A buzzword that captured a lot of media attention a few years ago was the idea of a “food desert.” Defined by the CDC as “areas that lack access to affordable fruits, vegetables, whole grains, low-fat milk, and other foods that make up the full range of a healthy diet,” food deserts are traditionally discussed in the context of developed countries like the U.K. or U.S. whereby communities (often distinguished by geographic location, racial/ethnic background, and/or socioeconomic status) are unable to reasonably access healthy foods [1,2].

Food deserts aren’t something we talk about in the developing world context, but as I think of my situation in Malawi, we’re facing a similar issue; it is systematically impossible for certain communities to access a variety of “healthy” foods, which combined with other factors like culture, education, and food security, can significantly impact one’s diet. In particular, foods like low-fat milk, yogurt, or whole grain anything, are expensive and often physically difficult to obtain here. A single-serving of yogurt can cost as much as 220 Malawian kwacha, which is almost enough to purchase a large  meal of nsima, meat, stew, and vegetables that would fill you for several hours. Healthy foods are here but for the masses, they are inaccessible, like a mirage in the middle of a desert.

Food deserts are also characterized by lack of access to fresh fruits and vegetables, such as was all too common in cities adjacent to my undergraduate institution of Michigan State University. In certain communities, the only accessible places were often convenience stores, which carried non-perishable, non-nutritive foods. Here in Malawi, this is not a primary issue. Fruits and vegetables are available in large quantities and relatively inexpensive prices, even by living standards here. But these healthy foods present other unique challenges, creating an obstacle to a nutritious and fulfilling diet. First, to eat them in their most nutritive states (raw), you need to clean them. This assumes the availability of clean water, which is not always a reality. Second, once you’ve purchased fruits and vegetables, you need to store them. And this is something that I’ve found to be a challenge. Electricity is not consistent, thus refrigerator storage is not a long-term option. Those who can afford a freezer often store things there, but of course this isn’t an ideal way to store fresh fruits and vegetables. And leaving many of these items on a shelf or in a storeroom drastically decreases their shelf-lives.

When I informally asked friends and colleagues here – “how are you able to keep food?” – the responses I got were interesting. In addition to storing food in deep freezers, many keep large quantities of maize meal, Irish potatoes, and eggs but buy fresh foods like fruits, vegetables, and bread on an almost daily basis. Even if we’re on the main road coming back from a field visit, a co-worker may pull over and within three minutes, purchase enough fresh veggies for that evening’s dinner. And while this makes a lot of sense, it presents additional challenges.

1. You must be able to get to a place that sells these fresh foods at an affordable price. I walk 30 minutes to get to the open-air market (as opposed to buying things at almost quadruple the price in a grocery store near work), which is ill-advised to do after work hours when the sun is already setting. Even driving or taking a taxi is challenging with the fuel crisis that has peaked at my three-month mark.
2. Fruits and veggies aren’t sold individually; they’re sold in bundles. Thus, what I call inexpensive – one bundle of tomatoes for a one-person household once a week – becomes more expensive for a woman who has, on average, 5 – 6 children and a husband to feed.
3. If you buy fruits and vegetables, and they start to spoil, you have to cook them, and cook the nutrition out of them to make sure that you’ve killed all the bacteria. For example, if I have tomatoes that I’ve tried to save for three days, I usually end up making a stew or pasta sauce, and I usually add spices and salt. And while I do these things modestly, ask any Malawian, the meal accompanies the pile of salt used for seasoning, not the other way around.

So, here in Lilongwe, when you look at the facts – the high costs, the far geographic proximity, the unavailable safe food storage – I am, by definition, in a situation where I cannot access healthy foods. And while I know many expats here whose situations are different – fuel reserves provided by their governments, generators in the homes to ensure 24/7 power, higher incomes to warrant paying 800 kwacha for 5 apples (the same price of buying a Malawian meal for three or four) – it becomes almost impossible to expect the local community to have access to these nutritious foods. By definition, I’d say that here in Malawi (and throughout the African continent), we are most certainly in a food desert.

And once we understand that, we see that the solution to improving diet is not just based on changing individual preferences but reshaping a greater system and set of policies [3].

What do you think?

Sources:

[1] Cummins, S., and Macintyre, S.(24 Aug. 2002). Food deserts” – evidence and assumption in health policy making. BMJ, 325, 7361, 436-438. Retrieved 27 Oct 2011 from <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123946/pdf/436.pdf>

[2] Pearson, T., Russell, J., Campbell, M. J., and Barker, M. E. (2005). Do ‘food deserts’ influence fruit and vegetable consumption?—a cross-sectional study. Appetite, 45, 195-197. Retrieved 27 Oct 2011 from <http://gis.sheffield.ac.uk/Library/Downloads/Publications/2005_FoodDeserts.pdf>

[3] Caraher, M., and Coveney, J. (2003). Public health nutrition and food policy. Public Health Nutrition, 7, 5, 591-598. Retrieved 27 Oct 2011 from <http://journals.cambridge.org/download.php?file=%2FPHN%2FPHN7_05%2FS1368980004000710a.pdf&code=d2ed946c9be9c1f95695a37a3d8fa71f>

Yesterday, Cape Town, South Africa was named the World Design Capital by the International Council of Societies of Industrial Design. Having spent the summer in Cape Town and witnessed firsthand the extensive campaigning the city has done in its bid for the title, I’m absolutely thrilled to see it has paid off for the Mother City. This award presents numerous opportunities for growth and development of an array of economic, social, and cultural initiatives. Furthermore, the licensing fee is only 160,000 Euros and the opportunities presented by the award far outweigh the costs incurred.

For one the award will provide Cape Town an opportunity to be featured on a prestigious global stage. Given the city, and country’s, heavy dependence on tourism this sort of positive attention will only encourage tourism and foreign investment, both of which are instrumental to economic growth. Another significant advantage of the award is the networking opportunities granted to local artists, architects, and other cultural industry workers. Not only will this allow inward flows of ideas but it will also allow Cape Tonians to exhibit their talents and ideas on a global scale, further improving Cape Town’s, and by extension, South Africa’s image.

Now the real question is: what will Cape Town do with all this attention? Will the city use this opportunity to accentuate its strengths as a city and attempt to conceal its various social and economic problems? Or will city and design leaders take this as an opportunity to showcase all of Cape Town to the world, including its less glamorous attributes (i.e. the numerous townships on the city’s outskirts), therein painting a holistic picture of the reality of living in one of the most unequal cities in the world?

Cape Town should embrace this opportunity to expose the whole city, for better or worse, to a very interested and engaged global audience. Highlighting only the affluent areas of the city runs the risk of perpetuating the already deeply-entrenched inequality; and given the high crime rates resulting from socioeconomic disparities, no one benefits from that.

Dr. Amy Lehman talks about her experience working in the ICU, visiting Lake Tanganyika, and launching the Floating Clinic. She speaks about the great cost of care in the US just to extend care when many in the Lake Tanganyika Basin don’t even have access to a health clinic. An area that has been “left behind” where there is a great need to innovations in health care access. The interesting side of the film is that it was called bringing “modern” health care to Africa. Does Africa need modern health care? Is there any room for traditional health practices?

Last week, I spent four days in the field visiting five different health facilities across the Central Region of Malawi. My organization was doing the first round of supervision since our new community health workers (CHWs) completed training two weeks ago, and it was interesting to see the fruits of the two week training. As I’m based in the monitoring and evaluation (M&E) section, my primary task was to assist in the evaluation of our six different tools that we ask CHWs to collect information on. This largely meant spending anywhere between five and 30 minutes looking through a few of the books and papers with colleagues, checking if all of the information written made sense, if all of the relevant questions were answered (such as: what is woman’s HIV status? Who, if anyone, has the woman disclosed to? How far along is the woman, or how old is her baby? Does she have other children, and know the status of those children?), if data was properly transferred from one book into a cumulative log, and if total numbers were added correctly to represent the number of women coming in each day. While it may seem simple enough to answer these questions, different sites revealed that it will take time for our CHWs to adjust.

Although no two days were alike, the most eventful day had the following schedule:

• 9:00 am: Started off early on a bumpy, dirt road to get to a health facility
  10:45 – 10:50 am: Greeted the head person (often a nurse) of the health facility
  10:50 – 11am: Met with the two to three CHWs at each site, and asking for their feedback on the experience thus far
  11:00 – 12:30 pm: Completed the supervision checklist through surveying the CHWs
  11:00 am – 12 pm: Critically evaluated the different data collection tools used (while other colleagues went through checklist), and providing feedbacks on areas for improvement as well as successes
  12:00 – 12:30 pm: Finished discussion and providing overall comments
  12:30 – 1:15 pm: Traveled back into town
  1:15 – 2:00 pm: Ate a hearty lunch of maize-based nsima, rapeseed mixed with peanut flour, and chunks of beef in a tomato stew
  2:00 – 3:00 pm: Traveled on a dirt road to the next health facility
  3:00 – 3:10 pm: Arrived at new facility, met CHWs, and attempted to carve out a space to sit and discuss.
  3:10 – 4:00 pm: Looked over data collection tools, while Manager went through checklist
  4:00 – 4:15 pm: Provided overall feedback and comments
  4:15 – 5:15 pm: Traveled back into town.
  5:15 onward: Spent time looking for affordable but clean accommodation, ate dinner, and went to bed.

While these routine visits were a great way to start getting involved in the overall management of the organization, they were not without their challenges. In particular, the language barrier was a major issue and so I spent much more time observing than participating (and having a colleague translate bits and pieces for me).

Regardless, the most exciting part was realizing that I’ve been able to witness a complete process since I’ve been here from my observation of the candidate interviews at a health clinic, to the training of new employees, to the observations of their first few weeks on the jobs. The challenges for these health workers – especially in regards to data collection and managing relationships at their respective hospitals – are many; but the rewards of seeing HIV positive women take ownership of the fate of their peers are equally as great.

This past week the health community made tremendous strides towards global eradication of malaria and the hundreds of thousands of deaths the disease causes each year.  The GlaxoSmithKline-funded and Gates Foundation-endorsed drug, RTS,S (commercial name, Mosquirix) was unveiled last Tuesday. This miracle malaria vaccine’s claim to fame, according to small preliminary trials previously done in Africa, is that it was found to have halved the risk of children becoming infected.

While this is wonderful news for the millions of people at risk of contracting malaria, the vaccine is still undergoing larger clinical trials at 11 health research centers in 8 African countries (Malawi, Ghana, Gabon, Burkina Faso, Mozambique, Kenya, Tanzania and Senegal). The vaccine will be tested on 5-18 month old children and would not be released commercially until 2014, at the earliest.

The famously generous Bill and Melinda Gates Foundation is playing a huge role in the funding and development of continued research on the vaccine, but the pharmaceutical giant, GlaxoSmithKline(GSK)  is the manufacturer and financial benefactor of the research and eventual production of the drug. Again, RTS,S may be an extraordinary success for global health. However, I can’t help but think of two possible problems with the release of this vaccine: accessibility and affordability. My hope is that GSK will make the vaccine affordable and accessible for those who need it most. My fear is that the vaccine will share the same fate as antiretroviral treatment, the drug treatment used to enhance and extend the lives of people living with HIV. Antiretroviral treatment, although extremely effective, remains inaccessible and unaffordable to many people living with the virus.

RTS,S, even in its early stages, is a huge step towards the eradication of malaria. Even if the vaccination’s effectiveness peaks at 50%, RTS,S will reduce malaria-related deaths in children by half. To guarantee that this life-saving vaccine is used to its fullest potential, GSK, the Gates Foundation, governments and the global community must understand that the development of a vaccine is not a success unless its affordability and accessibility is ensured for all.

Health in restaurants and hotels in developing countries is a serious issue. In Rwanda, many restaurants and hotels have closed due to the poor sanitation of the restaurant. The bars and restaurants were serving poorly stored and expired food to customers. However, people are now stepping in and doing something about this, “Owners of affected restaurants are expected to pay fines and renovate their business premises before they are allowed to reopen.” Some of the owners said that their capital limits them when it comes to hygiene and that is one of the reasons that they do not have the highest standards for cleanliness.
When I was in Rwanda for five months, many of the bars and restaurants looked very nice on the outside but their bathrooms and kitchens were not as clean as you would expect looking at the dinning area. At one restaurant that was very popular among the locals, I even got food poisoning from their Hawaiian pizza, the ham had gone bad but they did not replace it with new ham. Because other countries do not use as many preservatives in their food, food spoils more easily than they otherwise would in the US. Foreigners need to relearn how long they can keep a food item before it goes bad, but the local restaurant and bar owners should already know this.
Having an unclean restaurant, especially in the kitchen where it matters, can lead to serious health issues, chronic or acute. I think the best way to help with this is to conduct a health investigation every now and then for every bar and restaurant and put up an award if they pass, like they do in the USA. The owners should be required to have someone clean out the kitchen, fridge, freezers, dinning area, etc every day. They need to wipe down areas thoroughly and promote good health. Rwanda is a remarkable country with amazing food and to see many people get ill from restaurants being uncleanly is upsetting.
I think one of the main reasons that people aren’t as aware of the health issues that could arise from not properly storing food is that many of the people in Rwanda cannot afford a fridge, microwave, freezer, or any other necessary item for storing food and so their bodies have become more accustomed to eating foods that might not be cooked properly or stored properly or even prepared in a completely clean area. When I went to the villages in Rwanda, I remember seeing the ladies in the back of the house preparing the food in a big pot over a wood fire and the landscape around them included: trees, dirt, children playing with dirt, their laundry hanging and the buckets they were washing them in, etc. In the villages they cannot afford a nice kitchen and so they make their food with what they have around them. People who eat this way everyday, their bodies know no different whereas people who use a kitchen to cook, their bodies are not used to it and so they get ill. This is just a difference in culture and the owners should not be punished for their lack of hygiene but now that they have been made aware of the consequences, they should have to follow some more guidelines that are set up by a health organization in Rwanda.

Last Friday President Obama announced that he will be sending 100 armed military advisors into Uganda with the mandate to capture LRA leader Joseph Kony. While you can dispute the political feasibility of the President’s choice, it is completely unreasonable to argue that this is an example of, what radio host Rush Limbaugh calls “Obama killing Christians.”

In a shocking move given his usually respectful, informed, and polite tone, Rush Limbaugh chose to criticize President Obama without knowing the whole story. Here’s the worst part of his ignorant rant, taken from his horrible website:

“So that’s a new war, a hundred troops to wipe out Christians in Sudan, Uganda, and — (interruption) no, I’m not kidding.  Jacob Tapper just reported it.  Now, are we gonna help the Egyptians wipe out the Christians?  Wouldn’t you say that we are?  I mean the Coptic Christians are being wiped out, but it wasn’t just Obama that supported that.  The conservative intelligentsia thought it was an outbreak of democracy.  Now they’ve done a 180 on that, but they forgot that they supported it in the first place.  Now they’re criticizing it.

Lord’s Resistance Army objectives.  I have them here.  “To remove dictatorship and stop the oppression of our people.” Now, again Lord’s Resistance Army is who Obama sent troops to help nations wipe out.  The objectives of the Lord’s Resistance Army, what they’re trying to accomplish with their military action in these countries is the following:  “To remove dictatorship and stop the oppression of our people; to fight for the immediate restoration of the competitive multiparty democracy in Uganda; to see an end to gross violation of human rights and dignity of Ugandans; to ensure the restoration of peace and security in Uganda, to ensure unity, sovereignty, and economic prosperity beneficial to all Ugandans, and to bring to an end the repressive policy of deliberate marginalization of groups of people who may not agree with the LRA ideology.”  Those are the objectives of the group that we are fighting, or who are being fought and we are joining in the effort to remove them from the battlefield.”

Since it’s obvious Mr. Limbaugh obtained his information from the LRA Wikipedia page, I’m wondering why he didn’t take the time to read the rest of the page, which chronicles the various atrocities (murders, kidnappings, rapes, mutations) for which they’re responsible? Is it perhaps because his hatred of the President constants leads him to use his show as a platform to purvey baseless and uninformed criticism of the President? So much so that it doesn’t matter to him if what he’s saying is even true? What does Rush care of what he’s saying is perpetuating completely ridiculous, ‘Christian’ imagery of a vicious group?

Do your homework, Mr. Limbaugh, or don’t bother opening your ignorant mouth other than to inhale and exhale.

The image below shows global Occupy (fill-in-the-blank) protests

SCOUT BANANA’s mission is to educate, motivate, and activate. Now, I’m not playing favorites but I’d have to say that for me, getting active is the final and most important step in any social organization, movement, or attempt to make change. I know that students all over the U.S. and across the world are eager to learn about social issues and are motivated to be a part.  But I also know from my own experience that many young people are unable or unwilling to move outside of their comfort zone to get into the act of promoting social progress, justice and change locally and across the globe.

This is why I found the Occupy Wall Street movement to be so surprising, encouraging and confounding. What conditions made thousands and thousands of young people across the country come out for economic justice? To be clear, the Occupy (fill-in-the-blank-city) is tremendous. But more important, it’s the largest movement fueled by young people in the U.S. in recent history. What I don’t understand is why this particular movement is any more important to young Americans than social justice, immigrant rights, global healthcare and nutrition, and international human rights. The list goes on. What is it about Occupy Wall Street that made these people get off of Facebook and Twitter to storm their communities and seek economic justice?

My original question remains: Where are all of the activists?  Social problems ranging from blatant human rights abuse of immigrants in the United States to horrendous healthcare inequality in much of the Global South remain. Yet there have been virtually no protests, movements, or demands for change from the source of our greatest engine for change: young people and their incredible collective power.

Remember that the act is the start of change. Remember the billion people without access to proper healthcare. Remember the people whose basic human rights have been violated. Occupy Wall Street should be the first of many acts against injustice everywhere. We must do more than share a link on Facebook, Tweet a link, or forward an interesting article to our Listservs. We must act.

ICT Works highlights new data from the International Telecommunications Union today, indicating a sharp drop in the price of broadband access across African countries. From their post:

With the exception of Bangladesh, the ten countries with the greatest value change in the ICT Price Basket are all African. The question remains: does the basket accurately represent the cost of access to end-users or does it emphasis the price suppliers pay to other suppliers? Health informatics rely on fully-developed, robust infrastructures; the flattening of cost structures in the connectivity supply chain is a step in the right direction but its impact in African nations remains to be seen. If you have expertise in this area, let us know in the comments.

The challenge – or perhaps the beauty – of working “in the field” is that no two days are like. Some days are filled with activity, as we travel around to different to different health facilities to interact with community health workers at the site level. Some days are, well, uneventful (unless you count all the social media that I’m able to catch up on). The last few weeks have been no exception.

Two weeks ago, I assisted with a community health worker (CHW) training for 25 new CHWs. Although my Chichewa is still lagging, I was able to supervise the monitoring and evaluation components of the training. One workshop that proved challenging for many of the CHWs was the transfer of information from a case study into the logbooks that data is to be recorded in. This activity is crucial because it will impact the quality of information collected and later used to measure programmatic success.

Last week, I attended Malawi’s 2010/2011 National AIDS Commission (NAC) Annual Review Meeting, which was an enlightening two day conference on Malawi’s national HIV achievements and challenges. Through this interaction, I learned so much about Malawi’s national HIV/AIDS strategy from the major players themselves. I met several interesting individuals involved in the fight against HIV, from NAC officials to consultants, human rights specialists to public health professionals, doctors and business people alike. Having worked with Senegal’s National AIDS agency a few years ago, it was interesting to gain a first-hand perspective of another country’s national response to HIV.

This week’s excitement involved one day in the field, where I visited three different health facilities to observe and evaluate current data collection and quality. One site had superb data in all six tools that we evaluated; another site revealed a need for more constant supervision and support. CHWs also expressed different challenges they faced, including partnership with the health facility, client volume, and HIV test kit and drug shortages (two serious problems in the response to HIV in Malawi).

The other challenge – or beauty – of this line of work is that schedules are often unpredictable. My attempts over the last 19 years of school to follow a schedule have been put aside, as instead I aspire to learn the art of patience and flexibility. One has to be prepared to attend a meeting with 10 minutes notice, or to spend three days waiting to hear what task is next. I’m not sure what’s planned for next week, but it is sure to be another adventure.