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.

Sexual Violence and the Peace Corps at 50

This article is a preview of the hearings held by congress today, which can be streamed here.

Kate Puzey's mom, Lois, gave testimony as well, speaking to the need for whistleblower protection and confidentiality breeches leading to her daughter's death. I couldn't watch the video so someone should let me know if anything unexpected or promising occurs. I doubt it will, but I am feeling extremely pessimistic and bitter about the Peace Corps as an organization right now, although I just want to preface this entire post by saying that I love the Peace Corps and simply want it to reach its potential as the force I know it can be, the organization that I believe in. But right now it needs to make some serious changes.

The first time I was made aware of the Peace Corps inappropriate response and attitude toward victims/survivors (I will use the word survivor in my own words and only use "victim" when quoting others) of sexual assault and rape was the third or fourth week of training. We were all gathered at Songhai for our weekly medical training session and most of us were dreading pretty hard the "rape talk." We were actually surprised with it on that Tuesday as we were expecting it the following week. Immediately I knew this was going to be bad. You should never surprise a group of people with a sexual violence discussion because you never know who will be triggered in the audience. That day, someone who needed to avoid the conversation would not have been able to without causing a scene. I was very interested in how they would present the information. As a women's college graduate with a modest but passionate background in women's studies, I was worried about the ability of the male host country national physician employed by PC/Benin to give a sensitive and appropriate talk on the subject. My concerns were, at first, made irrelevant because they showed a video. I thought, "Oh good! The Peace Corps knows that HCN doctors probably aren't the best resources for this information so they've prepared something with a strong survivor-empowering message for us to watch instead." Oh boy was I so wrong. The video very clearly focused on survivor's use of alcohol and culturally inappropriate attire as reasons for getting into risky situations, a clear case of "victim-blaming" that I was disgusted to see from an official Peace Corps Washington video. The rest of the video was similar; women cried and were vague about the help they got from Peace Corps. It was made clear that pursing legal action would be difficult and the primary message was "don't get too close to men and drink too much." I was horrified. When the HCN doctor finally did start talking I was further devastated. There were casual references to rape and assault situations, joking and making light of the video, more victim-blaming, and discouragement for coming forward if anything ever actually happened here.

I excused myself, went to the bathroom, and cried. I was already tired and frustrated with stage (training is just, in general, sort of a frustrating time) and the idea that statistically SOMEONE in the room had experienced an assault or rape and was being forced to listen to this crap was so disheartening I literally couldn't take it. One in four American women has had an experience like that and most of us know what it's like to get close or feel the threat of it and discussions of rape and assault can be extremely triggering and must be treated with respect. Dismissive attitudes of both our facilitator and the video itself were disturbing and so inappropriate for an organization representing America that I had to literally grieve for a few minutes.

I put this information in my training review of course. It was one of the biggest problems I've had with the Peace Corps and since then I've learned increasing amounts of information about the inappropriate response of the Peace Corps to volunteers who become victims of crime. Current PCVs and RPCVs should absolutely participate in the First Response Action survey regarding our sexual assault training here.

 I've felt extremely compelled the entire time of my service by Kate Puzey's story and the response of PC/Benin and Washington. PCVs in Benin are intimately aware of inefficiencies in this area and it is a source of constant frustration. I find it hard to believe that ALL Peace Corps countries have this much malcontent on administrative issues. I know it's tough everywhere, but I honestly think the ET rate would be higher worldwide if it was like Benin everywhere (approaching 25% here). That gives me hope that we just happen to be in a more "malignant" program that is doing its best to change and become better equipped to handle itself. The idea that other countries might be better is encouraging. But as far as crime responses go, it seems like it's a worldwide Peace Corps fault. Especially as far as sexual assault and rape reporting goes.

I won't repeat statistics and stories you can read elsewhere, but it's a problem in reality and not just the attitude of the training video screened. Reporters are not valued, treated like they were the cause of their own effect, and discouraged from pursuing justice. This is often done in the name of cultural sensitivity and understanding but really it's just bullshit. No culture condones rape even if the details are varied across the spectrum. But the important thing is that American norms on the subject are very serious and frankly, the Peace Corps should treat these incidents exactly the same as if they happened in America. The fact that host country nationals are in administrative positions shouldn't matter. Train them to respond as an American to these issues. There's no excuse.

A few solutions were presented in the NYT article that I agree with wholeheartedly and think are feasible and legitimate. One, hiring someone trained in sexual assault survivor empowerment to specifically overhaul the Peace Corps's approach to these incidents and their appropriate response through trainings and policy revamping. Two, get rid of that fucking video and replace it with something created by a knowledgeable and credible crisis center or organization. Three,  the development of "sexual assault response teams" to collect forensic evidence and provide advocacy to survivors. I also think there needs to be an advocacy group established in each country of volunteers and trained professionals who can counsel on that specific country's procedures for filing a report and pressing charges. Another suggestion would be to follow the First Response  Action group's 7 point plan to specifically address issues of sexual violence against Peace Corps Volunteers including the "Survivor Bill of Rights" with standardized protocols of response. These things should be legislated in the states and enforced abroad immediately.

Politics should not enter into the equation at any point. This is not a Democrat/Republican issue at all, but an American one. We are serving our country and the world and should be protected appropriately under law. These arguments do not devalue the promise of the organization promised by JFK or hurt the Democrats and should not lead to funding cuts or compromised legitimacy of the Peace Corps. Director Williams needs to commit to supporting future legislation protecting the volunteers because it's the only responsible course of action he can follow as the head of an organization with increasing numbers of female volunteers in the world.

These criticisms are not aimed at breaking down the Peace Corps or discouraging future, interested volunteers, especially women. I think this has been and will continue to be one the most life changing and powerful experiences of my life. I love Benin and I love the people. I feel at home here and am more proud than I've ever been to be an American citizen and a representative of my country abroad. I think joining the Peace Corps is one of the best decisions I ever made and would encourage people to follow me. But I also know that the organization can be improved, the experience of women in the world can be made safer and healthier and more in tune with truer American values. The Peace Corps has a responsibility to act as a role model in how it responds to sexual violence; it is a visible organization and a powerful force in a world that generally mistreats and devalues women. It's about damn time it started acting like it.

Ok, maybe some more editorializing

So I have some more thoughts that I need to get out about this. And, remember, I do not speak for the Peace Corps or the US or Beninese governments...I'm just one volunteer, a cog in the machine, a brick in the wall. So, okay.

I've been reading a few of the volunteers' blogs on peacecorpsjournals.com about the special; I was just curious about what some of them thought about the whole thing. I was really surprised to see the level of ABC bashing and the huge amount of support for the Peace Corps as an organization. I mean, I understand that Applicants need to not say anything worthwhile on their blog. But, other volunteers? I refuse to believe that all these other volunteers can so easily write off the news story as "bad journalism," purely sensationalistic crap, and then in the same sentence give support to the both Kate's family AND the Peace Corps administration. I mean, maybe next time, 20/20 could try to do something good and not "attack a national organization"? Really? Have you ever read the Constitution of the United States of America? I just can't accept that these PCVs and applicants are all just blindly throwing support to the Peace Corps as this great and wonderful organization saving the world. I mean, come on. Yeah, the 20/20 special was muckraking, sensational, incendiary and tear-jerking and it damn well needed to be. It's been almost two years since her murder and the Peace Corps certainly isn't getting the American public invested or the Beninese government for that matter. I can completely understand turning toward the media. At least people are talking about it now. Ongoing investigation my ass. There are 4 lawyers in this country.

Look, guys. It's not like a random volunteer was murdered and people are upset that the Peace Corps is mishandling the case and not giving us details. That's not what's frustrating to me and to other PC/Benin volunteers here. Peace Corps Benin specifically caused her murder. She brought attention to the behavior of one of her fellow teachers and Peace Corps language facilitator by a private email that was inappropriately forwarded to the coworker's brother, one of the higher ups in the PC/Benin and she was brutally murdered as retaliation for the loss of his job. Peace Corps Benin killed Kate. The story damn well better be sensationalistic.

It's nice to think that the Peace Corps administration in your country has your back. And I'm pretty sure that most of the time, in most countries, they absolutely do. I really do feel safe in Djougou. I love my community and I honestly believe in the work that I am doing here for the Peace Corps and as a representative for America. I genuinely like the good folks who work at the bureau in Cotonou, both the Americans and the host country nationals...but, it doesn't serve anyone's interests for PCVs to just close our eyes and give blanketed support to the organization. I know that the Peace Corps is great, but I also know it can be better. I feel like I have a responsibility as a PCV in Benin and as an American to criticize the Peace Corps and I'm not planning on stopping until I see this organization reach its potential. And the fact that I'm able to do it at all is what makes both the Peace Corps and America so fucking amazing.

Elaina

Happy New Year!

January 09, 2011
8:42pm

I have finally gotten back to my place after what has been a month of travels and holidays. Colt has been and gone, we’ve rung in the new year, my three month integration period is officially over, and in less than a week, my stage will have been in country for half a year. Before I delve too much into that whole passage of time thing, I thought I’d let everyone know that this Friday, the 14th, 20/20 is supposed to be airing the special on Kate Puzey’s death. Please tune in and someone send me a copy!

Colt was here for almost 15 days and it feels like we built a little life for us here during his time. Christmas morning was a blur of travel to Djougou and we basically showered and crashed into bed for several hours. I think he had been traveling for like 40 hours or something by that point. We woke up on the 26th and did our Christmas morning then. We took lots of ridiculously adorable photos and made dinner…tacos! Then we basically spent the rest of the week eating local food and watching an insane amount of 30 Rock and Inception (I almost convinced him to let me watch it a third time, but he convinced me to watch some Californication instead). We enjoyed each other’s company and fell into a lovely sort of routine that involved meeting up with some of my friends here, eating too much, and seeing my village. I thoroughly enjoyed myself. New Years’ was rung in with card games, cake, and champagne. Colt read Ender’s Game while I continued to gavage myself with 30 Rock and we started to get a little sick of each other. I think the constant cold showers started to get to him…no hot water and it is damn cold in the mornings here during Harmattan. We smoked some hookah on my roof the last day we were in Djougou and got yam pilee once more with cold cokes and then watched Pineapple Express and giggled like dorks while we cuddled. Ahhh. Then we stayed two nights in Cotonou where we just ate out at all the nice places I can never afford (Chinese, Thai, Lebanese, etc) and his last day we spent at the workstation while I was sick and throwing up for several hours (good timing!). He held me, though, and although we ended up not getting to go out to Indian food that night like we’d planned, it was nice to just spend those last hours alone and close. I did feel sort of guilty though…but I guess I shouldn’t have tried to be so macho and drink the shower water. That’s what I get haha. His flight left on the 7th late at night and he has safely arrived back home and had Christmas with his family. I sent a bunch of random African gifts for him to disperse to various people, just little trinkets and stuff, nothing fancy (I am so broke right now!). It was a wonderful visit, we took lots of pictures and videos, and hopefully the next 8 months and 3 weeks will pass by without hardly any notice at all! Yeah, we’ll see about that. =(

Hmm, let’s see…what else? Big projects are starting to get going now that I’m allowed to really jump into work…several girls and boys camp meetings are going on this month and I am going to get back into going to the health center regularly in addition to my time at the office. I need to get some scrubs made for the maternity so I can help with births, but until then I am going to help out a midwife nurse when she inserts IUDs and Norplant birth control. The Peace Corps has restructured some of its goals so that now what was my primary project (sexual health and family planning) is now technically a secondary project…so I also need to try to get more involved with the maternal health side and do more prenatal consultations and stuff with the midwives. In a really bullshit red tape move, the Peace Corps noticed that volunteers weren’t meeting family planning goals, so instead of giving us more training or directive, they just decided to abolish that program as a major source of focus, thereby making the stats look better, but not fixing the underlying issue. That’s just one example in a growing list of examples about Peace Corps administrative bureaucracy that seriously hinders volunteers’ ability to effectively work abroad. Sigh. Onto more pleasant things…

Er…yeah, I got nothing. Oh! Next month I’m going to Pendjari, the national park, with Andrew and Krista, Eric, and a couple other people. I had originally planned on going with Colt when he was here…but well, that didn’t work out. So too bad for him, I guess I’ll just send him a picture of the awesome lions I’ll see!

It’s hard to believe I’ve been here for 6 months already. Time has really flown by it seems and yet it feels like I’ve been here for soooo long. For some reason I can feel like I just boarded the plane from Kansas City a couple weeks ago and also feel like I’ve been here for years simultaneously. I guess it was the same thing in college; day to day felt insanely drawn out, but by the time I graduated, I felt like I’d just blinked and it was over. I do wish I would have savored my time at Wellesley a little more, but I think I did okay. Similarly, I think I’ll do fine here in my looking toward the future and yet relishing my moments in the present. I suppose there will a time when I look back on my service and wish that I would have just been more involved in the day to day small things and knowing that keeps me a little more grounded even though I just want it to be a year from now so badly. The time will come, though, and probably sooner than I think I’ll be saying goodbye.

And when I do…I’ll be a vegetarian again. Because right now…well, I’m not. Not exactly. I’ve decided to be an Afri-tarian. I only eat meat while I’m here in Africa. I’m just so protein deficient especially if I want to avoid palm oil fried wagasi. I’m also basically a vegetarian for economic reasons stemming from the commercial meat industry in the United States, which clearly does not exist here. So I’m eating fish and poultry which I haven’t eaten since 2004. The chickens here are all free range and crustaceans are basically just big bugs anyway. I’m actually sort of grabbing onto meat eating with gusto. I was calling myself a ‘meatatarian’ for a while, especially while gnawing the bones of a particularly tasty guinea fowl when colt was here. I’m planning on enjoying it while I can and reverting back when I finish up here, although there is something to be said about spending my money on free range meat in the United States as it adds an even more forceful economic incentive for companies to use humane treatment of their livestock. I’m not sure, we’ll see.

Moving on…Medical school packets for the advisory committee are due in a couple weeks so I need to really get cracking on that. Hopefully that will keep me busy enough to not count down the days until I see Colt again. I need to have an awesome application so I can go home to interview!

And speaking of that, I wanted to publicly declare that Colt and I are clenched into a competitive battle to lose weight. Whoever reaches their goal weight first gets to decide the number of children we’ll have in the future. This is not a decision he will get to make. Thus I must win. So please, no one send me pasta or sugar. If it’s in my house I’ll eat it, but if it’s not, then I will be the champion. Send Colt, however, lots and lots of goodies. I’ll update my wish list to include canned or packaged tuna and mints instead of chocolate and velveeta cheese…as much as that pains me.

I guess that’s it for now…things should start to get back to a semblance of routine, or at least as routine as is possible in Benin. For example, tomorrow is a voodoo national holiday and I don’t have to go in to work. Hello, Lord of the Rings marathon! My life is sort of awesome, yeah?

See ya when I see ya,

Elaina

AAARRRGGHHH

So I'm definitely staying the night in Cotonou and will be trying to get some American food tonight. I feel like crap, though, so it's not exactly super fun or anything.

I'm also just generally in a bad mood because I forgot my computer charger in Porto Novo and my battery is going to die in a few minutes. Also, i spent about 2 hours loading pictures on these blog and then the internet cut out and the post didn't save. So, I'm really frustrated right now. I should have brought a book or something.

GRRRRRRRR

Rewind--what?!

I got a phone call a little while ago from D, my placement officer.

Apparently getting engaged is considered one of a few "life changing" events. Ok...well, whenever an applicant has a life changing event they are required to wait a year before being reconsidered for service...

WHAT?!?!?!

After a mild panic attack and some deep breathing, D went on to explain that they make very few exceptions to this, but that he'd be willing to fight for me to become one of those few exceptions to the year waiting rule. IF I can demonstrate via writing a detailed letter that I should be considered a special case.

Ok, so a) I was being courteous when I informed the Peace Corps of my engagement. As many people have implied, I didn't HAVE to tell them at all. I was trying to be honest and helpful =(
b) Having a ring on my finger does not change AT ALL the level of commitment and seriousness of the relationship.
c) We've planned on my Peace Corps service since THE DAY we started dating over 4 years ago.
d) We WANTED to get engaged before service because it would make things EASIER not HARDER. Having the peace of mind that this engagement brings actually makes us both calmer and more okay with the impending separation.

So basically, I wrote a reeeally detailed letter about our background, expectations, plans for marriage, plans for dealing with the distance and communication, why we chose to get engaged now, and how there is no "life altering" aspect of this engagement that makes waiting a year make any sense at all.

D said he'd fight for me to his superiors, so here's hoping I wrote a decent letter. I just faxed it a few minutes ago. Hopefully things will go well. I have a good feeling, but it's still extremely frustrating to me. I just don't understand why they can't just take me at my word that my relationship is stable and I don't expect to ET? I get asking questions about it upfront, but when I say that we can do it, they really need to accept it. It seems so paternalistic to continue to question my capacity to keep my relationship together while serving abroad. After making sure that we know it's going to hard and getting my assurances, they should be happy!

/rant.

We'll see. Hopefully I'll know something by next week.

E

shutdown mini rant

All this Mali buzz and fellow blogger successes with PO contact encouraged me to update my file with the health desk. So I sent in copies of my CPR and First Aid certifications attached to an email about my current activities related to health and French, etc. I got this shutdown response:

"Your updates have been received by the Health Desk. A copy of your email detailing your updated experience and copies of your certifications will be placed in your file.

Currently, your file is in line to be reviewed by the Assessment and Placement Staff. Your file should be reviewed within the next few weeks and then it will go to your Placement Office Specialist who will consider you for an invitation. The latest that invitations can be issued for the program you were nominated into is the end of May.

Hopefully from this you are able to get some sense of a timeline. Unfortunately, due to the high number of summer programs that the Placement Office is currently working to fill, I am unable to pinpoint an exact date by which you will hear from us concerning a placement."

MAY?? MAY??!
I am just really frustrated at this point. I know they say 6 weeks minimum, but I mean, come on. It is just not realistic to expect a graduating senior to just sit around and twiddle my thumbs while I pass up on every other opportunity that comes my way. I want the Peace Corps, so I'm waiting, but it's irritating. I'm irritated. I applied over 9 months ago. I just want to be able to start looking for supplies and planning for this. I will only have a month after graduation to think about it and get ready to leave and that's just not enough time for me to be comfortable. I mean, I'll deal with it, but it's just a hassle. Maybe the Peace Corps should hire some more people in order to not inconvenience the applicants unnecessarily. I mean, I understand needing patience. But 9 months is ridiculous and a longer waiting period than any other job I could be persuing. This wait and uncertainty is a deterrant for potential applicants and it gives the Peace Corps an image of inefficiency, red tape, and excessive bureaucracy. A rolling admissions program for those who apply early would better serve future peace corps volunteers and their families. I'm frustrated, my family, friends, and fiance are frustrated, and we're all anxious to know what my plans are post graduation. It sucks! ok...
/rant.

But other than my frustration, things are going well. I'm working on some bio projects and beginning to work on some of my final papers for various courses. I can't believe there's only 20 days of classes left in my college days. Totally wild.

I am officially going cold turkey on my own blog for the next 2 weeks. Going underground is apparently the only way I can deal with this excessive waiting. I'll probably be checking pcjournals in general, though, if only to catch other people's invites while i wallow in my own self pity. haha

Elaina