Life and AIDS Work in NorthWest Cameroon

Children at Work

There has been a surge of interest in child trafficking here in Cameroon with churches, government agencies, legal firms, and foreign donors raising awareness of the dangers of sending children from rural areas to the cities to work as servants and street vendors.  Parents or guardians usually receive some money for "lending" their children to distant relatives, and there is concern that these youngsters are prone to exploitation, neglect, and sexual abuse once they are away from their families, friends, and neighbors.  I have even met a law student from the US here for a 6 week internship who is portraying this as child slavery, though in the vast majority cases, these arrangements are temporary and made between family members.   

What makes this a complex issue is that children in rural areas have traditionally done a lot of work at very young ages, from child care, to farm work, to selling fruit and vegetables and hauling firewood.  Is it healthy for them to work such long hours and have such big responsibilities?  Many poor farming families can not afford to send all of their children to school, so some stay home to work.  UNICEF defines child labor as exploitation when it keeps them away from their family and allows them no time for school and recreational activities.

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A girl brings home the goats at the end of the day.

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This young girl moved into the orphanage for a couple of months to take care of her younger brother full time.

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Kids fetching water and doing laundry.

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Hanging out and "helping" mom at the restaurant.  In urban areas in the north, there are kids serving as dishwashers who sleep on the streets. Unlike this little boy, they are away from their family and can not go to school.

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P.S. All photos are by Ingrid Frey.  Thanks, Ingrid, for providing visual stimulation while I wait for a new camera.

Dancing through discouragement

It has been a rough couple of weeks. I am worn out from struggling with the financial constraints and the religious restrictions that  -in combination- are strangling Project Hope's ability to prevent and manage HIV/AIDS in this community.  The one great thing about working here, however, is that there are always pleasant surprises that reward your endurance. 

This week there was a blow out about how the hospital staff are providing counselling before and after an HIV test.  It turns about that some are not following the standard of care which requires you to provide information about all the means of preventing the transmission of the virus to others.  In other words, the Catholic counselors simply tell people who test positive that they should never have sex again. 

But just when you feel like "That's the last straw,"  something happens that would never occur in the US.  We go to a party, and suddenly you are dancing hand in hand with the nurse who said he would never ever promote condoms in any situation.  He's smiling and swaying and you are smiling and swaying, the anger is gone, and amazement settles in.  While that soft Afro-Latin pachanga is pulsing, it seems like we can all get along and enjoy the moment.   

The next day it's back to the grindstone of working with no printer, no condoms, burned out volunteers, and overwhelmed management but that one graceful moment was a delicious reprieve and even small surprises bring a needed rest.

Love's Labor Lost?

It is time to retire my blog's former subtitle, "Love's Labor and Being Lost," because my feelings towards my work and surroundings have changed to the point that that subtitle no longer applies.

Love's Labor

When I first arrived, there was the delicious feeling of diving blindly into the kind of work I love: deep, intense, complicated, with layers and layers of social, cultural, emotional, economic, medical, and environmental causes and consequences.   Plunging into work was like jumping into a lake at midnight on a warm summer night- irresistible no matter the risks.  Rocks, seaweed, turtles, schistosomiasis… Who cares?   Just think of the feeling of water shimmering in the moonlight.    The thrill of working for a worthy cause was so powerful that it was easy to accept the inevitable difficulties as the price you have to pay for having an adventure and intellectually stimulating work.   

But after a few months, the daily struggle for basic funding and the chronic conflict between the Catholic and medical view of HIV/AIDS prevention have taken its toll.   So the initial enthusiastic outpouring of ideas and activities has changed to a slower more cautious investment of my efforts and emotions.  There is nothing exciting about not having ink for education materials and watching the diminishing enthusiasm and attendance of the unpaid volunteers .  And it is draining to work with people whose ethics are in direct conflict with your own.  So what started out as a delightful labor of love is becoming a grueling long-term commitment for better or worse.   The work is still important and intriguing, but it now feels like a stubborn struggle, not an energizing endeavor.

Being Lost

Initially I felt disoriented all the time.  Each time I took a taxi, say to Rondpoint Ngolak, I had no idea where I would end up…at the store with the item I needed, in a traffic jam, or diverted to some big mysterious ceremony.    

People would greet me by name, but their faces were unfamiliar and I could not tell if they knew me because they sold me an egg the day before or because they were the person in the support group who lost 3 children to AIDS in the last year.

Now not only do I recognize faces and know the names, but I also now know which people will show up on time, which ones are just being friendly to get money, which ones will help me with the language, which ones like to gossip and which ones know which gossip is true.   

I can walk home at night without a flashlight because I know which side of the road will be slippery and which shadows are trees, and which ones are people standing in the road.    

I am no longer lost.  I know what is going on.   Now the challenge is to keep moving forward despite the disappointments and complications.

Seeing Mount Boyo Through Fresh Eyes

Here are some great photos of the Njinikom area from Ingrid, a recent visitor.  I have been here long enough that I appreciate seeing the familiar scenes through fresh eyes. Here are her pictures from a hike up Mount Boyo.

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"Downtown" Njinikom with the view of Mount Boyo.

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Nestor hiking along the ridge.  In the background, under the eucalyptus trees, is a small house where a mysterious goat-herding hermit lives.

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Looking down on Njinikom from the top of Mount Boyo.  This area has one of the few remaining cloud forests in West Africa, actively being preserved from the expansion of agriculture.

Running on empty

I have been working at Project Hope for about two months now, but I still do not understand how the organization sustains itself on a day to day basis.  There are about 50 volunteers that work for Project Hope as HIV/AIDS educators, support group leaders, coordinating the home-based care program, and developing the programs for orphans and vounerable children. Only the three most senior managers receive a monthly salary.   The rest occasionally get a stipend for specific activities or trainings, but usually they are expected to do this important work for free.

For the last 2 months, however, there has been a cash crunch, so salaries and stipends have not been forthcoming.  Some people have received small discretionary payments, but it is not clear when or how much they will be to paid.

We have also run out of ink for our two printers and photocopier, and our three desktop computers all have a virus that needs to be fixed by a professional.  But there has been no money to cover these operational expenses, so we have gone without printed materials for the last 3 weeks.  Instead all notices, posters, proposals, and work plans are written by hand, or printed by "borrowing" a colleague's office.

There is an accounting system but only one person has access to it, and the source and amount of funding is mysterious.  I can not tell if the Franciscan Sisters can get emerrgncy funds from their many foreign friends, or whether they squeeze dribs and drabs from unused portions of the hospital or convent's budget to keep this project on life support.

How long will it be possible to operate on a day to basis without a budget for basic overhead expenses?  How long will the staff be able to sustain themselves on idealism, compassion,and good intentions?  This financial insecurity is already undermining the staff's ability to focus on the programs, and I worry that if this continues for much longer it will breed resentment and despair. 

Big Day Maria

Today was "Big Day Maria," a public holiday to celebrate the assencion of Mary, mother of Jesus, into heaven.  It is an offical holiday throughout Cameroon, so even non-Catholics like me got to take the day off from work.   

Here in Njinikom, the day was celebrated with two huge, interminable masses at the Catholic church where about 70 children took their first communion.  My camera is broken so you will just have to picture a parade of little girls in tiny white wedding dresses, complete with veils, gloves, and earnest prayerful expressions.  Boys were dressed in suits, most of which seemed about three sizes too big for them.  The most surprising moment of the service was when the priest said to the children, "Maria is our mother and Satan is our father."  No touchy-feel-good sermon here!   

Afterwards, the girls' soccer teams had a championship tournament in the field below the church.  I love the idea of a competitive girls soccer league and think that it is really cool that Project Hope sponsors a girls team as a way to empower young women and promote gender equity.  But I decided to not to watch the game because the only thing more interminable than a church service is a soccer match. 

Instead I decided to make the rounds of the community in order to partake in some of the feasts at the homes of the parents of the girls and boys who took first communion.  First, I visited the home of my official supervisor, Augustine, and met his wife and four daughters. They had a generous spread of all the traditional foods: chin-chin, chicken, koki beans, fufu and njama-jama. The girls were playing with balloons brought by some German visitors while the adults watched African music videos of writhing well-endowed females and studly men driving around the streets of Paris.

Then, I hiked up halfway up Mount Boyo to visit with another family where I ate eru, gari, and jolof rice.   Others were drinking cheap whisky and watching bad romantic comedies from South Africa and Nigeria.  One of the adult daughters there for the celebration had just come back from working at the United Nations and as a diplomat in Senegal and South Africa.  I tried to convince her to help me get a job in Geneva at WHO or the UN, so I can continue to soothe my restless soul and avoid coming back to the US while George Bush continues to erode our economy, ethics, environment, and human rights.

Then I went home to hang out with the cat and watch the sunset over the hills in my backyard. It finally occurred to me to count the number of mountain ridges from my house to the horizon.  There are seven.  But it was impossible to count the number of shades of grey, blue, and pale yellow as the sun set.  It was spectacular with rays of sunshine piercing through huge fortresses of cumulous clouds just as if to prove there really is a divine presense..the devil as father notwithstanding.

How the other staff lives...

I have moved again, leaving behind the moldy abode with the two Congolese seminary students, and moving back to the original place.   As a memorial, I wanted to send out photos just so you can see how the African staff and younger foreign medical students live. 

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The bathroom, which I shared with the seminary students.  The Austrian nun in charge of lodging insisted, "There is no point in providing a toilet seat since the Africans always break them."  But in the house where I now live with the more senior foreign volunteers, all the toilets have seats.

I never saw any spiders in the bathroom, but the German medical students that live in the other side of this duplex shrieked when they saw huge hairy critters in theirs.

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The backyard. After taking a shower, you had to walk through this courtyard, past whoever was hanging out doing laundry or otherwise killing time.

Contrast this to the view of a papaya tree, cow pasture, and mountain vista in my original (and now current) house.

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The kitchen with hotplate.  There was running water but no refrigerator.  I did not spend much time here because I lost my zest for cooking.

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The living room.  The green walls and dark floral prints gave this the warmth and charm of a medical ward or funeral parlor.  But maybe I am being too critical.... at least you can sit down and have a chat, if you are not undermined by a sense of gloom and impending depression.

Ups & Downs of Life Abroad

Living here can be a thrilling and fatiguing ride on an emotional roller coaster.   You can climb the heights of exhilaration one day, only to plunge into the depths of frustration a few days later. But to paraphrase a popular cliche, "When I am on the roller coaster, I am fully alive.  All else is waiting.”

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The "Upsides"

• New discoveries everyday: fresh passion fruit, a new waterfall, a great local expression (No be so?)
• People think you are a genius if you can master a few phrases in their local language (How are you, What is your name, Where are you going)
• The beauty and tranquility of rural life (except for the rooster crowing at 6AM every morning)
• Walking by moonlight.  The smell of pine and jasmine at night.  Overhearing familiar but unexpected melodies wafting out of people’s houses.
• The sense of accomplishment knowing that it is possible to live on $224 a month
• Intense conversations about religion, relationships, culture, and other complex and controversial topics

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Incandescent smiles and extended eye contact

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• Distance from the global crises in the news:  The wars in Iraq, Israel, Lebanon, global warming, the erosion of the bill of rights, and the administration’s subversion of the international statutes against torture, all seem so far away that they are almost irrelevant.   I have important work to do and an opportunity to make a difference in a cause that I believe in.  I do not have much time or energy to get bent out of shape about macro issues that I have little or no control over. 

• Seeing clients in the market, on the street, and how they live life day to day.   They are not just anonymous beneficiaries or AIDS victims that you encounter in their deepest crisis and never see again.  They are three-dimensional people living ordinary life in real time.  You know their children, what they sell in the market, what happened when they disclosed their status to their husband, how their family’s reaction has changed over time, how well they sew, where their fields are.  How they can be generous, annoying, listless, encouraged, ordinary, and extraordinary depending on the day and the people they are with.

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The Downsides

• The taunting tone of children as they yell “Wabong-na” or “White man, give me something” as you pass

• Working at my desk, hearing the endless inconsolable wails of toddlers in orphanage—visiting the orphanage seeing the dead eyes of the teenagers who are supposed to be caring for them.  Are the babysitters so depressed, neglected, and abandoned that they have no empathy left for others?

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Mystery meat: What is this that they are offering me?  Egussi?? What’s that? Cow brain?  Ground kidneys?  Mashed bitternut seeds?  Smoked monkey meat?   People will be offended if I do not eat it…Oh well, just eat it and don’t think about it.  Ugh!! Stomach churning, waves of nausea, fear.  I hope I do not regret this later.

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• Impatience with the slow pace of change.  It is discouraging when impediments seem to be blocking new approaches and undermining the progress you thought you were making.
• Worrying about reverse culture shock:  Will I hate going back home to a city without views of the mountains, where people do not greet in the street, where fruit is expensive and relatively tasteless?   Will Americans seem shallow and self-centered when I return?  Will press coverage of Africa strike me as condescending and awash with pointless pity and pessimism?  When I get a “real job,” how will I be able to tolerate sitting in an office all day, developing and managing social service programs for clients that I have little or no contact with? 

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Despite the vicissitudes to day- to-day life, in the end it is satisfying to experience life in all its intense details and to observe the constant changes both within and around you.  At times, it may push you to your limits, but it sure is more interesting than most movies and TV shows.

Beaten by witches

amazonI have had a cold for about a week now.  It started out with the normal allergies, scratchy throat, sneezing, and sniffles.  Then it graduated to back aches, fatigue, and bone pain. 

I was telling the folks in the office about it, and they said that around here people would say that the back pain is the result of being beaten all night by witches who want to punish, kill, or drive me out.  So, I decided to make a joke about it with the next person I saw.   "Can you help me?  I am being beaten all night by witches.   What can I do?"  Their jaw dropped and a look of shock stopped them in their tracks.   "Sorry!! You need to leave immediately and go back to the US. The people here are evil.  You must go before they get you."

After reassuring them that I was just joking, I got to thinking what it would be like to live in a community where you sincerely believe that your neighbors and extended family would harbor such ill will against you that they would pay a traditional healer to cast an evil spell on you.  In the olden days, such witches and sorcerers would be exiled from the community.  But people say that now witchcraft is so pervasive that people are afraid to take action against sorcerers for fear of being accused themselves of practicing witchcraft.  I guess there might be a certain sense of security in believing that no illness and accident is random, and that every occurance has a meaning.

Slippery when wet

More shots of the rainy season...

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Walking back up the hill to the hospital and my house after an afternoon of shopping.

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Bringing back lunch.  People carry balls of fufu in thermos containers like this.

HIV/AIDS Care in Njinikom

HIV/AIDS care here in Njinikom is quite good.  The hospital offers many services that did not used to be available in Africa, like CD4 counts and anti-retroviral medications.  Unfortunately many people can not afford it even with government subsidies. 

MEDICAL SERVICES

St Martin de Porres Hospital, where Project Hope is based, is a government approved HIV/AIDS treatment center.  It provides a full spectrum of services including the following:

• Voluntary counselling and testing.  Confidentiality is strictly enforced.  An employee was recently fired for warning his friend that a woman he was dating was a patient who tested positive.
• Prevention  of Mother to Child Transmission- Nevirapine and zidovudine are available to pregnant women and if taken appropriately will prevent HIV transmission from monther to child in about 95% of cases as compare to about 80% of cases with neviropine alone (monotherapy.)
• Highly active retroviral therapy- the hospital offers two highly effective drug cocktails that uintil recently were not available in Africa.  This treatment is available for free for children 0-15, once they pay for all the pretherapeutic tests such as a CD4 count, liver panel and kidney function test.  This used to cost about 18,000 ($36) but with subsidies was just reduced to $6 by the Ministry of Public Health.
• Adherence clinic for people taking antiretrovirals to make sure they were complying with treatment and not experiencing problems with the ARVs.

This is a really comprehensive spectrum of services, far better than what was the norm for AIDS programs in African countries in the 1990s.  At that time, treatment was not available so organizations focused on prevention and home-based hospice care.

COMMUNITY OUTREACH

Project Hope complements the hospital's medical services with community outreach and support for people infected with or affected by HIV and AIDS.  Their services include:

• Education, awareness raising, and prevention (but no promotion or distribution of condoms)through market outreach and youth clubs. I plan to work with Project Hope and local church leaders on developing some sermons that reduce the stigma, discrimination, fear, and denial surrounding HIV/AIDS.
• Promotion of HIV Testing.  We are thinking of starting an outreach through bars because people who drink are more likely to have unprotected sex.  Furthermore, if they can afford to buy beer they can afford the cost of an HIV test (the price of 6 beers).
• Support groups for people living with HIV and AIDS
• Training in income generating activities for people living with HIV and AIDS, who are advised to avoid strenuous farm labor and need extra cash to pay for their medication and check-ups
• Orphan and vulnerable children program, including training for the family caregivers and partial financial assistance with school and medical expenses.  In addition, we just won a proposal from CARE which will pay for the school fees of 100 orphans.
• Home-based care program for people living with HIV/AIDS

In short, Project Hope is providing a lot of needed services.  In fact, it is considered to be the best community-based HIV/AIDS program in the country, despite their not proving information about and access to condoms.

Cameroonian Cuisine

The food here in Njinikom, and in the North West Province in general, is very plentiful, inexpensive, and good. Fresh fruits and vegetables abound. Right now corn, bananas, peanuts, tomatoes are in season. Habanero peppers are also always available and are the most popular seasoning after Maggi (or salty, meat-flavored bouillion cubes.) People eat a bit of meat and fish if they can afford it. Servings are usually very small, the size of live mouse (or half the size of a computer mouse). In other parts of Cameroon, people eat monkeys and other wild game, but here they only have chicken, beef, and goat in very small quantities.

Cameroonian cuisine is very satisfying comfort food. It is not fancy, but it is flavorful. One of my side goals is to get my cholesterol level down to a level where I do not need to take lipid lowering medications.  I might just be able to achieve that if I can avoid the palm oil and fried foods, like the delicious "beignets" or small doughnuts/munchkins.

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BREAKFAST

• Banana muffin: 30 cents
• Coffee with powdered milk (must make at home)
• "Pap with teabread:" traditional breakfast of slightly fermented corn porridge (pap) and sticks of fried dough (teabread)

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LUNCH

I almost always eat at the hospital canteen because it has good, inexpensive freshly cooked food.

• Fufu and njamajama: 50 cents.  Fufu is cooked cornmeal, tastes like polenta.  "Njamajama"
• is a sauce made of cooked huckleberry leaves, a drak green slightly bitter leaf like a cross between spinach and kale.
• Rice with peanut sauce: 30 cents
• Manioc with okra sauce; 30 cents
• Plate of black beans cooked with garlic, ginger, and palm oil: 20 cents

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Youths eating rice with groundnut sauce. 

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DINNER

• Grilled mackerel with "bobolo" or stick of slightly fermented manioc: $1.25
• Spaghetti made at home
• Potatoes mashed with red beans and mixed with palm oil (free at a friend's house)

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SNACKS

You can get all sorts of great snacks by the roadside. 

• Corn: one cob, grilled 20 cents
• Mangos: 5 for 10 cents
• Pineapple: 30 cents
• Peanuts: handful of fresh peanuts 20 cents
• "Soya" or meat on a stick: 20 cents each, need 2-3 to fill up

In addition, you can get imported packaged foods, like cookies from Saudi Arabia and the Phillipines, which are more expensive