Youth Boot Camp Dec 27-28

In the first few meetings of trying to start a campaign on gender-based violence in Shoshong, one of the police officers suggested doing a youth boot camp.  In this boot camp, youth would learn about life skills and gender-based violence.  They would also do some exercising.  The police officer, Sebetlela, had the idea to have the camp overnight.  That way the youth would be a bit uncomfortable and it would challenge them.

During the holidays, many youth come back to Shoshong if they live away.  Even if they stay in Shoshong full-time, they are out of school and normally just loitering around.  Sebetlela thought this would be a great time to engage the youth and empower them to understand these issues better.  We hoped that the youth that attended the boot camp could then lead the village in the gender-based violence awareness campaign.

Unfortunately, it was a bit difficult to organize everything on time for the camp on December 27th.  It ended up okay in the end, but Sebetlela was running around the afternoon before the camp to try to secure food and other donations.  We didn't have much time to plan, which made the camp not as effective as it could have been.  But we have fun and learned a lot so we can do a better job planning next time.

Setting up the camp before everyone got there

While waiting for more people to arrive, I showed Boitumelo (one of the participants) how to use a male condom...no need to sit around when you have spare condoms and water bottles!

Gotta eat first!  Here we are cooking magwinya (fried dough...aka fat cakes)

Before the sessions started, the participants and some of the facilitators played games to get everyone excited about the boot camp

One of the first sessions.  Before we get into the specifics of life skills, we thought that the participants needed to do some self-exploration.  These were the questions the facilitator, Rebecca Kowa from the clinic, asked the participants to answer.

Two of the organizers (Sebetlela, the police officer and Boetelo, a councilman in Shoshong) participating in the first exercise.

Most of the participants

More fun in between sessions!

We tried to keep everyone up throughout the night.  The participants talked about self-awareness and self-esteem, spitting your time between social life and work, the difference between violence and abuse, etc.  The youth learned a lot and it brought them closer as a group.  The camp ended at about noon on December 28th.

Ngwaga o Mosha!

Ngwaga o mosha or Happy new year!

2012 has been an amazing year...the "long stretch" of Peace Corps service.  Volunteers have said that when you begin the January to December part of service, it can seem like it will never end.  But as most things do, it feels like it has gone by in a flash.  I can't believe I will be ending my time in Shoshong in less than 5 months.  But I don't want my adventure in Botswana to be done quite yet.

I do hope to extend my service in Botswana another full year.  There are a few options when one decides to do this.  One may apply to stay in one's village or go elsewhere.  One may work in the same kind of organization/job or choose a different path.  One may work in one organization or split time between a couple.  I am applying to work outside of Shoshong.  I am not exactly sure what kind of organization I would work for.  It all depends on how many other volunteers are applying and what they would like to do.  I won't find out if I have been accepted for a couple months.

Reflections will become stronger after the two years, I am sure.  But there are a few things I have been thinking about lately.  The first is if I would ever do Peace Corps service again.  An NGO called World Spine Care opened up a clinic in Shoshong.  It is very exciting.  There have been many American and Canadian volunteers over the past 8 months.  The most recent one asked me where my next Peace Corps post is.  I laughed and said that I go home after Peace Corps Botswana.  And then I said I will never do Peace Corps service again.  She looked a bit surprised, as if I meant that my experience had been so bad that I could never dream of doing it again.

However, it is just the opposite.  Peace Corps service is different than getting a great job in which you travel to London, Cairo, Berlin, etc.  Peace Corps service isn't just seeing the world.  It is becoming a part of a community.  For me, it meant learning a language.  Although we will never fully integrate into our communities or become fluent in the local language, we can become very close with people around us.  And that is very different than living in a big city.  It is an amazingly special experience.  And it is also very difficult at times.  I have had a beautiful experience in Shoshong and I wouldn't trade it for the world.  Similarly, I wouldn't want to try to do this again.  I am now a child of America and a child of Botswana.  Splitting my heart between the two is enough.

It is difficult for someone to understand what I mean when they only do a summer abroad or spend a month volunteering somewhere.  Spending two years of your life is a real committment.  And once is enough for me, I think.  Things can always change, of course...so I shall never say never.  But at this point, I am satisfied with one tour of Peace Corps.

The other thought I have had of late is about Botswana culture.  I have written extensively about it in this blog, trying to point out similarities and differences to life in America.  That process has merit and I understand it.  When we experience something new, we inherently categorize it with what we already know.  It's how our brains work as humans.  We try to understand the world around us based on the framework that we know.  But there are moments in which I think, "This aspect of Botswana culture is a contradiction."  One example is how community-focused they are in general.  Food is shared within the family.  There is a lot of community support, especially at funerals.  That being said, families can often be a source of real hardship.  Many people I have worked with feel a lack of understanding, and even strong judgments from their family members.  Why does it seem like there is so much love on the one hand, but a lack of trust and empathy on the other?  It seems to not make sense.

And then I realize that it doesn't make sense because I am trying to interpret peoples' behavior within my understanding of "normal" behavior in the United States.  Cultures cannot be compared to one another because they evolve separately.  Each is unique and must be understood in that context.  Nothing is weird or a contradiction...it's just the way it is.

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.