Report on visit to the District Environmental Health Officer
Ketwin Kondowe


His role
In his words, his work has more to do with disease prevention and health promotion than the science of medicine. The DEHO is a preventive health service that covers everything from enforcing standards, food handling inspections, health programming around, malaria, food safety, hygiene, water, sanitation, disease surveillance and response as well as the Health Surveillance Assistants. Working under his direction, he has 6 degree graduates of environmental health, 5 diplomates, and 548 Health Surveillance Assistants (HSA) throughout Kasungu District.
Clinic
He started by welcoming the initiative to establish a clinic at Chilanga. Kasungu District Hospital is congested and they are looking to build a series of satellite clinics in the area around Kasungu. The DEHO has already established one at Linga in the West on the road to the National Park and another to the East on the road to Mtunthama at Kasalika. The Catholics are opening one to the north at Kafukule West. The Chilanga clinic will provide a much needed service to the community and help relieve the congestion and improve the quality of care available. He pointed out that in terms of road accidents there is no facility on the long stretch of road between Bua and Kasungu, so it will help with that as well.
By his estimate, we will be serving about 7400 people in the area immediately around Chilanga and over 15,000 in the whole catchment area of the clinic. Most of the people are from Chief Kaomba's area, but it will serve part of Chief Lukwa's area to the west as well.
Village Health Workers
He again welcomed the programming initiative Melodie had drafted and especially our re-assurance that it is meant to complement the work of the HSA and not duplicate or drain away from them. He told us that the President has committed to doubling the number of HSA to allow 1 per 1000 population, so our initiative is a welcome adjunct. His department is available for training purposes, or consultation as needed.
Engineers Without Borders (EWB) has had a placement at Santhe rural hospital (ed. note where Bwelezani's wife Mercy works). She developed a method of self-assessment and follow up with the HSA to allow them to improve their performance. He was aware of problems with some HSAs and this was going to be a tool to allow his department to deal with underperformers.
Contact Ketwin Kondowe, District Environmental Health Officer
099 971 7233 kckondowe@yahoo.com

Canadian sustainability
The budget I had allocated for transport finished yesterday and I had to take the car back to Sputnik Car Hire in Lilongwe. The three weeks has flown by with busyness. I used the occasion to check out the Canadian agencies working in the country to establish links and see if any of them can help pick up the Canadian end of this sustainability exercise, now that we have established the sustainability of the project here at the Malawian end.
I went to see what was left of the CIDA office and was informed that the last three professional officers, 2 Malawians and a Brit, will be out of work at the end of November when Canada closes the office permanently. The DFATD, formerly CIDA, desk representative had come up 2 days before to announce the closure. I had planned an hour or more of sharing what we were doing in Makupo and Chilanga, but it was just a series of goodbyes and hand shakes and good lucks, over in 15 minutes. Much as I have little time for the aid industry I left with a sense of great indignity, that the Harper government had removed this last pretense of caring for some of the most disadvantaged people in the world.
My visit to WUSC was much more profitable. Jacob Mapemba is an amiable, extremely competent country director with 9 professional staff running a variety of programmes. They bring as many as 40 volunteers each year and are involved in many programming initiatives. WUSC's new 5 year plan takes effect next April and will feature economic empowerment for women and youth as its focus. Lonjezo and Jacob shared phone numbers and email addresses and he will let us know of funding and placement possibilities for the future. He was forthright and forthcoming, so we need to improve our project writing and reporting skills to take advantage of these opportunities. He will encourage his volunteers to use the guesthouse as a way of learning about village life.
Engineers Without Borders Canada is housed in a small house behind a big house and staffed with about 6 long term people who are sprinkled around the country in water, sanitation and logistical support and evaluation with the Ministry's Health Surveillance Assistants programme. Their big effort is the placement of as many as 15 - 20 engineers in short term positions during the Canadian summer months. I met Holly Lafontaine from Windsor at the DEHO office in Kasungu and we had lunch together. She described some of the programme to me. They operate on very little budgets, use buses to travel and live modestly in local communities. They are not really connected to the established NGO network and work directly with local partners in the Ministry of Health or Water offices in the districts. Check their website. www.ewb.ca I was impressed by the failure report.
Their Lilongwe base is just around the corner from the CPAR office. They are in a big old colonial house with the classic big 4X4 carrying their logo and of course the flag. The programme manager is Joseph Zimba. I explained the work in Makupo/Chilanga and my purpose in visiting. He gave me an overview of their programme, which ironically has very little health component to it. They operate in Ethiopia, Tanzania, Uganda and Malawi and have only ever been involved in clinic building in Uganda. Dokiso Nchama our doctor friend in Cornwall travelled to Malawi on one of their familiarisation trips in the late 90s or early 2000s and had checked with them in Toronto to see if he could solicit any interest in helping with this clinic. They declined and the programme manager here reconfirmed that their programming was already set and did not involve any clinics for the time being. www.cpar.ca
I am not particularly discouraged by the apparent lack of interest. We are coming out of the blue and they have already established programmes, priorities and planning that they are committed to. Nonetheless, I think it would be wise to approach each one of them again through their head office and local representatives to keep the Chilanga clinic and its Canadian connection alive for possible future support. We should add to these the Presbyterian Church in Canada who rebuffed me because they don't support Canadian initiatives. Another movement toward more long term Canadian support would also be the link that we propose to build with the OPSEU health workers sector. Still another initiative would be to approach the doctors who are either from Malawi or who have worked here to check in their networks for help. Dokiso and I have discussed the idea of getting visiting doctors to come to Malawi. With our guesthouse at Makupo and the clinic across the road it would be a good place to contribute their expertise for a month or two at a time.

Ideas are not hard to find, it's something else to make things happen. As Stephen Leacock once said, “Writing is easy. You just write down what occurs to you. It's the occuring that is difficult.”More soon.

Lilongwe Kasungu 3 & 4 October More research




I needed a new quote for Shannon who is fundraising for a well or possibly two for next year. Kenneth joined me in the Ministry of Water Development and Irrigation to learn the process. He is a church pastor with a real commitment to development of the people as a necessary adjunct to his spiritual mission. The new quote came in at K1,810,000 or about $5200 down from about $7500 for Nguwo paid in 2011. The Malawi Kwacha was being held at an artificially high rate by the late Bingu wa Mutharika and is now floating at closer to its true value. The next village for a well on our agenda is Chindui which is on a ridge in line about 1 kilometre north of the Chilanga Secondary School.


We then went to see Mrs Monica Kandodo at her business office also in the Capital City Centre. When I met her with her husband on Sunday, she had offered her services as a Chartered Quantity Surveyor. I had no idea what that was, but was soon to find out how valuable an offer it was. She is going to help us pro-bono, because she often attends church at Chilanga and is a member there. She has her own company and her office is replete with examples of projects she has worked on and is currently working on. She will pass by at least once a month for a site inspection, report on the technical progress, the financial situation and how it conforms to the work done. They have a standard format for reporting which she is going to send to me. With her technical expertise and access to communication and resources, she will be indispensable in monitoring progress once we have fundraised enough to restart the work.


Later in the afternoon, we went to the office of Collins Kaunda, the architect to set up Skype interaction between him, myself and Carl Mulvey in Montreal. Collins high speed hotspot phone was out of battery so we used the dongle and quite successfully communicated for about 15 minutes. The quality of the line and reception improved as we went along. We spent some time clarifying the delegation of authority, how the architect and contractor get paid, interpreting the Bill of Quantity, and how the contractor was selected.


In brief, Collins was approached at my request by Jack Kamanga to review the plan I had brought from Canada in January 2012. He in turn gave it to a quantity surveyor to break down into its components and price. He returned two copies of his estimated price list known as a Bill of Quantities, one with his price figures indicated and another with no figures. Contractors were invited to bid on the project using the blank sheet Bill. A committee representing the Chilanga Church, Senior Chief Kaomba, Makupo Village and the architect reviewed the submissions and selected Jack Kamanga's submission as being both closest to the Quantity Surveyor's figures and with a portfolio indicating a standard of quality in previous projects.


Kenneth and I returned to Kasungu Friday morning to meet the District Medical Officer, Dr Jerome Nkhambule. It was a cordial reception. He was initially reserved about an imported plan, insisting that the Ministry of Health had standards and norms that he would prefer to keep all new installations in line with. However, once we opened the blue print up and walked through some of the features, he very quickly warmed up to the EKM ideas. Once we had established that it was an outpatient facility and that maternity would be referred to the Kasungu District Hospital he was enthusiastically affirmative. He indicated that he would have a written confirmation in the next week to extend his approval to proceed so that the clinic could fall within the CHAM / MoU and receive government staffing, drugs and services accordingly.

He arranged for his colleague, the District Environmental Health Officer, to meet us on Monday morning to pursue the health outreach and promotion work that we are proposing.

We started the report on Monday with an organisational meeting of the research team and I spent all day yesterday writing the draft, which we will review and revise to send tomorrow from Lilongwe. We are already up to 7 pages and growing. It is quite impressive what we have done in a brief 2 weeks since I got here, if I do say so myself

As we do this part of the work, we are still in the process of making the process happen. Monday we submitted a formal request from the Chilanga community to the District Commissioner, the most senior civil servant in the district, with a copy to the District Health Officer who is in charge of all health related activities in the district, governmental and non-governmental. They have both responded favourably by phone and are pursuing the matter along the administrative pipeline to get the final approval of the Ministry of Health and any other relevant authorities.

We return to Lilongwe on Thursday to pursue the technical matters further with the architect, contractor and quantity surveyor and also to meet the World Renewal representative from the US about their support in the absence of the Canadian Presbyterians. World Renewal is apparently what the old Dutch Reform Church has evolved into.

At the same time, I have been setting up procedures with the secondary school that can be used later on by the clinic rapporteur as well, to help them with report writing and giving supporters some feedback. (ed. note - I am the least qualified guy to do this function given that it is one of my greatest weaknesses.) It will be good practice for us all. Over the past 3 years, the school has received computers, a new classroom and laboratory block, books for the library, money for scholarships and sports equipment and if they want to continue benefitting from all this goodwill then we must become better reporters.

Next week, we have a meeting to establish the academic scholarship for women students at the secondary school. In another meeting, we will set up the formal Health Advisory Board of the clinic. We foresee a meeting with the District Health Officer and his outreach colleague the District Environmental Health Officer to discuss both the clinic and the Village Health Assistants project that Melodie and I have concocted.

In summary, I am running fast and trying to squeeze the writing into the spaces between the runs.

On a personal note, the friends gave me a discretionary fund and after talking with Nellie we decided to help out 3 women whose teeth had succumbed to infection before they began their ART AIDS medication. It is so evident that they are self-conscious about not smiling and with a couple of bridges or false teeth they will be back to their happy smiles again. We are going to the dentist at St. Andrews for extractions, and fillings and thereafter find out where we can get replacement teeth of some sort.

Weather report. I dressed and carried clothes for the hot, dry season. The last 2 days has seen heavy cloud cover and cool winds from out of the east. I am sitting bundled up like Ebenezer Scrooge as I sit trying to type away on all this writing I have to do. I have had to borrow an old Vanier hoodie from one of the boys because I only brought short sleeve summer stuff.

Enough said. This note stands in the way of an excuse for the report being too long.