Malawi’s missing midwives

The Guardian March 8, 2011

 Just found this article by Brigid McConville on a day when new President, Joyce Banda took a leaf from Bingu’s (the late President) notebook and banned Traditional Birth Attendants TBAs.

In the past 3 years few nurses were trained, as Bingu’s government failed to fund nursing student fees. So my question is where will the nurses come from. One of the most serious issues in Malawi today

Is there any chance of up-skilling the more skilled TBA’s in the short term?

• Brigid McConville is director of the White Ribbon Alliance for Safe Motherhood (UK)
In Malawi the risks of women dying in childbirth are among the highest in the world, and local women need to be empowered to press for change. Malawi is crucially lacking in midwives and nurses, with around three-quarters of staff positions vacant. On a fact-finding missing to Malawi, I can’t help noticing a 5 metre-high billboard at Lilongwe airport: a young woman in jogging gear and headphones advertising an offer of high-speed downloads, live TV, music and video calls. Mobile phone technology has truly arrived.

But midwives and nurses still haven’t. Around three-quarters of staff positions in Malawi are vacant, and sometimes women are arriving at health facilities in rural areas to give birth – to find only a cleaner to assist them. It’s only 50-50 that a woman in Malawi will have a midwife, nurse or doctor on hand in childbirth; the rest give birth alone or with only a neighbour to help.

In this small country, the risks of women dying in childbirth are among the highest in the world: 510 women will die for every 100,000 who give birth, compared with 12 in the UK. The loss of newborns is so common that they are not buried as other people are, but often in a nameless, limbo category of their own.

Lennie Kamwendo, a stalwart of the White Ribbon Alliance for Safe Motherhood and former president of the Association of Malawian Midwives, has been a newspaper agony aunt for many years. In a country where it’s difficult to talk about sexual health openly, she put her mobile phone number on her column and took calls from women day and night – at no charge.

Kamwendo is immensely proud of the profession of midwifery. Yet her colleagues, especially in the remote rural areas where 90% of Malawians live, are often working alone, day and night, to save women’s lives without the back-up they need. When things go wrong, they get blamed. When the health clinic is late to open because the nurse or midwife needed a few hours of sleep, lives are put at risk and communities are angry. When exhausted midwives respond rudely, word gets out and women don’t come – again putting lives at risk.

A few years ago, the government simply cancelled all training of health workers; the midwives trade union and others threatened a strike, and training was restored – but a year’s “crop” of health workers was lost. And that was only 500. Meanwhile, the system lacks accountability. A medic told me how this year, as in previous years, doctors knew that blood banks didn’t have enough supplies to get through the Christmas season. But their views were not heard, and women died as a result. Did a minister or senior civil servant lose their job as a result? No.
Why aren’t people up in arms about this needless loss of life? Levels of literacy in Malawi are low, and only around half of women can read. Midwives told me that women tend to think of professional healthcare as a privilege rather than as their right. So when things go wrong, they don’t complain.
Only when women are aware of the dangers of giving birth without skilled care, and know their rights to health services, can they press for change. Only when they are asked about their experiences – and listened to by policy-makers – will things move forward.
The White Ribbon Alliance in Malawi wants to make a film that will do just that – and show it in villages, on television, in parliament. Maybe the music will come from the charming permanent secretary at the ministry of health? Apart from his day job, he is a popular “selector”, known as Dr DJ. I heard about him from a young advocate in Lilongwe who regularly checks Facebook on her mobile phone.
So if phones and Facebook are available across Malawi, why not nurses and midwives?

The international community has promised resources to cut maternal deaths by three-quarters. The Malawian government has promised to invest in health workers. Let’s make sure these promises are kept.

Why Development Aid for Africa Has Failed

A commentary by Kurt Gerhardt

Development aid to Africa has been flowing for decades, but the results have been paltry. Instead, recipients have merely become dependent and initiative has been snuffed out. It is time to reform the system.

Development aid to Africa is a blessing for all those directly involved — both on the giving end and on the receiving end. Functionaries on the donor side, at least those abroad, earn good money. Many of those on the receiving end, for their part, know how to organize things in such a way that their own personal interests don’t get short shrift.

There is no reason for these two groups to be interested in changing the status quo. Yet even so, some within their ranks are starting to suggest the situation as it stands cannot continue. The development aid of the past 50 years, they say, is hardly justifiable given the disappointing results. Even individual donors, who know little about how development aid works in practice, increasingly sense that something might be amiss.

They’re right. The aid has failed to a large extent.

We have taken on too much responsibility for solving African problems. We have essentially educated them to, when problems arise, call for foreign aid first rather than trying to find solutions themselves.

This attitude has become deeply rooted inAfrica. This self-incapacitation is one of the most regrettable results of development cooperation thus far. Poorly designed development aid has made people dependent and accustomed them to a situation of perpetual assistance, preventing them from taking the initiative themselves. It is this situation which represents the greatest damage done, far worse than the enormous material losses engendered by failed aid projects. And there are many.Africais strewn with idle tractors, ruined equipment and run-down buildings.

Deeply Rooted Misconceptions

The mothering mindset, widespread in industrialized countries for decades, is in direct violation of the subsidiarity principle. This principle states that providers of aid, whether private or governmental, should not assume any duties that could be carried out by the receiver country itself. Furthermore, it mandates that aid be given such that those providing it can cease giving as soon as possible.

Plenty of Lip Service

The subsidiarity principle should have been key to designing this cooperation from the beginning. In reality, it has played far too small a role.

The donor side is certainly not lacking in theories, clever strategies or concepts — international development agencies have cabinets bursting with them. What’s lacking is a basic understanding and clarity when applying principles. The realization that northern countries cannot develop the South — that people and societies can only do so themselves — is given plenty of lip service. In practice, however, the idea hardly plays a role at all.

Development experts sent to Africa come from societies that tend to value efficiency and speed to a greater degree than is generally found in Africa. Furthermore, foreign aid workers, as a rule, only spend a few years in a target country. Their desire to “achieve something” often leads them to do more than they should according to the subsidiarity principle. But by doing so, they inhibit Africa’s own momentum and prevent it from growing stronger.

A further breach of the subsidiarity principle is found in the existence not only of the immense national and international development agencies, from the German Society for Technical Cooperation (GTZ) to the World Bank, but also of myriad private organizations both small and large that cover the continent with their network of charitable works.

Occupying Powers

These are the de facto occupying powers of the post-colonial period.

The second tenet of the subsidiarity principle holds that aid should become dispensable as quickly as possible. In Germany alone, the livelihoods of up to 100,000 people are dependent on the development aid industry. One can imagine the outrage that would result should someone seek to dismantle these agencies. But exactly that should ultimately be the raison d’etre of these agencies. After decades of providing aid, their continued existence is proof of their failure.

It is contrary to the logic of subsidiarity to give a person something that he or she could acquire or produce on their own. Yet in the hopes of doing good, we have done exactly that far too often in recent decades, whether it be a grain mill in a village or a council of GTZ experts for a government ministry. A considerable portion of Germany’s bilateral aid, amounting to more than €1.5 billion ($2 billion) per year, is given as grants — in other words, as a gift. Indeed, all of the least developed countries tend to receive foreign aid in the form of grants. Two thirds of the countries in sub-Saharan Africa belong to this category.

These perpetual gifts have made partners into beggars, ones who no longer value the things they have been given and consequently have not maintained them well. Apart from a few exceptions, emergency aid being one example, free aid was and remains fundamentally wrong.

Part 2: The Question of Money

Aid given with no strings attached robs the recipient of competence. The method has resulted in a divorce from reality inAfrica, at all levels of society. It’s time to accustom our partners to normalcy — those who want to initiate a project but lack the necessary funds to do so, must take out a loan and pay it back. Indeed, this is where aid from abroad can make a significant contribution: by seeing to it that everyone committed to development has access to loans, and particularly by supporting microcredit programs.

The urge of foreign aid workers to quickly produce results promotes quantitative thinking and gives short shrift to efforts aimed at helping locals learn how to develop themselves. One example of this erroneous notion is the goal among donor companies, adopted 40 years ago, to donate 0.7 percent of GDP in the form of development aid.

It makes no sense to establish amounts before discussing the projects that should be funded with that money. The worst thing about this discussion is that it, once again, is purely quantitative. It feeds the disastrous attitude that more money necessarily means more development. In this way, lessons learned over the past decades are completely ignored.

Instead, people like Bono and Bob Geldof are allowed open access to our governments, where they propagate the “more money” idea — and where they become stumbling blocks to African development.

Nothing to Do with Development Aid

It is easier to evaluate numbers than the qualitative effects of development aid. We cannot develop others. Only endogenous development — what people and societies achieve themselves with the power of their own minds and hands — deserves the name. No one can be developed from the outside.

Many would argue that when development aid brings water pipes and roads to Africa, it stimulates and strengthens local efforts. But perhaps the opposite is true, and the more we do, the more likely it is that our partners will sit back, because foreign aid is taking care of things to their satisfaction. Although the latter has proven to be true a thousand times over, development aid functionaries still overlook it with astonishing consistency.

Pouring further billions into funds for the climate, AIDS and other issues may, in fact, be necessary. But it has nothing to do with development aid. These payments will not cause political leaders in the Sahel countries, for example, to make more of an effort to combat soil erosion on their own. These countries could long ago have begun doing something on this issue — they could even have used their masses of unemployed youth for the job. But so far, in cases where something has been done, it generally was the product of foreign initiative and not endogenous.

Our development aid has not lent enough support to the efforts of people in Africa themselves. Often it has even been an impediment, because our aid was focused too much on the object and too little on the subject. Too often the project or program, not the people, was the focus. The aid passed the people by.

The result has placed Africa in an undignified position — and no amount of money from the enormous, globally organized network of aid organizations will free them. Only Africans themselves can accomplish that.

Translated from the German by Ella Ornstein,1518,712068-2,00.html

Who said that Malawians need AID?

Getting the best return

Mary often asks me who I’m writing for, but I never really know, who reads or who cares, but being just off the plane after 32 hours travel, maybe it’s therapeutic!!.

Six weeks in Malawi was again exciting, enlightening and generally crazy. We had the sudden death of the President, his body sent to South Africa to allow time for an attempted coup, the grand tour in the golden trailer RIP 1, the millions of dollars, allegedly, found in bags in his bedroom and in his gold plated mausoleum, the vice president sworn-in, a palpable sense of relief and hope among our village friends, and the certain possibility of a better future. We’re told,  by our Malawian friends, that Ireland, almost alone, supported him to the bitter end, something they always question.

In Malawi, this was the hungry season when most villagers are down to one meal a day, still in the cold, rainy season. The maize has grown if you have fertilizer and the wet, red soil sticks to everything.

We had hardly drawn a breath of the rarefied air, before we were reminded of our commitment to a 200 strong women’s cluster in Doroba. Four of their representatives had trudged 30 km, in the downpour, to our pump factory, in the city to say thanks for the fifty pumps, but what about our preschools? In only one year of self help success, these shy, helpless and hopeless women had become eloquent, forceful and focused. Yippee!! They knew their community needs and our requirements and had a list of five areas where preschools had already begun operations, with carers, the use of a building, a school committee and the chiefs on board. Mary decided that we should meet each community separately and make sure that they all understood that they needed WORKING committees and school gardens for a feeding programme. By the end of six weeks we now have 11 new preschools (17 in all), where all the carers have had one day’s hands-on training, with Mary and her crew, just to get them started. I have’nt mentioned the cratered tracks, the desperate journeys, the nightmares for the bony-assed!, the magical scenery and the dire poverty. All that matters now is that these communities have a common mission, to get their little ones to school and keep them there. In these remote rural areas education is prized.

Meanwhile we opened our second adult education class in another deprived area of Mzuzu. Both will be models in a new push for adult literacy. While working closely with the District Education Manager we will continue to move the process forward in the villages with preschools.

Continuing with education, our volunteers from DIT, continued work on an English language project, for secondary school begun last year, while Mary gave the keynote address, and a workshop, at an In-service day on School Management. Plans are well under way, with the Education Ministry, for a two week training programme, by experienced, Irish teachers, to enable Malawian teachers to deliver training to their peers.

Despite the fuel, forex and sugar shortages, we managed to deliver 160 pumps to our partners in Zambia which will enable them to bring clean drinking to over 70,000 remote villagers. Considering the population of Roscommon is 63,896, I figure this is a bit of an achievement!

Oh, Our beehives are going great and we bought 2 piglets for breeding on the farm.

Land ownership in Malawi is very low especially for women, but in the last ten days we managed to buy 23 acres of land, in trust, for a group of 21 women and three men to enable them to set up a model, commercial, co-operative farm

It has the backing of all nine chiefs in the area, as well as support from the Ministry of Agriculture and Agro forestry, all of whom attended the hand-over meeting, at one day’s notice, under their own steam and without allowances. (maybe a first)

All this was achieved by a unique farmer, Dupu Mshanga, who will facilitate the project.

The Wells for Zoë  funding will be repaid by the end of four years and then passed on to a similar project elsewhere.

They have plans for cows and pigs, (with the help of the Ministry) paprika (for which we have a market) and pidgeon pea, Bananas and bees (we have a market for the honey), sunn hemp and velvet bean, no organic fertilizer or chemical pesticides.

These self help women will achieve all this because they are women, and because they are inspired. They will empower themselves, because they are the only ones who can do that. The final remark by Dupu was that they were never the recipients of Aid, they can do it by themselves and while they appreciate our help, he agreed that, in five years, W4Z would have convinced them that they had done it all by themselves.

John (and Mary Coyne):

Ian Sutton

Hydrogeogogist Ian Sutton volunteers with Wells for Zoe in Malawi

We grabbed this from, about out man Ian Sutton

We’ve been lucky enough to feature a wide variety of careers and different sectors in the Career Paths series and this time we have something very different for you. In this installment, we’re delighted to feature Ian Sutton, a Project Hydrogeologist who works in Water and Sanitation services and who’s work takes him all over the world.

Hello! Ian and girlfriend Tara head for Malawi tomorrow May 29, 2012, to volunteer with us on water and education related projects in Mzuzu.

Ian worked with us in 2007 while doing his thesis and  now he’s turning to check up on us to see if we’re doing things correctly!!

Harisen and Charity will meet them at the airport and renew the friendships.
This is Ian.
Name: Ian Sutton
Age: 29
Birthplace: London
Marital Status: Single
Children: None
Highest Education: MSc
Institutions attended: Trinity College Dublin, Cranfield University, UK.
Academic achievements: BSc hons, MSc

About You

1) What is your current role?
I’m a project hydrogeologist in the water sector of a multinational company mostly working on consultancy jobs. The work is varied with new interesting projects coming in all the time. We do a lot of work on operational, environmental and water resource solutions for mining companies, government ministries/agencies and water utilities. Work gives me the opportunity to see a lot of interesting places throughout the UK, West Africa and South America.

2) How did you get into your current role/ industry?
I applied for my current job after having spent about 2 years studying for and working in the water and sanitation overseas development sector. I had been a mineral exploration geologist before that. Language skills were a big help in getting my current job, as well as having experience working overseas. I am currently getting technical hydro-experience in the private industry something that I hope to be able to apply to certain aspects of the overseas development sector in years to come.

3) How many years have you been in your current role/ industry?
3 years.

4) What other roles did you do before finding your current role?
From the most recent to the oldest:
• Managed a water supply project in northern Haiti, it involved rehabilitating an old water supply network about 18km long piping water from mountain springs to several villages, a collective of farmers and a large coastal town. In total about 10,000 beneficiaries. It was a real eye opener to overseas development work, although the work required a fair bit of technical problem solving, working and communicating with local communities was by far the most important aspect.
• Gold and coal exploration and drilling supervising geologist based in Mongolia for two years. It was great fun mapping in the wilderness, logging core, and interpreting geophysics among other things. It is a great place.
• Volunteered on the Suas programme providing teaching ideas to NGO schools in Calcutta. Wonderful experience and a great way to get into development type work. Being part of the programme definitely set the tone for wanting to continue along the lines of overseas development.

5) What was the worst job you ever had?
Night shift core logging at a drill rig in minus 20 degrees with no heater and a dodgy stomach. Only lasted two nights thankfully.

6) Did you always want to work in your role/ industry or did you get into it late?
I don’t think it is ever too late to get into a certain role or industry. I have changed industry three times; from mineral exploration, to overseas development, to technical hydro-consulting. It’s good to mix thing up and not to get stuck in one position.
It can be tough to change industries and can often mean taking a pay cut, but at the end of the day the more experience you have over a wide range of environments the more useful you will be either to your own company or someone else’s. Many skills can be applied over a range of industries.

7) What advice would you give to other people looking to get a career in your industry?
For hydrogeological consulting and hydrological consulting, and probably engineering in general, get a good technical base so that you are confident in your work. It’s good to start off working in a team where you can learn from your peers.
For overseas work a good way of getting experience is through volunteering initially. People you meet along the way can also lead to work further down the line. Hold onto contact numbers and email addresses.

8) What do you like most about your job?
The variety, meeting new people all over the world and having a balance between travelling to new places and having a base to come back to.

9) Anything you don’t like?
Work can take over your life sometimes, its really important to keep a balance and to relax, when you have a lot of client deadlines it can be hard to do this sometimes.

10) What time do you get up for work?
It varies a lot, when I’m working in the field anywhere from 5am to 7am. For an office day I’d usually get up at 8:00am.

11) Where would you like to retire to?
Ireland with sunshine, a reggae bar in Jamaica, or a Spanish villa! Anywhere with good food, good company and good weather!

12) Favourite website(s)?
Don’t have a favourite, probably BBC if I had to choose

13) What would be your dream job?
Successful musician

14) What are your goals or plans for the future?
Practise more guitar!
To continue to find work that I enjoy and that motivates me.

15) And finally, the three luxury items you want if you were trapped on a desert island?

Surf board
Good company
(and maybe a luxury yacht)…. (or a trip to Malawi)