26 June 2009


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.



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