Essential Grace Magazine December 2020 Vol. 1 Issue No. 5
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From Essential Grace Magazine
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Dear Reader Welcome to the Christmas edition of the magazine! I know many of you have the battle scars to show just what a fight you had to put up in 2020. Yes, COVID 19 was a major feature, however we cannot overlook the other themes that are just as important in the world. Such themes include World Aids Day which is observed on the 3rd of December around the world. HIV/AIDS has not stepped down in any way, in fact it has become more challenging for some people due to the lack of antiretroviral medicine during lockdowns. Logistics and the lack of resources made it difficult to get these important medications to the people that live in rural and hard to reach areas around the world. Another theme that has become even more widespread and destructive is the misinformation or fake news surround the latest pandemic to hit our planet. As much as the coronavirus itself is deadly, not knowing the right facts, treatment, and prevention methods has been putting many people’s lives at risk. Personally, I have always supported prevention rather than cure. Protect yourself and your loved ones by keeping your distances, wearing your mask, keeping your hands and surroundings sanitized. Considering how bad these disease is, is it really too much to ask to keep yourself and loved ones safe? As we have all been advised to spend more time indoors while being COVID 19 safe; we have provided some popular recipes to try out as you celebrate the festive season. These are delicious dishes from a few countries around Africa. Have a great festive season and a fantastic new year!
Julie Soko Managing Editor Essential Grace Magazine essentialgrace@zoho.com @essentialgracemagazine2020 www.issuu.com/essentialgrace 3|Essential Grace Magazine
Meet the team Julie Soko, Managing Editor
Special Thanks to: Mtendere Kishindo
Essential Grace is a free online Magazine and registered publishing organisation focused on promoting mental health and wellness in Malawi and beyond through different mediums.
Editorial Assistant
Comments and feedback on any of our articles or contributors can be addressed to essentialgrace@zoho.com or through the contributors personal contact information.
Contributors
Contact us for information at
Sub-Editor
Naomi Msusa Editorial Assistant Art and Design
Thandi Soko De-Jong
Thandi Soko-De Jong, Julie Soko, Steveria Kadangwe,
0995 147 290 Our postal address is P.O. Box 323, Zomba, Malawi
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In This Issue Mental Health
Get to know your editors Dr M. Kishindo Julie Soko
World Aids Day Disabilities awareness Monthly Theme Christmas Recipes from Around Africa Mental Health and being COVID 19 Health and Wellness
smart
Coping with the second wave COVID 19 COVID 19, HIV/Aids, and mental health 6|Essential Grace Magazine
Blues News
My name is Dr Mtendere Alice Kishindo. I am the current Sub Editor for Essential Grace Online Magazine. I come from Lilongwe, Malawi but I currently live in Wuhan City, Hubei Provence in China. I am a lecturer in International Relations at Hubei University of Technology, China. I have a PhD in International Relations from Central China Normal University. Although my career is in social science, I would call myself a creative of sorts because I often find myself dabbling in the Arts. I am the current curator of Poetry‌? a poetry page on Facebook. I also own and run an editing and proofreading service in Wuhan called LiteralWorks. My first job as an editor was for a Malawian online magazine named Afrocentric in 2008. Afrocentric was a registered youth led concept that I with a group of three friends initiated to promote and market the African/Malawian Culture among youth in Malawi and across the continent. I am also a poet. I love poetry as an expression of self, of others and of we (a people or a culture). I have been writing poetry from a very young age. My father first introduced me to literature and I loved poetry as a form of writing the most.
My COVID 19 Story The COVID-19 pandemic found me in Wuhan city also known as ground zero for the virus. Globally, Wuhan became very popular because it was the first city to be locked down from the world for 76 days. The lockdown was lifted on April 8th 2020, I found the experience to be both humbling and scary for me. Looking back, I can say that life under lockdown was crazy for a lack of a better term. It went from being able to go outside of your apartment freely, to having to ask permission to do so. This was very difficult for me. During the city’s lockdown, one had to be given permission to leave their home, and only one member of the household could leave at a time. Before leaving the apartment, you had to let the building security manager know that you intended to leave the building (preferably a day or two before the excursion).
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One had to state the day and time you wished to leave and return to the building. The building manager would either grant you leave or deny you, depending on the reason you wished to go outside. In this time, there was a great sense of separation because you could hardly see anyone around the buildings. Most countries had evacuated their nationals, as such many foreign friends had gone back home, and being that the lockdown came during the Spring festival holiday, most Chinese friends had travelled back home too. It was quite a lonely 76 days. The apartment buildings were empty, shops closed and streets deserted, Wuhan was a literal ghost town. But I should add that the community managers checked in on me frequently whether it was for compulsory COVID-19 testing, to check my temperature or to inform me of community news. Once in a while they would round up the residents and give out free vegetables. That was a very nice gesture that reminded all residents we were going through the epidemic together. The community managers worked hard to make locked down residents feel safe in a time where touching an elevator button could have been fatal. There were a lot of adjustments that had to be made within the home as well. I had to learn to regulate my sleep because there were more hours in the day than before. I had learnt to avoid being idle and to plan activities throughout the day to keep myself busy and to ensure my sanity. I had to learn how to do my shopping through a community leader and accept the limited food items they were able to find. I had to learn how to ration food because I couldn’t leave the apartment. I had to accept that all these restrictions were for my own good. Psychologically the lockdown was rough. It was hard to watch the news or talk to people because there wasn’t anything uplifting to share. To make it worse, most communities in China got barricaded. In my community, the barricades didn’t come up until much later in the outbreak. Most residents at this point knew not to go out. As COVID-19 peaked it became quite clear taking the risk to shop or go to the hospital wasn’t worth it. The barricades stopped people from going out at all hours, it made sure temperatures were checked and that people were wearing protective wear in the right way. For those that broke the lockdown law, fines and punishments were given. My building had a sensitization officer going door to door showing us how to wear masks and other protective tips. Now, that they have lifted the lockdown, people are able to go out whenever they want (using a health pass). However, building security managers still had to check your temperature every time you left and returned. My family during COVID-19 I come from a big family and we are always in touch. I talk to or text my mother and my cousins every other day (that's the thing about being an only child) and so although I was physically alone, I really wasn’t. During the lockdown I had a lot of conversations most of which were spent trying to convince my family that I was okay and safe. There were a lot of phone calls and Whatsapp messages to respond to, in fact it has become a 8|Essential Grace Magazine
routine to check in with everyone once the day starts. When Malawi diagnosed its first patients, I felt as though I was experiencing a second wave of the virus here in China. So far my role has been to prepare my family and friends mentally for what they are about to experience, to remind them of the protective measures and how to stock up on rations. I worry about them most because the health care systems when compared to China are just not up to par with what is needed to combat the virus. Tips for dealing with COVID 19 in a foreign country As I spent 76 days inside my apartment, I learnt some ways to cope with my new reality. Here are some of them;
I made sure all my online services were up-to-date and active. I had to activate my online banking, payment apps and ordering-in apps. Since we were not going to be able to leave the apartments, online services became a life-line, although these services became very limited and expensive. I made sure I stocked up on prevention items such as medical masks, gloves, disinfecting sprays, gels and alcohol. Everything that was bought had to be sprayed down or sanitized, so having a lot of disinfectant was a necessity. I also needed a lot of laundry detergent, if it happened that I went outside, the clothes worn outside had to be washed immediately. Stocking up on food, especially non-perishables saw me through. I had a lot of canned foods and grains in the apartment. My shopping list prioritized foods that could be preserved, but I also thought of moments where I would need my comfort snacks and was the hardest part of making a budget. The great thing about living in my community was that the building managers shopped for our fresh foods, so vegetables were guaranteed in my diet. I made sure that I interacted with the family every day. The long days were depressing at times and since you couldn’t meet up with country mates or go to a cafe, scheduling online calls was a priority. I usually spoke with my friends and family. We frequently used Zoom, Whatsapp, Instagram and Wechat. Those moments made all the difference, however I should add that being in the epicenter of the virus meant that a lot of pity came my way. I had to navigate the concerns I received and made sure that I filtered out the irrational worries and dealt with what was real to me.
Listening to everyone worry about you can be a trigger for homesickness and sadness. I had to remind myself that I wasn’t sick, I wasn’t dying but I was safe and doing my best to cope.
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My name is Julie T. Soko, I am the founder and editor of Essential Grace Magazine. I am a counselling and organisational psychologist. I live and work in Zomba City, Malawi. I trained as a counselor at the college of Applied Psychology in Cape Town, South Africa where I lived and worked for 7 years. My areas of interest within therapy are trauma interventions, psycho-education on mental health issues, and working with empath related dysfunctions. My counselling practice – The Haven Center – has been open to the public since 2018 providing mental health interventions through both in-person and online mediums.
My COVID 19 Story Sharing traumatic experiences is one positive step towards healing. Particularly when the traumatic experience is shared by many. The beginning of the year started off on a positive note for me. I had many ideas and plans including some community mental health awareness projects, support groups for teens and pre-teens, as well as monthly workshops within the community. I had already started on the pre-teen work through the monthly workshops conducted in February and March. I was excited about the work, it needed a lot of work and improvement but the interaction with the young ladies was worth the effort. My practice was also going through many changes during January and February. Although my undergraduate training had prepared me with all the practical tools on how to open and run a private counselling practice; the work on the ground brought many challenges and needed more adaptability and on the spot thinking from me throughout the initial phase. Since I work alone, I ended up being extremely busy. I was bordering on becoming overwhelmed with the number of cases I was getting at the time, coupled with the administrative and financial management side of it. When we started hearing news of the virus in China, many reactions were of indifference. It was an unknown illness and didn’t seem to have much difference to the swine flu or other such viral illnesses that seemed to last for only a few months. I doubt that anyone would have expected it to become as big as it did. My sister and her family had been in Malawi for the Christmas holiday and had just returned home to Namibia in early January. In fact, we had many family visits during 2019 and most of us travelled a lot throughout the year. By March, as the cases started to rise beyond borders, I was still convinced that this would be very well maintained and would be over soon. My sister and I had made plans to travel to Kenya during the first week of March for a few days as she was presenting a paper she had worked on that had been published. We were to stay on the campus of a Christian University in the Karen area of Nairobi for one week. The agreement was that my sister would 10 | E s s e n t i a l G r a c e M a g a z i n e
be travelling from the Netherlands where she lives, and I would be meeting her in Nairobi a day later. The trip was very short for me, a mere 2 and a half hours from Chileka Airport. I don’t even remember wearing a mask or being asked to do this while on the plane or in either of the airports.
We had a great trip! It was short but we managed to see most of the city and eat some great food. Again, no masks or social distancing were required during this time. Nairobi is a densely populated city, so much more than any city in Malawi. Public transport, shopping malls, even the city streets were so packed that we were overwhelmed by it. We were blessed to have a local guide to show us around, however, we did take some adventurous trips on our own to discover the city. What we did not realise at the time that COVID 19 had been spreading across continents and was making its way through to Africa. After the week was over, It was a different case for my sister, she returned home straight into the first lockdowns. The reality of COVID 19 began to hit home after that. There was a lot of fear which I felt even more because of living in such a small city. My fear was more around people dying in large numbers from this pandemic. That would mean losing many people that I know and have lived close to since we are in a small community. This fear was realized when three families in my neighborhood lost one and even both parents. Although these were not necessarily COVID 19 related deaths; it was still a traumatizing experience for many. 11 | E s s e n t i a l G r a c e M a g a z i n e
we each returned to our homes through what appeared to be a very different Jomo Kenyatta International Airport. Suddenly, we had to use sanitizer even before we entered the Airport car park. There was an atmosphere of tension and fear that hadn’t been there a week before. Most people were wearing masks and looking uncomfortable. It made us anxious as we said goodbye and checked into different terminals. Returning to Malawi was a strange experience because the reception at Chileka Airport was very different as well. We were separated into different ques; everyone coming into Malawi from outside Africa had to fill out forms and provide information on how they would be traced within Malawi. The rest of us were allowed to pass through without this requirement although many safety measures were implemented at every entry point into and out of the airport. However, a few days after I arrived back in Malawi I learnt that my sister and I had been in the Jomo Kenyatta International Airport on the same day with two people that had tested positive for COVID 19. Mental health problems were on the rise and many people experienced stress related symptoms such as shortness of breath, dizziness, insomnia, loss of appetite, panic attacks, most of which were already associated with COVID 19. In light of this, my workload increased and I ended up having many clients that I helped through telephonic sessions. It was a challenge to start with but eventually this became the norm, and I like the rest of the world had to adapt and grow along with the new normal. COVID 19 continues to be a challenge all around the world, we are not in the clear yet. We all need to continue to be safe, to adapt, and to grow
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Themes of the Month
World Aids Day
International Disabilities Awareness
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World Aids Day st
1 December, 2020
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Each year, on 1 December, the world commemorates World AIDS Day. People around the world unite to show support for people living with HIV and to remember those who have died from AIDS-related illnesses.
The Theme for World Aids Day, 2020
Global solidarity and shared responsibility requires us to view global health responses, including the AIDS response, in a new way. It requires the world to come together to ensure that: Health is fully financed. Governm ents must come
together and find new ways to ensure that health care is fully funded. No one country can do it alone. Domestic and international funding for health must be increased. Health systems are strengthened. Inve stments in the AIDS response in the past few
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decades have helped to strengthen health systems and have been supporting the COVID-19 response. But more needs to be done to further strengthen health systems and protect health-care workers. Access is ensured. Lifesaving medicines,
vaccines and diagnostics must be considered as public goods. There must be global solidarity and shared responsibility to ensure that no individual, community or country is left behind in accessing life-saving health commodities. Human rights are respected. A human rights approach applied everywhere will produce sustainable results for health. The COVID-19 pandemic has exposed the fault lines in society and
how key populations have been left behind in many parts of the world. The rights of women and girls, and gender equality, are at the center. The COVID-19 pandemic has significantly affected women’s livelihoods, which have been disproportionally affected by lockdown measures, and lockdowns have resulted in an increase in violence against women in household settings. Women must be included in
decision-making processes that affect their lives. The world cannot afford rollbacks in decades of hardwon gains in gender equality. Now is the moment for bold leadership for equal societies, the right to health for all and a robust and equitable global recovery. This World AIDS Day join us in calling on countries to step up their efforts to achieve healthier societies. This World AIDS Day let us demand global solidarity and shared responsibility.
Learn more on how you can get involved with raising awareness on Aids related issues especially relating to the current COVID-19 crisis. Go to www.unaids.org for World Aids Day campaigns and material to use
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On World AIDS Day 2020, WHO is calling on global leaders and citizens to rally for “global solidarity” to overcome the challenges posed by COVID-19 on the HIV response. WHO has chosen to focus on “Global solidarity, resilient HIV services” as the WHO theme for World AIDS Day this year. The key actions are: 1. Renew our fight to end HIV The global AIDS response has slowed down: it’s time now to invest, to innovate HIV services with broader health care and the pandemic response to get back on track to end HIV by 2030. Missing the global targets for HIV for 2020 should not be a setback but a renewed call to do better. 2. Use innovative HIV services to ensure continued HIV care. There are many new approaches countries are adopting to ensure HIV care during the pandemic. WHO has recommended multimonth prescriptions of HIV medicines to protect the health of people on HIV treatment and to reduce the burden on overburdened health services.
3. Engage and protect our nurses, midwives and community health workers We urge policymakers to ensure that frontline health workers, nurses, midwives and community health workers are engaged and protected when delivering services for HIV and COVID-19. 4. Prioritize the vulnerable – youth and key populations We need to ensure that children, adolescents and members of key and vulnerable populations affected by HIV do not fall through the cracks of health care disruptions during COVID19. Key populations include people who use drugs, men who have sex with men, sex workers, transgender people and people in prisons that are disproportionately affected by HIV.
Access the WHO website for more information, statistics, and campaign materials for use in the efforts to raise awareness related to the World Aids Day initiative. www.who.org 18 | E s s e n t i a l G r a c e M a g a z i n e
HIV Preventative Checks Despite the strides made by these programmes, certain factors affect the effectiveness of these programmes. The most affected groups when it comes to HIV are:
Steveria Kadangwe, staff writer
When it comes to HIV/AIDS, the culture of preventative medical care is not common in Malawi due to among other things, lack of accessibility to medical facilities and fear of knowing your status. But when you know, you can do something about it and as we have seen, many have gone on treatment and are virally suppressed. Getting tested for HIV brings with it anxiety and stress, especially if the person is engaged in risky behaviour. There are many programmes that have been implemented to curb the spread of HIV including prevention of mother to child transmission for pregnant mothers, life skills education for school children, making condoms and voluntary testing available across the country and providing treatment to those who are HIV positive. 19 | E s s e n t i a l G r a c e M a g a z i n e
Women More women than men are HIV positive (13% women vs 9% men) according to the Malawi Population Based HIV impact assessment. What is more alarming being that amongst 25 to 29 year olds, 14.1% of women are HIV positive, versus 4.8% men. This is because women are more likely to go for testing than men. Men are also more likely to have multiple and concurrent partners. According to research, 13% of men had multiple partners in the past year of the research but only 1% of the women did. Many programmes to do with health issues focus on women who then take action, but men do not have such programmes. Young people About one third of new infections in Malawi in 2018 were among young people aged 15-24 years old. 47% of the young people in this age group do not know their status and have not gone for testing. Girls in this age group are also 10 times more likely to enter into early marriages than boys, mostly to men who are not in the same age group as they are. 14% of young people have sex before the age of 15. Poor knowledge of HIV prevention measures and lack of openness about sex, sexually transmitted infections and prevention
especially in the rural areas also contributes to the prevalence of HIV infections amongst young people. Sex workers Although sex work is illegal in Malawi, this is only on paper. Due to the criminalisation of this profession, sex worker information cannot be adequately tracked and therefore it is difficult to know the prevalence of HIV amongst this at-risk group. Sex workers in Malawi face high levels of human rights abuses, including discrimination and stigma when seeking HIV services, further increasing their vulnerability to HIV. They also experience high levels of violence, discrimination and abuse from police, intimate partners, clients and members of the public. Men who have sex with men This is the group that no one wants to talk about and again homosexuality is criminalised in Malawi yet this group is at risk as well. Men who have sex with men may also be arrested if their sexual orientation is exposed when seeking healthcare, causing many to shun HIV and other sexual health services. They may be harassed and bullied in the community, experience stigma and around 12% have been raped. High-risk behaviours are common, including multiple sexual partners, inconsistent condom use and exchanging sex for money. It is estimated that around 55% of men who have sex with men do not regularly use condoms. Children and orphans An estimated 74,000 children (aged 014) were living with HIV in 2018 of whom 20 | E s s e n t i a l G r a c e M a g a z i n e
61% were receiving antiretroviral treatment. This is a very low statistic especially considering that treatment is readily available and can help them to be virally suppressed. Mother to child transmission of HIV has reduced due to implementation of specific programmes. There are an estimated 500,000 orphans in Malawi (ages 0-17) as a result of HIV/AIDS. Poverty as well as lack of access to medical care means that many of them cannot access testing and treatment facilities. Although preventative messaging, condom use, life skills education and prevention of mother to child transmission programmes have increased in the past years and reduced the spread of HIV, there are some issues which affect effectiveness. Cultural issues Some cultural rituals promote unsafe sex and exposure for young people especially girls. Multiple and concurrent sexual partners, which can increase the transmission of HIV, is a feature of Malawian culture. The 2015-2016 health survey found that 13% of men had two or more partners during the 12 months prior to the survey, compared to 1% of women. For married men, this figure increases to 16%. Legal A bill was rejected in parliament in 2017 which would have criminalised the deliberate transmission of HIV to others. Criminalisation of sex work and homosexuality also makes the population within these groups more likely to get infected but less likely to
seek medical help – they may be subjected to mockery and harassment both at the police if they go to report things like violence or rape, or by medical practitioners due to the unique nature of medical help they require. Human rights watch interviewed 45 LGBTQ people in Malawi who reported that they routinely faced discrimination and stigma in health care settings, resulting in them avoiding those services altogether. HIV stigma once someone knows and declares their status is also a big problem and people would rather not know than go through this. This leads to isolation and affects access to care. The health system Although HIV is one of the key priority areas for the country there are issues that affect delivery of health service. Malawi has one of the lowest physician to population ratio (2:100,000) and nurse to population ratio as well (28: 100,000). To make matters worse, rural medical facilities are unevenly distributed and people sometimes walk 10km to access these services. There is usually no electricity, water or even toilets in some of the facilities. HIV testing kits regularly stock out and some labs cannot test for HIV. What can you do? Know your status. Get yourself tested and checked. And like we often recommend in this magazine, seek mental health support to deal with the
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results, especially if they are positive. Talking to a therapist helps to give you a new perspective and ability to cope with unexpected news. Men’s health is important and information about doctors who they can see needs to be made readily available. The culture of going for regular checks and medical examinations should be fostered and encouraged. Each person needs to take responsibility for their own health. There is a lot of work that needs to be done in the health sector to increase access to health services. For example, the LBGTQ community who are faced with many challenges, discrimination and stigma when it comes to accessing health services, including HIV services. Health care workers should treat them like any other person who comes for help and treatment. The silence surrounding this area is detrimental as men who have sex with men often have women in their lives as well, while engaging in at-risk behaviour. The health system also needs to prioritise this area. There is a lot of work that has been done to decrease transmission, increase the number of people who are on treatment and support those who need services but more needs to be done, especially in creating awareness amongst rural youth on preventative measures.
90-90-90 targets in HIV care focus on that 90% of people living with HIV know their status; of whom 90% are on treatment; of whom 90% are virally suppressed (90-90-90). This is where Malawi is at the moment and it is worse amongst the 15-24 year old age group (Source: www.avert.com). Awareness and prevention needs to be stepped up. And if you are in this age group, take care of yourself.
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The COVID-19 pandemic has changed
to make a difference to COVID-19 outcomes,
deaths were diabetes and being older.
many things about the way we live our lives. Researchers all over the world have been trying
although this may be because patients with untreated HIV stayed home to protect themselves.
However, the investigators stated that the increase in risk of death from COVID-19 in
to find reliable information about this new virus. This was reflected in this year’s AIDS 2020 conference, which was held virtually to encourage social distancing. Many pieces of work were presented to answer some of the questions raised by coronavirus and its impact on people living with HIV. The following five articles highlight some of the key discoveries. There has been much concern around whether having HIV makes a person more likely to catch or become seriously unwell from COVID-19. Researchers in the USA found that HIV does not
Similar conclusions were found in a study conducted in London, where COVID19 patients living with
HIV-positive people may be exaggerated if other illnesses were missed from their medical records. Another important
HIV improved faster than patients that were HIV negative, when accounting for other
question is why coronavirus causes some people to become so unwell but not
illnesses and social class. Another London study also confirmed that Black people living
others. The severity of COVID-19 relates to dysfunction of the immune system, in
with HIV are more likely to require admission to hospital for COVID-19 than White people living with HIV.
which too many proteins known as cytokines are released, causing serious damage to the
These studies directly contradict a South African study which found that HIV did increase the risk of
researchers at Mount Sinai in New York
increase the risk of catching or dying from COVID-19.
death from COVID19 and that risk was higher in those with uncontrolled HIV. The researchers found that
Furthermore, taking HIV treatment did not seem
the greatest risk factors for COVID-19 related
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body. HIV targets the immune system, so
wanted to find out whether this prevented the release of cytokines and thus provided some protection from severe disease. However, they found that HIV-positive patients who died of coronavirus still produced large numbers
of cytokines irrespective of CD4 count and HIV viral load, with higher cytokine levels than people who survived. Will changes to health care caused by coronavirus have a negative impact on people living with HIV? Many African countries responded quickly to COVID-19 by implementing changes to medication distribution and follow-up appointments. Some have decreased the number of clinic visits and now dispense more HIV treatment to last longer, known as multi-month prescribing. Data presented from a South African study showed that when people are given fewer clinic appointments, this does not lead to poorer HIV management.
Read more about the impact of COVD 19 and the impact it has had on HIV/Aids around the world at www.aidsmap.com
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The 3rd of December is International Day of Persons with Disabilities (IDPD). On this Day WHO joins partners to celebrate "a day for all". This theme reflects a growing understanding that disability is part of the human condition. Almost everyone will be temporarily or permanently impaired at some point in life. Despite this, few countries have adequate mechanisms in place to respond fully to the needs of people with disabilities. In 2020, the UN’s theme was “Building Back Better: toward a disability-inclusive, accessible and sustainable post COVID-19 World”. WHO supported this theme by underlining the importance of fostering an inclusive culture and responding to the urgent needs of people with disability in all aspects of society, especially during the COVID-19 pandemic. Key messages
Disability is part of the human experience. WHO recognizes that a world where all people attain the highest possible standard of health and well-being is only possible if health systems are inclusive of people with disability. People with disability have been amongst the most vulnerable populations during the current COVID-19 outbreak due to many health, social and environmental barriers, discriminatory attitudes and inaccessible infrastructure. The COVID-19 pandemic provides a unique opportunity to build back better our health systems so that they are more inclusive and responsive to the needs and human rights of people experiencing disability in all their diversity.
Countries need to shift towards a service delivery system rooted in the communities, reaching out and empowering people with disability
www.who.int.com
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The Community and the Differently Abled By Steveria Kadangwe December is Disability Awareness Month. All of us have encountered those who are differently-abled, as they are part of our society. Disability can come in many forms such as visual and/or hearing impairment, physical disability, cognitive and learning disabilities, and psychological disorders. Some people become differently-abled as adults – for example after accidents, illness or other medical conditions like stroke. One time I went to Mountain View School for the Deaf in Bvumbwe, a full primary school. The school offers special needs education, hearing aids, and is a facility for the hearing impaired. I went as part of Malawi Writers Union, to take part in a prize-giving ceremony for a poetry competition. The quality of writing was outstanding, even though the children were young and in primary school. It changed my perspective about those who are differently-abled. Imagine if they were given the same opportunities as everyone else! However, some of those children were left at the school by parents who never visited or provided for them. There is no doubt that the 150 students at this school are not the only hearing-impaired children in the country. There are more out there who need access to facilities like this. As a community, we can support, encourage and help parents and guardians of differently-abled children and also be an active part of the differently abled children’s lives. They develop mental health problems because of a society that does not welcome, support or encourage them. Currently, education appears to be a challenge for differently-abled children in Malawi. Schools are often not centralised or are far away from rural areas. If someone 29 | E s s e n t i a l G r a c e M a g a z i n e
cannot walk, they eventually get too big to be carried to and fro. Teachers and carers are often not trained to handle special needs children. Buildings do not have wheelchair access despite being required to make this provision by law. Tertiary education options are limited. We expect the government to step in and improve the welfare of the differently-abled, but according to UNICEF, there are limited funds available in Malawi; and these funds are made available mostly to be used to pay salaries and allowances, rather than being put into programmes that will uplift and transform the lives of the differently-abled. Parents of differently-abled children have many struggles like discouragement, especially if the child has cognitive disabilities, feeling overwhelmed in cases where they cannot understand the needs of the child or how to help them. Stress, anxiety and depression are also some of the emerging symptoms. Sometimes this stress can manifest as violence against the children. In our society, differently-abled children can be easy prey for predators and child molesters. In such situations, their carers may struggle to protect them. While we all cannot train to become teachers of differently-abled children or donate money to help schools like Mountain View, we can do our part to support both the children and their parents. There are mental health issues that come with being in this situation, and as a community. We need to educate ourselves and develop empathy and understanding to support them. First of all, we can be their advocates. Instead of using disparaging terms, we could build them up and encourage them. Some children with cognitive challenges quite intuitive, possess special artistic skills, or talents that can be nurtured. Secondly, we can support their education. We should not talk to them like they are not
able to understand basic issues. This attitude may affect their self-esteem and may in some cases even impede their development.
who they are as a person or negate their worth and value as people. Everyone has limitations, and we should talk to them about that.
We can also support parents by volunteering to help with the children and providing material support. Raising a differently-abled child can become overwhelming. Many parents are consumed with guilt about feeling tired, afraid, resentful, exhausted or even depressed. By supporting them and asking what their needs are, stepping in to help, and sometimes just giving them a platform to talk about their feelings; we can encourage them and show them they are not alone.
When the child is frustrated, we need to give them space and allow them to express their feelings, to cry or talk about it. We may not be the parents, but we can offer a listening ear and a supportive environment. Some may not even be able to express themselves clearly, but we need to be patient and listen to them in order to help them deal with their feelings.
We can also choose to be a part of differently-abled children’s lives. This may require investing some time and resources in order to understand the nature of their impairment. They need to be included in social activities so that they can assimilate into society. Mental health challenges may develop when they are segregated and clearly treated differently from other children. We, the community, can change that. I had a conversation recently with Professor Chiwoza Bandawe, a Clinical Psychologist in Blantyre who shared some thoughts about parenting differently-abled children. As a community, I believe the knowledge he shared can also help us when dealing with the differently-abled around us. Differently-abled children experience stigma and being mocked and laughed at when they go to school. They are often frustrated about not being able to do the things that other children can and if they are younger, may not even understand why they cannot. As parents and as a community, we can emphasise the unique giftedness of the children. Physical limitations do not change 30 | E s s e n t i a l G r a c e M a g a z i n e
We can give them dignity and pride by recognising their uniqueness and constantly affirming them. In this way, we can strengthen their mental resilience and ability to survive in a world where odds are stacked against them due to lack of support, limited facilities and resources, and build them up to contribute to society positively in their unique way. And what about adults? Many people become differently-abled as adults and often sink into depression as they find it challenging to cope with the new circumstances. Some were born with disabilities and have grown up in a world that is hostile and does not consider their needs as differently-abled people, but we as a community can change that. Learn the correct way to refer to their condition. For instance, do not say things like ‘retarded’ or ‘dumb’, which are unacceptable and often create stigma and offense. Do not talk over them to their nurses or helpers – talk directly to them and acknowledge them as people. Yes, depending on the nature of their disability, they may not understand
or may need you to slow down – adapt and be sensitive. Sit down when talking to someone in a wheelchair so they don’t strain their neck looking up at you. Don’t victimise, exploit or take advantage of them, by using their limitations to your own gain. Be a moral human being. Ask before offering to help. They may be slower but it doesn’t mean they will fail to do something. And if they decline, don’t jump in anyway. Refrain from giving unwanted and unsolicited medical advice which is not helpful and can get overwhelming as many people feel obligated to do this. Be respectful – don’t slow down your speaking or raise your voice when speaking to someone with a
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disability. Be yourself – you may for example slip and say ‘see you later’ to someone with a visual impairment but that should not make you apologise profusely or make the interaction awkward. And finally you can educate others. Be the person who steps up and challenges someone who calls a differently-abled person a ‘retard’. Speak up in your organisations if there are practices that discriminate against or segregate differently-abled people, for example, lack of wheelchair access, declining to employ someone because they came in a wheelchair or even mockery against those with speech issues in informal settings. Supporting the differently-abled starts with you and me.
Health and Wellness Christmas recipes from around the African Continent
Tips caring for your mental health and staying COVID 19 smart
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Christmas Recipes from the African Continent 33 | E s s e n t i a l G r a c e M a g a z i n e
Snacks Mkate wa nyama For the filling Minced meat lemon juice salt to taste black pepper (ground) cumin (ground) Method Put everything in a pot and cook until it’s well cooked and drain any broth away. Keep aside to cool. Other ingredients Samosa pastry (square ones) Eggs Method Place one samosa pastry flat and fill it with some meat filling and top it up with half of a beaten egg. Fold all the four sides. Now place another samosa pastry flat and place the folded pastry in the middle of the new pastry, folded side down and fold the same way. Cook in a griddle greased with a little bit of oil or a frying pan on low heat. Repeat with the remaining pastries.
Mkate wa Nayama is a snack commonly made in Tanzania
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Makoenva (Lesotho Cinnamon Rolls) Ingredients 2 teaspoons yeast 1 Tablespoon sugar 1 cup water 1 teaspoon salt 2 teaspoons vegetable oil flour 1/4 cup raisins Oil for frying equal parts cinnamon and sugar combined to roll them in.
Instructions Combine yeast and sugar in a bowl and add in 1 cup of lukewarm water. Wait until it turns bubbly and frothy about 10 minutes Add salt and oil. Add flour until dough doesn't stick to your hands while Add in the raisins and mix together Let the dough rise until it doubles in size Stretch the dough and pinch off a medium size pieces Put in hot vegetable oil to fry until golden brown Roll them in cinnamon and sugar Serve warm with cup of rooibos tea Enjoy! These rolls are common to Lesotho and can be enjoyed as a snack or as a desert
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Kenyan Potato Bhajia (known locally as Zigege)
Ingredients Potatoes – 3 medium Chickpea flour/besan/kadalai maavu – 1 ¾ cup Rice flour – ¼ cup Turmeric powder – ¼ tsp Ajwain/carom seeds – ¼ tsp Dhania Jeera powder/Cumin coriander powder – 1 tsp Red chili powder – 1 tsp Garam masala – ½ tsp
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Ginger – 1-inch piece (finely grated) Salt – to taste Dried fenugreek leaves/Kasuri methi – 1 tsp (crushed) Cilantro – ¼ cup (finely chopped) Water – as needed Oil – to deep fry the bhajias
Method
Wash the potatoes and peel them. Using a mandolin, thinly slice the potatoes and keep them immersed in a bowl of water. Rinse the sliced potatoes and then dry it entirely by patting it in between kitchen cloth or paper towels. It is important to have the slices very dry because if it is wet, it will dilute the batter. In a large bowl combine the flours and all the spices. Add water slowly and make a thick batter. The batter should be as thick as pancake batter. Heat the oil to deep fry the bhajias in a wide pan. Place ¼ of the sliced potatoes in the batter and mix well. Take out one slice of potato at a time and shake off the excess batter in it. Now slowly drop this in the heated oil and repeat the same with few more slices of potatoes. Cook the bhajias until its golden brown on both sides and then drain them on a paper towel-lined dish. Serve the Kenyan Potato Bhajia warm with ketchup or chutney!
There are many variations of bhajia. In Malawi we have a similar recipe that can be found in most local markets or outside schools and is eaten as a snack. Although the method and ingredients may differ the dish remains excellent all round!
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Main Course
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Senegalese Mafe with Peanut Sauce Ingredients 1 (3 pound) chicken cut into pieces 1/2 cup peanut oil 1 large Spanish onion, diced 2 plum tomatoes, peeled and chopped 4 cups chicken stock 2 tablespoons tomato paste Salt and white pepper 3/4 cup natural peanut butter
1 small head green cabbage, chopped into 1-inch pieces 2 large sweet potatoes, peeled and cut into 1-inch pieces 4 carrots, peeled and chopped into large dice 4 turnips, peeled and chopped into large dice 1/2 teaspoon cayenne pepper Chopped roasted peanuts, for garnish
Directions Season chicken and brown in oil in a large heavy pot. Add onions and tomatoes. In separate pot heat chicken stock and whisk in tomato paste. Thin peanut butter slightly with hot liquid and add all liquids to pot with chicken. Reduce heat and simmer 30minutes. Add vegetables and cook until chicken and vegetables are tender (approximately 45 minutes). Season to taste with salt, cayenne and ground white pepper. Garnish with crushed peanuts.
There are many different types of Mafe recipes across West Africa. Try this one for a taste
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Nigerian Jollof Rice Jollof rice is a dish popular not only in Nigeria but in several other West-African countries, such as Senegal or Gambia, Ghana or Sierra Leone.
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Ingredients 1 teaspoon dried thyme 2 dried bay leaves 5 to 6 cups stock (vegetable, chicken, or beef) or water, divided 2 teaspoons unsalted butter (optional), divided 4 cups uncooked long-grain rice or basmati, rinsed Salt, to taste Black and white pepper, to taste Extra: sliced onions, tomatoes Get Ingredients
1/3 cup oil vegetable/canola/coconut (not olive oil) 6 medium-sized fresh plum/Roma tomatoes, chopped, or a 400-gram tin of tomatoes 6 fresh, red peppers (or 4 large red bell peppers), seeds discarded 3 medium-sized red onions (1 sliced thinly, 2 roughly chopped), divided 1/2 to 1 hot pepper, 3 tablespoons tomato paste 2 teaspoons curry powder
Directions
In a blender, combine tomatoes, red peppers, chopped onions, and chillie peppers with 2 cups of stock, blend till smooth, about a minute or two. You should have roughly 6 cups of blended mix. Pour into a large pot/ pan and bring to the boil then turn down and let simmer, covered for 10 - 12 minutes In a large pan, heat oil and add the sliced onions. Season with a pinch of salt, stir-fry for 2 to 3 minutes, then add the bay leaves, curry powder and dried thyme and a pinch of black pepper for 3 - 4 minutes on medium heat. Then add the tomato paste - stir for another 2 minutes.
Add the reduced tomato and pepper mixture, stir, and set on medium heat for 10 to 12 minutes, until reduced by half with the lid on. This is the stew that will define the pot. Add 4 cups of the stock to the cooked tomato sauce and bring it to boil for 1 - 2 minutes. Add the rinsed rice and butter, stir, cover with a double piece of foil/baking or parchment paper and put a lid on the pan—this will seal in the steam and lock in the flavour. Turn down the heat and cook on low for 30 minutes. Stir rice—taste and adjust as required. If you like, add sliced onions, fresh tomatoes and the 2nd teaspoon of butter and stir through.
*To make Party Rice, you'll need one more step. Now Party Rice is essentially Smoky Jollof Rice, traditionally cooked over an open fire. However, you can achieve the same results on the stove top. Here's how: Once the rice is cooked, turn up the heat with the lid on and leave to "burn" for 3 to 5 minutes. You'll hear the rice crackle and snap and it will smell toasted. Turn off the heat and leave with the lid on to "rest" till ready to serve. The longer the lid stays on, the smokier. Let the party begin!
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Curry Fish Ingredients Fish Seasoning 1kg fish steak 1 teaspoon curry powder ½ teaspoon minced garlic ½ teaspoon minced ginger Salt and pepper to taste Curry Fish Stew 4 tablespoons canola oil 1 medium onion chopped 4 large garlic cloves minced
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1 teaspoon grated ginger 1 teaspoon fresh minced thyme 2-3 tablespoons curry powder 1-2 bay leaves 1 tomato diced 2 green onions chopped ½ -1 cup coconut milk 1 1/2 cups water or broth more or less Hot pepper (Habanero, Scotch Bonnet or Chili Peppers) 3-4 basil leaves 1-2 teaspoon paprika ½ red bell/green bell pepper 1-2 tablespoon parsley Salt and pepper to taste
Instructions Season fish with, salt, curry powder, white pepper, ½ teaspoon garlic and set aside. You may do this overnight and refrigerate until ready to use. In a Cast Iron Skillet, heat oil over medium heat until hot, and then add the fish and brown on both sides - about 35 minutes until fish is brown. You may omit this part, if desired. Remove fish and set aside. Drain oil and leave about 2 tablespoons. Add onions, followed by minced garlic ginger, thyme, curry powder and bay leaf, stir
for about 2-3 minutes for the flavors to blossom, then add tomatoes cook for another 3 minutes. Pour in coconut milk and water, continue cooking for about 3-5 minutes. Then throw in hot pepper, if using any, bell pepper, basil leaves and smoked paprika. Return fish to the pot with accumulated juice. Bring to a boil, salt and cook for about 10 minutes. Add chopped parsley. Adjust sauce thickness and seasoning with water or broth. Serve warm.
There are many variations to fish stew in Malawi. You might have a special recipe that is tried and tested, why not try a new way with any type of white fish that you prefer.
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Desserts Peppermint Crisp Fridge Tart Ingredients 250ml whipping cream, whipped to soft peaks 2 packets of Tennis biscuits 375g tin of caramelised condensed milk 20ml caster sugar 3 Peppermint Crisp chocolate bars, crushed 3-4 drops of peppermint essence Instructions Whip the cream and then add the caramelised condensed milk, castor sugar and peppermint essence. Beat until well mixed and then stir in ⅔ of the crushed Peppermint Crisp. Place a layer of whole tennis biscuits in a buttered 29x19x5cm dish. Spoon ⅓ of the caramel mix over the biscuits and spread evenly. Continue in layers, finishing with a layer of filling on top. Refrigerate for at least 4 hours. Decorate by sprinkling the remainder of crushed peppermint crisp on top. Cut into squares and serve. 44 | E s s e n t i a l G r a c e M a g a z i n e
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INGREDIENTS CHEESECAKE LAYERS 16 oz. cream cheese, room temperature 1/2 cup sugar 1/4 cup cocoa (I used Hershey’s Special Dark) 4 tsp Baileys WHIPPED CREAM AND COOKIES 1 cup heavy whipping cream, cold 2 tsp Baileys 1 1/2 tsp cocoa 3 tsp powdered sugar 15 Oreo cookies, crushed INSTRUCTIONS Beat cream cheese, sugar and cocoa together in a bowl until smooth. Add Baileys and mix until well incorporated. Set aside. In another bowl, whip heavy whipping cream until it starts to thicken. Add Baileys, cocoa and powdered sugar and continue to whip until stiff peaks form. To make the trifles, divide half of the cookie crumbs evenly between the four cups (or jars) and spread into an even layer in the bottom of the cups. Pipe, or spoon, an even layer of cheesecake filling on top of the cookie crumbs in each of the four cups. You should only use about half of the filling. Pipe, or spoon, an even layer of whipped cream on top of the cheesecake filling in each of the four cups. 46 | E s s e n t i a l G r a c e M a g a z i n e
Divide remaining cookie crumbs between the four cups and evenly distribute the second level of crumbs on top of the whipped cream. You can keep a little bit of crumbs aside, if you want to use them to sprinkle on top of the finished trifles. Pipe, or spoon, remaining cheesecake filling on top of cookie crumbs, distributing evenly between the four cups. Top each trifle with a swirl of whipped cream and a few more cookie crumbs, if you kept some aside in step 8. Refrigerate until ready to serve. I recommend setting them out for about 15 minutes prior to eating, so that they aren’t too firm.
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Blues News: the latest in mental health news
Mentally coping with the second wave of COVID 19 and the come-back of lockdowns
COVID 19, HIV/Aids, and Mental Health
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Mentally coping with the second wave of COVID 19 and the come-back of lockdowns With the first lockdown, even though it was incredibly stressful for a lot of people, it was also novel. This second time around, the fun has been taken out of it, and so I think that’s really impacting people’s ability to cope,” says Dr Alexis Whitton, psychologist and research fellow at the Black Dog Institute. But there’s reason to be hopeful: even if you’re already feeling burnt out, just making a few simple tweaks to your day-to-day habits can make the world of difference.
Here’s how…
Identify your triggers During the first lockdown, did you often find yourself feeling overwhelmed? If your mood took a nosedive at the same time every day, you might have unwittingly been engaging in repetitive behaviours that didn’t serve you well. This time around, be on the lookout for similar patterns and see if you can pinpoint the trigger. “For example, you could be waking up in the morning and scrolling through your work emails [or reading the latest COVID-19
news and feeling like you can’t manage,” says Black Dog Institute research fellow Dr Alexis Whitton.
“If that particular behaviour is setting you up to feel very stressed for the day, change it so that you’re not consuming that information first thing in the morning.” Instead, do something different. Go for a walk, play with the kids, drink a cup of tea in the sun – anything to get your day off to a more peaceful and positive start.
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Create a routine Remember the old adage about eating an elephant a bite at a time? If the previous lockdown taught us anything, it’s that giving some structure to your day can help break it down into manageable chunks. The same applies this time around. “It doesn’t have to be a completely structured routine, but just some little rituals that signal the start of the day, the end of the workday if you’re working from home, something to impose structure on the day so it doesn’t
feel endless,” Whitton says. Creating designated spaces for different activities can also be helpful in delineating work and leisure – use your desk or dining room table for work, move to the couch or kitchen during your lunch break, and head outdoors for some exercise once you’re done for the day.
Tackle unhelpful thoughts The constraints of COVID-19 restrictions might make it difficult to engage in positive behaviours. However, if you find yourself having unhelpful thoughts, it’s important to challenge them before they overwhelm you.
“One of the helpful ways people can watch out for and change this type of thinking is to write it
down and add the nuance to the thought,” Whitton says. “For example, if you’re thinking I feel trapped in this apartment, try writing down all the things that [you] can do, both inside and outside that day. This will often highlight that you’re actually not trapped; there are plenty of things you can do to add some variety to your day.”
Make good health a priority If your first lockdown experience was characterised by too much food and not enough exercise, you’re not alone – but this time around, you’ve got the benefit of hindsight to help you make healthier choices. Healthy food, portion control, and an increased commitment to exercise can have really positive benefits on your weight and
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other aspects of your physical health, as well as on your emotional wellbeing. “During the previous lockdown, [there was a period] where everyone was staying at home and eating junk food and drinking too much, but then as it went on, people started taking notice of how this was making them feel,” Whitton says. “I think there’s now a greater awareness of the importance of maintaining a healthy lifestyle – we know that if we’re physically healthy, we’re better able to cope with stress.”
Go easy on the alcohol Feeling bored, anxious, or stressed? For many of us, pouring ourselves an end ofday drink became an increasingly common way to deal with the rest round of COVID19 restrictions – in
fact, a Black Dog study showed that 50 per cent of people surveyed in April said they were drinking excessively to get through it. But this time around, there are some good reasons to think carefully before you reach for that bottle of wine. “The rebound effects that you can get after having a few drinks can increase negative thoughts, impact the quality of your sleep, [and can reduce your] tolerance for frustration – all things that can work against you in terms of dealing with added stress,” Whitton says. Switching to alcohol-free drinks or trading your drink for a late afternoon walk, a chat on the phone, or a virtual dinner party with friends can also help you avoid temptation. Find more resources to help you maintain a healthy mind, as well as resources on online mental health tools you can access during the COVID 19 pandemic from The Black Dog Institute at www.blackdoginstitute.org.au
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COVID 19 HIV/Aids, and Mental Health By Steveria Kadangwe There is a lot of concern with regard to COVID-19 when it came to those living with HIV but this should not cause you anxiety or affect your mental health. Medical advice that is given is for people to continue taking their medication and practice the safety precautions against the pandemic just like everyone else. Many organisations in the country are allowing people to work from home, yet we are still getting exposed to the virus as we go to many events such as engagement ceremonies (zinkhoswes), bridal showers, church services and events and so on. We all need to be deliberate about taking preventative and protective measures as not everyone is cautious or careful. Avoid worrying excessively, rather focus your energy on what you can actively do to fight this disease. The following tips and infographic from an HIV/AIDS resource website, www.avert.org has some useful information for those living with HIV in the COVID-19 era: Find out if your clinic has changed service delivery conditions during the pandemic. For example, have they stopped seeing patients at the clinic, can you access medical care from home? Try to stock-up on your antiretroviral treatment in advance. Do this to ensure you have enough for at least 30 days, ideally for three months. Ensure your vaccinations are up to date (for example influenza and pneumococcal vaccines). Stay at home as much as possible and avoid crowds. Wash your hands frequently and use sanitiser if water is not accessible. Know how to get in touch with your health care facility and have a plan in place for when you feel unwell and need to stay at home. Eat well, exercise as best you can (even at home), and look after your mental health – do the things you enjoy, strike a work-life balance and take adequate rest. Keep in touch with others through different methods such as through online or telephone social networking sites to stay socially connected.
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Essential Grace Magazine Promoting mental health and wellness through media Contact us essentialgrace@zoho.com / essentialgrace@yandex.com Call: 0991 938 203 / 0995 147 290 55 | E s s e n t i a l G r a c e M a g a z i n e