Saturday, March 28, 2015

Whiskey Baby

Whiskey Baby
Whiskey Baby

Discarded plastic whiskey bottles go a long way here.  Entrepreneurs collect them, fill them with sweetened food coloring mixed with water and sell them to bus passengers who hang out of the windows at the many stops along their journey.  The travelers yell out to the vendors, while the vendors are yelling out to the passengers, pushing their wares.  Somehow the transaction is completed despite the cacophony.   Small children in the hospital corridors toss back swigs of water in these Mozambican-style water bottles.  When I first arrived, I wasn’t sure what to make of all the toddlers drinking what I thought was some kind of clear alcohol. I had started to wonder if my secondary project should be a children’s AA program.

But the most creative and heart warming use of these bottles are the toys created from what we would regard as refuse.   A group of boys in my neighborhood cut out a square section on the front, secured elastic bands across the length, and fashioned guitars.  There was actually sound, and not all that bad, when you consider that the entire effort had its beginnings as garbage.  Dried strips of pineapple leaves served as shoulder straps.   A halfway decent sound, utility and trend setting recycling, all from a discarded item.

Usually the whiskey bottles are outfitted with wheels made from the red covers of medicine bottles and turned into cars.  As many people here are on HIV medicines, TARV, these empty bottles are a familiar site, littering the yards and streets.  Four bottle tops serve as wheels placed on either a whiskey bottle, also a common item littering the streets, or on the original plastic rectangular medicine container.  Personally, I prefer the whiskey bottle model.  Think sports car with oversized drag racing tires compared to a Buick station wagon, the kind my mother drove around with her brood of six unruly kids.  (We also were known to hang out of the windows, yelling, on our annual winter trips down south.  But there were no vendors to yell back to us. Or sell us sugar water. Though I do remember our antics did result in numerous stops at Stuckey’s for pecan and key lime pie.  And of course, this reward only increased the frequency and decibel level of our howling.)


Boys and Their Cars
And, little girls, seemingly being genetically disposed to care- taking, this half of the knee high population sees empty whiskey bottles and immediately thinks baby dolls.  Cast off pieces of hair, store bought braids that were formally woven into their mother’s or sister’s heads as sculpted works of art, (now also trash remnants littering the roads), are inserted into the bottle opening to create a baby doll.  Within minutes the children are loving these ‘baby dolls’ and carrying them on their back, wrapped in a tight cloth, as their mothers did with them.

Whiskey Baby Love

The best thing about these toys is the lack of attachment.  Important at the time for entertainment, and having provided an opportunity for creativity, resourcefulness and construction skills, once the kids lose interest, the toys revert back to disparate pieces of trash, once again taking their place as litter in the yards and streets.  It’s like the parallel universe of the toys on the Lost Island in the Rudolph Christmas movie.  There is no guilt, no sadness, no crying children or crying toys, no need to rescue and repair these items.  It is just trash, utilized in its original intent, again by kids seeking to play and then back to trash.  Plain and simple.

Parents do not mob toy stores to purchase the latest must-have item for these kids.  Children’s rooms are not amassed with playthings, collected, kept on shelves, shoved in plastic bins and closets, under beds, and in attics.  (Children here don’t have shelves in their rooms.  Actually, they don’t have rooms.  And attics don’t exist either, just so you know. )  Kids don’t cry when their toys are lost or left behind.  These kids simply don’t have toys, the way our kids do, or the connection and regard for such items.  And, it doesn’t seem to be such a bad or sad thing.   Nor do these kids seem any less happy with their trash-made cars and dolls.


A friend of mine became so sad when I told him about these Whiskey Babies. He told me he had never imagined there were little girls in the world without dolls.  In a world where life is tenuous, when the focus is on the here and now, when life is lived not on the fringes but clinging to the threads, the plastic whiskey bottles that drown out the pain in the adult world can oddly enough bring about joy for their children.

Malaria Month

While Hallmark promotes holidays such as Grandparent’s Day and National Kitten Day in the US, people on the African Continent recognize such events as Tuberculosis Day and Malaria Month.  This week we “celebrated” Tuberculosis Day in Nicoadala.  The top executives of the province and the hospital opened the event by reading long and formal proclamations followed by political promises to improve care for patients, their families and the general public.  A theatre performance by a group of activists picked up the pace using a humorous skit to remind people about simple tips for prevention and treatment.

Any attempt to provide health education is useful here.  Clear and repeated messages are sorely needed to counter the misinformation, myths and lack of information.  In a culture where many people are uneducated and rely on the customs of their ancestors and local healers, health care improvement is an on-going challenge.

Peace Corps addresses health issues, like Malaria, by encouraging all volunteers to gear up their activities to  “Stomp Out Malaria”, a popular program in Africa working towards the eradication of this disease.  April is designated as Malaria Awareness Month.  The idea is that with an increased effort the world at large, and our communities in particular, can focus with renewed interest and energy and make a serious impact towards eradicating, or at least preventing malaria.

“Stomp Out Malaria” involves volunteers holding seminars and trainings in their communities, facilitating events for mosquito net distribution, and using social media to share websites and information.  The real trick, though, is to inspire behavior change.  Raising awareness and providing education are only the first steps, and usually the easiest and most fun. This is the fanfare, the horn-blowing and throwing of confetti, the marching in proverbial and actual parades, waving in the by-standers to join the festivities.  But initiating behavior change, and measuring this behavior change, is crucial for long-lasting and effective progress.

And, the behavior change is asking that the population practice new or different actions, actions not always consistent with the culture.  We all know that change can be an obstacle in our lives.  It can induce feelings of fear and doubt in the suggested action, in the messenger and even in our selves.   Attempting to change behavior is no small feat in any circumstance, and particularly a looming undertaking for a Peace Corps Volunteer serving in a foreign country.

And, the thing is, as is the case with Malaria, as Americans, we know the disease can be eradicated.  Malaria existed in the US up until 1951.  So teaching prevention methods, while extremely important in this setting, feels like throwing that one starfish back into the sea.  Undoubtedly it is essential to that starfish, or the person sick with the disease, but it doesn’t address our continued inability, or unwillingness, to eradicate Malaria.

Meanwhile Peace Corps Volunteers and other health workers try to educate people about malaria.  We encourage people to remove stagnant water from their yards and to cover any water tanks or buckets.   We suggest that they cut up or bury old tires and trash, places where mosquitos breed and produce eggs.  We demonstrate the proper usage of mosquito nets and plead that they use them nightly, the time when the mosquitos are most active.  We ask that they not use the nets for fishing or to cover and protect their crops.  We try to show the cost of the illness, how losing time in the garden and needing to purchase additional foods for a healthy recovery are more expensive than it is to simply purchase a net.

Yet, this all goes back to the issue of behavior change.   Understanding that stagnant and still water is a risk is difficult to comprehend when the dangers of microscopic-sized organisms cannot be seen.  Covering basins of water requires having a cover and instituting a new habit.   Burying or burning trash is an additional effort.  Here there is no community provision for trash removal. 

And, trash is the by-product of a purchased item, something that while common place today was once a status symbol.  If we believe that almost all of our actions are based on financial platforms, as I purport, then discarding the wrappers of processed foods in one’s yard was proof of one’s social and economic standing.  Now, it is simply a learned behavior, and a result of not having any other option, to throw the trash in the yard.

And if a mosquito net can bring in fish which could be sold, or to yield more plants from the garden, a portion to be sold in the market, isn’t this a financially sensible choice?  The alternative is to protect from a bug that may or may not bite or infect.  And, if it does, there is medicine at a cost of only five metacais, as compared to one hundred metacais for the purchase of a net.


Malaria Month Brochure
All of these are factors to contend with when educating people here about malaria.  The behavior change, I am convinced, is best addressed on the financial level, by comparing the higher cost of illness to the affordable cost of prevention.  It is time also to convince our funders, the world over, that their combined donations to treat this disease would best be spent to eradicate Malaria once and for all.  That is a behavior change we could easily measure.

Thursday, February 12, 2015

HALLO MR. CHINESE LADY BABY!

 HALLO MR. CHINESE LADY BABY

There is a bicycle táxi driver in town that greets me everyday. He screams out, “ Hallo Mr. Chinese Lady Baby” as he passes me, giving me a fright every time.  Surely he is using every English word he knows and he compacts them all in one exuberant salutation.  My neighbors have a cadre of names for me as well.  The adults call me Mama Hobin, Mama a term of respect here in Mozambique.  Robin seems a hard name for them to either hear or say.  Hobin is the result.   The children call me Rubin, Robini and other more or less similar versions. 

I don’t correct anyone.  I answer to them all.  It isn’t the words or the sounds that matter, but the communication intent.  And that, any language instructor would say, is the central obstacle to language proficiency.  Diction, sentence structure and conjugation are key elements, and shouldn’t be ignored.  Yet, as with most things, I go about my language learning differently.

Walking down the hospital corridor last week, I tried to side-step an area of the just washed floor.  Making eye contact with the maintenance man, I smiled.  He smiled back and said, “F—k you”.   It wasn’t until I turned the corner that I realized he had spoken to me in English.  And, I realized just what he had said.   I returned to find him in a huddle with the cook, both of them giggling like naughty children. 

Mary, the cook, and the maintenance man, have been practicing various English words and phrases.  The maintenance man told me he hadn’t meant to say this out loud.  He had been repeating the phrase to himself and it just popped out when he saw me.  They were both embarrassed.  He had no intention to offend,  he just desperately wanted to try out a little English.   They happily accepted my offer to share more useful phrases.  Our friendship was cemented with that exchange.

Mary, the kitchen worker.  Who could imagine this sweet face
saying such things?
It wasn’t their choice of words that mattered, they simply wanted to communicate.  Like my neighbors and the bicycle taxi man, people use the words they know, even if the words aren’t the best choice, are pronounced wrong, or make no sense at all.  The intent is to communicate, to connect.

Since my arrival, I have stumbled with Portuguese.  I found myself responding in Ukrainian, or with bits of French and Spanish.  My talkative and expressive self was mute, held captive by this language I simply couldn’t seem to speak.   So, I decided not to speak at all, but to listen.  But even this proved difficult, as I couldn’t decipher the sounds.

Most Mozambicans, when they speak, are barely audible.  Their voices are quieter than a whisper.  I am not sure if this is a remaining effect of colonialism, but when posing a question to a Mozambican, it is not uncommon to receive no answer at all, or at best, a hushed response.  For someone trying to learn the language, and having a hearing deficiency, it was maddening. 

My language learning needed a new strategy. I couldn’t rely on learning from my colleagues when I wasn’t able to understand   them, let alone hear them.   I realized I first had to listen to myself.   I had to hear my own anxieties and my needs.  I had to put first things first.  This included making a comfortable home, learning how to do all the new daily activities, and integrating into my surroundings, regardless of the language.  I had to settle. 

It probably took me longer than other Peace Corps Volunteers, but I was able to find a way to communicate more comfortably.  I sought out quieter environments, conducive to personal or small group conversations.  I read Portuguese Peace Corps manuals at night to increase my vocabulary and to better understand sentence structure.    But most importantly, I let go of the constructs of language success, constructs that I had allowed others to define.   


My language has improved these past weeks, as if by mere chance.  I still fumble with pronunciation and sentence structure, but staying true to my belief that it is the intent of communication that matters, and not the specifics, allows me to relax.   Being non-judgmental with my own use of language, as I am to others, seems to have opened the gateway of my brain’s language receptors.   And, in this state of mind, connecting to others is easier.  I am not sure if I have strung together phrases as strange as, “Hallo Mr. Chinese Lady Baby", but if so, I hope others enjoyed it.


Monday, February 9, 2015

The Mobile Clinic

I love the efficiency of the Mobile Clinic, sponsored by Columbia University, PEPFAR, the CDC and the Mozambican government.  My colleagues normally insist that I sit up front to enjoy the air conditioning and the area views from on high.  But, I prefer to sit in the back of the vehicle.

Mobile Clinic - side door for vaccinations
The small chairs fold down and we strap ourselves in for the bumpy journey.   The drawers latch shut, keeping medicines and stethoscopes and log books in place.  Folding chairs supplied by a major USA camping outfit are stored neatly in between the cabinets.  The heavy metal ladders that allow us to exit and enter the side and rear of the van lock into the floor.

Enter here to begin with consults 
I look out the window and see only the tops of coconut trees and blue skies that are full of puffy white clouds, the kind of clouds that make you feel like an eight year old girl, the kind of girl that dreams of unicorns and fairies and purple ponies.  The litter-lined streets and the mud houses and the throngs of people moving along the side of the road don’t exist for the moment.  The chaos of Mozambique is far, far away when I sit inside this well-organized, expensive and sterile mobile medical unit.

The place we are travelling to, and where we will dispense medicines and provide consults for the day, has been built in a cleared area.  Trees have been felled to make room for hundreds of tents.   Severed trees and stumps sharply stick out of the land, fooling one to believe that the flood had violently torn them away.  But this area is above the flood zone.  The damage to the land was made by man, for man.  Cooking fires smoke in front of the heavy canvas and plastic tents as the residents sit languidly on tree limbs, their gaze lost to the smoke and embers.  The scene is straight out of a low budget apocalypse film.


Outdoor Cooking Station




Surveying local families
Our team of five visits a handful of tents to survey them about their conditions.  We ask if they received mosquito nets, and if so, we request to look inside to verify that they are in use and hung properly.  We quiz the residents on the use of the water purifier and ask if anyone in the household has had malaria in the past two weeks.  Half of the families are not using the nets.  They tell us their daughter has taken the net to the river for washing.  We explain that the nets do not have to be washed for the first three months.  They were distributed only a few weeks ago.  Likely the nets are being safe-guarded by the family, as a prized possession, or they have been sold.  Only a handful of those asked know how to use the water sanitizer.  Most of the bottles are yet unopened.

Raised bed with mosquito netting

Tent wtih no flooring, mosquito netting tied to tent posts


Mosquito netting over straw mat













Wordly Possessions











The tents have no flooring and no ventilation.  For those using the nets, they sleep on straw mats and tuck the sides of the netting underneath them.  One family built a raised bed, meant for four, with the net hanging from the ceiling rafter.  Plastic water jugs and plastic plates and cups sit to the side of the tent.  The blankets are used as doors.  Some families drag large pieces of trees indoors to try to keep them dry from the rain that continues, almost daily.  Three stones make up the outdoor fire-pit, most of them burning throughout the day.  Dishes are washed outside and dried on a table made from sticks.
Drying Rack
Firewood stored inside the tent



Crews have built latrines throughout the camp, each providing six individual stalls.  Three- sided shower areas, sheeted in the same heavy black plastic as the tents, dot the landscape.  World Vision and US AID use these temporary homes and shower stalls as billboards, their names printed larger than life on the material, as if this is the latest trend in humanitarian advertising.

Women's Latrine with hand-washing station, called Tippy Taps ( yellow buckets )


















I think of all the camping trips I have enjoyed, and those I haven’t, usually due to rain.  My mind flips through the pages of the L.L. Bean catalog, imagining all of the fancy gadgets available to our American need to tame the outdoor experience with luxury.  And, I realize that these people aren’t in these tents as a choice, or for recreation.  They are there with families, some with small children, up to eight people living in one tent.  They will live in these tents for up to four months, at which time the government will be able to supply them with metal roofs and cement to build a proper home. 




But for now, as the rains continue to pour down, life in these camps will continue.  Roughly 90% of those who come to our clinic are sick with malaria, in addition to respiratory illness and stomach malaise.  We hand out malaria meds like candy and offer paracetamol and other benign pills to attempt to counter their discomfort.  It is surely not camping like I have known and I doubt that I will ever think of camping in much the same way.  But at least, for a few moments, we can offer these people a clean and somewhat hi-tech experience.