CHAKWINDIMA, Malawi— I had first traveled to this village four years ago to start reporting on a book on Americans who go to Africa to help children. It turned out that as I traveled from Malawi to Ethiopia to Kenya to Uganda, almost all the Americans in the field were motivated by their faith. Here in Chakwindima, about 25 miles southwest of Lilongwe, near the Mozambique border, it was no different. I had met a North Carolinian by the name of David Nixon, who had started a school and feeding program for orphans after visiting the area in 2002 with a group from his church.
By 2009, Nixon’s program, called NOAH, had become a lifeline to more than 300 children. When I arrived here this past week, the program had diminished quite a bit; Nixon had held fast to his vision of educating hundreds of children around Chakwindima, but his responsibilities back in North Carolina had forced him to scale back the project to feeding 150 children: He now was raising his six-year-old grandson and that made it extremely difficult to travel to Malawi or to raise funds for the project.
Still, NOAH remained vital to many here. It fed nearly 150 children each day and it looked after the health care of many children, including five who were HIV positive.
I am in Malawi to look at what is happening with the Obama administration’s Global Health Initiative (GHI), which was launched two years ago to broaden the focus of US-funded health programs toward improving the overall well-being of people as opposed to numerous efforts battling one disease at a time.
While in the capital of Lilongwe, I had met with US government officials as well as the country’s Permanent Secretary for Health, Willie Samute, who had told me that Malawi was focusing on lowering the fertility rate. Both Samute and the US officials said that getting the message through to people in villages was not easy.
I wanted to see why, and Chakwindima was a good place to inquire. Fosina Bester was overseeing the NOAH project, and when I arrived, she was dealing with a health emergency: A grandmother had just brought a tiny child to NOAH, saying she was HIV-positive, very ill, and needed health care immediately.
The grandmother, Eneta Sam, 44, was outside with the child, Gloria Napialo, who weighed 17 pounds and was nearly three years old. “We went to a private hospital and they were no help to us, so we came here as a last resort.”
I put my hand on Gloria’s forehead. She was warm. The grandmother shifted, and Gloria started to cry. Her stomach was bloated and she had a penny-size open sore on it. “To see a child like this really pains me,” Eneta said. “Since she was born, she has been ill.”
The family tested the child for HIV only a few months ago after the child’s mother had died from AIDS-related complications. Eneta saw two lessons from her daughter’s death: One was that some people, such as her daughter, still were so reluctant to acknowledge their HIV status that they didn’t even tell family; and two, the health of families was connected to a number of factors.
Family planning, she said, was at the heart of a family’s health. “It’s now easily available in Chakwindima,” she said. “It’s a very good idea. For women, it means your health improves, and your children’s health also can improve if you are not having children every year.”
She said that the US government was supporting the distribution of contraceptives in the area, but that some people still were reluctant to use them.
NOAH’s Bester agreed. “The problem is with us in the village,” she said. “There’s also a problem with some about getting tested for HIV. Some women know they will get tested if they go to the hospital, so they don’t go. They don’t want to hear the result.”
In the nearby village of Manase, Bester went to see a 14-year-old girl, Annie Chigoneka. Annie was positive but her fraternal twin sister, Hanna, was not. For several years, Annie has had periodic bouts of illness, and in May, her CD4 count dropped to dangerous levels. NOAH helped bring her case before doctors and paid for her transport into Lilongwe. A doctor put her on antiretroviral treatment. When I met her she was just four weeks into treatment, and she said she has started to feel better.
Since the NOAH school closed, both girls were enrolled in government public school. Annie was in primary grade 6, while Hanna was in primary 5. Both classes had nearly 100 students each with one teacher. In contrast, Annie’s class in her last year at NOAH, grade 4, had 14 students. “She was one of the best students in the class,” said Bester. “She really performed well.”
But the girls’ future – and their future health – was tied to the family’s poverty. NOAH provided free schooling and free meals for its school, and the girls’ grandmother, Enia Chigoneka, said that she may not be able to afford sending the girls to the government school next term, which starts in September. The cost is estimated at 5,500 kwatcha, or about US $30 each, for a teacher fund, uniforms, examination fees, and books. If they don’t go to school, the grandmother worries about their future.
“Girls aged 12, 13, and 14 who stop school often get married because of poverty,” she said. “Families can’t support them. I don’t want that to happen to my granddaughters. I don’t want them to get married off, but I don’t have the means to keep them in school.”
Annie wants to be a nurse, Hanna a teacher. “I want to help others,” Annie said. “I’ve experienced so much sickness that I don’t want others to go through it.”
When I left, I thought once again about the fragility of those deep in poverty, and about how the closing of a school made young girls suddenly vulnerable. Would the twin girls become a nurse and a teacher? Or would they be pregnant in a year?
So many factors were at play, and so much seemed out of their control.