Tovwilane – helping each other

Tovwilane – helping each other

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.

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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.

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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.

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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!

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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.

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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!

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Play is the work of childhood

Play is the work of childhood

Our morning was taken up by a Skype meeting with Ian Smith, a tutor on the Doctorate in Clinical Psychology at Lancaster University.  Ian joined us during our visit last year and was keen to remain involved in thinking about opportunities to collaborate on research.  Isaac (academic coordinator at the SJOG college) and Devlin (clinical psychologist) also joined us for these conversations.  Together we identified a range of areas which would benefit from further exploration, with an overall aim of developing a psychological understanding of mental health difficulties and influencing the way in which care is provided within Malawi.  These areas included: drug and alcohol addiction; the influence of increased access and use of social media on mental health; dementia and ageing; and post-natal mental health.  The meeting felt very productive and we each left with a list of tasks and an enthusiasm to move these plans forward.  Watch this space!

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With the few hours of our day remaining, we headed over to see the children at the SJOG Umoza vulnerable children’s project and the Child Development Centre.  We had brought some activities with us, as always the children were curious about us and what we had brought along and were keen to involve us in their games.  We introduced them to the game of ‘snap’ with picture cards and soon had a few boisterous boys who enjoyed the chance to show off their newly developed prowess!

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Each time we are with them we are struck by the respect they show to us, e.g. always bringing games back to us and not assuming ownership.  We were lucky enough to be the models for a game of hairdressing and we noticed how the children enjoyed the feel of our hair and seemed intrigued by it being smooth to touch.  Spending time with the Umoza children is always a humbling experience; it’s a privilege to be part of and witness them children and being playful, something which is unlikely to be a priority when they are outside of SJOGs walls.

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We also spent some of the afternoon with children from the CDC; we had brought some sensory toys with us and soon had a group of children running around chasing bubbles and trying to figure out how these were being made.  One of these children was a young girl who we had met during our first trip to Malawi in 2014.  The week we met her was her first week at the CDC and there were concerns about whether she would thrive there as she was unable to communicate and having toileting accidents in the classroom.  She was very withdrawn and seemed reluctant to engage with people but with lots of time and attention she began to come out of her shell.  Today she ran up to us and immediately grabbed our hand to play ‘round and round the garden’, which we had taught her all those years ago.  Speaking to the teachers also revealed that she has learnt some simple sign language and can now ask to go to the toilet and communicate other needs.  It was fantastic to see her again, in particular the confidence and happiness which she showed.  We feel so very lucky to watch these children grow up and be a small part of their lives.

At the end of the afternoon we spent time with Dixon, who we had previously met when he was attended the Umoza project but who is now training as a bricklayer with SJOG’s Institute of Vocational Training.  Dixon and Joseph (Umoza’s music teacher) kindly gave us a further lesson in playing traditional African drums – there is video evidence but we’ve decided not to share that here!!  This musical feast culminated in a spontaneous goodbye song – we hope you enjoy once we’ve posted it to Facebook!

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We were invited to share one of our final evenings in Mzuzu with the Brothers of St John of God.  It was lovely to return to their home, where we stayed during our trip last year.  We shared good food, good company and a few rounds of ‘would you rather’ – we’ll leave you to ponder on whether you would rather have legs for arms or arms for legs!

“Old people are works of art” (Eleanor Roosevelt)

“Old people are works of art” (Eleanor Roosevelt)

To start a new week we arrived at Devlin’s office to confirm our plans for the day.  Devlin had travelled to Blantyre on Friday night (a 10 hour bus journey) to facilitate a 2-hour parenting workshop on Saturday before travelling back to Mzuzu the same day.  He spoke about how this had been positively received and he hoped that further input would be requested in the future.  This reminded us of the scarcity of psychological resources in the country, with Devlin being one of only 3 psychologists here.

We discussed our developing thoughts about how we might support and collaborate on research with the agogo projects.  We asked about the training that staff currently receive; Devlin explained that the projects are led by social workers who will receive some education around older adults and associated issues during their training.  The projects rely on volunteers; we later found out through talking to several volunteers that they come from the local communities who are supported by the projects.  There is also someone within each village who is identified by the village chief to liaise with SJOG if they have any concerns about agogos in their village.  Currently there are not many opportunities for these volunteers to access training or specialist knowledge as part of their role.

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We decided that the best use of our day would be to travel to Massasssa, the second agogo project.  We were kindly driven to the village and enjoyed the meandering road through local markets up to the agogo service.  The service is in the hills and has a wonderful view that allowed us to truly appreciate how far the agogos travel to arrive.  They were keen to point out the direction of their home villages – the picture below is taken from the agogo centre; one gentleman told us that his house was a two hour walk in this direction!

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We were warmly welcomed by the agogos and staff, who explained that there are two groups of agogos who rotate attendance each week due to the large numbers of local agogos in need.  This is in addition to the agogos who are visited at home due to being unable to access the agogo centre.  The staff shared that the traditions of these agogos are different from those at Towilane due to descending from a different tribe.  Part of this difference includes their traditional songs and dances which they demonstrated throughout the day.  They would often burst into spontaneous song in the middle of a group conversation, often to acknowledge or celebrate the important things being spoken about.  Following tea and bread (which they wanted us to share) there was a facilitated discussion around health issues.  This initially focused on possible contributing factors to having a high or low blood pressure.  There was some acknowledgement from the agogos of psychological factors e.g. worry about their children, but the discussion largely focused on diet and exercise.  The agogos explained that without this ongoing psychoeducation they had been unaware of these facts.  This had allowed them to make changes to their lifestyles and they had noticed improved health as a result of this.

We were then invited to contribute to a more general discussion around health issues and we took this opportunity to explain the purpose of our visit and gain their ideas of how we could support the projects, the agogos and their communities.  There was a lot of energy in the room when we spoke about memory and people asked us lots of insightful questions about dementia as well as providing examples of difficulties that they were experiencing.  Examples included questions around whether dementia can kill you, if dementia exists in all countries around the world, how do we identify dementia in the UK and whether there are treatments for dementia.  We did our best to address these questions but recognised that this could form a much bigger piece of work in the future.  We explicitly asked the agogos whether it would be helpful to learn more about dementia and to find ways of assessing for dementia which are culturally sensitive.  The response to this was loud cheering, shouting and traditional vocalisations.  We double checked the meaning of this and staff explained that the agogos felt very positively about this idea.  Staff and volunteers expressed their own keenness to learn more and develop their skills.  We wondered whether these projects would be a lovely opportunity to work with staff, the agogos, their families, and local community representatives.

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Following a shared lunch we took time to sit and rest outside with the agogos; we had taken some handcream and soon had a queue of women wanting a hand massage.  They explained that moisturiser is very expensive in Malawi so this was a luxury in many ways.  The agogos kindly gave consent for us to take pictures and asked that we share these in the UK, as well as bringing them back to show them next time we visit.  We then joined them for an afternoon of ‘motivational talks’ where the agogos shared their life stories with each other.  We noticed the prevalence of traumatic life events within these stories e.g. early loss of parents, witnessing physical violence and injuries.  They tended to focus on the theme of overcoming these difficulties and thanking God for this.  We reflected that in the UK such discussions might be more structured if in a therapeutic setting due to the potential of this causing further distress.

Our wonderful day with the agogos ended with a literal bucket of tea – they prepare tea in a large bucket and then serve individual cups to each of the 53 agogos.  Some of them poured their milky tea into bottles for the journey home.  Each agogo came to say goodbye as they left for the day and expressed a hope that we would visit them again.

On our return home we had planned to have a cooking lesson from one of the chefs at St John of God, Edward.  He demonstrated how to cook nsima (a staple food made from cornflour) and groundnut vegetables.  Edward was very much in teacher mode and had a great catchphrase of ‘have you seen it?!’ when he wanted us to really pay attention!

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Before we could bake our African Cake the power went off in our accommodation so we ate by torchlight and finished cooking in the main SJOG kitchen.  It was a lovely meal to share with someone who has become a friend over the years and for those of us who we see in person, you can look forward to a truly Malawian meal on our return!

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Old ways don’t open new doors

Old ways don’t open new doors

Apologies for the delay in posting this before the weekend – we had a busy day on Friday which we want to tell you all about!

We spent a little time after breakfast meeting some of the women’s groups as SJOG.  These groups are collectives of local women who each contribute to a central fund and then use these funds to make business investments (e.g. materials to make things to sell).  These women are typically caregivers or parents of the children who access SJOG services due to their vulnerability and need.  We were interested to learn that, since our last visit, a few men have also been able to join these groups.  It was explained that in the past men have not been allowed to join these groups due to concerns from the women that the men would not allow them to remain in control of their funds.

Our main focus for the morning was to travel with Devlin (clinical psychologist) to a local community building to close a week-long training programme with primary school teachers.  This training had been organised by SJOG and SOS, an organisation which runs foster homes for orphaned children.  They had identified that primary school teachers often struggle with behaviours which they find challenging in the classroom and wanted to provide a space to consider the unmet psychological needs which may underlie these behaviours.  We were interested to see some of the work they had been doing over the course of the week; several flipcharts we noticed showed that their conceptualisation of people included body, mind and spirit.  We noted that in the UK we often think about mind (i.e. thoughts or judgements) and body (i.e. physical health) but may fail to fully consider a person’s belief systems and spirituality.

As a closing exercise the teachers were asked to generate lists of common practice when faced with challenging behaviour and role play some of these.  We noticed that listening to this feedback felt very uncomfortable at times, largely due to the strategies mainly being shaming and punitive and sometimes including the use of physical force (e.g. whipping children).  One of the teachers explained that although government policy now prohibits the use of corporal punishment this continues to be a common strategy.  The teachers then reflected on their perceived lack of alternative ways to ‘control the class’ and how such strategies had been used when they were children.  We wondered if the large class sizes (between 60-90 children) would also impact on the ability of teachers to use more pro-active and less shaming strategies.  During this conversation there was an interesting energy in the room; we observed the teachers to laugh while talking about these strategies and again noticed the use of humour in uncomfortable situations.

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We were struck by the skill Devlin employed to explore these practices, specifically helping the teachers to feel understood whilst offering a psychological understanding of the detrimental impact of these strategies on a young person’s emotional wellbeing.  Devlin’s validating, curious and high energy approach allowed the teachers to consider these impacts rather than become defensive.  They were able to acknowledge that their own feelings of anger and frustration would often lead to more punitive strategies.  By the end of the morning we identified an ongoing need for teachers to be supported in developing this understanding further while also learning new approaches to take to the benefit of the wellbeing of teachers, their classes, and individual children.

After lunch we snuck in a bit of time with the vulnerable children’s project.  As we arrived a group of girls were being supported to bake some scones and we were invited to join them.  On walking into the building to begin the baking we noticed that the children had removed their shoes.  As we went to take ours off, they erupted in laughter and shook their heads, indicating that we, like the staff, did not need to do so.  We enjoyed seeing the girls work together to make the mixture but unfortunately had to leave before we saw the finished products.  As we walked to our next meeting we noticed that all of the boys were outside playing various sports; something we have noticed throughout our stay is how rarely boys and girls play together and how there are definite differences in how they spend their time.

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Our working day ended with a two-hour presentation by Andy Davis, a risk management specialist from Trident Manor who has travelled with us to Malawi.  Andy had kindly provided this workshop to SJOG to discuss issues around personal safety for both staff and clients.  The workshop was attended by a range of senior SJOG staff from across the various programmes.  It started with a light-hearted quiz which showed us all just how little attention we often pay to our surroundings, and then moved on to explore ways in which staff can be more aware of and responsive to ensuring their own and others’ safety.  We are hopeful that further input from Andy will help to create a safer environment for the staff and clients at SJOG, and for our trainees and volunteers.

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To relax at the end of a productive week we travelled to the shores of Lake Malawi.  We’ll leave you with a picture of this incredibly beautiful place…

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Agogo on then…we’ll have a dance!

Agogo on then…we’ll have a dance!

On our third morning we’d arranged to visit some agogos (an honorific term for the older generation).  Although we’d been asked to be ready for 8.30am we had no idea who would be picking us up; it was a pleasant surprise to see Brother Jean-Claud, who we stayed with last year and who makes excellent Guava jam!

Jean-Claud and a medical clinician took us to visit the Towilane elderly service, just outside of Mzuzu.  We visited the service a year earlier, when they were using a school building whilst a purpose-built centre was being constructed.  See below for before and after photos!

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On our arrival we were greeted warmly by the agogos, some of whom remembered us from our previous brief visit.  They enjoyed seeing a photo of their group which we had taken last year.  Unexpectedly but to our complete delight the agogos burst into song to welcome us back – a moment we didn’t capture on camera because we wanted to fully experience it.

We then joined Jean-Claud and two staff members on a series of home visits to agogos who could not independently reach the service.  Our first visit of the day was with a beautiful and friendly man who we later learned was the chief of his village.  He had broken his arm last year and this resulted in him having very little use of this arm and being in evident pain.  He explained that he had to rely on his younger brother to take him outside of his village on a bike if needed.  This visit and several others highlighted the lack of resources available for these agogos (e.g. walking aids and comodes) and the reliance on family to offer support.

On a later visit there were concerns about an older gentleman’s wellbeing following a stroke.  We observed how difficult it seemed to explore his cognitive functioning without any standard processes for doing so.  This led us to reflect on how useful cognitive screening tools might be within this setting and whether there is scope to translate and adapt any existing tools.  In general, the visits largely focused on physical health monitoring (e.g. weight, blood pressure, temperature) and providing medication.  Humour was often used to engage in discussions around difficult topics such as addiction.  Staff were clear to offer advice to improve wellbeing; we noticed our personal pull to explore the reasons why these difficulties are around and what they meant to the person.

One of the staff spoke of his desire to further his training; there is a recurring theme of local people being motivated to want to better themselves for the benefit of their community.  He explained his dilemma that to pursue further education would result in him losing his job and source of income; another example for us of why the Umoza Scholarship will be a valuable opportunity to promote sustained development.

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We returned to the service base just as the agogos finished their lunch.  They invited us to join them outside where they sat on the floor.  Interestingly they were shocked when we sat on the floor with them and rushed to find chairs for us; this and a few comments about us being “from the Motherland” was a reminder of the history of Malawi and the fact that it was once (in the agogos’ lifetime) a British colony.  We spent the afternoon trying not to reveal our lack of rhythm as we danced with the agogos to the sound of drums and their singing.  We have put a few pictures here and will try to upload a video soon!  The energy and openness of the group was a heartwarming experience to be part of.agogos-2.jpg

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We returned to Mzuzu just in time to see the children of the Umoza vulnerable children project, some of whom recognised us from previous visits.  It was especially nice to see a boy who we met during our first visit to Malawi who had been very poorly last year but who now looks back to good health.  Before leaving for the day all of the children were given a bowl of porridge and we were touched when one of them offered to share their porridge with us.  Lots of the children were curious to learn about us and to make a connection; we now have lots of Chitumbuka teachers (their local language)!

This evening we are planning to meet up with Andy Davis, managing director of Trident Manor, a risk management company who have been incredibly generous in their support of The Umoza Trust.  Andy has travelled to Malawi to support us with our own risk assessment and has offered his time to provide training to SJOG staff.  We’ll tell you more about this tomorrow!

Ain’t nobody I’d rather be

Ain’t nobody I’d rather be

Having awoken refreshed and raring to go we went in search of familiar faces to say hello and to begin making plans as to how our short time here can be most useful.  In true Malawian style we had no specific plans or arrangements, but everything seemed to fall into place!

Our first meeting of the day was with Devlin, one of the few clinical psychologists in Malawi.  We reflected on the partnership between The Umoza Trust and St John of God (SJOG) and our plans for future placements (trainee clinical psychologists or other mental health professionals).  Devlin shared his ideas around how we might support the psychosocial counselling course staff to develop their skills further by introducing therapeutic models that they may not be familiar with.  One of the key values of The Umoza Trust is sustainability and this feels like a valuable way in which skills could be shared.  We now need to give some thought as to how this could be culturally sensitive and how we can ensure that staff are able to link their psychological understanding of a client to the interventions they offer.

We then shifted focus during a meeting with the academic lead and principal of SJOG college.  We thought about opportunities for collaborative research and how our time in Malawi could be used to scope out areas of need and speak to some of the psychosocial counselling students who are currently planning their research projects.  One area which could benefit from a deeper understanding through research is the agogo (elderly) programme.  We plan to spend time there tomorrow to learn more about these important services.  We also discussed next steps towards The Umoza Scholarship which will offer support towards tuition fees for psychosocial counselling students.  One of our tasks for this week is to design processes for this which ensure that it is fair and equitable.

Before lunch we took the opportunity to visit a class of children at the Elvira learning institute.  We enjoyed spending their break-time with them and noticed how caring and supportive they were towards each other, particularly those with additional needs.  They enjoyed wearing our sunglasses (much better than we do and sometimes upside down) and comparing skin colour.  It’s lovely to see some of the children we spent time with on our first visit to Malawi in 2014 moving through the programme.

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After lunch we wandered through the markets and beautiful countryside on our journey to the House of Hospitality, SJOGs inpatient ward.  We visited Lakoma, their acute ward, and were able to spend time talking with the clients there.  One lady introduced us to her newborn son who was staying in a separate building within the unit with her grandmother.  She explained that she had struggled after the birth of her son but was feeling better after three weeks in hospital.  When asked what had helped, she cited the values of SJOG staff, most importantly the respect she has been shown.  Two gentlemen shared their belief that admission would clarify what was “wrong within their bodies and brains”.  We wonder whether this reflects the increasing prevalence of a medical model within mental health services in Malawi.  It was lovely to hear them talk of being accepted and considered equal to the staff providing care on the ward.

On our walk home we were joined by a student studying psychiatric nursing who we had met last year.  He spoke of his decision to train as a nurse as the only way to develop the skills to do the best job he could in the hospital within which he worked.  Unexpectedly he posed us the question “what do you like most about yourself”.  In true British style we uhmmed and ahhed before answering for each other!  We were intrigued as to how he would approach this question; he simply replied with “I like the fact that I am me”.  Elaborating on this he explained that he couldn’t be happy trying to be somebody else, so tried his best not to compare himself to others.  We thought that this was such a powerful philosophy to live by that we used it to inspire our blog title today (thanks Chesney Hawkes!)

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Our final reconnection of the day came when we visited a friend and kind local who we met last year.  She had been running a grocery stall but due to difficult times now transports her produce to various locations in the hope of increasing sales.  As soon as she saw us she gave us both a hug and then rushed off.  She returned with a parcel of food as a gift.  As always in these moments we were struck by the kindness and friendship that people show in even the most difficult of times.

For an unplanned day we seem to have done quite a lot!  Looking forward to updating you tomorrow 😊

Home sweet (second) home!

Home sweet (second) home!

Thirty hours, two taxis, three trains, two fights and a beautiful drive later – we are back in Mzuzu!


Despite it being over a year since we last visited, we’ve felt a wave of familiarity and comfort ever since landing in the Warm Heart of Africa. We’ve felt warmly welcomed back by new and familiar friends 😊

En-route to Mzuzu we were able to stop off at the Lilongwe Hospital and see the amazing building progress that’s been made over the last year.  More from there next week! During our drive we learned more about the agogo project for the elderly which also seems to have grown in scope since we were last here. Our driver, Happy, spoke of the positivity that the development of these services has been met with by local communities. We acknowledged that other adults in the UK and Malawi can often feel lonely and isolated, and Happy noted that locals have been really enthusiastic about finding ways of responding to this need.

We had a brief and welcome break during our journey to stop at a local market – the picture below can’t begin to capture the vibrancy of life in this hive of activity!


We arrived at our accommodation to find that a fecliois dinner had been left out for us – very welcome after a succession of meals in the air! Planning an early night so that we can start the day bright as early in the morning!


Tionenengo machero (see you tomorrow!)

(Update – we have only been able to post this today; we did indeed have a very early night (9pm) and early morning (6.30)!)