Obesity and Hunger in America and Benin

Here in Benin, I find myself thinking a lot about food, nutrition, and weight from both a biological and sociological perspective. Many people here don’t have healthy food options or are malnourished due to simple lack of food. It’s quite common to see people who are skeletally thin (marasmus), people who are bloated from lack of protein (kwashiorkor), and people who are just fat from a diet high in carbohydrates. A lot of this range is typical for developing countries. Carbohydrates play a key role as staple food items, eaten with every meal to fill the stomach. They are typically cheap and easy to prepare and gives a feeling a fullness without adding much nutritional value. Here the staples are pâte (“blanc“, “noir“, or “rouge” made with corn meal, yam skins or corn meal and tomato sauce), yam pilée (boiled and smashed yams), akassa (fermented pâte), or the remnants of colonialism: rice, spaghetti, or couscous. Of those carbohydrate staples, only couscous has any sort of real protein value, and although the unprocessed, natural staples do have some nutritional value, they are primarily used to simply fill the stomach and curb hunger. With the carb, a meal will usually include a palm oil based sauce made with tomatoes and onions, a vegetable sauce with okra, a sesame based sauce or a peanut sauce with a protein item if it is available: goat, chicken, guinea fowl, or wagasi (traditional cheese). Often times a meal is just a large pile of carbohydrates with a simple sauce when money is too tight for meat. This type of eating after a while leads to obesity and protein deficiencies in children and adults. For the most part, obese or overweight people in Benin do not follow an observable socioeconomic trend. The richer are often overweight just from overeating, the poor from a low quality diet. Mostly, though, obesity is not a nationwide health problem here, but a symptom of malnutrition in general.

Thinking about these things, I started wondering what was going on in the US. Right now in the United States, obesity has reached epidemic proportions. Over 65% of American adults and 16% of children are considered overweight or obese (having a Body Mass Index of 25 kg/m2 or higher) and it’s only getting worse with processed sugars, oils, and sugar sodas and beverages. It is estimated that by 2015, 41% of all Americans will be obese (BMI over 30 kg/m2). Clearly this is an important issue, and one that is much broader than the scope of my little blog post today, but it got me thinking about the medical science behind obesity, hunger, and satiety. So I pulled out my handy dandy pathophysiology textbook, The Pathologic Basis of Disease by Robbins and Cotran, and turned to Chapter 9: Environmental and Nutritional Diseases. I wanted to find out what makes some people fat and some people thin and how we can, as a nation and as individuals, work toward curbing the obesity epidemic and keep ourselves healthy.

First off I read about what exactly the problem with fat really is. We all know that obesity can lead to higher levels of cardiovascular disease, hypertension, and type 2 diabetes. Obesity has also been strongly correlated with rates of cancer in both men and women, as well as breathing problems and liver disease. All of these risks are increased if the fat is primarily stored in the middle of the body, around the midsection in the mesentery and around viscera in the abdominal cavity. I believe that modern medicine, and current scientific research clearly indicate that being overweight is a health risk. There are also many social pressures to be thin and the interplay between health and society with weight issues is an interesting one, but not what I want to talk about right now. Right now, I want to know what’s going on with the biochemical pathways that lead to obesity and why some people are fat and others thin.

At its most basic level, obesity is a “disease of caloric imbalance that results from an excess intake of calories above their consumption by the body” (439). A person is fat if they’ve consistently eaten more calories than they’ve burned off. It really is that simple. Of course, the pathogenesis of obesity is incredibly complex and not totally understood yet. Hunger, satiety, the urge to eat and to stop eating, metabolic pathways and mechanisms are all things that need ongoing research. It is clear that genetics, environmental signals, nutritional factors, and psychological signals all go into the triggering of the metabolic response and that it is a complex system based on many different interactions. However, obviously obesity would not occur without the intake of food.

The mechanisms that regulate energy balance can be separated into three parts: the peripheral or afferent system, the arcuate nucleus in the hypothalamus, and the efferent system. The afferent system generates signals from various site such as LEPTIN and ADIPONECTIN produced from fat cells, GHRELIN by the stomach, PEPTIDE YY (PYY) from the intestines, and INSULIN from the pancreas. The hypothalamus processes and integrates these signals and generates efferent signals. The efferent system carries the signals from the hypothalamus to control food intake and energy expenditure.

I want to talk about a few of the afferent components that regulate appetite and satiety: leptin, adiponectin, and gut hormones. Stick with me, this is cool stuff.

LEPTIN. The name leptin comes from the Greek word “leptos”, meaning “thin.” It is a hormone synthesized by fat calls and is a product of the ob gene. The leptin receptor is the product of the diabetes gene and belongs to the same family of receptors as IL-2 and other cytokine receptors. Mice deficient in either leptin (ob/ob mice) or leptin receptors (db/db mice) overeat and gain weight because they don’t sense their fat stores and behave as if they were starving (439). Leptin levels are regulated by multiple post-transcriptional mechanisms. In the hypothalamus, leptin causes the secretion of anorexigenic neuropeptides and inhibits neurons that cause feeding-inducing (orexigenic) neuropeptides. Basically leptin makes you feel full. In people with stable weight, these factors are all in balance. In someone with inadequate stores of body fat, however, leptin secretion is diminished and food intake increases.

Loss of function mutations in the leptin pathway in people are extremely rare. Some individuals (5% of massively obese people) could have problems with the receptors that sense the anorexigenic signals (the sense of feeling full) and would continue to overeat as if undernourished. These conditions are rare, but it’s been proposed that problems with the pathway could be associated with more common forms of obesity such as leptin resistance, rather than deficiency. Another way leptin works is to stimulate physical activity, heat production, and energy expenditure (440).

ADIPONECTIN. This hormone is produced by adipocytes and directs fatty acids to muscle for oxidation. It causes an increase in insulin sensitivity and has most receptors in skeletal muscle. Adiponectin has been called a “fat-burning molecule” and the “guardian angel against obesity” and when injected into mice, it causes a significant decrease in fat mass.

The total number of adipocytes is established during childhood and adolescence and cannot be changed in adulthood. Fat people have more fat calls than lean people. People can gain and lose weight by increasing or decreasing the size of existing adipocytes, but the number is predetermined. Trying to keep weight off is difficult because of a lack of a decrease in the number of adipocytes as well as an enhanced appetite caused by leptin deficiency.

GUT HORMONES. There are several hormones produced in the stomach, intestines, and pancreas. One of the most interesting is ghrelin. It is the only known gut hormone that increases food intake (orexigenic effect). If injected into mice, they eat voraciously, causing weight gain through increased caloric intake and reduced energy expenditure. Ghrelin levels rise before meals and fall 1 to 2 hours after eating. Interesting to note is that in obese and overweight people, the postprandial suppression of ghrelin is weakened which maintains the obesity through continued eating.

PYY is secreted from endocrine cells in the ileum and colon and levels of this hormone are low during fasting and increase after food intake. PYY levels increase after gastric bypass surgery and if injected, energy intake decreases. There is research going on now to use PYY as a treatment for obesity. Amylin, a peptide secreted from the pancreas with insulin that reduces food intake and weight gain, is also being evaluated as a drug for obesity. Both of these hormones act by triggering the hypothalamus to reduce food intake.

All of these factors work together to control hunger and satiety. Knowing what we know now, what can we do to prevent obesity and the risks that come with it? To a certain extent, how much lectin, how much adiponectin, and all those other hormones are predetermined by your diet as a child and genetics. You can keep your weight low, but if you have a lot of adipocytes and are naturally heavier, it’s going to be more difficult to regulate your weight. I’m pretty sure I fall into this category, and maintaining my weight in a healthy range is very important to me for both health and societal reasons.

Diabetes, cancer, hypertension, atherosclerosis, and cardiovascular disease all run in my family and there is indeed a correlation with high body fat content. Knowing how to eat and how much to eat is necessary for both my weight and credibility as a future physician. Eating a healthy diet of high fiber and low animal fat can help prevent colon cancer. Avoiding nitrosamines and nitrosamides from preservatives in meats can protect from gastric carcinomas, and just generally eating a healthy diet rich in veggies, whole grains, fruits, complex carbohydrates, healthy oils, and low in salt can help protect against cancers and heart disease.

Another thought is the idea of calorie restriction. It has been shown convincingly that caloric restriction decreases the incidence of many diseases and increases the lifespan in experimental animals. The particulars are not completely understood but it is thought to be related to lowering of insulin and IGF-1 levels and increased activation of sirtuins, proteins that promote metabolic activity and longevity (also associated with red wine, yay!). With a calorie restricted diet, animals live longer due to less oxidation and thus telomere breakdown and have a greater resistance to carcinogenesis and lower cholesterol levels. Most obviously, a restricted diet leads to weight loss and thus protection against many risk factors associated with obesity.

After doing all this research, I’ve decided that one of the best ways to stay healthy is to maintain a weight between BMI 18 kg/m2 and 24 kg/m2. I know BMI is not a perfect measurement, but for now, it’s the best we’ve got. Of course you can still be unhealthy within that range, and of course there are some people who can maintain health outside of that range, but in general, it’s a good indication of an appropriate weight to decrease risk factors associated with obesity and being overweight. In addition to maintaining a healthy weight, a low calorie diet with healthy foods seems to be a good option. Lots of fiber, healthy proteins, complex carbohydrates (limited pâte or yam pilée!), and lots of fruits and vegetables is a good solution. And as always, exercise. Several times a week for at least half an hour, up to 60 minutes when possible, your heart rate should be significantly elevated. This is such a simple thing that so many Americans, both obese and normal range weight, just don’t do enough. Exercise increases endorphins, makes you feel good, keeps your weight low and your figure slim, keeps your heart healthy, and helps stimulates the metabolic pathways. It’s win-win. Eat less, eat healthier, exercise more, and maintain a healthy weight range. Check.

Addressing the national problem is a question that countless physicians are working on. I think public service announcements, frank conversations with primary care doctors and pediatricians, and nutritional guidelines and information are all good starts. The obesity epidemic is complex, so close to issues of race and socioeconomic status, connected to ideals of beauty and worth, value in society and mental health. It’s going to take a lot of effort to really effectively stem the trends and there are a lot of political aspects to the changes that should be proposed. One thing we can all do for posterity is to help make sure our kids have healthy options and to really think about childhood obesity as a major sociological problem. Issues like sugar soda in schools, healthy lunches, sedentary lifestyle changes, and videogames all go into it. We know now that the number of fat cells is determined in childhood and adolescence, and we also know from personal experience and anecdotal evidence that it’s hard to lose weight as an adult if you were fat as a kid. So let’s keep our children within healthy weight ranges by making sure their diets are rich with nutrients and they’re staying active. That way when they grow up they’ll have an easier time staying healthy and avoiding all those risks associated with being overweight or obese.

Like America, Benin has a lot of work to do in curbing both obesity and malnutrition in general. With more and more outside influences like sugar soda, candy, and other processed sugars and starches, developing countries are becoming increasingly at risk for obesity. As a health worker here, I am often talking to people about diet, especially about the importance of eating vegetables and lean protein. Fish is popular here and cheaper than red meat which helps make my job a little easier. It’s tough, though. A lot of the reasoning behind the unhealthy diets here is money, just like it is in the US. I think it’s easy to forget that sometimes, especially when thinking about the United States. But it’s true. To facilitate behavior change, we have to address the problem in a local, community based way. I’m learning that every day here and I know that understanding will be crucial to me as a physician later. It might not be easy, but change starts now. It starts with us. I know I don’t always eat as healthy as I should, especially when I’m in America (Taco Bell anyone?), but I think I’m beginning to see the importance of diet in long term health a little more clearly now that I have all this free time to think about food.

This has been a nerd alert, shared from me to you. So go out there, and use your nerdiness to do some good in the world!

Not much else is going on, just getting ready for the girls' camp at the end of the month! Gotta read up on sexual health knowledge!

Thanks for listening :)

-E

Peace Corps Reform

There is little doubt that the Peace Corps is a valued and respected organization. For fifty years, volunteers have impacted the world and served as beacons of American altruism. The organization as a whole has often been above reproach, a legacy of the Kennedy administration, and returned volunteers and currently serving volunteers alike shy away from criticizing the agency that has been such a huge part of their lives. This is starting to change, and rightly so. If the Peace Corps wants to stay relevant for another 50 years, it has a long way to go.

A recent article describes many of the challenges facing the agency and many of the questions that must be answered. In the article, there is reference to Chuck Ludlam and his wife, Paula Hirschoff, two RPCVs who have taken the lead in the Peace Corps reform action. Their 20 point reform plan calls for budgetary reforms and ways to strengthen the organization (including decreasing the alarming 35% ET rate and plans to achieve sustainable first goal results). They and others are also pushing strongly to get PCVs “whistleblower rights” protecting volunteers when they do speak out. This is, of course, an issue very close to home (literally; Kate’s village, Badjoude, is 30 kilometers away from me). Kate’s death was a direct result of Peace Corps administration not respecting her confidentiality and it never should have happened.

Luckily, many of these reform movements are seeing press. The ABC 20/20 episode about Peace Corps scandals has gotten people talking. Ludlam and Hirschoff have continued speaking out, even if controversial, and I know they are working hard, contacting current volunteers and RPCVs to lend support to reform. The Congressional hearings last month about sexual assault changes in the agency are a step in the right direction, but we need more. I happen to have a few ideas on the subject…

What we don’t need is simply more volunteers. Before we worry about expansion, we need to strengthen. We need better development priorities, sustainable project training. We need better qualified volunteers with more experience. We need to make sure that volunteers are safe and protected, even from the Peace Corps itself. We need better systems for volunteers reporting crimes like sexual assault and rape. We need better training and more resources. Absolutely we need better transparency from the agency and hard-hitting evaluations and feedback. The ET rate is too high, red-tape and country specific bureaucracy lead to tension and frustration for volunteers, our role as a development organization has never been really established, and projects are often unsustainable. We need significant reforms on all levels.

One thing specifically would be more financial support for projects. We as volunteers have to raise money for most of our projects. It would be nice if the Peace Corps as an organization could provide funds for specific ideas. For example, our girls’ camp this month was funded entirely by friends and family in the states. This is a major undertaking that has been successful in this area of Benin for five years and makes a clear and distinctive impact on the community. It is a major project for many of us and yet all the financing is external to the Peace Corps. Another idea, one that Ludlam and Hirschoff agree with, is increased collaboration with larger aid organizations. The Peace Corps is not an aid organization, per se. It’s sort of a mini-aid organization with large cultural and community based exchange aspects. If we were partnered up more frequently with bigger organizations, we could be valuable volunteer workers for developmental aid in a more roundabout way. This is basically what I am doing working with PSI, a large American based international NGO. I am, however, one of only two of us in our 60 member training group who actually works with an organization of this magnitude. And I’m still frustrated with my work a lot of the time.

I initially thought my frustration was only due to the general difficulty of working in development aid in Africa, but that’s just not true. I’m frustrated not only because development work is hard, but because the Peace Corps isn’t really a development organization at all! We don’t have the training or resources to really be effective with international development work. We aren’t really even expected to be. Maybe this realization will help me stop beating myself up about not saving the world. I’m just supposed to experience the world. I’m not sure I accept that, though.

I know that a lot of people value the ambiguous nature of the Peace Corps as more of a cultural exchange program than a development program, but personally, I resent it. I wish the Peace Corps would figure out what we’re really supposed to be doing. If we want to shift work more toward a legitimate development program, we would have a lot of changes to make. Things like data collection, selecting more experienced volunteers, and allowing administrators and managers to work for more than five years would help us look more legit. Of course, not everyone wants this. A lot of people still see the Peace Corps as a time for personal growth, learning a new language, becoming a better citizen of the world, and to a certain degree I totally agree with this. I have already been immensely impacted in how I will approach the world and I know I’ve gotten to know my community much better than the workers in more traditional aid agencies do. I have friends here and am really a part of this place. I’m not sure that would be possible if the Peace Corps was more centralized and focused on development. The fact that Volunteers make the agency what they will is a powerful and romantic idea. We do what we need to do without a set-in-stone mission and there’s something wonderful about that, I agree. But what is it that we really need to do in the world? What is our real goal as an organization? Do we want our tax dollars to go to recent college grads on a two year cultural vacation? We need to figure these things out before we can move forward. And it’s not just me that needs to get thinking; this is something Peace Corps Washington needs to decide.

It has been 50 years. It is time to start asking those penetrating questions. We, as volunteers, as returned volunteers and managers inside the administration, have a unique responsibility to speak up. As Hirschoff and Ludlam say:

“Those of us who revere the Peace Corps should take the lead in asking these questions. Those who care the most…should ask the hardest questions. The Peace Corps is an historic and romantic vestige of the values of the 60s and the New Frontier, but that role is not sufficient to explain and justify its role in the 21st Century. The ultimate act of loyalty to the Peace Corps is to ask the tough questions before outsiders do.” 

So let’s get crackin’. Once again, I really hope I’m not coming across as an anti-Peace Corps volunteer. I know the administration here has my blog address, but I’m not sure how frequently they stop by. Probably not at all (but just in case…hi, guys!). I don’t think my criticisms can be considered inappropriate content and I’ve never had my blog be mentioned to me by anyone in the administration…yet. But I worry about it sometimes. The fact is, we’re not really protected over here and I’ve heard stories of administrative separations (ad-seps) for online content. Granted, those were usually due to country specific political posts, or wildly disrespectful information about the country or the country’s people, but…the fear is there. Ultimately, it doesn’t matter. I won’t be silenced just because I worry about who is listening. I believe I have a right and a responsibility to talk about this stuff, to challenge the organization that I believe in so strongly to become better.

I hope in fifty years there will be someone like me riding around on her hover board (you know, ‘cause it’s the future), making the choice to join a still relevant, still powerful, still life-altering and idealistic Peace Corps. But we have to start now to make that happen.

Taking the leap

I've been thinking about faith lately, contemplating the reasons we believe in certain things and choose to allow so called reason to take the reigns on others. Do we choose these distinctions or do they just somehow develop? Can the balance shift and should we seek out challenges to encourage our assumptions to change?

Something I've been feeling in the last 9 months is that what we know to be true is never static as long as we allow it to grow. Ideas, beliefs, faith--all these things are dynamic and should be dynamic for social and personal change to really be affected. We can so easily get caught in our knowledge, in what we know to be true, that we forget how to learn, forget that discovery comes from the sometimes unforeseeable opening of the mind.

I've become so jaded while here. I came to Africa thinking change was possible and somehow along the way my thoughts shifted to a deadlock. Everywhere I looked I saw roadblocks to change from the very people who could benefit the most. All the stereotypes we laughingly discussed at the beginning of training seemed to be true. From believing that people here wanted my help to assuming that I was irrelevant and unwanted, my truth made a complete shift. I struggled with finding friendships among women who seem to just perpetuate the injustices against them, and men who daily and constantly harass me to the point of demoralization. Sometimes I really do just want to give up because I know that nothing I do here is going to have any sort of impact in the long run, so what's the point?

Volunteers get together and binge drink. Sometimes there's a therapeutic bitch session where we complain about the administration, the country, the people, the corruption, but mostly people just drink themselves into a stupor so they don't have to think about it at all. It's cathartic in its own way, I suppose, but not particularly helpful and not something that I participate in often. There's something so juvenile about it, like being trapped in a frat house party where no one seems to justify the real occasion. I'm not trying to blame the volunteers; life here is difficult and frustrating so much of the time. But we do get so trapped into our own assumptions and our own frustrations that no one really says anything about anything anymore. It's just the same thing every time, hoping to pass the time away so we'll be one more day closer to being finished with the pointlessness of these two years.

The last three weeks I've been paying my thirteen year old neighbor girl to come over to my house on Saturdays and help me with my laundry. I get everything set up, she washes, and I help her hang the clothes up to dry. She's quick and efficient and gets 500F out of it, which is a pretty good deal for us both. This last Saturday she didn't show up at the time we had agreed on, 10am, which was extremely irritating for me. I assumed that she had either forgotten or didn't care enough to respect my time or her money and I was grumbling pretty angrily to myself while I started doing the laundry on my own. I was starting to scrub a t-shirt when I thought to myself that perhaps something had happened, maybe there was an emergency. Of course that would be my first thought if I was paying an American girl to come over and help me. I would immediately worry about her and want to check up to make sure she was okay, not angrily assume that she had ditched me for some other more interesting activity. Why did I make the choice to be upset with my neighbor for those reasons? Was it a choice? I tend to think yes it was.

 I am conditioned to think the worst of my fellow neighbors because time and time again, the worst is what I've seen. When a Beninese man comes up to me, my first instinct is to be aggressive and dismissive. I am rude automatically because so often I am harassed. Is this fair? I don't know. I'm not sure if it was wrong for me to assume that my neighbor had ditched me. But when she showed up, an hour later, she explained that she was making lunch for her little sister and brother because their mother was traveling somewhere and couldn't make it to my house on time. She said that she would have called but that her family cannot afford a cell phone. Immediately I felt both guilty and elated. Guilty because I had assumed that she was just being lazy and in reality she was working much harder than myself. Elated because a small part of my cynicism had been chipped away by this girl with her honesty and strength. I realized, for just a moment, that my time here did not have to be shaped by the static preconceptions I'd developed, and all I felt then was joy.

As far as faith goes, I know that nothing is certain. I know that challenging our assumptions is the only way to get to a place of acceptance, of peace, because if we let ourselves, we will be surprised by small acts that alter our perceptions. Before I got here, I knew I would change the world. Three months ago I knew I wasn't going to make it all the way through my service. Today I know that with an open heart and mind, I can be changed. I wonder what I'll know tomorrow?

a light at the end of the tunnel

Things are looking up. Colt will be here in 29 days, the Harmattan winds have started bringing cooler nights and wonderful midday breezes, my french is almost always adequate in any given situation, and those damn baby goats are as cute as ever. I have a new found sense of duty after filling with patriotism post season two of the west wing. i am serving my country by living here, i am working toward international cooperation and peace by living with the people making little money and hand washing my laundry. There is honor in that and i am really starting to believe it. I thought I believed it when I applied, but Peace Corps applicants have no idea about so many things. I think it takes at least a good chunk of a year to realize how much you don't know and even more time after that to find the perspective that will foster effective work. I am at that point. I started so completely misguided and I had done my homework! I was as possibly prepared as can be expected from a well educated American 22 year old and rounding up to my fifth month here I am only now seeing that there might actually be a place for me here. I had to get lost in myself, in the dark, before I could see the possibility for something other than a cheap idealism. I have come full circle as it were, and i am just now understanding that there was something almost insincere about our desire to serve.

Coke and Development Economics

11/04/10

Right now I am at a buvette drinking a coke and listening to some bollywood music under a huge mango tree. It is still light outside, but it won't be for too much longer; the sun sets early here. I am sitting by myself which is considered totally weird to the Beninese. If I wasn’t looking very busy scribbling in this notebook I would probably be hit on at a rate of like 4 men an hour. On second thought, I’m not sure the notebook makes a difference…

A few weeks ago I was here with Doug when we found out about the 5 year old who drowned in the well and for some reason I can’t help but think of that every time I am at this buvette, even if just for a brief moment.

Damn, I wish I had a diet coke instead of this delicious regular one. I miss those. When I get back to the states, I am going to drink one every day! Oh wait…

In the spirit of keeping you all informed and aware of my life, I suppose I will describe the scenery here while I wait for my dinner of couscous and spicy omelette.

Inevitably the scene changes whenever I show up. It’s calm here I imagine, before I arrive; the people all clustered around the mango and guava trees, nursing their bottles of Beninese brews. They talk quietly in French and local language about whatever it is that they talk about. I get there, though, and the charm is temporarily broken. The kids start screaming ‘batouré, batouré!’ Women come up with things for sale on their heads: bananas, fish, fried bread with spicy sauces. Men try to get my number or sell me phone credit, leather shoes, or knockoff sunglasses called Ray Bon’s. I greet them all, tell them to go away, and sit while the scene slowly goes back to something akin to what is was before.

I can never really just disappear, to slide into anonymity and just observe some moment here; wherever I go is shaped by my presence. The closest I get to being invisible is when I wear a headscarf like the Muslim women and a long skirt, but even then people do double takes. I get hit on a lot less that way, though.

My homologue, Imorou, calls me and decides to come meet me. He shows up and we get to talking. We speak franglais, my favorite foreign langue parceque I parler it so bien. Imorou is getting better at it, but still has trouble mixing French and English together in one sentence. He laughs when I talk about wanting to ‘manger something.’ We talk easily, Imorou and me. We discuss malaria for a bit and the politics of racism, a discussion that he hold mostly in French and I in English, but we each understand the other. I admit to him that I get angry and frustrated by the indifference that most of the world has for Africa.

‘Me, too,’ he says simply, taking a sip from his soda and leaning back in his chair.

I get to thinking about my purpose here as I am wont to do on hot, African evenings. I guess I thought that I would have had more inspiration living here, more insight into solutions, but honestly I am just more confused.

I see poverty, sure. It’s everywhere, ubiquitous. Dirt roads, mud houses, walls in disrepair, trash everywhere, dirty clothes, beggars. I guess when everyone is poor it becomes the average and there isn’t anything unique about it anymore. I don’t even think about it most days. People get by, same as anywhere. Things are different, sure. Few people have THINGS like cars, refridgeraters, ovens. Is that what poverty is? Not having an oven?

I make 90 mille a month which is less than 200 dollars US, and honestly that is not very much money at all; it wasn’t enough to buy a fridge (100 mille!). It’s not much more than most people here make, either. Imorou makes way more than that. Hell, most zemidjans make more than that if they aren’t being lazy.

I’m not sure what my point is. Clearly people in Africa don’t have a lot. The richest person in Djougou makes like 1 percent of the income of a poor American. I’m struggling because I’m really having a hard time seeing how it matters. If women are having healthy babies with few complications why does it matter that the health center is unairconditioned? Or if kids are going to school why does it matter that they had to walk 2 miles to get there? If all the kids do it and are fine?

But here’s the thing: not all pregnancies ARE healthy and not all kids DO go to school. Sure it’s like that in the states, too, but it’s normal here, it’s more common here for a woman to die of post birth hemorrhaging and for thirteen year old girls to drop out of school so they can take care of their younger brothers and sisters. There is malnutrition and suffering and unclean, unsafe working conditions. Just because I’ve gotten desensitized to 8 year olds walking 10 kilometers barefoot doesn’t mean the kid couldn’t use some shoes. Just because no one is complaining that they make one dollar a day doesn’t mean they’re living easy.

People here work HARD, too. I didn’t visit the health center for almost a week and when I saw it yesterday there was a new, huge cement wall painted and complete around the entire center. I am constantly noticing new buildings, new businesses, new mamans selling street food. Things change and evolve here so quickly I am constantly surprised by the work ethic, especially since I’ve always been told that people here are hyper laid back or even lazy. That is just flat out not true, at least not in my experience. So why the fuck are people still dying from tuberculosis?? Is it just money? Benin already relies heavily on foreign aid; it’s like 80 percent of the GDP or something. Throwing more foreign aid can’t possibly be the solution, but hell, maybe it is. Jeffrey Sachs, my once favorite economist says that is indeed the answer. More money, more money. I really want to see change from within the country, though. Work ethic is good, sex relations are bad…women are not particularly valued economically. Maybe there’s something there that needs exploring, I don’t know.

I don’t know. Is education the answer? Yes, probably. That and a little bit of everything else. There’s no way that just giving more money to the government could be the answer, is it? Just a few more billion…clean up the streets, create some jobs, make sure kids are sleeping under mosquito nets. Fuck, I really don’t know. I am not an economist, I’m not even really an international aid worker. I’m just a health volunteer who feels underutilized doing a job I’m not sure about in a country that I’m not even sure wants my help or even needs it.

This was not supposed to be a rambling attempt to understand the role of foreign assistance in fighting poverty in Benin…but oh well. Hopefully some of this stuff will get a little clearer before I have to write my personal statement for medical schools. All I can say now is ‘um, yeah, so I do something one might call ‘work’ in an African health center…and maybe Jeffrey Sachs is wrong,’ which I don’t think is going to quite land me an interview at Northwestern.

Imorou doesn’t really seem to have any answers either. When he mentions colonialism all I can think about is how America was once a colony, too, but I don’t have the guts yet to say it out loud. I think I might have heard that on the West Wing anyway and I wouldn’t want to pass off Aaron Sorkin’s ideas as my own.

So we lapse into silence or move onto another idea, leaving Africa’s problems to the diplomats and politicians at least for tonight. I go back to watching the goats and chickens under the mango tree while the sun sets and I finish my coke.

Just a Tuesday Morning Development Discussion

October 5, 2010

I am having a conversation with Alain, a work partner here at PSI and he is trying to speak English. It is not easy to understand and we are both trying to get connected to the wifi in the office that has been spotty for the last few days. I wish that the air conditioner was turned on, but they never have it on in the mornings.

“It is not very fast,” he says slowly, deliberately, typing something on his laptop.

“Well, this is Africa.” I smile when I say it, teasing, but I am frustrated. Immediately I regret the comment as his eyebrows raise, surprised. He smiles back, but there is tension now.

“It is always fast in America?” He doesn’t look at me.

“Oui.” There is a long moment of silence, something that has just started getting less awkward for me, but now I feel like my months of habituation haven’t happened.

And then: “Tell me why you are here. What are your ideas to help the development of Africa.” He smiles when he asks, but I can feel the anticipation filling the space between us. I don’t know how to answer anymore. If he had asked me months ago I would have said something about providing my time and skills to the people here to help them help themselves, but honestly I have not felt particularly useful in weeks.

When I got here I thought that my idealism was held in check. I thought of myself as someone who was skeptical of the whole idea of aid work and that I had read enough so that naïveté was the last thing I brought with me. Well, it wasn’t true. I don’t think I was lying to myself exactly, but I was definitely clouding some truths about what I wanted to accomplish here. I would have thought that I could answer a simple question about what I hope to do here for the next two years.

But I don’t have any answers and that sounds so cynical it makes my stomach hurt.

some years of independence

SOME YEARS OF INDEPENDENCE

August 1st, 2010, 12:37pm CST, 18:37 Benin

Today is the 50th anniversary of Benin's independence and it is a big party (grande fete!) all over the country. Many volunteers throughout the country are in Porto Novo, the capital, to celebrate and hang out with fellow Peace Corps folk. It's been really awesome to meet many of the COSing (Close of Service-ing) volunteers before their flights back to the USA. This morning I went to an awesome parade in the town that my host papa works in. He is, apparently, the mayor's primary right hand man, which is pretty darn sweet. Papa seems to be doing pretty well for himself as an elected official and he also has a farm that I got to see today. I finally took pictures!! I will try to put them on facebook, but y'all might just have to wait for my kick ass awesome photos until I figure out the best way to display them and when.

Last night I had the wonderful pleasure of meeting Jess, the volunteer who lived with my host family 2 years ago. She actually has a really amazing blog, Under African Skies, that I've literally been reading since last July 2009 when i first applied to the Peace Corps. She bunked on my floor in her old room after we spent the evening at a buvette (bar) with a bunch of other people from her stage and the one below hers. She is leaving Africa this week for her COS and she never went home to the states during her time here, so she said it was a really strange feeling to be going back. If you've read all my blog and want some more Benin reading, you should head over to hers and catch up on her posts. Under her (and her post mate who was also COSing) expert guidance, we stayed out way past my normal curfew, took zemis at night, rode 2 people on one zemi, and creatively explained to our host dad where we'd be that evening. I felt like a major rebel! But, I think my wild days are behind me...I don't think my French is good enough to fib to him again!

So, seeing all the 2 year volunteers has really re-opened my eyes to what this committment of service really can be. I signed up for a 2 year service, not a maybe-2-years-but-probably-I'll-just-make-it-to-next-summer service. I need to live in the moment and accept my decision, not because I need to force myself through something I hate, but because I should understand the magnitude of this life style that I've chosen and respect myself enough to have the fortitude to fulfull my promises. I know that a certain someone might be a bit disappointed by this realization, but he knew this was important to me even before we even started dating and when I left last month, for all intents and purposes, it was for the entire 2 year service. So he understands and while I feel a little guilty for wavering in my decision the last few weeks and giving some false hope for my early return, I think he respects me more for being true to myself and to my dreams. Besides, what the hell would I do in Topeka, Kansas for a year?

Another good thing about this whole thing is that I can start to think and plan of ways for him (and anyone else who wants to and can afford it!) to come and visit me while I'm here. I know for a fact that I will need to come back myself sometime in the fall of 2011 in order to interview for medical schools, but it would be really cool if he could visit me sometime before then and then maybe once more afterward. I think three conjugal visits will keep me going throughout my time here, n'est pas? So, I'm thinking: CHRISTMASES AND BIRTHDAYS PLEASE DONATE TO HIS BENIN FUND! If we're really lucky, he could come and see me for this Christmas so I wouldn't have to be alone. That's pretty soon, but if we can get the money figured out, I think it would really help me to transition to this life en seul.

Ok, well. I just thought I'd end this with the thought that has been going through my head for the last 48 hours, the thought that propelled me into re-imagining my entire service here. These words were spoken by a true genius, a true prophet of our day, a man whose brilliance for motivation can ne'er be matched and whose words pull me through the tough times to reach that flighty temptress... a complete, successful service:

YOU'RE NOT HARDCORE UNLESS YOU LIVE HARDCORE.

No truer words have e'er been spoke.

E

PS We find out our posts on Friday! Ahhhh!

a history of my love affair with africa

I was 12 when I first fell in love with Africa. I was in between Harry Potter books and needed something to fill the addiction gap in my heart. I found the historical detective novels of Elizabeth Peters based around British Egyptologists in the late 1800s. My stepmom, Jeni, and I read through the series one summer and into my 7th grade year and Egypt came alive for me. More than just the ancient history, Egypt was a mysterious place even for the characters that lived and worked there. I got lost in the Cairo streets and actually cried when I found out that they don't actually let tourists climb the Great Pyramids anymore. I was ravenous for more. I knew all the dynasties by heart, the methods of mummification, the various forms of the Egyptian language and quite a lot of the hieroglyphics. I even began teaching myself Arabic and at one point before 8th grade could actually read aloud the curling letters, although I did not know much of what I was reading.

I imagined myself as first an Egyptologist and then as an anthropologist, studying not only the ancient cultures, but that of the people living there today. I definitely had an academic perspective about the whole thing, although a lot of my perceptions were flawed, based on fiction books set over a century ago. I'd like to think that I never patronized the hypothetical people of my future studies, but I don't really think there's any middle schooler out there that really grasps the idea of white privilege and true development work.

My concept of Africa was heavily influenced by Egypt until I was 15 and my concept of the future replaced from the removed analysis of the social scientist to the directly impacting physician. I saw Dr. Carter on ER when I was in 9th grade and his visits to the Congo transformed my assumptions and broadened my interests exponentially. I first attached onto medicine and decided that it was ethically irresponsible to study people and not help them when I had the possibility to aid them. Soon after I exhausted my initial drive for information about medicine in general, I gravitated back to Africa. I studied the philosophies of the people and read about dictators and the history of the oppression of apartheid. I read about the Rwanda genocides and tried to educate myself as best as I could about the continent and the challenges that have been consistently faced by the people there. I was, and still am, continuously shocked that a place of such rich history, the birthplace of humanity, is so often blatantly disregarded by the international community. I have essentially decided that it is racism, pure and simple.

Throughout my college career I have developed my academic passions for development work and development economics. My interest in both medicine and economics are intimately tied to Africa. I have pursued academic literature on agricultural practices in Subsaharan Africa as well as environmental economic ties to population growth, GNP, and politics. I have learned extensively about justice issues in women's health as applied to international cases and issues. The only thing I have not done is formally major or minor in Africana studies. I chose a more indirect route by selecting biology and econ, but in my spare time have voraciously read Jeffrey Sachs and Amartya Sen. All this academic work has only strengthened my passion for the continent, my belief that the most vulnerable people are the ones most ignored by those with the most power, and the fact that I am not content to study and analyze. I must do something. I must use my hands. I have to hold a child or build a latrine. I cannot keep Africa as an abstract concept for me anymore; I am compelled to do.

I've worried for some time that this instant gratification streak of mine is somehow anti-intellectual, that after all my time at one of the top liberal arts colleges in the world all I want to do is weigh babies and sleep under the African sky. Shouldn't I leave the down and dirty for those less privileged to my education? Well, no. And I'll tell you why. And it's definitely not white, liberal guilt.

In my framework of justice, guilt has no place. Justice to me is not about getting what people are due in this world. That view is antiquated and doesn't meet most ethical standpoints these days. To me, and others who chose such epistemological pursuits, justice means seeing one another rightly, using love to view those most vulnerable, and ascribing dignity and equal value to all persons at birth. Justice means not treating people as embodiments of stereotypes and respecting each person's inherent autonomy. In my opinion, activism is simply making sure the world knows about this framework of justice. I am compelled, no, obligated, to act on the principles that I have learned about in theory if I judge them to be true. And I do. I believe with a near religious fervor in the ideas of loving rightly and transforming my intellectual study of development into action. In fact, because I am privileged to be white in this racist world, I have a pretty big obligation to educate myself and to give back. Guilt does not play into it, only fact.

Africa has been screwed over and romanticized for hundreds of years. I've been talking about how fucked up that is since I was 12 years old and it's about damn time that I actually got my ass over there and gained something more than theoretical backing to my claims.

So come on placement office, I've been waiting for this since 1999.

Elaina