Archives - Reports July - December, 2009

FOOD SECURITY
Community Nutrition Open Day
This was held in conjunction with CARD and the Department of Agriculture Chimteka. We had a successful Open Day, which was practical, informative and fun, with a large attendance.
As an outcome, CARD are willing to support activities regarding food security e.g. they may be able to provide further seeds, especially for soya, which is often provided to villages on a ‘pass-on’ basis, with a possibility of monitoring activities in the long term. The potential for introducing other sources of animal protein, such as rabbits and guinea fowl was discussed, as these are easy and inexpensive to maintain. There is also the possibility of introducing goats.

Village Committees
These meetings were timetabled to begin in August and run for the next few weeks, to incorporate 21 Chimteka villages. Isaac, from Boma, as well as agricultural extension workers from Chioshya, Chimteka, Mchinji and Boma are involved. CARD has now agreed to extend their support of food security from 6 villages to other villages. The idea of these meetings is to make known to Chiefs/farmers and TA, that activities be demand-driven, with emphasis on community ownership and sustainability.
The objectives are to: identify food/nutrition problems; prioritise problems; explore causes of problem; discuss solutions; develop action plan; monitor activities; evaluate. Village Care plans summarising this information, have started with Belo village.

Dry ginger coloured hair and puffy face are signs pf malnutrition

A ‘Food Calendar’ is to be drawn up and used to indicate times of the year when food is both available and in short supply. The community has to be educated regarding: food preservation and storage;
recognition of symptoms of malnutrition; a balanced diet using the multimix principle plus other aspects of food fortification. Pregnant Mums were advised in advance re these meetings and encouraged to attend.

Problems noted to date:
*The use of fertiliser. It seems a certain amount will shortly be available, cheaply, on a government subsidised scheme using coupons. The tendency is for all fertiliser to be used to grow tobacco, (given priority as it is a cash crop), while the food crops are neglected. The use of manure is being considered as an alternative fertiliser. This is being encouraged by CARD.

*Some villages are devoid of all protein sources. Ideally, every village will have sufficient protein to provide for families and use as cash crops as well.
There is a possibility that soya will also be available on a subsidised scheme.
High protein/Quality protein maize (QPM) may be available re pilot scheme; a certain amount is to be free of charge; Isaac is following up on this.
Women selling food

There has been some discussion with ADMAC- based near Chioshya Agricultural Dept, they market/sell local produce at cheaper rates. They are willing to assist us with a co-operative situation, including ‘swapping’ of produce; this will be of particular benefit to the more vulnerable families.

Community Gardens
The gardens, one for each village, are proceeding according to plan. There has been replanting of seedlings etc., where appropriate. All concerned are happy that growth is as expected. Monitoring is to continue on an ongoing basis, as previously decided. The Chimteka Primary school and the HIV positive group will have its own garden as soon as possible.

Screening
Screening has been on-going in some of the twenty-one Chimteka villages, from April ‘09 to July ’09. Statistics are available showing the prevalence of malnutrition, both moderate and severe forms of acute malnutrition, as well as the percentage of underweight children. Children of normal/standard weight/height,are indicated.
The second Nutrition Education day is intended for next month. This is to be funded by the District Agricultural Department, and co-ordinated by Isaac and myself.

Community-Based Therapeutic Care (CTC) and Malnutrition
We had a meeting with the DHO and key personnel at the local Kochirira Rural Hospital as a follow-up to last month. The potential for inpatients and outpatients from Kochirira to be included in the treatment programmes for malnutrition was discussed.
I suggested that an outreach clinic to Chimteka might be provided by Kochirira and severe patients be admitted to their Nutrition Rehabilitation Unit, until more HSA’s are trained. The following was agreed subject to approval:
Mr Elias Kamngola (Supervisor)
Responsible for 17 HSA's
• HSA’s, based at Kochirira, already trained and experienced, will attend, on a fortnightly basis to deliver CTC service.
• The service extends to, under 5’s, pregnant and lactating women and HIV positive patients.
• Likuni phala and Chiponde will be provided. These supplies will be stored at Kochirira and monitored by the stock controller there.
• HSA’s will be responsible for transporting themselves and the food supplements.
• Elias and I are to coordinate the programme, ensure an education session is delivered at each clinic, and submit monthly reports.
• Severe cases will be admitted to the NRU. On discharge, these patients will automatically be incorporated into the Supplementary Feeding Programme, hence they will have further monitoring on an outpatient basis.

Screening is due to be carried out on the numbers suffering from malnutrition in each of the Chimteka villages. However, since the HSA’s were under pressure this month with the water and sanitation campaign, we could not reach as many villages as planned. It is envisaged that more detailed dietary information will be available by use of a ‘Diet History’ questionnaire, containing data on: frequency of meals, components of meals, daily calorie intake, daily protein intake and nutrient intakes of iron and calcium with emphasis on vulnerable family members, pregnant Mums and children under 5)

HIV POSITIVE Group
A mobile ARV Clinic for HIV+ residents of the villages was held.
It supplies ARV treatment/other necessary medication/condoms etc; distributes Vitameal; provides Nutrition Education specific to the group, with one to one support available should an individual require it. The idea of Community Home based Care, of the HIV positive individual, was introduced recently to Chimteka and Chioshya. Fortina was trained, and has now to facilitate the training of others.

Playground
The children were very excited when the playground was upgraded. This effort was led by my friend, Jude, who is currently visiting and was assisted by Francis and some of the chiefs.
They put in new swings, volleyball, football goalposts, netball, a seating area and fun pipes.
The existing merry-go-round and seesaw were resurrected, painted and welded.
The nursery school was painted and decorated.
Games/arts/crafts/movie night took place.

Disability Group
A meeting was held with the DEM. He suggested:
All disabled children are assessed by the Special Needs Teacher/Advisor, based at Kamwendo, to establish requirements regarding nutritional support/physiotherapy programme/equipment and aids required for school. Once fully assessed, the decision as to the child’s suitability for school attendance is made. The special needs advisor usually follows up with the Social Worker and Headteacher.

A donation of wheelchairs has been promised by Mr. Harroon Sacranie of Crossroads Hotel.

Olivetta had both feet amputated. A meeting was held with Dr Kanda; he informed us that all Physiotherapy, outside of two main hospitals, has been cancelled due to lack of funding. He is in the process of arranging a referral for Olivetta, to the Central Hospital, Lilongwe; one of the centres where Physiotherapy services are still available.

Maternal Health
This month there were celebrations as Mchinji District DHO won an award for the largest decline in maternal deaths, in Malawi.
> Figures for April –June 2009, as applicable to Chioshya Health Centre, include:
• Total Number antenatal visits =865
• New antenatal attendees = 319
• Total patients admitted to maternity wing = 155
• Total deliveries by skilled personnel = 126

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Report – May and June 2009, Grace MacLean
The Chiosya Health Centre
1 2 3 4
1. Chiosyia Health clinic serves a population of about 25,000 people.
2. Dr Joseph Bwezonii is the only doctor available.
3. Nurse/midwife Fortina Kalitsuro serves the population single-handedly.
4. Ms Grace MacLean - Volunteer Nutritionist.
Women of child bearing age account for 23% of the Chioshya catchment area.
Children less than 5 years account for 17% and under 12 years, 5%.
Left is a home for the chimteka orphans

The needs and requirements of the orphaned population and those suffering from HIV/AIDS, are of ongoing concern.

Antenatal outpatient clinics at the Chioshya health centre provide the following treatment: Iron supplementation, to prevent/treat iron-deficiency anaemia during pregnancy, vitamin A supplements, treatment/prevention of malaria, antiretroviral therapy for HIV positive Mums (including treatment at time of delivery to decrease the rate of mother-to–child–transmission of the virus).

Community-Based Therapeutic Care (CTC) and Malnutrition
Mchinji District has been scaling up CTC services since January 2009,to include rural hospitals and health centres. The nutrition screening programme, in which I was involved in April, aimed to identify those children under 5, who are suffering from moderate acute malnutrition and severe acute malnutrition. This data provides a basis for the establishment of a CTC programme, based in the Chioshya Health centre, serving the Chimteka community.

1 2 3 4 5
1. Skin disorder associated with malnutrition
2. Nutrition rehabilitation unit at Mchinji District Hospital
3. 6% of under 5's in the Chimteka catchment area suffer from severe acute malnutrition(SAM).
4. Severely malnourished wasted child (Marasmus) - 25% of under five’s die as a result of lack of food
5. High calorie/protein milk is used as a treatment for SAM

Children with severe acute malnutrition from Chiosya/Chimteka must travel to Mchinji District Hospital for inpatient treatment.
The service depends on availability of Ready to Use Therapeutic Food (RUTF), principally, Chiponde, a peanut-based product,of thick paste consistency. Those who are classified with moderate acute malnutrition are given a 2 week supply of RUTF. To date, Chiponde has been supplied in Mchinji District by the Clinton Foundation. A recent change has occurred, whereby 50 % of the product must now be supplied by the Ministry of Health.

Diversification of Food Production
An over dependence on maize as the main source of food in Chimteka, gave rise to the implementationn of a CCS programme of crop diversification.

Between April 16 and May 11, 2009, sixty three farmers received training on:
(1) commercial poultry production (2) vegetable and orchard growing
49 of the 63 participants were male and 14 female.
Each course lasted 10 days and included theory and practice in animal and crop husbandry techniques. The newly developed Chicken Khola with its 120 laying hens was used for practical demonstrations during the training. There was also a practical demonstration of sowing seeds in the field and the extraction of soya milk from soya beans.

Farmers were also trained on harvesting, processing and utilizing garden produce. This will enable them to store and prepare their foods using methods for them to get highest possible nutritional value.

The courses also covered the business aspects of poultry production including record keeping and marketing of eggs, and financing the production using loans.

Tomato, vegetable and maize seed were distributed free of charge.

Some grow ground nuts and bananas but these are sold for cash

Following the training in April and May, one community garden for each Chimteka village was planted in June. These will be monitored on a weekly basis.

It is also proposed to set up community vegetable gardens at the primary schools and health centre serving Chimteka.

School
Many Chimteka children arrive at school which begins at 7 am without taking breakfast.
Most children will not receive a meal until late afternoon when parents/carers come back from the fields.

A typical meal for Chimteka children comprises nsima (a dough made from maize) and greens. Maize is normally milled twice which depletes all nutrients rendering the staple food lacking in nutritional value.
As a result applications have been made to:
set up and run a school meal programme
include Chimteka school in an existing District Vitamin supplementation programme

Maternity Care at the Health Centre
Antenatal outpatient clinics at the Chioshya health centre provide the following treatment:
Iron supplementation to prevent/treat iron-deficiency anaemia during pregnancy.
Vitamin A supplements in treatment/prevention of malaria.

Antiretroviral therapy for HIV positive Mums (including treatment at time of delivery, to decrease the rate of mother-to –child –transmission of the virus). Weight monitoring - failure to gain appropriate weight may indicate food shortage or presence of undiagnosed HIV. Postnatal care including review of mother’s health and advice/support with breastfeeding.
Education relating to health, sanitation and nutrition.

Disability Group
Stella, shown here, has the use of left arm only, has never been to school and has no access to sevices.
This group includes children and teenagers.
The nature of the problems encountered necessitates, one-to-one consultation.
Patients are usually screened on a home-visit basis.
Types of disability include: blindness/partial blindness; cerebral palsy; polio; epilepsy; paralysis; intellectual/learning disability.
Typical problems relate to:
Malnutrition
Mobility - severe lack of physical aids and equipment for mobility.
Services - inability to access services e.g. assessment/treatment by Physiotherapist.
Medication - lack of appropriate medical review/understanding of therapy, e.g epilepsy control.
Education - non attendance at school due to lack of transport and the cultural belief that a disabled person is beyond learning.
As a 4 month old infant Olivetta had both feet amputated following severe burns
She ‘walks’ on her knees and she has no wheelchair. She has never been to school. CCS has enabled Olivetta to attend an Orthopaedic Surgeon & physiotherapist with a view to obtaining prosthesis.
Her physiotherapy assessment revealed good muscle tone in lower body, rendering her suitable for prosthesis. Further discussion with Orthopaedic Surgeon was anticipated, at this point, however he was not available. Follow up arranged.
Intervention:
Provide individual personal care plans developed following home based needs assessments and liaise with local committees and teams with a view to supporting these needs.

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Report – April 2009, Grace MacLean
Child Health Campaign


Mchinji District extended this programme to all children under five, in the Chimteka villages. Vitamin supplementation and de-worming were carried out by the HSA’s.



Disability Group
Two new bicycles were donated to this group.
The group conveys thanks for these.

Nutrition Screening
Approximately 430 children were screened in a random survey.
I was helped by Fortina, 17 HSA’s (Health Service Assitants) and their supervisor, Elias.
A high protein ‘porridge’ using local ingredients, was devised and offered to malnourished children.
Sample ingredients were given to carers to take home.
A follow up on those children deemed to be malnourished is in progress.
A follow up with the DHO (District Health Officer) to discuss findings is arranged for next week.

Official opening of Chimteka Primary School
School has begun; the official opening is rescheduled for 8th May and finally took place on 9th May.
In April, enrolment reached 438 but this number is increasing daily. There are 4 available classrooms.


Finished and Unfinished Teacher's Houses
Teachers were assisted with relocation to Chimteka. One teacher is due a baby next week; maternity leave may be up to 4 months, no cover is available.
Invitations were sent out for the Opening party with Mr. Haroon Sarkanie, owner of Crossroads Hotel, as Guest of Honour.
School uniforms are ordered.
Pupils are rehearsing traditional dance etc.
I shall represent CCS.
Francis and I are to meet UNICEF to discuss: donation of school resources; nourishing food provision for children during school day and any additional requirements of vulnerable children.
I shall liaise with Dept Education re inclusion of school/nursery in vitamin supplementation programme.
I shall liaise with the Headmaster re a referral system for those children who experience health/nutrition difficulties.

Training of Farmers
Farmers continue training, which is to be finalized in the next few days.
Please refer to separate report.

Chickens
120 chickens arrived.
This coincided with education from Livestock expert, George. [Previous training was deemed superficial and incomplete].
The chicken committee now confident; chickens are healthy, as is khola.
The chickens have begun laying.

Meetings
Officials from Ministry of Health visited Chiosya Health Clinic.
They were not impressed with the conditions.
They were interested in the findings of our Nutrition survey, and our ideas re developing the Health Clinic.
This is to be discussed further, at next week’s meeting with the DHO.
World vision visited to explore our ideas on community/capacity building.
I met with some of the orphans at their homes; for example:
10 year old Jonathan was orphaned as a baby and is reared by his Grandmother. Gran looks about 90 but does not know how old she is. Jon is HIV Positive. Gran brings him to our mobile ARV clinic on a regular basis. Jon looks healthy, he is very bright, has very good command of English, but he has never attended school.
We told Gran that Jonathan will be enrolled in our new school and will be provided with uniform/books/food.
Jon is delighted with himself; I left Gran in tears …. Both send thanks to CCS.
These situations, unfortunately, are all over Chimteka.
I want to focus on these as much as possible, harder than it sounds, as things are always so intense/distractions abound.
Meetings with Francis, Fortina, Elias, Facilitators, and Farmers are on an ongoing basis. Back to Top

Report – March 2009, Grace MacLean
I met with the chiefs of the 20 villages in Chimteka and had a formal introduction in the presence of every villager. We distributed the 1000 mosquito donated by Mr. Haroon Sarkanie, a local Hotel owner. This really was a brilliant lifesaving measure, not to mention the value of local business supporting the project. Afterwards we held our meeting, which typically goes on for hours in the heat.....

They grow an extremely limited variety of food, hence the limitation on available nutrients.
The first task is to educate and broaden the variety to full capacity, then arrange for the cooperative to make it income generating. Given my lack of agricultural knowledge, I then arranged to meet the District Head of Agriculture.

He has agreed to give me an Agricultural Officer, who will undergo to produce a needs assessment for Chimteka, with regard to demonstrating, educating and monitoring. This includes a short and long term plan. I need them to follow up when I am gone, for example, fruit trees can take a few years.
I have asked to start asap, as the growing season is quite soon.

I also met the one District nutritionist for the area. He does not have a clinical role.
He has agreed to support me as well. Progress!!
He will also provide education for the farming end of things, including, for instance, methods of extracting juice from fruit.. He has a good knowledge of nutrient content of the various food groups with some basic resources for teaching, so can educate on reasons for eating fruit and veg. We are looking at producing our own plumpy nut, (Chiponde), therapeutic food, which would be very exciting.
Together we plan to source resources to update the Health Surveillance Assistants or, HSA’s.

These are very important as they are 'on the ground'. They typically assess for malnutrition, malaria, and diarrhea, offering basic treatments. However I am keen to assess their knowledge base and update, they were trained in 2003.
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Report - February 2009 from Brian Cranmer
Week 1
We continued with the construction of the Teachers Housing at the project site. The eventual grinding down of the Ministry of Water and Irrigation spurred us forward when they eventually finished the work they had started (in November!) on our three boreholes. They had said this was going to be a three week job and in the end it took three months! This is how things work sometimes in Africa - slowly, and with much frustration.

I extended my visa and spent some time helping Grace to settle in, showing her around and introducing her to people. Grace is very independent and full of initiative so it has been a very smooth start for her. We had a Professional from the Agricultural Department come and brief our Chicken Committee on how best to manage the khola. We have not been prepared enough (the bedding must be 4 inches high and of a certain type of wood shaving). We’ve put our start date back a few weeks while we focus on other activities.

Week 2
A few vehicle problems have slowed us down. There is a problem with the ignition and questions are arising now about what to do in the long-term for the smooth running of the project. We’ll look into it once we get over a few important tasks. Robert has been working hard finalising the two fundraising proposals but sadly we’re hitting the same obstacles as we have with the boreholes – ministerial departments being slow to respond to our requests for information. It was hinted that it might take up to 6 months to acquire a title deed to our land!

The Primary School is looking great as the carpenters finish making brand new desks for the classrooms, plus furniture for the headmasters office. We approached the District Commissioner once more and he pulled through for us, giving us the best news we’ve heard so far in 2009. Mchinji District has promised us 4 teachers! So once we complete our teachers housing we will have four primary teachers living on site and we will officially open our Chimteka Primary School at the beginning of the year’s second term – April 27th!

Week 3
With the vehicle fixed, our team of three (Grace, Rob and Myself) have been spending a lot of time visiting the site and suitable clinics and schools in order to model ourselves on a few of the better run institutions around.

Through a partnership in Lilongwe with the Crossroads Hotel we received a donation of 1000 Mosquito Nets and the owner of the hotel, Haroon Sacranie organised a media event with newspapers and TV reporters covering a night of speeches and celebration at the handover. MPs, Diplomats and some of the Business Elite of Lilongwe were invited and financial donations were submitted to us at the end of the night. Several of them commented on how they were moved by the shocking statistic that in Malawi 1 in every 4 children die before they reach the age of 5, mainly due to malaria, diarrhoea, tuberculosis and other respiratory infections.

Haroon is also in the process of making a donation of wheelchairs to our community. Last week I met with a Disabled Peoples Support Group and interviewed the 46 members individually. The committee then gave me a list of the 10 most needy individuals, adults and especially children who through their immobility cannot work or get to school. We hope that Haroon will support them and help to provide them with wheelchairs. One very touching case is a young 9 year old girl named Olivetta who lost her feet in an accident as a child, but being bright and determined still crawls to school every day.

Week 4
We ended a short but busy month with the submission of our proposals for funding from Irish Aid for a Water and Sanitation Programme and a Maternity Ward. The WatSan proposal has been passed by VMM. However we will need to resubmit the Maternity Proposal. We are hoping so that we receive funding for the Sanitation Project and we can start to dig even more boreholes and provide the villages with pit latrines to help improve the sanitation in the villages and therefore reduce the incidence of disease.

We sadly lost 2 members of our HIV/AIDs support group at the end of the month to this terrible epidemic. I think the lesson from February’s activities is that statistics in the end are only numbers. It’s only when we put a face to them that we truly know the scale of poverty in Malawi.
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Report - January 2009 from Brian Cranmer
Week 1
I arrived back in Malawi on January 7th after taking a break at home in Ireland for Christmas. It was quite a shock to the system coming from -5 Degrees to +25 and feeling the suffocating humidity of the rainy season again. For the entire month it rained quite regularly in the afternoons. The noon humidity would give way to tropical storms that usually lasted an hour or two and left the evening sky clear and the air cool and crisp. I spend some days being briefed by Robert Osborne, the volunteer that had been working on site while I’d been away. He was busy getting down working on a funding proposal for a Health and Sanitation Programme we are hoping to get started in the area. The main intention is to provide all 17 villages with proper toilet facilities, plus clean drinking water (which we’ve already supplied with boreholes).

When I’d left in December we had paid for 3 boreholes and the Ministry of Irrigation and Water Development had promised it would take three weeks to complete them. When I went to check they had been dug and capped but no pumps were in place so people were still drinking dirty water from shallow wells in those three villages. I confronted the Ministry immediately and they said there were shortages of cement. I gave them 2 weeks to finish their work or I would be requesting a refund for work unfinished.

Week 2
Robert was completing the preparations for our Income Generation Project – a Chicken Khola which the community would manage to produce eggs from 120 layer chickens onsite. They would sell the eggs at usual market price and within three months it is hoped they will be making enough money to cover the running costs of the project, e.g. chicken feed. It’s not a guarantee that this project will work, but it is known to have worked and made great profits in local areas. It’s really an attempt to have the CBO generate some money of their own so as not to be in the long-run totally dependent on outside funding for the running costs of the larger project.

At the same time we decided to have a local tailor employed to produce small uniforms for the pre-school children so as to make them feel part of a school and to prepare them for primary. So we purchased a lot of material, thread, zips etc. and this is ongoing. Also, Fr. Julian has some carpenters working on making desks for our primary school classrooms, from money he received from the 11 for 1 schools charity in Scotland.

At this point we are now based entirely in Mchinji and have phased out of Lilongwe completely. We (Robert and I) are soon to receive another volunteer from Ireland, Grace McLean who, as a Nutritionist, will be helping to improve the diet and health of the pre-school orphans onsite. The house we are staying in has three bedrooms and is in the heart of the Mchinji Boma, ideal for meetings with key officials at the District Assembly and Hospital. We have established an excellent network of contacts in the area and many of them have visited Chimteka in the past few weeks as part of our preparation and research for our funding proposals. We are looking now to submit proposals for funding to support our Health and Sanitation programme and also to build a Maternity Clinic at the existing Chiosya Health Centre.

Week 3
A chance meeting with a friend in Lilongwe led to a meeting with the Lions Club of Malawi who are keen to assist us. I gave them a list of our needs and some quotations and they came to visit us. 1000 mosquito nets were promised and the hint of future twining with the Chimteka project was a very encouraging outcome of the meeting also.

At this stage we decided to go ahead with electrification on the project site. I went about getting some information on solar power, as it is renewable energy and has no real running costs. The Ministry for Energy recommended Su-Kam Energy Solutions Ltd and we met a couple of times with a man called Ashwin. After a survey of the site and a quotation we agreed to go ahead and get power installed at the Community Hall, Pre-School, Kitchen, Toilets, Church, Chicken Khola (a good advantage for the IGA since fooling chickens into thinking it is daylight when it’s not makes them lay more eggs!!), and the Head masters office.

Week 4
Solar power agreed and Teachers Housing coming along fine. Robert has been writing nothing short of a thesis for our funding proposals! Desks are filling up our Primary School. The first Maize harvests have started and each village is donating a 50kg bag of maize to the pre-school to feed the orphans. Tobacco plantations are green and plentiful and there will be a strong economy in the coming months on which to build. The District Commissioner promised us three teachers (and was then arrested on corruption charges – but rumours are that he has been set up and the charges won’t stick. Having met the man I’d be surprised if they are true). The vehicle is running fine but we will need to have it seen to once we have a breather. It’s been a very hectic and productive month. February will see some fruits of our labour. The rains are now torrential, which is good for Malawi. Everywhere is green, so many shades. It’s almost like being home. It’s just like being home ….
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