The other day I found myself thinking about the popular question, if you were trapped on a deserted island, what would you bring? A friend asked me this while I was preparing to travel to Cameroon, and it felt pretty real, but I didn’t know how to answer exactly. What do I need to get through the day? In terms of material items, Cameroon is such a diverse country that it was difficult to prepare for. Was I going to be somewhere rainy, or somewhere dry and hot? I may as well have prepared for a stint on a deserted island. I didn’t know if I would be in a rainforest or a desert, a city or village, an anglophone or francophone region. I packed a little of everything, not knowing what I would need or want, or have access to. Continue reading
It is 7am and I am in Ngaoundal. While standing on the platform, I yawn and surprise myself when the train whistle chooses the same moment to announce its arrival. Slightly amused, I adjust my bags one final time before boarding the approaching crimson Camrail train. As the engine pulls up to a halt, crowds form in front of the doors, and people aggressively encourage one another to mount the train despite the fact that in attempt to descend the train, other passengers deposit their suitcases onto the crowd. Women in colorful pagne wrap skirts carrying avocados, mangoes, beignets, bananas, corn, bottles of honey and other popular items on their heads traverse up and down the platform, selling to passengers through open windows. “Il faut advancer, madame” someone behind me says as I approach the door of the train car, while a woman from above places suitcase after suitcase into my path. I finally pull myself up and into the train, and begin to look for an open seat. Walking down the aisle, I pass men, women and children, all weary from a sleepless night on the train.
I find an open seat next to a man and two women who seem friendly enough, and store my backpack and moto helmet underneath my seat. Looking around, three guys across from us have amassed an impressive number of mangoes and plantains through the windows of the train over the last few hours. Their legs slide in alongside the brimming plastic bags. Further down the train car, a tired looking mother gives her child a piece of greasy chicken to eat, and places him between her and another passenger in their narrow bench seat. I am reminded that I have not yet eaten since I made dinner with my friend at his house last night, so I too, hail down a woman selling beignets. I ask for three and pay through the open window. They are still warm.
Once I finish my breakfast and the train begins to move, I pull out a book and begin to read. A man travels up and down the narrow aisle, selling some sort of brown remedy he claims can heal tooth pain. Another man passes with bottles of hand sanitizer and tissues. I glance around and think about how different this train ride is from my commutes to work while living in DC. More sunlight, more food, more luggage, and fewer headphones, fewer newspapers, fewer announcements. It is amusing to imagine how different DC metro would be with people selling produce at Dupont Circle metro platform.
A few minutes into my book, the man seated next to me starts to ask questions about what I’m reading and then where I’m from. In these moments, I am happy to answer a few questions, but weary of where it will go if I continue to converse with him after too many minutes. Sure enough, before we are even an hour into the ride, he asks me for my phone number. In these moments, I never know exactly how to navigate the situation without having to oblige. With more than one insistent man, I have given my number just to stop him from harassing me. If I give a fake number, they call it and get upset. I tell this one that I don’t give out my number to people on the train because my number is just for work and the last time I gave my number to someone I was called five times a day for three weeks. He insists that he would not do that to me, and as some sort of proof shows me that he has another American woman in his phone, and a Mexican woman as well.
Luckily, at that moment, a notice rustling near my feet and realize that the woman across from me has a chicken hoarded in a grocery bag under her seat. “Ah! Madame, la poule va sortir, faire attention !” I warn her, and secretly bless this chicken for the diversion. With the chicken properly bundled, the four of us enjoy a lively conversation about how she will prepare the chicken, where each of us is traveling to, and our careers. Mr. Creep is a soldier stationed in Yaoundé with the army and is going home to visit his family for a week. The older woman lives in Ngaoundere and was on a trip to Yaoundé to visit her son and his family. The other woman happens to work at a District Hospital in the Adamawa and we have a lively conversation about HIV prevention and treatment, and the necessity for more community-wide education.
After three hours on the train, I finally notice the familiar sites of Ngaoundere and ready my bags for a speedy departure through the station. It looks like rain. I get my things gathered and as the train slows I navigate the crowded aisle to a door, but today they decide not to open this set of doors, so instead of being at the front of the group, I am at the tail end, hah. I turn around, stretch my legs and slowly make my way through the traincar. I pass the woman and her baby with hands still greasy from chicken. She straps him to her back and I let her into the aisle in front of me. I decide to never lament descending a plane again. Once back on the platform, I look around and notice one woman. Her three young children stand huddled together as she hauls their many pieces of luggage off of the train. While in the US, many people are lucky to have personal cars for taking trips, and can cram as much stuff as they want into their car, most Cameroonians have to rely on public transportation. I am relieved that I’m learning to pack lighter and do not share her burden. Luckily there were some porters nearby able to help her get her luggage to the front of the station. I watched as they hefted the suitcases onto their heads and strolled away.
I walk through the station and parking lot to the road to find a moto driver. As I do so, chauffeurs from bus agencies approach asking if I am traveling on to Maroua or Garoua. I politely shake my head and continue walking. As I get to the road, I see the familiar cluster of moto drivers and am pleased that the first driver accepts my proposed price for a moto to the Peace Corps office. I put on my helmet, mount the small motorcycle and we are on our way. He expertly navigates through the traffic and we pass a variety of boutiques, fruit sellers, tables displaying shoes and other items, mosques, and bars. After about ten minutes we pull up to the Peace Corps office; I pay the moto driver, and knock on the front gate. It is 11am, and I am in Ngaoundere.
Last week over two days I helped counsel fifty women on family planning through part of a Ministry of Health campaign offering free condoms, IUDs and contraceptive implants to all who came to the Danfili integrated health center. This campaign was co-sponsored by a couple of NGOs present in the Adamawa. In Cameroon, according to the Population Reference Bureau, about 77% of contraceptives available in Cameroon are offered by the private sector. During the campaign, the health staff inserted 28 IUDs and 22 contraceptive implants, while I helped collect demographic information, vitals, and used my broken Fulfulde to help counsel clients on the different methods. At the end of the two days, we were tired and triumphant by the successfulness of this campaign.
In the days leading up to our campaign, the chief hired members of the men’s group (les Hommes Dynamiques) and women’s group (les Meres Liders) I work with to inform the community. They did an outstanding job, referring all of the clients who came in during the campaign. During the previous year the CSI received a total of 95 clients seek family planning which proves the success of their campaigning.
During the campaign, the average age of our clients was 26 years old and all had had at least one pregnancy already. 70 percent of the clients never attended school, and 84% were muslim. The average weight was 51kg, or 112lbs.
According to a United Nations Population Division update, the unmet contraceptive need in Cameroon is 23% and about 14% of women use modern contraception. Unmet need for family planning is defined as the percentage of women of reproductive age who want to stop or delay childbearing but are not using any method of contraception.
When I spoke about this with the campaigners they brought up that some of the women they campaigned are tired of having babies and have been interested in seeking family planning but did not have the money to come to the health center. BOOYAH. By having a campaign for free contraceptives, we are reducing the barriers associated with unmet need.
The organization I interned for last year, DKT International, is a results-driven social marketing organization committed to reducing unmet need worldwide through increasing access to and affordability of contraceptives. Throughout the year, country directors send reports on activities conducted in the field (including events like the campaign we just had) and I synthesized the data in terms of results—How many condoms were sold in Brazil? How many IUDs did our providers in India insert? By the metrics DKT and other contraceptive social marketing organizations use, 100 condoms are presumed sufficient to prevent pregnancy for one couple for one year, generating one CYP (couple year of protection). If a country program sells 50,000 condoms in the year, the program can claim to have aided 500 couples in preventing unplanned pregnancy for the year. Additionally, if a program sells 50 contraceptive implants, and each implant can provide 3 years of pregnancy prevention, the program can claim to have provided 150 years of unplanned pregnancy. CYPs are a helpful metric to show the impact DKT has on reducing unmet contraceptive needs worldwide.
When updates from the different DKT programs worldwide came in, seeing these numbers was motivating. I was proud to be associated with an organization that empowers women and families in such a way, but felt too far removed from the reality of these results. I tried to imagine the impact of all these “CYPs,” but sitting comfortably at my desk in Washington, DC, many of my questions were unanswerable. Who are the people who use or receive these contraceptives? What is their understanding of contraceptives and family planning, and who teaches them? How do providers find clients? What training do they receive?
Reflecting on these questions confirmed my interest in joining the Peace Corps by concluding that the only way I could answer these questions was to go into the field and see for myself. Now that I am here, I am happy to say that I better understand the realities of these numbers, and also appreciate the importance of monitoring and evaluation.
In M&E, it is important to differentiate between outputs and outcomes. For example, an output from our campaign in Danfili resulted in 50 women receiving long-term contraceptives to prevent unwanted pregnancy. If my math is right, we provided 181 CYPs.
The outcomes of these CYPs will be a little more difficult to quantify, but through providing free contraceptives to fifty women, they will have more control over other aspects of their life, such as feeding, clothing, and educating their children, seeking health care for themselves and their children, and reduce the incidence of child and maternal mortality. Through part of the visit we collected the women’s phone numbers, and I am planning a way to use their numbers, to either send health updates through sms, or to canvas for interest in a women’s health class at the health center. Updates to come!