I actually tried to check online the other day but got distracted by reading Last Days first, and then the power went out while I was about half way through the 2nd page of valentines.  It went out again twice yesterday, so we'll see if I actually get to finish this email.  The keyboard is sticking in an annoying way, however, so hmmph, I may not last that long here even if the power does.  I already got kicked off the server once today. 

 

I want to tell you about what I'm actually doing in village every day, give you a snapshot of the cast of characters, more adventures in travelling, and the state of health care here, but we'll see how far I get this time.  I actually have work to do still today.  I'm in Atakpame to try to track down people and information (ha!), to buy Depo and other supplies for our dispensaire (some things never change), and to shop for prizes for the raffle we're having in village to raise money to repair the dispensaire's cistern.  I had the local (local, as in 54 km away) hygiene assistant come out to assess the damages, cuz it's been broken since at least before the last rainy season.  It'll cost us about 30,000 cfa to repair it, only 60 bucks, but we don't have it.  Actually, we do.  We have 50,000 cfa but we need that to replenish our basic stock of medicine and supplies.  Very basic.  The previous chef de poste of the dispensaire (a nurse) siphoned off a lot of the meager profits, so we're slowly trying to build it back up, and to restore villagers' faith in the dispensaire.  Anyway, when I had the meeting with my nurse and the management committee re how we're going to find the money to fix the cistern before the rainy season starts in March or April, I discovered that they all expected me to find the money for them.  That's what white skin means -- unlimited access to money and opportunity, which is probably why i get so many marriage proposals or at least please have a baby with me, or take the one I have back to america with you.  Well, I explain again, that's not why i'm here and also the reason they wait until March for our conference on Project Design and Mgt is because they don't want us getting involved in fundraising projects within our first 3 months.  However, once the rain starts it's too late, and the dispensaire needs water, and for christ's sake the rain is free and abundant.  So I suggested a raffle because people here like to gamble it seems, and Esco had mentioned she'd done that once.  I wasn't sure how they'd take to the idea, but they were all over it.  So here I am in Atakpame to buy a 10 dollar radio cassette player, and a few other small items (tshirts, barettes, sunglasses, a calculator maybe).  We'll see how it goes.

 

My official homologue is the new chef de poste, and he's a hard worker and good guy if not always the best informed.  Example:  at a talk we were giving at the local middle school about teen pregnancy, he told the kids that sex too young "weakens the brain" of teenagers, that it actually damages the nerves.  I laughed later, saying I couldn't believe he said that (I thought he was doing it to scare them into abstinence) and he said, No it's true.  When I flat out said No it's not, he said that it's different with africans; mainly because they have sex for hours at a time, unlike the white folk and the next day they're just completely weak and exhausted, and if you're a kid, well that damages the brain.  He also told the girls that we only start out with 5000 eggs, and that we lose one every day we are on our periods and then if we waste some with early pregnancy & then abortion (more on that subject later), well then -- and he did the math -- that leaves us with only about 5 to work with when we DO want to start a family.  The latest was during a conversation about IUD's.  (BOYS, you can tune out if you want for the rest of the paragraph).  I'm trying to compile a list of where on earth women can go to get one around here -- neither he nor our midwife is trained in family planning, so can't insert IUDs, norplant, or even prescribe emergency contraception I think (no Plan B here, just the old pill combination).  The sole option it seems is Depo, since noone thinks the women will remember a pill every day (incl. the women themselves), and they don't trust condoms for a variety of reasons.  Anyway, he told me IUDs were not good for the grown women in the village, because they don't practice la toilette intime (douching), and therefore weren't clean enough.  He did confirm they use soap and water, of course, but that wasn't enough for him.  I gave him my 2 cents on all that.  I am investigating how to get more people trained in family planning in my corner of Togo, but it all boils down to money and the fact that the Ministry of Health doesn't have any.  I found a sage femme (literally Wise Woman and the title given to the most educated midwives) who agreed to come to my village and do the training if I found the patients and the money for her travel and per diem.  We'll see what happens.  Why on earth they don't train them for this during their regular training I dont know.  They can both deliver babies for crying out loud.

 

People out in the bush are treated according to their symptoms.  Almost every case of fever, fatigue, body aches and/or headaches is automatically attributed to malaria and treated with chloriquine and tylenol.  There are no labs out there, no microscopes to do an actual test of the blood.  No wonder the parasite has become resistant.  Accordingly, the sun and hard work in the fields, and making charcoal, and a host of other things causes malaria -- because every time someone feels hot and achy, or fatigued (!) they likewise attribute it to a maladie they know is called malaria but which they evidently don't understand.  I'm planning on giving some talks on the subject, and in the meantime wondering why they think they were given mosquito nets for their kids to sleep under. 

 

STD's are treated this way as well.  They don't even give them a name anymore, they just call it whatever the symptom is.  "Vaginal Discharge", "Lower Abdominal Pain", "Genital Ulcers", etc.  There's a formula to follow.  If the patient has this symptom, give them this and/or that antibiotic and send them off.  If the symptoms persist, they need to come back and we'll try this regimen.  If that still doesn't work, off they get sent to the lab many km away for a specimen analysis, finally.  They used to give the assumed STD a name, like Gonorrhea or Herpes or whatever, but found that they were often wrong by the time the patient got analyzed, so rather than write the wrong assessment down in their health booklet that patients keep (dispensaire doesn't keep patient records in general), they just write the symptoms and what they treated it with.  More antibiotic resistance in the making?  Seems so, but they don't have much choice.  Travel is a bitch here, and that's coming from someone who has the means and the time to endure it. 

 

Speaking of which, I've found a much better way to travel by bush taxi, at least while I'm out in the sticks.  Instead of riding inside the van, either crowded in with, literally, 18 other people in a 9-placer -- the dust blowing in thru the broken windows and floorboards (I am always filthy, absolutely filthy at the end of it, not to mention my contact lenses) --  or squeezed in between the driver and two other people in the front, navigating my legs around the stick shift but ending up a tad cleaner in the end, I've taken to riding on top of the van with the lackeys and the spare tires and the bags of corn and the occasional goat.  Not only is it cleaner and quieter and less cramped, but the view is great and I have more wind in my face than dust.  Also, the next time we have an electrical fire under the steering column, I won't be stuck between the fire and the passenger next to the door (in this case, Jeff) panicking to try to get out a door that has to be opened by pulling a piece of coat hanger towards the windshield while simultaneously giving a hard shove (alas, I knew how to open it since it's the car I usually take out of village, but was not in the position to do so).  He had tried to get out thru the window, but they'd pushed his head back in since they were diligently trying to get the door open for him.  When the back finally emptied out, I did a scuba diver's launch backwards while yelling to Jeff to grab my backpack as I saw him finally scooting out the passenger side and turning to grab his own bag.  His version of course has me running for my life while he's trapped in the flaming inferno, and me yelling from half a mile away, "Jeff don't forget my bag!"  My counter version is that he actually jumped out of the car before it even stopped and ran screaming to the 20 foot statue of, yes, Jesus out in the middle of nowhere, and pleading, "Jesus, save me!"  Another night, I didn't get home until 9 pm, after getting in the van at 4:30 pm in Pagala, 52 km from Kamina.  Not only do they so overload the cars with people and packages and whatever else they can cram in, so much so that the frame of the car rubs against the top of the tires even when we're not driving thru a ditch, but that particular night the driver and one of his lackeys decided to stop the car and run off into the bush in the pitch black night after none other than a bush rat that had run across the road.  For crying out loud, I yelled in French out the door, we're tired!  I know how to drive you know!  I'm going to take the damn car!  Serves him right that he ran into a nest of ants, ha!  and came back half naked and slapping himself all over his body.  There have been other incidences as well, of course.  But on top of the van at least, I can go limping into the sunset with a hot beer that one of the local merchants sold me while we were sitting up there with his milk crates full of drinks and a bag of ice that is mostly melted by the time we get to village but which gives us cold drinks for a couple days anyways.  I suggested he buy them cold and the ice would last longer but I don't think he got it. 

 

I realized a few weeks ago that I need to start telling these stories before they become commonplace and mundane to me.  This realization came as I was recounting the story to my friend Jesselyn, and she pointed out that I didn't seem to notice that as I spoke we were sitting in a bush taxi of all places, on a busy Atakpame street full of people, driving on the wrong side of road, and speeding backwards while a moto was coming straight at us.  Neither of us even flinched.  It just seems so normal now.

 

Out of time.  Will be back in in a couple weeks for a stilt dancing festival, and hope to hear from you all!!!!  Sent you a letter, Jenn, by the way, hope you get it....and got grandma's large large package -- love you!