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. 

Meningitis Vaccination Time

There was a national campaign to vaccinate vulnerable populations against meningitis A  this month in Senegal and I was able to go out with teams on several of the vaccination days. It was almost exactly like the Yellow Fever Vaccination Campaign that happened earlier this year, which went really well. I like participating' it's interesting to see how it all rolls out, it's great to get out into the bush and see new villages, and it's reassuring that big vaccination campaigns like this happen on a regular basis. 

I'm not a nurse or doctor or even an EMT, so pretty much all I did was fill out the little pink proof-of-vaccination cards. The Health Center staff knows that PCVs can write quickly and are generally pretty efficient when it comes to things like setting up a vaccination site and making sure everything proceeds in a relatively orderly fashion, so on all the days that I went out with vaccination teams that was what I did. We filled out hundreds and hundreds of little cards (location, name, age, date, vaccine lot number, expiration date, closest health structure), made our best guess when it came to a lot of the ages, and ran through a little spiel about meningitis more times than I can remember.  

There are always challenges - the vaccine must be kept cold, things tend to run late, some people are afraid of needles, it's hard to fuel up the trucks when the nearest gas station is 50 miles away, there are stock shortages, people are speaking Wolof and French and Puular and Malinke and Jahonke and Bassari all at once - but the health workers do am impressive job of keeping it all together.

Ndiaye, the nurse who was our team leader, is an extremely calm and professional person, and the Red Cross Youth volunteers were helpful. Overall it was a great vaccination campaign and it's nice to know that the vaccine lasts 10 years.

Vaccination Time!

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!