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?