A Trip of a Lifetime with Theatre for a Change

In July of 2017, I was given the opportunity of a lifetime. Only a few months earlier, I had been chosen as one of three students in the United States to travel with Concern Worldwide, a non-profit organization currently working in 29 countries to transform the lives of the world’s poorest people. Curious, excited, eager, and more than a little bit scared, I had only just begun to process what I would experience over the next seven days. What I did not know is that I would come home from Malawi a completely changed individual, rethinking each and every aspect of my life.

On our third day in the country, we packed up the van and traveled out to our third destination: Mbembembe Primary School. Little did I know that this small primary school would become a place I would write about and remember forever. At this school I experienced a feeling I had never felt before, and to this day, I still cannot find the right words to describe it. At this school I was introduced to Theatre for a Change, and experienced first-hand what the organization is doing to empower women and girls, providing them with the essential tools, encouragement and education they deserve.

Theatre for a Change works to empower the most vulnerable and marginalised women and girls worldwide to find their voice and assert their rights. They use a combination of drama and participatory learning, with a particular focus on sexual and reproductive health. Theatre for a Change runs a range of projects in Malawi, where they have operated since 2007.

Their work with schools consists of the Teacher Training Project, which trains teachers in Government Training Colleges across the country to improve their own sexual and reproductive health and the health of the students they go on to teach, and the Right to Learn Project. The Right to Learn Project, which I saw in action at Mbembembe Primary School, works to make schools into safer environments for children, focusing on reducing school related gender based violence and discrimination.

Though we only were able to spend an afternoon at the school, the lessons I learned are ones I will carry with me forever. The Student Council group we interacted with had many different purposes and roles within the school community, all extremely important to the success of the program. While talking with some of the children, we learned that abuses are often reported to the Student Council, in which case the students would approach the Head of the school and explain the situation. The Head would then decide (depending on the specific case), whether to contact the police or the Village Head. I thought it was absolutely incredible how involved the students were with the activities.

Using theatre and movement, Theatre for a Change is teaching young girls and boys to interact with one another, gain self confidence, and learn in depth about gender based violence, as well as other school-related issues facing them. We were able to be a part of the activities for the day, interact with the children, and experience firsthand the impact Concern and organizations like Theatre for a Change are having.

‘Agents of Change’ are responsible for managing the program and helping to implement it within the community. ‘Agents of Change’ go through special training in order to be a part of the community’s schools. Yami was the AOC we met with when we visited. She was extremely inspiring and so incredibly passionate about what she was doing. Even when there was no interpreter nearby, dancing, moving, and laughing with the students was a feeling like no other. I remember that day so vividly, and the feeling I had dancing around in that schoolroom, surrounded by joy, positivity and motivation, was simply irreplaceable.

Some of the specific lessons covered in the classroom included school-related gender-based violence and sexual education with a focus on reproductive health and contraceptives. One statistic that stood out to me was the sheer number of girls who skip weeks of school due to their menstrual cycles. Because there is no secluded, private area for them to change every few hours, they must walk the average distance of fifteen kilometers back to their villages to do so. Most decide to stay at home for the remainder of the day, because of the long distance walk back to school. This causes girls to miss important lessons and activities in the classroom.

While talking with the girls afterwards, many of them asked us to provide them with these changing areas, and expressed their disappointment at having to miss out on so many weeks of school. In that moment, I felt a responsibility to come home and share these stories. The children had a passion for learning and growing as human beings. This passion was so strong and so clear to me. I began thinking to myself, “These girls are missing out on opportunities, on an education, simply because they are girls?” It was like a smack in the face. How is this okay? How have I lived so many years of my life complaining about the classes I get to take, the opportunities practically thrown at me, left and right?

In leaving the school, I felt selfish. I felt angry, upset and disappointed in myself for not previously recognising the exceptionally comfortable life I live. However, I also left feeling empowered. I felt responsible for sharing what I had experienced, and responsible for creating a new standard for myself once I arrived back home. I realized that it was normal to feel angry, sad and disappointed. But I was reminded that organizations like Theatre for a Change and Concern Worldwide, along with so many others, are devoting their lives to helping these children.

Theatre for a Change is doing exactly that – changing lives. The human contact and sensitive connections made between students, teachers, and community leaders were nothing short of miraculous. Learning through movement, song, and theatrical exercises can transform lives. To be a part of that journey, even for a day, was a true gift.

For more information on Theatre for a Change visit tfacafrica.com or follow them on Facebook, Twitter, Instagram and YouTube @tfacafrica, and use the hashtag #WeAreTfaC to spread awareness.

 

#BeBoldForChange: Tshepy the Journalist Turned Entrepreneur

To mark International Women’s Day 2017, I have conducted a series of interviews celebrating women I feel have had positive influence on society. The first woman is Tshepy Matloga.

My name is Tshepy Matloga, a 30 year-old South African journalist turned entrepreneur. I am the founder of Chronicles Media Group (South Africa) and co-founder of Encore Creatives PR and Events (Malawi). At the moment I alternate between South Africa and Malawi. When I am not working I read – I am an avid reader of African literature. I have been an entrepreneur for three years and since then I’ve been selected as one of the 100 brightest young minds in South Africa, the 20 most influential young people in SA, and I am a Nelson Mandela Institute of Development Studies (MINDS) alumni. I have also been featured on international mediums such as True Love magazine and She Lead Africa. I am also a founder of Malawi’s only women’s business and lifestyle magazine Inde, which was born last year. My ultimate biggest goal in life is to one day become the president of South Africa.

  1. What is the special thing in your life that makes you feel bold?

My identity. About three years ago I left my job and decided to venture into entrepreneurship with no money and definitely no collateral to ensure I got a bank loan as a startup capital. I remember marveling through the Book of Chronicles in the Bible. This is a book I draw motivation from when I need to recharge. I had spent years helping people set up their businesses and I felt that at that moment God was communicating with me to say, it’s time to create your own path. I started a media company, Chronicles Media Group.

  1. What does it mean to you to be a bold woman in the year 2017?

I come from a society that spent years entrenched in racism and patriarchy. I am grateful for the women who shattered the glass ceiling and paved a way for me to be able to dream in colour today. Women like Miriam Tladi, Lillian Ngoyi, and Charlotte Maxeke who lived a purposeful life. Because of these women, today I have a voice that is not interrupted when I speak.

  1. What important roles do you think women around you, including yourself, play in society?

I was raised by my mother and her siblings. Three gentle giants, I call my mothers. They have taught me without saying a word that when women collaborate, we can raise men and women of substance. Because of the values they instilled in me, I now mentor young ladies who want to venture into entrepreneurship as a career.

  1. What mistake (s) have you made in life that you think young girls could learn from?

Allowing people to box me in their idea of what a ‘good’ woman should live her life like. Don’t let obligations dictate how you live your life – there is no happiness in living your life on society’s terms and I learned the hard way. Don’t think you’re on the right path just because it’s a well-paved path. With age, I have learned that we are the ones who live with our choice, not our parents and definitely not society, therefore never choose the crowd to the detriment of your happiness

  1. What advice do you have for young girls who want to be as bold as you are?

We are lucky to be living in an era where the world is filled with opportunities for women to make a difference in the world. Find your purpose and pursue it regardless of how difficult the journey may be. I believe that in one way or the other, we are all here to leave the world a much better place than we found it.

  1. What changes do you hope to see with regard to economic, social and leadership inclusion of women in the next 10 years?

Seeing  more women taking up leadership and entrepreneurship positions all over the world. I dream of a world where women won’t have to fight for inclusion in decision making, because equality will be a norm.  A world where women don’t get violated and disrespected, and where boys grow up to be men who are taught the importance of treating women as equals.

Follow Tshepy on Twitter: @tshepy

Cover photo credit: Tsephy Matloga

Being a Woman and an Entrepreneur in Malawi

By Mayamiko Chiwaya, Student Driven Solutions graduate, age 16

Starting a business in Malawi is not an easy thing. Most people think that once you come up with a business idea you can implement it right away, which is not always true. To start a business requires hard work and dedication. In this edition, I will share with you the challenges women and girls encounter while striving to start small businesses in Malawi.

According to my investigations, the first challenge that women and girls in Malawi often meet is lack of recognition. Women and girls are not recognized as people who can develop Malawi as a country through business. It’s for this reason that they often fail to start small businesses because they are not given the chance. For example, in most banks in Malawi, women are given smaller loans than men.

Pamela Banda, age 18, a successful young lady operating a shop selling fashion items once experienced this challenge when getting a loan from the bank, but still managed to get a small loan from her mother’s bank to launch her business. She shares her story:

“At first people underestimated me because of my age. People thought that at my age I couldn’t run a business because most of the time, people my age have not completed secondary school in Malawi. Apart from being underestimated, I also met different discouragements. I received negative comments from people. They said business was for uneducated people. They said educated people work in offices and other institutions while uneducated people have to do business since they do not have the capability to work. As for me, I did not believe it because nowadays in Malawi things have changed and the economy is not normal so one needs to work and do at least a small business in order to live a decent life.”

Pamela started her business because she saw that her parents had a big responsibility in taking care of all the children. They weren’t able to help everyone so she decided to start the business to support herself. She makes profits and is able to support herself through college. Her parents pay school fees and the business supports her with pocket money. She was even able to buy a laptop using the profits!

Agness Ngozo, age 30, operates a butchery business and said she also encountered the same problems that Pamela described:

“I faced a lot of discouragement from different people, including my own husband. They said to own a butchery was a masculine business not feminine so I had to stand firm to the idea and now I own several butcheries.”

Agness started her business because she didn’t want to be a housewife with nothing to contribute. She hated always asking her husband for money and it caused them to fight. She got a loan to start her business two years ago and has managed to expand the business to new areas. She says, “I have many customers and people love to buy from me because I sell quality meat.” She is able to take care of her family and pay her children’s school fees.

It seems the discouragements most women face when they want to start a business come from their husbands and friends. Mostly people do this out of jealousy since they think they can’t do it themselves.

When I asked Pamela how she managed to overcome her challenges, she said:

“I put God first in everything. I know that I may have the knowledge, a good attitude and a hardworking spirit to do business but if I don’t put God first God will not reward me. Apart from putting God first, I also have confidence in me. I believed in myself and I believed I could do it no matter what. I also challenged the people who discouraged me from starting a business. The more I challenged them, the more I took control and their discouragements over me diminished.

“I would like to encourage my fellow girls who are fighting hard to start businesses that they should have self-confidence because confidence makes us win before we have started. I also had some goals, which guided my decisions and actions so whatever I was doing was in line with my goals. If I had not set goals, I could have been easily moved by what people were saying.

“Lastly I learned through my past experiences, which helped me make better decisions. I know that the good decisions I’ve made in my life have come from learning from errors, mistakes and pains. If I had not failed, I could not have learned and I could not have become a person who makes good decisions today. It was through all of this that I managed to overcome the challenges I faced during the start of my business.”

At such a young age, Pamela did not allow age to be the barrier for her to start a business as she knew that age doesn’t matter, but what matters is how you age.

 

101_1131
About the Author, Mayamiko Chiwaya:
I am 16 years old. My ambition is to become a successful entrepreneur in Malawi. I am passionate about writing, designing, and baking. I like to play football and read novels. My favorite quote is, “Age doesn’t matter but how you age matters.” I was raised in a family of two by a single mum who is a nurse. I am a graduate of Student Driven Solutions and am now running a business.

Student Driven Solutions has launched a crowdfunding campaign to support their work: “Please consider making a donation as little as $1 and as big as infinity! All donations help support girls like Mayamiko start businesses to jumpstart their future.”

 

Midwife By Choice, Not By Chance

This post was written by George Nkhoma.

My name is George Nkhomo and I work as a nurse and midwife in the rural district of Chitipa in Malawi.  I grew up as a house boy, not knowing my real family. Then, after searching for my roots I learned that my mother died while giving birth to me. At that point I knew I wanted to do something to help other mothers and ultimately decided to become a midwife. I have been committed to make a difference for other mothers and babies ever since.

Malawian Midwives are among the most passionate and hardworking midwives in the world. In my District, most health centres operate with one midwife per facility. Most of these are dual qualified, which means they single handedly deliver all nursing and midwifery services to the whole catchment population. This means that providing services day and night, all month round, all year round is entirely his or her call. I am yet to know of another profession – in Malawi or beyond – that serves the population this much.

However, it is shocking how much our profession is understaffed. According to a 2016 survey by White Ribbon Alliance for Safe Motherhood Malawi (WRA Malawi), the country has only 3,233 bedside midwives serving a population of over 15 million. That means only one midwife per 1,200 women of child-bearing age, even as the World Health Organization recommends one midwife for every 175 women. While we often hear about the failure to achieve maternal, newborn MDGs and other subsequent goals, we hear less about the numbers of midwives we will need to achieve those targets.

Being one of those 3,233 bedside midwives, I have discovered throughout my practice that the current crop of professional midwives is determined to achieve results, however we work in a frighteningly poor environment.

We often work several 24-hour shifts for days in a row without a break. Recent government cuts have left midwives and patients without food. Our pay, the equivalent of $250 a month for those with advanced degrees like myself, doesn’t cover our basic living expenses so many midwives also have to farm or run small shops. We do not have the most basic supplies like sterile gloves; we lack fuel which can mean working in the dark or by mobile phone torch light.

The result of these working conditions is that women in our maternity wards give birth untended while midwives, often the only health worker on shift, rush between one life-threatening emergency and another.

It’s clear that Malawi has a critical shortage of all health workers. Yet while it is well known that we need doctors, clinical technicians, and nurses, the extent of the shortage of midwives is only now emerging.

If Malawi is to achieve its Sustainable Development Goals, this needs to be well looked into at the planning phase. Our government needs understand that we are not the same as nurses, and to train and employ more midwives.

Malawi did well in achieving some of the MDGs, including the reduction of child mortality, much of which was due to immunisations. However child mortality includes newborns as well as babies and children under five. Thirty percent of all child deaths globally are amongst newborns. Premature births in Malawi remain among the highest in the world at 18.1% according to the World Health Organization (WHO), and neonatal mortality remains unacceptably high. It is the skills of midwives which can prevent these deaths. Midwives can also prevent the needless deaths of far too many Malawian mothers who continue to die while giving birth.

Midwifery is the face of the health sector in any country, deserving of the utmost attention, not the status quo. The health indicators it drives are determinants of health for any nation. Yet with such low numbers of midwives, poor motivation and working conditions, limited openings for professional growth and declining supply of resources, the future of my profession remains uncertain. The pressures we go through, the dilemmas we encounter, the commitment we give, the good work we do is all unacknowledged and seemingly unappreciated by society. These conditions make it hard to give mothers and newborns the quality, respectful care they deserve. But we are doing our best, and we are making a difference.

There are regrettably a few midwives who are misplaced in this dear profession and who have given us a bad name. This is typical of individuals in every profession, but the wonder is – why has their behavior resulted in such negative generalizations about the whole of midwifery? There is an old Malawian saying; nsomba ikawola imodzi zose zawola, which means ‘one bad fish means all are bad’. But we are not fish, we are midwives, and all but a very few are highly admirable professionals.

At the pace we are going, we are unlikely to achieve Malawi’s national safe motherhood targets: to ensure that all pregnant women deliver at a health facility; no woman dies in childbirth; no newborn or child under dies; that all pregnant women attend antenatal care as early as they recognize they are pregnant. But the negative stories so often published in our newspapers are pulling against our efforts.

Instead, the media should be highlighting the need for our government to invest in midwifery. They should also promote health seeking behaviour in our people, and show how the best practices of midwives keep people healthy. Better to do this than to magnify one mistake made by one midwife and tarnish our whole profession. 

This and more is why I recently took part in a workshop by White Ribbon Alliance, graduating as one of the first ever midwife Citizen Journalists in Africa. I am working to change the image of midwives by writing and speaking about the true state of my profession.

I am a midwife by choice, not by chance, and I am proud of my profession.

georgeGeorge Nkhoma is a passionate midwife and manager at Chitipa District Hospital in Malawi. His interest in midwifery grew from personal experience in that his mother lost her life giving birth to him. 

George graduated from Mzuzu University in 2013 and joined Chitipa district hospital in May 2013, where he also serves as the maternity department unit manager and safe motherhood coordinator.

Featured image: Hospital in Malawi. Copyright White Ribbon Alliance 

Improving the health of pregnant women and children in Malawi

An integrated community health facility project to improve maternal and child health.

Pregnancy is such a dangerous time in a Malawian woman’s life that it is considered unlucky to tell people about it.

The majority of women in Malawi live in scattered villages and find it hard to reach health facilities. They lack the information needed to make informed health decisions and facilities struggle to provide the quality services needed to save mothers’ and babies’ lives.

Women and Children First (UK) has supported maternal, newborn and child health (MNCH) projects in Ntcheu District since 2005. This integrated community/facility project, implemented by the Malawi Ministry of Health’s Perinatal Care Project between 2010 and 2014, strengthened both the demand and supply sides of the health system to address maternal, newborn and under-fives’ health issues.

Photo Credit: Women & Children First UK
Photo Credit: Women & Children First UK

Overall, the project was very successful in enhancing the coverage of essential maternal, newborn and child health interventions in the target communities and health facilities.

The final evaluation showed 94% of women were delivering in health facilities, the percentage of newborns getting postnatal care within 2 weeks of birth had increased from 35% to 95% and the percentage of women attending ante-natal care in the first three months of pregnancy doubled. Women’s knowledge of good childcare practices increased from 12% to 96%.

Community women’s groups played a central role in the project. Through these groups. women identified their most pressing maternal and newborn health problems and devised strategies to address them, mobilising locally available resources to do so.   Common strategies were: improving sanitation and village hygiene; village savings and loans associations; kitchen gardens to improve nutrition; drama groups to share MNCH information; and bylaws to discourage early marriages. Led by specially trained local facilitators, the women’s groups raised awareness of the value of antenatal (ANC) and postnatal care (PNC) and delivering with a skilled birth attendant.

“I’m 18, married and have four daughters. There weren’t any problems with the births. Now I use a contraceptive injection. In the group …. we learnt that when you are pregnant there may be problems, such as swelling of the feet, anaemia and nausea, and also that some women may still bleed during pregnancy. We have also been taught about some of the dangers of childbirth, for example eclampsia, blood loss and problems in removing the placenta. I share what I have learnt with other women, and encourage them to join the group.” Regina Ntebe, Daudi Village

Involving the wider community was important and the sensitisation of Village Chiefs, the training and deployment of growth-monitoring volunteers who promoted immunisation and improved nutrition, and encouraged men to accompany their wives to ANC and PNC contributed to the successful outcomes.

“We encourage all the women to join the groups. The … project has really helped us to ensure that almost all women now have their babies in health centres.” Group Village Headman Chipusile

Key interventions for improving the health services for pregnant women and newborns included training healthcare staff on care of women in labour, care of the newborn and emergency obstetric newborn care and the provision of medical equipment. Lack of consistent supervision for frontline staff was identified as an issue during the mid-term review and additional coaching and mentoring was provided to midwives and nurses during the final phase of the project.

group
Photo Credit: Women & Children First UK

The project findings provide a picture of “healthy communities” in Ntcheu, with population coverage indicators recording systematically higher rates than the country-level available estimates. The only indicators showing relatively unsatisfactory achievements were for male involvement in the postpartum period.

The women’s groups were highly regarded by all sectors of the community as key interventions contributing to improvements in maternal and newborn knowledge and care-seeking practices. Many of the community interventions have became embedded within the community infrastructure.

Whilst the demand for services increased, quality of care at the health facility level was often compromised due to staff shortages, inadequate emergency transport systems and poor facility infrastructure and resourcing. The supportive supervision and mentorship programme was rated very highly by health facility staff.

There was a positive improvement in women’s satisfaction with care received at facilities, resulting from education and empowerment of women in regards to their healthcare rights through the women’s groups, respectful care training for healthcare providers and the combined community/healthcare facility interface meetings.

“Nowadays women are supposed to report any bad treatment they receive at a health facility to the village leaders.” Village headman

However, maintaining high levels of satisfaction will be a challenge if health services cannot reliably provide the expected level of care.

Women and Communities Working Together to Improve Maternal and Newborn Health

When women work together, change happens. Regardless of where you live in the world, this is a fact that cannot be denied. Women give life, care for their families, work in markets, trade commodities and help their families grow and thrive. We have all heard that if you invest in a woman, she in turn will invest 90% of what she earns back into her family to improve their livelihood. So why do millions of women – and their babies – continue to face unnecessary and life-threatening risk and danger around the world every day? Women lack access to adequate healthcare facilities, skilled birth attendants and at times are not allowed to receive care from a healthcare facility due to cultural stigmas. Despite notable progress that has been achieved, the fact remains that health disparities for women and newborns continue to be broad and interlinked.

In 2014, the World Health Organization set forth a recommendation based on fifteen years of maternal and newborn health research. The recommendation posited the need to create women’s groups to improve the health of mother’s and newborns around the world. The good news is, change for the health of mothers, their babies and communities in happening right now in countries like Bangladesh, Malawi and India. Over the past six years, women’s groups have been piloted in these countries. The purpose of these groups is four-fold. Women of reproductive age and expectant mothers gather together in their communities to identify and prioritize maternal and newborn health issues. Many of these groups are led by community health workers and skilled birth attendants. Women and in many groups men begin to work together to strategize on how they help mothers and babies thrive in their communities.

In rural Bangladesh, these strategies were put into practice as health workers gathered mothers and their young children into groups. Mothers attended at least six meetings prior to giving birth. They were supported and learned about good health practices and proper newborn care. From 2009-2011, there was a 38% reduction in newborn mortality in these communities. In India, expectant mothers between the ages of 15-49 participated in women’s groups from 2009 to 2012. Through a participatory learning process, women came together to talk about the maternal and newborn health issues in their communities. Through learning about the problems and seeking effective solutions, there was a 31% reduction in neonatal mortality in these communities.

In Malawi, change for mothers and newborns is happening in leaps and bounds. In a country where maternal mortality still remains very high, at 510 per 100,000 live births, communities are stepping up to tackle the issues. Reporting and understanding maternal deaths is a significant problem in a variety of communities in Malawi. Through University College of London’s (UCL) Institute for Global Health, in a pilot study conducted from 2011-2012 communities in the Mchinji district rallied together from 2011 to 2012 working to report maternal deaths. Through identifying the number of maternal deaths in their community, community members were able to think about the causes of death as well as potential solutions.

Women and Children First UK is leading the way in their approach to women’s groups in Malawi and other regions of the world. Through their work with women’s groups the number of mother’s seeking care from skilled birth attendants and receiving post-natal care has increased significantly. Mikey Rosato, Senior Programs Manager, passionately talked about the change happening among mothers, fathers and entire communities. Women’s groups are nothing new nor are they rocket science. Rosato remarked, “When you bring 30 women together in a community they have all the power they need to create change for maternal health.” Rosato and other colleagues focus on local community-led approaches which are the best solutions for improving the lives of women, mothers, fathers and the entire community as a whole. The result? Feasible solutions and action for mothers and babies which is led by the community for the community.

In all of the women’s health groups, women and communities spent time evaluating their work.  The Women’s Groups model is a sustainable way to work towards improving the lives of women, mothers and newborns around the world. These groups are further evidence that women’s strength often comes in numbers. Communities, women and healthcare facilities can and are working together to create change and improve the lives of mothers and babies.

Want more information?

Cover Photo Credit: Macpepple-jaja foundation, Flickr Creative Commons

Follow the hashtag #GlobalMNH and @GirlsGlobe on Twitter, Instagram and Periscope for live coverage from the Global Maternal Newborn Health Conference, and stay tuned on girlsglobe.org.