Sunday, August 7, 2011

Project Report: STI & HIV/AIDS Awareness Program for Rural Vanuatu (NAC 149)

On July 11th, 2011, the workshop Wanem Nao HIV/AIDS mo Sik STI began. The workshop would include talks about sexual reproductive health, STIs, and, ultimately, HIV/AIDS. Before this could happen though, I needed to bring in help from the outside. On the 8th of July, I left Naviso, East Maewo and made my 4-hour trek to West Maewo. In West Maewo, I stayed one night before going to East Ambae to bring in fellow volunteer Nancy Miyake, who had worked in North Ambae (now with Save the Children in Port Vila). After leaving East Ambae, we made one more stop in South Maewo, Baitora, to bring Lindsay Templin. With two more Community Health Volunteers (both female), we made our way back to West Central Maewo and stayed one more night. On the 9th of July, the three of us made the walk back to Naviso via a bush road from Telise Village. A little over 5-hours later, we arrived, wearied and dirty, in Naviso.

The following day, July 10th, we collectively went to Church in the morning and afterwards I was able to make my community announcements about the workshop: beginning on Monday and going through Tuesday. Prior to this, I had been conducting a 4-week media campaign promoting the workshop. This involved repeated reminders during community announcements after church, various flyers, and talking with the community. Leading up to the workshop, I could feel a palpable excitement; people were continually asking questions about the dates and times. After announcements, I had to make some final arrangements and later in the day the other volunteers and I would make preparations. I had to make sure the pig, two roosters, rice, and other kakae was ready for the next two days. Additionally, I had to meet with the Youth Committee that was supposed to perform my drama tomorrow during the workshop – this requires some storytelling:

Two weeks prior to my workshop I searched out 8 – 10 people to help me make a drama visualizing the affects of HIV on the Immune System. I finally got a list of names and set two days to meet before I would go to Ambae to get the other volunteers. These two days would be used to prepare and practice the drama. The first day we were supposed to meet at 7 AM. Of course, being American, I arrived promptly at 7:00 only to wait until 8:45 before everyone showed up. After this, the leader of the Youth Committee, Esron Boe, told me that he would be going to Lalaone in North Maewo to make Copra and would miss the next practice, but would be back before the workshop; this was my first problem I ran into – I did not see him again until July 20th.

In his stead, Ephram was charged with leading the group and Ephram seemed motivated and interested in adding to the drama to improve the entertainment quality. The next time we were supposed to meet I did not want to wait a long time; I decided to come late and meet the late ones halfway. I arrived at 7:45 and found no one. I waited until Ephram came down and told me that they had been there at 7:00 and waited, danced, and finally, assuming I was unable to come, left. Well that did not work. Ephram decided that we could meet the next day, in the morning, before I left for West Maewo and Ambae. The next day I showed up promptly at the Nakamal, after Morning Prayer (as stipulated by Ephram) and, again, found no one. Opposed to waiting, I went to Ephram’s house to find him asleep – he had a kava hangover and had missed prayer. He told me that he would grab everyone and meet me at the Nakamal. About 10 minutes later, I was met by Ephram with bad news: ol man oli lus (All the people are gone). Ok, we decided that we will meet after Church on the Sunday before the workshop, July 10th.

This brings us back to the Sunday preparations. After Church, I find Ephram and he tells me that he will find all the people and get me from my house and we can practice. So, I go back to my house and wait. I do not see Ephram again until that night drinking kava. At this point, I tell him, since we had met once, the participants know the drama and I just need them ready to act on the second morning of the workshop.

Jumping ahead, on the second day of the workshop, July 12th, I go and get Ephram in the morning and tell him to get everyone ready. A small time later, Ephram comes and tells me, once again: ol man oli lus. Well, lucky I am used to this and found willing participants to come and act impromptu. Lesson Learnt: Locals can, but I am not allowed to work on ‘Island Time’.

Now, we can get back to the meat of the story. The preparations were finalized on Sunday, as Nancy, Lindsay, and I went over the workshop details and prepared the Reproductive Health materials – at the same time, making sure we understood how the sexual organs worked ourselves. Once we were all on the same page, we were ready for the workshop.

July 11th, 2011: Day 1 – Sex and Ni-Vanuatu

We began the workshop with an opening prayer and the Bananas Dance Ice Breaker. After this we went outside and played a massive name game. By the time we finished this and went back inside, attendance had boomed and we had somewhere around 70 – 80 people of all ages in the Church. We began the day by splitting the groups into two (males and females) and using picture activities to learn about reproductive health. This took up much of the morning, but before breaking for lunch, we had the groups split into two again (after learning this activity would not work with males and females together) to define what ‘sex’ means. This was an eye-opener and a funny activity; I no longer believe that Ni-Vanuatu have reservations about sex.

After breaking for lunch, we came together again and started the STI talk covering: STI i minim wanem, Wanem ol nem blong sik STI, Wanem ol saen blong sik STI, Hao nao blong blokem sik STI, and i gat meresin blong sik STI. Following these talks, we went into a picture activity that involved some critical analysis of family planning methods. Finally, we closed the day out with a talk from the Nurse, Nicholas Bage, about the services offered at the Mamalu Vanua Dispensary (family planning, STI treatment/medicine, condoms, etc.). After, the workshop was closed with a prayer, thus completing day one.

July 12th, 2011: Day 2 – HIV/AIDS and Gender Play

The second day of the workshop began with a fruit salad dance followed quickly by an outdoors activity: Telephone. Yes, the classic game of telephone, where you try to pass a message down a line or in a circle and see what comes of the message in the end. The activity was meant to represent the importance of learning correct information and how toktok blong rod can lead to misunderstandings and problems. Following this we went into the first section of the day.

Wanem nao HIV/AIDS?
The day started with the Immune System talk and the Drama, showing how HIV attacks the white blood cells and how other diseases can enter the body without resistance. After this we went through the activity: Laef Laen blong Sale (Sale’s Life). I used a clothes line with different signs to indicate age groups and life events. I demonstrated how HIV/AIDS can cut your life short; this was emphasized by cutting the clothes line and having every sign fall to the ground. This part turned out to be surprisingly dramatic as the signs hit the ground. The next activity covered the meanings of HIV/AIDS. We closed this section with an activity called ‘Finding the Ball’. In this activity the participants made two lines (males and females), shoulder-to-shoulder, and passed a ball back and forth up and down the line. After the facilitator said stop, the other group would have to guess where the ball was in the opposite line. This activity was meant to demonstrate how HIV does not have any signs and you cannot just assume anyone has or has not contracted the virus. After this we went into the next section of the day.

Hao nao yu serem HIV/AIDS?
This section was complete with picture activities that allowed the participants to explore the answers to each question. This developed great climates for discussion. The two activities explored what waters of the body HIV could pass through and what were the chances of sharing HIV in different activities. Following this we had a talk about the different general activities that would share HIV based on the waters of the body: Sex, Breastfeeding, Blood Transfusion, Bloody wounds, and Having HIV and being pregnant/giving birth. At the completion of this section we broke for lunch.

Hao nao yu save blokem HIV/AIDS
After lunch we began with another Bananas Dance and a game entitled: Juggling My Life. During the game participants stand in a circle and throw different objects around. The facilitator continually puts in more objects (the objects meant to represent life’s responsibilities), after a small time, the facilitator introduces a bigger object and three smaller objects meant to represent sex, pregnancy, STIs, and HIV/AIDS. The activity is supposed to demonstrate the difficulty of juggling your responsibilities and how sex, a bigger responsibility, can lead to different consequences that individuals might not be able to manage. Following this we went into a pictures activity to explore different ways for blocking HIV transmission. After this we touched on the poster with different ways to block ‘sik STI’ from the previous day. After this came the String Activities that used string and circles of participants to show the ease of possible HIV transmission between groups and islands throughout Vanuatu. Finally we went into condom steps and practice, using male condoms only, as female condoms had not reached Lolowai Hospital in East Ambae when we had last passed through. The condom work closed out the section blocking transmission.

Closing Activities
After the last activities, that were done in separate groups (male and female), we came together again to participate in a Gender and Development activity called: The Thing Game. The males and females were set-up as teams on either side of the Church and told that, exchanging turns, people from each group could come grab from the pile of ‘things’ and women would “act like a man” and men would “act like a woman”. While they did this we would record each activity. These resulted in a great amount of laughter with men pretending to breastfeed and give birth and women pretending to act drunk and rowdy, put on male condoms, and drink kava. The activity was followed by a debriefing session that touched on the multiple responsibilities that men and woman shared and how using a condom was a responsibility of everyone: Yumi Evriwan gat Raet blong karem Kondom. Finally, we finished the day’s activities with a talk about the difference between treatment and cure and how testing worked in Vanuatu.

As a group, the other volunteers and I answered all the questions from the ‘question basket’ that had been collected throughout the workshop (the first day’s questions were answered in the morning). Following this, the workshop was ended with a chorus and a closing prayer. Afterwards, the community made a ‘Thank you’ ceremony/lafet and killed another pig for kakae. The volunteers and I were presented with Salusalus and drank kava with the Chief. The village performed a small custom dance and everyone brought in local kakae too. The celebration was a big one and made for a great ending to the NAC-funded workshop in Naviso, East Maewo.

Success Story
In a small tangent, I can tell you the story of one Auntie of mine who, following the workshop, approached Nancy and explained to her: after going to the workshop, she discussed with her husband and they had decided to start using condoms. She asked Nancy if she could get her some condoms and Nancy passed the information to me. Later, I was able to get her the condoms she had asked after. This is explicit proof of the need to make these workshops with facilitators of different sexes and the importance of volunteer collaboration.

NAC-Funded HIV/AIDS Workshop: North Ambae July 17th – 18th

Summary: The Benefits of Volunteer Collaboration
After the workshop in Naviso was completed, I followed Nancy Miyake back to her site in North Ambae to assist in facilitating her workshop. The workshop was designed similar to the workshop in Naviso and Nancy and I changed sections based on what worked and what did not work in Naviso. Moreover, we added new sections to test in North Ambae. Nancy’s workshop involved three different villages in North Ambae. The experience was rewarding and the community opened up well to me during talks about sex and other sensitive issues. Nancy’s workshop was benefited by the presence of Rolingson Tari, the PENAMA Provincial STI, HIV/AIDS Officer, and his counterpart, VSO, Eric Ochieng, a volunteer from Kenya.

The workshop in North Ambae was very successful and I believe without the collaboration between Nancy and me before the workshops, at a PEPFAR-funded workshop for Village Health Workers, and before/during the workshop in Naviso, the end result would have been quite different and nowhere near as successful. I believe collaboration between volunteers is necessary for growth and this can be seen explicitly in my work with Jennifer Blount, the education volunteer in Naviso, and my work with Nancy on the HIV/AIDS workshop. These things could not have been possible without PEPFAR and NAC Funds and the backing of Peace Corps Vanuatu staff. The next collaborative workshop will take place on September 18th in Baitora, South Maewo. With the cooperation of so many volunteers these workshops can only improve and with them, the collective understanding of Ni-Vanuatu regarding all aspects of Sexual Reproductive Health, STIs, and HIV/AIDS.          
          

Friday, August 5, 2011

A Series of Thoughts: American Local Language

Talk in that Language

Before I begin, I must state that Naviso is Anglo-phone, meaning the schools teach in English – though Anglo-phone kind of implies they speak English, which isn’t the case. Anyway, one night I was in the Nakamal rather late after drinking kava, The kava was finished and I was hanging around with the late night crowd (the guys who never go home at night and just eat dinner at the Nakamal – usually the younger guys – similar to the bar patrons who are there until past closing every night) and in comes a visitor, from West Maewo, who starts spouting about going to University in California – in not broken, but definitely not fluent English. At this point, my small brother looks at me and says talk to him, I don’t quite get his meaning, so I ask again and he says, with a big smile on his face: Talk to him in the language you talk in America! Oh! English!

I want to party all night long

When a person dies in Naviso, a hundred day celebration follows – a Bongi. Every 5 days until the 20th day they make a lot of food and drink a lot of kava. After the 20th day, they do the same every ten days. On the 15th and 100th day (and some other days if they decide to) they hold an all-night custom dance which involves stomping of feet, clapping, and singing – for the men – and, basically, running in place and pounding your feet for the women. I have to say, the women’s part is much more physically exhausting and demanding, but after about 4 – 5 hours, I regretted dancing for so long and decided my time was better spent sleeping on a mat in one of my Bubu Women’s open air kitchen.

Is that safe to drink? – Peace Corps is bad for your health

When you really think of the demands of the Peace Corps you come to the realization that Peace Corps is bad for your health.  Besides the obvious stress factor, the moving from home to the middle of nowhere really beats at your emotional, mental, and physical health. Country-specific, my liver probably looks like Swiss cheese thanks to the incredibly culturally-appropriate kava. Of course, what I’ve heard is that the effects of kava, on the liver, disappear after a small amount of time where you have not drank kava – at least, that’s what I keep telling myself. Fortunately, I have absolutely no regrets in joining the Peace Corps and actually encourage everyone else to consider service, but I am a little off my rocker.

The irony of the question ‘wota ia i sef blong dring?’ (is that water safe to drink?) is that, by our standards in America, it probably never will be safe. Our question also hinges on local knowledge about, to put it crudely, what shit happens to be in the water. In America, all our water is treated, thus safe drinking water means treated drinking water (there are some possible exceptions of course in the bottled water sector – though I don’t believe anything those guys tell us anymore). While my water source is one of the cleanest in Vanuatu – a spring/cave source – it still isn’t treated. With rain catchment, I inherently don’t trust it and more people seem to get sick from these giant disease buckets than any other source. Really, water runs down a dirty gutter, is strained once, and then sits in this giant tank for who knows how long – a disease bucker wan taem. But, to get back to the point, how do the people know if the water is, in fact, safe? I believe the appropriate question should be: How sick will drinking this water possibly make me? 
      

Tuesday, August 2, 2011

A Series of Thoughts: Circumcisions and a Kava-Diet

Well, I’ve seen more expensive prices

Today, as I was walking purposefully down the “public road”, after finishing my run at the school, I saw that the Nurses had put a new notice on the Dispensary notice board. Previously, this board was used primarily for my public health posters, promoting the benefits of cutting your fingernails and using a toilet, but, more recently, the board has been adopted for its actual purpose of announcing Dispensary, work-related news (olsem the Nurse’s schedule and hours). Today I saw that they had put up a fee notice. The notice was basically a menu of different services offered and their respective prices: out-patient fee 150 VT, in-patient fee 300 VT, etc. – nothing special… right? Well, I thought so too until I got to the bottom and read: circumcisions 1000 VT or you can pay with two fowl or one piglet. Maybe the chickens, but I’m not giving up a pig to cut the top of my child’s penis off, no sir; I don’t care anything nothing about possible hygienic possibilities.     

I wouldn’t go to that extreme

The other day, Jennifer and I sat “storian-ing” with our neighbors in Tanbwalu, outside the nakamal. Jennifer had to go to the store and since I was at her house and the store is on the way back to my house we ended up passing the nakamal together. This led to us both sitting down for a toktok. After a barrage of comments about Jennifer’s recent trip to Pentecost – leading to the realization that as PCVs, we travel around Vanuatu a lot more than the locals – the Mamas we were talking with got into the usual groove of commenting on how ‘fatfat’ aelan laef has made Jennifer – ‘fatfat’ being a compliment here. Finally, Jennifer had to go and, with a final ‘fatfat’ comment thrown at Jennifer as she walked away, the comments were then directed at me: this is when and how the arguments developed. Two Mamas, Marian and Hanson, could not agree if Kava or running was preventing me from becoming ‘fatfat’ because, of course, trips to Port Vila make me ‘fatfat’, but I lose all my weight in Naviso and become ‘bunbun’ – I would say the difference overall is negligible, but maybe the mass Taro consumption is making an impact.

That would be cool… possibly…

Since Peace Corps has changed its focus to goal three: returned PCVs sharing the culture of their host country with fellow Americans, I’ve begun to think about the possibility of Peace Corps paying for one person in every volunteer’s site to return with the PCV to the US for a small trip, olsem wan wik. This payment would include round trip fare and medical expenses and would be up to the PCVs discretion (if they want to do it and who to choose). After these thoughts, I have continually thought about whom I would take back, presupposing this was possible. I’ve thought about my Host Papa or maybe a good friend. Lately, I have thought that I would ask my host papa samting olsem: What would you say if I told you I could pay your road to come stay with me in America for a week? After this question I would let him make the decision. He might go “Hell yes!!” or he might recommend one of my brothers – who would have a longer time to tell stories to the following generations (not to sound morbid regarding my Papa’s life expectancy). Then I came to the realization that this might be a scary possibility for any of the people I took, similar to my transition in Vanuatu. It’s hard to think of it that way because the US is home to me, but not to them. Granted they wouldn’t being staying for two year, leaving home and going so far can be a, simply, shocking experience. I think an older candidate or an adventurous youth would be best… if this was possible.

UPDATE: I have contemplated this more and for the next weeks that I am in Port Vila I will be exploring some grant opportunities to try and find money to pay for this. I believe the total cost would be somewhere around USD 6,000 for a round trip ticket, medical expenses, passport, and logistical costs – to get them to the US. I believe, in the interest of Peace Corps Goals 2 and 3 (Sharing between the cultures of the host country and the US), that this would be an amazing way to achieve cultural understanding. Additionally, if those of you following my blog have any grant application ideas, please share your thoughts. I honestly believe this would be an amazing cultural sharing experience and, of course, it would be ridiculously awesome.        

Monday, August 1, 2011

A Series of Thoughts

An Introduction of Sorts

Up to now, I’ve had a number of different blog “tactics”. First off, I attempted to recapture everything in one blog no matter the length of time. Secondly, I worked ahead of time, on Maewo, to prepare multiple blogs covering various stories and topics (none of these recaps being exceptionally short). Lastly, I tried to stick to topics, did not prepare ahead of time, and kept things short (more or less commentary on multiple events). In essence, this last one was the best version of a recap, but inevitably left out a lot of detail. I have learned that being in Port Vila discourages me from spending the time to blog. While being on Maewo, I have a near insatiable desire to write all about my various exploits (big to small). With this in mind, I have tried to prepare ahead of time, but keep things short and detailed—something of a true commentary. Each commentary will cover a short number of activities or musings, more often than not, of mine the past months. This might result in some expanded storytelling, but as of now they are simply a series of thoughts (or perhaps the ravings of a madman). 

Let me touch on these things first…

The Chairman comment from the previous blog comes from the PHAST workshop I held in the beginning of May. I realized many things in the speed blog entry at Lolowai Hospital were unexplained and I will now touch on those things now. During the PHAST workshop, the participants felt the need to give me a title—this is a trend in Naviso; I have spent a lot of time watching committees form and titles handed out (after which the committee does nothing, but we now have a Secretary of the Disaster Response Committee). So, in that same vein, I was given the title “Mr. Chairman” during the PHAST workshop. Every time some wanted to address me they would raise their hand and say “excuse me Mr. Chairman”.

Regarding Condom Man, he is a creation of a fellow Peace Corps Volunteer (whose identity must remain confidential for obvious Super Hero reasons) who distributes male and female condoms in the latest joint UN/Vanuatu Ministry of Health social marketing campaign to encourage condom use. He, of course, was introduced at the PEPFAR Village Health Worker HIV/AIDS training of trainers in Pango, Efate (outside Port Vila). Actually, calling him a he could be misleading; we should probably use a gender-neutral pronoun. It’s probably wrong to try applying a sex/gender to Condom Man (even though that name directly opposes this statement)—might send the wrong message about responsibility.

Adjusting to “Aelan Laef”

For those of you who have been following my Vanuatu exploits regularly, yu save finis se I’ve been living pretty flas in the backend of the middle of nowhere. What, with my fancy water-seal toilet and raised tap/showerhead and an indoor tap/sink. I’ve been living the High Life. Now, I must readjust. I officially moved in May 5th, 2011—approximately 6 months after arrival. I did not have much time to adjust before I left for Ambae and Vila at the end of May, so this has really been my readjustment period these past months. Now, I am surrounded by naked children who cry incessantly (all being around two years old) and desire to follow me around and sit in my house all the time. Additionally, I never really understood the “fishbowl” problem until now. While hanging around in my house, I am constantly made aware of a shadow in the doorway who happens to be a person, usually a child or yungfala. I usually ask “olsem wanem” (What’s up?) and quickly get a “No” (Nothing) more often than not. After this, they usually stand around for awhile staring at me. I have combated this these past months by being exceptionally boring most of the time; unfortunately, my inclination to play music on a speaker makes me far less boring and is now an invitation to come inside and sit. On top of all this, I have had adjust to swimming naked in the river (the swimming hole); the rough equivalent of swimming naked in a public place. There is a “private” place for the men to swim naked. It’s not really private—I constantly sit there in the river and watch people walk by in front of me. Luckily, years of training have made it so they don’t turn their heads 45 degrees and look right at me.

Workshops: Yes, I do work in Vanuatu! This is not just a Vacation!

Poetically, I like to consider myself a used car salesman. I mean why recreate the wheel when you can just take it, put some more flair on it, and call it a wonderfully new idea (I especially like adding pictures to everything). “Participatory Methods” also make everything easier as, inherently, the participants do the work and I just facilitate—no leading necessary and that means a lot less talking. Sounds like a scavenger, huh? Well my friends, there are truth to these words… I guess the difference is I understand the importance, the methodologies, and the purpose behind each different “wheel”. I also am almost finished with my MPH requirements, so the three letters to my name will add credence to my assessments… hopefully…