8.08.2015

HIV Testing in Mbakaou and The Lessons of Cameroon

Alex Leading a Education Session with His Counterpart
Cameroon teaches you a wide variety of lessons, one of which is: In Cameroon, nothing ever works, but everything works out. I was reminded of this lesson last weekend in Mbakaou where I conducted part of my HIV testing campaign alongside my wonderful clustermate, Alex. Together we were reminded of this all important Cameroonian lesson (along with other lessons, which I’ll get to) as we tried to make our testing weekend a success and as we tried desperately to search for hippos in Lake Mbakaou.

Let’s start from the beginning, shall we? Friday morning I arrived in Mbakaou, a village equidistant from Tibati as Ngatt, but much larger, after I waited for 2 hours in the rain on the side of the road trying to find a car that would take me to Tibati. I arrived in Mbakaou just as the sun was coming out and Alex warmly welcomed me to his house and his village with a big mug of mint chocolate tea (Um, YUM!).

After quickly unpacking, Alex and I discussed the game plan for the weekend. Alex apologizing repeatedly for not having set plans, but I reminded him that usually in Cameroon that works out for the best. Once we were properly caffeinated, we decided to go to the chefferie in the center of town and immediately begin the education sessions and testing. When we arrived to the chefferie we found it locked. Alex said the chief promised he’d allow us to use it that day, but when we tried to find the chief, we discovered he was in his fields with the vague return time of “sometime later today”.

Okay, change of plans. I suggested that if we don’t have the option to test Mbakaou that day, then we use the free time to hit some villages nearby, which would maximize our reach. We decide to reschedule the Mbakaou testing for Saturday, which we deemed even better since it was a market day. After rendezvousing with Alex’s counterpart and the health center nurse, we quickly rented a moto, bought gas and made our way to Gantang. See? Things didn’t work, but they still worked out!

Gantang is a small Gbaya village maybe 5 km outside Mbakaou. Everyone gathered in a circle on their plastic chairs as they listed to me discuss transmission, prevention and stigma. When I finished, Alex whipped out the wooden penis to do a condom demonstration amidst stifled giggles. When we finished, the nurse tested everyone and when the tests were completed, Alex and I joined in to assist in the post-test counseling, where only one person had an ‘uncertain’ test result. Good news!

We quickly packed our materials and made our way to Naskoul, a village 2km further down the road. Naskoul is a bit larger and a crowd of unruly young men were already gathered - prime targets for our campaign! I met the chief, introduced myself, and was then held up for a good 20 minutes as he tried relentlessly to flirt with me despite my insistence that I was ‘married‘. While I was trapped in the flirtation ambush, Alex was playing with the kids and scaring them away (thank God!), and the nurse was doing the testing.

After escaping from the flirtation ambush, I walked over to the nurse alongside Alex and we noticed he was throwing the dirty needles uncapped on the ground. Alex told him to cap the syringes before someone steps on one but the nurse said that was too great a risk to himself. How does that saying go? “Sacrifice a few for the many?”, well, in Cameroon apparently it goes something like “Sacrifice the many for me”. The nurse's willy nilly tossing of bloody needles all over the place might have been fine in his eyes, it wasn’t in our eyes. I went back over to the chief and asked for a receptacle to throw the needles in before the kids nearby decide that they’d make awesome toys. After dealing with his flirtations some more, he agreed and fetched us a bucket. The nurse left Alex's counterpart and I to pick up the uncapped syringes one by one praying to God neither I nor anyone else gets stabbed in the meantime.

40 tests later and it was time to do the education session again. I gave Alex control of the session this time so he could practice his French. When it came time to do the condom demonstration, the tipsy men roared with laughter and a few more tossed back whiskey sachets. What better environment to drink in than watching two white kids put condoms on wooden penis? I gave the female condom demonstration (which never ceases to be a spectacle) and some men asked for encore presentations - um, no.

Drinking Sachets in Naskoul
Post-test counseling was quick, with only two tests out of 40 coming back as ‘uncertain‘. The sun began dipping below the horizon as we headed to Boulintin (me with a live chicken in my arms on the moto) to alert them that we‘d test there on Sunday. Just as the sun set, Alex, his counterpart and I returned to Mbakaou famished and fatigued. Alex and I rendezvoused with the chief who returned from his field to confirm that he would unlock the chefferie for Saturday. Alex and I went to get fish, as Mbakaou sits on the edge of Lake Mbakaou, and we bought a 1.5ft long fish for $3.00. After gorging on the succulent fish and baton de manioc, throwing back a few whiskey colas, and watching a couple episodes of The Daily Show, we called it a night and rested up for the large testing event the next day. So as we saw, things didn’t quite work as we planned, but they still worked out.

Saturday was meant to be our large testing campaign since Mbakaou it is a big village, and because it was market day we anticipated even more people. After a quick breakfast of beans and eggs we made our way to the chefferie which was (astonishingly) unlocked and cleaned up (thanks, chief!). The friendly chief greeted Alex and I and thanked us for doing the testing campaign (no problem, chief!). As I set up the room for the day, Alex went to the health center to find the nurse so we could have him start taking blood. As I arranged the room and exchanged pleasantries with the chief, Alex called me in a panic: “So it looks like the nurse lied to us. They don’t have three bottles of chase buffer, they only have the ¾ of a bottle which we were using yesterday”. Chase buffer is the liquid that goes on the HIV tests along with the blood. It was the one thing which my hospital is short on, so I told Alex to tell his health center to acquire and donate to our cause - the only thing they had to contribute to this big testing campaign. They told Alex weeks prior that they had 300 tests worth, so basing everything on that figure, I brought 300 HIV tests. Turns out, the man lied and really only had about 100 tests worth. Go figure. Had we had known in advance they didn’t have enough chase buffer, I could’ve seen if I could have bought some more elsewhere, but alas, no, they chose to lie instead. That’s another lesson that Cameroon teaches you: Lie like your life depends on it so that you can put off the other party’s disappointment until a later time. Cameroonians love lying to you, endlessly. So realizing there was nothing we could do, I told Alex to bring what they had so we could at least begin and play it by ear - perhaps we’ll have a low turnout in which case we won’t even finish the chase buffer they’ve got!

Well, I was wrong. The testing was wildly popular, which in any other circumstance would be great, but when you have to turn people away because of someone else‘s error (curse you, nurse!) well, then it sucks. We tested in batches of 20 people, did our small group education talk, and then individually gave them their results and post-test counseling. When we had tested 125 people, however, the chase buffer ran out. I called pharmacies in Tibati, my health center and other people to see where (or if) we could buy more, but it appeared as if it’s only sold along with the tests, which we had plenty of. We closed up shop and Alex kept apologizing for the lack of chase buffer, which wasn’t his fault in the slightest. The man whose fault it was (the nurse) didn’t acknowledge his error or apologize for lying repeatedly to Alex and me. On top of that, he also didn’t realize the danger of all the uncapped syringes that overflowed the garbage bin (again!), which I took to calling the “bin of death“, which once again Alex’s counterpart and I were left cleaning up and disposing of. Figuring since we could no longer test in Boulintin like we intended to on Sunday, we instead planned to try our luck at finding hippos.

Sunday came and our hippo contact told us to arrive in Boulintin at 8am to meet with the fisherman who’d take us out on the lake on a canoe with a motor attached (so we could quickly escape the hippos should the need arise). Given that Douala apparently hasn’t been getting much rain, Lake Mbakaou’s water level is extremely low because all of it is being sent to the hydroelectric plant in Edea to power Douala; consequently, the hippos are easily spotted in the low water, making it the perfect time to try to catch a glimpse of them.

Lake Mbakaou
Alex and I made our way to Boulintin where we met up with Jean (the contact who knows the fisherman), who claimed he spoke with the aforementioned fisherman the night before and arranged everything. As we waited for a while in Jean's house, he insisted “He’ll be here soon!” Well, he wasn’t. After spending an hour or so listening to Jean ask me questions about Chuck Norris (please, kill me now), Alex and I decided we should just go down to the lake and wait for the fisherman there. When we arrived, the fisherman was nowhere in sight. Go figure. Another man claimed that he was out fishing, clearly unconcerned that he had an appointment with us over an hour ago and was therefore wasting our time. We waited another 45 minutes and then we started getting anxious and doubting if he was going to arrive. Jean, recognizing our not so subtle restlessness, finally took to yelling the fisherman’s name into the lake in hope he’d here. Yeah, that’s effective.

30 or so minutes later the fisherman rowed back to shore. We quickly greeted him, negotiated the price and got ready to set up and leave.
“But wait!” the fisherman cried, “I first need to go to Boulintin to fetch the motor for the boat!”
“You don‘t have it with you even though you knew since last night we were coming?” I asked.
“Oh no, no, no” he replied. What a preposterous idea: to think a Cameroonian would do such a thing as plan ahead!

So off he went on his moto and Alex and I plopped back down in the sand as I doubted if we’d see him again. In this exchange I was reminded of several other lessons that Cameroon teaches you: (1) Always, always bring a book to read, because no matter what, you will wait everywhere for a long period of time; (2) Don’t assume Cameroonians will plan ahead or ever be prepared, even if you have previously discussed whatever the event may be; and (3) Cameroonians will always waste your time (and not care in the slightest about it) because you are odd since you don’t function on African Time.

After another 20 minutes or so, Alex cast a dubious look at the darkening sky on the horizon and I cast mine at the fierce sun which seemed determined to render my sunscreen worthless. Finally Jean suggested we paddle out to the canoe that we’d take to the hippos. We piled in a small canoe and made our way to where other canoes were docked. We pulled up to one particularly submerged pirogue and I jested, “I hope that isn’t our boat” thinking in no way that it could be. But oh! Alas! It was.

Alex and I waded our way out to the boat as Jean got into the sinking boat and began scooping out the water. Alex and I looked on skeptically, mumbling “Du Courage” every once and awhile as the submerged boat began to surface and the murky water and fish who made the canoe their home were thrown out. After another half hour or so passed and our pirogue was as waterless as it was going to get, Alex and I got weary again.

“Do you have his phone number?” I asked.
“He’s not answering”, Jean replied.
That’s a great sign, right? As I asked Alex how long we should wait before we give up, we heard a moto approach.
“Is it him?” Alex and I repeatedly demanded as the moto grew closer.
“Yes, yes, it‘s him“, said Jean, “Oh….wait….maybe not….”
When the moto arrived the driver was not our shifty fisherman friend. The moto driver conversed with Jean in Gbaya for a minute and Alex and I asked what was happening.

The River that Leads from the Dam
The moto driver turned to us with a shadow of a smirk on his face and said, “Oh, his mother died, so he isn’t coming”. I was immediately skeptical as this is often an excuse used by Cameroonians to get out of things they don’t want to do (what happened to the ‘I’m ill excuse‘? Why your mother died?). And given the driver’s grin, I was even more skeptical that this statement was a fact. Dejected (this was the fourth time hippo spotting has fallen through for Alex) we got on the moto to head back to Boulintin, but instead were dropped a ways off. As we walked to Boulintin, Jean pulled up with a different moto and took us to Mbakaou.

On the way we stopped to see the Mbakaou dam and when we got off the moto a self-important guard asked for our ID cards, which I had left at Alex’s house since IDs are never checked outside of checkpoints. What did this fool think we were there to do? Blow up the dry dam? Does he really think we snuck into Cameroon somehow without having the proper documents (and anyways, who in his right mind would want to do that??). The guard quickly let up about asking for my ID but as I took out my camera the guard insisted pictures were forbidden (what, is the dam some well-kept Cameroonian secret? No!). Alex insisted that he’d taken pictures there many times before, but the guard insisted on being a pain in our ass, so instead of giving the guy any more satisfaction in harassing us, we went back home.

So back to that all important Cameroonian lesson. Clearly at this moment things were definitely not working. Intent on making things still work out in the end, and given that we were intent on seeing at least some type of wild animal, we went to a man’s house who has crocodiles. Apparently 20 years ago a fisherman caught two crocodiles and on his way to go sell them he was caught by wildlife guards who informed him he could either pay a fee and give the crocodiles to the guards (who’d probably sell the crocodiles themselves) or the fisherman could keep the two crocodiles. Paradoxically the fisherman couldn’t release them back into the wild. So the man decided to keep them, for crocodiles make wonderful pets, do they not? I’m not sure what the fee that the man was asked to pay but it was probably a lot cheaper than what this man has spent on feeding these two crocodiles for the past 20 years, because they are huge. The fisherman built them a big open pit in his yard where he allows visitors (read: PCVs) to come see them. Alex and I bought a cow heart, split it in two, and we each tossed a half to each of the crocks. As we stood and watched the crocodiles move about their little habitat, I couldn’t help but think of what a great addition these two crocodiles would make to my compound in Ngatt - any time a child would annoy me, I’d just have to dangle the annoying kid over the pit and they’d behave real fast. Sadistic? Maybe. Effective? Certainly!

So there you have it. Things don’t work here, but they always work out. The testing campaign didn’t go as planned, but we still got 125 people tested, and since I’ve returned to Ngatt, I’ve acquired another 200 tests worth of chase buffer, so we already have a new testing weekend scheduled for September. We didn’t get to see the hippos, but I got to throw a raw cow heart in an open pit to two ferocious crocodiles. So, things worked out in the end, somehow, as they always seem to do in this dysfunctional functioning country.

Crocodiles in Mbakaou

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