ARV treatment in Malawi

When I first got to Malawi I had no idea what ARVs were. To be honest, I’m not ever sure if I’d ever heard the name. But the more time I spend here, and more specifically the more time I spend working at Baylor’s pediatric HIV hospital, the more I realize how important these drugs are for patients suffering from HIV/AIDS.  ARV meds can be the difference between an HIV/AIDS patient living until he’s 80 years old, and an HIV/AIDS patient dying at a very early age because of the disease. Patients who put themselves through regular ARV treatment come across as healthy and happy people. People who don’t have access to this type of treatment can suffer through a slow and painful death.

The whole reason I bring this up is to highlight a piece of news that I just read in the Malawian newspaper this morning. The article informed me that there are currently 250,000 people on regular ARV treatment in Malawi. This may sound like a good number, but when you go digging into the details you’ll realize that this means that only 25% of people living with HIV/AIDS in Malawi are receiving the care they need to survive. You see, the population of Malawi is just over 14 million. And many of the most recent estimates about HIV/AIDS in Malawi suggest that the national prevalence rate is somewhere between 12 and 14 percent. This means that even at a very conservative guess, there are over one million people living with HIV/AIDS in Malawi today. (A more adventurous guess would put that total much closer to two million, around 1.7 if you want to be exact). But regardless of what the total number is, this much is clear – there is a significant number of Malawians infected with HIV/AIDS who are not receiving access to ARV medication. When you consider that in some countries like Botswana and Namibia the ARV coverage rate is between 70 and 80 percent, you can see that a in a country in Malawi where only 25% of people are covered, there is still a lot of work to do. 

I don't care about your name! I just want to see you dance

In a lot of ways this past week has been the culmination of my first six months in Malawi. Every single one of our sites – Area 36, Area 25, and Kawale – has recently finished their 10-week GRS HIV education curriculum and as a result we’ve been spending the past couple of days graduating all of the newest members of the GRS family.  All of our coaches and all of the kids graduating have put in a ton of work and effort to get to graduation day, and I don’t know if I’ll ever be able to convey the happiness and joy that fills the room when these kids accept their certificates. Most of the graduation classes put together a poem or a song about GRS to help celebrate the day. I’ve been blown away with the amount of talent and effort that goes into each one of these works of art. I’ve been taking a lot of pictures, and actually a lot of videos too, but as always I won’t be able to post them onto my site because of the terrible Internet here in Malawi. I have a hard enough time posting these blog updates!

Anyways, I’m basically writing this post to talk about two things that I’ve enjoyed the most in the past two weeks:

1)     Dancing – I can’t even count the amount of times that I’ve been forced to dance in front of hundreds and hundreds of people during my graduation ceremony tour. It seems that Malawians are more concerned with seeing an individual’s dancing ability than anything else. At one graduation ceremony yesterday one of the teachers in charge of the program literally said the following to me after I was done introducing myself: “I don’t care about your name! I want to see you dance!”.  After he finished saying those fateful words all of the kids in attendance, close to 1,000 in total, started clapping their hands frantically in eager anticipation of my moves. Needless to say I didn’t disappoint (that is one video I might intentionally be hiding).  The whole dancing thing may seem a little weird at first but when you think about it, it’s pretty awesome. It just shows you how much people around here enjoy life, no matter the circumstances. They could be starving, dying of some disease, in total poverty, but if there is a beat they will dance and enjoy life for as long as they can. I was trying to think about what would happen in the States if one of the teachers started clapping and waiting for everyone to dance and I immediately recognized the fact that almost every single American kid would just sit in his seat and be weirded out by what was happening. In Malawi, the kids are ready to dance and have fun whenever and that makes things a lot more fun for me.

2)     Commitment to GRS – One of the most astounding things I’ve been trying to wrap my head around recently is the level of commitment that these kids show to the fight against HIV/AIDS. As I was sitting through a graduation ceremony yesterday I started asking myself – “Why are these kids even here? Why would they devote so much extra curricular time to our program when there is no tangible benefit to be gained?”. In all honesty I was having hard time finding answers to these questions. I mean, we were putting these kids through an intensive 10-week HIV education program, where they devote hours and hours of time outside of school and giving them no tangible reward.  I was imaging myself at that age and thinking about what I would have done back in the day, and I’m pretty sure I would have avoided any sort of serious extra curricular work at all costs.

But then it hit me – these kids don’t need any monetary or tangible rewards for this education because all they really care about is the knowledge itself. This is a disease that affects almost every single Malawian (I guarantee that everyone in the graduation room knew at least one person touched by HIV/AIDS). These kids just want revenge. They want to learn about what has been attacking them and their communities so that they can one-day defeat it. To sit back and watch the level of commitment that these kids had within themselves gave me a new sense of inspiration and passion for my work. Their dedication proves just how serious the problem of HIV/AIDS is in the region, and it proves that we need to do everything in our power to beat it once and for all.

In other news, starting to get very excited for the Super Bowl. Sunday night will be a very very late night but its hands down one of my favorite events of the year so I’m going to find a TV and get my popcorn ready.

Prediction – Colts 31, Saints 23 

Witchcraft in Malawi

So I’m going break my own cardinal rule and discuss something unrelated to GRS and HIV/AIDS work on my blog. Normally I wouldn’t want to waste your time with anything other than updates on my work for GRS but something really spooky and interesting has peaked my interest recently.

In the past couple of weeks, there has been a lot of talk about witchcraft all over Malawi and in some other African countries. The more I started hearing these stories the more spooked out I became. Pretty much every hundred yards you go in Malawi you see a signpost for the local witchdoctor (basically it’s a skull and bones flag that extends from the witchdoctors hut into the sky). In these huts, witchdoctors are rumored to do all sorts of black magic. They cast spells, they create bizarre potions, they cut people to get blood, and they do all sorts of wacked out stuff.  Many of the spells are designed to cure sickly loved ones, or even to get some crush to fall in love with you, but there are also some more sinister ones as well. Some neighbors have been accused of getting the local witch doctor to injure or kill another neighbor to settle some dispute over land or money. As I’m writing all of this stuff, I can imagine most westerners who are reading to digest this info with a mixture of disbelief and humor. I’m sure most people are asking themselves – “How can people actually believe this stuff works?”

Well to answer that question, almost every single Malawian that I have talked to about witchcraft genuinely believes in it. In fact, not only do they believe in it, they swear by it and would most probably die to defend it. At first I thought like I imagine most westerners would think on the subject, I kind of just laughed it off and didn’t take it seriously at all. But the more I thought about it and the more I discussed it with locals, the more I appreciated what it means to local Malawians. Witchcraft is an integral part of Malawian culture and as such it should be respected and taken seriously. That being said, while I was reading the local papers this morning I read a very interesting article about witchcraft.

The story is more or less as follows: two older Malawian women were allegedly teaching some little girl the ins and outs of witchcraft, some woman in the community was murdered, the little girl accused the two women of casting a murderous spell on the victim and as a result the police took the women into custody. As I write this, the two older women are sitting in a jail cell facing a maximum sentence of 10 years imprisonment with hard labor. Apparently, the Malawian courts recognize the accusation even though there is no evidence to support it (I guess evidence is hard to come by in the world of magic and witchcraft). I make a point not to try to judge things too much when I’m in a foreign culture, for the most part I understand that Americans have traits and habits that the rest of the world mocks and we, as Americans, make fun of many foreign cultures for being “different”. All that being said, I couldn’t help but be reminded of the Salem witchcraft trials when I was reading this article. I mean, it is one thing to recognize and respect the Malawian predilection for witchcraft, but it is another thing all together to think that it’s ok to put someone in jail for 10 years without any inkling of evidence.

Finally, I know I said that this post was completely unrelated to my work for HIV/AIDS. But you probably won't be suprised that the world of black magic/witch craft isn't too far away from the world of HIV/AIDS in a lot of cases. Many local people believe that if someone is diagnosed with the disease it is because someone else has cast a spell on them. Too many people, and especially children, think that HIV/AIDS is the work of black magic and not of bad choices (unprotected sex etc). I can't tell you how many times I've discussed the role of witchcraft when discussing HIV/AIDS with children here. I do my best to tell them that there are real and tangible ways of avoiding HIV/AIDS but a lot of children don't believe me. While many children may agree that leading a healthy life style can be one way of avoiding HIV/AIDS, according to them there is nothing you can do to avoid the disease if a witch doctor has you in her cross hairs.

All right, well I just thought this stuff was pretty cool so I thought I might share it with you. Hope everyone is doing well wherever you are! Miss all of you!

Home Sweet Home

Back in Malawi!

Sorry for the delay in between posts. Since my last post on November 27^th, I’ve traveled through Zambia, Zimbabwe, Botswana, Namibia and South Africa and also spent a bit of time at home with my family and friends. The traveling may sound like all fun and games and admittedly I had an unreasonable amount of fun. But getting to know different cultures and meeting people from different African nations was truly a fantastic experience. Africa is such a huge and diverse continent and each new country that I visit seems to amaze me in new and exciting ways. Unfortunately Africa is all too often thought of as one country or one culture, which is so crazy because each country is so extremely different from its neighbor. There are so many different languages, religions, traditions, customs etc, it almost feels like you’re going to a completely new continent every time you go to a new country in Africa.

            While I was at home I was able to regroup and reenergize myself for the next couple of months in Malawi. I absolutely love it here and I couldn’t imagine doing anything else, but that being said sometimes it is very difficult to go through a typical day here. The work we do is so amazing and rewarding in so many ways and there are some days that I feel so good about everything that is going on, but there are also some days where I just feel completely mentally and emotionally destroyed. Some days you go to work and see the kids living with HIV and you get inspired by their ability to overcome whatever obstacles come their way. Other days you just can’t get over the tragic circumstances that these kids are thrown into from birth. The job and all of the emotional baggage that comes with it is an emotional rollercoaster so having a couple of weeks off at home was really great for me.   

            I thought it was going to be really tough to go into the office on Monday morning after 40 hours in a plane/in an airport but I was actually really happy and excited to get to Baylor. I missed all of our coaches and everyone here a lot while I was away so it was good to see everyone. I bought all 20 of our coaches Red Sox t-shirts to reward them for all of their hard work and also to spread the good word of the Boston Red Sox.

            This week Rachel and I are checking up on all of our coaches and supervising them in their class interventions. The first intervention cycle of 2010 (a 10 week HIV education course that runs through the GRS HIV/AIDS curriculum) started two weeks ago so our coaches have been working hard to maximize the impact that they are making. We’ve starting the planning for the graduation ceremonies that will take place after the 10-week intervention cycle is completed. These graduations are designed to reward the kids for their hard work and commitment to GRS so I’m excited to do everything possible to make these kids happy.

Beyond that, Rachel and I are also continuing to plan half-day VCT events all over Lilongwe. We’re doing our best to expose GRS to new regions and new schools and we’re also trying to incorporate some major Malawian celebrities to attend our events and help us attract large crowds. The Malawi national football team just made a pretty impressive showing for themselves in the African Cup of Nations (basically the African version of the World Cup) and so we’re trying to get some of the national team players to help us spread the GRS curriculum. I’ll keep you updated on any progress that we make.

            Hope you guys have a safe, healthy and happy 2010 full of fun adventures! Feel free to shoot me an email if you want to say hey – erenkmunir@gmail.com

Some food for thought on Thanksgiving Day

Hey everyone,

I hope Thanksgiving Day finds everyone well and that you all manage to spend a little time with the people you love. I sure wish that I could have the three F's in my life right about now -- family, friends and football. But I'm happy to settle for some nsima, which is what I eat every day, and my new Grassroot Soccer family.

I just wanted to write a quick entry to share some of the latest research in the world of HIV/AIDS. All the information is coming from the Kaiser Family Foundation, one of the leading researchers of HIV/AIDS and other global health problems in the world. KFF is an American non-profit that does a lot of good work all over the world and I love reading all of their most recent updates.

Here are two links to the latest stats and figures for the global HIV epidemic. The first link is a general stat sheet that covers HIV all over the world while the second link focuses exclusively on Africa's relationship with the HIV/AIDS virus.

1. World

http://www.kff.org/hivaids/upload/3030-14.pdf

2. Africa

http://www.kff.org/hivaids/upload/7391-08.pdf

In case you don't have time to look through the two links I'll share some of the facts that I find the most interesting.

A) 67% of people living with HIV/AIDS live in Africa (that's 22.4 million people). 70% of new HIV/AIDS infections take place in Africa, and 70% of all HIV/AIDS related deaths occur in Africa. There are mind blowing percentages when you consider that there are currently 33.4 million people living with HIV/AIDS and Africa only accounts for 12% of the world's population.

B) The Adult HIV/AIDS prevelance rate in Sub-Saharan Africa is 5.2%.

Sorry to give you guys such a sombre Thanksgiving post but I think it's important to think about things that this while your giving thanks for whatever your giving thanks for.

Before I sign off, I will finish with a really important quote from the KFF:

"The latest country estimates from UNAIDS and WHO indicate that in most sub-Saharan African countries, HIV/AIDS prevalence has stabilized, although often at high levels. In addition, some countries have even begun to experience declines. Finally, there is evidence of reduced risk behavior in some parts of the region. Most countries in sub-Saharan

Africa have developed national responses to HIV/AIDS through National AIDS Commissions, legislation, programs, and services"

There is hope after all!

Happy Thanksgiving!

315 people tested at our 3rd and final testing event!

Sorry for the delay in between posts, November has been a busy month for GRS in Malawi. Things are finally starting to settle down now that you lucky people in the States are getting ready to chow down on some Turkey.

Rachel and I hosted our third and final half-day VCT testing tournament this past Saturday in the Kawale district of Lilongwe and the event was a huge success. The final numbers on the day were as follows – 315 people tested, 9 people were found to be reactive and of those 9 only 2 of them were over the age of 18. I have a couple of notes about the day as a whole:

· The number 315 is absolutely phenomenal. In our previous two events we managed to test 120 people and 220 people respectively so to beat our previous high by almost 100 is a great achievement. The fact that we’re improving on our numbers by right around 100 people from one event to the other is making the GRS Malawi team recognize the limitless potential of these half-day events. With continued improvement we’re hoping that one day we can try to test 500 or even 1000 people at these half-day events.

· The final budget for the day ended up being around 270 dollars. With the help of Baylor Hospital here in Lilongwe we’ve managed to cut pretty much every single unnecessary expense so that we can focus our money on things that will make us more efficient. The fact that we’re testing over one person per dollar that we’re spending is a pretty cool stat; especially when you consider that the standard budgets for testing events in Southern Africa can go as high as two or three thousand bucks while testing right around the same number as us.

· The thing that amazed me most about the event was how smooth and hassle free it was. At the previous two events we had major problems that came out of nowhere at the last second, for example in Area 25 one of the teams didn’t show up and in Area 36 four of the teams showed up two hours late. We had a few unexpected hiccups at Kawale but for the most part we dealt with them quickly and didn’t let them disturb our rhythm at all. We avoided one major catastrophe when Mother Nature decided to be kind and hold off on the rain until the end of our event. At one point it started to drizzle a little bit and I totally froze. I knew that if it started pouring everything would have been ruined – the kids would have run home, the PA system guys would have packed up shop and the counselors would have gone home as well. I can’t even begin to imagine how terrible it would have been if it had started raining. For one thing, we probably wouldn’t have tested 50 people and all of the 270 bucks that we spent would have gone to waste.

· One of the toughest parts of the day was when this 18-year-old kid came up to me and told me that he had just tested positive for HIV/AIDS. I tried to support him as much as possible and raise his spirits but the worst part was that he didn’t believe the outcome of the test. He kept saying that he didn’t believe the doctors but when I asked him why he couldn’t come up with one good reason not to believe them. I tried my hardest to tell him that he had to visit the Baylor clinic in the next week to follow up the positive result and consult with one of the clinicians at the hospital but he seemed very hesitant and almost hostile. After a while we managed to calm him down and we booked him in for an appointment this week but for a little while that was kind of a scary moment. I think his reaction to the positive result was a product of two things: 1) I think he was scared and part of the HIV/AIDS culture here is to run away from things that scare you. 2) I also think that this was a classic case of HIV/AIDS stigma. The kid didn’t want to believe that the positive test was real because he didn’t want to accept that HIV/AIDS was a real problem. Either way, as long as he goes to his appointment and sticks to his ARV’s he’ll be ok but we definitely need to keep an eye on him.

· I don’t want to finish on such a somber note so just before I conclude my post I’m going to talk about one of the coolest things about the Kawale event -- the presence of the local community Chiefs. In Kawale, and actually in a lot of Malawian communities, the Chiefs are the most influential people in the area. We extended invitations to all 12 Chiefs in the Kawale area and we were all extremely surprised to see all 12 of them show up on the day of the event. These Chiefs were undoubtedly one of the main reasons we managed to boost our number to 315. Their presence inspired kids, mothers, fathers, and absolutely everyone around to come out to our event and test. The best part of the whole Chief experience is that some of them actually agreed to test. We were by no means expecting them to agree to test and we were ok with that, we thought their participation would be enough of a help to our event. In fact, some of them almost declined our invitations because they were worried that we would force them to test. But in the end, after they saw what we were doing for the kids and how fun everything was some of them actually agreed to go into the testing room. The fact that they not only showed up to the event but actually participated in the testing aspect was a huge help to GRS in Malawi and a testament to their wisdom as Chiefs. Hopefully we can continue to build a working relationship with them because their power is unparalleled in Malawian culture.

All in all the day was a huge success and I’m really happy because it means that I can start my 3-week journey home on a high note. Starting on Friday Rachel and I are planning a nice long trip from Lilongwe to Cape Town through Zambia, Zimbabwe, Botswana and Namibia. We’re planning a couple of fun activities along the way – some of these fun activities include bungee jumping from Victoria Falls, sand dune surfing in Namibia, visiting a sweet safari park in Botswana and white water rafting down the Zambezi. I’ll be sure to let you know how it goes if I survive and I’ll take as many pictures as possible.

Happy Thanksgiving to all of you wherever you are in the world!

Great coverage of GRS Malawi in the Press

Hey Guys,

Just wanted to write a quick update with two important things.

1) In the last week, all of the major Malawian media organizations have been sending requests to interview Grassroot Soccer about the record breaking number of HIV tests at the two events that we hosted in Area 36 and Area 25 last week. The two biggest newspapers in the country have covered the events and all sorts of important people have been congratulating us on our huge numbers. Apparently the 615 people that we tested last Sunday is a record number of tests in one day in the history of HIV/AIDS in Malawi -- pretty awesome news.

One of my jobs in the past week was to write an article/press release to detail the success of our events. The Grassroot Soccer website posted it on the main website today, so I'll include the link if you want to check it out (if I were you I would check it out, not to read the article but to look at the picture from the event). Here is the link to the article on the GRS site:

http://www.grassrootsoccer.org/2009/11/03/arecordnumberofhivtestsinmalawi/

And if you don't want to look at the link, I'll copy and paste the article from the site here:

GRS Malawi saw unprecedented success during the weekend of October 23-25, 2009, through two community HIV testing events in Lilongwe. On the 23rd of October, through a half-day Voluntary Counseling and Testing (VCT) tournament combining soccer, GRS activities, and HIV testing, GRS Malawi tested 215 people. Two days later, the GRS team, in partnership with the Baylor College of Medicine/Abbott Fund Centre of Excellence, tested another 610 people during an impressive community sensitization event with over 4,000 people in attendance. Testing a total of 825 Malawians in one weekend, GRS Malawi is making great strides to fight the pervasive stigma and fear that deter people from learning their status. David Jones, Vice President of the Baylor International Pediatric AIDS Initiative, stated, “there has not been a larger single HIV sensitization event organized in the country ever, or more people tested at a public event in one day.”

The following is a first hand account of the weekend written by Eren Munir, a Grassroot Soccer intern in Malawi:

After weeks of preparations, the weekend set to begin at noon on Friday, October 23rd, with a half-day VCT, and end at 4 pm on Sunday, October 25th, with a community-wide sensitization event, was finally here. Charged with the ambitious task of completing two separate testing events in two distinctly different areas of Lilongwe, Malawi in just 52 hours, we were unsure what a realistic goal for the events would be, but decided that testing 300 people, between the two, was reasonable.

Having tested 115 people at a similar half-day VCT tournament three weeks earlier, we hoped to test 100 people during Friday’s tournament. By incorporating soccer and HIV education into a positive environment around testing, however, we were able to provide counseling and testing services for 215 people, surpassing our goal while spending only $235 for the entire event! The cost-effectiveness of our model, which capitalizes on the power of soccer to encourage people to test, is inspiring. With one success behind us, we prepared for Sunday’s sensitization event, unsure of what to expect from an event we had never run before.

The sensitization event was even less predictable, and with church attendance a common Sunday activity in Lilongwe, we wondered if we would be able to draw a significant crowd. On our side, however, was the presence of Mafunyeta, one of Malawi’s most popular musicians. Early in the afternoon, with over a thousand people in the audience, we anticipated testing 200 people. But as the golden Malawian sun beat relentlessly on our backs, and the day wore on, suddenly, people began streaming in by the hundreds. Soon, the crowd had tripled, and over 4000 people gathered for the music, performances, and HIV education presented by GRS and Baylor’s Tingathe and PMTCT Outreach Programs. The sea of people before us was a powerful sight and at the end of the day, the news that 610 people had tested during the event was overwhelming. Bringing the total number of people tested to almost three times our initial predictions, the GRS team felt proud of and inspired by the community’s collective action in the face of an epidemic that claims the lives of more than 60,000 Malawians every year.

2) The second piece of news is that we’ve had to push back our next VCT event by 2 weeks. We were supposed to have our third and final VCT event in the Kawale district of Lilongwe this Friday (the 6^th) but because of a massive overhaul in the academic schedule, our plans have been completely changed.

Basically, the Malawian Government decided yesterday to completely switch the academic calendar by moving the Christmas holiday for each government school and by shortening the vacation time by 4 weeks. Can you imagine how upset you would be if you were a student and your vacation time was completely ruined???

The new academic calendar certainly makes things a little more difficult for us but we’re still going to try to have our even in Kawale before the break starts at the end of November. I’ll keep you updated as I know more.