Around the world in 80 days – Part 3: Malawi

12 April 2013
 Malawi field

Scientists in Malawi working with ‘locals’ around 30km from the nearest hospital

Over the course of four months, Barry J Gibb visited the Wellcome Trust’s major overseas programmes in Africa and Asia to make a film about the Art in Global Health project. In the third of his journal entries Barry arrives in Malawi.

Flying to Blantyre in Malawi was a rather ramshackle affair. The flight was in a diminutive 32-seater plane (I counted them). After jamming the camera bag under the seat in front of me, I tried to relax in the dated, rather worn looking contraption that was about to exceed 20,000 feet.

It was around this time that I was also beginning to get seriously edgy about the memory cards I was carrying. Backing up the video data wasn’t something I’d considered prior to leaving, which suddenly struck me as very, very silly. For the next trip, I’d ensure there was a portable drive, constantly backed up, in with my main luggage. For now, I’d have to simply accept that every day, hours of precious, carefully collected footage were precariously far from home.

Arriving at Chileka International Airport, the driver who had been arranged to pick me up was absent. Having learnt my lesson in Kenya, there then followed an Oscar-worthy performance as I did my utmost to look like a native, ignoring the numerous attempts to become my new best friend, taxi me around, carry my bags, etc. Fortunately, the driver showed up after several minutes and was so solidly built the other drivers parted like water.

The hotel was not what I was expecting. Having been away from home for a week, I was looking forward to the company of strangers, dinner in the midst of people, if only to soak up a little human contact. Instead, I discovered myself in a gated environment, with no dining area and no bar. And so, each night, dinner would be brought to my room by Frank, a warm, friendly member of staff, who would carefully lay the table, place the array of food he had made on the table and leave. The one time the hotel did indulge in communal dining was breakfast, an experience shared not just by the diners but by the hotel’s pet deer. This beautific creature would show up and just stare at me with its huge, gorgeous eyes as I chewed through toast.

Research, washing and Scottish roots

During my first visit to the Malawi-Liverpool-Wellcome Trust Clinical Research Programme, I met the Programme’s wonderful Public Engagement team: Tamara, Elvis and Bertha, the woman who would be my main point of contact and guide. They had formulated a great plan of whom to meet (by which they meant interview) and when. But first I had to meet my artist, Elson Kambalu.

Elson is a wondrously laid back individual, confident yet unimposing. It was clear he knew what he wanted out of my visit as much as I did and he orchestrated much of our time together which, as it turned out, was fantastic.

After a few light interviews on the hoof, including one with the Programme’s enthusiastic and generous Associate Director, Professor Moffat Nyirenda, I was escorted around the centre, camera in hand, to get a sense of how the place runs. I observed as entire teams, devoted to the statistical analysis of the scientific data being collected in the field, entered their precious numbers and personal information into computers. The question begged, where is the data coming from?

Some of it is coming from the hospital adjoining the research centre. As we wandered around the hospital grounds, the area was dotted with nurses having their lunch on the grass. The fusion of black skin, ultra white uniforms and luscious green grass made for a spectacular sight. This was heightened by the overwhelming quaintness of the place, a distinct 50s feel, revealing itself in their uniforms and hairstyles.

A little further on and we were confronted by bushes covered in clothing. This, it turns out, are how the hospital’s residents dry their clothes following a wash. It was as if nature had abandoned chlorophyll and started sprouting vividly coloured cotton finery.

As in Kenya, the hospital in Malawi had its fair share of maladies and suffering. Again, it was important to film with sensitivity; to capture these images without crossing the line into voyeurism. In a well timed moment of levity, Elson suddenly appeared at the end of a corridor with his own video camera and, for a moment, we were caught in a ‘film loop’ of documenting each others process of documenting.

Over lunch, Elson gave me a little history lesson about Blantyre, the financial capital of Malawi, as we sat in the shade of a tree in the grounds of an art gallery he frequently supplies works to. Amazed at my own ignorance, I learnt that Blantyre’s origins lay firmly in Scottish territory (as do mine). David Livingstone had left Scotland, come to this place, named it, brought Christianity and left a very considerable mark. Our lunch arrived and I watched with quiet respect and fresh understanding as Bertha said grace.

Being an artist in Blantyre, Elson informed me over a sandwich, is a bit of an oxymoron. There are no art schools and very few artists. It’s not even considered a profession. Those artists that exist, like him, have forged their way to prominence, forming a strong alliance of like-minded people who help each other out whenever they can.

Back at the research centre, I filmed the scientists in action, again marvelling at how similar the process of science must be across the world: pipettes, eppendorf tubes, centrifuges, PCR machines… All that changes is the skin, the bone structure, the culture and the target disease.

Malawi proper

Next up, I was delighted to get out of the centre, to get a taste of Malawi proper. When told we were going to the ‘Hit TB Hut’, I wasn’t entirely sure what to expect. But tucked away, near a town, by a mountain, was another man called Frank and his place of work, a tent that he erects on the loose, dusty earth wherever he needs to be.

The low-fi, yet critically important nature of what people like Frank do is stunning. Before interviewing him, I watched he and his assistant in action, speaking with visitors from the local town, collecting data about tuberculosis; trying to piece together human movement with disease. It also becomes very apparent how critical personality is. People like Frank need to gain the trust of the locals quickly, often via meeting and working with the town’s leader. After just a few seconds with Frank, it’s obvious why he’s so well matched to the task: a large, open smile and a firm handshake quickly followed up by a shoulder barge.

Then it was Elson’s turn to be interviewed. A canny man, he took me back to his scenic cottage, in a very nice part of town it turned out – but, as with many places here, the relatively rich rub uncomfortable shoulders with the relatively poor. Elson had also brought a couple of friends along, one, it turned out, a singer of local repute – Agoroso.

After clearing the set of people, we did our interview, much to the delight of the chickens on the grounds who seemed to cluck furiously every time Elson said something profound. As always, the challenge in such a situation (one of ignorance with no possibility of doing a recce), is to do the very best you can with what you have. In this case, I positioned Elson so that he had natural light on his eyes and placed a large piece of his own art behind him as a backdrop.

To compensate for the chickens’ enthusiasm, Agorosso decided to put on a spontaneous performance in Elson’s garden. There followed three, lovely acoustic tracks as we watched and listened, entranced. So entranced that I didn’t notice the tripod get knocked and the camera fall to the ground, smashing its eyepiece off. Trying to regain calm, with two more days of filming to go, I grabbed the camera and quickly noticed it couldn’t focus. My heart started a downward trajectory. Fortunately, common sense kicked in and I adopted what should always be the first course of action with any technical piece of kit: turn it off and on again. To my joy, the camera found focus – we all cheered!

On the way back to the centre, Bertha, my largely silent yet efficient companion, commented on my apparently remarkable ability to remember faces and names. This, it seems, is not a common ability or trait she has witnessed in Blantyre. The other trait she told me I exhibited was a close adherence to “English Time”, a term used to describe punctuality. This will not be a surprise to my colleagues. However, it seemed my use of time as an actual reference point to be adhered to was a largely alien notion.

Barriers

The next day, after having breakfast with the wide-eyed deer, I went with Anja, a clinician working at the Programme, and Bertha to Chikwawa. Located around 40 kilometres south of Blantyre, deep in a hot, steamy basin, Chikwawa is home to the hospital where Anja and many other scientists are fighting an ongoing battle against malaria.

On the journey, Anja explained the issues they face are not just due to mosquitoes but language and barriers to understanding. For example, there is no word in the local language to describe a small tube. This means that when people are being asked for blood samples, they can think they’re being asked to fill up a bottle the size of a soft drink receptacle. Add to this the suspicion that one’s blood may not be used for scientific purposes but to drink and the cultural waters become rather muddy.

Superstition is rife in Malawi. Christianity may have a strong foothold but local healers and witch doctors are commonplace and hold powerful sway over people. This becomes a medical issue when faced with a choice of seeing the local healer, who lives in the village or getting up around 4am in the morning and walking up to 20km to the hospital. People die because sometimes they have no medical options and it’s thanks to people like Anja that the mystery surrounding medical practice is shrinking and the likelihood of medical intervention is becoming a tangible alternative.

The conditions the scientists work in here are rudimentary, cramped and very hot. A single refrigerated room exists to maintain the medicine. Everyone else just gets used to the incredible humidity. Scientists work in rooms no bigger than large cupboards, using simple equipment to try and save lives. The juxtaposition of suffering and sickness alongside selfless people doing their level best to help others survive I found profound.

Then, in a triumph of Malawian over English Time, we were informed that a group of schoolchildren had been waiting for us to show up for around two hours at their local school. We departed quickly, Elson elaborating on why the level of education in Blantyre was relatively poor – a child must be old enough to walk to and from school. So while, in the UK, a child enters school before five years old, here, they can’t learn until they can cover large distances on foot.

Despite the wait, the children, adorned in their best blue and red uniforms, seemed in good nature. No doubt because Elson, ever the marketeer, had told them I had come over from the UK specifically to film them. Observing both Elson and the children working was fantastic. His enthusiasm fed theirs as they drew their own health-inspired art on large, bespoke canvases. Elson’s plan was to collect their art and display it in a gallery.

And then, just as my second camera battery was almost out, something magical happened. Without any warning, the children assembled into a group, and sang. Feet stamped a rhythm and voices joined in harmonic unison to create some of the best music I had ever heard. It was moving. They belted out three songs in all, Elson and Bertha joining in on the last one, singing, dancing, joyous. It was the best possible way to end the shoot.

Barry James Gibb

Barry is a Science Multimedia Producer at the Wellcome Trust.