There is a simple yet deep satisfaction that comes from
achieving a daily routine here in Nicoadala.
Each morning I empty the tea kettle of cooled water that I’ve boiled the
night before into my water filter, ensuring a fresh supply of drinking water. I boil another kettle to wash and make a cup
of coffee. I dress for work in one of
the five or six outfits available to me.
My breakfast is usually simple; fruits or an egg, yogurt when it is available and I am
living large. I’ve gathered water from
the well the night before and know I will do so again in the early evening,
when it is cooler.
My walk to work involves greeting the same people each
morning, the same people who are doing the same activities every day. The small children are playing around the
carpentry shop, seeking out bits of wood and wood shavings to turn into their
toys. Their plastic cups, empty now of
their porridge, sit in the dirt. The
cups will still be there when I return after lunch. The women are moving to and
from the well, large basins of water balanced on their heads. I shudder to think how the nerves in their
neck are being compressed. The men sit
in the carpentry shop, an open- air structure with only one power saw. The remaining work is done with hand tools,
used to make furniture and doors. The
men sit and talk, preparing for their day.
I leave my dirt street, just behind the bus stop, and enter
into a world that has been awake for hours.
Busses are being loaded with everything imaginable, looking as if they
will topple over. Young barefooted men
stand atop the bus hoisting up the items from below. Women crowd around, in their brightly colored
cloth wraps, waiting for the bus departure, while keeping an eye on their
worldly possessions above. Vendors hawk
fried bread, packages of cookies, dried fish, phone credit, and wooden
trinkets. Small mountains of fruit line
the street, as do the skins and shells from the discarded pineapples, bananas,
mangos and coconuts. Our area is known
for its fruit. The smell of dried fish
and garbage permeate the air.
The lines of bicycle taxis stand at the ready. Daily they try to convince me to use their
services. I decline, explaining that I
like to walk, that it is good for one’s health.
They laugh and turn to one another, confirming that the white woman
chooses to walk. It is obviously a topic
of interest and surprise. Their doubt
does not subside though we have this exchange each and every morning.
Upon arriving at the hospital, I greet the waiting patients
in the local language. They are always
surprised and most of them smile. The
hospital has open air corridors of cement, built to serve as the waiting room. Due to the proliferation of air-borne
diseases like tuberculosis, the architecture is intended. It is also a very cost-effective measure to
gain more square footage. Unfortunately,
the rain and direct sun dictate that the patients move to the cement floor to
wait for their consults. The wait could be hours, sometimes all day.
I step over the patients and make my way to the reception
office. As there is no computer system,
and some patients come without their medical cards and file numbers, the first
few hours of the morning are spent searching for the patient files. Once the files are found, they are sent to
the appropriate office. The patients are
called, one by one, when the clinician is ready to serve them. Later in the morning I work in the counseling
office where the patients are sent directly after receiving a positive HIV test. Here they receive counseling to ensure they
understand the nature of this disease and their next steps. Not all patients will begin treatment. Their CD 4 level must be 250 or lower before
they are eligible for the free medications given by the government. What this means is there is no treatment,
except for pregnant and lactating women, until they are exhibiting signs of illness.
The other units, Maternity, Childcare and Nutrition, Dental,
Pharmacy, Emergency and the Lab, do their part to serve the crowds of people
each day. There is an open-air kitchen
in the back of the hospital, near the morgue, where food for the inpatients is
prepared daily. Two cooks light fires with
stacks of wood that they’ve gathered that morning, cooking in pots that look
like witch’s cauldrons. Patients eat
porridge and bits of fish or meat with a tomato sauce. Having helped in the store- room of the
hospital, I know that the food given daily to the cook is meager, at best. One can of tomato paste feeds 40 people. Add this to a kettle full of water and that
is a meal with a stamp of approval from Ronald Regan. And the unwrapped fish and meat is stored
together, in a freezer with intermittent electricity. A stack of onions sits in the corner of the
store-room on the floor. Bugs scurry out
from underneath when the cook reaches for the one kilo allowed daily, which I
confirm on the scale.
The hospital has two doctors who also serve 14 area clinics.
Medical staff are government clinicians, trained with a year or two of general
medical study. Bachelor degree
recipients, of which there are very few, are referred to as Doctor. This
includes the counselors and psychiatrists, who dispense medicine. Running water is only available in a few of
the wards and offices. Staff dressed in
blue lab coats fill large garbage barrels of water each morning in the offices
and in the two bathrooms with western dump-flush toilets. Uniforms are important here. They protect one’s precious clothing and more
importantly, signify status. Staff in
blue coats pump water from the well and clean the hospital. They also carry files to and from offices. Staff in white coats administer health care.
Two days a week I work in the nutrition program, helping to
measure and weigh the babies and children.
Vaccines and Vitamin A is dispensed. We offer short workshops,
instructing new mothers to breast feed only for the first six months. When introducing foods to the babies, we
educate them of the risks of disease from dirty water. We suggest they use the same bowl each day to
monitor the food intake of the children, hoping to detect change in diet and early
signs of sickness. Often we cook
porridge and show the mothers how they can add green leaves or fruits to
augment the nutritional value of the foods.
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| Porch area of hospital kitchen |
And in every office there are reports and forms. Hospital workers spend most of their time
completing forms, registering notes in large hard covered books; information
that doesn’t seem to be used or referred to.
The concept is that these registers ensure documentation to avoid
pilfering, in the case of the store- room, for instance, and to report to the
government for funding. The reporting is
laborious and time consuming, and mostly inaccurate.
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| Indoor hospital kitchen cooking area |
Our work as Peace Corps Volunteers is to assist with capacity
building, improving the systems, the monitoring and evaluation, the patient
flow, general care and the organization process. Along the way, we offer education about HIV
and nutrition and malaria. But, it is
not something we can do upon our arrival.
To be effective we must first understand just how things actually work
here, logistically and culturally. We
must first learn, ourselves, about the medical issues.
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| Baby being weighed |
And, along the way we build trust and relationships. We role model professional behavior,
including showing up to work regularly, setting goals, encouraging
collegiality, treating others in a respectful manner. In the communities we interact with our
neighbors, slowly forming friendships and demonstrating our commitment. Our neighbors are our colleagues and patients
and our integration at home contributes greatly to our professional and program
success. It all sounds so simple and
that the inadequacies would be easy to remedy.
It is anything but.
For the volunteer, for me at least, it is a constant battle
to clarify and lower my expectations. I
am not here to find a cure for HIV or Aids.
I am not going to change the economic system of the country. I do not have the answers or training or
resources to eradicate malaria. I am
not going to do big and great things.
But, I can offer, in small ways, my interest, motivation, commitment,
and the experience that I do have. And,
meanwhile, the experiences and training that I am acquiring outweigh what I can
offer. Corny but true, Peace Corps is as
much, or more, about my personal growth than it is the community impact.
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| Mothers lining up with their children for weighing, measuring and vitamins |
And, while I struggle with the heat, the frustration with
the language and whine on social media about the lack of privacy and the less
than ideal hygienic living conditions, there is something that keeps me
here. Maybe not forever, but for now,
the simple satisfaction of accomplishing daily routines, of noting small impact
on co-workers and neighbors, of seeing smiles and affirmation in the eyes of
patients, this can be enough.
Even the difficult moments leave me with lessons and deepen
my personal experience. Though I’ve
lived in other countries, I haven’t had to integrate into a community and culture
in the same manner that the Peace Corps experience demands. It is said that Peace Corps Volunteers are
planting seeds for trees whose shade we will never enjoy. I think this is true and I try to remember
this in the most exasperating moments. It hasn’t been easy and yes, I will continue
to struggle and experience the highs and lows, riding the roller coaster that
is the Peace Corps experience. But so
far, I’m in for the ride!
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| Nutrition Talk to the mothers |
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