Tuesday, June 17, 2014

In Which I Get Nosy, Ask Questions, and Learn Things as a Result

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. 

Friday, June 13, 2014

Fasika in Addis Ababa

After my adventurous stay in Harar, I spent Easter, or Fasika, with an Ethiopian Orthodox family in Addis, hosted by Liya Berhane, a girl I met through Couchsurfing.  I met up with her near her house in the affluent Bole Tele neighborhood Saturday morning, and we dove into conversation about her father and aunt, with whom she lived; her university studies in Toulouse; and her imminent plans to move to Maryland to rejoin her mother and brother.

The family’s white-gated house was charming, with a lovely front garden shaded by an enormous spreading acacia tree.  The neighborhood was quiet and leafy, and palpably breathed wealth, from the manicured lawns and high walls to the scattering of embassies and consular residences. 

I was greeted by two German girls, Johanna and Lisi.  Volunteers from Kenya, they were returning to Germany to continue their university studies and similarly Couchsurfing along the way.  The last guest was Bez, a family friend of Liya’s from London, back home in Ethiopia for the Easter holidays.

We spent the day wandering Addis, chatting energetically over fresh-squeezed juices in a sunken beergarden.  I found the other girls, international and articulate, a pleasure to spend time with.

Liya’s Aunt Babaji, who had accompanied us through the morning, left around 3:00 to take her place at church.  Although the mass wouldn’t start until evening, it would be impossible to secure a space inside the cathedral past the early afternoon.  Resigned to spending the night outside the walls of the church, we opted to wait until after nightfall to walk over, and spent the afternoon and early evening napping and drinking coffee and tea to prepare ourselves for a night-long vigil.

Around 9:30 we finally roused ourselves and dressed.  Liya lent out white headscarves and traditional shamas, gauzy tunics, as needed.  Acutely aware of the cold—night on the Abyssinian highland felt frigid to a body used to Cameroonian equatorial heat—we bundled into thick white gabi, wool blankets that doubled as outer robes.  We joined a stream of similarly-muffled faithful heading to the enormous Holy Medhedaleim Church, where candles in abundance flickered valiantly against the night.  Worshippers stood, knelt, and slept in bundled heaps against the thick stone outer walls of the cathedral. 

Lisi and I deposited our gabis outside with the other girls, left our shoes in a pile of footwear outside the doors, and slipped barefoot into the women’s side of the packed church.   We picked our way cautiously through the mostly grounded crowd, threading up a staircase until we found perches just below the balcony.  From there we had a clear view of the priests in the nave of the cathedral, arranged in a tight circle of beards and robes.  They chanted lugubriously, accompanying themselves with clanking iron clappers.  To a slow rhythm set by a deep drum, they stepped into and out of the circle, throwing their arms back and forth, that motion setting off the metal bells in a sort of funereal Hokey Pokey. 

As I listened to this mournful dirge, I let my eyes wander across the women’s side of the church, spread out below me.  Individuals had been swallowed into anonymity, as everyone was dressed uniformly in a thin white shamas and matching headscarf.  Only about a quarter of the observant were sitting up, awake; the rest (presumably reaching hour seven or eight of this marathon service) were sprawled in the pews or aisles, asleep, still tightly swaddled in layers of white cotton.  I had the sudden, inescapable impression—perhaps influenced by the nature of the holiday, the late hour, and too much incense smoke—that I was gazing over a chamber of corpses in funeral shrouds, awaiting resurrection.

After another hour and a half or so, the heat and the overcrowding on the staircase escalated from irritating to unbearable.  Lisi and I nodded to each other, rose, and negotiated our way to the door.  A blast of cold midnight air greeted us; we hurriedly found our shoes and made our way back to Liya and Johanna, gratefully accepting the proffered gabis

We spent the next three hours cycling through an interminable sequence of prayer: standing, rocking, kneeling, and genuflecting, our foreheads to the ground.  Once Johanna stayed in that position for quite some time; I thought she was feeling particularly worshipful, but as she straightened her neck with a wince, I realized she had fallen asleep, prostrate.  Liya, kneeling behind me and Lisi, reached forward to tap us when it was time to stand, whispering descriptions of the prayers being sung and the sacraments being offered—several baptisms and a wedding among them—in a rapid hiss.  When parts of the service were in Amharic, she translated directly.  The scripture, however, was in Ge’ez, the ancient and now dead language of the Ethiopian Coptic Church, one of the oldest Christian traditions in the world.  During these portions she shrugged helplessly. 
Tired, but powering through the service.
Finally the service was over.  We made our way through the celebratory crowd to the front of the church to find Mr. Berhane and Aunt Babaji, brimming with a sort of elation.  Once home, we divested ourselves of our many layers of white cotton, talking and laughing as animatedly as though it were evening and not 4:00 in the morning.

Presently Aunt Babaji brought out a huge platter of sour, fermented injera covered in red lentils and soft white cheese.  During the fast of Lent, Orthodox Ethiopians eschew all meat and dairy, making Easter day a long-awaited, anti-vegan embrace of all things animal.

The eating continued for much of the day, interrupted by what in fairness should be called a nap rather than a night’s sleep.  Breakfast was thick, delicious, focaccia-like bread, called dabo, made from sourdough and traditionally cooked for Easter; spicy stewed goat; and tella, acidic homemade beer.  The two German girls left for the airport, and Bez, Liya and I whiled away the morning roasting, grinding, and brewing our own coffee.

Green coffee beans

I learn to roast

Bez grinds the coffee with a mortar and pestle like a pro

Our finished product: the most satisfying cup of joe I've ever drunk

We lazed around for much of the afternoon, reading and going for a long walk to Khaldis, Ethiopia’s Starbucks-inspired fancy coffee chain.  As though we needed any more dairy, we indulged in ice cream and large, goopy caramel lattes, an unexpected taste of corporate America.  I continued to be impressed by the level of development I was witnessing, at least in the Bole neighborhood: we passed a mall, a movie theatre, an upscale cupcake bakery, and not one but two Pinkberry-style frozen yogurt joints.

The eating continued when we got back with a large Easter dinner.  Family from Liya’s father’s side came pouring in as we feasted on shredded chicken dripping with butter and studded with whole hard-boiled eggs, more of the goat cooked with slices of injera and green pepper, soft cheese, more bread, more injera.  We waded in meat and dairy, and washed it all down with another round of the curiously sour beer and tej, a potent local liquor. Aunt Babaji delighted in feeding everyone gursha, “little bites” wrapped in injera and popped directly into another person’s mouth.  I laughed self-consciously as I opened my mouth, feeling like a chick, but I could feel the love behind the gesture, and was thrilled to be included in the family in such a complete way.

I chatted for a while with Mr. Berhane, a lawyer and an intelligent and well-read man.  We talked Ethiopian and U.S. politics; as he had lived through the Derg, the Communist regime that ruled Ethiopia with an iron fist from 1974 to 1987, his lucid commentary on that period provided a nice counterpart to what I had already read and heard.  My first day in Addis Ababa I had stopped by the Red Terror Museum, established by victims of the regime to record the crimes carried out under the Derg.  There I had entered into a long conversation with Frey, a docent who was imprisoned for eight years with no trial and no idea upon what charges he was being detained.  “They were targeting the young and the educated.  I had not even finished high school, so I was not educated,” Frey told me drily, “but I was young.  That was enough to put me under suspicion as an enemy of the revolution.”  He spoke of the constant horror he felt at the possibility that he might now run into his jailors and torturers on the street; all had received amnesty under the Western-supported Tigray government that took over after the Derg collapsed.  I was interested to hear that Mr. Berhane’s analysis of the current and in some ways equally repressive tribal government echoed that of Frey and of Jamal, a young engineer and my bus seat partner on the way from Harar: the choices for an educated person are to lay low, to join the regime, or to flee the country.  Opposition is not an option.  The current government under Hailemariam Desalegn may not carry out open assassinations of its citizens the way the Derg did, but it’s hardly a democratic alternative; the media is controlled, ethnic conflicts have been not only tolerated but encouraged, and people are still thrown into prison without trials or a writ of habeas corpus.  All three stressed the support this government continues to receive from the U.S., where it is viewed as an ally against Islamic extremism, a threat posed in the region by Al- Shabaab.  As Jamal bitterly told me, taking the sting out of his words with a sad smile, “You fight your War on Terror at the expense of the Ethiopian people.”

Liya’s father and uncle cleaned their plates, then brought out the choicest parts of the goat.  These had been kept aside, raw, to be sliced, dipped in spice, and eaten as a final course.  On their insistence, I joined them; this was my second time in as many months eating raw goat. I was coming to find it surprisingly appetizing, despite—or perhaps because of—its evocatively muscular mouthfeel. 

I tumbled into bed that night full, sleepy, and transcendently happy.  I had arrived in Ethiopia a solo traveller with a few contacts and no solid plans, and had found by the end of the week an adopted family and several new friends.  I had struck up conversations with strangers, been invited into the house and life of a Muslim gang lord, gone to a wedding, been jumped on-- but not savaged-- by wild hyenas, and spent the Easter holidays with one of the kindest and most effusive families I’ve had the fortune to be welcomed by.  It was the least-coherently planned vacation I’ve taken, and subsequently the best.  I can’t wait to make it back to Ethiopia for a longer stay.