How Malawi saved lives in Cyclone Idai

Simon Allison Africa Editor of the Mail & Guardian, based in Johannesburg, covering news and politics on the continent.

Long before the world heard about Cyclone Idai, Labana Steven’s mobile phone was already lighting up with messages about rising waters across southern Malawi. Then came pictures of flooded villages. Steven quickly sent mobile phone credit to his contacts, who then called him to detail the devastation they were seeing. Help was needed, they said, and fast.
It was early March, and a towering, unrelenting storm had been battering the region for nearly a week. The storm eventually moved out to sea and gathered strength, making landfall again in southern Africa on 15 March as Cyclone Idai, before leaving a trail of destruction across Mozambique and Zimbabwe.
The storm submerged vast areas of southern Malawi, with the districts of Nsanje and Chikwawa hit especially hard. In total, an estimated 868,900 have been affected by the heavy rains and flooding, including 86,980 people who have been displaced and 672 injured. Some 60 deaths have been recorded.
The dramatically lower death toll, compared to past flooding events in Malawi, reflects lessons learned from floods in 2015 and meticulous preparations to mitigate the consequences of similar natural disasters – a preparedness that contrasts starkly with the difficulties humanitarian actors are experiencing in Mozambique and Zimbabwe in the wake of Cyclone Idai.
It is no accident Steven was among the first people contacted by residents. He has been a humanitarian worker for several decades, including 15 years with Médecins Sans Frontières. He is also from southern Malawi. One reason people knew to contact him was that they remembered meeting him during the last great floods in 2015 and had saved his number. At least 176 people died then.

“I want to emphasise the part of involving the community. It’s not good just to work through assumptions."

Listening to the locals

Steven believes other countries can learn from Malawi’s example.
For MSF, one simple lesson from 2015 was to raise the height of the shelves where medication is stored, to prevent the drugs from getting wet.
According to Steven, an even more important lesson – as far as humanitarian organisations were concerned – was the importance of listening to and cooperating with local communities; of working with them to gain their trust, and then responding to their identified needs. For him, this is a process that began years ago.
“I want to emphasise the part of involving the community,” said Steven, who is still with MSF. “It’s not good just to work through assumptions, to say maybe they are traumatised, they don’t have anything, they don’t have money, they are illiterate. We can easily then miss the truth of the best way to help them.”
This approach had a direct impact on MSF’s emergency response this year.

Local leaders, thanks to their intimate knowledge of the area’s topography, were able to explain how the floodwaters would move, helping MSF to target its interventions.
It was also through these discussions – spearheaded by Steven – that MSF realised that local communities had already established emergency evacuation points, and so were able to direct mobile clinics to the areas with the greatest need. “Because of that, it was easier for us to help them [than in 2015]; it was faster,” said Steven.
While aid from external actors was better focused and made a difference, Steven believes the most effective response to Cyclone Idai came from within affected communities, whose members took extraordinary steps to minimise the scale of this year’s disaster.
Although preparations differed from village to village, examples included: creating village-level civil protection committees that took responsibility for preparations; establishing early warning systems that used whistles to sound the alarm; and identifying assembly points on high ground and informing people how to get there safely when the waters began to rise.

Fishermen to the rescue

The most effective homegrown response, however, may have been the enormous rescue operation mounted by local fishermen in dugout canoes. The fishermen ferried tens of thousands of people to dry land over the course of several days.
One of those fishermen was a 32-year-old who gave his name only as Trouble.

Simon Allison/TNH

Trouble is a fisherman and watchman who rescued stranded families from tree tops and high roofs.

A watchman at a port near Ndamera village in Nsanje – which straddles the Shire River and is surrounded by Mozambique – Trouble grabbed his canoe when the floods came and paddled across the vast new lake that had suddenly engulfed farmland and villages.
“I am one of them who was carrying the people,” he explained. “I would find them in the trees, or in rooftops. Most of them had no belongings.”
The people he found were hungry, injured, and traumatised. Some had been stuck in branches for days without food, he recounted.

“When the water came, we were only able to save our lives, not our belongings.”

Trouble’s was not an entirely altruistic service. He charged 1,000 Kwacha ($1.37) per person if they could afford it. But if they couldn’t, he would take them anyway, he said.

Trading chickens for safety

Some fishermen struck a harder bargain.
A woman who gave her name only as Maria said that when her village of Masanduko – a long swathe of cropland along the Shire River – became inundated, she sought refuge in a tree with her baby and five chickens.

Simon Allison/TNH

Maria's village, Masanduko, was totally submerged by the floodwaters. She is now living in temporary accommodation at Khungu Bwe Camp in Chikwawa District.

Several long, lonely days passed before she saw rescue on the horizon, in the shape of a dugout canoe. “When the water came, we were only able to save our lives, not our belongings,” she recalled. “They asked me to pay, but I didn’t have any money.” After long negotiations, the fisherman finally accepted payment in the form of the five chickens. “All I have now is what I am wearing,” said Maria.
Once on dry land, Maria knew to make her way to a temporary shelter in Khungu Bwe Camp, in Chikwawa District – one of 187 such camps in the country.
Khungu Bwe is one of the camps where UNICEF is helping those displaced by the disaster. The UN agency has built temporary toilets, decontaminated the water supply, and even set up a theatre troupe to educate people on health, hygiene, and sanitation.
When The New Humanitarian visited Khungu Bwe, actors – drawn from around the region and speaking in the local Chichewa dialect – were performing a skit that warned of the dangers of open defecation. The crowd of several hundred people roared with laughter.
“Usually we call this theatre for development,” UNICEF’s Ken Limwame, who is running the programme, said. “This time, it’s theatre for emergencies. This is a traumatised population, and this gives them some psychosocial help as well as conveying an important message.”
UNICEF, too, credited careful preparations with saving lives – preparations inspired by a desire to respond more effectively than in 2015.
The agency had stockpiled supplies in strategic locations in the flood-prone region, which meant it was able to respond much faster than in the past. As UNICEF spokesperson Rebecca Phwitiko put it: “The only thing that would have been better is to have even bigger stockpiles.”
(TOP PHOTO: Households escaped the floods mostly via dugout canoe, with whatever possessions they could salvage from the rising water. This canoe is pictured in flood waters near Bangula in Nsanje district.)
https://www.thenewhumanitarian.org/news-feature/2019/04/08/how-malawi-saved-lives-cyclone-idai?fbclid=IwAR0QOC-5b5VCQDrpPL-a5VqKOHHTdHitZPIIqQwV8TsmLskMRmb_ybkXc88 

New clinical trial for a HIV vaccine regimen commences

By Pacharo Munthali

A new experimental HIV vaccine trial has started at the UNC Project in Lilongwe; bringing hope to all as the world continues to strive for an HIV-free generation.
According to the UNC Project’s Co-Principal Investigator for this trial, Dr. Mitch Matoga, the study is taking place through a public-private partnership National Institute of Allergy and infectious Diseases (NIAID) under the National Institute of Health (NIH), HIV Vaccine Trials Network (HVTN), Janssen Vaccines and Prevention B.V. and the Bill & Melinda Gates Foundation.
The first participant in the new trial received vaccination at UNC Project clinical research site in Lilongwe in the afternoon of 10 May 2018. Since then Malawi through the study has registered 23 participants.
Matoga said the new large-scale study, which is also taking place in South Africa, Zambia, Zimbabwe and Mozambique “will evaluate whether the vaccine is safe and able to reduce the incidence of HIV infection among 2,600 HIV-negative women in sub-Saharan Africa.”
Despite the world registering tremendous advances in HIV treatment and prevention, many people are still contracting the virus every year.
Unfortunately, women are the most affected. According to UNAIDS, women and girls account for nearly 60 percent of people living with HIV in Eastern and Southern Africa and Malawi’s HIV epidemic remains “generalized and feminized”.  While the country just as the rest of the world has recorded a significant reduction in new HIV infections and AIDS related deaths; adolescent girls and young women among others are bearing “the highest burden of the epidemic.”
Around the world, there are over 2 million new HIV infections each year. In 2016, according to UNAIDS, “Malawi had 36 000 (31 000 - 45 000) new HIV infections and 24 000 (20 000 - 31 000) AIDS-related deaths.”
“No matter how many people we can get on ARVs, we cannot keep up with the pace of new infections,” Said Matoga, adding that “the search for an effective HIV vaccine is as important as ever if we want to achieve a world without AIDS.”
The search for an HIV vaccine has historically been daunting due, in part, to the unique properties of the virus, including its ability to rapidly mutate and create multiple strains and sub-types prevalent in different parts of the world.
Malawi is targeting 170 participants who will only come from within the city of Lilongwe. In Malawi, it’s only UNC Project Malawi that is conducting the study.

Is it time to revisit definition of a planet? Scientists think so…

The solar system is made up of planets. Earth is a planet. So is Pluto. This will never change. At least for now.
“It always has been, and it always will be,” Will Grundy of Lowell Observatory in Flagstaff, Arizona is quoted on Sciencenews.org. But he has a challenge. How will he convince the world? How will a forty year old man in Chitipa in Malawi be convinced otherwise.
Now he just has to convince the world of that.
For years, centuries, the word planet has meant “wanderer.” The wanderer had included the sun, the moon, Mercury, Venus, Mars, Jupiter and Saturn.
However over the years of debates, the moon and sun were dropped from the definition. But Pluto was included, after its discovery in 1930. That idea of a planet as a rocky or gaseous body that orbited the sun stuck, all the way up until 2006.
The challenge is the definition of the planet. The way it is defined and application of the definition has been varying.
The International Astronomical Union sensing the challenge described a planet as “any round object that orbits the sun and has moved any pesky neighbors out of its way, either by consuming them or flinging them off into space.” This is where Pluto fails to fit in. Especially when compared to the last part of the definition. It’s perhaps the reason it’s called a “dwarf planet.”
The definition has flaws.
It forgets and overlooks thousands of “exotic worlds that orbit other stars and also rogue ones with no star to call home.” Secondly, studies show that “it requires that a planet cut a clear path around the sun.” But no planet does that; Earth, Mars, Jupiter and Neptune share their paths with asteroids, and objects crisscross planets’ paths all the time.
Grundy and the team members of NASA’s New Horizons mission to Pluto have meticulously laid out these arguments against the IAU definition of a planet March 21 at the Lunar and Planetary Science Conference in The Woodlands, Texas.
There is need for a simple definition. Grundy says the definition should be “any round object in space that is smaller than a star.”
“There’d be about 110 known planets in our solar system,” Grundy quoted as saying.
The reason for the tweak is to maintain the focus on the features — the physics, the geology, the atmosphere — of the world itself, rather than worry about what’s going on around it, he says.
The New Horizons mission has shown that Pluto is an interesting world with active geology, an intricate atmosphere and other features associated with planets in the solar system. It makes no sense to write Pluto off because it doesn’t fit one criterion. Grundy seems convinced the public could easily readopt the small world as a planet. Though he admits astronomers might be a tougher sell.
“People have been using the word correctly all along,” Grundy says. He suggests we stick with the original definition. That’s his plan.
For Ipyana Mwaungulu in Chitipa, he still has to follow the debate.

Creating Demand for Male Circumcision 

Jhpiego has been working in Malawi since 1999. Its work has focused on a number of health interventions including the provision Voluntary Medical Male Circumcision (VMMC).. PacharoMunthali in this article follows up the Voluntary Medical Male Circumcision (VMMC) work that Jhpiego has been carrying out in Zomba. In the article he explores the successes registered so far. He strives to find out gaps that as a nation we need to address.  

 It’s morning. Precisely, it is three minutes after 9 hours. Since arriving at the health centre, apart from meeting the medical personnel and being briefed on the procedure that is followed, he uttered nothing. For ten minutes it seemed as if he would say nothing.

 He is Village Headman Mzazira II has been waiting outside Chipini Health Centre. It is a symbolic wait, at least he knows. It’s not just his wait. Once he gets circumcised he believes his subjects will follow suit. He is at Chipini Health Centre for his screening and Voluntary Medical Male Circumcision (VMMC) procedure.

 Chipini Health Centre is a Chingale -based health facility in Zomba district. The district with 2014 population estimates hovering above 600,000; the district has high HIV prevalence rate.  

HIV prevalence is around 15. That’s alarming. The District Medical Officer, Dr Vanessa Kandole early this year was quoted by Malawi News agency, describing the situation as “pathetic.”

"As a key component of prevention of HIV, Voluntary Male Medical Circumcision (VMMC) is important in Zomba as one way of reducing the prevalence rate which currently is on the higher side," Kandole had explained in the media.

Kandole has stated that VMMC campaigns have been conducted since 2013 in Zomba. As a result at least 18 thousand males have gotten the smart cut. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS); an estimated 5.8 million males had undergone VMMC by the end of 2013 in 14 priority countries in East and southern Africa.

The effort towards attain such cuts has been collaborative. Being led by Ministry of Health, Jhpiego has been one of the players. The presence of Jhpiego in areas around Chipini Health Centre has been one instance.

Today at Chipini Health Centre, male community members are waiting anxiously. In numbers, so far there is presence of eleven individuals – men and of course adolescent boys. All these mortals want to be subjected to the meticulous procedures of male circumcision. Voluntarily medically sound of course. All this is being done for a good reason – HIV prevention.

 When his turn comes, he will undergo counseling. After counseling he will go through the screening process. It is after screening that he will submit himself to the actual VMMC procedure. It’s a process.

 “You see this is symbolic. I am a village headman, and I want to lead by example,” Village headman Mzazira 2 says as goes inside the clinic.

 “I want my people to appreciate, and soberly understand that this is life,” he grins.

Chipini is just one area in which Jhpiego is carrying out its intervention. Jhpiego has been in Malawi since 1999. From 2010 to 2011 Jhpiego, under MCHIP, facilitated the development of national standard operating procedures for voluntary medical male circumcision (VMMC).  During that period Jhpiego implemented Malawi’s first pilot initiative on VMMC for HIV prevention in Mulanje, resulting in provision of male circumcision services to 4,348 men.

 In 2012, Jhpiego received additional funding through Maternal and child health integrated program to provide VMMC services to more than 8,000 males in Thyolo District. As Jhpiego expands its work the foot prints that it has marked are indelible. Since 2011 to date 115647 males have undergone voluntary medical male circumcision.

 Jhpiego has a number of advocacy approaches. One of them is through the use of chiefs. After conducting advocacy meetings with chiefs in the target districts, the Ministry of Health requested MCHIP to offer VMMC services in vulnerable and hard to reach health centres only to ensure the procedure is recognized as a medical intervention and is not confused with traditional rites of initiation.

“Our work especially on promotional activities have focused mainly on inter and intrapersonal communication at the local level. The approach has yielded enormous success,” says Samson Jali, Community Mobilisation Assistant.  

Jhpiego is working in a number of districts. The VMMC project called Sankhani has spread from Chikwawa, Zomba to Thyolo.

 Why choosing these districts?

“Ministry of Health and USAID after World Health Organization (WHO) recommendation identified some districts which were a priority due to high HIV prevalence. The three are among the priority districts,” says Lionel Chipeta, Communications and Demand Creation Manager.

As Chipeta shows the figures of the number of clients that have received smart cut, he reveals that they foster demand creation through interpersonal communication.

“Mostly we are using Interpersonal communication which triggers honest discussions with individuals and groups. We also have events like pool tournament, bawo tournament, football bonanzas which are simply crowd pullers and then we engage them into discussions using Community Mobilizers,” he adds.

Two main obstacles are apparent so far. In the three districts where implementation work is being carried out, Chipeta says, they “still haven’t registered a lot more of the older population.”  Those that are above 15 haven’t been forth comingas expected.  

“At national level, Malawi has done about 7% of the modelled targeted number while countries like Tanzania have reached about 90% of their target, Botswana is at 41% while Zambia is around 53%. As a nation, we is still very low in reaching our expected target to halt more HIV cases as desired.”Adds Chipeta.

“We still have people failing to comprehend and understand the science behind VMMC,” he adds.

So far, as they look forward to next year, Chipeta believes progress has been admirable. They only need to strengthen the approaches to reach out to more young adults, especially those between ages of 15-29. This group is at high risk as it is very sexually active.

Jhpiego’s approach has embraced the enormous involvement of community leaders such chiefs.  

“Chiefs are custodians of culture and they are in authority in the districts we are currently working. It is credible to involve them so that this intervention is not seen as an alien intervention. At all levels people have to understand the science behind VMMC and how it works,” Chipeta concludes.

 VMMC is a Ministry of health intervention. For its success, the Ministry is working with a number of partners. Jhpiego is one of them. Jhpiego is implementing partner with funding from Presidents Emergency Plan for AIDS Relief (PEPFAR) and United States Agency for International Development (USAID).