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.

1 comment:

  1. Lindsay10:20 AM

    I got to "dirt vs. pavement has a physiologic calming effect," and said, "Seriously," out loud in my office.

    Bonne chance with all that Gardasil stuff... I pay $180/dose because Kaiser won't provide it, so I have to go to a local women's health/abortion clinic and pay for it out of pocket. Sigh, health care. But it's true: at least I can buy my health.

    Du courage with the a-hole taxi drivers and enjoy some koki for me!