Here are a few of the non-landscape photos I took on a recent trip to the Northwest of Cameroon, where we were visiting local health centers to get a better idea of their needs.
Click on any of the photos to see a larger version, and view the whole album. Also make sure to look below for the landscapes and a journal on the trip itself...
Showing posts with label health. Show all posts
Showing posts with label health. Show all posts
Tuesday, November 10, 2009
Thoughts on the Northwest
Thinking of the mountains, my mind wanders to things I associate with my life in Denver; snow, microbrews, and grad school. Being back in the mountains now, it seems a little incongruous to combine those images with ndole stew of leaves of peanut sauce, fried plantains, shared taxis, and the constant greeting of “you are welcome.”
I’m sitting in a hotel in Bamenda, the largest city in the northwestern region of the country. It’s about 400 kilometers from Yaounde, and much higher up in the mountains, at least 1,000 meters. The city itself is surrounded by incredible scenery; sharp green mountains jut up at crazy angles, waterfalls pour off the hillsides, and things I never expected to see in this part of the world, like pine trees, are everywhere. I knew that places like this existed in Africa, of course, but most of my experience in this part of the world has been in scorching-hot, barren, and utterly foreign environments. Differences in the city itself aside, you could drop this territory down anywhere in the Appalachians or the Pacific Northwest, and it might be hard to tell the difference.
Of course the similarities end once you get to the people and the city, however. Mountain scenery aside, this is definitely still sub-Saharan Africa; the infrastructure is crumbling, goats wander the streets, motorcycle taxis carry four people at a time with enormous suitcases strapped to the back, and people run to approach passing cars constantly, selling plantains, carrots, kola nuts, cookies, and tissues, all balanced on their heads. Fortunately, the government seems to have had the foresight to pave the roads on the most treacherous of the mountain passes, which I’m certain has helped to prevent at least a few of the horrific accidents that happen on Cameroon’s roads on a daily basis.
Northwestern Cameroon borders Nigeria, and is home to the largest portion of the country’s English-speaking (Anglophone) minority. I knew before I came here that it existed, but it’s still bizarre to hear even small children speaking to each other in English, or at least a form of it. ‘Pidgin English’ is the lingua franca here, and it’s fascinating to listen to my colleague Leslie, originally from the area himself, communicate with people in the patois as I attempt to make out what he’s saying. “How be de day, you do go market for buy? OK, small time?” I had no idea that something like that could mean ‘How are you, are you going to the market? OK, goodbye.’
I’ve been traveling through this part of the country with Leslie, and we’re visiting local health centers in the Bamenda area and some of the surrounding communities. We’re visiting these places to get an idea of the needs of the various health centers. The idea is that by meeting the doctors and nurses who run these facilities, we can get a sense of what they lack (which is plenty), and use that information to write proposals targeting donors who might be interested in providing some of the supplies and equipment.
The places truly run the gamut. Yesterday we went to see a small clinic outside of Kumbo, a town much higher in the mountains, more than 2,000 meters (about 6,500 feet for the Americans) up. The clinic had two small rooms, a couple shelves of basic anti-malarial and diarrheal medications, and a few beds with mismatched sheets. The Catholic nurses there try valiantly, but they’re limited by what they have, which isn’t much.
Contrast this with the hospital we visited in the village of Shisong today, just outside of Kumbo. The hospital was built in collaboration with the Catholic church in Italy, and honestly, it’s an amazing facility. Hund
reds of beds (from what I could tell); radiology, ultrasound machines, skilled nursing for people with HIV/AIDS, and a cardiac unit equipped to perform open-heart surgery. The brand-new buildings looked like something you could drop down in the States, and it wouldn’t look much different. And all this in a mountain setting that feels like a living postcard.
What’s amazing to me though, is that this facility is located at the end of a dirt track in a small mountain village, along a rocky path that could wash out at any time during the lengthy rainy season. I think it’s wonderful that this place exists, but if someone is having a heart attack, all the defibrillators in the world won’t save them if the road to the hospital is washed out.
This is part of a larger issue from what I can tell though, and something that strikes me about Cameroon as unique. As opposed to other places I’ve worked, such as Chad, Niger, and Sudan, this place has such incredible potential, and could be so much more than it is. This is not to say that places like Chad don’t have anything going for them, but the degree to which it exists is far more in Cameroon, I think. The mountain scenery, for example; with a functional road, decent network of hotels, and the right amount of promotion, people would come from around the world to visit here, I’d imagine. Its green year-round, the temperature is always pleasant, the air is clean, and the views are truly stunning. If it was done right, this could be a tropical version of Switzerland; instead, it’s a collection of villages and towns stuck in the mud on the way to paradise, figuratively and literally.
This place could be an economic powerhouse for the country, and could play a major part in catapulting Cameroon not necessarily into the industrialized world, but something much more together than it currently is. Due to short-sightedness, ethnic politics, corruption, and what often feels like a lack of imagination, this doesn’t seem to be happening. This part of the country, as the Anglophone minority region, has always been somewhat marginalized, and has been a stronghold of the political opposition, such as it exists here. Because the Anglophones have generally been opposed to many of the policies coming from the Francophone leadership in Yaoundé, this region has often been starved for funds by the central government, a tactic obvious in the decaying roads in the center of town, the regular power outages, and the lack of opportunity for most of the people here. It’s best not to discuss politics too much as a foreigner here, but looking around, it’s hard not to notice this sort of thing.
One thing Cameroonians are known for, for better or worse, is being ready to take advantage of a possibility where it’s presented. One person’s opportunism is another’s entrepreneurial spirit, I suppose, depending on how it’s approached. Visiting the cardiac center in Shisong today, it’s obvious the potential to do incredible things here exists. Driving the pitted streets of Bamenda and Kumbo, and the lakes of mud separating the two, it’s easy to feel like there’s not much hope. The question, I guess, is which way are things going, and which side will eventually win.
Friday, July 24, 2009
Health Education, Water Testing, and Renk
Here's another album- most of this one is from a visit to a health education session, where facilitators were working with the community to talk about how to prevent things like malaria and diarrhea, etc. I also have photos in this one from a visit to a few water sources, and a testing program put in place after the use of filters. Finally, there are a few random ones from Renk. There's a story about the water testing below the photos...
A fresh, and safe, cup of the Nile
Magara, Upper Nile state (Sudan) – Miriam Adam’s two- year-old daughter takes hold of a plastic cup with both hands and tips her head back, taking enormous gulps of water. She quickly drains the cup, putting it down with a satisfied look. Not long ago, her cup of water, drawn from the banks of the Nile less than 200 meters away, could have contained any number of viruses and parasites- now, Adam has no need to worry about what her daughter drinks.
“The kids were sick, but they aren’t now,” she says, speaking in Arabic.
Six months ago, Mercy Corps and a consortium of three other non-governmental organizations came to Magara village to provide water filters for the community, who until now had been drinking contaminated surface water from open pools and the Nile River without any form of treatment. The filters given to the people of Magara, which look like small concrete pillars with a spout protruding from the side, are locally made and easy to produce. When used properly, they provide an easy and cheap way for people to access safe drinking water, an important step on the path to better and healthier lives.
“When contaminated water is poured in, it trickles through and the bacteria, viruses and suspended solids get trapped in between grains of sand. As a result, clean water comes out,” explains Francis Okello, the Water and Sanitation Sector Head for the Northern Upper Nile Recovery and Rehabilitation Programme (NUNRRP). “The filtered water is absolutely safe,” he adds. “It’s obviously better to drink water from the filter than directly from the river.”
This technology, known as the bio-sand filter, was first developed at the University of Calgary (Canada) in the mid- 20th century, and uses the principle of slow-sand filtration to make contaminated water drinkable. The filter contains a bottom layer of gravel, with another layer of finer sand on top. When river or well water is poured through the filter, the grains of sand trap bacteria and viruses, and eliminate turbidity (cloudiness).
While the bio-sand filters are a new addition for families in southern Sudan, the concept of slow-sand filtration is a very old one. “Since time immemorial we’ve been using slow- sand filtration on a large scale for big cities but never at a household level,” says Okello. “We’re simply scaling it down from commercial to household level, but the principle remains the same.”
The filters require virtually no maintenance, only an occasional cleaning, as there are no moving or electronic parts. Simple designs such as these ensure durability in the harsh environment of southern Sudan. The filters come in three varieties, each constructed from different materials, but designed with the same basic structure of an upper chamber filled with sand and gravel, and a faucet or spout. The cheapest filters are made from zinc, and cost approximately 28 Sudanese pounds (11 U.S. dollars) to produce. Filters can also be built from plastic barrels or cast from concrete, but each of these is more expensive, 80 and 42 pounds (32 and 17 U.S. dollars), respectively.
“When the gravel and the sand become dirty I clean it out and wash it,” says Mohammed Ahmed, a resident of Magara, just off the single strip of dusty tarmac stretching more than 500 kilometers from Renk to Khartoum. Ahmed and his wife have four children- before receiving the filter six months ago, water-borne diseases were a constant issue for the family.
“We used to get sick with diarrhea and worms,” he says. “Now that we have the filter there are no diseases to worry about.”
Underground water is located far too deep in the area around Renk to drill boreholes for hand pumps, meaning that people have traditionally relied on water gathered from the river or other standing sources, leading to high levels of disease. Since 2007, Mercy Corps and its consortium
partners– the Fellowship for African Relief (FAR), Strømme Foundation, and Tearfund– have provided more than 2,200 filters to households throughout Upper Nile State. If each filter theoretically serves a family with multiple children, more than 10,000 people are likely to benefit from pure drinking water.
“People are much healthier now,” Okello says. “For years they’ve been unable to access safe drinking water, and just getting it from the Nile. Since the introduction of the bio-sand filters we’ve seen reduced rates of diarrhea and other diseases.”
The filters work extremely well, but the organization regularly tests the water to ensure their continued effectiveness. On a recent Friday morning Peter Agok, a Sanitation Supervisor for Mercy Corps, and Charles Primo, a Water and Sanitation Officer for the organization, visit several water sources and families around the town of Renk. Their plan is to sample water from the filters, and see how it differs from original sources such as wells and the Nile.
Agok and Primo’s first stop is at the village of Kolang, where they want to see the hafir (reservoir), located about 20 kilometers from Renk, along a bumpy dirt track. The hafir is
a large pit, dug in 2008 by Mercy Corps. It is roughly 20 meters by 40, and three meters deep, according to Primo, and built on a downward slope. As rain falls, it collects into a carved channel, gradually flowing down into the hafir. Primo walks to the edge of the water and dips in a plastic bottle, filling it just over halfway with brownish rainwater.
“The hafirs are a problem,” Agok says. “The water has a color and a bad smell- this is why we suggest they use filters.”
Following this, Primo and Agok collect three other samples, one from a well where a nomadic family is gathering water one jerry can at a time, and two from filters in Magara. Returning to Renk with the samples collected, they continue to a surprisingly well-organized laboratory at the water- treatment facility at the edge of town, near the riverbank.
Over the next 45 minutes Agok and Primo carry out a variety of tests on the water samples from the hafir, the well, Mariam Adam’s, and Mohammed Ahmed’s house. Primo carefully spreads growth solution onto a Petri dish, placing a few drops of water inside. Agok, on the other side of the room, pours a sample of hafir water into a clear plastic tube, squinting at the top to measure the turbidity. A moment later he takes a small sample of water and pours it into a color-coded meter to measure the pH- walking to the door, he holds the device in the sunlight, looking carefully at the small numbers on the side measuring the water’s natural acidity. Finished with their tests, they note the results in Arabic on a worksheet, close the lab, and lock the door, knowing their work is a small, but meaningful, step in improving the lives of vulnerable people in their community."
A fresh, and safe, cup of the Nile
Magara, Upper Nile state (Sudan) – Miriam Adam’s two- year-old daughter takes hold of a plastic cup with both hands and tips her head back, taking enormous gulps of water. She quickly drains the cup, putting it down with a satisfied look. Not long ago, her cup of water, drawn from the banks of the Nile less than 200 meters away, could have contained any number of viruses and parasites- now, Adam has no need to worry about what her daughter drinks.
“The kids were sick, but they aren’t now,” she says, speaking in Arabic.
Six months ago, Mercy Corps and a consortium of three other non-governmental organizations came to Magara village to provide water filters for the community, who until now had been drinking contaminated surface water from open pools and the Nile River without any form of treatment. The filters given to the people of Magara, which look like small concrete pillars with a spout protruding from the side, are locally made and easy to produce. When used properly, they provide an easy and cheap way for people to access safe drinking water, an important step on the path to better and healthier lives.
“When contaminated water is poured in, it trickles through and the bacteria, viruses and suspended solids get trapped in between grains of sand. As a result, clean water comes out,” explains Francis Okello, the Water and Sanitation Sector Head for the Northern Upper Nile Recovery and Rehabilitation Programme (NUNRRP). “The filtered water is absolutely safe,” he adds. “It’s obviously better to drink water from the filter than directly from the river.”
This technology, known as the bio-sand filter, was first developed at the University of Calgary (Canada) in the mid- 20th century, and uses the principle of slow-sand filtration to make contaminated water drinkable. The filter contains a bottom layer of gravel, with another layer of finer sand on top. When river or well water is poured through the filter, the grains of sand trap bacteria and viruses, and eliminate turbidity (cloudiness).
While the bio-sand filters are a new addition for families in southern Sudan, the concept of slow-sand filtration is a very old one. “Since time immemorial we’ve been using slow- sand filtration on a large scale for big cities but never at a household level,” says Okello. “We’re simply scaling it down from commercial to household level, but the principle remains the same.”
The filters require virtually no maintenance, only an occasional cleaning, as there are no moving or electronic parts. Simple designs such as these ensure durability in the harsh environment of southern Sudan. The filters come in three varieties, each constructed from different materials, but designed with the same basic structure of an upper chamber filled with sand and gravel, and a faucet or spout. The cheapest filters are made from zinc, and cost approximately 28 Sudanese pounds (11 U.S. dollars) to produce. Filters can also be built from plastic barrels or cast from concrete, but each of these is more expensive, 80 and 42 pounds (32 and 17 U.S. dollars), respectively.
“When the gravel and the sand become dirty I clean it out and wash it,” says Mohammed Ahmed, a resident of Magara, just off the single strip of dusty tarmac stretching more than 500 kilometers from Renk to Khartoum. Ahmed and his wife have four children- before receiving the filter six months ago, water-borne diseases were a constant issue for the family.
“We used to get sick with diarrhea and worms,” he says. “Now that we have the filter there are no diseases to worry about.”
Underground water is located far too deep in the area around Renk to drill boreholes for hand pumps, meaning that people have traditionally relied on water gathered from the river or other standing sources, leading to high levels of disease. Since 2007, Mercy Corps and its consortium
partners– the Fellowship for African Relief (FAR), Strømme Foundation, and Tearfund– have provided more than 2,200 filters to households throughout Upper Nile State. If each filter theoretically serves a family with multiple children, more than 10,000 people are likely to benefit from pure drinking water.
“People are much healthier now,” Okello says. “For years they’ve been unable to access safe drinking water, and just getting it from the Nile. Since the introduction of the bio-sand filters we’ve seen reduced rates of diarrhea and other diseases.”
The filters work extremely well, but the organization regularly tests the water to ensure their continued effectiveness. On a recent Friday morning Peter Agok, a Sanitation Supervisor for Mercy Corps, and Charles Primo, a Water and Sanitation Officer for the organization, visit several water sources and families around the town of Renk. Their plan is to sample water from the filters, and see how it differs from original sources such as wells and the Nile.
Agok and Primo’s first stop is at the village of Kolang, where they want to see the hafir (reservoir), located about 20 kilometers from Renk, along a bumpy dirt track. The hafir is
a large pit, dug in 2008 by Mercy Corps. It is roughly 20 meters by 40, and three meters deep, according to Primo, and built on a downward slope. As rain falls, it collects into a carved channel, gradually flowing down into the hafir. Primo walks to the edge of the water and dips in a plastic bottle, filling it just over halfway with brownish rainwater.
“The hafirs are a problem,” Agok says. “The water has a color and a bad smell- this is why we suggest they use filters.”
Following this, Primo and Agok collect three other samples, one from a well where a nomadic family is gathering water one jerry can at a time, and two from filters in Magara. Returning to Renk with the samples collected, they continue to a surprisingly well-organized laboratory at the water- treatment facility at the edge of town, near the riverbank.
Over the next 45 minutes Agok and Primo carry out a variety of tests on the water samples from the hafir, the well, Mariam Adam’s, and Mohammed Ahmed’s house. Primo carefully spreads growth solution onto a Petri dish, placing a few drops of water inside. Agok, on the other side of the room, pours a sample of hafir water into a clear plastic tube, squinting at the top to measure the turbidity. A moment later he takes a small sample of water and pours it into a color-coded meter to measure the pH- walking to the door, he holds the device in the sunlight, looking carefully at the small numbers on the side measuring the water’s natural acidity. Finished with their tests, they note the results in Arabic on a worksheet, close the lab, and lock the door, knowing their work is a small, but meaningful, step in improving the lives of vulnerable people in their community."
Monday, June 8, 2009
Near Khartoum?
Sorry for the delay on blogging- no excuses, I've just been lame...
I'm in the village of Bunj, about halfway between the towns of Renk and Malakal, an today, I go out with the health promotion team to observe a 'mass education' event.
It turns out to be big success. More than 100 people gather as Asunta, a tall grandmotherly woman addresses the crowd, along with El Faki, another health promotion agent. They take turns with a megaphone, speaking to the crowd in Arabic, pausing every few sentences for one of the men in the crowd to translate into Mabaan, the local language.
"Mosquitoes live in standing water, so you should try to drain anything near your house," Asunta says, as she holds a drawing of a smiling mosquito looking hungrily at a lake. The crowd nod their heads.
And so it proceeds- El Faki exhorts them to use mosquito nets for pregnant women and for children. He walks through the audience, holding a picture of a family sitting under a net- again, they nod.
The training also is focusing on preventing diarrhea, and Asunta tries to teach the children a song.
"I wash my hands like this/ like this/ with soap and water/ with clean sand," she sings in Arabic. The kids repeat after her, clapping along and miming hand washing, following her lead. By the end, the kids are clapping constantly, and with a huge shukran! (thank you), Asunta ends the song.
It was very interesting to watch all of this, and really get a sense of development in action, I suppose. More interesting though, is an interaction that I have after the education campaign, as we wait for the Land Cruiser to arrive.
I'm sitting with Asunta and El Faki, another man, and a girl who looks to be perhaps 15-years-old. She wears a purple shirt with white embroidered flowers and an orange sash/headscarf wrap. As you would expect, she doesn't speak a word of English, and my Arabic ends somewhere around "thank you," and "give me one Coca-Cola." Fortunately Asunta is there, and she translates.
She's incredulous at the fact that I can't speak Arabic, and I smile sheepishly.
"Where are you from?" she asks.
"America," I answer, "very far away."
"Far away," she says. "Is America near Khartoum?"
Wow. How do I answer that one? This is a girl who likely hasn't traveled more than 50 kilometers from her village in her life; Khartoum is maybe 500km away, an enormous distance for her. How do I explain that my home is about 25 times farther away, more than 10,000 km?
I laugh. "No, it's much farther away than Khartoum," I say. I wouldn't want to sound patronizing here, but the honest truth is that I don't think this girl would begin to understand if I told her that I lived across an ocean, and flew 1,000 kilometers per hour 10 kilometers in the air to come here. I suppose the simple explanation is probably the easiest in this case, even if it's only the partial truth.
Our conversation only lasts a few moments, but it serves as yet another reality check into just how vast the difference is between the developed and the developing world. Because of who I am and where I was born, I've been the beneficiary a good education, a decent health care system, roads that work, and so much more. The girl I'm speaking with has seen none of those things, and likely never will. I don't mean to sound overly fatalistic here, but it's simply the reality of life in this corner of southern Sudan- life goes on more or less as it always has, with the addition of a hand pump here, or a plastic sheet there.
I wonder sometimes if this whole 'development' enterprise is really as patronizing as it can feel. NGOs are digging boreholes for pumps, building clinics, and helping people set up small businesses, all of which are good things. The part that hits a bit of a sour note for me is the fact that the things that are built are still incredibly basic- a person from the developed world would never drink out of a pump like the ones organizations install, and would wait for a medevac helicopter to take them to to Kenya before visiting a clinic like the ones most NGOs build. I know there's an argument to be made for 'appropriate technology,' for building at a level that makes sense for the community in question. Still, it seems a bit hollow to me. I'm not sure if there's any good answer to this, but I have to wonder..
In any case, end of musing/rant. Heading back to Renk tomorrow, a town which feels more like the north than anything else I've seen in southern Sudan. Everything is in Arabic, and they have things like raisins and shwarma. Not a bad spot, actually, to spend the remaining couple weeks in Sudan. I'm looking forward to getting out of here soon though, and for the next chapter to begin...
I'm in the village of Bunj, about halfway between the towns of Renk and Malakal, an today, I go out with the health promotion team to observe a 'mass education' event.
It turns out to be big success. More than 100 people gather as Asunta, a tall grandmotherly woman addresses the crowd, along with El Faki, another health promotion agent. They take turns with a megaphone, speaking to the crowd in Arabic, pausing every few sentences for one of the men in the crowd to translate into Mabaan, the local language.
"Mosquitoes live in standing water, so you should try to drain anything near your house," Asunta says, as she holds a drawing of a smiling mosquito looking hungrily at a lake. The crowd nod their heads.
And so it proceeds- El Faki exhorts them to use mosquito nets for pregnant women and for children. He walks through the audience, holding a picture of a family sitting under a net- again, they nod.
The training also is focusing on preventing diarrhea, and Asunta tries to teach the children a song.
"I wash my hands like this/ like this/ with soap and water/ with clean sand," she sings in Arabic. The kids repeat after her, clapping along and miming hand washing, following her lead. By the end, the kids are clapping constantly, and with a huge shukran! (thank you), Asunta ends the song.
It was very interesting to watch all of this, and really get a sense of development in action, I suppose. More interesting though, is an interaction that I have after the education campaign, as we wait for the Land Cruiser to arrive.
I'm sitting with Asunta and El Faki, another man, and a girl who looks to be perhaps 15-years-old. She wears a purple shirt with white embroidered flowers and an orange sash/headscarf wrap. As you would expect, she doesn't speak a word of English, and my Arabic ends somewhere around "thank you," and "give me one Coca-Cola." Fortunately Asunta is there, and she translates.
She's incredulous at the fact that I can't speak Arabic, and I smile sheepishly.
"Where are you from?" she asks.
"America," I answer, "very far away."
"Far away," she says. "Is America near Khartoum?"
Wow. How do I answer that one? This is a girl who likely hasn't traveled more than 50 kilometers from her village in her life; Khartoum is maybe 500km away, an enormous distance for her. How do I explain that my home is about 25 times farther away, more than 10,000 km?
I laugh. "No, it's much farther away than Khartoum," I say. I wouldn't want to sound patronizing here, but the honest truth is that I don't think this girl would begin to understand if I told her that I lived across an ocean, and flew 1,000 kilometers per hour 10 kilometers in the air to come here. I suppose the simple explanation is probably the easiest in this case, even if it's only the partial truth.
Our conversation only lasts a few moments, but it serves as yet another reality check into just how vast the difference is between the developed and the developing world. Because of who I am and where I was born, I've been the beneficiary a good education, a decent health care system, roads that work, and so much more. The girl I'm speaking with has seen none of those things, and likely never will. I don't mean to sound overly fatalistic here, but it's simply the reality of life in this corner of southern Sudan- life goes on more or less as it always has, with the addition of a hand pump here, or a plastic sheet there.
I wonder sometimes if this whole 'development' enterprise is really as patronizing as it can feel. NGOs are digging boreholes for pumps, building clinics, and helping people set up small businesses, all of which are good things. The part that hits a bit of a sour note for me is the fact that the things that are built are still incredibly basic- a person from the developed world would never drink out of a pump like the ones organizations install, and would wait for a medevac helicopter to take them to to Kenya before visiting a clinic like the ones most NGOs build. I know there's an argument to be made for 'appropriate technology,' for building at a level that makes sense for the community in question. Still, it seems a bit hollow to me. I'm not sure if there's any good answer to this, but I have to wonder..
In any case, end of musing/rant. Heading back to Renk tomorrow, a town which feels more like the north than anything else I've seen in southern Sudan. Everything is in Arabic, and they have things like raisins and shwarma. Not a bad spot, actually, to spend the remaining couple weeks in Sudan. I'm looking forward to getting out of here soon though, and for the next chapter to begin...
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