Third Year Update
12 years ago
Thursday, April 30, 2009
What Do You Do When It Is 110* Outside? You Walk 92 Km, Of Course.
So, it’s hot outside. And what do you do when it’s hot outside. No, not just hot. Hot season hot. You walk 92 km, of course. My friend, Josh, and I, did not want to attend the Hard Core party. This is a party that happens in the northern most part of the country to celebrate all the volunteers up there having to go through hot season. The party site is in the Sahel which is probably one of the hottest places on earth, as temperatures up there are easily 130* during hot season. There was also a Soft Core party all the way in the very, very south. This is for all the volunteers in the South, and pretty much anyone else who wants to come, who have the easy life during hot season, where it is only about 110*. Josh and I did not want to travel all that way. So we decided, “Hey, let’s just try to die instead.” We mapped out this elaborate trek where we would start in my village and go all the way up north (almost to Ouaga). About 200 km in total/ 40 km a day. We made it about 92 km in two days, and on the morning of the third day, he quit and hailed a bush taxi home. He quitting is understandable because he wore Chakos, which wasn’t the best idea for the trek, but I commend him for making it as far as he did. I did not want to finish out the walk out by myself/ I did not think it would be safe for me to do so. So, I stopped walking as well, and just came to the capital. However, am I upset that I did not get to finish the trek? No. A bit disappointed but then I realize in life, it is not always about the destination, it’s more about the journey to get there. We had fun though. The first day of walking was mostly en brousse so we really had no idea how long it was to get to Bagre (a large village that would be our first night’s stop). Once would get to Bagre we would pitch a tent and camp out for the night. Not only did we not know the distance, but either did any of the locals. After walking about 10 km, we decided to ask a local how far it was to Bagre. We new it was about 30-40 km. The local tells us. Oh, it is 15 km. 15 km?!? We say Bagre slowly and then spell it out and we repeat that Bagre is 15 km away. The local shakes his head, and is like, “yeeeess, of course I know Bagre. It is 15 km away.” We thank him and walk up a bit further and ask the next person. This person tells up 12 km, next person 4 km, and next person 50 km. It seemed like the closer we got to Bagre the number of km that the locals told us just seemed to go up (and asked we asked like a million locals.). Along the way, little kids would love to come up and shake our hands (sometimes in throngs), would then proceed to follow up for a good distance, and ask us why we were making this trek. It was somewhat Forrest Gumpish. We had like an entourage of little children. The adults, on the other hands, were just mystified and confused why we were walking 200 km. I think for some villages that were all the way out en brousse, they may have also never seen a white person before. Along the way, we ran across the Burkinabe marathon record holder who was training for the upcoming marathon in Ouaga. He invited us over for breakfast and to meet his family and also gave us tips for our trek. He was extremely nice. Turns out he was originally from Zabre which is my neighboring district capital. Small world.
Wednesday, April 29, 2009
Current Status: Dying
So…hot season has begun. As I read the needle of my little Swiss army knife’s thermometer, I realize I don’t particularly like hot season (the maximum temperature for the thermometer is 120* and the needle has passed that mark). While I have adjusted considerably well to the hot temperatures of Burkina, some days it is almost unbearable. The heat would not be so bad if their was relief from it, but there isn’t. Although the majore lets me put water bottles in the vaccination freezer, so that is pretty cool. The silver lining of hot season is that it is also mangoooooo seasooonnn! and avvvoccaddoo seasoooonn! I think those are God’s gifts to Peace Corps volunteers who have to go through hot season in Burkina. I eat huge mangoes like there is no tomorrow. I have come to think of myself as a mango snob because I won’t even eat the small to medium sized mangoes; only the big ones will suffice. The smaller the mango, the more fibrous it is. On a random tangent, this is perfect meal. I have made it for every lunch and dinner for the last three weeks: benga (beans), with a piment salsa, green peppers, tomatoes, onions, avocados, and sometimes corn. Followed up by a big mango. If I close my eyes, it reminds me of Chipotle burrito salad minus about half the ingredients, but so good, nonetheless. Although, I can only have the avocados on the Zabre market days because since it is so hot, the food spoils if I try to save it for the next day. All the other vegetables I can get to last at least until the next day. Anything cooked goes bad after a couple of hours. So there is the heat factor to deal with as well as the constant sweating. When I first arrived in Burkina, it seemed so un-Godly hot, but now, those temperatures were not so bad. I don’t really sweat, I just glisten. However, for the first couple of times that I sat down and later get, up my pants or skirt from my butt all the way to my knees would be soaked. I was like wtf? Did I sit a puddle of water? How did I not notice and why do I keep on doing it? Come to find out, it was not a puddle of water…Older volunteers have told me in previous hot seasons they would be popping Benedryl like M&M’s just so they could fall asleep at night. Even though it’s hot, the season so far has been milder than previous ones. The erratic and short mango rains during the night make sleeping more bearable. There have even been a couple of times where I had to put a towel over me and wear my Santa Clause Christmas socks that my parents sent me. It is too hot to sleep inside my house, so I sleep outside.
The Fruits Of My Labor
So here are some highlights from my Etude de Milieu. My Etude ending up being about 20 pages in total but I thought I would bring in the general highlights and leave out all of the charts/graphs/stats. I would like to thank my unofficial counterpart Ganga for the completion of my Etude. It would never have been possible without his help and guidance. Even though he is a dolo(local beer) drinking, chain smoking, somewhat sketchy guy (in a creepy uncle kind of way). He is absolutely amazing; if I need anything set up e.g. a meeting, traveling 9 km with me to a district capital in 120* weather, conducting meetings/surveys, he is always more than willing to help. And he never asks for anything in return. A major part of my etude was conducting door to door surveys with 75 family compounds (30-40 minutes with each family). Those were a long couple weeks. Especially, when you are biking between 5-8 hours a day visiting families and your filtered water runs out. You cannot drink the water that the families offer you because its well water. Ganga likes to remind me of this as he takes a big swig of what seems like delicious water at the time. Enjoy the rest the Etude!
General Information
XXXXXX has a population of 6165 inhabitants; the village is separated by eight quartiers (Chirikou (1&2), Gnitara (1&2), Barigou, Koma, Fourbè, Onobisa, Chenga Bissa, Zoaga Gnitara, Widi, and Dirè). The principle ethnicity in Beka is Bissa with a small amount of Mossi as well. All of the Puehls in the region are located in one of Beka’s satellite villages. Christianity, Animism, and Islam are practiced in Beka. Animists are the most numerous, followed by the Catholics and Protestants, and a few Muslims. In Beka there is one Protestant church, one Catholic Church, and one mosque.
The community of XXXXXX is found the Sub-Saharan climate. In the last fifteen years, the average rainfall per year is around 927 mm, with about fifty days of rain on average. The region is characterized by a dry season that extends from October to May and a more humid/rainy season from June to September. There is little vegetation in the region, and deforestation is a mounting problem with the overgrazing of animals and bush-fires.
Economy
Agriculture is the principle activity of the Bissa, and therefore the vast majority of XXXXX. The principle crops are sorghum, millet, rice, maize, and peanuts; the secondary crops are beans and vegetables (African eggplant, eggplant, onions, tomatoes, green peppers, cucumbers). Because of a reliance on the rainy season for water, and production constraints due to a lack of machine, the majority of farming is for subsistence. A lack of fertilizer coupled with unreliable rainfall leaves the soil dry, nutrient depleted, and therefore, uncultivable. Hence, the quality and quantity of the crops is sub optimal. Furthermore, there are no artificial methods of irrigation used. Farmers also engage in market gardening between each rainy season. Because there is a lack of rain in between rainy seasons, farmers use the water from the barrage to irrigate the market gardens.
Animal husbandry is the primary economic activity of the Peuhl and a secondary activity of the Bissa. During the dry season, the Peuhls migrate to Ghana and the Ivory Coast while the Bissa remain in XXXXX and do market gardening. Livestock includes goats, sheep, chickens, pintards, cows, and pigs are raised. The majority, if not all of the farmers, do not have the means via money or transportation to vaccinate the animals against potential diseases. For this reason, the animal mortality rate of XXXXX is extremely high, with an average rate of 65% per herder. Difficulty accessing water sources, poor land quality, and the abundance of sachets in the fields, leaves the animals even more vulnerable to mortality. As a result, animal husbandry as a means of income generation is highly unreliable.
Micro-enterprise constitutes a secondary means of income that is practiced year round. There are sixteen boutiques, thirteen buvettes, seven tailors, and seven mechanics in XXXXX. The market is every three days, and one day after the Zabrè market, which is also every three days. Due to the proximity of its satellite villages, many vendors from XXXXX travel to other markets and vice versa. On non-market days, there are a number of women who sell items daily such as African eggplant, benga, peanuts, peanut rings, rice, gateaux, oranges, and porridge. Unfortunately, while the market has many items it also allows for illegal vending of street medicine which has caused the problem of self-diagnosing and self-medicating. At present, the market has no latrines.
Prostitution is also practiced in XXXXX and neighboring Zabrè. Because many girls lack an education, and ultimately a means to income generation, they engage in prostitution near the barrage and the gold mines in Youga.
Education
There is a primary school located in the central quartier of XXXXX. The majority of the children come from XXXXX, Fourbè, and Yorko. There are four classes: 1) CP1/CP2, 2) CE1/CE2, CM1, and CM2. The ratio of student to teacher is 87:1. Currently, there are 156 girls and 190 boys enrolled at the school. Only about 20% of children are enrolled in school and all others are not enrolled for various reasons. For example, many families cannot afford to send their children to school while some children are forced to help their families in the fields and/or are consistently sick. Furthermore, even if parents had the means to send their children to school, enrolling it is not feasible due to overcrowding. For those students who are fortunate enough to continue their studies, there is a lycèe located in Zabrè. There is a terminal is located in Manga which is 90 kilometers north of Zabré. Because of a lack of money, lodging, and transportation, acquiring an education past the lycèe level is not a very likely option for students in the region. Currently, only two students in the XXXXX region attend university in Ouaga. School lunches are no longer provided by Catholic Relief Services (CRS). CRS stopped providing lunches in the fall of 2008 to respond to the worsening food crises and to promote sustainability by encouraging local farmers to sell their crops. Many students go without lunch since one is not provided for them at school. The director of the school states that collecting money from the parents is not a viable option due to the level of poverty within XXXXX. At present, the school does not have a library.
Apart from the primary school, there is also a Koranic school for those of the Islamic faith. Additionally, there is one Bantarè school. The school, which teaches Bissa alphabetization, is located in the central quartier next to the Koranic school and market. Presently, sixteen women and one man are enrolled.
Maternity
The midwife arrived in March of 2007. Baby weighings and vaccinations are every Monday, Tuesday, and Wednesday. Prenatal consultations are every Thursday and Friday. While the maternity offers the most basic of services, it does not go beyond that which puts the women of XXXXX, and its surrounding villages, at a huge disservice. The hours for baby weighings/vaccinations and for new and follow up prenatal consultations are not respected. Patients arrive and usually seek personnel at their homes or simply wait for long periods of time. On more than a few occasions, the AIS will show up three hours late and sometimes not at all. Many of the women become frustrated and are forced to return home without having their baby weighed; this discourages maternity utilization, especially for those who live far away. For those times that the AIS does show up, baby weighings are not properly conducted. For example, clothes are not removed when a child is weighed. While the AIS identifies to me those children who are malnourished, he does not notify the mother. The AIS does not speak Bissa; therefore, an accurate and thorough consultation cannot be done. However, even if the AIS did speak Bissa, there does not seem to be a motivation to sensibilize the women, let alone inform them on their child’s condition. Needless to say, nutrition consultations are not performed. While the maternity has a lot going against it, attendance for baby weighings, vaccinations, and prenatal consultations is good for the villages of XXXXX, Yorko, and Fourbè. However, because of the distance between all other satellite villages and XXXXX, attendance is low for those villages. There is a lot of room for improvement.
Aire Sanitaire
There are fifteen aire sanitaires in the district of Zabrè with fourteen CSPS; there is one hospital (Centre Medical Avec Antenne Chirgie-CMA). Additionally, there is a HIV/AIDS testing center in Zabrè at the CMA. The test costs 500 FCFA. There is not a CREN in the district; the closest one is over 80 km north in Manga.
a. The priority problems to be addressed in 2009 are the following:
i. Low rate of preventative services
ii. Insufficient medical personnel
iii. At home deliveries
iv. Lack of education on health issues
v. Persistence of malaria
vi. Increased prevalence of HIV/AIDS and STI’s
vii. Increased prevalence of respiratory infections
viii. Strong prevalence of diarrhea and malnutrition
The priority problems that the CSPS would like to address during 2009 are the following:
Elevated morbidity and morality rates due to malaria
Elevated morbidity and morality rates due to diarhea
Lack of energy source
Low rate of community participation
Low rate of preventative services
Observations
Malnutrition
Malnutrition is a major problem in XXXXX. The majority, if not all of the villagers, recognize, when asked, that malnutrition is a problem but do not identify it as a pressing malady in the community. Villagers, for the most part, know which foods are good for them i.e. fish, rice, tomatoes; however, they state that they do not have the financial means to incorporate nutritious foods into their diet. Instead, most just accept that because they cannot afford to buy food besides millet for tô and okra and greens for the sauce, their children will remain malnourished. There is a misconception that crude food causes malaria; hence, many women overcook the sauces, thus killing any nutrients that they greens have. Sensibilizations are needed to teach the women on proper cooking techniques to retain the nutrients within the food. Infertile land, coupled with a lack of machinery and unreliable rainfall, make for an undependable source of food or income generation. Therefore, farmers can only engage in subsistence farming. This, along with high animal mortality rates, intensifies the ongoing issue of malnutrition.
Malaria
Malaria is very prevalent in the XXXXX region. Currently, an adequate number of the villagers know that mosquitoes cause malaria. However, a larger number of villagers believe malaria is caused by other factors such as too much sun exposure and the consumption of watermelon, Maggi, and crude foods. Malaria is easily preventable, but because villagers lack the financial means to fight malaria by investing in screen doors, mosquito nets, and the later re-treatment of the mosquito nets, they are left vulnerable to the endemic. As a result, malaria contributes to poverty by promoting school/work absenteeism as some are forced to either a) drop of out school or b) be unable to work in the fields. In conducting the community survey, it appears as if most families own at least one mosquito net, but they only use the nets during rainy season or not at all because the nets are quite hot. The mosquitoes bite around dawn and dusk which coincide with the times that the women and children obtain the water from the well. Thus, women and children are the most susceptible to malaria. In addition, all of the wells are uncovered which in effect encourages mosquito breeding. With this said, while malaria is prevalent in my region, in my opinion, malaria is misdiagnosed and over diagnosed. If a patient exhibits any combination of these symptoms—headaches, fatigue, vomiting, fever, etc, ---it is assumed he/she has malaria without any further testing. To confirm the presence of malaria, a blood test is needed. However, without the financial means to pay for such a test and also the speed of conducting the test/waiting to hear the results discourages utilization of such a test. Hence, the Majore prescribes malaria medication to patients without verification. This can only lead to more drug resistant malaria strains. Lastly, the money spent on unnecessary medications (depending on whether or not the patient has malaria), prevents villagers for paying for future medications when they are actually really sick.
Out of pocket payments
Most villagers cannot afford to go the CSPS. For this reason, many times families recognize that a family member is sick but do not seek out medical attention. In some instances, families wait too long too seek medical attention. As a result, the medical bills are exponentially higher and in some cases the family member may die. While health insurance seems like a good idea in theory, health insurance is still relatively expensive at 2,500 fcfa per person, especially when villagers do not engage in family planning. Because most families cannot afford to go to the CSPS every time a family member is sick, they seek out medical attention from a traditional healer or self diagnose and self-medicate with medicines found in the village market. Needless to say, neither method is very effective. Out of pocket payments could be more feasible if villagers practiced saving and/or making distinctions between buying luxury goods versus necessities. While dolo drinking is not a major problem in XXXXX, villagers do not think about forgoing or cutting back on dolo drinking in order to save money. This practice could be extended to buying gateau, peanuts, etc. In addition, sensibilizations are needed to educate fathers about the importance of investing in their families’ health, and subsequently their future. For example, most villagers do not think in terms about the importance of investing in soap. If each family invests in a bar of soap, which costs around150 fcfa, they can prevent diarrhea, for example. In the long run, by practicing good hygiene and remaining healthy, fathers will not have to pay for large CSPS bills which may cost upwards of 2,000-4,000 fcfa.
Potable water
Water is and will remain a huge problem in the region until potable water is not only available but accessible to the entire population. There are two pumps in XXXXX—one located at the CSPS and on located near the market. However, the pump near the market has been locked up and therefore not available for usage. There are five wells and one barrage that are dirty but used frequently for drinking, bathing, and washing clothes. Moreover, the wells remain uncovered which allows for rain and wind to bring in dust, nitrates, or fecal matter. Hence, these uncovered wells leave the population not only susceptible to malaria, but cholera, and diarrhea as well. Almost all of the villagers recognize that pump water is more sanitary than well water or the water from the barrage; however, without access to potable water, they are forced to use unsanitary water. If one were to get walk to the nearest pump, it could be anywhere between 45 minutes to a few hours. On a positive note, a Canadian Non Governmental Organization (NGO) called Tin Tua, which is based in Fada, is going to start construction on four pumps. It will cost the villagers a small fee each time they get water from the pump. But to pay such a fee is relatively feasible. In addition, a water tower was built in the last few years, but with only one working pump, the water tower is ineffective to bringing potable water to the entire community.
Sanitation
Village sanitation needs to be addressed on a grand scale. The lack of waste management and promotion of hygienic practices puts XXXXX at a huge disservice. Less than one percent of the population has access to latrines. A good number of people state that latrines are important in the prevention of maladies but all state that they do not have the means to afford one. On the other hand, even if latrines are present i.e. behind the CSPS, villagers do not use them, as they prefer to defecate in the fields. Without latrines and their usage, fecal matter is everywhere in the village and fields. This contributes to, and exacerbates the problems of diarrhea and other maladies, as most maladies are spread by fecal-oral transmission. Trash cans are non-existent and the village is littered with garbage including black sachets, which contribute to the high animal mortality rate. Villagers do not feel that waste management and sanitation promotion are an issue, as they do not relate waste management/sanitation to malady prevention.
Methodology
This Etude de Milieu for XXXXX was compiled during the months of December 2008 to March 2009. There were a multitude of individuals and organizations that aided in its completion. They include the following: CSPS staff, COGES, NGOs, the mayor, the MCD, the prefecture, the gendarmerie, the director of the primary school, the Agents de Sate Communitaire, the chief, and of course the villagers. I also toured the CSPS, the district hospital, reviewed the micro-plan for XXXXX, and the five year plan for the Zabré region. Every Monday, Tuesday, and Wednesday I participated in baby weighings/vaccinations at the maternity. I would also sit it on consultations regarding malaria, leprosy, intestinal parasites etc. At the beginning on each month I attended CoGes meetings and with the help of the CoGes, we carried out two 4 day door-to-door polio vaccination campaigns, one 5 day tetanus campaign, and a nine day elephantitis campaign. In addition to the vaccination campaigns, I conducted a door-to-door survey in the air sanitaire of XXXXX, meeting with 75 family compounds, and talking with each family for about 30 minutes to discuss their health needs and general knowledge of health issues.
My Role
Because of the serious, multifaceted problems that face my village, I would like my role within the community to be interrelated between the health and small enterprise development sectors. Remoteness, poverty, maladies, lack of an education, infertile land, high animal mortality rates, and insecure jobs are just some of the many underlying issues that create the current dire health and economic state of XXXXX. Hence, it is my hope that by focusing on these underlying issues, I will be able to assist XXXXX in living not only a more healthy and positive life, but a more prosperous and sustainable one as well. Based on information collected in my Etude, I have made a list of primary and secondary goals for my next two years in XXXXX.
Primary objectives:
• AIDS sensibilizations
o SIDA STOP Bike-a-thon, Mobile Depistage,
• Sensibilize the community on the importance of taking preventative measures, performing good hygienic practices,
• Conduct a malaria workshop
• Lead a girls summer camp
• Conduct a hearth model
• Moringa and bouille demonstrations
• Sensibilizations on family planning and contraceptives
Secondary objectives:
• Sante Avant Tout activities in Primary Schools
• Foyer ameliorer and soap making projects with different women’s groups
• Start a savings and credit club
• Plant a school garden with profits going to fund lunch programs and the future enrollment of students
• Create a compost and lead sensibilization on the importance of composting
Community Survey
1. What is the name of the Chef of the family?
2. What is your ethnicity?
3. What is your religion?
4. What do you do for a living?(merchant, farmer, herder)
i. What are the obstacles of being a merchant, farmer, etc?
1. How is the quality of the land, crops?
2. What is the animal mortality rate?
a. Why do you think there is such a high mortality rate?
ii. Between each rainy season what does your family do to earn money?
5. What is your water source (well, pump, barrage)?
i. How do get water during the hot season?
ii. How long do you have to walk to get to your water source?
iii. How do you store your water when you are not using it?
iv. Is there a difference between water from a pump and water from a well?
1. If there is a difference, what is the difference?
a. (If respondent answers pump water is better for one’s health than well water) Knowing that pump water is better for the health of your family, why do you go to a well?
6. Do you own a latrine?
i. Why does a person use a latrine?
ii. (If respondent answers latrines help prevent illnesses) If you know latrines help prevent illnesses, and you do not have the means to own one, how do you prevent germs/illnesses from entering your household?
1. (If person responds going to the bathroom far from the house as a means to prevent germs from entering the household) If you defecate far from your family compound to prevent germ transmission, how do you avoid illnesses from animals who defecate in your courtyards and/or fields?
7. Do you wash your hands?
i. When do you wash your hands?
ii. What do you wash your hands with?
1. Is there a difference between washing one’s hands with water only and washing one’s hands with soap?
iii. Why do you wash your hands?
iv. If a person eats without washing their hands’ first, does anything happen?
8. Do you practice family planning?
i. If yes, why?
1. What type of birth control (pill, shot, patch)?
ii. If no, why not?
1. (If person responds family planning is too expensive) Do you know how much birth control costs?
9. What sort of health issues do you talk about with your children?
10. When was the last time you went to the CSPS or the maternity?
i. For what reason did you go?
ii. What was the diagnosis and the advice/recommendation of the Majore?
11. If you do not have the means to go to the CSPS or buy medicine, what would you do?
i. How often do you visit a traditional healer?
1. Does his/her advice work? How much does a traditional healer costs relative to the CSPS?
12. What are the most reoccurring illnesses in XXXXX?
i. What are the most pressing illnesses in XXXXX?
13. Since the last rainy season, what sort of illnesses has your family experienced?
i. What did you do?
ii. If you did go the CSPS, what was the advice of the Majore?
14. In your opinion, why do children and adults become sick in XXXXX?
i. In your opinion, why do children and adults die in XXXXX?
ii. In your opinion, why is there a great prevalence of malaria in XXXXX?
1. How does one acquire malaria?
a. (If respondent states malaria is caused my eating certain foods and has had a family member diagnosed with malaria)If you know watermelon or Maggi causes malaria and your family avoids cooking with it/eating it, how do you explain your family member being diagnosed with malaria?
2. How can one avoid getting malaria?
3. Do you own a mosquito net? If so, how many? Do you use the mosquito nets year-round or just during the rainy season?
a. Why does a person use a mosquito net?
b. What would happen if a person does not use a mosquito net?
iii. In your opinion, why is there a great prevalence of malnutrition in XXXXX?
1. What sorts of foods does your family eat on a regular basis?
2. What sorts of foods are good/nutritious to eat?
a. If these foods are good/nutritious for your family, why do you not eat them?
15. During your pregnancy did your diet change?
i. If so, how did it change?
ii. What sort of foods did you eat?
16. Do you believe anyone in the Zabre region has AIDS?
i. What do you think of a person who has AIDS?
ii. Is a person with AIDS in Burkina stigmatized?
1. (If the person replies there is no stigmatization) In your opinion, why is there stigmatization of AIDS in other countries but not Burkina?
iii. What are the modes of transmission for AIDS?
General Information
XXXXXX has a population of 6165 inhabitants; the village is separated by eight quartiers (Chirikou (1&2), Gnitara (1&2), Barigou, Koma, Fourbè, Onobisa, Chenga Bissa, Zoaga Gnitara, Widi, and Dirè). The principle ethnicity in Beka is Bissa with a small amount of Mossi as well. All of the Puehls in the region are located in one of Beka’s satellite villages. Christianity, Animism, and Islam are practiced in Beka. Animists are the most numerous, followed by the Catholics and Protestants, and a few Muslims. In Beka there is one Protestant church, one Catholic Church, and one mosque.
The community of XXXXXX is found the Sub-Saharan climate. In the last fifteen years, the average rainfall per year is around 927 mm, with about fifty days of rain on average. The region is characterized by a dry season that extends from October to May and a more humid/rainy season from June to September. There is little vegetation in the region, and deforestation is a mounting problem with the overgrazing of animals and bush-fires.
Economy
Agriculture is the principle activity of the Bissa, and therefore the vast majority of XXXXX. The principle crops are sorghum, millet, rice, maize, and peanuts; the secondary crops are beans and vegetables (African eggplant, eggplant, onions, tomatoes, green peppers, cucumbers). Because of a reliance on the rainy season for water, and production constraints due to a lack of machine, the majority of farming is for subsistence. A lack of fertilizer coupled with unreliable rainfall leaves the soil dry, nutrient depleted, and therefore, uncultivable. Hence, the quality and quantity of the crops is sub optimal. Furthermore, there are no artificial methods of irrigation used. Farmers also engage in market gardening between each rainy season. Because there is a lack of rain in between rainy seasons, farmers use the water from the barrage to irrigate the market gardens.
Animal husbandry is the primary economic activity of the Peuhl and a secondary activity of the Bissa. During the dry season, the Peuhls migrate to Ghana and the Ivory Coast while the Bissa remain in XXXXX and do market gardening. Livestock includes goats, sheep, chickens, pintards, cows, and pigs are raised. The majority, if not all of the farmers, do not have the means via money or transportation to vaccinate the animals against potential diseases. For this reason, the animal mortality rate of XXXXX is extremely high, with an average rate of 65% per herder. Difficulty accessing water sources, poor land quality, and the abundance of sachets in the fields, leaves the animals even more vulnerable to mortality. As a result, animal husbandry as a means of income generation is highly unreliable.
Micro-enterprise constitutes a secondary means of income that is practiced year round. There are sixteen boutiques, thirteen buvettes, seven tailors, and seven mechanics in XXXXX. The market is every three days, and one day after the Zabrè market, which is also every three days. Due to the proximity of its satellite villages, many vendors from XXXXX travel to other markets and vice versa. On non-market days, there are a number of women who sell items daily such as African eggplant, benga, peanuts, peanut rings, rice, gateaux, oranges, and porridge. Unfortunately, while the market has many items it also allows for illegal vending of street medicine which has caused the problem of self-diagnosing and self-medicating. At present, the market has no latrines.
Prostitution is also practiced in XXXXX and neighboring Zabrè. Because many girls lack an education, and ultimately a means to income generation, they engage in prostitution near the barrage and the gold mines in Youga.
Education
There is a primary school located in the central quartier of XXXXX. The majority of the children come from XXXXX, Fourbè, and Yorko. There are four classes: 1) CP1/CP2, 2) CE1/CE2, CM1, and CM2. The ratio of student to teacher is 87:1. Currently, there are 156 girls and 190 boys enrolled at the school. Only about 20% of children are enrolled in school and all others are not enrolled for various reasons. For example, many families cannot afford to send their children to school while some children are forced to help their families in the fields and/or are consistently sick. Furthermore, even if parents had the means to send their children to school, enrolling it is not feasible due to overcrowding. For those students who are fortunate enough to continue their studies, there is a lycèe located in Zabrè. There is a terminal is located in Manga which is 90 kilometers north of Zabré. Because of a lack of money, lodging, and transportation, acquiring an education past the lycèe level is not a very likely option for students in the region. Currently, only two students in the XXXXX region attend university in Ouaga. School lunches are no longer provided by Catholic Relief Services (CRS). CRS stopped providing lunches in the fall of 2008 to respond to the worsening food crises and to promote sustainability by encouraging local farmers to sell their crops. Many students go without lunch since one is not provided for them at school. The director of the school states that collecting money from the parents is not a viable option due to the level of poverty within XXXXX. At present, the school does not have a library.
Apart from the primary school, there is also a Koranic school for those of the Islamic faith. Additionally, there is one Bantarè school. The school, which teaches Bissa alphabetization, is located in the central quartier next to the Koranic school and market. Presently, sixteen women and one man are enrolled.
Maternity
The midwife arrived in March of 2007. Baby weighings and vaccinations are every Monday, Tuesday, and Wednesday. Prenatal consultations are every Thursday and Friday. While the maternity offers the most basic of services, it does not go beyond that which puts the women of XXXXX, and its surrounding villages, at a huge disservice. The hours for baby weighings/vaccinations and for new and follow up prenatal consultations are not respected. Patients arrive and usually seek personnel at their homes or simply wait for long periods of time. On more than a few occasions, the AIS will show up three hours late and sometimes not at all. Many of the women become frustrated and are forced to return home without having their baby weighed; this discourages maternity utilization, especially for those who live far away. For those times that the AIS does show up, baby weighings are not properly conducted. For example, clothes are not removed when a child is weighed. While the AIS identifies to me those children who are malnourished, he does not notify the mother. The AIS does not speak Bissa; therefore, an accurate and thorough consultation cannot be done. However, even if the AIS did speak Bissa, there does not seem to be a motivation to sensibilize the women, let alone inform them on their child’s condition. Needless to say, nutrition consultations are not performed. While the maternity has a lot going against it, attendance for baby weighings, vaccinations, and prenatal consultations is good for the villages of XXXXX, Yorko, and Fourbè. However, because of the distance between all other satellite villages and XXXXX, attendance is low for those villages. There is a lot of room for improvement.
Aire Sanitaire
There are fifteen aire sanitaires in the district of Zabrè with fourteen CSPS; there is one hospital (Centre Medical Avec Antenne Chirgie-CMA). Additionally, there is a HIV/AIDS testing center in Zabrè at the CMA. The test costs 500 FCFA. There is not a CREN in the district; the closest one is over 80 km north in Manga.
a. The priority problems to be addressed in 2009 are the following:
i. Low rate of preventative services
ii. Insufficient medical personnel
iii. At home deliveries
iv. Lack of education on health issues
v. Persistence of malaria
vi. Increased prevalence of HIV/AIDS and STI’s
vii. Increased prevalence of respiratory infections
viii. Strong prevalence of diarrhea and malnutrition
The priority problems that the CSPS would like to address during 2009 are the following:
Elevated morbidity and morality rates due to malaria
Elevated morbidity and morality rates due to diarhea
Lack of energy source
Low rate of community participation
Low rate of preventative services
Observations
Malnutrition
Malnutrition is a major problem in XXXXX. The majority, if not all of the villagers, recognize, when asked, that malnutrition is a problem but do not identify it as a pressing malady in the community. Villagers, for the most part, know which foods are good for them i.e. fish, rice, tomatoes; however, they state that they do not have the financial means to incorporate nutritious foods into their diet. Instead, most just accept that because they cannot afford to buy food besides millet for tô and okra and greens for the sauce, their children will remain malnourished. There is a misconception that crude food causes malaria; hence, many women overcook the sauces, thus killing any nutrients that they greens have. Sensibilizations are needed to teach the women on proper cooking techniques to retain the nutrients within the food. Infertile land, coupled with a lack of machinery and unreliable rainfall, make for an undependable source of food or income generation. Therefore, farmers can only engage in subsistence farming. This, along with high animal mortality rates, intensifies the ongoing issue of malnutrition.
Malaria
Malaria is very prevalent in the XXXXX region. Currently, an adequate number of the villagers know that mosquitoes cause malaria. However, a larger number of villagers believe malaria is caused by other factors such as too much sun exposure and the consumption of watermelon, Maggi, and crude foods. Malaria is easily preventable, but because villagers lack the financial means to fight malaria by investing in screen doors, mosquito nets, and the later re-treatment of the mosquito nets, they are left vulnerable to the endemic. As a result, malaria contributes to poverty by promoting school/work absenteeism as some are forced to either a) drop of out school or b) be unable to work in the fields. In conducting the community survey, it appears as if most families own at least one mosquito net, but they only use the nets during rainy season or not at all because the nets are quite hot. The mosquitoes bite around dawn and dusk which coincide with the times that the women and children obtain the water from the well. Thus, women and children are the most susceptible to malaria. In addition, all of the wells are uncovered which in effect encourages mosquito breeding. With this said, while malaria is prevalent in my region, in my opinion, malaria is misdiagnosed and over diagnosed. If a patient exhibits any combination of these symptoms—headaches, fatigue, vomiting, fever, etc, ---it is assumed he/she has malaria without any further testing. To confirm the presence of malaria, a blood test is needed. However, without the financial means to pay for such a test and also the speed of conducting the test/waiting to hear the results discourages utilization of such a test. Hence, the Majore prescribes malaria medication to patients without verification. This can only lead to more drug resistant malaria strains. Lastly, the money spent on unnecessary medications (depending on whether or not the patient has malaria), prevents villagers for paying for future medications when they are actually really sick.
Out of pocket payments
Most villagers cannot afford to go the CSPS. For this reason, many times families recognize that a family member is sick but do not seek out medical attention. In some instances, families wait too long too seek medical attention. As a result, the medical bills are exponentially higher and in some cases the family member may die. While health insurance seems like a good idea in theory, health insurance is still relatively expensive at 2,500 fcfa per person, especially when villagers do not engage in family planning. Because most families cannot afford to go to the CSPS every time a family member is sick, they seek out medical attention from a traditional healer or self diagnose and self-medicate with medicines found in the village market. Needless to say, neither method is very effective. Out of pocket payments could be more feasible if villagers practiced saving and/or making distinctions between buying luxury goods versus necessities. While dolo drinking is not a major problem in XXXXX, villagers do not think about forgoing or cutting back on dolo drinking in order to save money. This practice could be extended to buying gateau, peanuts, etc. In addition, sensibilizations are needed to educate fathers about the importance of investing in their families’ health, and subsequently their future. For example, most villagers do not think in terms about the importance of investing in soap. If each family invests in a bar of soap, which costs around150 fcfa, they can prevent diarrhea, for example. In the long run, by practicing good hygiene and remaining healthy, fathers will not have to pay for large CSPS bills which may cost upwards of 2,000-4,000 fcfa.
Potable water
Water is and will remain a huge problem in the region until potable water is not only available but accessible to the entire population. There are two pumps in XXXXX—one located at the CSPS and on located near the market. However, the pump near the market has been locked up and therefore not available for usage. There are five wells and one barrage that are dirty but used frequently for drinking, bathing, and washing clothes. Moreover, the wells remain uncovered which allows for rain and wind to bring in dust, nitrates, or fecal matter. Hence, these uncovered wells leave the population not only susceptible to malaria, but cholera, and diarrhea as well. Almost all of the villagers recognize that pump water is more sanitary than well water or the water from the barrage; however, without access to potable water, they are forced to use unsanitary water. If one were to get walk to the nearest pump, it could be anywhere between 45 minutes to a few hours. On a positive note, a Canadian Non Governmental Organization (NGO) called Tin Tua, which is based in Fada, is going to start construction on four pumps. It will cost the villagers a small fee each time they get water from the pump. But to pay such a fee is relatively feasible. In addition, a water tower was built in the last few years, but with only one working pump, the water tower is ineffective to bringing potable water to the entire community.
Sanitation
Village sanitation needs to be addressed on a grand scale. The lack of waste management and promotion of hygienic practices puts XXXXX at a huge disservice. Less than one percent of the population has access to latrines. A good number of people state that latrines are important in the prevention of maladies but all state that they do not have the means to afford one. On the other hand, even if latrines are present i.e. behind the CSPS, villagers do not use them, as they prefer to defecate in the fields. Without latrines and their usage, fecal matter is everywhere in the village and fields. This contributes to, and exacerbates the problems of diarrhea and other maladies, as most maladies are spread by fecal-oral transmission. Trash cans are non-existent and the village is littered with garbage including black sachets, which contribute to the high animal mortality rate. Villagers do not feel that waste management and sanitation promotion are an issue, as they do not relate waste management/sanitation to malady prevention.
Methodology
This Etude de Milieu for XXXXX was compiled during the months of December 2008 to March 2009. There were a multitude of individuals and organizations that aided in its completion. They include the following: CSPS staff, COGES, NGOs, the mayor, the MCD, the prefecture, the gendarmerie, the director of the primary school, the Agents de Sate Communitaire, the chief, and of course the villagers. I also toured the CSPS, the district hospital, reviewed the micro-plan for XXXXX, and the five year plan for the Zabré region. Every Monday, Tuesday, and Wednesday I participated in baby weighings/vaccinations at the maternity. I would also sit it on consultations regarding malaria, leprosy, intestinal parasites etc. At the beginning on each month I attended CoGes meetings and with the help of the CoGes, we carried out two 4 day door-to-door polio vaccination campaigns, one 5 day tetanus campaign, and a nine day elephantitis campaign. In addition to the vaccination campaigns, I conducted a door-to-door survey in the air sanitaire of XXXXX, meeting with 75 family compounds, and talking with each family for about 30 minutes to discuss their health needs and general knowledge of health issues.
My Role
Because of the serious, multifaceted problems that face my village, I would like my role within the community to be interrelated between the health and small enterprise development sectors. Remoteness, poverty, maladies, lack of an education, infertile land, high animal mortality rates, and insecure jobs are just some of the many underlying issues that create the current dire health and economic state of XXXXX. Hence, it is my hope that by focusing on these underlying issues, I will be able to assist XXXXX in living not only a more healthy and positive life, but a more prosperous and sustainable one as well. Based on information collected in my Etude, I have made a list of primary and secondary goals for my next two years in XXXXX.
Primary objectives:
• AIDS sensibilizations
o SIDA STOP Bike-a-thon, Mobile Depistage,
• Sensibilize the community on the importance of taking preventative measures, performing good hygienic practices,
• Conduct a malaria workshop
• Lead a girls summer camp
• Conduct a hearth model
• Moringa and bouille demonstrations
• Sensibilizations on family planning and contraceptives
Secondary objectives:
• Sante Avant Tout activities in Primary Schools
• Foyer ameliorer and soap making projects with different women’s groups
• Start a savings and credit club
• Plant a school garden with profits going to fund lunch programs and the future enrollment of students
• Create a compost and lead sensibilization on the importance of composting
Community Survey
1. What is the name of the Chef of the family?
2. What is your ethnicity?
3. What is your religion?
4. What do you do for a living?(merchant, farmer, herder)
i. What are the obstacles of being a merchant, farmer, etc?
1. How is the quality of the land, crops?
2. What is the animal mortality rate?
a. Why do you think there is such a high mortality rate?
ii. Between each rainy season what does your family do to earn money?
5. What is your water source (well, pump, barrage)?
i. How do get water during the hot season?
ii. How long do you have to walk to get to your water source?
iii. How do you store your water when you are not using it?
iv. Is there a difference between water from a pump and water from a well?
1. If there is a difference, what is the difference?
a. (If respondent answers pump water is better for one’s health than well water) Knowing that pump water is better for the health of your family, why do you go to a well?
6. Do you own a latrine?
i. Why does a person use a latrine?
ii. (If respondent answers latrines help prevent illnesses) If you know latrines help prevent illnesses, and you do not have the means to own one, how do you prevent germs/illnesses from entering your household?
1. (If person responds going to the bathroom far from the house as a means to prevent germs from entering the household) If you defecate far from your family compound to prevent germ transmission, how do you avoid illnesses from animals who defecate in your courtyards and/or fields?
7. Do you wash your hands?
i. When do you wash your hands?
ii. What do you wash your hands with?
1. Is there a difference between washing one’s hands with water only and washing one’s hands with soap?
iii. Why do you wash your hands?
iv. If a person eats without washing their hands’ first, does anything happen?
8. Do you practice family planning?
i. If yes, why?
1. What type of birth control (pill, shot, patch)?
ii. If no, why not?
1. (If person responds family planning is too expensive) Do you know how much birth control costs?
9. What sort of health issues do you talk about with your children?
10. When was the last time you went to the CSPS or the maternity?
i. For what reason did you go?
ii. What was the diagnosis and the advice/recommendation of the Majore?
11. If you do not have the means to go to the CSPS or buy medicine, what would you do?
i. How often do you visit a traditional healer?
1. Does his/her advice work? How much does a traditional healer costs relative to the CSPS?
12. What are the most reoccurring illnesses in XXXXX?
i. What are the most pressing illnesses in XXXXX?
13. Since the last rainy season, what sort of illnesses has your family experienced?
i. What did you do?
ii. If you did go the CSPS, what was the advice of the Majore?
14. In your opinion, why do children and adults become sick in XXXXX?
i. In your opinion, why do children and adults die in XXXXX?
ii. In your opinion, why is there a great prevalence of malaria in XXXXX?
1. How does one acquire malaria?
a. (If respondent states malaria is caused my eating certain foods and has had a family member diagnosed with malaria)If you know watermelon or Maggi causes malaria and your family avoids cooking with it/eating it, how do you explain your family member being diagnosed with malaria?
2. How can one avoid getting malaria?
3. Do you own a mosquito net? If so, how many? Do you use the mosquito nets year-round or just during the rainy season?
a. Why does a person use a mosquito net?
b. What would happen if a person does not use a mosquito net?
iii. In your opinion, why is there a great prevalence of malnutrition in XXXXX?
1. What sorts of foods does your family eat on a regular basis?
2. What sorts of foods are good/nutritious to eat?
a. If these foods are good/nutritious for your family, why do you not eat them?
15. During your pregnancy did your diet change?
i. If so, how did it change?
ii. What sort of foods did you eat?
16. Do you believe anyone in the Zabre region has AIDS?
i. What do you think of a person who has AIDS?
ii. Is a person with AIDS in Burkina stigmatized?
1. (If the person replies there is no stigmatization) In your opinion, why is there stigmatization of AIDS in other countries but not Burkina?
iii. What are the modes of transmission for AIDS?
My Monthly Pilgrimage to Ouaga, My Mecca
I try to come into the capital at least once a month. Besides Ouaga being my Mecca, I have to come for reasons of maintaining my sanity. In early March, I attended FESPACO, which is the biggest film festival in Africa. That was really fun as I got too see a lot of great Indy movies/documentaries and the like. The last time I was here, I attended a soccer match between Burkina and Guinea. Each team was vying for a spot to make it to the Africa Cup. From there those qualifying teams from the Africa Cup will then go on to the World Cup in South Africa in 2010. Soccer is huge here. At the last game I attended, I was almost stampeded. That’s right. Stampeded. Like a bunch of PC volunteers running towards the Fanchoco cart (Burkina’s version of America’s ice cream truck) in a 120* heat, a group of grown men ran me over. And it wasn't even when the match was going on! It was half time! I was getting up to leave to go find something to eat with my friends outside of the main arena. As we were almost to the gate, they open the gates, and all hell breaks loose. Men were pushing and shoving to catch a glimpse of the game that was not even playing….. Logic? People were shoving to get in the gate as other people were shoving to get out. I lost my friends in the throng and I was going down the stairs when a guy pushes me down. Do any of the other men offer to help? Nope, they either choose to step on me or around me. Mostly the latter. I ask you this: where is the chivalry??? I finally manage to get up when I get pushed down two more times. At this point I am almost in tears and I manage to get up and push the man in front of me and say, "STEP BACK!" Granted this guy had no idea what I was saying, but it brought me some consolation. Even though there were guards/policemen? at the gate they had no control over the situation. Beating Guinea 4-2, Burkina will be playing Cote d'Ivoire June 19th for advancement to the Africa Cup. Burkinabe love their soccer but Cote d'Ivoirians (is that even a word? well, it is now) are absolutely nuts about soccer. This game is like the best thing to happen to Burkina since its independence in 61’. Especially since Burkina is awful at soccer but has somehow managed to make it far enough to play Cote d’Ivoire. At the last Cote d’Ivoire game last month, 19 people died and 100 were injured in a stampede. I have heard that the arena holds 33,000 people, but yet, 50,000 want tickets—most people but tickets the day of…at the arena. Now you would think I would learn from the Burkina game and not attend the next match. But nope, I don't have enough sense for that. I will be in my Burkina gear and waving the flag.
Upcoming Projects...Yayyy..I Am Finally Useful
Malnutrition is a huge issue in Burkina as it is very prevalent. There are many causes of malnutrition. They include the following: 1)low birth weight(malnourished mothers) 2)Inadequate breastfeeding during the first six months of life (e.g. introduction of complementary food or drink before six months), 3)Children are weaned from the breast milk too early (e.g. ahead of the recommended 2 years--another pregnancy), 4)Unbalanced diet (the child does not get a variety of foods (construction, energy, and protection, 5)Insufficient food intake, 6)Micronutrient deficiency, 7)Diarrhea and childhood diseases (Often times a child will lose his/her appetite due to illness. That, coupled with diarrhea, exacerbates malnutrition).
In a few days, upon returning back to village I will be starting a hearth model with a group of women from one of my village quartiers (neighborhoods). The Hearth Model is a way to combat malnutrition at the community level. The Heath Model was introduced in the 1980’s in Haiti and has since been replicated in countries such as Vietnam, Guinea, Mali, Tanzania, etc. The model posits that despite poverty, there are local practices, knowledge, and resources that can be exploited to promote positive health practices. If adopted, even mothers in the poorest of communities are still able to raise healthy, well-nourished children. In practice, the Model brings together six to ten mothers of malnourished children over a two week period to practice and learn healthy nutrition behaviors. The Hearth Model has three main objectives: 1) to rehabilitate malnourished children, 2) to educate women on basic health issues, 3) to demonstrate that raising well nourished and healthy children is possible even with limited means. The Hearth Model is a project that does not require a lot of funding. An effective project simply requires community participation and cotising money or sharing the locally available materials. There is no medicine to cure malnutrition; only a nourishing diet and protection against diarrhea can alleviate malnutrition. However, prior to the beginning of the project, vitamin A and guinea worm will be administered. The Hearth requires 12 days of participation for approximately two hours each morning. The mother will come with her child and assist in the making of four enriched porridges that the group of mothers has chosen to make. There are several different recipes that they women can chose from(12 in all); recipe selection depends on the time of the year and locally available projects. In addition to preparing the porridge, each mother will learn about different health topics. Instead of choosing twelve health topics, I have chosen six to focus on in the first week; the second week will be review of the first week. The six topics I have chosen are the following: 1) Overview of the Hearth and basics of growth monitoring and baby weighing, 2) Early childhood nutrition and signs and causes of malnutrition, 3) Proper weaning, 4) Treating water, food preparation, and personal hygiene, 5) Diarrhea and Oral Re-hydration Salts (ORS), and 6) Malaria and its prevention. Each morning the child will eat the porridge and then bring enough home to last the rest of the day. The porridge is not meant as a replacement to the breast milk and other complementary foods, but as an addition to them. The child will be weighed on the first and last day of the Hearth. Weight gain is not always immediate or guaranteed as it takes time for a child’s appetite to increase or if it takes some time for the child to like the recipe. Prior to the commencement of the Hearth, it is recommended to find a Mama Lumiere (a woman who is highly respected in her quartier, who has healthy children and practices good healthy behaviors) to help lead the Hearth. Ideally, she is of the same ethnic and socio-economic group as all the other women in the group. After finding a Mama Lumiere and getting her agreed participation, she will then find interested mothers and then give me their child’s heath cards. I will then review the cards and pick out those children who fit the criteria for the Hearth. For this Hearth, I initially rejected about 2/3 of the children, and chose eight children. They were either too young or did not fit the weight requirement. I felt really bad doing this. Children must fall under the category of moderately to severely (lower level of severity) malnourished; these children must also have stagnant growth or trouble gaining weight. It is not recommended for children on the higher end of the severe malnutrition to participate, as they should be directed to the clinic for a referral to a CREN (explained in one of my previous blogs). However, with a lack of money, most families cannot afford to send their children to a CREN, so many volunteers (including myself) allow children who fit in this category to participate. After choosing the eligible children, it is then necessary to visit each father to explain the project and get his permission. After I have each of the father’s permission, I will then meet with all of the mothers a group to decide on recipe selection, best time of day and date to have the hearth, where to hold the hearth, and whether or not the women want to cotiser the money or share the materials. However, at this meeting that was originally intended for eight women + the Mama Lumiere, many more women got word of the meeting and came with their children and thier health cards to see if they made the cut. Eventually, the number swelled to include twenty kids. While having this many children/mothers participate is not recommended as it is less personal, I am not one to tell a mother who wants to help her malnourished child, that she could not participate. Although, I did have to turn away a couple of mothers because their childrens weights were in the healthy range. I did tell them that even though their child did not need to participate in the formation, the mother and child could still participate to learn about the enriched porridges and health topics. All that remains is to meet with the families one week and one day before the beginning of the Hearth to administer the vitamin A and guinea worm medication. I will visit each child after one month, two months, and one year later to check to growth monitoring as well as to see if the families are putting into practice what they learned at the formation.
There are potential obstacles to carrying out an effective project. In previous volunteers’ experiences, women will often arrive late or not at all, some women may send their daughters to attend that morning formation and/or just to pick up the porridge, mothers may give a portion of the porridge to other children in the family, some children get sick during the Hearth which the mother might attribute it to the Hearth, and some children do not end up gaining weight (some even lose). Despite all of these obstacles, if done correctly, the Hearth model is effective.
In addition to the hearth, I will be starting a couple of English clubs where I tutor children and adults. I will also be starting to teach health classes to the primary school students once a week. Rainy season begins in a few weeks so it is quite hard to start any big projects. Once the rains come, everyone will be in the fields from dawn til dusk(most of money that the family lives off of for the rest of the year comes from the money earned during the rainy season). However, along with the rains, comes the mosquitoes and consequently, malaria. Therefore, I would like to give a couple malaria sensibilizations before the rainy season begins. In July I would like to lead a week long girls club, start a moringa garden in september, and put together a AIDS bike-a-thon for late September.
In a few days, upon returning back to village I will be starting a hearth model with a group of women from one of my village quartiers (neighborhoods). The Hearth Model is a way to combat malnutrition at the community level. The Heath Model was introduced in the 1980’s in Haiti and has since been replicated in countries such as Vietnam, Guinea, Mali, Tanzania, etc. The model posits that despite poverty, there are local practices, knowledge, and resources that can be exploited to promote positive health practices. If adopted, even mothers in the poorest of communities are still able to raise healthy, well-nourished children. In practice, the Model brings together six to ten mothers of malnourished children over a two week period to practice and learn healthy nutrition behaviors. The Hearth Model has three main objectives: 1) to rehabilitate malnourished children, 2) to educate women on basic health issues, 3) to demonstrate that raising well nourished and healthy children is possible even with limited means. The Hearth Model is a project that does not require a lot of funding. An effective project simply requires community participation and cotising money or sharing the locally available materials. There is no medicine to cure malnutrition; only a nourishing diet and protection against diarrhea can alleviate malnutrition. However, prior to the beginning of the project, vitamin A and guinea worm will be administered. The Hearth requires 12 days of participation for approximately two hours each morning. The mother will come with her child and assist in the making of four enriched porridges that the group of mothers has chosen to make. There are several different recipes that they women can chose from(12 in all); recipe selection depends on the time of the year and locally available projects. In addition to preparing the porridge, each mother will learn about different health topics. Instead of choosing twelve health topics, I have chosen six to focus on in the first week; the second week will be review of the first week. The six topics I have chosen are the following: 1) Overview of the Hearth and basics of growth monitoring and baby weighing, 2) Early childhood nutrition and signs and causes of malnutrition, 3) Proper weaning, 4) Treating water, food preparation, and personal hygiene, 5) Diarrhea and Oral Re-hydration Salts (ORS), and 6) Malaria and its prevention. Each morning the child will eat the porridge and then bring enough home to last the rest of the day. The porridge is not meant as a replacement to the breast milk and other complementary foods, but as an addition to them. The child will be weighed on the first and last day of the Hearth. Weight gain is not always immediate or guaranteed as it takes time for a child’s appetite to increase or if it takes some time for the child to like the recipe. Prior to the commencement of the Hearth, it is recommended to find a Mama Lumiere (a woman who is highly respected in her quartier, who has healthy children and practices good healthy behaviors) to help lead the Hearth. Ideally, she is of the same ethnic and socio-economic group as all the other women in the group. After finding a Mama Lumiere and getting her agreed participation, she will then find interested mothers and then give me their child’s heath cards. I will then review the cards and pick out those children who fit the criteria for the Hearth. For this Hearth, I initially rejected about 2/3 of the children, and chose eight children. They were either too young or did not fit the weight requirement. I felt really bad doing this. Children must fall under the category of moderately to severely (lower level of severity) malnourished; these children must also have stagnant growth or trouble gaining weight. It is not recommended for children on the higher end of the severe malnutrition to participate, as they should be directed to the clinic for a referral to a CREN (explained in one of my previous blogs). However, with a lack of money, most families cannot afford to send their children to a CREN, so many volunteers (including myself) allow children who fit in this category to participate. After choosing the eligible children, it is then necessary to visit each father to explain the project and get his permission. After I have each of the father’s permission, I will then meet with all of the mothers a group to decide on recipe selection, best time of day and date to have the hearth, where to hold the hearth, and whether or not the women want to cotiser the money or share the materials. However, at this meeting that was originally intended for eight women + the Mama Lumiere, many more women got word of the meeting and came with their children and thier health cards to see if they made the cut. Eventually, the number swelled to include twenty kids. While having this many children/mothers participate is not recommended as it is less personal, I am not one to tell a mother who wants to help her malnourished child, that she could not participate. Although, I did have to turn away a couple of mothers because their childrens weights were in the healthy range. I did tell them that even though their child did not need to participate in the formation, the mother and child could still participate to learn about the enriched porridges and health topics. All that remains is to meet with the families one week and one day before the beginning of the Hearth to administer the vitamin A and guinea worm medication. I will visit each child after one month, two months, and one year later to check to growth monitoring as well as to see if the families are putting into practice what they learned at the formation.
There are potential obstacles to carrying out an effective project. In previous volunteers’ experiences, women will often arrive late or not at all, some women may send their daughters to attend that morning formation and/or just to pick up the porridge, mothers may give a portion of the porridge to other children in the family, some children get sick during the Hearth which the mother might attribute it to the Hearth, and some children do not end up gaining weight (some even lose). Despite all of these obstacles, if done correctly, the Hearth model is effective.
In addition to the hearth, I will be starting a couple of English clubs where I tutor children and adults. I will also be starting to teach health classes to the primary school students once a week. Rainy season begins in a few weeks so it is quite hard to start any big projects. Once the rains come, everyone will be in the fields from dawn til dusk(most of money that the family lives off of for the rest of the year comes from the money earned during the rainy season). However, along with the rains, comes the mosquitoes and consequently, malaria. Therefore, I would like to give a couple malaria sensibilizations before the rainy season begins. In July I would like to lead a week long girls club, start a moringa garden in september, and put together a AIDS bike-a-thon for late September.
Highlights From the First Three Months
Okay, so I know I have not posted in about two months but with good reason. I originally was going to post last month but classic Brittany style I procrastinated until the very end of my etude period to finally start my Etude du Milieu. So…instead of blogging, I was writing my Etude. The Etude du Milieu is pretty much a community analysis of my site's health needs. With this, I will have a base for assisting my community in its health development. During this time, I was not supposed to do anything but my Etude. My assignment for the first three months was to just to try to integrate into the community by attending community events and the like. "Try" being the operative word. However, like all things, I am sure my integration will come with time as well as my local language level. At times it is difficult because only like 1% (probably not even that) of my village speaks French. Sometimes, I feel like if I had gone to an English speaking country, it would have been a lot easier for me to have integrated. But then I think where is the challenge in that? And you know, I love speaking my Franglisa (French+English+Bissa). My Bissa level is slowly improving. I have been taking individual lessons for about a month now (every three days). In a lot of ways, Bissa is easier to learn than French or English as there are no verb conjugations. However, it is still very hard and I am rather confused by the sentence structure. If a cavewoman and Yoda, from Stars Wars, were to conceive, I would be the resulting child. For example, instead of saying “I eat bread,” you would say, “I bread eat.” The noun always goes before the verb. When I speak to the villagers e.g. a three or four word phrase or sentence that I constructed in which afterwards I feel proud of myself, I usually wait for some recognition of what I said. If they understand me they will usually respond in Bissa. 100% of the time, I don’t catch a word of it. It’s like; I don’t understand you so just listen to me ramble. The first three months were challenging. Because I could not start any projects, I had a lot of free time. Yep. Lots and lots of free time. My wall and I are like BFF now. However, I did help three times a week at the maternity with baby weighing and vaccinations. It was my job to help put the baby in the slings and read out the weights. It’s a very important job. Sometimes, I would feel a certain wetness come on my feet, and I think to my self hmmmm...what is that???... I look down and the baby peed on me. No biggie, really. I just consider it a perk that comes along with the job. Part-time Starbucks employees get healthcare, I get urine. It all evens out. Even though I enjoy helping out at the maternity, it is really emotionally trying. I see ALOT of malnourished babies who come in month after month with no increase in weight or they just keep decreasing. There are times, when I am weighing one of the severely malnourished children, that I become nauseous. I don't know if it's my giardia kicking in, the smell of urine, or just the site of the malnourished infant in front of me, but I have to excuse myself from the room. I also have been involved in lots of vaccination campaigns: three tetanus campaigns and three polio campaigns. For the tetanus campaigns, the women come to the clinic, but for the other two campaigns we have to go in brousse visiting all of the family compounds. My partner Antoinette (member of the COGES) and I spend anywhere between five and eight hours biking/walking en brousse delivering the vaccinations to the children and women. I also conducted a community survey but I will go more into depth on that in another blog entry. I also go to Church every Sunday. Even though I do not understand a word of it, it gives me something to do and allows me to interact with the villagers a bit. The Catholic masses are two hours and conducted in Bissa; whereas, the Protestant services are four hours and conducted in French. Two hours of not understanding a word vs. four hours of understanding the majority of the mass. Hmmmm...tough decision. Needless to say, the Catholic mass always wins out. Sometimes, a boy will give his French bible and show me the verses for the day so that helps. I also always arrive late. Not that I am a bad Catholic, although I do consider myself a Cafeteria Catholic, but I just never know when mass starts. Here, nothing, starts on time and were always waiting. I will explain that in another blog. So I always arrive late and there never is usually any space for me to sit. However, no worries, the ushers just kick people out of their seats so I can have a seat. The Sunday before last, like usual, I arrive late, and there was no where to sit. So what do the ushers do? They kick a woman who seriously looks like she’s ninety and about eighty pounds (with a cane!!) off of her stool so I could have her seat. The Niscarra has arrived! Make way! You try to say no, but they just don't listen. Mass does have its entertaining parts, though. The ushers always make their rounds and poke sleeping people to wake them up. If a baby starts to cry, the usher motions to the woman to either a) take out her boob, or b) leave. I also have picked up walking. Burkinabe really do not understand the concept of walking just to walk or exercising in general. Many times I will be stopped to ask where I am going. I will respond no where really and that I am just walking to walk. They usually will respond and gesture, “Are you going to Yorko?” for example. I will then say, “No, I am just walking.” They tend to look confused and then say, "But Yorko is that way. You are heading towards Yorko?" I say, “No, not Yorko.” The villager will then say, "But Yorko is that way..." Finally, I will just say, "Sure, that sounds good. I am walking to Yorko.” They will then respond or make a gesture that says, "Well hop on the back of my moto and/or bike and I will take you to where you are going." I then say no that is okay I prefer to walk. Other people in neighboring villages or my own village who either know me or have seen me ride my bike will stop and ask me why I am walking. I will usually respond that I just want to walk. They will then ask, “Is your bike broken?" I will say, no. It is usually followed up with, "But you're walking???" Yep, I am walking. Here, if you have a bike, moto, or car (I never see cars in my village), are status symbols. Hence, if you have one, you use it. That is why they are always confused as to why I prefer to walk. My official counterpart, who lives like 50 feet away from the clinic, I will never see walking. He will moto-it those long fifty steps to the front door of the clinic. I will usually walk three hours a day (an hour and half in the morning and an hour and a half at night). In the beginning, I just did it to have something to do and it gave me a great way to meet the villagers and practice my Bissa, but then I just kind of kept with it. I also am reading a lot and one of my favorite things to do is to listen to the BBC on my shortwave.
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