Sunday, July 06, 2008


This is our water boy hoeing up our garden area for us. You never know what treasures you'll find in the dirt around here. Bowls, shoes, bags, bottles, syringes, glass, cans... the list goes on and on.

I was just amazed I survived the experience without cutting myself on some hidden treasure.

(I hope I didn't just jinx myself...)

Saturday, July 05, 2008

What I do


Many people - both Guineans and friends back home - have asked me: "so what do you do?"

My response to Guineans up until now has pretty much been "Well... that's a good question..." followed by some vague generalities about what Peace Corps volunteers are (and are not), as well as questions for them about what they think are their community problems and what they think I could do to help. That was my main job up until last month, trying to figure that out. Unfortunately, I still don't have a good picture of what my role ideally will be. Of course I have ideas of what I want to do or what I think would be a good idea, but it doesn't really matter if I'm not on the same page as the community. I am not here to fulfill my own agenda.

So, seeing as that isn't exactly the answer you're looking for, I'm sure you're still asking "ok... but what do you actually DO?"

(since I kind of rambled and explained much more than the average person will want to read, I went through and bolded the actual 'stuff' I do.)

Well, some days I just sit around the DPS. The DPS is the Direction Prefectoral de la Santé. It's the managing body of all health facilities in our area, an area with a population of about 450,000 people. (But all populations are estimates in this country. It could really be anything between 300,000 and 700,000. Even that could be off.) Some days no one actually shows up here while other days it’s a madhouse with trainings, reports, paperwork, supervisions, etc. Most days it is somewhere in between, with one or two people who show up and work to varying degrees. There are 6 people who work here. They are always in and out of town for various trainings, marriages, burials, sacrifices, baptisms, sicknesses, etc. The secretary just had a baby last week, so we haven't see her much and probably won't for a while.

The work comes in waves, some weeks with nothing to do and others with an onslaught. I've tried to do mini consultations with the DPS staff about how, yes, the report might not be due until the end of the month, but we can still start now to save time, because at the end of the month there is the regional training and supervision reports to do as well. So in other words, one of the roles I've tried to take on is to help the staff organize their stuff and motivate them to think and plan ahead.

Each quarter they do supervisions of the 13 area health centers. I have gone along with them on these supervisions for the past two quarters. It's really interesting to see the common problems throughout the area and how the DPS tries to address them. They do an evaluation of a couple of key points and make a plan for improvement. I've tried to help the DPS see that follow up and accountability are just as important as the initial supervision though... As of now, no one really does anything with their improvement plan. I can give you a page or two full of reasons why this is.

Since the secretary has been out, I also help sometimes with typing. I don't mind if I have nothing better to do, but I did not come 4000 miles and do 3 months of training to be their secretary. I think the government would be a little disappointed in the return on that investment. So I try to explain that to them... but they don't really seem to get it. None of them can type more than 10 WPM. They just want their report typed and say that's how I can pull my weight around here. Great. I think holding a typing class might be a better use of my time.

I also sit in on a lot of meetings, trainings, and workshops here at the DPS and in the community. This helps me get a better idea about what their priorities are and what they're already doing. In April, I sat in on an HIV/AIDS planning meeting held by one of the local mining companies. They have a certain sum of money each year earmarked for development projects. For the next 12 months, their objective is an HIV/AIDS campaign. In order to do it right and avoid repitition, they wanted to collaborate with the DPS, the ministry of health, local organizations and others who also work in that domain in our region. They planned out a great campaign, but failed to realize that PSI, a major international NGO, is doing a campaign exactly like it in this area over the exact same timeline.

Communication was lacking somewhere.

Other meetings/trainings/workshops have been about malaria, area supervisions, maternal mortality interventions, child rights, vitamin and vaccine distribution campaigns, and cholera interventions.

Other than hanging out at the DPS, I also go from time to time and observe at the local Health Center. I've been trying to get a better understanding of how the center functions, their strengths/weaknesses, what the community thinks about it, and ways that I might be able to help. So far it's been a lot of sitting around and watching while everyone around me speaks a language I don't understand...

Which brings us to my next activity: studying Susu, the predominate local language in our village. I'm trying to learn more... but it's hard and discouraging. At the DPS, we only speak French since everyone was appointed here from other regions. Pepe, my counter part, is from the forest for example, and speaks Toma. Camara, Sylla, and Nabe are all from Haute Guinea and speak Malinke. Bah speaks Pular. It's a nice big mix here.

I've also started typing up all my Susu notes that I took during training. Both of the other local languages they teach during training have useful reference books, dictionaries, etc. Susu - nothing. We do have a workbook, but its confusing, refers to things that don't exist, and lacks answer keys to all the exercises. This frustrated me, so I'm trying to make my notes into a brief Susu reference for incoming volunteers. They deserve something.

I've also started my garden as I've mentioned before. The hardest part is over, so now it's just upkeep. I spend time around the yard rigging up ghetto fences to keep the goats out, watering if it doesn't rain, researching info, and figuring out how to make it better. This also includes answering a myriad of questions from people as to what the crazy white girl is doing now. I try to give them little one-on-one sensibilizations about what I'm doing and why. (ie: nutrition and importance of eating a variety of vegetables, why planting trees is important, how to grow things better.) Anyway, hopefully the garden won't die while we're out of town.

Dan and I have also started hanging out with the literary club at the youth center in town. Basically it's a theatre youth group. They just shot a short film (in which Dan and I made a cameo appearance as a French couple), preformed monologues and a skit at a democracy and good governance workshop for regional officials, and are currently working on a few short plays with themes such as HIV/AIDS, education, and tolerance. We look forward to working with them more and collaborating on messages to share with the community.

Other than that, I do a lot of hanging out in general, trying to get to know people and understand the community. This is probably the toughest part of my 'job' for me. It's hard to make friends here, especially when so many people just want to get something out of us. There are some days it's hard to want to be out in the community and take the constant barrage of questions, jeers, cat calls, and stares. Other days it's not so bad and is actually fun and enjoyable. I guess it depends on my mood.

That's my work description as of lately. Hopefully I'll find more concrete projects to keep me busy soon. I'm planning on painting some educational health murals, building a solar dehydrator for community demos, doing some computer skills classes with the DPS team, and holding some organizational trainings for the Health Center Chiefs. We'll see how all that plays out.

Other than work, what do I do? I wash my clothes on rocks down at the river, go shopping in the market, cook and experiment in the Dutch oven, go to sacrificies in the community, improve my slingshot skills, watch movies, read, write, jump rope, and take naps. It might sound like I'm pretty busy, but I'm really not. Everything is so open and aimless most of the time that I find myself bored too much for my liking. (Which is one reason I've typed so many long blogs...)

Any more questions?

Friday, July 04, 2008

A look at IST and other stuff in Guinea

the start of my garden.
I used little baggies to start my seedlings on my porch.
Hoeing up the back yard.

Here is an after shot with seedlings in the ground and a make-shift fence to keep sheep out. (it doesn't really keep anything out though... )

The side of our yard where I put some extra tomatoes, lentils and green beans. I thought I should take advantage of open dirt.
My herb box. If you look closely you can see the baby basil and cilantro. The oregano is MIA

Fidele with the bandanna we put on him to keep the flies off of his wounds.

This is the son of the guard of our compound. This is the fear we strike in small children, simply for having white skin. The girl holding him is the guard's second wife's sister.

What a typical taxi looks like on the roads here.

We had a stick bug on our window one morning. He stayed there all day.

A truck accident at the bottom of our hill. I just want to know how in the world one giant truck did not see the other giant truck coming...

A coming storm as viewed from our front porch.

The same storm coming over the soccer field as viewed over our back wall.
The produce section of the grocery store.

The thrift store Guinean style. Where to buy clothes in the market. The locals call these 'dead white people clothes.' The only logical explanation of why someone would give away clothes that are still wearable: they must be dead.

Where shoes go to die and be reborn.

Tomatoes ready for market.

This mango was HUGE. It gave me over 5 cups of fruit which I made into a wonderful cobbler. The next time I made a cobbler, it took 5 average size mangoes to give me the same amount of fruit.

Just a pretty picture.

Our field trip during IST to Dalaba.
Another random Dalaba picture
Everyone makes fences however they can here. Gotta protect from the roaming livestock.
City scape Mamou

Heading to IST, our bus broke down for an hour. A bunch of white people draws an inevitable large crowd of children.

Learning how to prepare bouille (enriched poridge) at in service training (IST).
Learning how to dip mosquito nets during IST.

Enjoying our bouille.

My APCD Annaliese is in the blue shirt. She's off now to bigger and better things with PC Romania.

Josh, Dan's APCD, who is also about to leave.

Wednesday, July 02, 2008

Things I took for granted back home:

(in no particular order)

running water and indoor plumbing
electricity - any time, every where.
electricity that's strong enough to recharge stuff
garbage trucks
washing and drying machines
grocery stores
target, and yes, even walmart
food that you don't have to sanitize before eating
water that you can drink without getting sick
processed food
cars (especially those with all their parts)
known and enforced traffic laws (ie: speed limits, not letting 12 year olds drive a motorcycle taxi, safety standards for drivable cars, traffic lanes, etc)
phone books and business directories
air conditioning
competent doctors who have been to medical school
hospitals with sanitation standards
a well functioning government
doors and windows that shut all the way
the weather channel
debit and credit cards
50 choices of anything you might want
gas stations that don't run out of gas
things that start on time
businesses that have regular hours of operation
(stable) phone coverage
microwave and other appliances
being able to sleep without a mosquito net and not worry
in-home internet (or just internet anywhere within an hour drive)
a common language
price tags and set prices
comfortable chairs and couches



Rainy season means more mosquitos. Last Monday I got 24 mosquito bites in about 1 hour... below the ankle... on just my right foot. I stopped counting after that. Don't worry though: I usually wear repellant so its not usually that bad. Plus, I'm taking my malaria prophylaxis and sleeping under my mosquito net at night, so hopefully I will avoid getting the palu.

I attended a 3-day malaria workshop the first week in June at the DPS (Direction Prefectoral de la Sante... aka: the place where I am posted.) It was very interesting. Basically, the Ministry of Health here in Guinea has decided that they needed to reevaluate how they diagnose and treat malaria, especially since there has been such an increased resistance to the main meds they prescribe. You ask anyone in a health center in this country and they will tell you that malaria is the number one health problem here. While I don't doubt the truth in this claim, I do doubt the rate at which it is diagnosed. They will tell you basically, if you have a fever, you have the paludisme (malaria).

The health care situation in this country is probably difficult for most Americans to get their heads around. Let me illustrate a little by explaining the structure:
*The largest cities have a hospital, usually. The size and capabilities of hospitals varies enormously on where you are. Some I would classify as fairly decent by my standards, while some would give an unaccustomed American nightmares for life.
*The average bigger cities here just have a Health Center though. These are staffed with anywhere from 2 to 20 people, depending on the population and number of people who actually use the center. The Health Center Chefs (and assistants if there are any) may have gone to university medical school (7 years total including what we would call undergrad studies), but some have attended only 3 years of medical technical school after they completed high school. The rest of the staff are usually hired locally and may only have had a week or two of training on whatever their 'specialty' is. Everyone still refers to all the staff who work in the center as 'doctor,' regardless of their level of training. The health centers do things like diagnose ailments, treat minor injuries/traumas, give vaccinations, hold pre-natal consultations, assist child births, etc.
*Smaller towns and villages have Health Posts, which may only have one assigned staff person. Their main job is to give consultations, treat simple problems, and give referrals to either the health centers or hospitals. Some can handle more things than others. The director at a health post is most likely someone who went to 3 years of technical school after high school. I know a couple that dropped out of university or tech school after one year and are Post directors, though. It all depends.

Since we live in a big city, we have 2 Health Centers and a hospital. I've done several observations at the central health center to get a better feel of what the health situation here is really like for the average Guinean. It's not something I think I can even really illustrate to you, but it's something that is so commonplace for every Guinean.

The health situation here is really something I think you have to see to understand. There are just so many small instances where I try to imagine what an American would do, say, or expect versus what I see the Guineans doing every day. Guineans are completely oblivious to the standards that Americans have mostly come to expect and rely upon.

I'll try to give you some examples:
-A mother comes in with her baby. After waiting an hour or so without being acknowledged by anyone on the staff, she is seen for a consultation. She tells the lady who is giving the consultation (who may or may not have had any training beyond a 4 day workshop on how to diagnose illnesses) that her baby has felt really hot for the last 2 or 3 days. The lady gives the baby a shot for malaria and prescribes some medicine. They leave after the 3 minute consultation.
-There are a few ambulances in the country, some of which work, but rarely get used. When you get in a car accident, most passing cars will stop to help you. If you're seriously hurt, a passing taxi will try to make room for you and take you to the closest health facility.
-Don't like the hours of your doctor's office? The health center staff here usually packs up and goes home at noon. Their posted hours say they're open until 4:30.
-For all of you who complain about your insurance only covering a day or two of hospital stay, a woman here goes home an hour or 2 after having a cesarean as long as there are no complications.

Overall though, it is apparent that they do try their best with what they have. It's not easy to work in the health system here. Their resources are very limited and the needs run very high. They see death and serious illnesses or injuries that they can do nothing about. It's just the way it is. On top of that, the health system is all government run. All directors at hospitals, centers, and posts are appointed positions. They don't get to chose their post or even really give preferences. They are sent to whatever region the health ministry wants and put into whatever village the regional and prefectoral directors want.

As PCVs, we have great medical care. The PCMOs (PC medical officers) here in Guinea will bend over backwards to make sure we are healthy and happy. If there's a major problem or something that local resources can't deal with, they will even fly us out to Senegal or somewhere that can handle it. It's just hard sometimes to see the night and day difference between our situation and that of the locals.

I think Michael Moore should visit some third world health care systems...