30 July 2009

Sustainable development - and YOU!

Dear all,

Two years ago, I emailed asking for help about a soy and nutrition project in Mvangan. Thanks to your help, the funding came through, and I trained nurses, teachers, women's agricultural groups about soy, how to plant soy, how to cook with soy, how to sell and market soy, how to prevent, recognize, and treat malnutrition. I published a manual in French on malnutrition, nutrients, and prevention and care. We had a soy fair one week before I left village, publicizing it to the community, and selling over 25 different traditional dishes the women's agricultural groups had created with soy. When I left, I had heard nurses talking to mothers about nutrition and doing nutritional consultations (something I had started at the hospital), I saw people planting, promulgating, and cooking with soy, and people from farther away villages coming up to me to ask about the projects.
(see http://jenny-and-cameroon.blogspot.com/search?updated-min=2007-01-01T00:00:00-08:00&updated-max=2008-01-01T00:00:00-08:00&max-results=4 and http://jenny-and-cameroon.blogspot.com/2009_06_01_archive.html for summary and photographs of what I did).

In the past two years, this small "soy project", thanks to the hard work, creativity, and determination of new volunteers in Mvangan and Ebolowa and their wonderful Cameroonian counterparts, has grown beyond anything I could have imagined.

The South of Cameroon is probably one of the most challenging places to work, and to work in real, person-to-person, capacity building development. And that's where all of this has taken place. Sustainable development isn't just a buzz word for multinational NGOs - it's real, it's been happening, and through the training of trainers and capacity building that the new volunteers have done, it's going to continue.

And now they need your help, again. Please donate, if you can - any amount is helpful. If you can't, please pass on to others who may be interested.


Another project (see links above) I worked on at post was getting library books donated from a French NGO, Les Enfants de Madame Ici. The books came to village and people have - and are waiting to - eagerly enjoy them, but there's still no structure to house them. Another ongoing project is the "Reading Rainforest" (see below), to create a library and multimedia center, in collaboration with the mayor and other officials in town. In a place where almost no one has books (including school books), and there are few 'distractions' in town, this would be an amazing addition and a very enriching resource to last for many years to come.

Peace Corps Partnership is the major way Peace Corps Volunteers can get projects financed, especially in Cameroon where we have no USAID or almost any NGO support. Donations - in any amount - come from anyone, to make up to the project's total. The community contribution is at least 25% of the total, in material and work hours donated. Our grants undergo a rigorous review both in Cameroon and in DC at the national level.

I'm currently back in Cameroon, doing HIV/cancer research for the summer, and it's wonderful to be back. I'm on my way to Mvangan tomorrow for the first time in over a year and a half, but I've been very lucky to see many friends from Mvangan already, who have come to Yaounde to see me. 7 weeks - shorter than even our Peace Corps training time, before being posted for 2 years to village, is fleeting quickly, and I will be in France and back in San Francisco to start my second year of med school before I know it...

In the meantime, have a wonderful summer - and thank you for what you've helped us to continue accomplishing already.


16 July 2009

Dictator Pants.

le 5/7/09
Sunday afternoon, meeting Roger, Ton-Ton’s best friend from village (Makak). He names a place to meet and I thrill that I know exactly where it is, and I walk there. I’m getting to know my neighborhood. It’s like a very crowded village…
I scan the tables for him, re-scan, don’t see him, then laugh at how easily I forget how not inconspicuous I am. I can sit down, wherever. He’ll find me.
Church times were my favorite times in Mvangan. I went a few times early on, socially – good integration thing. Different churches (there are at least 5 there). Later..I realized that 10 am to noon Sunday morning was the one time all week I was guaranteed to have to myself – and I cherished it. We blancs have set up our society so individualistically. Even in a room with others, we’re often alone (online, reading, cubicles, etc). We insulate walls, soundproof things, don’t want to disturb the neighbors.
I thought today I would get time to myself – 4 glorious hours before meeting R. Pascale was going to go to church was a 10 oclock service…she ended up leaving after one. Taking awhile to get ready, especially with a baby, isn’t remarkable. And I didn’t feel I had the right to be annoyed – didn’t, really – it’s herhouse. It really is the perfect situation for me now. It’s just funny – and Cameroonian – how Eric described it to me, and I – Americanly – misconstrued it. He said his sister would take a neighbor’s room. I’d pay that rent, she’d move out, and I’d stay in her place. Not saying his sister shared room room with her younger sister, Flora, and her (Pascale’s) baby, Megan. They’re the ones sleeping in the other room (Megan and Flora), but cooking and most things take place in Pascale’s room. (Just learned that the permanent occupant of the second room – which is called “Hollywood” – is also staying there, in-between her various trips. She was apparently one of my running partners on Sunday). Anyway. Full house. Last night, Sol came over for dinner. I’d met him, once before, in Mvangan, and he hugely annoyed me. He just finished a PhD in radiology and nuclear medicine here. He came to Mvangan, seemed kinda slimy, had a printed and bound 20 page HIV project he was going to drop in and implemenent – to the cool tune of 1 million ($2000) for a 2 day seminar. It was written in the normal Cameroonian flowerly, pompous government language that doesn’t mean much, with a ridiculous budget that he was expecting to get financed by some NGO somewhere. All under the name of some youth association in Mvangan he was the president of – a paper association, with probably a very nice stamp. Doc was all excited about the project that I was going to do with Sol. I was jaded – I’ll talk the talk while he’s there, whatever, knowing it was never going to happen – and not caring because I did the same sort of trainings, with no budget, at least once a month, with continuing activities in-between.
So, Sol came over for dinner last night. I helped prepare (which VP found funny. Ohwell. The other morning, when I was getting ready for work and she was still in bed – I swear she’s the only Cameroonian who sleeps later than I do – and said “don’t get up.” Her reply “What, you make breakfast? You’ll burn yourself. No, no, I’m getting up.” All protests feeble. (My qualifications in fancy French and improvisatory cooking really don’t count here, apparently). Even reminding her that I did everything for myself in Mvangan, she was still a little incredulous. (another subject for later). Gombo and couscous de mais (fufu corn). They’re friends, she and Sol. Ok, I’ll start again with him.
News is on. We talked politics (Cameroonians – including those with much lower education levels than these, can discuss politics from Cameroon to Africa to Europe to the US. The big political happenings lately have been: 1) Omar Bongo’s death in Gabon 2) A French NGO declaring in a newspaper that Paul Biya (president here for the past 26 years, and prime minister for 21 years before that) has “ill-gotten funds.” 3) Biya suddenly and without warning shuffling around a bunch of ministers, including the prime minister.
1) Bongo was younger than Biya but had been president longer (since Gabon’s independence – longest-running president in Africa, I believe). Those two hierarchies created a rivalry between them. I used to live about 60 km from Gabon – it’s the same tribe in the north of Gabon as in the South of Cameroon (Bulu-Fang). There are more jobs in Gabon than in Cameroon, supposedly (also much smaller population), and the Gabonese are “lazy” – they don’t “produce anything.” (supposedly. I don’t know). Rumor is Gabonese used to come to the Mvangan market, one reason it was from 5 -6:30 am (aka market with flashlights…). Anyway. People liked to cross over to Gabon to sell bush meat and other things because they could get much higher prices there. That’s CEMAC (Central African Economic Union) at its unofficial best.
So, Omar Bongo died. Apparently, a few months before his death, an NGO (see 2) “broke” a similar “shocking” story about him. With the stress of not wanting to be deposed and go to jail before dying in office…his heart gave out somewhere in Spain. And the country’s been peaceful, which is good and tenuous for a country that’s never held elections. (free ones anyway. Although “free” elections in Cameroon are another story. Yes Biya is the democratically elected president. By over 90% of the vote, somehow).
** I’M NOT A PCV ANYMORE SO I CAN SAY ANYTHING POLITICAL THAT I WANT!! Just saying. I could also take a moto without a helmet, legally, and cross national borders, legally… At any rate **
Rumors go between Bongo’s son and daughter, both ministers (sim. to Secretaries in the Cabinet in the USA) in the government taking power. Other people think it’ll be another family, another party. We shall see. So far it has perturbed Cameroon’s World Cup qualifier against Gabon, moved it back a few months.
2) So after what happened to Bongo, Biya is afraid of the same thing happening to him. Supposedly. It’s amazing, seeing him on TV, how exactly he looks like his state photo that hangs everywhere…it’s over 20 years old. That’s a lot of makeup and hair dye. But what’s hilarious to me – and what I expressed to my Cameroonian friends, who agree, is the absurdity of officially refuting what EVERYONE knows is true. Everyone knows he’s really a dictator, and that everyone in government steals money. A lot of money. This is a rich country where the people are poor. Though, the illegality of the taking money is questionable. Biya likes changing laws in his fashion. If he wants to run for another term, he changes the constitution. So the maximum number of terms, legally, is always one more than his current one. So maybe the amount of money he gets is also in the constitution. A few months ago, a man was arrested for complaining in a taxi about Biya blocking all the roads in Yaoundé whenever he moves through the capital. He had the misfortune of being next to a policeman (military police, gendarme) en civile. He’s been in prison since then.
So, to “prove” how unfounded the rumors were and how aghast and offended the “whole” country was by this NGO’s declaration, the secretary of the RDPC (BIya’s party, also CPDM) went on TV, and there was a youth rally/march in Yaoundé. The last is the most honteux. Shameful? Despicable? Disrespectful of the people. Basically the police/army paid a bunch of youths and gave them free t-shirts to march across the city “in support of Biya” and say so on TV. Whatever. Open secrets of corruption around here…gods, I just laugh at the news. Does the government think the people are stupid or blind? They’re sure as hell not.
3) Changing of government made huge news. It’s mostly shuffling old ministers around to different posts, that have nothing to do, of course, with their fields of study or qualifications. Biya is wily, though. He removes an anglophone prime minister and replaces him with an anglophone prime minister from a similar area. Removes an Ewondo from one post and replaces him with another Ewondo. Etc. Meanwhile, people get double posts – double salaries – wherein there is no way, according to me, that one can actually act as director of a hospital and minister of women and family. Or minister of defense and head of police (totally different branches here). Etc. There are so many reasons things in this country don’t function better….
I also found out from Sol that the constitution says the president is replaced, in case of death or incapacitation or whatever, by the Secretary of the Senate (like Senate pro-tem?) There isn’t a Senate here. Cases on the constitution, etc, are also supposed to be decided by the Supreme Court.
There isn’t one.

Going to Ebolowa this weekend, one of the first steps in going home...
to come, post-partum death, being called Dr. here, and research in Cameroon.

08 July 2009

La Villageoise

le 3 juillet 2009
Yaounde, CMR

They’re getting used to me au quartier. The day I carried my suitcase home on my head…I’m still villageoise. (Then again, I also did that in San Francisco a few weeks ago. I found the perfect bookshelf to fit under my desk on the street – the amount of my furniture that comes from the street is increasing – was 5 blocks away. Heavy and cumbersome to carry in front of me, with hands – besides, with a bum wrist, that never works out too well. So I hefted it onto my head and carried it home, comfortably, that way, crossing intersections and getting quite a few interesting looks. It really is the only sensible way to carry most heavy things. It’s amazing). Anyway.
This morning I was going to get café at the resto near work (café = anything hot in the morning. Powdered milk and sugar. Matinal (cocoa) and sugar and sweetened condensed milk. Nescafé + sweetened condensed milk + sugar. Etc…), but it wasn’t open. I went there for lunch yesterday.
“Il y a quoi?” (what do you have?)
“Poisson avec la sauce de mangues, avec le plantain pilé. » (Fish with (savage) mango sauce, with pounded plantain)
I said “serve me” and sat down. Thought a minute. With that meal, he’s got to be Bulu. So when he came out with the food, I named it – “nfia ndo’o a kos; a ekon.” He looked at me, grin spreading across his face.
“Wa kabo Bulu?” (Do you speak Bulu?)
“Ma kabo.” (I speak it).
Proud for recognizing the food. We continued in Bulu for awhile. I’m impressed by what I’ve retained…(not that I was ever so great at it). The woman at the other table, also Bulu, also from Ebolowa, was encouraging me too. He brought a fork and spoon over. For plantain pilé and fish?
That’s all finger food, of the best kind. I asked (in Bulu) for water to wash my hands, and proceeded to eat in what I considered the right way. The woman across used the fork and spoon. I spit out bones. I am villageoise.
I asked him for café – I saw the tell tale Chinese flowered thermos - and he said “a mane ya” (it’s finished). Meaning – there’s no more hot water. “Akiti,” he said, “Akiti.” (Tomorrow, and morning). But the door was closed. I know café is rare except in the morning. Chez Ibrahim in Bandjoun we could get it, B usually insisted – no condensed milk – good with a cakey beignet. Even Alino and Carine wouldn’t make me café in the afternoon. Morning and evening. Cécile and I, bread and milk and sugar…
I always existed on multiple levels here, but it’s a different kind of extreme now. I was comfortable everywhere – Akam, fin fond de la brousse, champs, one room houses, Mvangan village, high school kids, Doc, nurses, kids, provincial officials. Anyone. PCVs. Now…
Went to my first medical “seminar”, on cervical cancer prevention. Arriving, I found it was sponsored by Merck-Central Africa to promote Gardasil (the HPV vaccine – actually, one of 2 currently on the market). It took place at Djeuga Palace, a fancy hotel in Yaoundé I’d never been to – not quite the Hilton, but more Cameroonian. Two young white people were handing out surveys where we picked up seminar packets – I gave them the usual white people onceover/stare. Turns out they’re from med school in Geneva and doing a survey on cervical cancer knowledge here (among physicians? since that was the audience… a bit odd). The packets didn’t include any fancy clocks or bags like a US conference would, but it was a nice plastified folder (indispensable here) with an Atripla sticker on the front, a ‘prescription pad’ for Gardasil, a used-looking Gardasil pen, and peer-reviewed lit papers on Gardasil. Okay. Cameroonianly, it started late, many speakers went twice over their allotted time while repeating the previous presentation, people answered cell phones in the middle of it, and walked in and out of the room. The chairs were narrow and so close together you were sitting on the fabric of your neighbor’s clothes. I was with JC, one of the doctors here who just finished medical training in Russia (he’s Cameroonian. It’s actually common-ish for Cameroonians to go to medschool in Russia or Ukraine…met one from Ukraine at a gare, once, chatted for a long time. They usually go not knowing any Russian, then learn enough to do medicine…impressive. Anyway). I was annoyed with the repetitiveness of the presentations, which could have been accomplished in one hour rather than three. I learned more about HPV, cervical cancer risk factors, screening, the pertinence of cancer work in Africa, though – cervical cancer (due to many of its risk factors) is much more common in sub-Saharan Africa than in the US or Europe – and, because of little to no prevention or treatment availability, often kills. I knew a little about the low-tech ways to detect it (it’s really cool actually – using vinegar or iodine) from FACES projects in Kenya last year. Nothing was said about treatment. Nothing. Surgery and chemo, I guess, which are both available in Yaoundé and probably in Douala, but are unbelievably expensive. Then the Merck rep got up to talk about Gardasil (and very little about his “competitor” vaccine, which, in the realm of preventing HPV, is exactly the same…). After the Cameroonian MINSANTE (ministry of health) rep had spoken about the cost. 35,000 F CFA per dose. That’s $70 per dose, for 3 doses. In a country where monthly income, on average, is probably about $30 to $40. Yeah, right – who the HELL is that going to help?
Considering the prevalence of HPV AND, by consequence and other risk factors, cervical cancer, is very high here in causes of morbidity and mortality – sounds like a fantastic public health project (eh, Global Fund?) to vaccinate girls. If a) the effing patent expires on the vaccine (that there are PATENTS on HEALTH CARE PRODUCTS is another soapbox for another time) 2) the world decides it’s a worthwhile cause 3) figures out a way to get it here so it actually gets to the people who could use it. Supplies over money. The Merck rep was proud because they had brought the cost down from 62,000 F CFA per dose, initially. Great. And I know in the US it’s what - $200 per dose? Something inane like that. (Just looked it up, because money and health infuriates me so much…and because I’m online again at work, and it’s raining so I can’t go home yet… at the San Francisco Adult Immunization Clinic, probably one of the cheapest places in the US to get vaccinated, it’s $155 x 3 doses). So once again, everywhere in the world, the rich, bourgeois (less at risk, in a lot of ways) get to buy their health, and those who are already effed and starting out in a worse place…can’t. Awesome.
ANYWAY. Dr. N told me later he had first refused to participate because Gardasil is ridiculous to prescribe here; they need to come up with another solution and not pretend it’s really going to be the “new wave of cervical cancer protection in Cameroun.” But for political/professional reasons, etc, etc, he decided to speak.
Levels. In Cameroon. During the conference, I was so frustrated I walked out to find a bathroom. In the lobby at the bar were an older white man and young Cameroonian woman (gross. Jellyfish. Another topic for another day…) being serenaded by a Cameroonian guy playing a guitar and singing about malaria and falciparum (the species of plasmodium that Anopheles mosquitoes here are infected with, which gives the worst/most dangerous kind of malaria…) surreal. Then bathroom with a toilet seat. (That, in Cameroon, is a high level of fancy). I left immediately after the conference, in serious need of a Castel (beer), skipping the “aperitif” offered (and all the beers they had were petits, anyway). (At this point, I had been working/at conference for 12 hours…) A friend from PC was COSing, so I went to join him and friends at the bars near Texaco at Omnisport. The most popular PCV hangout close to the Case.
Took forever to find a taxi – I think it builds character, or something, to be rejected 10-20 times a day here. On the way to Omnisport…right about Selecte, the road I had walked from PC so many times, know so well, every taxi to PC going that way, every car… years and years of memories in that intersection. Along that road. Seeing ghosts. I was so dazed and lost in memories that I forgot to get out money until we were at the stop, and the taxi driver yelled at me. I can take it.
Saw PCVs I taught when they were in training…they remembered me, I vaguely remembered faces… after ordering a Tuborg glacé (fancy), went across the street to the street food mecca I dream about. Many evening, that corner is really what I want for dinner. A full ode to Cameroonian street food may appear elsewhere, but here, I’ll just laud the poisson braisé (grilled fish) and baton, grilled chicken, fried and grilled plantains, koki, boiled fish, grilled corn, soya (beef-on-a-stick)… so, so good. Evening with PCVs and Cameroonians, eating and drinking exactly what I did before, at a bar I used to go to and probably the same table. Surreal. Went home finally after Pascale called, worried about me. Got back to the quartier, walked down the dirt road to the quartier (dirt vs pavement has a physiologic calming effect on me), to the house by the “first mango tree”, as Eric directed me. Pascale had made a salad (avocado, tomato, onion) – a beautiful gesture – something people rarely eat here but “know” that “blancs” eat “all the time.” Ohwell. Nothing goes to waste, just goes to another neighbor.
Next post – on politics – half done, more to come on the clinical side as well. I’m here, I’m really here, and it feels right.

02 July 2009

Bugs from the Beginning of Time

le 1er juillet 2009

Sometimes in Cameroon it’s better to be in the dark. Then the rustlings are only imagined roaches, what have you, less comfort here without a resident cat. Just walked into the latrine with my confident headlamp – I’m getting used to this, again, it’s like riding a bike… and the few inches-long cockroach on the door is more startled than I am. I didn’t have a headlamp, before; that would have fixed my months of no table situation, reading propped on aching wrists, elbows, hunched in front of the kerosene lamp while trying not to get in its shadow. I miss those, the lamps. The smell of them. The comforting swish and clink of petrol against cheap metal, the spreading splash on the cement floor as I didn’t realize it was empty until after 6 pm…
Petrol bottle – a 1 liter soy oil bottle – I had from first day in village. Filmy green now. Yellow cap.
So, the roach and I. He won’t move, I do my business, get ready to leave. A light comes on over the wall – startles me. So the other side of the house’s latrine has a lightbulb. (4 rooms in a row, narrow, cracked concrete verandah). I remember how 2 weeks ago in clinic (or was it just last Tuesday?) I heard a rustle, gathering the trash, and a roach arced onto the floor. Medium one, by my standards. Not by everyone else’s. They were impressed by my quick reflexes – splat. Y moved to pick it up with a paper towel and I, slightly taken aback, reached under the sink for a disinfectant wipe. Our clinic is by no means sterile, for America. But here, I don’t reach. There’s a small one when I pick up my washcloth. Reach into my bag for a pen and one zips neatly over the side.
Light doesn’t help much. There’s one bulb in here (I’m alone, second night in a row, VP is sleeping in the end room). Not really enough to read by. Last night, up at 3:30 and wired for no reason, I finished a novel by headlamp. Now, I can’t tell if this pen is blue or purple. That is to say, much more light than in my first home in Cameroon, host family in Bandjoun. I couldn’t see the color or texture of dinner most nights – helpful, in the beginning (and I’m the least picky of eaters. Except here). Roaches and I still haven’t bought a mosquito net…get home so tired. All this jumping into 9 hour work days and humidity (80%? More?) Adjusting. I’ve got a hell of a lot more support than last year, which is good. (Latest rustle from inside my rain jacket. Ohwell). But American boss and Cameroonian boss are saying different things – and I’m more inclined to work with the Cameroonian one, Dr. N (not Doc. A lot more formal – and older – than that. Then again, he’s also the only oncologist in the entire country, and one of three in Central Africa. Big man). Dr. R, the American boss (who isn’t here, yet) wants me to be in charge. I’m project manager, or something. Do I have the skills? Actually, as I’m discovering, yes. My research-in-Africa experience from last year in Kenya, writing surveys, piloting, training interviewers, interviewing – and all that I learned here, before. (And, I’m pleased to note, medical knowledge. This year was of use. Not doing clinical stuff – yet – Dr. N’s getting a meeting for me with the head of hospital, end of this week or beginning of next.). Tomorrow evening I’m going to a medical seminar, though. My first – and it’s here. Fitting.
Roaches. The first time I was offered snake I didn’t eat it – picture vividly Régine lifting the top from the frying pan and the meat crawling with roaches. I guess they would have left with reheating, don’t know. Didn’t find out. That was 2 weeks at post, give or take. There’s the night I woke to one crawling on me, trapped under the mosquito net. The several times I had to completely disinfect the kitchen, killing hundreds in a morning (with the babies, no exaggeration there). It’s not that my house was dirty – it’s the rainforest, there are cracks in walls and floors, windows and doors don’t’ close, and they lay pods everywhere… realizing what the dark oblong pods were, on walls and kitchen shelves. The satisfaction in crunching them. And the night Cécile and I were waiting up to travel to Ebolowa (anywhere between midnight and 4 am, whenever the Kouma driver woke up and felt like leaving), and I was hanging out at her place with the kerosene lamp while she checked on patients. A roach illuminated in the penumbra. I tried to focus on the patterns on his back, whorls, tortoiseshell (I’m convinced that, in addition to being twice as large, they’re more beautiful here), and we stayed like that, quiet, still, contemplating each other.


** Addenudum** This morning, Pascale mentioned the roaches. She’s used insecticide to get rid of the large ones, but the smaller ones, a different species apparently, just won’t leave. Nothing to do.

26 June 2009

Update ...Going back to Cameroon

There will be more, but COS trip came and went, medical school interviews came and went, I moved to Chicago and wrote and volunteered for Obama, then I moved to Kenya for 2 months, and then I moved to San Francisco to start school at UCSF. First year of medical school ended, and this summer they're funding me to go to Cameroon and do HIV research. Last minutes before leaving for Cameroon, 5 houses later, a year and a half older, and an official Californian, I'm reminded of Peace Corps dreams about being in the US and packing again for Peace Corps, being in REI, getting everything I needed, doing it right. This isn't quite the same, but there's some of that. One bag full of presents (tu m'as garde quoi?) another one with pagne to wear, and lots of people who know I'm coming through various word of mouth - and others who don't and will find out soon.
Updates to come, as I'll be living in Yaounde this time, with internet and phone and paved roads. 7 weeks will fly, compared to almost 27 months - but I'm looking forward to making Cameroon part of my present again, and not just the past.



Dear all,

I've been remiss for the past 6, 7 months with updates. I've written many half emails, many sketched-out emails, but I haven't had time or computer access or enough electricity to finish them.

And now I'm coming home.

I was considering extending my service, either in Cameroon or in another PC country in Africa, but every day I spend at the hospital in my village – which is every day I'm there – I'm poignantly reminded of how much I want to be doing this work, but as a doctor. So I'm going to medical school in the fall. Not for MD/PhD, as I thought prior to Peace Corps, but for MD/MPH (Masters of Public Health). I want to work in international, rural, public health medicine. So far, I have five* interviews that begin immediately after my return to the States; I'm waiting to hear from other schools (during the writing of this email, got another – it's six now).

November 30, 31 days from today, I'm leaving Cameroon for a long time. It's not forever, but it's indefinite and is at least a few years long. I'm beginning to think that, in many ways, leaving Cameroon is harder than it was to leave the States back in September 2005. Then, I knew I'd be back in 27 months, that I'd have some form of communication with my close ones, whether by letter, phone, or email, and that I was setting off on an adventure I'd been anxiously awaiting and preparing for a very long time. I knew where I was going and what I was going there to do, though in reality I had no conception of what my life or work here would be like. I just knew it was the right thing to do.

Now, I'm leaving very close friends – Cameroonians and Peace Corps Volunteers alike, though I'm much more likely to see and communicate with PCVs on a regular basis. Friends in my village and other villages, other towns around the country – most don't have email, few have phones and fewer live in places with phone reception, and almost no one has a PO Box or address to send mail. And I don't know when I'll see them again. Many, most probably, I won't. I'm leaving Peace Corps, Cameroon, and Mvangan (my village), where I've had the deepest sense of purpose that I've ever felt at any job or school in my life. It's not a do-gooder thing. It's not a hardship thing, or a "primitive"/simple living thing, or a struggle. For two years, I've felt that I was exactly where I needed to be, and doing what I needed to and wanted to be doing. (This is why I'm going into public health medicine). I don't work or do something "useful" every day, not even nearly, but I love my life here and it's not something that could be replicated under any other circumstance. Walking around Ebolowa, my provincial and banking capital, yesterday, I ran into several friends and we ended up going out together. Simple, easy, afternoon spent talking and drinking and laughing. Good friends, with whom I've also worked for the past two years. This is not unusual or particularly special, but something about the relaxed spontaneity and the ease of talking to new people on the street without particular protocol or rules is unique to my experience here. Getting into a shared taxi, walking down the street, travel in the bush – and getting stuck together on the road – I greet everyone and lapse into conversation. You don't walk onto a subway or city bus in the United States (I think this is true – I really don't fully remember) and start greeting and talking to everyone around you. In the Western world, we're closed and anonymous. Here, nothing is anonymous or even private – but it makes for constantly shifting human connections during the day. No matter how frustrated I may be, no matter how many things have gone wrong in a day, I know something spectacular or wondrous is going to happen. It always do. And it's about the people. I can't go anywhere now – rarely even in Yaounde, the capital city – without running into someone I know and would like to stop and chat with.

Work-wise, things really took off last September and I haven't stopped running since. (Though there are still days when everyone I work with has traveled or is in a seminar somewhere and I sit and draw posters for the hospital, read, or watch TV. I take the lazy days when they come, because often I'm working all day on the weekends – 8 – 14 hour days, depending on what project Doc has in mind, so I take days off as I want/need. That's another thing I'm going to miss about Peace Corps.)

Last September: first nutrition conferences, working on various things at the hospital, traveling, preparing for training.

Last October, first, training with the new group of Health/Agro PC Trainees (and my one year in country). After that, preparation for my AIDS week at the Mvangan high school - in-services for the HIV counselors, preparing lesson plans, etc, and the week itself (see: http://www.worldviewmagazine.com/issues/dispatches.cfm?id=45 , article written by another PCV about my work). From AIDS week, the students at the high school came to me and decided to form a health club. We worked on HIV/AIDS education at school and a few other topics. We then planned activities for December 1 (World AIDS Day), with skits and teaching and a party.

November was more hospital work, health club, preparing for my water project, and Thanksgiving in dormant volcanic mountains in what looked like a Swiss chalet with about 30 other PCVs. This stretched into my water project (already described), which was also December. More hospital work. Two weeks in France/England for Christmas and New Year's.

January, week in Akam (Johns Hopkins village) on healthy hunter education, with a grad student from the States who also works in Madagascar with Rachel, my good friend and college roommate who is also a PCV there. Mid-service: week in Yaounde after a year in country for medical and dental check-ups. Back to post and immediately launched into a nation-wide vaccination campaign. This, I meant to write up and email – it was very interesting and I have a lot of fascinating stories and pictures – but it only got as far as the sketched out stage. Maybe someday. This was 9 days of intensive work, with one day when I was in the office, still working, at 2 am and realized I'd been working since 6 am the previous day. The campaign was for measles vaccinations, vitamin A supplementation, and free mosquito nets, for children 6 months (vit A) and 9 months – 5 years. As a district team, Sylvain, Doc, and I trained all the nurses. Then Sylvain had to go to a funeral. There are six health areas in our district, and we had three supervisors – me, Ebolefou (lab head – see water project) and Econome (hospital accountant/ a nurse/ my neighbor). Logically, that's two areas per person. But they decided to each take one, leaving me with four. I was also coordinating all supervisions efforts and doing all the paperwork/ epidemiological stats to send to the provincial level every night. So I was traveling up to 100 km/day, mostly on motos on bad roads, and working in the office all night. This was nothing, though, compared to what our teams of nurses were doing: vaccinating on foot, walking all day for 5 or 6 days. Really incredible, strong people, getting paid next to nothing for their efforts. The supervisors (minus me) and the provincial level guy who was "supervising" us (doing very little and making the health district spend lots of money on him and his whole family, whom he had brought down as "assistants" we were supposed to pay) made bank. Thank you, UN, WHO, Global Fund, and whoever else made all this possible.

In February, my nutrition/soy project started in earnest, with detailed description (up to September) here:

The primary goal of Peace Corps Health Volunteers is to act as catalysts for behavior change in disease prevention. Actually noticing a change, however, is incredibly difficult. In my two years as a Volunteer, the one area where I already see a lasting impact is my nutrition and soy project. As I had identified a high prevalence of malnutrition in children under 5, I began work with nurses on nutritional counseling and treatment of malnutrition over a year ago. In order to make a larger impact in the community, I decided to collaborate with the sub-divisional head of agriculture and work with women's groups. The project began with nutrition education for women's agricultural groups; we began with four different groups of about 35 women in all. We explained basic nutrition, signs of malnutrition, prevention of malnutrition, and the agricultural and nutritional advantages of soy. Women who were interested in participating in growing soy signed a contract: they were required to plant the soy, to reimburse twice the amount of soy seeds received at harvest time, to talk about the advantages of soy in the community, to participate in seminars on nutrition and basic business practices, and to participate in a community-wide soy exposition and fair. For the second phase of the project, I created a manual on nutrition and treatment of malnutrition, based on my own translations of multiple resources into French. Using my manual as a text, I led a three-day seminar for 23 district nurses and teachers of home economics, focusing on nutritional status of the community, ways to teach about nutrition, micronutrient nutrition and deficiencies, malnutrition treatment and prevention, and nutrition for special groups. We concluded the seminar with practical cooking demonstrations with soy, led by a local woman who had been cooking with soy for about ten years. Next, with the sub-divisional head of agriculture, I taught four seminars for the women's groups, encompassing nutrition, signs of malnutrition, soy incorporation in local cooking, and basic business practices for marketing soy. The final project phase will be a soy fair, at which the women will present soy recipes and information on nutrition. The women's groups have been very energetic about soy and are already creating new recipes for their families and educating others in the community. Now, people come ask me for soy, and the women I have already worked with are growing vast quantities of soy and creating new recipes for their families. Nurses at the hospital are using information I have taught them to do nutritional counseling with mothers. I am ecstatic to already note a significant change in diet and food availability and an increase in nutritional awareness.

(for the PC/Cameroon annual report, as my PC supervisor requested I write up my work on this project).

Other various things over the months: lots of work in the health district on coordination, in-services, and supervision; more HIV community education and testing (many different ones at various points), another training of HIV/AIDS peer educators and the formation of a support group for people living with HIV/AIDS (infected and affected), visit from Deirdre and associated brief vacation in Limbe, presentation at in-service training for first year Health PCVs in Kribi, work with BAD (see last September entry and emergency C-section) and write-up of major action plan and full health district analysis, interspersed nutrition work (writing manual, doing seminars, etc), my dad and uncle's visit and associated brief vacation in Kribi, three glorious weeks at post (longest, last, uninterrupted time alone – in July) with several community HIV testing campaigns and the accidental exposition of a colleague/friend (who is fine now), wonderful vacation in the north of the country with Ingrid and Justin, two good PCV friends. The trip up, on the train plus bus traveling, was 32 hours traveling straight the first…2 days. Trip included "safari" and lots of interesting, completely different places to village, visiting lots of PCVs there, brief jaunt into Arabic-speaking land…etc. Back down to Yaounde (16 hours overnight on a wooden bench on the train, in the bar car, surrounding by people talking loudly all night – but ended up having really fun conversation in the morning), and then to Douala to pick up Sylvie. Back to village with her, week of nutrition seminars for women's groups, medicinal plant training with Peace Corps, and off to Limbe for a few days prior to COS conference with Lindsey and Justin. Sylvie left, and we went to Yaounde where the US government put us up in a very nice but very isolated hotel for 3 days and talked to us about administrative procedures and "life after Peace Corps." Extremely stressful few days when all … 17 at that point, of 29 who came to country, we're 15 now… were worrying about whether to stay/go, what to do with the rest of our lives…etc. It's like we had a two year hiatus of calm and not worrying about those things. Purpose. Finding purpose. And perhaps more importantly, finding a source of income.

After this, I went back to post for a week, where I worked on finishing med school secondary applications (oddly and wonderfully enough, for my first three months at post – and last three, it looks like, I've had power. Not for the year and a half in-between, but it's a fun way to leave – and practical, too, in terms of applications – and having to stay up late to finish everything I need to do. And watching shows). We also had a district coordination meeting (in-service, where I taught) and worked on other hospital and district supervisions, etc. Week in Yaounde for Training of Trainers (TOT) for the new crop of Health/Agro trainees coming in – the ones who are going to replace us. Plans for post-COS (Close of Service) travel and finishing applications. Back to post for several weeks – more nutrition conferences, district supervisions, new personnel at the hospital to train, action plans to write, etc, etc. Then October 14 I left for the last long time, to go to training. I taught the trainees about reproductive health, HIV, etc, and nutrition. A very intense week working with the 20 health trainees and also the 22 agros. Oddly emotional, realizing that two of these – yes, I'm being replaced by two people, health and agroforestry, the first time agro volunteers have ever been in the south province, where they're desperately needed – one of Lindsey's and my pet projects over the past year and a a half was lobbying Peace Corps on this point – are going to take over and continue the work that's been mine in the place that's been my home.

15 november

Site visit came and went, a very, very busy, oddly stressful time, at the culmination of which I had six guests (that's seven in the house, including me, and 2 cats! New record for Mvangan. Imagine all that without water or electricity, people having to carry water, trying to have enough lamps, kerosene, candles, etc…and cooking, dishes, cleaning…) Everyone was here - 2 other PC Trainees (plus my two), Rachel, the new education volunteer in Ebolowa, and Lindsey – because my good friends Alino and Carine were getting married. I can't express how major of an event that is. In the two years I've lived here, that's the first wedding that's happened in my town. People here – and in the South province especially – very rarely get officially married. Women will have many different children with many different fathers, little security, and men will leave when they want to and… marriage here is a huge deal. Huge. And these are two good friends, a wonderful couple, who have two wonderful sons. He's Bamoun, from the West province, and she's from the East province but has grown up in the South. Two very very different cultures. His family made the very long trip down for the wedding, first time they'd been in the rainforest. There's no way to adequately express what I felt that day or in the weeks leading up to it. What it means that in Cameroon, you can choose whether your marriage is monogamous or polygamous. How many of the traditions here really touched me and I'd actually try to emulate them. Two in particular that I especially like: the couple chooses a fabric ("pagne") for the wedding and sells it in copious amounts…guests who want to, purchase it, and make clothes to wear to the wedding. So on the day, you see a sea people wearing your pattern, supporting you. And for months and years after, you see the clothes around town, as well. Two. At the reception, the emcee asked who had gifts for the couple and wrote us all down on a list. Then, in order, each person/group was called up – and a different song was played for each – and we had to dance the gifts up to the married couple. Then we danced with them to the rest of the song. Joyous, festive, and fun! That the couple gets to dance with all of their friends. There's really no way to begin to explain things. Like, the party started 3 hours late not really because they couldn't get the generator to work or it was pouring rain but because the bride's little brother had to go find an sacrifice a rooster for the groom's ancestors, who were unhappy (partly because of the monogamy thing). And so it goes.

My last weeks in Mvangan were a whirlwind, of work – amazing work, our "Journee du SOJA" – Day of Soy, where the women presented 15 different dishes they'd made and talked about nutrition and soy and all the authorities and lots of community members came and tasted/bought food – went better than I could have imagined. Of course there were mishaps and changes up to the last minute, like the adjoint sous-prefet needing a car sent for him because he didn't want to walk the 100 meters. Whirlwind of exasperations and frustrations and thigns that are typical Mvangan and don't surprise me anymore 9week of litigations over my agro replacement's house, as the second adjunt mayor broke in, said he'd rented it from another person than I'd rented it from, the real owner being in jail for having stolen money from the government (some of them, yes, do get punished) – basically he was trying to get money out of me. Anyway that got resolved the Friday before I left on Sunday. Whirlwind of goodbyes…unreal. I had a party on Sunday, which I'd initially planned to be a small affair, that I could afford, with the district personnel. To combine with Thanksgiving – we made stuffed chickens, I made the stuffing and mashed potatoes and pineapple pies and other cakes. But Doc decided to turn it into something much larger – and in very un-Cameroon fashion, where you pay for your own parties, on your birthday you buy everyone drinks, etc – he paid for everything else (besides what I had already). There were, I don't know, 20 different dishes? Including my favorite Cameroonian foods. There was monkey (not a favorite…), what every good party in Mvangan has to have. Beer and wine and palm wine and champagne…(how you measure a good party here). I couldn't express how touched I was. Everyone I'd worked with in Mvangan was there, my close friends…Essome, whom I'd worked with for all the agriculture/nutrition projects, who's been a wonderful collaborator and friend and is the counterpart/supervisor for the new agro volunteer and I'm so proud…he had meetings in Ebolowa Saturday and Monday, but he came down early Sunday – to go back that night, and pay for transport both ways – just to see me. Sylvain, my counterpart and one of my best friends. Cecile, one of my other best friends, who bought a pagne to make outfits for me and for my mother. My friend Eric and his youth group, who had a painting commissioned to symbolize my work in the community and my sadness at leaving. Mama Fran (Doc's wife) and all the other women who spent so much time and energy making everything, preparing everything, for me. And Doc…I can't even begin to describe his gift to me, later that night, the most symbolic, most powerful thing I've ever had.

As it's Mvangan, and I'm not surprised, we didn't leave Sunday evening – Alino hadn't come back with the car yet when we wanted to leave (5 pm); he returned at 7 pm, and in typical Mvangan fashion, decided we should leave at 3 am instead. I had to be in the medical office in Yaounde at 8 am to start COS (close of service) processes Monday morning. It's 5-6 hours, in a private car, on a good day (in public transport? Mvangan – Yaounde is 8 – 14 hours). So we left at 2 – early! – as I'd told them my meeting was at 7:30. Doc had me ride in front, for my last trip out of Mvangan, and with the brights on, even in the middle of the night, I was again stunned by the immense beauty and grandeur of the rainforest. We arrived at 7:50 am. The other PCVs thought maybe I'd decided not to leave after all…

And now suddenly I'm in Yaounde, with two days in country left – two nights at the Case, including this one – and I fly out on Thursday. Not forever, as I keep assuring everyone. Cameroon is my home. I want to work in Africa. And I will come back. But it's for a long time. None of it is real yet.

Thursday, with a good friend, I fly to Johannesburg. Spend a night there with another friend, the Baltimore Sun journalist who wrote the article on bushmeat in Akam (see previous post, June 2006). Dec 1, fly to Antananarivo (Madagascar) – then Dec 3 fly to Maroantsetra to see Rachel (! College friend/roommate, PCV in Madagascar) and travel to her village. Dec 9, fly back to Johannesburg, there until Dec 13 when we fly to Dakar (Senegal) and meet another PC/Cam friend as she leaves Cameroon. There until the 22 nd, when I regain WINTER in Paris. In France with family until January 6, when, after 27 months, I return to the United States. I am looking forward to visiting and seeing everyone again, but it's difficult to conceive of leaving this entire life I've had, for the past 2+ years, which has been so good to me.

There will be more to say, but none of it will come from Cameroon.