'My Words are My Weapons to Curb Inequality'

Occasionally we ask colleagues to share their experiences working in global health. This month, Nandi Bwanali, Partners In Health’s public relations coordinator in Malawi, wrote about her upbringing in Malawi and what it’s like to work in Neno District. She’s from the country's capital, Lilongwe, and came to us through a fellowship with the nonprofit organization Global Health Corps.

My mother had me when she was 14, so my grandfather and grandmother raised me while she continued her education.

I grew up during a time when not much was known about a lot of things, and once they were discovered no one would say anything about them. Diseases were not really an everyday topic. Malaria was something I knew people could get but not really die of. HIV/AIDS was what TV advertisements went on and on about, but it wasn’t anything we had to bother ourselves with. It didn’t help that apart from the ads, HIV/AIDS was the main topic of Kenyan movies played on repeat on the local station. I have an early memory of my uncle begging my grandmother to change the channel: “Even Nandi could tell you what causes HIV. It’s all they show these days!” he said gesturing to 10-year-old me.

As far as I was concerned, people with HIV had hair falling from their scalps and ribs poking out of their chests and were nobody I knew or had to concern myself with.

Diabetes and hypertension—or “sugar” and “BP,” as I knew them—were more familiar terms in our household. My grandpa was unfortunate to have both. My grandmother was terribly afraid of needles and, in hindsight, I think so was my grandpa because he quickly taught me to give him injections. It was a fun activity for me. I would jump up to my task every day, and we would have long talks about how I would one day be a doctor and help others too.

I never took these diseases seriously. In my view, my grandpa was everyone’s superhero who just needed a little shot twice a day, much like Popeye needed his spinach. That was until diabetes eventually took him away from us in 2005.

“Bambo” means father in Chichewa and was the name I gave my grandpa. He was the only father figure I knew. At his funeral I heard people say that if someone had just given him something sweet he would have lived. This got me thinking about the fine line between life and death. For the next couple of months, I thought about this constantly. Months turned to years, and more familiar faces passed away from various ailments. My grandmother, a woman with a thousand stories, would explain to me what happened after we came back from every funeral of neighbors, friends, and family.

I realized diseases like HIV/AIDS were not just limited to radio and TV ads, and that, in fact, there was little known about the diseases that plagued the country. There were also no treatment options for people who contracted them. Wives were buried because of their husband’s infidelities, and children were left in the care of relatives who knew nothing about how to fight these diseases. I learned that “AIDS is a Killer” was not a song we merely sang as we played with clay dolls and wire cars, but a statement that stood for the countless people who were dying every day with little hope. Suddenly the Kenyan movies whose lines I had come to memorize reflected people who had died around me—a young, oblivious girl.

My grandpa’s death is a heavy memory I carry every day, but his life has been my constant motivation. I did not become a doctor. I was selected to go to university at 15 to study education. It became clear that teaching was not the path I wanted to take in my search for service. The injustices that rattled me were related to gender issues and disease. Having an English literature teacher as a mother had its effect. I understood the power of narratives, and I knew I wanted to tell stories.

I went on to study marketing, specializing in communications. I worked with the British Council in Malawi as the lead for customer service and communications. As a diversity and inclusion volunteer, I also coordinated projects to create equal opportunities in the organization. In November 2014, my boss sent me a newsletter about Global Health Corps’ fellowships for young professionals. She encouraged me to apply.

I didn’t think I would be selected without knowledge about global health, a term I did not fully understand. But I knew I wanted to contribute to a cause that would ensure that years on, I would not live in a country where the majority of people were burdened by disease and poverty. I wanted to play my part with the best of what I could contribute. 

I gave it a shot and was fortunate enough to be among the 2 percent of applicants selected. I can proudly say I am now a Global Health Corps fellow placed at Partners In Health’s office in Neno, Malawi. My words are my weapons to curb inequality.

My grandmother thought I was crazy when I told her about my interviews and that I had been selected to work in Neno. She repeated Neno a couple of times and asked me if I even knew what the place was like. She described it as a forest in the middle of nowhere with no roads and basically the last place any sensible person would volunteer to go. Neno is indeed a forest and the bad roads and mountains play a part in making it immensely isolated, but it was where I wanted to go.

Unlike most people that work for PIH, known locally as Abwenzi Pa Za Umoyo, I did not know Paul Farmer. Nor had I read Mountains Beyond Mountains. But PIH stood out from other organizations because it stayed in the areas it worked. It pledged itself to a portion of the 80 percent of Malawians facing extreme poverty in rural areas. This was the type of commitment I wanted to be associated with and the population I wanted to serve.

I had fears when I first started out, but every day I learn something new as I meet patients and hear their stories, which I share with partners who support us. Days contain small and special moments as foreign and local mix together. Chickens roam the office. American slang and Chichewa conversations fill the hours of long car drives to villages. Skype calls to Boston are common. I always spell check in Word, converting “programme” to the American “program.” And I have learned, to my surprise, I’m just as exotic as the organization I work for. At least three times a week I’m asked, “Are you Malawian?” as my accent reflects my town life. It has been a great conversation starter.  

In the 10 months I have been here, I have made new friends, some of whom have appeared in PIH stories. HIV prevalence rates and malnutrition statistics are not simply figures, but apply to Malawians I now know. They represent people and their burdens. I have seen health structures rise up in parts of Neno where people used to die without places to go for health care. I have seen pregnant mothers who once risked their lives by delivering at home rest their worries when PIH provided maternal waiting houses closer to their homes. I have watched the array of professionals who make this work possible—doctors, nurses, construction workers, transport officers, accountants, and many others—come together with a common goal to provide a preferential option for the poor.

Looking back, I laugh at the irony of life. Now I am the one sending out health messages on TVs, radios, newspapers, and digital channels. I am sure my grandfather would be proud of me and my cause.