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Vignettes

February 20, 2012

They will meet.
Six of us drove around all day to have meetings with various community elders, chiefs, and to visit the clinics that Medair is helping to rehabilitate and capacity build.  I came along to attend meetings with the boma (village) chiefs to request that they mobilize their people for a community meeting at which Medair’s Community Liaison Officer will attempt to get the community to realize how much improving their hygiene practices will help their lives, and then present them with an offer of a Hygiene Promoter Training.  The community then selects those to be trained.  We drove north from Geigar on the highway, then headed into the bush on dirt roads that only exist during the dry season.  Because they are destoyed each year, the roads are never constant, and a new path is forged each year, sometimes several new ones.  We tried to find our way on these roads making decisions of direction at dozens of forks in the roads.  Each time, someone in the car predicted, “They will meet!”  Sometimes, this was the case that the path diverged and converged after a row of bushes, but sometimes they did not meet.  None the less, we made it to our destination by following the tiny white fleck on the horizon that signified a building, which meant a town, which meant it could be the town that we are seeking.  Some of those in the vehicle had been to this town, but never from the direction we came.  We didn’t have a GPS or the coordinates of the destination.  Once in the town, we went to the clinic, but it was closed.  Where is the nurse?  As we drove through town, we saw familiar faces of projects past, who each tried to help us accomplish what we wanted.  One chief was notified we’d arrived and came to meet us under a tree.  We were told the other chiefs were coming.  We waited and waited.  And so we met with the first, as we waited to meet the others.  They never arrived and were reported to be unavailable and far away.  But alas, “they will meet”.  My path will diverge and converge with that of so many, but in the end, “they will meet”.  All paths lead to the same place, and from every path, you can get to where you are going.  They will meet.

The nurse, as it turns out, was delivering a baby.  We saw him at the clinic later, drunk as a skunk.  He was proud to show us a series of rabies vaccine that he’d purchased in his pharmacy side business and was keeping it in the vaccination cold chain fridge.  My 3 rabies vaccination shots cost over $700 in the US.  I wonder how much he paid for his.  And did his stay in the cold chain, or were they in fact useless now?  Also at the clinic was a pile of boxes of expired medications and some loose, uncapped needles, provided by the Ministry of Health.  They weren’t used because 1. they were kept in boxes, not unpacked so that it could be known what was in stock, 2. the clinic staff aren’t trained to prescribe some of the medications, not knowing what they are for, and 3. there is no feedback system between the clinic and the Ministry of Health, so whatever is sent is a guess of what is needed at the clinic.  I also spotted a lab room, all equipment covered in dust, obviously unused.  A centrifuge, a microscope.  While we were at the clinic, a young girl came to tell this nurse that the woman who delivered the baby was feeling light-headed when she walked.  At the same time, a midwife came to the clinic, so the girl also told the midwife of the problem.  The nurse barked at the girl saying, “Who are you to come tell me what is happening?  It is up to me to go check on the patient to know what is happening!”  One of our staff asked the midwife to please visit the patient, and explained to the girl that the mother had lost a lot of blood and needed to take some iron supplements.  The midwife said, “Why should I go now?  Was I called to attend the birth?”  She hadn’t been notified.  The nurse insisted that he would go.  Our staff member wanted to keep this drunk nurse away from the patient, so she pleaded with the midwife that it was her responsibility to go.  The midwife agreed to go, but only for the sake of our staff member, but otherwise she wouldn’t because of the drunk nurse.  This is apparently how the clinic is functioning currently.

Sub-Standard.
We drove into the returnee camp in Renk to a particular hut with walls and roof of straw and wooden supports.  Hardly a building.  This was the administrative office of the returnee camp.  Thousands of people fled from southern Sudan into many places, including the north of Sudan, many settling in Khartoum.  Now that they have a country to return to after decades of building a life in a foreign place, they loaded up as much of their household as they could onto trucks and barges heading south into South Sudan.  Now, they are in the northern most tip of South Sudan, waiting for transport further south, back to their homes or to better cities.  This is a temporary camp where thousands of people have set up dwellings using the furniture from their home in the north, and various materials provided by NGOs offering aid.  Their roofs are bedframes and chairs.  Their walls are blankets and the back of cupboards or wardrobes.  Their tables are trunks of belongings.  They largely rely on the aid provided – food provisions, dwelling materials of sheets of plastic and cord, soap, etc.  The land is not their own, and so no care is taken to keep the environment clean.  This contributes to poor health throughout the camp.  On this day, our goal was to plan for a community clean up day – one day where each and every member would clean the area around his/her dwelling, gathering up the trash and bringing it to a nearby burning pit, and sweeping the dirt for debris.  The camp is divided into sections 1-8, each with its own chief and Medair-trained hygiene promoters, all of whom were present at the meeting.  We discussed how the clean up day should be, pay, voluntary work, where the rubbish pits should be, how the rubbish should be transported, who will clean up the open areas that no one will claim, how we can motivate the community, and the responsibilities of the involved parties: Medair, the chiefs, the HPs, and the community.  After the plan is set, one of the chiefs begins to argue that this job is not a 1-day job, it is, in fact a 5-day job, requiring 5 days of pay, but also one full day of cleaning the environment is too tiring.  Here is Obstacle 1.  We try to explain that this is a short campaign to begin the cleaning of the camp, which is an ongoing process.  The community is responsible for keeping their area clean and Medair wants to facilitate a 1-day campaign to get the bulk of the work done so that maintenance of cleanliness is easier.  They see this project as Medair’s project and Medair’s goal that they are helping us to achieve.  They don’t need the camp cleaned for themselves, but Medair needs it clean for the donor’s approval, to show the progress that made with the loads of money that we apparently have been given to provide for the people everything that they need (and apparently more that they don’t, like a clean environment).  Obstacle 2: The chiefs want more pay.  The HPs want more pay.  We try to explain that the money promised to them for their participation is an incentive, not a salary.  They are volunteers, responsible to the community, and Medair wants to help make their hard work appreciated.  This is not understood, for they are losing a whole day to this project, when they could be…doing what?  Most of them don’t have another income-producing activity to be sacrificing time away from.  Obstacle 3: They need rakes, 2 per section.  Agreed.  Obstacle 4: This is not spoken directly, but the biggest obstacle of all is that Medair is trying to help the inhabitants of this camp to live under a set of minimum standards (“Sphere”) of dignity, health, and life, but they are refusing to participate in this achievement, and even deny a desire to meet these minimum standards, such as living in a clean environment.  These standards are those that should be attempted to be achieved even in the most grim emergent circumstances.  And they reject even that.  What is Medair to do?  All plans for the clean up day were put on hold until it could be presented at an aid coordination meeting to see which other NGOs can contribute.  But no matter how much is poured into such a campaign, if the community refuses to follow up with keeping the environment clean, then the camp will be in the same state as it is in today in about a month.  If they don’t want it, why should we do anything?  It can’t be forced.

By the way, some of the families living in this camp actually have vehicles!  The question that comes to mind is, if they want to go south, why don’t they just drive?  But why would you do that when IOM is offering a free barge ride?  Some of the dwellings in the camp are not occupied, or have one occupant and loads of household items.  The family brought all their things to Renk and left one person to guard it while they returned to Khartoum to live their lives, waiting for the free barge ride.  When the barge is near to Renk, they will pay for transport to return to Renk to load their things onto the barge from there.  These are the things that are happening, the ways people are surviving and taking advantage of the systems.  I don’t think its wrong, just ironic.  If you wanted a new life in your new country, wouldn’t you sell all your things, travel light and hope to get you and your family all the way back “home” safe and sound?  Why hold on to all the “stuff”?

Mobilization.
Mobilization is a frequently used and heard word among my colleagues.  To move.  The first step to any project is mobilization, of the community.  We want the community to become active in what we want them to do.  Sometime we try to let them discover that what we want to do is also what they want to do, but this is difficult and often not achieved.  Community ownership, of a movement, of an idea, of a project is essential to the project’s success, but very difficult to achieve.  We think, “If we could just get everyone to pitch in just a little time, effort, money, then this problem could easily be solved!”  But when the ownership is lacking, so is the will to move.  In Awerial, DE and I were driving to a clinic that Medair is rehabilitating.  On the way into the town, there were hundreds of people migrating towards one point in town.  At that point were hundreds more in colorful garb, singing, shouting, and dancing, while many of them were carrying bundles of dry grasses used for roofs and fences.  A large group of them danced and sang their way to the market in town and stopped at each shop to request a donation.  What was happening, here?  Mobilization!  For what?  Rebuilding the church.  Not just the church, their church.  The community’s church that everyone attends and cares about.  I saw the beauty of community mobilization under community ownership!  Wonderful!  But how do we get them to mobilize for a clean up day or a hygiene lesson?  In Geigar, with Medair’s Community Liaison Officer (CLO), the payam (county) Public Health Officer, and the Geigar chief, we planned a community meeting for today, Monday late afternoon at the 4 large trees by the river, a nice shady spot where the sun sets somewhere into Sudan (the border of which is marked by the river).  The CLO and I were out all day where “they will meet”, and upon our return to Geigar, started to walk to the 4 trees.  We heard horns tooting and many people shouting, and again, all people seemed be walking through town to one point.  Could it be?  The community is so mobilized for the community meeting about hygiene promotion?  Were they calling all the people to come, follow the horns, for something powerful is happening among us!?  I was excited but the CLO was skeptical.  We asked a couple boys what was happening.  “Someone has died.”  We asked an older man and the report was that 3 people were found floating in the river, dead.  We got to the place from where many people had recently scattered and again asked what happened, if there was violence involved, if they had been shot?  We always have to be aware of the current events to keep track of our security level.  The real story was that an elderly woman left her home while everyone was sleeping and apparently drowned in the shallows.  Her body was found this morning and they had just buried her by the river.  The mobilization was for the loss of the grandmother of this community.  Their grandmother.  Thus, the community meeting could not possibly take place, as it was said that this was her day and they celebrate her life, for this was her time to go.  Mobilization is possible.  Not even just possible, but they are better at it than any community I’ve seen in the US.  Start singing and dancing and everyone comes to help and celebrate.  Blow the horn and all come to mourn.  Beat the drum and they will all come to share in a dance.  As long as its their own.

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2 Comments leave one →
  1. hdknowles permalink
    February 20, 2012 10:59 pm

    Wow, how frustrating but how interesting as well. Can’t wait to read what you write about when this journey comes to an end to see if there has been any progress made. What an amazing adventure for you.

  2. Candee Van Iderstine permalink
    February 21, 2012 12:46 am

    I can really feel your frustration. It is like telling a kid to clean up their room. They don’t care how it looks, don’t understand why it is important to the parent and find it just an unnecessary chore. But when you are older and it is your house, you get it. And we are not even talking about real health hazards when we talk about a kids room. Can the clean up be a barter? Those who clean up around their homes once a month will get some chicken or some fruit or something extra special with their meal? Or how about a contest. The person who brings the most (by weight) to the fire pit/dump station, gets a reward. Something to get the kids really involved. The clean up isn’t hard, they just need motivation and don’t really get that it is a health issue. And that it should be a regular task. If the reward were by weight of stuff brought in, the kids (teens?) might be tempted to do more cleaning up in the common areas. Most of us work for rewards ($ is just one type of reward) and how many ‘kids’ clean their room without an allowance? Medair is giving these folks life needs and it is not too much to make some of those entitlements dependent on ‘community service hours’. If something is given free, it is taken. The chiefs should be the ones to enforce the clean up rules but Medair has to set the incentive- either a reward ($, food, clothing?) or the punishment (No food for the family until the area around their huts are clean). I personally think people respond better to rewards and if the youth can get involved, it just may set them up for some good life long habits.
    When someone moves out, do they have to leave their dwelling clean? If not, then when someone moves in, they should have to clean an empty dwelling in exchange for getting a clean dwelling. Thus staff only has to clean up one dwelling (the first one) and each ‘move in’ has to clean the next one and so on. If they have a real sense of community, they will not want to leave their place a mess for others to clean.
    It is so easy to sit here and think about how to motivate people. It seems it is just a matter of making it important enough to them. Keep trying and you will find the key. The culture may be different but people are people and we all seek reward for our labors (personal or financial).
    Your reward will be finding keys to motivate these people to live a healthier life and understand what it takes to do that.

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