Tag: #public health

Summer Vacation

Posted on by Christina

Greetings! It doesn’t seem like it’s been so long since I wrote, but I guess it has. First of all, a huge thank you to everyone who donated money for Camp GLOW…it’s now fully funded and it’s set to start in 2 weeks from today! So excited, and so thankful for all of your support. I’ll make sure to update you on how it goes and post pictures from the camp.

Also, thank you for the kind responses to the last blog. As an update, Fidelia is doing well. People have been helping out little by little with what they can, and the family is doing as well as could be expected for the moment. She’s almost three months old now and in the care of my work partner’s older sister. Here’s a photo of her on her grandmother’s back (if the internet cooperates to post it):

Fidelia

As for me, life has been fairly busy lately. My latrine project has been taking up virtually all of my time. We successfully built 20 latrines and the project is coming to a close. We actually got six more latrines out of the project than we had planned because of some kind of shifty business that had happened during the drafting of the budget. Apparently people working on the project with me had thought that they were going to be able to use the grant money/materials for other things (such as building their own houses, eating, buying televisions, etc) without me noticing… They were incorrect. So, we ended up with a lot of extra money. I was kind of put out about the whole situation at first, because it is admittedly annoying (and an insult to my intelligence) that they thought they could trick me like that, and also it just kind of stings that when you’re trying to do something nice for someone, they’ll still try to pull a stunt like that, but finally my friends here have helped me to not take it too personally because it’s unfortunately so widespread that it happens essentially universally in the country.

I’ve now gotten to the point where I see it more as a game–can I catch the mason before he steals my cement? Can I trick him into accidentally admitting that he took more materials than he needed? I still ended up losing a small portion of the materials that I bought to problems like that, but the vast majority were used for the intended purpose, and I was able to build 20 latrines, which is a significant number, so I’m fairly happy with the outcome. And I’ve learned so incredibly much in the past few months from this project–not only about how one actually builds a latrine: the materials you need, the prices, the number of bricks that one package of cement will make, etc, but also about how people work: how to manage them, to read behind what someone says to understand what they mean, to resolve conflicts and work-related crises, and especially how to do all these things at the crack of dawn (this project has really impeded my running routine, and more than once I had my work partners or the masons knocking on my door before I had gotten out of bed in the morning–that was always a lovely start to my day). I’ll definitely be happy when it’s over and I’ve turned in the final reports, but I’m glad I did it. And I’d consider doing another similar project, because there was a ton of interest for it in the community and I know it will go much smoother the second time.

We’re pretty solidly in the middle of summer vacation. Though the school year only officially ended last week, no one has gone to school since early June, when the three big end-of-the-year exams happened. In the Beninese school system (which is modeled on the French school system), you have to take a big test at the end of primary school, then at the end of “junior high” and finally at the end of “high school,” and if you don’t pass, you don’t move on and you don’t get your diploma. It’s kind of like the IB program in the US, except that I’m pretty sure IB students still get a normal high school diploma even if they fail their IB exam (correct me if I’m wrong–admittedly I don’t know much about IB, having been an AP student during high school…). The results of all the exams were just released in the past couple weeks, with fairly typical results, I suppose. The vast majority of the candidates passed their post-elementary school exam, slightly more than half passed the post-junior high exam, and less than half passed the final exam that gives the equivalent to a high school diploma, called the BAC. I know various people who both failed and passed all three exams. They read all the names of those who passed on the radio, so the day of the release of the results, everyone gathers around whatever radio is nearest and listens intently. It’s fun when you hear the name of someone you know, and is probably really great for them because everywhere they go, people will be congratulating them. But also everyone knows if your name didn’t get read, and that’s tough. The oldest girl in my concession family just tried the post-junior high exam for the second time and failed again, which is really discouraging.

It’s odd, because apparently this sort of school system works in France, but here it just does not seem terribly successful. I mean, less than half of the students who complete high school actually get their diplomas each year–that isn’t a sign of success. It must be really difficult to have to repeat the same grade and the same exam over and over again, but there aren’t a lot of options here for people who don’t get their diplomas, and often people are already in their mid 20s before they finally get their BAC. I think probably a lot of the problem with the schools is the lack of proficiency in French from an early age. In the US, most of the students start school already speaking and understanding English, and if they don’t, there are supplementary classes offered to them, but here (especially in a rural place such as where I live), the children often start the first year of school not knowing a word of French, having only spoken Fon at home. Then there are also structural and personnel problems in the school system that keep them from accelerating as much as they might in their studies, and I think a lot small things just add up day to day, week to week, and at the end of the year, they’re still not proficient. For example, there are only six hours in the Beninese elementary school day, and Wednesdays are half days. Attendance for teachers is pretty flexible, and they are often late or don’t show up, and sometimes even when the teacher is present, the class will be left to just hang out if he is tired or wants to grade papers or write the next exam. Nearly all the work that American teachers do at home or in their free time is done during the school day here. But admittedly they aren’t paid very well, and some of the money that they should be earning typically disappears at some point through the chain of payment, so that by the time it gets to them it’s even less than it was. And when people aren’t paid well, it is difficult to motivate them to do the best job they can.

And then there are outside factors, such as the fact that many of the kids don’t eat well before coming to school or during the school day. And that they really have no time to rest–any time they’re not in school, they’ll be working around the house, or in the fields. On the weekends, almost all the kids will be helping their parents in the fields, and summer vacation is like one long session of field work, because it coincides with the rainy season, which is when there is a lot of work to be done in the fields. So while American (and I suspect this is similar for French) children use their summers to recharge or learn new things or otherwise improve themselves through various types of lessons or camps, their Beninese counterparts are doing manual labor so their families will have enough money to pay their school fees the next year. Which makes me even more frustrated about the state of the school system, because people sacrifice so much to pay for school which is of such low quality. But as is kind of a theme here, it’s the best that’s available, so they have to make do with it.

Reflecting on this problem has led me to an idea for a project that I’m in the process of planning–a kind of academic summer camp for kids just entering junior high. I’ve been really excited about this since the end of the year, and had tentatively programmed it for mid August, to run until mid or late September (the school year starts again in October), but have been running into funding difficulties because I haven’t gotten the official stamp of confirmation on my extension yet. Since I’m not “officially” approved, I’m not eligible to receive grants, so I’m looking into trying to find other funding sources because it’s not a terribly expensive project, and it looks like it still might happen. But basically, the idea is to select a group of kids that will be in 6th grade this year–either because they failed last year or those who have just passed out of elementary school–who aren’t the strongest students but are motivated and to provide them with 4-6 weeks of intensive reinforcement in French language and possibly also math skills. I’ll recruit a few local teachers who are good, reliable, trustworthy and interested in helping the community to lead the academic sessions, and then I’m going to intersperse some more camp-like activities that I’ll lead, possibly with the help of other volunteer friends, like games and art and talking about health and nutrition and study habits, etc.

I’m in the process of trying to balance what I think would be the most beneficial with what might be the limit of the reality for these kids; I’d like to take up a good portion of the week with activities and then supervise a study hall kind of a time afterwards or in the evenings, but I know that their parents need them to help in the fields and at home. It’s a little difficult to figure out what is within the realm of possibility, but we’ll get there. Then, if I can work it out logistically, we might try to continue the extra support into the school year and see if we can succeed in making a positive difference in some of these kids’ academic careers. We’ll see.

Honestly, I’m finding myself in a bit of unfamiliar territory here because my area of expertise is health, not education, but I’ve taken enough classes on education and I’ve also been a student enough that I think I can manage this. As my work with the health center has been steadily dropping off as time goes along, I guess I’m sort of throwing myself into more youth activities and working with the schools as a replacement for that–as something to fill the hours of the days between big projects such as the latrine project. But also, as I’m getting more jaded with reality, I’m clinging more and more to the idea that things can change through youth, and that the next generation has opportunities that the previous one does not. So wish me luck!

—

In other news, my cat is doing great. He’s getting quite big now and has recently been vaccinated against rabies, which I’d been wanting to do for awhile. I’m not sure if I told you that he had learned how to get into my ceiling (which is a layer of straw mats that are suspended between the walls with iron wire), but he has. And at first, when he went up there, he didn’t know how to get down, and I had to go through an annoying process of rescuing him from the ceiling each time, but recently he’s learned how to descend as well, so his habit of getting into the ceiling is much less annoying than it was. And I think he finds some sneaky mice up there, too, so that’s good. I’m going to try to post a picture of him in his ceiling hammock here–we’ll see if it works. Until next time! CMK

CeilingCat

A (belated) Mother’s Day Requiem

Posted on by Christina

The night that she died, a full moon rose over the village.  As the daylight faded out and that irreverent globe of too-bright white light ascended, a crowd gathered around and women began to wail.  They thrust their hands up at the sky and cried out the name of the woman who lay motionless and pale in the van that had tried in vain to get her to the hospital.  I caught a glimpse of one of my students–the woman’s 12-year-old daughter–in the middle of the throng, grief contorting her young face into something beyond her years and tears streaking her cheeks as she wept.  At some point, people who know what to do in these situations shuffled the wailers into a room to calm them and the rest of us sat in silence on benches outside their house, heads in our hands.  The silence was occasionally broken by people sighing or making noises of disappointment and disapproval, words of welcome and condolence being exchanged quietly each time someone new arrived, or some woman being again overcome by grief and screaming out into the night.  Near dawn, they buried her inside her house, as is the tradition, under the floor in the room where just the night before she had slept, while a 9-month old fetus prepared to enter the world.  Her husband, my work partner, was stoic and accepting beyond belief, telling everyone that it was the will of God to take his only wife and what was left for him was to take care of his four children.

It turns out to be one of the heartbreaking things of the world: a newborn baby with no mother.  What should be a joyous day of welcoming a new member into the family becomes filled with shock and sorrow and confusion.  Maternal mortality, or the death of a mother in the process of or directly after giving birth, is something we see fairly rarely in the states nowadays, but in the developing world, giving birth is one of the more dangerous things a woman will do in her life.  The newborn baby girl cried incessantly all night, as if to remind anybody who might have forgotten that something was seriously wrong.  And the next morning, before anyone had recovered from the fatigue of the previous night’s mourning, it became clear that the problem of the baby had to be dealt with.  What does one do with a newborn without a mother in the middle of rural Africa?

The woman in this story was a friend of mine–as my work partner’s wife, she had taken care of me through that first confusing visit to post and our relationship evolved from there–and while language barriers kept us from exchanging too many words of depth while she lived, the way in which she died hurt me because I keep wondering “Could I have done more to prevent this?”

She had done everything right during her pregnancy–gone to pre-natal consultations, taken her vitamins, even gotten an ultrasound to ensure that the baby was doing well and would be born in good health, and of course she had planned to give birth in a health center, not at home.  But there is a lack of qualified health personnel in Benin, especially in the rural areas, as in much of the developing world.  So though she gave birth in a medical facility (the private clinic in town, not the health center where I am based), she wasn’t fortunate enough to be assisted by a well-trained aide.  In the majority of rural medical facilities in Benin, and I’d venture a guess that this is true in much of the developing world, much of the day to day work is done by informally trained nurse’s aides because people who are well-educated/well-trained prefer to work in more urban areas, leaving a serious personnel shortage in places like the one where I live.  Thus, you have nurse’s aides, and then the informal aides to the nurse’s aides who have their hands in most of the daily work.  There are qualified personnel supervising the aides, in theory, but in practice one or two people cannot be present twenty four hours out of the day, seven days a week.  This is how it came to be that my friend’s wife was assisted in her birthing by a young apprentice who missed the signs that this birth should have been performed in a larger hospital.  The interesting thing about practicing medicine in remote areas that lack trained personnel is that it turns out to be fairly possible to avoid and treat many problems based on observing only the signs; i.e., you see a lack of color in a child’s palm/inner eyelid or you note that a pregnant woman’s blood pressure is outside of a certain range and you know that both of those cases need to be referred to a higher level medical facility, though you don’t know what causes the signs or what the underlying problem is.  The training of even low-level medical personnel (largely funded by international aid) on recognizing these types of signs seems to have been fairly successful in the Beninese healthcare system, and is probably the reason that we don’t see more maternal or child deaths in my health center.

So one might well say that it must have been the will of God to have this woman die in childbirth.  It was quite simply bad luck for her to encounter complications while supervised by someone lacking training.  We have young apprentices like this at our health center as well, and they also perform births by themselves at times and usually it goes fine.  What presents itself here is the sharp reality of living in a resource-poor country: you do your best with the human and material resources available, and that has to be good enough.  Perhaps at the time that my friend began hemorrhaging post-birth, the clinic’s trained nurse was taking care of a seizing child with a raging fever, or perhaps she was out of town, buying new drugs for the pharmacy, sleeping, or any variety of things; I don’t know because I wasn’t there.  But by the time the apprentice realized that she was in over her head, the woman had already lost so much blood that they had barely gotten her into the vehicle to take her on the 30-minute ride over a dirt road to the larger hospital in Glazoué when she died.

The baby girl, Fidelia, is one of my biggest worries these days.  I just see so many ways that her story could end badly and quickly, and not many realistic paths to avoid such chances.  I’ll do what I can personally to help, but when it comes down to it, the reality of the situation is this: If she’s a fighter, then she’ll make it.  If not, well, she could easily join the ranks of the 6% of babies under one year of age who die every year in Benin.

The first big problem is how to feed her, because in the developing world, exclusive breastfeeding for the first six months of life is an important foundation for good health and nutrition throughout the child’s life.  Clearly, with no living mother, this becomes difficult.  I had hoped that they would be able to find a surrogate mother to nurse her until she was old enough to start eating other things, but there is a strong cultural belief here that if another mother begins nursing someone else’s child like this, her own child will die.  Thus, even though my work partner has a younger sister with a four month old baby, he felt he couldn’t ask her to nurse Fidelia because it would mean the death of her baby.  I deployed all of my persuasive abilities for the case of the surrogate, but at some point you just have to accept culture because it’s deeply embedded and difficult to change.  However, the newborn’s digestive system can’t handle food that one might feed to older children, meaning that if breastmilk isn’t an option, she has to be fed using baby formula, which is expensive, difficult, and often dangerous in rural Africa.

Formula feeding may be widespread in the U.S. but for Fidelia, I don’t see it as a viable solution.  Anyone who has been a parent or an older sibling or even a babysitter for a young baby will remember the hassle of having to wake up multiple times during the night to mix up a bottle for that screaming bundle of joy.  That was the fun part of having a kid, right?  Now imagine doing that while you’re camping, and you’re coming close to seeing what it would be like to use baby formula in rural Benin.

You have no microwave, no safe water, and no dishwasher or even sink in which to clean the bottle.  You wake up to crying in the middle of the night and know that you have to get up, find firewood, start a fire, boil water, wash the bottle with some of the boiled water, and wait for the rest of the water to cool before you can mix it with the formula and give Fidelia her bottle.  And you’re going to do that several times each night?  Not easy, my friends.  It won’t be long before you start cutting corners–maybe washing the bottle with regular water at first, not bringing the water to a full boil, eventually using regular water or preparing the formula in advance and letting it sit all night–because after all, you are cumulatively exhausted and she’s screaming and everyone around you is waking up every night because the houses are so close together and they’re sympathetic that the child has no mother, but they still want to sleep.  And each of those tiny corners puts the baby in a little more danger of diarrheal disease, one of the biggest killers of children under five in Africa.  Then there’s the issue of the cost: formula is expensive, especially for a family that supports itself by farming.  Each can of formula costs around 3500 francs, which is about $7, and will need to be bought every 2-3 weeks at first, and probably every week by the time she nears six months.  For perspective, know that lunch money for most kids here is 50 francs, meaning that you could feed another child for over 3 months with the money that you’ll use for two weeks of formula.  The prohibitive cost will lead to you trying to economize by reducing the amount of formula added per unit of water water, which will quickly lead to malnutrition, which in turn makes the child more susceptible to other illnesses.  And to make the situation even easier for you, if the formula runs out, you don’t just zip out to the grocery store and buy more: you have to journey over that dirt road for at least 30 minutes and might not even find it in stock at the one pharmacy that sells it in town.

There was a glimmer of hope for Fidelia about a week after her birth: the social service center put my work partner in touch with a group of nuns that take care of orphan children.  They said they could keep Fidelia with them in Glazoué for as long as the family wanted and it would cost them nothing, as long as they came and visited her whenever they could.  So my work partner had accepted and sent her there–a tough decision but one that he made for the wellbeing of his child–and then less than a week later, the nuns called back to tell him that they could no longer keep her in Glazoué, but would have to send her to the larger orphanage about 3 hours away.  He didn’t want her to be so far away, so he brought her back to village and now she lives with his older sister.

What would you do in this situation?  It’s a pretty tough one.  Like I said, I don’t see a lot of ways for it to have a happy ending.  Which I suppose it’s so important to try to prevent things like this from happening.  One way to do this is by boosting funding for healthcare and training for healthcare personnel; organizations like the World Health Organization and UNICEF and even our own USAID are doing good work in those areas, and as I mentioned above, it is having an impact.  Another is to increase general education amongst the population about health issues, the danger signs in pregnancy and birthing, the benefits of having fewer children and spacing them well, etc, which is something that I’m working on with PC and many health-related NGOs also focus on.  And a third preventive measure comes back to educating and empowering women and girls.  Because a well-educated woman will take control over her own life, get married later, have fewer children (which reduces the risk of maternal mortality), have more resources available to her, and overall have a higher chance of a healthy, long life.

So I’m going to make another plug for our annual girls’ camp, Camp GLOW, which will take place in early August this year.  We have the chance to make a real impact in these girls’ lives, an impact which can continue for years and impact the lives of the next generation as well, but we’re still missing our goal by over $1,700.  I know that times are tough and money is tight, but please if you can spare a little bit to help us out, you will truly be making a difference.  I also know that I’ve been letting down my end of this blogging deal and have been pretty bad about posting lately.  I promise I’ll do better, and in exchange, I hope you’ll pass along my plea for help or the link to the blog to at least one person who might be interested or have missed the more recent posts.  Here’s the link to donate: https://donate.peacecorps.gov/index.cfm?shell=donate.contribute.projDetail&projdesc=13-680-015

As always, thank you for all of your support through this journey.  Stay well and enjoy the beginning of summer.  Peace and love.  CMK

Potatoes and electricity and wi-fi, oh my!

Posted on by Christina

Hello friends!  Hard to believe that at this time last year I was stressing over what to pack for Benin, wondering what it would be like, and squeezing in a few last get-togethers with all the people in my life.  Now I’m approaching my one-year anniversary in country and the new group of volunteers will be arriving this month, making me part of the “experienced volunteer” crew.  The time has really flown, though certainly last June feels very far away.  

At any rate, I have some excellent news to share with you today–our Camp GLOW project is fully funded as of a couple weeks ago!  Meaning now we are all set to bring the girls up to Parakou in September.  Fantastic!  So a huge, giant thank you to everyone who donated–in Fon, we say enachenuwe (meaning: it will come back to you–because what you have done is so important that nothing I could say would really convey my gratitude, so I just trust that the powers that be will ensure that you are rewarded for it).  I really appreciate the huge wave of support for this project that I got from you guys.  And if you meant to donate but didn’t get a chance, don’t worry…there will certainly be other opportunities to support my work in this community.  

I’ll try to post again soon because I am in the city this week with electricity and even wi-fi at my hotel.  I’ve brought two students from our high school to get trained to be peer educators on health topics.  They are a boy and a girl who are in the rough equivalent of 9th grade and are somewhere between 14 and 17 years old.  After this week of training, we will officially introduce them to the community as health workers and they’ll begin doing health education sessions with other young people in the town.  The program focuses a lot on sexual education/family planning, but also covers things such as malaria and diarrheal diseases, all of which are extremely relevant in rural Benin.  I’m excited about it because it’s a much more sustainable model of educating than if it were me doing the work.  Because these kids live in the community, they will be able to continue after I leave or pass on the roles to other students.  And also, because peer pressure is such an important force in the lives of young people, they have the potential to make change that would be extremely unlikely for me to achieve.  So this week is dedicated to supporting them through this training [and taking advantage of city luxuries such as hot showers and fresh vegetables].  And though the schedule is pretty packed, I think I should find time to finish a post I’ve been working on, so stay tuned…

Also, an aside, as long as I’m talking about unrelated things: I’m sorry for the lack of mail correspondence lately.  I owe many of you letters and I promise I will get them to you in the next few months.  I’ve been finding myself with less letter-writing time recently, due largely to an increased amount of work (which of course is a great thing) and have really fallen behind on correspondence.  I still love to receive your letters, to stay up-to-date on everything that’s happening in that parallel world across the ocean, and I know that it’s discouraging when you write letters and you don’t get them back, so I will make an effort to get better about the responding part.  Thank you to everyone who is still sending me mail–it makes my day every time!  

Heading out to get some sort of fancy city dinner now (maybe even salad!), so until next time: eyizandé!

P.S. Rafiki update: While I was gone at my last training, Rafiki decided to embark on a home improvement project.  I had left him with my concession family, in the spare room of their house, so I was quite surprised when I got back to find him waiting for me inside *my* house.  Apparently he was so distraught at being locked out that he ripped off the bottom corner of the screen that covers my front window and wedged himself himself through the wooden slats that are on the inside.  (I had forgotten to close the slats before leaving, because I usually keep them open for light and air, but when I leave I like to close them to keep the dust out and in case of rain.)  And once he did that, he could easily enter and exit through the window without anyone helping him.  What a problem-solver: he created his own cat door.  I’ve left it like that for now, because it’s kind of convenient not to have to let him in and out of the house, but I think he’s about to outgrow that option, because the space between the slats is not large and he’s getting closer and closer to full-sized these days.  So I think when I get back from this training, I will get the screen repaired and start training him to use the door again.  Silly cat.  But an innovative one.

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.