HIV AIDS Meeting the Challenge in Kumbo

Travelling to Kumbo

 
Kumbo Used To Be Called Banso
 

Had our trip to Kumbo been a couple of years ago, it would have taken a full day due to the road.  The road construction extends for miles and miles.  The trip took us three hours and proved to be very pleasant.   Along the way, there is a surprising amount agriculture and with the expectation of rainy season just ahead, lots of cultivation and planting activity.  The country side is very hilly and we were pleased to note that they are planting their rows across the hill.  However, the soil is depleted of nutrients from years of heavy use without giving back to the soil.  We climbed many hills but one in particular our driver said one had to go slowly to prevent the car from overheating because the hill is so steep and so long. 

Other than the terrible streets (deep pot holes, no pavement), Kumbo is a delightful large town.   We found our hotel, ordered a sardine sandwich on their pure white bread that is sweet with coffee that came with creamer and, although OK, decided the next lunch would be from our snacks.  Our IDF hosts were ready to take us to the meeting hall where HIV positive mothers and HIV positive children were assembling.

Meeting HIV Women and Children

We met the Chairperson, Yuri (Evelyn) 15 months ago.  She had travelled to Bana to witness to our seminar group.  Oussemaotu had recognized that the village of Bana had numbers of HIV positive people were were not addressing the problem.  Evelyn told her life story to the group.  Her coming forward in her community of Kumbo to break the stigmatization surrounding HIV AIDS has helped many people. 

Evelyn Showing Us A Picture Of Her Two Children

Meet Evelyn through Utube:  https://www.youtube.com/watch?v=fRo1JEPEozQ

Several years ago a project was undertaken in Kumbo to identify HIV AIDS positive person, have testing done, antiretroviral drugs made available and support groups set up.  There are three groups with over 200 people actively participating.  As well, a microcredit loan program was begun. 

As people were coming into the meeting hall, I went to each of the children asking them their name and age and what level they were in school.  The meeting time had been set especially for them to come directly from school.  We were soon underway for a lively meeting. 

Each person in the room introduced themselves, children included.   Microcredit entrepreneurs proudly named their businesses:  farmers (pig, sheep, corn, beans, poultry), small store operators (fruits, vegetables, beans), a dressmaker, a restaurant operator, a person selling ground nut pudding, sandwiches and bread from a mobile cart and a person operating a sewing/knitting business. 

Integrated Development Foundation (IDF) gives training on business management, How to keep records to determine is there is a gain or loss.  They conduct home visits, help the person live positively, to build up their system, do hospital follow up.  The importance of early testing was emphasized so treatment can begin right away.   The cost of an HIV test has been reduced from 20000 to 17000 (very expensive for Cameroonians –$40 reduced to $34.00 Canadian!) 

Three support groups have been formed to help each other.  Children come together to share experiences, to talk about respecting the health regiment, to encourage doing well at school.  (These TALK groups are very important.  Many children have committed suicide after being told they are HIV positive.  Some have dropped out of school because they are stigmatized.) 

The District Delegate, known as Uncle George, spoke from experience.  He said of the six that lived in his house, four had been taken by HIV AIDS.  He said they could not accept the situation and were not careful to take care of themselves.  He said if you are an able person today, you may be disabled tomorrow.  It is important to accept life and go ahead.  He told us that many funders have poured a lot of money into the country and the masses could not handle it; that we are here because we love humanity.  Many people have much but don’t know how to reach those who need it.  After the delegate spoke, the group sang a lively song about HIV AIDS.

They had a poster welcoming us that came in very handy for me to give them a summary of a well balanced eating pattern.  Allan gave a short talk on Conservation Farming and the importance of Cover Crops to give back to the soil.

A meal to feed the multitude was placed on the table.  Rice, beans, huckleberry with agousi (pumpkin seeds shelled and the inner part ground to make agousi) and bananas.  The meal was delicious.  The servings the children gave themselves really surprised me.  The incredible part was that everyone had something to eat!

This program is world class.  As Allan said, they are each champions.  Many times throughout the meeting, the need for strict adherence to taking the medication everyday at the same time every day is so important.  AIDS is not a death sentence but it requires a disciplined approach to each aspect of living. 

Visits to Microcredit Entrepreneurs

We left for the market at 8 sharp.  The first two entrepreneurs run shops situated along the street.  Situations very.  The first shop keeper is on her own.  She and her children live  behind the shop.  The shop was tidy, nice counter and table to the side where she serves meals but today no meals because she is off to her farm to plant Irish Potatoes.

The second lady’s shop again very appealing displays.  Her husband has a tailoring business in the front corner complete with a treadle machine, iron and cutting table.  They too live behind the shop. 

Now,to the market.  Evelyn (Yuri) knew exactly where she was going.  The walkways are narrow and people were bringing in goods on hand carts in the main area so one had to be careful to keep to the side.  We were impressed with the variety of products.  Guri is a food made from grinding and cooking corn, they drying it.  People mix it like porridge.  Lots of beans, ground nuts, plantain, tomatoes sold, including the woven basket, Irish potatoes freshly dug, dried cassava, huckleberry, along with things unusual to us like cow pea leaves and lots of agousi.  Each of the Microcredit Entrepreneurs we visited had been at the meeting the day before.   In retrospect, Kumbo compared to Bana and Wum has an excellent food supply, good variety, good selection of legume based beans for protein, vegetables and fruits and this is dry season.  I was fascinated to see a table of mushrooms!  So, all you need is money.

Off to another Entrepreneur, this time a sewing, knitting business.  Two sisters are involved in the sewing, tailoring and knitting sweaters business (sweaters are often part of the school uniform which they also make).   Basic sewing is done on a treadle machine with a surger to finish seams.  They have an apprentice working with them. 

HIV AIDS Meeting the Challenge

Dressed traditionally ready to go to the council meeting at 10, Evelyn (Yuri) met us to not only take us to see a number of other Microcredit Entrepreneurs but to visit her own home and show us her chickens!  We walked down the rough, semi steep path to Yuri’s rented home.  Yuri recently has taken a baby whose mother abandoned her for the city, leaving Yuri to take full care of the baby.  Yuri has a young girl caring for the baby who at present is sick with mouth thrush.  The young girl would normally have taken the baby to the market stall with her but they want to assess the baby’s illness and see if the baby should go to the clinic.  Yuri took us into her home to show us how she handles breakfast for her two children and what she is feeding the one year old baby.  This certainly makes the Nutrition Seminar come to life.  Yuri sets out Ovaltine, Powdered Milk and Soya alongside a thermos of water.  The children make their own breakfast.  Milk based, this is an excellent beginning for them for the day. 

Outside there is a common tap that brings in town water.  Yuri raises chickens in a separate building, a few at a time to make a little money.  She has a small farm plot at another location.  Yuri is on city council as well as being very active with the support groups for HIV AIDS.  She looks the picture of health and wants to help others know how to live with HIV and be a healthy, productive person. 

Conservation Agriculture Application of Cover Crops

The Application of Cover Crops to Conservation Agriculture at the IDF Demonstration Farm

Village of Bana (West Region/Cameroon, Africa)

 By Allan Sorflaten 

Conservation agriculture (CA) refers to the practice of planting crops using minimum tillage and keeping the soil covered with cover crops or mulch. Farmers are asked to keep their use of hoes, ploughs and other tillage implements to a minimum. The practice is based on reduced or even no mechanical (or hand) tillage, a vegetative soil cover and beneficial crop rotations. The natural composition, structure and biodiversity of the soil thus is kept intact as much as possible. Practitioners of CA avoid burning plant residues because of the benefits these materials can bring to the soil as they decompose naturally. The use of natural fertilizers such as livestock and fowl manures and organic composts are emphasized. The soil is never allowed to lie bare. It is protected most of the time with crop residues such as leaves, stems & stocks and other vegetative matter from previous crops and also by using suitable cover crops that have soil improvement benefits (using intercropping and rotation crops). In so doing, the negative effects of wind and water erosion are minimized and soil fertility benefits are particularly realized by the use of appropriate leguminous crops.

Allan first presented an Introduction to the Principles of Conservation Farming during a 2 day seminar at Bana in November 2011. He then followed up with a more intensive 3 day seminar/workshop in November 2012. This 2^nd event included participants who were more genuinely representative of farming interests in Bana than the first. They were selected so as to include young farmers, women’s groups and also faith based or religious groups.

Shortly after this 2^nd workshop IDF successfully secured the rights to a few hectares of property in the Village for use as a Conservation Agriculture demonstration farm project (Champs École). Boundaries of the property were secured and the farm now appears secure from the point of view of land tenure. For this, thanks are due to the good graces of the Chef /Le Roi Traditionelle de Village, King Sikam Happi IV. The objective of this demonstration farm is to promote a resurgence of farming interest by small landholders in Bana using the very do-able practice of conservation or natural agriculture. The Farm occasionally has access to advisory input from the Regional Division/MINADER (Jean Woupi, Phillip, and the Irrigation Specialist).  IDF/NGO has been the implementing agency throughout and has excellent facilitating & planning skills and is skilled at mobilizing resources.

IDF has made excellent progress throughout the past year in developing the demonstration farm (Bana Champs École). Allan completed an additional CA seminar there (February 25/26) on the use of leguminous cover crops in CA systems.  All of the participants were those from the 2012 workshop who  are continuing to help develop the new demonstration farm. The content of this Cover Crops Seminar can be viewed on the attached Slide Share format. 

From the outset of this seminar/workshop series, Allan has emphasized the role of contour cultivation and other sustainable cropping techniques, many of which are not always commonly practised here. So we’re less surprised these days than we used to be when we see row crops pointing straight down the slope.

Now and then we encounter a few individuals who superbly fit that old extension model of the innovator or early adopter. One of these is Roger (pronounced Rogé) Tianni of Bana who in addition to his own impressive crop farming activities is providing a good deal of his own labor and valuable advice in helping to develop IDF’s demonstration farm. Roger has been a participant in our activities right from the time of that first CA seminar in 2011. As well he’s the only small farmer we’ve met who has actually developed and is using irrigation on his home farm. Perhaps he’s not really a small farmer with about 4 or 5 hectares under cultivation.

The IDF demonstration farm/champs école has access to water that it needs for a gravity based irrigation system during the dry season. Right now a few of the short crops like huckleberry (morele), cabbage, hot pepper, etc. can be grown at the bottom of the hillside on the flat land.

A well thought out system has been devised to bring a reliable and steady flow of water by pipe from a short distance upriver for hand distribution by watering cans. The system can be viewed as the first or rudimentary step in constructing an irrigation system powered by mechanical pump and with storage at the top of the hillside for gravity distribution to crops. The irrigation specialist from MINADER West Regional Division has been involved with planning the proposed irrigation system for Bana.

Cover crops or crops that can be associated with a complementary crop for the benefits that they may bring to the primary crop generally appear not to be considered here, possibly because they simply are not recognized as such. Long standing patterns or habits of “le houe” farming we suspect are also influential. As well, the attitude sometimes is expressed that there’s no point in changing established ways because there’s never enough money available to farm the modern way using purchased inputs like manufactured fertilizers.

Mr. Dagobert is a local authority on plant based medicines and has been a source of valuable information for us here in Bamenda. Early on this trip he provided us with advice on the use of locally sourced leguminous trees and other plants as cover crops and also contributed an excellent supply of seeds for the same at no cost. We happened to meet him quite by chance at the Vegetable Growers Seed Sales Outlet in Bamenda.  On our first visit to his small farm we learned that his son is doing a Ph.D. in Philosophy at the University of Quebec. On our second visit Allan actually spoke with his son in Quebec City (using Dagobert’s mobile).

Other sources besides Mr. Dagobert  have generously provided financial resources for the IDF (Bana/Befang) farm seeds including the Rotary Club of Truro and Sorflatens.

Because public relations is important in furthering the purposes of the IDF demonstration farm, the good relationship that has been developed with Mr. Jean Baptiste of Radio Flambeau in Bafang will be maintained and expanded hopefully to include print media and television. Improved public awareness about the benefits that Conservation Agriculture can bring to the many, many poor  farmers throughout this region of Cameroon may encourage the Government/MINADER to implement programs that will further the practice of CA here and elsewhere throughout Cameroon.

The retired physician Dr. Poungey who in collaboration with IDF is an active supporter of palliative care in Bana speaks positively about the benefits of increased quality food production that CA can bring to those in need of the most basic care and nutritional consideration in their daily food needs.

https://www.slideshare.net/LydiaSorflaten/bana-conservation-demonstration-farm-in-cameroon

SAHOCAH Bafut: Where Miracles Are Made

SAHOCAH Bafut:  Where Miracles Are Made

One place we really wanted to visit is described well:  ‘Sajocah is a rehabilitation center in Mambu, Bafut, Cameroon that serves people, primarily children, with disabilities. Established and run by the Tertiary Sisters of St. Francis, Sajocah–which stands for St. Joseph’s Children and Adult Home–offers temporary housing for patients and their caregivers, patient assessment, intensive physical therapy, classes for the blind, job and skills training, and more.’  (http://sajocah.wordpress.com/)

Initially, the interest came for two reasons: one,  Rotary’s involvement with Polio eradication, I thought we would be seeing Polio victims.  Right away, Sister Prisca clarified that they have not dealt with Polio victims for the last 10 years due to the Polio eradication program. Secondly because Oussemotu has brought a little girl with severe problems for assessment.  When children are crippled, they are often rejected by their families, thought to be possessed, and often just dropped at SAHOCAH on the doorstep!  Sister Prisca talked at length, she  was very anxious to take us through the ‘Children’s and Adult Home’ area opposite side from the hospital.  

 It was Sunday so everyone was in a relaxed mode.  We viewed the classroom where 23 primary and secondary blind students go to school.  There were several blind persons sitting on a bench.  Sister Prica asked the blind ‘reporter’ to give us a history of SAHOCAH.  That he did, most capably.  Each Saturday he gives interested people an update on World News that he summarizes from listening to the radio.  As we moved forward, he came behind us to tell us to make an association between Canada and the Cameroon because they both have French speaking populations.  

We could see inside the ‘Cane Room’ where the blind learn weaving.  All along the way, Sister Prisca showed such love and caring for the children.  Each hallway has children sized parallel bars, very necessary for children who have had recent surgery for knocked knees, bowed legs, club feet and hip replacements as well as amputates, prosthesis, and more.  All were children that we saw. Teams  of orthopedic surgeons come from  Italy and LUMOS Belguim came to perform  surgeries. In the Physiotherapy  section, it was strange to see all the equipment children sized.  A little exercise bike, short parallel bars, etc.  Sister Prisca proudly showed us an album of ‘before’ and ‘after’ pictures.   Life changing-legs straightened, club feet restored to normal, children able to be mobilized otherwise unable to walk.  One rather upsetting situation occurred when a girl of about 10 with prosthesis on both legs  knew she could not cross the gap to the next set of parallel bars.  She was crying.  Sister Prisca immediately supported her waist and she was happy to proceed on the next set of parallel bars.  In 2013, 840 children and 91 adults were treated, 645 were orthopaedic.  A group of technicians and physiotherapists came from Belgium in November of 2013 to teach technicians how to produce modern arm splints out of local materials like aluminum sheets, plastic, etc.  We saw many sophisticated braces alongside plastic lawn chairs placed into old wheel chairs for a seat!  Whatever, they make it work! 

Shoe repair is big in Cameroon.  They have a shoe repair training shop, sewing, knitting and embroidery workshop, a dairy farm with 36 cows, a piggery with 30 pigs and a bakery.  An amazing place! 

Their biggest need is water.  Despite the fact that they have a sophisticated drilled well, it failed over a year ago so the hospital and the Children’s and Adult Home are without water.  An estimate has been done on the cost of repairing the well (1.5 million CFA or $30,000 Canadian dollars).  Put that one to the Rotary test!    I hope to be able to share the interview with Sister Priska at the well with you through utube:                                                                                          http://www.youtube.com/watch?v=D2J3iznhtZ8&list=UUKLdLUrOXVJPkIJuTTJxaAQ

Believing in People, Investing in People

Believing in People, Investing in People

Two years ago we met a 17 year old girl, Mimi, at the hotel.  She was with a young boy who was carrying a scale and offering to weigh us for a little money compensation.  Although I was not specific as to where we worked, Mimi found us and thus began a journey to attempt to help a talented girl establish herself in life.  It has been a rough road.  Mimi became pregnant shortly thereafter.  We helped her with her school fees.  She did not do well with her exams.   Mimi is back at school this year.  A younger girl is looking after the baby. 

Mimi’s mother is a very talented person.  With a little help, she has established herself in a business in the Bamenda City Main Market.  One has to see this market, it is otherwise unimaginable.  Cameroon is famous for its exquisite 100% waxed dyed cottons.   Fabrics are designed for special occasions, organizations, village promotions and further enhanced by the incredible designs created for both men and women.   

Mimi’s mother met at the market, we entered  through the Bamenda City Main Market gate.  Streets are well market designated for designers and textile vendors.  Never have I seen such color in fabric!  The latest design is for today, Women’s Day March 8^th 2014.  Mimi’s mother has her treadle machine set up just inside their small, efficiently arranged small shop.  There are two apprentices, two ladies on electric machines (one an industrial machine) and a man who operates a serger.  If my count was right, there were seven little ones being cared for by the various ladies.  One little boy was eating a bowl of beans, the small baby was ready to nurse, the toddler was situated beside one machine, two little boys were quite curious about the camera.  Amidst all of this, we managed to do a little film.  I have never seen a treadle machine so efficiently operated. 

Mimi and her Mother are from the village of Sabga.   The village appeared to be well represented in the market.  We went to visit Mimi’s aunt who operates a textile shop.  There is a strong family resemblance between the two sisters. 

Two years ago, Mimi’s Mother was very sick.  She has made changes in her life; she and Mimi moved from Sabga to Bamenda where Mimi can go to school and Mimi’s Mother can be employed.  She has addressed her health issues and has regained her energy and stability.  Very rewarding to see.  Again, IDF through Oussematou has taken an individual (in this case both Mimi and her Mother), given counselling and a little help.  Mimi’s Mother is doing really well.  We are hoping that Mimi with do well with her studies.  It is not an easy world, especially here!


http://www.youtube.com/watch?v=FxMOg3Yfk30&index=3&list=UUKLdLUrOXVJPkIJuTTJxaAQ

Palliative Care: Reaching the Elderly, Starving and Vunerable

Palliative Care:  Reaching the Elderly, Starving and Vunerable

There is no welfare or social safety net in Cameroon.  If you can’t grow your own food and you have no money, you are in danger of starving.  Accepting referrals from Dr. Pounguey, a retired doctor who, since 2011 has undertaken 21 consultations in the city of Bana.  He says sick people can be completely destitute.  So, it is through Dr. Pounguey and community people that IDF searches out these cases, does an assessment, keeps records and does what it can to give a little assistance to individuals and families in extreme poverty without income, often without food.    We visited four such situations to deliver a package consisting of a large bag of rice, 5 pounds of beans, five boxes of matches and five large cakes of soap.  Each package, about $20 Canadian, means everything to these individuals and families. 

The first man we visited lives alone and has no family.   He is visually impaired and hard of hearing but has a great sense of humour.  He thanked us for the rice, beans, soap and matches.  He wanted to carry it into his house by himself.  Without electricity and almost blind, this way he would know where to find things.  He is 83, has diabetes and has a lot of pain. Allan asked him if he cooks for himself.  He said yes, if no one brings him something already made!    

Travelling down a steep washed out road to the second situation, a young man was all over the road, arms flailing.  Oussematou called him a mad man.  She says that during dry season, many people become mad.  Right away I said malnutrition (B Vitamins in particular) further exaggerated by lack of food and water in the dry season. Most people live on fufu (corn) sometimes with huckleberry (dark green vegetable) or unenriched rice with beans. 

Each time we enter the real world of poverty, reality hits.  Dirt floors.  Cooking inside the one room house with no chimney.  Three rocks balancing a large pot over the fire.   All food preparation is done on the ground.  No table.  Usually small bamboo individual little stools.  Water carried in a pail or plastic container.  Dishes washed in cold dirty water.  It is good to know that it is possible to help, if only in a small way.

The second person, a widow still able to live in her home.  Traditiionally,  the husband’s family comes in to claim the family house.  IDF has followed this family for a long time.  The husband was a long term diabetic and as a result became unable to father children.  His wife had a baby by another man.  This caused much trouble.  But, it was she who nursed the diabetic husband through to his death.  We met him last trip.  At that time he was very emaciated and could barely walk.  Again, this family does not have a plot to grow food.  The rice and beans, matches and soap were much appreciated.  It was here that I was most concerned about a toddler (grandchild) playing around the open fire banging two small plastic pop bottles together.  His balance wasn’t great and he was wearing a flammable plastic covering over his diaper.  Not to mention the smoke inside the one room structure! 

By the third visit, it was very dark.  No electricity means light is dim or nonexistent.  This elderly man has a daughter who brings him food but again, he showed his appreciation abundantly.  We tried to visit a lady with seven children but she was not home.  

The next morning, the hotel said there was someone to see me.  I went down to find a lady I did not recognize who spoke only French.  I told her to wait and Oussemtou would come to help.  What a surprise.  Last year we met Odette, a woman with seven children whose self esteem was so low, she would not look at me and just seemed so lethargic.  At our farewell gathering, Oussematou brought her, dressed her in a new dress (didn’t help) and told us, you wait and see what happens as I work with her over the next year.  An issue at that time was another pregnancy.  Odette wanted another girl.    Oussematou encouraged her to not carry another pregnancy.  Methods are different here.  After much work, Oussematou was able to arrange an injection that will prevent pregnancy for five years.

So, Oussematou gave Odette a job.  To carry water and make rice and beans for a man who had no one.  One year later, here is Odette so capable of facing the camera to tell us she has been working some at the hotel, at the hospital cleaning.  Although Oussematou says Odette still has some mental issues, she is doing well. 

I have an excellent interview with Odette which I hope to share with you on utube. 


http://www.youtube.com/watch?v=nKh9exoq5Bg&list=UUKLdLUrOXVJPkIJuTTJxaAQ




 

School Garden Project: Bana, Cameroon Conservation Farming

School Garden Project: Bana, Cameroon

Mme. Wouapi is the Head Mistress or Principal of the Public School in Bana.  The school has 405 students.  Behind the school is a hillside where Mme. Wauapi applied the principles of natural agriculture.  The students planted and grew cabbage, onions, potatoes, corn, beans and cassava using the conservation farming method thus introducing students , colleagues and parents to conservation agriculture. 

Results : A good harvest: one important part was used for consumption , another sold and the last part to keep seeds for the next season.  Cooking demonstrations were held to teach how cassava leaves could be cooked and how meals could be balance.   The money from the sale will permit the opening of a fund to support school activities.  With some of the money from last year, uniforms were purchased for teachers. 

Jean Baptist from Radio Flambeau Banka reported as follows:                                                                    ‘ Corn with mulch is also implemented by the latter Mrs. Wouapi also undertook cassava selective method and the results are expected. It plans to encourage other fellow Directors for the application of these methods of natural culture in other schools Bana . The field school to be monitored and cleaned by both students as teachers . It is a presence as a result of the application of the balanced consumption (she lost a few pounds since the last meeting. Students, colleagues were introduced to prepare balanced meals, use the palm nuts crushed , eat less fat (no oil), fruits, use cassava leaves, peanuts and especially of eating good natural harvest before selling the rest.
Results: preparation with colleagues and students practice activities in the presence of community volunteers
In short, to maintain good health, we must improve nutrition
Recommendation: It is necessary to raise domestic animals (chickens, pigs ...) for droppings, eating good harvest products (not always sell) educate students in schools and involve parents not to throw garbage and manufacture composts.’

We received pictures along the way of the school project.  Cabbages were bigger than a person’s head!  Mme. Wouapi showed pictures from her computer of the corn (healthy, green, tall, productive plants). 

We visited the school.  I was again taken back by the facility.  We first met Mme. Wouapi when she was Headmistress of the Nursery School in Bana, an amazing project initiative set up and operated by community persons.  I have great respect for Mme. Wouapi and even more so when I see the challenges she is facing and the initiatives she takes to do her best in the situation. 

Children were called from classrooms, bringing their hoes, to come to the garden.  It was here that we were first introduced to the fact that the school has NO water.  The latrine, a good looking structure, remains unused.  They said that it is too difficult to clean because of lack of water.  Mme. Wouapi goes for precious water using large jugs.  She travels to the top of a big hill where there is a well and a water storage tank.   Imagine how 450 people are told to use this water!  I suggested that Mme. Wouapi work through IDF to contact the Irrigation/Water specialist to conduct a study to put in a water pump (drill a well) for the school.  This would be an excellent project for Rotary!  As well as providing water for 450 people, three crops could be grown a year in the extensive school garden.

Children stood by their hoes, sang to us, then returned eagerly to their classrooms.  This school operates totally in French.

Nutrition Workshop: Bamenda, Kumbo, Bafut and Wum

Nutrition Workshop:  Bamenda, Kumbo, Bafut and Wum

Always a challenge, the topic for this workshop was to be Nutrition for HIV Positive Pregnant and Lactating Mothers and Infants and Children who are HIV Positive.  Observations and learnings went far beyond the course material.   Ten participants were brought in from Bamenda, Kumbo, Bafut and Wum.  It was easier to pay their transport and accommodation then for us to travel and present to four communities.  UNICEF, USAID, WHO and Toronto Public Health have excellent materials that were well used.  Core to the building of the workshop materials were the 30 Counselling Cards developed by UNICEF for field workers. 

 A reporter was designated for the day.  His comments were very detailed.  They were interested in Colostrum, the advantages of this first precious milk for the newborn.  The graphic chart showing 12 feedings per 24 hour period was surprising to them.  They were intrigued by the ‘skin to skin’ recommendation for the newborn, especially the premature or low birth weight baby.  They loved the kangaroo care, looking at the front carrier.  In Cameroon, most babies are carried on the mother’s back.  The changes in breast milk, both during a normal feed from a lighter to a milk with more fat in it;  the adaptation of the breast milk for the premature baby and how the constitution of the breast milk changes almost daily as the infant grows during the early days.  Exclusive breast feeding for the first six months was emphasized.

Mme. Oussematou cautioned the participants in counselling the mothers to allow them the option of infant formula, that formula is good milk and sometimes the only option: for example, when the mother dies and there is no ‘wet nurse’ available.  Lydia had emphasized that it is wrong for formula companies to provide just enough formula to mothers to discourage breast feeding.  All agreed that breast feeding is the best way but sometimes not possible.  The Counselling Card on reasons to choose breast feeding promoted a discussion on how impossible in this environment it is to properly wash and sterilize bottles.  Many children die of diarrhoea caused by contaminated water.

One of the participants talked about how important it is to be tested for HIV and to be on antiretroviral drugs if HIV positive.  She said that HIV is manageable as long as a person addresses the problem early and adheres to the treatment, eating properly and being closely monitored.  She said that removal of the stigma of HIV is very important.  Another participant told us that she herself is HIV positive and is enjoying a healthy and vibrant life.  She said by sharing her story in community of Kumbo, stigmatization has been reduced, people have come forward to be tested and treated when positive.

Emphasis was placed on a balanced diet with greater food requirements for the pregnant and lactating mother as a result of being HIV positive.  The basic diet is corn or rice.   Fufu is made from white corn, often eaten with huckleberry, an excellent vegetable.  But, the need for protein to be added was emphasized with beans and ground nuts (peanuts) being great substitutes for chicken, fish and meat.  Another common family meal is rice and beans.  Adding pumpkin, tomato, pepper or carrot would help the need for Vitamin A in the diet.

A discussion that almost stumped me was on the need for iodization of salt. In Canada, we try to minimize the use of salt.  Here in the market, salt in large open bags is cheap but not iodized.  Goiter is a major problem.  Never would I have thought, as a person trained in nutrition, that I would be advising people to use salt!  So Oussematou’s advice to them was spend the 600cf (a little over a dollar Canadian) and buy a box iodized salt to be used sparingly.

Milk here is not a common food.  At the hotel, we are served heated reconstituted skim milk powder with our morning coffee.  Rickets (bowed legs and knocked knees) is too common here.  All those pictures from the nutrition text books come to life here.  Especially sad to see children hardly able to walk because of rickets.

USAID, WHO and UNICEF all point to the Cameroon as having a major problem with Vitamin A deficiency.  Blindness and eye problems result.  It is uncommon to emphasize vegetables in meal planning in the Cameroon.  Often farmers sell the vegetables at the market to obtain much needed money for the family, depriving the family of good vegetables. 

Mmn. Oussematou summarized the history of breastfeeding and HIV positive mothers.  Initially, HIV positive mothers were advised not to breastfeed because of the possibility of transmission but in time, it was determined that threat to the infant mortality was greater when not breastfeeding and, with good antiretroviral follow through, proper nutrition and care, that breastfeeding should be recommended.  One participant cautioned about sores on the nipple bleeding and the blood ingested by the infant allowing for transfer of the HIV virus.

Another concern I voiced was seeing people washing dishes in cold, dirty water,then placing them in the dirt.  One participant said this could not be helped.  Breast feeding allows for sterilized milk at just the right temperature!

One thing that I feel should be addressed by government is the need for Vitamin B enrichment.  Iron and folic acid are available as supplements to the pregnant woman coming to the clinic.  Rice and flour should be enriched with Vitamin B and iron.  Maybe Vitamin B enriched beer would be helpful to some.  There are sure a lot of big beer trucks on the road.  Not recommended for pregnant and lactating women!   I feel the increase in ‘crazy people’ (as they put it) during dry season is nutritionally related to malnutrition, Vitamin B deficiency in particular.

Never before, despite the years racked up teaching Nutrition, have I seen the need so great for basic good basic nutrition.