Hygiene, Condoms & a Preventable Death

Last month, as the doctor’s time here came to its end, we finally got to what I had been very much looking forward to: the workshops. On the schedule were two community workshops in Ba’aka villages, and a workshop for health personnel from nearby clinics and health centers.

It is a universal law of nature that the back of a classroom always fills first, as demonstrated by these attendees in Yandoumbe. Also, you might be able to tell from the hysterical laughter in the room that at the time the subject of the lesson was yes, sex (and the various diseases one can get during it).

One grizzled woman was adamant that a condom, if used near a woman’s period, or if broken inside a woman, would cause her death. Amazingly, a workshop attendee had a condom on him and so the doctor got a volunteer to help demonstrate that condoms are actually quite strong and can even fit around a water bottle.

Here are the kids demonstrating how one should cough or sneeze: into one’s elbow! This also applies to all of you reading this. I’m serious. As you can see this workshop, held at Mossapoula, consisted primarily of children. This is because only a handful of people showed up despite many notifications in advance and the village chief going from hut to hut to ask people to come. After a few hours of waiting around, I commandeered a nearby classroom where kids were attending regular school and took over for an hour.

Some of you may already know how I’m obsessed with proper hand-washing technique, and that was a vital part of my curriculum. A few weeks later one of the gorilla trackers, who apparently attended one of my workshops during his time off, showed me how I taught him to wash his hands. That alone validated my whole month with the doctor (click here if you missed that post).

I thought our time spent treating individual patients was over, but the day before our last workshop and my departure for Bai Hokou, there was an emergency case regarding a tracker’s daughter. She was pregnant with her first child, but had been in painful labor for days. Her strong-willed mother—over a head shorter than me, with no toes on her left foot but terrifying nonetheless, and not least because of her bulging muscles— refused to let her seek medical care as she did not trust Western medicine.

We tracked the woman down and after a yelling match between other community members, her husband and her mother, we finally got her mother to agree to let her go.

 The woman’s husband and his first wife, who was to accompany her to the private Baptist clinic, helped her onto the moto.

The motorcycle ambulance convoy. She’s not visible in this picture, but the doctor is between the driver and I. 

After we arrived at the clinic, the doctor soon discovered that the fetus was dead, but for how long she could not say. Her husband (who as I mentioned earlier, has two wives) had untreated syphilis, which may have been the cause of the baby’s death. Though it was too late to save the baby, the mother’s life was still at stake as there was a severe infection inside of her. The only option was to evacuate the woman to the nearest actual hospital in Nola, 100 km away. The woman’s mother refused again, but was eventually convinced.

The doctor and I then had to frantically jump through several bureaucratic hoops; time was of the essence if this woman were to be saved. One was a visit to the woman who was in charge of the local public health center during the night shift. Her husband happens to be the local “sub-prefect”, who went on a long (drunken) rant about how the local government should not help a private clinic to evacuate a patient despite the fact that it was the official protocol that all evacuations must be authorized by the head of the health center. He continued to say that the couple in charge of the private clinic were unqualified and uneducated, unlike the staff at the public health center. It was very, very difficult to hold my tongue. The two individuals who run the clinic are in fact lovely, caring and competent health workers while just a few days ago, one of his government health staff—the only one present at the center at the time—had been completely drunk and acted completely inappropriately while a woman was in labor. He asked for bribes, offered to get her stung by a scorpion he claimed would hasten the delivery and sexually assaulted her. And there I was, nodding my head as the sous-prefet went on and on about how incompetent the private clinic staff were compared to his staff.

At one point, I had to rush to the WWF office to get some paperwork copied and some cocky eco-guard (armed guards whose job it is to protect the park) stopped me and refused to let me through because I was being “impolite”. No matter that a woman was dying. I am so incredibly sick of African men on power trips—they are arguably the single most significant hindrance to development on this continent.

Here, some of the woman’s relatives are packing food for the journey to Nola. 

Sadly, we found out the following morning that she died soon after her arrival at the hospital. Though the doctor felt like she failed, the woman would have had a much better chance if she had sought proper medical care days earlier. That can be traced back to the lack of education, the lack of access and the discrimination against the Ba’Aka—all problems that obviously started way before the doctor came here.

A picture we used during the presentation. 

The following morning, we had our last workshop. The aim was to teach health personnel how they can improve based on what the doctor and I witnessed over the past few weeks. The major problems in the local health system are the overprescription of antibiotics and the misuse of drugs. Antibiotics are prescribed for every single ailment—whether it’s a cold, malaria or a bruise. One example of drug used carelessly is  dexamethasone, which is prescribed highly frequently for a host of complaints ranging from fatigue to comas. According to the doctor, in reality it should only be used in cases of severe allergic reactions or pulmonary crises when the patient is unable to breathe, such as during an asthma attack. A very potent drug, it should not be used lightly and can even cause death if improperly taken.

The local health center’s lab tech, who had been the most stubborn and frustrating person to work with those few weeks, declared during the workshop that “there was no discussion” regarding the way they use their drugs: he said he could only explain to us why they were forced to use such drugs because he insisted, as he had many times before, that the Czech doctor simply could not understand the circumstances and diseases the local population had to deal with. I personally believe that he just did not want to listen to two young foreign women. There is no quick solution to all of the issues leading to poor healthcare in this area. But a new doctor has just arrived a few days ago, and we are hoping that some leadership and proper medical expertise will do this place some good.

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Medical Rounds on Moto

For the past three weeks, I have been a translator/nurse/assistant/photojournalist for a young Czech OB/GYN.The ultimate aim of her visit is to improve the health practices—which are believed to include many wrong or harmful ones—of the local hospital (which has no electricity or running water and closes at noon), the private Baptist clinic, traditional midwives or village health posts. Right now, she is the only doctor in a 100-kilometer radius. Things happen slowly here however, and so the doctor spends every free minute treating as many patients as she can, anywhere.

To get everything done, the two of us have been shuttling between Ba’Aka villages and health clinics on a moto taxi.

We make quite the sight.

Some of the quick tests the doctor uses.

She goes through dozens of malaria tests every day, and most are positive. I got to perform a few malaria tests, which was fun (including on myself!). The second test I did, which was also the first I did on a child, was under unusually stressful circumstances: we were outside our house when an elephant was dangerously close and trumpeting rather loudly. I was trying to focus on getting the blood sample from the squirming child while readying my body’s flight response, in case it was needed.

A kid so feisty that he squirmed out of his mother’s grip and yanked out the syringe the doctor had inserted into his leg, hence the five adults holding him down in the photo above.

The newborn baby whose birth we missed by a few minutes. 

Being an interpreter is much more difficult than I expected. The literal translation itself is not an issue at all. The difficulties arise when the equation includes medical terminology, a whole other language—Sangho—which is too simple to include words like “contractions” or “fever”, a Czech’s not-so-great English and Central African French. Add cultural misunderstandings, low levels of education in the general population (including health staff) and the fact that the vast majority of our patients are too young to speak for themselves: now there is a real headache-inducing problem.

One of the hundred photos I have of the doctor making small children cry. 

The most hated person in the village. 

Here is a typical conversation between myself and the patient’s relative (I am skipping the steps where I translate from the doctor’s English into French, and where the nurse/assistant translates into Sangho or Ba’Aka):

Me: “How long has he had a fever?” (Note that people use the term “chauffer”, or “to heat”, to mean to have a fever. Also: when people don’t have an appetite, the local health workers call it “anorexia”. It is quite strange to be told that a little baby has anorexia.).

Relative : “Oh… since!” (In the CAR, “depuis”, meaning “since”, is an acceptable answer by itself. It means that it has lasted. For an indefinite amount of time. No further details are ever given.)

Me: “Since when??”

Relative: “Oh.. It’s been a while!”

Me: “So a year? A month? A week?”

Relative: “Oh… maybe 2 weeks.”

Me: “Does he have any other problems?’

Relative: “No.”

Me: “No other symptoms at all?”

Relative: “No.”

Me: “Does he have a cough?”

Relative: “Yes.”

Me: “… Diarrhea?”

Relative: “Yes.”

Me: “Have you given him medicine?”

Relative: “Pas encore.”

(Another peculiarity of the local variety of French: “pas encore”, which actually means “not yet”, is synonymous with simply “no”. It is a subtle but important difference, particularly when speak with hospital staff: one can never deduce whether the staff planned on giving a medicine, or was never going to in the first place. Furthermore, Sangho borrows heavily from French while often distorting the original definitions. For example, “jamais”, which means “never”, is most often used as an emphatic “no”. As you can imagine, this makes for confusing exchanges: “Does he have a fever? “Never!”)

In Mossapoula, a mixed Ba’Aka and Bilo (Bantu) village. 

Then, the health worker usually repeats everything three or more times, just to ensure we know they are knowledgeable and informed. This means that it takes about 10 minutes to extract information that in more efficient circumstances could have been exchanged in a few seconds. Meanwhile, the Czech doctor just looks perplexed and tries to interject with more questions and comments while I’m still teasing out a proper response. It is exhausting.

A baby who is being weighed, and who is very unhappy about it. 

One of the funniest moments yet was when the head of the hospital’s maternity ward grabbed the wooden penis model sitting on her desk to point out her daughter, then without skipping a beat used it to break open an injection vial against the side of her desk.

Another kid who was more than willing to fight back. 

A few days ago at the Baptist clinic, there was the case of the daughter of a WWF tracker, an 18-year-old Ba’Aka girl, who claimed to have been in labor for three days. This was her third pregnancy; the previous two babies had died before they reached their first month. She was clearly very nervous. We checked her several times over the course of two days. With no cell reception at our house, and no reliable cell reception in general, it is rather difficult for us to keep in contact with the staff of any health facility, who were instructed to call us for any emergency. After a long day of work yesterday, we checked on her once again at around 9 pm. It was impossible to communicate with her and she did not seem to understand anything we asked, and we were afraid that she might be in need of a medical evacuation to a larger hospital 100 km away.  The doctor decided that we’d come back at 1 am. It might not sound that late but here, most people including myself wake up at approximately 6 am. Not feeling well to begin with (not surprisingly considering the number of sick people I have been exposed to), it was quite unpleasant to wake up and hop on a moto in the middle of the night.

At the local public hospital. 

I sat there, half awake, fully miserable and completely aware that my misery was pathetic compared to what this poor girl was facing. The awareness that my self-pity was completely ridiculous makes me even more miserable. I couldn’t quite believe that I was waiting outside an electricity-less clinic, in the middle of a night, for a woman to give birth while my moto driver played Justin Bieber’s “Never Say Never” on his phone’s crackly speakers. At least the stars, as usual, were beautiful. When the doctor and midwife concluded, as had been concluded several times before, that the woman was not ready for labor, I decided that I was not committed enough to spend the night here (especially not on a hospital bed that is merely wiped down in between patients) and went back with the moto driver.

The doctor doing all the work during a delivery in which the woman gave up on pushing. I used to feel awkward standing in the corner relaying questions and answers back and forth while she conducted  vaginal examinations, but you get used to it. 

The resulting baby!

We were near the house when the moto driver suddenly stopped. “Elephant!”, he pointed out. It took me a little while to make out the elephant in the monochromic scene revealed by the dim headlights. Holy shit, it was a massive elephant with giant tusks standing in the open, right on our path! As the elephant slowly retreated away from us, the moto driver seemed to think we could continue on the same path. He was not our usual, trustworthy driver and his reckless speeding moments before did not make me confident in his risk assessment abilities. Finally, we took a long roundabout way to the house, hoping we would not cross paths with the elephant.  The adrenaline and stress of the night made me unable to sleep the rest of the night.

The hospital at night.

I found out this morning that the woman did indeed give birth, without any complications. Despite the facts that the Czech doctor and local midwife had slept the night at the clinic precisely for her case, and that they had gone to a clinic out of fear of any birth complications, the three older women who had accompanied the Ba’Aka girl declined to wake any one up for the delivery, and chose instead to have her deliver the baby outside, behind the clinic, on the ground. By the time the doctor was woken and arrived at the scene, the baby and the placenta were already lying on the bare sand.

Nocturnal medical care was primarily lit by my headlamp, as were many post-delivery vaginal suture jobs.

We’ve had three deliveries (not including a delivery we missed during our lunch break), a death (a small child who was brought to the hospital too late), a stroke and countless malaria and pneumonia cases. We’ve had to fight against hospital staff, who automatically prescribe antibiotics no matter the diagnosis. The health chief of the hospital wanted to give dozens of antibiotic pills to a young, healthy and strong man who had gotten beaten up, but who had no open wounds. His reasoning was that we did not know whether the stick he was beaten with was smooth, or rough, and hence we could not know whether it transferred microbes through his pores. Another hospital staff member brought us his child who was not recovering from his flu “despite” the month of antibiotics he gave him; he had no idea antibiotics could not kill viruses. The head of the maternity ward was adamant that long-term contraceptive use sometimes caused sterility, which is disconcerting considering the fact that here, a woman giving birth a dozen times is not out of the ordinary. The lab tech, who is de facto the doctor of the hospital (but who has no training beyond lab work), gives antibiotics to breastfeeding mothers in order to ward infection off in otherwise healthy infants.

The scene in Yandoumbe, a Ba’Aka village, illuminated by my flash.

The roots of the problems—educational, socio-economic and political—run so deep that I have no idea where anyone is supposed to start. But we must start somewhere, and so this week we will be holding basic sanitation and health workshops for the local communities and health workers. There are so many easy preventive steps that could be taken so I’m quite excited! As a lover of public health, I absolutely abhor the ubiquitous practice of shaking hands. Everyone shakes everyone’s hands. All the time. Gross. Virtually everyone has worms, because no one washes their hands. This is not helped by the fact that the Ba’Aka do not use latrine facilities, and instead do their business everywhere. (As hunter-gatherers who have only recently become more sedentary, they’ve never had the need to care about sanitation before.) I’ve also tried to teach everyone I’ve seen coughing that they should cough into their elbows, instead of into their hands or well, everyone else’s faces. Wish us luck!

What the scene actually looked like. As tired as I was, I couldn’t deny that the night sky was beautiful. I’ve never seen more stars than I have here in the CAR, which according to National Geographic has the least light pollution in the world. Not very hard to believe. 

HIV/AIDS: Stigma Kills

Site Visit 9: Education Fights AIDS (Maroua, Cameroon)

It is often said that in reality, it is not HIV/AIDS that kills—it is stigma that does. It is because of stigma that people are afraid to get tested, ashamed to admit their status or to seek treatment, and embarrassed to even talk about the realities of the epidemic. Stigma isolates people, strangles discussion and spreads the virus. The dream of Education Fights AIDS (EFA) is for “the idea of stigmatization to be completely erased.”

EFA was founded by Drew, a Peace Corps volunteer and two Cameroonians named Alim and Adama. Their goal is to empower youth aged 15-35 who are affected by HIV/AIDS by helping them to create associations. Each one is unique and has their own activities, but they all share three primary goals: empowerment, education and enterprise. These associations are given technical assistance, training and some funding by EFA, but ultimately they want them to be completely autonomous and independent entities. EFA also runs a peer education program, in which they train members of the associations to go back into their communities to “sensibilize” people—which means to educate them in order to remove the stigmatization and discrimination that surrounds HIV/AIDS.

Above: Albert Jumbo (Left), Sali Aïssatou (Center), and Hamidou Djïjuï (right). Hamidou talked about how he had no friends after he found out about his HIV-positive status. Now, he is the president of the associations’ Coordination Committee.

EFA is a model example of an organization that responds directly to the needs of the people they serve. The first association was already being formed when they asked for Drew’s help, and EFA was only formed because of the need for a legal entity when donations started coming in from friends and family. EFA’s mission is to support and serve the needs of the associations as the communities see fit—they listen, then act, and that is what has made them so successful.

Each peer educator we met were passionate about their personal transformations and about their work. Each individual had a unique story, but they all had a common thread: thanks to EFA and to the associations, they were transformed from a lost, humiliated and hopeless person to a confident and passionate advocate who is respected in their communities.

In these associations, HIV-affected youth find a second family and a newfound purpose in life. Youth who were once kicked out of their homes after finding out their HIV status were now invited back as favored children after proving that they could be productive members of society, thanks to their associations’ income-generating activities. Now, parents approach EFA directly, asking them to help their HIV-positive children—something that was entirely unheard of just a few years ago.

Before, I could not even look at myself in the mirror. Now, I am not afraid to present myself, and I tell my story with my face uncovered. – Sali Aïssatou (watch her video here)

Sali did not have a choice when she was married off at the age of 13. She found out she was HIV+ a year after her husband died of AIDS. At the time, she didn’t know much about HIV—she was taught about it in school but she thought that it was “only for prostitutes, and that married couples were spared.” This is exactly the kind of stigmatization that she now fights against. She is currently the president of her local association and is determined to allow her daughters to marry who they want, when they want—no matter the social pressures.

Above: Thérèse Pehlem 

Thérèse Pehlem, 32, has been a member of her association since 2006. She described her feelings when she found out she was HIV-positive: I had no hope, I was alone, I was stuck, I was lost. I told myself that life was over. Now, she is not only a peer educator, but a trainer of peer educators: I used to be scared, but now, put me in front of a church, a crowd, a whole community! They ask me left and right to talk about my experiences! When I asked her if she could say something in a video (above), she leaped at the request, ready to talk, and it was clear that this was where she excelled and shined—speaking about HIV to teach others.

Albert Jumbo, 36 years old, has been a member for 5 years (watch his video here). Having lost his wife to AIDS just a year ago, he raises four young children on his own. When he first found out he was HIV+, he told himself that he would just sell all his things, and live the rest of his life in isolation and idleness: I didn’t care about associations, and I didn’t even want to be near these people… but now I’m a peer educator, and I’m not even scared of sensibilizing a whole church congregation!

It was truly inspiring to hear about the personal transformations of the individuals we met, and they were so vibrant and passionate that it was almost hard to believe that they had once lost all hope. Amazingly, not a single member of all of EFA’s associations has passed away in the past two years—a testament to the life-changing effects of EFA’s associations.

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How you can help: Donate to their project called “Providing HIV Services to 1,000 Cameroonian Youth”!

The Inspiring Women of Mbosha

Site Visit 6: The Inspiring Women of Mbosha (7/3) – Mbosha Village, Cameroon

It is a small miracle that our car, a taxi borrowed from a friend of a friend, survived the journey. The rattling piece of metal took us over rolling green hills, down narrow, bumpy red dirt tracks and finally, to the remote village of Mbosha.

We traveled all this way to meet the women who, determined to meet the needs they saw within their community, decided to form a women’s group. With the help of Self-Reliance Promoters’ NGO (SEREP),  they set out to get things done. As you can tell from the video above, their passion and energy are infectious.

The village has no electricity or running water. But yet two women from the group run a health center that in addition to providing basic health services, has already helped give birth to over 70 babies since its creation in 2005.

The women who run the clinic are volunteers. Despite having families to take care of and crops to tend to, they have taken the time to get the proper training to provide basic primary healthcare for the people of Mbosha.

Above: One of the women, with her year-old daughter (born at the health center), with Mbosha village in the background.

Above: The women in front of the new center that is currently under construction.

As they try to build their capacity, they realized that they needed a bigger space! And so they have started building a new clinic. As you can see, construction is well under way. The new health center features more room for patients, a latrine out in the back, and a separate building for a kitchen!  Word has spread about the health center to the surrounding communities, and so those who must travel from afar to get here do not have local family or friends to shelter or feed them. The new building, kitchen and extra space will help solve this problem.

Above: The kitchen-in-progress

SEREP is also trying to get a palm oil project off the ground, which would consist of purchasing palm oil for both these women’s families’ consumption and for re-sale to generate some income. I can assure you that palm oil is an absolutely vital part of the Cameroonian diet. It is found in virtually every single traditional dish, and as one friend put it, “if it is not made with palm oil, then a Cameroonian will not eat it.” Currently, because of the lack of funding, the project is not currently taking place.

And last but not least: three of the many, many children who were born in the health center that they wanted me to take pictures of!

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Check out Meg’s blog on the visit.

How you can help: : Donate to “Help Mbosha women build a primary health centre” or “Feed a Cameroonian family: SEREPs Palm Oil Project”!

Fight against the stomach devil

Site Visit 4: Nourish International (Njinikom, Cameroon) – 6/24

Fight against the stomach devil, the sign said. Fruit tree domestication nursery is for you!

The people of Njinikom have come up with ingenious and eco-friendly ways to better their community. “Pa Sala” is a respected community leader and the director of “Mboyni Farming Group”. The farming group grows seedlings that are then distributed to those who need it, including the Widows’ Group. Pa Sala is a wizard when it comes to nature: he has single handedly planted many trees to make his village much greener than before, devised his own irrigation system using a stream from the mountain, and has even grown three types of mangoes on one tree. He even has an apiary, allowing him to collect honey while the bees help pollinate the trees that he planted!

The Widows’ Group, part of a local NGO called Berudep, is headed by Anna, a smiling and friendly woman. Local culture dictates that when a woman is widowed, she is married off to her deceased husband’s brother or closest relative. Despite being a tradition, these women are often neglected in their new households. Seeing this, Anna decided to bring these women together to be support for each other. She has taught them about planting medicinal herbs that has helped them become healthier, while they also act as therapy for each other during tough times. Most recently, they are working on planting fruits and vegetables on a plot of land, enabling them to support themselves while also allowing them to sell any surplus. They also hope that the new variety in their diet will help them fight against malnutrition. Working side by side on their own plot of land (currently rented, and hopefully to be bought soon with the help of Nourish International!) has given them a priceless sense of purpose, camaraderie and hope.

The volunteers of Nourish International have spent the last month helping out at the tree nursery and at the fruit tree farm. Both Pa Sala and the widows expressed how grateful they were to have these volunteers help them, and how much it meant to them to have people come all the way from the US just to work with them in the fields. I think Anna said it best in the video at the top of this post!

How you can help: Although their project, called “Fruit Tree Cultivation in Cameroon-UT”, is no longer active as the volunteers are already there, check out other projects in the “Women & Girls” category, or all the other projects in Cameroon!