Flash Forward

The sun was just rising in Mambu as I climbed into Father Cosmas’ small Suzukui jeep.  After three house of dodging pot holes and leaving behind a large cloud of red dust, we arrived at our destination, Saint Peter and Paul’s Parish in Ndop.  I met Father Cosmas a few months prior to our excursion when I was working in Mambu  as a Peace Corps Volunteer.  As one of the few people who lived in Mambu, but not from Mambu, he helped me understand the mindset of the people.  We bonded as I complained to him the difficulties in mobilizing the community to repair their water system.  In the process we became friends and one day he invited me to speak at a youth retreat in Ndop about servant leadership.  After we spoke, we walked around the grounds and I was immediately struck by the cleanliness and peacefulness of the retreat center.  I thought to myself that someday it would be nice to return and stay longer than just a day.  Flash forward seven years and there I was, staying at the same retreat center, co-facilitating a training session with Peer Educators on promotion of exclusive breastfeeding.

Peer Educators teaching women in the market about breastfeeding

It was a cold, rainy afternoon in Melim when we finished a discussion with women about their beliefs and practices about breastfeeding.  Many interesting themes came from that discussion, including women emphasizing that they rely heavily of the nurse or midwife for information about how to feed their child.  When asked what information the nurse will provide, one participant said the nurse may tell them to drink palm wine to stimulate breastmilk flow.  Two important conclusions came from that discussion: first, a great song about breastfeeding that was used as the theme song in our audio program; second, that nurses in the area need further training in how to encourage and support women in breastfeeding.  Flash forward three years and there I was, co-facilitating a training with health workers on infant and young child feeding and learning a new song about the importance of breastfeeding.

Health workers singing a song about breastfeeding in Pidgin at the end of their training.  English Translation:  What is breastmilk?  Breastmilk is the best food for the child!  You wash your hands, you sit down, you give your child breastmilk.  You wash your hands, you sit down, you give your child breastmilk. 

“The possible answers are like a ladder.  If you very much agree with the answer, you will circle 5.  If you somewhat agree with the answer, you will circle 4, if you agree you will circle 3, if you somewhat disagree you will circle 2, if you really disagree, you will circle 1.”  That is how my assistant Gilbert tried to explain to a room full of mothers with small babies about how to answer a post-test with Likert scale questions.  No matter how he and I tried to explain the concept of a gradient of possible answers, I don’t think they ever quite understood. Instead, they just circled 3 or looked at whatever their neighbor was circling.  Flash forward three years and there I was working on a new survey about breastfeeding practices in preparation for training with data collectors.  This time all of the possible answers are either yes or no and the surveys will be completed in private. 

Data Collectors practicing interviewing caregivers for the Infant Feeding Survey

Data Collectors practicing taking a child's height

At the end of my trip to Cameroon I was reminded of all the mistakes I’ve made, the lessons learned, and the relationships built during the past eight years.  There is still so much about Cameroon that I don’t know or understand, but it is gratifying to be able to use what I have learned in the design and implementation of new projects.  I see now how some of those struggles and misunderstandings help me do my current job better.  I still am amazed at how I became involved in this country in the first place and how God continues to keep me involved through new grants and projects.  A few months ago I was trying to explain to a friend my involvement in Cameroon and said, “I didn’t choose Cameroon.  I didn’t grow up longing to go to Africa.  In fact, when I was a child and traveled to Canada with my family I was so relieved when we crossed the border back to the States.  It hasn’t always been easy and there are many days that I wish I wasn’t involved.  But as I look back and see how things have come together I know that it is my calling and task.” 

A calling is a deep sense that your very being is implicated in what you do.  You feel that you fit into the scheme of things when you do this particular work.  You have a sense of purpose and completion in the work. It defines you and gives you an essential tranquility.

Life at Work, Thomas Moore

Pa for this Pikin

"It's a Happy Father's Day, a Happy Father's Day!  It's a Happy Father's Day, a Happy Father's Day!"  We sang this song in church while the deacons collected the offering.  I didn't even know that Cameroonians celebrated Father's Day, let alone that it could be an offertory song in church.  Wonders never cease, as Cameroonians say.  

In Pidgin, a father is called Pa for Pikin. So on this Pa for Pikin Day I think its fitting that I pay a small tribute to my own Pa.  When I was getting ready to come to Cameroon as a Peace Corps Volunteer nine years ago, he was more excited about it then I was.  I was filled with "what-if" questions and the worse case scenarios.  He saw the adventure and the educational, career building opportunity.  As soon as he and my mom could, they came and visited me in my village in 2006. 

Watching a surgery at the hospital

They came and saw my life, greeted many people, and ate a lot of fufu and njamajama.  I was so grateful they came because it was a significant demonstration of their support and it made our conversations afterwards about Cameroon so much easier and richer.  

My parents with the Fon of Mambu-Bafut

After I finished my Peace Corps service I remember my dad telling me that he never doubted I would complete the two-year commitment, even in the midst of some serious challenges.  And partly because of his belief and support I continued to be involved in  Cameroon years later.  

I returned to Cameroon in 2011 to do research for my doctorate and this brought my parents once more to Cameroon.   

Embracing the local transportation system

Papa Jerry and Baby Kate

And then I returned to Cameroon again to work as Nutrition Advisor and this brought my dad to Cameroon for a third time.  But by this time his visit wasn't so much to see me, but to see my Cameroonian friends and family who considered him their, "Papa Jerry."

A surprise visit to Ma Doris

In traditional dress, a gift from my colleagues

After I finished my Peace Corps Service in 2007 I was very unsure of what to do next. I felt like by returning to the States I had abadoned the Cameroonians who were so hospitable and generous to a young, naive, inexperienced 23 year-old.  It was my dad who encouraged me to go on and get my doctorate so I could teach in America and do research in Cameroon and have a "foot in both places."  And here I am in Cameroon, for a fourth time, doing just that and very grateful to be doing so.  

So Papa Jerry, Happy Father's Day.  Thanks for always challenging me to dream big, aim high, and use all of my God-given talents to serve with a foot in both places.  I danced and sang in church this morning  in remembrance of you.  

Greetings

I’ve been back in Cameroon for a little over a week and have experienced the joy of reuniting with friends, colleagues, and vegetable sellers. I’ve seen people I met while being here as a Peace Corps Volunteer, research coordinator, and now nutrition advisor.  Each person greets me slightly differently.  Some of the greetings have made me laugh, all have reminded me of what Cameroonians value. Some of my favorite so far:

 “Waay Kate!  You are there?”

“Wow!  This is you!”

“You are most highly welcome!”

“I dreamt last night that you were around, so this morning I just had to try your number.  Imagine my surprise when you answered!”

“My heart told me that you were around, so I had to see if your number would pass”

“Greet your children for me, eh?! And your friends!”

“Please Dr. Kate, stand up and bring us greetings from Obama.”

“Wikijun! Wikijun!”  (welcome, welcome in  the Lamso language)

“Yes, my Sister!  I am so happy to see you! You are most welcome!  How is your family?  Even though I cannot see them, it is only my love for them.”

The majority of greetings that I’ve exchanged in the last few days haven’t just been about me and the other person. With each greeting I personally receive, it is immediately followed with a question about my family and colleagues the US.  I have learned that it is impolite to respond by just asking about them, so I in turn ask about how their children are doing in school and if everyone in the house is healthy.  There is recognition that we both exist within a larger network of people and to not ask about them is to ignore a part of who we are.

A couple of months ago the Pastor of the church I attend in Virginia talked about the South African phrase, Sawa bona, which means “I see you.”   If you are a member of his tribe, you might reply with Sikhona” which means “I am here.”  The order in which this exchange takes place is important because it signifies that until you see me, I do not exist.  It’s as if when you see me, you bring me into existence.  This idea is part of a much larger frame of mind called Ubuntu, which is common among native people in Africa below the Sahara.  The word Ubuntu comes from the phrase Umuntu ngumuntu nagabantu, which means, “A person is a person because of other people” in Zulu. 

Although in the past week I’ve been reunited with almost everyone who is apart of my life in Cameroon, I know the greetings and the questions about me, my family, my friends, and yes, President Obama, will continue.  And that is ok, because being here and asking about them and their families and them asking about me and my family and friends reminds me that I represent an American and Cameroonian network of people. 

The Cameroon Baptist Convention Nutrition Counselors after a Refresher Training.  Some of the many people I have greeted in the last week.

A Letter to a Young Global Health Professional

I was in the middle of packing my bags for another cross-the-world move.  As I was dusting a wooden figurine of a mother and child before placing in my suitcase, I was trying to remember how many times I have struggled to fit everything I value into 2, 50 lb. suitcases.  It then occurred to me that this is most likely the last time I will face this dilemma, as my years of living abroad have come to an end.  In less than a month I will start a new job as an Associate Professor at Liberty University.   I will switch from living in Cameroon and visiting America periodically to living in America and visiting Cameroon periodically.  With that transition brings a sense of mourning at the end of my lifestyle as an expatriate in a country I love and appreciate as well as a reflection of all that I’ve learned and experienced since I arrived in Cameroon 8 years ago.  Part of my new job will be to mentor students who are embarking on careers in global health.  As I packed up my things in Cameroon  and moved to Virginia I’ve been thinking about what I will tell my future students and this is the condensed list:   

1. Be aware of the edifice complex.  Americans and Westerners in general, could be described as product-driven people.  After months of planning, meeting, discussing, and writing we want something tangible as a demonstration of our hard work and commitment. When I first started working in Cameroon as a Peace Corps Volunteer, our Country Director at the time described this phenomenon as “edifice complex.” We want a physical sign that shows that somewhere, somehow we helped a community develop.   It causes us to give ourselves over to irrational frenzy, repeatedly forgiving others who fail to honor their commitments, and focus so much on a final project that we forget about the process and the people involved.  I few years ago I  had the opportunity to return to the village where I was engulfed in my own edifice complex—helping 2 villages rehabilitate their depilated water system.  When I returned a year later, I was surprised that the people didn’t talk about the water system.  They recalled conversations we had that I had forgotten about because I thought they were insignificant at the time.  They asked about my family and wanted me to ask them about theirs.   Although the relationships built through sharing your knowledge and listening to theirs may not have any tangible benefits, I believe it has more lasting value then any edifice project you will ever manage or participate. 
2. Your job is to build trust and add value.   Recently, much more seasoned global health technical advisors then myself, wrote a commentary in the journal Global Health: Science and Practice  and offered this excellent advice.   They make a pertinent point that as an outsider, host country nationals will be polite and respectful to you, but that is different then trusting.  Building trust happens over time and being straightforward about your agenda.  You will add value by assembling evidence-based options, presenting it to your counterparts and allowing them to choose which ones best fit their country's needs.  
3. The question isn’t why but what.  It was hot.  Rain was pouring down.  Armed guards were standing close by.  My heart was aching.  My colleagues and I were visiting a uranium-mining town in Niger.  We were some of the few foreigners who had visited this town in the southern tip of the Sahara Desert since 5 Frenchmen were kidnapped just a few years prior to our visit.  While trying to process the number of malnourished children I saw earlier in a part of the world that is considered off-limits to foreigners, a colleague offered me this excellent piece of advice.  He told me that the questions of why is there such inequality in the world or why does a mother watch her child die of disease that is completely preventable will kill me.  Instead the better question to ask is what can you do?  There will never be answers to the why questions, but there will answers be to the what questions.  It takes some time, it takes some listening, it takes some reflection, but the answers will come.  And those answers will be more life-giving and practical then any possible answer to the why questions.   
4.  Its always worth it to love.  One of the perennial questions I’ve faced is how much do I invest in people when I will only be there for a short time?  I invested a lot in my friend Eunice when I was a Peace Corps Volunteer and she died.  Life is fragile and riskier in Cameroon. I learned early in my time in Cameroon that the people who become some of your closest friends might not be there when you return the next time.   I once heard of a Returned Peace Corps Volunteer who returned to his village for a visit a few years after he left and everyone was either dead or had moved away.  For many years I’ve wrestled with the question how close to become to Cameroonians and risk the sadness of saying goodbye either because of distance or unexpected death.  About two years ago I met a 77-year-old woman who was born in Cameroon, spent most of her professional life in Cameroon working as a nurse, retired to the United States, and now semi-annually returns to Cameroon.  I asked her how she approaches her relationships with Cameroonians and she responded simply, “You can’t stop caring for people.”  And she is right.    One of the greatest blessings of this profession is being a part of people's lives around the world.  But you can't do that if you don't first love and care for them.  People can tell if you are there because it is a job or because you care and are invested in them as people. It is seen in simple things such as greetings and questions about their lives and families.   Yes, you will eventually leave and yes, you may lose someone close to you because of unforeseen circumstances.  But the joy of their friendship and sharing in their lives, whether for a short time or a lifetime, far outweighs the sadness.
5. Take care of yourself so you can take care of others.  After I graduated from my doctoral program, one of my professors gave me this piece of advice.  Burn out and cynicism is very high amongst global health professionals.  I’ve learned that if I keep a daily routine of journaling, praying, and exercising I can live almost anywhere.  Find your rhythm and what rejuvenates you.    You will need this to maintain inner balance and peace when you live in a place where schedules are flexible and daily living feels overwhelming.    
6.  It will always work out, just not the way you think it will.  One of the skills you will learn as a public health professional is to plan and evaluate programs.  But at the end of the day you will have to just trust.  You are not in control.  It will all work out, just not the way you think it will.  So plan that innovative project, write out the budget justification to last penny, find the most talented staff, and then trust that it will all work out completely different then you anticipated. 
7. Travel light.  Always be ready for the car to break down and you have to carry all of your belongings and hitchhike.  Invest in a good pair of Chacos, a scarf, a lightweight dress, and a backpack and you'll be fine.  For a much better (and funnier) advice on this topic and why it is important, read this blog post.  
8.   Saudade.  After you have been in another country for awhile, a common question arises, do you build on what you already know and stay here or start someplace new?  There are positives and negatives to both situations.  Whatever you decide, if you have done your job well, when you are leaving you can share with your friends this Brazilian word, saudade, which means, even though you are far from me, you are close to my heart.  I will take what you have taught me and share it with others, either back in this country or in another country.    
9.  Learning can never be undone.  At some point you will have to go home and reintegrate to your home culture after you have experienced and changed much.  This can be unexpected challenge.  Life is full of paradoxes and this is magnified when you live in two very different cultures.   Be patient with your fellow Americans and remember that they haven’t seen or experienced what you have.  In her book The Dance, Oriah wrote, Once you recognize within yourself a hunger for something beyond just continuing, once you taste even the possibility of touching the meaning enfolded in your life, you can never completely be content with just going through the motions.  There is no going back.  Learning cannot be undone.  Your learning and experiences in another culture cannot be undone.  It may make you feel out of place when you return to your home culture. But if it has refined the meaning of your life and deepened the core of who you are, it is worth it.  
10. And finally, the best quote/words of advice that I received from a seasoned global health professional when I first set out on this journey,  God has been profoundly real to me in recent years.  In the midst of outer dangers, I have felt an inner calm.  In the midst of lonely days and dreary night I have heard the voice saying, "Lo I will be with you always."  Martin Luther King, Jr. 

Small Time I Di Go, But For Now I Go Over Enjoy

I was talking with a friend when I spoke this Pidgin phrase, meaning, “Soon I am going, but for now I am really enjoying being here.”  

Little Stone Lodge in Kumbo

 I was in Kumbo last week facilitating a workshop with 30 peer educators on promotion of exclusive breastfeeding.  I lived in Kumbo from 2011-2012 when I was doing research for my doctorate.  When I arrived last Monday I walked into the Little Stone Lodge where I lived in 2011,  immediately the smell and sight of the place brought back memories of the people I met, the struggles, joy, and lessons learned during that year.  I laughed and was filled with delight as I saw people again who were a big part of my life when I lived there.  Like, Doris, who neatly packed away my earrings and peanut butter that I accidentally left in the house 6 months earlier.  Nothing says friendship like someone who packs peanut butter inside a cardboard box with the words written, “Sister Kate’s things, DO NOT TOUCH!!” and hides it in a cupboard for six months.  

Facilitating the workshop brought my life and work full circle.  The first phrase of my research in 2011 involved asking a variety of people in Kumbo about breastfeeding practices, knowledge, and beliefs.  I quickly learned that the women knew a lot about breastfeeding and were provided with good information at the antenatal clinics, but their husbands and grandmothers did not and often influenced the women, or they themselves, gave the baby other foods or liquids before six months.  There was a need to develop tools to educate other people about the importance of exclusive breastfeeding instead of only pregnant and lactating women.

One of the first people In interviewed in 2011 and still meet each time I go back to Kumbo

When I returned to Cameroon last April as a Nutrition Advisor for an HIV grant, one of my goals was to promote exclusive breastfeeding in the community.  I desired to do this because research has shown that if an HIV positive woman exclusively breastfeeds her child for six months and takes her anti-retroviral drugs the risk of her transmitting HIV from mother to child is almost zero.   So there I was almost 3 years later telling peer educators, people respected in their communities, that sex does NOT spoil breastmilk nor does palm wine stimulate breastmilk flow, beliefs that I learned earlier that negatively influence breastfeeding practices.  I think they were surprised that a “white man” knew of such beliefs and openly spoke against it.  That or they enjoyed my attempts at explaining why the beliefs are not true in Pidgin.

One of the Peer Educators learning about proper positioning and attachment for breastfeeding

Some of the Peer Educators and Life Abundant Primary Health Care Health Promoters 

Song about breastfeeding that the Peer Educators wrote to sing in their communities to promote exclusive breastfeeding and women's nutrition

  Each morning as I watched the sunrise from the upper window in the Little Stone Lodge I reflected on my life and work in Cameroon in the past and in the future.  I continue to be amazed at how my past experiences have prepared me for what I’m doing now in Cameroon and what I will be doing in the United States in a few short months.   A couple of months ago I was offered a position as Associate Professor in the Masters of Public Health Program at Liberty University.  After a lot of prayer and thought I accepted the position with the stipulation that I could continue my work in Cameroon.  The school administration agreed and I signed a contract to start January 2014.  I have tried twice to completely leave Cameroon and have failed both times.  This time I am trying a new approach of simultaneously working in both continents, but with a home in the US and yearly visits to Cameroon.  The opportunity also enables me to work towards my goal of bringing students to Cameroon and exposing them to the realities of health and life in developing countries.  When I was in college I was able to visit a couple of developing countries with my professors and it strongly influenced my lifestyle and career choices, I hope to provide the same opportunities for my students. During the five years that I have lived and worked in Cameroon I have learned so much from the people, not just about breastfeeding, but about life.  In the future I hope to continue learning from them while also sharing what I have learned with my future colleagues and students.      

 

All is grace.  Light and water, shelter and food, work and free time, children, parents, and grandparents, birth and death--it is all given to us.  Our vocation is to receive these gifts and say thanks.  If I have any vocation it is to receive from the people the gifts they have to offer to us and to bring these gifts back up North for our own conversion and healing.
Henri Nouwen,  Discernment