Saturday, June 29, 2013

Hospital in GB - Construction and Patient Life

I like responding to requests! Someone asked me this week to talk about construction work and the weather.  (Note:  I wrote about putting up a church roof in Bohong in my blog entry of October 26, 2012 – you could check that out, too.)  I am writing today about some renovation work being done at the Protestant Hospital in Garaou Boulai – supported by the Église Évangélique Luthérienne au Cameroun and its partners  Much of the money for the renovations comes from an ELCA World Hunger grant.  I decided to add a little about what it is like to be a patient and the construction of a paillot in Baboua as well.  Weather will come in a future blog entry…

Adding On and Fixing Up
The Protestant Hospital is very close to my guest house in Garoua Boulai.  I walk on the road that cuts through it each time I go to town (including to the market).  For two months I have been watching construction there.  I have considered taking pictures, but thought, “Why be obsessive about taking pictures?  This is not my area of work…”  Well, I guess you might find it as interesting as I do, so maybe I should have taken pictures at earlier stages of the work!

The plan is to create covered walkways between the main hospital building and other nearby buildings where patients stay.  The workers have also replaced the roof on some patient rooms, redone the outside wall coverings, replaced the doors, and will soon paint. 

The workers started by cutting down some branches of a tree in the courtyard so that there would be room for the walkways.  Then, they began making cement blocks.  We think of buying them from a lumberyard, but here they mix the cement, put it in molds, and then put the blocks in the sun to dry.  Here are two pictures – one is the pile of cement used to make blocks – and also used to dry clothes…  The other is the cinder blocks drying in the sun with the walkway and courtyard in the background. 

It is similar to the process used to make mud bricks that are most often used for houses, schools, etc.  The mud bricks can be fired to make them stronger.  The pile of bricks is covered by straw and wood and then it is burned during the course of a night.  Like a kiln, but not fancy…  Here’s a picture (from a village in CAR) of the mold for mud bricks and some of them drying in the sun.

The building pictured at right had its roof removed and new supports put in place.  Then, new corrugated tin was put on top.  This is the most common “permanent” roof.  Also common are thatched ones.  (See the section below about building a paillot.)  This building also had 2 skim coats of cement (I think) added to the underlying bricks.  It will soon be painted.  The doors are new, too.  The rooms in this building are for patients. 

Aside:  Cutting the Grass at the Lutheran Station. 
On my way to take pictures of the construction, I passed three men cutting the grass which had gotten thigh-high.  They were using machetes which always fascinates me, so I took their pictures.  The man in the second picture is sharpening the blade.  Because this is the station build by the US missionaries, the maintenance man, Jean, also has a lawnmower which he uses regularly.  Either this grass got too high for the lawnmower or it is not part of the area Jean regularly cuts…  

Life as a Patient at the Hospital
Writing about the construction at the hospital makes me think about differences between a patient’s life here and in the US.  As you can see, the hospital here is not as large as most in the US and in not enclosed in one building.  Of course, hospitals here don’t need to be heated in the winter!  The walkways are to shield people from the sun and rain (somewhat, because when it rains hard and blows, these walkways are not enough!)

Here in Cameroon doctors visit patients in their rooms and, in another area of the hospital, see out-patients.  Nurses give medications, take temperatures, and routinely check on patients.  Records are kept.  All of this is much as it is in the US. Here, though, patients or their families keep the notebooks that are used for records.  They also buy the medicines at the hospital pharmacy and are also expected to buy the needles needed to give medications or take blood for analysis.  (At least they can be sure that the needles are clean!) 

There are other differences, too.  The hospital provides beds with mattresses for in-patients, but the families provide sheets and meals.  Cooking is done outside over wood fires (the way most families also prepare meals at home.)  Family members bring mats and rest/sleep on the floor of the room to provide care.  Sometimes they also bring foam mattresses.  The picture at the right shows a large mat in my living room that is similar to those families bring to the hospital.  (I didn’t want to intrude to take pictures of families and sick patients in the hospital. And, yes, that is a chimney in the corner – not that it is ever cold enough to have a fire in it!)  These mats used to be woven from straw but are now most often made in factories with plastic thread.  The picture at the right shows a couple of old mattresses being used to cover some building materials to protect them from the rain – or maybe this is just a garbage pile that will be removed later!  Hospitals here have no televisions or telephones for patients.  Patients who have them bring their own cell phones, of course. 

Patients here spend much less to get hospital care, but, even so, many people can’t afford to come.  There is generally no insurance although those who work (other than as farmers in their own fields) may have some assistance from their employers.  For example, I help pay my employees’ hospital visits and medicines and I know the Lutheran Church here has an assistance plan for their workers.

Building a Paillot
While I was in Baboua, the roof of the paillot next to my house needed to be replaced.  I took pictures of the stages used.  First, the old straw roof and wood supports were removed.  Then the men replaced the wood supports – of two different sizes – and then replaced the straw.  The whole process took several weeks.  This paillot has a low stone wall enclosing it.  Some just have the poles that hold up the roof.  This is the paillot that one of the guards of the station in Baboua uses at night.  He is very glad to have the protection when it rains hard!  Paillots are also used as protection from the sun, but as a night guard, Dimanche generally doesn’t use this paillot during the day.


Tuesday, June 25, 2013

Baboua in Garoua Boulai!

Wow!  I almost felt like I was in Baboua,  CAR yesterday!  Seven people I have worked with there was all in Garoua Boulai, Cameroon – and all at once for part of the time!  Seeing and working with these people makes it so much easier to do the work I was sent to do.  (I was so happy to see people and busy working with them that I didn’t even think about pulling out my camera.  The pictures here are, therefore, not of people.)

First, Rev. Jackie Griffin came from N’gaoundéré Sunday.  We are doing a vehicle shuffle.  It is too complicated to explain it all, but I can say that there are currently seven vehicles in front of my house!  (One would think I was a rich American…)  Many are there because it is not yet secure enough to have them in CAR.  I keep saying seven vehicles, but only one key for me.  In any case, Jackie came with one pick-up and is leaving with a different one.  I just went out and took a picture of the front of my (guest) house – can you count all seven?  (When Jackie leaves I will be back to six and later this week someone else is coming for one, so that will be five….)

Next, David Zodo, Curriculum Advisor, and Mathias Votoko, Community Developer, both from the Village School Program, arrived about 9 a.m.  I knew Mathias was coming to talk to me about some financial questions, but I was pleased to see that David came, too.  We worked for the morning completing the monthly report of activities and the request for money needed for the next month along with several other tasks.  I really appreciate working with such dedicated people! 

Later, the Mayor of Baboua came.  He stops by when he has business in Garoua Boulai.  I appreciate his friendship and the news he brings.  Yesterday he came, in part, to be able to visit with Jackie, another friend of his.  The five of us had lunch together.  Fortunately, I had made dinner for Jackie and me on Sunday and had ended up with way too much.  We ate it all Monday!  It is a courtesy to provide food – in any culture, but especially when it there are few restaurants in town.  It is also my pleasure.

As we were finishing lunch, David Gbaberi, a Cameroonian, stopped by. He had been working on a small problem with the pick-up Jackie brought.  It turns out he is related to the mayor and Mathias.  Small world.  He sat and joined our conversation for a bit.

Then, as we were talking, Patrick Kelembo, the administration for the EEL-RCA, arrived with his wife and the church’s chauffer.  I had not seen Patrick for quite some time, so I was pleased with the visit and news from Bouar. 

Also yesterday, I then had visits from other people from Garoua Boulai.  Rev. Nestor NGuembe, Director of the Bible School in Garoua Boulai stopped by to say hello to Jackie and greeted the others who were here.  He didn’t stay long since we were in meetings.  In the afternoon, I had my regular Gbaya lesson with Robert Ngnako for 1 ¾ hours (cutting it short because of all the other work and visitor…).  Soon after he left, Crispin Didier Nzamiyo stopped by.  We had arranged his visit before I knew I would have lots of other company!  He is the Financial Officer for EMIPA, a program currently funded by the European Union, that works to provide basic services to villages – a permanent school, wells for clean water, health clinic, and/or other needs identified by the villagers.  They also emphasize teaching nonviolence to parents and families.  He wanted to explain the program to me so that we might consider working together at some point in the future.  It was very interesting to hear what they are doing.  Of course, I have no idea now what might be possible in the future, but who knows? 
Pretty flowers outside the house

After all those visits and related work, I was fortunate that Jackie prepared dinner for us!  We relaxed in the evening and now I am up and back to “regular” work – email, phone calls, studying Gbaya, and writing a blog entry.  Yesterday was a very satisfying day for many reasons.  I hope you can say the same about your day today.

Sunday, June 16, 2013

Humanitarian Aid

Humanitarian aid is provided by donors to people, organizations,
CA soldiers at the border during
our first evacuation
and/or countries in need with no consideration of race, gender, religion, ethnic group, or political affiliation.  It is often provided in times of crisis.  According to Wikipedia, “The primary objective of humanitarian aid is to save lives, alleviate suffering, and maintain human dignity." Well, it seems likely that CAR should qualify to get such aid – there has been continued conflict and insecurity since December 2012, but especially since the March 24 coup.  Many people are displaced – within the country or having fled to neighboring countries.  In an already poor country, these added troubles can be devastating, especially to people in villages – common people trying to live as best they can.  But who decides if the need is real? Where to help out?  The kind of assistance that is best?  Where does the money for support come from?

As you might guess, much of the financial support comes from individuals, organizations, and companies from so-called 1st world countries, i.e., rich, developed, “civilized” ones.  They send money through organizations such as CARE, Caritas or ActAlliance.  This last is the third largest such organization in the world. 

A little history:  during the humanitarian crisis in Rwanda in the mid-1990s, many organizations went to help and/or sent aid.  Since there was no coordination among them, some services overlapped while others in need were not given the assistance they needed.  One result was the creation of ActAlliance.  They now work together to better provide services.  Request must come from all members at one time; all individual requests are denied. 

Lutheran World Federation, one member of ActAlliance, has a Global Missions branch.  It is not related to development or evangelism, but is strictly humanitarian.  They have a roster of people who can be called to form an Emergency Team that goes into crisis areas to assess needs and make suggestions. 

EEL-RCA Nat'l President,
While ActAlliance partners often send experts to help out, they try to work within existing organizations to be able to get programs up and running sooner.  Also, they want to increase capacity that already exists.  For example, they may train people to recognize and help distressed children; they may work with nurses to set up system to care for the increased need; or they may work to connect international donors with programs that can distribute needed food and supplies.  ActAlliance aid is temporary, but the hope is that more permanent improvements can result from the short-term aid.

A two-member team from LWF is currently in Cameroon to begin an assessment.  They started here because many aid organization leaders who evacuated from Bangui (the capital of CAR) settled in Yaoundé for the time being.  The team also came to Garoua Boulai.  After talking to the Sous-Prefet (local political leader), they met with seven leaders from the Église Évangelique Luthérienne – République Centrafricaine, the regional representative for ELCA, and me.  They also visited a refugee camp that has developed about 40 km away.  (I went with them on that visit – see below.) 

EEL-RCA leaders shared their view of the situation in the country, especially the western area where the Lutheran Church is active.  They also talked about current programs that might be able to assist in the delivery of humanitarian aid.  We all talked about developing capacities to meet some of the need without expanding programs beyond what the church would be able to support.  (Since aid is temporary, it doesn’t help to hire lots of people who aren’t able to continue working after aid money stops. It is better to train current workers or extent current programs through training and additional support, including some materials.  The team made no decisions only discussed the current hardships and possible solutions.

The team left at 5 a.m. yesterday, headed toward Yaoundé again, with a stop in Bertoua to meet with some officials there.  June 18 they fly to Bangui to meet with officials and view the situation in order to assess the viability of
sending aid and what kind it should be if it is sent. 

This team included a Dutch man, who has worked internationally for 30 years and understands how to assess and develop emergency aid, and a Cameroonian, who has worked for the UN and other international organizations.  His most recent job was with the UN in Kaga Bandoro so his knowledge and contacts will help the team assess the current situation.  The emergency team has two months to investigate and make recommendations to ActAlliance.  In fact, though, after one month, they are requested to send a report with a general outline of types of needs and local organizations that can assist in meeting those needs so that donor members can begin to consider what aid they might offer.  The goal is to get aid on the ground to the people as quickly as possible, but in an organized, systematic way that can truly help the people in the long-term. 

Refugee Camp of Central Africans in Cameroon

Many people fled their homes in CAR during recent difficulties.  Some now stay with relatives in other towns, both in CAR and in neighboring countries.  Others ran to their fields and are living there.  Still others found an empty space in the countryside (again in CAR or neighboring countries).  Finally, some who had no one with whom to stay headed to developing refugee camps.  Because Garoua Boulai (GB) is so close to the CAR border, many Central Africans came here.  The coup happened on Palm Sunday so as they arrived local officials housed them in the school that was on Easter break.  About 1,200 people came.  After a short time, the officials needed to find a new place so that classes could restart, so when they were offered land near the town of Nandoungué, they accepted.  It is about 40 km from GB and already has a Central African community (mostly people who had been refugees from troubles that took places from 2003-07). 
Flag of the Central African Republic

Of the 1,200 at the school site, only 350 moved to the new camp.  Some found relatives or friends to stay with in GB.  Others had taken advantage of the camp to get some basic supplies like blankets, cooking pots, etc.; these went back home – probably to Cantonnier, the Central African town just over the border from GB.  (Which one of us, if we were as poor, wouldn’t try to get much need supplies for our families?) 

Over time, people have continued to arrive at the camp near Nandoungué, usually arriving in small groups of 3 or 4.  There are now about 900 people.  Some are families; many are young people who were high school or university students.  Fortunately, there are currently only a handful of unaccompanied children but MANY are young children. 

Some refugees say that they want to stay in Cameroon having had enough of the repeated insecurities and difficulties.  (Not that their lives in Cameroon are easy now!)  Others are longing for peace and the chance to go home.  Some left for political reasons such as supporting the former president.  Others left because of fear.  All are grateful to the International Red Cross (that runs the camp) and the UN High Commission for Refugees (that provides tents and other supplies). 

The camp is set up with tents that house a family, usually four people, although some hold double that.  The problem is that these tents were designed for the desert region further north.  Now that it is the rainy season, the hard packed clay ground gets wet and water puddles and seeps into the bottom of the tents.  Since people sleep on mats on the floor of the tent, the camp is looking for ways to keep the tent floors dry.

People cook for themselves and often look for small jobs, such as working in someone else’s field or selling beignets (donuts), to be able to buy food.  The Red Cross does provide some food but is currently having trouble
Preparing Food
keeping up with the demand.  They have just found funding which will help in the near future.

A big problem is having little to do.  During the school year, classes were held for primary-age students in a local school to help them pick up skills they missed.  Now that the school year is over, they stay in the camp.  Organizers are still working on ways to help students of all ages continue their studies; they have ideas for intensive courses to be offered in July to help students make work they missed when schools were closed or they were not able to attend. 

This refugee camp is divided into four blocks each of which elected a chief.  There is also one chief for the camp as a whole.  They have also established three committees, men, women, and youth, which help manage and run the camp.  They work together to promote education, health, and security.

The camp has built two latrine areas (now not enough for the number of refugees) and a well to provide water.  They also have a first-aid tent to care for small problems.  Larger ones are sent to area hospitals.  The first baby was born in the camp two months ago!  We saw her; she is a healthy, happy baby, well cared for by her mother.  Another woman was just going into labor as we arrived.  Life continues and moves on. 

NOTE:  One doesn’t take pictures at a refugee camp and I hadn’t recharged my camera battery during the days of the meetings, but I wanted to include some pictures for you to see.  The pictures in this blog entry are from October-December 2012 – before pictures.  I particularly picked children because they are among the most vulnerable.  They have little, but look how happy they look!  There is a human will to find joy in life.  Let us hope that there will soon be humanitarian aid flowing into CAR from various sources so that hope and joy can become evident again.