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In part 2 of this interview, Patience Mkandawiretalks with Thomas Hatch about Fount for Nations recent evolution, work during the COVID school closures, and next steps. Part 1 of the interview focused on the origins and initial challenges in developing an organization that has developed school, hospital, and community programs to support the education and development of differently-abled children in Malawi. In addition to being one of the founders of Fount for Nations, Mkandawire was selected as an Obama Scholar at Columbia University during the 2021-22 year.
Gaining control of the program and focusing on schools Thomas Hatch: You’ve told us about the origins of Fount of Nations in the activity center you established at a hospital; about the first two years after you established Fount of Nations with work in activity centers in several hospitals and in resource centers in schools. What was the next step? What was the next big transition point?
Patience Mkandawire: At that point, we expanded to include more attention to community engagement, which also has its own set of challenges, but we also closed the hospital program. We narrowed our focus to working with schools and community engagement. At the same time, we realized that because we didn’t have our own space we operated basically on the whim of the schools and the teachers; we had no control over our programming. We started thinking that to really control our own program and maintain fidelity of our programs, we needed our own center, like our model school. We started planning for that and that opened in 2020, which was bad timing, of course, because that’s when the pandemic hit.
But when we started doing more work in the community, we realized the economic barriers that many of our parents faced, which was not something we had focused on. We started doing home visits and found that a lot of our parents had come from a village, left their land, and come into the city and were living in areas with very poor economic conditions. That started us thinking that we should develop an economic empowerment program. Initially, I was not too keen on this, but my field team insisted that we really had to do it because the parents weren’t listening to us. There was a time that one of the counselors went out for a group counseling session and when she came back her face was gloomy. “What happened?” I asked her, “Was the turnout not good?” And she said “This is by far the best turnout. I had close to 40 parents come to the session, but all of them are on my neck saying things like ‘words can’t help us because all you do is talk to us. We want money, we want a livelihood.’”
“This is by far the best turnout. I had close to 40 parents come to the session, but all of them are on my neck saying things like ‘words can’t help us because all you do is talk to us. We want money, we want a livelihood.’”
I was opposed to that because it’s not an area we knew anything about. Nobody on our team was an expert on it. But we began to do some research on micro-finance, and we tried a partnership with another organization that was already doing business and economic empowerment for mothers.That partnership however didn’t last long enough to yield results. We were stuck on logistics of how to train parents that often had to take care of their kids full-time. I am not sure what it really was but most organizations we tried to work with weren’t really willing to make adjustments to take into account the unique needs of children with disabilities or their families. But we soon learned about Opportunity International. They had been training farmers and other populations in financial literacy, and we were able to get them to do financial literacy training for us. Then, once the parents were trained, we realized we needed to give them access to money…so we reached out to some of our funder friends, the Segal Family Foundation who connected us with a funder that was willing to give direct social cash transfers to some of our parents. We linked the cash transfers to the child’s education. In that way, we created incentives for increasing children’s attendance at school, and it turned out great.
TH: You said the economic impact program was successful, but what was your measurement of success?
PM: We measured academic indicators such as attendance, progression and parent involvement in learning. We also measured social indicators like how many meals do the children eat a day. For example, before the program (and during the pandemic), 76% of the parents said their child ate once or twice a day because they just didn’t have any money. After the financial literacy training, the numbers flipped. Over 80% were able to eat three times a day. In addition, close to 70% of the businesses they started with the initial social cash transfers are still running.
The Pandemic & Beyond
TH: Can you talk a little bit about how the pandemic affected the development of your program. What did you learn and how has that influenced how you think about developing and sustaining the program in the future?
PM: The pandemic is why I am here in the US, as part of the Obama Scholars program. When the pandemic hit, schools closed. And that was the first time we had ever imagined that anything would happen to our schools, I just can’t describe the feeling… All our programming happened in schools; our teacher training happened in schools; our parent convening happened in schools; many of our community convenings happened in schools. Schools are central in almost every village so they were very easy access points for us to meet people and to convene people, and suddenly, schools were all closed. And our teaching was all paper and pen. We had started doing some digital data collection, but our teachers across the country still taught on the blackboard
I remember one of the first things I did was give a break to the entire team. We just decided “Okay we’re all going to go home, and we’re going to take a two week break to think about what we’re going to do. Can we survive without schools? Like what sort of work can we do? How can we support our participants? Our community members? Our champions? Our advocates?”
“Can we survive without schools? Like what sort of work can we do? How can we support our participants? Our community members? Our champions? Our advocates?”
Over that break, the Government started to respond. They said “We’re going to have remote learning programs and we’re going to have TV and radio programs.” But I was thinking, “How is this going to reach a child who learns differently? Who cannot process? Who cannot hear?” Fount for Nations needed to respond too, but at that point, our team was also at risk and there was a lot of fear that we might die. But the team realized “if we are this scared, imagine what our parents are going through?”
It was really a team effort, and my husband and I would check in with individual team members and ask, “How are you doing? What are you going through?” But one by one, they said things like “We need to come back to work.” First, we said “We’re going to support the government in doing remote learning, and our parents are going to be teachers.” That was a gamble, but we brought back our volunteers and decided they would provide the support because teachers could not go in the homes. We had the volunteers meet with the teachers and learn about the typical lesson plans for the week and then the volunteers would call the parents, and the parents taught the children. Fount for Nations led a coalition of 4 education partners of the Segal Family Foundation to deliver remote learning to 3000 primary school learners across the country. One of our other long-time-partners, Rays of Hope ministries, released a handbook for teachers to support the school radio programs, and we used that to train our volunteers. Then we just started deploying SMS texts and phone calls, and that’s how the kids learned during that period. All this is happening on the phone. It was a surprise in some ways how well parents responded. Our volunteers would set appointments with the parents, and if our volunteers were late, we’d receive a phone call, “I just wanted to check with you because I’m looking at the time, and she hasn’t called yet. Is everything okay?”
The second thing was the counseling sessions. We also did that on the phone. Our counselors set up a protocol for mental health screening, and we started calling all our parents. They’d get a call – “How are you doing?” – to check in. If the parents’ needed extra support, the counselors would refer them or consult with them. We were also taking a gamble because this was the first time we’d ever called the parents for counseling sessions. Our counseling sessions had been in person. If the parents needed to cry, the counselor was there to just feel that with them. Now the sessions were not only over the phone, some of them were with a person the parents had never met because we had to increase the number of volunteers to make all the calls. It was a much higher volume.
It was crazy, and I was just upset at how in 2020, we still didn’t have any digital options for kids with special needs to learn in Malawi. In 2020, we didn’t have any psycho-social or mental health support for parents. In 2020, we didn’t have any therapists that could offer mobile services or online services. In 2020, Fount for Nations was one of three, maybe four organizations in the country that focused on education for kids with special needs. I just felt “I can’t do this,” because clearly people were not convinced that our work was as important as we think it is. That’s when the opportunity to come to Columbia came up. Joseph, my husband, said “Go. You need inspiration. You’re stuck. I think you need to go and meet awesome people. Meet experts. Get inspired. Come with ideas and then we’ll continue.” So I did, and I’ve been studying things like comparative policy studies at Teachers College, non-profit policy and advocacy, learning how international education policy is formulated. So now I’m thinking Fount for Nations is much more than a direct service provider. I’m thinking of Fount for Nations as a critical player in the ecosystem for inclusive education: as bringing all these stakeholders together to define and sustain the ecosystem and to inspire more actors to care about this issue.
in 2020, we still didn’t have any digital options for kids with special needs to learn in Malawi. In 2020, we didn’t have any psycho-social or mental health support for parents. In 2020, we didn’t have any therapists that could offer mobile services or online services
That’s been a big shift in terms of our plans and in our overall strategy. For example, in our training, we’re thinking of using a “train the trainer” model and focusing on being really, really good at that. We could offer that training to a wider range of organizations that can support learning and development for teachers and for children, particularly those who have learning difficulties. I’m also thinking about how to get back to the health care system because there’s still a role that they play, especially in assessment and diagnosis. I’m also thinking more about research now. How do we collect action-oriented data? How do we apply evidence-based research and implementation? Now merging those three things – advocacy, training and research – is becoming the core of our future plans. We are now working towards Fount for Nations becoming the Center of Excellence for Inclusive Education in the country and bringing together all these elements to really reduce the inequalities that exist in access to quality education for these children. I want to acknowledge that from our journey we’ve learned that the child’s education has not really been what the child is taught, but who else is around them that supports their learning. If the teachers’ perceptions are wrong; if parents’ perceptions are wrong; if community perceptions are wrong; if healthcare is not supported; if research is not adequate; if the government does not fund social services, then, no matter how creative our approach is – which was our initial idea – kids still won’t be learning. They still won’t be succeeding.
“We’ve learned that the child’s education has not really been what the child is taught, but who else is around them that supports their learning.“
TH: You really tied up that story beautifully and transitioned into where you’re heading. One thing you didn’t mention, though, that kind of brings you back to your initial experience with your brother, is your interest in growth monitoring because you’ve identified early screening and assessment as critical factors moving forward. Can you just say a word about your strategy with that?
PM: Yes, it was like a light bulb moment when I realized we could build on that. Like I said before, children in Malawi go to see a community health care worker for the first five years of their lives. From birth up to five, every single month, they have to go for growth monitoring. They are just going to get their weight checked; they’re going to get their height checked. And it’s mostly for nutrition screening, deworming, vaccinations, but they never get screened for developmental delays or learning difficulties. But I realized it’s a great opportunity because we could intervene early. The project I’m working on right now is, first of all, to adapt the assessment tools that are recommended so they are simple to screen for developmental delays and learning difficulties. And then we’ll train the healthcare workers to administer those assessments at the regular checkups that the kids come to anyway. That way we’ll get to see how many kids are at risk of developmental delays or at risk of learning difficulties. Then we can design workshops for the parents, because, with the pandemic, we’ve found that they can teach and help support their kids. For example, now that we know a child is struggling to sit up, how can we support the kid early on? And how can we intervene early? For most of these issues, parents would not know or understand that their child has something like epilepsy or even cerebral palsy until they were in primary school or even later. For example, I remember Elisa, whom I met when she was 17, and she had to drop out because she was just too big to be in primary school, and no one knew she had epilepsy until she repeated the same class 4-5 times! I wonder if we had met Elisa when she was six months or a year old? What difference might that have made? Could she have coped with her condition and been more successful? We want to make sure that these kids have a strong start by giving parents the information about what conditions their children have and the information that they need to help cope. Hopefully this generation of children will have a much better start.
In part 1 of this interview, Patience Mkandawiretalks with Thomas Hatch about the origins and initial challenges in developing Fount for Nations, an organization that has developed school, hospital, and community programs to support the education and development of differently-abled children in Malawi. Next week, part 2 of the interview will focus on Fount for Nations more recent evolution, work during the COVID school closures, and next steps. In addition to being one of the founders of Fount for Nations, Mkandawire was selected as an Obama Scholar at Columbia University during the 2021-22 year.
The Origins of Fount for Nations Thomas Hatch: Could you start by telling us a little bit about how Fount for Nations got started. What got you interested in these issues?
Patience Mkandawire: It was basically my mom who pushed me. She loved helping people and there was a time I was taking my baby brother for growth monitoring — in Malawi, growth monitoring happens every single month for children from birth to five years. When I was 14 or 15, being the eldest, I took my brother into the clinic and we were stuck in a line from 7 am to 3 pm and all he needed to do was get his weight checked! I went back home, and I said, “Mom, that was such a waste of my time.” She just told me, “You’re not the only one who wasted your time, so maybe you should go and help out.” And so I did. I went back to the clinic, and I asked a Dr. “Why do we have such long lines? How can I help?” “We don’t have a lot of people who do triage,” the Dr. told me. “If you wouldn’t mind just weighing babies that will drive the traffic a lot faster.” That’s how I started.
I said, “Mom, that was such a waste of my time.” She just told me, “You’re not the only one who wasted your time, so maybe you should go and help out.”
After that, I started volunteering at a local hospital [one of only two hospitals in the country that offered chemotherapy] and I had a lot of time to understand why the kids were in the hospital, and I was very curious about their learning. At one point, I met a boy who had lymphoma and he told me that he was in grade four, but I found out he could not write his name — he wrote his name backwards and confused the B’s and the D’s. For me, that was so fascinating because I never really struggled in school, and here was this boy who was supposed to be moving into upper primary school, how could he not know how to spell his name? I talked to an American pediatrician there who sort of took me under her wing. She showed me things around the children’s ward. She introduced me to special needs, and she told me he might have what we call dyslexia. At that point I set up an activity center for children at the hospital. I worked with a team of UN volunteers, and we did a little bit of fundraising for it. We did a toy drive and then a book drive, and I spent a lot of time with the kids, tutoring them and giving them opportunities for play and coloring and drawing and things like that.
That was really the first step. Then I went to college and studied nutrition and food science. The hospital was in the same city where I studied, so it was easy for me to just go there to check on things because I was not doing this alone, I was doing this with the team of professionals. After college, I didn’t have a job right away, and I volunteered at my mom’s school because my mom was a teacher at a private school. There I met another boy. This time it was looking like he had autism and his teachers were automatically failing him. But I got to spend time with him, and I discovered how he learned and found he loved storytelling and drawing. I experimented by telling him stories for whatever lesson he was supposed to be learning and asked him to draw. For example for his history class or his geography class, I’d tell stories about the Amazon and the insects there and the other species, and then he would draw. He did so well, and l thought “What an interesting way to learn.” But then I thought, “If this is what it looks like in a private school, I wonder what it would be like in a public school?” I visited a public school, and I found a lot of the same drama and problems there and that really started everything. It was a combination of experiences. I volunteered in different spaces then finally, I was like, no, something needs to be done and that’s when I set up Fount for Nations, with the support of my mom and my, then, very close friend who’s now my husband. We registered the organization and wanted to focus on children’s learning and children learning differently and to use creative arts as a way to teach literacy and numeracy. After I registered the organization, I went back to the activity center at the hospital, and it became one of the places that we worked. We re-opened the center with trained volunteers and trained healthcare workers. We professionalized it because I was now more aware and more organized.
TH: After establishing Fount for Nations you worked in healthcare settings and in schools, but did you have a focus at that time on working with children with developmental or learning differences?
PM: That hasn’t really changed. I wanted to see that children who learn differently or are differently-abled can progress in school, but our scope was larger. We did programming in hospitals and programming in schools and programming in communities. And our goal was wherever a child is, they should be able to continue learning and succeed in their learning. So that was basically it…we wanted to see these kids do better in school and progress through school. We’ve been trying to achieve that ever since.
“that was basically it…we wanted to see these kids do better in school and progress through school. We’ve been trying to achieve that ever since.”
But the hospital programs, initially, were a little bit different. Even though it all started with a child who had cancer and a learning difficulty, not all of the children in the hospital were like that. For the hospital program we had to open it up. Our criteria were that the children had to be in primary school, six years to twelve years old, and the other criteria was they had to be in the hospital receiving treatment that would keep them out of school for a period of three months or more. According to the school schedule, if a child misses three months or more then they repeat the whole year, and we wanted to avoid the repetition. If they were going to be in a hospital for more than three months receiving treatment, then they qualified for our program. Kids with malaria, for example, did not qualify, because those are short treatments, but if they had tuberculosis, if they had cancer, or if they had HIV – that was also a very big deal at that time – then they could be enrolled in our program because they would be absent from so many classes. We later reduced this requirement to a month or more of hospitalization or if they were on treatments that required multiple hospitalizations.
The school program, on the other hand, has always been 100% children with learning differences because we work in school resource centers. These are special centers within the school where all the kids with different conditions come in and that’s where they get their support. In the resource centers, it doesn’t matter the child’s age or their ability, they are all put in one room with one teacher. That’s why it was such a challenge because even two kids with autism or two with cerebral palsy had very different needs. Children with cerebral palsy may have some mobility or no mobility. Some kids with autism were highly functional, but others weren’t. As a consequence, with the resource centers at the time, some of it was just the amount of work that the teachers had to put in to offer individualized learning. That’s where we came in: to provide the volunteers to reduce the student-teacher ratio. When we started, that ratio was around 45 or 50 to one teacher. We placed up to three volunteers per school reducing it to about 5 to 10 kids per teacher or teaching assistant. That’s how it was structured in the beginning, for the first two to three years of our work, focusing on strengthening the health care system and strengthening the school system to be able to support the children.
TH: What are some of the first challenges you faced as you tried to work in these different areas? PM: The first challenge was at the hospital where I started the first activity center and in understanding the place of education in health care. There was a new leader at the hospital. He was not a pediatrician. He did not think that there was value in addressing the social-emotional aspects of patient care. He felt that we just needed to focus on physiology so we were in conflict. As one of only two hospitals in the country that offered chemotherapy, kids and their families often had to travel 400 kilometers from their homes to receive treatment. This was not easy on the families, so the hospital would admit the children for the duration of their treatment. That meant six months in the hospital, nine months in a hospital, a year in the hospital. And this is time away from school, away from socialization, away from friends, away from play, away from everything that is familiar to a child. My argument was that this affects their recovery; it affects how they respond to the medication; and, of course, it affects their parents, many of whom don’t believe their kids can get better. So, we offered emotional health care for the parents and also for the child focused on play. And we used play to explain the different conditions and to explain the process of chemo to them. We used to play to help them just unwind and not be afraid of all the needles and being in the hospital. Also, we used play for learning and for providing continuity so that when they went back into school they are not lost and they have not regressed.
Everything came to an end when we were planning a fundraising event to renovate an old building into a new activity center for the hospital because we were starting to run out of space. There was a building that they used as a construction warehouse that was empty, and we wanted to renovate it. Everything was all set, but the day before the event, there was a misunderstanding with the hospital director and he literally kicked us out of the hospital. Just like that the program ended, and Fount for Nations left the hospital. I was so disappointed, but the beautiful thing about it is we had trained volunteers and healthcare practitioners, nurses and community health workers to provide play therapy and support the children socio-emotionally. I think the program stopped for about six months, but then it picked up again and now it’s being run independently.
The other challenge we had was with schools. We worked in resource centers for children with learning differences in government primary schools and those schools had their own unique challenges like low teacher salaries, lack of training for teachers, and teachers being overburdened. Initially, we sat down with the teachers and we said, “What do you need to help you succeed? To help these kids succeed?” And they said “we need extra help; we need teaching assistants, we need materials, we need help with parents.” So, we focused on all those things.
We also asked the parents, “Is this helping?” And what the parents said was, “This is great, but there is a lot of stigma and discrimination in the communities, and we get really discouraged and really disheartened.” We had been doing a lot of information sessions with parents to help them understand the different conditions that the children had, and we wanted to help them with coping strategies. But they told us, “The problem is bigger than us.” Building on that, I wanted to help combat myths like these kids are bewitched and should be locked away which comes from the community, so we started doing a lot more community engagement and started working with chiefs and local leaders to start raising awareness around the abilities of children with developmental and learning differences.
We had an advantage for this work because in schools we started what we called “showcases.” At these showcases, kids from the resource centers would demonstrate what they had been learning. Because we used creative arts, it was very tangible, with displays of bangles, mats and color paintings among other creative projects. People were super excited. They’re like “oh these kids can actually do things!” Around the third year, we started an annual auction. We took what the kids produced at the hospital and the schools and worked with an artist to frame them, and then we auctioned them off. Part of it was fundraising but the most important part was raising awareness about what these kids can do about what they are learning. It was an educational family fun day as well as a fundraiser.
But after a year of doing everything that the teachers and the parents wanted, we realized we couldn’t financially sustain it, so we sat with the teachers again and asked them, “What works? What doesn’t work? What has worked for you, this year, and what hasn’t worked? And what are your priorities?” They told us, “We would like you to focus on teacher training and parent support.” So, we dropped the material support. We dropped the volunteer program. We dropped the showcases. Instead, in addition to providing trainings for teachers, we started advocating in communities directly as opposed to having the school as our base. That later on served us in the pandemic because we had other avenues to deliver our programming, as opposed to just being stuck in a school.
“…We started advocating in communities directly as opposed to having the school as our base. That later on served us in the pandemic because we had other avenues to deliver our programming, as opposed to just being stuck in a school.“