From Lilongwe to Liwonde at 90 kilometers per hour

A few photos sitting in the front seat as we drove to Liwonde National Park.

Cars are common in the big cities, but bikes are a luxury for many of the 75% of Malawiians who live in rural communities.  Motor bikes - a common fixture in many developing countries - are basically nonexistent in Malawi.

Walking back from market:

Staying dry on a rainy day:

This morning at breakfast outside our hotel

Mvuu Camp

I took these pics yesterday on a small motor boat on safari.  Wow.

The internet is slow, so I'm only posting a few pics until I return:

                            

                            

Meeting with _the_ Chief Justice of the Republic of Malawi, Lovemore Munlo

So much is happening, and I'm finding myself with little time to write!  Yesterday our team had a meeting in Blantyre with the Chief Justice of Malawi, Lovemore Munlo, who expressed his commitment to making these one-stop child abuse centres a reality!

Today we were in the capitol, Lilongwe.  I had breakfast with Supreme Court Justice Twea, and then we had a full day of stakeholders meetings, bringing doctors, police, judges, and social services together for the first time to discuss creation of a one-stop centre.

Rain finally poured from the skies - a welcome gift to farmers who have been very concerned because this year's rainy season has been very dry and their crops are in danger.

Gotta run...

The Plight

The Victim Support Unit of the Blantyre Police Department is literally an 8 x 12 foot shack with a tin roof.  Three desks are scrunched inside, and it is here that VSU handles 20 child abuse and 150 domestic violence cases per month.  With funding from UNICEF, VSU child protection officers received training by a clinical psychologist to provide short-term play therapy to child survivors of abuse.  The shack is an inadequate setting for therapy, and often the child’s home is not a proper location; thus, there are many children who do not receive even short-term therapy.

As we sat under a tree meeting with leaders of VSU, the Public Prosecutor’s Office, National Juvenile Justice Forum, and UNICEF, a young child age 5 or 6 was brought reluctantly into the office – he had been picked up by police moments earlier smashing cars in the parking lot of Shop Rite.  No parents in sight.  His name?  Unknown.  He was mute and had a bad left eye.  Before we knew it, he had snatched a bottle of water from under one of our chairs and walked off quickly, gulping it down like it was another day’s work.  Everyone turned their heads and sighed, sad, wondering what depths of neglect this child had suffered… and survived.  When he came around again, Eric gave him a granola bar, and he quickly warmed up.  When I pulled out my camera, he brought out the most beautiful smile:

As a pediatrician I quickly ran through the different possibilities for why he did not speak, but in that moment, none of that mattered.  His smile knocked me flat.  We learned he would have to be taken to an orphanage, where we could only hope that he would have a better life.

Inspiring Individuals

Magistrate Esmie Tembenu (in red) presides over the Child Justice Court in Blantyre, where children under 18 accused of crimes against children receive humane, thoughtful interventions with all parties sitting around a table.  The child survivor sits in a separate room, where s/he testifies via closed circuit television.  Yes, this protocol for child survivors is sometimes practiced in family court in the United States, though not nearly enough.  Interestingly, the parties around the table are: the magistrate, the prosecutor, the probation officer (who does a home and school assessment of the alleged offender and recommends services), the alleged offender (who has no attorney) and his/her parents who cross examine the witnesses.  Questions are submitted to the room where the child survivor sits, and these questions are asked to the child by their guardian.  Thus, the child survivor's guardian (or whichever relative s/he is most comfortable with) is the only person in the room with the child, and this relative is required to ask the questions exactly as they are worded by the parties in the courtroom.

Justice Tembenu states that significant attention has been given to making sure that child offenders are treated fairly - they are never found "guilty" but rather "responsible" and they are almost never put in jail but rather given services or sometimes a residential centers where they receive counseling and vocational training.  Counseling sometimes involves religious and moral counseling.

In the entire scope of child protection, the Malawi Social Welfare Office is only required to write a report assessing the home situation of child offenders, but never for child survivors.  Furthermore, if a child is abused by an adult, they must go to criminal court where they wait in line next to alleged thieves and murderers.  There is great hope that the experience for children in criminal court could also be made much more child friendly.

This mother smiled when we walked in the room, and she was more than happy to have her picture taken by Eric, but when this photo snapped, you could see the full range of emotions she was experiencing as her child is struggled to survive the ravages of marasmus, the most severe form of malnutrition.   Community-based nutrition clinics have been growing across the country and have benefitted greatly from developments like Plumpy’Nut, but currently the mortality rate from malnutrition reaches over 50% in certain regions.  Here at Queen Elizabeth Central Hospital – the largest government hospital in the country – their treatments have been able to lower the mortality rate to 15%.

Any time I start to get a little proud of myself for the work I'm doing, I simply think of Neil Kennedy, one of the most inspiring pediatricians I have ever met.  In December 2008 I emailed Neil out of nowhere telling him I had received funding to do child abuse training and asking him if he'd be interested in having me come to Queen Elizabeth Central Hospital.  Child Maltreatment had always been an interest of his, but with his multitude of responsibilities, he had never had the opportunity to bring police, social services, and judges all into the same room to discuss how they could improve the care they provide.  He has been an absolute champion for child protection, heading the new Blantyre Children Protection Team and quickly improving the amount of coordination between doctors, police, and social services.

Besides being a galvanizing force in child protection - along with Justice Twea of the National Juvenile Justice Forum, the Office of Public Prosecutions, the Police Victim Support Unite, the Social Welfare Office, the Ministry of Gender and Child Development - Neil also is the head of Pediatric Training for all of Malawi; he helped rewrite the curriculum for the College of Medicine, and he runs the only Pediatric Cardiology Clinic in Malawi.  And he has the most lovely wife and children who we had dinner with tonight.

Quite a day!

Dinner with the Vice President and a hike up Mt. Mulanje

Tonight we had the great honor of having dinner with the Vice President of Malawi, Right Honorable Joyce Banda.  Over the past years, VP Banda's story has become well known: in the early 1980's at the age of 25, she was married with three children and was being beaten by her husband.  She left her husband, which was rare for any woman in Africa to do, and she formed the Malawi Women's National Business Association which eventually grew to over 50,000 strong.  She eventually became the Minister of Women and Child Development and was able to get the Malawi Parliament to pass the first law outlawing domestic violence.  After later become the Foreign Minister of Malawi, she was elected in May 2010 as Vice President with President Mutharika.

Among Banda's many new roles, she is the African Union's Head of Healthy Motherhood which is making significant inroads to reduce the current rate of over 300 maternal deaths per 100,000 births.  She has worked with local chiefs who found successful interventions - encouraging women to deliver in hospitals rather than at home by charging a fine of one goat if a family decides to deliver at home - and spread this practice to many other villages.  The results have been dramatic, but as a result, the hospitals are now overwhelmed with patients and need more resources.

We are very excited to continue growing our relationships with such dedicated, innovative, dynamic leaders in Malawi.

Earlier in the day, we hiked up one of the highest peaks in Malawi - Mt. Mulanje:

We hiked nearly one third to the top of Mt. Mulanje to an amazing, refreshing waterfall.  In this photo you see a mother with an infant on her back.  She is poking a hole in the ground at the base of each corn stalk so that her children - using a teaspoon - can pour a little fertilizer into the hole for each stalk.  Fertilizer is incredibly valuable, but because of tough economic conditions, the government's subsidy is not enough to cover the costs.

Tomorrow is our first set of meetings with doctors, police, social welfare, judges, and UNICEF!

Leaving this week

Our team will be traveling to Malawi January 8-21 as the lead consultants to continue building capacity and providing training for the creation of Malawi's first one-stop centres for child abuse and gender-based violence.  We probably will have good internet connections while there, so I should be able to write and post photos to this blog!

UNICEF donating $125,000 to our work.

Because of our work in Malawi in March, UNICEF decided to include doctors in the planning process of a "one-stop centre" for child abuse and gender-based violence, and further, to build the centre on to a hospital:  UNICEF is giving $100,000 to Queen Elizabeth Central Hospital in Blantyre to build the country's first-ever one-stop centre where doctors, police, and child protection workers will all have offices together in order to provide the best care to children and adults who have been abused.

Today we received the initial blueprints from the architect!

The additional $25,000 is for our team to return to Malawi in January 2010 to continue training and capacity building with our great partners in Blantyre, Zomba, and Lilongwe!

Rockin'

Football, anyone?

YONECO Children's Band

The YONECO Children's Band performed on the second day of our conference.  They rocked.  And they broke our hearts at the same time.  All 13 of the band members were children begging on the streets before they got involved with YONECO.  The lead singer's parents both died from AIDS, and one of the songs he sang was about their death.  But it wasn't a sad song - it was full of energy.  Truly an inspiration.

The Blantyre Box

In this country with 7 million children under age 15, there are less than 20 pediatricians.  Ten of them work here at Queen Elizabeth Central Hospital (QECH) and the Medical College in Blantyre, where they are very active clinically and have published much research in the fields of pediatric emergency medicine and infectious disease. 

The hospital has 250 beds for children; however, due to the heavy burden of malaria, HIV, meningitis, malnutrition, and diarrheal illness, there are usually 350-400 children squeezed into the 250 beds.  Pictured here is the Blantyre Box for newborns (which got its name after becoming popular at QECH).  A thin mattress and sheet are placed in the box, and heat is provided by those small white boxes at the bottom, which are simply switches to turn on light bulbs whose heat radiates upward to heat the box.  the plastic cover on top also helps retain the heat.

 

Twelve per cent of all Malawian children die before the age of five.  Before mosquito bed nets were widespread 5 years ago, the mortality rate for all children under five was 25%.  The hospital has no ventilators for patients in intensive care units, and supplemental oxygen only reaches 30% in the oxygen condensers.  The operating room is the only room with a ventilator, and the analgesic medication is provided by a person continuously pumping foot pedals to deliver the medicine.

Fifteen percent of the children admitted to QECH for malnutrition do not survive, while rural villages see 25-50% mortality rates.  Most of the pediatric hospital beds are 5 feet x 3 feet, with two children in each bed, and their mother on their side of the bed.  In a large room of 150 children, with 150 mothers, and beds only 3 feet apart, the challenges of reducing the spread of infections is daunting.  Mothers all sleep on the tile floor by the bed.  For children not lucky enough to have a bed, the mother is given a mattress to place against a wall, where she will stay with her child the entire time.  

My first day visiting this hospital was one of my toughest.  Yet the doctors here show an energy and drive that is very inspiring and made me want to stay to learn more!

Child Parents

Of Malawi's 14 million residents, half are under age 15, and 1.2 million are orphans - having lost at least one parent.  The number of child-headed households is staggering and leads to a wide range of psychosocial issues.

Azungu! Azungu!

 

Our truck pulled off the main road and continued along a series of dirt roads toward our final destination - a small bakery supported by JBF.  A motor vehicle is a rare sight in these distant villages - so as we neared the bakery (an outdoor stone oven with a partial thatch roof for protection), children started running along our truck and yelling, "Azungu! Azungu! (White people! White people!)"

Whether the children were hoping for charity, or just curious and enjoying the comraderie, you can see in this video it was hard not to get swept up in the moment.  

Our neighbor in Zomba

The Jane Lampert Orphan Care Center

Orphan Care Centers

A single room, no electricity, cement floor, and the most adorable orphans being cared for by volunteers from the community.

"Rain, rain, go away! Come again another day!"  No where does song of more meaning than in orphan care centers like this one, where children receive their one meal per day.  But on days when the rain is heavy, the dirt roads turn into treacherous mud, and the food - being brought on foot or bicycle - does not arrive.  And that's only on weekdays.  No deliveries are even scheduled on weekends.

The Road to an Orphan Care Center

Walking Home From Market

Our daily drive from Zomba, the former capitol of Malawi, to Blantyre, the commercial hub, took us along this road where the typical scene included groups of children not in school, sitting within inches of cars like our traveling 60 miles per hour, and mothers with babies strapped to back or side, balancing food or a pile of firewood on their heads.

Years ago, the government charged fees for children to attend primary school, but when they decided that primary education should be free, they did not increase the number of teachers to meet the demand.  We met a woman who teaches Standard 2 (2nd grade) who has 120 7-8 year-olds in her class all day.

What distinguished these roadside scenes from the extreme poverty of many other less economically developed countries is that in malawi there are almost no motor scooters and motor cycles.  Everyone is on foot or on a 20-year-old bicycle.  We drove for miles without seeing another vehicle, and when we did it was often a minivan full of passengers or a commercial truck carrying Coca-Cola or Carlsburg Green.

The internet connections have been spotty and slow, so I haven't been able to write posts as I would have liked.  But upon my return, I will definitely catch up on all that has happened.  The new partnerships we have formed have gone above and beyond what I could have hoped for, and we are all quite elated and excited to continue moving forward.

The Market

Day 1: A Warm Welcome

All 11 of us made it safe and sound, landing in the capitol, Lilongwe this afternoon.  Rainy season just ended, so everything is green, and the corn grows tall.  Malawi's number one export is tobacco - it's trading season opens on Monday, and the President will be attending the opening.

Presidential elections will be taking place in May, and the campaigns officially begin March 20.  Soon after leaving Lilongwe's airport, I saw this great billboard, which includes a portrait of President Mutharika.

The  Malawi News ran an article today on JBF and the Partnership to Protect Children.  Jack's mission of creating financial investments in Malawi, while also helping those who are most vulnerable is opening many doors for us.  

It's been a long 24 hours of travel, so after dinner, we 're headed to bed.

Washington D.C. Malawi Embassy

Last night, the Malawi Embassy was gracious enough to host us for a meeting to further discuss the many initiatives being supported by the Jack Brewer Foundation.

Deputy Ambassador Kena Mphonda (on left) shared with us much information about current ongoings in Malawi.

Our flight for Malawi is now boarding in Dulles - so off I go!

Ready. Set. Go.

Tomorrow we're flying to Washington D.C. for a reception being thrown for us at the Malawi Embassy.  And then Friday we're heading on the plane: D.C. - Rome - Ethiopia - Malawi.  We can hardly wait!  Time to start packing!

Two Weeks Until Malawi

On March 12 we will travel to Washington D.C. to meet with the Malawi Ambassador to the U.S. and discuss all of the JBF programs - from JBF microfinance and orphanages to our Partnership to Protect Children (PPC) work with the Medical College and with YONECO.  

During our first week, March 16-20, each of our PPC members will meet individually with local professionals in our respective fields to learn first-hand how children are cared for and to lay plans for our formal conference March 23-24.  Erica and Kristin will meet with therapists and community outreach workers in Zomba at YONECO; Ken will meet with police and prosecutors in Zomba; and I will be training pediatricians and OBGYN's at Queen Elizabeth Central Hospital.

On Thursday March 19, the entire PPC team will spend the day with Jack Brewer at one of orphanages that is supported by JBF Worldwide.  We want to ensure that the partnerships we grow in Blantyre and Zomba will be carried over to the orphanages, which provide home to the most vulnerable of all groups of children.

The conference we are creating for March 23-24 along with MacBain at YONECO has become a very special new relationship: local doctors and police will for the first time sit down together, along with YONECO staff, to talk about the needs of children who have been abused, to gain expertise in this complex field, and to grow the partnerships with each other in order to strengthen the net that is needed to catch all children.

Our plans are all being finalized... the excitement is rising... and we are ready to step on that plane.

Our Team, Our Partners

I could not have hoped for a better start for the Partnership to Protect Children (PPC).  We are growing by the day.

Our Core Team

MacBain Mkandawire, Founding Director, Youth Net Counseling (YONECO), www.yoneco.org/mw, in Zomba, Malawi.  MacBain founded YONECO in 1997 to address the social injustice and reproductive health issues affecting youth, women, and children.  In 2006, YONECO created the first child abuse hotline in Malawi, and  currently Mr. Mkandawire is engaging leaders in the Malawi government to create buy-in from police, prosecutors, and social services to join the partnership.

Neil Kennedy, MD, Senior Lecturer, Department of Pediatrics, College of Medicine, Malawi, and Consultant Pediatrician, Queen Elizabeth Central Hospital (QECH), Blantyre.  Dr. Kennedy trains medical students and pediatric residents and works at QECH, which has 250 beds for children.

Karen Manda and Martin Nkuna, UNICEF, Malawi Office of Vulnerable Children and Child Protection.  Karen and Martin work with leaders in government and the community to help improve the systems that respond to children in all aspects of child health, development, and safety.

Ken Appelbaum, JD, Deputy Chief of Child Abuse and Sex Crimes, Queens County District Attorney's Office in New York.  Ken has over 20 years experience as a prosecutor, including the last 12 years prosecuting child physical and sexual abuse.

Erica Smith, LCSW, has done therapy and research regarding traumatized children and families and has been a professor for masters level social work students in New York.  Erica will work with local therapists in Malawi who are working to help improve the mental health services provided to children.

Kristin Barlup, a director at Common Ground, a non-profit which creates innovative solutions to reduce homelessness, is the Community Outreach Director of the Partnership to Protect Children (PPC) and will be growing the relationships between local organizations in Malawi and PPC.

Jack Brewer, Founder of Bridging the Global Gap (BGG), www.jackbrewerfoundation.org, is funding the Partnership to Protect Children, and was responsible for growing the relationship between PPC and the Malawi government.  Jack Brewer and other BGG officers and SIPA classmates will be continuing their microfinance program in Malawi when visiting in March 2009 along with PPC.

Aaron J. Miller, MD, FAAP, Director, Lincoln Child Advocacy Center at Lincoln Medical and Mental Health Center, Bronx, New York; Assistant Professor of Clinical Pediatrics at Weill Cornell Medical College; member of the International Society to Prevent Child Abuse and Neglect, and the Ray Helfer Society; Founder of Partnership to Protect Children, and author of this blog.

Our Partners

Honorable Joyce Banda, Malawi Foreign Minister, Founder of the Joyce Banda Foundation which runs seven orphanages and two additional secondary schools.  Hon. Banda started the Malawi National Association of Business Women, was a key proponent of the law passed by parliament outlawing domestic violence, and in 1997 was awarded the Africa Prize for Leadership for the Sustainable End of Hunger.

International Society to Prevent Child Abuse and Neglect (ISPCAN), www.ispcan.org.  ISPCAN Councillors Joan Van Niekerk and Julie Todd of South Africa, and Councillors Lisa Fontes and Howard Dubowitz of the United States have been instrumental in helping to shape the PPC curriculum, and more importantly, to provide guidance and insight on how to best grow the partnerships within Malawi and the PPC.

The Ray Helfer Society, www.helfersociety.org:  Helfer Society members Linda Cahill, Resmiye Oral, David Corwin, and Kristin MacLeod have shared information on curriculum development and long-term program development as PPC works to grow a partnership that is both sustainable and replicable.

Columbia University School of International and Public Affairs, www.sipa.columbia.edu.  SIPA is where the Partnership to Protect Children was first born in September 2008 when EMPA student Jack Brewer first told his classmate Aaron Miller that he should bring a program to Malawi to help children and to begin creating a new partnership.