Peer Support

Last week was VSO peer support week. This four day event held twice annually is an opportunity for all the volunteers in country to get together and share experiences.

This was my first and I found it to be a very useful event. On a personal level it was a great opportunity to discuss the general ups and downs of Malawian life and share some war stories with other vols. On a professional level it was great to hear about some of the projects people had started within their placements and explore possible overlaps and opportunities for re-use in other areas.

Some of the interesting projects being implemented or designed were as follows;

• A role playing game to teach children and young adults about the dangers of HIV and the importance of practising safe sex
• Free Wi-Fi routers for nursing colleges (donated by a technology vendor) which will enable students and tutors to collaborate more effectively
• Introduction of a visual flowchart for nursing students so that they can quickly assess a patients care requirements based on their vital signs. For example, if blood pressure is over X you should do Y immediately. This would be something that every student could carry with them on the wards
• Do’s and Don’ts posters in HIV testing centres that remind both patient and tester what are important things to ask and inappropriate things to ask during counselling.  Many people are currently put off from getting HIV tests because of the embarrassment encountered at clinics

In our own project we decided to form a permanent user group that would meet regularly and feedback on how useful or otherwise the system was being. We’re very keen to move away from talking only to management at the ministry and get users on the ground much more involved in the development process. We also discussed ways of motivating and incentivising such users with things like off-site conferences or maybe even small giveaways  

All in all a very successful week, full pictures available here: http://flic.kr/s/aHsjMEpHXK

The Clinic

I suppose it was inevitable that I would get ill at some point during the year, I’m only grateful that it was after my family had gone back home and that it didn’t happen while I was on holiday.

On Monday last week I came down with a bug that saw me fixed to the toilet seat for much of the day. Remembering my training I drank masses of water tried to keep myself hydrated, however by about 4pm I had started to feel dizzy and was becoming feverish. Terrified it might be malaria I got Judy to drive me to the VSO approved clinic in Lilongwe which is far nicer than any of the general hospitals the country has.

Upon arrival the doctor took one look at me and before you could even say Malaria I was having blood taken out of one vein and sodium chloride pumped into another. I actually felt a million dollars as soon as they hooked me up to the IV drip as my main problem was really just de-hydration. The malaria test came back negative but my kidney function was impaired due to the lack of fluids so I had to stay in overnight on the drip for observation.

During my 24 hour stay they gave me a whopping eight bottles of antibiotics to get rid of whatever had caused the diarrhoea plus some Piriton to get rid of the side effects and a fever shot in my bum! To be honest I think they completely over medicated, partly because they’re terrified of having a VSO volunteer die on them and also (more cynically) because it means they can charge VSO for more drugs.

When they finally let me out I actually felt worse than when I went in because of the massive drug hangover I had, and just to make absolutely certain there wasn’t a single bacterium alive inside me they gave me yet another course of antibiotics to take home and carry on with.

Back at home I was so glad to be out of the hospital and “fixed” that I made myself a bowl of rich beef stew and cracked open a bottle of red. After dinner I popped one of the follow-up pills they’d given me and went straight to bed…

…Two hours later and I’m awake again, sweating, shaking and talking into the porcelain telephone!

The following morning, feeling like I’d been clubbing all night I read the leaflet that came with the pills they’d given me “Potentially Fatal: Disulfiram-like reaction when administered with alcohol” Great, they never mentioned that! I guess it’s not something that’s an issue for most Malawians!

Anyway, three days later and I’m finally back to sorts, it really has taken me longer to get over the treatment than it did to get over the illness.

I’ve decided not to take the rest of the antibiotics, I’m going to save them for next time and go and buy some ORS sachets for my first aid kit, that way I can hopefully avoid going back to the clinic

Visitors

Apologies it’s been such a long time since my last post. I’ve spent the last month travelling, first with Ron around the north of Malawi and then with my parents and sister in Zambia and the south of Malawi.

Ron's Visit

We spent a great two weeks touring around the north of Malawi, visiting several new places as well as showing off some others I’d been before. The trip did turn into something of a Top Gear special at times as we had the car battery fail on us at the start of the trip and then later on had a shock absorber fall off which we had to have hastily wielded back on by a local garage (only in Africa :-))

It was a great mix of Malawian safari and beach, camping and lodges. It was wonderful to see Ron again after almost four months of course and we both had an awesome time

Full pictures available here: http://flic.kr/s/aHsjKkTeGb

Family Visit

We’d booked a four day Zambian safari for the first week of my families visit in the South Luawangwa national park. This was my first opportunity to see some of the big game and cats that you don’t get in Malawi. We did a total of 4 game drives, two during the day and two at night, we were really lucky and saw some fairly uncommon sights; Lions with a kill, Lions mating (fairly disturbing photography) and a Leopard playing with her baby cub. To top it off most of the animals seemed to be with very new born young, presumably it makes sense to give birth just before the rains.

Some really great shots, full pictures available here: http://flic.kr/s/aHsjM7252k

After our Zambian safari I took my family on a tour of the south of Malawi. Again it was a mix of old and new for me, the highlight being Satemwa tea plantation in Thyolo; a little colonial but a wonderful and fascinating place to stay. We were in the old plantation managers house which came with two of our own domestic staff! Check out the colonial Dennis’s family portrait!

Full pictures available here: http://flic.kr/s/aHsjM6YEk9

Mulanje

For those of you that know me well you'll appreciate this is completely out of character but in a moment of pure madness I agreed to climb Mulanje two weeks ago, the highest mountain in central Africa, a whopping 3000m!

http://en.wikipedia.org/wiki/Mulanje_Massif

The five of us set off on Saturday morning after spending the night at the forestry lodge at the bottom of the mountain. It was a grueling 8 hour hike which I was totally un-prepared for. Chris, Briony and Jessica are all pretty fit and are in training for climbing Kilimanjaro, although I'm sure they could have easily been up in 6 hours flat they were very kind and waited patiently as Judy and I struggled up, offering kind words of encouragement which at times just made me want to hurt them :-)

All smiles at the beginning...

Less so several hours in

On Saturday afternoon we finally arrived at Chisepo hut atop the Mulanje plateau. The views were stunning but whether they were “worth it” was still unclear in my mind. It was much cooler on the plateau but the hut had a roaring log fire which we sat around and relaxed with a well deserved beer. Conversation turned to the porters who'd carried our bags up the mountain and how unbelievably fit they must be, we then started to wonder what the most offensive item would be that you could produce from your backpack at the top after they had carried it all the way; I think in the end we settled on a magnum of champagne complete with ice bucket and ice!

Our porters

On Sunday morning our guide Alex took the three sadists up to the top of Sapitwa (the highest peak) leaving Judy and I to lie in and feel sorry for ourselves. 5 hours later they returned and we all set off for another hut (roughly at the same height mercifully) where we'd spend our second night.

The second hut, Chembe was much nicer than the first and we had it all to ourselves which was great. Another log fire and more beer :-)

Monday morning we set off early down the mountain. It was incredibly steep and not for the faint hearted as some parts of the path came perilously close to the edge of large drops. I was much happier going down but although easier on the lungs it was certainly painful on the legs after a while

Finally at the bottom again we went for pizza in the local town, I have no idea how good or bad it was, I ate it in under 30 seconds!

Hard earned

Full pictures available here: http://flic.kr/s/aHsjJZiwHJ

The Pilot Begins

Well it's been a little over three months since I arrived in country now so thought it was high time I gave you all an update on how my project is going and what sort of impact we're having.

Despite a few road blocks and some difficulties in getting started the project is now progressing well. For the last three months we have been getting to grips with the iHRIS framework (see my previous post for detail on iHRIS) and feverishly customizing and developing it for Malawi's needs. We recently ran an initial user workshop where HR officers got to play with the system for the first time and give us some initial feedback on usability and reporting requirements. The workshop was a great success and generally the feedback was both positive and constructive. We're now about to begin our formal pilot phase during which we'll be rolling the system out to three sites in Lilongwe; KCH, (The main hospital in Lilongwe) Lilongwe district health office and the ministry of health headquarters.

During the pilot we'll be making regular visits to the three pilot sites to train and shadow system users as well as collect feedback and requirements that emerge. We plan to branch our code for the purposes of providing a stable production environment during the pilot while at the same time allowing larger scale development to continue on trunk.

The pilot is scheduled to run until Christmas with small incremental releases taking place as needed throughout. In the new year we'll be aiming to begin national roll-out with a more formalized training curriculum. Hopefully by the time I leave next June the system will be in use throughout all 34 of Malawi's district health offices

Challenges

One of the main challenges at the beginning of the project was stakeholder engagement. Unlike a traditional IT project where a client would approach a consultancy, here it is large aid donors such as USAID and WHO which have recommended and subsequently funded the iHRIS project. This has a huge impact on the working dynamic because although the Malawian government are keen to say yes and support anything that brings aid into the country they are also not sure of the benefits of such a system or what impact it might have on their working practices.

Although USAID are the primary donors for this project it is of course us (VSO) that are delivering it. This has added further complication because although both parties want the same outcome there are inherent challenges in cross-donor communication and agenda setting.

For quite a while it felt like we weren't getting much traction and that the project looked set to fail. In an attempt to prevent this we called a meeting with senior management at the ministry and representatives from VSO to discuss a way forward. It was agreed that the ministry should take a leading role in the project and own the delivery of the system. Since then things have been much improved; senior management have been much keener on status reports and we have managed to secure much more local resource time to help with the development.

The main hurdle that still stands in our way to successful delivery is by far and away infrastructure. Many of the district health offices do not have reliable Internet access and we're still unsure of where we can host our server.

We're currently in talks with USAID to provide 3G dongles to the district health offices for the purposes of accessing the system on-line which is great although there are concerns that they may go walk abouts if we're not careful.

For server hosting we're trying to secure some space in a data centre (which are exceptionally rare in Malawi.) The problem of hosting anywhere else such as in the ministry building is ensuring a continuous power supply and reliable air conditioning

So far a very interesting project with some unusual challenges. I will endeavor to provide another project update before Christmas when hopefully I can proclaim the pilot a success!

Liwonde National Park

Another safari weekend, this time in Liwonde National Park. Liwonde is in the southern region of Malawi and straddles both sides of the Shire river. It was the second time our VSO volunteer intake  had met up since in country training and it was really great to see everyone again.

The opportunity to go on game cruises along the river really sets Liwonde apart from other reserves in Malawi. The nine of us chartered a boat for a night and spent a wonderful 24 hours on the water, spotting elephants, crocs and a myriad of bird life.

I think the pictures do this trip way more justice than my words can so I'll leave it there. Below are a few of my favorite shots but be sure to check out the flickr link at the bottom for the complete, hi-res set.

Full pictures available here: http://flic.kr/s/aHsjHNdu1D

Senga Bay and Cape Maclear

My weekend travel schedule continues to be jam packed, I’m really trying to see as much of Malawi during my year as possible. For the last two weekends I’ve been to the lake which has been great R+R after my harrowing dentist appointment of the week before!

Senga bay is a peaceful cove with only a couple of tourist lodges and a thriving local fishing village. We stayed in a place called coolrunnings which is a great little backpacker lodge that puts something like 45% of its profits into local community projects.

Coolrunnings

Senga Bay Fishermen

The lake itself is crystal clear and stays shallow for a good fifty metres out. It was my first time swimming in a freshwater lake and I must say it’s heaps better than the ocean in a number of ways. Because it’s not salty you don’t feel grotty when you get out and because it’s a contained body of water it’s much warmer than the sea and much calmer.

The second weekend a slightly larger group of us went to Cape Maclear. The cove is similar to that in Senga but Cape Maclear is a little more touristy (as much as Malawi ever is) and has a few more lodges, some of which have late night discos.

The Lake Isn't Just for Fun

We hired a boat for the morning and went snorkelling around a small island just off the shore which was great, we saw lots of freshwater tropical fish and the visibility was excellent.

I can certainly see myself going to the lake as often as possible while I’m here, it’s a beautiful and relaxing place to spend a few days

Full pictures available here: http://flic.kr/s/aHsjHEZTwh