Reflections on Access to Health Care

Memory: November 2012

I wake up in the middle of the night with stomach cramps and nausea. I stand up and walk from my sister’s room to one of the bathrooms in my family’s home in Canada.

As I walk I feel faint and call for my Mother. I then loose all control of my body, collapsing onto the soft carpet floor.

I come to as my mother drags me to the bathroom and helps me sit upright. In minutes, two paramedics are hovering over me. They wait while my Mother cleans me (sorry about that Mom) and then I’m on a stretcher being hoisted into an ambulance. The ambulance ride is less than 5 minutes.

I’m wheeled through the emergency room and immediately get a bed in the emergency ward. I’m seen quickly by a doctor and hooked up to state of the art machinery. They take samples of everything you can imagine, conduct X-rays, give me an ultrasound and monitor me constantly.

Within hours, my father is on a plane home from Florida and my Mom takes the day off work to be with me. I was discharged late the next day.

As I lay on that hospital bed I felt angry for competing reasons. At first I was angry to be in the hospital, to be sick, to feel helpless and confused because I didn’t know what was happening. I wanted to go home.  

Then I thought about what would have happened if the same thing had occurred a month before when I as living in Malawi…

... and THEN I thought what would have happened if I was a ‘typical’ Malawian women.

In Malawi, the GDP per capita is $900 USD per year and 80% of the country lives in rural areas. Thus, the ‘average’ Malawian woman is living in poverty in a rural area. At the age of 27, I would most likely be married with a few children and have significant family responsibilities to attend to. I would likely have collapsed onto the mud or cement floor of a small makeshift brick or thatch house without electricity or running water in the home.

Just months previous, we had been delivering bicycle ambulances in a rural area. While thanking us, one of the carers who would be using the bike to transport sick people to the hospital told us that someone he knew had died the previous week because they couldn’t get him to the clinic.

Even if the person who passed away HAD been able to get to the clinic, they certainly wouldn’t have had anything close to the quality of treatment Oakville Trafalgar Hospital in Canada had.

Alinafe Hospital in Salima District

Reflecting one what would have happened to me if I had been born into a different body on a different piece of land, I felt simultaneously angry, lucky and sad.

In addition to being able to access a quality hospital, Mom had a good job that allowed her to take the day off work at no cost. Dad was able to buy an emergency plane ticket from another country to be with me.

The cost of my day in a state of the art hospital in a country where private care does not exist?

$0.

How did I get so lucky?

*** 

Memory: July 2013

My friend calls me one Saturday morning, telling me that she is sick with Malaria after a trip to Mozambique. She asks if I wouldn’t mind taking her to the clinic – she isn’t responding well to the medication she was prescribed. We go to one of Cape Town’s clinics where her international student medical insurance is accepted.

While at the clinic, her condition deteriorates quickly. When the doctor sees that her, her temperature is over 41 degrees. We are told that she must go to the emergency room immediately and then gets asked if her medicare covers private hospitals? (A note on South Africa’s health care system: there are essentially two of them – a private one which the richest approximately 20% of the country accesses and a public one used by rest who don’t have medical coverage or the ability to pay out of pocket.) My friend isn’t sure what is covered so we get referred to the closest public hospital.

By the time we get to the hospital, she is unable to walk. A porter comes with a wheelchair to take her to the emergency room.

I park and make my way inside to find her slumped alone on a chair, waiting in the crowded room to be triaged. After pushing my way to the triage station and insisting they see her immediately, they triage her ‘red’ (high priority) and she is finally taken to be seen by a doctor in the emergency ward.

We wait for hours while they take a blood test and eventually give her medication. They say if she can hold the pills down without vomiting, they will discharge her – they don’t have enough space to keep her there.

I’m asked me to leave the area – visitors aren’t allowed. In response, I search my bag, find an orange and smile at the security guard while passing it to him.  

Just before they discharge her, I give her juice and tell her to chug it – I’m hoping she will vomit because I’m terrified that they will kick her out of the hospital.

Just before discharging her, the doctor looks down again her file. His expression changes - her kidneys aren’t functioning properly.

I’m on her phone frantically trying to communicate with her family in America and at the same time, talk to her South African medical insurance. I call them on repeat, but it is the weekend and I keep getting passed to different places. No one can tell me if her plan covers a private hospital. Choking back tears, I tell the woman on the phone that my friend is very sick and that its pretty shitty that she can’t tell me if I can get her private care. She tells me there is nothing she can do and hangs up the phone.

Next I’m on the phone with my friend’s sister, trying to figure out if the situation needs, if they would like to transfer her to a private hospital at their own expense.

In the corridor outside the emergency room, I stand stunned. I have a million questions running through my head but the main one is ‘Should I try to get her to a private hospital?’ and ‘Can I afford it if it comes to that?’.

Never in my life have I had to ask myself these questions.

Never have I had to consider the cost of healthcare when making a decision. 

Never have I had to do a cost-benefit analysis with regards to a human life.

Rarely have I felt so lucky to be Canadian.

(Note: my friend is alive and after 3 weeks in the hospital has gone back to the States. We later found out the severity of the Malaria – she is lucky to be alive. She has lost most kidney function and is now in need of a transplant.)

*** 

Memory: June 2013

I’m sitting chatting with a friend in a small restaurant a few hours outside of Cape Town.

She is more educated than I am and has access to well paying work as a journalist.

She casually mentions that before leaving for Cape Town she had to decide between getting a polyp removed from her cervix or getting a mammogram. She is pleased that she chose the cervix operation because her periods are much less painful now.

My fork freezes mid-way towards my face. My eyes well up as she looks at me questioningly.

YOU HAD TO CHOOSE WHICH MEDICAL PROCEDURE TO GET?!

I had minor surgery on my cervix a few years ago and I’ve known for years that I will start getting mammograms when I turn 40.

It never crossed my mind that I would have to PAY for either.

It never occurred to me that I would have to pick and choose health services based on what was in the piggy bank.

Hell, my piggy-bank and health services don’t even fit in the same category in my mind.  

Despite hearing about health care debates in the States and hear-say on Americans making the trek North in hopes of accessing Canadian health services, the reality of the country less than 100km away from my home neverfaithdp3 really hit me.

Not to say our health care system is perfect. Not everything is covered and access to health services for marginalized peoples isn’t near as good as what I’ve had the privilege of accessing. I’ve had to wait months to get an appointment for an annual physical.

The concept of having to choose between cervical surgery and a mammogram completely floors me. 

*** 

Memory: November 2011

I’m sitting reading the newspaper in Malawi. The fuel crisis continues to rage and neither diesel or petrol are available at the pump.

Black market prices are skyrocketing (around $3 USD equivalent per litre if my memory serves me correctly). It is next to impossible to get a taxi cab, and if you can, it is close to prohibitively expensive.

I’m used to hearing about the crisis and seeing huge lines at the pumps on the odd day when a shipment comes in. I’m used to hearing about cars damaged from black market fuel which has been mixed with cooking oil or water.

I’m also used to the frequent (oftentimes daily) power outages.

Despite having become used to the fuel and energy shortages, this newspaper article put things in a completely different perspective. It was a story about 3 lives lost in the city in which I was living.

One woman died at home because the ambulance didn’t have the fuel necessary to pick her up.

The other woman was at the hospital giving birth and developed a complication. She was in emergency surgery when the power went out. Since there wasn’t any fuel, the backup generator didn’t go on and both her and the baby died.

The relationship between infrastructure, economics and access to hospital services had never crossed my mind. To have a power outage in a hospital was obscure enough – loosing two lives on one operating table because there isn’t fuel for the back up generator?

*** 

Coming from a country with one of the best health care systems in the world, these past 2 years have been a huge eye-opener for me. Access to health services is immensely important, and very few people are as lucky as I in this regards. Despite firmly believing that health care is a right, the daily realty for many people across the world is much different for many economic, social, ideological and political reasons. 

Leaving Malawi

Sitting on my porch drinking in the warm Lilongwe night air, Daniel tells me:

'I don't know if you've experienced this, but I feel much more alive when I'm in Africa'.

I ponder his statement for a moment, willing my experience to agree with his. It doesn't, I don't feel 'more alive' here.

I think about what I do feel here, what this place has given me if it isn't a feeling of being pressed up to life.

Realization and gratitude sweep simultaneously over me as the answer finds me:

I don't feel more alive here, and this place hasn't offered me what I want. It has however offered me something much more profound than filling my desires.

It has given me everything that I NEED.

When I decided to leave my life in Canada for a year in Malawi, I didn't hope that it would be easy. I did however hope to be challenged, to experience and to grow. I don't know if I've grown but I do know that I have been challenged and have experienced a great deal.

The experiences that I've had and the lessons that have been offered to me are all exactly what I needed at this point in my life.

I've also felt deep joy here, connected with fantastic people and enjoyed the beautiful landscapes. I've seen a complete different way of living and marveled at how people find joy and a beat to dance to in the face of hardship. I've even found new passions – who would know that I would become passionate about education for development and menstrual hygeine?

This place has also held up a mirror and forced me into all of my dark places – apathy, helplessness, discomfort, failure. And although I've been present in these uncomfortable places, I haven't conquered them. I haven't needed to conquer them, but I've needed to know them intimately, and that's exactly what happened.

I'm reminded of the opening line of the poem that my mentor Angela sent to me just before my departure.

When you set out for Ithaca, ask that your way be long, full of adventure, full of learning.

Those words were akin to beads on a rosary string for me. I would turn them over, touch them and they became my prayer.

And Malawi, a departure point to Homer's mystical Ithaca has been just that for me - full of adventure, full of learning.

This place has worn on me like a gentle sandpaper. So refined that I haven't always felt its rubbing, but so constant that when I take stock of this year, I realize that I don't recognize my own shape anymore – I've changed form.

I examine my reflection in the mirror and its odd to say but I even look different now, my skin is a bit worse for wear, my body weaker and rounder.

I wonder what my former self would think if I were glimpsing into the future and reading this entry on the way to Malawi. I was so hopeful about making a difference, building meaningful relationships and sparking positive transformation. I would even venture to say that I was more naïve than today about development and how things function. I felt firm in my conviction and stable in my values.

I think my previous self would smile at this entry and believe that I needed every experience to get to this point where I don't know anything. Where I've been transformed and become well acquainted with my dark places. There is one thing on which I know that my past and present self would agree:

I WOULD NOT CHANGE A THING.

My first post was rife with information about where I was going, what I would be doing. I won't conclude this chapter with facts about what is next. The truth is that I don't know. And that is how I know I'm on my way to Ithaca.

Malawian Proverbs

Sitting in the office with my colleague Eddie, I learn that the Malawian government has made a commitment to phase out a toxic compenent of HIV treatment. This response was partially triggered by an advocacy letter that Eddie himself signed.

Laughing, he say's 'I'm glad for the result. I thought I had burnt my fingers signing that letter'.

I sit dumbfounded for a moment, trying to understand what he is saying. After a second I realize that he is saying that he thought he had made a career limiting move by signing the letter, a very political act of advocacy.

After congratulating him oncemore on such a huge victory, I start thinking about the use of proverbs here. What a simple and beautiful way to express himself. It gives the listener an image, ignites the mind and accurately conveys his message. Burning ones fingers is much nicer than saying 'I thought I screwed myself over'

Malawians use a plethora of proverbs in daily life. These are used for expressing thoughts and feelings as well as imparting lessons.

Coming from a very direct culture, these mind twisters are oftentimes lost on me. Its a shame that I can't seem to wrap my head around more because they are one of the parts of Malawian culture that I appreciate most.

After a year here, I've managed to learn a few that I apply to my experience in Malawi.

Being that I'm leaving this week, I wanted to share the proverbs that have helped me understand this experience.

1) Proverb: 'Walira mvula walira matope.'

Translation: 'He who cries for rain cries for mud.'

In a country where over 80% of Malawians engage in subsistence agriculture (growing their own food to eat), the rains are fundamental to life. Mud being a byproduct of rain, the proverb reminds us that if we ask for something, we have to also be prepared to take what comes along with it.

I came to Malawi because I desperately wanted to learn about a different way of life, to develop as a person and to hopefully to make a difference. My time here has allowed me space to do these things but hasn't been without challenges. The proverb reminds me to suck it up when I'm taking a cold shower, sitting in the dark or craving cheese - because these challenges are the mud to my rain.

2) Proverb: 'Zidze pano ndi zatonse'

Translation: 'That which befalls one of us befalls all of us.'

Child in Rural Nkhotakota, Malawi

Follow the leader! Nkhotakota, Malawi

This translation apparently doesn't capture the full meaning behind the proverb. When asking colleagues to translate, they would say things like 'if the ship is off course, we are all going in the wrong direction' or 'when the rain falls we all get wet' – not direct translations, but they were trying to convey the actual meaning.

Coming from a culture which prioritizes individuality, this type of communal mentalitiy has been a pleasant shift in my way of thinking. It is true that events that have occurred during my time here have help bind me to the country. I felt afraid along with Malawians when the president died and a new leader wasn't announced for days. I felt angered alongside my fellow women at the trouser strippings and joyful at the coming into power of Malawi's first female president. Devaluation of the currency by 50% and the subsequent inflation was felt by all of us. The HIV virus impacts our workplaces, relationships and communities. When someone gets married (however distant the relation) we all go to celebrate.

Oftentimes when walking here, people come and walk beside me. Sometimes they speak and ask questions, and sometimes they just silently keep pace and provide company. There is a sense of community and connection to fellow humans here. Zidze pano ndi zatonse.

3)  Proverb: 'A child who doesn't leave his family compound thinks his mother is the best cook.'

Typical Malawian food: Nsima, chambo, soup and rape (green leafy veg).

First off: Mom, I love your cheese and brocolli casserole.

This said, trying new things allows us to experience more of the beautiful flavours and textures that life has to offer. Coming here and trying something different has allowed me to experience new music, different types of food, words in a new language, and a different approach to time to name a few.

I'm grateful for these experiences and have no doubt that they will continue to enhance my life after I leave.

The use of proverbs in language is something else that I have come to appreciate being here – something I wouldn't have gotten if I'd stayed on the family compound.

Eating typical Malawian food with my friend Happy Joe.

Pads for Empowerment

When I first arrived here, I was appalled to learn that menstruation is a major challenge for school age girls in Malawi.

Why?

Because they don't have sanitary products to use. 

Not only are pads too expensive for most Malawian girls and women, they are also widely unavailable in rural areas where 85% of the country's population lives. Some girls try to use coarse and poorly absorbent local fabrics, but they hurt them, smell and give them rashes.

This means that once a girl starts menstruating, she is likely to miss 3 days of school a month. This is often the 'straw that breaks the camel's' back that causes girls to drop out of school. Girls already have to worry about school fees, heavy work pressures at home and lack of electricity to study at night. Not being able to attend school while menstruating makes getting an education much more difficult.

I see this as an incredible injustice. I remember starting my period and finding it challenging although I had readily available menstrual products. 

FAWEMA (the girl's education NGO that I'm volunteering with) tried an intervention in a school in the South of Malawi to solve this problem. A group of volunteers (called a 'Mother Group) sewed re-usable sanitary pads to girls and saw performance and retention of girl increase. The challenge with this intervention was that it was unsustainable from a resource perspective. Some girls also complained that the pad was uncomfortable.

When my friend Mayme sent me a link to a competition for Women's entrepreneurship in the developing world, we decided to try to model this intervention with a few twists. We added an income generating component for sustainability, made the pad more comfortable and added an economic empowerment component for the female volunteers. Here's a YouTube video we made with the help of my friend Josee for the application.

We've called the project Tilimbikile, a word from Malawi's national language of Chichewa. It is used as an encouragement to work hard and remain strong. We believe that Tilimbikile captures the resilient spirit of Malawian women who are dedicated to improving their lives and bettering their nation as a whole.

Unfortunately we didn't get the grant, but have gone ahead with the project anyways, The World University Service of Canada provided funds to pilot the project. I've been busy the last few weeks rolling it out in 3 different groups in rural areas outside of Lilongwe. Here's what we've done.

My friends Sadia and Briony are fashion designers volunteering in Malawi. They designed a pad based on a sample sent over from Canada (thanks Michelle!). They used locally available materials and designed it so that it can be easily hand sewn.

We put together a curriculum consisting of one-day of pad sewing training and one day of basic business training. We tried it out with a train-the-trainer component on one Mother Group and then rolled it out, using those women as trainers. So far we've trained 3 other mother groups.

Mother Group members in the business training

Mother Group Member presenting the group's business plan at the business training

The idea is that the women can sew and sell the pads for a profit. Some of the profits go to the women with the aim of economically empowering them. A portion of the profits are reinvested in the project so that they can provide pads to needy girls so that they can stay in school on their periods. Since the Mother Groups work to help girls be retained and perform in school, they know the girls who need them most.

The trainings, although not without challenges, have been a lot of fun. It was so inspiring to see the women passionate about helping girls and empowered to make a difference. Hopefully we can roll out more in the future!

Here are some pictures of the past few trainings.

Mother Group Member Cutting Fabric from Pattern

The cut materials ready for sewing!

Mother Group Members sewing the pads

Even the Head Teacher sewed a pad!

Men getting involved - the group village headman (chief of a number of villages) of Nathenje learning to sew pads

My FAWEMA colleague Cecilia & I . Cecilia is the program officer implementing the project.

The women from Nathenje Secondary School at the end of the training

Life Lessons from Learning to Drive

Sometimes 'sucking it up' and giving oneself no choice but to do something is the best way to learn.

Learning how to drive was a grueling process for both myself and my parents. Depth perception is not my strong suit. Nor is time perception. On top of this, operating machinery is also not something that I'm naturally adept at. Combine these shortfalls with a fear of damaging an expensive piece of machinery or injuring someone? Young Drivers certainly had their work cut out for them when I enrolled in driving lessons 10 years ago.

I'm now an ok driver. I know my weak points and make up for them by being extra cautious. My caution has also had a negative sub-product: I haven't learned how to drive manual cars.

About 2 years ago I decided that I should have basic knowledge on driving 'stick' in case I wind up in an emergency situation, for example taking someone to the hospital or dropping a drunk driver off at home.

I've made some feeble attempts, always stopping when I stalled repeatedly or started feeling stressed out.

Since most cars are manual here and public transport is relatively slow and uncomfortable, I've spent a lot of time as the passenger in stick shift vehicles.

Daniel's car

My boyfriend also happens to have an unusually large, beast of a diesel SUV which I would drive occasionally. Always with someone in the passenger seat, I would nervously engage the clutch, start the car and proceed to freak out for the short distance I had to drive.

'I can't get into 3^rd!

Why is it stalling?

I'm not used to driving on the left side of the road!

Where is the blinker and how can I turn of the d*mn windshield wiper?

I would usually arrive at destination a few minutes later feeling panicked and beg the passenger to drive back.

The other morning I had a huge load of materials to bring into work. No one else was available to drive so I had no option but to drive the manual beast myself.

I shook off my nervousness, got into the car and just went. The odd part? When I was driving by myself, I wasn't scared and didn't even stall.

I knew that I had no choice but to make the thing move and when I couldn't get into third gear, I just put the gear back into second and tried again. I started finding myself listening to the car and seeing what was needed instead of panicking. I found myself driving confidently desbite being in the capital city of the most densely populated country in Africa (read: people everywhere).

The next morning I realized that tank was close to empty. Worse yet, Malawi is going through another petrol and diesel shortage meaning that everyone was scrambling to find a filling station with a bit of fuel left. I drove all the way to the first station, waited in the queue and was told that the diesel had just run out when I got to the front of the line. The attendant thought that there might be a shipment coming in next door so I rushed off, fought my way into the lot and found that the shipment wasn't coming. There a man told me that they still had diesel in one place: the dreaded bus depot.

Like many Southern African bus depots, the depot in Lilongwe is crowded, hot and smelly. Vendors, chickens and goats are milling about everywhere. Buses and transport vans are all honking, yelling and weaving their ways through the constantly shifting maze of chaos. I had no choice but to haul myself back into the beast and step on the gas. 

LLW bus depot

I arrived at the depot and started weaving through the chaotic mass. Women carrying unbelievably large buckets on their heads, fruit vendors and goats took no interest and refused to veer off course as I honked and yelled my way through the crowd. I got into the line, got cut off, snuck onto the other side of the queue and had angry men with jerry cans hit the side of the car. I finally made my way to the front, coerced the attendant to stop taking bribes for filling jerry cans and help me out.

I arrived home sticky with sweat, my heart pumping from the adrenaline. The car however was perfectly in tact and full of diesel.

If there had been a passenger beside me, I would have freaked out and probably landed in the nearest parking lot. Because I didn't have any option but to push forward and trust in my own abilities, I learned that I was capable of something that I never though that I could do.

Bicycles, NOT Wheelbarrows

Bike Ambulance Delivery - Salima District

Last week I had the opportunity to deliver bicycle ambulances donated by Silver Spire Church in Canada to 3 rural communities in Malawi. It was really special to meet the volunteers who will be using the bike ambulances to transport people living with HIV who need medical attention to clinics.

The stories from the recipients convinced me that the bikes and stretchers will make a huge difference:

The group in Nkhotakota said that a patient had died at home the day before because they couldn't transport him to the hospital.

In Dowa they explained that they have 8 bedridden patients that they can now transport to the clinic. They also said that having the bike will allow them to visit many more patients in one day.

In Salima district, the distance that we drove from the main road to the village spoke for itself (almost 20km on dirt road to the clinic). 

Delivery to Alinafe Hospital, Nkhotakota

Why bike ambulances?

If a Malawian living with HIV or AIDS needs medical attention and is unable to walk, getting to the clinic can be very difficult.

The bicycle ambulance is an innovative response to the needs of rural communities in Malawi. Due to extreme poverty, few health centres and high HIV infection rates, it is very challenging for sick people to get to the clinic. Many are carried, pushed in wheelbarrows or die bedridden because safe and dignified transport is not available.

Bicycle-ambulances provide a much safer alternative. By attaching a lightweight trailer and removable stretcher to the back of a bicycle, patients can be transported to clinics without risking further injury along the way. The relatively simple design enables the trailers and stretchers to be made locally with available materials. The ambulances also can be used to transport pregnant mothers and people who have passed away to the health care centres.

The bicycles can be used alone as well so that carers can visit more patients per day or carry out income generating activities to raise funds for their organizations.

Why home based care organizations?

In Malawi, community-based volunteers trained as HIV and AIDS educators, caregivers and/or advocates travel to neighboring communities and homes to care for those affected by the virus. Their ability to serve people is limited by their lack of transportation. By using a bicycle, a health care worker can see up to 5 times as many patients.

The home based carers really blew my mind. They work HARD as volunteers in grueling conditions. Many have very little but they choose to persevere for the wellbeing of their communities. They showed up to receive the bike ambulances singing and dancing and I found their gratitude overwhelming. A big thank you to both the home based care groups and Silver Spire Church for the difference that they are making.

Home based care volunteers, Salima District

Bike for AIDS Campaign

The World University Service of Canada runs the Bike for AIDS Campaign through which the ambulances and bikes are donated. Since I've arrived here in Malawi, the campaign has received support from my friends and family in Canada which has resulted in 5 ambulances (includes bike and stretcher) and one stand alone bicycle to be provided to home based care organizations in Malawi.

A big thank you to Christ Church United, Silver Spire Church, Aunt Pat & Uncle Max, Aunt Mary & Uncle Sandy, Beth, Michelle, Deb, Heather and my parents.

If you are interested in learning more about Bike for AIDS or making a donation, please check it out here!

Weight in the Western World

I woke up to the sound of an e-mail coming into my inbox. I open the e-mail to find a blog post from Jezebel, a feminist blog which I read religiously. The title? 'Shut the **** up about Lady Gaga's weight already'.

Apparently the tabloids are ablaze with headlines about how the beautiful, slender pop star has gained 25 pounds.

This makes me feel an anxious stiring in my (softer than when I left Canada) stomach. As my time in Malawi comes to a close, I have been thinking about what it will be like to go back to the Western World. There are many things that I'm looking forward to in Canada, at the top of the list being family, friends, consistent clean water, the light going on EVERY time you flick the switch, and (of course), cheese.

One thing that I'm not looking forward to is my culture's obsession with weight. Living in Malawi has been very liberating on this front. For the first time I can remember, I have let the weight thing go. In Canada, I learned at a very young age that thin = beautiful and grew up conscious about my weight. I'm sad to admit that I can not remember one day since I was 11 years old when it wasn't on my mind, how if only I was thinner, I would be more attractive. If I wasn't trying to loose weight, I was trying to accept my weight and not gain any.

Moving to Malawi and living in a culture where bigger is often considered more beautiful has given me a completely new perspective. It has allowed me to worry less about how people perceive the way I look and to feel more comfortable in my skin. This change in perspective, combined with a prevalence of carby foods and not having access to boot camp classes 3 mornings a week has caused me to put on a few kilos... and guess what?

The world hasn't ended!

I still enjoy going to the beach, have meaningful friendships and a lovely boyfriend who couldn't care less. The summation of my discomfort with gaining weight has come in the form of the waistbands on my pants. So why do I want to warn my friends and family that I've gained weight so that I feel less shame about it when I get home? I feel nauseated when I think about trying to reintegrate into a culture that holds narrow and oftentimes destructive ideals of beauty.

I recall with a new awareness the painful effects of idealizing thinness. There was a young woman a few years ahead of me in high school who died from anorexia and I have friends who were hospitalized as young as 13 from the same. I remember being 12 years old and lying in bed hungry by choice, fantasizing about food in my room directly above a fully stocked kitchen. Living in a place where over a quarter of the population is physically stunted due to malnourishment has given me some perspective on how messed up that really is.

I hope that I can go back to Canada with a positive perspective that will help heal this societal problem but I worry about how it will feel too. It is one thing to experience a shift in values, but another to hold onto those values in a place where every billboard tells you that you are wrong.

I suppose speaking out about it is a first step, and I feel grateful to have this blog as a forum to start doing so.

The Art of the Bucket Bath

 

Since the day I stepped off the plane 11 months ago, Malawi has been generous in her teachings to me. She has gifted me with many a lesson, sometimes subtly, but more often in an unexpected and rather intense manner.

In my time here I have learned pieces of a beautiful Bantu language, learned how to tie a chitenje, eat Nsima with my hands and ride a bicycle through a roundabout. I've learned the importance of acknowledging a fellow human being with a smile and a greeting and how to always be prepared for a power cut.

At my goodbye dinner in Ottawa, my friend Sara stood up and did a toast. 'I hope that everytime you bathe from a bucket, you think of your friends here in Ottawa.'

The table erupted in laughter and I chuckled along at her joke. A bucket bath?! I mean I was going to be living in the capital city!

Well folks, most of the world doesn't bathe using a shower and I have been inducted as a sometimes-member of that club.

I'm very lucky to be living in a place where we have water most of the time. This said, water outages aren't uncommon here. Sometimes the water goes out unexpectedly due to broken pipes. Sometimes the water board goes on strike.

Sometimes the water board goes on strike and then the pipe breaks because it hasn't had water going through it in a week. (That happened last month for a total of a week and a half without running water).

These outages have made me realize how much I take running water for granted. I always heard the expression that 'water is life' but only recently started to understand what that means.

We need water to prepare food, to drink, wash dishes, wash hands after using the bathroom, when you squish a mosquito on your elbow and want to wash it off, when you accidentally spill something on the floor, to make coffee in the morning... the list goes on.

I find myself becoming increasingly aware of the myriad of things that I use water for every time the water goes off.

One of the most important functions of water is obviously bathing, and you kinda have to bathe even if water isn't coming out of the faucet. But how to go about getting clean when there isn't a shower with a steady stream of water at your disposal?

The bucket bath.

I have learned how to bucket bathe through trial and error and find my technique constantly improving. After 9 days of practice during the water board strike/broken pipe saga, I thought I would share my new found skill. 

(These pictures were taken and sent to Sara so that she knows I think of her often. Sorry if you find them to be TMI)

Generally, the steps are as follows, if you have a better technique please let me know:

1. Find water – I'm lucky that this process is relatively easy and does not involve walking a long way with a heavy bucket. For me it involves stocking up on jugs at the grocery store or going to the nearest working faucet (in my case at the backpackers down the road) and filling up.
   
   
2. Heat the water – this isn't always possible but if you have electricity it makes the experience much more pleasant unless the outside temperature is over 100 degrees.
   
   
3.  Identify water scooping mechanism. My favourite is a big plastic mug because it holds lots of water and can't break. Any other scoop is fine too as long as your mug isn't metal and your drain isn't 'leaking' electricity (oops learned that lesson!).
   
   
4. Take the scoop and dribble water on yourself to get wet. This will help you suds-up with soap. Don't use too much water at this stage because you want to have enough to get the suds off.
   
   
5. Soap up. Doing this everywhere in one go uses less water than doing each section individually.
   
   
6. 
   Trickle the water over the sudsy bits slowly and use your other hand to help rinse. The tricky bit? When you are washing your arms and armpits! 
   
   
7. Think of your friends in Ottawa and feel grateful to be clean and have water!