The question I’ve gotten the most since I’ve been in Togo is “So what exactly is your job?” Maybe because it’s kind of complicated and hard to relate to, I don’t feel like I’ve ever been able to give an adequate response. I’m going to try and explain it…

            Since moving to Bafilo in February of 2006, I’ve worked almost entirely with AED which stands for Association Espoir pour Demain (literally Association Hope for Tomorrow). AED is an association of people living with HIV/AIDS. This association began as a group of HIV+ people in the Kara region of Togo who would regularly meet with each other to discuss the day-to-day issues they faced and to lend support to one another. A Peace Corps volunteer was assigned to work with them and helped them find enough funding to expand it into what it is today and really get it to the next level. Today AED acts as a social support center, a place where members can receive free medical care including ARVs (anti-retroviral medicine which are drugs that keep the person’s immune system at a level where they can live a healthy life) and medicine to fight opportunistic infections, where they can speak to a psychosocial counselor, where they can receive nutritional ‘kits’ consisting of basic food items, a place where the members’ children can gather once a month with other children in the same situation and spend a few hours being entertained and learning valuable life lessons, etc…

            It’s hard to put a title on what I do at AED since it is so varied. I consider myself someone who can offer a different point of view when the association is confronted with problems to solve. AED is funded almost in totality by an NGO in the States called Hope through Health which was begun by a Peace Corps volunteer assigned to work with AED. Although it isn’t set in stone, I act and am treated as a representative of this NGO; meaning that I have a say in how the money that comes in each month is spent. Ultimately it is the members themselves who decide what the money gets spent on, but I do serve a role in advising those decisions. Since I do have this say, and let’s face it, because I’m American, I do have maybe more of a role than I sometimes deserve. In any case, I can comfortably say that I am involved in every aspect, to some degree, of the association and how it operates.

            AED is based in Kara, the Regional capital. On March 31, 2006, a month and a half after I got to Bafilo, AED opened its first satellite center in Bafilo. Another Peace Corps volunteer living in the area had been very involved in the association and had routinely brought people to Kara, about 20 miles, to get tested and to become members of AED in Kara. When that number got to be substantial, talk of opening a center in Bafilo began. By the time I got to Bafilo, all the preliminary work was done and I immediately became implicated in the process of opening the satellite center.

            My first year in Bafilo was spent working hand in hand with this other volunteer in all the aspects of introducing the association to the population here, educating the public on the disease and what AED could offer in terms of treatment, the logistical demands of opening and furnishing the actual building, training the staff on the services we would offer and what would be expected of them, figuring out the financial budgets and how to manage the money, etc… This work was very demanding and challenging in that we, the other volunteer and I, were accustomed to and expecting an ‘American’ work ethic and results, while we were working within a Togolese framework. It took a long time for all of us, the Togolese staff and we volunteers, to reach an acceptable middle ground for all parties involved. 2006 ended with the association having grown to have almost 100 HIV+ members.

            When my colleague left, I was left with the task of doing our work on my own. I don’t want to sound pompous or self-congratulating, but I do believe I’ve succeeded at this challenge. I’d like to explain a little bit more specifically what my duties include, and in order to do this I will explain the services that AED Bafilo offers and my role in each department. I can begin by saying that my responsibilities here can be compared to a managerial position back home, and that every role I play is done alongside a member of our Togolese staff.

            In my opinion, the most important service provided are the 3 times weekly free medical consultations offered at the center. On Tuesdays and Saturdays, the medical assistant from Bafilo is at the center, while on Wednesdays we have a rotation of medical personnel from Kara come out to see our members. While I have absolutely no medical training whatsoever, I am still involved in this aspect of our work. My duties range from the menial (making sure the doctors from Kara are in fact coming, ensuring that the staff is ready to greet and manage our members, checking to make sure that all necessary supplies are available) to the more important (helping the pharmacist check that the stock of medicine in the pharmacy is adequate and informing the doctor which products are missing, figuring out the logistics of sending our sicker members who need to be hospitalized to the hospital, spending time trying to convince family members to accompany their relative to the hospital (you can’t go to a hospital here alone, you need someone to feed you, change your clothes, buy your medicine, etc…)) I tend to work a lot with the pharmacist in this domain, ensuring that the pharmacy is equipped to handle our members’ needs and occasionally lending a hand in the pharmacy when we are busy or short handed.

            The home visitor program is one aspect of the work that I feel I could have done a better job at; not for lack of effort but because it has posed the biggest challenges.  Home visitors are trained community health workers that visit our members in their homes. They are the only staff that actually go into the home of the member and gets a first hand look at the member’s situation there. They are then able to report their findings back to the center and action can be taken on a particular problem or issue if one exists. Unfortunately, this works much better on paper than in reality. A lot of this program’s shortcomings lies with the fact that the work requires an approach that is novel to Togo and requires an extremely motivated individual. I wish I could have done a better job selecting and training the people we have working for us in this program. My responsibilities in this area included elaborating and trying to find ways to improve the quality of the work, training the home visitors in new methods of work, attending and contributing to a monthly meeting, and most importantly trying to find a way to act on the visitor’s observations and making their visits worthwhile.

            The psychosocial counseling has perhaps been the most difficult program to install. Difficult because counseling in Togo is something that is done in a more informal setting with close friends or relatives, not at a foreign building with someone you might not know so well. Finding capable people to act as a counselor is very difficult as well. My role in this domain mainly involved working one on one with the counselor and trying to find ways to improve his work. Together we elaborated a list of questions to ask members who came in for a session and worked on how we could use their answers to improve their situation. Again, I was mainly involved in a behind-the-scenes role, not being qualified or trained as a counselor and more importantly not having the language skills to properly communicate with our members, most of who don’t speak French.

            For my first year at AED, my colleague and I were organized a monthly kid’s club with our member’s children. This involved planning and running a club where the main goal was to distract and entertain the children of our members. We’d also try to teach the kids some lessons they could use in their day to day life such as communication skills, teamwork exercises and basic knowledge on HIV/AIDS. While this was probably the most fun part of the work at AED, it was time consuming and difficult in that many of the kids didn’t have a level of French where we could communicate with them easily. Eventually we passed this work off to Togolese staff and other volunteers in order for us to concentrate more on the other aspects of work.

            The overall management of the association is what takes part most of my time at work. Working with the staff and trying to help them improve their work is something that we work on daily. These activities range from showing them how to properly arrange and organize their offices to working out and demonstrating the hierarchical flow of the association. One day can be spent making sure the main room is swept and orderly while the same afternoon can be spent helping the pharmacist fill out the monthly order. Checking the finances is a big part of the job. I quickly understood that everyone is a little bit nervous and maybe untrustworthy of others when it comes to the money we receive every month so I make it a point to go over all the finances every month to make sure no money is missing but most importantly to reassure the staff of this fact. We have several reports that need to be filled out at the end of each month and handed in to the center in Kara for record keeping. It is my job to make sure the staff understands how to properly fill them out and secondly to make sure they are completed in time. Installing effective record keeping is something else I’ve been able to offer. We were lucky enough to have a laptop computer given to us on one of my trips home. We are now able to enter all the member information we previously had only in notebooks into an effective database. Coming up with easy-to-use forms the information could be entered in was something I was also involved in.

            Besides the technical aspects of my work, a lot of my time is also spent trying to mend personal problems between members of the staff. I would not be mentioning it here if this was something that only happened once in a while. I think that the work environment we’re used to back home is so different than what exists here in Togo, that by trying to install that concept here it has led to members of our staff not being sure of their position in the hierarchy which in turn has led to a lot of accusations and riled tempers. Since I am not Togolese (an ‘outsider’) and regarded as a kind of authority figure in the association, it usually falls on me to act as the mediator in these disputes.  Although this has proved to be unbelievably frustrating at times I think I’ve done a good job of making sure that these issues have not exploded into something that can’t be handled. Since we’ve begun no staff member has quit or gotten fired which can, in a way, be seen as a success.

            I don’t like to dwell on this next topic too much because I find it rather ridiculous for me to complain about the emotional difficulties tied to this job when I was surrounded by people whose lives would never be without the constant struggle that is living with HIV/AIDS. However, it was part of the job, a part that affected all others and without a doubt the most difficult aspect of my time with AED. Talking about this part can sound overly dramatic and I don’t particularly like sounding that way, but it is dramatic, it is sad, and it’s a fact of life. The last thing I want to do is make it sound like I’m writing this to evoke your sympathy or admiration (I think some people try to do that), all I want to do is try and describe what it’s like for someone in my position to work in this field.

First and foremost, a lot of people I knew passed away. Some I knew more than others, some I knew by sight, some just by name. The grief associated with this does not need to be described. While working with AED, I was always reminded that no matter how much we did, the end result would be the same, the people the association helps will die. This is something very difficult to come to terms with. Unfortunately, there was always a desire, more apparent on some days than on others, to throw your hands up in the air and give up. Thankfully there were also incredibly happy moments when you saw real improvements in someone’s health, when you see a family that bands together in order to fight this together, when you see babies and children whose lives are intertwined in this epidemic smile and have fun just like any other kid.  It seems that everything balanced itself out most of the time.

It’s incredibly grim to think that a person died prematurely because of a lack of concern on the part of family members, or a lack of education, or lack of money. Unfortunately this happens often. I, but mostly the staff of AED, have numerous times had to spend hours trying to convince family members to bring their relative to the hospital and stay with them. Sometimes we’re successful, sometimes we aren’t. Something that sounds so basic to us is much more complicated in reality here. It’s easy at first to be disgraced and furious at these family members who refuse to care for their loved one, but when you start to think of why this despair is so prevalent and try to see the bigger picture, it’s then that the feelings of hopelessness creep up…

Despite, and probably thanks to, the difficult sides to my work here, on the whole it has been so incredibly rewarding. What I’ve learned about this type of work, about life, about human nature, about myself, can never be measured. I’ve said this before, but my time in Togo and especially in Bafilo has been an education that no learning institution could ever come close to duplicating. It’s focused me into knowing what I want to do with my life and given me the personal and professional experience to know that I can do it. There are a lot of things I wish I could have done differently and therefore better, but I feel that I’ve face many challenges here, I’ve overcome them as well as I could, and I feel like my work here has been an accomplishment that I can be proud of.