By Jennifer L. Giacomini '99
I finally made it to Katchamba. I'd been waiting to arrive since I found out I was coming to Togo nearly four months before. My volunteer post, Katchamba, was a very remote village in one of the most underdeveloped districts in the nation. Electricity didn't exist at all here. Nor did paved roads, so all the roads were marred with huge holes the size of small craters, residual effects of the recent rainy season. Even the Peace Corps Land Cruiser had some difficulties navigating around the holes and sand pits on the way to Katchamba.
Sunday, as the Land Cruiser crested the hill two kilometers from my village, I first saw the première Ecole Publique of Katchamba in the distance. I then recognized a huge baobab tree in the middle of the village. Most of the village was situated on the left side of the road; only a few courtyards graced the right side, mine included. The village sported a small market in the center and a large teak forest on the outskirts. What a lovely first glimpse of the village where I would be spending the next two years.
The midwife, Aimee, played hostess the next day in the absence of my counterpart (a village nurse whom we left in Kara to fix his moto) by showing me the dispensaire, or health clinic, and introducing me to many more villagers. Aimee and her husband had a very thin 2-year-old boy named Laurence. The boy's skin, taut and pallid, was coarse to the touch and his eyes huge and empty. He could barely walk. Aimee said he was just a sickly child — and you can only do so much for those children. I couldn't help but wonder from what other illness he may have been suffering, but I felt powerless to do anything. C'est comme ça, en Afrique. That's how it is in Africa.
We first toured the dispensaire, giving me a great indication of my future job. The clinic was the only real cement building in Katchamba, and one of the largest at about 1,200 square feet. It consisted of two large, scarcely furnished treatment rooms, a small storage room, a pharmacy and an office. The inside of the building appeared abandoned, covered in dust and grime. The furniture and equipment looked like they had been abandoned by some other office in a faraway land. The most interesting was the birthing table, butt and head marks worn into the wood from the pain of countless births.
A large waiting room sat open-walled facing the main road. Interior and exterior walls were newly painted, showing mold streaks of only a few rainy seasons. When we arrived, two mothers, each laden with a small child, sat on the room's two benches. One of the children suffered from diarrhea and fever; I didn't understand what ailed the other child. Aimee talked to the mothers in the local tribal language of Konkomba. Every once in a while she translated her directions into French for my benefit. She gave both children aspirin and an injection. Aimee explained that the vaccine "arrête le sang," or stops the blood.
Confused — I didn't know if she meant something to congeal the blood or a general antibiotic to stop the bacteria — I questioned the midwife on her tactics. She shot me a glance that suggested I stop talking NOW. I don't have any medical training per se, but I know a lot of science about the body, viruses and bacteria. I learned a great deal in college about the brain, the body and their medical reactions. And my mother has been a nurse my entire life, so I have learned a lot via assimilation. Yet I had no idea what Aimee gave to those children.
We then headed to a nearby campement, or outlying village, to remind them of the polio vaccination campaign on Wednesday. The entire campement had seen better days; the buildings and villagers appeared very old and dirty — the result of too much abuse and not enough maintenance. Gaping holes disfigured most of the straw roofs, protecting none of its occupants from the harsh elements of the African savannah. Chalky dirt spoiled everyone's beautiful ebony skin. Many of the children showed classic symptoms of malnutrition: distended bellies from parasites, large heads with huge eyes and impossibly skinny legs somehow supporting their misshapen bodies. Several had taut pale skin and bright red hair, classic symptoms of a severe form of malnutrition called Korshiorkor.
I couldn't believe the level of poverty these villagers faced on a daily basis. I learned in training that most of the malnourishment and illnesses are easily preventable by practicing simple forms of public health that we Americans learn in primary school — easy applications like hand washing, bathing, proper storage and consumption of food and water. It seemed this village knew nothing of even the most basic sanitary practices. I never wanted to get used to seeing distended bellies or unnaturally red hair.
My naming ceremony was Tuesday, market day, and it turned out to be one big party. First thing that morning, the entire village gathered in the chief's meeting vestibule. Three neighboring volunteers biked in for the festivities, most likely exceeding the number of white people ever seen in the village at one time. The chief welcomed the village, my counterparts, the volunteers and me. The chief's translator repeated the words for everyone to hear, followed by the men's translator, then the women's, all in Konkomba. Aimee translated the welcome into French, and Samarou (my long-lost counterpart who had returned sometime during the previous night) repeated it for my benefit. Everything I said in response was translated in the opposite order. All this translating, a gesture of respect for the chief and me, served only to give me a headache. It made for a very long ceremony.
After lots of discussion and several minutes of contemplation, the chief finally reached a decision and gave me a name — Katchampi, meaning woman of Katchamba. Such a common name on the surface, but apparently reserved for only the special women of the village. An elderly woman was the only other Katchampi in the village, so named as the spirits had instructed. I was named so because my role in Katchamba was to help not only the village, but also the township of Katchamba, with my vast knowledge and expertise. Energy and expectation exuded from the villagers; I immediately grew self-conscious about the amount of knowledge and expertise I might actually have.
We filed outside for dancing and feasting. Women served riz gras (a tasty combination of rice, tomatoes and spices) and home-brewed tchapka, or millet beer, until we could eat and drink no more. Then everyone danced for hours, stamping their feet in unison to the deep beat of the tam-tams. Children played on the perimeter of the festivities, often imitating their elders and sneaking wily glances in my direction. A few brave children sneaked into the circle and danced along with the adults, until one of them danced off-beat and got whacked on the head. All the brave ones would then scatter back to the outskirts, and the entire charade repeated itself. Infants, swaddled in a pagne in the small of their mothers' bouncing backs, slept, breast-fed or moved to the music as they heard it.
I tested my dancing shoes after observing for long enough to recognize an underlying beat. Thummpa, thummpa, thummpa. Although my dancing proved awkward compared to their practiced ensemble, they loved my participation. So we danced. We danced until I didn't trust my legs to support my body. I sat down to rest and instantly the crowd dispersed to prepare for the market.
Our day began Thursday with a trek to two small villages to administer polio vaccinations. I personally vaccinated more than 100 children, and Samarou probably doubled that amount. Every move I made was scrutinized by several onlookers. Numerous children saw me and ran in the opposite direction, believing me to be a ghost who had come to collect and take them to the nether world. I can only imagine their genuine terror, caused by stories of witches eating the souls of children to fortify their evil powers. Plus, this particular ghost fed other children horrible-tasting, slimy liquid, undoubtedly instantly eating their souls and thus eventually killing them. No wonder they were terrified.
The whole time, I analyzed the lack of health care in such a remote area. Even the simplest public health concepts proved foreign. I knew I had to work with these villages to broaden their knowledge quickly and effectively, and hopefully save a few lives in the process — or at least improve their quality of life. But I couldn't help but wonder — how?
After a relaxing siesta, I pensively headed to Samarou's house for dinner and drinks. A small crowd was forming outside his courtyard, observing Samarou talk with a distraught woman. Apparently she had brought her ill child to the health clinic, found no one there and proceeded to Samarou's house. She was now waiting for the matron, although both Aimee and Samarou had already told her it was too late to help her child in Katchamba. They needed to go to the hospital in Guérin-Kouka, with its better facilities and medicine — a mere 30 kilometers away. The woman had neither the transportation nor the funds to take her child to the hospital.
Samarou's wife, meanwhile, served drinks and prepared food. We chatted and relaxed while this woman and her child sat five feet away. Samarou and some other villagers randomly and intermittently yelled at the poor mother for not going to the hospital. She always had the same reply: Il n'y a pas les moyens. There's no means. Realistically, her child might die anyway, even after spending lots of money at the hospital. So why bother? Such is the fatalistic attitude of villagers. So she waited.
We continued drinking the local drink as I watched the mother and her child from my perfectly positioned seat. She alternately cradled the baby girl in her arms and laid her on a cloth on the ground. The infant couldn't have been more than 10 months old and didn't appear malnourished or suffering from another obvious illness. She was just very pale and limp.
Samarou set the table and served us dinner. Seconds later, I watched the life literally leave the little girl's body. The mother saw it too. The 10-month-old child, previously unconscious, abruptly went lifeless and completely still. I had never actually witnessed someone die. How sad that my first run-in with death had to be a small child, whose life ended before it really began.
The mother cried with despair. Such a sad, pitiful sound, that of a mother keening for her dead child: a low, heart-wrenching shrill originating deep in her throat. At that exact moment, the father finally arrived to bike them to the hospital. He was too late. She swaddled the corpse in a pagne on her back, her husband helping her move the unwieldy body into position. They covered the head with a scarf wrapped around the mother's neck. It reminded me of the white sheet we Americans use to cover the dead.
I was shocked. And speechless. I had no idea how to react. I felt selfish because I had more than 50,000 CFA (about $90) in my pocket to give the carpenter for my furniture. I could have rented a taxi and paid the medical bill. I was torn because I knew if I had offered money, I would have set a precedent and others would begin asking for and expecting money. The child probably would have died anyway, and I would then be expected to pay for the burial. But I was deeply saddened, and my heart goes out to all the children of the world whose lives are extinguished far too soon.
If only I spoke French better. If only I had gotten here earlier. If only I had already provided general health knowledge. If only …
But life goes on. Samarou and his family continued to eat dinner, prodding me to do the same. My appetite left me when that child's soul left her. The crowd dispersed and everyone returned to their daily, mundane activities — seemingly unaware that one of their own had recently left them, or unwilling to deal with such a common occurrence as death.
I knew at that moment that my two-year service would be wrought with many trials and probably few triumphs. I also recognized that public health plays a larger role in sustainable development than I had previously thought. People cannot improve their quality of life via educational and environmental gains when they are not healthy enough to pursue any advancement. So this became my plight in the Peace Corps — to dispense as much "common" knowledge of basic health practices as possible.
And so my Community Health Agent program was born. Samarou, Aimee and I trained 28 health workers from nine different villages on a variety of topics over the following 18 months, including pre- and postnatal health, immunizations, nutrition, malaria prevention, HIV/AIDS and many more. We figured that the more information people were exposed to, the more likely it was that their practices would be altered for the better — and the more likely they would be to listen to those who had training on those topics.
A French and Togolese proverb fits this concept perfectly: Petit à petit, l'oiseau fait son nid. Little by little, the bird makes its nest. And indeed it does. I hope the teachings of my health workers are some of the sticks that make up the nest in Katchamba.
People often ask me if I made a difference in Togo as a volunteer. I have revisited that question for countless hours. I know that if I made a difference in one — just one — life, then I did my job as well as I possibly could. I believe I did positively touch the lives of our 18 health workers. I can only hope that they each now make a difference in the life of just one person by passing on the information I passed to them.
At least that's what I tell myself to convince me it was all worth it. And it was.