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!