Health Club in fun and in frustration

I loved working with youngsters at the local secondary school this year on health education, especially alongside this dynamic young nurse-in-training Dibril from the hospital where I also work. But it was a major uphill battle getting logistics in place! Every week at school was another distraction - one week I arrived to find all the kids marching out of the school grounds on the way to the morgue to pay respects to the deceased wife of a former (from the 70's) principal; another week all classes were cancelled so the students could help clean up the school for a visit from a dignitary - all 2000 students were required to come to school with their machetes and clear brush, cut grass, and paint the whole week.

Weeks before and after vacations were totally lost as students and teachers hardly show up; and in between there always seemed to be some excuse for why school was not in session, such as the teachers being given two weeks off to correct exams (over what material, I always wonder, as they never seem to be in class) and prepare trimester grades by hand. There was often some kind of ceremony, such as the principal announcing in front of the whole school the five best and worst students of the term, that kept us from meeting, or students would have left school upon finding their teacher had never showed up. When we could meet, finding an empty, unlocked classroom with a chalkboard took up half our 45 minute break slot (no room scheduler!), and getting the message to the students that we were meeting that day was even more of a runaround (calling the "club advisor" ahead of time never got me anywhere, and he was gone half the semester for a very formal 2-month long funeral - no substitute for his classes).

But when the dust had settled and the Gods had convened to bring together functional circumstances, it was awesome doing heath games, songs, and education around HIV, reproductive systems, hygiene, hand-washing, nutrition, and gender-relations / confidence-building skits together.

We decided to write and perform a song about HIV for the end of the year, to present in front of the school. Here are two brave students sharing their lyric ideas with the group.

And one giving her poem idea - we wrote the composite of what they came up with on the board behind.

Naturally the dance moves were added before we really had the lyrics down and the routine was a bit jumbled, but I tried to instill some "practice makes perfect" discipline and they really came into their own! The song talked about being a young generation that needed to protect itself and promote proper knowledge, reduce stigma, and save the future of Cameroon. We tried to strike a tone between fear (no cure!) and hope (but highly preventable!).

Finally the day of the year-end ceremony arrived, the flag was raised...and my girls were TERRIFIED and embarrassed to sing in public, especially about AIDS. Many stayed home (or just came to school very late, not sure), others ran off...

...from our 25 who wrote the song to our 16 who rehearsed up to the end...we ended up with just 4 girls present, ready and willing to share their message with their peers at 7AM that morning. I was so proud of them! And though shaking and wavering and turning in the wrong direction, they sang!

Thank goodness for our club president Diane for holding the club together by a threadbare shoestring and giving a great speech on HIV to her peers. Schools are hard to work with, but students are endearing and promising if you can bare the surrounding absurdity and utter lack of organization.

I had to laugh when after months of being near my wits end with this school and having wasted a lot of time coming for club meetings that never happened, the principal missing most of our scheduled meetings, and the whole system feeling like a terrible joke robbing these kids of an actual education...and then so few girls showing up to sing on our last day, the girls who did come still asked me enthusiastically: "Auntie, are we having club this week??"

What a blast! Pics from our other income generating activity trainings for vulnerable patients. Soymilk/tofu, soap, beaded jewelry, fabric dying...followed with a business skills seminar

My kind of Saturday morning! Income generating activities for people living with AIDS - day 1.

Ok, so we need to work on photo composition - I'll get a better group shot next time. Yesterday was awesome - one of those uber satisfying moments when something you've been planning for months, and anticipating for much longer, finally comes together and goes off better than you dared hope for.

These 25 individuals who attended this soap-making training yesterday are all living with AIDS (I have their permission to thare the pics of the day), and are all following ARV treatment through the regional hospital in my town - couldn't they be an ad for the restorative power of taking your AIDS drugs? Most of them do not live here but travel in from nearby towns for anonymity- even so, they are impressively open and unashamed of their status compared to what we see in tiny no-privacy villages. Finding strength in numbers and away from their chatty neighbors, they form an active community of PLWHA (People Living with HIV/AIDS), regularly attending the educative talks sponsored by the hospital where they pick up their drugs once a month and meeting with nurses who provide counseling.

In getting to know the services already offered and the pressing needs of the patients, it became clear that financial stress was holding many people back from maintaining good health. While international donors help keep the ARV drugs free to patients, the regular testing needed to track the disease's progress, plus the medical charges for opportunistic diseases (such as tuberculosis, which bodies with weakened immune systems have a harder time fending off), and the transport to and from the hospital are not covered and add up quickly. Many people miss their check-ups and get off track with treatment (which has serious consequences) because they do not have the money to come in; others spend money on school fees for their kids, or clothes and shoes, instead of on medicine and nutritious food to support their treatment.

Working with the excellent and committed staff of the AIDS unit, we decided that doing income generating activity trainings, taught by local Cameroonians, could give people a leg up in becoming more financially stable. The hope being that even just a handful will start selling on their own (most commerce here is completely entrepreneurial - selling peanuts, flip flops, burned CDs, or phone credit individually on the side of the road or out of a hut). After getting the hospital on board, identifying the most in-need, enthusiastic patients, activities that were accessible to anyone (and did not require a fridge for example, which making yogurt, juice, or jam would), and local trainers, I applied for a PEPFAR grant through Peace Corps to finance the labor, materials, food, and transport. PEPFAR is the US's biggest fund for AIDS relief, started by President Bush and considered by many as one of his most successful legacies. I've learned about the program for years, so actually getting to do a project on the ground through its backing is exciting.

I was worried everyone would be late, and really tried not to get my hopes up for how the day would go - but when I arrived at the hospital at 8AM (program started at 9) there were already 15 participants waiting, cleaning up the site and eager to get going! Look how studiously they are noting all the steps and details of the process as our leader gets started mixing ingredients (notebooks and pens were included in our budget - those who do not write are drawing the process). I was thrilled with their active participation, good questions, and interest in trying this on their own. Our hope that they would find this practical and concretely beneficial for their life came true - and the motivation of this being able to generate money definitely gave their energy a boost. The woman leading the session actually has a daughter with AIDS who is also on treatment at the hospital - she knows how expensive it can get, and herself started making soap to raise money to help her daughter keep up with health-related costs.

When I asked people if they could see themselves making and
selling soap on their own, the response was always "Absolutely! If only I had the money to get started (...HINT, always implied)." With the dilemma in mind that you have to spend money to make money (startup costs like this cutting table came off as prohibitive to most), we are hoping to launch a second phase of the project in which we offer start-up grants to those who develop (with our support) and submit the most promising business plans for taking their new skills to the street. Yesterday it was easy to pick out the man below in the red track suit jacket and the woman further down in the orange t-shirt as particularly motivated - they were leaning on every word and scrambling to get their hands dirty in the process. This is the kind of enthusiasm we have our eye out for, and which I hope will turn into a tangible way for them to safeguard their health and improve their quality of life.

We are incorporating as much business training as I know how - luckily a couple of nearby Community Economic Development volunteers are going to help me out when we bring everyone back together to focus on understanding your market, doing a feasibility study for your project idea, creating a business proposal, marketing, pricing etc. Yesterday I wanted everyone to see what their profit margin could be doing this, but when I asked the woman how much she could make from this quantity of soap, she had not the slightest idea, nor had she thought about it or knew how to figure that out. She can tell she makes money, but she has never recorded her expenditures or earnings. So we crawled through calculating the bulk pricing of ingredients, how much of each we were using to make two trays of soap, how much we could sell the total product for, and what that came out to in terms of profit. We realized that only by buying in bulk and selling for more than she was could you come out enough ahead that people would even be motivated to try it.

We are incorporating as much business training as I know how - luckily a couple of nearby Community Economic Development volunteers are going to help me out when we bring everyone back together to focus on understanding your market, doing a feasibility study for your project idea, creating a business proposal, marketing, pricing etc.

Yesterday I wanted everyone to see what their profit margin could be doing this, but when I asked the woman how much she could make from this quantity of soap, she had not the slightest idea, nor had she thought about it or knew how to figure that out. She can tell she makes money, but she has never recorded her expenditures or earnings. So we crawled through calculating the bulk pricing of ingredients, how much of each we were using to make two trays of soap, how much we could sell the total product for, and what that came out to in terms of profit. We realized that only by buying in bulk and selling for more than she was could you come out enough ahead that people would even be motivated to try it.

This warmed my heart as a health volunteer, seeing everyone use our new soap to wash their hands before lunch! Side note - the legs and grey skirts on the stairs belong to nurses, who are in a row intricately braiding each other's hair while on the job. This is one of the most common scenes I observe here many times a day - there is a lot of downtime, in school, at work, at home, and much of that time and whatever money is available to women goes toward hairstyles.
I love how this group exemplifies the total mixing of styles you find here - traditional African dresses, jeans, button down blouses and t-shirts, athletic wear, headwraps or baseball caps, mixing and layering loud patterns... Women and men are constantly going between traditional and western styles, or wearing them all at once, with cute shoes, blinged out handbags (see below!) and shiny jewelry to accessorise (thanks to the excess of Chinese imports you can get any of those things for
$0.20, though of course they last about a week). It's a part of the culture I love - anything goes.  

Another everyday occurrence is people scrambling to keep any potential profits or benefits you present close to home. Every person I have talked to this program about has immediately asked if we already have people doing the trainings and preparing the meals, the hope being that either they can do it (even if they don't really know how, they will figure it out!) or that they can bring the work to someone in their family, which will guarantee them a piece of the profit pie, as well as a "now you owe me" one-up-man ship type of advantage: I help you, you help me. If you ever ask anyone where to buy nails, curtains, or eggs in this part of town, it’s never the closest or best-liked or well-stocked shop they will point you to - instead they will take you on a wild goose chase to track down their cousin, who has a little hardware shack - and if he left for a four hour lunch break, you should wait for him and not go anywhere else. If someone is out of tomatoes, she will take you to her friend's stand across the market, making it clear she is the one bringing business...hint hint for when she is next in need of a helping hand, which is sure to be soon.

So naturally when I brought up with the hospital staff that we needed someone to prepare our lunches, the team leader jumped in with, "Yep, I know someone, don't worry about it." Guess who? Good ol' mom...who turns out to be an AWESOME cook - yesterday we had delicious ndole with plantains and baton de manioc. All the trainers have asked if we already have someone for the other topics- they are hoping they can lead us to someone or get booked for that gig as well. It's an interesting aspect of their extremely interdependent society: all these favors for others help build up your own safety net. When systems like bank loans, health insurance, damage insurance, credit cards, orphanages, and welfare don't exist, your family and friends end up playing all those roles in ways that as Americans most of us could not imagine getting tangled up in.

This is one of the reasons it's extremely hard for people to save money; even those who work never seems to have $1.00 to their name. First off, hardly anyone has a bank account - what you have is in your pocket and usually gets spent immediately, partially because otherwise ten family members are imploring you to help them with school fees, medicine, housing, food. If you are lucky enough to come out ahead in your work, your money is never your own, it is absolutely expected that you will help out family members who need it, and there is always someone - a reality that is emphasized to me each time I try to talk to someone about saving for college or to start their own business. This famous culture of African solidarity unfortunately seems to keep many people from being able to move up
as individuals. Hopefully if we give small loans to people where they are required to put the money toward start-up costs, they will at least cross that hurdle of not being able to save up enough before its claimed away by others; then, whether the profits of the selling are helping them or their family, at least it will be bringing money into the community.  

 And on the note of people being stuck in the cycle of poverty and need, and of programs like this that aim to help break that cycle for a few, I want to share a great article, passed on by my sister.

David Brooks hits the nail on the head of what I see as a grassroots worker in Cameroon: "You can cram all the nongovernmental organizations you want into a country, but if there is no rule of law and if the ruling class is predatory then your achievements won’t add up to much." While I love the work I'm doing here and do not doubt that the information and skills I get across are impacting the lives of certain individuals, change at the larger scale that can bring improvements to a whole society requires action and cooperation from national institutions, something desperately lacking here. 

Here is an articulate, insightful wake-up call to social justice-lovers like myself, and to my generation of do-gooders faithful to a religion of global service, about the shortcomings of our preferred approaches, and where big change really stems from. An eye-opening read. http://www.nytimes.com/2012/04/13/opinion/brooks-sam-spade-at-starbucks.html?_r=2