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Doing Development in West Africa
A Reader by and for Undergraduates
By Charles Piot Duke University Press
Copyright © 2016 Duke University Press
All rights reserved.
ISBN: 978-0-8223-7403-9
CHAPTER 1
Students Reflect
Stephanie Rotolo, Allie Middleton, Kelly Andrejko, Benjamin Ramsey, Maria Cecilia Romano
Stephanie Rotolo
It was barely 5:30 in the morning, but the sun had already begun its ascent, and people and animals were moving about the courtyard. I pushed back the mosquito net that hung above my straw mattress in the corner of the room and slipped my feet out onto the warm clay floor. After a quick, cool bucket shower, I returned to the room, dressed, and ate a breakfast of bean fritters and local beer. I watched and listened as neighbors came and went, conversing in a language I did not understand. I turned off my gas lantern, gathered my notebooks, and gave my Kabre greetings to the women in the courtyard before making my way down the mountain to the small clinic. I passed homesteads and fields along the way and wished everyone I came across a day of productive work.
I was in an entirely different world. I had spent months preparing for this experience — studying the history and culture of the community, practicing my French, and designing my research project — but there were some things I simply could not have anticipated. Effective communication did not just mean speaking a different language; it also required breaking down cultural barriers and being innovative in getting a point across. Time seemed to move at one's own discretion, and what would normally be a ten-minute walk could take up to a half-hour, if, as expected, you stopped to greet the people in your path along the way. Thus, meetings and interviews took place when all participants were present and ready, regardless of the time they had been scheduled. Communication with neighbors required visits to their homes and engaging in face-to-face conversations. The rare cell phones in the village were used for professional purposes or in cases of emergency. Without electricity in the homes, individuals would go to sleep when the sun went down (by 7 PM) and wake up when it rose again (6 AM). Everyone contributed to work around the home and in the fields, and neighbors worked together as one entity for the larger good, redefining the way I perceived "community."
Despite being welcomed by all with an inordinate amount of hospitality, I was still the anasara ("Nazarene," in Kabre) or the yovo (from the German jawohl, in Ewe), the white person. I was stared at by children who had never before seen a foreigner; I was heckled on the streets and in the market; and I was asked countless questions about my life at home and my reasons for coming to this community. A few weeks into my stay, on a Saturday afternoon at a small village market, a woman I did not recognize approached me and told me that I had "saved her." I was confused about what she was referring to; my host brother explained that this was her way to thank me for the health-care discussion I had led the previous weekend. One of the other students and I had decided to host community-wide discussions after Sunday church services to address maternal health, sanitation, and malaria. Apparently, this woman had attended and was adamant in expressing her gratitude for our work in the community.
I had not thought much of it before, but the esteem in which I realized I was being held as a white, foreign student was hard to believe in and get used to. I was told by village chiefs, men's working groups, and other community members how much my work meant to them. While it was certainly comforting to hear this trust, it seemed at times that the community believed more in my capabilities than I believed in myself. In a meeting with the chief of the canton, I was reassured that regardless of what I accomplished during my stay, this experience should be about creating a partnership; that above all, my presence would establish a connection between the villages and a city in my home country.
Most of my days were spent sitting in on consultations at the clinic and conducting interviews, as men took breaks from their long hours of work in the fields. One of the hardest aspects of my research was leaving my preconceptions and personal beliefs at home. As I sought to understand the community's traditional medical system, I delved into entirely unfamiliar topics and issues. Growing up, I was taught that health and disease were simply biological matters, whereas Kabre understood them as interwoven with spiritual and social relations and concerns. With each interview, my previous understandings were twisted and flipped upside down. "Il ne faut pas avoir des inquiétudes," my translator would tell me. "Don't worry." Through the challenges, the fear, and the frustration that inevitably come with cross-cultural experiences, I thought back to what the canton chief had told me when I first arrived in the village about creating a partnership and mutual understanding between cultures. I was there to learn, and I quickly realized that my most enriching experiences would come from asking questions and participating in the local culture as much as possible. I had originally traveled with a research plan in mind, accompanied by particular questions I wanted to ask and issues I thought would be important to discuss with the community. After a somewhat rocky and inhibited start, I finally got comfortable with the interviews — speaking to my translator in French who would then relay information in the local language to the person being interviewed, and vice versa — and allowing them to deviate from what I had intended. I found that doing so gave me greater insight into Kabre culture and opened doors to more questions and areas of research. With few exceptions, people were generally excited about my project. They seemed proud of their culture and wanted to share their personal narratives and insights.
This engagement extended well beyond my formal project. I learned to prepare a local yam dish called fufu and made and sold local beer at the nearby market. I played soccer with my host brother and spent hours under the stars in the courtyard playing card games and telling stories with the entire family. I attended ceremonies to the rain spirit, participated in funeral rituals, and spent time in the fields with men's work collectives. By fully immersing myself in Kabre daily life, taking risks and letting go of my fear of failure, I accomplished more than I had imagined and created real relationships that have lasted beyond my stay in northern Togo. The community's unfailing optimism in the face of adversity taught me the value of working through all the challenges with which I am presented, regardless of how insurmountable they may appear at first.
Alexandra Middleton
On my last night in Togo in December 2012, I went to dinner with Dr. Patassi, one of the leading infectious disease physicians in the country, at a restaurant in the capital, Lomé. Patassi, as others call him, is Kabre and lived in the northern villages until he was twenty. He thus grew up using the same local medicines I studied during my fieldwork. Yet he left the villages to pursue biomedical training in Moscow before eventually returning to Lomé to practice. A few minutes into our conversation, I found myself explaining my project to him, telling him about my interest in local healing practices and the challenges of collaboration between biomedical clinics and the House Medical System (HMS) I researched in the north. His response, as I should have anticipated, was skeptical, but it still jolted me: "Why are you interested in that?"
I was thrown in part because his words resonated with those of my pre-med peers back at Duke who had queried me about my interest in studying non-biomedical forms of healing. In the two years since then, I had chosen not to pursue a career in medicine and instead to explore the anthropology of medical belief and practice, letting go of the idea (of both the doctor in Lomé and my Duke peers) that there might be a single truth by which others might be judged. My fieldwork, and the discourse of medical anthropology I tapped into, allowed me to see such views as epistemic, nested in histories and power plays. Part of my own development — as a thinker, an anthropologist, and a person — required holding on to this insight and moving past stark either-or dichotomies. In this sense, my work evolved with me.
Throughout, the research process for me involved a set of internal negotiations and justifications. Often I questioned whether I would end up contributing anything substantive by the end of my stay. In all honesty, much of the on-the-ground research process struck this very same vulnerable nerve. It frustrated and confused me. Especially at the outset, it felt meandering and unfounded, at times without direction. I quickly learned not to become too attached to any sort of schedule or agenda; at a moment's notice (and sometimes even without notice) it could be felled. Meetings were cancelled and rescheduled; interviewees were often absent or preoccupied with tending their crops and fields.
Furthermore, I quickly grew overwhelmed by the enormity and complexity of the indigenous medical system. I started out with a medical census of sorts but realized that two months would offer barely enough time to scrape the surface. I also realized that the community was reflexively oriented to this deep-rooted medical system and that, as an outsider, I could not expect to immediately understand, navigate, or conceptually inhabit it. Given these circumstances, my work was characterized by constant reassessment and internal questioning, driven by a restless desire to figure out what would best serve the community itself and not just my own intellectual or personal curiosity.
In the midst of these disenchantments, I stumbled upon a partial realization that still continues to play itself out, even as I have returned to the United States. As I relaxed my rigid definition of "change" or "progress," I realized that I would not be able to serve the community unless I really knew it. Even if I struggled to understand or even fully condone the use of local medicines, I could at least try to know the community whose lives depended on them. I consciously tried to be more present in my interactions with my family members and the community. I attended all of the ceremonies and funerals that I could. Instead of retiring to my room early, I stayed outside into the night playing cards with the village kids. I brewed the local drink (made by women) with Stephanie and sold it in the Farendé market, much to the delight of my neighbors. When the local musicians played, I applied the few West African dance moves I remembered from the dance class I took during the second semester of my freshman year and joined in the collective movement.
In addition to all of the shifts happening within me, I began to notice a shift in the responses of those around me. At the beginning, I imagine, the Kabre saw me (understandably) as something of a recluse and as a student who asked strange and seemingly obvious questions about traditional herbs, who stumbled through the local greetings and could hardly carry on a conversation in French. But as I invested more time and energy in my interactions, the divide began to disappear. Even the simple act of stopping on my way down the mountain to engage in a greeting with the toothless old woman who lived outside my homestead yielded smiles and, on my part, a deeper feeling of connection. Welcoming but inevitably detached hospitality morphed into coexistence and laughter.
If I were to attribute this budding intimacy and trust solely to my own efforts, that would be misleading and untrue. Even before I arrived in Kuwdé, a considerable measure of agency and trust was granted by virtue of my professor's rapport with this small community, built on his twenty-five years of fieldwork there. When I entered the village, I received a degree of trust and acceptance that I realize is probably rare in fieldwork and certainly in other areas of international engagement and volunteerism. I was able to ask questions and probe local knowledge in ways that probably would have taken years to establish on my own. For this I felt even more indebted to the community of Kuwdé and even more compelled to contribute something in return.
Since my return, I have repeatedly asked myself: what was the takeaway from my experience in Kuwdé? Among other things, I developed a true appreciation for the fact that change and progress come in modest, often immeasurable amounts. In the middle of an interview, one of the medical workers at the Case de Santé (Health Hut) said, "Thank you for your questions. We learn from them." Our interests as engaged "outsiders" with a desire to learn from the community drive their interests. Our investment in indigenous medicines lend a sort of local legitimacy to the system itself. Our interest in collaboration between the biomedical and local medical practices is, we hope, generating interchange and dialogue between the two, however slowly and subtly.
But on perhaps a more essential level, our presence had an additional effect, however modest. "When you bring your students here, it brings the village to life. No matter what our local struggles, things become sweeter," a village woman told our professor at our farewell ceremony. That sweetness (happiness?) is perhaps the most resonating affect I will take away from my time in Kuwdé. It is a different flavor from any I have seen or experienced in my life to this point. It is founded in people, not in acquisitions or individual accomplishments, money or hedonistic pleasures. It is the toothless smile of the old lady after I greet her in her own tongue, the euphoric giggle of a young child chirping from the tall grasses as I return a bonjour. In this place where survival and health are not one's own business but the business of an entire village, exchange and interchange yield the most enduring sense of fulfillment, purpose, and vitality.
Kelly Andrejko
The first day I set foot in the Hôpital du Bè, in Lomé, Togo's capital, my heart was about to beat out of my bright blue scrubs. I had just zoomed to the hospital on only my third motorcycle ride ever, and it felt as if all eyes in Lomé were on me. I took a deep breath and reminded myself why I was standing in the sweltering heat of an African summer, in the waiting room of an urban Togolese hospital. I had received a grant from Duke to travel to Togo's capital for eight weeks the summer after my sophomore year to conduct research about the intersection between biomedical and traditional medicine, as well as to shadow health professionals at the hospital. Nevertheless, all of the confidence I had conveyed in my grant proposals seemed to be evaporating as I looked around for the director of personnel with whom I was to check in. Quickly scanning the room, sweating bullets, I saw a person screaming with a green and furry infection on his leg. No, not him, I thought. I saw an authoritative-looking nurse in a striped red outfit glaring at me. No, not him. Then I saw a smiling man in white lab coat heading my way. That's him!
The day before, in a comfortably air-conditioned director's office, it had been carefully explained that my fellow Duke student, Camille, and I would be spending two weeks in each of the hospital's main units — gynecology, pediatrics, and general medicine — leaving the remaining two weeks up to us. Day one for me was a trip to the sale d'accouchement (birthing room).
As I was dropped off in the birthing room, I quickly remembered that my shadowing experience back home had been confined to the consultations of a pediatric neurologist, all neat and bloodless. I was instantly overwhelmed as I stepped into the stuffy, poorly ventilated birthing ward. Momentarily struck speechless by the birth occurring on one of five cloth-covered metal tables directly in front of me, I was broken out of my stupor by a midwife handing me a pair of gloves and a face mask and instructing me to take over for her. In my rusty French, I sputtered that I was there just to observe; I was not trained in any way to help with birthing. This would be a conversation I would have dozens more times at the hospital that summer, as no one could understand why I would travel to a hospital in urban Africa with no medical training. Saying no was one of the most difficult parts of my work at the hospital, as the doctors were clearly overwhelmed with patients, yet I knew I did not have the necessary knowledge to be of use. In the birthing ward, the midwife looked utterly confused until the lady in the stall next to us started screaming in Ewe, the local language, that her baby was coming, and the midwife signaled for me to follow along.
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Excerpted from Doing Development in West Africa by Charles Piot. Copyright © 2016 Duke University Press. Excerpted by permission of Duke University Press.
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