(A little girl outside of Lilongwe)

Life after Zanzibar has been rather anticlimactic, yet my day-to-day routine continues to be somewhat chaotic. The latest drama – after 42 years, Malawi has severed its ties with Taiwan in favor of pursuing relations with mainland China. This decision has severe ramifications, not only for several of my projects, specifically the Electronic Data System (EDS) for antiretroviral therapy and the early infant diagnosis pilot, but also on the thousands of patients Taiwan Medical Mission currently treats. Taiwan plays an integral role in HIV/AIDS prevention programs, and has supported many jobs in agriculture and infrastructure projects. Taiwan’s pending absence will surely create an enormous gap within the public health sector.

(Taken along the North shore of Lake Malawi – Andy and I pulled over on the side of the road, walked into one of the villages and took all of the following images)

Malawi was one of the few nations that recognized Taiwan’s sovereignty. Yet, China muscled her way into Malawi – which is easy to do when you throw enough money at an impoverished country, six billion dollars to be exact. However, it is unclear how this money will be spent. More importantly, what kind of consequences will Malawi face once China targets all of its natural resources for their own growing economy?

(Lake Malawi’s nickname is Lake of Stars)

This past week, I made an emergency visit to the North to meet with the Taiwanese and to assist with supervision at the two pilot sites. Fortunately, we have been using parallel systems (paper and electronic) during this first phase of the EDS roll-out, so we haven’t necessarily lost data. However, we need to decide what’s going to happen in the clinics that are currently using the electronic systems.

(Outside of Ngala – Lake Malawi)

Furthermore, we are in mid-pilot mode with several countries anxiously awaiting the results from our formal evaluation on the use of EDS. And, Taiwan was planning to financially support the workshop that I’m in the process of organizing with WHO – so it’s been a bit of a scramble to find funding. Also, the main impetus for this conference was due to Malawi being the first country to utilize national data standards for ART – As such, two developers – the Taiwan Medical Mission and Baobab, built systems based on national specifications – which could then be merged together into one central repository using HL7 messaging. Now that only one system will remain, it negates the use of HL7 messaging, of which so much time and energy has been spent.

(Taken outside of Ngala – Lake Malawi)

The next few weeks will be quite revealing…Taiwan was given one week to pack up their belongings and leave the country. In fact, when I met with them we remained in the parking lot – which looked like a bazaar, with Malawians walking away with pots and pans piled high on their heads! And, some of the Taiwanese have lived here for years – thus returning to Taiwan may prove to be quite difficult. I couldn’t imagine being kicked out of a country and having one week to pack up everything I owned, purchase a plane ticket, and hope I had a place to return to on the other end. My heart goes out to all…

After visiting the clinic in Nkhata Bay, Andy and I had lunch on the lake. In the distance, we saw smoke on the water – but we couldn’t figure out where it was coming from. Upon closer inspection, we realized that they were mini-tornadoes (surely, there’s a more technical explanation – but I don’t know the words to describe what we saw).

Much love to all,

Amy

P.S. My friend, Gator, just forwarded the more technical term for our ‘mini-tornado’ – it’s actually a WATERSPOUT: A waterspout is an intense columnar vortex (usually appearing as a funnel-shaped cloud) that occurs over a body of water and is connected to a cumuliform cloud. In the common form, it is a nonsupercell tornado over water, and brings the water upward. Thanks Gator!!!