more field experiences...

This week I've been out the field, visiting our nearly finished health center rehabs. We've been going to the villages, doing the formalities with the chiefs and village leaders, and then touring the rehabs with ministry of health workers who check to see if the buildings meet country standards (one of which is that the building is painted blue and white to a specific height).
These are my first sur terrain missions that actually feel sur terrain, as I'm getting to meet the nurses and midwives and the beneficiaries, like these kids:
As part of the formalities, we sit in front of the village elders, give introductions and les nouvelles, thank you's all around. In the villages, most of the people don't speak French, so there's always some translation going on. For one of the traditional greetings in this area, the elders stand in front of us and repeat something in Baoulé while showing their palms to us, every time they repeat the greeting we respond by saying "yo". I have to figure out what it is they're saying, but the yo's kind of crack me up.

After our first visit we were offered palm wine. You can't really say no to any offer and it was my first opportunity to drink some so I was excited. I got a lot of laughs for taking this picture:
After our second day of visits, we were given a goat:
I'm excited to see what we'll get tomorrow!

more uses for pagne...

Today my colleague showed up to work wearing this shirt, which he got while working on a guinea worm eradication program in the 1995: (He said his wife found rediscovered it in his closet...)
For those of you who don't know, guinea worm is a parasite caught usually from drinking stagnant water that has larvae in it. Eventually the worm wants to escape your body so it breaks through the skin and starts crawling out. To make matters worse, it can take weeks for the worm to fully emerge and the only treatment is to start wrapping the live worm around a stick, as is depicted below. It's pretty nasty: if you want to gross yourself out just google image guinea worm. Happily though, thanks to programs like the one my colleague was involved in, guinea worm infections are becoming rarer and rarer.

institut national polytechnique

One of Côte d'Ivoire's big universities is here in Yamoussoukro, built by Houphouet-Boigny in the 1990s. There are actually 3 campuses, nearby but not attached. I visited the north campus yesterday with some locals. Classes start next month, so the place was all but abandoned. These buildings are where actual classes are held:

These are the dining halls:

All students live on campus, housing and food are included if you are accepted into the school.
Like all good universities, the school has a sports complex. Here's the pool which hasn't been cleaned since school is not in session:
I was surprised to find the American Corner! From signs and posters on the outside, this office is here to help students who want to study in the United States.

The architecture here is really pretty cool, but the buildings are starting to fall apart...

gazpacho salsa recipe

I was craving gazpacho Friday, adapted a recipe to this and it was yummy w/ baguette! Be a good option for anyone w/ good end of summer tomatoes, peppers, cucumbers etc...

• 6 tablespoons extra-virgin olive oil
• 2 tablespoons red wine vinegar
• 3 garlic cloves, minced
• 1 tablespoon paprika
• 1 1/2 teaspoons coarse kosher salt
• 3/4 teaspoon freshly ground black pepper
• 3 medium tomatoes, cored, seeded, cut into 1/4-inch cubes
• 1 small cucumber, peeled, cut into 1/4-inch cubes (about 1 cup)
• 1 green bell pepper, cut into 1/4-inch cubes
• 1/2 red onion, finely chopped
  
• 3 tablespoons chopped fresh parsley

Whisk oil, vinegar, garlic, paprika, coarse salt, and pepper in large bowl. Add all remaining ingredients and toss to coat. Can be made ahead of time. Toss before serving.

Original recipe

The only thing worse then being sick, is being sick away from home

I'm just coming out of the fog of 5 days of fevers, headaches, body aches, a little bit of vomiting and little sleep. Even though I've been taking malaria prophylaxis and I sleep under a net, I was pretty convinced it was malaria: there is a growing resistance to prophylaxis. So I visited a clinic and did a rapid diagnostic test, which was negative = no parasites detected in my blood (research shows these tests are very accurate). Nevertheless the doctor thought it was malaria and prescribed me ACTs. Malaria is often diagnosed here without a test, I had to actually request to have one. As I learned from the doctor I work with, when you have a fever here, where malaria is endemic all year round, malaria is treated presumptively. If you are still sick after treatment, then they'll investigate other possible diseases.

Ironically, I wrote a paper last year on this very situation: the overdiagnosis of malaria in Africa and disregard for test results, which leads to overuse of ACTs which will ultimately lead to drug resistance. No effective treatments for malaria will be a huge problem. Despite knowing this, I took the drugs. When you are feeling awful you'll do anything to make it end. Plus, I've been haunted by the story of an Englishwoman from CI, a teacher at an International school, who had cerebral malaria and didn't know it until she was in England on vacation and she died! Terrifying to think you could not know you had cerebral malaria. So yeah, reason gave way to fear. And now I'll never know what it was. But I do know if malaria is anything like what I had, then I fully understand how debilitating it is, how unproductive it makes you.

Happy to be feeling better!

Funerals

I went to a funeral wake today. The assistant health manager's brother died about a month ago. This weekend is the funeral. The wake was held at the morgue, after which the body was driven to the village. Funerals here require time and preparation, like weddings. Also like weddings, people dress en uniforme, matching outfits. The fabrics are more somber though. The family's pagne had a picture of a house, half of which was broken off into a rubble that was on fire. The words espoir perdu, hope lost, written beneath. Another pagne I saw a lot of people wearing had two doves on it. There were also a lot of t-shirts which have the deceased's photo on the front, on the back was printed BINO (a nickname) nous oublierions pas. Le directeur a tôt disparu. These funeral shirts are ubiquitous here, you see them all over. Family members and women cried and wailed audibly. Each time a new person arrived, it would start over. It was strange and surprising to be witness to something that felt so personal. I guess its just a different way to grieve.

In the past few weeks, there have been 6-7 deaths of family members of staff. This is how a life expectancy of 55 years old plays out...

ateliers

This week we've been preparing for a conference and 3 week-long trainings for all the health workers in the districts we work in.

We work closely w/ government officials, specifically the Ministère de la Santé et d l'Hygiène Publique and the Programme National de Santé Infantile. I've mentioned before, it took the Ministry 4 months (and numerous meetings and presentations) to agree to support our community case management (CCM) project. And even now, we only have their oral consent. So to guarantee the government's continued cooperation (especially in light of the upcoming elections which might result in a new administration), my organization along w/ UNICEF will be holding a conference to validate our CCM tools. Health officials and prominent doctors are invited to a multi-day conference to learn about our project and look at the tools we'll be using to implement the project (i.e. the training manual, teaching aides, supervision check-lists). It's ceremonial really, a way to get buy in from medical community and ensure continued government support for our program.

Its also a good way for administrators to make extra money.. Participants, in addition to their salaries, receive a per diem and, if the conference is not in their city, transportation money in addition to meals and lodging. Government officials love ateliers. The prime spot for conferences here is Bassam, a former capital and beach town about 45 minutes outside of Abidjan (just far enough so that participants will qualify for transportation money).

The trainings are for nurses and midwives that work in the rural health centers and will cover the ministry's new directives on IMCI (Integrated Management of Childhood Illnesses or in french PCIME: prise en charge intégrée des maladies de l'enfant - it has not been easy relearning all these acronyms in french!). Because the ministry doesn't have enough funds to train everyone, part of our collaboration is to pay for the trainings in our districts. So basically we will be paying the ministry to do trainings that they should be holding on their own.

Seems messed up, no? Why is donor money, that should be helping the beneficiaries, families and children, going to ministry people to take trips to the beach and do what they should already be doing? It is frustrating to me. On the other hand I know how little ministry workers make, especially considering what they could make if they leave the country. They are all doctors, they could easily get visas out of here. If what we do supplements their income and is incentive enough to keep the good, smart people here, perhaps its worth it?

frangipani tree outside my door

... but no one to give them too

la gare

this is becoming my favorite place to eat.. ... a short stretch of the main road through Yamoussoukro where vendors line the street with their grills and tables, selling grilled meats and accompaniments. my favorite thing to eat is poulet or possion braisé with attieké, made from fermented cassava, has a cous cous like texture: