjunction with his business will host the first Malawi awareness event in October at the shopping center on Ga. 21 where the organization's thrift store is located.
The free event will feature local Christian bands, free gift baskets that include hand-carved letter openers from Malawi, CDs and DVDs and inflatable attractions for children.
The event is not a fundraiser, McEwen said.
"There will not even be a love offering taken up," he said. "We just want to let the community know what is going on in Malawi and what the needs are there."
McEwen said he has been to the poverty- and disease-stricken country 15 times in the last four years and plans to travel there again this September.
His first trip was with another ministry's founder, who he had designed a free Web site for. When he went, he said he saw countless unsupervised children, many of whom were carrying around little baby brothers or sisters tied on their back.
"I knew that was where the Lord wanted me to be," he said.
Acts III is building an orphanage in Malawi that will accommodate 96 orphans, he said. Unfortunately, there are about 20,000 orphans in the village where the orphanage is being built and it is just going to "scratch the surface," he said.
That's why he wants more people to know about what is happening in the country so that they too will try to help in whatever way they can, he said.
Acts III has been trying to help people since it was established about four years ago.
The incorporated church's thrift store is funded through donations and sales. The organization gives clothing and items away to the needy for free and uses whatever other money it raises through sales to stay in business and fund church projects. It is run by both volunteers and paid employees.
The ministry does not yet have a church, but is planning on building one in the future. McEwen said they may start holding services in the store on Sundays.
Employee Terika Coppock, 24, said she has been working at the store for three years.
"I like what they are doing," Coppock said. "It's good that they are raising awareness."
The Effingham County Board of Commissioners will consider a request for the assemblage permit today during the commission's regular meeting at 8:30 a.m.
McEwen said he is expecting about 500 people to attend the event throughout the day.
The free event will feature local Christian bands, free gift baskets that include hand-carved letter openers from Malawi, CDs and DVDs and inflatable attractions for children.
The event is not a fundraiser, McEwen said.
"There will not even be a love offering taken up," he said. "We just want to let the community know what is going on in Malawi and what the needs are there."
McEwen said he has been to the poverty- and disease-stricken country 15 times in the last four years and plans to travel there again this September.
His first trip was with another ministry's founder, who he had designed a free Web site for. When he went, he said he saw countless unsupervised children, many of whom were carrying around little baby brothers or sisters tied on their back.
"I knew that was where the Lord wanted me to be," he said.
Acts III is building an orphanage in Malawi that will accommodate 96 orphans, he said. Unfortunately, there are about 20,000 orphans in the village where the orphanage is being built and it is just going to "scratch the surface," he said.
That's why he wants more people to know about what is happening in the country so that they too will try to help in whatever way they can, he said.
Acts III has been trying to help people since it was established about four years ago.
The incorporated church's thrift store is funded through donations and sales. The organization gives clothing and items away to the needy for free and uses whatever other money it raises through sales to stay in business and fund church projects. It is run by both volunteers and paid employees.
The ministry does not yet have a church, but is planning on building one in the future. McEwen said they may start holding services in the store on Sundays.
Employee Terika Coppock, 24, said she has been working at the store for three years.
"I like what they are doing," Coppock said. "It's good that they are raising awareness."
The Effingham County Board of Commissioners will consider a request for the assemblage permit today during the commission's regular meeting at 8:30 a.m.
McEwen said he is expecting about 500 people to attend the event throughout the day.
Malawi names road after Kagame
President Paul Kagame arrived in Malawi yesterday at the beginning of a three-day state visit. Kagame was met on arrival at the Kamuzu International Airport by his Malawian counterpart President Bingu wa Mutharika and accorded a 21-gun salute. President Kagame last visited Malawi during the inauguration of President wa Mutharika in May 2004. Today, the two presidents are scheduled to inaugurate a new highway, which is to be named after President Kagame.
Shortly after arrival in Lilongwe, the two Heads of State participated in a ceremony at the city’s Civic Offices where President Kagame was conferred the Freedom of the City of Lilongwe by the City Assembly – an honour traditionally granted to visiting Heads of State.
Expressing appreciation for the honour of the key to the city, President Kagame congratulated President wa Mutharika on the transformation of Lilongwe into a veritable seat of government during his administration.
Kagame was due to attend a state banquet given in his honour by the Malawian President at the new State House in Lilongwe last evening.
Shortly after arrival in Lilongwe, the two Heads of State participated in a ceremony at the city’s Civic Offices where President Kagame was conferred the Freedom of the City of Lilongwe by the City Assembly – an honour traditionally granted to visiting Heads of State.
Expressing appreciation for the honour of the key to the city, President Kagame congratulated President wa Mutharika on the transformation of Lilongwe into a veritable seat of government during his administration.
Kagame was due to attend a state banquet given in his honour by the Malawian President at the new State House in Lilongwe last evening.
Top Malawian child welfare official taken off Madonna adoption case
The senior Malawian child welfare official who was to go to London to assess whether Madonna could adopt a little boy from the southern African country has been removed from the high-profile case following allegations he solicited money from the singer for the trip.
Simon Chisale, the country's chief social welfare officer, said Monday the government had gone to court last week to have Penstone Kilembe, the director of Malawi's Child Welfare Services, replaced as the assessor in the Madonna adoption. Chisale was now planning to go to London, arriving Tuesday to carry out the first, much-delayed assessment of toddler David Banda's progress.
Kilembe, who returned to Malawi late Monday after attending a conference in the United States last week, said he had not heard of the move and denied any wrongdoing.
"I am not aware of these developments. I have just arrived from New York and nobody from my office has told me anything. I will be in the office tomorrow," he said.
Madonna and her husband, film director Guy Ritchie, were granted temporary custody of David, then 13 months old, last October. His father had placed him in an orphanage after his mother died.
Critics accused Madonna, who found David in the orphanage while in Malawi to launch a project to help the country's two million AIDS orphans, of using her celebrity status to circumvent Malawian adoption laws - allegations she denies.
The allegations were likely to be revived because of Kilembe's removal, as well as new reports Monday that Madonna was paying for a Malawi welfare official to study at a British university.
The latest developments and delays in carrying out the assessment as well as reports of internal government wrangling are likely to raise concerns that Malawi's Child Welfare Services is in a state of disarray at a time when it is under international scrutiny.
Andrina Mchiela, a top civil servant in the Child Welfare Ministry, said Monday that a staffer's tuition was being funded by the singer.
"Madonna is paying for everything and we are extremely grateful. She asked us whether we had any problems and we told her the ministry lacked trained personnel. We told her about (the staffer), and she immediately responded.
"Madonna indicated a willingness to sponsor more officers. We just have to inform her of our need," she said.
An e-mail was sent to Madonna's spokeswoman U.S.-based spokeswoman Liz Rozenberg requesting comment, but there was no immediate response Monday.
Malawian rights organizations have said their government needs help monitoring Madonna's planned adoption.
There have been newspaper reports in Malawi that Minister of Gender and Child Welfare Kate Kainja-Kaluluma stopped Kilembe from going to London because he had allegedly solicited funds from Madonna for the trip without the minister's knowledge or permission. According to the original custody order, Kilembe was appointed to oversee the adoption, which included inspections of the star's home in May and December.
Kilembe, who disputes the allegations, said he had spoken to the minister and that the matter had been resolved.
In an affidavit presented to the court, child welfare officials said Kilembe was leaving the ministry and "moving on to a new posting." It did not give details on his new position.
Chisale confirmed Monday that he had been appointed to replace Kilembe but refused to discuss the adoption further.
"Yes, I have just been informed I would do the assessment but I am not mandated to discuss the issue until perhaps we finalize the report," he said.
Madonna's lawyer in Malawi said he was co-operating with Chisale, who was to work with child welfare officers in London. A British child psychologist and lawyer would be part of the inspection.
The second inspection is scheduled for December and a report is expected to be filed before the courts in the capital Lilongwe by the February 2008 deadline for a judge to determine whether the Madonna and her husband are suitable adoptive parents.
The couple's custody order could be revoked if it is found that David was being treated differently from their other children, Lourdes, 10, and Rocco, 6, or if the toddler's rights were being violated in any way.
Simon Chisale, the country's chief social welfare officer, said Monday the government had gone to court last week to have Penstone Kilembe, the director of Malawi's Child Welfare Services, replaced as the assessor in the Madonna adoption. Chisale was now planning to go to London, arriving Tuesday to carry out the first, much-delayed assessment of toddler David Banda's progress.
Kilembe, who returned to Malawi late Monday after attending a conference in the United States last week, said he had not heard of the move and denied any wrongdoing.
"I am not aware of these developments. I have just arrived from New York and nobody from my office has told me anything. I will be in the office tomorrow," he said.
Madonna and her husband, film director Guy Ritchie, were granted temporary custody of David, then 13 months old, last October. His father had placed him in an orphanage after his mother died.
Critics accused Madonna, who found David in the orphanage while in Malawi to launch a project to help the country's two million AIDS orphans, of using her celebrity status to circumvent Malawian adoption laws - allegations she denies.
The allegations were likely to be revived because of Kilembe's removal, as well as new reports Monday that Madonna was paying for a Malawi welfare official to study at a British university.
The latest developments and delays in carrying out the assessment as well as reports of internal government wrangling are likely to raise concerns that Malawi's Child Welfare Services is in a state of disarray at a time when it is under international scrutiny.
Andrina Mchiela, a top civil servant in the Child Welfare Ministry, said Monday that a staffer's tuition was being funded by the singer.
"Madonna is paying for everything and we are extremely grateful. She asked us whether we had any problems and we told her the ministry lacked trained personnel. We told her about (the staffer), and she immediately responded.
"Madonna indicated a willingness to sponsor more officers. We just have to inform her of our need," she said.
An e-mail was sent to Madonna's spokeswoman U.S.-based spokeswoman Liz Rozenberg requesting comment, but there was no immediate response Monday.
Malawian rights organizations have said their government needs help monitoring Madonna's planned adoption.
There have been newspaper reports in Malawi that Minister of Gender and Child Welfare Kate Kainja-Kaluluma stopped Kilembe from going to London because he had allegedly solicited funds from Madonna for the trip without the minister's knowledge or permission. According to the original custody order, Kilembe was appointed to oversee the adoption, which included inspections of the star's home in May and December.
Kilembe, who disputes the allegations, said he had spoken to the minister and that the matter had been resolved.
In an affidavit presented to the court, child welfare officials said Kilembe was leaving the ministry and "moving on to a new posting." It did not give details on his new position.
Chisale confirmed Monday that he had been appointed to replace Kilembe but refused to discuss the adoption further.
"Yes, I have just been informed I would do the assessment but I am not mandated to discuss the issue until perhaps we finalize the report," he said.
Madonna's lawyer in Malawi said he was co-operating with Chisale, who was to work with child welfare officers in London. A British child psychologist and lawyer would be part of the inspection.
The second inspection is scheduled for December and a report is expected to be filed before the courts in the capital Lilongwe by the February 2008 deadline for a judge to determine whether the Madonna and her husband are suitable adoptive parents.
The couple's custody order could be revoked if it is found that David was being treated differently from their other children, Lourdes, 10, and Rocco, 6, or if the toddler's rights were being violated in any way.
Change from Arid to Wet Climate in Africa Had Significant Effect on Early Human Evolution
Newswise — A team of scientists from around the globe has determined that a drastic change in the climate of tropical Africa may have significantly driven early human evolution.
The team’s findings will be published in the Sept. 4–7 installment of Early Edition, published online in the Proceedings of the National Academy of Sciences. Among the findings: A transition from a long period of time (about 135,000 to 75,000 years ago) that included several extreme droughts to a stable, wetter climate may have stimulated the expansion and migration of early human populations.
The team includes researchers from Syracuse University, the University of Minnesota-Duluth, the University of Arizona, the University of Rhode Island, the University of Akron, the University of Bergen (Norway), the Malawi Geological Survey Department, the Geological Survey Department of Ghana, the University of Illinois-Chicago, the Scottish Universities Environmental Research Centre and the University of Wisconsin-Eau Claire.
The researchers studied lake cores from Lake Malawi, at the southern end of East Africa’s Rift Valley, and found that the megadroughts were some of tropical
Africa’s driest periods in the last million years or more. During the most severe episodes, the lake was below 15 percent of its current level—only 100 meters rather than 700 meters deep (more than a 95 percent water volume reduction). Before about 70,000 years ago, the climate was highly variable, African lakes dried up completely and then refilled, and plant and animal populations grew and died out.
Around 70,000 years ago, the climate became wetter and stabilized, and African lake levels rose dramatically, the researchers found. Once that happened, human populations grew rapidly and migrated. “Our research suggests that the population expansion and subsequent spreading of ‘Out of Africa’ colonizers may have been aided by the newly stabilized climate,” says Christopher A. Scholz, associate professor of earth sciences at Syracuse University and lead investigator on the project.
“Previously it was thought that the migrations and population changes of early modern humans were driven by the growth and collapse of high-latitude ice sheets,” Scholz says. “Our research suggests that instead, prior to 70,000 years ago, wet-dry cycles in Africa were driven by shifts in the Earth’s orbit around the sun.”
“The findings from the Lake Malawi Drilling Project and other similar lake drilling projects in the tropics are likely to make major changes in our understanding of the Earth’s climate history and its effects on our planet’s ecosystems,” says Andrew S. Cohen, a research team member from the Department of Geosciences at the University of Arizona. “This study shows what a rich record of surprises in climate change can be learned from deep and ancient lakes like Malawi.”
The latest findings are part of a multi-year, multi-institution project funded by the National Science Foundation and the International Continental Scientific Drilling Program to contribute to a better understanding of African and global climate history.
Lake Malawi, more than five million years old and more than 2,300 feet deep, is one of the world’s oldest and deepest lakes and is considered by many scientists to be one of the natural wonders of the world.
The research team faced numerous severe operational challenges in retrieving the cores. “Drilling in Lake Malawi presented many of the most difficult aspects of both continental and ocean scientific drilling, including a very remote location lacking infrastructure and very deep, ‘blue water’ drilling operations,” says Scholz. Drilling in the deepest site, which was 600 meters, required the construction of a dynamically positioned drilling vessel. The 26 members of the science and drilling teams lived and worked aboard a 160-foot converted fuel barge for six weeks while recovering the cores. Aboard the drilling barge, the teams lived in converted shipping containers, which were crammed in between the drilling rig and the large thruster engines that were required for stabilizing the vessel.
Professor Tom Johnson of the Large Lakes Observatory and Department of Geological Sciences at the University of Minnesota-Duluth, remarks, “A number of us in the African lakes research committee built the justification for a major drilling program on one of the East African great lakes for well over a decade, and finally made it happen in early 2005 with funds from the U.S. National Science Foundation and the International Continental Drilling Program. It is gratifying to see that our efforts are paying off with such spectacular early results.”
The team’s findings will be published in the Sept. 4–7 installment of Early Edition, published online in the Proceedings of the National Academy of Sciences. Among the findings: A transition from a long period of time (about 135,000 to 75,000 years ago) that included several extreme droughts to a stable, wetter climate may have stimulated the expansion and migration of early human populations.
The team includes researchers from Syracuse University, the University of Minnesota-Duluth, the University of Arizona, the University of Rhode Island, the University of Akron, the University of Bergen (Norway), the Malawi Geological Survey Department, the Geological Survey Department of Ghana, the University of Illinois-Chicago, the Scottish Universities Environmental Research Centre and the University of Wisconsin-Eau Claire.
The researchers studied lake cores from Lake Malawi, at the southern end of East Africa’s Rift Valley, and found that the megadroughts were some of tropical
Africa’s driest periods in the last million years or more. During the most severe episodes, the lake was below 15 percent of its current level—only 100 meters rather than 700 meters deep (more than a 95 percent water volume reduction). Before about 70,000 years ago, the climate was highly variable, African lakes dried up completely and then refilled, and plant and animal populations grew and died out.
Around 70,000 years ago, the climate became wetter and stabilized, and African lake levels rose dramatically, the researchers found. Once that happened, human populations grew rapidly and migrated. “Our research suggests that the population expansion and subsequent spreading of ‘Out of Africa’ colonizers may have been aided by the newly stabilized climate,” says Christopher A. Scholz, associate professor of earth sciences at Syracuse University and lead investigator on the project.
“Previously it was thought that the migrations and population changes of early modern humans were driven by the growth and collapse of high-latitude ice sheets,” Scholz says. “Our research suggests that instead, prior to 70,000 years ago, wet-dry cycles in Africa were driven by shifts in the Earth’s orbit around the sun.”
“The findings from the Lake Malawi Drilling Project and other similar lake drilling projects in the tropics are likely to make major changes in our understanding of the Earth’s climate history and its effects on our planet’s ecosystems,” says Andrew S. Cohen, a research team member from the Department of Geosciences at the University of Arizona. “This study shows what a rich record of surprises in climate change can be learned from deep and ancient lakes like Malawi.”
The latest findings are part of a multi-year, multi-institution project funded by the National Science Foundation and the International Continental Scientific Drilling Program to contribute to a better understanding of African and global climate history.
Lake Malawi, more than five million years old and more than 2,300 feet deep, is one of the world’s oldest and deepest lakes and is considered by many scientists to be one of the natural wonders of the world.
The research team faced numerous severe operational challenges in retrieving the cores. “Drilling in Lake Malawi presented many of the most difficult aspects of both continental and ocean scientific drilling, including a very remote location lacking infrastructure and very deep, ‘blue water’ drilling operations,” says Scholz. Drilling in the deepest site, which was 600 meters, required the construction of a dynamically positioned drilling vessel. The 26 members of the science and drilling teams lived and worked aboard a 160-foot converted fuel barge for six weeks while recovering the cores. Aboard the drilling barge, the teams lived in converted shipping containers, which were crammed in between the drilling rig and the large thruster engines that were required for stabilizing the vessel.
Professor Tom Johnson of the Large Lakes Observatory and Department of Geological Sciences at the University of Minnesota-Duluth, remarks, “A number of us in the African lakes research committee built the justification for a major drilling program on one of the East African great lakes for well over a decade, and finally made it happen in early 2005 with funds from the U.S. National Science Foundation and the International Continental Drilling Program. It is gratifying to see that our efforts are paying off with such spectacular early results.”
They've got the classrooms... Now what about teachers?
MINGA school has a new science laboratory but no Bunsen burners, a new library without books and classrooms with no chairs.
But none of that matters to the pupils who crowd into the basic brick buildings that serve as classrooms in the school just outside Lilongwe in Malawi simply for the chance to learn.
Together with Bottom Hospital, Minga secondary school was a pet project of Jack McConnell's when he visited Malawi in 2005. But like the hospital, there is still much to do. The children are still sitting on the floor and there are no computers, which is just as well since there is no electricity, either. For 200 pupils there are eight teachers, of whom only half are qualified.
On witnessing such conditions two years ago, Mr McConnell pledged to turn the school around, and he has made a good start. A gleaming new science laboratory and library have been built with £13,000 of Scottish Executive funding and both are now the envy of the district.
Both stand empty without the equipment needed to teach practical science or read books. New textbooks as well as radios, cameras, football boots and balls donated from Scotland were stolen and the school is waiting on various requests for laboratory equipment.
According to the Scottish government, three computers and 200 desks are coming. A delay with the contractors meant the new buildings had not been handed over to the school or had the electricity connected when The Scotsman visited at the end of last month, but both are said to be imminent.
Such delays are the reality of any building project. But for the eager school children, it is a little more difficult to understand.
John Phiri, 42, the headteacher, said he was going to soldier on and teach science in the new laboratory using sticks, stones and whatever else he can find.
"They [the government] are going at a slow pace," he said. "But we understand that. It is something to do with finances."
The science and maths teacher understood the original agreement included a fence around the school and equipment but had to be down-scaled because of costs.
However, he said the new buildings have boosted the number of pupils coming to school. Now he just needs qualified teachers and equipment in order to put them to use.
A request for equipment has been submitted to the government and is being considered.
Mr Phiri added: "It was very great for Mr McConnell to come to the school. We have heard he is coming here for good and that has increased our expectations."
Mr McConnell, the former first minister, has been recruited by the Clinton Hunter Development Initiative (CHDI) to work on education in Malawi.
As a former teacher, Mr McConnell was struck by the terrible conditions of schools including Minga when he first visited Malawi as first minister in 2005.
He said: "I visited a rural school where youngsters were being taught in a straw hut. If it rained there was no school because it came through the roof. There were no seats, no desks, no blackboard, no pens, no books. There was absolutely nothing.
"But the kids walked miles every day to memorise what the teachers were telling them. It was incredible. There was just such enthusiasm for education, even though it was so badly provided for."
Mr McConnell decided to use his position to help. "It was such a basic level of provision required to make a difference. I thought even a little place like Scotland, if we can pool our resources, our wit and our aid, we can do something to make a difference."
Two years later, Mr McConnell insists Scotland has made a difference, although changes in schools such as Minga will need to be viewed in the long term and need help from other agencies and Malawians themselves.
He said: "There is no point in providing teachers if there are no classrooms and no equipment and no point in providing classrooms and equipment if there are no teachers.
"It is a complex set of problems that needs to be carefully considered and [needs] comprehensive answers - not one-off initiatives; that raises expectations and lets people down."
Mr McConnell has always made clear that his commitment to Malawi is "lifelong" and he will need a lifetime to address some of the country's problems.
Malawi is still suffering from the decision to bring in universal primary education in 1994 without the teachers or buildings to accompany the policy.
The Department for International Development estimates the average pupil-to-teacher ratio is 84 to one, compared to around 15 to one in Scotland, and there are schools in rural areas where teachers look after up to 200 pupils at a time.
AIDS has made the situation worse. It is estimated that the virus kills 6 per cent of teachers every year and a high proportion of the education budget is going on funerals.
Then there is the issue of resources. For example, many teenage girls stop going to school because of a lack of toilet facilities, if they have not already dropped out.
The government has increased the number of teachers in training to try and address the 20,000 shortage but, in the meantime, the country is in need of more immediate help.
In his new role for CHDI, Mr McConnell is looking at education systems around the world for short-term solutions.
Classroom assistants modelled on Scotland's successful programme and distance e-learning used in the Highlands are all ideas being considered.
"It is going to take a generation or more for Malawi to realise real change," he said. "But I think for the first time for a long time, there is hope in Malawi and I hope Scotland has played a part in that and can do more in the years to come."
Mr McConnell said a key benefit of the link with Scotland will be personal connections like his own. He points out school links between Malawi and Scotland have gone from just ten to 100.
In Minga, the link with Sanday school in Orkney has meant pupils from both schools have been able to experience each other's countries. It has also meant that, for the first time in its 11-year history, pupils from Minga have been able to attend higher education with the help of funding from Scotland.
Another example is Global Exchange, a programme that sent Scots and Malawian youngsters aged from 19 to 26 to experience each other's everyday lives in volunteer work.
Mr McConnell said such schemes are changing the face of Scotland. "I think Scotland's involvement with Malawi has made Scotland a better place.
"Our engagement there will not only have helped the Malawians in years to come, but the next generation of Scots will be better global citizens as a result."
Life-swap gives new perspective
FOR Jennifer Nattan, going down to the borehole every day to fetch fresh water for cooking and cleaning will not only give her an improved posture but a realisation of how people in developing countries live.
The 19-year-old Scot has been living in an African homestead for the last three months.
The toilet is a pit latrine and the bathroom is a bucket in a thatched outhouse.
In Edinburgh, Jennifer lived in a four-bedroom house and had her own car. But watching the teenager play with the local children and carry water on her head, it is clear she is at home with her new family.
"Although we are rich in money, they are so much richer in family here," she said.
Miss Nattan is one of nine Scots living in rural Malawi and working in schools or community projects as part of the Global Exchange programme. The scheme, supported by the Scottish government, matches nine 18 to 26-year-olds from Scotland with nine young people from the same age group from Malawi. The 18 young people then live and work in each country for three months. Miss Nattan added: "Although it has been difficult, it has been brilliant."
Three months ago, in Caithness, the culture shock was reversed. Young Malawians experienced hot running water for the first time and learned about Scottish table manners. But they also saw the other side of living in Britain by volunteering in deprived communities.
Voluntary Services Overseas, the charity behind Global Exchange, says it is a move away from the "colonial" idea of sending young Brits to help the "Third World". Rather, young people come back with a balanced view of the challenges in both of their countries.
CULTURE SHOCK OF 200-STRONG CLASSES
CAROLINE Pitcairn's first sight of a Malawian classroom came as a shock. The 27-year-old teacher was not only surprised to find teachers taking classes of up to 200 pupils but noticed the children sitting on the floor were smaller than her pupils in West Lothian.
"The size of classes is the shocking thing, and the children not having a pencil but having to share," she says. "The children are lovely but some of them are much smaller than the kids back home. It is heart-breaking."
The tall redhead has caused quite a stir herself, turning up on a motorbike at the rural school she visits as part of her job as a teacher trainer with Voluntary Services Overseas. Her job is to help Malawian teacher trainers to train thousands of teachers in a new curriculum, moving away from "chalk and talk" to a more western idea of teaching children. She is also introducing innovative ideas on using local resources like bottle tops in under-resourced schools.
"It is moving away from teaching pupils just to write things down to learning things for themselves," she says.
But Ms Pitcairn will also have learned a lot herself to pass on to to her pupils when she returns home. "I will have better skills when I get home for getting ideas across, training others and teaching," she says.
But none of that matters to the pupils who crowd into the basic brick buildings that serve as classrooms in the school just outside Lilongwe in Malawi simply for the chance to learn.
Together with Bottom Hospital, Minga secondary school was a pet project of Jack McConnell's when he visited Malawi in 2005. But like the hospital, there is still much to do. The children are still sitting on the floor and there are no computers, which is just as well since there is no electricity, either. For 200 pupils there are eight teachers, of whom only half are qualified.
On witnessing such conditions two years ago, Mr McConnell pledged to turn the school around, and he has made a good start. A gleaming new science laboratory and library have been built with £13,000 of Scottish Executive funding and both are now the envy of the district.
Both stand empty without the equipment needed to teach practical science or read books. New textbooks as well as radios, cameras, football boots and balls donated from Scotland were stolen and the school is waiting on various requests for laboratory equipment.
According to the Scottish government, three computers and 200 desks are coming. A delay with the contractors meant the new buildings had not been handed over to the school or had the electricity connected when The Scotsman visited at the end of last month, but both are said to be imminent.
Such delays are the reality of any building project. But for the eager school children, it is a little more difficult to understand.
John Phiri, 42, the headteacher, said he was going to soldier on and teach science in the new laboratory using sticks, stones and whatever else he can find.
"They [the government] are going at a slow pace," he said. "But we understand that. It is something to do with finances."
The science and maths teacher understood the original agreement included a fence around the school and equipment but had to be down-scaled because of costs.
However, he said the new buildings have boosted the number of pupils coming to school. Now he just needs qualified teachers and equipment in order to put them to use.
A request for equipment has been submitted to the government and is being considered.
Mr Phiri added: "It was very great for Mr McConnell to come to the school. We have heard he is coming here for good and that has increased our expectations."
Mr McConnell, the former first minister, has been recruited by the Clinton Hunter Development Initiative (CHDI) to work on education in Malawi.
As a former teacher, Mr McConnell was struck by the terrible conditions of schools including Minga when he first visited Malawi as first minister in 2005.
He said: "I visited a rural school where youngsters were being taught in a straw hut. If it rained there was no school because it came through the roof. There were no seats, no desks, no blackboard, no pens, no books. There was absolutely nothing.
"But the kids walked miles every day to memorise what the teachers were telling them. It was incredible. There was just such enthusiasm for education, even though it was so badly provided for."
Mr McConnell decided to use his position to help. "It was such a basic level of provision required to make a difference. I thought even a little place like Scotland, if we can pool our resources, our wit and our aid, we can do something to make a difference."
Two years later, Mr McConnell insists Scotland has made a difference, although changes in schools such as Minga will need to be viewed in the long term and need help from other agencies and Malawians themselves.
He said: "There is no point in providing teachers if there are no classrooms and no equipment and no point in providing classrooms and equipment if there are no teachers.
"It is a complex set of problems that needs to be carefully considered and [needs] comprehensive answers - not one-off initiatives; that raises expectations and lets people down."
Mr McConnell has always made clear that his commitment to Malawi is "lifelong" and he will need a lifetime to address some of the country's problems.
Malawi is still suffering from the decision to bring in universal primary education in 1994 without the teachers or buildings to accompany the policy.
The Department for International Development estimates the average pupil-to-teacher ratio is 84 to one, compared to around 15 to one in Scotland, and there are schools in rural areas where teachers look after up to 200 pupils at a time.
AIDS has made the situation worse. It is estimated that the virus kills 6 per cent of teachers every year and a high proportion of the education budget is going on funerals.
Then there is the issue of resources. For example, many teenage girls stop going to school because of a lack of toilet facilities, if they have not already dropped out.
The government has increased the number of teachers in training to try and address the 20,000 shortage but, in the meantime, the country is in need of more immediate help.
In his new role for CHDI, Mr McConnell is looking at education systems around the world for short-term solutions.
Classroom assistants modelled on Scotland's successful programme and distance e-learning used in the Highlands are all ideas being considered.
"It is going to take a generation or more for Malawi to realise real change," he said. "But I think for the first time for a long time, there is hope in Malawi and I hope Scotland has played a part in that and can do more in the years to come."
Mr McConnell said a key benefit of the link with Scotland will be personal connections like his own. He points out school links between Malawi and Scotland have gone from just ten to 100.
In Minga, the link with Sanday school in Orkney has meant pupils from both schools have been able to experience each other's countries. It has also meant that, for the first time in its 11-year history, pupils from Minga have been able to attend higher education with the help of funding from Scotland.
Another example is Global Exchange, a programme that sent Scots and Malawian youngsters aged from 19 to 26 to experience each other's everyday lives in volunteer work.
Mr McConnell said such schemes are changing the face of Scotland. "I think Scotland's involvement with Malawi has made Scotland a better place.
"Our engagement there will not only have helped the Malawians in years to come, but the next generation of Scots will be better global citizens as a result."
Life-swap gives new perspective
FOR Jennifer Nattan, going down to the borehole every day to fetch fresh water for cooking and cleaning will not only give her an improved posture but a realisation of how people in developing countries live.
The 19-year-old Scot has been living in an African homestead for the last three months.
The toilet is a pit latrine and the bathroom is a bucket in a thatched outhouse.
In Edinburgh, Jennifer lived in a four-bedroom house and had her own car. But watching the teenager play with the local children and carry water on her head, it is clear she is at home with her new family.
"Although we are rich in money, they are so much richer in family here," she said.
Miss Nattan is one of nine Scots living in rural Malawi and working in schools or community projects as part of the Global Exchange programme. The scheme, supported by the Scottish government, matches nine 18 to 26-year-olds from Scotland with nine young people from the same age group from Malawi. The 18 young people then live and work in each country for three months. Miss Nattan added: "Although it has been difficult, it has been brilliant."
Three months ago, in Caithness, the culture shock was reversed. Young Malawians experienced hot running water for the first time and learned about Scottish table manners. But they also saw the other side of living in Britain by volunteering in deprived communities.
Voluntary Services Overseas, the charity behind Global Exchange, says it is a move away from the "colonial" idea of sending young Brits to help the "Third World". Rather, young people come back with a balanced view of the challenges in both of their countries.
CULTURE SHOCK OF 200-STRONG CLASSES
CAROLINE Pitcairn's first sight of a Malawian classroom came as a shock. The 27-year-old teacher was not only surprised to find teachers taking classes of up to 200 pupils but noticed the children sitting on the floor were smaller than her pupils in West Lothian.
"The size of classes is the shocking thing, and the children not having a pencil but having to share," she says. "The children are lovely but some of them are much smaller than the kids back home. It is heart-breaking."
The tall redhead has caused quite a stir herself, turning up on a motorbike at the rural school she visits as part of her job as a teacher trainer with Voluntary Services Overseas. Her job is to help Malawian teacher trainers to train thousands of teachers in a new curriculum, moving away from "chalk and talk" to a more western idea of teaching children. She is also introducing innovative ideas on using local resources like bottle tops in under-resourced schools.
"It is moving away from teaching pupils just to write things down to learning things for themselves," she says.
But Ms Pitcairn will also have learned a lot herself to pass on to to her pupils when she returns home. "I will have better skills when I get home for getting ideas across, training others and teaching," she says.
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