Monthly Archives: February 2015

Ten Things You’ll See In Mozambique that You Won’t See in America (But Maybe We Should)

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Same-Sex Friends Holding Hands

A recent study (LiveScience) in the United States found that the majority of the population still feels uncomfortable when they see two people of the same sex holding hands. While our country has, thankfully, made much progress in terms of accepting and understanding the diverse communities that share our home, we are still far behind in creating a safe climate, especially when as individuals we are not questioning our own thoughts and beliefs.

A couple months into my site, and I found myself holding hands with a male friend of mine as we joked, laughed, and walked back to a mutual friend’s house. Walk around Mozambique and you’ll quickly notice that the gesture of holding a friend’s hand (regardless of sex) is common and just as beautiful as it sounds (header photo).

Teenage students walking out of a school, an older adult leading his friend through a busy market, two doctors having a conversation in the middle of the hospital, two friends walking and joking down a street. How simple life is if we can simply let go of our uncomfortable thoughts and hang on tight to the one thing that bonds us: humanity.

Respect for Different Religions

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While this may be slightly unfair to say about our current American climate, nowhere else have I seen people with drastically different religious beliefs living in such unified harmony than in Mozambique. On any given day, one can see the congregation of the Catholic church gathering in the main lawn while the daily prayers from the mosque’s loud speaker fill the air above.

In the United States, a person is often not only judged by what they do but also what they believe. In our current climate, an individual’s beliefs are firmly tied to the actions and beliefs of others who identify themselves under the same religious umbrella, and we are quick to label the individual as a bigot, an extremist, a terrorist.

However, what an individual believes in Mozambique is the sole property of the individual. Their beliefs are not questioned, denounced, analyzed. One face is equal to another, and in a country that thrives on development and moving forward, it’s refreshing to see that the people of Mozambique have already learned something that American’s haven’t: tolerance.

Fun FYI: While writing this portion of the post, I was introduced to a Pastor who works at the local Catholic church. He is from Mexico and wants to learn English. Serendipity or divine acknowledgement?

Watching (As In Watching) the News

In a packed bar in my town, people crash glasses together, laugh loudly at inside jokes, and join together in singing and dancing. The television is showing a movie with the audio projected from speakers. Nobody is paying any attention until the movie ends and the program switches to Jornal da Noite (Nightly News). Silence blankets the bar, and all eyes turn to watch the television or screen and listen in as the anchor delivers the news.

The country is large, but when it comes to the news, everyone in Mozambique wants to be informed of the happenings across their homeland. Whether they’re getting updates about the floods in Zambezia or watching as two burglary suspects are placed in front of the camera in a display of public shaming, Mozambicans love their news. While one could argue that it’s simply an issue of variety (Mozambicans usually watch either the news or telenovellas), the amount of interest in the news is hard to ignore.

Election Season Enthusiasm

Coupled with Mozambicans’ love for the news is their commitment to national elections and choosing the best leaders for their communities. During the 2014 Presidential Elections (which usually only occur after two, 5-year terms of the sitting president), the energy in the air around the election was thick and loud. From the rallies that filled the streets in a color-coordinated act of support or the political posters that blanketed the town, Mozambicans made it clear that they are pushing for progress.

One of the better sights of the election season last year was seeing a truck full of older women (mid-50’s) with large signs, megaphones, and matching shirts yelling as they drove through the community to promote their political party. Regardless of sex or age, Mozambicans will put work on hold for the possibility of improving their daily lives. Crazy, right?

Rainwater as a Resource

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When I first got to the country, other volunteers as well as Mozambicans described the impending rainy season. “It’s horrible,” my German neighbor told me. “The roads become rivers, and the rivers become seas.” It was hard to believe him at the time, but upon returning to my site following a trip south for the holidays, the rain was heavy, the power quickly went out, but one thing surprised me most: the use of rainwater.

Children were using falling water from the roofs to wash their bodies (photo above). Teenagers with large buckets were collecting the water and carrying it out into the neighborhoods. Women were using small, plastic bottles to refill their beverage with fresh rainwater from the hospital roof (photo above). At first, it was hard to join on the rain-wagon. “I’ll just carry my water from the mosque,” I said. “I don’t need to use the rainwater.”

When the power finally went out for the month, it was clear that rainwater was the best option. I bathed in the water with the kids from my neighborhood, it became routine to set out my buckets during a heavy rainstorm and even wash my dishes and clothes with the falling resource. While we don’t necessarily need to establish a similar routine in the states with our abundance of water (in most states), the notion of this reusable resource is intriguing.

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With the increase of products being imported into the country (looking at you Coke), the amount of litter that is filling beaches and roadsides is staggering. However, people of Mozambique have learned to reuse these some of the resources found throughout the community in the house, in the market, and in their gardens.

Acting as water bottles, small Coke bottles are used to refill water (photo above). Vendors in the market use the same bottles to fill with oil to sell on the side of the road. Plastic coverings from mattresses and plastic bags are used to cover bananas as they hang on the tree, preventing insects from destroying the plant. While the country is still in dire need of a recycling plan, the community is attempting to reduce the abundance of trash by recycling it themselves.

Gardens & Fresh Produce

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The rainy season not only brings the floods and abundance of drinkable, usable water, but it is prime time for Mozambicans to build their gardens (photo above). The community is transformed from dry and dirty to fertile and lush lands, producing not only fresh produce for consumption and sale, but also providing local community members more work in the building and maintaining of the large gardens.

Children, teenagers, adults, and older adults will all be in the garden throughout the rainy season, tending to the crops, harvesting, and selling them in the local market. For this reason, there is a constant supply of fresh produce for the community. However, the issue still remains the cost for those who can’t afford the produce and the need for education of the community to learn how to build and maintain their own gardens.

Bicycles, and Motorcycles, and Walking, Oh My!

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While this just may be a circumstance of both income and increasing development, there are far more bicycles and motorcycles on the roads of Mozambique than large cars. The main highway that runs north and south through the country is packed with larger vehicles used by those who can afford them, but as you travel inward and away from the main highway, the local villages and towns are thriving on smaller, more cost-effective and environmentally friendly (whether they know this or not) means of transportation.

If walking through a small town in Mozambique, you’ll notice people yelling “taxi mota” in your direction. You’ll recognize the word taxi right away and realize that they are providing a service for those who don’t want to walk and need a ride. Usually this is cheap, helps the driver pay for gas, and builds a sense of a growing and thriving community.

Fun FYI: Peace Corps does not allow volunteers to own or use a motorcycle due to the dangers. If a volunteer is caught owning or using a motorcycle, it’s terms for immediate removal from the country. Bicycles, however, are warmly welcomed and recommended.

Hitchhiking (Boleias)

In the United States, hitchhiking brings to mind plenty of movies and stories about the dangerous men and women who walk the interstates and highways in search of trusting drivers. For this reason, hitchhiking is both illegal in the states and generally looked down upon as a collective culture. We’d rather drive to our destination with the doors locked and eyes forward.

In Mozambique, it’s not uncommon to see people receiving boleias (Portuguese for lifts) from friends and strangers both inside the community (on the back of motorcycles) and along the national highway. This is an ongoing topic being discussed by both Peace Corps staff and volunteers, because it could potentially be dangerous; however, the consensus is that it’s a safer option to the country’s national transportation, which is dangerous and often leads to more accidents than hitchhiking.

Business Owners, Community Members, Thriving

With the discovery of gas in the northern province of Cabo Delgado and other natural resources that are underneath the country, more and more international companies and organizations are moving in to harvest and export the resources. While this is creating additional jobs and increased money into the country (although many doubt that the money will be put back into the communities because of unchecked corruption), it’s also creating a dependency on international companies instead of looking inward.

Walk around a smaller community, and you’ll see small businesses and shops owned by members (even families) of the community. With enough motivation and resources, a person in Mozambique can build and maintain a rather successful small operation in a small town. The country has yet to build large factories or companies, so in the meantime, the age of the local business owner is still strong and vibrant, including agriculture.

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“Mota Pequena”

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Symmetry. Light. Love.

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Productive Chaos in the Face of Unemployment

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The scene is familiar to what we see in the states: A member of the group gives a PowerPoint presentation in front of the larger groups. The presentation is filled with statistics and findings from their area health center. Each slide paints a more detailed portrait of life and work for the presenting group. However, a harsh criticism hits the air.

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“These numbers are horrible,” he interrupts the speaker. “Where is the rest of your data?”

“Doctor, we collected all the information, and these are the results,” the presenter responds.

“Well it’s not good enough,” the doctor says. “We have to do better.” He turns to the group. “We are not playing here, we are working.” The group shifts in their seats. I catch eyes with one of the ICAP Mozambique team members. She gives me a soft smile and opens her eyes wide before returning attention to the doctor who is in charge of the group.

“What he is saying is that the information is all accounted for, it’s just lower than we want,” another member of the group says in support of the presenter. “But it’s all there.”

The group erupts in conversation, and the presenter patiently stands at the front waiting for the time to continue. The leader is now looking at his cell phone and smiling. Members of the nearly 20-person group are having loud, fractioned conversations about the data and presentation throughout the room.

There’s a name for this kind of environment: productive chaos.

In the United States (in most cases, or at least the ones I am most familiar), we are all about productive order. We sit, listen (or pretend to listen), smile, read along with the information, and wait for the appropriate time to ask our focused and polite questions to the presenter, the expert.

There is a somewhat artificiality to our system of presentations. The presenter knows what is expected of her or him, and the audience knows what is expected of them. With the exception of jokes and stories thrown in for effect, it is a polite ritual that goes back throughout our history.

As the only two Americans in the room, I lock eyes with another Peace Corps Volunteer (PCV) who is sitting across the room. She and I shrug our shoulders but sit in silence waiting for the chaos to settle. We expect the harsh comments to draw criticism or spite from the members of the group.

Yet, the conversation never turns toward the negative. Instead, the environment feels productive, energetic, fruitful. While it does cause the meeting to go two hours over time, we leave feeling like we just witnessed something truly refreshing: a meeting filled with criticism that doesn’t leave the group feeling like a failure. A level of honesty from a culture that cuts through the bullshit and gets right to the point.

The Issue of Employment
In the world of international non-governmental organization (INGO) work, the pressure to provide results is sometimes overwhelming. The groups on the ground need to show that they are worth the paycheck they are receiving, or else the worst is possible: being replaced.

As a developing country, opportunities are rare and hard to acquire. The availability of open positions is limited (although with the export of gas and other natural resources, the demand for more labor is increasing). Even for those who have higher educations, it’s a battle to fill positions in hospitals or government offices. This is why many Mozambicans live far away from their families for months or years at a time.

My supervisor just had a new, baby girl with his wife who lives in Maputo on the other side of the country. He opens his phone and shows me a photo of her in a pink hat. It’s easy to tell from his talking of her that he loves and misses her dearly.

Another colleague is a newlywed. He took advantage of the holidays in November and December to travel to Maputo to marry his now wife. His wallpaper on his phone is an image of her standing along the beach, the wind blowing her hair.

For them, being in Namapa and working for an INGO is simple: a good job with good pay to support the families who they love, who they will be able to see again once their contract is complete. They understand the rarity of a quality job and will do their hardest to succeed.

While unemployment in the United States is always a societal concern, we often make the decision on where to work based on the location of our families, loved ones. We need their constant presence to keep us motivated, grounded. Mozambicans need this as well, but until the day comes that more opportunities are established, the work they often do separates them from their support networks.

Action and Accolades
The meetings with ICAP groups from around northern Mozambique comes to an end. Additional chairs are brought in, and the drivers of our groups join the larger group for one last item on the agenda: awards.

The productive chaos is replaced with a slow clapping as the names are announced of the community groups that produced the best numbers for the past three months of reporting. My team (header photo) is awarded three times, and each time they stand to receive a rousing applause. They shake hands, hug and kiss, and sit down to examine their reward: an expensive pen still in it’s box. Photos are taken by a professional photographer.

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The accolades come not only with a gift and feeling of success, but a sense of security regarding employment. While similar to the states in the sense that we perform to keep our jobs, employment and purpose for Mozambicans goes beyond earning money. It falls firmly in the strong national pride that all Mozambicans hold dearly.

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Questions? Comments? Contact me!

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Community Needs Assessment in Mozambique: Personal Insights, Tailored Focus

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This is the second (first) in a series of posts about implementing health projects in a developing country. It is meant to introduce a reader to the inner workings of public health training and action, especially the collection of baseline information, and share with the world data, stories, and personal thoughts about the ongoing challenges of global health in Mozambique.

Public health is all about knowing who matters most.

We want to believe that all information that we need to be successful in any area or field is advice, input, and research from those who we deem as “experts.” While these voices are crucial in public health to develop a robust assessment, there are lesser-heard voices that act to compliment the information gained from national health statistics and evidence-based research and provide a more personal insight and tailored focus of the CNA.

The lesser-heard voices belong to those in the community who are living with and seeing the daily effects of any given disease or health issue: the mother of two who is HIV-positive along with her children, the community leaders who have daily discussions with their neighborhoods about issues, the volunteers in the health system that work to seek out the patients who have abandoned their treatment. They all have voices and deserve to be heard. The simplicity of public health: Listen to these people and, often, solutions will reveal themselves.

Public health is all about understanding those who matter most.

Before we can collect personal information from those in the community, we need to first better understand the community itself. Sure, we have national statistics, photographs of key places in the town, a history of the community, and an overall opinion about the health issues that matter most to people, but we need to round out our understanding with a current snapshot of the community and its resources to better understand the people.

Community Map

Everyone shook their heads in confusion when I first asked about a map of my community. From the local health leaders to those who work in the local government, nobody was able to provide a detailed map of the neighborhoods and main streets. Having an overall view of the layout of the community is crucial in understanding proximity, abundance, and availability of local resources for those living in the neighborhoods. Good place to start.

Instead of walking the entirety of the community and sketching out a rough map, I thought about who would already have this information through experience and knowledge of the community. The answer was simple. Located in each hospital in Mozambique are activistas, or volunteers from the community who search out patients who have either abandoned treatment or are in need of crucial medication. Each day, these volunteers are given stacks of cards with patient information. Their task sounds simple: search the neighborhoods, find the patients, give them treatment or bring them back to the hospital. The reality is much more difficult, but we will discuss that more later.

Working with the activistas, we created a detailed community map (below) with the district hospital as the central point, names and borders of neighborhoods, and the locations of key resources, including the markets, the police station, and churches.

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Seasonal Calendar

Now that we have a better understanding of the locations of key points in the community, we also need to better understand specifics about some of these points, mainly the abundance of food in the markets. Since nutrition and availability of food is firmly linked to the overall health of the community, we need to know which foods are available during which parts of the year, thus knowing which foods we are able to use in future interventions and health programs.

Working with the chefe (boss) of the market located to the east of the hospital as well as vendors who work daily in the market, we together created a seasonal calendar complete with the name of the product, the months along the top of the calendar, the time in which the crop is planted (plantar), harvested (colher), and sold/eaten (consumir). The yellow bars are the crops that are available all year. It is clear that Namapa has a high abundance of available food items. While the issue is usually cost, we now know that food is available.

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Additional Resources

In addition to an abundance of food from the markets, other resources in the community include: a community radio station that airs health messages in both Portuguese and the local language; water pumps around the community that provide a constant (with energy) supply of water for the neighborhoods; access to the national highway for travel and import of crucial supplies; cellular networks for both phone calls and internet access; and Namapa is home to the district government offices.

Public health is all about listening to those who matter most.

Now that we have a detailed profile of our community, a general opinion from the public and patients regarding health problems, a precise community map, and more information regarding the availability of food items, we are able to start collecting qualitative information from the community to best identify our direction for future health programs.

Activistas

Who better to understand both the inner-workings of the hospital system as well as the health issues in the community than those who are volunteering their time to locate lost patients and reduce the burden of diseases in the community? The activistas not only have detailed information on the best direction to take future activities, but since they are volunteer workers they also have an unbiased view to provide honest answers and a personal motivation that will help us to better understand Mozambican’s values.

At the time of this assessment, my hospital had six activistas (now seven). Using a sign-up sheet, I scheduled interview times with each activista. During each interview, I first collected demographic information (below) regarding the activistas, including age, where they are from, time as an activista, the reason for becoming an activista, daily hours in the hospital, daily hours out in the field, with how many patients they speak in the hospital, and with how many patients they speak out in the field.

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Following the collection of demographics, I asked each activista a series of questions about logistics, strengths, and challenges of improving health in Namapa. Below I will share a couple insights from each category, but all are located in my assessment that will be available once it has been reviewed and corrected for grammar by Peace Corps staff.

Logistics

Besides some of the demographic questions asked above, I asked the activistas, “What do the members of the community think about activistas?” All of the activistas agreed that the people of Namapa, especially those patients who abandon treatment early, believe that the activistas are improving the health of the community. People know that the activistas are linked to the hospital and, therefore, are able to provide information regarding health, illnesses, and prevention.

All of the activistas discussed the importance of the palestras (health talks) that they both create and complete out in the neighborhoods. Community health workers and Peace Corps Volunteers (PCVs) complete palestras in the community because of the lack of information regarding prevention and limited resources. The activistas discussed the fact that since they are seen daily in the community with important health information, they are trusted. It is more difficult for a PCV to enter the community with information since they are new.

Strengths & Motivations

I asked the activistas, “What motivates you to work as an activista?” Since the activistas don’t earn any money for their work (besides the occasional money given by one of our team members), they all agreed that helping to diminish the burden of disease in the community was their main motivation. The demographics show that five out of six of the volunteers are from Namapa, so they have a strong connection to the community.

One of the female activistas described how her son is living with HIV. Looking down as she describes the disease, it’s clear that the issue is close to her heart and family. Also, another volunteer said that he himself is living with a disease, and by working in the community, he knows he is helping others and decreasing the likelihood that they’ll acquire the disease.

Challenges

I asked the activistas, “What are the challenges of the job?” While they are all motivated by improving the health of the community, they all agreed that one challenge is actually diminishing the burden. They are out in the community each day searching for patients or giving health talks, yet the diseases continue to tear through the neighborhoods. They discussed how it is difficult for six people to reach so many people. With a population of more than 60,000 people, Namapa is too large of a town for such a small group.

Another challenge that is seen throughout the health system in Mozambique is the organization of the patient cards in the hospital. All patients are registered when entering the hospital, but because the system is not (yet) electronic, the paper forms are put into filing cases that are disorganized, dirty, and confusing to understand. The activistas spend crucial time in the morning simply searching for the patient’s information before heading out into the community. A faster system could help them reach more patients.

Finally, a problem that is also seen nationwide is transportation for the activistas. Since they are volunteers and there is limited funding for the hospitals, the activistas have to search the community by foot. With so many neighborhoods and limited time, not as many patients are reached. In the past, the volunteers had bicycles, but because of thieves, poor quality of the bikes, and poor maintenance, the bikes don’t last very long. Additionally, a motorcycle or car is out of the question because of cost.

Final Thoughts

I asked the activistas, “If you could change one thing about your position, what would it be?” While all of the volunteers said they were content with the job, they mentioned the need for a little bit of money for their families, transportation to get around the community, and the need for more material. The activistas enter the community without any physical pamphlets or information. Their palestras are just through speaking. However, there is the issue of literacy in the community as well as those who only speak the local language.

Public health is all about continuing the conversation.

The conversations with the activistas were crucial in developing a focused assessment. However, the conversation needs to continue into the implementation of the interventions or health programs. Additionally, we need to continue to speak with as many members of the community as possible to make sure all voices are heard and all voices are included.

Next, we need to better understand our organization’s reach in the community, speak with those directly affected by our organization, and identify any areas of improvement.

Questions? Concerns? Contact me!

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On the Power of Water, The Driving Force of All Nature

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“Rivers, ponds, lakes, and streams – they all have different names, but they all contain water. Just as religions do – they all contain truths” – Muhammad Ali

Exists in my small town a small sink. There’s nothing particularly beautiful about this white sink. It hangs three or four feet from the ground, attached to a wall just through the main doors of a local bar, seemingly out of place among tables and chairs. Framed directly above the sink is a curvy mirror, casting its reflection of customers in the space opposite. Resting on the ledge next to the shiny, metallic spout are two, small cups, both shades of pink.

On any given day, this sink is frequented by a variety of members of the community, since the owner of the bar allows anyone from outside to enter and quench their thirst during long hours in the sun, often working in manual labor or selling items on the street.

There are the young men with dirty, sleeveless shirts and cut-off jean shorts, who drain the small cups in one big gulp while also moving their faces side to side to examine their reflection in the mirror, pulling at strands of hair or dirt that rest upon their faces.

There are the young children who stand just outside the bar doors, hesitant to enter. They first scan the inside of the open-air bar, locking eyes with strangers, before taking the first step toward the sink. They swiftly gather as a small group, reaching up to open the spout, filling the small cups, and drinking, before dropping the cups and quickly retreating.

The visits are always short: in, quick drink, out, repeat. To many of the people who visit the sink, the environment of the bar inside the large, metal, gated doors is a foreign one. While they work tirelessly during the day, they are unfamiliar with the luxuries of disposable income, especially to be spent on cold beverages. To them, drinkable water is their luxury.

A River Runs Through It

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“You first,” I say to Wilson as we approach a flowing stream near the main part of the river. “Then I’ll follow.”

He and his father both laugh as they remove their shoes, empty the contents of their pockets into the deepest part of their sneakers, and hold them above their waists as they enter slowly into the water.

It’s mid-August, two weeks after arriving at my site, and since we are still technically in winter, the river is low with wide banks of sand and rock in the valley. Wilson and his father, my neighbors, have invited me to join them and their family on a trip to the River Lurio, just outside Namapa. We walk the wide valley with our final destination being the main flow of the river, just near and under the bridge that connects both sides of the valley.

They both make a high-pitched sound and laugh as they enter the water, which reaches them just above their pant line. As promised, I remove my shoes, empty my pockets, and follow them across the small stream separating me from them. The water is softly pushing against my torso as I make my way across. On the other side, we continue to walk along the sand and rock, this time more slowly and with slightly more pain, as we are still shoeless.

In the distance, we are able to see a large group of people sitting along the main flow of the river. To either side of the group are boulders with jagged edges. Atop the boulders are shirts, pants, and other articles of clothes, stretched out along the surface of the rock, resembling simple drawings or sketches under the setting sun’s light.

As we approach, Wilson’s mother greets us. She is sitting along the bank of the main part of the river with her newborn baby in her hands. “There you all are!”

“Sorry,” Wilson says to his mother. “It took a lot longer than we thought.”

“No problem,” she said as she turned the baby in her arms and tightened the blanket around her.

We all sit down next to her as the entire scene of the river unfolds in front of us. Her other children, some with floaties, are wading in the waist-deep water, racing each other against the flow and laughing with every successful inch forward.

Farther down the river, under the long, cement bridge, older kids are jumping from the boulders into a deeper area of the river. Two teenage boys are shimmying out of their shirts and pants, revealing only tight, white underwear, as they quickly dive into the river. One pulls out a bottle of soap, fills his hands, and starts to lather his head and body. Others across the river are doing the same.

Up river an older woman is near the bank of the water with her arms deep in the water (photo above). She raises them, revealing a long piece of clothing. She uses her hands to scrub the cloth, dip it into the water two or three times, and she rests it upon a piece of exposed rock with other pieces of clothing.

Just in my view is a large group of children at the farthest end of the bridge on the road. With buckets and soap in hand, they clean the car of a passerby, offering their time and cleaning abilities to make a few meticais (the currency of Mozambique) to spend on candy.

The lower half of my body is still wet, but I find myself not feeling discomfort, but instead peace. As my new home, I feel like I’m witnessing an important and reoccurring event in the lives of the people of my little town.

Wilson’s mother asks if I want to swim. “I’m okay here,” I respond. “But I’m sure it’s a lot of fun.”

Heavy Clouds & the Floods that Followed

The power has been out in the northern part of the country for nearly a month now. The floods that hit the country in mid-January continue to have a lasting effect on both the infrastructure and lives of the people attempting to recover.

Reports (Huffington Post) coming out from parts of northern Mozambique, especially the province of Zambezia, are devastating. The floods affected more than 150,000 people across the country. The event is described as the worst flooding since 1971. Hundreds were killed, and countless families are attempting to rebuild their lives after losing homes, clothes, food, and livelihoods.

Residents of the area describe seeing people attempting to swim the river, since the flooding badly damaged the cement bridge, making it impassable. Many of who did not make it to the other side.

The rainy season in this area of Africa is powerful and fierce. The calm waters seen in mid-August along the River Lurio are replaced with wide currents of water, crashing against the tall boulders lying on the riverbed.

No longer are people bathing or wading in the water. Instead, they describe the danger and have fear of the resting crocodiles that make the rivers their home during the season of endless rain.

The issues with the floods go beyond just the river. Inside the community, houses that were built using a mixture of cement and sand start to crumble. The water finds its way through the tin sheets of the roof and puddle within the sleeping spaces and kitchens of homes. Roads and paths within communities are swept away, replaced with mud.

Communities come to a stand still against the powerful nature of the rain. However, within this harsh environment are bright spots of joy and adaptability. To describe it is difficult, but to simply it into one word, it’s stunning.

Letting Go & Diving In

Week two of the power outage in late January, and I want to go home.

The water continues to flood inside my house, first filling my veranda before finding its way into my kitchen area. In the darkness, I come home following a long day of work to find my house nearly unrecognizable because of the foot-deep water.

After going through my water supply used for drinking, showering, and cooking, I carry my bucket and flashlight to the mosque next to my house where I have been collecting water from their pump. I am told that the pump does not work without electricity.

The increase in rainfall causes more mosquitos, and the increase in malaria and cholera threatens to attack an already weak community.

One morning I wake in my bed to the sound of a strong rain pounding against my tin roof. The sound is jarring as you’re not able to really think or hear much of anything but the rain. From deep inside the noise, I hear the voices of some of the neighborhood kids outside my house.

I open my front door, and three of the neighborhood children, wearing nothing but small shorts or underwear, are using an empty, cut-in-half container usually holding oil to scoop the water that is collecting on my veranda and tossing it away from the house. They are laughing, and when they notice me standing in the doorway, they yell “Good morning, Aleksi!”

The sight throws me off. After two weeks of frustration and dark, energy-less evenings, it all started to make sense. Adaptability. Who am I to be frustrated with a tough environment after two weeks when the families in Mozambique live with this all their lives?

I greet the children, go and change into a pair of swimming shorts, grab a bar of soap, and I join the kids on the veranda in attempting to remove the flooding water. We sing a song together, and then climb upon the ledge of my veranda, just underneath the lip of the roof where water is streaming toward the ground.

I slowly push my head under the cold, flowing water. I let it flow down the back of my neck, across my shoulders, across my back and chest, and down toward my legs and feet. I feel the coolness touch every part of my freshly woken spirit. I lather myself from head to toe, pass the soap to the children, and I watch as they do the same, smiling and laughing loud. Little white, soapy men standing under the rain as the water sheds the soap from our skin, and we open our arms wide to welcome the new day.

Across the road, the owner of a small shop and her friends sit underneath the covered veranda and laugh at our antics. We yell “good morning” to them before running inside, grabbing towels, and drying ourselves from the cold water and cool, brisk air.

A Source of Life

“Thousands have lived without love, not one without water” – W. H. Auden

I find much comfort in this small sink. There’s something particularly beautiful about this white sink. While seemingly out of place, upon second glance the sink is placed exactly where it should be. In the heart of the community, the sink provides much needed sustenance for those who often go without.

The visits to the sink are always short, but they are constant and consistent. During the rainy season, people supplement the loss of water in the sink due to lack of energy by collecting water in large, 2-liter, plastic bottles just outside the doors of the bar. The water streams from the roofs of nearby buildings, and the children and teenagers take turns catching the water inside the bottles and passing them along to friends.

Underneath the covered area of the bar, I am able to watch all this happen before my eyes. No one else gives much attention to the already familiar routines of the season, but in my mind is the driving force for my existence here. My attention turns back to the sink, where the two, pink cups lay in their sides, waiting for the next person to arrive. It’s easy to relate, because so am I.

———–

Questions? Comments? Contact me!

Note: The title of this post comes from a quote by Leonardo da Vinci, when he said, “Water is the driving force of all nature.”

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Design: Gillian Flynn’s Sharp Objects

One rumor about Peace Corps is true: There is a lot of time for reading. Since we are buried in intimidating statistics all day, light reading is usually the avenue of choice. After reading Gone Girl by Gillian Flynn, I decided to continue and read her first novel, Sharp Objects. While the material might be a bit ugly for many, Flynn writes her main characters with the same insecurities, emotional fragilities that many of us are quite familiar. Her novels don’t simply have you rooting for the hero. They make us question whether we should. This is one of my favorite quotes from her first novel. It resonates with me, and I’m not sure why. Maybe it’s better not to know why. (Photo: Lurio River outside of Namapa, Mozambique, by Alek Shybut).

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Community Needs Assessment in Mozambique: Where Do We Begin?

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This is the first in a series of posts about implementing health projects in a developing country. It is meant to introduce a reader to the inner workings of public health training and action, especially the collection of baseline information, and share with the world data, stories, and personal thoughts about the ongoing challenges of global health in Mozambique.

Public health is complicated.

The area of study and practice, focused more on the prevention and detection of disease rather than the actual treatment of it, is underfunded, underreported, and largely misunderstood (case in point). The area isn’t without its controversy, but each day public health workers are attempting to diminish the burden from diseases for millions of people across the globe through epidemiology, monitoring & evaluation, and education (although, as we’ve seen in the states, even education can be somewhat ineffective against an individual’s personal beliefs).

Public health in a developing country is more complicated.

When you first arrive in your host country for Peace Corps service, you spend two months living with a host family, learning about the language and culture, and receiving a mountain of information about health statistics throughout the country. This training often leaves one feeling overwhelmed, living and working in the constant shadow of statistics, findings, recommendations for future research and programs. The voices heard during training are many, and the statistics forced into a volunteer’s conscious are intimidating.

The trick isn’t lowering the mountain, but looking at it from the right angle.

While many volunteers arrive at site ready to destroy (or slightly reduce) this mountain of information with absolute force, strength, and ideas passed along from experts, the public health practitioner first takes a step back, looking at the larger community, researching the entire story, before taking a step forward toward public health practice. One of the main tools used during this analysis is a community needs assessment (CNA). AKA my baby.

The CNA asks you to collect all the necessary information relevant to your site, speak with as many people within the community (leaders, business owners, members of the community), and identify any gaps in service, or areas of health that aren’t already being addressed by other organizations, community groups, or available resources. Instead of doing a cannonball into the deep end of the pool, the CNA both eases you into the pool and helps you find an open area to swim. (There must be an analogy for urine in the pool, but I can’t yet place it). And as we all know, it’s better to (ideally) have a swimming buddy.

Collection of information & sharing the experience with a counterpart

In terms of sustainability (especially in developing countries), it’s important to share your research methods with a host-country national, or in non-Peace-Corps-speech, someone from the country in which you are serving. I arrived at my site with a supervisor but no counterpart, so I first sought out an interested mind in the ways of health. This came in the form of a young man who was new to the area and wanted to keep busy. His name is Flex.

Flex and I eased our way into the water. The Internet is overflowing with information regarding health around the world. With the right sites (here, here, here, yes also here) or even a quick Google Scholar search, you’re able to paint a pretty vivid portrait of the current health culture in any given area of the world. Here is a small sample of what we found on Mozambique, simply by huddling around a computer:

  • The country is home to about 25 million people with a life expectancy of 52 years
  • Low United Nations Human Development Index classification of 184/186 countries
  • The national prevalence of HIV, the primary cause of death among adults and tertiary cause among children, is 11.5% with a province (Nampula) prevalence of 4.8%
  • HIV testing in Mozambique is low with 34% women and 17% men receiving treatment, and testing is less prevalent in the north (23%) than the south (50%)

While the Internet will provide nation-wide statistics on health, it’s more difficult to find information on (in order from hard to solid diamond) the province, district, town, or neighborhoods in which you are serving. In order to build a complete case for whatever decision you decide to do for projects, you need to also collect your own information.

A lesson in language & early morning drunkenness

Since we have already decided to take a broad look at our community, we need to first start broad with our information collection. Would it be very helpful to full aside someone from the community and start to ask them about their sexual health habits if we haven’t yet heard from the community that sexually transmitted infections are an issue? On a first date, would you jump to asking your date about his or her divorced parents or first start by asking about family? Both situations are bound to end in a frustrated party (maybe a slap).

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I decided that I first wanted to collect information demographics (sex, age, if they live in Namapa, speak Portuguese, speak the local language), the general population’s ideas about major health concerns in the community, and where people are receiving their health information. Using the survey above, I spoke with 100 members of my community over the course of one day. By walking down our main street with a clipboard and an inquisitive expression, people were curious and interested to share their thoughts. The problem is always with language (attempting the survey after a few weeks at site) and attracting unwanted attention.

A common habit of many people in Mozambique is to drink at every hour of the day. Because of joblessness and a lack of understanding about the health effects of drinking, it is very common to see someone with a beer at 9:00 a.m. It makes for great business for local stores and bars, but the environment is often difficult to navigate with constant distractions from conversations with people who have had one too many cold beverages.

During my survey, a young man grabbed my wrist, pulled me into a dark, smoky bar, and sat me in front of a heavy-set man sitting down in a chair facing the front door. I looked around and saw many faces staring in my direction as I was placed in the chair. With a smile on my face, I greet the man. He tells me he is the chefe (boss) of the neighborhood and wanted to know what I was doing on his street. The tension soon faded when I told him my role as a health volunteer. Tension turned to absurdity as they laughed, shook my hand, and led me out the front door with the original young man by my side. He vowed to help me with my survey, but instead he stumbled about, yelled at passerby’s, and was eventually dismissed by me to head back to the bar.

Distraction alluded, I was able to finish the survey and collected the following results: (1) information about the perceived health problems in Namapa, and (2) where people obtain information about health in the community.

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Moving forward slowly

The information provided important details about the direction of my service; however, I still wasn’t satisfied with the information and knew that the collection of information would need to continue with more personal, detailed, and qualitative information, mainly in the form of in-depth interviews with key members from the community and focus groups with community support organizations around Namapa.

Questions? Comments? Contact me!

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American Insecurities, African Sensibilities

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I fear the morning. The morning is a daily reminder that there is so much to do and that what happened yesterday is already history. The morning means a new day filled with heartfelt attempts followed by the possibility of failure, embarrassment. The morning begins early, softly eases you from your sleep, then forces you to take notice.

While night allows you to sink into introspective thought, morning shows you in all its daylight the world in which you’ve agreed to help. The only problem is that you’re not sure how. While others thrive and shine in this possibility playground, the uncertainty and weight of it all debilitates me. My response to the morning is to close my eyes tight, shut out the light, and hope that the day passes in a moment.

My nights are long and my thoughts endless. The night is my friend for its seemingly slow existence. Others sleep, time slows, and those who are awake float on the night’s abundance of free space, filling the world with thoughts of the future, thoughts of the past. The night doesn’t ask for action, only contemplation. It is in this contemplation where my greatest ideas are created and my biggest anxieties are analyzed, piece by piece.

South by Southeast
In a training provided to my first-year AmeriCorps team in Federal Way, WA, we were given a personality test to determine our place upon a symbolic compass, with each direction representing a different personality type. This type of training is popular not just among service-minded folk, but businesses, colleges, you name it. Everyone enjoys being put in a recognizable box and told in which personality traits we thrive (just ask BuzzFeed!)

Along this symbolic compass, north represents the strong minded, action-oriented individual. This person lives to lead the forces. To the south, we have the soft hearted, group oriented individual. This person is eager to help but wants to make sure everyone in the group is heard. To the west, we have the organized, detail-oriented individual. Regardless of the leadership, this person wants to make sure everything is organized, accounted for. Finally, to the east we have the big picture people. These individuals thrive on imagining the future outcome of any project or campaign.

For my two years in AmeriCorps, I found myself being grouped mainly in the south with a little eastern tendencies. Basically, I’m concerned with taking care of the group, addressing issues, and sitting around talking about the difference we are going to make.

Sure, it’s an activity. A fun activity, in the keep-you-occupied-until-free-lunch kind of way, but still fun. Yet, while we realize these activities aren’t necessarily written in the stars, we find ourselves hanging on every word, reading every description, in hopes that our true selves will be unveiled to us. Back home, we are always looking for bigger answers to simple questions. Usually, we develop our own definition ourselves built from insecurities and doubts.

In the case of myself, I am still searching for a clear definition and often strangled by unrealistic thoughts of failure. I often place myself in the minds of others and imagine myself as someone who is annoying, uninteresting, unkind. I search out others who struggle with the same issues, and in these people I look for my answers and support.

I’m such a South.

Success & Self
It should come as no surprise that this post is being drafted in the nighttime. My mind is in a million places at once, and my thoughts settle on the people we are here to serve. I realize that the insecurities of which I find myself thinking often are a product of an American upbringing. Back home, success is measured in terms of output. What can you hold in your hands, what can you describe during a job interview, what can you produce that will provide sufficient evidence of success?

The people of Mozambique (and I can only assume other countries of this beautiful continent) measure success in an entirely different realm. Instead of bothering with personality tests and hyper-analyzing the results, (I’m Princess Jasmine! By why am I Princess Jasmine?) the people of Mozambique measure their lives in terms of health, family, and community: three things that have somehow let slip from our own definitions of success and life.

They do not wake in the morning and wonder about the interactions they’re going to have throughout the day, crippled by an unrealistic fear that failure is around the corner. To them, the morning is another day. Another day of being able to provide. Another day of hard work followed by spending time with loved ones. Another day filled with handshakes, cheek kisses, meeting new people, laughter, drinks, stars, dreaming.

Is this the big answer to my simple question? Is life this easy? Then why do I turn to isolation instead of socializing, something I’ve done since high school? Why do I believe that the nighttime holds more answers than the day? Will my mind eventually find the solution to its constant confusion?

Simple Answer: Estamos Juntos
The Mozambican welcomes the morning. The Mozambican does not worry about his or her place on a symbolic compass. Mozambicans find their direction from the direction of the collective whole. The collective whole is strong when healthy and happy. I now belong to this collective whole and can feel the love pouring in, but the trick is opening myself up to this inflow.

The trick is to not fear the morning but fear the idea of a personal world without the ability to face mornings, nighttimes. The fact that I’m able to wake healthy and happy surrounded by people who are living each day with love in their hearts and a sense of identity built on a strong history and even stronger national pride. A common phrase when meeting someone for the first time is “estamos juntos” or, literally, “we are together.”

I can’t promise that I’ll be able to face tomorrow morning without hesitation, but I can promise that I’ll allow the morning light to fill my eyes and show possibilities as they are: solely dependent on ourselves and our ability to recognize them, attempt them, and learn from them. If we are to succeed as volunteers, the answer is that simple. Mozambique will welcome us. Mozambique will recognize our role.

Mozambique is such a South.

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