Sunday, October 19, 2008

Brush Your Teeth!

Brush Your Teeth!

From my Western perspective, dental hygiene is a problem in my community. I wish that I could do a preliminary survey and find out how many people here brush their teeth, but I don’t think that is an appropriate thing to do. If I had to estimate, I would say that in my entire 450-person community, maybe 5 people use toothbrushes on a regular basis. But there’s really know way for me to know and it could be as low as 0. It’s not just my community; I’d say that the idea of dental hygiene is one that is fairly new in Morocco.
So I’ve decided to make dental hygiene my first, independent, education project. It doesn’t take a large investment of resources or time. I also think that people can see the benefit of their behavior change fairly easily (maybe except for those people whose teeth are too far rotted brushing may just push the teeth out).
In the schools I’ve been talking to the kids about brushing their teeth. Basically I tell them that if they don’t brush their teeth, their teeth will rot and fall out, just like the older people in my community. I try to be very blunt about it. I brought in a hard-boiled egg soaked in Coke, which made it turn brown, and then had the kids use toothbrushes to clean the egg. I also brought in a model clay mouth for the kids to practice brushing teeth on. (Side note, hands-on education is not apart of the teaching pedagogy here; it’s all about rote memorization.) Since doing the education, I’ve been coming into the school on a regular basis during their recess and having all the kids brush their teeth in front of me. It’s pretty funny to watch 30 kids slobber spit and toothpaste all over themselves and realize that this is my job. I think that an activity like teeth brushing is something that, if you’re a child, you need to practice doing over and over and over again until it becomes a habit.
The second aspect of my education is a lot more uncomfortable, although I think that I’ve unnecessarily imposed some of that uncomfortable feeling upon myself. Working with a local association (which basically means talking to one guy), I’ve divided my community up into six different groups (groups made by dividing the community by geographic proximity). On the day of a meeting, in the morning, I tell the people that we’re going to meet in the afternoon. When people slowly show up for the meeting, I tell them about what I’ve been doing in the schools. Then I tell them that my parents reminded me to brush my teeth twice a day every day and that they need to do the same. I feel a little uncomfortable telling grown adults to brush their teeth; telling them to help their kids is sort of a roundabout way of suggesting the idea to them. In the better meetings, the adults have asked about their own teeth and if they too can brush their teeth.
Finally, I’m going to supply the local store with toothpaste and toothbrushes so that once people run out of what I’ve given them, they can easily buy more.
That’s pretty much the plan. I still have one more meeting with adults. And I’m going to keep going into the school and making the kids brush their teeth in front of me. The big question is: will people change their behavior? Well I’m of two minds about that issue.
When I’m feeling pessimistic, it’s easy to be very negative about the impact of this work. Speaking generally, people here are very conservative and don’t easily change their ways. Pretty much everyone does everything the same way, which is the same way that their parents did it. Not just with hygiene practices, but also in many different aspects of life, people can’t imagine that there is another way of doing things. People are incredulous when I talk about things in America. Furthermore, I think that a habitual act like brushing your teeth is hard to change. For people to change their habits, they need constant reminders. I can do that to some extent with the kids, but it’s not as good as parents reminding them every night. Which brings up another cultural obstacle that I’m facing: parenting in the way that we think of it is not really a duty of being a father or mother here. Kids pretty much run free and do whatever they want. They don’t really listen to adults and adults don’t try to speak to them. So I’m not just introducing the idea of brushing teeth, I’m introducing the idea of parenting. Which may be harder to change.
When I’m feeling optimistic, I feel as though people might actual end up brushing their teeth. With the kids, I’m planning on really drilling the idea of dental hygiene into their heads. When I see kids on the street I ask them if they brushed their teeth (they tell me they did, but who knows if they’re lying). Kids (and everyone) are going to remember the American who lived in their community for a long time – if I go to the school every week and make the kids brush their teeth, they will remember that. In terms of adults, the most positive thing is that people who weren’t able to come to one of my meetings are approaching me on the street and asking me if I have any toothbrushes or toothpaste. We go to my house and I make them listen to my spiel before I give them the goods. This makes me think that people are talking to each other about what I’ve said and that they’re at least curious. People do complain about how their teeth hurt, so they recognize a problem. Another positive thing is that having my host mom as an ally is a great way for me to reach girls and women that I would otherwise be unable to speak to. Girls have asked her about getting toothbrushes/toothpaste from me (they are too afraid/embarrassed/ashamed/ to approach me). Once I resupply on toothpaste, I’m going to give her stuff to give to people and teach her how to teach others how to brush their teeth. It’s possible that having my host mom work like this will reach more people in a more meaningful way than I am able to.
I believe this idea of toothpaste and toothbrushes is either a) completely new to people here or b) something that people think of as a luxury item only for Westerners. People are always surprised when I say that I bought the toothpastes and toothbrushes in Tounfite (the market town, 28 km away) and how inexpensive they are. So hopefully if people see that it’s something they can afford they will buy into it. It’s also something that people are not at all ashamed to speak of. I felt weird teaching adults how to brush their teeth and worried about being condescending, but I’m going to stop letting the feeling hold me back. People are open to talking about the issue.
Balancing these two conflicting feelings, I guess I want to believe that people will change their behavior. There are many things working against me, but if I concentrate on this issue, some people will come around. Even if people don’t immediately change their behavior, introducing the idea of dental hygiene is the first step towards ultimately changing things. Change might not come immediately, but maybe I’m laying the foundation for behavior change in the next generation – at least that’s what I tell myself. Some volunteers are very negative about changing Moroccans behavior and I think they let that negativity limit what they try to do. I came here to do health education and I’m going to try and do it. Plus it gives me something to do and some feeling of efficacy.

I’m legitimately busy now. It’s getting to the point where I can’t do everything that I want and have to prioritize. So that’s really nice. Hopefully it will last. It’s not just dental hygiene; there are a couple of other projects that I’m working on.
By some amazing coincidence, someone who I don’t know in America read my blog and is interested in helping fund a water project in my community. So I’ve been trying to press local association people to work with me and get the ball rolling. On Thursday we went up into the mountains and found a spring. We measured the flow and made estimations about how far it is from a village. The village that it would serve already has a chateau (water tower), but it is empty because people cannot afford to pay the electricity needed to pump the water. The idea is that if we can reroute the water from the spring to the chateau, there will be no need for a pump (which pumps water from a well). If this project came through, it would bring running water to over 1,000 people and be a huge success. Right now women and children spend hours a day collecting water and having tap water would eliminate that work. Furthermore, because people collect water from wells and streams, there are many water borne illnesses. If the water is captured from a spring it starts off cleaner. Then we can treat the water in a centralized place (the chateau) and hopefully greatly reduce the frequency of water related disease.
Another project that I have been fortunate enough to latch onto is culminating next week. The midwife training, largely organized by another volunteer, is happening on Monday, Tuesday, and Wednesday. 12 women from three different villages in my commune will be attending. I am very excited for this training and I think it may be the most important thing that I do in my two years here. If it goes well, I plan to do another training next year and get women from other communities to come. There is a lot of bureaucracy and detail work involved in pulling off the training. We had a meeting with the Caid (mid-level government official) on Friday. I have to make sure that all the women have somewhere to stay in the town where the training is held. I have to make sure they all know when the training is and provide transportation for them. We’ve had to meet repeatedly with the nurses giving the training and go to the provincial capital (Khenifra) to meet with the Ministry of Health. We had to set up the building that will be used for the training. We had to write the grant for the project and then beg our family and friends for money (thanks again, by the way). And more. All the while dealing with a subject that makes people a uncomfortable. I think that talking about it over and over with certain people has reduced the taboo surrounding the subject and that itself has some value.
Finally, on a non-work related note, (although everything I do in my village impacts my work) I held a sadaqa at my house. Basically a sadaqa is when someone hosts a meal and feeds people as a way of giving thanks to god. The local religious leader normally says a blessing. It’s traditional to do when you move into a new house. I also felt like it was a good way of thanking certain people who have been especially helpful to me here. My house being small, my sadaqa was small, only 8 people (not including my host mom, who doesn’t count by most people’s standards). But it went very well. It was super expensive: I spent more than what I normally spend on two weeks worth of groceries. The food was good and people were excited to be invited into my house. It was especially important for my host family to know that they are welcome in my house, even though I’m sure they will never come over. Early on I had the idea that I would cook American food, but if I’d done that everyone would have been pissed. So, unfortunately, I had to enlist my host mom’s help (I don’t know how to cook Moroccan style food) and she did most of the cooking. I feel pretty awful about perpetuating the gender divide of labor here, but I’m not sure if there was any way around it. I tried to get her to eat with the men, but she refused. It’s probably better that way – everyone but me would have felt uncomfortable. It was a fun night. The only down side was that the next day some people who weren’t invited complained.
So things are good. My mom and sister are coming in about two months and that’s very exciting. The election draws near and it looks better and better for Obama. I’m hopeful. I’m going to bring my absentee ballot to my community and have people see how the voting works. It’s getting cold and I should be getting a wood stove for my house very soon. Hope all is well.


Robert said...

Hi Duncan! It's Robert from your hall.

I just stumbled back onto this after a long time w/o reading, but I really liked it. The post about the limitations of the blog and all the things that you take so for granted you don't think about them etc especially was really interesting, and good reading. I'll definitely be keeping some tabs on you.

Life with me is pretty good. I'm in China for the semester, trying to pick up a bit of the language and go exploring some. It's been pretty fun so far, and I'm definitely pushing boundaries, though nowhere near anything that you've been doing. Back to the States in late November, and then to Swat next term.

Hope life is good!

maryellen said...

dunc, back in the day, when i was in first grade, there was a national push for fluoridation and toothbrushing. so old as i am, attention to dental hygiene hasn't been around that long, even in the u.s.! and look how far things have come!

they had these red tablets that you could chew after you'd brushed your teeth to see if there was any gunk left on; i'll see if i can scare some up and bring them in, ma

Anonymous said...

Oh dude that suck! Why did not brush their teeth? They not know how to do it?