I’ve been in Malawi for one day, and what an enlightening day it has been. After flying into Lilongwe International Airport last evening, I was welcomed to the “Warm Heart of Africa” by a smiling customs officer who quickly stamped my passport and waved me right through to pick up my checked bag. It was the warmest, most efficient customs processing I’ve ever experienced anywhere, living up to Malawi’s national slogan!
I was met by Mercy Nyirongo, Wandikweza’s Project Manager. A good hot supper and then a nice guest room was most welcome. This morning we left at 7 a.m. for Dowa District, about 25 miles north of Lilongwe (Malawi’s capitol city.) While Lilongwe is a typical African capitol city, the countryside becomes very rural after leaving the city limits. We stopped at the Dzaleka Health Center, staffed by a couple Medical Assistants and Nurse-midwives. I learned that this center serves about 58,000 people and that the midwives deliver about one hundred babies a month. After a quick visit, we drove on rutted dirt roads to a nearby rural village where we were met by 15 Community Health Workers who serve in this district.
We sat down in a circle in the shade of a tree canopy, and this is where I learned about Wandikweza’s true value. Wandikweza means “Lifted up by the Lord.” It is a registered NGO (Non-Governmental Organization) founded two years ago by Mercy Nyirongo, a graduate of Africa University. It has no ties to any other organization, governmental or religious, but it networks with them to help develop and transform communities through their own inherent power. It creates true “grassroots” transformation in contrast to donor-driven development.
Each Community Health Worker (CHW) introduced himself or herself, and then one of them gave me a brief history of Wandikweza and its work. Each CHW was elected to fill this volunteer position two years ago in a general community meeting. Although most have minimal education, they were chosen because of the trust the community placed in them to handle its health needs. They were given brief but intensive training in the challenges, goals, and methods of doing community health work, they’ve been doing this very effectively since then. The major health issues they work with include Malaria, HIV/AIDS, Family planning, Nutrition, Safe Water and Sanitation, and Maternal and Child Health. These issues were chosen as the most urgent problems in rural village life.
Community group meetings and individual home visits are the main ways of working in the community. CHWs use large picture cards as a key health education method. The pictures depict desirable or undesirable health situations, and the CHW uses them as a platform to explain why any particular activity is good or bad for health. These are discussed in group meetings. Songs and drama are used to emphasize key themes.
After this introduction, we went on several home visits, with today’s visits focusing on the importance of prenatal and postnatal care for mothers and infants. Homes looked much like those in the village pictured below. In each home, we were invited to sit on clean reed mats on the floor, and then the CHWs used the large picture cards to get their health messages across. The last home visit was a three-week postnatal visit to a mother with twin babies. The babies were examined, weighed with an ingenious device that weighs the baby when the CHW uses it to carefully lift the baby in a sling. The twins looked healthy and were gaining weight nicely. At the end of our visit, the mother gave the CHWs her heartfelt thanks for the care she received, crediting them with saving her life through their teaching.
CHWs keep careful records and make monthly reports to the Ministry of Health. Statistics for the past two years reveal that their work has had an impressive impact. Cases of malaria have dropped threefold quarterly because of teaching about the proper use of bed nets. Testing for HIV/AIDS has increased threefold. Malnutrition has dropped to 4 cases per 100 infants. Households using toilets and safe water sources has increased from 30/100 homes to 50/100 homes. Ante-natal care has increased significantly, and delivery of babies at the Health Center have increased from 15/100 to 65/100.
The enthusiasm of the HCWs for their work and the respect they are given in the village was very clear. Health Surveillance Agents from the Ministry of Health are involved in all this because the CHWs report to them and work under their supervision. I talked with one of them, and he said that the Wandikweza Health Care volunteers have been a big help to him. He says the Ministry of Health would welcome them in all their districts.
Wandikweza is largely a volunteer organization that operates on a shoestring budget. Every HCW gets a very modest token stipend. It’s clear that pride in their work and the result they see in their communities is what motivates them most. The work of the Wandikweza Board of Directors and Manager is also volunteer, so there is virtually no overhead. Its an NGO founded and sustained as a labor of love. In a word, it is remarkable. I’m looking forward to learning more about it in the days ahead.