So as some of you know, in February I traveled to Senegal for 10 days with a couple dozen other UM graduate students as part of the International Development program. My health team went to study the implementation of public health programs (such as the President's Malaria Initiative), as they relate to malaria prevention among pregnant women. When not working, we explored Dakar, took trips to bird sanctuaries, checked out the local music scene, and generally had an amazing, whirlwind time. Below are some links to pictures and a blogs, for a more a better taste of our trip. Enjoy!
You can check out our group blog here: http://iedp2009senegal.blogspot.com/
(Although a group blog, I--in my capacity as a member of the 'documentation committee'--wrote quite a few of the posts. You'll probably be able to pick out mine.)
Here are my pictures from the trip: http://www.facebook.com/album.php?aid=2116970&id=1012910&l=73ce2655fd
For a little more background on the program, here's the official site: http://www.umich.edu/~ipolicy/iedp.htm
Tuesday, March 10, 2009
Saturday, August 30, 2008
Pictures from Africa: Summer 2008
After I left Cameroon, I traveled to Kenya on my own, then met up with my parents and brother in South Africa for two weeks of family adventures. Here are pictures of my time in each of those countries.
Cameroon (Climbing Mt. Cameroon): http://www.facebook.com/album.php?aid=2096465&id=1012910&l=4aa839992c
Cameroon (Buea): http://www.facebook.com/album.php?aid=2096765&id=1012910&l=f99c01e2d4
Cameroon (Mamfe): http://www.facebook.com/album.php?aid=2098884&id=1012910&l=ed286ac74c
Cameroon (Etoko & the health centers): http://www.facebook.com/album.php?aid=2098868&id=1012910&l=b82e0b97b0
Kenya: http://www.facebook.com/album.php?aid=2100001&id=1012910&l=d7c988449a
South Africa (Safari & Joburg):
South Africa (Cape Town & around): http://www.facebook.com/album.php?aid=2100196&id=1012910&l=50a46f6543
South Africa (The Garden Route): http://www.facebook.com/album.php?aid=2100206&id=1012910&l=016785c1e7
Enjoy!
Cameroon (Climbing Mt. Cameroon): http://www.facebook.com/album.php?aid=2096465&id=1012910&l=4aa839992c
Cameroon (Buea): http://www.facebook.com/album.php?aid=2096765&id=1012910&l=f99c01e2d4
Cameroon (Mamfe): http://www.facebook.com/album.php?aid=2098884&id=1012910&l=ed286ac74c
Cameroon (Etoko & the health centers): http://www.facebook.com/album.php?aid=2098868&id=1012910&l=b82e0b97b0
Kenya: http://www.facebook.com/album.php?aid=2100001&id=1012910&l=d7c988449a
South Africa (Safari & Joburg):
http://www.facebook.com/album.php?aid=2100185&id=1012910&l=62463a4f41
South Africa (Cape Town & around): http://www.facebook.com/album.php?aid=2100196&id=1012910&l=50a46f6543
South Africa (The Garden Route): http://www.facebook.com/album.php?aid=2100206&id=1012910&l=016785c1e7
Enjoy!
Saturday, August 23, 2008
Miscellaneous Observations: Part 2
After 3 months in Cameroon, I've got some more observations to share with you all.
-To do any job, the ratio of workers working to workers watching is 1:5.
-For a male between the ages of 8 and 68 a machete is a necessary accessory.
-Almost no one smokes cigarettes and it is considered uncouth to do so.
-Beer is an appropriate beverage at any time and at any occassion.
-There is a hierachy in the materials used to make houses, which reflects wealth. Mud is at the bottom, then tin/corrugated metal, then wood (which becomes gray in urban areas and orange in rural areas), and concrete is at the top.
-Pidgin (the most common language in the SW Province) = Jive + English + French + Jibberish - Helping verbs + Saying 'dey' a lot + Jamaican accent.
-There are no wild dogs, just wild goats, chickens, large rainbow colored lizards, vicious cats, giant ants, cocks that crow at all hours, and bugs and birds that make video game-like sound effects.
-The only setting on a TV or stereo is 'Max Vol'.
-Cameroonian men have zero game when it comes to women because they get all their moves from watching bad U.S. dating shows.
-Barbershops have strange names like: Decent Uncle, Dr. Paolo, Anty Unique, and Snoop.
-More women have facial hair (especially neck beards) than men do.
-Every time you drive down an unpaved road (which is 85% of the time) you have a 50% chance of getting a concussion or spinal cord injury.
-The smaller and more run down the exterior of a house (i.e. the poorer the family) the cleaner the inside of the home and the people.
-Children are given unfortunate names such as Gift (a girl), Precious (a boy), Bright (a girl), Prudencial (girl). We even had Elvis and Stella ran the inn in Mamfe.
-Slang terms: dash=to give or a bribe, chop= to eat or food, snap= take a picture, spoiled=broken.
-Eating a lot of peanuts is considered bad because they will make you break out but all food is cooked with a least a pint of palm oil, which is fine.
-The only time there is relative quiet is when the power is out.
-The standard outfit for women is a big, poofy maternity-like dress because they spend so much of their lives pregnant it doesn't make sense to have two sets of clothes.
-If you need to pee you say "I want to piss myself".
-It is possible to ride on the hood of car, as well as on the trunk.
-Every man and child owns a Cameroon national soccer team jersey, ideally one with the name Eto'o on the back.
-It takes 25 ununiformed men and 50 beers to man a road checkpoint (i.e. a bamboo pole on a string).
-To do any job, the ratio of workers working to workers watching is 1:5.
-For a male between the ages of 8 and 68 a machete is a necessary accessory.
-Almost no one smokes cigarettes and it is considered uncouth to do so.
-Beer is an appropriate beverage at any time and at any occassion.
-There is a hierachy in the materials used to make houses, which reflects wealth. Mud is at the bottom, then tin/corrugated metal, then wood (which becomes gray in urban areas and orange in rural areas), and concrete is at the top.
-Pidgin (the most common language in the SW Province) = Jive + English + French + Jibberish - Helping verbs + Saying 'dey' a lot + Jamaican accent.
-There are no wild dogs, just wild goats, chickens, large rainbow colored lizards, vicious cats, giant ants, cocks that crow at all hours, and bugs and birds that make video game-like sound effects.
-The only setting on a TV or stereo is 'Max Vol'.
-Cameroonian men have zero game when it comes to women because they get all their moves from watching bad U.S. dating shows.
-Barbershops have strange names like: Decent Uncle, Dr. Paolo, Anty Unique, and Snoop.
-More women have facial hair (especially neck beards) than men do.
-Every time you drive down an unpaved road (which is 85% of the time) you have a 50% chance of getting a concussion or spinal cord injury.
-The smaller and more run down the exterior of a house (i.e. the poorer the family) the cleaner the inside of the home and the people.
-Children are given unfortunate names such as Gift (a girl), Precious (a boy), Bright (a girl), Prudencial (girl). We even had Elvis and Stella ran the inn in Mamfe.
-Slang terms: dash=to give or a bribe, chop= to eat or food, snap= take a picture, spoiled=broken.
-Eating a lot of peanuts is considered bad because they will make you break out but all food is cooked with a least a pint of palm oil, which is fine.
-The only time there is relative quiet is when the power is out.
-The standard outfit for women is a big, poofy maternity-like dress because they spend so much of their lives pregnant it doesn't make sense to have two sets of clothes.
-If you need to pee you say "I want to piss myself".
-It is possible to ride on the hood of car, as well as on the trunk.
-Every man and child owns a Cameroon national soccer team jersey, ideally one with the name Eto'o on the back.
-It takes 25 ununiformed men and 50 beers to man a road checkpoint (i.e. a bamboo pole on a string).
The Arrival of Zara Egbe
Warning: The following post is graphic and kind of depressing.
In fact, the health center was so short on supplies that in order to clean off the amniotic fluid, Rebecca rubbed peanut oil all over the baby. She was then wrapped in a set of hand knitted clothes- shirt, pants, booties, sweater, hat, blanket. While all this was going on, no one asked Alice how she was doing, if she needed anything. She was simply left to soak in the mess on the bed. When she was given any help by Rebecca she was manhandled, and yelled for wincing when she was roughly given an injection of ergometrine (to stop post-partum bleeding). Alice asked no questions about the baby nor bothered to turn and look at her, check how she was doing. 
While we cleaned and packed up, a friend of Alice's came in and told me that it had been decided that the baby would be named Zara Egbe, in honor of the 'white man' in town and the two nurses who delivered her, Sharlotte and Rebecca, both of whom have the Cameroonian name Egbe in addition to their Christian names. Alice herself clearly had had no say in the matter but didn't seem to care either way. She was in slightly better spirits as we departed and had agreed to hold the baby, which we considered great progress.
Right now, somewhere in Cameroon, there is a baby named after me who I saw delivered. It's really weird. But for the whole story lets go back to the beginning, to Etoko.
Etoko is a small village 20 miles from Mamfe, but 2 hours away because the road there is in such horrendous condition. (See below.) 
I went to Etoko (pop. 1,200) to evaluate and redesign its small, barely-functioning health center, which was currently being kept afloat by the NGOs I was consulting for. I was accompanied by Sharlotte, my wonderful, amazing, cheerful assistant, who is also an excellent (but currently unemployed) nurse. Etoko is a village of farmers, most of whom never went to school because the nearest one is four miles away. We spent four days living in the health center, which consists of four bare, concrete rooms, with the incompetent nurse, Rebecca. We hung out with local women, played with children, toured the lush countryside, fetched water from the nearby stream, and cooked some delicious porcupine. Overall it was an enjoyable but uneventful trip. Until the last day.
I went to Etoko (pop. 1,200) to evaluate and redesign its small, barely-functioning health center, which was currently being kept afloat by the NGOs I was consulting for. I was accompanied by Sharlotte, my wonderful, amazing, cheerful assistant, who is also an excellent (but currently unemployed) nurse. Etoko is a village of farmers, most of whom never went to school because the nearest one is four miles away. We spent four days living in the health center, which consists of four bare, concrete rooms, with the incompetent nurse, Rebecca. We hung out with local women, played with children, toured the lush countryside, fetched water from the nearby stream, and cooked some delicious porcupine. Overall it was an enjoyable but uneventful trip. Until the last day. On the morning of June 17th, a Tuesday, Alice came into the health center. We had spent a few evenings chatting with Alice (or at least Sharlotte had done most of the chatting in the local dialect and I nodded politely) and she was quite funny and cheerful. always laughing about something. She was also 9 months pregnant and pretty uncomfortable given the extreme heat and humidity. Although rather articulate, Alice had stopped school after 6th grade because her parents wanted to marry her off, which they did, to a local farmer about 15 years her senior. Since then, she had spent most of her time helping with the farming and child-bearing. According to her health record, Alice is 20 years old, but she already has three children- a boy and two girls. This was her fifth pregnancy- one was a miscarriage.
When I woke up Tuesday morning at 7am Alice was already there, having come in as soon as her water broke. She was pacing, wincing, and chewing a stick which people use as a toothbrush. Her good friend, also named Alice, was with her. Alice2, age 22, was also pregnant, with her fifth child. While Alice2 swabbed the floor (being pregnant doesn't excuse women from physical labor in Cameroon), Sharlotte, Rebecca and I ran around the health center, preparing supplies for the delivery. This was only Rebecca's second birth and she was clearly nervous but luckily Sharlotte, all of 25 years old, is extremely competent and was helping her out.
At 7:30 Alice and Alice2 went outside to the outhouse to give Alice an enema, which Cameroonian women believe speeds up delivery. After they came back in I got trapped talking to a crazy old woman who wanted to take a picture with me while Alice was delivering in the next room. I go there just as the baby was coming out. It was incredibly messy because the enema clearly wasn't complete and the plastic mattress, scrap of sheet, and Alice herself were covered in shit, blood and various delivery-related fluids. The baby was out by 8am, a girl with a fair amount of hair and seemingly healthy, except for her eyes, which were red, puffy and swollen. It is recommended, especially in Cameroon where the prevalence of STIs is high, for babies to be given antibiotic or silver nitrate eye drops immediately after delivery to prevent blindness caused by chlamydia or gonorrhea infecting their eyes. But because this was a rural health center with such a lack of supplies that only two sets of gloves are allocated per delivery, there were no such medications.
In fact, the health center was so short on supplies that in order to clean off the amniotic fluid, Rebecca rubbed peanut oil all over the baby. She was then wrapped in a set of hand knitted clothes- shirt, pants, booties, sweater, hat, blanket. While all this was going on, no one asked Alice how she was doing, if she needed anything. She was simply left to soak in the mess on the bed. When she was given any help by Rebecca she was manhandled, and yelled for wincing when she was roughly given an injection of ergometrine (to stop post-partum bleeding). Alice asked no questions about the baby nor bothered to turn and look at her, check how she was doing. Because there is no scale at the clinic, the baby was not weighed and measured, just given a once over to make sure she was alright. She barely cried, just giving a plaintive wail every now and again. Once she was wrapped up, I suggested that we give Alice a chance to see and hold her. Sharlotte tried to give Alice the baby but Alice just turned her head away, refusing to look at her. It was clear then that Alice was not happy about the baby being a girl. After all, Cameroon is still a place where girls are considered unecessary and expensive, since they must be married off and are less useful on the farm. Boys are highly valued and mothers are judged on the number of sons they produce. Alice now had 3 girls and just one boy, and she clearly upset about that. Women in Cameroon believe that the sex of their baby is determined by them, rather than their husband, and thus blame themselves if they have a girl.
Watching Alice refuse to hold, or even acknowledge her child, I had to conceed that this was definitely not the happy occassion that we, in the West, romanticize childbirth to be. This was a baby who was quite literally born into shit, was likely going to be blind, and had a mother who didnt want her. This was not a cause for celebration for Alice, but rather an extra burden for her to carry. Looking at the disappointment and resignation on Alice's face, I was both frustrated and heartbroken. I was frustrated with her for not loving her baby the way I expected her to and frustrated with the culture of girlchild hating that exists in so many developing countries. But my heart went out to Alice, who while three years younger than me, had more responsibilities and fewer opportunities than I could ever imagine. Her attitude towards her child was a product of history, culture, sexism, economics, and politics, and she was only responding as she was conditioned to. All she and millions of other women have to define themselves is their identity as a mother and they want to fulfill the ideal their society creates for them.
Eventually Alice got up and changed and went into the next room, which been decorated and prepped by other women to serve as a maternity room. It appeared that every woman in the village had come to the health center as soon as she heard Alice was giving birth and had brought some supplies for her. They were extremely efficient and everything was brought in and set up in a highly systematic way, which should not be surprising given how often they probably do it, as Cameroon as a birth rate of 4.5 children/woman. Everyone fawned over the baby while Alice sat, ignored, in a corner. No one congratulated her or asked her how she was doing- it was all about the baby. The mothers and their children all sang and danced around, clearly enjoying themselves. Alice's 35 year old, toothless, raggedly husband came in, smiling. He hugged Alice proudly, but got no response from her. Oddly enough, he wasn't dissapointed about having another daughter- he actually seemed extremely happy about it, but he may have been putting on a front for me.
While we cleaned and packed up, a friend of Alice's came in and told me that it had been decided that the baby would be named Zara Egbe, in honor of the 'white man' in town and the two nurses who delivered her, Sharlotte and Rebecca, both of whom have the Cameroonian name Egbe in addition to their Christian names. Alice herself clearly had had no say in the matter but didn't seem to care either way. She was in slightly better spirits as we departed and had agreed to hold the baby, which we considered great progress.A few weeks later Rebecca came to Mamfe and I ran into her. I asked about Alice and baby Zara and found out that they had stayed in the maternity room for 5 days but left without paying a single franc. Why? Because the baby was a girl and not worth paying for.
Friday, August 22, 2008
Transportation: 4-Wheel Drive Anyone?
Q: How many adults can fit in a Toyota Corolla?
A: At least nine.
Yep, nine. Also, 7 in the cab of a small pickup truck, 26 men in a 12 seater van, 63 in a 25 seater minibus, three people in the driver's seat of any car, as many children as it takes in a school bus until one of them falls out. This is possible in Cameroon, where if both your butt cheeks are on the seat, you've got too much room.
Shared taxis, which are the primary form of transportation in towns like Buea, are usually Corollas and are supposed to hold no more than 7 people. They drive around town, picking up and dropping off at random locations but at least they only cost 100CFA, or 25 cents. After taking a lot of shared taxi rides, I noticed that they all seem to have the same accessories: an American flag air freshener, a sticker on the side window of an Asian woman, fake Hawaiian flowers across the dashboard, Jesus-related paraphenalia, green or blue lights inside, a furry cover for the driver's seat and an HIV-testing promotional sticker. This must be the Cameroonian cabbie starter-kit. Most cars have only 1 handle to roll down windows which gets passed around. And you know which cabs to avoid because the windshield will be cracked on the passenger side, where someone got thrown forward in an accident. (Seatbelts exist only for drivers.) But what really differentiates the taxis are the names or sayings painted on the side of the car. Below is a selection of my favorites from Buea.
-Bush Doctor
-The Spanish Lover
-Osama Billion
-Talk 2 My Lawyer
-Playboy
-Vatican Express
-Nice guy again
-James Bond
-Cockman
-Asshole
-I am covered in the blood of Jesus
-No food for lazy men
-Don Pedro
-No Satan
-Jesus for Life
-Maitre Julio
-Simple Chief
-Barcelona
-Nellyville
-One Mama
-Rabbi
-Red Bull
-Nazi Group
-Daddyroo
-Patience Express
-Loverboy
-Mitterand (like the former French President)
When not riding in strangely named taxis, I rode on 'Chinese mosquitos', known to the rest of the world as motorcycles. I have yet to convince the Cameroonians that most motorcycles they get are in fact Japanese, not Chinese. They are called mosquitos because they are small, fast, and deadly. They wouldn't be death on wheels if people consistently drove on one side of the road, there weren't potholes the size of swimming pools on the 15% of roads in Cameroon which are paved (and the rest weren't mud pits), people wore helmets, and there were such things as stop signs and traffic lights. I never saw an odometer or speedometer that worked, doors would jam so often window egress was a common sight, and to be a driver was to be a mechanic. As George, the head of UAC in Mamfe, said 'In Cameroon all drivers drink gasoline.' George himself drank gas many times during the summer in order to unclog the engine of his ancient, odometer-stuck-at-999,999, white station wagon. Even the driving school's car was in bad shape. It had no side mirrors, broken tail lights and deflated tires, and looked like it had survived a war. I guess if you can manage to drive that thing without killing yourself (or the driving instructor) you can drive anything in Cameroon. However, I still prefer my Chinese mosquitos.
A: At least nine.
Yep, nine. Also, 7 in the cab of a small pickup truck, 26 men in a 12 seater van, 63 in a 25 seater minibus, three people in the driver's seat of any car, as many children as it takes in a school bus until one of them falls out. This is possible in Cameroon, where if both your butt cheeks are on the seat, you've got too much room.
Shared taxis, which are the primary form of transportation in towns like Buea, are usually Corollas and are supposed to hold no more than 7 people. They drive around town, picking up and dropping off at random locations but at least they only cost 100CFA, or 25 cents. After taking a lot of shared taxi rides, I noticed that they all seem to have the same accessories: an American flag air freshener, a sticker on the side window of an Asian woman, fake Hawaiian flowers across the dashboard, Jesus-related paraphenalia, green or blue lights inside, a furry cover for the driver's seat and an HIV-testing promotional sticker. This must be the Cameroonian cabbie starter-kit. Most cars have only 1 handle to roll down windows which gets passed around. And you know which cabs to avoid because the windshield will be cracked on the passenger side, where someone got thrown forward in an accident. (Seatbelts exist only for drivers.) But what really differentiates the taxis are the names or sayings painted on the side of the car. Below is a selection of my favorites from Buea.
-Bush Doctor
-The Spanish Lover
-Osama Billion
-Talk 2 My Lawyer
-Playboy
-Vatican Express
-Nice guy again
-James Bond
-Cockman
-Asshole
-I am covered in the blood of Jesus
-No food for lazy men
-Don Pedro
-No Satan
-Jesus for Life
-Maitre Julio
-Simple Chief
-Barcelona
-Nellyville
-One Mama
-Rabbi
-Red Bull
-Nazi Group
-Daddyroo
-Patience Express
-Loverboy
-Mitterand (like the former French President)
When not riding in strangely named taxis, I rode on 'Chinese mosquitos', known to the rest of the world as motorcycles. I have yet to convince the Cameroonians that most motorcycles they get are in fact Japanese, not Chinese. They are called mosquitos because they are small, fast, and deadly. They wouldn't be death on wheels if people consistently drove on one side of the road, there weren't potholes the size of swimming pools on the 15% of roads in Cameroon which are paved (and the rest weren't mud pits), people wore helmets, and there were such things as stop signs and traffic lights. I never saw an odometer or speedometer that worked, doors would jam so often window egress was a common sight, and to be a driver was to be a mechanic. As George, the head of UAC in Mamfe, said 'In Cameroon all drivers drink gasoline.' George himself drank gas many times during the summer in order to unclog the engine of his ancient, odometer-stuck-at-999,999, white station wagon. Even the driving school's car was in bad shape. It had no side mirrors, broken tail lights and deflated tires, and looked like it had survived a war. I guess if you can manage to drive that thing without killing yourself (or the driving instructor) you can drive anything in Cameroon. However, I still prefer my Chinese mosquitos.
Friday, August 1, 2008
Touring the Health Centers: Part 2
Malaria, malaria, malaria.
Thats what I heard from every doctor and nurse I met with in Cameroon. I visited 17 health care sites, ranging from large government hospitals to rural clinics staffed by a single nurse, but at each the most common ailment seen was malaria. Some providers estimate that nearly 60% of the patients they see suffer from malaria. (Other common problems were typhoid, respiratory infections, gastrointestinal issues, HIV and STDs, and accidents.) Malaria is a problem all over sub-Saharan Africa, but Cameroon is plagued by particularly virulent strains, which can turn into cerebral malaria and kill within 24 hours of the first symptoms. Despite the prevalence and severity of malaria in Cameroon, people quite blase about it. Whereas the thought of getting malaria strikes panic in the heart of an American, a Cameroonian thinks of it as an annual ritual, like Christmas. Most people have lost track of the number of times they've had malaria and view it as a minor nuisance. However, malaria is the number two killer of children in Cameroon, after neonatal causes, accounting for 23% of all deaths for children under 5. Only 13% of children sleep under treated mosquito nets. (http://www.unicef.org/infobycountry/cameroon_statistics.html). Among adults, malaria is the number three killer, which partially explains why life expectancy in Cameroon is 50 years, for both men and women.
The reason that so many die from malaria is not that treatment is expensive. In fact, it could hardly be cheaper. To treat a simple case of childhood malaria costs 140CFA, or the equivalent of 33 cents. A simple adolescent case costs 230CFA and an adult case 600CFA. In comparison, a 600ml bottle of domestic beer costs 550CFA. The Global Fund, the WHO, and UNICEF pour an enormous amount of money into subsidizing malaria treatment and are constantly researching, re-evaluating and recombining the medicines to make them more effective, as strains of malaria become drug-resistant.
So if cost is not the reason for lack of treament, what is? The first, of course, is poverty. While the drugs themselves may not be expensive, getting to a clinic may be. Most Cameroonians live in rural areas, where health centers are not conveniently located. To reach one people often have to walk through muddy fields for hours, or pay 550CFA for a liter of watered down petrol to fuel their motorbike, if they are so lucky to have one. In addition, people must also pay the 200CFA (or more) consultation fee just to see a nurse and for any lab tests that must be done.
The government, under extreme international pressure, has developed programs to subsidize all health costs. Highly supported by GTZ, the German aid agency, the Southwest Special Fund for Health (SWSFH) is designed to keep costs down and encourage people to use health services but this program has mixed success. Why? Well this bring us to the second reason malaria kills: skepticism.
This skepticism includes skepticism of Western medicines, skepticism of the health system, skepticism of any government related project, and even skepticism of malaria itself. Cameroonians, on the whole, believe strongly in traditional medicines, and employ natural remedies and the services of a traditional doctor (a.k.a. a witchdoctor) as their first line of defense against illness. While herbal medicines may well work sometimes, the usually just serve to delay people seeking treatment in the Western health system, as they wait to see if their symptoms abate. Other people are reluctant to see a doctor or nurse, but believe in the power of Western medicines, and so they self-treat by buying drugs from street vendors. These drugs are usually expired, mislabeled, and sold at exhorbitant prices. Whereas a paracetamol (Tylenol) is sold under SWSFH prices at 2CFA, a street vendor often charges 100CFA a tablet, claiming it is a fancy, powerful, cure-all drug. While self-treatment can sometimes be harmless, most of the time it does a great deal of harm because, again, it serves to delay real treatment. And in the case of fast-acting cerebral malaria, such a delay can be deadly.
As for the health system and the government, Cameroonians have legitimate grounds for their lack of trust. Cameroon is rountinely rated one of the most corrupt countries in the world. In 2006 they came in 138th in the world, right behind Zimbabwe in Transparency International's annual report. As Postwatch, another anti-corruption organization wrote "Corruption in Cameroon is a living thing, a monstrous slimy hydra: vicious in outreach, cancerous in spread and disgusting in reach." I'm not sure the hyperbole is necessary, but it is fairly accurate. There are anti-corruption drives going on in the government, but when your president has been in power for 22 years and is the hand-picked successor of your first president, there isn't must motivation to clean things up. Earlier in the year the Minister of Public Health was brought down in one of these drives as evidence that the government is taking action. He allegedly pocketed about $12-$13 million dollars of international donations intended for HIV/AIDS treatment. Most likely this was a drop in the bucket of funds he embezzled during his tenure, but it still represents enough money to treat 36 million cases of childhood malaria (in a country of 17 million). For another example, look to the post office system. According to my friend Mr. Oben, a retired professor, years ago the post offices in Cameroon used to serve as credit unions, where people could save their money. Then, suddenly, all the money was gone- embezzled by various post office officials. And the people had no recourse to get their money back. So of course they are wary of doing anything that involves them, their families, their health or their money with the government, even if that means potentially endangering their health.
The widespread corruption in Cameroon has severely inhibited the development of the health care system, as well as people's willingness to use it. Government health centers have sprung up around the country but these centers are little more than concrete rooms and lack running water, electricity or sanitation, or even basic supplies such as needles, gauze, foreceps and kidney dishes. The roads to these health centers may be impassable, or may even not exist. Usually staffed by nurses, they receive little supervision, which allows for mistreatment of patients, and corruption by the staff. Because typically only 1 nurse (the Chief of Post) gets paid a meager wage, the rest are volunteers. However, they may receive a small stipend to cover their transportation costs out of whatever profit the health center makes that month. In order to make a profit, these centers often charge for unnecessary lab tests and services. Nurses sell drugs to patients out of their own purses, charging them exhorbitant prices and with-holding the drugs if the patient refuses to pay. While this behavior seems despicable, it is hard to criticize a nurse who, because of encouragement from her government, went to nursing school, only to find a dearth of paying jobs when she graduated and still has to feed her family. (By the way, that $13 million the Minister embezzled could have paid the salaries for 1 year for 14,000 nurses.)
Despite all this, during my tours of the health centers I met many dedicated, hard-working, caring and competent nurses. The story of one nurse in particular sticks with me. She was a well-trained nurse who had been placed two years ago in a new rural health center, by herself. The center had several rooms, was bright, airy and clean but lacked water or electricity. When she was placed there she was given just a desk, a chair, and a lamp. (The lamp strikes me as particularly useless, given the lack of electricity.) No beds, no supplies, no medications. (The large pharmacy room remains unstocked to this day.) For the first year she delivered babies on her desk, in the light of a bushlamp she purchased herself, with drugs and supplies she begged from other health centers, and having to run to the latrine 30 yards away to dispose of the waste, leaving the woman alone. Eventually she was given one rusty bed frame with a torn plastic mattress to use as her delivery bed. Now she goes door to door to check on the villagers since no one wants to come in to the clinic, and why would they? No one wants to deliver on a desk when they can deliver in the comfort of their bed at home, and no one wants to go to a nurse for a diagnosis when they have to go somewhere else to buy drugs. Frustratingly for this nurse, the clinic down the road, in the same health district, is overflowing with beds, supplies, and staff.
Here's another example of the misallocation of resources for you. A nurse at a small rural health center was seeing a lot of women who were experiencing complications during delivery and who needed to go to the district hospital for more advanced care. She applied for funds from an international aid agency to help alleviate the problem. They gave her a motorcycle, intending it to carry a full-term woman in labor and a nurse. And the nurse cant drive a motorcycle. Isn't development work hilarious?
On a less humorous and more frightening note, I must tell you about Dr. E, the single most insane person I met in Cameroon. Dr. E is in his late 30s and considered quite successful. He owns his own clinic, which has inpatient wards for men and women, a pharmacy, a lab, a delivery room, and a surgery theater, and employs ten nurses. But, like many incompetent and lazy doctors, he is scalpel-happy. He loves to do surgeries because they rake in money and he doesn't have to spend a great deal of time figuring out what's wrong with a patient. And Cameroonians believe in surgeries (if they believe in Western medicine) and are willing to pay for them so Dr. E markets himself as an efficient, inexpensive surgeon. He claims that while, yes, malaria is the most common illness he sees, appendicitis is the second most common. And herniated disks the third. Not a single other provider put either of those in their top ten most frequently seen illnesses. He charges 40,000CFA for each of those surgeries ($95), including post-op treatment and inpatient stay. Since the clinic opened in 2005, he has done 1,200 surgeries, sometimes as many as 10 a day, and seen 20,000 patients. (For those of you doing the math, that's surgery on 6% of his patients.) Dr. E is very proud of his surgeries, so proud in fact that he stores the organs/tumors/entrails of every surgical patient he's ever had. And he stores them in his surgery room (which has just one bed with a plastic mattress and a table of unsterilized equipment) in plastic buckets. They are crammed in together with just enough formaldehyde to keep them from reeking. And he will gladly, proudly pull them out to show you and explain the origin of each piece. So note, if you ever go to Mamfe, Cameroon do not under any circumstances, even if you actually have appendicitis, go to Dr. E. Your organs will end up in his buckets and you will contract a post-op infection, like most of his patients do.
But besides that complete psychopath, most of the providers I met were trying hard to provide the best care they could for their patients, while at the same time struggling to get by themselves. The system is highly inefficient and corrupt and the health problems Cameroon faces are enormous. But slowly progress is being made, and hopefully a new goverment will be able to improve the system, increasing access and quality of care for all its citizens.
For those of you who are interested (and apparently you are since you've read this far), I wrote rather long, detailed but interesting report on all of this. If you would like, I can email you a copy and you can subject yourselves to an even longer commentary on the Cameroonian health system as well as 17 health facilities. Just send me your email address and I will send it out when I finish it, which will be in the next week or so.
Thats what I heard from every doctor and nurse I met with in Cameroon. I visited 17 health care sites, ranging from large government hospitals to rural clinics staffed by a single nurse, but at each the most common ailment seen was malaria. Some providers estimate that nearly 60% of the patients they see suffer from malaria. (Other common problems were typhoid, respiratory infections, gastrointestinal issues, HIV and STDs, and accidents.) Malaria is a problem all over sub-Saharan Africa, but Cameroon is plagued by particularly virulent strains, which can turn into cerebral malaria and kill within 24 hours of the first symptoms. Despite the prevalence and severity of malaria in Cameroon, people quite blase about it. Whereas the thought of getting malaria strikes panic in the heart of an American, a Cameroonian thinks of it as an annual ritual, like Christmas. Most people have lost track of the number of times they've had malaria and view it as a minor nuisance. However, malaria is the number two killer of children in Cameroon, after neonatal causes, accounting for 23% of all deaths for children under 5. Only 13% of children sleep under treated mosquito nets. (http://www.unicef.org/infobycountry/cameroon_statistics.html). Among adults, malaria is the number three killer, which partially explains why life expectancy in Cameroon is 50 years, for both men and women.
The reason that so many die from malaria is not that treatment is expensive. In fact, it could hardly be cheaper. To treat a simple case of childhood malaria costs 140CFA, or the equivalent of 33 cents. A simple adolescent case costs 230CFA and an adult case 600CFA. In comparison, a 600ml bottle of domestic beer costs 550CFA. The Global Fund, the WHO, and UNICEF pour an enormous amount of money into subsidizing malaria treatment and are constantly researching, re-evaluating and recombining the medicines to make them more effective, as strains of malaria become drug-resistant.
So if cost is not the reason for lack of treament, what is? The first, of course, is poverty. While the drugs themselves may not be expensive, getting to a clinic may be. Most Cameroonians live in rural areas, where health centers are not conveniently located. To reach one people often have to walk through muddy fields for hours, or pay 550CFA for a liter of watered down petrol to fuel their motorbike, if they are so lucky to have one. In addition, people must also pay the 200CFA (or more) consultation fee just to see a nurse and for any lab tests that must be done.
The government, under extreme international pressure, has developed programs to subsidize all health costs. Highly supported by GTZ, the German aid agency, the Southwest Special Fund for Health (SWSFH) is designed to keep costs down and encourage people to use health services but this program has mixed success. Why? Well this bring us to the second reason malaria kills: skepticism.
This skepticism includes skepticism of Western medicines, skepticism of the health system, skepticism of any government related project, and even skepticism of malaria itself. Cameroonians, on the whole, believe strongly in traditional medicines, and employ natural remedies and the services of a traditional doctor (a.k.a. a witchdoctor) as their first line of defense against illness. While herbal medicines may well work sometimes, the usually just serve to delay people seeking treatment in the Western health system, as they wait to see if their symptoms abate. Other people are reluctant to see a doctor or nurse, but believe in the power of Western medicines, and so they self-treat by buying drugs from street vendors. These drugs are usually expired, mislabeled, and sold at exhorbitant prices. Whereas a paracetamol (Tylenol) is sold under SWSFH prices at 2CFA, a street vendor often charges 100CFA a tablet, claiming it is a fancy, powerful, cure-all drug. While self-treatment can sometimes be harmless, most of the time it does a great deal of harm because, again, it serves to delay real treatment. And in the case of fast-acting cerebral malaria, such a delay can be deadly.
As for the health system and the government, Cameroonians have legitimate grounds for their lack of trust. Cameroon is rountinely rated one of the most corrupt countries in the world. In 2006 they came in 138th in the world, right behind Zimbabwe in Transparency International's annual report. As Postwatch, another anti-corruption organization wrote "Corruption in Cameroon is a living thing, a monstrous slimy hydra: vicious in outreach, cancerous in spread and disgusting in reach." I'm not sure the hyperbole is necessary, but it is fairly accurate. There are anti-corruption drives going on in the government, but when your president has been in power for 22 years and is the hand-picked successor of your first president, there isn't must motivation to clean things up. Earlier in the year the Minister of Public Health was brought down in one of these drives as evidence that the government is taking action. He allegedly pocketed about $12-$13 million dollars of international donations intended for HIV/AIDS treatment. Most likely this was a drop in the bucket of funds he embezzled during his tenure, but it still represents enough money to treat 36 million cases of childhood malaria (in a country of 17 million). For another example, look to the post office system. According to my friend Mr. Oben, a retired professor, years ago the post offices in Cameroon used to serve as credit unions, where people could save their money. Then, suddenly, all the money was gone- embezzled by various post office officials. And the people had no recourse to get their money back. So of course they are wary of doing anything that involves them, their families, their health or their money with the government, even if that means potentially endangering their health.
The widespread corruption in Cameroon has severely inhibited the development of the health care system, as well as people's willingness to use it. Government health centers have sprung up around the country but these centers are little more than concrete rooms and lack running water, electricity or sanitation, or even basic supplies such as needles, gauze, foreceps and kidney dishes. The roads to these health centers may be impassable, or may even not exist. Usually staffed by nurses, they receive little supervision, which allows for mistreatment of patients, and corruption by the staff. Because typically only 1 nurse (the Chief of Post) gets paid a meager wage, the rest are volunteers. However, they may receive a small stipend to cover their transportation costs out of whatever profit the health center makes that month. In order to make a profit, these centers often charge for unnecessary lab tests and services. Nurses sell drugs to patients out of their own purses, charging them exhorbitant prices and with-holding the drugs if the patient refuses to pay. While this behavior seems despicable, it is hard to criticize a nurse who, because of encouragement from her government, went to nursing school, only to find a dearth of paying jobs when she graduated and still has to feed her family. (By the way, that $13 million the Minister embezzled could have paid the salaries for 1 year for 14,000 nurses.)
Despite all this, during my tours of the health centers I met many dedicated, hard-working, caring and competent nurses. The story of one nurse in particular sticks with me. She was a well-trained nurse who had been placed two years ago in a new rural health center, by herself. The center had several rooms, was bright, airy and clean but lacked water or electricity. When she was placed there she was given just a desk, a chair, and a lamp. (The lamp strikes me as particularly useless, given the lack of electricity.) No beds, no supplies, no medications. (The large pharmacy room remains unstocked to this day.) For the first year she delivered babies on her desk, in the light of a bushlamp she purchased herself, with drugs and supplies she begged from other health centers, and having to run to the latrine 30 yards away to dispose of the waste, leaving the woman alone. Eventually she was given one rusty bed frame with a torn plastic mattress to use as her delivery bed. Now she goes door to door to check on the villagers since no one wants to come in to the clinic, and why would they? No one wants to deliver on a desk when they can deliver in the comfort of their bed at home, and no one wants to go to a nurse for a diagnosis when they have to go somewhere else to buy drugs. Frustratingly for this nurse, the clinic down the road, in the same health district, is overflowing with beds, supplies, and staff.
Here's another example of the misallocation of resources for you. A nurse at a small rural health center was seeing a lot of women who were experiencing complications during delivery and who needed to go to the district hospital for more advanced care. She applied for funds from an international aid agency to help alleviate the problem. They gave her a motorcycle, intending it to carry a full-term woman in labor and a nurse. And the nurse cant drive a motorcycle. Isn't development work hilarious?
On a less humorous and more frightening note, I must tell you about Dr. E, the single most insane person I met in Cameroon. Dr. E is in his late 30s and considered quite successful. He owns his own clinic, which has inpatient wards for men and women, a pharmacy, a lab, a delivery room, and a surgery theater, and employs ten nurses. But, like many incompetent and lazy doctors, he is scalpel-happy. He loves to do surgeries because they rake in money and he doesn't have to spend a great deal of time figuring out what's wrong with a patient. And Cameroonians believe in surgeries (if they believe in Western medicine) and are willing to pay for them so Dr. E markets himself as an efficient, inexpensive surgeon. He claims that while, yes, malaria is the most common illness he sees, appendicitis is the second most common. And herniated disks the third. Not a single other provider put either of those in their top ten most frequently seen illnesses. He charges 40,000CFA for each of those surgeries ($95), including post-op treatment and inpatient stay. Since the clinic opened in 2005, he has done 1,200 surgeries, sometimes as many as 10 a day, and seen 20,000 patients. (For those of you doing the math, that's surgery on 6% of his patients.) Dr. E is very proud of his surgeries, so proud in fact that he stores the organs/tumors/entrails of every surgical patient he's ever had. And he stores them in his surgery room (which has just one bed with a plastic mattress and a table of unsterilized equipment) in plastic buckets. They are crammed in together with just enough formaldehyde to keep them from reeking. And he will gladly, proudly pull them out to show you and explain the origin of each piece. So note, if you ever go to Mamfe, Cameroon do not under any circumstances, even if you actually have appendicitis, go to Dr. E. Your organs will end up in his buckets and you will contract a post-op infection, like most of his patients do.
But besides that complete psychopath, most of the providers I met were trying hard to provide the best care they could for their patients, while at the same time struggling to get by themselves. The system is highly inefficient and corrupt and the health problems Cameroon faces are enormous. But slowly progress is being made, and hopefully a new goverment will be able to improve the system, increasing access and quality of care for all its citizens.
For those of you who are interested (and apparently you are since you've read this far), I wrote rather long, detailed but interesting report on all of this. If you would like, I can email you a copy and you can subject yourselves to an even longer commentary on the Cameroonian health system as well as 17 health facilities. Just send me your email address and I will send it out when I finish it, which will be in the next week or so.
Wednesday, July 23, 2008
The Top 10 Reasons Not to Shower
10. Sooner rather than later you will step ankle-deep into a pile of manure.
9. Your smell deters muggers, if not mosquitos.
8. You're cold for the rest of the day if you do, even if its 90 degrees outside.
7. You're lazy.
6. Instead of water, cockroaches or worms might fall from the showerhead.
5. Mud is therapeutic for the skin.
4. So you fit right in with the locals.
3. No matter how hard you try, your feet will never, ever even be close to clean.
2. Even if you don't smell your clothes do.
1. The water is not on anyway.
9. Your smell deters muggers, if not mosquitos.
8. You're cold for the rest of the day if you do, even if its 90 degrees outside.
7. You're lazy.
6. Instead of water, cockroaches or worms might fall from the showerhead.
5. Mud is therapeutic for the skin.
4. So you fit right in with the locals.
3. No matter how hard you try, your feet will never, ever even be close to clean.
2. Even if you don't smell your clothes do.
1. The water is not on anyway.
Monday, July 21, 2008
You Know You've Been in Cameroon Too Long When....
You know you've been in Cameroon too long when....
*you take having the electricity, water, and Internet working at the same time as a sign of the apocalypse
*you find the idea of being able to walk down the street WITHOUT being stared at, whistled at, or harrassed very strange
*you've stopped using helping verbs when you speak
*you no longer notice the rooster crowing outside your room at all hours of the night (or the evangelist proselytizing)
*fufu and eru is your favorite food
*you no longer fear the prospect of malaria
*you think the flashlight accessory on your cell phone is a godsend
*you start saying "I want to piss myself" when you need to pee
*your water bottle serves at least five daily functions (drinking, showering, filling the toilet, storage, doorstop, etc)
*most of your daydreams revolve around eating a piece of meat bigger than your thumb
*your circadian rhythms have adopted 'African Time'
*you can justify your refusal to shower at least ten different ways
*you don't believe that bread comes in more than one type (white)
*you've killed a (named) mouse in your house with a broom and rubber cement
*you point and stare more than the locals when you see a white man
*you start inviting yourself to funerals for the free booze
*there is no longer such a thing as 'matching' or 'clashing'
*you've seen a dead body in the road and walked by it, unfazed
*you've forgotten that a liquid form of milk exists, as does a non-liquid form of peanut butter
You might be a Cameroonian if.....
You might be a Cameroonian if.....
*you've ever uttered the phrase "please for container"
*you can carry a bucket of water on your head and carry one in each hand without spilling a drop
*you can give a play-by-play analysis of the 1990 World Cup quarterfinal match between Cameroon and Argentina from memory
*you have used prize-winning promotional beer bottle caps as a form of currency
*you own at least one piece of clothing with President Paul Biya's face on it (and at least three pieces with Eto'o's name on it)
*you work for or with three or more relatives
*you have lost count of the number of times you've had malaria
*your father has at least ten children by two different women
*you've never eaten pork and consider chicken a delicacy
*the country you consider most similar to your own is Canada because they are also French-English bilingual
*you suffer withdrawl symptoms if you go four days without eating snails
*you know at least eight ways to cook plantains
*you see no irony in trying to get visiting white men to come to church with you
*you believe that sometimes after people die their ghost goes to Europe, makes money and send its back home
*you have no sense of time or distance
*your definition of 'parenting' is saying "I will beat you" or "I will kill you" at least ten times a day to you kids
*your preferred method of resolving disagreements is screaming at someone in a public area
*you fall in love with people (particularly white women) after meeting them once
*you are running at least one palm oil or parrot egg exporting scam
*you flash. A lot.
*you prepare all of your food the same way: dry the ingredients, ground them to a powder, turn them into a paste, wrap the paste in banana leaves, steam them, and consume it as a bland, starchy ball
*you believe meeting a white man equals getting a visa
*you take justice into your own hands and punish thieves by pouring vats of acid on them, throwing them onto a pile of burning tires, or beating them to death in the street
*you love Spanish telenovelas dubbed in French, but speak neither language
*you consider breastfeeding an appropriate public, social activity
*you think the ability to type with more than two fingers is a sign of genius
*you're 5 years old and, disturbingly, can dance like a stripper
*your home contains no written material other than a Bible
*you believe in witchcraft, but not washing machines
*you listen to the same three songs over and over, everywhere
*you consider Maggi, salt and palm oil to be the three essential ingredients in any dish
(Sorry if these make no sense to you, but take my word for it, all of these hold true in Cameroon, as bizarre as they may be.)
*you flash. A lot.
*you prepare all of your food the same way: dry the ingredients, ground them to a powder, turn them into a paste, wrap the paste in banana leaves, steam them, and consume it as a bland, starchy ball
*you believe meeting a white man equals getting a visa
*you take justice into your own hands and punish thieves by pouring vats of acid on them, throwing them onto a pile of burning tires, or beating them to death in the street
*you love Spanish telenovelas dubbed in French, but speak neither language
*you consider breastfeeding an appropriate public, social activity
*you think the ability to type with more than two fingers is a sign of genius
*you're 5 years old and, disturbingly, can dance like a stripper
*your home contains no written material other than a Bible
*you believe in witchcraft, but not washing machines
*you listen to the same three songs over and over, everywhere
*you consider Maggi, salt and palm oil to be the three essential ingredients in any dish
(Sorry if these make no sense to you, but take my word for it, all of these hold true in Cameroon, as bizarre as they may be.)
Saturday, June 28, 2008
Brown Girl, White Man, Black Country
In Brazil people were convinced I was from Ecuador. In Cambodia people admired my big nose and told me that I'd be pretty if only I wasnt so dark-skinned. In India people considered me too American to be truly Indian and too Indian to be truly American. In the U.S. people (especially in Maine) have asked if I'm Mexican, Chinese, Arab, or African. In every country people are preplexed as to how/why a non-white person is carrying an American passport that says she was born in Scotland. But for all this racial confusion, no one has ever mistaken me for a "white man". Yet that's what I'm known as here. Of course, people dont literally think I'm a Caucasian male, but rather that I'm a foreigner. However, I can't walk down the street without a dozencalls of "white man, white man", mostly from kids under the age of eight. Even toddlers barely old enough to speak can squeak out 'wha-maa' and point at me.
Usually we (the other interns and I) can satisfy the kids by returning their calls with a 'hello' or 'good morning', which the kids, who are too dumbfounded by our ability or willingness to speak to them, can't reply to. Some bolder or more curious kids have insisted on rubbing my (above all the others') skin to see if the color rubs off. A few have even put mud on themselves and let it dry to try to match me.
But the biggest attraction has been my hair, especially among grown women. No adult woman here has just her own hair- everyone wears a wig or weave, or braids in fake hair. So the fact that I, a dark-skinned person have straight, relatively shiny, fast-growing, black hair is almost unbelievable, and definitely an eviable trait. More than a few women have offered to pay me to cut off my hair and give it to them to make a wig out of, especially after I described donating to Locks of Love. The rest of the women insist that I should braid it like they do, but I think I'll end up looking like a sorority girl just back from Spring Break in Cancun, and I dont really want that.
All of these behaviors and suggestions are regularly occuring and have become expected. But what I did not expect was the welcome I got in the village of Bakwele. I had gone to Bakwele, a small isolated village about 45 minutes drive away from Mamfe on a crappy dirt/mud road, to visit their health center as part of my research. With me were Sharlotte, a young nurse who is my assistant/translator, and Antoine, our driver. Because Bakwele is a rather unremarkable village, there is no reason for a 'white man' to pass through it, and we knew that I would be the only non-African many people had ever seen, or at least seen recently. Even driving the truck down the main path caused a sensation, as there are no cars and only a few motorbikes in Bakwele. This was all expected. But what the three of us were not ready for were the screams of 'AL-BE-NO! AL-BE-NO!' which erupted as I got out of the truck. Within a few moments what seemed like every kid in the village had gathered around me and taken up the chant, including a girl so young she couldnt walk without falling down every few steps, but who chanted with unparalleled enthusiasm.
Because there are a lot of misconceptions about albinos (who are relatively common here), the kids were quite scared of me. Most people believe that albinos are sub-human/ghosts/immortal/soul-less beigns who are cursed because of the sins of their parents. Several kids would run up to me to get a closer look, and then run away screaming in terror. None of the parents or grandparents sitting around made any move to quell the chaos and in fact seemed to agree with their kids' assessment of me.
Eventually we made our way into the health center, where we had a much more sensible welcome. All three of us were still startled and neither Sharlotte nor Antoine had a good explanation for that reception. (In other places we went a few kids might should 'white man' but most people kept going about the business and greeted me normally.) Even inside the health center we could hear the kids shoulding. During my survey of the clinic and interviews with the providers the kids would hang on the bars of the windows to stare at me (perhaps to determine if I was coming because of some problem derived from lacking a soul) and periodically shout 'Al-be-no' as a reminder to me of my classification.
Our walk back to the truck and departure created similar chaos to our arrival but the kids felt bolder now and would come up and touch me before running away shreiking. They ran after our car for almost a kilometer. Its hard to say if they were driving us out of town or were calling me back so they could examine me. Given that my skin is only slightly lighter than theirs, I wonder what they would have done if one of the real white interns (some of whom are imposingly large) had been with me; perhaps they would be a super-albino or even a phantom. I want to take a trip back to Bakwele just to conduct that experiment.
Outside that village no one has mistaken me for an albino but they have made other inaccurate guesses regarding my background. The chief doctor at the district hospital guessed Puerto Rican, which was unexpected since I doubt anyone else in Cameroon has ever heard of Puerto Rico, much less seen a Puerto Rican. Several people have thought that I was from the Middle East, saying that I look like 'those people America keeps fighting'. The most common guess is that I'm biracial. One guy even told me as part a marriage proposal (each foreign girl here gets at least 3 a day) that he "always wanted to marry a half black, half white", to which I replied I too shared that dream, and thus couldnt accept his offer. Yesterday a kid pointed me out to another one and said "Look, a 'black man' inside a 'white man'.
A couple days ago I had a difficult time convincing the Mayor's secretary that I was not in fact a Native American. Our conversation, which occured while I waited to take a trip to a village health center with the mayor, went as follows:
Him: So you are American?
Me: Yes.
Him: And you are an Indian?
Me: Yes
Him: So you are a red Indian.
Me: No, I'm a brown Indian, from India.
Him: (Silence)...Indians are custodians.
Me: (Shocked and perplexed face)
Him: ...of the land.
Me: Yes, I suppose that's true.
Him: Indians used to fight the cowboys.
Me: Yes, they did.
Him: As a red Indian, how do you feel about having Bush the cowboy as your President?
Me: Umm...(Considering the ways that question is ridiculous)
Luckily I was saved from answering by the mayor's arrival.
Eventually once people realize that my family is from India, they all have the same reaction: "You people make good movies and music." (I never thought there could be music and movies worse than those from Bollywood, but the comically bad products from 'Nollywood'- Nigeria- have proven me wrong.) Then they talk about how Indians are all beautiful and good singers. I have yet to disuade anyone of this notion, even after explaining that in a country of 1.3 billion people its not hard to find enough good-looking, talented people to fill up a movie set. Naturally this love of all things Indian leads the men to ask if I am married (and I always say that yes, I am, for two years to an American soldier- i.e. not someone to mess with) or if I have any available sisters, cousins or friends for them. (At this point I become an unfortunate, friendless orphan.)
So all you Indian women reading, know that there are lots of underemployed Cameroonian men who would love to marry you. And if you are a young biracial woman, there's someone here dying to have your baby. I'd take up these offers if only I wasn't an AL-BE-NO with no soul...:)
Usually we (the other interns and I) can satisfy the kids by returning their calls with a 'hello' or 'good morning', which the kids, who are too dumbfounded by our ability or willingness to speak to them, can't reply to. Some bolder or more curious kids have insisted on rubbing my (above all the others') skin to see if the color rubs off. A few have even put mud on themselves and let it dry to try to match me.
But the biggest attraction has been my hair, especially among grown women. No adult woman here has just her own hair- everyone wears a wig or weave, or braids in fake hair. So the fact that I, a dark-skinned person have straight, relatively shiny, fast-growing, black hair is almost unbelievable, and definitely an eviable trait. More than a few women have offered to pay me to cut off my hair and give it to them to make a wig out of, especially after I described donating to Locks of Love. The rest of the women insist that I should braid it like they do, but I think I'll end up looking like a sorority girl just back from Spring Break in Cancun, and I dont really want that.
All of these behaviors and suggestions are regularly occuring and have become expected. But what I did not expect was the welcome I got in the village of Bakwele. I had gone to Bakwele, a small isolated village about 45 minutes drive away from Mamfe on a crappy dirt/mud road, to visit their health center as part of my research. With me were Sharlotte, a young nurse who is my assistant/translator, and Antoine, our driver. Because Bakwele is a rather unremarkable village, there is no reason for a 'white man' to pass through it, and we knew that I would be the only non-African many people had ever seen, or at least seen recently. Even driving the truck down the main path caused a sensation, as there are no cars and only a few motorbikes in Bakwele. This was all expected. But what the three of us were not ready for were the screams of 'AL-BE-NO! AL-BE-NO!' which erupted as I got out of the truck. Within a few moments what seemed like every kid in the village had gathered around me and taken up the chant, including a girl so young she couldnt walk without falling down every few steps, but who chanted with unparalleled enthusiasm.
Because there are a lot of misconceptions about albinos (who are relatively common here), the kids were quite scared of me. Most people believe that albinos are sub-human/ghosts/immortal/soul-less beigns who are cursed because of the sins of their parents. Several kids would run up to me to get a closer look, and then run away screaming in terror. None of the parents or grandparents sitting around made any move to quell the chaos and in fact seemed to agree with their kids' assessment of me.
Eventually we made our way into the health center, where we had a much more sensible welcome. All three of us were still startled and neither Sharlotte nor Antoine had a good explanation for that reception. (In other places we went a few kids might should 'white man' but most people kept going about the business and greeted me normally.) Even inside the health center we could hear the kids shoulding. During my survey of the clinic and interviews with the providers the kids would hang on the bars of the windows to stare at me (perhaps to determine if I was coming because of some problem derived from lacking a soul) and periodically shout 'Al-be-no' as a reminder to me of my classification.
Our walk back to the truck and departure created similar chaos to our arrival but the kids felt bolder now and would come up and touch me before running away shreiking. They ran after our car for almost a kilometer. Its hard to say if they were driving us out of town or were calling me back so they could examine me. Given that my skin is only slightly lighter than theirs, I wonder what they would have done if one of the real white interns (some of whom are imposingly large) had been with me; perhaps they would be a super-albino or even a phantom. I want to take a trip back to Bakwele just to conduct that experiment.
Outside that village no one has mistaken me for an albino but they have made other inaccurate guesses regarding my background. The chief doctor at the district hospital guessed Puerto Rican, which was unexpected since I doubt anyone else in Cameroon has ever heard of Puerto Rico, much less seen a Puerto Rican. Several people have thought that I was from the Middle East, saying that I look like 'those people America keeps fighting'. The most common guess is that I'm biracial. One guy even told me as part a marriage proposal (each foreign girl here gets at least 3 a day) that he "always wanted to marry a half black, half white", to which I replied I too shared that dream, and thus couldnt accept his offer. Yesterday a kid pointed me out to another one and said "Look, a 'black man' inside a 'white man'.
A couple days ago I had a difficult time convincing the Mayor's secretary that I was not in fact a Native American. Our conversation, which occured while I waited to take a trip to a village health center with the mayor, went as follows:
Him: So you are American?
Me: Yes.
Him: And you are an Indian?
Me: Yes
Him: So you are a red Indian.
Me: No, I'm a brown Indian, from India.
Him: (Silence)...Indians are custodians.
Me: (Shocked and perplexed face)
Him: ...of the land.
Me: Yes, I suppose that's true.
Him: Indians used to fight the cowboys.
Me: Yes, they did.
Him: As a red Indian, how do you feel about having Bush the cowboy as your President?
Me: Umm...(Considering the ways that question is ridiculous)
Luckily I was saved from answering by the mayor's arrival.
Eventually once people realize that my family is from India, they all have the same reaction: "You people make good movies and music." (I never thought there could be music and movies worse than those from Bollywood, but the comically bad products from 'Nollywood'- Nigeria- have proven me wrong.) Then they talk about how Indians are all beautiful and good singers. I have yet to disuade anyone of this notion, even after explaining that in a country of 1.3 billion people its not hard to find enough good-looking, talented people to fill up a movie set. Naturally this love of all things Indian leads the men to ask if I am married (and I always say that yes, I am, for two years to an American soldier- i.e. not someone to mess with) or if I have any available sisters, cousins or friends for them. (At this point I become an unfortunate, friendless orphan.)
So all you Indian women reading, know that there are lots of underemployed Cameroonian men who would love to marry you. And if you are a young biracial woman, there's someone here dying to have your baby. I'd take up these offers if only I wasn't an AL-BE-NO with no soul...:)
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