Slovak development worker Michal Miadok is currently on his fourth mission on the coast of Kenya — as coordinator of the socio-health programme of Trnava University in the Kwale region. Before that, through St. Elizabeth's University, he completed several long-term stays in countries that one would not typically choose as a holiday destination. What was atypical and valuable about his work, and how does he look back on his previous stays with the passage of time?

During and after the rainy season, not only people in South Sudan and Kenya are plagued by malaria. Where did you first encounter this disease? Already during my volunteer stay in India (project Mission India). However, my first real encounter with this disease was in Burundi, where I worked as a logistics coordinator for St. Elizabeth's University in a hospital in the village of Rutovu. In this area, malaria occurs in one of its worst forms (plasmodium falciparum) and affects a significant portion of the population. People here die from it.

Did your volunteer stay in India change your view of the developing and developed world? Did it change your work or study plans for the future? India was a test for me — whether I could handle staying in such inhospitable conditions and challenging circumstances. Physically and mentally. The stay reinforced my decision to work in developing countries.

Through St. Elizabeth's University, you have completed three six-month stays in developing countries so far. Can any connections be found between your work in Burundi and Haiti? The first connection is that both Burundi and Haiti are among the poorest countries in the world. Both countries are francophone, and the security situation in both can at best be described as complicated. Both projects I was involved in were of a health-care nature. In Burundi, it was a hospital with an inpatient section for four different departments and two fully functional operating theatres. Around 50 local staff worked there. Two to three foreign doctors worked in the outpatient clinics and operating theatres, and also performed emergency duty — seven days a week, twenty-four hours a day. In Haiti it was a small clinic, where, together with one doctor and eight employees, we provided outpatient care for internally displaced persons (IDPs) — right in the middle of their provisionally built village on the outskirts of Jacmel.

How are people in Haiti coping with the aftermath of the devastating earthquake after 2010? Haiti was the poorest country in the Western Hemisphere even before the 2010 earthquake, but the earthquake itself was virtually apocalyptic for the country. One must imagine that in a matter of moments approximately 220,000 people died and 2.1 million (out of a total population of about 10 million) inhabitants lost their homes. Entire neighbourhoods were levelled to the ground, and the poorest population was hit the hardest. By the end of 2012, a huge amount of work had been accomplished — for example, of the original 2.1 million people who lost their homes, only 360,000 still lived in displacement IDP camps by the end of 2012. But Haiti is still absolutely dependent on the help (and cooperation) of the international community of humanitarian and development organisations. More than half of the population still lives on less than 1.25 dollars a day (which is the absolute poverty line), and nearly half still does not have access to safe drinking water. To the overall picture of the situation in Haiti one must also add malnutrition, cholera outbreaks, and the constantly worsening situation with food security.

What was a typical work day like for you in Haiti? First, early in the morning: handing over the keys to the technician to start the generator; preparing materials for patient registration; opening the clinic and checking the arrival of individual staff members. During the day: handling administration, purchasing fuel, food; repairing equipment (ambulance, generator, water supply system, etc.). The clinic gate closed with the departure of the last patient. In addition, we provided non-stop emergency care for the local community with our ambulance, with transfers to the nearest hospital at any time without restriction. It would happen that we were woken at eleven at night, but also at two in the morning, for the most various situations (from fractures and births to transporting the deceased to the mortuary).

How do you see the future of this island, say in ten years? Will people still be dependent on humanitarian and development aid (for example from Slovakia)? I do not see Haiti's future optimistically. Besides the reasons mentioned above, one must also mention the devastated environment (most of the forests on the Haitian part of the island have been clear-cut). Every year during the rainy season one can expect torrential rains that wash nutrients from the soil, cause massive landslides, floods, destruction of crops and, last but not least, hundreds of deaths. The country is absolutely dependent on food imports — mainly from the USA, but there too the harvest was very poor last year. Donor countries have stopped sending Haiti the promised amounts of financial aid, and humanitarian organisations are gradually leaving the island, after literally flooding Haiti three years ago. And that is not even mentioning corruption in all spheres of social life...

In Burundi you were probably also unable to move freely around the country. What was the security situation like there? In the region where we operated within St. Elizabeth's University project, various rebel and bandit groups were active, which had formed after the end of the civil war. The government was trying to disarm the population, but unsuccessfully, since fear of renewed violence persisted in the country and the government offered no financial compensation for surrendered weapons. Burundi has a nearly identical population composition as neighbouring Rwanda, where a genocide occurred in 2002. Driving at night was prohibited throughout the entire country, and military checkpoints were present at every turn.

How did local people react to the operation of health-care facilities in the region by a Slovak university (and with funding from Slovakia)? People were immensely grateful. Before the arrival of our organisation, the state could not afford to run the hospital and the entire complex was essentially abandoned and unused. Previously, patients had to travel 40 km to the nearest hospital in the district town of Bururi. We provided Burundians with quality medical and health care, with the constant presence of at least two specialists from Slovakia, Haiti and Egypt. In addition, we purchased medicines as needed according to the individual specialists' recommendations and paid motivational supplements to all employees.

You are currently working on the coast of Kenya (around Mombasa), but in 2011, as a logistics coordinator, you were responsible for several nutritional centres in the chaotic capital Nairobi. How many hours a day did you spend in the car, and how did you cope with the traffic? I once read a statistic that rated Nairobi's traffic as the fourth worst in the world. So I cannot imagine what it must be like in the cities in the top three. Traffic in Nairobi was catastrophic. Two lanes become four in Nairobi, people drive on the wrong side of the road and on the central reservation islands, and the entire traffic is (with a few exceptions) in a jam throughout the day. I spent most of my working hours in the car, and I coped by becoming an uncompromisingly aggressive driver.

Which project was closest to your heart, and why? Probably the first one — the volunteer stay in India (project Mission India 2008). For the first time I was working in a developing country, and moreover we were working with children from the 'untouchable' caste, whose members are in fact the poorest of the poor across all of India. The stay prepared me for future projects and, at the same time, freed me of romantic-adventurous and saviour illusions.

What do you consider the key element of Trnava University's project in the Kwale region (which activity is the most important)? Since it is a project funded by Slovak Aid — all goals and activities are clearly defined already at the time of submitting the project and applying for financial resources. All of them are therefore important and key. The renovation of the nutritional centre in the regional hospital in Kwale, equipping two additional centres in Tiwi and Mkongani, training community health workers, securing a supplier for supplementary nutrition, the actual examination and provision of care for children and their mothers, setting up a project library and regular educational activities for hospital staff, or the launch of model gardens — all of these are activities that are interconnected and make the project unique and important for the community. Now, before the project closes, however, the most important factor is sustainability (handing over the project to the local partner — the Kwale hospital; ensuring the continuation of activities even after our departure).

Several risk factors contribute to the increased incidence of malnutrition in the Kwale region. Which one do you consider the most prominent (maternal illiteracy, family size, unemployment, etc.)? In my opinion, the factor most negatively affecting malnutrition is poverty. And not only in the Kwale region, but on a global scale. And this despite the fact that poverty is a broad and complex concept, whose causes (and consequences, and a vicious cycle at the same time) are precisely the aforementioned factors. Not without reason is "Eradication of extreme poverty and hunger" the first of the eight Millennium Development Goals (MDGs).

Besides malnutrition and the already mentioned malaria, this region also has a high incidence of people infected with the HIV virus. How can Kenya, and other African countries, fight this deadly infection (and AIDS disease)? Kenya operates a national HIV programme called NASCOP, which is funded from abroad by USAid, UNICEF and the World Bank. From the donated money, primarily antiretroviral treatment (ARV) is procured, which is provided to patients free of charge at registered clinics (CCC – Comprehensive Care Clinic). However, there are many problems (insufficient capacity building; refusal of regular testing, especially among the male population; mothers who do not attend prenatal clinics; stigmatisation of HIV patients, etc.). Perhaps it would help if all relevant institutions ("stakeholders") appealed to people to be faithful and monogamous in their relationships. If they do not want to or cannot live this way — it is then important to emphasise regular testing and condom use. HIV-positive patients need accessible and affordable treatment and, of course, the necessary psychological support.

Why is development aid (and cooperation between donors and beneficiaries) from developed countries (from Europe, and therefore also from Slovakia) still needed in developing countries, or low-income countries? On the question of development cooperation with Kenya, I have become somewhat of a sceptic. Let me explain why. Kenya is a country where nearly half of the population still lives below the poverty line and where the minimum wage for an uneducated rural worker is at most 50 dollars a month. Despite this, this year after the March elections, three hundred Kenyan MPs approved a salary of 10,000 dollars a month for themselves. I consider this perverse. In my view: responsibility for socio-economic development or the state of affairs on their territory should primarily be borne by the governments of individual countries, which should care about more than just self-enrichment. Within development cooperation, it should be about an equal relationship — a partnership that entails the need to exert equally great effort and activity on the part of both actors to achieve a common goal. Development cooperation must take place under clearly defined and strict rules, where both beneficiaries and donors (the two sides of the partnership) will truly do everything possible to — eliminate the current unfavourable situation (insufficient access to education or safe drinking water, malnutrition, food insecurity, etc.). In Kenya, not everyone is trying to do that yet...

You probably no longer experience culture shock on the African continent. But what can still surprise you about local people? In a negative sense, it is similar to other countries — we are all actually the same everywhere, although the ingenuity and theatrical-dramatic abilities of the people of Haiti in extracting financial or material aid managed to surprise me quite often. In a positive sense, it is the ability of people to rejoice in life under unimaginably simple conditions. The immense strength and resilience of local people in the face of life's vicissitudes, and the ability to sing, dance or pray at any occasion and without shame.

Text: Božena Baluchová, Foto: archív M. Miadok a Pavol Markovič