6.22.2015

But What If We Don't Have Tomatoes?

Prepping Nutrition discussion Images
Long time, no talk! Yes, I’m still here chugging away in Cameroon. I’ve been wrapping up my projects, studying for the GRE, working on PhD applications, and trying to fit in a bit of time to relax - my hands have been full! But in case you were worried, no, I haven’t (yet) died of some mysterious illness, although it is not yet off the table. In all honesty, as my time is coming to an end here, there just isn't all that much (new) to talk about that I haven't already.

My HIV project is still underway - 600 of my 1,000 tests have been used, and the tests have confirmed what my counterpart and I suspected: that our HIV prevalence rate in our heavily migratory fishing population area of Cameroon is 10-12%, which is 4 times the national average. The majority of large testing days in my health district are finished, but at the end of July I’m assisting a new health volunteer in carrying out a 2-day testing campaign in his village - so hopefully by the end of July, 1,000 Adamawans will know they status and seek treatment!

As for “Phase 3” of my project - creating a support group for HIV+ people - well, that has been tried, and tried, and tried again with no success. The hard thing about Cameroon is (well, honestly, many things) the lack of will and the power of stigmatization. HIV is immensely stigmatized in and around Ngatt, especially among the Muslims. Many people have misconceptions about the origins of HIV, claiming that it’s a disease brought about by witchraft or eating too many mangoes. People are extremely worried about their status getting out in the community, which is understandable, but the fear inhibits them from even attending discrete meetings with other HIV positive community members. If people lack the trust in their fellow community members in keeping their status secret, then nobody shows up to the support group.

The other problem is lack of will. The origins of this project came from three women in my village who came to me one day, told me their status, and begged for a testing campaign and a support group with income generating activities. I followed through with my end of the bargain (I even bought seeds to create a large support group garden to improve nutrition), yet the three women didn’t uphold their end. Even when I told them I had seeds for a group garden and all they had to do was show up to my house, they still wouldn’t do it. There’s a point in Peace Corps work where you realize you can’t force people to change, and this was my moment. Whereas my testing campaign was a success, and hundreds (and soon to be a thousand) people now know their status and are seeking treatment, the support group side of my project was a complete failure. 

But as one door closes, another opens. I realized lately that getting people to show up to any sort of organized meeting is harder than pulling out teeth. So, I come to the conclusion that  if people aren’t going to show up to me, I’m going to show up to them and force them to listen to what I have to say. I know, it sounds like I’m torturing my community members, but I hope one day they’ll realize this pain is for their own good. 

My new approach to spreading community health knowledge is to lead health talks at the hospital on Mondays, Wednesdays, and Fridays on a certain health topic (which rotates weekly) for the inpatients. At any given time there are usually 15-20 inpatients and their family members mingling about our hospital compound. Whilst they mingle and cook in the evenings, I educate them on (mal)nutrition, malaria, family planning, and whatever else strikes my fancy. This, thus far, has been a wild success. All the women gather around me (because the majority of our inpatients are women and children) as their pots of boiling sauce simmer in the kitchen hut. They huddle around me and my drawings, with their tops off and their boobs sagging to their knees, to listen to what I have to say.

One week I was educating on malnutrition and a balanced diet and I discussed how at very meal they should be eating carbs/starches, vegetables and fruit. One woman raised her hand after examining my maison de nourriture (food pyramid) and she insisted, “We don’t have any of that food to eat”.  “You don’t have what food to eat?”, I asked.
“We don’t have fruits or vegetables - only corn!”, she replied
“What season is it right now?”, I demanded.
“Rainy season,” she quickly replied.
“Okay, and what can you buy in the market?” I asked. “Mangoes, avocados, bananas, folere…” She replied, and then suddenly she stopped, looked at me and laughed, “Ohh!! We do have these foods you talk about!”

The people in my community, especially those from the small encampments en brousse, insist that they have no food and that is a fact of life. Few realize that while our selection isn’t vast, we do have some fruits and vegetables that are able to sustain us. Not to mention, starting a garden would be insanely easy if anyone had the determination. 

My health discussions aren’t wildly interesting (at least to me), but at least I’m reaching a large group of community members, and I can only hope they are retaining half of what I say - although my translator tends to go on epic digressions which discuss completely irrelevant tidbits, so I hope my community isn’t retaining his useless rantings. 

I've now got less than 4 months left in Cameroon, so the time I have remaining to work is dwindling down as I wrap up my projects. I'm finishing up my HIV project, attempting to get my tri-weekly health talks on solid ground so it that it might function after I'm gone, and trying to enjoy what little time left I have in Cameroon. It's not been smooth sailing recently, but time is sure flying. 

5.08.2015

Depistez-Vous! (HIV Campaign - Phase 2)

Sensitization in Wandjock
 The most exhausting part of my HIV testing campaign is (thank God), done. The month of April was exhausting, stressful and angering in every imaginable way. Every week involved at least one trip en brousse to a village to educate and test for HIV. The testing days involved waking up early, taking a bumpy cramped moto to wherever our destination was, and then spending the entire day asking the same questions over and over and then either telling people they were HIV negative, or, unfortunately far too often, telling them they were HIV positive. Factor in the daily instances of ‘Cameroonian-struggle-bus-instances (which I define as things that should be simple, but which aren’t because Cameroonians make everything more complicated than it really is);  it was physically exhausting but more so emotionally exhausting.

The opening of my campaign was in Ngatt and it involved a two day testing event at the hospital. I was significantly skeptical about whether anyone would show up, but thankfully about two hundred people did over the two days. Spencer came up from the Centre region and assisted me in educating people on methods of transmission, how to combat stigmatization, and how to properly use a condom. While the Ngatt testing date didn’t have as many people as I was hoping would show up, it was still not a bad turn out.

Waiting for Test Results in Wandjock
The next day Spencer and I went to Wandjock, a village alongside Lake Mbakaou. While Spencer and I both did the education sessions like in Ngatt, we were also in charge of registration and pre- and post-test counseling. Unfortunately, post-test counseling involves telling people their status, and given that my Fulfulde is stronger than Spencer’s, it was always me telling people their HIV status. The first batch of 40 or so people was all adults among which three were positive. Each time I had to tell someone they were HIV positive was worse than the previous time. After the third time, I wasn’t sure I could tell one more person their status. Thankfully, after the initial 40 or so people, there was a large bunch of kids who came to get tested who were all (thankfully) negative. While the mood was far from jubilant most of the day, the mood was lightened, if only a bit, by the children who would respond to my ‘What is your ethnic group?’ question with “Arab.” The first kid who told me he was Arab, I asked again, thinking I misheard. Nope, he legitimately thought he was Arab. Spencer and I stifled our laughs and I asked the kid ‘Oh okay, so are you Saudi or Qatari…?’ The joke was lost on the kid, but Spencer and I got a few good laughs at several kids’ expenses.

I traveled to 8 villages throughout the month of April and tested over 500 people, with 1,000 tests left over to give for voluntary testing at the Ngatt health center for those who want to be tested on their own time. Unfortunately, we found that the HIV prevalence rate for my area was about 10-12%, which far surpasses the national average of 5%. The next step in the campaign is convincing those who are HIV+ to show up for my new HIV+ support group, but that is proving to be far tougher than my  boss and I anticipated. This week I’m attending a Working with HIV+ People conference, so my counterpart and I are hoping that’ll inspire us.

While the testing campaign was emotionally exhausting, there were some positive stories that emerged. One day I was testing people in Mbizor, another fishing village alongside Lake Mbakaou. 20% of the people I tested that day were HIV+. Most people are quite stoic when they receive the news; for some they already knew, and for others they have a hard time accepting the fact they have HIV. One woman was shell-shocked, but asked very calmly what she needs to do. I told her the first thing is to tell her husband.
Waiting for Results in Wandjock

The next day in Ngatt she came to the health center with the husband, but didn’t tell him why they were there. I explained that we wanted to test both of them for HIV, and the husband agreed. When I pulled the woman aside and told her that her second test confirmed that she does in fact have HIV, tears welled up in her eyes and she explained to us that her husband told her he has another woman whom he will run away and marry if she has HIV. Given this information, I asked my boss what we should do, but he agreed that we need to tell the husband and explain to him the realities, with the wife’s permission, of course. She agreed, left the room, and we called the husband in. He was HIV negative and was obviously relieved, but was shocked his wife was positive.

We explained for 30 minutes the realities of HIV treatment and how to prevent him from contracting HIV. We counseled him on how he can still have kids (which he wants) and told him that he shouldn’t blame or leave his wife. He agreed, but I was skeptical. We called the wife back in and he consoled her. After another discussion with the two of them together, we let them leave. The husband left and the woman followed behind him, both of them not talking. As I watched them leave, I was dubious whether he was sincere in telling us that he would stay with his wife. As he walked several steps ahead of his wife, I was convinced that my boss and I were responsible for the breakup of a marriage. But later in the day, my boss and I saw the couple sitting roadside before returning to Mbizor – they were sitting close, holding hands (already unusual for Cameroon), sharing their lunch, and laughing. The scene itself was not normal for couples in Cameroon, who usually show no signs of affection towards their significant other, but given the news they were just given, I was filled with optimism that this couple, might indeed, last.

Fishing in Mbizor
The next stage of my campaign will be the continuation of giving out free tests at the Ngatt health center and getting that HIV support group started. This project will lead through the end of my service which is fast approaching (!!!!!!). My time left in Cameroon is now less than 6 months, and while the past year and a half seems like it’s dragged on, I feel like my last bit of time will speed by, or at least I’m hoping it will. While I’m sure when I board the plane for my COS trip it will be bittersweet, I feel at this point, I’ve fulfilled all I wanted to in Cameroon. 

Daily annoyances, security incidents, and struggles seem to compound on each other and build to the point that they can burn a volunteer out. I will admit that I am ready to move on and quite frankly at this point I can’t wait. I am looking forward to my life post Peace Corps but for now the adventure, and work, isn’t over quite yet.


4.07.2015

Combating Malaria in Ngatt

Malaria Education Session in Ngaoumere

Yesterday evening, the winds picked up, the sky darkened, dust swirled around to imitate a small, weak tornado, and then suddenly – I heard it: the pinging on my tin roof. It was the first sign that the rainy season is approaching. It has been unbearably dry, hot, and dusty lately as the end of dry season rears its ugly head. Food is scarce, and water is scarcer. What water I do manage to find to bathe, drink and clean with is the color of my bright red hair from all the dirt that falls into the few wells which have a scant amount of water remaining. People stay at home, choosing to nap in the heat of the day rather than be enervated by the blistering sun. The hospital is quiet except for a handful of cases every day from waterborne diseases, such as typhoid.

Most people in Ngatt are anxiously awaiting the start of rainy seasons in April. They know that with rainy season come mangoes, oranges, and avocados; it is a time to start sowing crops, which means an increase in income; it’s also a time when the heat lessens and everyone can go about their life again. What they don’t often realize, however, is that while the rain, their work outdoors, and increased plant growth means the end of some of the burdens of dry season, a new enemy arrives: malaria.

Malaria is a serious public health problem throughout Cameroon. Many Americans are often shocked when they hear that most of us PCVs get malaria at least once, if not several times, during our service. It’s known as a deadly public health menace all around the world, but here in Cameroon, it is business as usual when you have malaria. Unfortunately over the years Cameroonians have been so accustomed to having malaria that it long ago lost its shock value. Not to mention, many Cameroonians still have false information about malaria.
Grassroots Soccer

Locals joke with me about why I educate them on malaria when it’s considered a ‘normal’ burden of life for them. What they don’t seem to understand, however, is that while they might be able to go about life as normal when they have malaria, there are certain groups who are more vulnerable, such as young children, pregnant women, and people with HIV/AIDS, for whom malaria can spell death. And while many Cameroonians feel like malaria isn’t too big of a deal, they don’t comprehend just how much they spend on malaria treatment per year, which they’d be able to save if only they slept under a mosquito net.

People in Ngatt know of malaria, or as it is called in Fulfulde pabbooje. They are used to having it annually, and they thankfully know that when it’s bad enough, they need to seek immediate medical care. However, many people hold false ideas about malaria, such as it is caused by water, or it is caused by mangoes – both of which are easily believable for them since malaria cases skyrocket at the start of rainy season, which brings both lots of mangoes along with the abundance of rain. Most people know that the best method of prevention is a mosquito net, and many of the Fulbe do indeed use their mosquito net that was given to them by the Global Fund a few years ago. The Gbaya, however, prefer to use theirs to fish with or use it to catch those delectable termites.

The Cameroonian government recently released a tiered payment system for malaria treatment. 
Treatment and testing for children under 5 is free, while pregnant women pay 4,000cfa ($8), and all others pay 8,000cfa ($16). This price includes testing, medicine, a quinine perfusion if necessary, as well as hospitalization costs in the case of severe, cerebral malaria. Between February 2014 and February 2015 we had a total of 38 positive cases of malaria in pregnant women at our health center, which represented 5% of overall 666 positive malaria cases last year. These 38 pregnant women paid 152,000cfa ($300) for their treatment. It’s absurd that these 38 women caught malaria in the first place, given that all pregnant women who go to their pre-natal consultations receive a free mosquito net as well as a prophylaxis medication. The challenge to eradicating malaria during pregnancy is a problem of behavior change communication, which means working endlessly to convince someone to change their daily habits.  It is exhausting and takes time.
Certificate Ceremony after Grassroots Soccer

While pregnant women spent nearly $300, all other adults from age 6+ spent a whopping 2,896,000cfa ($5,700). Positive malaria cases for people aged 6+ nearly equaled the number of positive cases of children 5 and under. While we have a large under 12 population in Ngatt, it’s absurd that the number of cases under 5 equal all those over the age of 5. What this suggests is that parents take malaria seriously in their children when all treatment and testing is free, but once they have to start spending the $16 for treatment, they stop taking their loved ones to the hospital, choosing instead to go to traditional doctors or directly buy less effective medicines from vendors in our local market.

Over the next month, I’m doing a series of malaria activities in my community, namely a grassroots soccer malaria curriculum and presenting on malaria in Ngatt’s weekly market in an effort to increase education ahead of the arrival of rainy season. These last few weeks I finished two “Grassroots Soccer – Malaria” curriculums with the primary school and another with neighborhood kids. All the kids knew of malaria and have had it at one point, but they had varying opinions on what causes malaria and how to prevent malaria. The kids at the primary school knew a little bit about malaria, but the whopping majority of kids in my GRS activity in my neighborhood proved to know next to nothing about the transmission of malaria. After a few activities, the kids had a much better understanding of malaria, but still failed to take malaria seriously.

What a Stank Face from this Sassy Girl
It’s a sad reality that malaria is so deadly, but yet so commonplace and ‘normal’ in Cameroon. Peace Corps Volunteers and community health workers face the tough challenge of convincing people to change their behaviors by using mosquito nets, seeking treatment, and actively trying to avoid malaria rather than accepting it when it comes. It’s most definitely discouraging work that sees little progress in the short time we are in our villages, but I think we all hold out hope that with enough education, slowly but surely people will start taking their health into their own hands for the sake of themselves, their family, and their community.

3.15.2015

The Link between Fishermen and HIV/AIDS


My time has been completely consumed lately by my HIV/AIDS project that I’m getting started. I’ve been attempting to link my HIV/AIDS sensitization curriculum to all the other groups I’ve created and work with on a weekly basis. I’ve been going village to village to educate people on the basics of HIV and why they should be tested; and I’ve been busy at home drawing posters, making pre- and post-test counseling sheets, and creating an HIV Support Group Curriculum and Manual for the support group that I’ll create after my testing event, but also for future PCVs to use. Needless to say, my free time that I used to spend reading, studying for the GRE, or researching PhD programs has shrunk to nearly nothing.

Thankfully, however, I love work. While I value free time, I like being busy, having deadlines, and being under a bit of pressure. I function best in that environment. I’ve been trying to delve my heart and soul into this HIV/AIDS project not only because I want to do one big project such as this during my service, but more importantly because it’s extremely needed in my community.

Ngatt, while being a mostly conservative Muslim and Fulbe small village in the Adamawa, is a bit unique in its high HIV prevalence rate. And while official figures are lacking, I’d even hazard a guess that the area around Ngatt has one of the highest HIV prevalence rates in the Adamawa, mostly likely comparable to the areas around large transit towns like Meiganga (near the border of the East Region and the Central African Republic) or Ngaoundal (the 2nd largest train stop between Ngaoundere and Yaounde). 
 
Pirogues in Wandjock
Why is the Ngatt area so affected by HIV if it’s not a very populated area? The population of the Ngatt health area is at most 5,000, and Ngatt proper’s population is around 1,500, with half of those being children under 12. And why is the prevalence rate so high if the culture is relatively conservative? The answer lies in the area’s largest industry: Fishing. The Ngatt area has a lot of cattle, and our cattle market is well-known throughout the area, but fishing is where the real money is, where the layperson can make a good wad of cfa during a few months of the year when Lake Mbakaou is dammed and open to fishing.

Lake Mbakaou is the largest lake in the Adamawa, and it supplies fish all throughout Cameroon. Besides Kribi, Lake Mbakaou is arguably the second largest supplier of fish. From around January to end of April, Lake Mbakaou is dammed and all the fishermen (both men and women) come from around the Adamawa (and Cameroon as a whole) to catch large tilapia, mackerel, and capitaine. From August to November, fishing in the lake is forbidden so that it isn’t over-fished. When the lake is finally dammed and opened to fishing, the lakeside village’s swell with an influx of fishermen food and alcohol vendors and prostitutes.

The Ngatt health district's HIV prevalence rate is between 10-12%, around 3 times higher than the overall Cameroon average of 4.5%. Cameroon has many groups that are considered ‘high risk’ populations, including prostitutes (in many cities, prostitutes are just a dollar), military, and truck drivers (because they are often stuck en route and find comfort in the arms of a warm prostitute). What is often missing from the list of ‘high risk/at risk’ populations is fishermen, which is very relevant and important to explaining my area’s high HIV prevalence. 

The link between fishermen and HIV isn’t new, but it is significantly lacking research. In fact, some of the earliest recorded HIV cases were around the Lake Victoria area in 1982. Yet despite this, many organizations have failed to consider fishermen among groups whom they consider at-risk.

While there is still much research needed to be done, many organizations have set out to begin researching the link between fishermen and HIV prevalence rates. The findings are somewhat shocking, but would explain why the Lake Mbakaou area has a high prevalence. Research has begun to show that in low and middle-income countries, fishermen are between 4-14 times more likely to have HIV than the general population. In studies conducted in Kenya, Uganda, and DRC, HIV prevalence rates among fishermen were on average 25%, which is around 5 times higher than the prevalence rates of the general population. In the same study, researchers discovered that HIV rates (in prevalence and in absolute numbers) were much larger in fishermen than in truck drivers, a well-known high risk group, and other at-risk groups including injection drug users, military, and prisoners (see graph).

According to Ann Gordon in the report “HIV/AIDS in the Fisheries Sector in Africa”, there are several reasons as to why fishermen are more at risk of HIV. A few of these reasons include:

·         Fishermen are normally young adults (15-35), which is the age group most vulnerable to sexually transmitted diseases. And ISTs increase one’s chance of getting HIV.
·         Fishermen are migratory, and therefore are less constrained by traditional social and family structures. For example, the Lake Mbakaou fishing season is February-June, so those who participate in fishing are away from their ‘home’ for many months and are more likely to participate in risky activities, such as prostitution.
·         Fishermen are considered as having a sizable disposable income and time off, which allows for plenty of opportunities to drink alcohol and participate in risky sexual practices.
·         In fishing communities, it is common for a small number of women to have sex with a large number of men, which increases ones chance of being exposed to HIV.
·         In fisheries where women participating in the catch, it is not rare for women to trade fish for sex.
·         Gender inequality and poverty make it difficult for women to insist on condom use.
·         Given the remoteness and seasonality of fishing communities, the availability of condoms and sexual health resources in fishing communities is often limited

The effects of HIV on fishing communities are multifold. For fishermen who contract HIV, they are no longer as productive, especially if they don’t adhere to their ART treatment and fall sick frequently. For families with an HIV+ member, many of their resources will go towards the care and treatment of their sick family member. And for the country as a whole, when entire fishing communities are ravaged by HIV/AIDS and the problem is large enough, then access to fish decreases, which then increases food insecurity and hurts the national economy.


In order to lower the prevalence of HIV among fishing communities, there needs to be better prevention, more access to testing/care/counseling/and ART adherence and better mitigation of poverty. I’ve created my project to address all three of these criteria in hopes that this project will actually make a difference and be sustainable. For increasing prevention methods, I’m addressing this by educating all the fishing communities in my area during their most-active season on the transmission and prevention of HIV as well as the importance of voluntary testing. With increased education among this at-risk population, I hope they will adopt the practices of using condoms and getting tested on a regular basis.

Furthermore, the access to condoms is non-existent in my area. If you want to buy condoms, you have to travel to either Tibati or Ngaoundal, which is an expensive trip for the average person. I’ve started a small condom stock at the Ngatt health center, which they will sell at normal market price (3 condoms for 20 cents). While condoms won’t be available in all villages, it’s my goal to make them at the very least accessible in Ngatt, where everyone from all the villages come at least once a week on market day to buy food for the week, sell their fish, or go to the health center for treatment. With condoms readily available in the Ngatt health center, everyone should be able to buy them if they want them.

Secondly, to address testing/care/counseling/and ART adherence, I’m leaving my health center with a supply of HIV tests so that they can continue an annual testing campaign. Furthermore, I’m creating an HIV+ support group which will meet bi-monthly to discuss mental and physical health and to monitor their adherence to their ART. The support group manual I’m creating will ensure the sustainability of the project so that my health center staff has a list of lesson plans and resources to ensure the longevity of the group.

Finally, my HIV campaign will address the mitigation of poverty by teaching various income generating activities to my HIV+ support group. They will learn and adopt these practices and teach them to other women who work in fishing communities so that the income disparity between men and women will begin to shrink, which will allow women to turn away from prostitution and empower them to use condoms.

Addressing the problem of HIV among fishing communities in my area is imperative for the continuation of the fishing industry, and also for the continuation of a healthy population. I’ve got my fair share of work cut out for me, and the majority of it won’t be easy since it deals with behavior change and communication. By the time I leave Cameroon, my project will just be barely getting its feet off the ground, but I hope that at least the ball will be rolling and perhaps a decade down the road my health center will start noticing the positive changes.

3.14.2015

Spreading the Word (HIV Campaign: Phase 1)

Sensitizing Nyongock Village on Transmission of HIV

After three months of being deplacĂ© because of a myriad of medical problems, I’m finally back at it in Ngatt: Eating gombo sec and couscous, talking about HIV, and kicking butt. My PEPFAR grant money finally arrived (it took a few months longer than expected). I went to Ngaoundere last week to pick up the nearly $2,000USD from the bank, and then I went on a huge shopping spree where I dropped nearly that entire sum, but not on anything fun like pagne or leather wallets, but rather on condoms, 1,550 HIV tests, syringes, gloves, and seeds for the community garden that the future HIV Support Group will create.

My testing campaign will be a protracted campaign, not a large 1 day event like the annual Race of Hope testing day in Buea that happened on Valentine’s Day. My campaign will go to 8 villages around Ngatt, and we’ll test about 2 villages a week over the course of 3 weeks. My campaign is more of a no-thrills villageouis campaign since none of the villages will have electricity and resources here are limited. There sadly won’t be music or videos to pump people up and get them excited about testing themselves for HIV, no, instead they are stuck with me, who will be trying my best to get people excited through low-resource games and a dozen hand-drawn pictures about the immune system, transmission methods, prevention methods and stigmatization. 
 
A Group of Fisherfolk and Gica
My campaign will start with a 2 day testing event on March 26-27 in Ngatt, and given the 26th is a market day and the 27th is a prayer day, we are hoping for a big turnout. Thankfully, Spencer is coming up to help with the testing in Ngatt, but his secondary job will be to keep me sane. Then on the 28th we’ll head to the somewhat large fishing village of Wandjock, which sits at the edge of Lake Mbakaou. The lake is currently dammed, so all the fishermen throughout the Adamawa come to catch tilapia, mackerel, and capitaine, and hope to not get eaten by a hippo in the process. But the influx of fishermen also means the influx of femmes libres and bordels - yes, prostitutes.  Women come from near and far to sell gin, vodka, and whiskey sachets to the fishermen (and women) during the day, and then other women come out at night and sell a very different service to the inebriated men.

Wandjock is the largest fishing village, but it isn’t the only one. We are also going to test Mbizor, a village a little further to the west on Lake Mbakaou, Nyongock, a bit to the east of Wandjock, and Ngaoumere, which is right near Nyongock. In addition to these at-risk fishing villages, I’m also doing a testing day in Kandje, a village between Ngatt and Danfili, and a cluster of Mbororo encampments that have a history of rampant STIs and HIV (Gan Laka, Mayo Solla, and Djaro Garga).

It’ll be an exhausting campaign and I receive mixed reactions when I tell locals about the campaign. Some people reply with “Yes! We need this! I’ll be the first in line!” to “Nobody will show up to that, especially if they know they are at risk of being HIV positive!” This gives me the difficult task of convincing everyone that it’s better to know your status, get started on the free ARVs, join my support group and increase their chances at a long healthy life, and to remind them that not  knowing their status will only make their lives more costly and short. While I’m hoping for the best turnout possible, I’m also trying to be realistic and remind myself that this is Cameroon, and things never quite go according to plan. Thankfully, in a two hour long village wide door-to-door survey my translator conducted yesterday, we got the names of at least 200 youth who will show up on the Ngatt testing day, not counting adults and children.
 
Lake Mbakaou in Mbizor
Even if all 1,550 tests don’t get used, we are leaving them at the hospital so that people can come on their own and get tested. I also figure that at the very least, if not everyone gets tested, at least the conversation about HIV and STIs has been started and is hopefully less of a taboo subject, which, I hope, will  encourage people to talk about risk factors and prevention methods.

In order to get the word to each village that they have a free testing day coming up, I traveled to Wandjock, Mbizor, Nyongock and Ngaoumere to give a brief education session and to inform them on the date of their testing day. I traveled by moto with Gica, the security guard at the hospital who I have a love/hate relationship with. I love Gica because he can translate for me and does good work when he is motivated. But far more often I get frustrated with Gica because he whines about not being compensated, is a bit too over-the-top for most Fulbe to appreciate, and he is 80% of the time drunk.

After scheduling our sensitization day for last Friday, Gica blew me off to get drunk at 8am. We rescheduled for Saturday and headed out to Mbizor. Mbizor is a small fishing village, with a mostly Gbaya population. Our sensitization went well. We had about 60 total men, women and children show up to learn about HIV/AIDS and the importance of being tested. After our presentation, we headed down to the Lake where I watched the fishermen as Gica pounded back some Gin sachets, claiming that he drives the moto best when under the influence of alcohol.

After a brief lecture by me about how I don’t want to be driven around by a drunkard, Gica finally decided to stop drinking and get back on the road. Our next stop was Nyongock, a small little fishing village of only perhaps 2 dozens people. We educated around half the village, and they got quite a kick out of my condom demonstration on my wooden penis. The by now tipsy Gica tried to help me convince people they need to get tested by sharing his own personal story, which went something like this: “HIV is like playing a game of chance. I’ve had sex with over 10 women who’ve died from HIV and I still haven’t gotten infected! I’m starting to lose faith in my blood now, so we’ll see what my HIV test says in a few weeks! If it’s positive, then I’ve lost the game of chance. If it’s negative, I would argue that I can’t catch HIV!”
 
Amadou teaching about HIV
It wasn’t exactly the message I wanted spread. First of all, Gica was somewhat promoting risky behavior by claiming he has had sex with 10 HIV+ women. Secondly, he was making it seem as if certain people are immune to HIV, which is also not the message I want to be spreading. When one man asked why he knew a man with HIV who died, but his wife never became infected, Gica told the man that some people are immune to HIV. I quickly tried to backtrack from Gica’s damage by explaining that we don’t know if the married couple was having sex, or if they were using protection, etc. But Gica kept interrupting me telling them that she must’ve just been immune.

After I scolded Gica a bit about doling out false information, I talked with the village health mobilizer about getting the word out about the testing dates. He agreed, wished me luck, and sent us on our way to Ngaoumere.

Ngaoumere is a village that is nearly non-existent in non-fishing season, but now it is a bustling little fishing town. Gica and I stopped to say Sanu to the female chief of Ngaoumere before heading to the education sessions. Gica by this time was pretty inebriated, and started to take off on the moto before I was on, resulting in me getting my right calf a little burnt. After a far more serious lecture from me about how I have no faith and confidence in him anymore, we took off far more slowly.

In Ngaoumere we had a very large turnout. I met with the women first in a small little room. There were about 20 females overall, with about 10 being adults. When I finished the meeting with the women, I went outside and educated the nearly 25 men milling about before prayer. The message was widely received, although one man tried to argue with me telling me that the condoms I was using for my demonstration were not the “originals” and therefore less effective…whatever that means.  

It was an exhausting day of educating somewhat difficult populations in the hot dry season sun, but overall it was a good start to my campaign. We educated nearly 200 people on the transmission and prevention of HIV as well as the importance of voluntary testing. While Gica was more of a nuisance than a help, I’ve recently found more motivated and sober men to translate and work with. Here’s to an exhausting but hopefully successful month!
Part of the Men's Group I Sensitized in Ngaoumere

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