Thursday, March 10, 2016

But My Boots Don't Have Any Straps

I’ve been thinking more about the issue of classism lately. Especially as a visiting Westerner, it’s easy to overlook this here in Malawi. Anytime I go outside in a rural area, people stop what they’re doing so that they can pay close attention to what I’m doing. If I enter a room where someone is busy (cooking food, for example), they immediately stop what they’re doing, and in what I think is a mixture of both nervousness and ingrained customs of being overly-respectful towards guests of certain races, they make a big gesture of giving me a wide berth and greeting me. When constantly dealing with this hyper-attention, one has a tendency to be ignorant towards the happenings in their absence.

Over time, the novelty of the mzungu’s presence wears off, and the mzungu can observe the regular ebb and flow of things. One begins to understand certain things that aren’t discussed in the Lonely Planet guide, things that aren’t seen along the tarmac road on the way to a weekend at the lake, and things that aren’t discussed at big NGO meetings in the cities. Compared to most visitors to Malawi, I think it is safe to say that I have relatively good insight into the good, the bad, and the ugly here. Over the years I’ve discussed many of these insights (at times foolishly you’ll notice if you read some of the early posts) but this new topic has been on my mind more lately. I think it’s because during this two-month trip I’ve been spending more time around people of higher socioeconomic status (SES) and observing how they treat those of lower SES. While here as a Peace Corps Volunteer, I spent the majority of my time living and working alongside the most populous social class in Malawi, the rural poor. Analyzing something familiar from a new angle often leads to new realizations. One of my favorite authors, Paul Theroux once wrote: “In countries where all the crooked politicians wear pin-striped suits, the best people are bare-assed.” I now agree more with this generalization than I did four years ago. Let me explain why.

My point is not to say that classism composes the ugly part of this society disproportionately more than any place else. While that may actually be true (requiring a longer discussion then I have the energy for today), my point is to say that this problem of classism is frequently overlooked with respect to discussions on development, aid, social justice, and even in everyday life. This holds true for both foreigners like me and for Malawians. Unless you’re a dirty Peace Corps Volunteer, a bankrupt diamond trader, or a Chinese criminal, most foreigners here immediately fall into the category of bourgeoisie. Most of them (us) are either here for enjoyment, business, or some sort of adventure to save the world. With the cost of travel and such, it’s not really possible for foreigners of lower SES to end up here. Consequently, the foreigners that Malawians interact with are disproportionately well off, and Malawians then have a very skewed view the distribution of social classes in developed countries (also think about how this works in the other direction, eg. Americans’ misperceptions of Africans). Putting aside the fact that foreigners here further deepen the valleys between the social classes of Malawi, as I described a little in the beginning, most visitors to Malawi simply don’t have the desire or time to think about classism within the local population. The ladder allowing folks to climb to higher SES is much more slippery here in Malawi than the ladder many complain about in the US. There is no question that this is intentional. In a place where the supply for all resources continues to fall behind a rapidly growing population, those at the top keep a tight hold on their position. Read the Wikipedia article on “Structural Violence” for an overview of how this is done. There are some that manage to break free from these ridged social structures (see my post  “A Feel Good Story” from 2011--the story has only gotten better over the past few years), but for a long time here, the rich have been getting richer and the poor have been getting poorer. With this happening over generations now, and with criticisms to the situation either absent or silenced, I’ve seen that classism here is so ubiquitous that it’s easy to overlook and even easier to ignore.

Although this entire issue can’t be traced back to the legacy of colonialism, I think this has certainly been a big factor. Malawi is a former British colony. From what I’ve been able to gather, the two sides—the British and what are now called Malawians—had a fairly peaceful relationship. The British utilized the cheap local labor to get filthy rich farming things such as tea. Placated by small improvements in their quality of life (eg. from wearing loin cloths to a proper pair of trousers), the Malawians took decades to realize how thoroughly they were exploited. Nonetheless, during the time of British rule, it was made very clear who were the “haves” and who were the “have nots.” When Malawi gained its independence in the 1960s, there were suddenly many new “haves” from the local population. They were quick to adopt the power-concentrating and resource-hoarding practices of their former leaders. Over the years, these tendencies have become more prominent and acceptable in the society. As an American, I would be a big fat hypocrite to criticize any of this. I’m just spelling it out for you. Again, the presence of classism in a poor country like this is of no surprise. It’s the blatant ignoring of it that amazes me.

Here are some experiences that I have had pertaining to all this. I’m currently working on a sanitation project at a seminary school in Malawi. The priests have been gracious enough to host me while I’m around for a few days managing the purchases for the project and monitoring the progress. They’ve provided me with good local food, a nice place to sleep, and transport to and from the school, all free of charge. In this rural environment, compared to most of the population in the area these priests live a very comfortable lifestyle. Most religious leaders in the US, at least where I’m from in the Midwest, have relatively modest lifestyles. Although the circumstances are much different here in one of the top five poorest countries in the world, religious leaders in Malawi hold much higher social status—both in terms of respect given to them and relative lifestyle and comfort. All that being said, I’ve been closely observing how the priests interact with the ground labors and helpers at the school. There’s definitely a air of authority that the priests walk around with. They routinely scold our cook about the food he cooks. He either picks the wrong food to cook or he picks the right food but doesn’t cook it properly. There’s always something wrong. The other night I tried to suggest that it was silly for us to be so fussy about the food when our friends in the nearby villages were barely getting one meal per day. I didn’t hear any response to this.

At the hospital I was working for six weeks, there was an interesting dynamic between the healthcare providers (eg. doctors, nurses, and other mid-level providers) and the patients, who were mostly poor subsistence farmers from the nearby area. There’s a huge gap in the SES of the providers and patients at the hospital. This holds true at most healthcare facilities in the country, but I think the difference is especially striking at this hospital that is relatively well funded (and therefore able to hire better educated staff—who, it almost goes without saying, are of higher SES) but also serves a mostly rural population. Who am I to judge, but I did find the staff to be regularly condescending to the patients and their caregivers. Seeing the staff shouting at these people was not uncommon. When interviewing patients about the history of their illness, they would often falsely shorten the timeframe. When I enquired the reason behind this, I was told that it was because they’re scolded by staff for delaying to seek care. The patients therefore lie about how long they’ve been sick in order to avoid being yelled at. Someone even informed me that women in labor were often slapped and ridiculed by staff when they weren’t pushing hard enough. A visiting American doctor mentioned to me briefly that he believes this issue of pervasive classism is a largely overlooked issue in discussion about improving healthcare in developing countries like Malawi. It was this little discussion that actually got me thinking more and more about this topic and eventually writing all this. His concern is that higher status providers simply don’t care enough about their lower status patients. The unexpected death of a well to do nurse’s child is a tragedy, but the death of a poor farmer’s child is very common and not much cause for concern. The farmer should have done a better job raising the child anyway.

Growing up in sort of suburban America, I never really experienced having servants or workers. But here in Malawi, as a consequence of some of the history here that I’ve already described and also a huge amount of low-skilled labor, the “haves” often have multiple people working for them in their homes: cooks, gardeners, maids, nannies, guards, etc. Often these people are desperate and grateful for the work. The “haves” get by paying these people very low wages (it’s the market price, after all), and as masters of their domain, they can show their dominance over their staff by scolding, micromanaging, and complaining about them. From what I can tell from reading books and watching too much TV, I suppose this type of master-servant relationship is nothing new in the context of world history. Maybe it’s just ignorant, middle-class dudes from the Midwest like me who are surprised by it all.

I regularly listen to the BBC, and the other morning they had a program about the death of the middle class in developed countries (not to be confused with “developING" countries like Malawi). They mentioned that the main reason for this is that more and more jobs are being taken over by machines and computers. I don’t know how they measure this, but they also stated that for the first time in the history of the United States, this year less than half of the US population is in the “middle class.” To overgeneralize and oversimplify (which my English teachers in college would never allow me to do, but this is my blog and I don’t have to listen to them anymore), I think a strong middle class is a major solution to this issue of classism. As we continue to struggle with so many other “-ism’s” in the US, I wonder if the issue of classism will continue to grow in the Land of the Free.

Thursday, February 25, 2016

The Beginning of CorpsAfrica in Malawi

Last night I had the pleasure of attending the swearing in ceremony for the first cohort of CorpsAfrica Volunteers in Malawi.

You can find many more details at the organization's website (, but my one sentence summary is that it is like the US Peace Corps but they recruit volunteers from within the country (eg. Malawians serving as volunteers in Malawi) instead of Americans going to developing countries like I did in 2008. It's a one year commitment for these inspired young adults. It was started by a former Peace Corps Volunteer that served in Morocco. She naturally started the program in Morocco, and they are just starting to train their third cohort of volunteers. This year they have expanded to two additional countries, Malawi and Senegal. I was amazed to hear today that all of this, including these new activities in Malawi, are being funded by a  Moroccan mining company.

I had a lump in my throat throughout most of the ceremony. I'm very excited to see how these guys do over the next year.
Taking the oath

I had the opportunity to visit their training a few weeks ago and talk with some of them. It's very inspiring to hear about their dreams, and some of their life stories will give you goosebumps. The current director of operations here in Malawi, Adam Gaskins, started his Peace Corps service while I was about half way through mine. It's great to see this old friend leading this group and hopefully taking things to the next level over the next few years. One of the new volunteers is a woman I worked with a lot on a variety of projects when I was here before, and I'm very excited that she has this opportunity to advance her skills and career.

In my humble opinion, community-based, human-centered organizations like this are the antidote to inefficient, obese, authoritarian organizations like USAID and Save the Children (just to name a few).

12 new volunteers cramming a years worth of luggage onto this little
bus before they head to their new homes. 

Saturday, February 20, 2016


1. When I lived here before, it took me at least a year, and many bumps on my head, to habitually duck at every doorway. To generalize, Malawians are much shorter than people from places like the USA. Add poverty to that equation and you get tiny doors all over the place. I have the most difficulty with those just shorter than me and above my eyes. I can deal with the slowly progressing bald spot on the top of my head, but right now it’s got a few scabs and bumps on it too. But I’m getting better—only bumped my head once in the past few days. I’ll be ducking through doors for no reason when I get back to the States in a few weeks.

2. If you haven’t already, check out my GoFundMe project: It’s easier for me to direct you there rather writing about it twice. You could even donate money if you want!

3. [The section has been censored by someone with the new nickname Madame NoFun.]

4. Last week I climbed Nkhoma mountain, which looms over the town and hospital I’m working at. I took a wrong turn and ended up taking a little path the goats use to get to the top, but it was still awesome. This is sort of the view from the top.

5. When I was here before, I went through more than a few bottles of spirits. I’ve never seen AK-47 Vodka (below) until the other day. It’s the cheapest vodka around for good reason.

Tuesday, February 9, 2016

Tricky Parasites

This is almost too crazy to be true so I’m going to explain it as if it is a hypothetical situation. That way its just part of my imagination rather than reality pissing me off.

Imagine it is the height of malaria season in one of the poorest countries in the world. Most adults who have lived in the area get over this illness without much difficulty because they have built up good immunity after dealing with multiple infections throughout their lives. However, young children and pregnant women regularly die from this disease. These days there are a limited variety of available drugs to treat malaria. Because the country is so poor, with the average person completely unable to pay the market price for these medicines and with the government not even close to being able to generate enough revenue to supply the country’s health centers with an adequate supply of these medicines, it relies upon places like the United States to supply the malaria medications.

Over the past year and beyond, there have been more and more reports about healthcare workers in the country stealing these donated drugs from the hospitals they work at so that they can sell them on the black market for 100% profit. Albeit slowly, the United States has caught on to this nefarious behavior and has decided to crack down hard. All health centers must now record the basic information of each and every individual receiving these medications. This new record keeping is in addition to the typical records for individual patients and pharmacy inventory—both of which are notoriously inaccurate. A new list of those receiving the medicine and where each of them lives must be available so that the cranky Americans can come at anytime and crosscheck this list by going into the community and making sure those who reportedly received the drugs indeed received the drugs. If there are any discrepancies, the supply of these lifesaving medications will be cut off. It turns out that many health centers aren’t organized (or motivated or aware or whatever) enough to even do this new record keeping. There is an entire district that can’t produce these records, and they just lost their entire donated supply of malaria medications.

Adjacent to this district, there is a large mission hospital that has been able to relieve some of this devastation because it is relatively well organized. Although their staff is completely overwhelmed this time of year with spikes in admissions due to severe malaria, they have been keeping good enough records that the Americans haven’t cut off their supply of malaria medications (yet). The people in the district nearby without any medications flock to the mission hospital in search of care. This hospital was already overwhelmed to begin with, and this further influx of patients further stresses its capacity. Furthermore, the patients coming from the district without any medicine are traveling long distances to get there and often arrive after much delay so that their illness is very severe by the time they get to the hospital.

To add to this, there is a parallel story that demonstrates the mission hospital’s difficult predicament: for many years, they have had a service level agreement (SLA) with country’s government. With the SLA in place, they received enough funding to subsidize basically all patient costs at the hospital. The SLA also allowed them to spray insecticides in houses throughout their catchment area of 80,000 people on a yearly basis before each rainy (ie malaria) season. This insecticide spraying is a powerful public health intervention for preventing malaria in endemic areas. While the hospital was doing this spraying over the past few years, they have seen a large decrease in the number of admissions and deaths during the rainy season. (There is an interesting story of natural selection and how the mosquitoes have rapidly gaining resistance to these insecticide sprays, but we'll have to save that for another day.) Unfortunately, due to a variety of reasons (including government officials stealing almost all the money from the treasury while the former president was visiting the USA a few years back) leading to depletion of funding for the program, the country’s government had to break the SLA a few months ago. As a result, the impoverished patients now encounter a fee for service billing structure. Word spread quickly that everyone now has to pay when going to the hospital, and many (not just those traveling from form the neighboring district) are now delaying to go to the hospital until they become very sick. Hospital staff also think that more people are seeking help from traditional healers rather than going to the hospital. Not only do these traditional healers swindle the poor with hoax therapies, but many of these therapies are dangerous. Only a small fraction of the hospital’s catchment area was sprayed prior to the current rainy season, and this is thought to be another big factor in the recent increase in overall malaria cases, death rate, and total death count.

Last week, the medical director of the hospital went to the Ministry of Health to discuss the possibility of reimplementing the SLA. He was armed with lots of facts about how detrimental the dismantling of the SLA has been over the previous months. The meeting never took place because there was no one there to talk to. Just before this meeting was planned, over 60 officials in the Ministry were fired because they mishandled funds from the CDC.

At this point, healthcare in the country is in complete disarray. But it has more or less always been this way so there’s not really any general sense of urgency to improve things in a meaningful way.

Saturday, January 30, 2016

Don't Let Your Boy Grow Up to Be a Minibus Conductor

Riding a minibus in Malawi is always an adventure. Crammed in with people that haven’t bathed for a few days, goats and chickens at your feet, baby’s peeing on your shoes, it’s a unique experience. Someday I’ll quit being so stingy and move around more in taxis or rental cars or even my own car. In the meantime, I continue to amuse myself with this immersive cultural experience.
My foot falls asleep just looking at this picture
As in most businesses, the more customers you have, the more money you make. More passengers in a minibus means more money. The four main factors that limit the number of passengers in the bus are 1) tolerance of the passengers, 2) road laws, 3) the need for a driver and conductor in the bus, and to a lesser extent, space. Unfortunately, Malawians are generally used to, and accepting of, poor customer service (at least compared to my high, pompous standards). They’re used to getting crammed into a bus like sardines because this is the way it always has been. I’ve heard people complain from time to time, but these seeds of upheaval are quickly put down by a stern scolding from the conductor and driver. Like most laws in Malawi, those regulating the number of passengers in a vehicle are very loosely and erratically enforced. This is due to police officers being underequipped, understaffed, under-motivated, bribed, etc. Probably the most important reason for poor enforcement of road laws is that certain roads rarely have police on them, and on those roads the conductor and driver can pack people in excessively without any fear of consequences. Until the Google car or whatever gets to Malawi, there’s no way around needing a driver. However, the space the conductor takes up is very flexible. To make more room for passengers, the conductor can stand up hunched over (the roof of a minibus is about as high as that of a minivan). He can put his head, torso and arms out the window (I’ve heard of more than one conductor being decapitated here, it’s a dangerous job). I’ve been in buses full with one to many people allowed by law, and while approaching a roadblock with police officers, the driver told the conductor to get out, run up ahead, and we’d simply pick him up beyond the roadblock. Very sly.

Maybe I’ve been in America for too long, but a couple days ago something hilarious happened that I had never seen before. I was getting on the bus to the hospital I’m working at. The bus was filling up quickly. The driver and conductor were confident there wouldn’t be any police along the way so they packed us in. We started off with what seemed to me to be a completely full bus, with the conductor hanging out the window barely keeping his legs inside. I was surprised when we stopped to pick up another passenger about a kilometer down the road. Everyone in the bus groaned. Someone asked the conductor where the hell this new passenger was going to sit. The conductor told everyone not to worry. The passenger got in with the conductor pushing his butt in from behind and quickly slammed the door shut. The conductor was outside and I figured we would just leave him behind and the driver would pick him up later or something. The conductor then jumped up so that one of his feet got onto an open window and he pulled himself up on top of the bus! I started laughing, and then everyone was more amused by me, the big white guy on the bus, being amused by the situation then the situation itself. We all joked that this would be a Malawian-style bus ride and that this would never happen in the States. We then proceeded to Nkhoma with the conductor clinging onto the top of the bus. The road to the hospital is curvy through some low mountains. We could hear him struggling to brace himself up there around a few turns, but I had the impression he’d done this many times before and probably had pretty good core strength for this work requirement.

I’ve said it before: this place never stops amazing me. A friend once said that living in Malawi is like one big acid trip, but I’m going to refrain from confirming or denying that…