another field visit

... so my prospects for doing more field visits were squashed a few weeks ago when a sub-contractor for one of our projects was car-jacked on the way to buy supplies. it was likely not a random mugging: she was leaving the project site w/ lots of cash and taking a route that not many cars go on. probably someone in the project site tipped off some thugs. corruption is lame. like i said, she wasn't staff of our organization and she wasn't even in one of our cars, but the word on the street was that it was associated with our organization. which makes it more dangerous if people assume we travel with lots of cash. so my plans to visit the other 2 districts we work in have been put on hold indefinitely! sad but understandable.

this past week I was able to go back up to Tiébissou district for a day visit. we visited 2 villages where rehabilitations having been taking place. here is the water committee of Lomokankro (all men, interestingly):
in this village, this committee already existed. they collect fees from the villagers who use the pumps, which go towards pump maintenance and repair. we trained them to do pump maintenance and also to spread basic hygiene messages to the rest of the village. the connection between clean water and health isn't lost on any of these guys. they know that those who get water from creeks usually get sick and they acknowledge that this does happen to those who can't pay. they mentioned they usually are willing to give a few free basins of water for these poorest households and the pumps aren't always monitored.. but it made me a little weary.

Lomokankro has 4 pumps, including one which is newly repaired and back in use:

we also put in a new well in this village, which will be hooked up to a water tower (château d'eau) to deliver running water to the health center:

so seems like we're doing a pretty good thing here. the biggest issue w/ pumps is that usually no one in the village can fix them when they break. if the village does have money to bring a professional in to fix it, there are often delays getting equipment and personnel out there. moreover, it takes a lot of time and energy to carry a household's worth of water from a well every day. just watching the young women who are usually charged with this task is tiring. so understandably, the people of Lomokangro are now asking for another water tower and an improved running water system to bring water to more areas of the village (which will also be easier to regulate, they noted).

on a side note, at the household water is often stored in these huge pots:

new addition

very excited for a new niece... ultrasounds are amazing, btw. congratulations to Tracy and Stephen!

more fabric!

this first one is for another wedding of a colleague. i actually have never met this person so i don't think i'll go but i bought the fabric!

this one is kinda funky, but pretty. its hard to get a good photograph but its a dark purple background w/ light purple, brown, and turquoise dots.

escargots

huge ones:

trucks

Yamoussoukro is part of the heavily trafficked truck routes that come down from Guinea, Mali, and Burkina Faso to Abidjan. In Côte d'Ivoire, most of the trucking routes are two lane roads except for a nice patch of 4 lane highway that extends from Abidjan to about an hour north. The roads are what most people in the "developed" world would describe as country roads: there is often no shoulder, no passing lanes, road maintenance often consists of filling potholes w/ rocks and dirt, and in this area tall grasses line both sides of the road, making it difficult to see around bends and for pedestrians to get out of the way. Overloaded trucks, cars, motos, and people all share the road.

Needless to say, there are lots of accidents. It's not uncommon to see the huge trucks flipped over. In Yamoussoukro, right down the street from my office, a gas tanker tipped over. Locals came and filled up their jerry cans and eventually they were able to push the tanker upright and off the street where it stayed for months while they waited for insurance to do something. Driving between cities is terrifying and exciting for me. Some of my colleagues can sleep through these drives (or even work on their laptops which I cannot fathom - I'd vomit) but I find myself unable to take my eyes off the road. One wonderful distraction from worrying about becoming another traffic accident statistic, is checking out the truck decorations:Pass on the left, as fast as a stallion:
This one says La Santé Avant Tout, health before everything... ironic.
Many have to do with God: Merci Dieu, Grâce à Dieu. People here are quite religious but I think it also has something to do with how dangerous their job is. Today I saw one that said Merci Maman. I realize this one is blurry, but you should be able to make out Bob Marley.

more about my internship...

My first month+ I spent most of my time cleaning and analyzing data from a baseline survey that was done in April. It was a smaller survey (2 page questionnaire carried out in just over 700 households) that set out to describe the target population and provide information on a few specific indicators: key behaviors, levels of knowledge, and coverage and utilization of water and sanitation services. Surveys like this are often part of international health projects. They are done at the beginning and end (and sometimes mid-way) and help NGOs and their donors know whether their projects were effective. An important thing I learned from doing this is that a good baseline survey does not have to be very complicated or long. Every question in this survey related directly to one of our indicators or answered a specific question we had about the target population. Although it is often tempting to ask more questions and collect more information (because it is interesting to learn more!), time and money and interviewee fatigue are good reasons to keep it simple.

So after analysis comes report writing, report reviewing, more report reviewing, and then finally a finished English draft. There is no money in our budget for translation, so I've offered to do a rough draft in French in my down time and hopefully our health manager will help me edit!

Since finishing the report I've been working on creating a monitoring and evaluation tool to hold all the information we'll be collecting for the health systems strengthening project. Basically its a massive spreadsheet where we input all data we collect from 50 health centers in 3 districts. I often dream in Excel! Luckily, a good monitoring tool for the CCM project exists already since its been implemented in other countries.

In addition to that, I am also helping the team get ready to train hundreds of community health workers: working on medication projections, revising communications materials (am I really qualified to know what will make sense to rural Ivorians?), and filling out purchase requests to buy all the materials we'll need (there must be a more efficient way than carbon copy).

Needless to say, there is a lot to do here and I'm learning a ton!

yum

biggest freakin' avocado i've ever eaten!

oh yeah..

I guess I should blog about what I do all day, why I am here.

Like I've said before, I am an intern for the health program of an international NGO. Our department is pretty small, we are just 6 people currently. There is the program coordinator (an expatriate also), the health manager (an Ivorian doctor who studied public health in Japan), 3 assistant health managers (also Ivorians), and then me, the stagiaire.

We currently have 2 major grants. The first grant is for a health systems strengthening project: re-equipping rural health centers, supporting them with essential medicines, training health staff and health management teams (i.e. community members who are responsible for managing the health center's finances), building pumps and water towers.

The second grant is part of a large multi-country grant for implementing community case management (CCM) for malaria, pneumonia, and diarrhea. These are the top three killers of children under 5 in developing countries (not counting neonatal deaths in the first four weeks from infection or prematurity complications). There is good research that suggests that a lot of these deaths can be avoided if care for these illnesses is made accessible at the community level. In West Africa, for example, about half the population lives in a rural area, the majority of who live further than 5km from a health post. So when a child is sick, its often not very reasonable for the mother (who is also responsible for most if not all of the household duties) to take her child to a health center. So the idea behind CCM is to train local women and men (who are often illiterate and have little education) to identify these illnesses and provide treatment (antibiotics, zinc, rehydration salts, and malaria combination therapy). If it sounds radical to you, then you aren't alone because many governments and local doctors are initially very skeptical too. It took our management staff 4+ months of meetings with the Ministry of Health and the medical community to get their support for a pilot project of CCM in Côte d’Ivoire.

Both of these projects are being implemented in central Côte d’Ivoire, in the former "confidence zone". In 2002, rebel forces from the northern part of Côte d’Ivoire launched a coup d'etat, using Bouaké (2nd largest city, located in central part of the country) as their base. Many people in the surrounding districts fled, including essentially all the government and health workers. The confidence zone was established by the UN mission to separate the government controlled south from the rebel held north. As you can imagine, basic social services in this area greatly deteriorated. So that's where we're working!

To keep this manageable (for you to read and me to write) I'm going to break this into a few posts. Here are a few links if you'd like to read more about pneumonia (short article from NYTimes) and the conflict in Côte d’Ivoire.

Sundays to relax...

..and get stuff done. Like making banana walnut muffins and cleaning all my underthings.

Agouti and other fun eats

Agouti is bushrat, popular meat in west Africa. I tried it once in Benin a few years ago, and today I finally succumbed to peer pressure and had some for lunch. It doesn't taste bad: it's a dark meat, not unlike wild meat you might eat elsewhere, it was braised and flakey. I guess it's just the mental block of eating something with the word "rat" in it. But I've overcome apparently. Here's a picture of what you'd see in the market. Yum...

Futu banane

One of my colleagues recently invited me over to make futu banane, which is a popular food here. It is basically pounded banana and manioc, the starch you serve with all kinds of different sauces. First you boil bananas and manioc. Then you pound them until they get the right consistency, which is a like mashed potatoes but sticky-er. You pound the bananas and the manioc separately, with a big mortar and pestle, then you combine them and pound some more. I tried doing some pounding and it is hard work! I lasted about 30 seconds.

Here are the boiled bananas and manioc underneath:

My colleague showing me how it's done:


Instead I helped with the sauce: the sauce we made was a mix of eggplant, spinach, and lots of peppers. All these ingredients are cooked and then mixed together. Then this is folded with a meat sauce: grilled or smoked fish, beef, agouti (bush rat), escargots... They eat it all here! This is the sauce before it was combined with the smoked fish:
Here is the final product. To eat you use your hands, break off a small piece, and dip into your sauce. FYI, they also make pounded manioc and pounded yam (igname pilé) in the same way.
The whole process of making an African meal of futu banane plus a sauce takes about 2 hours. A lot of women do this twice a day! In Cote d'Ivoire, this is typically a women's job. Men and even boys don't help with the cooking.

le marriage de Bedi

(I think that has a good ring to it...)

So this Ivorian wedding started out at the mayor's office, l'hôtel de ville

Cool chairs huh?

First comes the women relatives, who were singing.

Then the bride. (Please notice the woman to the left. This was the maid of honor. She took her job very seriously and was everywhere all the time, powdering the bride and adjusting her veil. I could not stop watching this lady all night!)

Then the maids of honor...

..big train!

The mayor presided over this ceremony, sitting behind a long table in the front of the room, with two other administrators at his sides. The couple sat in chairs facing them and their witnesses sat behind them. To my surprise, the mayor spent a a lot of time talking about the roles of husbands and wives and how important it is for couples to take their problems to their elders and NOT to the courts (our gender based violence coordinator was rolling her eyes and vowing to do a sensitization with him!).

After this the party moved a reception hall where a second religious ceremony took place, and then all the eating and drinking.

The band.

It is hard to keep Ivoirians from dancing. And they make have such good rhythm, they make it look effortless... and then I try and realize it's harder than it looks. (These are my colleagues!)

The happy couple.

The first dance.

The photographers.

The cake.

Champagne toast!