Katie Chalcraft has been awarded a Winston Churchill Travelling Fellowship and is currently travelling in Malawi and South Africa, exploring the use of arts in programmes working with people living with HIV. This blog is one of a series of journal entries from Katie as she travels.
To Temwa…
It was as if we were driving along a silver thread. Sitting on a bench in the back of the vehicle, my back to one window, looking out of the other, I could not see the road; I could only see the silhouettes of mountains in the moonlight. Sheer blue shapes, the enormity of the landscape, we were so high, and the drop-off so steep If the road were not so bumpy we could have been flying. I pressed my thumb and forefinger together in a cross and kissed them. I do this to pray for safety, a technique I have used on perilous adventures around the world in an attempt to bring peace of mind. I recalled the moment when my brother first taught it to me, I was to do it when I saw or heard an ambulance. I smiled to myself; I was now travelling in an ambulance. One of eight passengers, I was squashed between Kams, a volunteer from the UK for an NGO called Temwa, and Steve the medical assistant for a local health care centre. The driver was Rasheed, other passengers included Lucy a nurse, her husband and child and some villagers whose faces I could not see in the dark and whose voices I could not hear over the roar of the engine and the sounds of UB40 blasting from the stereo. None of us were ill; this was merely the only means of transport we could use to travel from Mzuzu to Usisya, a remote rural area in Northern Malawi.
The purpose of my journey was to visit Temwa, a UK-based NGO that are implementing a series of programmes aimed at providing sustainable, community-driven development in: health education, skills development, agriculture, irrigation and schools support in Nkhata Bay North. This remote region of 28,000 people has no electricity, no running water and is severely affected by the HIV epidemic. There are no other NGOs working in the region and the local government strongly encouraged Temwa to work in this area due to its need for basic development.
This year I received a grant from the Winston Churchill Memorial Trust to conduct research into ‘Tackling HIV-related stigma through visual and performance arts’. Temwa is the first organisation I am visiting as part of my research. The key objectives of my research are to gain a comprehensive understanding of how the visual and performance arts techniques of body mapping and interactive theatre affect the self-perception of people living with HIV (PLHIV); and to gather information on the perceived strengths, weaknesses, opportunities and constraints of these approaches from a wide range of stakeholders in Malawi and South Africa.
(It’s not) All About Me
When I initially wrote to Tonderai, Temwa’s Programme Manager, explaining my research interests and enquiring if I could visit Temwa, the response I received was curt. He proposed conditions under which I could visit: he stated that one of the major deliverables of my assignment must be that I design a project and create links for possible funding for a sexual and reproductive health programme amongst young mothers and adolescent girls in Nkhata Bay North. He said he would like to see the communities benefitting more from all those who come and work with Temwa. The conditions he specified were neither in line with my research nor with my expertise, however Tonderai raised a valid point and for this I am most grateful as it led me to re-frame my research. It is all very well going to organisations and learning from them but what was I actually contributing in return?
I am clear on what I want to gain from this opportunity and what learning I would take back to the UK with me. Through the experience gained in Malawi and South Africa I plan to develop a programme of creative workshops for PLHIV based on interactive theatre techniques and body mapping. These workshops will aim to support people in rethinking their relationship with the virus, their bodies, antiretroviral therapy, their lives and the laws and policies that affect them. This work aims to increase the quality of life of PLHIV by introducing new coping mechanisms to address the self-stigma, depression and low self-esteem often associated with HIV. The question remained: what would the organisations I visited in Malawi and South Africa gain from my visit?
I will share learning between institutions, highlighting best practice, and submit an abstract of my findings to the 2012 International AIDS Society conference. Following a conversation with Tonderai we came to an agreement. He identified a need for his organisation to develop their expertise in monitoring and evaluation; I could conduct my research with Temwa on the condition that I shared my experience in this area. I agreed to run a workshop for Temwa on a tool developed by CAFOD (Catholic Agency for Overseas Development) called the Batteries Methodology: A Participatory Approach to Assessing the Quality of Life of People living with and affected by HIV.
Journey to Usisya
Following a 9 hour bus journey from Lilongwe to Mzuzu, I was met at the bus depot by Kams who, together with a Project Officer at Temwa named Hilary, runs forum theatre workshops with the AIDS Action clubs in and around Usisya. Kams took me to meet Tonderai and the other staff at Temwa’s Mzuzu office. Tonderai looked tired and frustrated as he explained how the fuel crisis in Malawi is seriously impacting their ability to do their work. Temwa’s main office is in Mzuzu but their work in the field is conducted in Usisya, a remote area made up of 56 villages in and around the lake. The organisation’s vehicle was in repair and we needed both fuel and transport to travel to Usisya. Tonderai heard that fuel was on its way to Mzuzu (the closest town to Usisya), loading his car with jerry cans he set off from the office for the gas station joking that he would wait as long as it was necessary and that he was prepared for a fight at the pumps!
Unfortunately, after a long wait Tonderai returned without fuel, so Kams and I stayed the night in Mzuzu and hatched Plan B. Rasheed the ambulance driver from Usisya was in town – we would travel with him the following night.
Fuelling Health
Usisya is set in and around the mountains leading down to the lake, the views are spectacular but I am told that life is hard here. There is one health centre where Steve and Lucy work. However, there is no trained doctor there. Steve and Lucy serve a community of 14,000 people but their contracts are only temporary and they are limited in what they can do without a doctor; most cases need to be referred onto Mzuzu hospital. Rasheed drives the ambulance from Usisya to Mzuzu sometimes up to 2 to 3 times in a day. The journey itself is anywhere between 2 to 5 hours depending on the season and how passable the road is.
The roles of nurse and medical assistants are based at Usisya’s health care centre for 3-4 months only. People simply don’t want to stay for longer: the environment is too harsh. Steve and Lucy, like Rasheed, are not entitled to holiday, they are constantly on call and only get to leave Usisya for training. Transport from Mzuzu to Usisya is limited to the ambulance or the Petronics truck – an open truck leaving Usisya at 2am. The truck is packed with people; the journey is cold, dusty, bumpy and extremely dangerous. What is needed, I am told, are health professionals from Usisya itself as they would not mind living there as much as the outsiders, but due to the poor level of education in Usisya this has proved to be difficult. The fuel crisis compounds the situation: Rasheed, the ambulance driver with whom we travelled, spent 3 days in Nkhata Bay trying to get fuel for his ambulance, leaving the people of Usisya stranded and unable to reach a hospital. We were told of a woman so sick and in need of hospitalisation she embarked upon the perilous journey through the mountain passes in the back of the Petronius truck in his absence. It seems there are no special allowances in the fuel crisis for ambulances; indeed taxis seem to get fuel over and above ambulances. Word can get out that fuel is there but it’s all about who you know, and people book the fuel before it even arrives. Long queues of cars are a common sight in gas stations all across Malawi. Sometimes people wait at the pumps all day, leave their vehicles overnight only to return the next morning and begin waiting again. Many buy fuel on the black market but it is often mixed with water or paraffin. A few days ago an NGO worker told a story of a man trying to set himself on fire at a fuel station here, he was so frustrated having waited many hours for fuel that by the time he got it he decided to make a point by dousing himself in it and setting himself alight. The attendants managed to put the flames out before too much damage was done, it reminded me of the Arab Spring scenario but we are not allowed to mention that here.
