"as you cannot do what you want, want what you can do."

when i applied for the peace corps, this is pretty much how i imagined my job description:
live in an african country. help its citizens.

although this description is technically correct, i am finally starting to learn that there is much more to the job than just living here and making promises to help. now being in burkina faso, i have finally had the opportunity to learn and experience a little bit of what my project is going to be for the next two years.

my official project title is "community health development"...still sounds pretty vague, huh? by way of a brief summary, the peace corps is working in cooperation with the government of burkina faso to implement this big grandiose plan called the "bamako initiative." it was created about 20 years ago in bamako, mali by policy makers from all over the west african region who wanted to improve the quality of life through health care systems. the leaders decided that having just a couple of big hospitals in large cities to care for entire countries was not an effective way to care for members of smaller villages...surprise, surprise...and that the health care system needed a revamping that would include changes on a more local level.

enter: peace corps volunteers.

i will be working, in conjunction with the bamako initiative, in a small village health care center called a CSPS - centre de sante et promotion sociale - and a community group called a COGES elected by citizens to oversee the CSPS and ensure that community needs are being met. we will initiate small changes here and there, and be an informational resource in terms of diseases, nutritional information, maternity care, and basic access to health care.

last week, i had the opportunity to do a preliminary evaluation of the CSPS facility in my village, and to visit a current volunteer at another CSPS in a different part of the country to see how peace corps volunteers work with their community. all i can say following these visits is...yeesh.

upon first glance, the CSPS in my host village looks just like a huge empty warehouse building. upon entering, i found myself with the three other volunteers in my village in the "consultation room" where the head nurse warmly greeted us...smoking a cigarette. i thought that perhaps he just did it in his office, but after about a half hour interview with him about his role in the facility, we began a tour through the different areas and buildings of the CSPS, and he chain smoked the whole time. he weaved his way through patients hooked up to IV poles, and children waiting with other children, and even in the "maternity/birthing room" (which was really just a bed and a sink), cigarette lit the whole time. the sad part of this tour was realizing that this, this warehouse, this health building that doubles as a home for lizards and insects, was one of the well-functioning health facilities.

the CSPS site in the current volunteer's village was more of the same, but, sadly, worse. their facility does not even have a bathroom for patients, (i assume they must just go outside, dragging their IV poles with them) nor does it have any sort of maternity wing. it was just one building, with four or five beds, and another "consultation" room, with some informational posters that most community members are not able to read.

kind of overwhelming. where does one begin in this sort of situation to "help the community members"? i can think of several changes that need to be made in order for this to even be considered a "safe" health facility, but how do you decide, with limited funding, time, and resources, which changes are the most important? which changes are sustainable? and which changes are actually feasible?

what i would absolutely love to be able to do is just a complete overhaul of the village facility. start by building a latrine at the one CSPS site, and continue to make big, exciting changes from there. build a maternity wing, install electricity and running water, and hire educated people to work there to help the limited staff handle their more than 6000 patients. i would make similar changes to the CSPS in my village. this is what i want to do...but it is obviously not possible.

i read somewhere a quote by leonardo da vinci that has stuck with me and helped me to keep my wits about me in this situation: "as you cannot do what you want, want what you can do."

although all of these changes i want to make are not possible, i am in a surprisingly convenient situation to implement some changes that actually are possible.

perhaps instead of trying to build a huge new building, i can help the staff make changes to its existing structures that would help community members even more than electricity, or running water. for example, if the community is educated in how to purify their existing water sources, then they do not have a need for a brand new water source. a big part of the job of peace corps volunteers is designing "sensibilizations" to get important information like this out to the community, in a way that they will understand, and in a way that will make small, but crucial, changes not only possible, but desirable for community members. this is something that i want to do, and it is something that i can do.

there are also opportunities to work with community groups, most often women's groups, but sometimes theater groups or children's groups. we will be able to plan activities to educate people at the village level that CSPS structures exist, and that they are an affordable way to get health care for families. this is something that, sadly, many village members do not know. another small, piecemeal change that obviously will not make a huge impact on all of west africa, or even on all of burkina faso, but a change that will make a difference to the people that i am able to reach through these activities. this again, is something that i want to do, and more importantly, something that i can do.

it is so important for me to keep this perspective in my work here. i must want what i can do. and i promise to do it.