We began a busy Wednesday morning with a visit to Kisa (administrative manager for SJOG). Kisa is our main point of contact when arranging placements in Malawi and it’s always good to spend some time together in person whilst we are over here. We shared our hope that there may be more of us visiting next year, particularly given our research plans (see our earlier posts for details). Kisa explained that some of the accommodation will be taken for the next year by an American psychiatrist and her family. It will be interesting to see the impact of having a psychiatrist in Malawi; currently they have clinical officers who have some training in psychiatry and medicine but are not qualified psychiatrists. Our experience has been that medication is often the primary intervention offered, for example on the acute wards maximum dosages are offered and then reduced over time. We wonder whether having a psychiatrist in the service will lead to any changes in this area.
We then caught a lift back to the agogos at Korongo, a rural area just outisde of Mzuzu. This was our second visit to this established programme, however it was our first time meeting today’s group of agogos as they alternate which week they attend. Having recently spent time with the agogos project in Masasas, we are beginning to notice some of the differences between these two groups of people which we’ve been told about by staff. Today we learnt that the agogos from Korongo originate from the Ngoni people, who tend to live more rurally and farm the land, due to the remoteness of the area they tend to have less access to education and tend to present less formally (e.g. more relaxed clothing). At this centre a representative for the group tend to be asked how the group are and responds on their behalf, whereas people from the Tonga tribe (including those from Masasa) would answer individually. Today we were lucky enough to see some traditional dancing; the agogos improvised with poles which represented the spears that would be used in traditional ceremonies.
During the day we were unexpectedly asked to lead a group discussion around memory and ageing. A very obliging agogo stood with us and translated the questions and our responses. Although this was much appreciated, it is always difficult to know how accurately the essence of our responses was being conveyed, and this led us to consider ways to mitigate this during research in the future. We wondered if it would be helpful to have two translators, one to interpret the exchange between researcher and participants, and another to translate this interpretation back to English to ensure that concepts made sense and were accurately conveyed.
Although some of the agogos had questions around memory, we noticed that the majority of questions were about physical health e.g. aches and pains and blood pressure. We wondered whether this focus on physical health is a reflection of the priorities of agogos and their experience of what services offer. A pertinent example was that one gentleman, who was using a wheelchair, was curious as to whether we could offer support to provide better equipment for him. We explained that this was not our area of speciality, but that we definitely noticed a need for mobility aids and would look for opportunities to find support for this. If anyone reading our blog has ideas of organisations we could link up with to explore this further please let us know!
Today we discovered that if staff identify that an agogo has unmet physical health needs they would write a referral to a local government hospital which would then allow the person to receive free care. Given that healthcare is an expensive resource in Malawi, this referral agreement is a great asset.
During the afternoon we spent time with the service’s social worker, Sebastian, who provided further information about the support they offer. We learned that the name Tovwilane was chosen by the agogos and means ‘helping each other’. This really seems to embody the community feel of the service and the reciprocal nature of this relationship. Sebastian spoke about their service priorities, one of which was ‘sustainable economies’. He explained that the agogos and their communities are supported to form ‘women’s groups’ to provide income for their villages (see earlier blog post). The service also facilitates a weekly support group in each village where local communities can speak about issues faced by their agogos. The hope is that this will reduce less helpful beliefs about agogos being ‘useless’ or afflicted by a spiritual sickness.
One way in which we wanted to express our beliefs about their value was to spend time encouraging nurturing activities. We began by offering the women hand massages using hand cream; we noticed that the men were watching keenly and after checking with staff if it would be culturally appropriate, we asked the men if they wanted to take part. It was a wonderful opportunity to connect without words. We later found out that due to the price of hand cream and lotions in Malawi this was an even more unusual treat. Our day with the agogos came to an end and they began their journeys home. As we said farewell one of the agogos asked if they could sing us a song to share her hope that, although we were saying goodbye, we would meet again. Definitely a shared sentiment! Originally it was hoped that a bus service could be provided for the agogos, but as this has not yet been possible the agogos faced a walk of up to two hours. This also affects how long the services can open for, as time needs to be provided for people to journey to and from the centre in daylight hours.
As we were heading off to Lilongwe the next morning, we said our goodbyes to various friends in Mzuzu and got an early night in preparation for our 5am start!