Victor Kanyema is the manager of the Program on Social and Economic Rights (POSER) for Abwenzi Pa Za Umoyo, PIH’s Malawian sister organization. POSER is designed to alleviate the social determinants of poor health in Neno District, Malawi, by improving housing, providing workforce training, economically empowering women, and ensuring access to education. We recently asked the 36-year-old Kanyema to share the story of how he came to work with APZU and why his work is so important. The below transcript has been edited for brevity.
When I saw an advertisement in the newspaper for Partners In Health, I got interested and thought it’s high time that maybe I should join an international organization and contribute to the development of other parts of the country where I was born.
At the time, I was working with the youth movement in Malawi at a very popular and prominent organization called Active Youth Initiative for Social Enhancement. I had served with that organization for about 11 years, joining after I graduated from secondary school. I went to college on a part-time basis while I was also working so that it would balance out and I’d have qualifications relevant to my field.
After I applied to Partners In Health, I got invited to Neno for interviews. A truck came to take me and several other people to the interviews. I knew of Neno, of course, but I had never been there. We passed through mountains, we crossed the river, we climbed the mountains. There were five of us and we kept on asking, “Driver, are we there yet?” He said, “No, we are going there, wait.” Inside I was nervous, thinking about what type of community this is. Because I could see we still had a lot of driving to do, even after 1 hour and 30 minutes of just going and going. It looked like there was nothing. Within myself, I thought, “I don’t think I can work in this community.” I was nervous—it was so far out there. So I said a prayer within myself.
I eventually started seeing some positive signs of development on the car ride. I saw houses for health workers near the hospital. During the interview, I first told the Partners In Health people that I didn’t think I could work here. But after I saw the buildings and the other various structures that Partners In Health has constructed in partnership with the government, I told them that I think I am ready to work in this community. Almost everybody laughed.
This is how I came to Partners In Health.
At first, it was so challenging in Neno. My wife and whole family was in Blantyre, two hours from Neno, and there are not many good roads between. So every week, every Friday, I had to make sure I could find myself transportation to Blantyre. It wasn’t an easy thing. I had to make sure I got back to see my family.
For your information, my wife is a nurse. She was working at a position in Blantyre Adventist Hospital, which is one of the best. So she was working there and it was hard for me to keep on moving up and down, going to Blantyre on Friday and coming back on Sunday. The challenge was to get out of Neno. We’d pack ourselves to the maximum in cars. We did not care what is happening or who you are sitting with as long as you find yourself going to your family.
It was a new environment, an environment where I had never worked before. I was excited because I wanted the experience of working in an international organization. The biggest difference with my previous job and my job in Neno was the scale. I find it to be good because we are able to touch so many lives through the various support and programs we have, even though there are many challenges.
It’s not a one-man show. We work together and learn from each other so that we can reach our goal.
The first thing I concentrated on was understanding the concept of the Program on Social and Economic Rights (POSER). Who were the families we were to work with? What tools do we have to help us make decisions about who we should support and why? How do we reach them? I had so many questions. Who are the partners that we are working with?
I came to know the team in Neno well. I learned what their roles are and how to help each other and develop as a team. It’s not a one-man show. We work together and learn from each other so that we can reach our goal. (Read more about POSER's work.)
During this early period, my first assignment was to go into the community and visit the patients, chat with them, talk with them, get data. The clinical department refers patients to POSER. We have three steps to support. The first step is the patient himself or herself presenting their grievance to POSER or to the clinic or hospital or health center based on the proximity to where they are coming from. The second step is following up to see what challenges this particular patient or client is faced with on a daily basis in their community. Third is to develop a strategy and deliver support. So after going into field and getting the data, we sit down and analyze it all. And we make a decision to say let’s support families A, B, C, D based on what we have seen.
We believe as PIH and Abwenzi Pa Za Umoyo (APZU) that treatment alone is not enough to meet the needs of the patients. If we are missing elements of social and economic accompaniment, clinical treatment itself may not work because our patients are so vulnerable. By helping them have habitable homes, we are addressing multiple issues: psychologically, physically, and even economically.
We are serving and lifting somebody from extreme poverty to a certain level of hope where he or she can start living a life of independence.
We are serving and lifting somebody from extreme poverty to a certain level of hope where he or she can start living a life of independence. Independence cannot be realized if we cannot intervene and help lift somebody to that level. That’s why we are constructing new houses and renovating existing ones. Those houses serve as part of our strategy to prevent communicable diseases or other opportunistic infections.
Poorly constructed houses, poorly ventilated houses can raise the risk for pneumonia. Other houses in poor shape can be a breeding ground for malaria because there are so many mosquitos. If we treat a patient for pneumonia and he goes home to a damp hut with a leaky roof, he’s going to get sick again. But if we are creating a good environment for the patient to live in, then we contribute positively to the health of a particular individual and the community.
After working in Neno for a time period of a year, I admit that it was becoming difficult. Every weekend going to my family was challenging. At the end of the day it was becoming problematic on my part. I was failing to have enough to feed my family and also feed myself here. I was spending on going back and forth between Neno and Blantyre, and it was hard to save anything.
I had to communicate with our country director and I said, “Doctor, I need to talk to you. I’m having challenges here and I need help. I wish my wife could come to Neno.” I said that if my family was here, I could better concentrate on my work. The country director understood and said that if there was ever an opening, he would give my wife a chance to apply. Later on there was a need for a palliative care nurse. Luckily, my wife, Judith, was a capable palliative care nurse. She had to apply. She had to go and interview. She did well, and they knew she was capable.
It still wasn’t easy for either of us. She had visited me twice or so and the first time she said, “This is where you’re living? I don’t think I can make it.” I knew what she meant. So we had to sit down to discuss it. I said, “Let’s try. I know there is an opportunity here. There are so many other people that are staying here. If they are making it, then we can also do it. There’s no difference between them and us. I love this community, I think in time you too are going to love this community.”
Now we are so motivated because all of us are in Neno. And we bought a piece of land in Neno because we are planning to stay—we just love the community, and we are so attached to the people that we are working with. Buying land in Neno is a sign that we want to continue serving the people here.
There are many changes that have taken place in Neno since I arrived two years ago. The health system is improving and getting stronger every day, and we are providing great medical care. And POSER is helping in many ways, socially and economically.
We have two restaurants that we are using to help empower women economically. Part of this process is to help empower women to become independent. They receive training on managing a small business. We work hand in hand with the government’s Office of Social Welfare. They provide facilitators who have knowledge of business skills and customer care so that participants become business-oriented and knowledgeable enough to stand with other competitors that are there in the market. These women normally go through a two-year period of training. After that, they need to graduate so that they can pave the way for other women to come in and use the same facility and go on to graduate.
What matters is this: Are we there to serve humanity? That is what is important.
Economic empowerment is very important for women in Neno. We have seen that a good number of women we have supported through the restaurant programs have become independent. They are economically empowered and independent. They can construct their own houses. They can send their children to school.
Education is another important area. Education is the backbone of any development, and it is part and parcel of POSER. This is very important because so many parents—because of the high level of poverty that exists in the district—might have difficulties getting their children into school, both primary and secondary school. They find it difficult to supply them with learning materials and food and transport. But because of our intervention, we are relieving the parents of the burden of having to supply scholastic materials for their children.
We are working hand in hand with the Ministry of Education, Science, and Technology. We are working with teachers, and we have a team of what we call “teacher point persons.” These point persons work with children on a daily basis to provide psychosocial counseling and to motivate them to understand the importance of education.
We are also helping children that have lost parents and are without parental care. We can help ensure that they do not end up in an impoverished cycle. If they do, they may end up compromising their decision-making and health, especially girls. If a girl has reached a certain age, she may think that maybe the best way to survive is to sell her body. So we need to prevent people from entering into that cycle by making sure that we provide basic necessities, encourage children to go to school, help people have sturdy homes, and empower them economically.
This is what we want to see happening in Neno, and it is. It doesn’t matter where we are. What matters is this: Are we there to serve humanity? That is what is important. That is what motivated me and inspired me to believe in this community. Together we are going somewhere.