Richard Zule-Mbewe

I have finally found a way of sharing my voice. At the beginning I guess there is conversation that was meant to break ice. You will notice some quality issues being not adhered to. However, the conversation echoed much of what I believe is the situation on HIV and AIDS in Malawi. You will be directed to my personal blog for you to listen to the voice. I had been trying to post it directly, but i have to admit i have not made any progress.

Richard with Face AIDS

I will leave to remember that May, 2010 was a month in which I led a conference call on HIV and AIDS with Face AIDS, an organization based out of Stanford in California. The members of the organization had asked me to share thoughts and experience on HIV and AIDS. I have been trying to find a way how I can share the recorded voice to the GHC community and to all who dare to listen about the disease.  I am yet to find the best way of doing this. It coincided with yet another amazing and exciting assignment within the GHC community. I had to lead a discussion on HIV and AIDS in terms of access to care and treatment.

As some of you may be aware GHC community believes in having continued and positive conversations over many issues which affect each one of us globally. For instance, we have been able to discuss aid effectiveness in the developing countries. Looking at how aid has been used and forecasting future endeavors by the donor community taking into consideration of several declaration papers such as the Accra and Paris declaration papers respectively. All these declarations do agree that aid or grants has to be mutually agreed and be used more on a partnership basis. We have also been able to focus on a glaring reality about how mothers die during pregnancy. We have explored that some of the policies do leave out people meant to benefit from. For example arguments have been that maternal health has improved globally. Unfortunately, on a close look policies to guide maternal health focused on child’s health and not that of the mother.

Consequently, mothers have ended up just being vessels for giving birth. It is such a diversity of issues that make GHC community exceptional. I truly believe a foundation is slowly being laid for future leaders towards health equity and justice.

HIV and AIDS have caused a lot of havoc both socially and economically in places where its prevalence is high. Reports indicate that AIDS is among the top 5 diseases in the Sub Saharan Africa responsible for deaths. This is a region that has huge number in people living with virus. Around 20 to 23 million of 32 to 35 million around the world with HIV live in this region.

HIV and AIDS has had a negative socio – economic impact across the globe. This has led to a paradigm shift in some governments in terms of responding to it. As such they do not consider HIV and AIDS a health issue only but as cross – cutting problem of societies’ fabric. Which I think the best will be looking at its impact and in seeing what works and what does not. I guess this may go a long with the studies that seem to be proving that HIV and AIDS had been used as a weapon of war in a case of the Africa’s great Lakes region. Also consider the effects on HIV programs that political conflicts had in Eldoret, Kenya in 2008.

UNDP had estimated that Sub Saharan Africa (SSA) had lost about 1.5 years of its man power as a result of HIV. This is mainly because families either spend time taking and nursing the loved one who are sick or burying the dead. Being an agrarian based economy there has been loss of farm produce, hence in some parts there has been shortage of food due in part to the same. This is beside natural phenomena which include rainfall and other climatic conditions.

Furthermore, civil services have been affected as government have to pay either gratuities or pension funds in lieu of those who have died or be responsible to repatriate the dead plus all the things required for burial. Teachers, Uniformed personnel (Military, Police, Prison), truck drivers have been rated to be at relative high risk to the pandemic. Deaths of teachers have led to lowering standards of education as the few remaining teachers have to take care of huge classes. This is just but some of the impact HIV and AIDS has had globally.  

However, I am excited, inspired and enthralled by the contribution GHC Fellows have made on HIV and AIDS. One in question is the Expert Client Project through Clinton Health Access Initiative (CHAI) in Liwonde, Machinga a district along Shire River in Malawi (Scale – up… ). This against a backdrop of some cynicism from some quarters with such high sounding sentiments “war against HIV and AIDS is falling apart.” Of course what is known is that the interventions have slacked and gone at a slow pace than it was envisaged five years ago. Economic melt down that world experienced in the past couple years has been one attributed to this slower pace as governments which fund most of the projects had to also with domestic problems. But still I do believe with hope and optimism driven by passion slowly the battle will be won one day.  

Articles:

Center for Global Development: HIV Monitor

CGD has been one of the organization that monitors aid effectiveness and they have been among organization that have been following PEPFAR, GFTAM and World Banks support on Malaria, TB and AIDS.

Books

Helen Epstein, The Invisible Cure: Africa, the West and the Fight Against AIDS

Stephanie Nolen, 28: Stories of AIDS in Africa

Princess K. Zulu, Warrior Princess: Fighting for Life with Courage and Hope

Almost a year ago my language on health sector was confined to terms like self-efficacy, lost to follow up, transferred out for continued care and all technicalities in monitoring and evaluation. On the other hand was to do with how best we can deliver an activity that will break the silence that shrouds issues to do with HIV and AIDS. Reaching the point where thoughts of stigma and discrimination about the same were reduced to almost nothing. All these I got from the children whose resilience challenged me day in day out.  It was them with which I drew much of inspiration to continue serving the under served and to some extent the “vulnerable”.

Being among the pediatric population may not necessarily require a recipe-like document to appeal. I guess mere understanding, simple grinning and talking their language serves well than anything.

Like I have stated, this was before my initiation into yet another health principle that did not exist in my vocabulary before it was posted on Global Health Corps. This term came as “Health Literacy”. I had tough time understanding the whole concept and it was even harder to explain to my relatives, friends and colleagues. This meant explaining more than two issues. These are Health Literacy itself and “Fellowship”. Amongst most of my peers, save for Crispin and Mathias, this term was to be treated synonymously as “scholarship”. Therefore, any mention of fellowship meant that Richard had been awarded a scholarship. Uuh! Such things may be hard to believe by most people who might have not felt the bluntness of such reality.

But I know why all this. Opportunities for fellowships across Sub Saharan Africa and Malawi in particular are very rare. Something that is a bit commonly known is scholarship. Prior to 1970s, several governments in the developed world such as US and Britain used to offer such to most Malawian citizens. It’s rather hard to exactly know if such opportunities still exist at government level. Suffice to say that just a couple of years ago there was something like a revitalization of such opportunities with Taiwan taking a lead. Taiwan is no longer in diplomatic relationship with Malawi. Another country among the Flanders community in Europe dropped Malawi on such program due to what was termed as nepotism at the highest level. It was rumoured that adverts were put in the local paper as a cover up to something that had already been decided upon. Shame!

Anyway, I am glad that I had be among the few to embrace the concept of fellowship and that fellowship exists to build ones capacity that may not be intrinsically acquired in a classroom setting. I remember, when I was about to fly out of Malawi someone asked me about this. “What do think you will benefit from this?” Just like my earlier allusion, I said, “I believe I will acquire skills and knowledge that a formal class room setting would not manage to inculcate in me.” Furthermore, I did not miss an opportunity that the fellowship’s mission resonates well with my life long endeavour. That is being of service to the communities that need such most. Oh!! No. I am always caught up in such a situation where chronology of things supersedes the theme of the day.

Alright, I will try to stick to what I want to communicate. In the past eight months or so I and Maggie have had a wonderful time understanding health literacy and being able to make case out of what we have understood. This meant us doing a qualitative analysis of a health literacy environment. This is the period we both called “Flies on the wall” No longer a fly on the wall. Through this we were able to see some initiatives across the University Hospital and its Ambulatory Care Center (ACC) being done in order to address the issue of health literacy. For those of you east of the Atlantic Ocean, especially the “warm heart of Africa”, the ACCs would be more or less like the Out – patient departments. Remember that at Queens’ Central Hospital in Blantyre or Kamuzu Central Hospital in Lilongwe?

Well, I have remembered what I would like to share here. Health Literacy as defined in Health People 2010, is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” The definition entails that three important things are happening simultaneously. Therefore, it is necessary to know that the onus is both on the provider and the client. As both sides of the communication divide will have to obtain, process and understand information. This goes on take into consideration all things that will make obtaining of such information effective. For instance, how can one ably navigate the health system? This can either be physical in case of building or otherwise in case of health insurance, prescription labels. Then some of you know the Hippocratic maxim “…never do harm to others.”

Health facilities make sure that they provide service regardless of color, SES and/or inability to communicate in the language that either the provider or the patient use. It is such an overwhelming task to skim through and understand most information that is passed onto patients in most health facilities. This can either be verbally or written. Most will agree that people who have studied their specialty are bound to use the same terminology they learned in college for not less than four years. This will be to anybody or simply to the laity like me. It is even hard for someone who may not communicate in that language. For instance English in case of US. So Health Literacy takes into account of such situations. Where people with limited English proficiency (LEP) or even those who may not be able to utter an English word should be take care of as any other person. This can be achieved through use of interpreters’ service.

Good news is that there are several benefits that may come if we improve Health Literacy environment. These are: increase positive health outcomes, decrease health care utilization, decrease costs, improve quality of care, and meet national standards in case of US just to mention but a few. But global I would Health Literacy being a better vehicle for prevention considering that Health Systems are under resourced.  Therefore, using the few resources that are allocated to health promotion campaigns can as well countries achieve optimum results.

Wow!!! Look at how Global Health Corps can manage to achieve in less than a year. The fellowship has endowed us with new and better way of looking at health movement. I have every reason to smile that it was a nice thing to join this part of movement, which I think it will also be good for those considering to the same in 2010/11. Mind you there is synergy amongst the fellows. Synergy at the mid – year retreat.

Every year on December 1, the world commemorates the “World Aids day” and each year has its theme. This is one of the important days on the fight against the pandemic. The other is the May, 18^th when the world unites against in candle light memorial vigil. These day have made distinctive impact in the fight against the disease for more than two decades. World aids has been there since 1988 and the candle light memorial since 1983. This today’s commemoration marks 21^st anniversary since it was first designated. Interestingly, for the first time in the history of candle light memorial in 2008, the day was inaugurated by the Malawian President Dr. Mutharika in Africa. I am saying for the first because the day has always been inaugurated in the US.  Perhaps this indicates how the problem of HIV and AIDS has become more global. This calls for the need to collaborate globally and engage each other, if we are to fight the disease.

For the 2008 candle light memorial vigil I was excited to have been invited to participate in the event that was held was in the Lilongwe Capital City’s soccer arena Civil ‘Civo’ Stadium. Soccer here has been used due to the diversity in the audience intended. You would agree with me that most African nations and indeed Europe they call the sport football, which is a different issue altogether in the US. So to avoid such misunderstanding better choose a term to be appreciated by many. Well, back to the issue, I was excited because my participation, rather our participation I was not invited as an individual. The invitation was extended to Baylor College of Medicine’s Children Foundation – Malawi (BCF – M). The foundation has runs the only specialized pediatric HIV and AIDS care services in Malawi and serves largely the central region. It has some presence in Zomba and Blantyre in the south and Mzuzu in the northern region respectively. The services range from the provision of antiretroviral therapy, nutritional support to psychosocial support to the population it serves. The psychosocial support, by June, 2009 it had registered about 150 children to its membership club called Teen Club.

This does not any way mean that the foundation is only serving 150 children. Since its official inception in 2006 it has ever enrolled about 4000 patients under its care. The ages range from less than 6 months old to more 18 years.  So being the largest facility providing care to this age group, the organizers of the event felt obliged to include us in the program. Therefore, we had to join the big walk at 6:00am from the Nico Center, popularly know as “Pa Hyper” after one of the building’s biggest client. The children came and participated in the march to the stadium, hoping that someone will also tackle the challenges that children with HIV and AIDS encounter in a day to day life. On personal note though, I was shocked on behalf of the children whom I had accompanied that there was nothing near addressing the plight of the children. To say the least I was shocked to the extent that if I did not accompany these children I would have walked out the stadium way before the candle was lit by the country’s president.

Having about 91, 000 children who are eligible for ART and about 250,000 children orphaned due to deaths of parents due to HIV and AIDS related sickness bother me most. Furthermore, those at policy making level, makes me wonder if they have ever sat down and start think if it is prudent to think that there are no children who are HIV positive after having found out that the virus has been with the human population for more than half a century. Consider this; what could have happened to a mother was HIV positive say between 1985 to about early 2000 in Africa, when services like pMTCT where not known let alone available to many such people. For sure children being born to such mothers were at more risk to contracting the virus during birth as there was not prevention in place to protect such. So does it make sense for people to continue giving less regard to children who might have been in such a situation? For obvious reasons, no. This where is anger and frustration may be coming from. For some of us and me in particular who really are passionate about helping the children have there voices heard are hardly given an opportunity to meet people like the Global Health Council president, the GHC is one of the greatest stakeholder in the organization of candle light memorial vigil. I don’t even know if the organizers had even thought of a post event analysis to think what went well and what was left out. If they did nothing was heard. Or I did not hear anything to that effect.

It is rather disturbing to realize that of 33.2million people living with HIV and AIDS out of which 22.4million are in the Sub-Saharan Africa as per UNAIDS and other bodies in the frontline fighting against the disease estimates, about 2.5million are children.  They get infected before reaching 25 years and are killed by AIDS before they are 35 years. Ironically, this hardest hit region enjoys some relative peace, of course with exception with countries like Democratic Republic of Congo. May be were not doing enough, or our interventions are not good enough to fight HIV and AIDS.

I had an opportunity of attending a Grand Round at the New Jersey Medical School marking the world AIDS day. The speaker was Dr. Roy M. Gulick, Professor of Medicine, Chief-Division of Infectious Diseases, Weill Medical College of Cornell University, New York. Some of the statistics that came out  were relatively new to me but informative. These are since the time AIDS was first diagnosed in 1981, there has been 70million people to have ever lived with the virus. Half of them are living, the converse is true. And the whole of North America (US and Canada) has 1.4million people living with HIV and AIDS, with US having about 1.2million. More than 50,000 (56,000) new cases of HIV infections are reported every year in the U.S. Now when we look at the disparities, perhaps or perhaps not we need to focus some energy in the Sub-Saharan Africa.

However, it is only good to say that there are some people who are working day and night to make sure that HIV and AIDS is dealt with. This is either through conducting the vaccine trial. One of such is the Thailand vaccine trial that has managed to let scientist that if we all put efforts we will conquer AIDS. As one of the investigators, “though the trial showed 31% effectiveness in preventing HIV, but it should be said that it is still significant.” There are also other organizations like Clinton HIV and AIDS Initiative (CHAI), Baylor International Pediatric HIV and AIDS Initiative (BIPAI), Partners In Health (PIH) and PEPFAR a United States government initiative that are doing an incredible job in the fight against HIV and AIDS. For instance, BIPAI has made itself a champion in pediatric HIV across the Sub-Saharan Africa. It has a network of clinics in Botswana, Lesotho, Swaziland, Malawi, Uganda, and Tanzania and partnered with others in South Africa, Mozambique and Libya. The other good thing is that they have tried to build capacity on local staff on HIV management through the national foundations.

Also another way of fighting against AIDS is to appreciate the role that young people can do. For instance, if one follows this link will understand the sentiment being made by young leaders across the globe (http://www.worldaidscampaign.org/). However, there are even a lot of young people especially the adolescents who seem to have no voice, like the ones I have lighted above. These children face stigma and discrimination to some degree in different situations. This can be at home or any other social gathering. There are a lot of unheard stories across the globe about HIV and AIDS.

It is no secret on my part that I have a passion about serving the underserved especially children living with HIV. Until three months ago I was available for children in Malawi to offer my support psychosocially. The support transcended across my professional attachment with Baylor. I just had to be by them every third Saturday of the month. Having them address me with not so good a diminutive of my name as ARichaR, (as a form of respect I guess) it really made feel good.

As we commemorate the “World AIDS Day” under the theme, “Universal access and Human rights” we should be mindful of the both the strides made in the last quarter century and the challenges that are so enormous.

*I dedicate this piece to the two children who died in 2008. These are YM who died a day after I had promised to give him a camera in January. And BP an energetic 15year old boy who died on the Christmas Eve (24^th December). May the souls of the two children continue to rest in peace.

It is hard to document what would be the 10 best moments and 10 worst moments in the last quarter of the fellowship program. Suffice to say there are some issues that came out in the process that are worth remembering and/or sharing.

At least it will be good for me and Maggie to say that we are excited about our three months of work, where we attained the status of being “flies on the wall”, then went to do desk research pulling out literature that documents the benefits of having a population that is health literate and then presented our report to the Executive Leadership.

Just on Thursday 11/12 we presented the reported to the Executive Leadership, where we ably generated positive feedback. It’s not easy for such leadership to be seen nodding their heads in agreement with what you are saying. And at the end saying ‘Oh! Some of the things you have been saying we needed to change long ago. It’s great that some people coming from outside can still notice the same things. It means there is great need to do things in much better way.’  In hindsight let me point out a few things that I have experienced in this first quarter of the fellowship. I keep mentioning the time period so that someone should not be caught off guard when is asked to apply for an extension of  my visa, hahaha! Get that Jonny, Katie, Dave and Barbara?

I should say that I am in this great nation where you would fault nobody if he claims that, “we are great nation”. Listening to a lecture from Stephen Baker, MD (the University Hospital) in a conference with future radiologists, a picture of how USA is great easily comes to mind. For instance, he asked the audience, “Where else in the world do you find an examining board for radiology?” I being among the audience started searching for one–perhaps Japan, what about Russia, and then United Kingdom?  He came back and proudly said no, no it is only USA that has a board and it is the only nation that produces specialists in radiology.   This is but one of the lectures that I have attended in addition to  going into consultation rooms to observe. Hospital procedures have to be based on ethical principles too. Upon the mention of this what comes to mind is the lecture by Pat Murphy, a lady who is able to give true life experiences and how people in the process have goofed and/or made successes.

The State of New Jersey and the UMDNJ in particular is culturally diverse–both in terms of people who come to access care and treatment and the personnel employed. It is estimated that UMDNJ has about forty–eight ethnic groups with no less than fifteen religious affiliations. Is not it wonderful to have such a mix? Obviously it is. The Human Resource and Training does a good job of orientating all new staff members on cultural competency, so that each understands the community that they will be working in. This came through a one day orientation workshop at the hospital.

Why do I have to belabor myself in putting all this down? Well this is part of learning the ABCs of the UMDNJ and the University Hospital (UH) in particular. To me the UH is a wonderful facility. Of course this is in comparison to the facilities that we call major referral hospitals like Kamuzu Central Hospital in Lilongwe and the one named after the Queen of England Queen Elizabeth Central Hospital in Blantyre. I would say there is great disparity of care between what I observed here and the two hospitals I have mentioned. Perhaps this helps to explain the fact put forward by Melissa Médecines Sans Électricité in Rwanda. That is not an isolated case in Africa.

Pre Fellowship era

One thing that I like is looking back and seeing what I have done, focusing on the failures with the aim of making sure that I should not fall into the same failure in the future. Or at least be able to offer advice to someone who may be experiencing the same things as I did. So please forgive me when I am being too historical. In June 2009 I had not started thinking of Health Literacy  in my vocabulary or my career. Back then I would only be able to respond to a data query either from my supervisor or any user. I would advise how to collect quality and reliable data that would enable managers to make informed decisions. I would help in checking the effectiveness of an intervention through evaluations. Sometimes, if one asked me, “Richard what would you do to monitor and evaluate an integrated program that seeks to provide ART, to both adults and peds, PMTCT, Nutrition support?” Simple answers like “well first I need to know the instruments that we will use and also know what the national standards are”. I would also stand at a national conference and talk about the best way to support more than 100 children with chronic illness such as HIV and AIDS. In the process joggling people minds into thinking about how such programs can be replicated in other areas across Malawi.

Other side of life

First things one would notice in the US: huge cars (trucks), by this Katie would remember what I said on 08/11 when she came to welcome me at La Guardia Airport. I said “It appears you Americans like fancy things that are not only beautiful but also huge?” She laughed and said “I guess so”. What about huge meals I hope one will not dare to notice huge bodies, of course not because of obesity, hahaha!

What about stone skiing (skipping) in the river? One can throw a stone about 2.5meters–sorry I don’t know what is that distance in feet. Oh then tree leaves are changing color, going out to see the leaves changing color. Sorry most of these are yet to make sense to me.

I need to improve on the media relations like augmenting some of these blog posts with pictures and of course better language, which is not only a part of being health literate but also culturally competent.  So next time watch out for what I have learnt on cultural competency.

Today (November 02), my former co-worker at Baylor then, based in UK, asked me, and “how are things three months after being decorated as a fellow”. I said wow! You are kidding me; you mean I have spent three months already with Global Health Corp? He said yes, and I did my arithmetic and found that indeed it is almost three months now. So if the program was a 12weeks fellowship, by now I would have been thinking of flying through Dulles International Airport either via Newark or La Guardia. At least I can remember the exits.

Sometimes, you feel like writing something that needs to be shared. But on second thought, you find yourself saying no, there is nothing here that is “news worthy”. News worthy, here is used in a context of what has been happening in Malawi for a couple of years now. It all started when the head of state left the country for an international summit. Upon arrival from the sojourn he called for a press conference with the home paparazzi. He had taken his time to outline what engagements he had accomplished while outside. Like the pledges and promises that were made by some powerful world leaders. It was said that some of the pledges were fiscal support to our national budget. Some of you have already started saying, wow! That might have been a fruitful meeting for the big kahuna of Malawi. Lest we forget, to pledge or to use the biblical term “promise’ is one thing and fulfillment of such is another thing. Under this guise, the paparazzi thought, may be it may not be relevant to ask the president what he had outlined because it was cogently done and he had promised to give them a communiqué to that effect.

Now what follows, question time by the press. Mr. President, “we have heard that you went on vacation under the auspices of the multi – National Corporation that has interests in opening some mines in some parts of the country. During your inaugural you promise the nation that your leadership will implement zero – tolerance on corruption. Having this mind Sir, does this not amount to corruption?” The day that has started well was seen tumbling before the pressmen. As a result, the president got annoyed by such kind of the question. He pondered and wondered why of all issues they would ask him such instead of asking more about the pledges and perhaps at least some praises. “You the Malawian press is very sick. Instead of wanting to know more what I have brought for the nation, you are asking me such no sense. I am calling off this conference.” Indeed the conference was called off. That was the first time the conference was called off, of course in my life time.

At this point, questions, stones and every weapon are being thrown at this. As I can understand this there is nothing to do with global health equity and justice. It appears there is more political undertone to it than it is to health. Mind you, even the health systems that we are trying to navigate, or advocate for, the politics of the nations have much stake to it than anyone else. Therefore, it is good to understand what it takes to convince leadership, a little of praise will make them feel good. But it should not be overdone as it is done in most countries east of the GMT.

A couple of weeks ago, Maggie posted “No longer a fly on the wall” in which she documented some issues on Health Literacy, both at the University Hospital and nationally. She said, Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Health People 2010). This is the basic definition that both Department of Health and Human Services and Institute of Medicine (IoM) agree on. I and Maggie agreed also to make use of this definition whenever we are presenting issues on Health Literacy to the leadership of the hospital at UMDNJ.

We had a six week period of observing, sticking ourselves to the wall as flies would do and assume that we are not doing anything that should jeopardize the consultation process between the provider and the patient. (The use of “we” here reflects more of team work than anything else; it has to be regarded in that way). Of course, she said what are the benefits for implementing health literacy initiatives and for that you might as well consider reading it again. All our observations, literature review of some white papers, peer reviewed journals have been presented to the practice managers in October. We wait the convening of the executive leadership meeting on November 12 to present the material to them. From there I assume will be on the operations side of the Health Literacy.

What else should I share about the Health Literacy? That’s where my earlier observation comes in. The kinda of feeling where you censure oneself, that it may not be necessary. I will definitely find something to share next time.

For time being, I have enjoyed the “Super Size Me” some of you might have forgotten about the movie. If you need it I may ask my good friend Maggie to find one for you. I should also say I have come to learn about some American social issues through watching a number of movies. So “super size me” came out topping the list. Guess what, I already had a negative feeling about the MacDonalds, Burger King (BK), not because you would not find them in Malawi, but the junkness of the food. So what this movie did to me is to augment that earlier predisposition on the food issue.

Being my first post on GHC blog, it is only natural for me to at least post a longer write up of events. Therefore, you will excuse me for doing that. I have no excuse of not being a blogger before. I have one (http://www.zulembewe.blogspot.com/) though I only have few posts on it, but at least I had an opportunity of having it. If you have time you visit it. As for errors in language mechanics, well that will be borne by that fact that a learned language is not easily mastered.

Maggie, that is my partner, did a job commendable for posting a video which was introducing me to the fellows. It was only proper for her to just do that because apart from an in-country fellow she was the first to come over to Newark, NJ.

I am around, lest I may only exist as in the eyes of very few people among the fellowship fraternity of the GHC. For I know the team at Covenant House, Newark, NJ and CHAI, Liwonde, Malawi respectively have at least seen and heard me talking. I have a chance to chatting with Emily and Jeffry before I had embarked on an arduous flight to US. Meeting them was like opening the door for my departure and I started feeling the connection among the fellows.

Perhaps flash back of the trip would be helpful at this point because Monday August 24, 2009 marked two weeks of my stay in the U.S.A. therefore, I feel it is proper now to say “Muli bwanji nonse?” (How are you all?). I am sure this expression should not be strange to Emily, Maggie I doubt if Edwin know anything about it. Yes the first country, though at times it becoming hard for me to regard US as such because if I compare it with my own then US is a continent, I have been to apart from Malawi.

You know what, when I get this offer I was very much excited and I am still excited. But the immigration processes that I had to undertake nearly took away my euphoria and thrill a bit. Imagine someone packing things ready for the trip on July 10^th visa application appointment was only available on July 22^nd. As if that is not enough, on July, 22^nd the officer at the consular sending me back because in his wisdom I did not had enough backing documents.  Mind you I was thinking that by July 24^th or latest 25^th I will depart. I had to oblige to that to avoid jeopardizing my desire of becoming a fellow. The extra documents that they were looking were sought in no time and went back on July 29^th. The visa was issued the following day that was the time I started seeing light at the end of the tunnel. I said, “Ah what is separating me and health literacy consultant is the Atlantic Ocean, otherwise I would have just walked” at the site of the visa. Anyway, I have taken all this experience that deprived me a chance of attending the Palo Alto training at Stanford University the back of my mind. After all, I have a partner, Maggie, who is capable enough to guide and offer advice where need be.

First things first, August 09, 2009 were wonderful day for me. This was the day I left my country for first time in my history. And taking on what I would a long flight. I was in air in a period of not less 26hours. After such a long flight I was finally in Washington DC on August 10 where I waited for so called national flight to La Guardia Airport in New York before proceeding to the heart of New York City I suppose. On the day NYC was very humid and made appreciate most of geography lessons that I had learnt since my primary school. At time did I experience that level of humidity? The following day I was in Newark, NJ where now I call my home nestling in UMDNJ Student Housing Complex along the 180 West Market Street.  Here I found Maggie, my partner waiting to welcome “a newcomer” in America. She really did a wonderful job on the day. She introduced me to Ketline and Christine on the same day together we went to Top Diners for dinner. Being someone who knows “Nsima” and perhaps rice, it was a little bit hard to choose a meal at this point. However, I did try because I knew no-one would prepare that kind of dish at that moment. Next time I will try to ask for it, who knows I may be given.  As I had just arrived I need a few groceries, we on her wheels going about shopping.  The next day was for us to have a kick-off meeting with some stakeholders of the University Hospital the hub of our fellowship I guess. Then, of course shadowing and observing how the health literacy environment is. (“Flies in the wall” as well put by Maggie).

My other exciting moment were about to come, and they came following day and days after. They were exciting because they were punctuated with questions like where do you coming from. Well anywhere in the world one would be asked such a question. But my answer to this question made me a feel like a “hero” I am the only person in the midst of many who say something about my country and the US. Where Malawi is and what is it known for?  My answer has been Malawi is in the south-eastern part of Africa and I am about to acquire information to do with latitudes and longitudes. Well it is now being known by Madonna’s adoption of David Banda of Mchinji. At least such response sent stitches of laughter amongst what I would call my admirers. Then series of other equally interesting questions follow gushing like waters at Victoria Falls on Zambezi River. (Victoria Falls may be an area of interest to visit while you are in Africa) Such as have you been to US before and are you excited that you are the US? Honestly, this is my first time I am in US and for sure I am excited to be here because I will learn a few things here and will help me continue celebrating diversity. At least, if I were a politician back home I would have been considered for a post of presidential advisor on international relations.

The long and short of it is that I am settling down in Newark, NJ that is socially and I feel welcomed and all the nervousness that I earlier seems to have waned away. I am still learning the ABC of both Newark, NJ and the US as a whole. Therefore, expect my better picture and perception of these in my other posts to come. As fellowship and what it demands of us will follow later.

Zikomo Kwambiri! (Thank you very much)