Choices

In Peace Corps philosophy, every project should have a local counterpart—a community member who is (hopefully) as passionate as you are.  You learn from each other while doing that project.  This is called “capacity building.”  Ideally, volunteers never do anything alone.  The point is to empower community members to do things themselves, to connect them with the right people/contacts/funding…whatever it may be.  Then, in the future, after you are gone, they may continue the work without you.

That is the pie in the sky view of things.  When you are on the ground, things begin to look a lot different.  How do you organize the community to host an event?  Which people do you choose as counterparts?  When do you pull back and let others take over?  If people seem excited but don’t do their end of the work, do you catalyze them to do more?  Or do you realize that the community buy-in for the project is low and abandon it?

Over the course of my service, I have allowed my projects to be dictated by community members’ interests.  I haven’t felt lazy or bored, for the most part.  Every week, my schedule fills of its own accord.  There have been specific instances in which I have taken initiative, like teaching life skills in the schools and giving health talks at the clinic.

November and December can be slower months.  Schools are closing and people are leaving for the holidays.  Lately, some volunteers have done events relating to the 16 Days of Activism Against Gender Violence Campaign.  I think it would be a great thing for us to do in Shoshong.  Perhaps a march, poetry contest when schools open back up…something.  Gender-based violence is rarely talked about and I think we should open up the dialogue.  Peace Corps volunteers can be really useful in this regard.  Culturally, it can be difficult to talk about sensitive issues.  Because we are foreigners, it is easier for us to initiate community dialogues about things like gender-based violence, HIV, sexual practices, etc.

I am breaking my mold a bit in spearheading an event myself.  My plan is to have the community come up with the whole event, if they think it is a good idea in the first place.  And then we will go from there.

Slow moving is okay.  In fact, it is wonderful.  It is how I have lived for the past year and a half.  But there is such a thing as allowing yourself to become idle and complacent.  And I don’t want to feel like my service is over.  I have six months and I intend to utilize them…or I intend to try, anyway.

We all make choices about how we want to conduct our Peace Corps service…how we want to enjoy our lives.  And at this point, my choice is to continue to be active.  That is not to say that any of my projects will succeed.  But at least I will have attempted to do something.

Cervical Cancer in Botswana

Many women in Botswana are dying of cervical cancer.  Cervical cancer is caused by HPV, the Human Papilloma Virus.  Although there is widespread knowledge about HIV in Botswana, other sexually transmitted infections (STIs) are not well-known.  More women die from cervical cancer in Botswana than from any other kind of cancer.  The tragic part about the situation is that cervical cancer is preventable.  Women must simply go their local clinic or hospital for yearly pap smears.  If abnormal cells are found on the cervix, a series of measures can be taken so that the abnormal cells do not turn into cancer.

HPV is not only a problem in Botswana.  According to the Center for Disease Control, at least 50% of sexually active Americans will contract HPV during their lifetime.  There are more than 40 different strands of HPV.  Some of them cause genital warts, others cervical changes.  There is no HPV test for men, which is one of the reasons why it is so easily spread.  You could have been infected with HPV years ago and not know it.  HPV rarely has any symptoms (other than warts) before it causes cervical cancer.

Luckily, foreign donors and the Botswana Ministry of Health are recognizing this as a problem that can be solved simply.  Get more women to do pap smears.  Get the results in a timely fashion.  Follow up with the women who have abnormal cells on their cervix.  Piece of cake, right?  Unfortunately, no.  Some women (especially younger, sexually active women) are afraid to do pap smears because they believe they are painful.  Results are not received in a timely manner.  Occasionally they are lost altogether.  And tracking women down in a large village with no transport, and where many people don't have cell phones...well, you get the picture.

Positive steps are being taken to remedy this serious health issue in Botswana.  In the past, HIV has been the message of the day.  But the Ministry of Health is realizing that it needs to integrate other messages about sexual reproductive health into HIV awareness.  Raising awareness about cervical cancer is a large part of that.

Former President George W. Bush came to Botswana a few months ago.  He announced a new multi-million dollar initiative to  step up cervical cancer screenings.  For more information, check this out.

What makes me most excited is the "See and Treat" program that the Ministry of Health is rolling out next year.  To ameliorate the issue of lack of timely results, the Ministry is trying a new tactic.  Doctors and trained professionals in a handful of hospitals across the country will be screening women for cervical cancer using vinegar.  When vinegar reacts with the cells on the cervix, one can identify the cervical changes and treat on the spot.  This eliminates the difficulty in finding women for follow-ups.  Here is a great NPR article about this new initiative.

When so much of our work is centered around behavior change and HIV, it is refreshing to hear about something exciting and different.  The "See and Treat" program could really make a difference in Botswana.  I hope other countries are using the same model.

As PCVs, we can refer women to places where they do the "See and Treat."  We can spread awareness about cervical cancer in a more comprehensive way.  Working to increase the number of women screened for cervical cancer in Botswana is something achievable that can make us feel fulfilled.  It is a great time to be working in international public health.

One of the More Enlightened Days

I have had some thoughts about the Peace Corps experience in general lately, but haven't figured out how to put them down on paper until now.  So...here ya go:

Peace Corps service shows you that there is a lot more to life than work and a paycheck, if you didn't know it already.  Many other experiences can also do this, but Peace Corps is one of the most effective.  You are forced to find fulfillment out of smaller things in life: the beauty in the sunrise, the relief that comes with approaching rain clouds, the carefree nature of children's laughter.  You can no longer define yourself by what you do.  Instead, what becomes more important is how you do it.  You realize how much you enjoy writing by candle light.  You actually meditate.  You read books you always meant to read, but never seemed to get around to before.  Peace Corps challenges your understanding of the world.  Through that, you emerge---the same as before, but oh so different.  You listen more.  You approach problems in a more nuanced way.  You observe without judgment and experience without reservation.  Who you are deepens and broadens.  You begin to see your well-being inextricably linked with the well-being of those around you.  On the worst days, you feel lost...pull-your-hair-out-, punch-a-pillow-, cry-at-a-sad-movie-just-to-feel-something-LOST.  On the best days, you think, "Wow...I may just actually be considered a member of this community.  How about that."  Every day, there are small fulfillments.  Maybe you learned a new Setswana word or mailed in your absentee ballot.  Occasionally you think someone may have learned something from you.  But being a Peace Corps volunteer means being humbled everyday with the knowledge that you may never see the fruits of your labor.  Because the destination is unknown and indefinable, you must be satisfied with the journey.  If you don't laugh at the absurdity of how long it takes to do ANYTHING, you'd go crazy.  You could come out of Peace Corps tired, frustrated, and happy to be ANYWHERE else.  Hell, you will probably feel that way periodically anyway.  Ideally, days with more clarity come.  And they tell you that you are part of something bigger than the daily grind.  You have been given an opportunity that few have.  It's not about being a representative of the United States.  It has nothing to do with John F. Kennedy or Peace Corps.  At the end of the day, your legacy is your own.  People may not remember any of your failed projects, but they will know that you cared.  And that matters.  Peace Corps gives you the opportunity to examine yourself.  After two years, let's hope you like what you find.

Panel on Safe Male Circumcision

For the most part, Peace Corps volunteers understand that we will rarely see the impact of our hard work.  I do feel appreciated by some people in my community, but they usually say, “You are so important” or “You are doing so much.”  They rarely single out specific interventions or projects as particularly noteworthy.  Peace Corps Botswana has mechanisms to recognize volunteer work.  We can submit success stories to the monthly newsletter.  We get positive feedback from our program managers.  And recently PC has started “Realities from the Field” panels.  PC staff invites volunteers working on specific interventions to come give a presentation to our governmental and non-governmental partners in Gaborone.

On November 20^th, the “Realities from the Field” panel was on safe male circumcision (SMC).  I presented on my work, along with four other volunteers.  The idea behind these panels is to give feedback to policymakers.  We tell them what is going on at the ground level, our successes and challenges in the safe male circumcision campaign.  We presented to a group of over 20 people with representatives from the Center for Disease Control, President’s Plan for Emergency AIDS Relief, Department of Defense, Botswana Ministry of Health, Population Services International, JHPIEGO and ACHAP (organizations working on SMC in Botswana).  It was definitely a room of heavy hitters.  We told them how men and women were receiving SMC in our villages, myths and questions we encountered, etc.  They can then shift their programs as needed.

The panels are great for Peace Corps volunteers because they are an appreciation of our work that we rarely experience otherwise.  I worked with Bright Mosimegi, a nurse at Shoshong Clinic, to develop a Setswana SMC/pap smear informational pamphlet for our April Month of Youth Against HIV/AIDS event. We designed it in Setswana because all of the pamphlets on SMC from the Ministry of Health were in English.  Some people speak English in Shoshong, but plenty do not.  Since we wanted everyone to be able to understand the message, they needed to be in Setswana.  The Ministry and its related partners in the SMC are starting to translate their materials into Setswana, but that is still a problem.

At the panel, I presented on my pamphlet and related health talks at the clinic.  I roughly translated the pamphlet, explaining to everyone the headings and information contained therein.  Many people asked me questions.  Then at the end, one man said that he was so happy to see this pamphlet.  He said that the Setswana was simple, which one rarely sees in pamphlets designed by public health specialists.  He was happy that the pamphlet was accessible, urging the groups there to involve people on the ground to make more pamphlets like this one.  And then everyone clapped.  It was such a great moment.

Before the panel, I sent the pamphlets out in an email to all volunteers in Botswana.  At this point, I think that about 5 other volunteers are using it.  Knowing that I have created something that is making health information accessible to people is a great feeling.

In the last post, I wrote about becoming comfortable in my role as a Peace Corps volunteer.  I learned early on that there is no reason to reinvent the wheel.  Using already existing programs and materials is the way to go.  It is really nice knowing that a product of mine will help volunteers and other service providers in Botswana better explain the importance of safe male circumcision and pap smears.

Left hand side is SMC; right is pap smear info

General translation of the pamphlets:

PAP PAMPHLET

What is pap smear (direct translation: testing for cervical cancer)?

•  It is done every year
• Checks the cervix

What does pap smear test for?

• Non-sexually transmitted infections like yeast and bacterial infections
• Sexually transmitted infections like gonorrhea, syphilis and others
• Sexually transmitted infections that can be treated, but that without treatment can give you pelvic inflammatory disease and cervical cancer
• Sexually transmitted diseases that cannot be cured like genital herpes

Consequences of not testing:

• Many of these diseases show no symptoms, so you can have them and not know it
•  If you do not seek treatment, some can become cancer
•  Cervical cancer can lead to fertility and even death

SMC PAMPHLET

What is SMC (direct translation: cutting the foreskin of the penis safely)?

• SMC is the surgical removal of the foreskin of the penis by health professionals in a health facility

SMC reduces the chances of the following:

•  Contracting sexually transmitted infections like syphilis
• Contracting HIV by 60 percent
• Getting penile cancer
•  Getting urinary tract infections
• Transmitting HPV to female partners

Why does SMC work?

•  The foreskin is easy to tear during sex
• The foreskin holds CD4 cells, which HIV targets
• It is difficult to clean foreskin, resulting in diseases if not cleaned properly

Other things you should know:

• SMC does not prevent HIV
•  Men must wait 6 weeks before having sex after doing SMC

Year Two Adjustments

I have felt a dip in workload lately.  This oftentimes coincides with the closing of the schools.  So many of us work in schools in some aspect or another, so the holidays bring a slowdown of projects.  Being six months away from close of service is a strange time.  We are still involved with projects in a real way, ideally beginning to see what our counterparts can continue without us.  We want to continue to grow our work within the community, but starting a new long-term project now seems foolish.  We are probably as comfortable as we will ever be in our villages.  We are thinking about plans after Peace Corps, but still have six months staring us in the face.

I have sensed a change in myself these past few months.  There are still difficult moments, ones in which I want to shut myself up in my house with a glass of wine in one hand and a bar of chocolate in the other.  But the difficulties don't have so much to do with the fact that I am a Peace Corps volunteer. They have to do with the fact that I am human.  If I were living anywhere else, those moments would still happen.

It is interesting to talk with volunteers who have been in service less time than I have.  It reminds me of my past phases of adjustment.  One volunteer wrote an article in our monthly newsletter about becoming unhappy as the doubts of Peace Corps service grab hold.  She was telling us not to give up on personal development, reminding us how to be responsible for finding the joy again.  The basic gist was that we can choose to be happy.  It made me smile because I realized that I no longer think about my service in that way.  I am just content.  I do not need to search for things to make me feel this way.  There was a time when Peace Corps service felt like something to have to "get through."  But I do not feel that way about the next 6 months.  I am not counting down.  I don't look at my time in Shoshong as  "service" anymore.  I am living in Botswana.  It is not something insular, different from my other experiences in my life.  It just IS my life.

A large part of the unique frustrations of Peace Corps service is the constant feeling of failure----or if not failure, then at least questioning whether or not you are making any kind of difference.  Wondering about actual legacy and impact is a big topic, for another post for sure.  But part of becoming content is realizing that I absolutely have succeeded in making a difference.  The key is in redefining success.  The best definition I have ever seen was hanging in the computer lab of Shoshong Junior Secondary School:

"Success is going from failure to failure without losing your enthusiasm."

Reminds me of golf.  Every shot is a new chance.  Every shot has the potential to be amazing.  And if anything, that has been my success...that regardless of how many projects never started or how many people said they would work with me and never followed through, I have continued to be enthusiastic if someone wants to start a project with me.  I have not been discouraged because of failure.  It's not really determination or perseverance, but rather a pleasant acceptance of the way things are.

Mosinyi's Coronation

Late August, we had a really exciting event take place in Shoshong.  My brother, Mosinyi Mosinyi, was coronated as chief of our ward, Bokaa!  Shoshong has three wards: Phaleng, Bokaa and Kgamane.  Phaleng and Bokaa are the largest, each having roughly 35 sub-wards.

Mosinyi now presides over the customary court of Bokaa, deciding on matters that are brought there.  He also gives people advice independent of court proceedings.  He can try cases of land disputes, marriage disputes, etc.  He is also seen as a leader in the community now that he is a chief.

Here are some photos from the event and the week leading up to it:

A lot of people came the week before to help clean, cook and prepare for the coronation.  Here, they are preparing the mud mixture that they will put around the tree.

 

Collecting straw to cover the small house in the back of the compound

Both my house and the main house were re-painted.  This is Mushi, one of Mosinyi's friends, painting the main house.

At any gathering, there is a metal fence put up where people are cooking.  The women always cook the starches, greens and other salads.  The men take care of the meat.  I think 11 cows were slaughtered to feed people at the coronation.  You can see some of them behind the metal wall here.

One of my favorite dishes is bogobe jwa lerotsi.  It is a starch made from sorghum.  Then you put little pieces of melon in it.  Yum!  Here the women are peeling the melons.

Program for the event (I have a shirt with the top part on it...its PRETTY GREAT)

People waiting for the event to start

The seat of honor with all the male village elders sitting behind it

Here comes Mosinyi flanked by chiefs of Shoshong and nearby villages

A group of young men doing some sort of drama (you can see me on the left videotaping)

Me videotaping

The next to perform was a chorus from Shoshong

Then a traditional dance group from Shoshong Junior Secondary School

How it looked at the kgotla - lots of people!

I wrote a poem for the occasion.  It was mostly in English but I think people liked it.

There were many speeches by old men I didn't know, but I didn't put those photos up here.  This is the part when Mosinyi was actually being coronated.  I thought it would be more ceremonial, but they mostly read the history of the Bakaa tribe, said some words of advice and then we went on our way.  Here, Mosinyi is sitting down.  Standing behind him (l to r) are Chief Mosinyi from Kalamare, another chief from somewhere I don't know, and Chief Mosinyi from Shoshong (one of the chiefs at the main kgotla).

Mma Mosinyi sitting at the table of honor

The best part: when we get to eat!  Here is Susan helping out with the serving

It was a lot of fun being part of the celebrations.  I was honored to read a poem and be included as a real community member.  It was special for me (and much easier to sit through) because it was my brother becoming chief.  These ceremonies take hours and hours, so it is really nice when you actually know the subject of the proceedings.  I don't think I have ever seen that many people at an event in Shoshong.  It was truly a great day!

General Updates

Apologies for not writing for so long.  Some people lessen their blog posts because they find they run out of things to say.  That's not the case with me.  I have so much to update!  I have just been so busy.

In October, I had two visitors.  The first was a trainee named Paige.  The other was my mom!  I had a great time with both of them.  It is so nice to share your village and your experience with other people.  My mom only planned on being here for 9 days but because of Hurricane Sandy was stuck in Gaborone for an extra three days.  That was three more days of laying by the pool at the hotel, three more days of good meals and shopping.  I wasn't complaining!

But it is so nice to be back in Shoshong working everyday...no visitors, no need to leave for any reason...just doing my thing.  Traveling all around so much gets tiring.  It is funny how things change.  There were days in which I wanted to be ANYWHERE ELSE but Shoshong.  But these days, I feel like I never want to leave.

There is a new group of community mobilizers in Shoshong.  They will be working to motivate men to get circumcised.  I am sure I will be partnering with them in some way.  I am continuing to try to work in the schools.  The one Life Skills class I was teaching has ended and the kids are finishing up their exams.  But I still have some time for some programs this month if I can kick it in gear.  New projects continue to come up.  I always like to leave my schedule flexible for these things.  It's really nice.

I will write more specific blog posts on Paige and mom's visits, as well as other things that have been happening.  Hopefully my internet works well enough to upload photos.

Peace Corps Reconceptualized

Many people talk about how Peace Corps is not what it used to be.  Most volunteers are given cell phones.  We are all expected to fill out a quarterly report with objectives, goals, outputs and outcomes.  Many volunteers have regular internet access and are able to contact people at home quite frequently.  This is not the picture of the Peace Corps of the '60s and probably not the picture many people have in mind when they still think of it now.  It makes sense that PC is changing.  The world is changing.  Internet is available in more places, as is running water and electricity.  So our lives within PC service should naturally change as well.  There is nothing wrong with this.

But PC is caught between its history and its future with no clear direction.  Some volunteers are still doing development work in the way we normally think of it--digging ditches, building agricultural systems and teaching in schools.  But more of us are moving to projects in secondary states of development--working on things like behavior change related to health, educational systems and curricula (rather than first-hand teaching), etc.  There is plenty to do, but PC needs a reconceptualization if volunteers are to be as effective as they could be.

PC is still thought of as the free-flowing, life-changing, design-your-own experience.  But the constant push to monitor and evaluate our impact takes away much of the spontaneity of past PC.  There is nothing inherently wrong with M&E.  In a political climate in which Congress is increasingly hostile toward PC, trying to put numbers to dollar signs is important.  This aspect cannot be overlooked.  However, assessing if people REALLY learned anything from your health talks is difficult.  And ascertaining if people are REALLY changing behavior based on ANYTHING you do is damn near impossible.

To PC's credit, increased infrastructure has meant better training, better safety and care for volunteers.  These are great things.  I have only experienced one kind of training, that of PC Botswana.  So I can't speak for many others directly.  Yet, I have met currently-serving volunteers in Senegal, Mali, Rwanda, Ethiopia, Macedonia, Burkina Faso, etc.  We all have differing views on satisfaction from our experiences.  And within any country, there are volunteers who end up doing a lot of activities and others who don't.  Sometimes it is the primary job site that makes it difficult.  Sometimes it is the village.  Sometimes the volunteer doesn't have the right tools to figure out how to make things happen.  And sometimes we can try until we are blue in the face and nothing sustainable gets started.

Sustainable.  There's that word.  The word everyone talks about.  Sustainable development.  What in the world is that?  From what I understand, the idea is that we help people in our villages build something that will continue when we are gone.  I am not talking about a house or a building.  I am talking about programs, activities, increased learning...whatever it may be.

Peace Corps is great for building world peace and friendship - 2 of its 3 goals.  But it is not very successful at measuring the level of sustainability of its programs.  I don't believe this is a unique situation within PC Botswana.  I think it has to do with PC philosophy within the entire organization and manifests itself in trainings.

In training, we are taught many roles of a volunteer.  We can be a learner, a change agent, a facilitator...blah blah blah.  These are sessions that Washington hands down, so I know every volunteer worldwide is getting the same spiel.  It's like it dances around two words that would change the way each of us looked at our work: community organizer.  That is what we are.  We are community organizers.  When a fellow Botswana volunteer used those words when talking about her service (she had served in Mali before coming to Botswana), a light bulb went off in my head.  Ah hah.  So that is what we should be doing!  I firmly believe that Peace Corps thinks it explains this and explains how to do it.  But it doesn't.  Like my friend said, understanding this would probably result in less volunteers.  Being a community organizer is hard work.  Going into a community, learning the language and trying to help it see things from another perspective in order to cultivate innovative solutions is really tough.

Even with this acquired knowledge of a month ago, I haven't been able to make huge changes in my service.  I have been more active in trying to bring people from different sectors together.  I have urged a more community-based approach to events rather than top-down planning that is oftentimes implemented.  PC says to find the "movers and shakers" in the community and work with them.  It gets challenging when the official opinion leaders are not the ones who actually do anything.  Finding the people who actually want to work means your sustainable development projects will look a heck of a lot different than you thought.  And what if you feel like you live somewhere for two years and nothing sustainable comes out of your work?  How would you feel?  I guess I will find out in 8 months.