Malawi Monitoring & Evaluation Visit Part 1
The Bishops’ Appeal Advisory Committee has supported the Tearfund IMPACT project on several occasions through multiple donations that have reached €20,000. The Committee was encouraged by reports of the success of the programme regarding the decrease to the point of eradication of Parent to Child HIV transmission. The committee was also interested in Tearfund’s approach, which mobilises church and community leaders to identify the needs and the resources within the community to respond through its own means.
Education Advisor Lydia Monds visited the projects in Malawi to evaluate the work, listen to stories from community leaders and beneficiaries and to hear from the various groups where they would like to see the programmes develop on into the future.
Martha is a mother buddy from Ekwendeni. This means several things. First, it means she has been trained to work with expecting parents to radically reduce parent to child transmission of HIV through a diligent programme of anti-natal clinic visits, HIV testing, ARVs and nutrition. Martha is supported by wider voluntary care groups in the community who identify pregnant women for her to visit and through initial and refresher training she receives by Tearfund partners. She started this role as an understudy before receiving her own clients, numbering 138. Being a Mother Buddy also means that Martha is HIV positive and her desire to support other mother’s is borne out of the transformation such a programme has brought to her own life. She shared with us that her 1st child was born HIV+ but after the programme her 2nd child was born HIV-.
One of the most important and difficult tasks that Martha has is convincing the fathers of the unborn babies to attend anti-natal clinic. Within Ingoni culture, pregnancy, birth and young babies are not a man’s concern. The child is owned by the father and cared for by the mother. The desire to have both parents involved goes beyond the need to cultivate support networks for an expecting mother. At the clinic both parents can get tested for HIV/AIDS and syphilis together and can receive counselling if one or both of them are positive. Women who are tested on their own are not only unlikely to tell their partner their status, but are also unlikely to return to the clinic. Home births without any anti-natal support drastically increases maternal and child mortalities.
Fathers who had engaged with the programme spoke of fears and suspicions being alleviated as to why their wives took so long at the clinic. Together they were given information on everything from nutrition, rest, hygiene, and family planning and if one forgets the other can remind. Initially many men went because they heard there were board games available to play whilst their wives were being examined, and because it put their wives to the top of the clinic queue. Gradually though, with marriage counselling and discussion, they began to see their role in the process. Several men spoke of collecting firewood or carrying water or even cooking the family meal for the first time, with a new understanding that the unborn baby was their responsibility as well.
Martha teaches couples how to make maize meal porridge with added eggs and legumes for a balanced nutritious meal and prepares mother’s for birth. (This support is also provided by ‘Group Therapy’ run by Care Groups who alert Mother Buddies to a pregnancy in their village She then teaches a strict baby diet of breast milk for the first 6 months only introducing supplements later. She teaches about how to stay malaria free. New-borns are tested at 6 weeks and then again at 12 and 24 months. So far, all HIV positive parents in her care have given birth to HIV negative children.
Tricon and Loveness gave birth to HIV negative Catherine in March 2015. Their older child, Benjamin, is 11 years old and HIV positive. Realities such as these are painful reminders of what life is like in the absence of the IMPACT programme. The couple were also identified as vulnerable through a Consortium of village chiefs and church leaders (17 denominations work together in this catchment area to identify those most in need of training and support) and were given chickens. The eggs provide nutrition as well as an income and they use the manure to fertilise their vegetables and maize.
On paper, the IMPACT project phased out after 3 years on 31st October 2014. However, the structures that were put in place in the community have ensured that it has continued in many forms. For example, 110 pregnant women have attended the clinic, 98 of whom have been accompanied by their husbands. Of the 3 women who were HIV+, all have given birth to HIV- babies. The Consortium of village and church leaders have also been made aware of particularly vulnerable families and have continued to support them through a united effort, irrespective of the needy family’s denomination. The support is holistic as outlined below.
Emergencies: The consortium provides ox carts and bicycles for expecting mothers who need to get to the clinic in times of emergency.
Conservation Farming: Key village workers attended Conservation farming training in Zimbabwe. After the flash floods that devastated so many homes came one of the worst droughts people can remember in the last decade. Through simple yet very precise techniques, people who followed conservation farming methods got to reap a harvest, whilst traditional farming methods did not produce any food. Added to this, conservation farming, called ‘Farming God’s Way’ in some of the villages, replenishes the soil of its depleted nutrients, prevents topsoil erosion and reduces and then eliminates the use of chemical fertilisers, which drastically reduces costs for the farmer. It also is a lot less labour intensive. Once your fields have been prepared the first year, the method can be redone without tilling or weeding and so enables elderly and disabled farmers to produce harvests without high levels of discomfort. In the top left picture Gift is showing us his field covered in dried maize stalks which keeps in the moisture. All farmers explained the method in the same precise way, with strings used to measure distances between planting stations and rows of maize. All of them saw the benefits and are now beginning to expand the method to other crops. Gift is going further and training other farmers, bringing them to his field to show them the differences between the crops grown traditionally and those grown through conservation.