.project 21

so do you what its like
to sit in a chair
maybe a wooden one with broken down slanting slats
or a plastic blue one
to drink tea with milk, tea with sugar and sugar and sugar
tea that is syrup and candy and hint of spice

and facing you
facing you are two people
each week the same
each week different
they have brand new note books
they are in their best clothes
clean dresses and hats
matching skirts and headscarves
pens in their hands
eyes on mine
expectant
waiting

and to know
when i sit there
that what i have to tell them isn't what they really want to know
that what i have to tell them isn't what they are really hoping for
and that i will phrase it
and re-phrase it
and explain
and re-explain
and try
through it all
to give them something
they can work with
something
they can take home
something
that matters

community health
the branch of nursing i most despise
the branch of nursing most needed her
Project 21
lasting until September
spending one week in each village in the district of Bere
lectures, dental work, Community Health Worker training, Midwife training
I am lecturing on TB, HIV/AIDS, Malaria
and I created and am teaching the training program for the Community Health Workers (CHW)
and this is a pilot project
we are training 2 CHW in each village
networking with them
developing a framework
that will help facilitate the greater
the much needed changes

changes like potable water accessible to each household
changes like Indoor Residual Spraying of DDT
changes like getting a big-time grant to eradicate Malaria in Chad
changes like getting a grant for well-drilling or other methods of providing potable water

these are the changes that are needed
these are the changes that are years away

but here we are

and when we assess,
I ask -
what are the biggest community health problems that your community is facing right now??

and its always

always

always

#1.  Lack of Potable water
#2.  Malaria

no family here has been un-touched by the Malaria
it is like a buzzing scourge
deadly
invading homes
wells
latrines
zzzzing and retreating
biting and receding
a miniscule army
killing more than any
armed conflict in chad
combined

leaving welts on the skin
and holes in the ground
missing spaces
broken hearts
resolute
dogged
determination

every village
i sit there
every week
and i hear the problems
the children are dying
the suffering of the people during rainy season
no clean water
the diseases caused by lack of clean water
the abuse of women
gender in-equality
measles
malnutrition
HIV
starvation

and they sit there
with their pens poised
and their papers blank
and hope
they come with hope
hope

and what do i tell them?

i give them a schedule
I assess their knowledge, experience, willingness to participate
i tell them they won't be paid
i tell them we are operating with almost no funding and low resources
i tell them this is the beginning
that we wanted to create CHW
and place them in a position of respect in the community
to position them
so they could affect change
so they could organize their community
blah
and so blah
but really, we are fighting to get grants
to get funding
to get the kind of weight it takes
to take on the problem of malaria
to take on the problem of water

but we can't explain that
we can't promise anything
we can't
but i want to
I want to so badly

so instead
i tell them about first response
i talk about ABCs
c-spine
I talk about wound care,
burn care
i give them first aid kits
i have it all typed up into protocols
I explain HIV, TB,
the free hospital services for them
their role in CHW in preventing MDRO TB - how they can encourage people to go to the hospital
I tell them about the health centers

how a consultation is only 100 CFA (20 cents) and how if they go there 1st and then get referred to the hospital, then the hospital free of 1000 CFA will be free
i tell them how to encourage and circumvent
i give them referral sheets
tell them how, with a piece of paper in their hand
people are more likely to go

i give them papers on malnutrition
recipes for nutritious bouille
i tell them about dehydration
recipes for ORS solution
i tell them about neem tea - how it can help prevent malaria
I give them a tylenol fever protocol
I give them a malaria protocol
go over the late signs and the early ones

i go over how to treat wells - even though powdered bleach isn't available in this area
i go over how to treat drinking water - even though liquid bleach is expensive to buy
i go over other methods of water treatment
most of them impracticable
none of them the solution most needed

but what i don't tell them is how
when they get to the hospital
they will have to wait all day
how the nurses may demand bribes
how they will prescribe things they don't need
how the lab might refuse to test them
like they refused the 10 patients that came from the first village for an HIV test
or how a man waited in the hot sun with his sick daughter all day
and how if they are hospitalized, nurses won't take good care of them
i don't tell them that the health centers are often terrible
giving people bad advice
sending away the sick
treating the ones with money 

and some of them listen
and some of them don't
and some of them are effusive in their gratitude
and some of them aren't.
all have varying levels of education

but they keep showing up.
they keep keeping their appointments

and in 22 days - i have promised them powder blue lab jackets and stethoscopes and blood pressure cuffs

none of which is funded by the project 21 grant

and they are now conducting a house-to-house village assessment, assessing water, assessing malaria, introducing themselves

and i can't help but feel like i'm failing them
that i'm not giving them what is really needed

but how can i do it anything differently?

i have listened, reworked, revised,
spent long hours

i have tried
and failed
and come up with the best program possible in lei of the situation, the funding, the area, what the hospital can and cannot provide, the time constraints

but if someone doesn't come and take Marci and my place - i will be heart broken

completely

i don't want to be the person that offered the glimmer of a solution
a promise that they can make things better

and then vanishes,

like all the white people that have come before me

so i sit there
and listen to all the things i cannot fix
all the things that took centuries to break down
all the things that will take decades to fix
all the things that take money
all the things i don't understand
all the things i cannot solve

and i drink the tea
and i go to the next village
but i still feel like i am failing

why is the relationship between the west and the rest so broken
why does it takes years of dedication and blood and money before change can be affected?
why can't things be simple??

someone that's an economist help me out here

i have been reading enough on economics and foreign aid lately to realize that the west has helped to create the broken parts of the 3rd world we see today

that grants and fluffy loans to failing states is not the answer

that pouring large amounts of money into cumbersome NGOs is not the answer

that we should support entrepenourship, microfinance, endeavors that help people help themselves and that demand a profit margin

but here,

kids are dying

because mosquitos bite them

kids are dying

because they don't have bleach in their wells

it sounds so simple.

can it be?