Life and AIDS Work in NorthWest Cameroon

Tourism in the Extreme North: Intriguing, Annoying, Hazardous

Tourism in Cameroon is tough. Although this country has many spectacular sights and is far more developed than other African countries, the decrepit transportation infrastructure makes travel grueling and dangerous.  Furthermore, the lodging and food can be quite expensive for what it is. 

I wanted to go to the Extreme North Province of Cameroon to satisfy my curiousity and wanderlust, but in the end, it did not feel like it was worth it.  Fortunately, Alex is a lot more laid back about the experience.  Having never been to Africa before he expected the difficulties and was willing to roll with the punches.  I just got annoyed. 

I realize now that what I like most about being here is living and working in a small village where I know people in the context of their daily life and community.  Being a tourist is not at all fulfilling in comparison.  After dealing with all the delays, discomforts, and potential dangers, what you get to see of the destination is quite shallow and superficial.

Here are some of the highlights.

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Mosques and Mobil stations are ubiquitous.

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Alex in an elephant's footprint.  We did not get to see any elephants but did see their guerilla tactics to keeps the annoying tourists at bay:  stomp up the road so that the land rovers can not get past.

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What is faster:  a land rover or a herd of giraffes?

Giraffes!   Here a herd of giraffes races past.  When they run it looks like they are in slow motion, but they can cover a lot of ground with their gangly limbs.
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The beautiful Porte Mayo hotel, a relaxing oasis in the hot and dusty town of Maroua. 

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View of the volcanic mountains surrounding Rhumsiki.

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The similarities between Cameroon and Mali are remarkable.  As in Mali, it is hot, dry, the people are predominantly Muslim, and the lingua franca is Fulani.  The main food is millet paste and sauce made of peanut butter or various green leaves.

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Alex playing with a cat in Rhumsiki.

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A woman sits next to her house, two granaries and kitchen.  She is one of 46 wives of a chief.
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Bus accident.   Our bus hit a pothole, lost control, and toppled over into a culvert on our way back.  We were not hurt at all, but one man died and a woman severely broke her leg. 

The only good thing to come out of it was that we had a long talk with an Iman from Chad in the shade of a thorn bush, while waiting for our luggage.  Then, some nuns from a nearby town took pity on us and fed us delicious food and put us up in their calm sanctuary, without even asking for a marriage certificate.

From Yaounde to Ngaoundere by Train

After a day in Yaounde, Alex and I made our way to the extreme north, bracing ourselves for a long complicated trip.   

The start was auspicious.   We heard that it could take three hours to get a reservation on the train and that you might need to show proof that you are legally married in order to get a two person sleeper car.  So just to be on the safe side the Peace Corps director wrote us an affivadit to  prove that we are legally married.  (Our marriage certificate, slightly stained from the rain that came through the roof of the train car.)

But once we arrived at the train station, we sailed to the ticket window and got a ticket in less than one minute.  Then, another surprise, the train left at 6PM sharp, with none of the usual delays while waiting for the vehicle to fill up or baggage to be loaded, as on the buses.

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Settling into the sleeper car for the long trip north.   Having a beer and good reading material can make the 18-26 hour trip almost bearable.

We chugged through the night uneventfully, until we woke to the sounds of yelling outside the window.   The train had stopped and the security guards were arguing with some strangers who had congregated on the tracks.   We did not find out till the morning that armed robbers were known to stop the train in the midde of the night in order to grab what they could.

At 3AM, it was ominously quiet again and for the next 7 hours we did not move.   A cargo train had derailed ahead of us.   

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A view from the train

At about 10AM we finally started rolling again, when suddenly at 10:30AM the train lurched to a stop again.  There was a flurry of activity at the back of the train.   A man from one of the local towns who was surfing the trains jumping on while it rolled through the station and jumping off once it was in the outskirts, lost his grip and fell partway under the train and lost part of his hands as the train sped past.   After another long delay he was put on the train to transport him to the nearest hospital.

We finally arrived in our destination, Ngaoundere, about 10 hours behind schedule and 26 hours after our departure setting a new record for delays. 

As Alex said, "Maybe we have wandered too far from the beaten track."

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The train station in Ngaoundere.  Only 8 more hours in the bus to go!

Money Misadventure

Today, I had to go to the bank to get some of my personal savings to pay for my trip to Northern Cameroon with Alex.  I brought two means of obtaining those personal savings: travelers checks and an ATM card.   Even small errands like this end up becoming a scavenger hunt here in Cameroon.  So follow along for a blow-by-blow decription of my 2.5 hour long extreme adventure in getting cash for my vacation.

11:35:  I went to get my credit card and travelers checks from the safe.   Here in Cameroon you need to bring the receipts for travelers checks or they will not cash them.  So I got those as well.

11:45  Left the office with the country director who was kind enough to give me a lift to one of two banks he knew have ATMs that work with US accounts.

12:00: The ATM at first bank is not working, and they do not cash travelers cheques in US dollars, just those in Euros.

12:10 Walked through the rain to the next bank, Credit Lyonnais.  Insert my ATM into the machine and nothing happens.  I start to feel nervous when after 5 minutes the screen is still frozen.  Ask another customer for help, then at long last my card is spit out, rejected.   Walk upstairs trying to find the person responsible for travelers checks, and finally find a secretary who says that they are a branch office and I should go to their main office downtown.

12:25  Dodged more raindrops on the way to the next bank.  My hair is damp, my sandals muddy.  They only cash travelers checks for people with an account.  And their ATM is down.

12:50  Arrive in downtown where all the main bank branches are located.  First bank  has not ATM and only does Thomas Cook, not American Express travelers check.

12:55  Arrive at second major bank downtown.  Huge lines snake along the walls of the main lobby.  There is no sign of an ATMs (because there are none.)   After asking several people, I find a small spiral staircase that leads down into the basement.  I stand in one line, waiting for the impartial clerk to make eye contact.  She stares down at her paperwork as if she does not notice the ten people in line waiting to talk to her.  Finally I make it to the front of the line, "Go to the next counter."  There is no one there.  Wait 5 minutes for someone to show.  "Sorry we can not cash travelers checks because the internet is down, and so we can not validate the check numbers.  Try across the street."

1:10 Walk across the street.  Wow!  There is a small buiding with hge shiny windows and not one but three ATM machines.   Insert my card.   Wow!  It is asking my passcode!  Type it in.  Wow!  It asks how much money I want.  OK, $100.   Then, suddenly, the machine spits out my card.  "Insuffient funds."  This has got to me a mistake.  But no after trying all three machines, three times, I can not even withdraw $50 from my account. 

I am beginning to get worried because I need cash to pay for a cab to the airport (a whopping $40 round trip), and a night in a hotel ($22).  What if nothing works?  Will I be able to borrow money from another volunteer or Peace Corps staff member?

1:15   Go inside the bank to try my luck with the travelers checks.  Walk up a spiral staircase to their travelers check counter.  No one is there.  "Come back later.  She will not be back for 20 minutes."   I am getting more nervous.  I have an important meeting with the country director and director of the health program at 2pm.   Am I going to make it?  I do not have a cell phone anymore, so I can not even call them to tell them I am running late.

1:30 The clerk finally arrives.  "I am not sure we will be able to verify your checks.  The computer system has not been working.  But let me try."  Tipity-type-Tipity-type-Tipity-type...  Her face is passive and unreadable.  Nothing is happening.  Tipity-type-Tipity-type-  "Can you fill out these three forms?"  So I print my name, birthdate, birthplace, US address, reason for obtaining cash, passport number.   Sign three times...no here also. Tipity-type-Tipity-type-Tipity-type...  Finally something happens. "Are you OK if we give you 88,000 for $200?"  As a matter of fact, it is not OK.  The current exchange rate would normally give me 100,000, so they are deducting $24 for the pleasure and security of using travelers checks. But hey, beggars can not be choosers, and I need the money.  "I'll take it."

Two hours later, and $24 dollars poorer, I have enough cash to pay for a cab to the airport and a hotel room tonight and maybe for part of my train fare to the north.  Alex is bringing cash to cover the rest.   Carrying so much in cash would be insane in any other country, but here in Cameroon, that is better than the alternative.

2:05 I am back at headquarters for my meeting.  "So what are you doing here in Yaounde today?"

By way of Dubai

My husband Alex is coming to visit.  His initial flight was canceled, and his new itinerary takes him to Cameroon by the circuituous route of Boston- New York- Dubai- Nairobi- Yaounde.   Despite the inconvenience he is thrilled to see another part of the world, and he has always enjoyed spending hours and hours lookign out airplane windows examining geography from the air.  Here's an excerpt of the e-mail he sent to me from the Dubai airport.  Enjoy!
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This is one of the coolest trips I've ever been on. We flew in over the Persian gulf and the man made resort islands that they have been building here. It looked a little like Los Angeles from the sky except for the minarets and mosques.

The gulf here has an almost indescribable color. I can't do it justice but I can say that it varies from dark blue to the color that copper turns when its very weathered. That copper green color shows up everywhere there is an up-welling of current and everywhere a ship has sailed. So each large ship had billowing clouds of blue-green water for miles behind. As we were taxiing towards the terminal I saw the ski area. Yes, the ski area. Actually, its more of a ski facility.

The flight had almost no one on it, and Emirates airlines is a joy.  They have a camera on the nose of the plane and one on the bottom looking down that you can tune in to on the computer video system at any time. Since the seats around me were empty, I set one of the monitors to the forward camera and one to the down camera and then I could watch out the window too. I was in hog heaven during take off and landing. Sunrise on the screen in front of me was cool too.

The plane has outlets that I can plug my computer into. So I watched one movie on the airplane system and one on my mac and I worked for an hour or two. I've got an hour or so here in Dubai then a five hour flight to Kenya and four hours to Yaounde. Yipes, thats crazy. I'll probably sleep a lot on those flights.

In Dubai its fun to stumble around gawking only to notice other Europeans and Americans with what is obviously the same stupid look on their face. I'm going to go walk around and enjoy the next hour or so in this mall.. um, I mean airport.

Scenes from Work

It has been a busy and tumultuous week in Njinikom.  In the last seven days, Project Hope staged two trainings, conducted outreach in the largest secondary school in the district, called a huge meeting about the floundering youth program, and staged a harsh crackdown on staff and volunteers.  I will not get into the management crisis here, but did want to share my photos and observations of the staff in action.

The trainings and presentations bring out the staff's best qualities: charisma, dedication, and multilingual animation skills.  My description can not capture the verbal Olympics of explaining, in Kom and Pidgin English, why HIV antibodies can cross the placental blood barrier but the HIV virus can not.  It is awe-inspiring.  Here are some photos to give you a flavor of the level of interest and interaction in the trainings.

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TRAINING HEALTH WORKERS IN OUTREACH CLINICS: Preventing Mother-to-Child Transmission of HIV/AIDS

Trainees discussing a case study about a man deciding to sell his house to go on anti-retroviral treatment.

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Lillian leads the trainees in a song after they complete their post-test and demonstrate improvement.

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TRAINING FOR TRADITIONAL BIRTH ATTENDANTS:    Safer Delivery Practices to Reduce HIV Transmission

The second trainining was for traditional birth attendants from remote villages.  They learned about safrer delivery practices to avoid contracting or transmitting HIV while serving as midwives.

Here FPaul leads the group in a trust exercise.  The person falling in the middle represents the person with HIV/AIDS and the people around him represent the friends and family members that support him.   As people find out his status, they abandon him reducing his social support until only three people are left.  Afterwards there was a discussion about how stigma and discrimination is exacerbating the HIV/AIDS epidemic by discouraging people from getting tested and leaving them alone to cope with illness while hiding it from family and friends.

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PRESENTATION AT HIGH SCHOOL:  How HIV/AIDS Affects the Career Prospects of Youth

On Wednesday, we were called to give a presentation at the Government Bilingual High, which has 1,500 students.  They were providing a full day of guidance counselling on career options and academic pursuits. 

Here FPaul is giving the statistics on HIV/AIDS, including the prevalance among young people (10.5%), prevention methods, and the importance of life skills.   In the near future Project Hope may be establishing a life skills program at teh high school to teach youth about communications skills, effective decision making, managing their emotions (including love and lust). 

My favorite part was about the common myths and misconceptions about the virus, such as the rumor that AIDS stands for American Idea to Discourage Sex.

Friends at Work and Play

One of the great things about working here is the close network of friends, colleagues and acquaintances that has sprung up around me within just a few short months.  I can go down to the crossroads anytime and be guaranteed to run into at least couple of people that I can talk to or have a beer with, even if is just a shopkeeper or a policeman who met me once.

There is an instant intimacy that develops when you work in a small town. I have been surprised and gratified to delve into very personal and philosophical subjects after only a beer or two.  Since all the hospital staff are well educated and speak English, there are no language barriers and the cultural differences that do exist make for more interesting conversation topics.

There are not the same barriers between your personal and professional life here.  Maybe Cameroonians are just more open and interested in outsiders, or there is just a shortage of educated peers.  Whatever the reason, you often end up hanging out with the same people that you work with. 

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Barbara (my housemate) and Clement (nurse who often works the night shift at the hospital) during a serious moment at work. 

Are they saints?...

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....or are they sinners?   

Here is Clement with his girlfriend of the night.  He is a great salsa dancer and likes to banter back and forth in comicly convoluted bureaucratese.

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Barbara often works with MacDonald, a nurse who leads the clinic for the prevention of mother-to-child transmission of HIV/AIDS and for adherence to anti-retroviral therapy.

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Barbara and Mac also hang out together after work.  Here they are with their friends, Clement, Louis and other hangers on.  We ended up getting thrown out of this bar at 2AM and spending several hours trying to figure out why and what to do about it. In the end, Clement and Louis walked home (it took two hours) while Mac, Barbara and I got a hotel room for 3 hours and took the first cab back at 6AM.

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Lillian is a social worker who conducts voluntary counselling and testing at the hospital and home visits for people with HIV/AIDS.  Here she is discussing a case study of married women who finds she has HIV/AIDS and suspects her husband.   

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The discussion continues... I love the way that they listen intently to one another.  It is clear that these coworkers really like and respect each other.

Men and women coworkers have friendships here, and there is little or no sexual harassment though we dance close together and discuss relationships in an irreverent and spicy way that you probably would not do with your colleagues in the states.

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Belter cooking "Kati Kati" chicken for the monthly dinner among hospital staff.

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Here a group of us hangs out talking, eating popcorn, and watching the movie "Memento" on Shannon's laptop.

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Margaret established an eye clinic in a neighboring town.  Here she is hanging out with Godwin, who is her boss, landlord, and friend. 

Signs and Sayings

I love the local sayings and the homemade signs painted by local artists.  These signs and sayings seem to adorn every small business, consumer item, and means of transportation.  Here are some of my favorites.

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"No food for the lazy man."

- Embroidery on purse.

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"Keep out evil."

- Painting in bar

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"If I Be Know"

- Sign for car wash

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"God's time is the best."

- Sign on sandwich and omelette cart   

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"When I grew up to be a man, the first thing I wanted to be was a pedestrian until I met Amour Mezam Express [bus lines]."

- Placard at a bus station

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"If na you"... then who?

- Mud flap on bicycle

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"More talks, more blessings, hard working success!"

- Motorcycle mudflap

 

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"Shame on Mr. and Mrs. Wicked"

- Sign on local taxi

More Kittens!

It is expensive to get a cat fixed if your income is $224 per month.  Also, the vet's office in the nearest town looked dirty and dangerous when Shannon went to investigate and inspect the facilities. 

So, Tiffy ended up getting pregnant again, for the second time in the 5 months I have been here.  Here she is looking cute and showing off her round belly.

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On Monday night around midnight, Tiffy ran across my bed and started rummaging through my suitcase.  I turned on the light to figure out what the commotion was and saw she was in labor.  So I ran to get her box, and about 3 hours later, after a lot of huffing, yowling, and licking, she was nursing her four brand new kittens.

A Few of My Favorite Things

As my departure date approaches, I am beginning to get a bit sentimental.  I am trying to use my time wisely so I can enjoy the last few weeks to the fullest.  So, in the spirit of this harvest and thanksgiving season, I want to commemorate some of the things I like best about this place.  Here goes...

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Watching the sunset on my backporch.

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Kids playing with homemade toys.  This is a car made from a sardine can.

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Drumming in church and the counterpart harmonies of the "vernacular choir."  (This means they sing in Kom, not English.)

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Shannon and FPaul.  They share a passion for HIV/AIDS work, a great sense of humor, as well as deep resevoirs of emotion and intelligence.  Although they let me down by deciding not marry one another, I forgive them.  Better yet, they forgive me for pushing them both, individually, on the marriage issue.   

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Juju dancers, cropping up on a weekly basis for various death celebrations, making the weekly tally of deaths bearable.  As the Mother Superior said, "If we can do one thing well, we know how to celebrate death."

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Cute kids

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Goats, their "who me?" attitude, and the way they shriek when being forced to go where they do not want to go.

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Split sleeves.   I can not get enough of the colorful fabrics and fabulous fashions.

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Everyday people can not only make great music, they also can make their musical instruments.

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"Koki"  To prepare: boil black-eyed peas, then mash them up with a large spoonful of palm oil and jabanero peppers, wrap in a banana leaf and boil for 15-20 minutes.  When cool, serve with boiled plantain or cocoyam.   Delicious!

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Volcanic mountains.   Cameroon has a string of volcanic mountains that stretches from Atlantic Ocean, through the NorthWest Province (where I live), and all the way to the border with Chad.  Here is the volcanic island of Malabo off the coast of Limbe.

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Did I mention the fabulous cloudscapes from my back porch?

Bittersweet Harvest

Here in Njinikom, Thanksgiving is celebrated during the whole month of October when women are harvesting the first batch of food crops (corn, peanuts, potatoes) and planting the second batch (beans, cocoyams). Men are responsible for the primary cash crop, coffee, whose prices have been plummeting in the local market, even as they soar at Starbucks and Dunkin Donuts. So this is a depressing time for them.  Ten years ago, the price of one bag of coffee used to pay for the school fees of four children.  Now, it only covers part of the fees for one child.

Here Thanksgiving is celebrated in the church, not in the home.  Instead of feasting, people are expected to offer a portion of their harvest to the church to express your gratitute for the work accomplished in the last year.  If you are a businessman or government worker, you make a cash donation.

I attended one Thanksgiving service, and the following is a hodgepodge of thoughts I had while listening to a sermon at the ironicly named Martyr Baptist Church in Wombong with a severe cold under influence of Benadryl. Most of the service was in the local language of Kom, with the pastor giving a two minute synopsis of 45 minutes passionate preaching, so I had a lot of time to drift along on the stream of consciousness, imagining the connections between the few phrases that I understood.   I do not know if it was the medicine or my mood but the whole experience was more surreal and spiritual than usual.

"Work now while it is still day, for the night is approaching.” This reminded me of the sentiment that propelled me on this voyage.  I spent five years exploring ways to do HIV/AIDS work in Africa, analyzing the opportunities, and even coming close to going to Zambia, before my doubts about the organization cropped up and a US job seemed like a better bet. I also ruled out teaching HIV/AIDS prevention at a refugee camp with former sex slaves and child soldiers from Liberia. 

"I am here. Send me.”  This was the feeling that precipitated the plunge into the unknown that was this assignment in Cameroon.  The timing was right, and no opportunity is perfect.   Working on HIV/AIDS in a small rural hospital run by a convent of nuns?  Sure!  Why not?   Even now, after many frustrations and disappointments, I can still recapture some of the initial enthuasiasm and embrace the work for what it is, a lot of effort with unknown effectiveness.  And on the good days, I can still just work for the sake of working, without a need to see the desired results.

"The work is large, but the laborers are few." The pastor was probably referring to subsistence farming, but it could equally apply to HIV/AIDS education.  The work is overwhelming, emotional, intimidating, and exhausting.  When I was making the decision about whether to take on this challenge, I asked myself a lot of questions to make sure I could take it on.  "Can I see things for what they are, but not become bitter and disillusioned?  Can I be enthusiastic and generous without being blinded by people who were just saying what I wanted to hear so I would give them money?  Can I persevere when the inevitable setbacks occur?  Can I keep my hopes high even after disappointments?   Can I push for progress without being pushy and prejudiced?  It is not better, worse, just different.  Can I accept things as they are without being complacent?"

"This is the time to take stock of the fruits of your labor and to be thankful, no matter how meager the harvest.” This called to mind the disjointed relationship between passion and perseverance. The more you care about something the more likely you are to burn out and become bitter and disillusioned. To persevere, you have to guard against investing too much of your heart and soul in your work. You can’t lose hope when people are dying, when the projects you started are not sustained by the people you trained, when portions of generous donations go missing, when the management seems more committed to maintaining their power and level of comfort than to doing what is best for the patients and supporting the volunteers who do the bulk of the work. You have to learn grace, to give without expectation, to trust that you are not wasting your time and struggling in vain.

I promised myself to work hard, and not get bitter no matter how disappointing the results. This is difficult because there are so many failures and frustrations, and the "lessons learned" are vapid, not valuable. Yes, I have helped a few: a woman arrived with open sores on her neck and an expired coupon for an HIV test. I paid for her test, but she died two weeks later because she was already in late stage AIDS.   Another woman who finally sought treatment as a result of church outreach also died within a few weeks because by the time she came for treatment it was too late to be effective.   The lessons: fear, shame, and poverty are barriers to seeking out HIV tests and AIDS treatment on a timely basis, but I knew that already.

Despite this, it is important to end on a positive note.  On this Thanksgiving, I want to look back on my experience and remember, as one very young and enlightended Peace Corps Volunteer said,

“Development will happen when and how Africans want it to."  I do not know what is right for them.  This is their home and they will live in it.  Our job, as foreign development workers, is to give them a few new tools and insights, so they have the opportunity to see and do things in a different way.  But in the end, they must decide what is best for them in their context.