Tricycles and Wheelchairs Update 1

There we have it! It’s less than 2 months since the appeal for donations went up on here and already we have 2 tricycles doing good service around the streets of Ntcheu. Two people have had a life sentence of confinement and dependence removed thanks to this latest agent of empowerment. Their stories are remarkable and I give you a small close up of each one here. But before I do that, I should like to thank everyone at home for all their generous contributions. Without these, none of these patients would have had this unique chance to see their lives so suddenly imbued with hope again.

Case1: GC is a 60 year old man who grew up with a congenital condition causing all his limbs to be short and disproportionate. Over the years he developed contractures of both his legs, resulting in impaired mobility. How that deteriorated after he had the fall that led him to come into hospital under my care! He broke his femur and despite it healing in the end, his mobility and especially his confidence suffered a blow. His job as a goat seller at the market took a turn for the worse as a result and he himself came up to me to plead for help towards a mobility aid. Any difficulties I was having in selecting suitable candidates for the project were at once solved and I referred him to the rehabilitation technician of our hospital to be measured. I promptly delivered these to the office in Blantyre and within a month the tricycle was ready. I was already a Blantyre resident by then but I hadn’t lost all my links with Ntcheu. So I called the hospital transport manager to ask if there was any vehicle going from Blantyre to Ntcheu soon. By some stroke of fate, the same truck that delivered Janet and I into Blantyre with all our boxes, was back on another errand that same day. Since I had 2 tricycles to deliver together, again all my worries about uniting the patients with their long awaited tricycles were solved. A week later, I went to hand them over to GC (and BK, presented below). Not without some ceremony which is customary and expected with this kind of thing, the handover was done with the blessings of the DMO, DHO and administrator of Ntcheu DH. As GC wheeled off in his new transporter, you could sense that a whole new chapter had opened up in his life. One where he would regain some of that lost independence and resume remunerated work. Nothing more than that serene smile of gratitude on his face could convey it better...
Before
After
That Smile!
With DHO
With DMO

Case2: BK was a victim in so many ways. Born also with a slight abnormality affecting his physiognomy and leading to premature cataracts, he became the target of mockery and abuse from other people. Aged only 18, he was thus assaulted in Blantyre while I was still in Ntcheu and suffered panga knife cuts all over his lower limbs. These went through many of his tendons and nerves and healed very poorly. He was eventually referred over to his home district of Ntcheu from Blantyre to have rehabilitation. His legs had become almost completely dysfunctional by then, being complicated by infection and neurological deficits. With all his life ahead of him, consigning him to a fate of lifelong dependence and immobility seemed incredibly unfair. Thankfully his hands were spared. So, once the project got set up, I had no doubts who would be one of the first beneficiaries and I made sure I got all his contact details. He got measured in the same way as GC and had his bike made in the same batch. This was delivered to him 2 days after GC got his under the auspice of the entire orthopaedic department this time in the Ntcheu DH courtyard. His brother accompanied him and the new pride of being able to live a dignified life was the greatest gift of thanks anyone would want in return of this gift of mobility and independence to BK.
Before
After
With our amazing orthopaedic team

Check out the first donations on youtube to see the difference you can/have made to these patients’ lives:
http://www.youtube.com/watch?v=YOmHayuJbzk
http://www.youtube.com/watch?v=dfLLSDorkLo

About the project:
The bikes do take a little while to get used to. So the patients have to be reviewed by the rehab tech at first to make sure they are using it properly and safely. That is why the Ntcheu project works so well, as we have our own resident rehab tech there, Mr Mittawa. He has been extremely useful in getting the project set up and will remain as a link person there for future patient selection and work up. The bikes also will need some maintenance over their lifetime and they are made so that the cost of this repair is down to a minimum, using the same parts as the cheapest bikes around. If well maintained, they should last a good 20 years or more. The best thing about this project is that it employs Malawians to build the bikes locally and also supports the organisation which runs the workshops, called Malawi Against Physical Disability. This organisation is really transparent and has enormous potential to come to help to disabled people across the land. The only thing limiting them is lack of funds. By receiving more orders for their workshops, they are able to assist more disabled Malawians, who would otherwise just have to live with their disabilities. So far we have 2 tricycles. There are 2 more orders underway. And depending on how much more money I raise, we’ll have even more people being given this unique chance of some life changing improvement.

The mean machines!

Being shipped to home county- Ntcheu

Please keep your contributions coming. All you need to do is email me on ashtindoorgakant@yahoo.co.uk for details of my bank account (maybe paypal soon).

Early days in Blantyre

3 years ago, when I left Blantyre after 3 weeks at CURE hospital to go back to London, I was overwhelmed by the great sense of human coldness and general sterility I experienced upon arrival. I was longing for more of that great human warmth and colourfulness characteristic of the Malawians I’d met in Blantyre. This, by all accounts, is mostly the same to date. But to get an idea of how much more so it must have been in Ntcheu, consider the fact that upon landing in Blantyre for the first time as one of its residents, as opposed to a mere passer-by, I felt almost as I did when I left Blantyre for London. I suddenly felt immersed in a big cold city full of superiority-complexed people, dodgy dealers, excessive security and smoke. Of course, all that is relative, since when compared to your Mayfair and Brixton quarters of London, Blantyre, despite all its superciliousness relative to Ntcheu, would still represent a saintly opposite! And of course, the initial feeling of antipathy towards it gradually softens as I start to discover that the city is nevertheless diverse and that I still have the choice to make my lifestyle not so different from what it was in Ntcheu. Every big city has this corruptive potential, some more than others, but ultimately, it only corrupts you as much as you are willing to let yourself be corrupted.

Blantyre cradles many extremes at once. On the one hand, you get a sea of anonymous Malawians, flocking to the city in search of any work they can find to get themselves out of poverty and be able to support their relatives back where they came from. These people walk everywhere, eat only the cheapest available food, sleep in the most basic settings, usually some distance outside the city itself and are essentially indistinguishable from the rural inhabitants. Interestingly, the phenomenon of urban drift does not appear to be anywhere near its counterparts of Asia, where there is a real congestion as a result. Townships around here are relatively small.

On the other hand, you find another group of people who are only ever known to walk when it involves moving from a 4x4 into a building, or back! They are made up of Malawi’s emerging upper middle/ upper class, the asian community of wealthy tradespeople and muzungus. At first I was surprised to find so many rich Malawians, but the more I thought about it the less surprised I became. If so much money is actually said to be injected into this country’s economy and the poverty level, essential services and infrastructure remain so stagnant (based on many old timers’ accounts I’ve heard and my own comparison between 2008 and now), the money must be going somewhere! This is not a generalisation, just a reflection of the surprisingly high number. These people live in exclusive areas in and around the city, guarded by electric fences and armed security. They frequent the numerous posh establishments around and shop in your high end supermarkets. They establish that stark contrast for which the city is famous.

In this dangerous juxtaposition of extremes, one finds another trait for which Blantyre is famous- crime, namely break-ins! Whether an extreme in scaremongering among the wealthy, desperate to safeguard that wealth, or a real extreme in the crime rate, I haven’t had a chance to establish yet and hope not to establish it by personal experience either. But its influence is ubiquitous. Enhanced security is everywhere ranging from broken glass embedded in the walls to electric barbed wire! Another peculiar manifestation of it that no one can fail to notice is the daily parade of armoured guards with angry barking dogs, which one security company likes to exhibit.

There is a middle ground though and it’s made up people who are neither rich nor poor, but are generally trying to get by. It is also fairly substantial which is reassuring. It includes salaried Malawians, students, and many lowly paid NGO workers (like VSO!) as well as members of the above –mentioned wealthy groups who decide not to behave like venerable super-humans. The middle ground, of course, sits uncomfortably between the rich, eager to lure them closer, and the poor, eager to humble them. Those who are in it by choice, probably abide to the latter category, whereas those who fought to get into it in the first place probably want to ascend further to get into the former category. Janet and I for one (two!), will probably try as much as possible to live the low impact life we’ve got accustomed to in Ntcheu, but still won’t alienate ourselves from a good bunch of people who might have opted for the more comfortable cosinesses of expat life. The factors determining lifestyle here are complex and there are plenty of good intentioned people living quite a plush existence.

Janet and my arrival in the big city has been accompanied by 2 crises incidentally, which are linked to the lifestyle choices referred to above. Firstly, one on a national scale, is the fuel crisis (Petrol/Diesel Palibe) which reached its dizzy heights just before we arrived. This had the strange ability, for once, of uniting the rich and less rich (and also poor, when you add in thirsty minibuses) under the same roof with the same desperation for a commodity. One might point out that the rich end of the spectrum were the more desperate, having grown so much more dependent on the stuff to ‘fuel’ their fancy lifestyle. Minibus passengers, if forced to, would probably be able to leg a few miles home if no transport was available. This crisis, apart from blurring the contrast between rich and poor, also throws some important questions about the state of this country. The effects of oil dependency can really be observed at close range and it certainly is worrying. As any ‘disaster’ it hits the poor first and hardest but knowing how the rest of the world is also so addicted to that liquid, one wonders what it might look like if suddenly in Europe or North America, people and industry and public services and trade suddenly got made to scrounge around for the last remaining drop of fuel in town for three weeks on end. This is what is happening at the moment here, and no one is spared. The queues outside fuel pumps are endless, the chaos bewildering- with everyone squeezing in best they can, straddling central reservations and even the opposite lane-, and the traffic unbearable. Janet and I, seeing this, are so glad we resisted the temptation to buy a car here. Beyond this relatively minor inconvenience, all services are also suffering. Supplies in the hospitals are at an all time low. Staff are being forced to adapt their timetables around fuel availability. Patient referrals from district to central hospitals for higher levels of care, are being paralysed, resulting in deaths at times. Meanwhile the 10-20 gas guzzler motorcades of certain individuals don’t seem to be suffering in the least!


We're actually in the wrong lane here and the 4x4 below is straddling back to the correct one. The line of cars is the fuel queue, not parked vehicles.

"FUEL PALIBE"- No Fuel!

The second crisis, one on a more personal level, is our pains with housing. This again has revealed some insights which forcefully tempered our precipitous attitude towards moving into a space of our own. Of course we wouldn’t have had the luxury to do that, were it not for the amazing hospitality of Hanna, fellow VSO volunteer, who literally welcomed us in like old friends. All this time, we believed that we would be moving in houses similar to some of our fellow expats, thinking without actually questioning it, that this was the norm. It’s only once we were told that we would receive a limited budget towards our accommodation, that we realised how exclusive these areas were. Yet there are many alternative options around, which are much less expensive. Sadly we don’t get many expats wanting to live there, opting for the posher areas where other expats live. It results in a strange segregation almost where expats have little chance of interacting with ordinary Malawians other than at work or their house employees. Our situation is unique in that we are the ones doing our house hunting instead of VSO placing us in a house (since my transfer to Blantyre halfway through my placement was a situation quite unfamiliar to them). Of course, I’ve wondered why the VSO houses have tended to be in the posher parts of town and the reason for it seems to be down to the fact the houses are actually provided by the college of medicine, which is a well-paying partner of VSO. So their employees (VSOs) are placed in their houses and VSO ends up paying, although ideally they should. In light of the difficulties in finding suitable accommodation for volunteers, and the constant pressure from the latter’s concern about security being inadequate elsewhere, the simplest (and sometimes cheaper) option for VSO has been to go with the posh houses. They try and cut the costs by encouraging people to share. Couples are given a special status (which is likely to change soon, with necessary budgetary tightening) whereby they are entitled to a house by themselves. Sadly none of those are available for us at the moment, not least helped by the fact that the ‘partner’ in my case is no rich college of medicine, but rather a poor relation called Queen Elizabeth Central Hospital! All this tedious delay however (2 weeks in a spare room with half opened boxes) has had a positive effect nonetheless. It has enabled us to understand the system better and make our quest for more suitable accommodation- within our means and in line with our desire to keep it simple and around ordinary Malawians. The light is finally starting to appear at the end of that tunnel we feel...

Of course it’s still very early days here and I will probably come back over my first impressions of this city. It feels so complex in its dynamics. Yet at times, things are also deceivingly so downright simple. Things will change and numerous new discoveries will be made for sure. After a year in Ntcheu, I don’t think I even scratched the surface. Blantyre is potentially more intricate. So I’ll keep my senses and observations acutely tuned to take in the most that one year can aspire to. But at face value, for now, to a new-comer this is what it has felt like. More to come.

The sound of Ntcheu (Part2)

Today is the 7th of February. 1 year day for day since I’ve been in Malawi. Momentous date indeed. Especially since today also marks the day when I conclude my stint in Ntcheu to settle in the ‘Big City’ which is Blantyre. One thing you can be sure about is that I didn’t leave quietly! I left in true Ntcheu style. With a bang! A party that brought me in line very much with my earlier woes about the place. It will be clear after you read the preliminary notes that I wrote in advance about Ntcheu, how much I’ve grown accustomed to this one sensory stimulus.That’s what I imagined my leaving Ntcheu would sound like:

I won’t miss it. I’ll miss the place, the wonderful people, the amazing friendships, the good times, the fabulous countryside and so many things, let there be no doubt about that. But I won’t miss the sound of Ntcheu. Maybe I didn’t elaborate enough on that one!(?) But beyond the crazy fanfare of dog/hyaena howls, pounding rain drops on my tin roof and Uncle B’s sickening floor beat, Ntcheu was also the seat of unregulated noise in every context imaginable. And to my utter surprise, hardly anybody complained. Only the hardest hit (e.g. my friend who runs a guesthouse right behind Uncle B) saw the disturbance it was causing. Not a single person thought it might interfere with learning and concentration for example. And so, it went on. For some, it was a statement of status. The louder your speaker, the wealthier you are. The louder your shop’s music, the more attractive is your shop. It attracted more customers in that simple way. Thus, on our one mile long shopping street, you’d find no less than 20 nicely cranked up music systems, competing for who could blare out the loudest noise, hardly a few metres from each other. They invariably had a system inferior to the speakers (placed outside the shop by the way), which would magnify everything including background fuzz, to decibels that would wake a deaf man up! As this cacophony is taking place, one would be ill advised to stand right in front of a speaker, lest they end up with ringing ears for the rest of the week. Yet, to my bafflement, there is usually some guy happily sat on/next to/ in front of it, inflicting some irreversible damage to his eardrums. Occasionally you’ll find a dancer, inebriated far too early during the day, volunteering some of his moves for some attention.

Move away from this commercial noise, which essentially lasts only during shop opening hours, you get the night club feature which has no official finish time... at least not in practice. There is an interesting order to this disorder when you look deeper. The epicentre of chaos regularly changes location. My singling out Uncle B was highly misleading. I probably chose it for it funny sounding name and for the fact that it was my first presumed culprit. Then I found out that on any given night, there would tend to be one club that dominated the sound scene. And each time, it was the same speakers that would lie behind the chaos. This, I later discovered, was a set that got hired out in rotation, so only one club could have them on any given night. Whatever the mode of distribution though, the effects of it can be felt miles away. This is not helped by the town plan of Ntcheu- if such a concept can be applied. The bars that spew out this noise all face a valley where the hospital and most of its staff residences are located. I’m sure the wind also mostly blows in that direction! There are nights when it feels literally like someone is having a rave outside my room (Janet, queen of noise tolerance, will even confirm this for me!)

Then also is the one ultimate thing that no Malawian will raise their voice about- Religion. Of course, the sense of mutual tolerance of each other’s religion is highly amazing and commendable, but whether that justifies a church amplifying its sermons such that the entire town has to listen to it, I don’t know. This is what Ntcheu Catholic church is famous for. Much more prominent than the other churches, who also have powerful speakers indoors that can be heard till the end of whichever dirt path they lie on, this one boasts exceptionally powerful speakers (and members- whose money must have gone towards them) that sit right outside the church. Thus everyone in Ntcheu wakes up no later than 7am on a Sunday, to hear not only the singing but also the speeches and frenzied collections from this one church.
And the list goes on. Music really plays everywhere here and as loud as one’s system will allow. It plays outside our morning handovers in the hospital in the form of health education chants by some 50 shrill female voices. It plays in my orthopaedic office, even during consultations. It plays in theatre all the time. It plays on the wards from patients who do not need to check with others if it’s alright with them. It even plays next to the library. It plays in buses such that you could not possibly answer your phone with a chance of hearing what the caller had to say, assuming you heard it ring in the first place. It plays in almost every house, including mine (even though my ex-flatmate very soon minimised it). It plays in every shop and every bottlestore as I said. You can even hear it all the way up Ntcheu Telephone Mast mountain, coming from a particularly notorious “beer garden” at the foot!

One might think, especially knowing my historical aversion to noise, that this is somewhat exaggerate. But trust me, I have become a hell of a lot more tolerant to noise, and this time it really IS bad. The only way to disprove that is by experiencing it!

So that is how I thought I would be leaving Ntcheu. But Ntcheu has been my home for a year. Ntcheu has been the first African town to take me in as its resident- not just a tourist. Ntcheu has developed me in ways that couldn’t possibly have occurred anywhere else. Ntcheu has turned me into the doctor of my dreams, but beyond that also into a gardener, a bird spotter, a re-born footballer, a ‘famous’ pool player, a dancer, an explorer, a boundless foodie and so many other things. So whatever challenges it might have laid in my path, Ntcheu has become a part of me. And, in fact, more so for these very challenges. I’m so glad I had the chance to share that with Janet even if it was only for the couple of months which she spent mostly here, while awaiting confirmation of her lecturing post at the College of Medicine in Blantyre. The Ntcheu experience is so authentic it couldn’t be described merely in words even to someone who’d be living only a couple of hours away. Ntcheu is a landmark along the landscape of our lives, the freshest of them all. I really will miss it as a whole, with or without its music. The proof: today, as we were driving down in our removals van, I caught myself asking the driver why he didn’t have any music on. A few months ago, I would have been secretly praying as we got on that van that the CD player was broken!
Farewell Ntcheu. Blantyre ahoy...


My Beautiful Ntcheu dwelling


Party House getting ready!

Dj'ing is serious business here!