Archive for the ‘Public Health’ Category

The Return of Souley

In Capacity Building, Career Development, Growing Up, International Development, Niger, Peace Corps, Public Health, Sustainable Development on September 25, 2010 at 3:16 pm

I just got back from visiting Doutouel, my old Peace Corps village in south-western Niger. It was such an incredible day, I’ve got to get some of my thoughts down before I crash.

Here are the big observations.

The millet is awesome there this year. The rains have been good, they anticipate harvesting in the next 3-4 weeks. They seem to have planted their usual mix of millet and sorghum, with squash and various leafy greens growing near the huts. One of the all-star gardeners helped a fellow villager construct his own new garden well, on their own.

They got a primary school! Right after we completed our PC service, in 2001, the government of Niger built a Primary School. Over 100 kids attend it, they’ve had four classes now. Only 5 kids fully graduated on to the next level so far, but that’s 5 kids more than had ever even had the chance before. And, just the fact that the children of Doutouel will have at least exposure to education means that a lot of development indicators will improve – girls will get married later and have fewer children being the most important, in my opinion.

They also have a health clinic! I was totally surprised to see this – Doutouel is a pretty small village – only about 660 people, plus the outlying areas that are administratively coupled with Doutouel. But it’s far enough away from the main clinic in Torodi, the market village, that people used to wait until grave circumstances to bring sick people to the clinic. The clinic used to be seen as where people go to die, not where to maintain one’s health.

The road is well traveled! The French paid for a road to be built from Torodi through Doutouel to the next largest village, Adare, which is about 25 kilometers from Torodi. The road is clearly the main reason the government finally came around to giving them a school and clinic – they could finally reach it. There was a bush taxi there when I got there. It was such a pleasant surprise. Getting down to Doutouel from Niamey used to take pretty much a whole day, depending on how we would get there. Today I went in an NGO vehicle, in perfect condition, and stopped for no one until Torodi. If we hadn’t had to stop along the way to pick up a PCV and visit the local functionaires, I could have been from my hotel in Niamey to Doutouel in less then an hour.

I cannot overstate how medieval my village used to seem when I was there from 1997-1999. You could mostly only walk there – the land cruisers could make it but with great difficulty – in fact my villagers brought out some old pictures of when they helped us pull a land cruiser out of the nearby river. But there was almost no modern technology in my village other than radios. Now, several people have cell phones. There’s the obvious clinic and school. There is a school teacher who lives there and is almost like a Nigerien Peace Corps volunteer, especially in the way he seems to act as a kind of ambassador for the outside world.

I was happy to take a current PCV with me, a young woman from Boston, just starting her second year as a PCV. I don’t want to use her name or give away her village, but having her around was very helpful for bridging the gap between PCV’s in the area. After spending the day with me, hopefully she has a sense of all the work that was done in the area for more than 20 years before she got there. She was also nice enough to use my camera to take pictures of my visit so I could concentrate on my Fulfulde and greet as many people as I could.

I was so deeply moved to see our best village friends still there, doing as well as I could have expected. My neighbor’s kids were doing great – the two oldest kids are basically adults now, with kids of their own. Even the youngest, who used to be very sick with constant ringworm, looked to be thriving.

I must stress that Doutouel was and still is a very lucky village, environmentally. Even in a bad drought year, they still have a seasonal river that they can use to water their gardens. They’re Fulani herders at heart, so they take good care of their animals. They have a low water table, and multiple coping mechanisms during lean years. They even have a granary that was built with the help of another NGO. I didn’t show up empty-handed, I brought them a whole sack of millet which they put in the granary for when they need it. So as far as Niger is concerned – they’re not a village that is a candidate for blanket feeding.

Still, they never have done all they possibly could. For instance, I’ve always thought they could easily plant rice or sugar cane in their vast water basin that gets annually inundated, and then sell it to buy food. But property rights make that difficult – it’s been brought up to them before but the organization and complications involved, and the newness of it make it too difficult for them now.

Overall, I was deeply moved – like, trying to keep it together moved – to see my old friends, and to see the positive changes in Doutouel after just 10 years. Every step I take in my career, when I encounter a question about appropriate technology or a development intervention, I think about what my villagers would do. It was so rewarding to see the key things being attended to: Primary Education, Public Health, and Infrastructure.

I hope to return the next time I visit Niger, which hopefully won’t be another 10 years from now. After all, it’s so easy to get there now! And my villagers can call me now!


Gaston Kaba – Health APCD in Niger Retiring

In Niger, Peace Corps, Public Health, Sustainable Development on April 22, 2009 at 10:20 pm

Wrote this in tribute to my old Associate Peace Corps Director for Health in Niger – Gaston Kaba:

My wife Andrea and I were PCV’s in Niger form 97-01. We were Ag volunteers so we didn’t report directly to Gaston. However, we found him to be a very useful and helpful Nigerien to talk to, especially in the beginning before we really knew what we were doing. We were volunteer leaders during the second half of our service and I had the opportunity to install new Health PCV’s in their villages with Gaston. He would always keep his cool – while PCV’s would be getting themselves very worked up and upset over perceived misjustices or misunderstandings, Gaston would always be able to work things out. I think in time the PCVs would come to understand how much Gaston helped shape the enabling environment in their villages. Having Gaston on your team as a PCV helped give you that gravitas – of having an educated, respected, literate and fluent dotijo – vouching for you, so your villagers knew you weren’t totally crazy.

I went to Gaston’s office one day to ask for some Child Survival money – about $500 – for a garden well in my village. At the time in the late 90’s he had a huge amount of money to spend on anything related to Child Survival. He asked me for a proposal, which I provided, and then I returned to my village for a couple of weeks. When I got back – he said – “I’ve got $3000 from the Rotary Club of Truckee for you – let me know how you can use it!” That money ended up continuing and expanding the Torodi team garden well project and the installation of at least 10 wells that year. And that’s really just a drop in the bucket of the 13 years Gaston was Health APCD.

So – from the bottom of my heart – I thank Gaston for his service – Na Gode, Ay Sabu, Mi Yetti, Merci Beaucoup! Sannuka da Aiki sosai.

Sustainability or Dependence?

In International Development, Niger, Public Health, Sustainable Development on October 21, 2008 at 4:55 pm

I’ve been following this for the last couple of weeks – Doctors Without Borders (known also by their French acronym, MSF) have been asked by the government of Niger to suspend their activities.

This is an interesting case study. MSF has provided tons and tons of medical coverage in Niger and has saved probably thousands of Nigerien childrens’ lives. Their work there has been an excellent opportunity to perfect the “Plumpy Nut” nutritional supplement as well.

But to a certain extent, I can see where the Niger government is coming from. It seems to me that President Tandja and his subordinates are a proud bunch – imagine if your country became the posterboard for famine and malnourished children. You too would be sensitive to NGO’s taking advantage of the situation to exaggerate their effectiveness or the need for their services in order to enrich themselves.

So, is this a case of MSF using Niger as a platform, overstaying their welcome?

The hard part is that it’s not like their services are not sorely needed in Niger; infant mortality is chronically high in Niger. A good year for Niger still includes 25% of children dying before their 5th birthday and life expectancy in the upper 40’s.

Perhaps if MSF reconfigured their interventions to include extensive training of local medical services, rather than flying in international staff – they could contract the locals more. I don’t personally know MSF’s practices – perhaps they are using locals more.

Help Niger help itself, basically. I think that’s all the Government of Niger wants, instead of a handout.

Warriors don’t get days off

In Governance, International Development, Niger, Public Health, Sustainable Development on March 23, 2007 at 5:27 pm

That title is an homage to a friend of mine… but I think it encapsulates how we should look at famine and hunger. I just read this UNICEF press release about the current situation in Niger. According to their report – global acute malnutrition in under-3yr old kids in Niger is down, but it’s only down from around 15% to 10% on average. The article definitely strikes the right tone – there is still a ton of work to be done and we can’t allow positive statistics to slow down the aid and intervention.

Celebrating a drop in malnutrition where there are still hundreds of thousands of “wasting” babies and toddlers is like celebrating that you only failed with a 50% rather than a 25%. You’re still failing and there is enormous room for improvement.

One thing I wish was highlighted more was the idea of more system-wide interventions to improve the quality of life in Niger. The aid organizations will rush in when people are dying, but that just reinforces aid dependence. Nigeriens always expect someone to drop in when things get bad; I found when I was there that this caused complacency, to say the least. Why should the village contribute their own funds to build their local water-pump when some projet will give it to them for free?

I suppose I’m talking about two things – aid dependency and advocating for a better political economic system. The latter would greatly improve the conditions of Niger to where households are better able to weather droughts and freakish locust invasions. I’m talking about solid institutions, better governance, schools, infrastructure, etc. Put those in place, not just so Doctors Without Borders or UNICEF can get around easily when the going gets tough, but so Niger has more to offer the global community than an outstretched hand.

Way to goiter!

In International Development, Public Health, Sustainable Development on December 17, 2006 at 3:53 am

This is the most emailed article in the NYT today, about the huge effort to iodize salt in Central Asia in the last 15 years. There are some good lessons here for sustainable development work. Mostly, I was interested to read about using local symbols and famous people to get the masses on board.

The target problem was that there was a high level of mental retardation in Central Asia, among other places, and it was found that using iodized salt would be the most effective way to reduce the problem. So, governments and NGO’s got together to publicize the benefits of using iodized salt instead of non-iodized. That was half the battle, the other was getting salt producers to iodize their salt.

What they did, and here’s what I liked – they devised a recognizable and familiar symbol to put on iodized salt so people at the market could easily tell which salt to buy. Then famous local celebrities who’s opinions were respected were brought on board to remove the stigma that iodized salt somehow had to it.

This kind of thing has parallels all over the world, especially in developing countries. When I was working for the Carter Center in Niger doing Guinea Worm eradication work, we used to treat water sources to kill the Guinea worm vector (click the link to learn more) – it was a very mild chemical that would disperse within 3 weeks, and it was as harmless as using fluoride in the water… But depending on how the villagers felt that day, some would blame us for their decreased virility while others would say their kids were smarter.

Perception is everything – the lesson being that marketing is a very important and integral part of any public health intervention.