Wrapping things up

I should have posted my final blog a long time ago, but I honestly believe that it took me a semester to process through everything that I have learned from this summer. From the initial cultural shock to the eventual appreciation of the rich Kabiye culture, I had come a long way from my days as an over-the-top-enthusiastic-service-learning student who thinks that she can "help" these people with book smarts. In reality, listening, empowering and being there for the people in Togo was the best thing I could do to "help" them.



I had went into CMS expecting to observe some major need and being able to help them to create a plan to solve it. As my summer progressed, I realized that the CMS was a well established clinic. Their programs were running fine. The issues that they had weren't anything that I could help to fix in a two month period, especially when I did not observe them until the last few weeks.

For example, the French Ministry of Health decided to discontinue medical donations to this region of West Africa due to the abuse in distributing these drugs. There was nothing I could do while in Africa to help them. I did come back and inquire about medical bridegate, but they requested that only doctors can request for these supplies. Another example was the need for more public health education. The l'assistant d'hygiene was not doing all part of his job. So I suggested for the next student intern to take on the job of the public health educator and visit villages. Of course, I only realized this need when I was ready to leave.



However, through my shadowing and endless conversations with the nurses and the staff at CMS, I realized that they had a non-medical need that I did not anticipate--encouragements on their jobs. From my observations, most of the staff comes from the Southern part of Togo, which is culturally different from the North. Most of them were sent by someone to work in the rural region. They had given up electricity, time with family and kids to come to work in Farendé. The director had been a successful young nurse in Lomé, but when the village asked him to come back and serve the people of his parent's village, he reluctantly left a life of exploration at the age of twenty-seven to work in a somewhat dead-end job in this rural village. Several nurses live away from their families and miss their children terribly. The accountant hardly ever leaves the clinic ground (since he lives on the grounds of CMS) to mingle with the local population. This lack of social support is affecting the staff's enthusiasm for their jobs and the turn-over rate at the clinic.

Thus, the only thing I could do for them is to encourage and confirm what they have done for the health of the people in the village is worth it. I spend whatever time I could find listening to these nurses talk about how they miss their families. I sent a thank you card to the director at the end of summer and said that though no thanks are uttered, many (including me) are grateful for their sacrifices to bring basic care to the local people. I hope that with this poster and their pictures (they don't get to take photos much at all), they would feel more uplifted in their spirits.

With the case de sante in Kuwde, I was able to set up an insurance system and drafted an insurance policy in French for the village. But for CMS, I took a lot more from them through my shadowing experience with them. Being there, encouraging them was all that I could do. Yet, knowing those people's more-than-adequate abilities, maybe what I did was all that they needed.

For me, I will somehow incorporate this summer into the rest of my time at Duke. I will be taking some more development and service courses. With that said, I had an awesome time, and I will not forget the lives that have touched mine.


Here are some links to the photos that are on facebook (I will try to find a way to use Pisca online album):

Highlights from Togo


I ended up taking a trip to Ghana after my time in Togo. We ended up in a Benin middle school touring group and visited a national park as well as the slave castles. Here are the photos.

In Touch With Nature Part II

As I was saying, I love my job because it allows me to go up and down the mountain and enjoy the view of the valley and the mountain tops. Plus, walking outside always puts one in intimate contact with nature. First of all, I am never really sure what animals I would encounter. My room has housed crickets, lizards, large spiders, mice (like the one i found in my suitcase...) and your other normal critters. In the households, the dogs and the chickens are allowed to run freely while the goats and sheeps are tied up. But in the moutains, animals are allowed even more freedom. You can see pigs, baby goats and everything moving around. I encountered two baby goats the other day while climbing up the rocks to Kuwdé. They were so tiny and fuzzy that I really thought about having a pet goat.

Today, as it turns out, I would be surprised at what animal I would meet. I had gone up the Kuwdé for a meeting with the committee of the case de santé and the families that have participated in the pilot health program. Since there were no other modes of transportation other than by foot, I arrived late due to my previous meeting. I hurriedly moved to my seat in front of the classroom and looked around at the participants, "One person, two person... good.... a monkey... another person... WHAT? There is a monkey at my meeting?"

It turns out that Odile, one of the community health workers had a son with a pet monkey that replied to the name "C'est moi" (it's me). Madeline had asked if the monkey could join the meeting and was granted permission. Thus, there was a monkey at my meeting. He was a very good and quiet monkey even though I believe that the meeting about health insurance seriously bored him. At one point, he was lying on the table looking like he wanted to take a nap. I was cracking up, but I had to keep a strict face for the sake of everyone else.

On my way home, I marveled at how much outdoor experiences that I have had here. Almost every moment is occupied outside. My shoes are always caked with mud, and I can never cease to admire the beauty of the savana and the rosy color of the sunset. Now that it is night, there is a concert outside my room performed by crickets, frogs and toads. Every time that I try to walk outside at night, I never fail to step on some kind of toad. Since there is no electricity here, the sky is perfect for star gazing.

I am surprised at how well i have adapted to no electricity, no running water and plumbing system. I have officially learned how to follow the schedule of the sun and how to shower with only a half bucket of water. Here, nature is at a finger's touch, and I liked how I know my surroundings.

In Touch With Nature

July 30, 2009
There is so much to write, but perhaps I will just describe my day. It is amazing how I have become accustomed to the way of life in the village of Farendé.

I woke up at 5:30am to get ready to find François, the clinic director, at 6am. I have to say that at the present, I am incapable of sleeping pass 5:30am. In the US, I would never be able to wake up at 5:30am even if I tried. But here, I wake up when the sun comes up and I rest and stop working when the sun goes down. I have never lived so near nature and animals in my life than I have done so here in Farendé.

In the US, I pretty much spend my day in a building and never pay attention to the nature around me. The West has essentially created a system where we are completely separated and work independently from nature. Nature can have no impact on our lives until it destroys something like with Hurricane Katrina. My life in the US is basically moving from one building to another, using cars as medium. I do not ever have to be outside unless I decide to be "more" in contact with nation, like going for a run outside, or persuading my parents to go on a hike. In the US, I have to go somewhere to "experience" nature.

Here, it is completely different. Nature is such an integral part of my life that my activities depends on nature and the weather. First of all, there is no such thing as a living room. Once I step outside my room, it is the outside courtyard where any visitor can just come in without being invited. I have no glass on my window. It consists of just a few metal bars and a curtain with wooden shutters. Above my head is a tin roof that magnifies the sound of rain by at least 100 times. Besides the fact that my room put me at constant contact with nature, I find that I am hardly ever in my room, or in a building in general when I work. Today, for example, I have hardly been in a room at all. Starting at 6am, I ran over to Françcois's house to give him my goodbye gift to him. After a day of meetings, I finally returned to my room at 7pm after the community meeting in Kuwdé, and it is almost time for bed.

Another thing about Africa and its nature is that the rain comes only in extremely hard down-pours, and that it has a mystical power to stop all activities. One automatically knows that whatever is planned will be canceled or pushed back to a later date if it rains at all. I have so grown into this mentality that I know my appointment with the chef du village would be pushed back or be totally canceled today due to the 5:30am rain.

The protocol for when it rains that you must find a place to hideout and stop all activities until the rain stops. Most people have a good reason to do so because the road is unnavigable when it rains. The usual red-as-blood dirt road turns into a giant red-ish orange mud puddle that engulfs your shoe if you try to walk in it. But, the rain is absolutely frustrating if one wants to accomplish anything useful because no one does any work when it rains. For example, if you are to meet with a group about a project, you would almost have no chance to meet if it rains. First of all, since African time already dictates that everything actually happens at 2 hours after the scheduled time. If it rained and no one wants to leave the house, you would be at the mercy of the rain as to when it would stop and the people would come out. The rain has almost complete power over one's schedule.

Besides the weather, I also feel more attached to nature by my increased knowledge in the local plants. In the US, I think I label anything that's green into the category of plants and leave it as that. But here, everyone knows at least a plant or two and what each does.

I followed the Chef du Village today to find the plants of the traditional medicines here. The moment we stepped out of the house, he began to point to trees and grass (that I had dismissed as annoying weeds) to be the main ingredients in many of his herbal remedies. It turns out that most Kabiyé people keep only useful trees (as in trees that can give you medicines and fruits) in the fields and cut down all other ones.

In addition, the people here uses every piece of land to gain the maximum yield. The moment you step out of the house; you are in a corn field. No such thought is given over to decorative grass. If there is a tree to give shade, it is usually a mango tree or a Barbabe (?) tree that give useful ingredients for cooking or treating diseases. Even the flowers they plant are more useful than just to decorate. They are the type that releases a scent to chase away snakes. People here have an incredible knowledge of which grass or tree (which may just look like a decorative bush to non-locals) can be eaten or used as sauces.

My morning with the chief ended at 1pm, and I promptly ate and went to my afternoon meetings. The first one was at the foot of the mountain in Farendé, while the second one was at the top of the mountain in Kuwdé. I love how my job takes me to both of the villages. I am always walking between the two, but I will have to describe my walk another time.

Once again, my time is almost out and I must return another time to finish this post.

Initiations Explained

As promised, I'll finish my explaination of the initiations. As i said before, the dances in the village shows everyone that the young men have matured. It si like a debutante ball, but for guys.

Besides the initiations, there is a large wrestling match every year in the Lama-Kara region called Evala. This ceremony is for young men, 18-20, to show their strength to the public and the fact taht they are mature ane ready for marriage. This is a huge ceremony that people from around the world fly in to watch. The president takes a week off just to attend the matches. Rumors have it that the president invites the winners into his army.

I went to watch a wrestling match in Kouméa with Alex, Madeline, Jeff and Jesper. With our cameras held tightly in our hands, and money around our necks, we came upon a field of hundreds of people. There were wrestlers flexing their their muscles, red-cross personnels walking around, vendors and beer-sellers milling around, and a huge group of women [in matching pagnés (skirts from a piece of cloth) and T-shirts that has a photo of the president in the front (he is up for reelection next year) and the words, 'Kouméa supports you!' in the back] singing and dancing together to the rythym of the drums. Besides the civilians, there were lots of military personnel aith their green berets, black vests and serious machine guns hung around their necks. Military trucks and machine guns were all prepped for the safety of the president.

There were two teams, red and white. Each round of wrestling consisted of 5 men from each side. Which team wins the most matches for the round wins the round. On each side, there's also a "cheerleading" team of 10 or so men dressed in feathers and fur, dancing to the beats of traditional music of drums and shakers. I heard from the people around me that each time a team wins a round; the "cheerleading" team shouts out some smart insult at the other team like in a rap show-down.

A friend of Jesper, a wrestling coach, told us the wrestling matches represents how one lives in life. Unlike when you are younger, you can no longer turn away from a fight. Like in life, you must fight.

Initiations

In the region of Kabiyé, you have to prove that you are ready for adulthood and marriage. This means that both men and women go through initiations as a sign of their maturity. Men have to go through 5 initiations while women only have one. As a sign of how this community has changed with the times, these initiations are completely voluntary.

Last Monday, right after I left the market in Kara, I went directly to an initiation ceremony. Like all "scheduled" meetings or events in Africa, this didn't start on time (more on the concept of African time later). The initiation was held in the homestead of the first chief of Conton (like a county) in the region. One of the grandsons of the family, Henri, is a director for the PeaceCorps in Togo, and he knows basically everyone who is anyone in Togo. Everyone who is even slightly related to the 4 initiates were invited to attend the ceremony.

As I waited with Madeline, Alex, and Jesper, Jesper explained about what these initiates had to do the night before the initiation. It turned out that each initiate had to do "kidnap" a child, half their age, whom they believe to resemble them. I am not all sure why they needed to kidnap the child, but I know that this is one way for the people here to build relationships with those who are younger than them. These young children become life-long friends with the initiates who chose them. The initiates take care of the kid like their own sibling.

After making our rounds of typical greetings, and photo taking, the initiation finally starts. First, we see a man leading the initiate and the young child to the center of the courtyard, all with their head ducked (not exactly sure why, but it could be for respect for something). They stop in the middle of the yard, and both the initiate and the child crouches in waiting for the initiation. Then, we see a woman of the initiate's family rubbing red palm oil on the initiate and the child. Afterwards, an uncle, or the father of the initiate makes a big speech to the entire town announcing that the boy has become a man. Now he is capable of building his household, and he is now ready to marry. Then, the same woman from the household offers the initiate a calabash of beer. But the initiate has to refuse because it is to show that he can resist something so good as a calabash of beer. Afterwards, the initiate runs away with the child behind him.

This repeated for each initiate. Later that week, I witnessed a traditional dance in the market by younger initiates. While the traditional music played, young men, shirtless, wore skins of dead animals around their necks stumped around the market. Unfortunately, I am running out of time and have to explain this later.

Brief intercession

I have to say that every time I am in Kara alone, I end up finding friends and Chinese people. First, I saw Laby, who is a master in linguistics from my village. He helped me out, but had to leave with his girlfriend to go back home. Right now, I am actually in the house of some Chinese people who were sent by the government to aid Togo. Howdid that happen? Well, I was buying bananas when two chinese men approached me and said, "Ni Hao." I was so taken aback by correct Chinese that I immediately responded in Chinese as well. It turned out that there was a van full of Chinese people from Sheng Yang who worked with the Chinese hospital here in Kara. They were so surprised to find a Chinese in Togo that they immediately took me to their house for lunch. There a lady who is the head of the team. There are 4 other men, and a young translator. All of them thought that I was too young to a college student. Some of them said that their daughters are older than me. Well, I can't help it. Because all Chinese people are endearing to each other outside of China, they stuffed my bag with gifts of food and drink. They felt sorry that I have to live in a village with no electricity or running water. I am grateful to them, but I told them that life in the village was fine.

Onto more productive topics. I am working with the insurance system more and more. The plan is to go over Tara's budget for the cas de Sante. Kalina, Charlie's daughter, and her boyfriend are both here to work with the medical system with me. I am really excited because Jeff is supposed to be a medical management major, so his expertise would be greatly appreciated in this project. Presently, I am working on writing up forms and future evaluations. I am trying to work out all sort of kinks. I will talk to many of the people who participated in the insurance system last year and have their inputs. Hopefully, everything will work out.

Now I feel obliged to talk to the Chinese before I have to leave for Farende. Watch out for next week's blog though, because there are lot of initiations that will go on this week.

What does a chemistry major do in Togo?

On the way up to my host family in northern Togo, Dr. Piot asked all of us students to tell him of our majors. Madeline: cultural antrhopology, Alex: Political science/government. So far, so good. Dr. Piot nodded his head as he could see why these humanity majors would come to Togo to work on their respective projects. Then it my turn. "Chemistry," I said. He literally turned around and said "WHAT are you doing in Africa?"

So I am here trying to answer that question. As I have already said in my profile, I want to learn about how doctors heal patients in an environment where health is understood as a physical and spiritual matter. I am also here to give my service to best help the need of the organzation. My time here in split between working in a decent size clinic in the bigger village of Farendé, interviewing local healers, and developing a feasible action plan for the local insurance system that they want to implement in a small village up the moutain, called Kuwdé.

The clinic in Farendé is called Centre Medicale Sociale, or CMS for short. It is a part of the Evangelic Church, but it serves as the local health institute. It is responsible for everything ranging from primary care and birthing to vaccination and public health education. However, like many of the health institutions in Togo, they are understaffed and underfunded. For example, there are three nurses and one l'assistant mediacal (almost, but not quite a doctor) who have to manage consultation room, injection room, wound dressing room and the two hospital rooms. The nurses each take a 24 hour rotation to take care of the patients, so there's actually only one to two people who can monitor the entire facility at one time. In addition, out of 10 people who comes to the clinic, about only 4 can actually pay for their medecine and consultation fees. Sometimes, I wonder how this instituion is even able to stay in business at all with their limited revenue. There is no government aid or any outside help except for the once-a-year medicine donation from Doctor without boarders. In order to help the clinic, they have used all extra space at the center to plant peanuts to support the staff. Right now, my goal is to work with the education programs that they have at the center to better the curriculum and to find people to teach them about how to prevent infectious diseases.

My other big project is working with the assurance system for the little village of Kuwdé. Tara, a student who came up with this idea last year, wanted to start an insurance system so that the people in the region do not have to pay very much when they come to the clinic. The problem in this village is that people cannot pay in full for their medicines. This is partly due to the poverty in this region as well as the way of life here. Most people do not practice saving money because they have never experienced what it means to have a steady income. The only way of life that they understand is the subsistance living where they toil all day to make just enough for that day. Thus, there is never the occasion to save, and they hardly ever have a sum of money set aside for rainy days. When they have to come up with a large sum of money for pay for things like medical expenses, their instinct is to sell something in their house, like a goat, chicken, or grains, to pay for the expenses. This practice, however, puts people at the mercy of the market. They can only make however much the market dictates. Thus, these people can never be sure of whether they can pay for the medicine or not. This chain of events ultimately affects the health insititute because the health worker cannot turn a sick person away due to his/her ability to pay. Thus, it is the health institution that ends up going into debt, and the personnels are not paid. This insurance system is here to provide some security.