Hacktivate

I have two good friends who work at the maternity hospital here in
Lilongwe: Deb Lewis and Joanne Jorissen. Both of them are selfless,
dedicated people with some amazing stories. They work at Bottom
Hospital, which is a great name for a maternity hospital. That is, until
you learn that it was named in relation to top hospital, which was the
hospital for white people. Bottom hospital was where the black people
went. Top hospital no longer exists (white people mostly go to South
Africa when they need serious care), but Bottom hospital continues to
churn out 12,000 babies a year with just four doctors. Malawi's maternal
mortality rate is rising, according to the latest WHO report Malawi
is the third highest in the world, and could be number one if it continues to increase.

From Deb:

i've been working in the labor and delivery suite, which consists of 15
or so beds, separated by flimsy plastic curtains, and a slew of nursing
and clinical officer students supervised by too few midwives, a couple
of clinical officers and NO doctors. one may pop in and out occasionally but is usually tied up with the real emergencies. the women bring their
own black plastic garbage bag to deliver on, as well as their own bucket
if they're rich enough and rags to clean up with and wrap themselves and
their baby. the first day i was there i was helping clean up a woman and
threw out the garbage bag filled with poop, blood, membranes, amniotic
fluid and one of her rags. big no-no, since she'll wash the bags and
rags out and use them again...for a tablecloth, the next delivery, but
likely not her trash.
...
today was crazy. i delivered a little baby boy this morning and was
feeling quite excited about it. then i went to check on an 18yo
[first time mother] who seemed to be in quite distress. of course i
can't understand anything she's saying or communicate back, but she
hugged my neck and i tried my best to give some moral support while i
found a translator. it's weird because it's not like there aren't people
around, it's just that it seems hard to find someone when you need them.
there are a number of students and nurses hanging about, but there just
seems to be no real system for monitoring patients. it seems you pick
up a chart (we only recently got actual charts), maybe check for a
couple contractions, and then move on. so anyways, i found out my lady
needed to pee, and since she was quite far dilated someone told me to
put in a foley catheter, which is a very scary thing here since the
environment is just NOT sterile so who knows how many bugs are given a
free ride to the bladder. so while i was bemoaning the sterility
factor and helping marijn (the dutch student) insert the catheter, a baby pops out on the bed across from us. yes, number two baby in less than a week that i've seen delivered with NO HELP! poor shelia with her full bladder had to wait, while we ran over to see about the baby, cut the cord and deliver the placenta. marijn took the baby to the resuscitation station which consists of a bag and mask ventilator with a bad seal, suction (but no proper tubes to suction with), and oxygen, with again no good tubes. there are no nasal cannulas and basically you have to stand there and hold the end of the tube in the baby's nostril. the little guy was okay, and just as i was inspecting the mom for any tears, a girl starts pushing, which wouldn't be such a strange thing in a labor ward, except that she's by herself and she's ON THE FLOOR! that's right, no beds. she delivered about 30 minutes later, still on the floor, a healthy little boy.

shelia eventually got her bladder emptied and she later delivered by
vacuum, which i didn't do. i called the clinical officers over about
another patient, who they took for c-section due to fetal distress.
again, this is by listening with not much more than a plastic cup and a
sporadic doppler.

later i washed all the suction and oxygen tubes with soap and water, no
chlorine or disinfectant to be found, so you can imagine how clean they
actually got...




From Joanne:

Last week I spent one afternoon with Sakina, a very sweet and absolutely
terrified 19-year-old who was pregnant with her first baby. She was
having a difficult labor but refused all vaginal exams. After much time
spent trying to calm her, she allowed me to check her cervix... Before I
left around 6, I told the nurses and clinical officers ... to be gentle
with her.

When I returned two days later I found out that she had refused a
section early in the night, a vacuum had been performed at 3am, and then
finally she consented to a section the following morning. Her baby boy
was born around 6am but his journey into the world was too difficult for
him to bear and he died just a few hours later. I was so upset. Yes, it
is possible that she stubbornly refused the section after the best of
counseling, and yes, the clinical officer who attempted the vacuum is a
kind person. But, it was incredibly difficult for me to imagine that she
allowed someone to do a vacuum (which in this setting involves inserting
a metal cap that is 4-5cm in diameter into her vagina), considering it
took several minutes just for her to allow me to touch her with two
fingers. It was also difficult to imagine that she would refuse a
section if she truly understood what was at stake, and believed that it
was a necessity not a threat. Possible, yes, but difficult to imagine. I
have seen women held down and threatened, and the vivid horrible
memories flooded my mind. After visiting her in postnatal, seeing her
silent tears, empty arms, and recent cut, I had a tearful conversation
with Tarek about the situation. He listened, tried to help me see this
one woman in the greater context of the Hospital and health care here,
reminding me that things are improving but also saying that at present,
the whole of Bottom Hospital is a human rights' violation.
....
A couple weeks ago the charge nurse (the only clinically practicing
registered nurse in the entire hospital) told me, "Joanne, I hope that
when you go back to your country you will tell them how hard we work.
People are always coming here and then saying horrible things about
Malawi and our work here." I'm sure she would count my blog among those
horrible things. So let me say now, that the nurses and midwives here
work HARD. That is the truth. There is no one who sits and chats the day
away. These women do work.

This Saturday will be the first official meetup for bloggers in Malawi.
If you have a blog and live in Malawi (or are just passing through)
please come! Pass on the word. We will be having lunch at Mama Mia's in
Old Town Mall at 12:30pm. A map is available here:

Map to Mama Mia's in Lilongwe

Here are the mostly active bloggers in Malawi that I know of:

• The Roving Frog


• Geeta in Malawi


• Tyler and Anna in Malawi


• Babycatcher


• Soyapi Mumba's Blog


• Mangaliso's World


• mphizi's kukaya things


• Lounge Chicken


• Anti-Bakili Muluzi


• Living in a Fishy World


• Malawi MisAdventures of Tess and Jim


• Dispatches from Malawi


• Madinga's blog

See you there!


(thanks to Soyapi for tracking these)

Update: I have now created a script to automate setting up a persistent reverse ssh tunnel.

One of the nice features of VNC is that you can reverse a connection. If you are behind a firewall (or a router doing NAT) that doesn't allow incoming connections, VNC allows you to connect to a "listening server". As soon as a connection is established to the listening server, the "listener" gets a regular VNC connection back to the originating box.

Last Friday, I figured out how to do the same thing and reverse a connection with ssh.

I'll lay out the process first, and then talk about the applications and implications afterwards.

The simple approach:

Assume we have two machines. A firewalled server at work and your laptop. You can't connect to the server at work because all incoming connections are blocked by the firewall. So you ask Pete (who is at work and behind the firewall) to login to the server and then ssh to your laptop with the following command:

ssh -f -N -R 10000:localhost:22 username@ip_address_of_laptop

This creates an ssh connection from the work machine to the laptop. the -f and -N are basically cosmetic options. The -R 10000:localhost:22 option causes the laptop to listen on port 10000 and forward any requests on that port to the work machine (this is basically ssh tunneling).

So now, you can ssh to port 10000 on your laptop and you will actually be sshing to port 22 on the firewalled server:

ssh username@localhost -p 10000

(you will have to use your username and password for the server - despite it looking like you are logging onto localhost)

An ugly but effective hack to get rid of Pete:

To get rid of Pete you could setup a cron job on the server that attempts to connect to your laptop every hour. You would have to setup passwordless logins (using public_key authentication), but then you would know that if you needed to get on the server you could just make sure your laptop was on and willing to receive an ssh connection at the right time. Using www.dyndns.org would help you handle changing IP addresses on your laptop.

A better approach:

If you have access to a machine that is always on and outside of the firewall then you can use it as a middleman. The idea is to log onto middleman from behind the firewall, setup forwarded ports as above and just leave it connected all the time. Anytime you need to get behind the firewall you just go through the middleman. Here are the steps:

Setup your middleman to do gateways and stay connected without timing out. Edit /etc/sshd_config and make sure the following options are set:

TCPKeepAlive yes
ClientAliveInterval 30
ClientAliveCountMax 99999
GatewayPorts yes

You have to restart sshd to make these changes.

ps -aux | grep sshd

locate the ssh daemon

kill -hup

This will force sshd to rehash the config. (thanks Phil Vell!)


Then from the firewalled machine run:

nohup ssh -f -N -R 10000:localhost:22 username@middleman

The only difference from before is that this is now connecting the middleman and not the laptop to the firewalled machine, and we are using nohup to make sure the process doesn't die when the user logs out.

Then with your laptop you log onto port 10000 on the middleman which will forward your requests to the firewalled machine:

ssh usernameAtFirewalledMachine@middleman -p 10000

If you were unable to edit the sshd_config then you can still do this, you just have to jump through two hoops instead of one. First you log into middleman, then you log into the firewalled machine:

ssh usernameAtMiddleman@middleman
ssh usernameAtFirewalledMachine@localhost -p 10000

Applications and Implications

You can do a lot with this. It eliminates the need for a VPN. Ssh allows you to forward any port so you can connect to the intranet, the email server, anything that was hiding behind the firewall. This post is already too long, so I will leave it to the comments section for some examples of this sort of thing.

It also makes it pretty easy for social engineers to get behind your firewall. ("Could you run the Necessary Operation Help User Protocol for me, just type nohup...")

But I am a Windows luser!

Windows users can do this as well. Just install ssh using Cygwin. All of the ssh goodies including a client, server and scripts to set it up are there.

A weekend in the life of a Lilongwe-er:

Friday night we met some friends to go out for Ethiopian food. The Queen of Sheba restaurant is just an extension of the owner's house. There are no signs, and like all of the nicer homes in Lilongwe, the house is behind an 8 foot barbed wire wall. I called a friend who gave me directions, but basically we had to drive around aimlessly peering through cracks in gates. We eventually found it and had a very authentic Ethiopian meal with loads of injera (fermented grain pancake like bread). Two years ago, Claudia and I traveled through Ethiopia for 3 weeks and by the end were totally sick of injera since you eat it for breakfast, lunch and dinner. This was our first injera since then - and I enjoyed, but 2 years wasn't long enough for Claudia.

Saturday morning I woke up just after five and headed to the local international school to compete in a Triathlon. Despite the short distances (250m swim, 10k cycle, 2k run) it was very tiring, but a lot of fun. There were about 15-20 men in my division, many of which I knew. There were all sorts of other divisions as well, including a triathlon for kids under 8. It was fun watching these tiny kids swim a lap, then zoom around on their little bmx bikes.

In the afternoon I went to Kamuzu Dam, which is about 30 minutes outside of town. I have been learning how to sail and a race was scheduled for 2:30. I figured that sailing a boat wouldn't require too much of my already spent strength. Boy was I wrong. The wind was very strong and I was having some great runs (can't remember the proper term) where I was completely hanging over the side of the dinghy. What I didn't realize was that my boat was taking on water, so when a wave came over the bow my boat plowed under it and capsized. We had practiced righting a capsized boat, but mine was full of water. Whenever I righted the boat (which requires a lot of energy), it either fell back over, or only the bow remained above water. As I continued to drift downwind from the sailing club someone saw me, went to get help, then promptly capsized his boat. Eventually an experienced sailor was dropped off and we decided to swim the boat to the shore, which included navigating a maze of sharp dead, sunken trees. On shore some Malawians helped us pull the boat on shore to drain it. We then tried to paddle out, only to be blown by the wind into the previously mentioned logs. The rescue motorboat arrived just as we slammed into a log and ripped part of our sail. I jumped into the motorboat and we eventually navigated out of the sunken forest, which was beginning to remind me of a setting from The Lord of the Rings. Then the motorboat ran out of fuel. So we had to row for about an hour into the wind while pulling the sailboat which was again taking on water. We eventually returned, but I was exhausted.

Sunday morning was church, but it was really hot and stuffy. We went home and collapsed outside in the shade for a couple of hours. At four, I played ultimate frisbee with about 15 others at Africa Bible College. I picked up a pizza on the way home and Claudia and I started the first episode of 24, season 4, which was loaned to us by some friends.

Have you ever seen Super Size Me? It is a hilarious and effective attempt to examine and change the eating habits of a nation. In Malawi, the government is not encouraging a switch from Big Macs to brussel sprouts (there is not a single McDonald's in Malawi - rejoice!), but nsima to rice and potatoes. Yesterday the Wall Street Journal ran an interesting article about how it is going:


In a recent episode of the radio soap opera "Zima Chitika," which translates as "So it Happens," a character asks his wife to cook dinner. Although their village home is stocked with sweet potatoes and vegetable gravy, she issues a testy rebuke. "We won't eat tonight. We have no nsima."

Then a wise village grandmother intercedes. "We can eat whatever is available, there is no need to have just maize!"

...

As part of this message, Malawi's democratic government is invoking a bit of food nationalism during its tours and on the radio. Specifically, it's reminding its citizenry about maize's alien -- that is, American -- roots. Originally a New World plant, maize was first introduced to Africa from the Americas by Portuguese colonizers in the 16th century as a reliable staple for slaving outposts. It took centuries for maize to penetrate the African heartland. The European explorer David Livingstone "discovered" Malawi only in the late 1850s. But having arrived, maize quickly displaced native crops.


Read the whole thing here.

A lot of interesting stuff is happening in Tunisia (which is a great place to visit BTW) during the World Summit on the Information Society there. I expect that a lot of interesting announcements will be made - I will share the best here on Hacktivate.

One thing that is supposed to be unveiled though, is the $100 Laptop. Here is the latest picture:



Worldchanging sums up the latest information about it here.

One of biggest selling points put forward by Negroponte is that it can cost effectively replace textbooks. I think this is a great idea. Even simple paperbacks cost $30 here in Malawi - so a $100 machine that can display thousands of different books will be a great leap forward.

I have been reading books on my old Palm for years. Project Gutenberg has most of the world's classics as text files which can easily be converted and loaded onto a Palm and read with the excellent Weasel Reader software. A Palm will run for hours and hours even with the backlight on - which makes it ideal for nighttime reading.

Viva la ebook revolucion!

After reading The Nation's article about how people are coping with the famine a friend of mine, Stacia replied with a letter to the editor. I thought her response was fascinating:


Thank you for your story in the 12 November 2005 edition of The Malawi Nation by George Ntonya "Hunger takes toll in Salima".

I empathize with these communities and hope that the government, non-government organizations, and local community groups can come to the aid of those affected by food shortages. I also hope that these organizations and communities continue to investigate all their local food resources such as the bamboo seeds, mangoes and termites which they are now diversifying into. When eaten in the right quantities, these 3 foods alone can provide many of the nutrients that we need to have a healthy life, and in fact, are more diverse in nutrients than ufa woyera (processed maize flour)!

* Bamboo (Nsungwi in Chichewa) seeds are an "important food source" according to Useful Plants of Malawi, 1955-75 editions, by Jesse Williamson. She describes them as similar to rice in flavour. Edible bamboo shoots are high in protein and vitamin C and are eaten worldwide.
* Mangoes are an important source of carbohydrate and vitamins A and C. Mango leaves are also edible and are full of vitamins and minerals, as well as medicinal properties.
* Termites are particularly nutrient dense food. High in protein, fat, B vitamins and minerals. A handful of Termites supplies an adult with almost all the iron they need in a day!

As a nutritionist, I always want people to have access to a wide variety of foods from all the 6 food groups every day. The current diet and food supply that we are seeing in Malawi does not meet the nutrient needs of the population, nor does it supply food every day of the year. The reason for this is that it is too focused on maize. According to the Malawi Food Guide, an average adult should have about 200 gm of cereal grain on average per day (this would include millets, sorghums, rice, wheat, oats, maize, etc.). Even if a person chose to eat all 200 gm from maize alone, this would mean a person should have no more than about 73 kg of maize per year!

The rest of the diet should be from the other food groups: Fruits (such as mangoes); Vegetables (such as mango leaves); Animal foods (such as termites); Legumes/Nuts (such as kabaifa, kamumpanda, or mbula nuts); Staples (such as tubers from water lilies or buye); and Fats/oils (such as avocadoes or coconuts).

We should be applauding these communities for diversifying their diets and for reviving traditional knowledge, using it and sharing it. We should encourage the use of these foods as part of a diverse diet and help communities to access the other food groups to complement their current diet. We should investigate and promote other local sources of foods that are being under-utilized and forgotten. We should reduce our dependency on maize.

Instead, the article treats these foods (bamboo seed, mangoes and termites) as inferior, stigmatized, and something to be ashamed of.

As an example, the article describes the 2-hour task of preparing Bamboo seed to eat, but this should be compared to the laborious, expensive task of raising maize and processing it. Just to focus on the processing part here, Malawians regularly spend 3-days processing maize into white flour which includes pounding, winnowing to remove bran and germ, soaking, rinsing, drying in the sun, cleaning to remove dirt and bran from drying, measuring it in a tin, taking it to the mill for grounding, drying in the sun, cleaning again to remove dirt, and finally cooking. The end product has all the protein, minerals, fats and vitamins removed, leaving only a white starch.

This is where we need to change our mindset about what is food and what we are doing in Malawi with the resources that we have.

I applaud Action Aid for submitting a sample of the bamboo seed to MBS for analysis, I hope that this action is used for Malawi's other under-utilized resources and that these important foods become a regular part of our diets. Many people may be surprised to know that there are over 500 foods that we could all be choosing to grow and eat rather than the one or two that have promoted this current crisis. This would be true diversification and go very far towards ending Malawi's chronic "hungry season".

If you have any questions or would like more information concerning the wide variety of food plants that Malawi is blessed with, please feel free to contact us or visit our demonstration plot in Chitiedze.

Sincerely,
Stacia Nordin, RD
Kristof Nordin, Permaculturalist

Hacktivate has been following the famine situation here in Malawi for months now. Check out my famine tag for a list of all of the stories. One of the things I have been trying to stress is that it is a very complicated situation. Well the next two posts aim to make things even more complicated. First off, consider the following article from the Malawi Nation from a few weeks ago (I am posting it in full, because they don't seem to have it on their website):

Recently Amazon launched a new service they call the Mechanical Turk. It is a very interesting scheme that allows humans to get paid for work that computers cannot do. When I tried it out yesterday, I was given the name of a business, its address and 5 different photographs that were taken near the business. It was up to me to select the photograph that best represented the business specified by the name and address. If I was successful I would get paid $.03. With my slow connection I only managed to try 4 different locations, and out of those 4, I was only able to be decisive about one. Sadly, by the time I made my decision someone else had already solved the puzzle. Yet it was a fascinating glimpse into the future, a future where human thinking and ingenuity become commoditized.

For Africa and the developing world the Automatic Turk is a good way to earn some cash. Assuming the work doesn't require local knowledge just 33 selections will earn a Malawian more money than they can make in a day. If each selection requires 2 minutes to complete, then an Amazon Turk worker could earn a dollar an hour - big money in Malawi and many parts of the world.

I was going to write more, but I discovered that Ethan Zuckerman said pretty much everything I was going to say. I recommend reading it.

Anyways, try it out and let me know what you think. Shall I open an Amazon Mechanical Turk factory in Malawi?

The Hippo Roller looks like a pretty simple idea that could have a great impact on Malawians:


The innovative design allows water to be placed inside the "wheel" rather than carried above the wheel. The 90kg (200 pound) weight of water is borne on the ground resulting in an effective weight of just 10kg (22 pounds) on level ground. Children and the elderly can easily manage a full roller over most types of terrain.

We spent a couple of hours driving with some of Claudia's Malawian colleagues this weekend. As we were driving, we passed three people dressed in grass skirts and wooden masks with machetes in their hands running towards a village. Wilson and Temwa (Temwa is a frequent contributor to the my blog's comments!) explained that these were Nyao, members of a secret society. They worship their ancestors, do a lot of graveyard rituals, and force people to give them money otherwise they will be beaten. This got us onto the topic of curses and the evil eye which exist in similar forms in most traditional cultures all over the world. They told us that many workplaces are full of fear of such things, particularly in government offices. They explained that most government positions and promotions are the result of either appointment or seniority and rarely the result of performance. Hence a common way to climb the career ladder is to try and get rid of the person above you. Some people visit traditional "doctors" and get curses placed on their superiors, while others bypass these old fashioned ways and simply murder them. They buy rat poison in the market and then bribe people to add it to the tea of their intended victim. I thought that these might just be stories, but both Temwa and Wilson knew people who had such things happen to them, or who had narrowly avoided a poisoning because the tea-maker's conscience got to them. Wilson and Temwa were proud to say that such things don't happen at OIBM. They said that people are too busy, and besides you get ahead at OIBM by working hard, not because your boss dies. At OIBM if you set your tea down on your desk and then leave the room you can drink it when you return. Not so at the electric company, ministry of agriculture, and even schools!

This weekend we were invited to a traditional Malawian wedding. The
wedding was for the nephew of the Chairman of OIBM, Francis Pelekamoyo
and it promised to be a unique and authentic experience as it was going
to take place in his village about 2.5 hours north of Lilongwe.

Francis is a very special Malawian. He was head of the central bank
under Hastings Banda and by all accounts did an impeccable job. He was
able to retire from his position with only praise and has since
continued to benefit Malawians with his expertise and integrity.
On the way to his village we drove through his farm and it was so
refreshing to see a small dam, pipes and pumps. He was irrigating! Sure
enough, we were later told that everyone who works on the Tithe
(Tee-Tay) farm was "prospering" even when their neighbors were facing
famine.

We arrived for the wedding reception and were instantly announced by
name to the entire throng of people. And I do mean throng. The reception
was in an open area on the farm and there were people everywhere. The
important guests (which somehow we were included in, despite never
having met the bride or groom) were seated under a thatched structure
for about a hundred people. There was a circular area about 30 meters in
diameter, which was roped off outside of which were a couple hundred
more people all jockeying for the best view of the event. There were
even people in the trees.

We were called out to do a dance offering for the bridge and groom.
While all of these people are watching Claudia, myself, Francis, and two
other OIBM employees danced out into the circle and we dramatically
(perhaps even rhythmically?) pulled money from our pockets and deposited
it into a bucket. Again and again and again. Claudia and I had prepared
perhaps 10 notes each, which was not even close to enough. Everybody
else had huge wads of notes that they just kept pulling out, raising
into the air and then letting it fly. It didn't matter that most notes
didn't make it into the bucket, as there was a crew of people dedicated
to tracking down notes. It would have been strange to do anywhere, but
being surrounded by local villagers who were obviously quite poor made
it feel absolutely bizarre. Yet after we returned to our seats the same
thing continued over and over again. Different people would be called
up, or there would be a dance to join in on, but every time there would
be the money bucket and people dancing their cash into it. We were told
that many people save up their money for a wedding so that they can be
seen flaunting it like this. There were other parts of the reception
that were pretty strange as well - in fact beside the clothing worn by
the bride and groom, little resembled anything from a western wedding.
At one point the bride brought out a plate of small pieces of wedding
cake and proceeded to get down on her knees, in the dirt, in her dress,
and offer pieces to the guests - myself included! No matter what the
bride and groom were doing they were constantly dancing a sort of
understated groovy sway to the music. They were probably just really
tired, but they never really smiled. Danced yes, smiled no. Here is a
picture of the bride and groom, dancing with the cake plate. Note the
people in the tree behind them!