First - Happy 4th. As there will be no fireworks here (and I am somehow not invited to the party at the U.S. embassy, I've invited some of my new friends to the deck at the Grand Hotel to watch the sunset).
It's occurred to me that it's because I'm often in places where there are large numbers of tourists, there are usually enough people who speak English for me to get by. Not so, here. Soumana is my translator from 9:00-5:00 and I really struggle with the simplest things when he's not around.
And even with Soumana, the cultural differences here make communication a little challenging. Just one example, I told Nourou, the "boss" of the video crew, that I couldn't afford the gas for him to take the the whole crew to the village but that we could fit his cameraman in the vehicle with us. On Tuesday morning, the whole crew showed up and they had even aquired a fifth guy.
Anyway, Tuesday morning, after getting tires and stopping at many roadside stalls for snacks, water (in plastic bags), etc. Madam Traore, Boure the (very serious) cameraman, Nourou (because for some reason he couldn't be left behind), Soumana and I set out to take a young woman, Biba, and her little boy back home.
Biba has been at the Dimol Center for three months. The son she had with her is her 4th child (the majority of fistulas happed with the first delivery) but she had too many deliveries too close together. It's unusual that the boy survived. (I put him at 3 months. He is not unusually thin and while he seemed a little lethargic, I thought it was the heat. It turns out that he is actually 7 months old.)
Biba has had two surgeries to repair her fistula and she actually needs a third but her prognosis is very good. (There are 26 Nigerien doctors trained to do fistula surgeries - largely thanks to UNFPA's Fistula Fortnight in Nigeria three years ago - and four of them practice at the National Hospital here in Niamey.) Normally, Biba would stay at Dimol until she had fully recovered but she wanted to go home and I wanted to see Dimol's "reintegration strategy" so Madam Traore agreed with Biba's promise to return in three months.
There are no road signs in the bush and there are VERY few signs that announce the name of a village (Welcome to Kabe Popluation 230). So, the way you find the place you're looking for out of the thousands of villages is a) find one of the drivers of the bush vehicles that bring villagers to Niamey in the morning and take them home at night and ask him how to get there and b) ask everybody you pass. You meet some very interesting people that way. Occassionally, if you missed an important fork in the "road" but not far back, a kid or young man will jump on the back of the vehicle or cram in beside the driver and get you back on track.
The drive was supposed to take about two hours (I think I said earlier that there was no A/C.) It took four. Apparently, we took a very circuitous route. We drove for long stretches across landscape that, to say it looked like moonscape, would be to exaggerate how much was going on. I mean nothing. There were were times when the only markers to indicate the road were the giant ant hills and times when the only marker was the tire tracks of the vehicle that came before us.
This is the rainy season but there is very little green. The Nigeriens are worried. (Mostly they grow millet and other grains.) One interesting fact that I learned from Madam Traore - most fistulas happen at the end of the rainy season because (she says) a woman's family won't stop working to take her to a health facility if her delivery is going badly. ("Fistula is an illness of poverty.")
On the way we stopped by a village with a health center to ask the nurse, Fatiya, if she would come with us. There isn't a health worker in every village so Fatiya has to travel around and people have to come to her. For her work she makes about $75 a month - which is good by Nigerien standards but apparently not enough to make her independent. The health centers are a project of the President of Niger (Despite many, many heated political debates in the car - in the local dialect Djerma - I really can't tell what people think of the government except that it's not very effective.)
Fatiya looks like she is in her mid-20s and seems very serious about her job. She's been a health worker for three years but she says it's frustrating. Apparently, a company or an NGO or the government donated pharaceuticals at a very low cost but Fatiya was not able to get the houses of her village to donate to a pot of money. She tried to explain that it would be for the good of everybody but they said she would use the money for her own purposes. But she keeps trying.
By the way, apparently the only white people who come to the villages in Niger are doctors because just about everyone who talks to me asks me if I can fix their eyes/hand/wound (even with Fatiya just a few feet away). Soumana has to constantly tell people that I'm not a doctor. (In town, there are few white people but I'm no oddity. Nobody seems to notice my glaring white face in the crowd.)
In the village, the kids are petrified of me. (Possibly because I forgot to take something to hold my hair back in the car and I suspect I looked like a witch.) They crowd around at a distance and the really brave ones will shake my hand if I'm persistent.
When Dimol takes a woman home after her fistula surgery, they send someone ahead to tell the chief and the Imam that they are coming and want to do a presentation for the village. When we arrived the more important men of the village greeted us and little boys gathered around but no women or girls.
(Before I make the following observations I should say that Soumana, the guys on the film crew, the men who work in my hotel and the mostly male staff of UNFPA have been really great to me.) Soumana said you can tell when a village has never been "sensitized" by an NGO (meaning there had never been programs for women or for health, etc. sponsored by an organization like Dimol, CARE, Oxfam, etc.) because they women don't great guests. But if an NGO has been active, the women are much more empowered to come meet visitors.
Madam Traore told the men that the woman should attend the meeting and, duly chastised, the men used the exuse to order the women around - barking at them to come out of the huts and sit down. Then Madam Traore spent about 20 minutes lecturing the men to treat their wives better and about 20 minutes telling everyone about sanitation and their health. Only larger villages have a paid health worker like Fatiya so the women of Dimol are trained in basic health precautions and to identify potential problems. When a woman like Biba returns, it's announced to the village that she is now their health worker and that she may tell them to get medicine or to see Fatiya or that a very young woman should go to Niamey to have her first baby. This is an subtle order to the men not to yell at her because she "inappropriately" tells them what to do.
In front of the village, Dimol also gives the woman the equivalent of about $100 to start an income-generating project (like making soap) because most of them have been abandoned by their husbands so they have no support.
Somehow, the route back to Niamey was "obvious" to everyone else in the car as we went "directly" and in only two hours.
