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. 

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.

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! 

Cervical Cancer Awareness Training

Along with a few other Volunteers, I've been helping out with an ongoing collaboration between Peace Corps Volunteers and an NGO called PeaceCare that is aimed at improving cervical cancer prevention and treatment in Senegal.  

We've been coordinating trainings for local health workers intended to raise awareness and improve understanding of what cervical cancer is and what resources are available to prevent ant treat it if it develops. The training that happened in my village was lead by a trainer from the District Hospital and the local midwives. They gave a presentation and then lead discussions with Community Health Workers and Community Liaisons, or "Neighborhood Aunts" as they call them here. They talked about on anatomy, the basics of cancer and cervical cancer, testing, treatment and barriers to care, and then discussed ways to broach the topic with people in their neighborhoods. My role was to arrange all the things that make a meeting happen: announcements, renting a room and chairs, borrowing a projector, hiring someone to cook lunch, and handle things like reimbursement for transport. 

Despite the language barriers - the District trainer spoke only Wolof and French; most of the local women only spoke Pulaar - the women had really valuable, engaged conversations. The midwives and the head of the women's groups did a lot of translating, I drew some basic reproductive anatomy illustrations, and everyone was impressively attentive. Many of the local women aren't literate, but I noticed that several of them had carefully copied the anatomy drawing into the notebooks that had been handed out, which really made my day. I didn't talk much at all, but I learned some interesting vocabulary ("cervical cancer" was translated as "the sickness of the stomach of the mother of the baby") and as women got more comfortable they started telling stories and jokes, some of which I even understood. It was really heartening to see how many people showed up - traveling even short distances can be such a pain in rainy season - and very encouraging to see how interested and responsive people were to the issues being discussed.

And then, just after the training was all over and I was just beginning to get a little self-congratulatory about how well it had gone, several things happened in rapid succession. First, I realized that there was a hole in my pocket and the key to the rented room had fallen out at some point during the day and after quite a bit of hurried searching I had to accept that it was lost. Since there's no back-up key I promised to pay to have the locks changed and then set about cleaning up and returning the rented chairs to the other side of village, but because the car had already gone over to the market and we couldn't call it back because the cell phone network suddenly went out a helpful neighbor kid and I had to carry the chairs, stacked on our heads, up and down the ravine that now runs through the center of our village. On the last trip I slipped and scraped up my shin, ripping my pants and making my eyes tear up a little bit.

I still had to run around to collect all the receipts, grab my backpack from my hut, and say good-bye to my host family before heading off for several weeks (for project work and summit) and my ride back to Kédougou was getting impatient. Once they saw I was bleeding and upset, though, everyone was really, really nice about having to wait a few extra minutes.

So, now I'm in Kédougou working with a couple other PCVs to finish up prep work for the PeaceCare team's upcoming visit and things are going pretty well - lots of unexpected schedule changes, but that's par for the course here. As you can see from the photos, even after just a few days, my scrape is healing up quite nicely. I'm very pleased with my immune system.