Life and AIDS Work in NorthWest Cameroon

Dreams Come True

In the last week, my last in Cameroon I have come full circle.  I now see that many of my dreams have come true during my six months on Cameroon.  I mean dreams in both senses of the word:

::: Dreams, the lofty aspirations you think you may never achieve, such as taking six months off to work in Africa on HIV/AIDS at the grassroots level :::

as well as

::: Dreams, those surreal nocturnal experiences that evoke magic or menace, like the dream of flying, losing all your teeth, or going to work naked, again ::: 

I am lucky to have achieved things I have dreamed about for years:

• Engaging in hands-on development work in Africa with little or no bureaucratic paperwork
• Collaborating with a team of talented individuals whose commitment and communication skills sometimes gave me goosebumps
• Creating a network of Cameroonian friends and colleagues
• Exploring an almost undiscovered paradise and its complex culture
• Adding some new items to my repertoire of exotic languages and anecdotes
• And, last but not least, enjoying the support of a spouse who understands and appreciates my independence and idealistic ambitions   

Yet, on the other hand, I have also encountered difficulties that are so profound that they left me feeling dislocated and doomed.  Indeed a few of my meetings with the Mother Superior/Executive Director were so unpleasant and unpredictable that they felt like a nightmare gone awry.

We usually talked about important problems, such as donations going "missing" and whether or not condoms are an ethical way to prevent HIV/AIDS.  But when the Matron felt that her authority was questioned, she could become hostile and go on the offensive, asserting her control through cut-throat criticism.

In the end, we could not bridge the deep rift between our world views despite common goals and good intentions.   Yes, we both recognized that we are similar in many ways: opinionated, passionate, and committed to what we believe is right. 

But  even after countless conversations, we still had completely different opinions. I believe condoms are an ethical way to prevent HIV/AIDS.  She believes they are an evil device that promotes promiscuity and anyone who uses them will burn in hell. 

But I suppose that is a lesson in and of itself: some differences are irreconcilable and no amount of conversation or cultural relativism can overcome them.  In some cases there is no universally acceptable interpretation of ethics, and efforts to create one may be futile.   I suppose that is what makes my experiences here a gritty reality, and not a dreamy illusion.

Grand Finale

Alex and I enjoyed my last week in Njinikom to the fullest.

On Sunday, we went to FPaul's Thanksgiving celebration at the Martyr Baptist Church in Wombong.  Unlike the American version, in Cameroon Thanksgiving is celebrated by giving a portion of your harvest or annual income to the church to express gratitude for a year of good work.  In my case, I was giving thanks was for spending a wonderful five months in Njinikom and for surviving the bus accident unscathed.

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Thanksgiving offering

Little girl and congregation

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On Monday, I got caught up on work: teaching staff how to complete the design and content of the new website, while Alex stayed at home and got caught up on his own work for MOTU.

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On Tuesday, we went to a raucous potluck dinner at MacDonald's (also known as the bad boy Snoop MacYeng.)   The food was excellent as usual and spirits were high.  Alex ended up drinking far too much Guinness.

Here we are with Gloria from the pharmacy.  She likes to joke she will be the future Minister of Health, so we need to be nice to her now.

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Wednesday night, Alex and I were invited to the convent for prayers and dinner.  Alex's head nearly blew off when in the midst of the high pitched singing the nuns whipped out their drums and pounded out an uplifting beat.

Thursday was spent on more work, revising budgets, completing reports, and conducting my last program management training session.

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On Friday, Project Hope organized a large send-off party for me, complete with traditional dancers, a present of matching traditional outfits, a plate of delicious ginger scented fried chicken, and many quintessentially complex Cameroonian speeches.   "Who is Fiona Smith?" intoned T.Paul.  "That is what we are here to discover and discuss."

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Saturday, we went with Fpaul and his fiancee, Victorine, to visit the two most powerful traditional leaders in our region:  The Fon of the Kom people, and the Ado, who leads the Fulani herders that live high up on the plateau.

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Here Alex arrives at the Fon's with FPaul.  Alex must not have made the right sacrifices to the Saint Cristopher the protector of travelers, because on this trip the motorcycle he was originally riding on broke its chain, and he needed to get a ride on FPaul's motorcycle.

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The Fon.  He is an old man of about 80 with about 60 wives.  He was very interested in FPaul's fiancee, Victorine, asking her name, address, and father's name.   Both of them were freaked out by the experience and were dreading the red X that appears at the doorway of the intended's house.  No one knows what happens to the women who turn him down.

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The heads of certain neighborhoods are required to donate carvings to the Fon.  Here I am standing in one of the most elaborately carved doorways with two of the Fon's more than 100 children.

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We continued hiking until we got on top of the plateau where the Fulanis live and herd their cattle.

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The Ado.  He is very laid back and approachable in comparison to the Fon.  The Fon required a donation of $30, but the Ado was happy to receive 4 blocks of soap worth about 80 cents.

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The hike back was equally spectacular with views of volcanic hills in the mist.

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Victorine and FPaul.

One of the highlights of the hike was watching the two of them joke around and entertain each other.  At first, Victorine was very shy around me, barely saying five five words (yes, no, I don't know) in my presence.  So I was pleased and relieved to see her open up and actively engage in conversation. 

It is great that they can now be more open about their relationship.  Up to recently, they hid it because pre-marital relationships, though common, are not really approved of in the culture.  Furthermore it is expensive and intimidating to get engaged because of the number of hoops you have to jump through to get the families' formal approval and save money for the wedding.

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.

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.

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

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

A Reprieve to Refocus

September has been a time of tentative new beginnings.  Project Hope is always involved in a broad spectrum of spontaneous activities that are tangentially related to HIV/AIDS.  So I have been working on a creating a communication strategy to tackle diarrhea among children under 5 and on management training with the three paid staff to develop a strategic plan for revitalizing this organization and moving it forward.

One key issue is to decide how integrated Project Hope's approach should be.  As a spontaneously evolving community-based organization, it addresses some of the causes and consequences of HIV/AIDS like poverty and preventable illnesses.  Project Hope has already established income generating projects for people living with HIV/AIDS so they have a viable alternative to farming.  This makes sense because one of the reasons people do not get tested and treated for HIV/AIDS is lack of income.  Project Hope also works on integrated management of childhood illnesses: diarrhea, respiratory tract infections, and malaria, because they affect the orphans and vulnerable children in our program.

But the disadvantage to an integrated approach like this is that organizations needs staff with a broad range of skills.  The bookkeeping skills that help you run a successful small business are not the same skills that allow you to train community based organizations in digging wells and protecting water sources.   Of course, counseling on HIV/AIDS requires a whole other set of medical knowledge and psycho-social skills.

Sometimes an integrated program feels like it is not focused enough to be effective.  But on the other hand a narrow program that only provides HIV/AIDS treatment and promotes abstinence and fidelity does not meet all our clients needs.  In addition, being involved in activities that are not HIV/AIDS related helps Project Hope reach people who are still afraid to be associated with us for fear of being stigmatized as being HIV positive.

Is Project Hope's integrated approach open-minded and enlightened?  Or is it diffusing its limited resources in tangential issues?  It is too early to tell for sure, and in the end, it may be both.

Back to School Spirit

Labor Day is celebrated on May 1 in Cameroon, as it is in the rest of the world.   So tomorrow is not a holiday,  but the first day of school. 

Already the village is in back-to-school spirit, bubbling over with teenagers back from their holidays in the big city.  There are sophisticated strangers parading down the road, calling out to each other in exaggerated nonchalance.  Teenage girls saunter seductively in skintight pants, and boys strut in baggy jeans and slouchy hats.  I even saw a few couples walking down the road hand in hand, something you hardly ever see around here. 

This afternoon everybody is down at the soccer field watching yet another championship soccer game.  Meanwhile, at the tailor shops, seamstresses are working overtime to finish school uniforms: royal blue polyester pinafore dresses for girls, and white shirts and navy slacks for boys.

Njinikom has no less than 3 secondary schools: VOTEC where you can learn to run small businesses like a family restaurant, hairdressing salon, or tailor workshop; Jua Memorial College, where you can study liberal arts and social sciences; and the Georgian Academy where you can learn construction, carpentry, computers, and other practical skills.  In this area, starting private schools seems to be a cottage industry, there are at least three other secondary schools within an hour's drive.

I am hoping that the optimism and enthusiasm of the returning students will rub off on me.  I had a rough August with two projects dissolving.  At the tailoring workshop for people living with HIV/AIDS, the tailor in charge has continued to drink on the job despite repeated warnings.   Even worse, he stole money from sales, but since he is the brother of one of the nuns it seems impossible to get rid of him. 

The market program in Belo has also been floundering.   Eric, the charismatic outreach worker who showed up reliably week after week, got married and is under pressure from his in-laws to go to the capitol to earn money at the Guinness factory.  In addition, he feels like he has been marginalized fro Project Hope because he received training from an organization that incude condom education as part of this HIV/AIDS prevention approach.  Efforts to find and train a replacement in the village of Belo to have been unsuccessful.  We recruited people for 4 weeks and in the end trained 13 peer educators, but after the training no one showed up to take over.

People have been trying to console me by saying that such problems are common in Cameroon and that you can learn a lot from failure.  Unfortunately, I have not had any brilliant insights yet.

So here's hoping this September I can make a fresh start and get past this entropy and apathy. 

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.

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. 

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.

The story of Joel and an orphan support project

In the nearby village of Belo, there is a volunteer who is writing profiles of orphans in the community.  I was impressed by the comprehensiveness of the needs assessment and the thoroughness of the project plan and wanted to share it with all of you.  Although it is difficult to hear the stories of such children, it is heartening to know that people are working hard to help them.

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The profile below was written by Andrew Berger Seed of BERUDEP, and he can be reached at berudep@yahoo.com.

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NAME: Joel Xxxxx

AGE: 9

HISTORY: Joel’s mother had four fatherless children out of wedlock. The mother and four children lived with Joel’s Grandfather and Grandmother. When the Grandfather (provider for the house) died the traditional succession process was followed. The grandfather’s brother had to take on the Grandmother as a wife and provide for her family. He moved into the compound with his two other wives and children. When he died the succession went to the third brother of the original Grandfather. The current Husband and provider lives in the S/W province and rarely visits. Two months ago Joel’s mother died. Joel’s Grandmother is the sole Guardian of the 4 children now and is in bad health. Also living in the compound are the three children of the second successor’s first wife who also died recently. The oldest child takes care of the two young ones and also has a four month old fatherless baby herself.  The last member living in the compound is the second wife of the second successor. Her child is almost grown up and living in another province.

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MEDICAL HISTORY/SPECIAL NEEDS: None

SCHOOL ATTENDED:  None

CURRENT EDUCATION/PROGRESS:  Has completed primary 2 but his Grandmother cannot afford future fees. Would like to do full education.

BROTHERS/ SISTERS

Emmaculate – 19 years old educated up to primary six – will be provider for family when Grandmother dies.

Kelvin - 15 years old and currently lives with an Aunt in the S/W province. He is healthy and has his education paid for him by his Aunt.                                         

Eugene- 11 years old and has completed primary 4. He has been staying in the care of his Aunt in the S/W province since his mother died. He will be returning at the end of the school holidays.

COMMENTS: This is a high priority case where a young child cannot go to school because he has no family members left who are able to pay the school fees. If he should become sick or need any medical treatment it could prove fatal.                                                                    

HOST FAMILY PROFILE                                                                                     

HOST PARENT’S NAME: Veronica Fichcai                                                                   

AGE: 65+

PROFFESSION: Works farm when able however can barely walk.

RELIGION: Christian

FAMILY STRUCTURE: 

GRANDFATHER (dead)                  

GRAND MOTHER

MOTHER (dead)

FATHER (absent)                  

GRANDFATHER's 2^nd SUCCESOR (dead)

GRANDFATHER's 3rd SUCCESOR (dead)                                                   

FATHER'S 1^st WIFE

FATHER's 2nd WIFE (dead)                                                                                                      

4 CHILDREN (no father)                            

3 CHILDREN of GRANDFATHER's 2nd wife

1 INFANT (child of eldest daughter – no father)

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ADDRESS: xxxxxxxxxx

DISTANCE FROM BELO: 10 mins walk

DISTANCE FROM SCHOOL: 15 mins walk

COMMENTS: We would like to sponsor all 3 children living with Grandma plus the other 3 children living on their own from the second successors first wife.

COST: 3 pounds 78 pence per week

When the going gets rough...

As some of you already know, the last two weeks have been very stressful for me.   First I observed an abstinence only HIV/AIDS training for youth club leaders, which included false information about condoms and a fair amount of moralizing which implied that HIV/AIDS is linked to laziness and other sinful attitudes.  I am doing what I can to remedy the situation, but it is very draining and disturbing to witness this.

Then on Monday, I was suddenly and inexplicably moved from one house to a far more rustic one, which although it is much larger than my previous place, smells strongly of mold, has no toilet seat, no refrigerator, and almost no kitchen supplies.  Instead of a view of mountains in my backyard, I now look out onto 4 outhouses.

So what to do when the going gets rough?  Go shopping of course!

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Fabric shopping with Ingrid, a friend of Shannon's, here for a 4 week visit.

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I am babysitting the cats of the two Catholic missionaries who are now living in my former room.  Here is one posing on one of my new fabrics. 

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Here is the other kitten playing on the other fabric that I bought.

Making Napkins

This Monday, there was a sewing workshop for one of the support groups for people living with HIV/AIDS.  The purpose of the workshop was to teach them some skills that would help them pay for their medications

One of the activities was learning to make napkins, which could be sold to the many foreign visitors and volunteers who come to Njinikom.  The first day, the participants struggled with the machines which seemed to eat the fabric alive, skipping stitches, bunching up in ugly puckers, only to dissolve in other places.  No way would a foreign visitor buy a set for $10 even if their bleeding heart was hemoraging.

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So, today, I tried a different approach, sewing by hand. 

Here is the facilitator of the support group, Jean Bernard, giving it a try.

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Everyone seemed to grasp it really quickly, which was encouraging.  But what was discouraging was the strong smell of cheap booze wafting from the official trainer (not pictured).  And it was not even 11am.   The person in charge will talk to the trainer to make sure it does not happen again, especially on Thursday, when we have visitors from UNICEF Andorra stopping by.

Goat-raising for family caregivers of AIDS orphans

Project Hope has a pilot project with Heifer International in which the family caregivers of AIDS orphans are given five goats and training in how to house, feed, and care for them.  Goats have about 3 litters a year, and the idea is that these caregivers sell them and use the money to pay for the food, clothes, school fees, and medical expenses of the AIDS orphans that they are taking care of.

The goats are fed banana leaves, which have a natural ingredient that prevents diarrhea.  One of the interesting parts of this program is the ethno-vet program....growing herbs that serve as natural antibiotics and other medicines.

This old man is one of the caregivers, and in the background is Augustin, who runs the project Hope's program for AIDS orphans and other vulnerable children.

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Hilda from Heifer International and Augustin in the process of doing a participatory evaluation of the goat raising project for the caregivers of AIDS orphans.  The group listed their goals from the past year and then used beans to vote on how they did on each objective. 

For each objective, (for example, improve family nutrition, improve income, raise more goats, etc.) each person in the caregiver support group voted whether the activity was in "seed" phase (a good idea that had not yet sprouted); seedling (small initial activity); tree; or fruiting tree (the activity was benefiting community members.

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Goat shed used to shelter the goats from the rain.

Market Outreach

Yesterday, we started a market outreach program in a new town.  We met with the mayor to introduce the idea during my first week, and for the last week, the market outreach volunteer, Eric has been securing the space getting the names of interested volunteers, gathering supplies, and begging for the $3 needed to pay for transportation, since we have not received UNICEF funding for the last 6 months.

When Eric arrived the promised stall had been given to someone else, he had to clear out the new space and sweep it out before he could hang up the posters.  But once he got out the microphone, he was able to lure in a large crowd, not just of youth who are the primary audience, but also many adults with questions and concerns.  Can you get AIDS from eating from the same spoon as an infected person?  Is it true that a man can prevent AIDS by practicing the withdrawal method?  One woman came for advice because she tested positive four years ago, has three children, but her husband refuses to get tested or to use protection.  A policeman came to say that condoms are causing sexual disorders and perpetuating AIDS.  Fidelity is the only answer, and these are the final days as predicted in the bible.  A boy came to ask what can he do to help with older brother who has AIDS but can not afford the $6 per month needed to pay for treatment.

Be sure to click on the second photo to se how the youth are responding to our AIDs prevention messages.

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Training Dynamos

All this week, we all worked hard to plan a training for 50 women who lead local women's groups.  The topic was managing common childhood illnesses, including malaria, malnutrition, pneumonia, and HIV/AIDS.  There were many memorable moments.  Both the trainers and participants were lively and engaged: clapping, questioning, joking and throwing out big concepts and rich vocabularies.  Almost all women knew how to read and write, took copious notes, and were quite vocal and knowledgeable.  One even knew malaria was caused by the Anopheles mosquito, which she knew by name.

Photo 1: Local artist, Serginus, aptly pronounced "Sir Genius."  He is a shy young man who in addition to making incredible illustrations pof the various healthy and unhealthy behaviors, takes care of his sick, widowed mother and two younger siblings.

Photo 2:  Trainer par excellance and man about town, T Paul. 

Photos 3-6:  Members of the particating women's groups.  They had great names like "Bind Us Together," Love Ourselves,and Momora Farmers Union (an all woman group.)

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My Colleagues at Project Hope

Here are pictures of some of my coworkers at Project Hope.

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1. The Project Hope main office, a container,with a roof on top. we also have a youth and AV entertainment center in a different building on hospital grounds.

2.  Jean Bernard- Oversees the home based care program for people living with HIV/AIDS, which is currently serving about 150 people in this area.

3.Dr. Chris Nji, Project Director, with Sister Anastasia, Finance Manager

4.  Pamela, the Internet diva at the hospital's cyber cafe where I write this blog.

5.  F. Paul and Shannon- collaborating on Monitoring and Evaluation and writing up a curriculum about worms and other intestinal parasites

6. Shannon, Serginus, and T-Paul: developing materials for a training.

My first day at work

After a relaxing weekend of going to market, checking out the Catholic youth service, and settling into my nice new apartment, I had my first day at work, which started off by, of all things, throwing up right in front of the office.  I had taken my malaria prophylaxis without eating breakfast, which made me nauseous.  Fortunately there was only a cup of coffee in my stomach, and I don't think anyone noticed.  But needless to say it was a surprising and humbling way to start the day.   

During my first two days at work, I have spent most of the time reading the binders left behind by the three previous former American volunteers and getting introduced to the local dignitaries.  This small little town has a mayor, a police chief, a sub commanding officer, and a representative of the Fon, the traditional community leader, all of whom expect a formal introduction.

I have also been meeting many of the 45 volunteers working at Project Hope, including three government appointed nurses working on antiretroviral compliance and home based care for AIDS patients, three young teachers working on youth outreach and other communications projects, a pharmacist overseeing 20 local health clinics that give AIDS test to all women coming in for prenatal care, and many others.  It seems like all the workers except for the two nuns in charge are men in their late twenties or early thirties, who in addition to volunteering for the project, have real jobs ( i.e. paid work) at the hospital or at the secondary school in town. 

The work days have been relatively short, from 7or 8am to 2 or 3pm, as is the typical Cameroonian schedule.  I am generally so exhausted from absorbing so much information that I need to take a nap before I can do anything else in the afternoon.  However, pretty soon they should have me working 12 hours days, if my experience will be like that other previous volunteers.