18 March 2018
[Above photo: The Mua Mission dance troupe.]
AMARI (African Mental Health Research Initiative) is a brilliant project (another) of the Wellcome Trust, UK’s largest health care research funding source. It is a joint venture of medical schools in Malawi, Ethiopia, Zimbabwe, and South Africa to develop researchers and career pathways for them so they can understand mental health and illness in sub-Saharan Africa. At the annual conference in Lilongwe last week, 47 MS, PhD, and Post-doctoral students presented their research. And the program has only been running for 2 years! It was thrilling to see eager, intelligent young Africans moving toward common goals that will benefit all of us, most certainly their countries and immediate communities. In addition to providing understanding, they will develop innovations in health care for [better] delivery of effective mental health interventions, both at the individual and public health level. Some greybeards from the respective universities, as well as from Kings College, London spoke at the conference, also. Their perspectives were a welcome contrast to the meat and potatos of our work at the College of Medicine.
I did get a cold from the constant air conditioning in the Bingu wa Mutharika Conference Center (I now understand why we have power outages in other parts of the grid!) but it was hugely overshadowed by the excitement of the conference. Stefan, Chiwoze, and Dalitso of our Department of Mental Health were the local organizing committee and did a fabulous job. Great rooms, great food, the best conference bags ever (colorful silk-screened cichlids from Lake Malawi), and excellent conversations. 72 psychiatrists in Ethiopia but not a single Child and Adolescent Psychiatrist. Nor a Child and Adolescent Mental Health Clinic. National mental health budgets are generally less than 1% of the total health budget but mental illness creates 10-20% of the health burden—-direct costs, work years lost, family and economic disruption, etc. >50% of the population is 16yo and under in most countries. Half of all adult mental illness declares itself by early adolescence. And on and on. Lots of work to do to address the problems upstream. Get ‘em young!
We saw incredible traditional dancing by a troupe from the Mua Cultural Center, the richest trove of traditional culture and history in Malawi. The Center was built by Father Claude Boucher who has been at the Mua Mission (as a White Father, referring to the Order’s robes, not their skin) for 50 years and has created a magnificent museum of masks, photos and cultural artifacts, as well as workshops for traditional craftspersons and performance artists. The troupe members sang, stamped, beat drums, clapped hands, and danced stories from the Chewa and Ngoni past—tales of the harvest, slavery, the advent of HIV/AIDS, puberty rites, fertility—all with costume, skill, and immediacy.
The HIV performance began with drumming by the men and singing and syncopated clapping by the women—enter a tall, slender man with a dark hood over his head, a dark loincloth, and holding a bundle of flaming sticks in each hand. He danced wildly, with the flames singeing his legs and the coals burning his feet, eventually falling down into a spasm followed by immobility and silence. He was carried off by 4 men. The entire audience of about 120, having seen so many patients with HIV/AIDS and so many AIDS orphans, was stunned.
The performance preceded our final supper and was held in an outdoor, sandy courtyard at Kumbali, a beautiful lodge outside of Lilongwe. [Madonna appropriates it when she visits Malawi.] At supper I sat with 5 students, mostly Ethiopian although one woman was from Tanzania and doing her studies at Addis Ababa University. She is a psychiatrist who is getting a PhD and has left her 3 children and husband for a year to go to Addis for the coursework. She’s made a lot of sacrifice but she looked pleased with her choice. Still, she is a very warm person and missing her children and husband.
I’ve been feeling sad about leaving Malawi. We have enough good friends now and I am learning a lot about the System and how to work within/around it. I applied for the Fulbright to Myanmar a year ago after hearing a lecture from a population expert that Malawi’s will double by 2034. Since they can barely feed themselves now and the birth rate is down to 4.8 children per household, it seems a recipe for disaster and hopelessness. That is true, but my reaction is now tempered by the disasters in the US and much of the rest of the world in terms of violence, hunger, poverty, sex trade, ivory trade, drug and arms trade, corporate and government greed and corruption, income and opportunity inequality, and so on. Malawi is beautiful, people are generally non-violent, there are very few guns here, and there is an orchard full of apples and few to no other apple pickers.
I suppose the AMARI Conference made me realize that there are lots of smart and committed people to work and hang around with, even if this landlocked ship looks like it is going to sink. The world itself appears on the decline and this is not a bad place from which to observe the disasters. Why were we created so that reproduction was so much fun? Expanding populations make everything worse.
We watched an old film,“What About Bob?”, last night and laughed at the verities therein. It’s great how the family members instantly recognize Bob’s kind, if cloying and unboundaried, nature, which so contrasts with Richard Dreyfus’ character, who is pinched, controlling, and vain. Even so, the family is able to confront and love him. It’s a good, light-but-profound 1 hour and 38 minutes.
Linda has been running on fumes for a few weeks, as she clarifies in her blog. Yesterday was the graduation ceremony and jewelry sale of her under-the-mango-tree women’s craft group. They learned to make a wide variety of stunning offerings, as well as how to open a bank account, entrepreneurship, marketing, display of wares, etc. They all dressed for it, visitors came and bought a lot of items, and it was a very sweet time. Linda is donating the materials, the artists’ salaries, and her own time; proceeds from the sales will go to the women to do as they wish. Buying materials so they can do this themselves, and teach others, would be a desired goal but it may be that things are so tight the money must be used for survival only. Some of them walked 2 hours twice per week to come to and go home from the classes. That’s the thing about gifts; people will use them as they want to, just as our kids will do what they want to after they are independent (and often before). It does lighten Linda’s load a bit, however, not to have to run back and forth twice per week between her 1st year nursing students turned loose on the wards at Queens and the crafts group.
We’ll get our Mozambique visas this week, with luck. And get the car back from Eugene Murphy, an Irishman who runs a tight auto maintenance and repair shop out of town. He has a gift of gab and is a wise soul about Malawi after many years here. Quite a find! We’re off to walk to the minibus to get to the road to Peter and Caroline’s for lunch, having no car and rain threatening (dissuading us from biking). It is a several mile walk through woods and maizefields, which exercise is welcomed by us both.
A psychiatrist in Malawi 