I'll Try to Limit the Sad Posts From Now On

So I’ve been in Malawi for two weeks now. This past week was my first of six weeks at Nkhoma Synod Hospital. One can find it on Google Maps. It’s about 50 km northeast from the Chadabwa/Mitundu area I was working in as a Peace Corps Volunteer. I have been and will be working mostly in the pediatric ward at the hospital. We’ve had 80+ patients each day, with a turnover of about 20% each day due to new admissions, discharges, and deaths. This is an absurd number of patients given that the staff is at most three nurses, two clinical officers (somewhat similar to a physician’s assistant in the States), one doctor for only half the day, and me and two other medical student who barely know what the hell were doing. This is the maximum staff we have. Usually, most of these people are either out in the parking lot talking with friends or hiding somewhere thinking about how tired they are. But that’s a rant I’ll go on a different day. Today, by briefly explaining three patients I worked with this past week, I want to give you a picture of how bad the situation is here, especially now as the rainàmosquitoesàmalaria ramps up.

I didn’t really take care of this first child because there was nothing to do by the time she got to the hospital. She was about one to two years old and suddenly developed malaria at home. The story I heard was that the family lives in a very rural area on the outskirts of the hospital catchment area. There’s a very basic health center near to there home, and when the parents took the child there, the staff quickly told them to go to our hospital because her illness was so severe. This is a distance of about 30 km over muddy, washed out, hilly roads. Unfortunately, the health center’s ambulance was broken. Then were told to get the child here on their own. This time of year, most families have miniscule cash reserves. The yearly cycle of cash flow from selling portions of one’s harvest reaches its nadir around this time, and basic things like arranging rapid transportation to the referral hospital become very difficult. The parents managed to scrounge up enough cash to hire a motorbike to bring them to the hospital. This was the only motorbike in the area, and apparently it had some problem so that it could only get up to a maximum speed of 10 km/hr. On the steeper hills it lost power, and the mother with child in hand had to get off and walk. About two thirds of the way to the hospital, the motorbike completely broke down, and the mother had to carry the child the rest of the way. By then, the child was seizing. By the time they reached the gates of the hospital, the child was dead.

There was another child, a cute cubby little 4-year-old boy, who I hadn’t seen until after he had been in the hospital for a few days. He also had malaria, and it was confirmed that the parasite had gotten into his brain (called cerebral malaria) on the second day of admission. Before I saw him, he was seizing on and off for a few days and combative at times when awake. The nurse had asked me to see him because he was acting strange after he seemed to have recovered the previous 24 hours. I went over to his bed and saw him sitting in his mother’s lap with her barely able to hold on to him as he was flailing around and biting her at times. He was laughing at the same time, and at first glance he just looked like your typical problematic toddler. I told the mother that he looked much better and full of energy! She gave an awkward laugh but then shook her head and briefly stated that he was acting very strange. I watched him for a bit and realized that his eyes were darting all over the place. He was calling out the names of people that weren’t there. He was swatting at flies that weren’t there. A couple of the other clinicians and I brainstormed what was wrong: HSV brain infection? Rabies? Psychotic episode? We couldn’t figure anything out that day and couldn’t really settle him down. The next morning one of the doctors saw him, and she immediately proposed the idea that he’d simply lost all his vision. I flashed my penlight over his eyes and he didn’t react at all. We ended up having the ophthalmologist come up and take a good look at the retina of each eye. He confirmed our suspicion. We concluded that he lost his vision due to the malaria infection in his brain. Given that he is young and his brain is still developing, there is a chance some of his vision will return, but most likely he will remain blind the rest of his life. I was choked up as I broke this news to the family.

The saddest story for last: The doctor and I were seeing a new patient. Again, this one had severe malaria (pretty much every patient we admitted in the last week had malaria +/- other stuff) and looked pretty bad. We were asking the mother about what was going on with the child, and I asked her weather anyone else in the family had been sick recently. She offhandedly said her husband died the day before. I’m fairly decent at Chichewa, but I often mishear things, especially when people use words/phrases with double meanings. I was surprised but what she said and thought maybe I was mishearing her so I called over the nurse to make sure we were all on the same page. We were understanding each other, and we quizzed her a bit more about the husbands death to see if might be related at all to the child’s illness (for example, did he have TB that he might have given the child?). It didn’t seem like he had any type of contagious disease so we moved on trying to figure out how we were going to treat this very sick child. Without going through all the details, I’ll skip ahead to the next morning. Most days, the majority of the medical providers at the hospital meet up at 7am for Morning Report. This entails discussion about what happened on each ward overnight and maybe a brief lecture on a certain topic from time to time. The clinical officer that was on the peds ward overnight described how this child had declined quickly and passed away a few hours prior. I can’t imagine how that women felt first loosing her husband and then loosing her last-born child the next day.

At least one baby/child has died in the ward every day I’ve been here. After living in Malawi for over three years and knowing how dysfunctional things can be here, this doesn’t surprise me at all. It only makes my angry.

The guesthouse I'm staying at, just up the hill from the hospital. I don't have any evidence yet, but I still think it's haunted.

Globalization of Butter

On my flight to Addis Ababa, I had the pleasure of spreading Land O Lakes butter (from the great state of Minnesota) on my bun.

On a different note: as part of my grand plan to make this 13 hour flight bearable and begin adjusting to the 7 hour time zone change, at the beginning of the flight I had three glasses of wine, 10 mg of melatonin, and 75 mg of Benadryl. That seemed to do the trick. I was feeling nice and sleepy, put my jacket over my head, and fell into a deep sleep. Later on, I woke up to the hustle and bustle of another meal getting doled out of the noisy cart being pushed down the aisle. At the beginning of the flight, I remembered them announcing that we would get breakfast shortly before our arrival in Addis towards the end of this flight. I woke up, pleased with myself for being able to sleep for the entire flight and up just in time for another complimentary meal from Ethiopian Airlines. I looked at the map of where we were at on the screen on the back of the seat in front of me. I had only slept for two hours! We still had 9 hours to go! As the lady in the seat next to me shifted and knocked my arm off the armrest, my frustration with the situation only made going back to sleep more difficult. At that time we were just getting a snack. With two toddlers frequently running up and down the aisle, stuck in a middle seat with barely enough room for my legs, and wide awake,  I had to wait many hours in my seat before our breakfast came and we soon arrived in Ethiopia.

Back To the Warm Heart of Africa

Yesterday, I arrived back in Malawi. I’ll be here for two months so I thought I’d resurrect this blog. I expect to be pretty busy so I can’t promise too much writing but I’ll do my best.

Some initial observations in the first 12 hours: Nothing’s really changed. People are still very friendly and excited to talk to an American whether they have ulterior motives or not. In a country of now over 16 million people (and rising quickly) everyone still seems to know everyone. The driver in my cab ride from the airport grew up in Mitundu, the community I used to work in. This was surprising because I ran into him in Blantyre (a couple hundred kilometers away from Mitundu), and he knew all the people I worked with. The same family is still running the country. When I left at the end of 2011, Bingu wa Mutharika was president. He passed a few months after that. Depending on who you ask, this was going to be a fresh change for the country. Well, glossing over a lot of the details, four years later his little brother is now in power, and the new boss is the same as the old boss. On sunny days during the rainy season, you can still see forever. Packs of skinny, dirty, adolescent boys in ragged clothes still roam the city streets begging for money, getting especially vocal towards foreigners. It’s still a big seen when I go jogging in the morning. This time of year the weather is still much better than the Upper Midwest.

I’m off to Chikwawa today. A year ago, devastating floods displaced many of the people living there and destroyed much of the local infrastructure. I’m interested to talk to people about the situation one year on. I don’t expect to hear much good news, but maybe I’ll be surprised. This place is full of surprises.

Final Thoughts

So I've kind of lost interest in this whole blogging thing, but I understand that a lot of you are still interested so here's one more for all of my fans out there:

I'm leaving Malawi this Tuesday, closing a chapter this in my life. I have grown a lot as a person during my three plus years here. I'm ready to move on to bigger and better things (hopefully), but I'm also sad to leave. Many people have been asking me over the past few weeks "What will you miss most about Malawi?" The answer is simple: my friends. I have built many strong relationships over the past few years, and I have to admit that saying "goodbye" to everyone hasn't been easy. My time here has been well spent, but I am spent, and I want to go home for a little while. I plan to come back someday, but I've got some business to take care of first.

To end things, here are a few words of wisdom:

In general, poor people are cooler than rich people.

The best way to charm a Malawian woman is to bring her pumpkins from your garden.

"Give me my money!" is not an effective begging strategy.

It's important to have a balanced diet. If most of your calories come from maize and overcooked greens, your wounds will heal slowly and become easily infected, you'll find yourself tired all of the time, and (if you're a growing boy) you'll be more likely to end up six feet under rather than six feet tall by the time you're 18.

Be wary of over-polite strangers; they probably want something from you.

When you teach a man to fish instead of giving him a fish, make sure that you teach his neighbors as well so they don't become jealous and jack his fishing pole.

Life is less complicated when you only have one brand of beer to choose from.

Life is more complicated when you had one too many beers and forgot to put on a condom.

Life is less complicated when you don't have to fill up your car with gas because you don't have a car.

Life is more complicated when you can't fill up your car with gas because of daily fuel shortages and mile long lines at the gas stations.

Life is less complicated when you fall off your bike and into the mud when you're almost home.

Life is more complicated when you fall off your bike and into the mud 20 kilometers from home while wearing your nice clothes.

Life is less complicated when you know that there isn't a chance in hell that a single drop of rain will fall between the months of May and October.

Life is more complicated when it pours rain for three days straight and there's mud everywhere.

Akon was cool the first 1000 times I heard him.

Michael Jackson will always be cool.

It's not fashionable for a grown man to wear children's snow pants as shorts in the middle of summer (or any time of year for that matter).

Washing your hands with soap isn't easy when you can't afford soap.

If you're too cheap to buy TP, then a suitable substitute is unclaimed exams from you're students. (I understand that this point is debatable)

It is much easier to read a magazine while on a toilet instead of while squatting over a hole in the ground.

It is much easier to squat over a hole in the ground rather than squating over a toilet with no seat.

If you're walking through the bus depot looking lost with three half-opened bags in your hands while talking on your IPhone, then you deserve to be robbed.

The best time for a misanthrope to go out in public is Sunday morning.

Having people's undivided attention is good when you have something to say but bad when you want to crawl into a hole.

A kid can't learn to read and write if he has to heard cows all day.

A kid can't learn to speak English if her teacher can't put a full sentence together.

It is not any fun to live in a place where it's necessary to have three guards and a ten-foot fence around your house.

If over half of your students are failing, then it's a lot easier to grade their exams if you have a good buzz going.

If over half of your students are failing even though you work your butt off and can objectively be considered at least an average teacher, then your students probably just aren't very smart.

If you don't understand what a democracy is, then you probably shouldn't try to institute one.

Finally, this place is really, really messed up...and that's why I like it so much.

Nkhuku yanjiru siiswa. Chewa Proverb

[Translation: A jealous chicken will not hatch chicks.]

A Feel Good Story

As a United States Peace Corps Volunteer you hear a lot about "sustainable development," "capacity building," and other fluffy terms like that. The reality is that, in the grand scheme of things, we really don't do a whole lot to "save the world." In a world of 7 billion people (and counting) there are only a few thousand Peace Corps Volunteers, and the work that we do is a drop in the ocean. However, it's not healthy to think about this too much.

It's better to focus on the little things, the small victories. For example: There's a young man named Moses that has been living with me for almost three years now. We've both benefited a lot from being around each other, and we have something like a big brother-little brother relationship. Moses had a rough upbringing, an upbringing that is representative of many children in Malawi. His father ditched the family when he was a young boy. Life is hard enough here for a family living in a rural area, headed by both a mother and father. These problems are only magnified for a single mother. Moses' mother struggled (and is still struggling) to raise a big family on her own.

In Malawi primary school is free, but like most things in life, you get what you pay for (especially when you don't have very many taxpayers to take care of that "free" primary school system). This means that most children here, as did Moses, go to a primary school that functions more like circus. Limited resources, understaffing, lazy teachers, and general apathy...it's astonishing to see how dysfunctional these schools are. Anyways, this is where Moses' education started.

Later in his primary school years, money became especially tight. It was decided that he should go and live with his father. By now the father was a well off with lots of farmland, a few vehicles, and a decent house. It looked like Moses would be able to finish his childhood happily ever after, reunited with his father. However, things didn't work out that way. Moses' stepmother didn't like him too much. At meals this stepchild of hers was given food last. When there was work to do around the house or in the field the biological children were allowed to play while the stepchild was breaking his back. This went on for a few months until the stepchild had enough and went back home to live with his mother where life was hard but at least he would be treated like a human being.

But money was still a problem. It was decided that Moses should find a job, even though he was still a few years away from finishing primary school, so he could support the family a little bit. He was sent off to help a guy raise his cattle. Moses' job basically entailed herding a bunch cows around all day under the hot sun while his friends went to school. He did this for about a year, and consequently missed a year of school.

He eventually went back to school. In Malawi, at the end of primary school every student writes a national exam that is used to select the students to different tiers of secondary school. The best of the best go to national schools. The next tier of students go to government schools. The lowest tier is selected to Community Day Secondary Schools. However, in reality at least half of the students that take the primary school national exam don't end up going to secondary school because they either can't afford it or they weren't selected. By the end of primary school, Moses was a promising student, and it was a surprise that he wasn't selected to any secondary school at all. Somehow he slipped through one of the many metaphorical cracks in the Malawian education system.

He wasn't going to give up that easily. A friend of a friend was able to find him a place at a nearby Community Day Secondary School, Chadabwa CDSS. These bottom tier schools don't have a lot regulation, and it is often possible to attend one of them even if you weren't selected there so long as you're able to pay school fees and fatten the administration's pockets. But as I already said: you get what you pay for. These schools are relatively cheap and therefore provide relatively poor education and produce relatively poor results (I'm saying "relatively" here because every level of education in Malawi, from nursery school up to university, is pretty shameful, but these CDSSs are the bottom of the barrel). Most "graduates" of these CDSSs have dreams of going to university, becoming a doctor or a nurse or an accountant, and never going back to the village again, but the reality is that most of them end up living the same life their parents have: doing backbreaking labor on a daily basis and struggling to get by. This is all very depressing when you think about it too much so let's fast forward so we can get to the good part of the story.

Moses had four years ahead of him at secondary school, and he quickly made it clear that he wasn't going to be just another village kid with no future. While his friends were out dicking around like typical teenagers, he was usually found with is nose in a book or asking thought provoking questions that were over the heads of his under qualified teachers. He was consistently at the top of his class, head and shoulders above his peers. These peers started to become jealous. They started spreading rumors that Moses was doing so well on exams because he was using witchcraft (yes, this sounds completely ridiculous to those of us that come from the developed world, but here in Malawi witchcraft is perceived to be very real, and accusations are thrown around all the time...but I won't go off on that rant right now). Moses was advised by his head teacher to ignore the crap he was getting from his classmates and keep focusing on his studies. That is exactly what he did, but it wasn't easy. Money was still a problem, and it looked like he already reached the glass ceiling created by the rural, dysfunctional secondary school he was attending.

Moses had dreams of attending the University of Malawi, but this seemed very unlikely. In a country of over 14 million people, the university system here only takes in about 2,500 first year students each year. Even those students at top tier secondary schools have a difficult time gaining admission to university, and most students from the bottom tier CDSSs don't stand a chance. Nevertheless, he took the national exams after completing secondary school last year, and the results were off the charts (for a student from a CDSS). It appeared that he would have no problem getting into university with these results.

But there was one other important hoop to jump through. The University of Malawi uses two main criteria when selecting first year students: first, there is the previously mentioned national exam which pretty much every student takes upon completing secondary school, and then students that do well enough on these national exams have the opportunity to take the university's entrance exams. He took the entrance exams back in April (around the same time I was taking the MCAT-as you can imagine, the house was full of nervous energy), and then he waited...for a long time.

For those of you that don't know, the government has been screwing around with the university for most of this year. Earlier in the year, there was a dispute between some of the lecturers and the police/government concerning academic freedom, government spies in the classrooms, etc. I won't go into all of the details here (you should be able to find plenty of information about this on the internet), but the main result of this was that the various braches of the university haven't been doing much for most of this year. This also meant that selection for the first year students was delayed... but that all changed on Saturday night when the selection finally came out. Late in the evening, the two of us were sitting anxiously next to the radio, listening to the local radio station that always has breaking new like this: "Now the selection for Bunda College of Agriculture, Bachelor of Science in Agriculture Education...Moses Samalani, Chadabwa Community..." This was a moment that I'll never forget, and take it from me, this couldn't have happened to a better person.

Unfortunately, stories like this are few and far between, but let's not focus on the negative. What we have here is a young man who had an impossible dream. With the odds against him, he worked his ass off, and he will soon start living that dream. (all of this may sound cheesy, but it's true!--it gives me a warm, fuzzy feeling inside)

"Here's a message to the newborns, waitin' to breathe
If you believe then you can achieve
Just look at me
Against all odds, though life is hard we carry on
Livin' in the projects, broke with no lights on
To all the seeds that follow me
protect your essence
Born with less, but you still precious..." Tupac Shakur

Top Ten Most Commonly Asked Questions of Bryan in Malawi

One of the three goals of Peace Corps is "to help promote a better understanding of the American people on the part of the peoples served" so although these questions make me laugh to myself, I can consider it work (volunteer work that is) when I am answering them.

10. Are there any poor people in your country?

This question, along with many of the following, is greatly influenced by the mass media from the US that many people here are exposed to. Mass media from the States that makes it all the way to Malawi is typically outdated and tends to focus on the themes of presidential politics, celebrity gossip, and bad pop music. You may be saying to yourself, "That's not much different than the mass media Americans themselves are exposed to." While that may be true, keep in mind that that is almost the only exposure to American culture they have. This is especially true in rural areas where it seems as you go further off the beaten path Dolly Parton's popularity seems to increase exponentially. Most Malawians (perhaps I should generalize here and say "most people from developing countries") don't know about American Indian reservations, homeless shelters, and urban poverty. However, with that being said, I must also admit that there is really no comparison between the poverty in the States and the day-to-day struggle most Malawians have to deal with.

9. Are you married?

In Malawi if you're not married by your mid-twenties you're probably either a social outcast or someone that's well off enough not to have to worry about the backward, outdated social customs that we have here. Most people, again especially those in rural areas, especially girls, are in a hurry to get married well before they turn 20. I don't want to go off on a rant here about early marriage and all that, but let's just say that there is an ocean between the marriage customs in America and Malawi. I'm in my mid-twenties, and some might say that I look a bit older because of my red goatee and mature demeanor (LOL). It follows that many people here can't wrap their heads around the fact that I'm a (fairly) normal young man with no wife. I typically receive advice that I need to marry here and buy lots of farmland. As tempting as that may seem, I think I need to move on with my life, outside of Malawi (January's right around the corner!).

8. When you go back home to America will you take me with you?

I usually answer yes (if I have the time and energy to bs), and then go on to tell them they're more than welcome to come along with me when I go home if they can find a passport and enough money for a plane ticket. Someone once proposed that I could smuggle them in my suitcase, and this may also be a viable option.

7. Do you know (insert name of some obscure preacher from the West that "evangelizes" in Malawi)?

My answer is usually just "no" followed by the silent treatment, but sometimes I want to go off on a rant about how out of whack with reality some of this stuff is. People here go crazy over religion! I won't make any moral judgments and say whether or not this is good for this already ultra-superstitious and logic-lite society, but I must say that I have a hard time sharing everyone's enthusiasm for "Ambuye!!!" I don't want to beat this topic to death, but here are three quick points about why religion in Malawi, in particular the denominations which act like the super zealous cousins of the Southern Baptism we have in the States, don't jive with the way I see the world: 1) If the church doesn't have enough chairs/benches, then all the "Christian" men are provided with a decent place to sit before almost any women are. 2) Night Prayers. "I know what we can do for fun this weekend! Let's spend all of our hard-earned (yet still sparse) cash on a huge stereo system so we can stay up all night yelling at Jesus with our gospel music blaring and the entire neighborhood unable to sleep!" Praise the Lord for giving me the wisdom to buy a decent set of earplugs a few months ago. 3) Speaking is Tongues. I'd only seen glimpses of this on TV back in the States, but I encounter this all the time here. I don't really see how regularly and frequently yelling nonsense fits into the values Jesus taught of compassion and thoughtfulness. In a place where witchcraft is so taboo and feared I find it ironic that this type of "prayer" is so popular.

6. Who taught you to speak Chichewa?

I'm asked this as if I have had one teacher that I meet with every day, but that hasn't been the case. After three years here, I'm fairly competent with this language. I've found that the best way (at least for me) to learn a new language is to constantly put myself out there, talking with people, making mistakes, and then learning from the mistakes. I'm laughed at on a daily basis (think about how foreigners trying to learn English are treated in the States by the general public-the same kind of thing happens here), and it would have been a lot easier to not put any effort towards learning this language that is of little use beyond Malawi's boarders and that I'll completely forget a few years from now.

5. How have you seen Malawi? (Translated to normal English: What do you think of Malawi?)

This very open-ended question always seems to be asked to me when I have a lot to say, can't think of where to start, and have little patience to talk with anyone. I usually explain that "Malawi is a good place with good people, but there is lot's of poverty here." This very simple and obvious answer is usually replied by an agreeable sigh and contentment. We can then move onto a more interesting topic of conversation like "When will the rains start this year?" Most people here (in general and relatively speaking), are very welcoming to outsiders. They're also very self conscious and curious people. They want to know about the outside world, but they are also interested to hear about how the outside world views them. This is something we don't really do in the States. We may be fairly up to speed with what's going on beyond our boarders, but we also kind of do our own thing and don't give a rip about how our actions affect peoples' perception (be it positive or negative) of our country.

4. What is the staple food in your country?

Malawians take pride in the fact that their staple food is maize, and they seem to think that every county has one particular food that they depend on for most of their calories. Obviously, this isn't the case in the States-which makes this question difficult to answer directly. I usually tell people that 1) The United States is a very big country with many different climates and therefore many different crops being cultivated and 2) We have many different cultures mixed together that have brought many different foods to the melting pot that is the United States. I enjoy telling people about the fact that there are people from all over the world in the US. At least during the past century, this has been one of our biggest strengths: diversity and a certain amount of tolerance for it.

3. What is your favorite food?

It would be easy and honest to say that my favorite food is pizza (with a cold beer...Oh my God that sounds good...I can't wait until January), but most people here wouldn't really understand what I'm talking about. So instead I usually tell people that my favorite food is nsima with roasted fish and pumpkin leaves with groundnut flour. But this is only halfway true because that meal is my favorite Malawian foods, but certainly it does not even come close to my favorite food which would most definitely be pizza, as I mentioned earlier. To be honest, Malawian food sucks. It's very plain and uninteresting. It must be the British influence. Did I mention that I can't wait to get home and eat good pizza? Mmmmm, a cheeseburger will be good as well.

2. Is it true that in the United States students only learn one subject?

People here tend to think (for whatever reason) that from high school onwards, American students specialize in one area only (eg. Mathematics). I can see that some of the confusion might come from the idea of having a "major" in college, but I really have no idea where this huge misconception comes from. My answer is: "No, that is completely ridiculous."

1. Can you give me some money?

I've beat the topic of begging and how much it annoys me to death many other times on this blog. Please refer to those previous posts for elaboration.

All of these questions are asked in complete innocence (even #1 most of the time), and although I don't feel like I'm changing the world when I respond to them, it does give me a warm fuzzy feeling inside when I ghetto stomp ignorance and replace it with truth. But some of these questions are really dumb, aren't they??? I look forward to American and its sanity (or maybe its insanity that I can relate to). Until then, wish me luck in keeping my own sanity in over the next three months.

"You can't connect the dots looking forward you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something: your gut, destiny, life, karma, whatever. Because believing that the dots will connect down the road will give you the confidence to follow you heart, even when it leads you off the well-worn path." Steve Jobs

Tiyeni Tigonjetse Edzi!

So as you may or may not know, HIV is a pretty big problem in Malawi. The national prevalence is around 12%, but it does appear to be declining or at least stable. In general, HIV is more common in urban areas and less common in rural areas (17.1% vs. 10.8%). In Mitundu, the semi-urban slum where I live and work, where hookers and beer have a firm grip on the local economy and in my year here I have seen multiple people pass away because "he/she was positive," the HIV/AIDS epidemic affects the entire population either directly or indirectly.Obviously, this disease is difficult to manage at both the individual and population level, but the general consensus is that the first step to making any progress is having a clear picture of who is infected and who isn't. Once this is known (to a certain extent) a few different things happen (in theory): 1) Those who are found to be negative are encouraged to stay that way by practicing the human virtues of monogamy, putting on a condom, using clean needles when shooting up, etc. 2) Those who are found to be positive can start anti-retroviral treatment (if necessary) that usually improves both the length and quality of life of individuals with full-blown AIDS. 3) Those who are found to be positive can be advised about how to prevent transmitting the virus to their sexual partners and newborns.

Over the past year or so I've been learning a lot about what is being done to prevent mother to child transmission (PMTCT) of HIV during birth and through breastfeeding. In short, the pregnant mother is mandatorily tested for HIV on her first visit to the clinic. If she is positive, then she is put on antiretroviral treatment during her pregnancy. The newborn infant may also go on ARVs for a few months. With this PMTCT strategy, HIV positive mothers are only transmitting the virus to their newborn infants about 1.5% of the time compared to around 25% of childbirths with mothers not receiving any of this treatment. There's some evidence that ARVs also prevent transmission via breastfeeding as well, but the party line at the hospital is still "if you're HIV positive you will have to give your infant formula rather than breastfeeding them." Without any treatment breastfeeding, HIV positive mothers transmit the virus to their infants about 20% of the time in the two months postpartum. With this, it seems like the best way for a positive mother to keep her baby safe is to avoid sharing any bodily fluids other than a kiss on the cheek every now and then. In a place like the United States, this plan of action is pretty straightforward: mom goes to store to buy formula which is affordable (or at least the government makes it relatively affordable), infant drinks formula mixed with nice clean tap water instead of breast milk, and mom doesn't really worry about what her infant is missing by not breastfeeding (such as passing on antibodies that strengthen the infant's immune system) because most of her friends don't do it so why should she. But in a place like Malawi, where most people sleep on the floor every night and a lot of people struggle to buy a few ounces of salt to spice up their typical dinner of maize porridge and boiled greens, things don't usually work straightforwardly. One, how's momma gonna buy formula for 3$ when she's only got 50 cents to feed a family of six and daddy's out having a good old time at the bar spending his monthly salary on hookers and beer? Two, do you expect an infant to do alright drinking well-water (the only option in most areas) mixed with formula when the adults that drink that same water are frequently infected with waterborne diseases like cholera? Three, momma's antibodies help the baby and momma a lot when a trip to the hospital is a 15-mile walk and momma's got no shoes. What's my point? I don't really know so let's get back to talking about the stopping the spread of HIV by knowing your status.

Last month my coworkers at Mitundu Youth Organization and I put on a two day football tournament (you're gonna have to remember that in most of the world "football" is what Americans call "soccer"). This wasn't your garden variety football tournament with parents yelling at each other, coaches bribing referees, and teenage boys falling to their knees and crying on the pitch after missing a penalty kick (wait...actually that did happen). Instead this was the "MYO VCT Football Trophy." MYO stands for Mitundu Youth Organization (with yours truly as the "programs advisor"), VCT stands for voluntary testing and counseling for HIV, football stands for soccer (some just say "mpira," but that's an inside joke), and trophy stands for tournament (which is ironic because there was no trophy given out and nobody expected to receive one). We did this with help (mostly in the form of prizes and money for workers' allowances) from Peace Corps, UNICEF, and a certain NGO called Grassroots Soccer. The idea behind all of this was that the football games, which turned out to be exciting and competitive with the local teams that participated, would attract lot's of people, and those people would then be exposed to the various HIV-prevention activities that we had going on at the same time as the tournament. These activities included an essay competition, condom demonstrations, dramas, testimonies by HIV-positive individuals, and most importantly, VCT services.

VCT entails first going through pre-test counseling. This is usually about a ten-minute pep talk about preventing HIV infection and asking the client a bunch of times, "Are you suuuuuure you want to be tested?" Once these preliminaries are out of the way, there's a little finger prick, and the client's blood is put onto a test kit. The test kit qualitatively tests for antibodies to HIV that may be in the blood. They call it a "rapid" test, but I suppose they mean "rapid" from an African perspective because it still takes about 15 minutes. The client is asked to wait outside during this time, and they are given every opportunity to run away with their tail between their legs and not hear their results. Most people, however, stick around for the post-test counseling which involves first asking the client once more, "Are you suuuuuure you want to know your results?," then the dramatic unveiling of the results, further counseling tailored to positive or negative individuals, a shoulder to cry on if necessary, and referral to the hospital for treatment if necessary. Knowing your status is important for the reasons that I stated above. I like to believe the counseling that is provided is also somewhat effective, but who really knows? It can't hurt.

At our local hospital here in Mitundu, people have a hard time accessing the VCT services because the counselors that run the show have a habit of showing up to work an hour or two late, then not doing a whole lot of work, then taking an extended lunch break, then maybe coming back in the afternoon to fart around for a little bit, and then going home an hour or two early. But who can blame these guys for being lazy when the government almost always gives them their paltry monthly salaries late and some months doesn't pay them for stretches lasting well over two months? I'd take a long lunch break too. So with this marvelous system in place they manage to provide VCT services to about 500 people per month at Mitundu Community Hospital. I am proud to say that we had 385 people test during our two-day event. It's amazing how much harder people work when you put a fair amount of money (straight cash homey!) in their hand at the end of a hard days work (the "fair amount" that our counselors were given was about 15$ for a full day of work--yes, labor is cheap in Malawi, but the Indians and Chinese are already all over that). Interestingly, only 8 of our clients (2%) tested positive. I talked to the counselors about this surprisingly low number (remember that the national prevalence is hovering around 12% and is probably at least a few points higher here in Mitundu where most people don't take the Seventh Commandment very seriously), and they told me that that is typical these days. It seems that the reason for this is twofold: First, a lot of people already know their status, and if they already know that they are positive, then they aren't going to go through the embarrassment of testing again even when there are prizes involved (There were actually a handful of people that did go through with the VCT even though they've had AIDS and they've been on ARVs for years. They just wanted one of the t-shirts that we were giving out to the first handful of people that tested. We quickly put an end to this-it's a waste of resources, especially when one test kit costs about 10$.). Second, there just aren't as many new infections these days (this is good news!).

Besides the constant begging for t-shirts (see previous posts for my description of the begging culture in Malawi and how it drives me up the wall), this whole event was a success and we had a good time. There weren't any big disagreements on the football pitch (except for one, but it only lasted 15 minutes so I won't count it). No accusations of bribing referees (I wasn't surprised to hear that this is common here. The referees routinely get their asses whopped at the end of matches for taking bribes, but apparently it's worth the 500 extra kwacha (~3$) because the same referees get into trouble regularly and take the beating over and over again.I'm not sure how much money I would need to get beat to a pulp.). There were no streakers (I'd do probably do that for 100$-that's like two week's salary!). I'm just trying not to think about how much of the prize money that we handed out was spent on hookers and beer. That kind of behavior doesn't really jive with the whole philosophy of the event we put on.

The essay competition winners (I bet you can't find me!):

A drama about how HIV will ruin your life:

And the Champs, Chimwala Football Club:

"So when they continued asking him, he lifted up himself, and said to them, He that is without sin among you, let him first cast a stone at her." John 8:7