A Different Perspective on Ebola

I am tired of reading American reports on Ebola talking about how it is actually a difficult disease to spread or how in reality it’s not very contagious. Which reality is that? Maybe it’s true in America, but Ebola is in Western Central Africa, not America. That’s the true reality. And in West Africa, where everything is unfolding, the reality is that the disease is very easy to spread. The proof is in the numbers. Would 6,263 people be infected, or would 2,917 people have died if this disease were hard to catch? The Peace Corps literally sent us an email several weeks ago saying that Ebola was so easy to kill, that a simple load of laundry—putting the infected clothes through the washer and dryer—would kill the virus. Well that’s great news for everyone in the First World, but what about my village? Am I supposed to go and tell everyone that they can put their clothes through the spin cycle and they’re safe? That is absolutely not the reality. That is almost the farthest thing from it. Let me assure you, Ebola is an incredibly easy disease to spread with this type of infrastructure, this culture, this life.

First, let us look at the health care system here. All of the articles say that gloves or masks or protective suits will prevent contamination. Again, that’s great news for the people who have access to those things, but what about the people who don’t? Levels of sanitation and hygiene for health centers here are not what they are in America. Don’t expect a white, shiny, sterile hospital. Picture a concrete room with dirt on the floors and chickens walking in and out freely. They don’t have enough supplies of alcohol or other disinfectants to regularly clean the facilities. There is no hand sanitizer. There is one set of tools. There is no running water, except for a tap out back (and that’s better off than many health centers). Nurses wear open-toe shoes. There is one pit latrine. That same latrine is used by all patients. There are very limited beds (6 to be exact). Beds are located in the same room in very close proximity. Patients and their families interact. There are no masks. There are no body suits. There are certainly no washing machines. There are no gloves. We recently had a vaccination campaign in which health care workers gave over 1,000 shots. Not a single glove was used. I have seen eye surgeries, again, no gloves. I have seen rapid malaria tests, in which blood is taken and put onto a screen, conducted without gloves. Part of this stems from the fact they do not see a necessity for gloves, part of this is because the health center literally does not have gloves because they are too expensive. Let me reiterate, health care workers do not have access to gloves. Are you still going to try to say this disease is hard to spread? Health care workers are also farmers and often have cuts and wounds of their own. Workers do not wash their hands before and after seeing each patient. Workers do not even regularly wash their hands after injecting an IV. This is not to belittle the nurses and staff. They simply have had different training in a different culture in different circumstances. But it does lead to very different standards, especially in regards to the spread of Ebola. Is it still difficult to transfer, in reality? Well let’s look at these workers in specific relation to Ebola. None of them have had any training with Ebola. The Cameroonian government has sent out some papers saying what the disease is and to make sure you sterilize your gloves and boots and aprons (of which the health center has none) after dealing with a patient. The government has not conducted any trainings or provided anything more than a three page document on the subject. If someone were to show up to the center tomorrow, the workers might not recognize the symptoms, they wouldn’t know how to treat it, and they would in all probability contaminate themselves. Sending an Ebola patient to my health center would be a death sentence to the workers there. That’s the reality.

The culture here also poses insurmountable challenges. People are close. The phrase “We are together” is more than just an expression, it is a true representation of life here. Everyone is your brother, your sister, your mother. You love everyone and care for everyone. You must greet every person you see by shaking their hand. Children hang all over their mothers and aunties. Little girls wipe their friends’ noses. Everyone sleeps in one large bed. Everyone shares food. You drink from the same cup, take pieces from the same ball of fufu with your hands, dip your forks into a single bowl of rice. When someone is sick, you take care of them. People were examining the culture in Central Africa where some of the Ebola cases have occurred in the Democratic Republic of the Congo. They found that children were able to live in households with parents who had contracted the disease but remained uninfected themselves. They knew not to touch their sick father. It is not the case here. They have never encountered Ebola before. They are used to malaria, which is not contagious. If a family member is sick, you must help them recover. You help them bathe, you clean their vomit, you throw out their bucket of urine. If a child throws up, the mother will be there to wipe it away. They don’t worry about contracting something themselves. Not touching someone is unheard of and inconceivable. Is Ebola contagious in this reality? You bet. Well, what if blood is involved? If there is blood in the vomit or stools, will that change people’s reaction? First of all, if you ask anyone what blood in vomit means, they will tell you it is indicative of witchcraft. It is a commonly known fact. When blood becomes involved in that way, someone has cursed you or poisoned you. Furthermore, unlike in the US, people do not fear blood. I have seen a little boy fall and cut his mouth, and an older girl on the street came running up and caught the blood flowing from his mouth with her bare hand. A stranger will have no problem coming up to someone in order to help, touching their arm, even if that arm is covered in blood. Is Ebola easily transferable yet? Families are living in small houses, sharing small rooms between many people. All of the women and children cook together and clean together and take care of one another. They hug each other and lean against one another and hold hands. People go to the bathroom in fields, in bushes, next to bars, or anywhere they get the urge to go. I have literally had a child pee less than a foot away from me while sitting on the grass. Her skirt was touching my leg and before I could even realize what was happening she stood up and pulled up her underwear. Urine can transmit Ebola. Right after she finished, other kids flocking to me ran through that spot. They walk around barefoot. Additionally, were someone to show the signs and symptoms of Ebola, and let’s say they somehow have access to a facility equipped to handle it, people often choose traditional healers over health centers. What’s the reality now? And what happens when somebody dies? Funerals are big events here. The tradition is taken very seriously in many areas. First you must prepare the body and dress them. Family members must touch it and hug it and weep over it. Then you must have an open casket where everyone in town comes inside the house to view the body, and possibly touch it as well. The truth is, if someone gets Ebola, their whole family will end up with it, and it likely won’t stop there either.  That’s the reality.

Just the way of life threatens the population. People here do not get the same type of health education growing up. The average person in America has a better understanding of germs and contagions than someone living in a village here. (Please do not misinterpret what I am saying. In no way do I believe Americans are overall smarter than people here, nor that most Americans have an advanced understanding of pathogens. I am simply stating that, in general, the American culture is germaphobic and parents emphasize to their children to “not touch that, it’s dirty,” or “that will make you sick,” and public schools teach about the transmission of diseases, and people commonly know the meaning of “airborne,” and can identify bodily fluids—more so than the average person who grew up in my village here). People do not understand how things are transferred, and thus do not understand how to prevent it or interrupt the chain of events. When recently talking to man about Ebola and trying to provide him with information, he told me, “I don’t believe in it.” Will that make it harder for him to contract it? No, in fact, total ignorance will make Ebola much easier to get, surprise surprise. I pressed him on why he didn’t “believe in it,” and he said, “I haven’t ever seen it. Many of us here don’t believe something until we see it for ourselves.” By the time he sees it, it will be too late for him. And in all likelihood he was being stubborn and just trying to make things difficult for me, but still, by having that attitude—one of indifference, lack of concern, and apathy—he neglects the chance to be educated about the disease. So even if he does in fact believe Ebola is out there, he is refusing to learn about symptoms, prevention techniques, or causes—which in turn increases his chances of contracting the disease. Does that reality sound like a difficult place to spread Ebola? Let’s also not forget the source of bush meat as a cause. That’s the only type of meat they eat in my village. Chicken is incredibly expensive, beef isn’t available, and if you want to eat meat (and you do because it is considered such a luxury), your only option is bush meat. Porcupine is incredibly common, monkey can be readily found, and bats are a delicacy. So what about now? Still a mildly contagious disease? People are going to continue to sell these things because it is their livelihood. Their family, their existence depends on the catching, selling, and preparing of bush meat. And people are not going to stop eating it because it has a status. Not eating meat means you are poor. I was eating a meal in village yesterday without meat and someone came by and offered to buy some for me. I said I didn’t want any. He moved a little closer and told me, “In our culture, not eating meat shows you are too poor, can I at least give you some fish?” The stigma of not eating meat will have people continuing to consume it for a long time to come, Ebola or no Ebola. I took a car the other day from the side of the road, put my luggage in the hatchback and had another man follow me into the car. He also put his luggage in the back. Two giant, 100kg sacks of raw meat, still bloody. Others got into the car and put their purses directly on top of his bags. He shook hands with the driver. He shared the front seat with another man who had to sit on top of him. Does that reality sound inhibiting towards the expansion of the disease? That’s the reality.

One woman asked me, so what can we do? If someone in our family shows the signs of Ebola, what should we do? Well, the immediate reaction is to take them to the nearest health center. But already we run into problems. First, how do they get to the health center? In their state they probably won’t be able to walk. There aren’t cars up here. They could take a motorcycle, but then there’s the risk of infecting the driver. There’s also the larger issue that once they get to the health center the health staff are totally and utterly unequipped to deal with the case. The family doesn’t have the proper methods of dealing with the person either. So then they should go to the nearest health center that is capable of dealing with an Ebola patient. That health center is probably over three hours away. They will have to take a motorcycle for two hours, then public transportation for an hour (and that’s assuming that the city in mind has a proper facility). That’s not a very good solution either. So then what? Contact someone and ask for a government official to be sent here to collect the person? Maybe the best option but highly unlikely due to financial resources, conditions of the roads, and the time it would take to reach this village. There is no correct solution for this situation. That’s the reality.

Cameroon is not prepared. West Africa is not prepared. A new facility with a few more beds is not going to solve this problem. It is going to get a lot worse before it gets any better. That is for sure. Right now, the main strategy is just to hope it doesn’t come here. It’s true they’ve closed borders, but we already know from Senegal that those borders are not foolproof. We can hope that it doesn’t make it here, but we are lucky to be able to have that hope. What about the other countries that are already being devastated by the disease? The count continues to go up and it doesn’t look like it’s about to steady out or drop off any time soon. Are you really going to tell them it’s difficult to spread? Ebola, whatever it might look like on paper, or whatever it seems like from an American perspective, is easy enough to spread here. It should not be downplayed. Numbers are going to continue to rise. The way of life here and the state of things guarantees it. This is the reality.

Travel

Travel in this country is always an event. Today, it was especially exciting. It started when I agreed to transport two kittens to their new owners. This particular drive normally takes three hours over an unpaved road. I had a box for the cats and figured I would carry the box on my lap and that would be that. How hard could it be? That was my first mistake. I loaded into the car, pressed up against the door and a woman next to me. In all, there were eight people in the car, plus the two cats. I had the box on my lap and we hit the road. Off to a great start! We were moving along when suddenly, there was a loud PSHHHHH and the tire had burst. We had not been driving for 20 minutes. Not an auspicious start. But we all got out, the driver changed tires, we loaded back in, and were off again! 

View from the road where we got a flat tire.

The car started to get quite hot. The sun had come out and body heat was taking its toll. Only the two front windows worked. There was not enough air circulating. Maybe 30 minutes after the tire incident, the woman next to me takes out a plastic bag. She opens it up and gets it ready. The driver wants to continue, but we beg him to pull over. He finally acquiesces. The woman gets out, vomits a bit, then we all climb back in. The car is really getting miserable at this point. It’s sweltering. We’re all sweating, but there is absolutely no relief and our sticky bodies are all pressed against one another. I manage to physically pull down the window with my hands. Finally, air! The window goes down about half way, but it’s better than nothing. At least the top of my forehead gets a cool breeze. Then we hit a really bad part of the road. It’s been bumpy the whole way, but now it’s totally uneven and there’s a lot of mud. We bottom out and the car starts sliding sideways and soon we are stuck. Everyone has to get out. Now, remember the car was stuck because of mud. That means we all had to get out in calf-deep mud and trek through it for a few minutes. It oozed between our toes and covered our shoes and legs and was totally messy and gross. We then had to wait half an hour while a team of men dug out the car and pushed it to safer ground. Then all of us walked down to the river to wash the mud off of our bodies. We got back in the car. We start driving again, only to have another tire burst. We all have to get out again, and begin to walk down the road as the driver changes tires. I have to scoop up my skirt to prevent it from dragging in the mud, while simultaneously holding a box of kittens, while also worrying about where I step to make sure it’s not in any of the deep mud. It was a challenge. The cats also decided that now was the time to try to escape! They began clawing out of the box and pushing their little heads out. So now I was also occupied with pushing cats back into the box. A man, seeing my struggle, offered to hold the box of cats. "Are you sure?" I asked, "They’re trying to get out." He assured me he wanted to help and took the box. I am finally able to focus on where I am stepping and things are much better, until the man yells, “The cats are escaping!!” I drop my skirt and run over to him to push the cats back into the box, only to step into an ankle-deep pile of mud in my haste. The driver finished changing the tire and comes to collect us, only now my foot is coated in thick layer of mud. The river is no longer nearby. I look around. I begin to scrape off some of the mud with leaves. “We have no time! Get in!” Says the man in the front seat. “I beg,” I say, and continue to scrape at my foot futilely. I give up and get in. Now, the kittens have totally destroyed the box and cannot be remotely contained. I have to clamp it down and cover the top with both of my hands. Did I mention I’m allergic to cats? We get going again, but everyone has lost steam. We have to stop and trek through mud several other times. The driver pulls over to the side of the road and opens his door, and shoos something out. “A mosquito?” A man asks. “No, a small scorpion,” the driver responds. He shuts the door and we continue. Finally, five hours after our initial departure, we pull into the car park. The journey is over.

Joke!

The next day (as it was too late to catch a car to my next destination by the time we got in) I go to the bus station at 8:30am to catch a car. I go to buy my ticket. The bus is going much further than my own destination, and thus I only want to pay for a ticket to bring me to my location. However, they tell me I must pay the full price for the last stop that the bus will make. Does it make any sense? No. Do I try to argue in vain? Yes. He will not sell me a ticket for less than the full price to go to a place I will not go. Eventually I talk to his superior who has a bit more sense and get a slight reduction. I get onto the bus. Two hours later, we leave. This bus does not have windows that open. Instead, we drive with the door cracked and activate the emergency openings in the roof. It is still not enough air. We make pretty good time though. In fact, we save a few minutes by leaving one of the rest stops before all of the passengers are back on the bus. Just drove off while they were still in the bathroom. I arrive at my destination at 3:00pm. Am I done yet? Nope! The next morning I must go to the main street to catch a car. There is another man waiting on the roadside with me. We are able to catch the same car. I put my luggage in the back, and he moves to do the same. He has two giant, 100kg bags of raw meat, freshly butchered and still leaking blood. He throws them in the trunk as well. It smells. The smell is not good. After an hour in the meat locker, I arrive at my other destination. Still not over. I now must catch a motorcycle for a three hour ride to my house. I’ll let you imagine that one. 

Treatment of the Mentally Ill

While walking home in the evening, I came across a women lying in the middle of the road, screaming in agony at the top of her lungs. It looked like her arm was bloody, and my first thought was that she had been hit by a motorcycle. There was a small group of people standing back on the road observing everything, so I quickly approached them to see if they knew what had happened. They did not. They told me that she was mentally ill, however. They seemed unwilling to do more than watch, so I went to the woman. She had a large head wound and her shirt sleeve was soaked in blood. She was crying and moaning that her head and arm hurt. I tried to ask her what had happened, but she did not respond. One man came over and said he thought she had come from the hospital. We asked her again and she said that she had been at the hospital and they drove her away, she returned and they beat her. The man nodded and explained that she often disturbed patients there and that this was a likely story. It is no secret that people with mental problems are not treated very nicely here. In town, people often make fun of them, push them away, or even throw things at them. However, it was saddening to believe that a hospital would do this to anyone, let alone a mentally ill patient. The hospital, of all places, should understand how to treat and handle someone suffering mental health issues. This left us in a bit of a dilemma. In her condition, under normal circumstances, I would have recommended that she go to the health center to receive treatment. However, if it was the health center that did this to her in the first place, that was no longer an option. I doubted that the police would be very helpful, if any of them could even be contacted or found. We were able to extract a relative’s phone number from her, and immediately called him. He was in a different town, but said he would call another person to come and collect her. In the meantime, I decided to go to the hospital (only a short walk away) to find out what had actually happened. I arrived at the hospital and found a nurse. I began to ask her if the woman had come to the hospital. “Yes, she was just here.” I then mentioned that she had some wounds and might have been beaten… “Oh yes, it was me,” the nurse replied. “She came in and scattered my things and put on my sleeping cap, and so I beat her well and then the guard brought her to the road.” Mystery solved. It was so disappointing to hear the health care worker talk about how she had beaten a mentally ill patient to the point of bleeding, all because the lady had put on her sleeping cap. It’s times like this that I become discouraged or disappointed with this country. How could someone hurt another human being like that? Beatings are rather common here, but normally it is a small slap to the arm, or a hit with a stick to a school child—still things that I don’t approve of—but not to the point where you have done true physical harm to the person. To beat somebody until they are bleeding from their arm and head is incomprehensible to me. I tried to advise the nurse on how to treat the woman in the future, but it didn’t leave much room for hope. We went back out to the woman, who started to wander off despite our pleas for her to stay. We called her relative one last time to let him know where she could be picked up, but that was as much as we could do. 

Vaccination Campaign

This past week my village health staff underwent the challenge of providing free yellow fever vaccines to everyone in the community. The government provided free vaccines to all men, women, and children who were over 9 months old. It was a wonderful opportunity for the people in village, as this new vaccine protects them for life. It was a great initiative, but difficult for the health to actually carry out. They had about four days to vaccinate 14 villages. There are three health workers qualified to give shots. They were busy, to say the least. Each day we split up and travelled to two or three communities before returning home late in the evening. Most of the travel was done by trekking to the villages, often in the rain as it is currently rainy season, carrying a container of the vaccine, a box of disposable needles, and a cardboard box for the waste. On one day, I trekked in between 15 and 20 kilometers. When we arrived in a community, we would gather the population at some central point, like the chief’s palace. I would unwrap the needles, and the health worker would prepare the shots. Everyone would line up, and then the health worker would inject people one by one. The health staff did not have gloves, they did not have band-aids to cover the injection spot, they did not have alcohol swabs to wipe the arms. They simply took the syringe, gave the shot, and the person walked away. Then the used needle was dropped into the cardboard box.

It was a very interesting experience, as the entire town would watch as a particular person received a shot. Young kids in particular liked to watch to see what someone’s reaction would be, laughing hysterically if the person cried out or made a funny face. A funny pattern emerged, in which very young children were expected to cry, but almost all other people were expected to show no sign of pain. For the young kids, it was acceptable to cry and people understood their tears without trying to interfere. However, around the age of five or so, it became unacceptable to show pain. Little kids over five years had to suck it up, and did their best not to cry or make a funny face when they were injected. I was amazed by a tiny girl who stepped up alone, without any parent forcing her to do so, to get the shot. They put the needle into her arm and you could see a flash of discomfort come across her face, but then she locked it down. It must have taken her everything to stay impartial, but she did not break. She walked away in her flowery dress without a single tear falling. It was almost heartbreaking to see such a young child put on such a display of bravery. But it wasn’t only the little girl who had to put on an act. All children (both boys and girls) were not allowed to react in any way. Young men were especially not supposed to show any sign of pain. They had to receive the shot without any change in facial expression. All adults were also expected to remain calm, although old men and women seemed to be allowed to make a bit of a joke out of it. The older adults would often make faces of discomfort, which was acceptable, but still drew peels of laughter from the on looking children. However, the rules were bent for women from the ages of 15 to 25. They were actually expected to overreact and be incredibly dramatic. They would get a shot and would cry out or scream or shout and then rub their arms and run away from the doctors and then huddle with their others friends making faces.

In all, it was a very successful campaign, and hundreds of people are now immune to yellow fever. 

What I Love Most About Life in Cameroon

As I approach the one-year mark, I reflect on all the reasons I love Cameroon.

1. It is the closest I will ever come to being a celebrity. People know all about my life, while I don’t know their name. I can go to a different town and someone will come up to me and ask me how my puppy is. Children run up to me and poke me, just to say that they touched me. People show up at my door simply to say hi, and then trek back to their village. Kids come running out of their houses when I walk by. People stand out in the street shouting my name and waving to me whenever I’m around. Mothers will give me their babies to hold. Everyone wants to snap a picture with me. Random kids will come up to me and hold my hand until I am walking down the road with a trail of people touching random parts of my body. I will never again be surrounded by so many people who care so much about me while knowing me so little.

2. I am beyond prepared for the ice bucket challenge, should anyone nominate me. You think you’re so hardcore for doing the challenge? I get to do that every morning of my life here. Water comes out of my showerhead after sitting in a high-altitude mountain jungle all night. Yeah, it’s pretty cold. And guess what? It’s not hot here. Despite it being Africa and all that you may be imagining, I am living on a foggy mountain. My showers are not exactly enjoyable. But I’m also not screaming or running away every time the showerhead turns on (like many of you do in the videos I’ve seen). While we’re on this subject, most of my friends don’t even have running water. They have to go walk to a pump and haul their water back. They think you’re crazy for pouring a giant bucket of potable water—mixed with ice (a luxury I haven’t seen in 12 months)—onto the ground. And you film yourself doing it. A bucket of water here goes a lot farther than that. A single bucket can be a few baths, a hand washing station, used for cooking, poured into a filter to purify for drinking water, and then still used to wash your filthy stinky clothes. Don’t believe how dire it is? Ask the particular volunteer who put his dirty bath water into his water filter to drink later. But yeah, hey, a job well done to you for dumping that water on your body to get out of donating to a charity and having the internet capabilities to upload it so all your friends can see the struggle you went through. Ashia to you.

3. Where else can you hear, “I have prepared rat mole for you. Will you eat?” And under what other circumstances would you actually try it? And when else would rat mole actually turn out to be pretty good?

4. There is no focus on your appearance. There is nothing so humbling as not showering for a week, forgetting what makeup is, and wearing clothes that reek of mold. The thing is, it doesn’t matter. People are still happy to see you. They clap and give you giant hugs. They even tell you that you look beautiful. They compliment your dirty hair, they point out your strong feet, they say you have nice eyebrows, they tell you they love your dress. You also don’t have to worry about gaining weight, because everyone wants you to be fat! They are actually disappointed if you haven’t put on a few pounds. They say things like, “See your stomach is like your back! There are even no intestines in there! You must eat more!” And then when you do eat some more they say with pride, “You are really getting bulky!” And they cherish you even more.

5. Picking your nose in public is totally acceptable. I’ll admit, I haven’t exactly caught on to this one. It’s still a bit strange to me to be making eye contact with someone or be in the middle of a conversation with someone who is picking their nose. But I will say that I think the concept is kinda cool. No shame.

6. Witchcraft.

7. I will never in my life get more marriage proposals.  I won’t. It’s the sad truth. I have already hit my peak. But the good news is that my peak is going to last for a solid two years. I literally don’t think a week has gone by where I haven’t had at least one proposal. The man sitting next to you on the bus, your moto driver, some stranger walking by on the street, your friend who you’ve already said no to fifty times, a gendarme officer, a guy who claims to be president, the village chief, that bartender you once bought a drink from… all perfect candidates to propose to you! Declarations of love are made in all forms, from poems to general shouts to kissing the soles of your feet (see previous post). You’ll receive texts like, “Good evening beautiful, since the first and last time that I saw you I thought that you pleased me and want to see you again. Make me a sign that you accept.” And, “Dier my name is frank, pliers I will call u latar, I nerd to see u. I am mad becurs of u, pliers I will u good bye kiss frank?” Who wants to miss out on gems like those?

8. Outfits here are incredible. Style takes on a whole different meaning. I believe I have alluded to some of the androgyny that occurs with clothing here (like guys wearing shirts with extra fabric clearly meant to be filled by breasts, or grown men in pink sandals with sparkley flowers), but I want to reiterate it. People have some really great outfits. When else in my life will I get to see an 18-year-old boy wearing a shirt that says, “Do you have enough footballs for a girl like me?” Or a tough moto driver with a pink silk jacket with the word “Pretty” in silver rhinestones on the back? Or people wearing santa hats seriously? The answer is, I won’t. So I’m going to enjoy it while I can. One of my favorite pastimes is simply observing what people are wearing. You might be having the worst day in your life, but then some man is going to walk by in a denim suit with “Mishel Obama” written on the front pocket while also sporting a zebra-striped pimp hat and wearing pink sketcher shape-ups, and the world is good again.

9. People have a true enthusiasm for life here. Even the smallest of things can bring massive enjoyment. For example, my carpenter noticed a glade air freshener cone that I had originally brought from the US. He asked if I had an extra. I didn’t, but I told him I’d have my parents include one in the next care package. They did. I went to his house and delivered it. You would have thought I had told him he had won the lottery. He went batshit. I don’t think I have ever been blessed so many times at once before.

10. I will never complain about potholes again. I have a new appreciation for any type of pavement, no matter its condition. The roads in my village have gotten so bad that people are using snow chains because of the mud. Snow chains. No joke.

I am incredibly grateful for my year in the one and only C-roon. My life will never be this exciting again.