6 Months Later...

People have often asked me how life has been since I got back to the states from Albania. Has there been a lot of culture shock? Was it hard to re-adjust? What was the most difficult part of re-acclimating to life in the USA? Now that I have a bit of time back here, I find that I can answer this question a little bit better.

Has there been a lot of culture shock?
Hmmm... well, not as much as I thought there would have been. Actually, I have found it more shocking that not much has changed since I have returned. Surprise, surprise! Life still went on without me. Lol. That shouldn't be a surprise, yet it is. Ha! Aside from my ego-check, I suppose there have been a few interesting things to note.

1. Everything seems to move at a very fast pace.
2. People you meet are not as easy going and welcoming. The "stranger danger" is alive and well.
3. There are way too many food options in the supermarket! lol Really, who needs 67 different cereal options?!

Was it hard to re-adjust?
Yes, and here's why. I got used to the community culture I enjoyed in Albania. People there do not let you sit alone. They ask you out to coffee, invite you to parties, and welcome you into their homes on a regular basis. New Jersey seems to be quite different and it has been a challenge to find friends and such to hang out with. That wasn't something I expected, yet after living here a while, I am seeing that this seems to be one of the hardest things to adjust to since I have returned. People don't seem to have time to just sit and chat.

What was the most difficult part of re-acclimating to life in the USA?

Again, it wasn't necessarily an issue of re-adjusting to "American Culture" so much as missing the friends I had made in Albania, both Albanians and Peace Corps volunteers alike. I must admit, I didn't know how attached I had grown being out there. Now I feel it. I miss it. I miss my friends. I miss my life in Librazhd. I miss my buddies in Tirana. I miss my good friends who are now making a home in Thailand.

New adventures... and a new BLOG!

Good friends are hard to find...

I was initially thinking to continue this blog as there seems to be a good number of followers. I thought again and decided that I wanted to keep this blog solely for my Peace Corps days in Albania. I have a couple more posts that I plan to write in reflection of the amazing experience I have had in Albania over the last 26 months of my life.

But the adventure doesn't end here... if you'd like to see where I go next, visit me at:

https://jonbreen.wordpress.com/

Back To The Land Of "E Pluribus Unum"

I returned to the US about a week ago and have been experiencing what people refer to as 'culture shock.' At first I didn't feel it... as I was in shock. I have since been living with my parents in our San Francisco home. As I prepare myself for my new job in New Jersey, I am taking this time to reflect, to relax, and to get re-adjusted to life in America.

Here are some things I've noticed so far since I've returned:

1. I seem to be moving slower than other people around me. Literally. Maybe it's that whole avash, avash mentality I've been acclimating to.

2. I find it hard to get up the motivation to coordinate any sort of get-together. With living in a small town for a while, I really got used to the whole "walk around and see everybody" routine. That simply doesn't fly here in San Francisco. (well, not for someone who hasn't lived here for more than 7 years anyway...) Nevertheless I have the resolve to leave the house every day and so social things as much as possible.

3. America is fun if you have the money. With so many stores, with sales and an endless supply of goods from all over the world, one could easily spend their life savings in a shopping spree if they weren't careful.

4. Things are expensive! From coffee to salads, everything I buy seems 10x what I'd pay in Albania.

5. A shocking (not so shocking) return to the City By The Bay:
There seem to be a lot more homeless people in San Francisco these days as well as many untreated residents with untreated mental health and/or substance abuse disorders. I grew up in San Francisco, and have lived here for more than 25 years. Never before have I seen so many people living on the streets. Just going down to Powell street station, one can easily see a row of people sleeping right on the floor of the main corridor. Most are just sleeping and staying warm, others clearly getting drunk, others with all their possessions spread out (possibly to sell, I'd imagine). I'm not sure what has happened in this city since I last lived here, but something seems shockingly different.

Saying Goodbye To A Village, A Country and An Extended Family

So this is goodbye. Albanians don't use the expression "Lamtumire" (farewell) very often as I'm told (except after someone dies or if one has a harsh break up with a lover). As I feel in my hart that I will return here one day, I am inclined to comply and simply use Mirupafshim (means "goodbye" but also literally means "may we see each other well again").

My goodbye to my counterpart took the form of a farewell lunch at our favorite cafe hangout near our work. Grilled chicken, salce kosi and potatoes, salad, grilled peppers and  various "fancy drinks." I thanked him for hosting me at his work for the last two years, for putting in such hard work to complete our projects, and for always being flexible with me to allow for some of my various secondary projects. I must say we made a great team. We visited some of the most remote village areas together with our Breast Cancer Outreach Project, took turns speaking in English and Shqip (Albanian Language) every morning over coffee, co-taught more health lessons than I can remember, and discussed various books, American Culture and even philosophy. I would often joke with him that he's my favorite person to argue with, because he will take the time to understand and follow the discussion until the end. I appreciated that as well. We both had our upbeat days and our rather challenging days. We got through them together (usually with long chats and lots of coffee). Yesterday I expressed my appreciation for his efforts and he did as well. As we concluded our work together, we were fortunate to have a new volunteer join him for the next two years.

For a great blog post and perspective on this transition time from a fellow Peace Corps Volunteer visit - http://www.livingthehyphen.com/2016/02/closing-service-and-moving-on.html

LGBT Outreach In Albania - A Grassroots Grant Project

The Outreach Team! All smiles as we celebrate the conclusion of our project.

LGBT Outreach - A Peace Corps Grant (SPA) Partnership Project

Overall, the grant went well. We worked in partnership with representatives from two NGOs and visited areas outside of Tirana to give high-school students, university students and other community members the opportunity to meet an LGBT person face-to-face and to ask them questions. We also ended up using the SkaNdal documentary as a tool to ease them into the subject matter. This proved highly-effective, and in hindsight, a prudent measure in some more isolated areas. 

Xheni explaining a group activity at our session in port city of Durres.

We successfully reached out to more than 250 individuals across 13 communities outside of Tirana and educated participants on LGBT issues in Albania. We worked with two NGOs to organize each outreach session in partnership with local Peace Corps Volunteers. We also met with potential community leaders during each session to build a more sustainable network of contacts for our NGO partners.

Hanging out after a fun informal discussion. Many girls reported knowing a gay person in their community!

Our initial objective had not changed much from our plan. We had some variation with regards to the level of LGBT awareness among our participants, thus we had to make adjustments to our presentation as went along. Through close collaboration with the Peace Corps volunteers, we were able to appropriately gauge the audience and cater the presentation accordingly. For example, some communities had already been aware of LGBT issues, thus we focused mainly on discussion and critical thinking topics relating to human rights and society. For those groups who were less aware of such issues prior to our visit, we decided to show the documentary and allow the audience space to ask basic questions before we presented. 

A community partner holding up a drawing from an activity - "Draw a Lesbian or Gay Man"

The community feeling was usually very positive. We had some instanced where the participants had stated some concern or reservations about the subject matter. For example, in Saranda, there was one woman who had religious beliefs that did not allow for LGBT acceptance. She stated that she didn’t have any personal feelings about it, but that she couldn’t accept it because of her religion. The presenters responded by thanking her for her honesty, and for her respect by attending the session and for voicing her opinion. Again, we re-iterated that our goal was simply to present the information and allow them to form their opinions themselves. That particular participant ended up spending more time interacting with the speakers after the session and even took a photo, smiling with them afterwards. We have experience this type of understanding several times throughout this project. Even if people had objections to LGBT people, they were still open to learning about this issue, and showed appreciation our outreach efforts. 

The girls from the GLOW National Conference were among the brightest, most considerate we have met in Albania

Through the strengthening of their outreach network, the NGOs increased their capacities. Each engagement was an opportunity for them to meet other Albanian community members and service providers across the country. Through debrief sessions after each engagement, partnering NGOs gained valuable perspective from the input of participants, Peace Corps volunteer liaisons and the local hosting service provider. Peace Corps volunteers provided feedback on outreach methods and presentation material, thus allowing for more successful engagements. Throughout this grant period, PC Volunteers also worked directly with directors of the partnering NGOs to discuss fundraising strategies as well as outreach methods for events and promotion. 

Participants in Lezha re-evaluating stereotypes through a critical thinking exercise

The network built throughout this grant will allow the NGOs to do outreach through such contacts, with less need for Peace Corps volunteer coordination. With these communities now engaged and primed with these initial visits, future engagement will be easier and thus have more chance at being successful. Also, the skills build by members of the NGO (both experiential and technical) will set them up for better outreach moving forward.

A group photo after our session in Elbasan. We had a great discussion going, with some very interesting questions.

Kristi, Xheni and Gene sharing their wisdom and answering questions in the northern town of Kukes

The response was a lot more positive than initially expected. Event participants were a lot more welcoming of the subject matter and a lot more engaging than the NGOs had anticipated. The NGOs were quite impressed by the level of progressive attitudes among their fellow Albanians. There were a couple participants who were not enthusiastic about the topics, but due to our strategy to only engage interested parties, such interactions were not very common at all, and every time one came up, it was discussed and resolved during the sessions. We left every session with a good impression and on good terms with both event organizers and participants. After receiving feedback from one session held in Durres with the GLOW group, we heard that one parent was concerned with the subject matter presented to their daughter and that they disagreed with such education due to their religious beliefs. 

Outreach often means sharing personal experiences. For me that meant 'coming out' to each audience.

Recommendations include continuing such collaborative efforts. Peace Corps volunteers should continue to welcome Aleanca and ProLGBT into their communities. Although the general impression of LGBT issues in Albania is that such awareness and acceptance does not exist, we have seen quite the opposite reaction from the majority of our participants. 

Alba fielding questions from the audience and Gene explaining what it means to be an Ally.

 

Further efforts should be made to work with the NGOs on an organizational capacity basis, supporting their existing efforts, in partnership with host country leadership. The efforts of the government of Albania align well with the goals of the NGOs, thus Peace Corps support of these efforts to move towards EU acceptance should be provided in some form.

Lessons Learned and Promising Practices

Post-session selfie with the fabulous girls from Korce!

We learned that it is better to engage interested groups rather than trying to fit a lot of people into a session. The response is usually better when we have the chance to sit and engage with each person in some way one on one. We also found that it is always a good idea to allow them to ask questions anonymously, as most are too shy to ask it out loud. We did this in several communities and got a better response than asking out to the group as a whole. We of course used the SkaNdal documentary to ease participants into the subject matter. We feel that as the LGBT rights movement progresses, future documentaries should be screened to keep communities informed. 

Smaller groups proved to be among the best engagements we had. This one in Berat was truly special.

Lastly, face to face interaction is everything. We have found that if someone has had a positive interaction with an LGBT person, that this is enough for them to accept LGBT people in their life. Thus we tried our best to be respectful of different and even opposing opinions, leaving each session as ‘friends’ with our audience. The most important thing here was leaving with a good impression.

Larger groups allowed us to reach out to a wider audience. Many thanks to our teacher partners!

Breast Cancer Village Outreach

As my time in Albania comes to a close, my counterpart and I have officially wrapped up our Breast Cancer outreach grant project! I am happy to report that we have exceed our goal of reaching out to 300 women in village areas by more than 200! Below is a summary of our activities and some of the issues we faced in administering the campaign. (With photos, of course!)

BREAST CANCER VILLAGE OUTREACH - A PEACE CORPS PCPP GRANT PROJECT

 Participants practicing detection with breast model

Breast Cancer continues to be an issue in Albania, particularly in regions where information is limited. Geographic barriers and isolation of rural village areas in the Librazhd Region of Eastern Albania have caused a dangerous lack of education leading to deaths due to breast cancer. My counterpart and I decided to take on this issue in our community for both professional and personal reasons. As the de facto supervisors for all the local health centers, we decided to utilize them as leverage for this project, both to actively help with gathering women and to create a network to better do outreach to the entire community. There are 77 villages in Librazhd Region across 11 Komuna. Over 85% of the population under DShP Librazhd jurisdiction live outside of Librazhd City. That is why we chose these remote areas as our areas of focus. These villages, some hours away in the mountains represent some of the most impoverished communities in Albania, and Europe by extension.

Me presenting with a nurse from our partnering health center. Speaking in Shqip (Albanian) was quite a challenge at first!

Goals Achieved - We successfully held seminars in all 11 komuna, an achievement never before seen in the region. We reached out to more than 500 women across these areas and even held two additional sessions as well as a Training-of-Trainers with all the nurses in the area. By the end of the grant period, my counterpart had contacts both at the health centers but also through the schools in every area of the county. We have essentially built a better network of outreach that can be used for future health campaigns. Also, my counterpart has learned valuable skills in project design and management that will allow him to access future project funds. 

By collaborating with local nurses, we were able to more-effectively reach out to women and build a greater health network.

We initially planned to hold formal seminars in each region, by working closely with local community members across the 11 komuna. We had to change gears a bit as it was extremely challenging to schedule these sessions, and, due to the spread out nature of the village areas, the isolation of certain communities, reluctance from local health staff and the changing weather all made formal sessions a practical impossibility in some areas. We therefore changed our strategy and instead did a few smaller presentations, one at the health center and another at the local school with teachers. To further our reach we sometimes went with a local trusted community member and walked the streets to greet women and visit their homes to share this information. This strategy made it easier for our local partners to schedule our visits as it put less pressure on them to organize women. 

This truly was a collaborative effort. We couldn't have done this project without our local partners - even the cafe owners!

The overall community feeling has been positive and we have found that most people are very receptive to gaining information for themselves and the women in their lives. We even encountered many men who were so worried about the health of their family and friends that they demanded we give them information for the women in their lives! 

Many have heard about breast cancer but were too afraid to learn more or even perform a proper self-examination for fear of detection. For these people, detection meant death. We acknowledged their worries and catered our outreach appropriately, addressing such concerns in our presentations. We reassured them that this disease is treatable, especially when detected early. That is why it is so important to learn as much as you can about risk factors, symptoms and proper exams (self-exams and mammography, based on age) 

A community partner demonstrating detection methods with local women in her community.

Capacity and Skills Built

My counterpart had developed many skills throughout this project, as well as in the project planning period. We met and together did a community assessment, looking at all aspects of life in Librazhd, particularly relating to health needs, services offered and places for intervention. After such discussions we did a brainstorming session to come up with ideas for a viable community project. We then attended a Project Design & Management workshop together and my counterpart had the opportunity to learn a lot regarding project planning, design, evaluation as well as the grants process. We co-wrote the grant application, worked together on each outreach session, and compiled all the information and prepared the grant report together. 

Women came from nearby villages to attend the seminar and bring back info to their families and communities.

My counterpart has gained valuable skills that increase his capacity in his current position, as well as develop himself professionally. Through our collaboration with local health professionals across the region, many had the opportunity to practice their presentation of information regarding Breast Cancer - some doing so for the first time. This will allow them to feel more comfortable doing similar work in the future, and have more impact through such engagements.

Sometimes humor is the best way to start addressing a serious and uncomfortable topic.

 

Sustainability

Through the successful collaboration across the 11 districts, we have achieved our goal of building a sustainable network of professionals (both local health center nurses as well as school directors). My counterpart can now utilize this network for future health campaigns.

Through the training of trainers for all komuna nurses as well as their re-engagement during the local health outreach sessions, we have prepared them with information they need to continue to reach out on our behalf. Many nurses agreed to continue to speak to all their community members about Breast cancer to make sure everyone in their regions has access to this information. We gave each nurse as many additional brochures as they thought they might use in the future. Thus the impact of these efforts will continue past the initial grant period, and possibly for much longer.

Unexpected Events

My counterpart and local partner walking the muddy mountain roads to outreach to extremely isolated communities.

As stated previously, we did not expect the seminars to be so hard to plan. We faced many issues in trying to plan large-scale sessions in remote areas where we are unknown, and where we know very little about the community layout and habits. We had to do mini-community assessments, including a daily calendar to identify the appropriate times to visit these areas. Many nurses were not able to gather many community members, thus we had to be creative and reach out ourselves once we got to these sites. 

Our community partner demonstrating a self-exam for our participants.

 

We recommend that the portable Mammography machine come back to Librazhd several more times, allowing more people to get a mammography, particularly poorer women. There is a great need across the region, and attention should be made to focus on rural areas, isolated mountain communities and poor women.

Lessons Learned

We learned that although women are aware of breast cancer, they are often believe it to be a death sentence, and thus do not seek out services nor perform self-exams. This is putting many women at risk of not detecting a malignant mass in time. Risk is further exacerbated by a harsher living conditions - including extreme isolation, lack of power, lack of cell phone reception, lack of internet access and very poorly-funded health centers. Since we can’t go to every woman in the community individually, we should work with those who have access to them. This proved extremely effective for this project, as these small communities are very tight-knit and they are very willing to share this information. It is about helping each other, and the community by extension, survive.

When geographic barriers existed, we did what we could to meet women where it was more convenient. Sometimes at work!

 

We found that, in full Albanian tradition, many agreement and work is done over coffee. We had many informal discussions with our potential partners before each session to build trust and to understand and assuage any concerns they may have. This was also our way of doing a community assessment. They know their community best, and we were able to leverage that simply though chatting before our engagement. Now that my counterpart has all these contacts at his disposal, he can increase his capacity for additional engagements. 

From Albania Days to Scarlet Knights

30 days left in Albania. 30 days! Crazy! The full impact of this still hasn't hit me yet, but it does come in waves. With two grant projects closing this week I am feeling a sense of relief and accomplishment. As things wind down here in the land of the eagles, I am beginning to set my sights on the future. Speaking of which... Where AM I going? What will I be doing?

Well, I may not know the future (okay, I definitely DON'T know the future) but I do have some viable prospects. So what am I doing? After a brief stay in San Francisco with my parents, I am planning to begin the next stage of my life on the East Coast. Namely - New Jersey (aka "The Garden State"). I was actually born rather close-by on Long Island, New York, but my family moved to San Francisco when I was too young to remember anything about the place. Thus this will be my chance to really see what life is like out there. Having been a west-coaster most of my life (except for the last two years in Albania...) this will be an experience.

I have decided to accept a position with Rutgers University in the Global Health Program. Quite an exciting opportunity! I will be working with nursing students to incorporate global health perspectives into their existing curriculum. There are many components in this new position, and a few are still being developed, thus I will have more details on this later. Needless to say, I am relieved to be gainfully employed yet again and helping with such an innovative initiative. One of the great perks of this position will be that I get to live near my brother and his family. I will also not be too far from many other relatives.