Time Flies When You're Having Fun

Sometimes, I forget that I've only just arrived in the RIM. A couple of months in Bababe and Kaedi, not yet two months here in Nema. So when I trade e-mails with friends, I'm amazed that they aren't shocked to hear from me and excited to hear what I'm up to. After all, it's less than four months since my departure. But on my end, it feels more like a lifetime.

For instance, I can communicate in a language that I could barely pick out of a lineup before. When I first came to Mauritania, my conversations ran along a standard line. "Bonjour," I would say. The response was either "Bonjour, [words I didn't understand]," to which I would calmly reply, "Does anyone here understand English? You speakee English? I'd try ancient Latin, if that's better for you!" But now I am able to understand what people say to me (for instance, "Good, the Christian is doing well"), and I am even able to respond. "Pardon, ma francais est faible," or "Sorry, my french is weak." How could it only have been four months, with so much progress?

Or work! On Monday, I begin offering sensibilizations (lessons) at the CREN (Center for Rehabilitation and Education on Nutrition), and the Centre de Sante, the maternal and child health center. I spent a week going to the two centers and making a general nuisance of myself in the hopes that my presence would be interpreted as enthusiasm. My plan paid off, and so I will be offering basic education on weaning, birth spacing, vaccinations, AIDS, nutrition, and more. Granted, I can only speak in broken French, and the directors of the two programs will be standing with me and translating my words into Hassaniya, the local Arabic dialect. But I will be working, offering education here in the RIM, and it hasn't even be a third of a year!

My cultural integration is also so far progressed that you would think I'd been living here for four years. I just rented a house, a lovely three room domicile. Big front yard, water spigot out front, and door that almost close, enough so that I can lock them. People often ask me about a house. "You live here?" "Yes, I do," I reply. "One person." "Yep, I'm American, and I live here in Nema! I'll be here for two years!" "Your house has three rooms. Why do you need three rooms?" "Because I'm American!" "Are you nuts?" "No, thank you, I'm allergic to nuts."

So you can understand why it feels like such a long time. My language, home, and cultural development have come a long way in a short time. You'd almost mistake me for a Mauritanian, if it weren't for the kids following me around yelling "Nazzirani! Nazzirani!" (Christian! Christian!"

Setting Priorities

Priorities aren't the same here. At times, it can feel like there aren't any. What I consider to be priorities in life aren't viewed with the same importance here. If I don't take a the time to try to see what the people of Nema do value, it can seem like no one cares about anything.

For the past two weeks, telephone services from the primary provider has been down. Mauritel normally has the best network coverage, as well as controlling the landlines into businesses that require internet access. But for two weeks, we have had to do without or struggle to make things work. Some people carry service with multiple companies to hedge their bets against these situations. The bank does not. Without internet service, the bank couldn't access client information, and so they closed their doors for several days. In order to get money for rent, I had to borrow a phone from another telephone provider, call the CFO in Nouakchott, have him call the bank in Nema, and wait. Altogether, it was a three day affair to withdraw about $200.

In the US, if the banks closed, the government would step in. If phone companies lost service, they would work around the clock to return service. Here, people take it for granted that these things will happen, and they let it be. Get another phone, borrow money from friends or buy food on credit until the bank opens. Why stress? There's nothing to be done about it. Meanwhile, I spent frustrating days trying to make the system work for me.

Ramadan has just ended. Now the Feast of EID-ALFITR is being celebrated. It is a three-day weekend, three days of eating, visiting friends, apologizing, and forgiving. Everyone will spend part of the time going to the houses of all of their friends, family, and neighbors to apologize for any wrongs that they have committed, and will wait at home for their turn to forgive. During the visits, food and drink is served. The front door is open, and everyone is welcome. Perhaps the most amazing part of this holiday is that I can't really see how it's different from any other day in Mauritania.

That is perhaps the primary priority of Mauritania. Relationships. Whenever I visit a house, I am welcome to come in, eat, drink, and stay as long as I like. There are almost always other guests. I met a man the other day through a Peace Corps staff member. They haven't seen one another since childhood, but because of that connection, I was invited in and called brother. In the US, everyone is welcome at Christmas and Thanksgiving. Here, the door never closes.

There are days when I miss my working cell service, when I would like to go to the bank and withdraw funds without a hassle. But it is nice to visit a friend and eat lunch with his family and his friends.

Why We Come Here

I've been visiting the hospital quite a bit lately. I'm not a doctor, and I certainly don't know what to tell a sick person about the recovery process. My work is entirely preventative, and my favorite phrase these days is "Je ne suis pas un docteur," I'm not a doctor. But I want to get in some face time with the people, and recognition as being involved in the health care process in some fashion.

Some of the health care professionals are very interested in talking with me. Some lose interest when they learn that I'm not a doctor, but many are happy to have any help that comes their way. Understandably. They work in the only hospital in the entire region, which is home to about 250,000 people. There are only 8 doctors, a handful of nurses, and some sagefemmes, who work with maternal health. Any help is certainly appreciated.

I especially saw this when I toured the operating rooms. Two OR's, neither of them particularly well stocked. Baba Sise (See-Say), who is responsible for sterilizing all materials, showed me around. Before beginning, he insisted that I wear a clean, white shirt over my own sweat-soaked button down, and that I change into a pair of tiny plastic clogs. In a city built on sand, the operating rooms are protected from the sand by a long hallway and a strong door (never mind that one of the rooms in the operating suite has a broken door held fast but ajar with a chain).

Baba and the doctors who came through remarked that they don't have much, but that they do what they can with the materials available. I have a hunch that they were hoping that I, the American health agent, would be in a position to donate medical supplies and improve their hospital. Doctors Without Borders donated an incinerator, new and powerful. But no one knows how to use it, so it sits unused behind the hospital. Which got me to thinking, what do these gifts really do? We can give them, but should we? If an organization offers materials that can't be used, what have we actually accomplished? (One would hope that this is an isolated case, but I have seen an incinerator that was never assembled in Kaedi because the donors never sent a technician)

Sustainability is, I think, the primary concern. The hope of the Peace Corps is that a volunteer will, over the course of two years, teach enough basic information and know the community well enough to make small differences that will add up to a big difference over time. Other programs will donate a single, large gift (a waste management system, for instance) and then move on to the next town in need. But will educational programs just stop without a dedicated staff to provide lessons, or will the people in the community take up the banner and continue the program? Will the gift be useful when the donor organization is gone, or will incinerators sit unused, or if used, break down without qualified maintenance staff available?

To me, the answer seems to be to combine the best parts of the Peace Corps with the best parts of donor organizations. Putting a big-ticket item into a town, and sending in a technician for a longer stay to train the staff in use, maintenance, and repair, seems reasonable to me. Longer-term integration would also allow the organization to see what more they could do, what more is needed, how their gifts could fit into the town.

As for the long-term, a town like Nema, a regional capital with a significant population, will ideally use and recognize the value of the gifts given by larger organization. When an incinerator no longer functions, the town can make the investment in its own health care system, or when garbage trucks break down for the last time, the town can invest in its own infrastructure. But that assumes that the town can afford such big-ticket items, and that the system is free of corruption, which would siphon off any funds. Making that assumption of internal accountability, I have grave concerns regarding the ability of a country struggling with poverty and development and competition in the global economy to make such an investment in its own infrastructure.

As the plight of Africa has come to the fore of American consciousness in the past few years-thanks in part to the efforts of so many high-profile people in business, politics, and entertainment-an argument that I've often heard against making donations to developing countries is that it creates a dependency cycle, that a gift doesn't provide the same sense of ownership as internal development does. That we need to be careful in forgiving debts, and in giving more money, because any gifts may be squandered.

I don't pretend to be an expert on the subject. I am not familiar with the complex inner workings or interplay of the economies of the various African countries, and how they interact with the US, the EU, China, Russia. I know that there is a difference between a gift of ten billion dollars and a trash collection system. I know that money given for a trash collection system can be embezzled. But I do know that a hospital needs an incinerator. I've seen too many used vaccine bottles and hypodermic needles on the ground, in the street. I know that a town needs a good water filtration system. Half of Nema leaves town for four months out of the year because the water table drops and the taps no longer work. I know that a town needs a good sanitation system. When the streets are filled with trash, diseases flourish.

And I also know that it is difficult for a poor country with an infrastructure from the mid-20th century and a population that has tripled since then, but an economy that hasn't, is not in a position to make the necessary investments in such basic needs.

That's not to say that I don't see the importance of local involvement and financial support for the programs that the people want to see. Such involvement encourages pride in the work being done. I have seen wonderful work done in education and in material support that has come from the local level. I am only suggesting that, given the depth of need in so many different areas of operation, significant support would be more beneficial than detrimental, if handled properly.

Standing in the hospital in Nema, it is difficult to give much weight to any argument against giving a better hospital to a town that needs it. Talking with people stricken with malaria, seeing women holding sick, malnourished, or premature babies, I can't argue against supplying the hospital with everything that it needs. Walking through town, stepping over scraps of rusty metal and around piles of goat and donkey shit, see how America as a nation could keep people from getting sick and having to go to the hospital. And carrying home buckets of water to put into my small, personal water filter, I remember that it is not a half of a population that leaves their homes in search of water, but tens of thousands of people.

We need to enter any development program with caution, certainly. But we can never, ever, forget that the goal of development, the reason we try to help, is because the less we do, the more people die.