MSF Blog: Chiradzulu part 22 (final blog)
February 2009

On the roadside in Chiradzulu... UNICEF sign against child trafficking in Malawi (photo by Pat Carrick)

I’m leaving in a few days, but as someone different than the person who arrived. I never thought I could be sick of papaya. I can cook for a dozen people with minimal planning and no recipes. I have survived for one year with the same 2 skirts, 3 pants, and 5 shirts (all of which I’m ready to burn). I can find humor in the most serious circumstances. I think living in Africa has helped me simplify my life, and that has made all the difference. Henry David Thoreau said that when you simplify your life, the universe makes more sense. Perhaps in our developed, industrialized, first-world we have so many distractions that we have forgotten how to simply be, and we are on this inevitable, insatiable quest to find ourselves.
I’m just a data manager, someone who crunches numbers. I loved mathematics as a kid because I could figure it out. It was like looking for patterns. I didn’t have to memorize grammatical rules or dates or biochemical pathways. But now I find history fascinating. I’m convinced that a good historian can predict the future. If you look back far enough you will find that we continue to repeat the same mistakes we made before. You will find patterns. But then people like Martin Luther King, Gandhi, Einstein, and now perhaps Barack Obama change the rules and shift the ground beneath us. During his inaugural address President Obama reminded us that a nation cannot prosper along if it favors only the prosperous.
And my next step? I imagine crawling out of the number world and writing something longer than a blog. Sometimes I even fantasize about being a guest on Stephen Colbert’s show as a best-selling author promoting her latest book. I’ve thought about this in practical terms – if I had my own 15 minutes of fame, if I had the attention of millions of people, what would I say? Perhaps just this: Do something, something that will help someone else. And somewhere along the way you will find yourself.

JAN 17, 2009
I have successfully worked myself out of my job. My staff – these 10 people – is the most dedicated and motivated team in Chiradzulu. They have taken over nearly all of my responsibilities and they have an interest and pride in their work that makes me proud. But it has left me with little to do. I have spent the last few weeks typing up my end of mission report and handover notes. The truth is, I have lost my motivation because of the lack of support I have received from management.  I suppose it’s a good thing that my team can carry me through these final weeks. They probably don’t even realize the burden they are bearing. It’s a shame that I’ve lost enthusiasm but I do feel a freedom to speak my mind now. Is freedom really just another word for nothing left to lose?

Road to the hospital in Chiradzulu, photo by Cecile Brucker

If you have robbed someone of everything they care for, doesn’t that free them to respond in any manner they see fit? What is happening in Gaza now is beyond my understanding. I only get snippets of it from BBC radio. Last weekend I was in a pizzeria which had a television and I couldn’t stop staring at it. Though muted, the images of people, children surviving the bombing – surviving but maimed and perhaps mentally scarred for life – and the ticker tape below counting the death and casualties had me mesmerized. What has been the international response to this? Is the US really standing behind the brutality and trying to justify it by saying “but they started it”?
If you lost everything, would you care anymore? A friend showed me a news clip of an Iraqi journalist throwing his shoes at George Bush. My eyes nearly popped out with incredulity, but then I was more surprised that my instant reaction was an eruption of laughter. How does a journalist in a country in which the US has invaded have the audacity to throw his shoes at a sitting president of the only superpower on the planet? Janis Joplin knows.
Why are we continuing to rob people of what they have if it’s just going to make them mad and then liberated to do desperate acts? Wouldn’t the more prudent response be to listen to them, understand them? Einstein said that peace cannot be kept by force. It can only be achieved by understanding. Why don’t we listen to our great thinkers more? Some people believe we are a doomed planet, a string of failed civilizations, continents of misguided societies. Yet we turn to our artists, musicians and writers as if they have the answers. And when they tell us, we praise them, but then don’t listen.

Martin Luther King said that history will have to record that the greatest tragedy of a period of social transition was not the strident clamor of the bad people, but the appalling silence of the good people. Are you listening?

Sandy, A - chiradzulu, Malawi

MSF Blog: Chiradzulu part 20

These last six months have been somewhat magical. There are a dozen people living in Chiradzulu representing every continent on the planet (except Antarctica). We expats arrived, stripped of our normal uniforms, our usual decorations, our regular badges of career, family, friends, clothes, cars, and neighborhoods. Things that would normally define our status, our place in society, sometimes even our identity. On this mission we are so starkly ourselves.
Perhaps being less inhibited, not as bound to what we are supposed to be doing, leaves us freer to be who we really are. I think it’s one reason everyone is so much more attractive. It’s a bit of a perfect storm, the freedom to be truly oneself, learning about oneself, and making true friendships. Perhaps none of us will realize the magnificence of it all until we are apart. Our nurse from Japan is leaving this week, and it’s the beginning of the exodus. I will leave in a few short weeks and am wondering if I can stay this open and honest when I return to my home country. Is it more fun to live with your guard up, or project an image, or simply being true in this moment?

We went to the lake on Christmas weekend and our doc from Colombia threw me into the water – fully clothed. I was a flash or rage in one moment and then a ball of remorse for shouting the next. Even after apologizing to him I felt like telling everyone sorry for having overreacted. But it’s fun to be human, to feel every sensation. We bear an orchestra of feelings, capable of a symphony of emotions. What a pity to be limited to the select chosen socially-acceptable few. If I have just this one life, I want to feel them all. The key is not to hold onto any, or you risk preventing the next one in full crescendo.

Like the feeling of awe when a Malachite Kingfisher flew into my office on New Year’s Eve. One of my staff caught it and set it free, but not before I could get a picture of it. It’s a beautiful bird with iridescent colored feathers and a bright orange beak. I hope it’s a good sign for the New Year. I try to begin each year with resolutions to become a better me. Five years ago I resolved to call my parents more, but as communication is so expensive here, they’re the ones with the large phone bill in 2008. This year I decided to resolve not to change myself, but give others the space to change. Every January 1st we hope and aspire to be better than we are, and too often we fall back into our regular patterns and habits. Some of that is due to our friends and families expecting that we simply stay who we were. If we gave people the space to reinvent themselves, would they? Even if only for a day. And if they were successful one day, could they repeat it?

I know changing behavior is hard, and removing an old habit leaves behind a gaping hole. Maybe if that void were filled or substituted with something else, the emptiness wouldn’t be so painful and more resolutions would be fulfilled. In that context, I will replace my judgment of others with curiosity; I will substitute expectation with encouragement. Gandhi said that we should be the change we want to see in the world. After all, a waterfall begins with a drop.

MSF Blog: Chiradzulu part 18

The rains have arrived and I can smell it

. The clouds roll in dark and low, like the Nothing from the Never Ending Story. When living on a mountain, you don’t look up in the sky to see if it’s going to rain – dark clouds tell you nothing. Instead, look across the landscape for a grey curtain passing along as hills and valleys disappear behind it. It’s raining everyday now. The humidity has exploded my hair and made drying clothes a multiple-day chore. We’ve adopted the Asian practice of going barefoot in our houses, leaving our shoes caked with red mud at the door.

Despite these inconveniences, I like the soggy interruption during the day. I’ve become too accustomed to my daily rhythms and the raindrops beating on our metal roof are a nice percussive interlude. It’s raining again and I’m distracted from my work. When it rains like this I just want to stare out the window and watch it come down. Fortunately I’m alone in my office lately, and being the data manager, there is no one to scold me back to work.

I may be the only “manager” at MSF France. MSF doesn’t like to use the word “manager,” instead they use the term “coordinator.” I guess they figure people prefer to be coordinated rather than managed. Data doesn’t have any feelings on the matter. Perhaps management is more about managing expectations than managing people. People have different motivations for their job, and making an honest living is noble in itself. In public health, there’s not much money to be made, or let’s say there are more efficient ways to make money. People are drawn to this line of work for other rewards. There is a motivation to help others, and a good manager knows how to nurture that seed. It can be frustrating as an employee to be planted with no opportunity for growth. Still, once I start any kind of daily grind back home, I know I will ache for the management frustrations, political discourse, and technical difficulties in Chiradzulu. But I miss my
family and friends. Thanksgiving has come and gone and we’re headed straight for Christmas.

I’m starting to feel a twinge of sadness that comes with the bittersweet end of something good. I’m two months from completing my mission and will spend these last eight weeks trying to preserve each moment. My favorite is the 15 minutes of chaos in the morning – people rushing about finding their teams, land cruisers and assignments for the day. It’s an organized madness that I relish. On my rides between Blantyre and Chiradzulu, I stare out the window and try to absorb images like a sponge. I want to remember the piles of fruits and vegetables sold on the side of the road, currently mangoes. Or the bicycles piled high with chickens, eggs, or some other commodity ready for the market. Or the children and their wide-eyed curiosity at the Mzungu in the white land cruiser. Meanwhile the landscape is turning green. Maize fields are showing their sprouts. I’m preparing the job profile for the next data manager. The cycle continues.

MSF Blog: Chiradzulu part 18

My staff started playing Christmas songs during the day. I guess it’s expected, but as the days get hotter approaching full summer mode, hearing Silver Bells sounds a bit off kilter. I suppose the entire southern hemisphere celebrates Christmas in summer. Is it necessary to change hemispheres just to see another point of view?

Billboard on AIDS prevention in Chiradzulu (photo by Rupa Kanapathipillai)

Next Monday is World AIDS Day. I know I ought to write something, considering I am on an HIV/AIDS mission in sub-Saharan Africa, but I don’t know what more to say. I’m grateful for the change of perspective gained from living here. I see first-hand the challenges of running an HIV/AIDS program, which seems to have as much to do with inadequate infrastructure and poor motivation as insufficient resources.

I won’t repeat the tale of irregular electrical and water supplies, or the inability to regulate the lab temperature, or the incapacity to process x-rays, and I don’t even know how the surgical ward copes. Even with a laundry list of infrastructure problems, this is one of the better hospitals in the country, mostly because people know MSF is here. Why does motivation to run a functioning hospital have to come from foreigners?
Our hospital doctors and nurse come home each day as if spent in a boxing ring. (I try not to complain when they are around.) They see Death daily; he walks hand in hand with the apathy of the underpaid, under skilled hospital staff. It’s difficult for me to understand how government clinicians and nurses see their job as a 9 to 5, clock-in clock-out, how-little-can-I-do position. The patients suffer, and then die. Even providing water to the hospital takes cementing pipes into the ground to prevent villagers from dislocating them and taking water for themselves. I don’t know what it’s like to have scarce water – or none at all – but you’d think people would respect the hospital’s water source. Then again, maybe it’s not about respect but rather survival. When you’re living for today, it’s hard to think about tomorrow. HIV has kept life expectancy around 40 – so how concerned can one be with life at 55?

View of shops in front of the hospital in Chiradzulu (photo by Rupa Kanapathipillai)

Many of us come to Africa with enough answers but few questions. It’s a cyclical story of short-term goals, insufficient collaboration, recurring apathy, and eventual burn-out, or the politically correct term, “donor-fatigue.” How long are we supposed to care about a continent when we don’t feel like they care themselves? But is it about how we feel they feel? Within a few months, or even years, have we gained enough experience to unravel motivations for all kinds of behavior and practices? Surely our post-graduate degrees have conferred some knowledge on us to understand why people do what they do. In the words of a Hollywood movie, we come to Africa with our hand-sanitizer, malaria prophylaxis, bed nets and laptops and hope to make a difference. Perhaps hope is not a strategy.

In graduate school, my friend had written on her mirror in lipstick to remember how to get through each day: First understand, and then be understood. We are all biased by the impressions put upon us since childhood, whether religious, cultural, or societal. Yet we use our own background as criteria to judge others, despite the differences. It’s easy to judge someone based on our own standards, but much harder if you understand their entire history. Does having a little patience and understanding take more effort than changing hemispheres?

Sandy, from Chiradzulu in Malawi

Sandy in Liwonde Park, writing from Malawi

Am back from a 10-day jaunt in Europe, and have a few travel tips to share:
1.   Comfortable shoes, above all else.
2.   After 12 hours, if you can’t manage a shower, freshen up with a spritz or two of Chanel # 5 at your next Duty Free.
3.   Never freak out. Remember, there are millions traveling around the world with you, if they can do it, so can you.
4.   Be nice to all airline staff. You never know who is going to let you into the executive lounge with an economy ticket if you have a 10-hour layover.

My fretted lay-over ended up being quite nice, binging on fast-speed internet access. As I sat in that Air France lounge of the swanky Jo’burg airport, I understood why people have split our planet into separate worlds – developed, developing; industrialized, non-industrialized; northern, southern. Whatever words you want to attach to the division, it’s still there. I didn’t see the poverty of Chiradzulu until I walked through the wealth in South Africa’s premier airport. I walked slowly, feeling a bit shell-shocked. Sitting in the lounge, sipping my ValPré spring water, reading the previous week’s Guardian and the plunging of the markets – the world’s economic crisis of our time, I imagined the losses people are bracing for. Homes, school opportunities, health and retirement security. And those on the other end of the spectrum: yachts, summer homes, lifestyles. But back in the developing world, where the grass is definitively less green, people are fighting to stay alive.

Last weekend one of our nurses died because she couldn’t get to a proper health facility in time. She was vibrant, fashionable, sharp, and less than 40.

One day I hope to be old, but I don’t want to attempt reliving my past by jumping on the backs of those younger than me. Nor do I aspire to be a guiding torch or beacon for future generations. I want to stay in the moment, relish each day, live in the now.

And in this moment we have elected a new president of the United States. It’s funny feeling proud of my country – I guess I hadn’t felt it in a long time. I think the most brilliant thing about his campaign was that he got us believing in ourselves again. “Yes, we can.” That’s some power, getting people to believe in themselves. Many of the great leaders did that. Gandhi, Martin Luther King, Nelson Mandela, Roosevelt (FDR).

I used to want to save the world. Somewhere in that ocean of altruism was a deeply buried desire to feel purposeful, worthwhile, meaningful. I had learned early that my life would only have meaning through service, assisting others. If someone else benefited from my existence, then my life was worthwhile. And yet, I think about all the people who affected me. That I wouldn’t be who I am without the nicks, scratches, chips and molding done by others.

Perhaps in your daily interactions you are sculpting someone else. Maybe we are all artists painting this world, weaving this remarkable tapestry that is ours. Do we share a common vision, a similar dream? Can we make it happen?

MSF Blog: Chiradzulu part 16

A couple of weeks ago I went with colleagues to a concert that was being held for HIV awareness. In between performers, the emcee made an announcement – “There’s some information back there. So if you have a disease or something, check it out.” When my colleagues and I looked for the table of information, we found a card table at the very back with various items strewn about: pamphlets, male and female condoms, and oral contraceptives. We have a lot of work to do.

Sometimes work seems like all we do, so I’m thankful for the distraction family and friends send regarding the upcoming presidential election and the collapsing capitalist market. As we watch our lawmakers play with our economy like it were a craps table, and debate on who to blame – the people who took unaffordable loans from the bank or the bankers who gave it to them, I’m grateful that information doesn’t flow on broadband here or I’d be as panicked as an Alaskan governor thinking I’m qualified in foreign policy because I live between Russia and Canada.

Getting on the internet in Chiradzulu has been an 8-month long course in patience. We have dial-up which registers as 33.6kbs, but it’s more like 3kbs on a good day. I never imagined that hearing those high-pitched sounds of my computer logging on would be a tune that I crave to hear. While waiting for my inbox to load, I practice multi-tasking by wondering if I’ve truly weaned myself from being an internet junkie, thinking about my next blog, and how did I end up gaining weight in Africa?

A view in the region of a Baobab crossing, photo by Pat Carrick

Food here isn’t as much about taste as it is about substance. People don’t prefer nsima (maize-based porridge-like substance) because it tastes better – there is no taste, they like it because it’s heartier, heavier, more filling. A morning greeting here is, “Have you had breakfast?”

I thought I was the only one who gained weight, but our Field Co confessed to me that her pants don’t fit anymore either. It’s our cook’s fault. If he wasn’t so good, we wouldn’t eat as much. I wonder if he prides himself on watching all the expats get fat. It’s his cakes – those cakes that he conceals as bread by baking them in loaf pans. But one bite and that crunchy crusty exterior gives way to a pillowy, sweet, buttery piece of heaven. Butter is his secret ingredient – a pound of butter. I’m meeting former colleagues at a conference in Paris this week and I’m embarrassed to be the only person they know who went to Africa and got fat.

My flight is at the crack of dawn on Tuesday morning. We can only use the airport during daylight hours now. Apparently a month or so ago the power was out because a transformer blew. By the time they got it fixed, someone had stolen the cables for the runway lights. You’d think I’d miss being able to count on a scheduled flight plan, but it wasn’t until we ran out of water one day last week that I actually missed home, but it didn’t last long.

After lunch that day, I stared off into the clouds and imagined how empty my house in Atlanta would feel after having lived with so many people. That evening I looked around our living room, at our collection of books and DVD’s in half a dozen languages, candles stuck in empty wine bottles waiting for the next power outage, folded laundry lingering on the table until claimed, backpacks and laptops strewn about on the dining table that serves as our evening workspace, and it felt like home.

Sandy, from Chiradzulu!!!

MSF Blog: Chiradzulu part 15
My friend’s brother died this month. He was less than a year older than me. Life expectancy in Malawi is something ridiculous, like 40. Everyone I know here has lost someone in their immediate family. Mother, father, brother, sister or child. It’s madness, and I don’t know how people keep their sanity. Our nurse from California reminded me that we look at our own lives – in our 30’s and 40’s – and think we’ve got another 30 or 40 years left, and statistically that’s probably true. But here in Malawi it’s not. Stalin said a single death is a tragedy but a million deaths is a statistic. It’s harder to think of people as statistics when you know their names rather than their diseases.

The thought of getting malaria or schisto doesn’t seem like such a big deal anymore. It’s leishmaniasis, onchocerciasis, and trypanosomiasis that scare me, not to mention TB and HIV. Life is raw out here, and if you’re not African it can seem too difficult.

Carrying wood on Chiradzulu mountain, photo by Pat Carrick

There’s a word to describe someone who is not African – Mzungu. Malawians say it’s not derogatory, but simply refers to someone who is not black. But I think it means someone who is weak, when compared to Africans. People are strong here, mentally and physically. Women pump water daily, and then carry buckets full on their heads as they walk home barefoot, with a baby on their back the whole time. It’s not just women, as I have seen plenty of children doing the same thing.

There’s a cleared soccer field here in Chiradzulu, and a group of children meet some of us there on the weekend. Most of the time they are dressed in their Sunday-best, but sometimes their bare feet and torn clothes are hard to overlook. Their ingenuity impresses us most. If the weather permits we fly a kite, courtesy of our doc from Pittsburgh. But the kids have offered to show us how to make kites, out of reeds and plastic bags. We also play games. A few weeks ago I played checkers on a hand-made cardboard-checkerboard using bottle caps as chips – Coca-cola versus Kuchee Kuchee beer. One boy, Junior, has this incredible toy car that he made out of wood and wires that has a handle attached as a steering wheel. Another impressive creation is a triangle shaped go-kart we’ve seen the boys riding down the hills of Chiradzulu. Sometimes we expats struggle with the desire to give things to our young friends, but always refrain for fear of encouraging them to ask for more. In the end, they are happy when we spend time with them, as are we.

A school sign in Chiradzulu, photo by Pat Carrick

Still, I can’t stop myself from contemplating their future. I haven’t told them my age, because mid 30’s is considered old. I tell them I’m 19 and they laugh and call me a liar. But I wonder how many will get to be as old as me.

Sandy, from Chiradzulu in Malawi

MSF Blog : Chiradzulu part 14
There is a growing and global lack of health care professionals. Countries such as the USA and France import skilled workers from other countries. But in countries like Malawi, there is a serious brain-drain occurring. Malawi has about 12 million people, and one medical school (since 1991) which, as of 2007, has graduated 254 doctors — ever. Many, if not most of these doctors, leave the country for more lucrative opportunities elsewhere. That leaves approximately 2 doctors per 100,000 people. Here in Chiradzulu, if our MSF doctors weren’t here, we’d have one doctor for the district of 300,000 people.

Of course one can’t blame the doctors, as anyone would prefer an international, better paying position. In Chiradzulu we have focused on task-shifting to provide adequate health care to patients. Task-shifting means clinical officers and nurses take on responsibilities that might otherwise be covered by a physician. More serious cases are referred up, but those with less training are asked to perform tasks where staff are in short supply. Task-shifting isn’t the only solution, but it is helping get medical care out into rural areas where patients might not always have access.

Mauwa Health Centre, Chiradzulu. Photo by Pat Carrick

 It’s not an ideal situation, but MSF is trying to make it work. Sometimes it feels like we’re paddling a boat upstream, especially when we calculate that one clinical officer may still see about 80 patients in a day. For them it becomes part of their normal work schedule, but maybe we should stop and ask what do we accept as normal these days?

 I know asking for a definition of normal can be a clichéd question, but perhaps we can dissect how something becomes normal. Could our impression of “normal” just be a collection of habits? Is it repetition that makes an act habit? My brother once told me that if you do something 12 times in a row, it becomes habit. I’m not quite sure where I’m going with this, but repetition, habit and normalcy seem to be on the same highway. If so, then I think I prefer the slower country roads where you might encounter something different, every once in a while, that could lead to something unexpected. Maybe it starts with opening our minds to the possibility of a different idea – one that we aren’t used to – one that’s not normal.

 How much complacency has set in when we discuss the era of the AIDS pandemic? Do we question the role of our own government’s policies that may be fueling the spread of the pandemic? More than 10 years ago, an editorial (AIDS 1995, 9:539-546) questioned the role of free trade promotion in declining sustainable rural subsistence economies (farming) that leads to more rural poverty and thus pushes people towards migrant industries. This also includes less employment for unskilled work, the kind that women with little education and low status rely on. In such situations, women often turn to prostitution. If you mix increasing migrant work with increasing prostitution the equation quickly leads to more sexually transmitted infections, which then contribute to higher rates of HIV transmission. Pardon the simplification of a very complex issue, but you can see how assuming the “normal” progression of AIDS in Africa may simply be us getting used to the idea of a continent being decimated.

If something is repeated multiple times, do we then take it as truth? Maybe it’s not about doing something different just once, but rather realizing the possibility of ideas that aren’t “normal.” It’s letting go of beliefs, and then sharing ideas. There are 6 billion people on the planet. Is it possible that the other 5,999,999 are doing it differently from you?

Sandy A. from Chiradzulu in Malawi

MSF Blog: Chiradzulu part 13

As the data manager on the team, I’ve learned tons about data management, STATA and staff management. But I’m more amazed at the obscure skills I’ve acquired, like 1) having a sixth sense of where the matches are when the power goes out; 2) cooking for a dozen people with two burners and an electric kettle; 3) driving a manual land cruiser with right-hand drive; 4) saying “Thank you” in a half-dozen languages; 5) finding constellations in the southern hemisphere; and perhaps most important 6) letting go of expectations. I’m not quite sure what my expectations were when I arrived. Somehow “saving the world” seemed a bit ambiguous, but was headed in the right direction. Now, after 6 months, I’m thinking I will have gained more than what I have given.

I am more appreciative of the extended family here. Though people may live with their spouse or parents, their financial obligations extend beyond the immediate family. Unemployment is probably over 50% (statistics are an evasive animal here), so when someone is working, they are often supporting people outside their immediate family. If someone asks for help, you just give – not necessarily a lot, but what you can, because you can. This is an area where I have stumbled a lot. I see many men drinking their money away, so am wary to fund such liquid assets. Meanwhile, prices of food have doubled in some areas, and though we expats may not have cookies or yogurt for a week, I don’t know what my national counterparts are sacrificing.

Shops in the region, photo by Pat Carrick

MSF-France has been in Chiradzulu for over 7 years treating patients who are living with HIV. There are about 15 expatriates, and 150 national staff. The expats come here as supervisors or managers, but most with little or no context of understanding Malawi. Even I have been here for 6 months, speak enough Chichewa to get by, but still stumble over many local customs – and I’m very far from understanding what exactly motivates people. In this setting we expats arrive to supervise staff. Some of us, on top of no Malawi-experience, have little or no HIV experience, while our national counterparts have been treating HIV patients for years – in Africa. But we are here to supervise and manage the program. Of course every new expat who is here for a few months wants to feel like they made a difference – that our time during a mission served a purpose – so we look for some new improvement to implement. We bring our expertise from whichever country we are from and impose our great ideas on these people of whom we are guests. Sometimes we don’t bother to ask our staff what they think. After all, we are the expats/experts.
It’s difficult to be a manager, there’s no one to tell you if you’re doing a good job – or if you’re doing a bad one. I wonder how long we expect to supervise? Perhaps what makes it difficult for MSF here is that it’s a long-term program. MSF is used to working in crisis mode which cannot be sustained for long periods of time. But this HIV project has been here for 7 years, and will probably be here for another 7, at least.

Chiradzulu Hospital, photo by Pat Carrick

Maybe what Africa needs from us first is a willingness to understand, only then can we be understood. If you want people to build a ship, you don’t teach them how to chop wood and build sails, you get them to yearn for the sea. (I think a French writer said that.)

We’re learning how to implement water conservation tactics, not because any of us are big Al Gore fans, but because we’re bracing ourselves for the impending water shortage. The guys on the mission have proposed communal showers.

Sandy, from Chiradzulu in Malawi