Le Petit Palud: Attitudes Toward Malaria in Cameroon.

Malaria

Mosquito_Tasmania_cropOne of the first things I noticed about Cameroon was how, often, I would see people at bars casually take tablets, what Cameroonians call medication. When I pressed to find out if someone was sick the answer would be, “C’est le petit palud” or it’s the small malaria. What? What does that even mean?

Malaria is a very serious disease that claims the lives of thousands of people a year in Cameroon alone. But to your local Market Mama malaria is an annoyance on the way to business as usual in a place where getting clear diagnosis and treatment is not always as easy as it seems. Still, le petit palud is often a describer for any number of things and could be simply a fever, typhoid or countless viruses. It’s so common here the seriousness becomes trivialized.  Here are some of the caveats to malaria treatment and prevention in my corner of the rain forest:

  • Prevention is lauded by NGO’s as a low cost reducer of malaria incidences worldwide. Personally, when I go into homes across the economic spectrum in Cameroon I rarely see nets. Why? They complain it reduces airflow in the bedroom. Many homes are already stagnant and swampy, why add an extra layer?
  • Medication is not regulated very strictly here. You can buy Coartem (malaria treatment), Ciproflaxin (basic antibiotic), Amoxicillin (another antibiotic), and even Valium over the counter here. When a Cameroonian is pressed for cash and can afford only a doctor’s consultation OR medication, 9 times out of 10 they will deduce the problem and buy their tablets.
  • The breadth of over the counter medications also compete with the widespread sale of counterfeit medications being sold among legitimate ones at roadside stands.  
  • Even getting malaria test results can be unreliable. Blood smears are not considered reliable by the Peace Corps in Cameroon and even the Rapid Tests can come up with false positives and false negatives.

OLYMPUS DIGITAL CAMERAAs an American with no natural resistance, I’ve been reminded by my Medical Officer that cerebral malaria can kill in 24 hours, especially if prophylaxis isn’t being taken prior to infection. It’s those kinds of numbers that stress me out when my own rapid test comes back positive. There is a lot of passion when discussing the long term effects for Americans taking Mefloquine, Malerone and Doxycycline. Nobody wants to be on an antibiotic for two years or have vivid dreams, but when I’m projectile vomiting with a fever and body aches I know the odds are in my favor.

Mosquito Photo Credit

Selfie Sticks in Whiteman Country

Here is a look at what stole the show on my European vacation. The selfie stick. I couldn’t stop staring—and usually the user is too self absorbed to notice that I was photographing them.

Spring 2015 Barcelona and Marrakesh II 095

It was my first time out of Africa in two years so I knew some things would seem weird. In Cameroon, to explain where you come from, another name for Europe/America (which might be perceived as the same thing anyway) is “Whiteman Country” which actually succinctly gets the point across. And the main thing I found jarring was the unabashed self absorbed behavior of my peers. The foreignness of this selfie stick made giving it Whiteman Country distinction seem appropriate. Now to be honest, I see Cameroonians in cities taking selfies, but we aren’t connected enough to make it a daily/hourly habit and we certainly don’t need a stick to do it. Maybe this behavior just a human thing, and we didn’t used to have technology that afforded us the chance to make it so obvious. I never liked selfies, they always seemed contentedly narcissistic but the selfie stick makes a lifestyle out of this.

Spring 2015 Barcelona and Marrakesh 601

I asked someone staying at my hostel what the point of them was, and he replied “Well, you don’t want to just hand your phone to someone, what if they steal it?”. I thought, but what did we do before selfie sticks? 1) It’s a mathematically irrational fear and 2) this is one more reason for people to isolate themselves more and not talk to “strangers”. I hate everything selfie sticks stand more.

I get irritated sitting next to a couple oscillating between taking a selfie and ignoring each other in favor of their phone. It’s tacky and it has become a part of our culture. How about trying this: put your phone down and be present.

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GINI in a Bottle: A Comparative look at Inequality in the United States and Cameroon.

When I sat down to look at the income inequality index for Cameroon, I thought I would spend most of my time defending Cameroon for the poor performance it’s done relative to other countries. Instead, the joke’s on me. Before your mind is blown, let’s look at some basic data you probably already know comparing Cameroon and the United States:

Comparative Table

Source: Cameroon & The United States

     The Gini coefficient is a measure of the inequality of a distribution, a value of 0 expressing total equality and a value of 1 maximal inequality. To be clear, income distribution should not be confused for a quality of life ranking. Measuring inequality is just that–examining the divide, not the average.  Inequality has more than individual implications. Broadly, it affects social mobility, infrastructure, political stability, and immigration/brain drain. A distorting factor of these values is that the gini coefficient does not take into account corruption and fraud.

When I was rifling around for Cameroon gini data, I thought to myself “Wait, Cameroonians don’t pay income tax. How do they calculate this?” Well, luckily I came across this paper from the University of Yaounde, where I found out there have been three large scale consumption surveys, the last two surveys reaching more than 10,000 households, that are representative of the total population. According to the 2011 UNHABITAT paper on urban inequality, the gini can be calculated two ways; consumption and income based inequality rankings. Both the income and consumption inequalities are linked to broader economic factors like labour markets, capital investment in public services, lack of pro-poor services etc. Using consumption based gini coefficients are a stronger indicator of inequality because high gini coefficients also denote unequal access to public goods, which may act as a hindrance to poverty reduction strategies and achievement of Millennium Development Goals.

My inspiration began with this error ridden article in the Atlantic, but I was still shocked to find that the States and Cameroon aren’t so different when looking at income distribution. There are multiple places to get your gini coefficients. Mr. Fisher of the Atlantic used the CIA World Factbook, but I prefer UNDP because of it’s international presence and intuitive presentation of data. When I was comparing his own maps and comments to the UNDP, they didn’t match up all of the time. So I made my own visual.

Below is a Venn Diagram, highlighting countries based on their gini coefficient. Conveniently in the middle, you will see Cameroon and the United States, who happen to have comparable levels of inequality.  The countries in the purple, center section all fall between the narrow difference in coefficients for Cameroon and the United States. All countries were selected based on regional and economic diversity–it wouldn’t be helpful to only put Europe in Blue and Africa in Red.

Venn3

Source: UNDP

Here are some of the major takeaways of the UNDP data: 

  • In terms of Human Development Index Rankings, the United States (no. 5) sticks out like a sore thumb when examining it’s gini coefficient. Aside, from Israel (no. 19) and Qatar (no. 31) there isn’t a lot of variance at the top. There are a lot of mid-20’s and low-30’s of almost exclusively Western European countries, indicating a higher level of income redistribution (tax, social welfare programs etc.) among classically “successful” nations. Most highly ranked countries have an average gini coefficient of 32.6, substantially lower than the United States–even when factoring an average that includes an outlier like the United States.
  • The United States having a high gini coefficient could be indicative of low levels of income redistribution (low tax rates, etc.) compared to other highly ranked UNDP countries. The U.S. is a great place to be if you are extraordinary, but less so if you are average compared to other OECD countries.
  • Latin America seems to struggle with inequality, Nicaragua was the only country in Latin America within the 38.9-40.8 window. As a group, they average a gini coefficient of about 47.4
  • The base for countries that have a similar gini coefficient can have a huge variance. For example, a country like Norway, with a gini of 25.8 and Afghanistan with a gini of 27.8 have similar distribution levels of consumption, but the “Bottom” or starting points are worlds apart. The same could be said for the United States and Cameroon.

In my village, there are several “big men”, people with wealth. What is different about how wealth is handled here is that they build a 5,000 square-foot house along the road, next to shanties. I feel like, compared to my upbringing in metro Detroit, wealth is more visible here, andt also less segregated. It is not just during funeral season that the wealthy come out, they participate and sponsor most of the social events here informally. My friend Brittany asked me, how large are the elite class in the U.S. compared to Cameroon? I don’t know. My impression is that, as a percentage, there are more wealthy people in the United States, but the spread is also wider. The big question here seems to be is this a problem?

The Hitchhiker’s Guide to Cameroon

OLYMPUS DIGITAL CAMERA  Transport in Cameroon is one of those outwardly chaotic systems with a surprising amount of efficacy. You can get almost anywhere in Cameroon without a car and on a budget. For an outsider, it tends to be uncomfortable and cumbersome, but getting from Point A to Point B also happens to be cheap enough that the average Cameroonian can afford it and those are the target customers. The proliferation of VIP buses in many of the larger cities indicate that Cameroonians are also not crazy about being crowded onto fuming, disintegrating buses.

Which brings us to hitchhiking—the non-VIP alternative to public transport. Internationally, hitchhiking is more common than in the United States; in Russia it has found itself being regulated and in Cuba it is the de facto transport method for urban women. Most drivers in Cameroon are men. In fact, I’ve only ever ridden in a car with a woman driver once, she made nothing of it but happens to spend half of the year in England and South Africa. To get a ride you should go to the main road. Sometimes, there is a man there who somehow makes his living hailing down buses and negotiating prices. You can tell him where you are going (tell him you want a private car) and see what he produces, or you can stray a bit away from the crowd to try your own luck. If you are doing this without the help of the worker, as a car approaches in the direction you are going, stick out your finger or point in the direction you are going, if they roll down the window or seem curious through body language tell them where you are going as they pass. Watch because they might slow down. Next, you  run up and tell them your destination, sometimes they will negotiate price on the spot. Always ask locals in advance how much you should pay to get where you are going.

How to have a decent hitchhiking experience:

  • If you can’t hold it in your lap, leave it home. When a driver slows down, if they see you bringing a roller suitcase plus the kitchen sink he will step on the gas. You need to be mobile. This is also just common sense because it reduces your chances of loosing something or being seriously robbed.
  • Dress how you want to be perceived. This is especially true for women. Cameroonians place a high value on physical appearance. You are supposed to look clean; women should wear dresses and try to look as fancy as you can afford. Knowing this, I do the opposite. I generally wear clothes that are already dirty, stains are fine, my shoes have visibly been repaired countless times and are held together by black thread, my pants have multiple holes in them and are probably men’s pants I got out of a hand-me-down box in Yaoundé. I want the driver to view me as poor, and as unsexy as possible. It reduces harassment, marriage proposals and people taking advantage of you.
  • When possible, do not pay in advance. This gives you the opportunity to charm the driver and possibly reduce your gas fee. I once had a driver explain to me that the more visible I am in the car, the less the police harass him for bribes because they think I might be a diplomat (considering the previously mentioned outfit, I found this laughable) which gives him his own monetary advantage. The man who hails cars for you at the main road may ask for money in advance, this is so he can take his own cut. That’s fine, but if you end up getting your own car, you might lose that money.
  • Find commonalities and smile. Generally, be nice. You represent your family, your culture, your organization. Ask them about their tribe and family. Remember that Bamileke are good business people and flatter them with this when you find out that is their tribe. When you find out that your driver is Bakossi, greet them in their language or talk to them about their Christmas traditions. You get the idea.
  • There is a certain power structure in hitchhiking in this transaction. Especially if you are female. The driver is not in business and he can dump you at any point. Most drivers won’t, but realize that you, the passenger, are the vulnerable one. For example, if the driver asks for my phone number I always give it to him. That doesn’t mean I pick up the phone later, but I don’t want to be stuck in his car defending why I don’t want to talk to him after this.
  • Life is just easier if you are a man or in a group.

OLYMPUS DIGITAL CAMERA    I’ve hitched a ride in everything from a tractor to a semi truck to an Audi. The rules all seemed to apply evenly here. Don’t forget to pay it forward.

The Politics of Sharing

You might have noticed that my blog seems to be lacking substance. It doesn’t feature a lot of the standard Peace Corps Porn of one white person surrounded by Africans in traditional clothes, I think twice before adding photos of me holding Cameroonian babies.

OLYMPUS DIGITAL CAMERAFrequently, I am in the throes, experiencing a high or low, because of the relationships I have built here. My friends and coworkers share their triumphs, struggles and daily annoyances. The juxtaposition that is life in Cameroon would fit neatly into countless narratives. Often, I sit down to write about my frustrations of getting two children to rejoin their classmates in school, the realities of corruption or my thoughts on the food here but I end up just saving a draft of it on my desktop. I have a whole folder full of the nitty gritty.

Why do I stop? Because I feel that to write about my friends, my village automatically patronizes them—as if I understand things more than them. I don’t. For instance, I hate the unending carb festival that is Cameroonian food, but later I came to understand that all that energy is traditionally used on the farm. Cassava has its place I suppose. The idea of my friend stumbling upon my blog to read about her own child marriage and subsequent ending to her education would make her feel scrutinized and used.

It is easiest to pass judgement on groups of people we never interact with, and for many people Cameroon is very far away.

A few months ago, I was sitting with a few other volunteers talking about middle America, in terms that make Kansas seem more foreign than Cameroon. My friend told me how she drove through small towns that were basically a cluster of houses along a road with no running water or electricity. I felt embarrassed because I didn’t know that places like that still exist in the United States. I never considered that a person in the first world could have a domicile with and address along a highway but no lights or water. Sure, I knew about homeless people, but this was news. This story is important because we all fall into the same category: human. Life in America and Cameroon may seem worlds apart, but at times the only difference seems to be the distribution of the types of experiences we have; America has extreme poverty and extreme wealth, it goes the same for Cameroon.

OLYMPUS DIGITAL CAMERAMedia, independent and corporate, is so often searching for the exception to the rule to speak for the value of a larger system; octomom, to display why sperm banks are immoral and Dr. Kevorkian, the de facto representative of assisted suicide.  I want people to know that Cameroon just isn’t that different, when it comes to the human experience. To write about them feels like I have to objectify and separate myself from them. We don’t exotic pierogi, and we don’t need one more “Cameroonians need help story”. To write about my story here means that I will be writing about their story, and I haven’t quite figured out how to do that yet. For the record, I have two friends who write very well about their Peace Corps experience in a way that honors the culture (you can find their blogs here and here). For now, I am very careful about how much I divulge on the internet.

Lessons Learned in 2014

This is a photo of the largest street in Douala, completely blocked with traffic on an average day.
This is a photo of the largest street in Douala, completely blocked with traffic on an average day.

The other night I was on a bus back to my village. A ride that should last 3.5 hours quickly turned into seven. Our bus broke down twice, ending with a passenger holding a phone for light while we both got the bus running again with a rusty butterknife and copper wire. Nevermind the driver. As we finally got moving again I thought about how exactly a year ago I was also on a bus to my village and it took us 11 hours to move 10 kilometres due to standstill traffic. There are stark differences. Last year, I vacillated between crying hysterically, yelling at people on the bus and climbing out the window to go to the bathroom. I felt completely powerless in a city I knew nothing about in the darkness. This year, I was calm, quiet and shared roasted peanuts out of a used soda bottle with other passengers. Instead of freaking out about the 10 people in a 4-person  row behind me, I made friends with them. My Motor City skills even came in handy!

2014-12-19 10.06.30So much about Cameroon finally feels normal. I’ve made peace with the peach and the pit of life here. Here are four souvenirs I want to bring home with me:

  • Gratitude. In college, I babysat for the 3 children of a family therapist. Before bed each child needed to tell me 3 things they were grateful for. Almost immediately, I adopted the habit for my own life and find myself using it when I am stressed or just daydreaming. I may have learned the habit of gratitude in college, but I mastered it here. The highs and lows mean that I need that stability to remind myself why I’m here and that things are almost always not that bad.
  • Patience. I would openly admit that patience might be one of my fatal flaws—I don’t have any and I have no intentions of cultivating in consciously. But here’s the catch, I seem to have learned it here. Nothing is a big deal in Cameroon. In a place where I can be delayed by hours or even days, I have learned to just pull out my book or make sure I have enough money for food. I’ve realized that if I am climbing on top of busses to yell at people, it had better be to make myself feel better because it will do absolutely no good. My friend Lauren said this to me recently, and I think it summarizes the best outlook for coping “Cameroon: where nothing works, but everything works out.”
  • Presence. Don’t come at me with your smart phone at dinner. Leave it in the car. All that multitasking leads to a lot of OLYMPUS DIGITAL CAMERAdistracted, meaningless conversations. In Cameroon, it’s perfectly fine to just sit with your friend and not say anything at all.
  • Being unplugged. I could write volumes on how much I love high speed internet. I miss streaming NPR all day. Fact is, that is just not reality here. In exchange, I’ve read thousands of pages, watched TV Shows I wished I’d always seen, and learned that life does go on when there is no electricity. It’s nearly impossible in the States, but that won’t stop me from being a little more careless with my cell phone.

Violence, Guns and Cameroonian Perceptions of American Culture

OLYMPUS DIGITAL CAMERAThis past week, I was having a Coke with my friend, Prosperity. He is educated, employed, Anglophone and thoroughly modern. He is also openly curious about American life. Whenever we get together we usually discuss politics and culture. One conversation led to him detailing how he has heard that America is very violent, that if he was to go there “I should fear taking a bullet at any moment.” I pointed out that I think Cameroon is just as crime ridden or worse, the difference is that the government doesn’t report on it. And if they do, the numbers are only a weak reflection of reality. I followed that up by explaining how increasingly prideful I am of Americans because when we don’t like something, we collectively or individually do something about it, reflecting on the riots in Ferguson over the killing of Michael Brown or the countless volunteers delivering water to people who are going without in Detroit as the city government takes drastic measures to balance it’s debts. As Americans, we do something about it when we don’t like a situation. We have hubris.

Inscribed on Cameroonian governmental signs, after the name or function of the building are three words that translate roughly into “peace, work, patriarchy”. This is their mantra, their motto. After a year of living here, I can attest to the “peace” part. Cameroonians have one of the longest running histories of peace in Africa, guns are very tightly controlled here, and I do not see men fighting here. Sure, they yell and wave their hands enthusiastically, but they seldom outright hit eachother (note: this excludes family members. Cameroonians still apply corporal punishment among family members, wife or child). When I meet Cameroonians, one of the first things they bring up is their pride in how stably peaceful the country is. To counter that, things are not perfect here, Cameroon is one of the most corrupt countries, regularly noted by Transparency International. Human Rights are violated here with little fear of repercussion, and Boko Haram is cementing their foothold of terror in the North everyday. But almost no one fears being shot to death on accident or on purpose.

If a person used the New York Times headlines to judge the level of peace in America, Prosperity would not be wrong to believe America is a place teeming with crime. America is facing an epidemic of racially charged gun violence, no one can deny that. Walking home, I acknowledged that America was violently created through the genocide of indigenous Americans and then industrialized through slavery. Violence is at the core of American culture. We shouldn’t be prideful of that. In fact, I think our leaders and people should demand reparations

But the question remains: Do we want non-Americans to view us first as a crime ridden, violent country? Will we allow that to be our legacy?

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