World Malaria Day!

The World Health Organization explains that "Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected Anopheles mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells. Symptoms of malaria include fever, headache, and vomiting, and usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs." Malaria is particularly lethal small children and pregnant women, and while there isn't a vaccine there are extremely effective treatments available, and people can avoid mosquito bites by using insect repellent and sleeping under Long-Lasting Insecticide-treated Nets (LLINs). 

Malaria is an enormous problem in Senegal, and, unfortunately, the region of Kédougou has some of the highest malaria rates around. Thanks to Universal Coverage programs and increased access to Rapid Diagnostic Tests (RDTs), many more people are sleeping under LLINs (at least during rainy season) to avoid malaria and getting effective treatment if they are infected. There are PCVs doing amazing malaria eradication work across Senegal, and you can click here to read the fantastic post that my friend Annē wrote about an ongoing anti-malaria project in the Kédougou region.

Diamé and I in 2012

Like many, many people I know, my little host sister Diamé came down with malaria last year. Thankfully, my host family lives within walking distance of a health structure, understands the importance of early treatment, and has the means to pay the small consultation fee to see the nurse to get malaria medication, which is free. It's never fun to see a sick kid, but as far as children-with-malaria-scenarios go, Diamé's played out pretty ideally - in the evening Diamé's mom saw she was listless and feverish, the next morning she took her in for an RDT, came home with a pack of Coartem (the locally available brand of malaria medication) and before long Diamé was back to normal. All too often, people put off seeking treatment, and by the time they get to a health structure they're so sick that they need more intravenous medication and fluids, which are expensive and can require hospitalization. 

Early treatment is great, but prevention is even better, and I'm really hopeful that this year Diamé won't get malaria at all. In addition to upcoming Universal Coverage follow-up bed-net distributions, there are plans to a implement seasonal malaria chemoprevention (preemptive treatment) program for all children under the age of 10 living in high transmission zones. It's an ambitious approach, but it has the potential to have a truly enormous impact on malaria in Kédougou. 

I don't want these kids to get malaria. 

I'm excited about seasonal malaria chemoprevention because it's a way to help break the cycle of malaria transmission  Anopheles mosquitoes become infected with Plasmodium when they bite a person who is carrying the malaria parasite; the mosquito becomes infected and then passes the parasite on to the next person it bites. If kids are on chemoprevention it means that they'll be protected from malaria, and they'll also avoid being carriers, which will help to reduce transmission rates and protect the entire community. Additionally, as someone who's been on preventative malaria medication of one kind or another for the last two years, it's really good to know that my little host brothers and sisters will be given a chance to benefit from the same kind of protection that I had during my service. They deserve at least that much. 

If you'd like to know more about malaria and the work that's being done to eradicate it, please take a look at Stomp Out Malaria, or check out what the CDC or the Bill & Melinda Gates Foundation have to say about the fight against malaria. 

Costa Rica comes to Senegal

Nisha finished Peace Corps in Costa Rica and then came to visit her sister/my friend Emily in Dakar for a few weeks. While she was in country she caught a ride down to Kédougou and I had the pleasure of showing her around Salémata. The ride out was dusty and slow, but we made it, and after a crash course in Pulaar greetings I put her to work painting names on bowls for my host moms. 

We spent a lot of time comparing Peace Corps service in Costa Rica and Senegal, and there were a striking number of similarities. For instance, the roads are terrible, public transport is difficult, host families can be wonderful, acronyms abound, and you eat the same thing every day.

Candid under the mango tree

We spent some quality time with my host family, took the obligatory snapshot in front of the absurd castle that a creepy French man built, had much with my friend Maimouna, and threw rocks at trees in a middling attempt to knock down a few mangoes. 

Having just done her own Close-of-Service, she was really understanding of the miscellaneous loose ends I had to wrap up and gamely hung around during my last work-related meeting. I'd asked my host father to call the meeting so that I could thank everyone who'd participated in the latrine project, solicit feedback and suggestions, and distribute the bars of soap and plastic screening that I'd purchased with the last bit of the project money. (The plastic screening was to replace the metal screening on the ventilation pipes, which already seemed to be rusting on some of the latrines; the soap was a last plug for hand-washing and a token of thanks for all their hard work.) It also gave me a chance to start my good-byes, explain how I would be replaced by another volunteer, and talk about what an honor it's been to spend these last two years with the people of Salémata.

The next morning we day-hiked out to Ethiolo, a nearby Bassari village, and walked around, greeting people, stopping in at the Health Post, and hanging out with RPCV Tatiana's former host family. They invited us to stay for lunch, and then we stayed for tea, and then we stayed to sample some of the local palm wine. Nisha scored big points by offering a giant cup of palm wine to two older ladies on the compound, and then we headed back to Salémata to check out the market.

It was a Tuesday, and Tuesday is Salémata's market day. Everyone comes out for the market, and we ran into all of my host moms, including Mariama, who was selling vegetables and palm oil. 

I feel like Nisha got a really good sampler of all of the things that I do while in village. It was really fun to have her around, she was up for eating out of a communal bowl and carrying water on her head, and really nice to have PCV there for all the acronym talk about COS forms and DOS reports and SPA grants and getting NCI and being an RPCV. There was downtime, day-hikes, work stuff, market day, lunches with friends, and little kids piling in to my hut to ask for photos and band-aids.  

Sajou Ba gets a band-aid for a small scrape on his head. 

Afterwards, I realized that taking her on a tour of all my favorite parts of my life in Salémata was also a really wonderful way for me to revisit the things and people that defined and enriched my Peace Corps service. It was lovely to take some time to really just enjoy being in Salémata before beginning the bittersweet process of saying my final good-byes and I'm so glad that her visit gave me an occasion to do so.

Chalk It Up

The wall of the Kedougou Regional House's kitchen hut features a large calendar, painted with blackboard paint and outlined in white house paint. Every month someone wipes it down and chalks in all the important upcoming events - birthdays, trainings, vacation dates, and holidays real and imagined. 

The House Calendar for April 2013

I like to do the calendar, and this is my last one, so I tried to make it count.

A few notes: COS = Close of Service, when people leave; VV = Volunteer Visit, when the new arrivals come to check out their sites; UAG = Urban Agriculture; AgFo = Agroforestry; True American Rainbow Party = We've been watching too many New Girl episodes lately.

Cryo Comes to Kedougou

I've posted about cervical cancer and Peace Corps' partnership with PeaceCare, a Chicago-based non-governmental organization, several times over the last couple years. It's been a productive and really interesting collaboration, and if you like you're welcome to read (or maybe re-read) about it here and and here and and here, too.

Over the last few visits Peace Corps Volunteers (currently myself, Marielle, Annē and Chip) worked with the PeaceCare team to increase awareness and understanding of cervical cancer, identify and collaborate with Senegalese cervical cancer specialists, and train local midwives and doctors to perform Visual Inspection with Acetic acid (VIA) to identify pre-cancerous lesions on the cervix. Acetic acid is just vinegar, and pre-cancerous cells are acidophilic, so they soak up acidic things and change color, making them easy to identify visually.

Chip with pause cafe snacks

Marielle with the cryo tank and gun

Once a pre-cancerous lesion has been diagnosed it can be treated with cryotherapy (using special equipment to freeze the lesion) to prevent it from becoming cancerous. This time around the team's goal was to get cryotherapy equipment up and running and to train several local health workers how and when to use it to treat patients. The trainees (one doctor and two midwives) did really well with the theory and practice on models, and were able to observe and practice a couple actual cryotherapy treatments.

Cryo tank and gun

Tracy, the PeaceCare team's fantastic
OB-Gyn, leading a training session

Unfortunately, there weren't enough women who came in with pre-cancerous lesions to allow the trainees to practice using the equipment an adequate number of times be certified as qualified cryotherapy treatment providers during the team's visit. Fortunately, a gynecologist who does cryotherapy in Tamba agreed to host at least one of the trainees and supervise the cryotherapy sessions until they have had enough practice to be officially certified, which is fantastic.  The treatment basically involves putting a special tip on the cryo gun and applying the tip to the cervix for a three-minute freezing cycle, removing it for a five-minute thaw cycle, and then repeating the process once. It's neither painful nor technically difficult, doesn't require electricity or a sterile operating room, and it's quite effective at destroying abnormal cells.

As great as cryotherapy is, the trip, as PCV Patrick Hair would say, "wasn't all Skittles." There were delays and stomach rumblings and scheduling debacles, but the team persevered and made a lot of progress. For me, the most significant moment came at the end of the last day of the cryotherapy training, when a woman who had been diagnosed with a pre-cancerous lesion during a screening in December 2012 came in and asked to be seen.

The trainee team (midwives Oulli and Diouma, and Dr Kabou) counselled her, explaining that they would re-check the VIA results and went over the benefits and risks of cryotherapy, and she consented enthusiastically. (I was in the room to translate for Tracy, who was guiding and supervising the midwives.) They told the patient that it might be a little uncomfortable and she replied the she didn't care if it hurt a lot if it got rid of the illness. Everything went smoothly, and during the treatment procedure the patient said it felt cold and slightly uncomfortable but not painful.

Immediately after the procedure after she was up and about and really, really, really pleased. In rapid  Pulaar (I was totally proud of myself for keeping up) she thanked the team profusely and explained that when she got diagnosed with an illness she had been very worried. She said that hospital stays are expensive, the nearest gynecologist is far away in Tamba, and if you don't have your health you don't have anything. She had completed secondary school and she understood the importance of health, that it's everything and you must care for it. She said it is so terrible to be told that you have an illness in your body, but that she was so happy that the team came to Kedougou and she was able to get treated. She thanked the trainees, Tracy, and myself, again and again, and then left, waving and smiling to the rest of the team on her way out of the hospital.

Her happiness and gratitude was both irrepressible and contagious, and everyone - the trainees, the PeaceCare team, the PCVs - ended the day and the Kedougou training on a wonderfully high note. 

Laundry

During the first year of my service I washed all my own laundry in plastic tubs (baignoires, as we call them here) with a washboard and soap packets. I washed socks, shirts, towels, everything, and I was passably competent (everything came out smelling fine at least) but never really became a stellar washing-lady or anything. There's nothing particularly awful about pulling water, carrying water, mashing the clothes around, and wringing them out, but there's nothing particularly great about it, either. 

The laundry area at the Regional House

I like hanging things out to dry, though. At the Regional House we have lines set up; in village people just drape clothes over fences or wherever and I have a couple little lines running over my latrine enclosure behind my hut so that I can discreetly dry my underthings. Drying laundry in the hot season is like magic - things seems to insta-dry. In the rainy season it's more of an exercise in futility, just an un-fun game where you hope the sun comes out long enough to get rid of the dampness before mildew starts to set in.

Laundry lines at the Regional House

Nowadays my laundry mostly gets done in village and it's my host sister Mariama Kesso who does the bulk of the washing. The first time I gave her my clothes to wash they came back so clean that they were an entirely different color (they had all been slightly orange, from the dust) and I gave up trying to wash things myself. I still launder my own underwear and things but she takes my pants, shirts, and sheets and washes them on Sundays, when she does her own washing. She does a better job than I ever did and is happy to earn a few extra mille every month, so it's a win-win situation. 

Americans in Saraya

It's been a busy month over here in Senegal. PCVs Marielle, Annē and I spent the last few weeks prepping for and then facilitating a visit from a team of Americans from the NGO peacecare. (Honestly, Marielle did the lion’s share of the leg- and paperwork, but we all pitched in to run preparatory trainings and take care of loose ends.) The team came to work on an ongoing cervical cancer screening and treatment project, and having them here was a great experience, we had a good time and I learned quite a bit. I would write more about peacecare and the work we’ve been doing with them, but I’ve already done so, here and here and here.

Cervical cancer screening and prevention is an interesting and worthy project, one that’s very valuable both for the local Senegalese communities and for the visiting American medical students and residents who are able to spend a little time working with Senegalese health professionals and seeing how the provision of health care is carried out in another part of the world. It was really nice to see Andrew again, and great to meet Gabi, Katie, Angel and Charles. Another peacecare team is scheduled to come to Kédougou in February of 2013, to lead cryotherapy (freezing of pre-cancerous lesions) treatment trainings for local health professionals, and we’re already looking forward it. 

And now, in somewhat scrambled order (it's hard to drag lots of photos around in Blogger sometimes), are photos of some of the highlights of the October 2012 peacecare trip.

Marielle and I walking; kids playing with red rubber balls during a screening day in a gold mining village; Charles (one of the visiting residents taking an out-the-window snapshot of the Kédougou mosque.

The whole team posing after a meeting with the top Kédougou Medical Officials; someone giving me Skittles; Patrick Linn greeting the Saraya village chief as he gave out Senegalese names to the newcomers.

Me translating for Charles while Madame Diop looked on; Mariama (who's favorite joke is that she's Canadian)and I talking shop; Marielle leading a stroll out to the fields around Saraya.

Annē and Patrick's host siblings; their brother making tea on their host family's compound; the kids leading us out to visit the peanut fields.

Crossing a stream on our way to the fields; Angel (one of the visiting residents) came thisclose to sticking the landing. 

Walking among the peanuts; loading into one of the hospital trucks to go out for a screening day.

Sitting through a meeting; eating ceeb u jen (fish and rice) and maafe tiga (peanut sauce) for lunch; some boutiques in the Kédougou market.

A "Tata" car in Kédougou; Fatou and I having similar thoughts during a meeting.

The Americans giving us wonderful, thoughtful, delicious treats; Andrew reliving the delight of being given fancy American snacks in Africa.

Fatou (the main screening trainer) and I jumping rope. It was a short little kids rope. She was better.

Charles and his fan club; the most amazing little kid just chowing down on some rice.

Rocks waiting to be crushed into dust (and boiled with mercury to separate out the gold); fancy fancy ceeb u yap (rice with meat).

On the path from the peanut fields; Sajou, in her fields with the Saraya Health PCVs.

Annē and the speculums on a screening day; Charles smashing an unripe baobab pod to see what was inside. (It was unripe baobab stuff.)

Annē/Sajou, LaRocha/Adama, Charles/Ibrahima, and Angel/Mariama - screening team extraordinaire!