Sunday, April 26, 2009

Les blancs font les choses!

Continuing the French lessons, this literally means, “White people do things!” and was the theme of my most recent conversations with Jacques, mostly regarding a number of technologies that have been developed to facilitate health care in alternatively-resourced settings such as rural Cameroon. We were discussing vaccine vial monitors, small squares stuck onto all vaccines which portray a purple circle surrounding a white square to indicate that the vaccine has not been exposed to temperatures which would render it useless during its travels from the laboratory to the rural heath worker's cooler. In the event that a vaccine has been allowed to get too hot and therefore become ineffective, the white square turns dark purple. It is a pretty great technology. another technology that impressed Jacques are the auto-disable syringes whose plungers cannot be retracted after being used once, thereby making it impossible to use the same needle to inject multiple people. The whole conversation started when Jacques was putting together a safety box for the disposal of used syringes and other medical materials. The box starts as a flat piece of cardboard and after following 7 steps of folding and punching out pieces it becomes a free-standing rectangular box complete with a handle and an opening with a sliding cover for inserting the used materials. The most recent development to come our way shows further how the manufacturers of these products recognize the realities of the health care workers who use these items everyday to save lives at the village level. The new pentavalent DTPw-Hib vaccine, which comes in the form a solvent which must be mixed with the vaccine solute before administration of the vaccine, comes in vials containing 2 doses of vaccine each. The advance here is that many of our rural vaccine posts only attract 5-10 children for each monthly visit, and since vaccines which must be mixed prior to administration, like the Hib, lose their efficacy between 10-12 hours after mixing, I've seen health workers decide not to vaccinate kids directly on schedule with these vaccines because to vaccinate 2 children they will then lose 18 doses of a vaccine such as BCG, which comes in a 20 dose vial.

All this equipment may seem rudimentary from the standpoint of the American system of medical care, but the difference it makes out here in the villages of Cameroon is hard to exaggerate. When studying such advances in school, I acknowledged these as neat and creative solutions to some significant technical problems with delivering health care in developing countries, but to actually see them at work is to understand that it is nearly impossible to exaggerate the difference they make. In a place where electricity, if it exists, is sporadic at best, vaccine vial monitors literally save thousands of lives that would be lost to vaccine-preventable diseases otherwise. For people whose manner of existence depends on the nearly infinite recycling of almost every possession, where children routinely scavenge things from piles of trash to use as material for toys, auto-disable syringes and safety boxes prevent many injuries as well as illnesses. So whether it's accurate to claim that it is the 'white people' doing these things or not, the impact is not lost on the rural health workers whose daily lives these advances impact profoundly.

Women's Day and Fete de Toro

March 8th marked the 98th Global Women's Day. In Cameroon, the day is celebrated with parades, debates and cultural celebrations in many villages. The women who parade nearly all sport outfits made from the same fabric designed specially for the occasion and sold country-wide. The parade itself is very brief, with women in various groupings marching in front of a bandstand with a number of local officials and spectators. The event was much smaller than that held for International Youth Day, and in some ways struck me as “Much ado about nothing”. For the most part, the women who are able to participate in this and most of the other events of the day are those whose husbands will allow them to buy the fabric and have their outfits made, as well as leave the household to take part in the festivities. It kind of strikes me as a Hallmark holiday taken to the extreme. My village didn't have a debate this year, though they had in previous years, the most recent of which turned into a session advocating the right of men to use violence to control wives who are not fulfilling their domestic obligations. Subjugation of women is a serious issue in my community and nearly all others throughout the region. One colleague told me he was not going to do anything for his wife for women's day because she did not respect and honor her obligations to the household and went out with her friends whenever she wanted to. This is a commonly accepted rationale, and the Women's Day celebration here did little to combat or even address this mindset. Joanna and I also attended the gala in the evening which turned out to be another pretty exclusive event, attended almost solely by the members of my community with power and means, which was disappointing but educational. The awkward highlight of the day was the invitation to participate in the opening dance, which I tried to refuse before being told that it would be insulting to do so. They then explained that what I would have to do was dance with a mystery “cavalier” (literally, knight), who would be announced just before the dance. As all this happened before dinner, I spent most of the meal agonizing over who I was going to be assigned to dance with and creating countless scenarios where I phenomenally screwed it up....luckily I was actually one of about 6 “couples” thrown together and the ceremony of opening the dance only lasted for about 8 seconds, largely uneventful thankfully!

Another interesting celebration which I got to witness the same week was the Fete de Toro, a traditional Mafa celebration which happens once every 3 years. My counterpart and I biked out to one of the villages served by our health center for the occasion. All week different villages had been taking turns celebrating with music, dancing, drinking and the ceremony involving the release of the bull from a compound and then the chasing down of that bull by any individual wishing to be involved. Jacques and I arrived in the village and after leaving our bikes at the house of one of the health center workers were shown up the side of a nearby hill to where a huge crowd was forming. At the top of the hill were set about 5 small huts which made up the compound of the family who had chosen to sacrifice one of their bulls. There were easily 250 people scattered throughout the houses and also across the rocky sides of the hill, a set-up which seemed the perfect storm for disaster if the bull got too wild during the chase. At the time of our arrival, the organizing committee, which is appointed by the traditional chief of the village and is identifiable by the wooden sticks they carry, were in the process of deciding whether to release this bull or not. After studying the situation carefully, they walked away from the hut where the bull was confined and moved off down the hill, followed by many of the villagers. One explained to us that the committee had chosen not to use this bull because they sensed that something bad would happen if they did. Given the layout and location of the crowd and the compound, I told Jacques I was inclined to agree, but he just laughed at me and explained that it wasn't that the environment was hazardous, just that after careful study the organizers had sensed something in the nature of the whole situation, the nature of the bull and the atmosphere of the day, which had foreboded disaster to them, so they decided to move on.
Luckily for us, there was one other bull in the village which had been offered for the fete, so after descending the first hill and climbing part way up another we were fortunate enough to find a bull that the organizers deemed acceptable and the fete was on. The head of the organizing committee coaxed the bull out of the enclosure within the compound and out into the field in front of the house, and what followed was a crazy scene of men jumping around grabbing at the bull in order to catch and subdue it as it bucked and stumbled around the yard, sending whole sections of the crowd scurrying out of the way. Fortunately Jacques and I got to observe the action undisturbed from a rock ledge partway up the hill. After a few laps around the field, the bull was at last mastered and guided back into the compound by the committee head, and the young man who conquered it was patted on the head with a handful of flour to mark that he had succeeded. The conquered bull would now be kept in the house for another 2-3 days before being slaughtered and eaten by the village in yet another celebration.
I asked around a bit (with Jacques translating the Mafa for me) to find out more about the origins of the Fete de Toro, but the closest thing to an explanation that I was able to get was that it helps them mark the passage of time in the Mafa culture: for example if someone wanted to approximate the age of a child, they would figure out how many Fete de Toros the child had lived through. Whatever the original reason, it was certainly an interesting cultural tradition for me to witness, and provided plenty of conversation with Jacques as I tried to explain the Western tradition of bull fighting, which definitely stretched my French vocabulary as well.
I think that's about all for now. Nearly every day continues to hold some new adventure, and I'll try to write more frequently and share these with you all when I can. Thanks for all the thoughts and comments.