Saturday, April 5, 2014

Update three years on


Since I left Maga three years ago I have kept in touch with people there and continued to co-ordinate projects which I initiated while there.  It is difficult to keep the projects going and most have run their course at this stage.  The most active project was "Uisce Beatha" under which the pumps in 82 deep wells were repaired by the end of 2013.  This number is greater than I initially thought possible but the success on repairing pumps already in disrepair has been offset by failure to put in place a process to repair pumps as they break down in the future.  The mayor had agreed that the council should take responsibility for repairs going forward and we had identified a technician and got approval for his recruitment, but he did not follow through on this.  Following local elections last year there is now a new council and a new mayor. This closes out whatever possibility there might have been for me to influence the mayor and councillors.

Local Elections

In local elections, each party puts forward a list of candidates and if any party's list gets an absolute majority of the votes the new council is made up entirely from candidates from that list.  The councillors then elect their new mayor.  While I was in Maga the mayor and all the coucillors were from the opposition UNDP party but following last year's election the new mayor and all the new councillors are from the governing RDPC party.

Security Situation

Islamist activities in the Far North of Cameroon have made it an unsafe area for Westerners.  The Boko Haram Islamist group, which perpetrates terrible atrocities, operates just across the border in Nigeria and following the Nigerian army's attempts to eradicate it some of its members have taken refuge on the Cameroonian side.  Thousands of Nigerians caught in the crossfire have also taken refuge in Cameroon and it is thought that Boko Haram fighters may be among them.  There have been skirmishes between the Cameroonian army and Boko Haram and there are reports of some Cameroonians joining Boko Haram.  Consignments of arms, probably with origins in the Central African Republic and destined for Boko Haram, have been found in Maroua.  A French family was kidnapped in the Waza wildlife park last year and a French priest was also kidnapped on the Cameroonian side of the border with Nigeria, both kidnappings claimed by Boko Haram.  At the time of writing there is news of the kidnapping of two Italian priests and a Canadian nun near Maroua.  As the security situation got worse, VSO pulled its volunteers back to Garoua, a city several hundred kilometers south of Maroua.


VSO has recently pulled out of Cameroon entirely.  It had already terminated the programme in councils on which I worked.  Its volunteers had had a very poor success rate in councils, mainly due to corruption and power plays from vested interests.

Wednesday, August 31, 2011

Cholera outbreak, progress on projects and other news

Cholera Outbreak

Cholera has broken out throughout Maga again this year.  To date (5/9/2011) there have been 982 cases and new cases are encountered every day.  This outbreak is extremely serious and is much worse than last year's outbreak.  Two weeks ago in response to an urgent request, I sent money to buy a large quantity of drinking water for the three medical centres.  The medical centre in Maga had 150 patients, which is around 10 times its capacity.  The uses to which this water is being put include making up drips to counter dehydration.

Project Uisce Beatha

The project to repair forages has gone well.  To date the pumps in 40 forages have been repaired.  There are 13 forages which are so seriously damaged that it would be better to replace them with a new model of forage but to replace an existing forage it is necessary to get the approval of the Ministre de l'Energie et de l'Eau.  Correspondence was put in train before I left Cameroon to seek this approval but it has still not come through.  Recently I rang the local member of parliament, who was in Yaounde at the time and had previously promised to help, and asked him to talk to the minister and try to persuade him to give the approval.  I have also spoken several times to the local delegate of the ministry to try to get him to break this deadlock.  This is urgent since the rains have come and cholera is rampant.

To help combat the current outbreak of cholera, Plan Cameroon, an NGO, has promised to contribute 3,000,000 fcfa (€4,500) towards repairing the forages.

Project for the handicapped

As a follow-on to last year's visit of the Fondation de Bethleem to the council to screen people with disabilities, tricycles have been delivered to 20 handicapped.  The local council made a substantial contribution to the costs.

Of the two children who had operations to improve their joints, the little girl can now walk for the first time and the boy (who used to travel 500 metres to school on his hands and knees) cannot walk but has been given a tricycle.

Other news

As part of the programme to prepare and launch the council's development plan, two people with experience in development and finance, respectively, have been recruited and their salaries will be paid by the state in the first year and 50% will be paid in the second year.  The council has completed recruitment to other posts which willl strengthen it and is waiting for the approval of the Prefet to proceed with this.

A state organisation, FEICOM, has promised to give Maga's schools 1,000 desks.

In July I received the sad news of the death of the Sultan of Pouss.

On a happier note, the wife of my friend Halidou Mal Oumar had a son and they have called him Tom Alipa Saleh.

A website on Maga is now available at

Thursday, April 14, 2011

Safe drinking water in Maga, Far North, Cameroon

Project Uisce Beatha

The Far North of Cameroon had its worst rainy season for over 20 years in 2010. One storm alone left 5,000 homeless and killed 14 people in Maga. Flooding was widespread, many houses collapsed, crops were devastated and diseases were rampant. In addition to malaria and bilharzia, typhoid and other water-borne diseases, there was a serious outbreak of cholera. The local people, the majority of whom live below the povery threshold of $1 per day, have little capacity for reconstruction or for paying for treatment when ill. The state, the local council and international organisations such as the UN’s UNICEF and FAO have given valuable support but major problems remain, the most important of which is access to clean water.

Virtually the whole population of 85,000 people depends on “forages” for clean water. A forage is an enclosed deep well (over 50 metres deep in some cases) with a manual pump. Maga county has 149 forages but around one-third are currently not working and nearly all are in need of repair. If there is no forage, or if the local forage is not working, people drink water from open wells, rivers, irrigation channels, lakes or even stagnant ponds. Flood waters carry human and animal excrement, fertilisers, weed-killers and general rubbish into all of these in the rainy season each year. There are almost no toilets and people frequently relieve themselves in the proximity of shallow open wells, thus transmitting diseases such as cholera. The quality of the water which many people drink is appalling. I could find no reliable statistics but while I was in Maga there were numerous illnesses and several deaths from water-borne diseases among the families of my friends and colleagues.

It is estimated that Maga needs an additional 190 forages but constructing a new forage costs over ten times the cost of repairing an existing forage so clearly the problem of fixing the forages which are not working, and on-going maintenance of all forages, should be tackled first. The state has launched a campaign to persuade villagers to construct latrines with their own resources and is providing funds to repair six forages but the cost of repairing the remaining forages far exceeds the villagers’ means in most cases.

I have recently come home to Ireland and do not plan to return to work in Cameroon but this is one problem that I do not want to walk away from. Before leaving Maga I launched Project Uisce Beatha to repair as many of the broken forages as possible before June, when the next rainy season is likely to start, and I got agreement from the local council that it will take responsibility for maintenance of forages in the future. Repairing all the forages that are currently broken and doing initial preventive maintenance on the others is estimated to cost €42,000 (including 15% contingency). This is an appreciable sum but the benefit will be enormous since the project will materially benefit the health of over 40,000 people, including a high proportion of children who are the most vulnerable to water-borne diseases. It is a goal worth striving for, and given the urgency of the situation I have provided funds (including some left over from previous donations from my friends in Ireland) to fix the 20 forages where the need is greatest. After allowing for this, for villagers’ contributions and the undertaking by the state to fix a small number of forages, €30,500 remains to be found. There are 15 forages which would be particularly difficult to repair and which would cost an estimated €13,000 and I have made it clear that it is unlikely that funding will be found for these. If these are omitted or deferred, the target reduces to €17,500 and the greater part of the benefit will still be achieved. Any contribution that you can make, however small, would be most welcome. The average cost of repairing a forage is €300, ranging from €50 to €900, but every €1 donated will materially improve a person's health and possibly save their life.

To gear up for on-going maintenance after the pumps which are currently defective have been repaired, the council is recruiting a technician who will visit each village once a month from June to inspect the forages, do preventive maintenance and do major repairs where necessary. Monthly contributions by villagers will be used to pay for replacement parts and the technician’s costs. The model which I have proposed is like medical insurance, where all contributions are put in a common account administered by the local council which will be used to meet the costs of repairing whatever forages are in need of repair in the future. This is different from the model used up to now, where each forage had its own account. In many cases these accounts proved insufficient on breakdown, and in cases where contributions would have needed to be made for a further number of years to pay for the repairs the forages tended to be abandoned. To the best of my knowledge this is the first time that an insurance type approach is being adopted in Cameroon. The common account has some other practical advantages. It can be monitored more rigorously to prevent individuals in the forage management committees from diverting the money collected to their own personal use, as frequently happened in the past. It will also help with management of the repair process where in the past some technicians disappeared with the money collected and did not carry out the required repairs.

Before leaving Maga I did seminars for the councillors and for the village chiefs to get their buy-in to the proposals. A local development organisation, ACEEN which has extensive experience in forage maintenance, backed by a Swiss NGO, International Project Aid, agreed to do an initial inspection of all the forages detailing and estimating the cost of the required repairs. They have also done training for two people who are currently doing “sensibilisation” in the villages. This consists of ensuring that there is a management committee for each forage, that they are effectively managing the use of the forage, that they are collecting usage charges to enable them to pay their contributions to the council and also that villagers follow good hygiene practices. Before scheduling the repairs to a forage under Project Uisce Beatha the sensibilisation team must confirm that they are happy with the management committee and the management committee must contribute 10% of the cost of the replacement parts.

It is sometimes argued that water is a human right and that all should have free access to it. Unfortunately the history of water projects in Cameroon indicates that people do not appreciate free water. Indeed in some cases where forages were provided free and where there were no charges for usage, villagers neglected them and after just a few years as many as 90% of the forages were no longer working. In any event, my funds are limited and the council’s funds are extremely limited. Hence in order to motivate them to look after their forages, in the project to repair the forages which are already defective and also in the on-going maintenance by the council, the management committees will be asked to pay a percentage of the cost of the replacement parts.

Programme to Provide Safe Drinking Water in Maga

Project Uisce Beatha forms part of a larger programme to provide acess to clean water in Maga. There are three towns in the county, Maga town, Pouss and Guirvidig. Maga town has piped water but the number of users is very small. A project to bring piped water to Pouss has been approved and funding has been obtained for it. With the help of donations from my friends, I brought teams of engineers and other experts to Gurividig to plan and estimate a project to bring piped water to that town. The council is currently looking for state or other funding for this project. Even if the three towns have piped water, it is unlikely that it will serve more than 5,000 people in the short term. Thus 80,000 people will remain to be served by forages. This gives a ratio of over 500 per forage, over double the number of users recommended by the UN. As mentioned above, it is estimated that around 190 new forages will be needed at a cost of between €5,000 and €10,000 each, depending on the terrain. Thus a project costing around €1.5 million would be needed to provide the new forages. In the following programme, Project Uisce Beatha consists of steps 3, 4 and 5.

Programme to provide safe drinking water to Maga’s population:

1. Implement the project to bring piped water to Pouss.

2. Get funding and implement the project to bring piped water to Guirvidig.

3. Sensibilise the villagers on the need for latrines and for good management of forages.

4. Repair the forages which are not currently functional.

5. Do initial preventive maintenance on the forages which are currently defective though functional.

6. Introduce an on-going programme to repair the forages which break down in the future.

7. Get funding to build 190 new forages.

If any person or organisation would like to help with Project Uisce Beatha or with other elements of the programme, please make contact  in the first instance by sending an email (in English or French) to the council at

Sunday, March 20, 2011

Taking Stock of Achievements in Maga

In March 2008 I became a volunteer with VSO (Voluntary Services Overseas) and I took up a position as Institutional Development Advisor to the Local Council of Maga in the Far North of Cameroon. This post is an attempt to take stock, on my return to Ireland in March 2011, of what has been achieved and of what remains to be done.

The diagnosis which I carried out in 2008 revealed that Maga council’s capacities were very weak indeed. The mayor made all the decisions and he and the Secretary General did virtually all the work. The executive had never met as a group and the council subcommittees had never been convened. The annual budget was prepared by the mayor and Secretary General without the participation of the councillors, including the four deputy mayors, who received the budget proposals at the council sessions at which they were approved. Around two-thirds of the 40 councillors do not speak French and are illiterate (the mayor is the only one who has a little English). Around two-thirds of the council’s 30 staff never did any work at all and most of the others did only occasional work. Only one (the Secretary General) had finished secondary school and several had dropped out of primary school. The council’s finances were in a very sorry state, partly because the previous administration had not had accounts approved during their five-year term and because a large sum of money had gone missing. It was impossible to apply to Government and other organisations for funds because their first demand was to see the accounts for the past three years. Nothing worked in the council offices, and in particular the computer and the photocopier had not been working for a very long time.

Maga is in a remote and disadvantaged area. For example, there are no surfaced roads in the county and in its 50 primary schools the average class size is around 150 and there are almost no desks. The electricity supply in Maga is very unreliable and may be cut for weeks. The rainy season, usually from June to September, can be devastating (as it was in 2010 when 14 people were killed and 5,000 lost their homes in one particular storm) and floods prevent people from coming to meetings. The city of Maroua is only 80 kilometers away but the road is bad and the buses which were in use in 2008 and 2009 broke down several times on most journeys.

Despite all the weaknesses and defects, there has been very good commitment to improve on the part of the mayor, his deputies, the councillors, the staff and the community. I did workshops for the executive, the councillors, the chairmen and secretaries of the subcommittees, the staff, the tax collectors and the village chiefs and the response was always good. It was necessary to begin at a very basic level and I needed to write plays and get local people to present them in Mousgoum (the most common local language) to get the messages across. For example, one of the workshops which I presented to the councillors, the staff and the village chiefs had to do with behaviours such as turning up late to meetings, or not turning up and not sending a message, taking phone calls in meetings and having conversations at meetings, behaviours motivated by prejudice, behaviours such as finding excuses for not taking action on difficult issues and also general lack of proactivity. On behaviours, as on the other areas mentioned below, there is consensus that there has been a good improvement although there is great scope for further improvement.

In relation to building the capacities of the council, the main achievements were:

* The mayor now communicates more, consults with others and delegates responsibilities.

* The executive has regular meetings at which important issues, including reports on receipts and expenditure, are discussed.

* The council subcommittees now meet and were involved in producing the annual budgets for 2010 and 2011.

* The finances of the council have improved, partly because tax receipts have increased under active management by the executive, and the accounts have been brought up to date.

* The council now has an IT room with two computers, a printer and an electricity generator and training of some staff in IT has commenced.

It has to be admitted also that there has been regression on many of these improvements, particularly in periods when I have been absent.

My role was to develop the capacities of the council so that the council could develop the infrastructure of the county and provide services to its citizens, including disadvantaged groups. During my time in Maga I found that there were many opportunities to launch projects for infrastructure development and to help disadvantaged groups. There is a lot of scope to access Cameroonian state funds for infrastructural projects but it is necessary to bring engineers and other experts to the county to prepare the estimates and plans. With the help of donations from some friends in Ireland I was able to support the preparation of proposals to the state

* to build 80 kilometers of roads to remote villages (unsurfaced but hopefully accessible in the rainy season),

* to bring piped water to Guirvidig (one of three big villages, the others being Maga, which has piped water, and Pouss for which a project has already been approved),

* to build ten “forages” (deep enclosed wells with pumps),

* to bring electrity to nine villages

* and to strengthen the electricity connection between Maga and Pouss.

In relation to disadvantaged groups, I supported a census of 350 handicapped people in the county and supported bringing a team from a local NGO, the Fondation de Bethlêem, to examine them. The Foundation is currently constructing tricycles for 20 of them and has performed remedial operations on two and there are plans to provide crutches for others, the costs being met jointly by the Foundation, the council, my friends and the families of the handicapped. I have also supported operations for 17 people suffering from hare’s lip, a condition which tends to have them treated as outcasts since local people believe that they are under spells and will bring misfortune on anybody who associates with them. Discussions are in progress on providing operations for people with cataracts.

At this stage, two years of the five-year plan to build the capacities of the council have been implemented. The work which remains is very real. The council has recently got approval to recruit six new staff with experience relevant to key roles and has also decided on a revised organisation in which existing staff will have their roles redefined. Once these changes are in place there are many actions in the plan which need to be carried out, starting with training and including the introduction of good people management practices. With support from the Government-backed PNDP (Programme National de Développement Participatif), the council has started work on preparing its development plan. This plan will set out the infrastructural and other developments which will be prioritised over the next five years. It is likely to be completed around June and the projects referred to above will be integrated into it. The council’s capacities will certainly need to be strengthened if it is to manage effectively the resulting projects.

One project which could not wait has to do with repairing pumps in forages, most of which are in need of repair. There was a serious outbreak of cholera in the county in 2010 and this is likely to flare up again at the onset of the rainy season in June in addition to the “normal” water-borne diseases, such as typhoid. I initiated this project before leaving for home and am coordinating it by telephone and email. I will cover this in a subsequent post.

VSO has been looking for a replacement for me for over a year without success and my return to Maga in October 2011, following completion of my original contract in May 2011, was an attempt to maintain progress while the search continued. I think that my return made a big difference but it is vital that VSO find a replacement for at least two years to carry through the remaining actions in the plan, particularly those which follow the recruitment and reorganisation of personnel and the preparation of the development plan. The main requirements are experience of management and passable French. The latter might appear intimidating to those not fluent in French but in reality people are very tolerant and helpful in relation to language (only one-third of them speak French in any case so they are very used to language difficulties). There is also a very good national volunteer in Maga who works closely with the international volunteer and helps with language as well as with cultural, social, legislative and other practical issues.

Wednesday, March 9, 2011

Maga's Development Plan and My Return Home

Apologies for not writing for quite some time. I was very busy and did not manage to fit it in. On this occasion I had committed to returning to Maga for only three months. I extended this for one month to the end of February but although there clearly was much to do I chose to work intensively and then leave rather than endure the increasing heat yet again. Maga really needs a volunteer for another two to three years and having worked the best part of the past three years I feel that I have done my bit. Aicha and I are now safely back in Dublin and I will do a few posts over the next few weeks for completeness. I also have to finish out some work in progress from here, including constructing a website for Maga and remotely managing a project to repair the pumps in a large number of the wells in the county.

While we were in Ireland last summer a friend, Atapassing Ajaccio Evele (more commonly known as Ezekiel) became a father and called his son “Collins” after me. Most people here think that my surname is “Tom” and that my christian name is “Collins”. Thus I am usually referred to as “Mr. Tom”, or as “Papa Tom” by children. Another friend whose wife is pregnant said that if it is a boy it will be called after me. This one will be called "Tom". I worked closely with Atapassing on projects for roads, electrification of villages, building wells, providing piped water to one of the big villages and also on various projects for the handicapped. He brought valuable knowledge to these projects and his initiative, energy and endurance must take the main credit for what we achieved.

One of the major council activities in which I was involved on this occasion was the preparation of the its development plan. This will be a five-year plan setting out the proposed development of the county’s infrastructure and is vital to attracting investment. The work is sponsored by PNDP (Programme National de Développement Participatif), a Cameroonian Government organisation. The funding is provided by the World Bank and by bilateral aid from governments involved in Cameroon’s debt forgiveness programme (the French Government is the largest bilateral donor, and in the case of the Far North the German Government is the main donor). The production of the plan takes about six months. A private company (CAFER in Maga’s case) is appointed as service provider and it puts together a team of around twelve people who are divided into smaller teams which spend four days in each of the villages of the county determing the needs and priorities of the villagers. The planning and methodology of these activities are very impressive and were clearly put in place by a very competent international development organisation for use throughout Cameroon. The plan will consist of a set of development project proposals and once it is ready one of these will be selected and PNDP will implement it with the council, thus transferring knowledge and expertise on project management. After that the council will need to attract funding partners from among Cameroonian Government organisations, domestic and international NGOs, the EU and supportive governments. Implementation of my own plan, to strengthen the capacities of the council (which was initially very weak and still is weak), is necessary to prepare it to take on responsibilities such as these. When the council’s development plan is produced it will provide a context for development of the county which Atapassing and I lacked in the work that we have done to date.

My role in relation to the development plan over the past few months was one of quality assurance. With Maga’s national volunteer, Doubla, I visited the teams working in the villages to verify that they were doing good work and to add value to the process where possible. Some of the villages were very remote and even finding them could be difficult. On one occasion when we stopped to ask for directions from a group of boys who were carrying basins filled with some produce on their heads, they were terrified (maybe by my white skin or my crash helmet), they dropped their basins, spilling the produce, and they scattered in all directions. On another occasion we were advised to follow the “grande route” which turned out to be a dirt track often barely wide enough for our moto and taking us through fields of millet, over very bumpy ground and at times through muddy streams. Sometimes we had to wade through them and somehow get the moto across. We came across one enterprising person who had a pirogue to ferry people, animals and motos across a deep stream but it capsized twice, dumping our moto into the water. However it was a privilege to visit and experience the hospitality in the villages and even in very remote villages they usually knew about my work with the council and said that they appreciated it. I have offered to be available over the internet to help with the completion of the development plan, if that proves feasible.

These visits underlined for me the enormity of the needs of the county and reminded me of a week that I spent, shortly after arriving in 2008, visiting the villages and sometimes sleeping out in the open. On that occasion I accompanied a man who was inspecting the county’s “forages” (deep enclosed wells with pumps) and while he did his inspections I spoke with the village chiefs and elders about their needs. On both occasions access to safe drinking water was the dominant priority in most villages. On this occasion the need is more acute. More pumps are now broken (perhaps as much as half) and there was a serious outbreak of cholera  in the county in 2010 which continued to the end of the year and will probably flare up again when the rainy season arrives in June. Large areas flood in the rains and human and animal excrement, as well as fertilisers and rubbish in general, are carried into open wells and ponds. People drink the water from these open wells and even from ponds and streams. In one village that we visited the only source of water was from a stagnant stream with very murky water where some local fishermen passed the day immersed in the water with their nets. In addition to cholera, typhoid and other water-borne diseases, there is a very high risk of bilharzia (it is thought that over 90% of the population suffers from bilharzia).

It is very difficult to walk away from such problems. I decided to mount a project to repair all the broken forages in the county before the start of the rainy season. Preliminary estimates indicate that 59 out of 134 forages are currenly non-functional and the man whom I accompanied in 2008 is currently carrying out fresh inspections to enable the project to be scoped. I have set up structures in Maga and Maroua so that I can manage the project from a distance. It will be the subject of a later post.

Before coming home, Aicha and I visited her family in Foumban. Her grand-mother had been very ill but happily had recovered. Visiting Foumban is always a very pleasant experience because her family is very welcoming and she has connections everywhere. In my youth in Ireland many people used to love “tracing” such connections and you had only to mention a name and they would be off: “He would be the son of X whose brother …” The Cameroonian equivalent is far more complex due to polygamy and my own efforts at understanding relationships often run aground very quickly. Everywhere we go in Cameroon we bump into Bamouns (often selling African art) whom Aicha knows and refers to as “petits frères” and “petites soeurs”. Foumban, and West Cameroon in general, has a much higher standard of living than Maga and the Far North but even so there were power cuts every day and there was no running water for most of the time that we were there. Also cholera was not far away: Bafoussam, a city about 30 kilometers from Foumban, has recorded 100 cases. In Maga it is impossible to get statistics and I expect that the mortality rate is much higher there because of difficulty of access to treatment and lack of money to pay for it.

It is lovely to be home in Ireland and I am quite happy to pay some extra tax to carry us through our own little crisis.

Sunday, December 26, 2010

Operations for Handicapped Children

In May, before I left Cameroon, we brought a team from the Fondation de Bethleem to Maga to examine around 70 handicapped people to decide whether they could benefit from tricycles, crutches or operations. Among 350 handicapped people whom we had identified in the county these were the ones who appeared to have these needs. It was envisaged that around 35 of them could benefit from tricycles and the Foundation had intimated that it could supply five free and 30 for each of which it would contribute €150 from a total cost of €200. The council undertook to contribute €30 per tricycle, I undertook to contribute €15 and the family of the handicapped was to be asked for €5. After returning to Maga in October I visited the Foundation to enquire about the results of their examinations. I was told that donations to the Foundation (mainly from Italy, its country of origin) had fallen substantially and that it could not deliver on what had been envisaged. It now proposes to give tricycles to 20 handicapped, none of which will be free and for each of which it will contribute €82. The tricycles, which it builds in its workshop, will not be ready until after Easter. The team which performed the examinations has selected their 20 highest priority handicapped and we plan to ask them to include a few others, children who did not make it to the list but have an urgent need for tricycles to get to school. The Foundation also plans to perform operations on a few handicapped (see below) and to give crutches to some others. It had originally planned (with the backing of another organisation) to give financial assistance to around 50 handicapped who plan revenue-generating enterprises but now says that it will be unable to do so.

The Foundation said that they were bringing doctors to Mouda early in December and proposed a list of 11 handicapped for further examination to determine whether they could benefit from surgery. We were asked to have the relevant limbs xrayed in advance and to transport the handicapped, each with an accompanying person, to Mouda (around 40 kilometers from Maroua which in turn is around 80 kilometers from Maga) for consultation. For each scheduled operation we would have to pay in the region of €120 (the Fondation would pay certain other costs) and the family would have to provide an accompanying person and food for a hospital stay of one to three months.

Because of logistical difficulties, we managed to bring only four handicapped for examination on this occasion, three girls and a boy. The boy travels 500 metres to school on his hands and knees, protecting his hands from the scorching and rough ground with flip flops. One of the girls has to crawl but she cannot use her hands and has to use her elbows in stead (Not included in this group is a girl who cannot use her hands or her feet and who uses her elbows to pull her body along the ground.).

The doctors were to be available in the Foundation on a Monday. We got agreement from a hospital in Meskine (around eight kilometers from Maroua) to do the xrays on the preceding Saturday. Each child was to be accompanied by an adult and they were to be housed with relatives in Meskine from Friday to Monday. One of the Maga councillors took on the difficult task of looking after the four handicapped and their accompanying adults from Friday to Monday. He had them brought by moto from their villages (some very remote) to Maga where we took a bus to Maroua on Friday afternoon. Happily the bus did not break down on this occasion. The councillor organised a taxi to take the four handicapped and four accompanying adults to Meskine (it is not unusual to put ten people in a car in the Far North). I went to my house thinking all was well but at around 9:00 p.m. I got a call to say that the families did not have the capacity to house them. The hospital lent them a vacant house which had no furnishings and no floor coverings. The temperature currently falls to the low 20s at night, which local people find very chilly, and although I was in my comfortable bed I spent a somewhat sleepless night thinking about them sleeping on a bare concrete floor and worrying about whether they would all catch cold (a serious condition for people as poor and undernourished as these). The next day we bought mats and blankets and organised food since their relatives had not taken up this duty. The xrays went smoothly and morale was restored. However we then got a message to say that the doctors had not arrived because their flight was cancelled (this can be a euphemism for their flight being taken over by a government minister and his retinue) and that the examinations would have to be put back to Wednesday. All agreed that the best thing to do was to stay in Meskine until Wednesday.

The councillor brought them to Mouda on the Wednesday and the visiting doctors selected two (the boy, aged 12, and the youngest girl, aged five) for operation on the following Friday. This was much earlier than we expected but we got permission from their parents to go ahead with the operations and we got their commitment that an adult would stay with each of them in Mouda for a two to three-month recovery period and that they would provide food for them throughout this period. The councillor brought the other two handicapped home and then returned to Mouda. The operations went ahead and the doctors were very happy with the results. The councillor spent a few days with them since the parents only speak Mousgoum and nobody in Mouda speaks that language. They are well housed by the Foundation but are now struggling to find money for food. I visited them to-day (St. Stephen’s Day / Boxing Day) and brought them stocks of rice and smoked fish.

Initiatives such as these pose difficult questions in relation to how to deploy the limited funds which my friends in Ireland have donated. I estimate that the costs will come to around €500 per operation (the estimate given to me originally by the Foundation was much less than half this). I would guess that if we could break the deadlock on getting birth certificates (there has been progress on this front) we could probably get them for 50 children for this money. There are roughly 5,000 children who currently need birth certificates to complete their education and for other purposes and there are also many other competing demands for funds. One of the two handicapped who were examined but not yet scheduled will need three operations and there are seven other handicapped who have not yet been examined.

Friday, November 5, 2010

Cholera in the Far North of Cameroon

Apologies to anybody who has already read my blog of 30th October. I have split it in two and added a little to this part.

Maroua is referred to as the epicentre of the cholera outbreak, which extends to Nigeria to the west, Niger to the north, Chad to the east and to North Cameroon, which includes Garoua, to Maroua’s south. Cholera is endemic in the Far North of Cameroon but this year’s outbreak is the worst for over 20 years. The most recent figures which I could find from the health ministry are from 26th September when 7,247 cases had been recorded in Cameroon (6,000 of these in the Far North), including 483 deaths. Local people believe that the real numbers are higher than these.

The Far North has a population of 5,000,000 and its outbreak is probably bigger than the Haitian outbreak which is currently getting much media attention. While the Far North has not had the scale of devastation of the Haitian earthquake, the severe rainy season there has brought its own destruction, as mentioned in a previous post, and has created conditions conducive to the spread of cholera. The mortality rate of cholera sufferers in the Far North is much higher than in most affected areas due to the poor infrastructure and health services in the area. Less than 30% of people have access to safe drinking water and there is one latrine per 4,000 people.

Médecins sans Frontières has set up treatment centres in Maroua and in Mokolo, a village around 60 kilometers to the west. The government has launched a campaign, mainly in schools, to promote awareness of good practices to avoid transmission of the disease and this appears to be working well. It also has a phase two plan aimed at providing infrastructure to reduce the risks in the future by building 50 new deep wells and repairing 200 which are broken. However, to put this in context, Maga is one of around 30 counties in the Far North and it needs 190 new wells and needs more than this number of existing wells repaired. Because of the lack of infrastructure here, I am very keen to work on the preparation of Maga’s development plan, for which state funding came through while I was away.

Lest it should appear that I am suggesting that I am at serious risk from cholera, this is not the case. While admitting that firm information is very hard to come by, I have the impression that the outbreak is under control. There appear to have been very few cases in Maga. The villages of some other volunteers have had serious outbreaks but the volunteers remain in place. I drink only water which I have filtered and keep large stocks of water in my house. I wash my hands all the time, in filtered water if I am touching food. After buying lettuce, tomatoes, apples and other food that is eaten raw I steep it in bleach for half an hour and I always wash it again in filtered water before eating it. I am very selective about eating or drinking anything that either I or Aicha has not prepared. Cholera is easy to treat. Deaths from cholera tend to be due to dehydration and I have stocks of Dioralyte which I can take should the need arise. Aicha and I had a vaccination against cholera before coming here. It is only around 40% effective but should reduce the intensity of the disease should it strike.

13/11/2010:  I spoke too soon last week when I said that the outbreak appears to be under control.  During the week there were new cases in at least three Maga villages, including seven cases in Maga itself.

01/09/2011:  There is a very serious outbreak of cholera in Maga this year which appears to be more severe than last year's.  I have not been able to get any statistics.