Polio eradication campaign

 

           Attendance is picking up at my American Civilization class. In the last three weeks we have increased attendance from 4 to 14 to 26 students. This week, one of the students said that there is probably only one of their classmates who will never show up to class. I also found out that this session is the only one that they have on Thursday, so it puts a bit of pressure on me to be able to offer them something they think will be valuable, if they are going to make the trip to campus, which is not conveniently located, when they could just as easily annex Thursday to their weekend and forget about the whole thing.

          This week, with about ten students showing up for the first time, we recapped a bit of what we had discussed previously from Guns, Germs, and Steel. The retention of information from those students who had attended the prior week was excellent. They also have a good enough grasp of English so that we can have class discussions.

          With all the talk about the “cargo” (as Yali refers to all the inventions in the book) that have come from “Western Civilization,” I was curious to see what the students themselves thought to be advantages brought to them from Europe/USA and what they considered to be disadvantages.

          In their small group discussions, they produced a list of advantages that included democracy, development, education, food, health care/medicine, technology (specifically Internet and mass media), transportation, and weaponry.

          Disadvantages that showed up and on their resulting lists were the absence of spiritual values, African division, alcohol, arrogance, civil war, food cloning (genetically modified foods), colonialism, demagogy, dictatorship, double standard, drugs, exploitation, fornication, individualism to the extreme, misuse of women, pollution, protection of dictators, slavery, smoking, and weaponry (nuclear, bombs).

           For the time being, I thought it best to bypass any discussions concerning the fact that the phenomena of civil war, fornication, misuse of women, pollution, slavery, and smoking are not in the exclusive domain of “Western Civilization.” We’ll leave that for a later time. But I did recognize that it was important for me to make a reference that the dividing line between the haves and the have-nots, and the limitations on access to advancement are not only playing themselves out on an international scale among continents with different resources. I suggested that they also think about this dynamic as it exists right here in Mauritania, from one ethnic group to another.

           Fortunately, many of the students nodded their heads in response, indicating to me that they realize that, on a smaller scale and in their own country, divisions between racial groups are responsible for keeping some people in positions of power and access, while others are struggling to get by.

           We also had a lively discussion that began when one of the half-dozen women expressed her opinion that it is “natural” for some people to be stronger than others and, therefore, take power over others. It seemed to me that because she is a white Moor, and therefore a member of the most influential  social class in Mauritania, that some of the others – especially those from the black ethnic groups sitting right there in the classroom – were understanding her to mean that certain groups of people have something on the order of a “divine right” to leadership positions.

          Eventually, she cleared up the misunderstand, as we ultimately determined that she had been referring to people with regard to their personalities rather than their racial background. It struck me that this sort of confusion and ensuing discussion was partly the result of people engaging in such a sophisticated discussion in English, which for them is their third, fourth, or fifth language, and their degrees of fluency vary from one student to the next.

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          UNICEF has been partnering with the Ministry of Health to vaccinate children against polio here. The previous campaign was in 2002. This year, there have been two rounds of door-to-door visits throughout Mauritania, with the intention of reaching every household in the country. I wasn’t able to participate in the first one, in October, because it coincided with my trip to Tunisia. But I was happy to sign up for the November round. I have enthusiastically supported UNICEF and its work since I was a kid doing the Trick-or-Treat-for-UNICEF routine.

          Thursday was the first of the four-day campaign, but I could not participate because of the class I taught in the morning. We were told to meet at 8:00 AM on Friday morning at the Sebkha Health Center. If Nouakchott had railroad tracks running through it, this neighborhood would be referred to as being on “the other side” of them. We got rounded up and taken – by ambulance! – to our starting point. All of us gringos were paired with Mauritanians, which was a necessity in order to facilitate the critical communication with family members in the local languages. My partner was Sy (pronounced “see”), an employee of the health center. He was the one who dealt with the vials of oral vaccine, transported in their refrigerated box with the slogan Bouter la Poliomyelite Hors d’Afrique (Kick Polio out of Africa), showing a soccer player imposed over a map of the continent, kicking a soccer ball toward the Indian Ocean.

          There was also participation from the Croissant Rouge, which is not a pastry smeared with strawberry jam, but the Islamic counterpart of the Red Cross, which uses the Islamic crescent instead of the cross that is widely interpreted here to signify Christianity.

          Each pair of us went door-to-door asking for kids under the age of five, so that we could give them oral vaccine and Vitamin A. I was left with the record-keeping and administering the vitamins. Kids through the age of eleven months got a smaller dosage of vaccine than those who were from one year through five years.  Those younger than six months didn’t get any Vitamin A, while those from six to eleven months got the contents of a blue capsule and those from one to five years got a red capsule, a higher dosage.

          When we arrived at the first house, I could see what a juggling act it was going to be: managing the sheet on which I was keeping statistics, the pen, the red and the blue vitamin capsules, and then finding a way to get the vitamin capsules opened efficiently. There was a little nipple on the tip of each capsule, which needed to be broken off in order for the liquid inside to flow into the child’s eagerly (or frequently not-so-eagerly) waiting open mouth. Instructions that we received by e-mail beforehand mentioned cutting the capsule open with the scissors that were provided, but there were no scissors provided. We passed the capsules around to four adults in the household, and nobody could pinch off the tip! Eventually, one of the men in the household bit it off and then put the capsule into the child’s mouth. Call me crazy, but that kind of a move seemed counterproductive to me – taking something from one person’s mouth to put into another’s – especially on a health campaign!

          Just as we were leaving that family’s compound, one of the men in the family noticed that a toddler was playing with a pair of scissors. (Children do not play with jagged lids still attached to tin cans until they are at least five, and they have to wait until they are seven or so to be allowed to play with discarded double-edge razor blades.) The man took the scissors from the child and handed them to me, giving me two more objects to juggle: not only the scissors, but a tissue that I needed constantly, so that I could continually wipe up the oily Vitamin A that dripped out when the capsule was cut open.

          There was no clipboard on which to affix the data sheet, and there was a bit of a breeze that day, so it was not possible just to lay the sheet down because it could fly away – as it did several times during the day. Add to that the shoulder bag in which I kept my snack, lunch, water, sunglasses, hat, and moist washcloth. It was an ongoing balancing act all day.

          I remember back to the time when the Salk vaccine was introduced; I must have been about seven or eight years old. There I was with my classmates lined up against the wall in the basement hallway of P. S. 64, the Bronx, and each of us in turn got the injection into our arms. My memory does not include any screaming kids afraid of the needle, although there must have been some. One would think that the medical advancement of an oral vaccine would have brought tremendous relief to today’s kids. Remarkably enough, though, some were amazingly resistant to having a White Devil squeeze a little capsule into their mouths! We had to contend with a fair amount of criers, screamers, and kids that had to be held down (some by as many as three adults!) so that the vaccine and vitamins could be put into their mouths

          The word of the day was tangaal, which is Pulaar for “candy,” and was the lie we told for both the vitamin and the oral vaccine, the equivalent of, “This won’t hurt a bit” when referring to a needle. To their credit, the older kids in the household were very helpful to us, coaxing their little brothers, sisters, and cousins to open their mouths, singing, “Tangaal! Tangaal!” But the little ones know their tangaal when they have it in their mouths, and some of them were not buying our story. Judging by the appearance of some of their teeth, a lot of them kids have more than just a passing knowledge of tangaal.

          On the streets and in the homes, our reception from the adults was always cordial, and there was a wide range of reactions from the children. As we made our way, it didn’t escape anyone’s notice that there was a bona fide alien in their midst. I could hear the voices even when I didn’t see the bodies from which they emanated, as they called out, “Toubab” or its equally prevalent and charming alternative, “Toubock.” There were as many smiles and kids coming up to shake our hands as there were terror-stricken tykes, holding their hands to the sides of their faces, mouths agape, reminiscent of Edvard Munch’s “The Scream.”

          The name of the neighborhood was Basara (BAHS-rah), a word that is ironically just one letter different from the Spanish for “garbage.” And we did find lots of garbage laying about in the streets, since there is no system for its collection. Flies were everywhere, and they especially took a liking to the residue of the Vitamin A capsules. Upon opening the front door, most homes consisted of an open courtyard area which had several small buildings, many of them of only one room, with all doors that opened onto it. Multiple members of extended families share the space, which means several adult men and women, as well as all of their children, with the occasional granny or gramps on the scene.

          The flies were horrendous – hovering over unwashed pots and plates, the outdoor mats, the animal turds. It made me appreciate even more my own fly-free home, where one of my first chores after I moved in was to cover all the windows (which are open 100% of the time, except for occasions when we have high winds and sand storms) with new screening. Thanks to my superior skills in that regard, I only get the occasional fly when somebody lets one in, upon entering or leaving.

          At one point we had a pack of eleven kids following us, ranging in age from about three to more than ten years old. The older ones who were not in the know wanted tangaal, too, and they were a bit miffed that we could not squeeze any into their mouths. When Sy shouted at them angrily, obviously telling them in their language that they should stop following us, they stood quietly while he spoke, and then, as soon as we moved on, they continued to follow us, which continued until our traveling theatrical show became old news.

          Because of the different vitamins and vaccine dosages, and because the vaccines were only to be given to children younger than five, we had to ask people how old their kids were, which yielded some of the most imprecise information we gathered all day, as parents could say that the child was un an et quelque, meaning “a year and something.” Nobody’s age was exact. Most kids’ ages were given in a range: “He’s five or six,” “She’s two or three.” It’s a country where birthdays are rarely noted or remembered, and never celebrated. In cases where the family had been to some sort of clinic, there was a little booklet for each child, and we were able to find a date of birth. Otherwise, we just erred on the side of precaution and, when in doubt, gave the vaccine.

          The “streets” were not in any kind of orderly grid formation. Nor are there street names or traditional house numbers. As we wandered, I began to wonder, If I lived here, how would I explain to somebody how to find my house? There must be landmarks that locals use: next to Sidi’s boutique or Dia’s coiffure or the video shop. It reminded me of a conversation I had had with my friend Mamouni, as I extolled the virtues of named streets and numbers affixed to buildings: It’s so easy to find places! Everyone has an address! Unimpressed, he translated a saying from the Hassaniya: “A person with a tongue doesn’t get lost.” And that is just the way it is: you ask around while you are looking for whoever it is you want to find and, somewhere along the line, people manage to help get you where you need to go.

          Our work on Friday lasted until about 5:00 PM. The weather was wonderfully cooperative: overcast most of the day, which made it easier to be outside, and that nice breeze. In contrast, I could see from the start on Saturday morning that we were going to be in for problems, as we had full sun from the beginning of the day.

          What did make the process easier on Saturday, though, was that since I knew what to expect, I was able to call on my Boy Scout heritage in order to “Be Prepared.” First of all, I fashioned myself a clipboard substitute; in lieu of the real thing, I used the sturdy front cover of what had been a loose-leaf binder. I kept the data sheet in place with two clothespins on the top and two on the bottom, and was able to keep a pen clipped to it as well. It had the weight I needed so that it would not fly away on the occasions that I needed to lay it down.

          I ditched the shoulder bag, which had gotten progressively heavier during the previous day, and opted for a fanny pack, which meant that everything I was carrying was able to be wrapped around my waist, which was also a more convenient place for the vitamins, scissors, tissues, and much less food. Instead of carrying water, I opted to buy it from boutiques as I needed it – more expensive, but less to carry.

          One of the important aspects of the campaign was the marking of each house, so there was a visible record as to whether or not anyone had been there to administer the vaccine. As we left each residence, I filled in the data sheet and Sy used chalk to write a fraction on an area next to the front door: the numerator indicating how many children were vaccinated, and the denominator showing how many children in our target age range lived in the household. When we saw that somebody had already chalked “3/3,” “5/5,” or “0/0,” we knew that we didn’t have to go, but would continue to look for another house where either (a) nobody had yet visited or (b) there was a fraction such as 4/6, indicating that two children had been missed on a previous visit.

          By 11:00 AM, we ran out of houses in the neighborhood where we had been deposited. In every direction, all the houses had been marked. While I was participating as a volunteer, it turned out that Sy and the other Mauritanians were being paid for their work. This meant that he wasn’t as motivated as I was to get back to the health center, hand in the remaining materials, and go home – no work, no pay! He said that his grandfather lived nearby and we could go rest there for a while.

          I sat in a small room typical of most Mauritanians’ homes that I have visited: worn carpeting, faded and peeling paint, thin and uncomfortable matalas on the floor, pillows filled with straw, and a television set connected to a satellite dish. Sy left me there for about twenty minutes or so, giving me pause to sit, stretch, and think. As I took it all in, I remarked that most Americans would be appalled to have to live in a room such as this – and I also realized that there must be millions of people in the world, if not a billion, for whom this would be considered a vast improvement, a dream-come-true of palatial proportions: closed off from the elements, with electricity, primative plumbing, and running water on the premises!

          After half an hour of rest, Sy decided we should move on, making our way slowly to the health center, and that he would get his hair cut along the way. When we reached the barber shop, I offered to give him all my material to hand in for me, but he insisted that I wait for him. I though, Oh, all right. I was just happy to be sitting and in the shade.

          When we got back to the health center, the chief of the operation, seeing that it was only noon, said that he would be sending us out again, to a different neighborhood. While we waited for the new assignment I ate my lunch – bread, a hard-boiled egg, and some raisins and peanuts that I had brought with me.

          Then we were driven to a neighborhood where the campaign had already visited, so it was our job to do back-up, checking for kids who had been missed during previous visits. Over time during our wandering through the streets, we managed to find a few. Additionally, when people saw Sy carrying his distinctive box of refrigerated vaccine, some of them recognized what we were doing and led us to their homes in order to vaccinate children who had been missed previously.

          By 1:00, Sy told me that we were not too far from a restaurant that some of his friends owned. “They’ll never find us there,” he explained, displaying his (lack of) work ethic. I wasn’t hungry because I had just eaten my lunch. I have been here long enough to know that it’s always best, if I want to eat, to prepare for it myself, since there is never any knowing if there will be a critter-free meal. As it turned out, it was one of the many we-only-make-and-serve-one-dish restaurants with only two tables, and the plat du jour was a national dish, chubbajin, which is fish and vegetables on rice.

          When Sy told me the menu, I explained that I wouldn’t be eating – that I had already eaten while waiting at the health center. He moved over to the other table. I teased him, Don’t you love me any more? And he said yes, he still loved me, but since I wasn’t eating, he would eat at the other table.

          When Sy was almost finished, another customer came into the restaurant and sat at my table. He was puzzled by the scene and asked what we were doing, so Sy explained the polio vaccination campaign. When I asked Sy if he enjoyed his meal, I addressed him as chef, French for “boss,” which elicited a remark from the other customer: “He’s not the boss! You’re the boss!” I explained that no, I didn’t know anything about polio vaccination, whereas Sy was an employee of the health center and knew a lot about what we were doing. I was just taking orders from him. To underscore my point, as we left, I said to Sy, for the benefit of the other customer, Okay, chef, I follow you wherever you go. Just tell me what to do and I’ll do it!

          After we left, Sy explained – but didn’t have to, as I am perfectly aware of the racist attitudes held here by many people here and elsewhere: in any group of people, it could only be the white person who would be in charge – le chef, le patron, le responsable. It’s obvious that some people need to have that idea shaken up a bit, so that they can see that their own people are fully capable of taking leadership positions.

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Dark Star Safari: Overland from Cairo to Cape Town represented to me, at one point, what my close-of-service trip would be, as I would take nine months or so to get from top to bottom of the continent before I returned to the USA. I have changed my mind on the trip since then, but this book by Paul Theroux did not hold any less appeal because of my decision. Theroux undertakes a voyage that combines his sense of adventure with a homecoming of sorts. He was a Peace Corps Volunteer in Malawi in the sixties. During this trip, he returns to Malawi for the first time in thirty-eight years. Much to his dismay, he finds that not only haven’t there been significant improvements since he was last there, but there are considerable situations that have gotten much worse. He ponders and pontificates concerning why things are the way they are – largely the corruption and the interference of aid agencies. I had heard before I read the book that he was of the opinion that it was only Africans who could help to improve the situation on their continent. Upon hearing a statement like that, and before reading the book, I thought that it was a mean-spirited thing to say. But upon reading his words, I can see that he is a compassionate person who is offering perhaps a minority opinion, but one that is in no way intended to hurt or denigrate the Africans he has come to respect and care for.

When my friend Craig told me about Contentment: A Way to True Happiness by Robert A. Johnson and Jerry M. Ruhl, and sent me a quotation from it, he had recently read some entries on my website concerning my fixation with living in the future, rather than appreciating being “in the moment.” I ordered the book and it finally made its way to me. My biggest act of foolishness regarding the book was that I was expecting it to be a “how to” book for being in the moment – “Just do these things and you’re going to be living in the moment in no time at all!” I couldn’t have been more wrong! Another friend, Beth, once told me, “There is no new information,” by which she meant that all the knowledge we really need to have in order to live our lives happily and successfully is already out there! I found that to be true of this book, which is excellent information for me, and a reminder that the best ways for me to be content are already inside of myself, waiting for me to use them.

The Best American Essays 1994, edited by Tracy Kidder is part of The Best American Series, of which I recently read one of the books on travel writing. I ruled out the volumes on science fiction, scientific writing, recipes, and short stories, which left essays and travel writing. For the most part, this was a disappointing volume for me. Though each piece was well-written from a technical standpoint, there were not many of them that captured my fancy, my interest, or imagination.

I’m not the kind of person who has to run out and get the latest best-seller so that I can be the first on my block to have read it. I did just read the best American essays of 1994, after all – something that could not even be described as “keeping up,” let alone being the first. But ever since I discovered the writing of David Sedaris, I don’t wait for any of his books to be reviewed by the New York Times, on the shelf of the library, in paperback, or sold at a discount. He wrote a new book? I’m getting it – paying full price, hard cover, don’t care how good or bad anyone else says it is – gotta gotta have it! Dress Your Family in Corduroy and Denim is his latest, and I was thrilled to have it mailed to Kristen while she was on home leave, so that she could read it first and then bring it back to me. My only disappointment was that I was finished reading it too soon!