Wednesday, January 19, 2011

Health Care In Burkina, Setting Boundaries At Site

Sorry it's been so long! It's hard to get to internet from my new site, but here's what I've been up to in the last month.

9 December – Romongo, 9:14pm

Today we had an interesting session with one of the higher-ups in the health system, the director for the Central-West Region. It really helped make the distinction for me that we work at the village level, overseen by a district, overseen by a region, overseen by the top country officials. He spoke wonderful, easily understandable French, a decent bit of English, and had worked with Peace Corps in placing volunteers in the past so he was very knowledgeable about what we were there for and was confident that even if our specific impact couldn't really be measured due to all the other aid work that goes on in Burkina, he will always request to have us here because he knows we make a difference. We also learned that at a national level, malaria, acute respiratory infections like pneumonia, diarrhea diseases, and HIV/AIDS are the most pressing concerns for the country, particularly the first two.

The national campaign against HIV/AIDS has been incredibly successful, with most current rates being quoted around 1.3%. While this could be due to any number of quirks in survey techniques and reporting rates, the country did take a very strong stand in the mid/late 1990s and the Ministry of the War Against HIV/AIDS (roughly translated) is headed by the President himself. All ARVs are free, provided you can afford the blood tests to find out the specifics of your particular strain and stage at your district or regional capital, which may or may not be feasible. Pregnant women are tested and treated for free as part of the campaign to reduce maternal-infant transmission. Oddly, it seemed obvious that many would not be able to afford the blood tests when we were told that they could cost between 11,000 and 15,000cfa, which is a lot of money here but only comes out to $22-$30. $30 to determine which free drugs you need to save your life, but it's too high for most everyone I will be working with over the next two years and unsurprisingly it seems like many people avoid getting tested or work very hard to avoid disclosing the results to anyone for fear of the stigma attached to being HIV+. Some people are chased from their villages, particularly women, and while there are some resources available at a big city like Koudougou for free ARVs, vocational training, and housing, many will struggle to survive on the fringes of society near their village.

It sometimes feels really overwhelming – you can't possibly help everyone, even if you're willing to raise money to afford testing for people, or to provide nutritious food to everyone, or to pay for transportation to higher levels of medical care. And I know that's the Peace Corps niche, capacity building so that a village and community can improve their standards of health through prevention of disease – hand washing, using mosquito nets, early treatment at a health center, assisted births – but even now in the “abstract” it's hard to know that at some point I'm going to have the ability to help an individual person that I personally know by giving them the money they need. While the Peace Corps can't control what we do with our money, they give a compelling argument for not starting a trend of paying for necessary medical costs. For one, it's not sustainable. While that doesn't seem like a big deal in the face of the pain of someone you know, here you're almost certain to come across not just one person who needs your help, but an overwhelming amount, and you could easily spend all of your time trying to solicit money from friends, family, and organizations in order to cure serious situations while not working to prevent more. And what happens when you leave? The savings and credit club that you helped to establish might be able to help provide emergency help, or perhaps those income-generating activities (IGAs) that you helped them to get off the ground would allow enough “extra” income to save for medical expenses, but if all you did was pay for the need yourself you've now left the community even more in need because they now know what is available but don't have the means to access it without you. I understand that and I absolutely support the need for sustainability. But I know that the first time I turn someone down will break my heart, even if I help them find the money elsewhere (and usually they can from family, but as the “rich” foreigner we tend to get asked first).

We talked about setting boundaries for our houses, for visiting times, for privacy and time alone. We talked today about integration. Some people adopt village names, work hard to learn the local language, and dive into their work, hardly ever leaving site. While they usually bond more with their community and feel more “integrated”, Aaron (Harouna) remarked after about a year that he was losing his identity as an American by molding himself to meet the expectations of his village, and that there's something to be said for still being seen as a bit of a foreigner (albeit one that is clearly no longer a stranger). The other extreme is someone who spends a lot of time out of site, insists on an American name, and speaks almost exclusively in French. They may not feel very well integrated with their community, but also are more sure of their self-identities as Volunteers serving for a set period of time to improve the health knowledge, attitudes and practices of the village as best they can, and might be slightly better prepared to re-integrate to American society (or perhaps worse off since they expect to have an easier time). I still haven't decided the tack I want to take, but I'm hoping that I will find a good balance between being present and integrated in my village, and keeping my sanity by leaving from time to time.

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