The majority of participants were recruited through the Karonga Prevention Study health and demographic surveillance system (Read profile paper). During an earlier survey household members were asked if they would consent to being visited and informed about a study on sexual and reproductive health. We selected three localities to illustrate a range of rural settings in Karonga District, which includes villages close to the main road and trading centres, remote rural farming villages and lakeshore fishing villages. We sampled men at random, ensuring representation of the populations of interest. Only one man declined to participate in the life story interviews, which were arranged at the participant’s convenience. The group discussions were more complex to arrange. Around 80 percent of those originally recruited attended.
As a result, we heard from a wide range of men, including those least likely to be found at home. Field notes reveal how accident, sickness and sheer hard work often delayed interviews (fishermen, for instance, are dictated to by the weather and cannot wait at home even if an appointment has been booked). The team was fastidiously punctual in order to have the best chance of catching employed men in their lunchtime.
FIELDNOTES BY GREEN KAPIRA
“I arrived at the house of the participant for the second time in this day at 14:00hrs. I was welcomed by his wife who was sweeping the verandah. After greeting l was told that her husband was sleeping because he was fishing last night and again from morning up to lunch. After he woke up, we exchanged greetings. I was happy to see this participant because I missed him almost eight times after getting agreement to meet. But l couldn’t find him; his wife reported that he had gone to fish all the time. While greeting each other we were laughing about missing him. The participant was able to explain many issues from his life; could laugh at a certain point and smile. I decided to stop the interview because the participant began to doze.”
FIELDNOTES BY BLESSINGS MWANDOSYA
“When I was thinking of leaving, it started raining heavily so that forced me to stay longer with the participant. He had some clothes to sew, but because I was still around he decided not to start but I told him there is no problem. We started chatting and he had some good advice to impart about marriage while he was sewing.”
FIELDNOTES BY AARON NDOVI
“We agreed with the participant to do an interview around 11:00hrs. Since the participant doesn’t have a phone I had to set off around 10:00hrs. While on the way to the village I noticed the participant together with his wife and child carrying them on a bicycle. They told me that they are on their way to the Uliwa private hospital to get treatment for their sick child. They said that they first went to Fulirwa hospital and after realizing that there was no treatment there they decided to go to the private hospital. We agreed to reschedule the interview. A few days later I indeed went there and arrived at the participant’s house around 8:40hrs. Upon arrival it was his wife who welcomed me and gave me a chair to sit on. She told me that the participant has just gone to search for a goat rope just within the nearby bush and will be back anytime.”
In all, 55 men and their 42 female marital partners participated in life story interviews, with a further 50 men and women contributing to group discussions. All participants called the northern region home, the vast majority being Tumbuka. The youngest men were usually unmarried. The oldest men diverged dramatically in their experiences, from five times married to decades with a school sweetheart. And while some men encountered the pain of involuntary childlessness, others fathered as many as twelve children. Everyone aspired to iron sheet roofs, as they remove the laborious task of replacing the thatch each year but while some lived in relative poverty other men lived in affluence in houses constructed from brick, concrete and glass, connected to electricity and satellite TV. Half of participating men had use of a mobile phone.
Everyone had some years of primary education and a quarter completed secondary education and above. The majority of men were farmers, followed by fishermen, business and skilled occupations from teaching to carpentry and medics. After a decade of intensive HIV testing offered by clinics, community organisations and house-to-house surveys, most men knew their HIV status and - with encouragement - accessed treatment.
Map of Malawi showing the location of the Karonga Health and Demographic Surveillance Site (HDDS) in Karonga District at the northern end of Lake Malawi. The second smaller scale map shows the households and health centres in the Karonga HDSS. © Karonga Prevention Study