At the beginning of our stay in Benin we were shown our internship schedule. The last week, i.e. this week, had not yet been filled in and we were given the freedom to add something ourselves. We then chose to spend this week visiting some of the many other projects of the Hubi & Vinciane foundation.

Entrepreneurial incubation centre

Our week started with a visit to ‘the centre de incubation’. This centre serves as a kind of meeting room and office for young entrepreneurs who do not yet have the means and money to make their projects a reality. Other projects are being built on the same site. There will also be a large goat shed, basins with fish and a large vegetable garden. The center itself has only been open for one month and the opening of the other projects should take place in about three months. Since the centre was very close by to our house at the hospital in Boko, and since the temperature was still quite ‘cool’, we decided to go by foot. Our regular zem driver (motorbike taxi) just happened to be at the entrance of the hospital. He couldn’t bear to see us go on foot, so he overtook us by motorbike and insisted on dropping us off for free, how sweet! We were looking forward to finally getting some exercise – we have both lost quite a lot of muscle here as we mainly have to sit a lot and since it is just too hot here to really exercise. But look, we managed to avoid some sweaty clothes again.

Sokounon Farm

Later that week we visited the large, green ‘Ferme de Sokounon’. This farm was located a bit outside of Parakou and is also supported by the Fondation Hubi & Vinciane. It is a farm where animals as well as fruit and vegetables are grown. In terms of animals, you could mainly find goats, rabbits, ducks, geese, and guinea fowl. The abundance of fruit and vegetables consisted of bananas, papaya, corn, cucumber, tomatoes, onions, etc. The farm is run by five priests and many extra employees. It was impressive to see how green it was, as soon as you step outside the farm, the environment is very dry. By using the nearby lake, the farm can provide almost enough water. Due to problems with the pump, it is unfortunately insufficient to water all plants optimally. The work they do there is very nice. In this way, some fresh vegetables can be provided in Parakou. During the current dry season it is too dry to grow local fresh vegetables. Real fresh products must therefore be imported and are often expensive.

Foundation evaluation

Our very last days at the foundation consisted of evaluating the foundation and handing out the posters we developed to the midwives in the ‘centre de santé’ and in the hospital. Our internship mentor here in Parakou had asked us to write a report about what did during our time here and what we learned, as well as about the good and weak points of the foundation itself. Some working points that we presented at the time were that there were insufficient sources of protein and vegetables in the meals that we prepared with the community workers in the various villages. The meals consisted almost exclusively of a carbohydrate source with a small amount of protein (usually in the form of ground, dried fish) and quite a bit of oil. The amount of vegetables can be compared to how much mint is present in a quinoa salad, so not much. We also noticed the lack of vegetables outside the villages, for example in the canteen of the hospital, vegetables were secondary. When we made this comment, we were told that the foundation is in the process of increasing these amounts but that such a process takes a long time. Adjusting a habit is a process of years and to transfer this awareness to the population, one should approach this step by step.

As a final point of work, we also reported that cooperation with the midwives for pre- and post-natal consultations in and around Parakou would be a great help to them. During our internship we noticed that these women often shared no, insufficient, or incorrect information with the women. For example, there are information bundles from UNICEF that are used. Unfortunately, the information accompanying the images is often misinterpreted. Regularly, no nutritional advice was given, although this is important. Fortunately, there is our poster that we have distributed in the hospital and in a number of health centres. This poster was developed by us on behalf of the foundation and was about nutrition for the mother during pregnancy. The foundation’s plan is to have future Nutrition and Dietetics trainees print the food for babies up to 6 months old on a different poster next year and to expand this series to older children in the coming years.

Back from our week of holiday, and refreshed from seeing our family, it was time to embark on our penultimate week of the internship! The week was dedicated to better understanding the Beninese cuisine and consisted of visited to local markets and restaurants. 

Tour of the markets in Parakou

We spent time in multiple markets around Parakou learning about the local ingredients and what they are typically used for. Compared to what we normally see in the shops in Belgium, the variety of types of grains, legumes, and seeds is overwhelming. A lot of products are available in multiple forms – you might have the fresh vegetable, then a dried version, and finally a powder. The alternative forms allow for longer preservation of the product, especially now at the end of the dry season when cultivation is at low point. The vast number of different types of leafy greens also impressed us, and these are mostly used finely chopped in sauces.

Meat is also available at the market – set out in the hot air with little protection. Some types have been dried to prolong the shelf life. Unfortunately, due to the relatively higher price of meat, it is inaccessible for a lot of the population. The most affordable is around 2500 cfa per kilogram, which is roughly €3.81. Instead, they rely mainly on plant-based sources of protein like soy, legumes, nuts and seeds, and then to a smaller extent dried fish or shrimp and eggs.

At another market, we explored a large area filled with mainly industrial products, most of which are imported. Tinned fish, tomato concentrate, mayonnaise, pasta, couscous, bouillon cubes, etc. are all on offer. It was interesting to visit the markets with a local guide, considering that we had been there in the past but failed to discover entire sections of stalls tucked away down narrow alleys off of the main street!

Visiting local restaurants

We also spent time visiting local restaurants to then see all of these new ingredients in action. At ‘Le secret de la vieille marmite’ one can choose a hot meal from a variety of stews made fresh that day – beef (including tripe) with vegetables, seafood with fish, crab, and shrimp, “meatballs” made from sesame, etc. Normally you pick the meat or other protein source, then a sauce, and finally an accompaniment like ‘pâtes’. 

‘Pâtes’ which normally in French would refer simply to pasta, has a different meaning here. In Benin, ‘pâtes’ are balls made from various flours that one pulls apart with their hands and dips in the sauce. The most common we have come across are made from corn (usually fermented), semolina, or cassava. Mashed yam is also another popular accompaniment. We choose a selection of things in small quantities to take away with us, including some “pâtes rouge’ (semolina with tomato sauce); we were warned that for a couple of our choices of sauce that this was not what you ate with it. But our appetites aren’t quite on the level of the locals here, so we decided to stick with one choice of ‘pâtes’ even if it wasn’t the right combination for everything we were trying.

Weeks 1 to 6 were an exciting experience. After four weeks of internship in the Boko hospital and two weeks of internship in some of the many health centers, it was time for us to be more ‘among the people’. From week 7, our internship days took place in several villages around Parakou. This was the chance for us to get to know life as it is here in Benin. We were able to see what a weekday is like for a large part of the population. Usually the men work in the city or elsewhere and the women stay at home to take care of the children, to cook, and also to work. Each village has a kind of specialization. In one village the women where the women make charcoal, we spent 45 minutes helping them also become specialize in preparing enriched bouillie (porridge) for the children. Another example are villages where they focus on making beurre de karité, while others gave us fromage du soya (better known to us as tofu) to eat at home.

The reason why we went to the villages was to see the work of the community workers of the Hubi & Vinciane Foundation. Often this was giving a kind of cooking class to the women along with education on topics such as nutrition for children. Each employee has his or her own villages, depending on where they live. Usually we arrived at the agreed place, looked for our guide and then waited for the many women who would follow. Since the villagers often did not speak French, a small explanation was given in the local language (often in Bariba). The visit is arranged through a collaboration between the employee of the Foundation and the person in charge of the village. These responsible persons are mainly articulate women who can easily encourage others to action and who will also be called upon, for example, in conflicts between villagers. This person in charge also takes on the task of gathering all the necessary ingredients for the cooking class. Then the cooking itself began. In between there was occasionally time to play with the children of the village and to take the babies on our laps. At the end, the meal was divided among all the mothers, and we always received a portion to eat on the spot.

On some of our internship days, we also did ‘dépistage’. This refers to the screening for malnutrition. Just as we were able to do during our village visits with the large group of Belgian students at the beginning of our stay in Benin, here too we were able to use a special bracelet that measures the upper arm circumference. Despite the fact that the Foundation regularly passes through these villages, we still found some children who were in the yellow risk zone. Our counselor then spoke to the mother of that child, although it sometimes seemed as if the mother was not really interested in improving her child’s nutritional status. These children are monitored several times a month by the Foundation.

On other training days we could follow along and participate in a presentation about nutrition for children younger than 2 years. Afterwards we could also be asked some questions by the women. Our guide was almost always needed for translation.

The difference a pen can make

Usually only the very young children are present during these sessions, as the children from 6 years old go to school. On one of our internship days, we noticed that the children had already returned from school before 10 am and that they were still present at the session in the afternoon. We then asked our guide if their break was not long over and why they were still there. It turned out that the children had come back home because they did not have a writing device to take notes in class and therefore, according to them, it was useless to go to class. We were quite shocked at this. The fact that a child simply cannot go to school because there is no writing material is something that shocks you.

In no time we started looking in our backpacks for what we had available and fortunately we were able to find three pens. The children were very happy, came to thank us and then rushed back to school in no time. At the beginning of our stay here, the group of Belgian students had given us a box of pens and some blocks of paper to donate where needed. So this was the perfect time to hand them over. Our supervisor of that day, Joseph, dropped us off at our house at the end of the working day together with the yam (a kind of large potato) that we had received from the women. We gave Joseph our pens, the blocks of paper, and some of our own paper as well. A few days later we received a picture of him showing some of the happy children who had received our pens. This way you see what a difference you can make, even if only by giving something as small as a pen.

Good news… or not…?

On the second Monday we went with Joseph on a home visit to children who are (on the way to being) cured of malnutrition. We were given the opportunity to follow up on a child we had seen in the hospital a month earlier when they came for consultation. In our week 2 blog you can read how this girl named Beauté, who weighed only three kilos at 15 months old, was in serious condition. Afterwards we were shown a picture of her when she was admitted to the hospital, at 9 months old, and then she was in even worse shape. Because of this, our guide told us that everything will be fine as she is in better shape than before. Now that we got to see Beauté again a month later, we can happily say that she is clearly in much better shape than she was a month ago. She has full cheeks again and eats well. Only we fear that Beauté has suffered serious brain damage due to malnutrition. You can see from the eye movements that something is not right and she barely makes a sound, let alone trying to communicate and can walk. Despite the improvement, we still fear for her future.

And now… holiday!

After these past two weeks, which we personally found to be the most interesting, interactive, and enjoyable weeks to date, it is time for a well-deserved holiday. Both we and Svea have been able to arrange a week’s holiday where our family comes to visit. Heather’s father comes over from Canada while Femke’s parents and sisters come to visit from relatively less distant Belgium. A week of traveling around will do us good. Afterwards we’ll get back to it completely, both on our internship and for our bachelor’s thesis. Our time here passes so quickly that the end of our internship here in Benin is already in sight.

Back from our weekend away, we were finished with our internship at the hospital in Boko and the next two weeks was our internship at the local health centres in Parakou. The first week we were at the centre in Ganou, a neighbourhood on the edge of Parakou in the north. The second week we were at the centre in Madina, a neighbourhood in the centre of the city.

The idea was to see how a centre on the “periphery” of the city functioned compared to one in the centre, and of course both in comparison to the hospital. In general, we found that the health centres functioned a lot like a miniature hospital. They had general consultations, a maternity ward with birthing centre and pre- and post-natal consultations, and a vaccination centre. The birthing centre was only for straightforward, natural births. Anything more complicated and the mothers would be sent to the hospital.

The vaccination centre

The vaccination centre is where we tended to start most of our days, because it is during these visits that other aspects of a child’s growth is also being checked. The mothers as a group receive an educational talk prior to the vaccines starting which focuses on proper nutrition for the age group that is being handled that day. In Ganou they also spoke about proper hygiene especially around the still present threat of Covid, as well as the importance of keeping an eye out in their neighbourhood for signs of children with polio. If a child comes in with polio, the treatment is free, and everyone is urged to report if they notice a suspected case in their community.

Starting from the vaccines at 6 weeks old, the children are also weighed before receiving the vaccine, so that the health care workers can keep track of their growth on the growth charts in each child’s file. In Madina they also measured the height/length of the children as well as used the armband measurement for children over 6 months to check for malnutrition. If any child was found to not be progressing in a positive way, the mother was pulled aside to receive nutritional advice from one of the health care workers. In general, both centres worked mainly with the UNICEF provided nutritional guideline books, using the images from this book to communicate the key takeaways to the mothers.

From 6 months old, the children also start receiving vitamin A supplements when they come in for their vaccines and weigh-ins, and they also receive a prescription for an iron supplement to be taken daily.

During these visits, the health care workers are also doing other tasks, such as checking for a tongue tie, and if necessary, snipping the tissue to free up the tongue and improve breastfeeding success. If requested, they will also pierce the newborn’s ears – a very common occurrence here. Most baby girls have their ears pierced within the first hour after being born!

The big difference between the two health centres was that in Ganou, all the vaccinations happened in a consultation room, so the mothers wait outside in an open area until they were called. It took a long time to get prepared to start receiving the children, but once they began there was certain amount of order to it all. In Madina, they used a large gazebo in the middle of the campus, where it was much more difficult to control the flow of people, so it felt very chaotic and at times overwhelming. The number of children received at each centre each day seemed quite similar to each other.

Consultations

Depending on the time we finished up with vaccinations, we would then head to the pre-natal consultations to follow with the midwives the sessions there. These were very similar to what we experienced working at the hospital. In Ganou, the women came into the consultation room one at a time, and you had the sense that they could ask questions if they were concerned about anything. In Madina, there were two examination tables next to each other (with privacy screens), where the midwife moved quickly between one and the other. We didn’t get the sense that the women had a lot of opportunity to ask questions, unless they really pushed and took the initiative to do so.

In Madina they also provided consultations about family planning, which in this case meant a consult on the best type of birth control the woman should use. Most of the woman we saw coming for these appointments already had a child or two and were looking for birth control in order to avoid falling pregnant again too soon. We saw two women fitted with the implant in their arm that provides contraception for up to 5 years.

We also followed the general consultations a few times. As the high season for malaria is slowly approaching, most of the patients we followed there were ill and were tested for malaria. When children were coming in for a consult there was then also a check to see whether or not the child was malnourished.

Enjoying some downtime

To finish off our weeks at the health centre, we headed out for our first restaurant meal in Parakou – more than a month into our stay here! We headed to Dody’s, well known among the expat crowd for its more European menu and indulged in some cheeseburgers to end the week. Then it was off to the Hotel Les Routieres for a few hours relaxing by the pool. Just the break that we needed after a long, hot week. It was also the prefect opportunity to introduce the newest intern in Parakou, Svea, to the life here. She arrived in the middle of March for an internship with the Foundation as well, although she is focusing on the agricultural businesses that the organisation is involved in. She’s living with us at the hospital in Boko, until at least the end of our stay here in Benin.

This weekend we were off on our first trip away from Parakou! Finally time to feel like tourists again instead of interns.

On Friday afternoon we took the Baobab Express bus from Parakou to Natitingou, in the west of the country near the border with Togo. We were really impressed with the bus, especially compared to our experience travelling to Parakou the first time. The bus was air conditioned, comfortable, and there were no travelling salesmen yelling their stories for all to hear!

Once we arrived in Natitingou, our guides for the weekend, Guy and Felix, were waiting for us with their motorbikes. It was a fresh evening ride about 40 minutes south to the village of Kossoucoingou and the Otamari Lodge. It seemed like a quiet and tranquil place to stay, but given it was pitch dark outside we needed to wait until the morning to properly appreciate it.

Our visit to Kossoucoingou was to explore the “Route des Tata”. The Tata is a traditional type of building, made from mud, but resembling small castles, with various terraces and turrets to explore. After waking up to a scenic breakfast and watching the local cows come to the village well for a drink, we set off with our guides to visit some of the families and local businesses in the area.

We learned how a local family makes fresh mozzarella-like cheese daily from their herd of cows, using a local plant to assist in creating the cheese curd. We also visited a local man who weaves baskets and whittles wood – Femke picked up a beautiful basket from him to use for fruit once she is back in Belgium. We also stopped to visit a local family building a new house and saw how they created the concrete-like mud from the ground and worked together to build up the walls of the house. And of course, throughout the visit, we explored the various Tata houses that we came across. Some of them are being used by the families, and others are open to tourists to discover what it is like to live in one.

On Sunday we were up early again for breakfast and to watch some local women making Shea butter. It was definitely a group project, as two women worked together to crush the nuts, which were then roasted, and another then ground finer and finer. The last step was gradually washing the cream that was produced, turning the mixture from a chocolate mousse-like creation to a white meringue. Once the solids were separated out, we were left with a creamy yellow oil; the Shea butter.

Afterwards we left Kossoucoingou and headed back to Natitingou. Just to the east of the city lies the Kota Waterfalls. It was a very bumpy ride on the “red” roads (dirt roads) to reach the waterfall, with a short hike down to the lagoon at the bottom. It was worth it, though, to go swimming in the refreshing water and stand underneath the falls! We even had some monkeys observing us from a distance; I guess they were jealous!

Unfortunately, the bus back to Parakou was fully booked, so we needed to take a taxi instead. A taxi here, however, is different than you would imagine in Europe or North America. They try to maximize their profits by filling the car up as much as possible and continue to take passengers on as they make their journey. Traveling in such a way, during the heat of the day and without air conditioning, made it for a very long, hot, sweaty ride. At one point there were 8 passengers in the car, as a couple were even sitting in the trunk! It was probably an experience we needed to have here in Benin, but not one we are very keen to repeat. 

But regardless of the less-than-ideal transport back to Parakou, we had a great weekend discovering more of the country!

A well-deserved rest day

At the end of last week it was Femke’s birthday. To celebrate this, the two of us went to hotel Les Routiers to take a dip in the swimming pool, enjoy the tranquility, and escape the heat for an afternoon. Since there is not much to do in the hospital in Boko, where we are also staying, we both worked every day for school. If we do an internship in the hospital during the day, we will be busy in the evening with either the necessary household tasks or with our bachelor’s theses or assignments for the internship. We also kept ourselves busy with schoolwork during the weekends, so that a day of rest and doing nothing for school was sometimes allowed and we enjoyed it immensely. You may be surprised, but even though we’ve been here in West Africa for a month, we haven’t been able to enjoy the sun and get a lot of color yet. 😉

Hotel Les Routiers is a well-known hotel in Parakou where many Westerners stay and where various ambassadors meet regularly. It was a pleasant visit, and we are thinking of visiting the swimming pool again during one of the upcoming weeks. Once we are finished at the hospital, we will need to commute into Parakou each day for our internship. Apparently, the hotel has tasty European dishes such as stew with fries, which we will definitely need to order! There is also a souvenir shop outside, which is very nice since Parakou is anything but touristy and we haven’t been able to buy any souvenirs yet.

Back to work

After a pleasant Saturday, we ended our weekend with a quiet day of work for school and then we could start our second week in the maternity department.

This week it was Femke’s turn to follow the prenatal consultations and Heather got the chance to give some nutritional tips to the women who were healing from their caesarean section operations. On Tuesday we were about to follow another woman in the delivery room. This time the experience was a bit more eye-opening compared to the last. Given that a normal, natural childbirth here always takes place without anesthesia, this is already a painful experience. But when it was noticed that the opening of the vagina was about to tear through, it was decided to cut the opening to prevent this tearing. This was also done without anesthesia. After the delivery had gone off without a hitch, the woman had to be sewn up again, of course, and this is again done here without anesthesia. Throughout the procedure, the woman cried out in pain and was told/called to her to stop yelling and to be quieter by the midwife.

This experience was yet another example of one of the most striking cultural differences between Belgium and Benin. There is no place here in Benin for sympathy for those who are in pain. When a 15-year-old girl who was about to give birth wanted to sit on a step last week because she was having a hard time, she was yelled at not to sit there and that she should just stand up or find another place somewhere else. It feels often like you’re not allowed to show any signs of weakness here.

It also sometimes happens that one of the new mothers speaks little or no French and if the midwife does not speak the same language as the mother, the midwife often gets angry with the woman because she does not understand her. Shouting at the patients and even hitting them with a book if they do something wrong, for example, is a regular occurrence here. The way of communicating is generally more aggressive than in Belgium, which took some getting used to.

It is also striking that everything is very focused on the parenting and domestic role of the women and that the partner is never involved in, for example, giving nutritional advice to the pregnant woman. Only if the woman seems to have misunderstood, the partner will also be informed. Even at the birth, the partners were not allowed to be present. The women are often three next to each other (ready to) give birth without anyone they know being present. After giving birth, they have to lie naked for a few hours without visitors being allowed to come or getting dressed (in order to be able to properly monitor the mother’s recovery and the afterbirth).

In the O.R.

Later in the week, Femke got an opportunity she wouldn’t pass up. She was allowed to follow the operation of an ovarian cyst. When she entered the operating room, she thought she was wrong at first, as the woman who was ready for the operation seemed to be heavily pregnant. In the end it turned out to be a cyst of 10 kilograms – the size of twins. The cyst was therefore completely removed together with the uterus. We won’t go into the gory details, but let’s just say it was an experience to remember. For the patient, it was literally and figuratively a great weight lifted from her shoulders.

Other than that, the working week was fairly quiet. We were able to arrange that we were given Friday afternoon off to go away for the first time for a weekend and to further explore the country. We opted for a weekend trip to Kossoucoingou, near Natitingou, close to the border with Togo. Exciting!