In the last three months, I have been training a voluntary Red Cross club in Mbang Mboum to carry out community needs assessment, organize interventions, and monitor and evaluate the effect of those projects. In short, having long ago given up on making much of an impact myself—and knowing that I will not be replaced, as my site is soon to be a dam flood zone—I’m trying to train 15 local volunteers to be me. I quixotically hope to leave behind a team of people who can do everything I was trained by the Peace Corps to do, only better: they’re part of the community, they speak the languages (all four of em!), and they will be around long after I’m back in America, connecting to the International Space Station with my iPhone 7S or whatever it is the kids these days do.
It’s slow going. Adult education carries its own challenges. If these volunteers went to school at all, it was not to learn critical thinking; it was to be told: swallow. Regurgitate. Don’t you dare ask questions, because I, your dictator-cum-teacher, am the authority and I am to be respected absolutely. You can imagine that trying to lead a seminar-style class on the scientific method (“There is no automatic right answer! It’s all about constant questioning! Doubt everything I’m telling you, unless you can prove it to be true!”) put everyone a little out of their depth.
With time, though, we’re getting there. Last week I collected the results of a community survey we spent a month completing. The volunteers were trained in how to carry out needs assessment. They did practice visits to each other’s’ houses, with me observing (this they clearly thought to be silly, but in fact, given how diffident, confused, or distracted some became, it was a useful tool). Finally, we split them into teams of two, divided the village into sectors, and off they went, clipboards and malnutrition measuring tapes in hand.
Now the results are in, and, having discovered that a public health statistics wonk resides deep within me, I have spent the last week piddling away precious charged-laptop hours making graphs and pie charts and Excel spreadsheets of what was found.
Many of the results were unsurprising: most people get water from the free surface-water wells instead of the paying deep-water pumps, and most people have recurring diarrhea. Some were unreliable: self-reported data would put 90% of the population as regularly attending pre-natal consultations and giving birth at the health center. As someone who works at the health center and sees our daily traffic, believe me, that just ain’t the case. Some were mildly depressing: even after exhaustive educational campaigns, 8% of respondents believe HIV can be transmitted via mosquitos.
But some of the data were informative, and so this data I will share with you. (Lest anyone think all I ever do in Peace Corps is play, here's a boring work-related blog to prove you wrong.)
This should come as a surprise to no one, but class structures exist, even in rural villages, and wealth makes health. There is, it turns out, a 1% in Mbang Mboum—those families of marabouts and hajjis—and they skew the data enormously. One of the questions on the nutrition section of the survey asked how many times a week women and children in the household eat meat, one of the best locally-available sources of protein and iron. The average was once a week. Two families, however—one that of traditional chief’s sister—reported eating meat daily. More troubling were the self-reported data on mosquito nets, which should be distributed annually to every family with a pregnant or nursing mother, or a child younger than five (which stipulations here in the Adamaoua translate to, every family). Only one household reported not having any bednets; the vast majority had two—although whether or not they’re used is another question entirely. Two is actually a reasonable number, as even in large families, there are limited sleeping spaces; children tend to be piled together on a floor mat, and a mother will sleep with several of her babies and toddlers in bed with her. The data would have put the average at two, then, except for one outlier that skewed the set: the family of a local notable who works at the health center reported having ten. This surpassed the number of people in the household by two. This is hardly shocking (someone working in the public sector in Cameroon is gaming the system to line their own pocket? Never!) but, given that these are the people I work with, it’s a little disappointing.
The most interesting of the results were the ones that I didn’t expect. One of the questions asked, “Who decides how many children the family should have?” I was prepared to see le mari, the husband (which was the most common answer). I was prepared to see Allah (this is, after all, a pretty conservative Muslim community). I was not prepared for the written-in answer: ce n’est pas une decision, it’s not a decision, which a whopping 30% of respondents independently came up with. Pregnancy just happens! It’s not something you control! This actually tells me a lot about attitudes towards family planning, in that I may have been focusing on the wrong angle: instead of assuming women need education about their contraceptive options, I should probably spend more time educating men and women about the fact that contraception is an option.
Having become obsessed with gender since being here, I also found it revelatory to break down the data by household demographics. I was interested to see that 37% of surveyed families declared a female head of household. This was a much higher number than I was expecting, although there are explanations. Divorce is not uncommon here, and is not nearly as stigmatized as I had expected it to be—most divorced women will get remarried within a few years, either to that same husband a second time, or as the second or third wife of another man. In the meantime, many move back with their families, but some live on their own, perhaps sharing a compound with a relative and her children. Widows, particularly those with grown children, often become matriarchs; the family that lives across the street from me is just that, a grandmother with an ever-changing and indiscriminate brood of grandchildren, nieces, and nephews. Finally, men who work as anything other than farmers will often move away, to the city or even farther, in search of job opportunities; these men—teachers, nurses, clerks, construction workers—don’t often bring their families with them, instead sending money back occasionally and visiting once or twice a year. In this case, in the absence of the husband and father, a woman becomes the de facto head of household.
Whatever the cause, these female-headed households had demonstrable differences in health knowledge and behaviors from their traditional, male-dominated neighbors. 100% of female-headed households reported giving birth at the health center, versus 72% of male-headed households. I have already mentioned that this is a suspect statistic in either case, and that I am quite sure at-home births are being underreported. However, given the need for a husband’s permission in order for a wife to leave her concession, it is not unreasonable to anticipate that a woman relieved of that burden would be more likely to go where she pleased, instead of sending someone to find her husband when labor pains began in order to secure his approval to go give birth in the maternity ward.
54% of respondents in female-headed households reported regularly using condoms during sexual intercourse, compared to 16% of respondents in male-headed households. 63% knew at least two methods of family planning, versus 45% of their male-dominated counterparts. The list goes on.
What’s the takeaway from all this? Obviously, that men are the worst. (Haha! Just kidding! Kind of!) In all seriousness, I am looking forward to sharing the data with my Red Cross team at our next meeting, and seeing their reactions—in particular, I want to see if they can help explain to me some of the responses that I found contradictory or slightly bewildering. As much as poring over the surveys immediately inspired about 12 project ideas, I’m reining myself in: this is for the volunteers to do with as they will. Based on the results, they’re the ones who will choose what health issues to address, and (with guidance, although hopefully not too heavy-handed) design interventions.