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. 

Name That Rash!!

As many people know, Peace Corps Volunteers love to describe in unsolicited detail all the positively revolting things that have gone into (and come out of) their stomachs, burrowed into their feet, or raised nasty welts across their torsos. I, alas, am no exception. 

So, a couple months ago I started getting this rash on my right knee. It wasn't particularly terrible-looking, but it was unbearably itchy, oddly hard, and started to flare up angrily in bright red swaths around both knees and across my lower back. I talked to Med, sent in some photos, applied hydrocortizone cream, and things improved. This was right when the nail of my big toe was threatening to become painfully ingrown, but after a few weeks of no closed-toed shoes (which I only wear for jogging) and soaking my foot every day my toe was fine and I went back to my normal routine, toes intact and rash-free. For a few days, anyway. 

To: Med Re: Recurrent Mild Knee-Rash

And then the rash came back with an irritating vengeance. I happened to be on my way up to the Thiès Training Center where two Peace Corps Medical Officers were kind enough to spend twenty minutes looking at my knees, running their fingers over the rashy parts, and deducing the cause of my discomfort. They immediately decided it was contact allergy, and guessed that it was caused by some sort of fabric that, combined with rainy season, my skin finds intolerable. We talked about my clothes, they asked about this and that and if I have any knee-length synthetic pants, maybe ones with seams around my knee and across my back. 

And then I realized - my running pants. My stretchy, frayed-at-the-synthetic-seams, capri-style running pants. The rash went away when I stopped jogging because of my toe. I am allergic to my pants. Problem solved. They gave me some strong anti-itch cream and, only a few days later, the rash has almost entirely disappeared. 

On a related note, while looking through my photos to find this picture I realized that I have an entire album's-worth of photos of rashes, stings, blisters, infections, and swollen lumps, taken by myself and  my fellow Kédougou PCVs and e-mailed to Med in the hopes that they can diagnose us from afar and spare us the long slog up to the Med Office in Dakar. Of course, I thought "Wouldn't it be funny if we all sent these photos in to the PC/Senegal Volunteer Newsletter? They could have a little matching-game-thing in the next issue, where people guess who was afflicted by what. Name That Rash!! Hilarious!" 

My suggestion went over pretty well with the Newsletter editorial staff; it might actually happen. 

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?

Baby Party

At the end of every month there is a Growth Monitoring (AKA Baby-Weighing) and Vaccination Day at the Salémata Health Center, and it is pretty much my favorite thing in village. It wasn't that way at first, though. The first few times I helped out the whole thing was so hectic (between 30 and 60 women usually show up with their children) and confusing that it really wasn't very enjoyable. I didn't understand the register system or how to fill out the Health Booklets, the babies' names all sounded like gibberish, the mix of Pulaar and French was disorienting, and there didn't seem to be an established order for who got to go first.  Over time I learned how the registers work, got to know people's names, and became comfortable enough to make start making little changes to help things run more smoothly, like carring over tables so that we weren't filling out the registers and booklets on our knees.

Overall, though, it was really heartening to see how much people in Salémata care about vaccinating their babies and making sure that their kids aren't underweight. The chaotic as they can be, Baby-Weighing Days are very well established and the Health Center staff are committed making sure they happen every month. When moderately malnourished (Yellow Zone) children do turn up (which they inevitably do) a midwife or relais consults with them, and helps provided largely by WorldVision, UNICEF, Catholic Relief Services (CRS) and the local Health Committee. If a child is severely malnourished (Red Zone) then they're admitted into the Health Center for therapeutic feeding. 

Here are the relais community health workers in charge of baby-weighing, as well as my host sister Mariama having her daughter weighed. (She was totally in the Green Zone.) 

Basically my role is to enter everything into the Health Center's registers, fill out new Health Booklets,  try to make sure things are moving along, and to smile and greet everyone. The staff has (somewhat) jokingly referred to me as the secretary on more than one occasion, which is fine by me. The Health Center already has local health workers who give shots and put toddlers on the scale and so I'm most useful when I make myself busy making things more organized and less hectic.

Here a visiting German gap-year student who stayed at the Catholic Mission for a couple months came to help out, and my friend (and same-name tokora) Adama took a photo of me holding a stack of Health Booklets.

Vaccinations Winding Down for the Day

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. 

Cervical Cancer and PeaceCare

So. Peace Corps is a federal agency of the United States' government. PeaceCare is a cleverly, if somewhat confusingly, named non-governmental organization (NGO) that works with American universities, current Peace Corps Volunteers, and local communities to set up collaborative, sustainable development projects. The project that they're working on in Senegal is focused on cervical cancer prevention through screening and treatment of pre-cancerous lesions. The focus of the project was chosen by Senegalese health care workers and community members; many people here have a friend or family member who died of cervical cancer because it wasn't detected until very, very late. Cervical cancer is a major cause of  morbidity and mortality around the world, particularly in places where Pap smears and the HPV vaccine (which is a good vaccine and boys and girls lucky enough to be living in places with advanced health care systems should all get) are not available, and I think it's a really good project. 

Map of Deaths from Cervical Cancer

Last year a team of American doctors came to Kédougou and trained a team of Senegalese health care workers to perform the Visual Inspection with Acetic Acid (VIA) procedure to screen for pre-cancerous lesions and to train others to perform VIA as well. Peace Corps Volunteers did a lot of the prep work, ran focus groups, planned logistics, and facilitated the trainings. The next steps will be to screen enough women to get accurate information about the prevalence of cervical cancer in Kédougou and to train local health care providers in cryotherapy to treat pre-cancerous lesions before they develop into cervical cancer. 

Now, another team of Americans is here to lead refresher courses, observe screening days, start discussing cryotherapy, and learn about health care systems in developing countries. Here are a few photos of the refresher course lead by Senegalese trainers at the Kédougou Regional Hospital: