Listen man, you're dur-ing.

Life is all about timing. You miss a train by 5 seconds; you make a train by 5 seconds. You get to the counter and grab the last chocolate croissant or someone else grabs it before you can get to it. You get to the pump before someone locks it up for the morning or you have to hope you have enough water in your water container to last you another 12 hours. To cite more examples would be slightly redundant, but you get the point. Timing is important.

And things that take a while often frustrate people or otherwise overly inconvenience those same people. When my brother was little he used to say, “But it takes too long, and you know how I hate that.”

So why do people procrastinate? Some people work better under pressure. Some people have more pressing needs to deal with (a job, money making opportunity, a family). Some people are just bad at prioritizing. And, some people just don’t want to pursue a course of action so they keep putting it off.

In the United States procrastination is seen as something to laugh about especially when you’re in college, high school, or something along those lines.

But sometimes, it’s not funny, and sometimes it can have dire consequences.

In French the verb durer means along the lines of “to take a long time”. You can say, “Man, I’ve really dured here” meaning “I’ve been here for a while”. “That meeting really dured” (Jeez, that meeting took a while). And while dur-ing isn’t always bad, the connotation certainly isn’t good.

The other day I was helping out with prenatal consultations and this pregnant woman comes in because she is having contractions. Gold star- seriously. Sometimes it’s incredibly difficult to get women to give birth at the health center because it’s either too far away from their home, they think it’s too expensive (which is ridiculous because it’s free- the state absorbs the cost), or something along those lines.

So then when we find out more information such as her previous birth had been with a c-section and that our midwives had actually told her to come in a week beforehand so they could discuss plans for giving birth in Koudougou (because of the danger of Uterine rupture after a C-section they like to refer women to the hospital for the birth immediately following the c-section. After that, it’s fine to give birth at the health center). 

Alright, so maybe a silver star at the moment but the woman is at the health center and that’s what’s important.

Now we have to get this woman to Koudougou quickly. And this seems like a job for the ambulance. But, ironically enough, the ambulance is actually in Koudougou picking up our supply of medications for the month of June. So we call the driver and explain that he should probably hurry back. As luck would have it, he was only about 10 minutes away so we waited for a bit and explained that we were going to refer the woman to Koudougou for her own health. So everything’s good the ambulance shows up we get the door open and…

Where’d the husband go? Apparently he went home to get something. What he went to get we don’t know but we’re all sitting around waiting for the husband and finally he shows up…with nothing. So while that was confusing we finally have the ambulance, pregnant woman, the husband, and their entourage. Awesome, go time. So we get the pregnant woman in the ambulance and what happens- she has the baby. Oops. Now it’s truly a debate as to which is more comfortable the birthing table in the maternity ward or the floor of the ambulance but there is definitely more room in the former.

As it turns out nothing ruptured and the mother and child were both fine. But we did speak to the father about how we were lucky and that he should not have spent as much time doing…whatever he was doing. And he just smiled at us and said that everything will work out, and we tried to impress upon him the importance of helping everything to work out.

Later that day all the midwives and I were sitting around just chatting and one of the midwives said something along the lines of, “People don’t like to go to Koudougou. So in the end they make up reasons not to go. They dure at the house, they just continually say no, or they say they don’t have money (again…for pregnant woman the state absorbs the cost (more or less)). And, the end result is dangerous”.

I guess now I’ve found another project to occupy my time here- convincing people about the benefits of care at a hospital and explaining that there are some things we cannot do here in the village and that you can’t really put a price on your health. 

The Polio Campaign

A few weeks ago marked the beginning of the second tour of the Polio Campaign. The goal of the campaign is to vaccinate every child (0-5 years old) against polio. And here’s the catch: you only have 4 days to do it. Sounds tough right? Actually, it’s not.

Here’s what we did: We made 5 teams of two people (each team made up of a nurse and a community health agent), gave each team a section of the village, a ton of vaccines, a sheet to check off how many dosages they’ve given, a marker, and a piece of chalk. And off they went.

Polio vaccines are actually incredibly easy to give: you just give two drops in the mouth of whatever child you’re trying to vaccinate and then you move on: since it’s a quick process, you need to have a lot of them when you leave in the morning (especially cause if the teams run out of vaccines, it’s one of my jobs to go bring them extras).

They bring the sheets with them to check off how many dosages they’ve given because at the end of the day we use that to figure out how many children we’ve vaccinated, how many we have left, and how much vaccine is “lost” along the way. Pretty easy to use system, which is great because being able to read and write is not a luxury that everyone here has. Also, at every house they stop off at the health agents note the number of children in the household and number of children vaccinated that way they know whether to come back to the house later. And, every child vaccinated gets the left pinky nail colored in with a marker (our village uses purple) so we can see whether the child has been vaccinated or not. Apparently, some parents will say my child has been vaccinated when they haven’t and some will say they haven’t been vaccinated when they have. It would be easier if everyone told the truth- but that’s the way of the world I guess.

In order to prepare for the campaign we did a lot of prep work. First we went out and spoke to all of the important people in the village, and informed them of what we were doing. Then, we divided our nurses and community health agents into teams, and then assigned each team an area for each day. This took into account: homes, churches, mosques, the market, the bus station, etc. Then, we told the town crier to go out and publicize the fact that we were doing vaccinations so that everyone would be “in the know”. The day before the campaign started we met with all the teams together, explained what they were doing, explained how to check and make sure the vaccines were okay to use. Then we said the French equivalent of “Have at it.” And, off they went.

The next few days were pretty interesting to say the least. Between people saying, “aw man this is really difficult” to people saying “aw man this isn’t easy” there was a lot of well, you only have 3 days left (or two days, or one day, etc). Then there were the random surveys. This meant that the major and I went out and just talked to people and asked whether their children had received the vaccination, how many kids they have, how they heard about the vaccination, and most importantly- what we were vaccinating against. The last one was potentially the most important question because this led to other questions such as, “why are you letting someone vaccinate your child but you didn’t ask what medication they were giving or what it would prevent against?”

By the end of the four days we had gotten to 99.54% participation rate which was good though not the 100% we had asked for.

Tuesday (the day after the last day of the vaccination campaign) a couple of moms brought their kids in to the health center asking for the polio vaccination- they had heard that it was going on but they were out of town and for some reason didn’t get the vaccination wherever they went. So, we vaccinated them and reached our slightly over 100% quota (the reason we had over 100% is that we vaccinated people from other villages who were either at our market or were passing through on a bus).

All’s well that ends well. 

Let me get this straight

A supervisory team from the state came to visit our CSPS the other day.

They came to check out how we deal with suspected cases of malaria first and foremost. We started off talking about simple malaria cases: we told them that we took vital signs, evaluated signs and symptoms, and then kept eliminating other potential maladies until we arrived at malaria. Awesome, one point for the Poa staff. They then asked us if we used the TDRs (rapid diagnostic tests) to which the answer is both yes and no. When we have them, we use them, but when we don’t we can’t. The supervisory team didn’t really like that answer especially the “run out” part. Then we had to explain that for most of 2011 we didn’t have the test because we couldn’t get any (from the state).

The new malaria directive is this: you have to do the TDR (makes sense), if you get a positive result you treat malaria (makes sense), if you get a negative result you do not treat malaria (again, makes sense). If the TDR is negative- you’re supposed to research other possibilities for the signs of malaria (fever, vomiting, diarrhea, etc). If you find something, you treat that, if you don’t find anything treat the symptoms, have them come back in a few days and see what happens. Once again- this makes a lot of sense on many different levels. There are lots of times in Burkina Faso when a person will come into the CSPS (health center) and say I have a fever. The nurse will then say alright, you’ve got malaria, and they’ll give the medication for malaria, along with an antibiotic (just in case there was something bacterial) and say come back in a few days. The flaw with that plan is this: currently the government here subsidizes the malaria treatment medication- so if people are being diagnosed with malaria just because they might have a fever- then this drives up the cost that the government has to pay. Also, the parasite will develop a resistance to the medication and that’s not a good thing. Same thing with the antibiotic- if you give it and isn’t needed it will become less effective overtime.

Example: today a guy came into the CSPS and said, “I have malaria.” We asked him why and he said that his body hurt. So we took his temperature (it was normal), asked if he vomited, had diarrhea, a headache, anything like that and he said no to all of them. So we ascertained that the guy did not have malaria. So then I asked him what he had been doing yesterday and he said he was building a school yesterday. In the hot sun. All day. So clearly, the guy was worn out- and did not have malaria. So, we prescribed him some rest, and some vitamins as well- but I was proud of our ability to follow a new directive.

So this new malaria directive makes sense- financially, medically, logically- all over the place really.

Here’s what really gets me:

There are these agents called PECADO (deal with malaria cases and aren’t nurses but are authorized to sell malaria medication). And they’re basically tasked with: if someone comes to you and says that they kind of, maybe, sort of, potentially have a fever- then they sell them malaria medication. No diagnostic tests, no assessment of any type- just selling malaria medication. It seems to me that this is somewhat at odds with the new directive (having two groups of caregivers operating in the same general area but following different directives) but then again, maybe there’s something I’m missing.

Not everything makes sense all the time but, hopefully, this will…at some point in time. And I’m still super psyched by our CSPS- and our ability to set an example and treat what’s there…and not what’s easiest. Go team. 

Je suis en brousse

There are about 175 Peace Corps volunteers in Burkina Faso. These range from people who are 6 months in, to those who are 10 months, to 18 months, to almost two years, and to almost 3 years. And while the stereotypical situation of being in a village hundreds of kilometers from another American, with no electricity, no running water, and having to bike 50 kilometers (uphill both ways) to get to anything remotely approaching “civilization” is still applicable in some circumstances- it’s not the rule- but it’s not the exception either. There are some people who are so far out that they have to stand on the roof of their houses to get a (kinda) cell phone signal. There are also people with DSL internet in their houses and can download music, movies, etc. I don’t fall into either group. Which, is kind of nice.

For starters, I can get a cellphone signal. The peace corps subscribes to something which is very much the equivalent of a “family plan” in the United States. All the volunteers can call eachother (and the staff people) for free- for the rate of $8/month- or something really close to that. Couple things though: 1) This is pretty cool. 2) This is really only useful if you’re in a place that gets an Airtel (name of the carrier) signal. And, there are some volunteers that do not get an Airtel signal, so they’re just paying for a service they cannot use. 3) If you want to talk to people you need to have a way to charge your phone (see below).

My village is on a paved road (called the guidron) between Ouaga and Koudougou (one of the large cities in Burkina Faso). This provides a large number of benefits including: 1) car watching 2) a nice landmark and 3) it means that travel is easy. It takes me 20 minutes to get to Koudougou by bus, and a little bit longer than that if I bike. But, all things considered, it’s not that far. Ouaga is around 90 minutes (if all factors are against you). Also, to both cities there are busses every half an hour or so- which means I can leave whenever I want. In villages that are way in the middle of nowhere, some people have to plan their entire day around leaving because there is only one bus that leaves all day and it’s at 5:30 in the morning. I have considerably more flexibility than that.

Next, my village has electricity. No, I don’t have it (yet) but it is in my village which means charging things is pretty easy. I just go to the CSPS and plug in whatever it is that I want to charge. In other villages people charge their cell phones through solar chargers, car batteries, and other things like that. But, not me. And, it also means that I can find ice and cold drinks in my village which is really nice when it’s hot out (it’s always hot here).

So, those are the majority of ways that my village is not way en brousse or “in the bush”.

Now, we get to the part where I get to continually remind myself that I am, in fact, in Africa.

My house is made out of cement with an aluminum roof. Aluminum and cement have a few things in common. 1) They’re both relatively cheap in Africa (so you can build with them and 2) They’re both really good at trapping and retaining heat. Funny how often those go together. It’s kind of an odd feeling to feel the walls of your house and be continually amazed by how hot they are. But, I’ve dragged my cot to the middle of my living room and get a great 4-way cross breeze so it’s not so bad.

I shower with a bucket (and only use 3 liters of water a day for showering purposes). It’s kinda strange to step into your shower and take water from a bucket- but there is something very Game of Thrones about it.

I poop in a hole. I don’t really think I need to elaborate on that one.

The donkeys, chickens, goats, and other animals. Having a donkey braying outside your house is irritating- and while I try and make sure there’s a significant radius between my house and the nearest donkey the sight and the sound says to me: TIA (This is Africa).

The dirt. It’s red. And, it’s everywhere.

Finally: there’s no ocean…anywhere.

All in all, I find I’m straddling a nice line between what is available/familiar and what is different. My village is large enough that I don’t feel claustrophobic yet small enough that everyone knows my name. I can charge things or sit under a fan for a bit but I’m not constantly in that environment. I can leave if I want, but most of the time I don’t particularly want to.

While this works for me, I’m sure that there are plenty of people that this type of situation would not work for. It all depends on the person and what you make out of the situation you’ve been handed.

So now you can decide, how far en brousse am I?

And I Plant Trees

The mission of the Peace Corps is incredibly varied and occasionally has you do things you know absolutely nothing about. For example, I’m a health volunteer so I have to work with the health “high five” (HIV- in the peace corps abbreviation language (and yes I do recognize the incredible irony in that abbreviation)). The “high five” are (in no particular order): nutrition, hygiene, HIV/AIDS, family planning, and malaria. I do know a fair amount about each of these- so it’s really not a huge deal. But, since I’m a Peace Corps volunteer in Burkina Faso it means that I also have to work with the other high five (why both programs chose 5 things with varying degrees of overlap is a mystery to me- and then called them both the high five is a complete mystery to me): HIV/AIDS, reforestation, youth development, malaria, and hygiene. The HIV/AIDS, malaria, and hygiene components are really no big deal because they’re with the health components. However, I have absolutely no idea about trees. I’ve never planted trees, I’ve never planted trees in Africa- although I did read an article in The New Yorker that basically said when planting trees in Africa, don’t use the same techniques that you used in the US (maybe I’m paraphrasing a bit- but that was the general gist of the article).

Keep in mind, I’m not sure I have it nearly as tough as DABA (the once business/agriculture program turned, completely environmentally based in a span of less than 6 months). Or, maybe I’m completely wrong and the system works amazingly well for them).

So, that’s what I spent the last few days doing- learning, and then- planting trees. Trees are incredibly important to life in Burkina Faso; they’re used for houses, food, medication, jobs, music. And, if you take trees without replanting them- it’s like you’re a parasite (I can actually say that all in moore, which is why it sounds a little awkward in English- my moore tutor made me right an essay on it). Also, the Sahel is apparently creeping further and further into Burkina Faso and that isn’t good. However, tree planting comes with a lot of potential troubles because if you water them too much, they die. If you don’t water them enough, they die. If they get too much sun, they die. If they don’t get enough sun, they die. If an animal eats them, they die. If a child cuts it down, they die. Sensing a pattern yet?

I brought the president of the COGES (in charge of the management of the CSPS- money, cleaning, etc), who is a farmer, and also triples as my moore tutor. I figured that he’d probably know people who could help us afterwards and he’d also have time to help me out (in short, I followed what I wrote in a previous blog post about choosing a good counterpart). At first, he said, “Absolutely, I’ll go because you asked me to go and that’s good enough for me.” Alright, fine. Don’t look a gift horse in the mouth, right? But, after that all he talked about was trees, how important he thought they were and how awesome it was going to be. Once he started doing this all I thought was… sweet.

Our travel to Yako (where my buddy Abe lives and the location of the workshop) was filled with some oops moments which, is a first for me- travel from my site has always been pretty smooth. But because we were traveling the day after Easter, every bus coming through my site happened to be full. So we waited at the station for a solid 3 hours before a little tiny car popped up and we hopped in. During the 70ish kilometers between my site and Ouaga we broke down no less than 5 times and finally when we broke down in the outskirts of Ouaga the driver just gave up and decided he needed a beer, and maybe some Gin too. 

Needless to say (because riding with a driver who has been drinking is just asking for trouble), I asked for our bikes to be taken off the roof and we biked the rest of the way to the bus station.

Once we reached the TSR station, the change was magical. I walked up to the counter, got two tickets for the next bus and we boarded it- and went off to Yako. I guess the moral of the story is- don’t ride in shady looking cars for distances greater than 30 kilometers, especially when you might catch a bus.

With the actual tree tour we learned where and how to collect seeds, the best time to plant, and how to best get seeds to germinate. We mixed dirt, compost, and sand to create the best mixture that would allow the tree to grow. Not the hardest thing in the world, but definitely useful to know when you know nothing about planting trees.

What we actually did not spend a lot of time talking about was mobilizing resources, and how to find resources within a community- and this would have been one of the more useful aspects of the tour. Seeds, fencing, people who want to create a garden don’t grow on trees (alright seeds do, but the rest of those things do not). 

First and foremost- seeds do grow on trees but the quality of those is not assured and it’s better to buy from a forestry agent- but those cost money. The person running the program said that if you want a better chance of success you should buy the seeds- but a government official doesn’t seem like he’d have any problems getting seeds from someone else who works in the same department of the government.

Second, fencing is super expensive. There is less expensive fencing but apparently- it’s not very effective. And, if you don’t have any type of fencing then it’s an invitation for animals and children to destroy your hard work. So where does the money come from to get fencing? If someone gives it to you, then that doesn’t help if other people want to replicate your tree garden. 

Third, the whole point of the Peace Corps is to have other people do it and to be somewhat of a facilitator. So, if I go and plant 1,000 trees by myself, it doesn’t do a whole lot of good. So, how do you find people who are interested? Who do you talk to? And, on top of that, where does the land come from to make the garden? The counterpart might know people but how do you broach the subject?

While there are a lot of questions- the information about how to physically plant the trees was incredibly useful- and I’m glad I had the opportunity to go. When I get back to my site I’m going to try and find a way to start up on this tree planting task- and see wherever it takes me.

This leaves youth development…