Hi Anna!

Thanks for adding your upcoming trip to the SOLID group. Just thought I'd offer a brief synopsis in the thread.

In January of 2007 two Salt Spring Islanders will travel to Africa to volunteer their time, skills and energy. Beth Gessinger, a retired nurse, and Anna Callegari, a pharmacist, will spend 11 weeks in clinics, hospitals and villages in Malawi, Mozambique, Swaziland, and Lesotho. Sala Hantle Africa is their combined vision of individual response to the AIDS pandemic.

Their goal is to provide direct patient care for people suffering from HIV/AIDS and to help support those affected by the AIDS crisis in some of the highest prevalence countries of sub-Saharan Africa. As they travel through this diverse range of facilities they will:

· Assist local physicians, nurses and pharmacists in direct patient care activities;

· Work with local HIV/AIDS support groups, in training and development;

· Provide community outreach and education on HIV/AIDS prevention and care;

· Provide pain management and palliative care workshops to local caregivers;

· Assist in the procurement and dispensing of medications in rural settings;

· Investigate potential for small scale dispensaries and clinics in rural facility settings.

If you would like to donate to their effort please visit the SOLID web site.

Soon there will be a button on the International Humanities Site to accept US donations, just waiting for them to get it up.

Thank you!

Thanks to my friend Meron for spreading the word so concisely, and in such a timely fashion!!! As you can imagine, life in the last three weeks before departure is pretty crazy, lots of purse wringing going on to get more donations of medical supplies, medications, and money! Doing great so far on that front, but lots more to do.

Will be following your journey and don't worry, I will be you Taxi and tourist guide in Swaziland and Lesotho :)

Ray

With ONE more week till departure, a quick update on progress so far:

Goods to take:

In the middle of my own packing chaos at the moment....at least 7 huge duffel bags full of medications, medical supplies, knitted baby hats, books, art supplies, training materials, and other sundries. Here's hoping the Air Canada attendants are in a realllllly good mood next week!

Funds Raised:

We are pretty delighted with having raised almost 47K in money and meds of our 52K Sala Hantle budget (modified from original proposal as Ha Makhata Schoolhouse funds have been provided by another incredible initiative). Spreading that around is going to feel really good!!!

Excitement Level: ALTITUDINOUS!!!!

Be in touch from beautiful Malawi in a week.

Am looking forward to updates from you and beth. I can feel the excitement almost as much as if I were going. Good luck with those bags, may good karma smooth your path through all your travels. Think how much lighter your load will become with each stop. By the time you get to Rustlers you'll be light enough to dance. I mean really dance! LOL Heather

Beth and I are almost half way there now, in Heathrow, after a blissful baggage experience in Vancouver. Good karma, immense help from our friends Rob and Linda, and we were on our way with 6 enormous duffel bags full of medications, medical supplies, books, school supplies, soccer balls, uniforms and countless other items. 24 hours from now we wil be arriving in Malawi, very excited to be on African soil again. Flight so far hasn't been too bad, despite the sudden onset of a wicked cold for me, sniffling and sneezing SARS like on the plane...not too popular. Only 15 more flying hours...my feet are already reminiscent of Miss Piggy's stuffed into my skechers. Will keep you all posted with photos etc as technology allows. All our best, Anna and Beth

Just had a meeting on Monday with a local man named Sam. He worked for an NGO in a few Sub Saharan countries specializing in forestry. It turns out that he will be visiting the tree nurseries SOLID built in Lesotho at the same time Beth and Anna are there and may be another set of hands for helping to unload Ray's container. There will be a lot of Mahoa from Canada to lend a hand in Lesotho come the end of March, beginning of April. So Great!

Arriving at Kamuzu Airport in Lilongwe, stepping onto the red saturated earth, and breathing in our first sample of the lavishly rich moist air was a blessing after over 40 hours of travel. Beth and I prepare ourselves for dealing with the first of many customs officers and border guards, and ingeniously (….truthfully without much scheming at all) place our most innocuous duffel bags at the top of the pile, and predictably are asked to open one from each cart. After rifling through both my underwear and miscellaneous clothing, and what appears to be mass production of very adorable baby hats, the customs officer and police man both agree that we can go through with our eight pieces of luggage, welcome to Malawi! We have managed to complete the first difficult task of our journey, delivering the multitude of gifts and donations from our many supporters in Canada with no extra charges!

We are picked up by the charming Davison, who carries a handwritten sign saying BERTH KISSINGER, which completely cracks Beth up, and are then delivered to Shoprite (should be coined Shopwhite) where we are tempted by an embarrassing selection of expat options. Beth and I take a deep breath, refrain, and choose the more Malawian options to sustain us (with the exception of a small amount of gouda). After changing a little US cash ($1 buys 143 Kwacha; 5 Kwacha buys 2 yummy bananas) we are on the road to Nkhoma Hospital, our destination for the next two and a half weeks. I had forgotten how rich and palpable the African experience is; even being witness to road side life brings an incomprehensible array of colors, smells, emotions, and vistas.

Young boys herd their goats, young girls walk proudly with bundles of firewood balanced precociously upon their delicate heads, women wander with cherubic babies tied to their backs, and the brightness of the worn clothing persists despite the tears and triumph over many washes. As we near the outskirts of town we pass “Furniture Row” where signs for coffin makers are ironically interspersed with bed manufacturers. The people wear beaming grins and deep brown skin, and offer tentative waves as they witness our porcelain presence. The scenery is exquisite, rainy season brings lush, vibrant greens, and deep muddy reds to the rolling landscape, which presents itself as a quilt of maize (corn), groundnuts (peanuts), potatoes, bananas, and dots of boulders and hills for pronunciation of the squares.

Arriving at the newly paved road of Nkhoma (Beth is flabbergasted by this) we near the hospital where we will try to assist in the amazing work these clinicians are offering. Still time for a walk through town before dark and on our journey we meet many of Beth’s friends, including a young nursing student Beth has assisted over the past two years of his training. These students work 10 hours a day for what used to be 150 Kwacha a month, just over $1 US. Now the government has decided that the students should get no stipend…they do get three meals a day….and have to pay their own way to the placement they are assigned to on completion of their training, an impossibility for many. We are taken on a lovely walk with Charles, witness stunning scenery, and warmly reconnect with old friends for Beth and new friends for me. On our way home we visit quickly with Barbara Nagy, the pediatrician and single mother of three, including two girls from China and a lovely little bub from Malawi called Happiness (the new addition). Night falls like a smothering blanket with its darkness, and the night sounds, unfamiliar excepting the cicadas, lull us off to sleep under our mosquito nets after our trying journey.

Our first full day in Malawi begins with an early trip to the local market, where the poverty is undeniable, and hopeful people gather with their small piles of produce, hoping to make enough kwacha to sustain them until the next week. We are told that this is a lucky year, there is still maize from last year, and not many people are starving. The evidence suggests otherwise, with the swollen bellies, sunken faces, and yellowed hair of malnutrition ever present. Hundreds of people are milling about, trying to sell corn, potatoes, tomatoes, nuts, beans, greens, goats and chickens. Bales of “donated” clothing are frantically picked through for a warm sweater for a young boy, or slightly shabby sleeper for the baby on a mother’s back. The people of Malawi are tentatively warm, and respond with beaming grins to our simple attempts at greetings such as Zikomo (good day) and Muli Bwanji (how are you). They are curious, and delightful, especially the children…ever present as half the population is under 14 years of age.

Our afternoon is spent on a quick tour of the hospital, which is a convoluted collection of brick buildings, corridors, and antiquated equipment. The pediatric ward is full, this year has proven particularly bad for malaria, and most Malawian’s suffer from this condition many times over in their lives. This ward has 45 beds, but often bulges with 100-150 children. The patients who are admitted to the hospital need one or two family members to provide meals and general care, no extra nursing here. The hospital is very well organized in terms of its programs; male and female medical wards, outpatient clinic, maternity ward, surgical ward and eye clinic. We deliver the many medical supplies and medications to Barbara, and she is thrilled, kissing the bottles of Augmentin, an antibiotic that is certain to save lives and difficult to get here. The 400 knit baby hats and receiving blankets that Beth has organized will prevent the newborn babies from getting hypothermic, as many mothers do not even have a cloth to wrap their babies in to take them home.

Tomorrow Dr. Hull and his team from Ohio arrive to provide surgical treatment for the VVF patients for three weeks. The Vesico Vaginal Fistula patients are primarily young women who deliver unassisted in very rural areas, and have greatly prolonged labors which results in a hole between their bladder or rectum and vagina. These women have no control over leaking urine or stool, and are shunned by their families, often their husband leaves them, and usually their baby has died in labor. Nkhoma Hospital is leading the way in providing treatment for these women and allowing them to begin new lives. Our day has been full, and after a lovely dinner with Barbara and the children we are off to bed, dreaming vibrant dreams of Africa and home.

Morning’s first light is accompanied by the harmonic singing of church groups, gathering for the first of many services today. Beth and I decide to attend the Chichewa sermon, and arriving a few minutes late, struggle to squeeze ourselves into the back of a throng of at least 600 to 700 Malawians, gathering to garnish hope for their lives. You can only imagine the number of times already we have heard “god willing” on this journey. The sermon smells of lecture, with many references to Yesu and Maria, and not one mention of HIV or AIDS. It is my first impression that this disease is still very much riddled with stigma here, and we have heard many examples of young people dying of “cancer” or “pneumonia”. There is a dense odor emanating from the pews, many of these people have worn their Sunday best but can’t afford soap to wash. The woman in front of us has her baby swaddled on her back, and mid sermon the baby produces a puddle of pee on the floor at Beth’s feet. I couldn’t resist asking Beth if there was a restaurant nearby where we could have lunch, again producing muffled hysterics. The highlight of the service, which was a protracted three hours, was the incredible singing, dancing and harmonies which produced goose bumps on my arms. I managed to sing along in Chichewa, perfectly pronounced I am certain…., by sharing the song book with the cute little girl beside me, who gingerly kept touching my arm, to see if my skin felt any different than hers.

After the service and a bite to eat we set off on a 6km walk out to Charles’s village, where his mother, grandmother, sister and her family still live. The journey is stunningly beautiful, and every available piece of land has been cleverly and meticulously crafted into a work of art of gardens and fields. The path is red and muddy and well worn from the villagers meeting at Nkhoma for food, work and “god willing” a future. The village is extremely simple….mud huts with thatched roofs, window panes devoid of glass, simple rondavels for cooking huts, and happy, warm and generous people. We have offered 500 Kwacha ($3.25 US) for food for the family, which provided potatoes, mangos, soap, a kilo of sugar, tomatoes….more than they had seen in the past six months. The grandmother is absolutely gorgeous with her leathered face and tiny diminutive frame, and she is so grateful for the visit. Charles’s sister Lea, who delivered her first child at 14, has just produced a third chubby son, who I immediately confiscate and cuddle, knowing just when to pass him over to Beth so he can pee down her leg….she seems to have a knack for that.

We arrive home, tired and content, and are confronted with the arrival of the Americans, who are a team of surgeons, a nurse and the doctor’s wife. They have managed to transport an incredible 12 “foot lockers” full of medical supplies, suction machines, and incredulously at least half of the totes were absolutes on the “must have food items” – peanut butter, crackers, cookies, sausage, cheese, probably marshmallows and dehydrated Big Macs. Yikes….Beth and I happily munched on our rice and greens, had a cup of tea, and are now off to slumber land….more to come in the next few days. With our deepest gratitude for all your support,

Anna and Beth

I just read Anna's post to the whole family during breakfast and we are all in tears now, tears of sadness and happiness all mixed together.

Thank you Anna for sharing your journey with all of us, it brings back a flood of emotions in this house, especially with Keiara sitting on my lap while I read.

Anna, I just want to say keep up the good work and the wonderful writing, it's so inspiring:)

Ray

Thanks Ray! I can close my eyes and just imagine myself sitting around your lovely, warm family dining table ... what a beautiful place that is to be. Give a kiss to all those wonderful children of yours for me (double up on Keiara, what a doll she is) and Jackie too!!!

:D

Feb 5

Nkhoma Hospital

This morning began early with rounds at 7am at the hospital, at the moment there is a sea of white faces, a plethora of assistance, all well meaning but with the potential to do a lot of talking rather than listening. We, being polite Canadians, are willing to do just about anything that needs doing (within a reasonable scope of practice of course).

Typical morning:

7 Babies born

2 children die of malaria

Motor Vehicle Accident with 6 deaths (care of the newly paved road to Nkhoma)

Multiple surgical patients admitted

5 more admission for the Nutrition Rehabilitation Unit (children starving)

Spent the morning doing menial chores in the pharmacy stores with Barbara, the pediatrician, trying to manage the fine line between budget constraints (the hospital is over $100,000 US in debt) and the desperate needs of the patients spilling out of the wards into the hallways. Seems somewhat inappropriate that the only pediatrician on staff spends hours in the bowels of stores while kids are dying on the wards, but that is Africa….things often don’t make sense to us from the western world.

Beth and I returned to compile a list of all the donations being offered to Nkhoma before returning to the wards to start our project….A Day in the Life of Nkhoma Hospital. We have been asked to document the comings and goings of the hospital, to try to reflect the needs of Nkhoma and the people it serves to a world which has, understandably, little conceptualization of this reality.

We are offered a tour of the hospital by Olive, the acting head matron of nursing (who had sent a note to Beth by bush telephone)

Laundry - none of the three monstrous industrial machines work, and there is a cute little tailor making cloth hats for surgery out of recycled sheets.

TB ward – isolation for multiple TB patients, as well as a unit for patients suffering from meningitis (seems an unlikely combination to me!)

Kitchen – most patients in the hospital require a guardian, usually a family member who cooks for them, washes them, and takes them (or their bodies) home. There is a small, very basic kitchen for the TB and VVF patients, who often have no-one.

Nutritional Rehabilitation Unit – This was very likely the most disturbing thing I have witnessed so far. Despite a good harvest last year people, primarily children, are still starving. In 2002 Malawi suffered from a terrible famine when donor pressure forced excessive sales of maize to repay debt. This, in combination with torrential rains, resulted in an unbelievably insufficient harvest. People were literally dropping dead on the streets from malnutrition. Even now, when maize is plentiful, many children have insufficient protein and calories, resulting in these pathetic creatures suffering with either anorexic like proportions, or worse, massive edema resulting in swollen feet, legs, arms, and eyes that are painfully swollen shut. We met a mother 13 years old, starving with her baby, and laughed with a grandmother supporting her daughter who had a 3 month and 16 month old, both starving. Luckily for these children Nkhoma Hospital exists, and has a very comprehensive rehabilitation program.

ARV clinic – HIV patients line the halls waiting for a chance to consult a clinical officer, and get their antiretroviral drugs. Many of these patients have walked hours, some in very feeble states, and waited all day for a chance to be seen. Currently there is no Voluntary Counseling and HIV Testing being offered…the hospital has run out of money for HIV tests (ok I have to comment – ludicrous!)

Medical Wards – 45 beds on each ward, with mattresses laid between the beds on the floor. The ward is overflowing with patients ranging from desperately ill with malaria to those dying of AIDS. For all this need there is a patient attendant on duty, with two weeks official training, and one nurse for all medical and surgical ward. One young woman who has just had a large tumor removed from her thigh shares her bed with her two guardians, and three plates of food, sima (pure, unadulterated starch), relish (pumpkin greens fried), and corn (more starch) – not much room for the reparative effects of protein in this diet. Wandering into the back “private” room I meet Mr. Nsenga, who is living out the last few days of his life in a hospital bed, succumbing to malaria and AIDS, the typical skeletal figure. Ironically on the wall above his bed hangs a colorful hand painted mural, depicting a plump and happy Malawian standing beside a diminutive thin white person.

Pediatric Ward – sometimes 3 to a bed, malaria season is claiming more lives than any other malaise in Malawi. Infection seems to occur so easily here; there is a three week old baby with a huge cerebral abscess (infection), luckily diagnosed and drained before the baby perished. A three year old lies on her back, legs dangling in the air in traction for the last three weeks, and she patiently plays with a rubber band and piece of string. Beth is asked to run back to the house for one of the antibiotic suspensions we have brought, a life saving potion in the form of a plastic bottle. There are so many suffering children and as you can imagine, funerals are commonplace.

Maternity ward – One of the best parts of my day, a 16 year old with a brand new, minute old baby, the mother ecstatic and the baby content, sure that all is well in his world.

Surgical Ward – This is Beth’s Malawian home away from home, where she offers her much needed assistance. The ward is full, and there are so many incredulous stories to tell. There is a young woman with the most gruesome surgical wound on her leg, a deep incision from hip to knee. The awful infection which necessitated surgery followed a visit to a traditional healer, who scarred her leg with a razor to ward off evil spirits, resulting in the worst infection I have ever witnessed.

Despite all of these stories we are so very grateful to have an opportunity to be of real assistance, and are feeling very clear that we are offering all that we can in the face of this pandemic. One of our success stories follows:

Kiera’s Gift – Before Beth left Canada, her neighbor’s daughter Keira came over to offer her allowance, $63 Canadian, and wanted us to find an appropriate person to help with the donation. We found her in Nellia Kauwambale, a 59 year old grandmother from Mozambique who presented to a health clinic in late September with a lump in her breast she was diagnosed with an infection, given a few antibiotics and sent home. In Oct she was diagnosed with breast cancer which needed a mastectomy. She then had to wait until Dec 22nd for the surgery, which successfully removed the tumor, but resulted in sepsis (serious infection of the blood). She was quite a complicated case, and was held in hospital until Jan 31st, when she was discharged. She was still in Nkhoma on Feb 6th as she had no money to go home. We decided to use Keira’s allowance to help this woman, her daughter and granddaughter go back home.

Total Bill 6332 Kwacha ($57)

Patient Paid 2000K ($18)

Keira Paid: Bill 4332K ($39)

Transport Home 1400K ($13)

Food 1268K ($12)

Thanks to Keira for her donation!!!

Next we have to find someone to help with her brother’s donation! As you can see, every little donation helps in Malawi, and there is so much need. Thanks for listening and being so supportive. Will be in touch as often as we can (technology is somewhat challenging here!)

All our best, Anna and Beth.

Feb 10, 2007

Nkhoma and beyond

This morning I feel as if I am sitting on the precipice of a fantastic dream, unwilling to pinch my pink flesh for fear that all will reveal itself as a figment of my imagination. The last two days have been beyond our comprehension, and we are floating with fascination and gratitude for the experiences.

Friday early morning comes quickly, despite our moonlit somnolence, and the skies soon offer a portrait of pink clouds and the promise of dawn. We are joining a team of a physician, pharmacist, accounts man and driver to travel to two of the remote clinics served by Nkhoma Hospital. Our jalopy is cleverly disguised as the hospital ambulance, and at 5:45 am, it arrives, delivering several ailing men, an emaciated babe, and a very young woman in labour. We are encouraged to alight, and in doing so I place my hand on the seat in what undeniably is some body fluid, likely amniotic …I am eternally thankful for the wet ones.

Soon we are hurtling towards the mountain pass that will deliver us to our first destination, Chigoda clinic. The route is circuitous, but stunningly beautiful. Layered hills are blanketed with a patchwork of crops of maize, cabbage, rice, tobacco, and groundnuts. The romantic mist slowly clears with the comforting warmth of the morning sun, revealing the serpentine road that winds down towards the valley below. The crowning jewel at the end of this journey lays promisingly ahead, the cool breezes and eggshell blue of Lake Malawi.

As if by divine intervention, the brakes start to fail near the bottom of the mountain; the controlled chaos of a sudden lurch, then the emergency brake. We are offered another glimpse of rural Malawi life, and move towards the local grain mill in search of a spanner, creating a scattering of children in every direction. Slowly they emerge from behind brick buildings and reeds to satisfy a curious glimpse of the gulewakulu (whites), and before long all the village children are laughing hysterically at their images captured within the camera.

With our drinking water as coolant, and the nod of Mr. Piri, our driver, we are off again to travel the blissfully flat route to Chigoda Clinic. As we pass over the last leg of the journey, a sandy road reminiscent of a goat track, we are delivered to the clinic; a simple brick building sheltering the concrete pews that support the faithful, who seem certain that the doctor has come to heal all. Hundreds of mothers and babies are waiting for the under five clinic, and we mingle and entertain the villagers until the doctor has finished seeing the sickest of the patients. Mr. Madetsa, a sweet little man with an infectious laugh comes here once every two months, and provides care for the more complicated cases that cannot be managed by the medical assistant based here. The pharmacy is stocked with only the most rudimentary medications, no designer drugs available here, and we are on our way to the next clinic.

The scenery is exquisite, and with a fraction of a turn of the head, the vista unfolds in a kaleidoscope of vibrant colours, textures, and forms. The Bilboa tree stands defiantly every few hundred feet, it’s trunk firmly stomped into the earth like an elephant’s formidable foot, and its’ laborious branches like arms, reaching wide to offer shelter for its’ people. Rice paddies vacillate in the breeze, making way for the proud corn stalks, which are gently coddled by pumpkins as far as one can see.

We continue towards the lake, to Malembo clinic, where Mr. Madetsa inserts Norplant implants, a contraceptive that offers women five years of birth control. Malawian women at least seem in control of their reproductive health in this way, but sadly the protection against pregnancy sometimes results in the freedom to engage in extracurricular activities. We learn that there are 12 million people in Malawi, and that 52% are under the age of 15. The life span is now reported at 37 for men and up to 45 for women, facts flying in the face of a reported HIV rate of 18% and falling. Many of the doctors here believe the numbers to be much higher at 30% and rising.

Having completed our work at Malembo we venture to the lake, which covers a third of Malawi and is incredibly beautiful. Rack after rack of drying fish defines the shoreline, and ramshackle huts are piecemealed together, offering shelter for those selling fish, bananas, mangos and avocados. The wooden shells of canoes, roughly hewn, evoke images of traditional antiquity and share the prime beach space with several large cows lounging in the afternoon heat. A gentle sensuous breeze cools us despite the scorching sun, and we watch mesmerized as young sinewy boys paddle out to “sea”. The children are indescribably excitable and delighted with their images in the camera, jostling for attention in front of us. One little boy comes running to us at the end of our visit with a camera fashioned from sand and mud, a highlight of the day that elicits spontaneous and contagious giggles from all of us.

We venture home, slowly but surely collecting passengers and cargo as we go, and at the end of our trip we share the ambulance with 8 people, 7 huge bags of rice, a kitten in a sack, and a copious amount of dried fish. As we navigate the dusty rutted road we notice that snow appears to be falling outside, one of the rice sacks has loosened at the top and rice is escaping. We screech to a halt and all are employed in not only tying the bag tighter, but then moving the bags inside the vehicle to protect against the impending torrential rain. I am moved by the actions of Mr. Modetsa, the clinical officer, who climbs to the top of the ambulance to collect handfuls of stray rice kernels, food is not wasted in Malawi.

We arrive home in the middle of an impressive rain storm, fourteen hours later, and after showering off the layer of dust and grime, fall into bed, lulled to sleep by the cicadas and odd electronic bat noises, and even the dogs barking protectively doesn’t wake us.

The next morning is Saturday and we have a lie in (8:30 this time!) and wake to find no power in the house. The American crew has managed to blow a fuse in the electrical system with their pancakes, eggs, sausage, kettle, and hairdryer extravaganza. We quickly escape to the relative sanity of the morning market and collect our week’s supply of tomatoes, onions, pumpkin leaves, and potatoes.

In the afternoon we are invited to join our friend Dalson in a trip to a nearby village, Milamba, which is about 8km away from Nkhoma, to participate in a community meeting. Nothing would have prepared me for what we were about to witness, although a little foreshadowing would have been wonderful as we arrived heathen like in our trousers (unheard of for a Malawian woman) and with only a soccer ball as an offering. Milamba is an outreach clinic for the Moyo Project, a very successful project currently funded by Save the Children, to provide HIV and AIDS awareness to rural villages in the Nkhoma area. The project currently serves 9 outreach clinics, and countless individuals, many of who are not benefiting from the public education system.

We arrive at the relatively humble building which houses the project in Malimba, and children descend on the vehicle as expected. What we are not expecting is the hundreds of children, 86 village chiefs, and some 900 people mobilized for this community meeting. The colours and sounds are somewhat overwhelming as everyone finds their places, the go gos (grandmothers) gathered in their radiant head scarves, the respected chiefs forming a wall of peppered heads and layered torn clothes, and the many children traversing the field like cheerful cherubs. Beth and I are introduced as honoured guests and the afternoon’s festivities begin.

First the local band is welcomed, and asked to perform their songs about the dangers of HIV and AIDS. The instruments are incredible, guitars garnished from old Mobile Oil cans and a rudimentary wooden neck, or large soup cans and wire. One of the performers hobbles up with a large stick, unable to walk because of a markedly deformed foot. The percussion section is comprised of a forked tree branch, with a wire stretched across, and bottle tops strung along the length. The band is remarkably talented, as they warn the local women of the dangers of HIV and to be clever, and ask men to respect their women and tighten their trousers.

The youth choir then rises to join their voices with angelic consequences, swaying back and forth in their mismatched blue shirts and torn trousers and skirts. They sing harmonically of the effect of HIV in their communities, and the multitude of children gathered at their feet are mesmerized by the message.

Courageous young girls and boys arise to speak their truth about the devastating effects of the pandemic in their lives in emotive poems, translated thoughtfully and gently by the teacher beside us, and Beth and I offer our gratitude and honour to the crowd in a small way, translated for the Malawians.

Suddenly excitement ripples through the masses, and everyone shifts to welcome the traditional spiritual dancers, who are emerging victoriously from the long grasses behind the group. These masked men, decorated extravagantly with a multitude of rags and elaborate feather headdresses, are invited to communicate with the spirits through dance. The elder chosen women are chanting and swaying, singing to call the spirits and offer space for the traditional dance, which reflect the cultural conditions of the people. These dances are frenetic and powerful, and one after another the men arrive in the circle to offer prayer to the spirits. This ceremony is used to recognize honoured guests, celebrate a new chief, or during funerals or initiation ceremonies for youth. It was one of the most moving events I have ever experienced, and Beth and I felt incredibly blessed and humbled to have been present.

I am so impressed by the clarity and openness in this community in the discussions of HIV and AIDS and it is a testament to the success of the outreach program. There must continue to be such efforts to reach the unreachable if HIV is to be controlled in this country. Incredulously this program is only funded until the end of March when Save the Children will pack up their laptop and vehicle, brush their hands together sanctimoniously, and declare their work done. There is so much more work to be done. We plan to assist Dalson in his search for further funding, and are happy to try to support this important work.

What will tomorrow bring? I can only imagine that it will involve the warmth and generosity of these incredible people. One more week of work at Nkhoma and we will be headed for Senga Bay on Lake Malawi, to work in a palliative care unit. Thank you for offering your imagination and interest in this journey.

All our best,

Anna and Beth

Anna writes the sort of detail that transports us all to Malawi. As we read through this thread over the next 9 or 10 weeks we will no doubt have a much better understanding of the culture, landscape, human condition, amazing initiatives, celebrations and struggles facing the people of Malawi, Mozambique, Swaziland and Lesotho. Anna your eloquent writing floods the imagination and opens up the heart. Thank you for keeping us so well informed. Much love to you and Beth. Heather

Greetings Beth and Anna. Muli bwanji? I hope you are both fine. From your great descriptive letter it is obvious you are moving along on schedule. Time will go so fast. When you get to Mozambique and cross the old railway bridge and arrive in Sena please greet Perpetua and Joseph for me and Luis in Kapasseni. Let’s hope the flooding there does not impede your travels especially to Kapasseni. I will cross over from Zambia later this year to pay them all a visit. The both of you are doing such a fine thing. May all the pot holes in the road be in the opposite lane. Please take care of yourselves and make sure you are traveling with an extra spare tire. Zikomo kwambiri! My very best regards, Garry

Sala Hantle Africa on the airwaves.

Radio personality Arthur Black will be doing a piece on Sala Hantle Africa for the CBC radio program All Points West today! Thursday, February 22, 2007.

Arthur's latest note to us, received yesterday:

Many thanks for the emails. The piece I'm writing is for the CBC radio program All Points West which comes out of Victoria and covers all of BC (except Vancouver). Should be airing tomorrow afternoon between 5 PM and 6.

Cheers, Arthur

Hoping we can grab a podcast for our web site.

palliative care and "conservation" at Lake Malawi

Life is many things in Malawi, but uneventful is not one of those. Lucy Finch, our host, and I are woken this morning by the saccharin sobs of an eighteen month old out in the courtyard, coughing and sputtering miserably, her cocoa skin flushed with fever. Her mother has arrived at “Dr. Lucy’s” unofficial office, her lovely home on Senga Bay, Lake Malawi, in the hopes of relieving her daughter of the bewitchment that is affecting her. Lucy asks simply if I have brought syrup with me, which thankfully I have, and we mix up a promising potion of western medicine to provide a reprieve from the pneumonia that has this sweet little girl firmly in its grasp. Lucy points out the uncharacteristically silky hair and evidence of malnutrition, the telltale markers of HIV infection, but the mother seems blissfully unaware of the signs. Now is the time to get her tested, Lucy advises, as the HIV antibodies, if found, will more reliably indicate the baby’s infection rather than the mother’s antibodies to HIV.

There is some hope now in Malawi for many suffering with HIV and AIDS, the medicines are available free of charge, but the suffocating grip of poverty prevents many from accessing the drugs for want of a fare for a bicycle taxi. Malawi is the third poorest country in the world, with an average income of only $580 per year, less than $2 per day, and a plummeting life expectancy, now some 37 years. For now the ARV treatments will suffice, but it is only to be expected that HIV resistance will occur in the near future, and then the future of my generation here is dismal, as second and third line options for treatment are currently unavailable; some twisted imbalance between the “haves” of the western world and the generic “have not” options of the developing world. Even though there is limited availability of treatment, the culture of bewitchment and stigma that surrounds HIV here means that many do not seek help until it is far too late for salvation.

Palliative Care is the only hope for the many souls suffering needlessly in the mud huts scattered like anthills over the landscape. By definition palliative care provides alleviation of not only physical pain, but also the spiritual and psychosocial suffering associated with the end of life. This is what Lucy and Tony Finch aspire to offer in the Salima District in central Malawi. Five years ago Lucy, a Malawian nurse, and her English forester husband, Tony, retired to Lake Malawi. Word soon spread that “Dr. Lucy” could help, and the courtyard of their home was filled each morning with the ill and desperate. Lucy’s passion for her work in palliative care gave birth to the Ndi Moyo Palliative Care Centre (www.ndimoyo.org); a day centre which forms the nucleus of an incredible home based palliative care service for the surrounding area.

For the last week we have been privileged to accompany Lucy on her rounds of some of the most remote and basic villages I have ever witnessed. The realities of people dying in their mud huts has hit us hard, and for each of the patients I describe below I am certain there are many more that are not receiving the incredible love and care that Lucy offers. The last few days have been indescribable intense, the experiences offered unlike any which we would ever experience in the western world, and I’m not at all sure how to make sense of these for mass mailing so I am just going to ramble.

Let me try to recreate several of the disturbing impressions of the last few days (names have been changed). The first home based patient we visit is Mary, a woman about my age with advanced cervical cancer, who appears in front of me as if a ghost as my eyes adjust to the light in the dim, crumbling mud hut. She is an emaciated skeleton, breasts hanging limply and with futility on her corrugated rib cage, too weak to remain seated for more than 5 minutes. When I take a picture of her and Lucy, at her request, she said in Chichewa “I am finished”. Four generations of women in her family sit in the room watching her die, cervical cancer being a common death sentence for the women of Malawi, a result of the high rate of infidelity, sexually transmitted diseases, HIV and resultant sickness.

Our next patient is James, a young, good looking, emaciated man, covered with the tell tale spots of Kaposi’s sarcoma, a late complication of AIDS, painful and loaded with stigma. His young wife crouches in denial beside the hut, playing a dangerous game of Russian Roulette with her six month old baby.

Gracie is an inpatient in the TB ward and her cachexia takes my breath away, she is impossibly thin and fragile, her frame disguised by the gently folds of the bed’s feeble blanket. Tomorrow she will somehow cling to a local minibus for an ultrasound appointment in Lilongwe, to determine if the mass in her sunken belly is a tumor or more TB.

Then there is Katy, a 12 year old girl whose life has been smothered by a horrendous case of cancer, Burkett’s Lymphoma. She lies in bed covered by a thin, dirty sheet, a sparrow’s frame supporting the gross deformation of her face caused by the tumor. Over the last six months her face has become increasingly swollen, her left eye protruding out of the socket and she has freakishly, disturbingly morphed into something unrecognizable, were it not for the sweet innocent voice emerging from her warped little mouth.

Janet is a 28 year old woman who has had 6 children, only her oldest son, 11, survives. She is HIV + and deaf from bacterial meningitis, but still manages to communicate that she keeps hearing her dead babies calling her.

Our last patient today is Samuel, a 31 year old, single man who presented to the hospital 6 months ago with left leg swelling and discomfort. I don’t know how to accurately describe the aggressive, unrelenting Kaposi’s sarcoma that has affected his leg, which is now blackened and swollen more than 10 times its normal size. He suffers multiple infected retched nodules that imprison him in his mud coated cell, even if he could still walk. The swelling and edema has extended up to his chest, necessitating multiple medications to keep him alive….for what purpose.

And then there is a “good news story” Annie, who is an AIDS patient, 10 years old, but built like a 5 year old, the skin on her arms horribly scarred due to a brutal case of shingles last year. Her mother and 5 siblings are dead, and her father has abandoned her, and is on his death bed, but at least she has grandparents that are caring for her and the availability of ARVs.

Though the descriptions above are difficult to read, let alone comprehend, they are the reality of the patients that Lucy assists every single day, bringing comfort, peace and dignity to their lives. We are so grateful for our community’s generous donations, which have allowed us to support Lucy and Tony’s work, and they are thrilled with the $6000 donation which will provide much needed medications, and further palliative care training for their dedicated team of nurses.

It is difficult not to be swallowed by the wave of grief that I have felt for these people, and I try desperately to cling to the life raft of positive examples; the success stories in this pandemic. The Tikondani Project, in Lilongwe is an inspiring example of the serving of the neediest, and perhaps most deserving, members of our global community. Street children in Malawi are displaced by many factors, the death of their parents, physical or psychological abuse, banishment from their communities because of perceived bewitchment, child labor, or children simply wandering from their homes and becoming lost. These children would have no future on the streets of Lilongwe, eventually turning to theft or prostitution to survive.

The Tikondani Project assisted over 400 new children last year, and reintegration of these children into their natural environment remains the goal, with intensive involvement of the seven social workers employed by the project. For various reasons there are some children who cannot be reintegrated, and currently the project assists 32 of these children by enrolling them in boarding schools to ensure a positive future. Many of these girls and boys are severely traumatized, and behave accordingly, but they have all made remarkable progress, both academically and in terms of emotional balance and social competence.

Today is a day of rest on the shores of Lake Malawi, which stretches 580km up the length of the country, and at up to 100km wide, is the third largest lake in Africa. Sipping our coffee this morning we glance over the still lake and witness what seem to be numerous black smoke plumes in the middle of the lake. Tony reassures us that these are not distressed fishing boats alight, but merely 200 foot high plagues of lake flies; swarms of tiny flies that engulf anything they pass over in an impenetrable wall of insects. Even 15km away they portray a formidable foe, and I am grateful for the shifting wind that keeps them at bay. This inland freshwater sea also boasts a huge variety of colorful fish, although the fringes of Cyclone Favio, currently creating chaos in our next destination, Mozambique, have clouded the turquoise waters. We forgo the snorkeling trip offer, and instead pile into Tony’s well loved Landrover, as I have a hand at four-wheel driving in the wilds of Malawi. Our first destination on this ecological tour of the surrounding countryside is the Stuart Grant Fish Farm, where a seemingly endless row of concrete bunkers houses a kaleidoscope of tropical fish, well on their way to their next adventure, a fish tank in Japan, Germany, even…Canada.

Satiated by the saturation of these innocent prisoners, we depart and venture down several goat tracks before finding the next safari locale, which funnily resembles a high security prison from the outside. Here a crocodile farm thrives, with some 13,000 sharp toothed crocs, ranging from a cuddly foot long to a terrifying twenty five year old patriarch. It is the stuff of horror flicks, thousands of crocs swarming in shallow ponds, climbing on top of one another in an effort to reach the cool of the shade. Predictably this is not a conservation effort; as soon as these crocs reach 45cm around the middle (don’t ask me what kind of karma has you measuring the circumference of a croc, never mind the job of wrestling the eggs away from the protection of the steel trap jaws of adult crocs) they are relieved of their lives; the skin sent away to France and the US to be made into fashionable handbags and shoes.

The variety of the African experience never ceases to amaze me. A few more days of enjoying Lucy and Tony’s incredible hospitality, and we are off to Mozambique, although that portion of the trip is questionable now with flooding and cyclone activity, as well as torrential rains! Will keep you posted as often as we can. Thanks for listening.

All our best,

Anna and Beth

Update

... there is no update. We haven't heard from either Anna or Beth since they moved on to Mozambique after the cyclone. It was a tough decision but they opted to stick to their travel itinerary and continue on in to Mozambique.

We are keeping the faith that they are well and safe and hope to hear from them as soon as they are in Swaziland.

Go well, Anna and Beth.

Finally, a long message from Anna!

It is difficult to determine the starting point for this chapter of our story, but I suppose the clearest option is with the drive to Mozambique, 15 hours from Salima over some remnants of tarmac and many rutted and water gouged clay roads. Tony, our generous host has offered to take us the length of Malawi, all the way to the border, but first delivers us to Blantyre, where we retire in a somewhat dubious but characteristically dependable backpacker's lodge. It is from here we must depart at the ungodly hour of 4:45am on the uncertain path ahead. As matter of course "locals" at the bar warn us; "you will never get through", "the road is completely impassable" and "I hope you have 6 or 7 days to get there". However as the drama subsides, and the reality surfaces, we learn that the road is relatively dry, and unless we get an abundant shower in the next 12 hours we may as well go for it!

Life becomes simpler, and somehow more complex as we progress towards the southern tip of Malawi and then on to Mozambique. Sporadic huts rise from sanguineous soil, at times indistinguishable from the numerous termite mounds dotting the landscape. The road becomes bumpy, then rough, then incredulous, undulating over concrete shells designed to alleviate flooding and harness the flow of rising water. It is difficult to imagine that entire villages exist in this vast grassland, but occasionally we witness signs of community such as schools, herds of goats, and the distant mirage of shady trees that signifies a village graveyard. We finally and thankfully arrive at the border of Mozambique, with its two officials, and we are thanked for visiting Malawi and wished well on our journey. On the other side of a 3km stretch of undesignated land we are welcomed by the Mozambican officials, asked to pay a $4 US entry fee, and told to report to the border guard. We approach somewhat tentatively as we have an obnoxious amount of baggage, not only our own, but duffel bags full of medications, medical supplies, and huge amounts of food for the orphans of Perpetua's project. The border guard is young, enthusiastic, and delighted to have an opportunity to practice his English. We share our food, give him a world map, and chat about everything but our baggage for two hours while we await our transport to Sena.

Thankful as we are for the shade of the cassia tree, we are more than grateful to finally see a sole vehicle trundling up the long and dusty road that awaits us. Perpetua hurtles out of the cab, unable to contain her excitement at our long anticipated arrival in her country. We exchange hugs and shake hands with all who have accompanied her, and pile our luggage and dusty bodies into the low slung, rusty and well worn mini pickup that is being driven by the chief of police of Sena District. The dilapidated truck strains under the combined weight of 7 people, and 8 bags, but despite the groaning of the chassis and suspension, he screeches to a halt midway home to offer a lift to an elderly woman making her way along the impossible road.

The landscape is immediately unfamiliar as we speed along the dirt track, no quilt of maize, no sorghum waving in the breeze, and no crops of groundnuts dotting rolling hills. The land is flat and dry, covered in thick grass emerging from sandy soil. The air is suddenly stifling and parched. As we approach Sena we bear witness to thousands of makeshift huts of straw draped over tents of twigs, the living legacy of over 100,000 people displaced from their homes by the recent flooding. Some have been draped by the tarps of global concern, UNAIDS, Med Sans Frontiers….yet still perch precariously on the verge of a nursery rhyme ending in the unpredictable breeze. These people have nothing save the hope that they can return to their homes along the Zambezi river to continue the sustenance that they know. We are told that the real reason for the massive floods in the Zambezi basin is the government's intentional release of waters from the overextended hydroelectric dams in Tete province nearby, and that Cyclone Favio is a convenient coincidence; really they have not had much rain this year. Ironically the villagers are now praying for rain so that the crops of maize that remain do not become drought affected and unusable in the stifling heat.

The last piece of the puzzle is placed as we cross the clattering, neglected wooden tiles of what was once the longest bridge in Africa, under renovation for the last 2 years, and closed to all but cyclists and pedestrians 6 days per week. As we survey our surroundings we see hundreds of people washing clothes, bathing and gathering drinking water from the remnants of the flood that still buries the borehole. Our frenetic driver, Nuru the chief, proves to be a somewhat rotund fellow, with a crunchy exterior and soon evident soft middle. When we arrive in Sena he arranges money exchange, offers us several beverages in his bar (cold beer!) and all of the goose and guinea fowl eggs in his coop, and tells us to "call him if we have any problems". We anticipate few, as the people are warm and welcoming, although there has been no deliveries of food for weeks, and bottled water is in slim supply. Perpetua is thrilled with the fresh vegetables we are able to bring for the orphan program as they have had nothing but porridge, nzima and beans to offer since the flooding.

Joseph greets us at the Kuwangisana Centre, the latest creation of the energetic and amazing team of Joseph and Perpetua Alfazema. Joseph and Perpetua met in Kenya in a refugee camp some 23 years ago, escaping the harsh brutality of the civil war in Mozambique. They emigrated to Canada, got married, and raised three children there, visiting Mozambique many times over the years to visit family and friends, and supervising the creation of the Kapasseni Project. They were soon undeniably compelled to return to their home to help alleviate the suffering that they were witnessing. Joseph and Perpetua have now left the comfort of Canadian life, packed up two of their three children, and returned to their country of birth. They welcome us wholeheartedly to their simple home, their kitchen a wood fire outside, their bath a bucket surrounded by the privacy of a bamboo screen, their toilet a pit latrine. The Kuwangisana Centre was born in Sena, a town encompassing a catchment area of 35,000 people, and serving the neediest in their community, those affected by HIV and AIDS. There is limited medical care in this village, a health centre exists but is not staffed by any doctor or clinical officer, and the remote location and harsh climactic concerns mean that often the trucks do not get through to deliver medication, even the life saving ARVs.

The official programs at Kuwangisana include orphan care, adult education, a monthly food support program, crisis care, and home based care for AIDS patients. There are four activists that provide home based care, Tiago, Marta, Lacerda and Arnaldo; a basic nurse who assists clients, Amelia; and a new part time registered nurse, Monica, who will provide essential health care. Currently the program has 24 orphans who are traumatized by the loss of one or both parents to HIV and AIDS. These children arrive at the gate of the centre at 6am most mornings, and are provided two nutritious meals, education, play, education in life skills, and lots of loving care from the centre's staff. Many of the adult residents in this rural area are uneducated, unable to read or write, so Kuwangisana provides adult education three days a week, supplying child care, a teacher, and any learning materials required free of charge. The Food Support Program ran the second day we arrived, and is offered once monthly when the HIV patients of the service attend to receive maize, beans, cooking oil, salt, sugar, soap, and water purification solution. The 25 HIV positive clients in the program gratefully receive their packages and sign their names or leave fingerprints on a list of attendance. There is a huge waiting list of affected people and the goal for this year is to extend the program to 50 clients. These people are gravely weakened by an inadequate immune system, unreliable access to medications, and a staggering shortage of food, and it is encouraging to see that many attend with a family member, slowly extinguishing the stigma that pervades this disease.

The home based care is the heart of Kuwangisana, and the activists offer assistance and hope to those whom the village has forgotten. The vast majority of the clients are women from 17 to 40 living alone or with young children in remote mud huts, with nothing to their name but a small patch of measly maize or millet, a pot to cook with, and a tattered mat to sleep on. Many have lost their husbands, and most have lost at least one child. The stories are heartbreaking. Once a week the activists visit their clients in their homes, assessing their general condition, medication compliance, health concerns, and offering overall care such as bathing, cooking, cleaning and shopping for those who have nothing.

One of our first adventures is attending two of the Lutheran churches that Joseph has started in four communities. We bicycle the 2km to the local church and are greeted by the joyful harmonies and mesmerizing dance of the parishioners who are joined by the rhythmic beat of the musical section, with cans full of tiny pebbles shaking methodically. We are given front row seats for the sermon, and there we meet Rosa, a 38 year old grandmother with HIV who is looking after 3 grandchildren, the littlest of whom is a gorgeous, cheeky, bright little fellow called Chico. We are mesmerized by him immediately, and broken hearted at his state of malnutrition and the fact that at almost 2 years he shows no signs of walking, probably the result of some entirely fixable hip dysplasia. We are determined to assist him, and plan to make inquiries with our orthopedic friends in Malawi. Before we depart we are surrounded by an insistent flood of people, pushing their children towards us to allow examination of pus flowing from ears, and any number of infections of the skin, hair, and many descriptions of the women's private parts. We offer the few antibiotic drops that we have, and mentally create a list of essential medications that we can help provide with donations from our community. The need here for basic health care is difficult to fathom in our immediate satisfaction western health world.

At the peak of the sun's intense 33 degree heat we set off on rickety bicycles with unforgivably hard plastic seats to Murrema, a village some 17km from Sena, winding along goat tracks and past stunning scenery. After repairing two flat tires we finally arrive, sun baked, and the chief of all the surrounding villages shows up to greet us, somewhat imposing, and reminiscent of a rooster fluffed up for his hens. We are told later that he has 3 wives, and is always looking for another, polygamy being commonplace in Mozambique. He has arranged for a bridge of reeds to be laid over the remnants of the flooded waters so that we can join the 150 people singing under the filtered light of the matriarchal mango tree. At the end of the service we are mentally transported to a scene from "The Gods Must Be Crazy." A local teenager drags out a hand carved stump of a guitar, a makeshift branch of a microphone, a homemade speaker, and a getto blaster, and proceeds to play the electric guitar and sing in amplified tones, providing the sustenance for the suddenly materialized vocal backup and dance section.

In the last 5 days we have cycled at least 60km over dirt roads and winding trails to meet some of the Centre's home based clients. The poverty here is even more pervasive than Malawi, and education seems almost nonexistent. Despite the availability of free education for children up to grade 7, the access for many, especially girls, seems prohibitive. Many of the HIV clients are ostracized from their families and communities, many have lost children and husbands, most have TB and other opportunistic infections to deal with as well as the burden of the disease. When we meet Maria we assume she is about 20 years old, although most of Perpetua's clients do not know exactly how old they are, and she is unable to care for her son Victor, so he is one of the "orphans" that attends the Kuwangisana Program. Victor is three years old, but is no more than the size of a one year old. His legs are painfully fragile little sticks supporting the classic extended belly of the starving African child. He is unbearably sweet, and gentle, docile beyond comprehension, has not learned to talk, and is dressed in tattered shirt, much too large for his delicate frame. Despite her HIV, Maria has had two children since Victor was born…both have died.

Two other clients, Anna Maria and Maria are widows of the same man, both blaming each other for bringing the curse of HIV into their home, and living solitary lives, surrounded by the stigma of AIDS. Both have had babies that have died of HIV, and both likely need TB treatment. The stories are devastating; these affected women have either lost their husbands or have been abandoned as soon as they got sick. Reliance on traditional healers is common in this rural area, and many bear the scars of either treatments or beautification traditions. Those who do receive ARVs are lucky to be able to continue them uninterrupted, as the Sena clinic has been out of stock for over a month.

Zita is lying flat on the remnants of her mat when we arrived, her HIV positive son lying next to her. She has an inch of dirty water in a metal cup beside her, no firewood, and they have had no food all day. The Zambezi river is too far for her to walk on excruciatingly painful neuropathic feet to collect contaminated drinking water. Zita's mother is out working in the field, trying to save any remaining maize with her cousin, who has given birth weeks before. We borrow a few coals from a neighbour, for Zita has no match, and a few cups of clean water from another hut to make corn porridge for the pair, who ravenously devour it. Our next client is a grandmother, married to a pastor, both HIV positive, and looking after a disabled orphan grandchild. Beside the mat a pig jerks in disturbing seizures, suffering some horrible disease, until a young boy arrives with a machete and slits the throat, throwing the pig into the fire to burn off the hair before butchering it and offering us some meat, which we decline.

Nutrition is woefully inadequate here as the diet consists mainly of maize meal and millet, with the addition of the occasional green leaves of the cucumber and pumpkin plants when the sandy soil supports them, and watermelon or mangos when in season. This year will be difficult, as the flooding has destroyed many of the maize crops, and there are no other options.

The men of Mozambique are noticeably absent in this struggle; many are in denial and are unwilling to take responsibility for themselves in the face of the disease. The polygamy is astounding to us, men are in short supply because of the war, but it is difficult to comprehend the willingness of the women to be the fourth wife when the women seem to do the majority of the work and bear the responsibility for the communities. Education seems the only answer, but a comprehensive, inclusive program is a long way off, at least in this rural area. Kuwangisana will soon begin a men's group to encourage positive change. The stories are so painful that it is difficult to not become desensitized to the stimulus, but to do so would be to give in to a very dismal future. Joseph and Perpetua are an inspiring example of how the suffering in this pandemic can be mitigated by the genuine compassion of a few individuals, and we are so grateful to be part of this effort. Our community has generously contributed $5,000 to be used to purchase essential medications and supplies, and to fence and prepare a plot of land for planting corn, cabbage, beans, tomatoes, potatoes and other vegetables to feed the orphans and sustain the project. Last night we sat in the cool of the night air, mesmerized by the fantastic light show of an approaching storm. Victor's petite, sweet grandmother arrived with 3 huge watermelons, giving her thanks to us for the light in her grandson's eyes, and all night long it has rained. With renewed hope every day, thanks for joining us.

Anna and Beth

Beira, the capital of Sofala province, and Mozambique’s second largest city is perched on the edge of the Indian Ocean, vainly attempting to sparkle like tarnished jewelry; its weary Portuguese colonial architecture telling the stories of a 10 year war to independence, and its stunted growth evidence of the 17 year civil war to follow. Beira is now attempting to recover in modern times, although the poverty resists progress with its torturous grip on the local people. Each abandoned building has become a repository for the residents of the city, seeking out a meager existence in the concrete rooms that have replaced mud huts; no water, plumbing, electricity or upkeep. The city is flanked by fields of sugar cane, coconut trees, and rice patties, testament to the farming that sustains the life of Mozambicans.

Just outside of Beira, in the village of Mafambisse, lies an inspiring good news story, the Mango Tree Kids Project. Adelino Semente was a young Mozambican man of 24 when he returned to his village home in 2002, and found many children existing in the bush, homeless, malnourished, and without loving care, the result of the AIDS pandemic. He founded the project with his parent’s assistance, and now provides care for 250 AIDS orphans, as well as supporting many other aspects of community development. With the initial cooperation of Italian and Austrian NGOs, he has developed a basic but impressive community centre housing classrooms, a kitchen, dining room, small health clinic, toilets, and a visually captivating circular meeting area where children and the local community elders meet to share cultural stories and traditions. It is Adelino’s dream that these children who have been abandoned by the whims of the disease grow to know their culture, and retain a strong sense of pride and identity. The roadblocks have been significant, Adelino points to the roof of his meeting room, nearly completed but stalled as the third builder has absconded with the money and left the project.

The garden is developing beautifully, and Adelino takes us on a tour of his medicinal herb garden, his passion after completing a comprehensive training course. He has planted an incredible number of plants in parched and sandy soil, and there thrives Tetracycline which he distills into eye solutions for infections, African Potatoes for the immune system, and many other plants whose leaves, roots and seeds provide relief of a multitude of symptoms including diarrhea, malaria, worms, fever, anemia and pain. Adelino is addressing the ongoing health needs of his orphans by arranging for a local doctor in Beira to offer his time several times monthly to attend to the medical needs of the children.

The Mango Tree Kids Project has inspired the surrounding community to get involved, and there are 15 youth volunteers, 6 women, and 6 men, all dedicating countless hours to these rosy cheeked and now healthy looking children. The children have been fostered in the local village with loving families, and come to the Mango Tree Centre for education and care during the days. The centre offers sewing classes and carpentry training for both the orphans and local community, in an effort to reach some self sustainability in the future. They manage to provide this training with rudimentary equipment, rusty saws and hand cranked sewing machines, but still have an enthusiastic and energetic group of students. Adelino is also providing training in the building of fire conservation cooking stoves, ingeniously designed and built of clay to offer some reprieve of the continual deforestation of the landscape.

The funding from outside NGOs has become nonexistent, and feeding these children has become a critical issue. Adelino winces slightly when he assures us that the children are well fed in the foster homes, but we are far too aware of the realities of Mozambican life to be convinced. The World Food Program has been canvassed, but nothing has materialized yet. We hope to assist Adelino in finding funding, and will connect him with the Stephen Lewis Foundation, and work to raise awareness of his worthwhile project. The centre currently invites the children for two meals on Saturdays, a breakfast of porridge, and lunch of beans, rice and vegetables, the crowd often swelling to over 300 children and many needy adults in the community. In the cooler season, Adelino works hard to produce a variety of vegetables and fruits to supplement the basic nsima diet they otherwise endure. The local sugar mill has generously donated 20 hectares of fields where the project will produce maize and vegetables to feed the children, as well as sugar cane to sell back to the company as an income generating project.

Gratefully the children look healthy, happy and well adjusted, and we are thrilled to spend some time playing and interacting with them. The volunteer staff receives training in counseling traumatized children, first aid, music, nutrition, HIV/AIDS education, and administration, and the environment seems to help these children thrive. We meet a cute little boy, John, who presented to the centre with TB of the spine so severe that is was slowly causing paralysis and making a simple breath torturous. He is now treated, nourished, and loved, and the beaming smile across his face is evidence enough for us. The other children are laughing and cheeky, with chubby faces, blissfully black hair, and sparkles in their eyes. Adelino’s dream is to provide food, vocational training, a preschool, library and cultural training for these children, so that they can grow in a loving supportive environment to be proud of themselves and their culture. His project is an inspiration and welcome reprieve from the hardship we have been witnessing. We have had a much needed rest now at Bill and Jenna Slade’s lovely home in Mafambisse, and their air conditioned comfort, shower, flush toilets, wonderful food, and immense hospitality has been most gratefully accepted. We fly to Johannesburg tomorrow, and are delighted to be joining Sipho Mamba in Swaziland for yet another inspiring example of ordinary people making huge impacts in the struggle against the pandemic.

All our best,

Anna and Beth

Johannesburg to Swaziland

The sprawling tentacles of Johannesburg’s bustling suburbs disturb my sense of placement in the world… how did we depart from the mud huts of rural Mozambique and miraculously descent upon this urban jungle? By this, our third visit to the modern and mainstream Jo’berg airport, we are in relative psychological comfort, and are blessed to be met by our friend Jobsi, who unblinkingly offers her home and hospitality for the second time this trip. Harry and Jobsi represent the new South Africa in my naïve and likely misguided perspective. They were raised in poverty, in two of the government’s enforced settlements, Tembesa and Sharpeville, and have risen far above adversity to now be one of the wealthy black families dotting the once segregated, and still strangulated, porcelain neighborhoods. The neighborhoods where barbed wire decorates every impenetrable fence, Dobermans and Rotweilers pant purposely at the gates, and ubuntu has been replaced by anxiety. As trusting Salt Spring Islanders who often leave their doors open, we are disturbed by this reality, and shocked by the daily reports of horror that define the Soweto Times and Daily News.

Jobsi invites us to a funeral, a weekly commitment on her part these days, and we are honored to attend. This time it is “Happy” a 44 year old man, separated from his family, who, overwhelmed by his problems, took his life. We gather under the colorful marquee tents that overtake the front yard of the little matchbox home in Tembesa, the largest township in South Africa. The typical hymns and harmonies are interspersed with sermon, and despite the absence of any other white people, we feel inconspicuous and welcome in the community. The segregation of white and black is still very apparent, at least in this ceremony, despite the fact that this man worked for South Africa Airways, and surely had many white colleagues. We travel to the cemetery in a serpentine procession of cars, lights flashing, and the local women’s group, started during the anti-apartheid movement, line our path and offer consistent support in their bright pink blouses and black skirts. These women gather weekly now, to offer each other friendship and understanding, and contribute regularly to a community fund to bury family members and friends.

The burial itself is surreal, we are but one of many grieving masses gathered to witness the shovelfuls of red dirt covering the simple coffin. Funerals have become big business in South Africa, and the colorful tarps, red carpets, and elaborate wooden boxes are testament to the relative wealth of the dead. A cacophony of hymns competes for splendor, as the men methodically cover the body with shovel after shovel of earth, leaving plumes of red smoke rising from the multitude of red mounds as we depart. We are doused with water when we return to the home to be cleansed of the lingering scent of death, and the mourners gather to share the food prepared and served by the smiling women’s group, and life goes on.

It is with a deep breath of appreciation that the Swaziland scenic rural beauty appears through the protective cover of cloud, and the rolling hills, red dirt roads, and rural thatched homesteads appear beneath us. Sipho’s smile is immediately familiar and his warm embrace transports us comfortingly back to our first meeting on Salt Spring Island, at the Community to Community Conference last fall. We decide to rent a car, as the Khamboke homestead lies a remote 100km south of Manzini, where we have landed.

The scenery becomes ever more magnificent as we head south, a semblance of the rural Nepal of a previous journey. Terraced hills are strengthened by the rich red soil that offers life to numerous crops, and proud homesteads are scattered over the countryside. We traverse the last rugged leg of road which provides a family welcome to Sipho’s simple and magical home, and we are greeted warmly by Colleen, Sipho’s cherubic and charming wife, and three of their wonderful children, Magi, Phumie and Lungi. Sipho’s homestead is a comforting blend of tradition and movement, with a simple concrete home surrounded by the traditional Swazi ancestral offerings, a rondavel with a shock of thatch providing shelter, and an intricately and methodically created ancestral shrine, each stone and stick purposely placed.

We are delighted to be visiting the informal orphan school that has been the result of much thought, compassion, and planning for Sipho’s family. Sipho retired from his position as Minister of Agriculture some 10 years ago and immediately recognized the need for orphan care to deal with the crisis of 600 orphans in his surrounding community. He responded selflessly by creating an informal school and orphan care centre at his grandfather’s homestead, some 4km from his current home. Walking over the gentle fields to the orphanage offers time to reflect on the significance and importance of caring for our families, neighbors, and friends both locally and globally, and my spirit is rejuvenated to see 42 healthy, bright, energetic kids playing outside the school. Of course there are issues, one little girl who has the stature of a six year old, yet is ten, surely has fetal alcohol syndrome, one little boy born with hydrocephalus perches on his bottom, content with the shunts draining fluids from his brain, several of the newest arrivals are severely malnourished, with the accompanying sores and scabs of lack of consistent care, but there is clear hope here, and a sincerity of mission that it is impossible to fabricate. We have brought $4000 from our generous community in donations of food, medications, and assistance in the construction of toilet facilities, structural support in finishing the roofing on a classroom and library, and funding a chicken project, providing meat, eggs and financial stability to the school.

The hospitality offered to us by the family was astounding and we were somewhat sad to leave the farm at the end of the week, on route to meet the infamous Ray of Revelstoke, an acquaintance over email, and soon to become a fast friend (literally). Ray and his wife Jackie have been shipping containers of donated goods around the world for a number of years, and being with Ray is akin to being in the middle of a well intended hurricane, doing good wherever he lands. Ray is one of the most energetic and dedicated people I have had the pleasure to meet, and he clearly does not know the word no! Everything is possible in his world, and Ray immediately had us schlepping boxes, loading containers, running around to projects serving 450 children meals each day, and after 6 days of activities we were pleasantly exhausted and felt as if we had known him for 6 months! The donations Ray receives are incredible; fabulous soup mix from the Gleaners of the Okanagan which will provide 200,000 servings of immensely nutritious soup for local orphan initiatives, bales of clothing, boxes of shoes, children’s books, computers, dried apples and pears, building materials, medical equipment, and countless other offerings. These orphans are so desperate for affection and attention that it is with much difficulty that we pry ourselves from their clutches when it is time to leave. Ray is so good natured that after meeting Colleen we loaded up a truckload of goods to take back to Sipho’s home, which had the family literally dancing with joy.

In the midst of all the revelry of container distribution, Beth and I took a well needed break, and took Colleen with us to the Hlane Game Reserve, where we were thrilled to see elephants, rhinos, giraffes, lots of various antelopes, warthogs, and numerous birds. Beth’s second mission to Africa and she has finally seen some animals! We are all off to Lesotho next, to arrange distribution of another container of goods for Mamello’s project, Ha Makhata, where 300 students are now benefiting from a new school and nutritious food, and a new community of friends awaits us.

All for now, and all our best to you,

Anna and Beth

Congratulations Anna & Beth!!!

Just got this note from Anna:

Hello Team!

Not usually one to blow my own horn, but thought we should all celebrate the fact that Beth and I are being presented with the BC Pharmacy Association's Award of Excellence for our work in Africa! This is quite a prestigious award....in 2003 the BC Center for Disease Control received it for their work in preventing the spread of SARS in BC. The presentation will take place in Kelowna at the end of May at the annual conference, and should be a great opportunity to share the work that SOLID is doing, and encourage lots more health professionals to offer their skills and time! Very exciting :)

A

I always knew that you were special. Ever Onward. Shirley Mc

Just got this note from Anna:

Hello Team!

Not usually one to blow my own horn, but thought we should all celebrate the fact that Beth and I are being presented with the BC Pharmacy Association's Award of Excellence for our work in Africa! This is quite a prestigious award....in 2003 the BC Center for Disease Control received it for their work in preventing the spread of SARS in BC. The presentation will take place in Kelowna at the end of May at the annual conference, and should be a great opportunity to share the work that SOLID is doing, and encourage lots more health professionals to offer their skills and time! Very exciting :)

A

Yeah! Mom ... you did it : )