This blog is solely the responsibility of Rebecca Hartog and does not reflect the views of Peace Corps.

Monday, April 28, 2008

Traveling, harassment, death, and HIV… and other things that just plain suck.

It’s been a sad last few weeks. Though fortunately, I wouldn’t say I’m as depressed as I was before (I guess I’m getting used to village life, even liking it), the last two weeks have not been kind to my life.

I came back to village from a truly terrible banking trip last Friday. I’m still recovering. The travel was altogether exhausting and it felt like everything that could go wrong, did. There were times when I actually feared for my life due to travel conditions. I was also super harassed while in Yaounde (people yelling out, in French, “Go back to your home in Europe!” Mental response: 1) Thanks. 2) Fuck you 3) Honestly, I would love nothing more than to go home. Then, not ten minutes later: a guy telling me in English he loved me and wanted to “fuck” me… deep breath… ignorant assholes), so by the end of the trip, I was kind of shell-shocked and terribly thrilled to return to village, where I don’t have to deal with life-threatening and terrible road conditions, and ignorant assholes who harass me.

The icing on the cake is that all the frustration and harassment and awful travel conditions were really actually pretty normal. Upon return to village, I was telling Magloire about all of it, and he told me it was all extremely normal, and that he’s been through worse. Well, that only made me feel mildly better. Mostly though, it’s depressing – that I am so shell-shocked by what is “normal” doesn’t exactly make me feel capable; furthermore, that it could be worse isn’t exactly an incitement to keep on traveling. Trying to be optimistic, I tell myself that it was a good learning experience. What I learned: traveling within Cameroon SUCKS. Avoid it at all costs.

Which brings me to another point: I was talking with Ralph about how even the negative experiences here can be positive, because often I’ll learn a lot from them. Or even if I’m not learning a lot, I’ll appreciate how things are run in America just that much more. I came to Cameroon so down on the US (I can’t even remember why), and now I cannot wait to get back. Ralph pointed out that yeah, that’s true about learning a lot, but so much of the learning as a PCV is negative learning. Like, learning not-to-touch-a-hot-stove-by-touching-it-and-burning-yourself-learning. I think that’s true. There’s not a whole lot of positive reinforcement – which may account for the whole roller coaster of emotions phenom. When roughly 90% of learning is negative learning, that 10% of positive reinforcement learning is a high better than drugs, sex, and rock-and-roll.

So after I got back to village and nearly collapsed from exhaustion, Magloire had more “good” news for me. There was an old lady who used to sit at this table in the middle of village and sell papayas and bananas and other assorted produce. She was always sitting there, and was really sweet. One day, she called me over and gave me some bananas. She always said hi to me. Well, apparently, she died last Tuesday (I got back on Thursday), and Magloire said she was asking about me, “Where is Rebecca?” the day she died. Though it’s not a tragedy – old people die, after all – it was sad. I welled up when Magloire told me. But that wasn’t the only news.

I don’t have many friends here, and many of the friends I do have I’ve met through Magloire and through the work at the youth center. One of the women who’s been involved at the youth center since its beginning (in 2005), has been, if not a close friend, at least a friendly acquaintance, and someone who I like. She recently got herself tested and found out she has HIV. Magloire said she came to him, sobbing, very distraught. It’s upsetting on a few levels, and it takes a bit of explanation to sort out. First of all, it was surprising, given that she’s been involved in work in “le lutte contre le SIDA” so I guess I kind of thought she might have picked up the knowledge, attitudes and behaviors to avoid contracting HIV. Furthermore, I now know several people in the village who have HIV, and none of them has any sort of support. All of them are hiding their status and have told practically no one, as far as I know.

Magloire knows many of the people in village who are HIV positive because he’s practically the only person in village trained in pre- and post-test counseling. So whenever someone tests positive at the hospital, they send the person to Magloire for help. It’s kinda fucked up – why doesn’t the hospital staff get some training in HIV counseling? And there’s really intense pressure not to disclose status, because there’s still insane discrimination for people living with HIV. Even though Cameroonians actually are pretty well-informed about how HIV is transmitted and what behaviors are risky (handshakes = not a risk; unprotected sex = risky), it’s like this knowledge has no effect on behavior. People who are positive are shunned from society, people won’t shake hands with them, won’t eat with them. But then you say, ‘use a condom if you’re having sex with someone and you don’t know his status,’ and that’s seen as absurd. “Condom?! No way!” It’s baffling.

So, in addition to the absolute lack of moral, emotional support, there’s no real medical support either. First-line ARVs (the cheapest ones) are supposed to be free for Cameroonians with AIDS, paid for by the Cameroonian government. However, that assumes that someone who needs ARVs can get to the provincial hospitals where they are distributed and where CD4 tests must be done to prove that someone’s immune system is depressed enough to need the ARVs. The transport to get out of Ngambé Tikar to a hospital where CD4 counts can be done and ARVs administered costs about 5000 CFA one-way, or 10,000 CFA round-trip (about $25).

To give context, I’d say I spend about 10,000 CFA in two weeks in village, but I’m a pretty big spender, comparatively to most villagers. Most people cultivate food, so they don’t have to pay for it – they just eat what they grow. I’m lazy and not Cameroonian, so I buy what others produce and do not grow anything myself. But since food is practically the only thing that I spend money on, I can’t imagine how long I could make 10,000 CFA last if I were your average villager. A month? Two months?? Who knows? So to tell a Cameroonian that he has to spend a month’s wages just to get to the hospital where he can take a test and get ARVs is kind of absurd. Especially since the majority of Cameroonians live in rural areas like Ngambé Tikar, where transport out of village is likely to be expensive.

The point is, rural Cameroon is not a good place to be HIV positive. My friend who recently found out she has HIV didn’t even get tested here in village – she went to a bigger, neighboring village to get tested, because a common perception is that the health center here doesn’t practice confidentiality, and if you get tested there and are positive, everyone in village will know by the next day. It’s such a shitty shitty system. I remember one day thinking that I’d like to get myself tested here to set a good example, but then immediately re-thought the decision, because I knew that everyone would know I got tested. And my irrational mind went to the “what if by some freak occurrence, somehow I was positive?!” Holy crap, I remember thinking about the fear of a small community knowing me to be seropositive, and thinking how I don’t know how I could deal with that. I mean really, I have no clue. On so many levels, it would be overbearingly depressing. My one loophole is that I could always leave and go back to the states, where things are no longer as bad. People here can’t.

I’ve got to work on improving this situation. I’ve got to figure out how.

8 comments:

Anonymous said...

What an upsetting post. The only bright spot is that the old lady who died asked about you. I take that as an indication that you are liked and appreciated, a real member of the community, even if you don't always feel so. Will you be able to do anything for your friend with HIV? Could she travel with you on your banking day to set up a program of ARV's for herself, and then maybe you could resupply her each month when you go to town for banking? In general, about education, could you set up an educational program for the local hospital staff? And as for confidentiality, could you talk to the Dr. at the hospital about setting up a confidentiality program and announcing it with a lot of publicity in the village? Would he be willing to serve as the test result recipient with a personal pledge of confidentiality? Could Magloire persuade him to do this? Or could Magloire serve this purpose? I think it would be a good idea for you to get tested and to make it known that you are doing so, especially if you had a new confidentiality program in place so you could say: "I'm getting tested and I trust this confidentiality program." It sounds, though, as if support delivery is the most crucial missing link. How can the ARV's be brought to the local hospital? Is that a job that you could take on? So many questions, all of which and more I'm sure you have asked yourself. I remember last fall, when I met with Melissa (returned PVC in STL), so told me: "People back home just didn't understand what a big deal it was when I reported that I'd persuaded someone to get tested." Your story brings this point home. You are doing good things with the youth group...change takes time. Please try to distinguish between a situation that sucks and you, yourself. You don't suck, not be a long shot. Loads of love and admiration. xxoo Mom

Anonymous said...

Hi,

I'm a recent Senegal RPCV working in Chad. Thinking of taking my 1 week of RandR in Cameroun. Any thoughts? I just kind of picked your blog randomly. I'd love to know if you guys have regional houses, and if so where. Are there Pulaar (Fula)-speaking areas that Cameroun PCVs work in? That's the language I learned in Senegal so I'd love to see what Fulbe life is like in Cameroun.

Thanks for any advice, especially about the north (Garoua and Maroua?). In case it helps, travelling sucks in Senegal too :)

-mike (mek6@georgetown.edu)

Anonymous said...

Becca Becca...What a time! You are so courageous and strong....I would have been done for on the muddy hill. Who would have thought that trying to help and save people would be so extremely difficult..

Love Deb

Anonymous said...

Hi Becca,
I've just started catching up with reading your blog over the last few months. I have a ways to go - there's lots of material there! I look forward to learning more about the work you are doing with the youth center, since I assume that has a lot to do with HIV prevention and assistance - and that is of course a heavy theme in this most recent post. I'll write back as I get the chance to read more. In the meantime, take care of yourself. Sending lots of love from all of us, Nance, Matt, Dorothy and Mei xo

Anonymous said...

Ted here
Becca - I no longer feel sorry for myself for that irritating hangnail. Seems like your post encapsulates all the misery and frustration of Africa. Reminds me of a story I read about a guy who came up with brilliant idea of donating hundreds of basic bicycles to a country in Africa, since it was such an important mode of transportation for many people. He returned some months later to see how it was going and found all the bicycles locked up in some storage area. Government officials had not yet given approval for their release. So he screamed at some people and busted them out. But then no one seemed to want to maintain the bikes so when they broke, they were effectively useless. So it goes...
The woman who asked about you not long before she died - I find inspiration in that. You touched this woman. She touched you. So that's not half bad. Not even one Hurricane Becca can save the world, let alone Africa. But you can reach hearts and minds, if only one at a time. So I have a great admiration for you for sticking your neck out. It's so much easier to stay on the sidelines. Plus you're not even Christian. If you leave behind a few people inspired by your work and example, you will have done well.
Take care

rachel said...

Jeepers. Sounds hairy. Any chance that one person could take the tubes of blood from multiple people to the hospital for testing? So, the phlebotomy could be done locally, and someone else could take the tubes? Probably issues still with confidentiality, safety, etc.

Anonymous said...

Becca,
Tough post; tough, tough problems. Can you think of ways to shift your paradigm? If you can't bring the M. to the mountain, bring the mountain to M.!

If CD4 counts are needed for ARV's, could you make it part of your mission in the next year and half to get your village hospital set up to do the testing themselves? And then to distribute the drugs locally?

Contact the Bill & Melinda Gates Foundation, Partners In Health (pih.org) and all your friends that know somebody/anybody in medicine. Contact companies that sell the instruments into 3rd-world environments (BeckmanCoulter?). You may find that there is an easy to use field testing method for this and maybe get a donation of an instrument or funds for an instrument, etc.

Another possibility might be monthly organized trips to the town to reduce the cost per person. This could serve the community in many ways and thus preserve anonymity for those going for testing.

Lastly: education, education, education.

Good luck.

Anonymous said...

Some resources:
http://www.cytometryforlife.org/

Hope there are some ideas here.