Life and AIDS Work in NorthWest Cameroon

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.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

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.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

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

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

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.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

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. 

====================================================================================

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

Are they saints?...

======================================================================================

....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.

=====================================================================================

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.

=====================================================================================

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.

====================================================================================

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.   

====================================================================================

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.

=================================================================================

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

===================================================================================

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

============================================================================

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.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

"No food for the lazy man."

- Embroidery on purse.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

"Keep out evil."

- Painting in bar

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

"If I Be Know"

- Sign for car wash

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

"God's time is the best."

- Sign on sandwich and omelette cart   

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

"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

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

"If na you"... then who?

- Mud flap on bicycle

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

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

- Motorcycle mudflap

 

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

"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.

======================================================================================

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...

**********************************************************************************************************************

Watching the sunset on my backporch.

**********************************************************************************************************************

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

**********************************************************************************************************************

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

**********************************************************************************************************************

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.   

**********************************************************************************************************************

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."

**********************************************************************************************************************

Cute kids

**********************************************************************************************************************

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

**********************************************************************************************************************

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

**********************************************************************************************************************

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

**********************************************************************************************************************

"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!

**********************************************************************************************************************

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.

**********************************************************************************************************************

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.

Teaching: A "Delicate, Noble, and Tantalizing Profession"

October 5 was "World Teachers Day" a national holiday celebrated with much pomp and circumstance here in Cameroon. Although it is called "World Teachers Day" I have not heard of it being celebrated in any other country. Indeed, one person I spoke with yesterday had a cynical conclusion. He said, "The government did not want to provide teachers with good pay or working conditions, so they "dashed" them (i.e. bribed them) with one day off."

Three of us from Project Hope attended to present information about how HIV/AIDS is affecting students, teachers, and the community in general. 11% of youths, or about 1,500 students, in Njinikom have HIV/AIDS, and Project Hope has identified at least 900 children in Njinikom who have lost one or both parents, many of them to AIDS. We described what Project Hope is doing through youth clubs and what the teachers can do to help contain the epidemic and help the people who are affected.

==================================================================

Festivities began with a march through the middle of town. Teachers sang, "I am a pedagogue, and I will do my best" dressed in outfits made with the official "Teacher's Day" fabric.

==================================================================

This young girl gave one of many speeches. "A teacher can not give what he does not have. A teacher who ceases to learn ceases to teach... Concern for each pupil gives them the push to dive into the river of learning with both legs and climb the ladder of success not with hands in pockets. Values are not taught, they are caught."

==================================================================
Here Francis Nkwain, a town elder who has served as a teacher, school administrator, and diplomat in Washington DC and New York City gives the history of professional teachers in Njinikom, beginning with the German missionaries.

He also alluded to some of the problems teachers face:  low wages, huge classes (one teacher I know has 90 eleven-year-olds in her class.   "Do not turn to drink out of frustration. Do not become indifferent and cease to care. If the world fails to reward you for your work. God will certainly reward you."

Absenteeism and corruption are problems in government schools.  In some, 30% of the teachers never show up for work and just draw a salary while working at private schools or running a private business.
==================================================================

Two teachers take in the speeches. Njinikom has two Catholic schools, so many teachers are nuns.

==================================================================

Next, the town notables handed out certificates of appreciation to top teachers.
==================================================================

Here one teacher shows off her certificate.

==================================================================

7 weeks and counting...

I am returing to my village today. I dropped my parents at the airport on Saturday and and stayed in Yaounde for a couple of days to work on establishing a new website for Project Hope, here at the Peace Corps office where the connection is fast and free.

I made the best of my time away: I shopped for hard-to-find items like chick peas, jam, and M&Ms, got a haircut, ate a lot of butter with my fresh bread, did some rigorous research on where you can get the best chocolate ice cream in Yaounde.

Seven weeks from today I return to the US, so  I have been pondering on what I want to do with my remaining time here.

• Teach Evaristus how to maintain the website
• Work with Tim Paul to complete the communication plan for the common childhood illnesses and pretest the messages and materials we developed
  
• Make final recommendations about the leadership and management of Project Hope and submit to Sister Xaveria
• Find out who FPaul is intending to marry and if possible, meet the lucky lady
• Finish my quilting projects with help from Titus, the fabulous tailor in Bamenda
• Eat as much fresh pineapple as I can
• Find a job in the US so that I can hit the ground running and not mope about the cold and the lack of fufu, jujus, and unexpected adventures

=====================================================================================

Eric, Evaristus (the new web guru), and me

Why am I here? What am I doing? Who do I want to be?

Being abroad for 6 months, away from friends and family, living on a tight budget, with little access to the normal distractions and amusements gives one a lot of time to think about existential issues.  Usually, I just spin round and round in my head, and once I am fatigued I simply decide to enjoy what is around: the view, the jokes, the ironies and oddities of everyday life.  But every once in a while, I get a glimpse of insight into the bigger questions and issues invoked by this extra-ordinary adventure.   

My latest batch of thoughts were inspired by Robert Strauss, the Peace Corps Director of Cameroon.  The following are some excerpts from his monthly mailing, edited to focus on what I thought were the most interesting points.

******************************************************************************************************

Along with all the various hardships one faces in Cameroon, we are also confronted with the same questions that many Peace Corps Volunteers - here and around the world - continue to confront. "What am I doing?" Did I make the right choice?" "Why am I here?" "Why are we in Cameroon?" "People here aren't starving. Shouldn't I be working where people are starving?" Or "Why am I not working at home to alleviate poverty? There are more pressing needs just miles from where I used to live than there are here."

Since arriving in Cameroon I have conducted many interviews, met several dozen of you in the office and more in the field. Every interview has been interesting. Some have been challenging, other intriguing. None, unfortunately, has provided me with philosophical tautologies to answer any of these questions. What they have done is clarified some thoughts I have about how one can think about the fundamental questions of development and how we decide what to do now that we are here.

Development itself is a peculiar field. How do we define development? From whose point of view? The United States, in terms of material acquisition and infrastructure, is by most standards "developed." Yet judged on the basis of American rates of murder and family cohesiveness we are perhaps not so developed. In the face of such conflicting information, how do we think about what we are doing here in Cameroon?

Not long ago I took a seminar in which the facilitator asserted that seeking answers to "why" questions was a waste of time. Find out "why" you do something and so what? Where does that leave one? Every why question generates a reason as an answer which can provoke another "why." At the seminar the facilitator had us go through endless cycles of "why" and behind each answer, behind each reason, there was always another question and another reason. And the reasons, though self-satisfying and self-justifying, ultimately got us all nowhere. Likewise with "What am I doing?" and "Did I make the right choice?" kind of questions. These are questions, as my facilitator pointed out, that don't get us anywhere. They serve mainly as some type of psychological justification for what we have already done. They do little to get us where we want to be.

The questions to ask, the facilitator suggested, are, "Who do I want to be?" or "What am I personally committed to?" The answers to these types of question draw us into the future. In the face of adversity and challenge (as we are all likely to face in Peace Corps), the answers to these questions pull us toward a future that inspires us, toward a personal possibility and commitment. The answers to "Why am I here?" or "What (the hell) am I doing?" don't do this and more often than not come from something that is pushing us from behind - such saving face, or parental judgment, or finishing up something no matter what or how distasteful. How much more powerful it is to be drawn forward by a personal aspiration or commitment.

In any given situation in life, no matter the hardship, we can choose to commit ourselves to something that inspires and motivates us by answering the question, "Who do I want to be?" In a Peace Corps context, this could be being the best teacher one can be, being an inspiring and supportive manager, being a compassionate and irrepressible health educator, or maybe simply being a good listener. The character of commitment is often built around an adjective; compassionate, dedicated, adventurous, supportive, innovative. You can try a different one on each day - "Today I'm going to be adventurous" - until you find the one that works for and inspires you. The beauty of this approach is that we don't have to like what we are doing moment by moment because what we are doing moment by moment is motivated by the person we are committed to being rather than the actions we are taking. The actions are taken only in service to the commitment, not in and of themselves. So when teaching or managing is a drag, or when all the crops have withered, or when the funds have been diverted, or when people didn't show up when they said they would, yes, it's distressing, it's troubling, it's unfortunate, it's a pain. But ultimately - unless there is arterial bleeding going on - it doesn't matter because circumstances and emotions do not need to affect the person you have chosen to be. You can continue to choose to be that person. And your commitment can sustain and inspire you in the face of bad weather, broken promises, failed communication, and all the many other annoyances that can plague and get us down.

So decide who you want to be: bold, courageous, compassionate, loving, adventurous, and try it on. Walk in that character for a day or a week or a month and see how it feels. And how the world around you looks when you see if from the point of view of a personal commitment you have selected. And then let me know how it works and how if feels.

Trek to Lake Oku

On Sunday, we rented a 4-wheel drive truck to take us to the mystical and mythical Lake Oku in the nearby Ijim forest preserve.  This is an important site for studying biodiversity, and it has some rare species of birds, frogs, and vegetation that are not found anywhere else in the world.  For more information about the interesting ecology of this area, see the following links

• http://www.birdlife.org/action/ground/bamenda/bamenda3.html 
• http://www.projectexploration.org/projectfrog/fu-082106.htm

====================================================================

Piling into the truck:  F Paul and Shannon in front, my father and mother in back.  ==============================================================================

The road was so steep and slippery, sometimes the drivers' assistant needed to get out to put stones under the wheels and push the truck out of the muddy ruts in the road.

=================================================================================

When the road got too steep and our bones ached from bumping along the rugged track, we got out of the truck and hiked up the rest of the way.

=============================================================================

F.Paul leads the way.  He has a masters degree in ethnobotany and studied the medicinal uses of the plants in this forest preserve, so he was definitely in his element.

=============================================================================

An Alchemilla glistening with dew.  This forest preserve is one of the few remaining cloud forests in West Africa, and the plants gather most of their moisture from the mists that are continuously drifting through.

===============================================================================

Prunus Africanus.  The bark of this tree has been stripped and sold to a pharmaceutical company which uses it to create a drug to treat prostatitis.

==================================================================================

The clouds drift by the summit and when they lift, they reveal the mystical Lake Oku.

==================================================================================

After visiting the Lake Oku, we stopped by to greet the second class chief.  We gave him 5 liters of wine as a tribute for visiting the forest.   We marveled at the traditional carvings on his house.  Only three people in the entire Kom kingdom are allowed to decorate their dwellings in this manner.

==================================================================================

The women's group of Anyajua were excited to meet my parents.  They sang a traditional welcome song and danced around with peace plants in a gourd.

====================================================================================

While in Anyajua, we also stopped by to say hi to FPaul's mother.   Here we are posing in front of the house where he was born.