Saturday, May 31, 2008

"Andrew, what do you actually do? You know, for a job?"

Sent via e-mial 5/31/2008
Hello everybody,

So as you all will no doubt remember, my last soul-less, industrial mass email kicked off a new series of Andrew's Guinea emails titled: "Answers to random questions you may have about my life here in Guinea."

This week's installment:

"Andrew, what do you actually do? You know, for a job?"

Great question. To answer, I will take you inside the planning, preparation, and execution of my latest health sensitization at the local ecole primaire* [please refer to the appendix at the bottom of the page if necessary] in my village.

As I've mentioned in previous emails, malaria presents an enormous problem here in Guinea. As the primary cause of death in the prefecture* where I live, malaria claims the lives of men, women, and children on an almost daily basis, particularly during the first few months of the rainy season (May, June, July). Although it is heavily over-diagnosed in local health centers (due to poorly-trained staff and/or the oversimplification of symptom diagnosis by the Ministry of Public Health here) and thus the numbers tallying the total of malaria patients are almost always inflated, the disease nonetheless continues to be an serious issue-- one made all the more tragic because of its preventability.

With this in mind, two weeks ago I set to work organizing a series of health sensitizations to be given in the local primary school discussing the topic of malaria: what it is, its symptoms, what to do if you get it, and most importantly for my work, how to prevent it.

The process went through several phases:

Phase # 1: Asking and getting permission
So very little gets accomplished in Guinea outside of the traditional, top-down heirarchical structures that are in place. If someone wants to organize a project in the village, they must first talk with the sous-prefet*, the village sages* and the authorities responsible for the sector in which they want to work (in this case, the directeur de l'ecole primaire*). To not do so would be a significant breach in protocol and cause all sorts of silly problems that would hinder one's progress.
Trying hard to be a good culturally-sensitive volunteer, one day last week I went to the sous-prefet's office and told him I wanted to do some presentations on malaria in the primary schools. Fine. No problem. Then, later that day at a baptism, I tracked down the directeur of the primary school and told him I wanted to do some presentations on malaria in the primary schools. Fine. We'd love to have you. I let M. Diallo, my counterpart know, and he told me to go for it.
Perfect! That was the easy part.

Phase # 2: Preparing visual aids
Yeah, here's the hard part. So as I may have previously mentioned, the illiteracy rate in Guinea must be well over 50%. I think there may be one grown woman in Bouliwel who can read and write a little, if that, and the non-fonctionnaire* men aren't much better.
"Well Andrew," you might say, "surely 5th and 6th grade kids ought to be able to read, right?"
Hm. Well, not necessarily. Education in Bouliwel (and the vast majority of Guinea) really stinks. Classrooms are dirty and ill-kept, teachers are poorly trained and poorly paid, kids are often forced to stay home to do chores or work in the fields, and overall a nasty, oppressive system of rote-learning keeps most kids from learning anything significant. All of which is made even worse when you only go to school for 2 hours a day, 4 days a week and your own parents are inalphabets* (as is the case with most children).
So all this is to say, whenever I want to do a health sensitization, I need to have pretty, pretty pictures and not much writing. (Imagine, for a moment, what life would be like if, every time you looked at writing all you saw were black lines and circles and the occasional dot) Which for me is not easy because I stink at art. Oh Mom, how hard you tried to raise your little children to be artsy, and cultured! And how hard we refused, and decided to play sports instead! If only we had known...
Anyway, I needed to make a bunch of posters with mosquitos and sick people and mosquito nets and stuff on them, and I knew I blew at art, so I grabbed my health manual and copied over a bunch of images* from my paludisme* workbook onto some big flip-chart paper. This took me several mornings of work, but after many painstaking hours of tracing and coloring in the health center ("what is that crazy porto* doing today?" people ask), I finally emerged-- victorious-- with three big beautiful malaria posters. Joy.

Phase # 3: Figuring out what I'm going to say
This part was pretty simple. I just looked over my malaria notes, gathered my thoughts, put myself inside the head of a Guinean 5th grader (what would I want to pay attention to during the half-hour before recess?), and trusted in my tried-and-true motto: Just wing it 'cause if you try and overplan it it's just gonna get screwed up anyway. And if it's really bombing just say something in Pular and they'll all laugh. Great motto.

Phase # 4: Actually giving the thing
So obviously this was the most important step, and I thought it went well. I showed up at the ecole 15 minutes early, greeted the 5th grade teacher, M. Sidibe, taped my posters onto the blackboard, and sat quietly at the back of the class, about as inconspicously as a large tapir charging down a group of small children (My approach to dealing with stares, whispers, and giggles varies: sometimes I just ignore it, sometimes I smile back or say hello, and other times I do something really weird like snort, make faces, or pick my nose (although, in retrospect, picking your nose here isn't weird at all ;) ah Guinea). When the kids got done with their exercise, M. Sidibe called me to the front and let me know that the floor was mine. Suh-weet!
To start, I made them all stand up and then I taught* them "heads, shoulders, knees, and toes," just to lighten the atmosphere and make a complete fool of myself to loosen 'em up a little bit. The salle* officially chauffed*, I then launched into my malaria shpiel, explaining that the illness is caused by a pesky blood parasite transmitted by sonsolis*, that you can only get it by way of mosquitos, and if anybody tells you you can get it from mangoes or the sun (common misconceptions) they are wrooooong. Very wrong.
I speak in slow, basic French with a smattering of Pular, looking to Sidibe during moments of confusion for a more detailed Pular translation. There were about 40 kids in the class.
They seemed mostly attentive, laughing at my occasional manhandling of their native language and responding at all the right intervals. They followed me through my symptoms explanation, facilitated, of course, by my beautiful visual aids (although I had this one picture that was supposed to be of a kid sweating, because that's what happens when you get malaria sometimes, and they all thought he had an outbreak of warts. Ehh). When I got to the Comment Eviter le Palu?* section, they latched onto the visual aids, and seemed to absorb really well the importance of mosquito nets, of long pants and long sleeves at night, of filling in or covering up stagnant water sources (mosquitos reproduce in stagnant water like puddles or wells), and several other key preventative measures. I encouraged them to take the issue seriously, recounting briefly the story of the little girl we lost to malaria two months ago in the health center-- a girl who could have easily been in 5th grade. They nodded and seemed to get it.
After probing a little for questions or confusing material, they all seemed ready for a little Porto tomfoolery, so I performed a hearty rendition of "I'm a little teapot" and called it a day, thanking Sidibe and his class.

Phase # 5: The follow-up
Yeah, so this guy seems a little less structured, and in fact, I'm still figuring out how to do it. For now, I mostly corner small children around the village and interrogate them: Can you get malaria by being out in the sun too long? Will you ask your dad to put screens on your house windows? Arrgh. Stuff like that. I am going to continue my series of malaria sensitizations with the other grade levels in Bouliwel-centre and hopefully get out to the primary schools in the districts as well. I'm also working closely with M. Diallo to monitor the number of malaria patients we see at the Health Center on a weekly basis. And, in conjunction with my Health Director and some other Health Volunteers, we're looking for ways to make mosquito nets cheaper and more accessible to everyone who needs one. As they say here in Guinea, "little by little, the bird makes his nest." Good stuff.

That's all for now! Donnie Stuart and his studly pectoral muscles are flying into Conakry on Monday night to visit for a few days, and after that I am taking a brief vacation in N. Ireland to see my beautiful girlfriend, Rene Marshall! Your prayers are much appreciated as Conakry has seen a few issues with some disgruntled military officers recently.

Love you all!

*primary school (grades 1-6)
*like a region or state
*the guy who's in charge of the village and all the districts in the local county
*all the gnarled old men who walk around in big boubous and who command lots of respect
*you can figure this one out guys
*fonctionnaires are the state-assigned skilled workers in the village-- usually teachers, health workers, civil servants, and others. Bouliwel-centre has around 20 (there are many more when you take into account all the outlyign districts). My counterpart, M. Diallo, is a fonctionnaire, for example
*illiterate people
*you can figure this one out too, I'm pretty sure
*white person in Pular
*when I say "taught," I mean I sang and told them to repeat after me, which went something like this: "OK kids, 'heads, shoulders, knees, and toes, knees and toes.'" (beckon for them to repeat) "Haads, blah blah giggles blah blah giggles." Good times.
*warmed up
*mosquito in Pular
*How to avoid getting malaria