Wednesday, December 9, 2015

Dealing with Children

Alex Buttgenbach

I’m back!  After going in and out of sickness over the past three weeks I thought a good place to start was where I believe I recently picked up a cold: at the primary school.  The health center was doing vaccinations for the measles in the whole community the week of Thanksgiving.  Although vaccinations are not part of my job, helping out in community wide efforts can be considered part of my job as is helping out with the health center.  In the United States, vaccinations are taken care of at a doctors office, health center or hospital, but in rural Cameroon, the health center has to actively seek out children and keep note of who was vaccinated by marking houses with chalk.  This vaccination was a little different.  We went to the schools to vaccinate each class and set up shop in the center of town at the Chiefs house. 

I was mostly active at the primary school, which was truly amusing to be a part of.  Usually the polio vaccinations are given orally through an eye dropper and don't encourage a lot of resistance form the young children.  However with the measles, the nurse gave them shots, and the kids were not excited about that.  Now in Cameroon, crying is highly looked down upon even among young children and immediately made fun of, thus each student was expected to take the shot as stoically as possible.  One of the health workers actually bullied the children who started crying and told them they were going to get two shots if they did not stop.  Ironically, the little kids starting at five years old often did the best job at not crying.  It was the twelve year olds that began to lose their minds when they saw the syringe.

Thus one of my jobs was holding down the children who were not convinced of the health benefits.  In two cases we had to chase a young male child down a road or into farm land so they could get the vaccine.  One time, the crying child completely out ran me and the other school children gleefully caught up to him and dragged him back holding him by each limb like we were going to draw and quarter him in Medieval England.  I felt kind of bad so I had them put him down and I walked him back holding his arm.  He was still in tears.  At some time that day I caught something from one of the kids, but I can’t complain since the vaccinations truly are worth the effort.

Nigeria is still classified as a country with polio and cases still inch into Cameroon.  In fact a few members of my support group and a few other Cameroonian's I know had polio as children.  It is an important reminder of why vaccines are so important and the impressive efforts of local volunteers who go out once a month to combat the spread of preventable diseases.  Even if the kids don’t agree.  

Saturday, November 21, 2015

Addressing Persons with Disabilities in Rural Cameroon

Last week my girlfriend and colleague Rachel visited Mbakaou to initiate a health training at my local health center.  Let me take a step back.  While I have primarily worked in health education with my main supervising body being the local health center, Rachel works with a disability support organization in the Northwestern city of Bamenda.  She regularly works with persons with disabilities, performs workshops for groups of men and women with disabilities and goes on a weekly radio show to discuss different issues for persons with disabilities among other projects.  It is often unusual for there to be strong support systems for persons with disabilities even in a city.  In the country side it is even rarer and often dependent on support systems from nearby cities.  Such support is more common in the Northwest.  In places like my region of Adamawa, it can often be rare.  This is a large problem that is often ignored by foreign organizations despite the fact that 95% persons with disability in Cameroon live under the poverty line. Thus for the last few months we have been discussing a project that could bring increased support for persons living with disability in my rural Adamawa village of Mbakaou.

I finally got to show Rachel around my post and I got to see her for the first time in one and a half months (it takes two and a half days to get from my post to hers, it actually takes less time to get from the capital of Yaounde to the United States), but we wasted no time in getting to work. The day after she arrived we started a workshop at the health center to train health workers and community mobilizers on the struggles of people with disabilities, added vulnerabilities of persons with disabilities and statistics illustrating the situation.  Over the course of the two day workshop, ten health workers and community mobilizers attended the workshop, and eight of the ten attended the full two days.  Along with educating the volunteers about the struggles and vulnerabilities we had a series of activities to illustrate our points.  We had the volunteers write their name with their writing hand, then their non-writing hand, then their writing hand on top of a book on top of their head and then with their non-writing hand doing the same thing.  We also had them listen to a monologue with cotton balls in their ears and race each other to the health center wearing blindfolds with guides providing only verbal support. 

Rachel’s pre and post tests showed very encouraging results and proof of our volunteers new found appreciation and understanding of issues for persons with disabilities.  Yet the largest proof of the workshop encouraging the volunteers to be proactive with disabled individuals was their demand to start a new support group immediately.  Before Rachel left we had held our first disability support group meeting in the health center, created an action plan and a constitution and chose a leader for the group.  The individuals of the first meeting were all physically handicapped and some needed help from the community organizers getting to the meeting. 

Since that time, we have had another meeting coordinated by my friend and community organizer Mohammed “FBI” Yaya and myself with the group.  The group is in it’s early stages but I am excited that the members are clear about their interest and their agreed upon goal to start income generating activities.  I can only hope this is a beginning to greater progress for the members of the group and the disabled community as a whole in Mbakaou.

Wednesday, November 4, 2015

Still Alive!

Hey everyone! I am so sorry that I have not written in several months but I am finally back and hoping to be consistent this time.  Part of the difficulty of writing this blogpost is writing original, interesting and positive material.  Part of the Peace Corps objective is third goal, which basically entails representing the host country back in the United States, or at least describing it for Americans.  So here we go again.

Since I am getting back to work, it is worth talking about a new project as of August that is one of my top priorities right now, and that is house visits.  In the last few months I have had a handful of setbacks when two or three projects fell through and the main counterparts I work with have been busy, away, moving away or simply uninterested.  School has also been out of session and a large amount of people were away visiting families between Ramadan and school starting.  So I began performing house visits, in which I would go into a home, check to see if the homeowner has and uses a mosquito net, and discuss malaria with them as well.

This project is well worth mentioning because it gave me a chance to see how active people were in fighting such a relevant and dangerous disease in the community.  The results, to be blunt, were a little disappointing.  I would say about three quarters of the people I visited had mosquito nets but less than a quarter of those people actually used them.  What made this worse and more awkward was that most people told me they did not have them even when they did and they would insist that they were using them even when they were clearly tied up and had been for a longtime. They did this because they thought (incorrectly) I was giving them or registering them for new ones.  Thus I asked people to let me into their bedrooms (that was the awkward part) so I could see if they actually had  or used them.  Twice, I was standing in front of someone's house, asked if they had one, was told they didn't and then I pointed to the mosquito net through bedroom window behind them and asked what is that?

I understand why some of them lied, they wanted or needed another one. But what bothered me was it was often clear the ones they had were not being used in the first place and they were often tied up over the bed of the head of the household instead of being used for the most vulnerable: young children (and pregnant women).  This was a little disheartening but I used the time to encourage the use of the mosquito nets they had, explained how pregnant women could get them for free at a nearby hospital with a prenatal consultation and explained important details of malaria.

Recent news reports indicate that efforts to fight malaria have been working and showing impressive results.  However, as I have seen, efforts by governments and NGOs will only show truly significant results if individuals are as active in fighting malaria.  I also performed house visits in Bolinting where my counterpart Housseini was extremely active in promoting health in the community. Sure enough the difference was impressive. Many more people used their mosquito nets each night.  However even there far from the whole community had and used them, which is so important in fishing villages like Bolinting and Mbakaou.   I hope to see improvements in the future, since as of now, the malaria vaccine is far from ready and personal practices are the greatest protections from the number one killer in Africa.

I hope you are all well and I promise to get back to writing these on a more regular basis.

Saturday, April 25, 2015

Fishing Season

Before arriving in Mbakaou for my service, I learned that Mbakaou was a major fishing town and that fish would be an essential part of my diet.  I was very concerned.  At the time, I was in training in the small landlocked village of Mengong, and I ate fish every single day with my host family.  They were good cooks but the quality of the fish was decent at best and I was eating EVERY SINGLE DAY.  Thus when I first learned I was going to cattle country (Adamawa is Cameroonian cattle country) I was very excited, until of course I found that the town in particular was the center of the regional fishing industry.  I didn’t know if I could do fish every single night for the next two years.
 However my concerns were soon washed away.  First, it’s still cattle country and beef is always part of the local diet. Second, when fishing season did start (last February, but really in full effect the last month or so), the Fish was amazing!!! On top of that, the fish is unbelievably cheap (even compared to other regions).  If I wanted a fish for lunch, namely one that had been caught that morning, I would go to one of the fish stands, choose my fish, watch it get grilled and then pay $0.40 to $0.80 cents for it!  For a good sized delicious fish!  Yes, translated into US dollars!  Also, it is well prepared healthy fish.  It’s not like other cheap things that seem too cheap to be considered healthy.  Like the vodka in Russia I heard about when I was there that costs less than a dollar.  STAY AWAY FROM THAT!  Like other seemingly innocent things in Russia, it could kill you.  Thankfully (and hopefully I am not jinxing myself), it is not the case for the fish of Mbakaou, Cameroon.  On top of that, mango and avocado season coincide with fishing season, which is a good sign for nutritional intake in town.
Despite the nutritious fish and increased incomes in the town, the fishing industry also has a few negative impacts on the area as well.  To start, many young men who would otherwise attend high school drop out to work in the relatively profitable fishing trade, much the same way several decades ago in the American rust belt, young men would drop out to work in coal mines (as a broad example).  This may provide immediate income for their families, but it is seasonal still relatively low income, and deprives both the town and Cameroon of educated individuals.  Also there are other negative effects to making one industry the center of a town’s economy especially when that industry is (legally speaking) seasonal.  Farming is also important, but aside from cattle raising it is often subsistent farming and is not as large as the fishing industry. 
Recently, I have also been learning more and more about the high HIV relevance in the fishing villages because of men who travel to the lake, fish and have relationships (or other sort of connections) with local women and then leave them behind. 
Finally, another concern has been raised in Africa in general and was particularly brought to light by a New York Times article, is the use of mosquito nets as fishing nets.  I have heard of it used in lake Mbakaou yet, however I have not seen it, but their use raises a lot of concerns.  First, people are not using their mosquito net to protect them from mosquitoes.  Living by a lake only makes them more vulnerable and most families only have one.  I am already having trouble convincing people to use their net primarily for their young children and pregnant women, who are the most vulnerable to malaria.  Moreover, while the nets are very effective in scooping up many fish (sometimes too many), they kill many fish because of the insecticide they use on the nets and they leave those toxins in the lake. 
All in all, fishing is an essential part of the town’s economy and lifestyle (including cuisine) and these problems need to be overcome so we can continue the fruits of the lake without major consequences.  I hope you are well and eating good food too!

Thursday, April 2, 2015

Bushman, Beekeeper and Survivor of a Thirsty Land.

Yes this is a grand overstatement, but it sounds better than: a peace corps volunteer who goes to remote villages for health animations, attends a beekeeping conference and is experiencing a drought.  Honestly the last one is worst than it sounds.
I was back at post for only ten days after the Inter-Service Training conference before going to a beekeeping conference in Ngaoundere.  In that short period of time I was able to hit the countryside and do a series of malaria and nutrition animations in very small villages on the lake and out in the bush (the countryside).  One of the villages Housseini and I visited in the bush looked like it was out of a Discovery Channel show with it’s painted houses that I never saw in the villages that sit on the road from Mbakaou to Tibati.  The villages by the lake are also important to visit, because I found, to my surprise, that many of the locals are still lacking a lot of information on malaria despite their close proximity to the lake.  On top of this they are a fair distance from the nearest health center making a visit expensive, difficult and often done in only extreme cases.  This is a major problem for healthcare in rural Africa in general.  A round trip motorcycle or car ride to the nearest health center plus the cost of treatment, can be a major blow to the family budget of a farmer or fisherman.  This is why prevention (especially with malaria) is so important and why I believe these odd little visits to villages are absolutely worthwhile.  I just hope the information is well received.  It can be a difficult sell convincing people to do anything different in their personal lives, especially if the information is coming from an outsider who does not even speak Fulfulde/Hausa/Gbiya.
Regarding the second overstatement, I recently attended a bee keeping conference.  As you might have deducted, income (or lack of) is a strong detriment of proper (or any) treatment.  Upon hearing of the conference, I saw the production of honey as a possible income generating activity in the surrounding communities.  My before mentioned counterpart Housseini runs a local agriculture group in the small town of Bolinting.  We are planning on starting the project with them.  As someone who use to be afraid of bees, this conference posed some challenges, but with a rudimentary bee keeping suit (a wide brimmed hat, raincoat, jeans, hiking boots, gloves and a mesh around my face) and lots of smoke derived from leaves, branches and cow poop, we were able to protect ourselves.  However now my hat smells like smoky cow poop.  The conference was interesting and I hope to keep you all updated with the project as it comes into being. 
Finally, the biggest problem I have been facing recently has been the lack of rainwater.  It is the end of dry season however rainy season is coming late leading to many of the wells drying up.  Worse, of the five pubic water pumps in town (many built by foreign NGO’s and corporations), only one works.  There is another one but it is privately owned.  There is a well in my compound however it is almost completely dry.  When I throw the bucket down to fetch water, the side of the bucket hits the bottom of the well and it usually brings up muddy water.  I do have a water filter that cleans the dirty water, but it often means not having very clean showers and buying lots of bottled water too.  It is a worrying concept and it surprises me that people seem so less concerned than myself.  The problem is also affecting cities and other regions.  In the regional capital of the Northwest, Bamenda, water has finally started running through the pipes after not working for three weeks!  And this is a city!  It does rain occasionally and when it does it rains hard.  But it is a troubling development if it does not start raining regularly soon.
That is all for now!  I hope you are all well!

Sunday, March 22, 2015

Hi, my name is Alex. May I ask about your poop?

I’ll explain.  In January, I was conducting an initial health survey in the town of Mbakaou.  I interviewed 82 households containing a total of 613 people (out of 4,167 in the town).  These questions (for the most part) were divided into sections of nutrition, malaria, water sanitation and sexually transmitted infections.  The questions regarding STI’s and HIV were awkward for many, were sometimes greeted by laughs and sometime they were simply too inappropriate to ask to certain locals (especially Fulani Muslims).  However the question that felt strangest to ask was “In the last month, how many days have you had diarrhea?” Could you imagine if a 24 year old man from say Europe or Japan showed up at your door, introduced themselves as a new resident and community organizer and then asked you if you poop has been strange or if you had someone with HIV in your house.  As slow (and awkward) as the survey could be, the survey was useful for both information and getting to know the people of my new town.  Also the people I interviewed were usually very kind and surprisingly open on sensitive questions.  I always received a seat by the homeowner for the interview and never received a rejection when I asked to conduct the survey.

Although my French is definitely improving and I was able to use it through the survey, I learned I need to continue studying it regularly in my free time and work on the local languages especially Fulfulde. Almost every interview in my survey required one of my counterparts (FBI or Alphonse) to help translate from French to Fulfulde or Hausa or Gbiya and back into French so I could record the responses.  I am focusing on Fulfulde, which is the most common native language in Mbakaou, Adamawa, the Grand North of Cameroon and also spoke in many countries through central Africa.  It is the primary tongue of the Fulani people but due its influence and widespread use, many others (especially in Mbakaou) speak it. 

Sadly Sub-Saharan Africa has a bad wrap with ethnic and religious conflicts, even nowadays.  However Mbakaou and Cameroon in general, are inspiring examples of coexistence between religions and ethnic groups.  Mbakaou is pretty evenly divided between Christians (of several denominations) and Muslims and both groups are very respectful and cooperative with each other.  It is an inspiring sight not just in Africa, but also in the world today.

I know it has been a while, but I hope to have another blogpost up soon! I hope you are all well!