Peace Corps Response: The Adventure Continues

In just five days I’ll be leaving West Africa, but I won’t be gone for long.

I've been offered and accepted a Peace Corps Response position with Save the Children, serving as a Health Program Specialist in Kankan, Guinea. It’s a nine-month assignment, starting in June, and I’ll be supporting the current Maternal and Child Health Integrated Program (MCHIP) that’s being funded by USAID and led by the non-governmental organization (NGO) Jphiego.

Home Sweet Soon-to-Be Home

MCHIP activities focus on strengthening family planning services, increasing local capacity for reproductive health services, and increasing the quality of care provided at the community level. As a Health Program Specialist, my main responsibilities will be to provide regular monthly updates on program activities in Guinea in English and French, to work with local staff to improve work plans and budgets, and to help coordinate the development of a Public Health and Nutrition Program. It will be a big change and a lot of responsibility, but I’m eager to work with Save the Children, to spend a bit more time in West Africa, and to eat avocados for breakfast every day. (Among other things, Guinea is renowned for having beautiful terrain, nightmarish roads and absolutely fabulous fruits and vegetables.) 

As excited as I am, there is a big opportunity cost – I was really looking forward to spending a summer in the Trinity Alps, to finally being around for weddings and birthdays, and to spending the holidays in California. Happily, I will have a long enough break to spend some quality time with friends and family, and the office where I'll work in Kankan is outfitted with electricity and a back-up generator  so it will be a lot easier to stay connected. Plus it will probably be all thrilling and novel just to be in an office, to have a desk and a chair and an internet connection. Who knows, maybe I'll even have running water at home. Fancytown! 

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.

Peer Support and All-Volunteer Conference

So far the month February has been a veritable festival of meetings. Things got started with a Peer Support Network (PSN) workshop preparation meeting, followed by a training of this year's new Peer Support Contacts (PSCs) and another meeting. New PSCs were oriented and trained, and outgoing PSCs lead workshops on dealing with issues frequently faced by Peace Corps Volunteers (PCVs) serving in Senegal. Topics ranged from basic coping skills to domestic violence to body image and it was great to hear about how Volunteers have helped each other in dealing with some really tough situations.

Peace Corps Senegal's Peer Support Network 

PSN fed right into our Close-of-Service (COS) conference, which overlapped with Work Zone Coordinator (WZC) presentations and meetings. Katie O. and I are the current WZCs and hopefully my replacement will also be interested in doing some coordinating once they get settled in. The PCVs in our area really like working on team projects (radio shows, world map murals, grafting trainings, etc) and it's nice to have someone who's centrally located (and has occasional access to electricity) to help out with getting things organized. In any case, I could be more pleased that Katie O. in taking over, the work zone ins in very good hands.

Work Zone Coordinators

All the WZC meetings lead into the Annual West African All-Volunteer Conference (All-Vol), where PCVs come from all over Senegal, the Gambia, Guinea, and Cameroon to present and discuss case studies, development in West Africa, and Peace Corps's work in the region. Usually Mali and Cape Verde would also send delegates, but the Cape Verde program was closed due to excessive fanciness (they're doing just fine without PCVs, apparently) and Mali is still in disarray. Ambassador Lewis Leukens came to speak about his work in the Foreign Service and the ongoing problems in Senegal's Casamance region. After his talk we chatted very briefly about U.S.A.I.D./Ambassador-supported community radio station in Salémata, which has proved to be both useful and extremely popular. (It turns out that PCV Marsha H. was taking pictures, which she kindly sent my way. I am not sure why I appear to be clapping. I am maybe applauding the success of the radio station?)

Chatting with Ambassador Leukens 

Current and former volunteers and gave presentations on a wide range of topics including malaria prevention, data collection, talibé support centers,  mercury harm-reduction projects for small-scale gold miners, and personal narratives reflecting on the many kinds of lessons that one learns while serving as a PCV. (My favorite quote from that session was "People will forget what you said. People will forget what you did. But people will never forget how you made them feel." - Maya Angelou)

During All-Vol my friend Marielle and I also opted to do oral language assessment interviews, which went much better than I'd anticipated. After too much instant coffee and over a week of nothing but English I was completely sure that my interviews would be a sweaty, semi-coherent slew of unconjugated verbs, but Djéba, my evaluator, was gracious and patient and I muddled on through. To my relief they placed me at the Superior level in French and Advanced- Low in Pular/Pula Fuuta, which isn't particularly spectacular but, hey, it gets the job done. 

To-Do

My training group and I had our Close-of-Service (COS) conference last week and I now I have an official COS date (May 1st, 2013!)  and a long list of things that I have to get done before then. With the latrine project wrapping up nicely I can turn my attention to helping run a Maternal & Child Health training, helping to facilitate another visit from the PeaceCare team, participating in the Kedougou Youth Leadership Camp, and handing off my various Peace Corps-related responsibilities.

The Maternal Health training was supposed to happen last November, but there were some... perturbations... during the whole grant-processing  procedure and things didn't quite pan out as planned, but the midwives and Health Center staff are enthusiastic and I'm hopeful that the training will happen in early March so that I won't have to pass it on to my replacement, who will be arriving in early May. I'm looking forward to PeaceCare's visit (cryotherapy training for local health professionals! How can you not be looking forward to that?) and of course, pretty much everyone knows how much I love camp, so that'll be great, too.

It's shaping up to be an exceptionally busy few weeks, but as hectic as it's shaping up to be, I am glad that I'll be busy.

I'm hoping that all the work will help keep me from dwelling on how sad I'll be to leave my host family and my friends here and from fretting about the somewhat intimidating prospect of returning to America. (So big! So expensive! So fancy! So many options for everything!) I'm definitely going to miss Mariama Kesso and her daughter Fatou (above - she's getting so big!). I will miss the kids (Sajou, Tijane, Mankaba, and Diabou, below left) who like to come by my hut in the afternoons (and some mornings, and most evenings) to color and practice counting and insist that I look at whatever they happen to be doing. I might miss Diabou (below right, with marker on her face) most of all. She was the last of the kids to warm up to me, she doesn't talk much, and one time she accidentally peed on my floor, but she's also funny and tenacious and always comes over to offer me peanuts and to help me sweep out my hut. She's a good little friend.

The Home Stretch

During my Pre-Service Training (PST) time crawled by so slowly, each day seeming longer and more sweltering than the one before. Twenty-seven months seemed to stretch off into infinity, a boggling amount of time. Now, a year and a half later, my Close-of-Service (COS) conference is coming up on the horizon and it feels like the earth has sped up; the weeks are just flying by. It isn't really a surprise (pretty much everyone I talked to about Peace Corps mentioned this phenomenon) but it's still somehow slightly shocking, like when a good friend's baby is suddenly starting kindergarten.

It make sense that this happens; at first everything, even the most innocuous small-talk, was a struggle and daily life was both exhausting and filled with huge blocks of unoccupied hours. I'm busy now, with work projects and to-do lists and mundane chores and Peace Corps responsibilities and social calls and vacation ideas, and even though I have so many more things I want to do while I'm here it's starting to feel like COS-ing is just around the corner. It's not bad, it's mostly pleasant to be busy, it's just a little strange to be most of the way through a thing that once seemed like it was going to last such a long time. Now that I really feel at home here it's time to start thinking about going home there. Funny how that works. 

Laare

Mango season is long over now, but there's been plenty of laare around for the past few weeks. Laare ("la-ray") is the Pular word for a super-sour fruit that grows on trees out in the bush. Most people like to mix it with sugar (which tastes kind of like SweetTarts candy), some mix in powdered milk (going for a CreamSicle-type thing I guess), some like to add salt (which tastes like something out of a tidepool) and little kids just eat it as is. 

I picked up a laare fruit at the weekly lumo market a couple weeks ago. It cost 25 CFA, or about 5 cents USD, and I bought a little 100 CFA sachet of sugar to go with it. 

I brought it back to my hut and cut it open. It isn't very hard to cut through; the skin is soft but the inside lining is a bit tough. At first it looks like it's a two-lobed fruit, but it's really just a bunch of pulp-covered seed packed in together.

 The part that you eat, the pulp, is slightly sweet and very tart. The longer you suck on a little seed-let (that's how I think of them, there may actually be a word for them) the more intensely our they become.

 The ridiculous sourness is why most people like to add sugar. I really don't get the salt thing, but to each their own.

 I ate some of the laare, spitting the seeds outside, and then gave the rest to few of my host brothers who were hanging out under the corossol tree near my host mom Mariama's hut. I think eating too much laare would give me a bit of a stomachache and also it's funny to watch the puckered, scrunched-up faces that the littler kids make while eating very sour things.

This reminds me of the monkey-brains
 in Indiana Jones.

Mid-Service

I was just up in Dakar for my mid-service medical appointments. About a year into service PCVs are supposed to come up to Med to have a check up with a doctor, a cleaning and x-rays at the dentist, and a tuberculosis test. Depending on what the PCV needs they'll also do a Pap smear, HIV and STI tests, MIF (stool sample) kit analysis, and tests for various parasite problems, such as schistosomiasis, a sort of snail-worm infection. Schisto, as we like to call it, is a neglected tropical disease (NTDs; they're horrible but fascinating) and is very common in my region. 

My check-up was pretty brief and boring; other than strep throat, switching off Mephaquin, a few relatively minor bouts of diarrhea and vomiting, I haven't really had any significant medical problems so far. (Knock on wood.) My schisto results haven't come back yet, but I don't have any cavities or tooth-problems (yay!) and my TB-exposure test was as negative as they come. The dental cleaning is a little odd, mostly because the dentist (a cheerful older Moroccan man) doesn't do things like give you a free travel-sized tube of toothpaste or provide a lead apron during x-rays. In fact, he takes the x-rays while standing next to you, sometimes whole holding the little square of film in place against your teeth with his own hand. He also develops the x-ray films right there, rinsing the chemicals off right into his little lab sink. It's how I imagine American dentists did in the olden days when it was totally okay to use fluoroscopes for fun and have women hand-number clock faces with radium paint.

In any case, it was interesting and good to get all checked out. And totally bizarre that I'm already more than halfway through my service. How is it June 2012 already?

Demystification & Installation

During Pre-Service Training (PST) the Peace Corps Trainees (PCTs) get to go on a Volunteer Visit (VV) to see the villages where they'll be living and serving for two years. Every region (and even every site) is very different, and it's really good to get a basic idea of what it's like there. Is there a water spigot or will you be hauling water from a well across town? Are there mango trees or just thorn bushes? Does the village have a baker and boutiques or nothing at all in the way of places to buy snacks? The PCT gets to sort of shadow a current Peace Corps Volunteer (PCV) for a few days, and hopefully that helps demystify the whole life-in-village thing a little bit.

I took PCT Katie O. out to her village, and it went really, really well. She'll be the first volunteer ever to serve in her village, and people seemed genuinely excited and really, really, really nice. They fed us wonderful food, (fonio! chicken and sauce!) showed us around town, and were just generally really hospitable. There's a baker, some boutiques, a bean sandwich lady, lovely community gardens, a couple good hand-pump forages for water, and her hut and latrine were mostly finished.

Katie (the PCT) and myself

Getting ready to bike the rest of the way in 

Yesterday, accompanied by Mamadou Diaw (basically the boss for Health PCVs in Senegal), we went back to install Katie in her village. The traditional village chief gave a welcome speech; the head nurse from the Health Post gave a welcome speech; Mamadou gave a speech about Peace Corps, likening a PCV to a knife, which cannot cut by itself, urging the community to be patient with language, and thanking them for their overwhelming hospitality. Her hut and latrine were all ready to go, her family had built her a little fenced in garden, and the entire community had prepared a huge arrival party in her honor. Dioula ("joo-la"), her sister and village namesake, had had matching complet outfits made, they gave her earrings and a necklace, the school children had prepared a song-and-dance in her honor, and the griot musicians and the older women all sang and danced -- it was an amazing party, above and beyond what most villages put together, and it was completely heartwarming. 

Katie (the PCV!) and her tokora

I tried to stay in the background, taking photos and greeting as many people as possible, playing the photographer and mostly taking pictures with her camera. After the first round of singing and dancing there was a parade through the village, which was funny because there was next to no one to to see the parade, since everyone was in the parade, but it was fun. 

Parade through the village of Dakateli

After all that the party continued, but they pulled us aside to feed us lunch. We were presented with the biggest bowl of rice I've ever seen, and a small vat of rich, wonderful sauce with two entire chickens chopped up in it. It was all very reassuring -- when a community invests this much time, effort, energy in making the PCV feel welcome, included, and well cared for it bodes well for everyone. Not that it isn't exhausting and overwhelming or that village life won't be incredibly challenging in many ways, but it's a very good start.

Dancing and singing for the new arrival

World Malaria Day

So. Malaria. Basically, a person gets malaria from the bite of a mosquito infected with Plasmodium parasites. The parasites get into the bloodstream, mess up the red blood cells, and start making the person all feverish and then really, really sick. If another uninfected mosquito bites that sick person then that mosquito becomes infected and can pass on  Plasmodium parasites to the next person it bites. 

Image thanks to iayork.com

Only female Anopheles mosquitoes can infect humans with the Plasmodium parasites that cause malaria. (Italics because it's the Latin name,not because I'm trying to be extra emphatic.) There are different strains of Plasmodium parasites, some more dangerous than others, and here in Senegal we have mostly Plasmodium falciparum, which is pretty much the worst kind. You can avoid getting malaria by taking prophylactic medications like doxycycline, mephloquine (Lariam), or atovaquone (Malarone). If, for whatever reason, these medications aren't an option you can reduce your chances of getting malaria by using insect repellent, sleeping under a bed net, and getting rid of standing water and other mosquito breeding grounds. 

If you do get malaria there are effective, affordable treatments available, even in places with  chloroquine-resistant malaria, like Senegal. Our Health Center is usually well-stocked with government- and NGO-subsidized Malaria Rapid Tests and Coartem medication packs, especially during rainy season, when most malaria cases happen. Here are photos of the Coartem for adults that Peace Corps gave me (but which I will hopefully never need because I'm good about taking my prophylaxis) and also of a pack of Coartem for children that's available at the Health Center. 

This past Wednesday was World Malaria Day, and people all around the world did activities and held events to acknowledge the damage caused by malaria and to raise awareness of how to prevent malaria. In Salémata, my village, Wednesday was also when our Health Center has its monthly vaccination and growth monitoring activities. We didn't do anything huge because it was already a pretty busy day, but we did have an informal causerie discussion with the mothers who had brought their babies to be weighed and vaccinated and who were just hanging out, waiting for the nurse to call them up. Adama Dioulde Diallo, one of the women who does community outreach  Salémata, used  my little set of info cards to give little presentations on how to properly use and care for Long-Lasting Insecticide-Treated Nets (LLINs) and we talked about setting up a bednet care-and-repair activity sometime soon.  

Adama Dioulde Diallo

If you like maps and are interested in learning a little more about malaria, please check out the CDC's fantastic Interactive Malaria Map. It's neat.