Tag: #immunizations

23 and Counting

Posted on by Christina

In our American lives, there comes an age when one finds it uncomfortable to acknowledge that one’s birthday has arrived, and that another year of life has gone by.  We don’t like getting old; for some reason we find it embarrassing that we have put another year under our belts, that we are getting less like children every day.  Fortunately, I’m not yet at that age, so I can freely talk about the fact that last weekend marked my 23rd birthday and I am now beginning my 24th year of life.  

As you may guess, age is a bit of a different concept in Benin than it is in the States.  To begin, many people don’t know how old they are.  Some have a rough idea of when they were born, marked by significant events that happened in their community around that time (the year such and such president took power, or the year that there was a drought and all the crops died).  Others may know the year but not the month, and those who know the month rarely know the precise day.  Even for those who know their birthdays, I often wonder if it’s accurate, because I know that I create birthdays for children almost daily at the health center.  When we are vaccinating, or when a kid comes in for a consultation, and the mother doesn’t know his birthday, she tells us as much as she knows, and I choose a day to write on his health card to be used as his birthday from then on.  A lot of one-year olds in my area now share my birthday, and many 6-month olds share my brother’s in September.  And it goes like this–my whim arbitrarily designating this important date (at least until the kid is going to enter school, at which time the parents may decide to forge a birth certificate with a younger age on it).  

At any rate, birthdays here are not a big deal, probably because so few people are aware of theirs.  Everybody knows that they are getting older every day.  This is a given, and here, people have little need to count as exactly as we do in the States.  I suppose that we keep track so carefully because age is tied to things such as when one can retire and Social Security and other such rights, but here, people simply work until they cannot any longer.  Then they have a little bit of time of relaxation [or equally possible, illness] where their kids will take care of them before they die.  The life expectancy in Benin is just under 60 years, so there isn’t a lot of old age to the extent that we think of it.  People age, and they age quickly.  Africa wears things out, and people are no exception.  By the time a farmer reaches the age of 50 or so, he already looks like he might be 70 or 80.  I sort of think that the “fete de Janvier” (celebration of new year’s) is observed almost as a collective birthday.  That is the time when people stop, reflect, and congratulate themselves on surviving through another year.  I think I didn’t blog about New Year’s because I was still writing about Christmas when January 1st passed, but it seems to be *the* big holiday in my region of Benin.  The celebration lasts for a week or so, and mainly consists of people taking some very rare time off of working their fields, everyone cooking a lot of food, and people going around to visit each other.  

All by way of saying, an individual’s birthday is not really reason to do anything differently in my town.  So it’s not strange that I really did nothing out of the ordinary on my birthday.  I actually told very few people that it was my birthday, just because it did not seem relevant.  As it happened, March 24 fell in the middle of Benin’s nation-wide polio vaccination campaign, so I worked that day, even though it was Saturday.  I’ve written a lot in passing about vaccination, and the preparation for vaccination, but I’ve never gotten around to really describing what the actual process of vaccinating is like.  So to fill in that gap, here’s a summary of how I spent my birthday:

5:40AM: Wake up to my cell phone telling me (in French) that it is 5:40AM.  Vaccination days are the only days I ever set an alarm, because we need to be on the road before most people are awake, meaning before it’s light out and before the roosters start crowing.  Beating African farmers to leaving for the fields is no easy task.  Now that I go to bed at like 10PM most nights, I’m more able to handle early morning things such as this, but I am still not what we would call a morning person, so this is slightly painful.  I get dressed, wash up a little, slather on the sunscreen, leave Rafiki some food, grab my motorcycle helmet, and leave.

6:03: Arrive at the health center to find half the staff there while half are still at home.  My vaccination partner (who we’ll call Francois) is not yet there, nor is the Major (the head nurse in charge of the health center).  I am slightly annoyed, since it was they who told me to be there at six.  Luckily, Francois lives right across from the health center, so I just pop over and wake him up with a knock on his door and a cheerful “bonjour! Je suis la!” (Good morning–I’m there! [Subtext: “Anytime you want to join me would be great!”])

6:15: I finish packing our portable cooler with ice packs and vaccines.  Double check my bag to make sure we have the other necessary components of this vaccination campaign–sheets on which we keep track of how many children of which ages we have vaccinated, vitamin A capsules to give along with the vaccine, a marker to color the thumb of children who receive the vaccine.  [The polio vaccine is given orally–you use an eye-dropper type thing to put two drops in every child’s mouth–so it requires a lot less equipment than other vaccinations.  Normally we also have to bring syringes (three different types for the different vaccines and for mixing the vaccines), cotton, a sterile solution for cleaning the skin prior to injecting, and a safety box for used needles, so I appreciate the lightness of our supplies today.] Everything’s there–we’re good to go.  

6:20: Francois comes back from getting gas (he had to wake up the man who attends to the table of empty wine bottles filled with gasoline, because he hadn’t yet set up shop), I mount his motorcycle, and we set off for our first destination–a largeish village about 30 minutes northeast of us.  The sun is just beginning to rise; we’re on schedule.  I wish I had made coffee before I left the house, but I also am appreciating the coolness of the air (won’t last long) and the way the land looks as the red road stretches out in front of us and snakes through fields of crops and trees off of which the morning fog is just beginning to rise.  What a cool place to be.  

6:40ish: We’re getting close to the village now and the road is getting narrower and bumpier.  Francois is an excellent driver and I feel safe riding with him.  He has gotten us to and from villages that are far more “in the bush” than this one without falling even once (the worst of which is one that is a solid hour away on windy, dirt roads that at times go through river beds, across huge slabs of rock, over expanses of deep sand–terrifying on a motorcycle–and/or become deeply rutted or washboarded, and we went there during the “easily accessible” time of the year…) so he has earned my trust.  I bounce up and down on the back of the motorcycle and tightly grip the vaccination supplies that I’m in charge of holding for the journey.

6:45: Almost there.  But “Attention!” (pronounced ‘ah-tahn-cee-own,’ meaning “watch out; careful’) there are stray branches sticking into the road at this point.  I jerk my head to the side or duck to avoid getting smacked in the face (I’m wearing my helmet so it actually wouldn’t hurt, but it’s a reflex thing).  Ah the quirks of traveling by motorcycle.

6:50ish: We roll into the village and see people up and about, making breakfast and washing up.  People are used to seeing us by now, so they know we’re here for vaccination.  The polio campaign is an especially vigorous one, because Benin, like many countries, is actually getting very close to eliminating polio altogether (last year they recorded no cases of polio; the year before that it was only 20).  When the incidence gets this low, it becomes even more important to vaccinate every last child–even one case is one too many–and zero is actually a very attainable number.  For this reason, the vaccination is to be done in a “door-to-door” manner, meaning that in lieu of setting up a fixed vaccination post and encouraging everyone to bring their children there, we will walk from house to house and ensure that all children under five in each household receive the vaccine.  [Vaccines here are free; they are provided by a collection of international public health agencies and international aid, so really the only reason that a child would not be vaccinated is if the parents refuse.  This happens occasionally, but generally people are pretty aware of the importance of vaccines and are eager to have their child benefit from them.]  Then we will mark house with chalk, writing the number of children under five that live there, and the number that we vaccinated, and note if we need to come back.

7-10ish: We walk around the village and search for all the small children who live there.  I get very good at saying a few select phrases in Fon: “Come here! Candy! Oh, it’s tasty.  Sooooo tasty! Come here…”  And then when the child is cornered, Francois and I go through a small routine that involves maneuvering the eyedropper device into the child’s mouth and making sure two drops of the vaccine enter the mouth (this is surprisingly difficult because children squirm), then cutting open the little capsules of vitamin A that were sent by a Canadian NGO along with the vaccines and squeezing the oily substance into the kid’s mouth (again, difficult–as much as you tell a kid that it’s like candy, they have a pretty good sense that it’s not true…though I think the stuff doesn’t taste too bad), then coloring in the nail on the left thumb with permanent marker so we can easily tell who we have already vaccinated (I learn how to say “hey, I’m going to give you a little bit of nail polish–oh, so pretty!” in Fon, too), and marking both the sheet and the door of the house.

When you’re part of a vaccinating team, you get kind of used to children running away screaming when they see you.  Sometimes you actually have to chase them down, though usually the parents or other children will do that for you.  Since the polio vaccine is an oral one and not a shot, the terror plays less of a role in the whole thing and it’s a more gentle process.  Still, the highlight of my day is when we come across this group of small children playing in the dirt and most of them abruptly get up and leave as we approach, but one little girl is looking at me with these big brown eyes and isn’t moving.  I smile and wave at her and she goes “zoom!” and crawls right at me and promptly gives my legs a huge hug and won’t let go.  She’s adorable, and probably about a year old.  I notice a bunch of white bumps all over her head; I think a fungal thing that affects some children around here, but I don’t think much of it.  I realize later how much my perceptions are changing, because I wasn’t bothered at all by that, whereas when I first got here I remember seeing things like that and thinking “we should do something about that!”  It’s interesting how quickly I’ve fallen into the habit of classifying things into “things that can kill a small child” and “things that probably won’t kill a small child.”  Since the first category is pretty large in Africa, I choose to spend my energy working on those things, which means letting go of things that fall into the second category.  In the States, since we’ve largely eliminated the things that we can in the first category, we spend time and energy on the second.  You would never see a kid running around happily with a skin thing like that in the States, but here we don’t worry about it.  And she was still totally adorable.

10:30: We have visited all the households in this village and vaccinated close to 200 children.  We get back on the motorcycle and drive 45 minutes to another village where we’ll repeat the same process.  

2ish: We arrive back in town, exhausted and hungry and hot and sweaty (the sun has been beating down for hours, and while normally one would avoid walking around in it, today we can’t avoid it).  We put the remaining vaccines back in the fridge and go home to eat.  We won’t be doing any more vaccinating today–we wouldn’t find the kids if we went to other villages, because they will have gone to the fields with their parents–so the only thing left to do is to fill out some paperwork and prepare for doing the same thing tomorrow.  I go home and sleep deeply for about two hours, then go back to the health center to exchange recaps of the day with the other teams of vaccinators and prepare materials for tomorrow.

6ish: I leave the health center and go hang out with the zemidjans in their gazebo-type structure.  This is somewhat of an evening routine for me.  The zemis are right on my way home and are really fun people and enough of them speak French that we can communicate.  And because we’re getting to be friends, they look out for me; it’s kind of like having a bunch of big brothers or cousins who are around all the time.  It’s nice.  And I often get free rides instead of having to walk places in the hot sun.  That’s nice too.

7ish: One of them gives me a ride home, where I’m greeted by the kids in my concession family.  They have been picking mangoes off the tree and they saved one for me.  Best birthday present ever:)  I talk to both sets of parents on the phone, and they each sing me a lovely version of “happy birthday,” which makes my day again.  My concession family shares a plate of pate and sauce with me, for which I’m grateful because I am tired and don’t want to cook.  

9ish: I sit out and talk to my concession family while looking at the stars and watching the goats move around the yard.  I go to bed before ten so I can get up and repeat the whole thing the next day.  Truly an excellent birthday.

N.B. Never fear, I also celebrated in more of an American way this weekend, in Savalou with about 12 other volunteers.  My friend Ali graciously hosted and we made tacos (for some reason, this is a Peace Corps Benin tradition–taco nights–not exactly sure why, but they were very tasty) and drank beer and just hung out.  It was a lot of fun.  Until next time, CMK.

 

Easier Said Than Done

Posted on by Christina

This is a story about expectations, complications, and perhaps naiveté.  A few months ago–about a month after I arrived at post, I decided that I wanted to do something fun for my concession family and make some sort of American food for them to try.  They were always giving me food and I wanted to reciprocate; also they often ask me about what we eat in my country so I thought it would be interesting to let them taste for themselves.  I decided that peanut butter and jelly sandwiches would be a good place to start–they’re something simple that requires no cooking, and they involve bread and peanuts, which are two popular food items here.  I also figured the protein from the peanut butter would be a good addition to the diet for the kids.  So I gathered the ingredients (this involved getting a friend to pick up jelly in Cotonou, because it’s only available in the big cities, buying peanut butter in Savalou, and picking up a loaf of bread on my way back in Glazoué–bread is not usually available in my town, and if it is, it’s only poor quality baguettes).  I got home and was quite excited to share my surprise with everyone.  I have to admit, I envisioned a Jif commercial-type scene, where I would make sandwich after sandwich and cut them in cute little triangles and children would smile up at me and ask for seconds.  You may guess that it did not actually work out like that.  Here’s how it actually went down:

I start pulling out the ingredients and the kids from my concession and others crowd around my door to see what I brought back.  It doesn’t take me long to discover that it’s much harder to make PB&Js in Benin than it is at home.  You never realize how important things like a kitchen counter are until you are sitting on the floor trying to cut a loaf of bread on a plate with raised edges as your cat is making an all-out attempt to steal bites of it (bread is one of Rafiki’s favorite foods).  Also, the loaves of bread here are not like those at home; they are weird and filled with air pockets and break in odd places instead of cutting into neat slices (as I am in the process of cutting the bread, I remember that saying: “the best thing since sliced bread,” and think, Wow, they’re right…sliced bread was a great invention).  The crowd of children at the door is just growing larger and larger as I struggle with the bread.  “The bread in my country is a little different than this bread,” I tell them as I butcher another potential slice.

Soon (but actually not that soon, because the bread takes forever) I have a small pile of relatively flat chunks of bread that can almost pass as slices, and it’s time to start making sandwiches.  I shoo away the flies that are gathering in the kitchen (one of the most annoying things about my house–since I haven’t yet gotten the screen door that I ordered 6 months ago(!), flies have a tendency to come in when I am cooking) and open the peanut butter and the jelly.  The kids are whispering to each other now, wondering what I’m going to do with these strange things.  They have never seen jelly before and think perhaps it’s crushed tomatoes in a jar.  I say the word for “strawberries” in French, but they have never seen a strawberry so they still don’t understand.  They are familiar with crushed peanuts, but they usually crush them themselves (a lengthy and difficult process) and use the paste immediately to make sauce, so we are in uncharted territory now.  I select the two best-looking “slices” and set them on a plate.  Carefully, with a spoon, because I thought my friend Ali was being silly when she insisted on finding butter knives for her kitchen, I spread the peanut butter on one chunk of bread and the jelly on another.  As I put the slices together, I hear a collective gasp of surprise from the kids–they think it is so odd that I would mix those foods like that (I think they are still thinking the jelly must be tomatoes, so I can understand their surprise–tomatoes and peanuts? Ew.).

Finally I present my masterpiece (probably the ugliest PB&J the world has ever seen) to the oldest kid there, who is already one of my buddies.  He and the whole crowd of children shrink back a little as I come to the door.  He looks at the plate, he looks at me, he looks at the plate again.
“Pour moi?” he asks me slowly, as if he really wishes it was not for him.
“Oui, pour toi!” I affirm, with a reassuring smile.
He laughs nervously, shifts his weight a bit, glances at the other kids, who are murmuring amongst themselves, and reluctantly reaches out to take the plate, as if it is something that might bite him.  The other kids shriek with the excitement of watching something funny happen to someone else while avoiding the unpleasantry oneself.  My buddy is trying very hard to be polite about this situation, but the food I have given is very odd.  He looks at it again.
“On mange ça? [One eats this?]” he clarifies.
I tell him yes, you eat it, and that in my country, it’s one of the favorite foods of children.  I encourage him to try it–he’ll like it.

We look at each other for what feels like a long time.  He’s still standing there with the plate, and I realize that he probably has no idea how to eat a sandwich, even if he wanted to.  Just like I had no idea how to eat their food when I first got here.  (Actually this still happens to me even after nearly 8 months–just yesterday I was presented with a meal I didn’t understand how to eat.  I had to wait for the person I was eating with to start taking bites so I could copy him.)  So I take the plate back, cut the sandwich into a bunch of bite-sized pieces (or try to…as noted, the bread doesn’t want to cooperate) and pass one out to each of the kids.  They take them, say “merci,” and run around the side of the house giggling.  I see them carefully inspecting the sandwich bits, peeling back the bread to see what’s inside, and taking tiny tastes of each thing.  Eventually, some of them get brave and just eat it.  They think it’s not too bad, but they’re not totally won over.  Some of the kids carefully deposit their pieces inside a container to “save for later” or to show their parents.  I don’t know if they ever ate them or if they fed them to the goats when I wasn’t looking.  But overall, it was a mildly successful cross-cultural encounter, and I do think they thought it was fun and appreciated the gesture.

As you might have guessed, I am not only writing about sandwiches here.  I am currently experiencing a lot of the “easier said than done” type of problem in my work life.  I’ve been preparing for Peace Corps for so many years, it’s ridiculous.  Unlike the paths that led some of my fellow volunteers here, mine was a concerted effort to end up doing this type of work.  And so I feel like I am well-prepared for this job; I studied public health and international development extensively during college, and I came in with a ton of ideas about what types of projects I could start on, as well as a lot of motivation to do them.  So honestly, while obviously I knew that things would be hard (if this was an easy job, more people would do it, or the work would already be done), I’m a little surprised at exactly how hard the “real work” is actually turning out to be.  [I put that phrase in quotes because PC is not only about doing development work–it is also about cultural exchange, in helping Americans learn about other countries, and helping people from other countries to learn about Americans.  And even in terms of trying to be an effective agent of change, it’s essential to build rapport through community integration; this means that personal and work lives are intertwined to such a degree that you really can’t disconnect them.  But even so…]

There are just so many obstacles in the way, so many hurdles to jump over, so many things that can go wrong at any given time, and things move so slowly.  Some days, work feels a bit like getting out of bed to go run full-speed at a brick wall, hoping to move it a tiny bit, and then going to bed just to wake up and try again the next day.  I suspect that it will get easier as I learn how to do things here and as I practice more and more, but it can be very frustrating.  Take for instance the example of strengthening the vaccination program at my health center.  I selected this as my first major project because it was something that my co-workers had suggested as a possible project when they applied to get a PC volunteer, and because vaccination is something that the health center already works on and with which people are already familiar.  I figured it would be a fairly simple project and would be a good way to ease into the work.
…Not so.  It turns out that there are a lot of things that go into creating a successful vaccination program, and I’m still working on trying to figure out how to coordinate them all.  First, one has to have a refrigerator in which to keep the vaccines.  We have this, but as I mentioned, since we don’t have electricity, it’s powered with petrol.  This means that if the person in charge of buying petrol is not very diligent, the fuel can run out and the fridge will turn off.  Petrol can only be bought in bulk in the market town, Glazoué, which is a 30 minute motorcycle ride away, and vaccines spoil quickly in the African heat.  Additionally, the thing just kind of stops working sometimes–if the “chimney” hasn’t been cleaned recently enough or if the quality of the petrol is not good or any number of unknown reasons.  So it is not always a reasonable assumption to think that we will be able to store vaccines for any period of time.  But let’s just say for the moment that the fridge is working.  The next step is to collect the vaccines from the regional hospital in Glazoué, which involves not only finding transportation to get there (possible enough if you’re willing to pay–more difficult if you’re looking for a free ride) but also filling out the necessary paperwork and getting the signature of the person responsible for the centre (who is not always present and doesn’t actually live in town).  Then upon arrival in Glazoué, you have to find the person in charge of the vaccines there (hoping that he hasn’t traveled that day or gone home early) and he has to have vaccines in stock.  Sometimes they run out and he has to go get more from a larger town with a larger hospital several hours away.  You also need to remember to pick up accessory materials, such as syringes and cotton for injections, and hope that those are also in stock.

Assuming all of the above steps went smoothly, you can start making plans to actually do the vaccinating.  My town is the seat of a county-type area, and as such, our health center is responsible for vaccinating in many of the smaller surrounding villages which do not have health centers or whose health workers are not trained in vaccination.  This is the part of the vaccination program I am aiming to strengthen; we do a fairly good job of reaching the people in town with our weekly vaccination session, but in the surrounding villages, the ball is really being dropped.  But to do mobile vaccination like that, you have the problems of transportation (who will drive? How many motorcycles do you need? How bad is the road that leads to the destination? Some of the places can’t be reached during the rainy season…), paying for gas, alerting the target population, taking into account events that will interfere with vaccination (such as market days and harvest season for certain crops), and making sure the work at the health center is covered while the vaccinating team is gone.  Remember, this is in addition to all the other things mentioned above.  And if even one of these pieces is not aligned, the whole plan falls apart.  And since our target population are farmers, if we don’t get moving very early in the morning, we have lost the day in terms of vaccinating, because the majority of the mothers will have gone to the fields by 8 or 9AM.

So it’s a struggle.  I am making progress, and that’s not the only project I’m working on.  I’m also doing health education-type work, laying the groundwork for a nutritional monitoring system, and trying to strengthen various parts of the town’s infrastructure in relation to health (such as installing hand-washing stations at the schools and working to expand the available foods in the market).  But as I said, none of it is as simple as it sounds like it would be.  For every project that I can explain in a few words, there are about eighteen steps and seventeen people who need to do something to make it work, and some days I wonder if I am fighting a losing battle.  Maybe I am, but I’ve never been one to back down from a challenge, and I rather think it’s my purpose in life to do the things that other people neglect because the think they are impossible or not worthwhile.  So I guess that means that my life won’t be easy.  And hey, as long as it’s going to be difficult, I might as well have fun and get some interesting stories along the way, right?

P.S. I posted new photos this weekend, and Rafiki has now gotten himself stuck in the mango tree two times.  I think he is either going to learn how to get out of the tree or not to climb it soon.  I’ll keep you updated.