Dear GAIA Supporter,

GAIA is strong and healthy, thanks to the unprecedented generosity of so many American friends, and we will be able to help many more African people in the years to come. But our October and November donations have dipped, commensurate with global market upheavals. The fall of world markets has affected many in the developed world, for sure, but in Africa the struggle for subsistence began long before that and continues seemingly endlessly. So I seek your help once more before year's end.

The predicament of African people is stark. An indicator of this is the $402,474.00 we have wired to Malawi for HIV and AIDS-related work since mid-September. These monies have paid for vital hospital equipment, which we have had to purchase despite economic pressures lest mothers and babies die during complicated labor and delivery. They provided high protein nutritional supplements to sustain sick and under-nourished people during a time without any resources. They enabled purchase and distribution of anti-malarial bed nets to homes with children under the age of 5 years, since malaria kills so many kids in this age range. They re-supplied nursing scholarships and school tuitions for orphans, instilling hope on the other side of a crisis that has gripped us all.

As always, we are scrupulously careful to convey your contributions to village front lines and through our Malawi staff to monitor how they are being spent.

The people of Malawi are worth fighting for. They have no room to cut back in light of economic downturns since they are already at the edge. We understand the uncertainties all are facing, but on behalf of the deserving families and those without families in Malawi we ask your help, in whatever way you can give it, one more time in 2008.

Many, many thanks.

The end of 2008 is a tricky time for non-profits in this unusual global economy. We do greatly know that. It is my duty and my privilege to add that for our friends in Africa it will be very difficult too.

You have been so great. We need your continued support, perhaps now more than ever - by check or credit card, on-line or via the post.

I have possessed the above photo for a few years. It always arrests me, because the boy watches me instead of the other way around. His gaze evokes questions from depths of personal insecurity -- questions like, what are we really doing in this village? Are our motives of the right kind? Are we appropriately respectful of others so different from us? And more.

Out of the hubbub of conflicting values and the chaos of competing claims upon us the social scientist Kenneth Clark insisted upon a single principle: The one thing necessary is simple human kindness.

A writer friend, Martin Cruz Smith, once asked the friendly question, why do you do this work? The answer was clumsy and brief: Because we can. Surely that is incomplete, but perhaps it is sufficient.

We can do this work because so many people believe in us and help us -- including financially. We can do it because a lot of people are committed to helping in some of the world's poorest villages. They see us as a partner through which they can concretize their own good will toward the most marginalized of all.

Many, many thanks.

The photo shows the oldest Presbyterian Church in Malawi. It was built not too long after 19th century Scottish missionaries followed Dr. David Livingstone to British Central Africa - subsequently called Nyasaland and then Malawi. Livingstone himself is still admired in these parts for first being shocked by the East African slave trade, and then for fiercely and persistently trying to stop it.

The Africans were and are greatly concerned with questions of how to understand the awesomeness of life - its wonder and its terror - and of who we are, how we got here, and how we ought to live together. As Rushdie said about human beings everywhere, "The soul needs all these explanations - not simply rational explanations, but explanations of the heart." And what they heard in places like the building you see seems to have been readily received, though in rural areas it did not totally displace traditional cultural outlooks.

The enormous appreciation we have for Malawi's people is due to the influence of the large questions in their lives, the "soul"- related stuff. Their living with these daily seems to account for why they are stunningly generous and caring toward others.

When mentioning such things I always feel obliged to say that GAIA is not a religious organization, though we sometimes work through religious groups to reach rural areas. These groups frequently provide crucial infrastructure through which to deliver health services. And we train religious leaders to play important roles in disease prevention and health care. With the greatest respect for what the Malawi people already do, we take satisfaction in being their partners to deploy mobile clinics, pay school tuitions for orphans, support rural hospitals and clinics, send young African women through nursing school, help village women help the people, and the like.

For me personally, however, the most powerful moments are when I see a Christian woman (of whatever denomination) or a Muslim man (of whatever emphasis) visiting someone who is very ill, doing whatever she or he can to help, and before leaving responding to the deepest longings of the human heart: "Let us pray together for healing, for strength, for an end to pain and suffering, for love to embrace you, for goodness in your life."

These women and men, living so bravely and generously on the edge of the abyss, are hugely worth fighting for, and we are all so grateful for your help.

We are very grateful for your help.

"Sally (my wife) asked a wonderful artist in Santa Fe, N.M., to convert some photos of Malawi people into paintings for our home. Nancy Poes accommodated us and then presented GAIA with the painting you see above.

Nancy named it "Woven World," which sums up everything we believe: That in the tiniest child is signified a benevolent future for our species, that no matter who or where we are each can assume a protective role, that the only real security is the human family uniting for the vulnerable, and that together we can create a dawn of warmth, health, and strength for the least little one and thus for all. And possibly in the woven fabric, deep down, is a power for healing, strength, and goodness that cannot be taken away.

The children of Africa need us, and their parents or guardians depend upon our kindness.

We are very grateful for your help.

“When you look back on a lifetime and think of what has been given to the world by your presence, your fugitive presence, inevitably you have to think of your art, whatever it may be, as the gift you have made to the world in acknowledgement of the gift you have been given, which is life itself. And I think the world tends to forget that this is the ultimate significance of the body of work each artist produces. It is not an expression of the desire for praise or recognition or prizes, but the deepest manifestation of your gratitude for the gift of life.” (Stanley Kunitz, former U.S. Poet Laureate, quoted in the July/August 2006 American Poetry Review.)

What Kunitz says about the artists could be said of each of us, and I thought about one young woman in particular when Ellen Schell sent a message from Malawi about a nurse we hired in 2003 when she was only 19. She has given so much. This is what Ellen said:

“In the evening we took Precious to dinner. Two years ago she decided to upgrade her technical nurse license to a diploma. She is doing extremely well and received a prize for being the best medical-surgical student. She has delivered several babies and some of these are named after her. She wants to work for GAIA again after completing her studies. She is a double orphan and has provided for her two younger brothers. One dropped out of secondary school, but the other finished and is at the Malawi College of Accountancy and doing well. She is a wonderfully gifted and committed person.”

The young nurses go through their daily rounds perhaps not thinking of themselves as artists, but they sculpt their lives by the decisions they make, creatively caring, sometimes having nothing to give but still giving, making things a little better for others. They continuously construct the generous selves they come to be.

We do shape our lives by what we do in the time that is given us, in our individual ways giving something back to life. And looking back on a lifetime of no matter what duration, maybe we can glimpse a self we really like because we have made ourselves into people of generosity, caring about others.

For your help with this we are all very grateful.

In ancient Rome abandoned children lucky enough to be rescued by adults were known as “alumni.”  The term referred to their dual status as foster children and pupil-servants.  Yale historian John Boswell mentions early Roman Christians calling themselves alumni of God.  Altogether the word stated the prospect of a loving and happier condition in a new kinship pattern with protecting others. 

In most Malawi villages where we work, about half the population is under age 15.  Country-wide there are between 500,000 and 1,000,000 orphaned children out of 13 million people.  The large numbers make infeasible the operation of western-type orphanages, though there are a few such in Malawi and they do good work.  Our emphasis is to assist orphans through community-based organizations and in villages, where they are cared for by those who know them best.  We supply food, school fees, books, and the mandatory school uniforms.

Several years ago Eileen Simpson wrote Orphans. Her subjects were not in Africa but I think they could have been.  She said they “don’t cry, scream, shout, or behave bizarrely.  Instead they observe visitors in searching silence….For me, the children’s eyes would have unspoken messages: You were more fortunate than we are, they would say.  Or, more distressingly: "Take us with you.”

Though extreme poverty and so many little ones limit what can be done, we feel honored to give a token of love and security to the children — or as we believe, to the alumni. 

We are very grateful for your help.

Rural health centers are the front line of Malawi’s health system, and I thought you might be interested in what a representative sample of these is like.  (The photo is not of the center described below.)

Our Malawi staff provide directions to the facility:  Drive out the X Road toward Y Town and just before the river turn left for 6 km on a dirt road until the first trading center.  There you will see the health facility.

It is one building with one room for out-patient care and another for consultation.  There is no laboratory or land line for telephone service.  One staffer has a cell phone and sends text messages to a larger hospital requesting advice or an ambulance, when needed.  A separate building is being constructed to counsel and HIV test villagers by rapid test kits.

The services here include vaccinations, nutrition education, and under-5 check ups.  Ante-natal care is provided, with education on the prevention of mother-to-infant transmission of HIV. Male condoms and depo provera tablets are available for family planning.

The center treats schistosomiasis, caused by a nasty parasite in the nearby lake, and eye, ear, and skin problems, and they have de-worming medicines for the children.  Home- based care is extended to the dangerously ill.  Malaria is a big problem, due to mosquitoes from the nearby marshes, but anti-malarial bed-nets are scarce and can be given only to pregnant women.

The center’s service area contains 22,570 people.  Of this number 10,884 are children under the age of 15.  There are 5,191 women of child-bearing age.

In one month 897 out-patients visit this tiny facility.  Complicated cases might be transferred to distant hospitals if there is room in them and if transportation is available.  So many hospital beds are already taken by HIV patients, and in the rainy season by malaria and cholera patients as well.  If a bed is indeed available, patients usually reach the hospital by ox cart.

A medication census shows there are no medications to treat asthma, hypertension, sexually transmitted infections, or malaria.  Even basic pain killers are in short supply. 

In charge of the facility is a Medical Assistant (MA).  MAs have just two years of training but must carry a heavy load.  He is thoughtful and dedicated.  He says, “As you can see this is a small clinic and I am the only trained person apart from the Health Surveillance Assistants [they receive 10 weeks of training] but the problems that people bring here are enormous.  If we had better facilities we could help them much more.  If I leave the clinic for something else then the clinic has to be closed, so we would like to have another qualified person here.”

At GAIA we are taking a hard look at basic health services, since HIV is so greatly intertwined with other infectious diseases, with maternal and child health, and as usual with the myriad problems of poverty.  We are so deeply grateful for your help.

This photo was taken during a visit to a Malawi village that we assist with orphan care.  You can tell by the clothes people wear that our visit was an important event.  The child in the wheelchair symbolizes some of the health needs found in rural areas, far from major health facilities.

Eighty-six percent of Malawi’s people live in rural villages, and we have yet to find a village with electrical power.  Fewer than half of rural people have safe water, and HIV is widespread, limiting the body’s ability to fight off otherwise non-threatening infections.  Villagers walk long distances to reach services elsewhere, with the sick being conveyed to treatment centers on bicycles or bicycle ambulances, though this is difficult during the November through April rainy season when dirt roads turn to mud. 

We have long hoped to obtain four-wheel drive mobile clinics enabling the delivery of health services to remote areas.  Our hopes were realized when The Elizabeth Taylor HIV/AIDS Foundation recently enabled the purchase, staffing, and equipping of two such clinics for deployment in southern Malawi, the region hit hardest by HIV and famine.

Since very early in the epidemic, Dame Elizabeth Taylor has been a stalwart advocate for people infected or affected by HIV, and we are tremendously grateful for her wonderful generosity.  Her kindness will enable rural people to receive HIV prevention, testing, and disease management strategies, the prevention of mother to infant HIV transmission, treatment of opportunistic infections, and detection and treatment of TB, a “marker” for HIV infections in this part of Africa.

Each vehicle will convey a clinical officer, nurse, nurse’s aid, and driver to selected villages.  The deployment of the vehicles and coordination with back-up laboratory and clinical services will carefully be worked out with government health officers.

This is a major addition to our on-the-ground services in support of the people of rural Malawi, and I hope all of you will feel the gratitude that we do to The Elizabeth Taylor HIV/AIDS Foundation and to Dame Elizabeth Taylor personally for her humane and humanitarian commitments.

After I mentioned that something had boggled my mind a friend asked what was happening inside my head during the “boggling.”  Her challenge drove me to a dictionary, which offered the definition, “to be overwhelmed, set reeling.”

We all may know that experience.  Students are sometimes taught in ethics classes that when the complexity of what you confront stops you cold, follow Aristotle’s advice: Do what a good person would do.

We see this enacted in Malawi.  In the country’s largest city, for instance, is a neighborhood greatly overcome by poverty and HIV.  Here lives a priest approximately 40 years old.  He was haunted by the plight of 3000 orphans and resolved to gain the trust and then the response of Catholic, Anglican, and Presbyterian Churches, and the Muslim community as well.  A strong interfaith organization emerged to help the children.      

In his own parish the priest organized an AIDS council to represent the Anglicans at the interfaith body.  He started a school that has now prepared 8 students (3 of them girls) to take the exam qualifying them to be auto mechanics.  Adult literacy is another problem in this neighborhood, so the priest has begun a class to teach people to read.  Thirty women eagerly attend.  The men, however, have difficulty admitting illiteracy.  He thinks that little by little the men will come along. 

A number of Malawi people seem not to be stopped — “boggled” — by the facts.  They just do what a good person would do.  It isn’t easy, nor do they appear self-righteous in their actions, or self-important.  Certainly there is no glamour.  In fact the work is hard and frequently disappointing.  They do what they do, I’m pretty sure, because deep inside is a feeling that they must, and all the words in the world wouldn&rsqo;t begin to account for it. 

One day I asked another rural pastor why he worked so hard for others.  The question seemed strange to him, but politely he came up with something.  In his second language what he said was, “Many people lose their dear life.”

Thank you so much for helping us to help people like this.

Rob McNamara and Jim Weiss are members of a wonderful church in the Philadelphia area that supports our work.  They traveled to Malawi and later reported to the congregation on their experiences.  I was present.  The reference to Gertrude is to one of our staffers.  I print a portion of Rob’s account, below. 

Rev. Dr. William Rankin
President & Co-Founder of GAIA

This was the day Jim and I went with Sister Gertrude Chipungu for the first time to visit Mtengowanthenga, where GAIA is working.

The minute we stepped out of the car onto the dusty ground, I saw a little girl swinging a pick in the field.  I headed toward her with my camera.  Francis, our Translator, came with me.  I wanted to find out if the girl was working or playing, but we couldn't get a straight answer because the kids became giddy when they saw the camera. Their clothes were filthy and full of holes.

About 10 meters to my left, Jim was involved in more serious business.  He was meeting with Sister Gertrude, the village priest, and a very, very sick woman, and the woman's care giver.  The woman and the care giver were sitting on a straw mat.  At some point Jim asked, Why is this woman not in a hospital?  The answer was that they did not have enough money.  Jim asked how much it would cost and they said 985 Kwachas.  Jim did the quick math and said that's seven dollars.  Jim said, I would like to give you this money so you can take her to the hospital.

Now here I am today, standing in the Parish House of St Thomas Church, Whitemarsh, Pennsylvania and God forbid that you or your sister or your mother or your daughter were ever this sick and had to be taken to the hospital in the back of a pick up truck. But this is Africa, this is Malawi and that's how it's done.

As the women were loading the sick woman into the back of Sister Gertrude's truck, Jim was not filming and I lowered my camera.  We were thinking of the woman's dignity.  Gertrude turned right to me and said, Please take pictures.  I felt very uncomfortable about it, but I took a couple quick shots.  Now that I have had time to think about it, I believe she was right.  I was sent by St Thomas Church to witness and report back to you what is happening in Malawi, Africa.  I believe what Gertrude was saying to us was, Look at this, look at this sick woman.  This is an ugly scene, but it is real.  This is AIDS, this is what it looks like, right here in the back of this pick up truck and it is happening every day in villages like Mtengowanthenga.

Gertrude, the care giver, and a few women from the village drove off to the hospital. I dropped my head and walked a few meters down the road to my left. There was a very shy young girl standing in a door way.  I asked her, Can I take your picture?  But she just looked down at her feet.  I motioned with the camera, can I take your picture, but again she did not respond.  I felt someone walk up to my right.  It was the priest.  I asked him to ask the girl if I could take her picture. He said in that very quiet African way, You can take her pickcha.  So I lifted my camera and took the shot.  I asked the priest to ask the girl what her name was, but he didn't have to, he knew the girl. He said, Her name is Mary, she is in the third grade.  That was her mother you just sent to the hospital.

On Sunday night, our last night in Malawi, we had dinner at Sister Gertrude's humble little house.  She told Jim and me that indeed the woman did get into the hospital, but she died 2 days later.  That made Mary the newest orphan in Mtengowanthenga.

Why am I telling you this story?  Because this happens far too often in Africa, it happens far too often in Malawi and it happens far too often in Mtengowanthenga.  We picked the right cause, we certainly picked the right partners [I pointed to Bill Rankin] and we picked the right village, and they desperately, desperately need our help.

Rob McNamara
St Thomas Church
Whitemarsh, Pennsylvania

During a handful of days at the turn of the year we wired nearly a half million dollars to Africa. This ensures that our infrastructure is strong entering the new year, that the women caregivers in rural villages are supported for the next six months, that the HIV prevention and care strategies of the women's micro-loan project are in place, that orphans are cared for, that the 80 young women on nursing scholarships are progressing, and altogether that we will add to the 15,000 lives saved so far in Malawi.

I thought you might be interested to know what our organization is like "on the ground" in Africa.

Our Country Director is a social worker with many years experience in program design for relief and development work. He is our key person in Malawi.

Our Central Region Programs Administrator, pictured above, is a nurse midwife with particular expertise in gender and development. She is also a Medical Mission Sister. She manages our growing nursing scholarship program and provides technical assistance and monitoring to many community-based organizations and rural hospitals that we fund to provide HIV-related services.

Our Projects Officer in the Southern Region is also a nurse midwife, with particular competence in rural health care. She supervises the soon-to-be ten nurses and health educators coordinating the training and work of approximately 200 women caregivers in 50 villages in the Blantyre, Zomba, Mulanje, and Thyolo Districts. She also monitors community-based organizations and rural hospitals that we support in this region.

The three senior staffers constitute our Malawi Technical Committee, which carefully reviews all requests for funding. What they recommend is carefully reviewed by the Grants and Program Review Committee of the U.S. trustees. This committee's recommendations eventually go to the entire board of U.S. trustees for final decision.

We have an African trust with its own Malawi trustees. These include our Country Director, a Malawi Anglican priest, a Malawi nursing school professor, and a Malawi woman who heads a robust community organization. The trust is authorized to own property in the country and advises our Malawi staff as well as the U.S. staff and trustees.

This "grass roots" leadership structure is well-trained, well-managed, and ensures that the destination of donor dollars is the intended one and that lives are protected to the maximum extent possible. We are proud of them, and hope you are too.