Maternal and Child Health Training: The Last of the Work Stuff

In March the maternal and child health training for "Neighborhood Aunts"that we've been trying to get off the ground for months actually happened, and despite some communications difficulties (the cell phone network went down for a week and a half) it went really well. “Neighborhood Aunts” are women who have been selected by their villages to serve as point people for disseminating important health information and encouraging healthy behaviors. Because they live and work in the community they are ideally placed to serve as health resources and can encourage healthy behaviors, such as attending pre-natal visits and seeking early treatment for malaria. 

For the most part, the midwives would lead a discussion or lecture, and then the women would break into small groups to practice leading health talks and having conversations about a given topic. Then, one by one, they would practice leading a health talk with the whole group, and the midwives would add or correct things as needed. The training was based on the "Neighborhood Aunt" curriculum laid out by the Senegalese Ministry of Health, and the schedule went like this:

Day One

·        Orientation and discussion of roles

·        The importance of advocating for ante-natal care

·        Pre-natal visits, attended births, post-natal visits, and miscarriage

·        Family planning and reproductive health

Day Two

·        The importance of advocating for child health (0-5 Years)

·        Vaccinations, seeking early treatment for illness and injuries

·        Community mobilization methods, implicating community leaders

·        Creating and managing community health funds

           

Day Three

·        Planning, implementation, following up, and reporting activities

·        The importance of the "Neighborhood Aunt"

·        Evaluation and distribution of monthly activity reporting forms

·        Review and closure

There were also group discussion about why maternal health is important, and the participating women spoke frankly and passionately about how women are often undervalued or seen as replaceable, and how that needs to change. They had the chance to ask all sorts of questions, talk about the reasons that people in their communities wait until the last minute to seek medical care, to discuss why some people are opposed to family planning, and to reaffirm the importance of having "Neighborhood Aunts" in a village.

The Community Center where the training was held is also where local youth can take vocational courses for trades like tailoring and catering, so the lunch and coffee break prep for our training also served as a practicum for a group of catering students. It was really fun to hang out during lunch and coffee breaks, both because the people serving the food were intent on showing off their skills and because all of the women were so obviously delighted at being served a fancy lunch that they didn't have to make from scratch themselves. I think it made them feel important, which made the training feel more important, too.

Once the chairs were rented, the radio announcements made, and the lunches all paid for, my main role was just to sit in the back of the room, taking pictures, occasionally holding fussy babies, and nodding approvingly whenever anyone looked over at me. About half the participants came from other villages, took three whole days out their lives, to attend the training, and it was great to see most of them really enjoying the training, asking good questions and taking their role very seriously. Best of all, the midwives were really pleased, and after the training wrapped up they talked and talked about how to best implicate the newly-qualified "Neighborhood Aunts" in their attended birth and pre-natal visit promotion activities. 

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. 

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

Post-Elections

So, after a lovely vacation, some time at the office in Dakar, and a visit to Thies to meet the new group of Health Volunteers (who seem really great) during their Pre-Service Training, I'm finally back in Kedougou. It's been a busy month so I have a bit of catch-up to do, and it seems like the best place to start is with the elections, which are totally over now.

There was some unrest in parts of the bigger cities during the first campaign period, so everyone was a little nervous about how things would play out, but much to our relief the first round of elections in February went very, very smoothly. The now-former president, Abdoulaye Wade, had rigged things so that he could run for a third six-year term (which is completely unconstitutional) and many people were understandably upset by this. The first round of elections narrowed the field down to two candidates, Wade and Macky Sall, for the second runoff election in March. The BBC covered the Senegal elections, the election run-off, and the April 2nd swearing-in of President Macky Sall. It's been an interesting time for Senegal, and I'm really glad that the elections went smoothly. Guinea's troubled transition to civilian rule in 2010 and last month's coup in Mali really make me appreciate how valuable - and difficult - it can be to hang on to stability and peaceful political transitions.

Supporters of President Macky Sall

Newbies!

In Peace Corps/Senegal trainees (or stagières, if you want to get all French about it) arrive and are trained according to their sectors, and there are three Pre-Service Training (PST) groups each year. The Preventative Health Education (HE) and the Environmental Education (EE) people train together, the Small Enterprise Development (SED) and Eco-Tourism (Eco T) people train together, and all the Agriculture (Ag) people  - Sustainable (Sus Ag), Urban (Urban Ag), and Agro-Forestry (Ag Fo) - train together.

I arrived, along with the rest of my HE/EE stage, as a Peace Corps Trainee (PCT) in March 2011, and was officially upgraded to Peace Corps Volunteer (PCV) status at our Swear-In ceremony in May.  Since then, one stage of new SED/Eco T volunteers has sworn in, but none of them were assigned to come down to Kédougou, so within our own region the rest my stage and I were still the newest people. That is, until the arrival of the new Ag PCTs. Over the weekend seven new Ag trainees came down to Kédougou for Volunteer Visits, or demyst, from “demystification,” when the trainees get to visit the sites where they’ll be living as volunteers, see current PCVs working, using public transport, going to the market, and so on. The PCTs are down here for a few days and then they go back up to Thiès to finish PST, and then after they swear in they’ll come back as PCVs to install at their sites.

We’re getting two new volunteers near Salémata, where I live. I’m sad to see the old PVCs go, but I’m also really stoked about the new kids (one of whom is actually older than me) because they seem pretty awesome.

For demysts in Kédougou it’s tradition that the current PCVs cook a big dinner for the visiting PCTs, and even though we were almost out of gaz (propane, I think) for the stove it all came together pretty well. We made Mexican-ish food: salsa fresca, cabbage salad (Kédougou been out of lettuce for a couple months now), a cauldron of beans, some fajita-style meat and onions, and we even splurged on some hyper-expensive cheese (pseudo-emmental, the only kind available) to grate up and sprinkle on top. My favorite part was the giant batch of tortillas that Lili, our good friend from the Jane Goodall Institute/Spain made. Delicious.

The PCTs arriving for demyst made everyone in my stage realize that we’re not the new kids anymore. We found ourselves wondering if just a few months ago we looked so clean (we did) and so eager (we did) and so mildly disoriented (we did) - it’s a funny feeling, meeting what basically amounts to a version of yourself from the very recent past. In any case, I’m really happy with the new Salémata volunteers! If all goes well they should be installing in early November, right before Tabaski. 

Work Stuff: Training on Cervical Cancer Screening

I saw this recent New York Times article about a cervical cancer screening program in Thailand, and it just so happens that this week I'm sitting in on a week-long training program that teaches local nurses, midwives, and health workers to screen women for cervical cancer. The ten trainees came in to Kédougou from surrounding towns and villages, including Salémata, my village, and are spending the week learning about cervical cancer issues.

The Kédougou training program, run by Kédougou Regional Hospital staff, and supported by Peace Corps Volunteers and Peace Care, is pretty comprehensive. There are sessions on cancer in general, anatomy, risk factors for cervical cancer, how to recognize pre-cancerous growths, available treatments, and how all of this applies to people living and working in Senegal.

The schedule for this week's training

For many reasons, including lack of education and resources, cervical cancer has a disproportional impact on people living in certain parts of world. (The United States isn't in the dark red zone, but we're not in the white, either.)

From the WHO's cervical cancer guidebook

If you're interested, do take a look at "Comprehensive cervical cancer control: A guide to essential practice," provided by the WHO.

Also, my own little PSA: As you prob'ly already know, human papillomavirus (HPV) causes all sort of problems, including cervical cancer. In addition to regular check-ups, there is a very safe, effective vaccine for HPV available for males AND females who live in parts of the world that have more developed health systems.

The End of Ramadan & Korité

Ramadan is different in different places, but in my part of Senegal Ramadan was from August 1st to August 30th. During Ramadan Muslims (if they aren't pregnant or sick or too young or too old or what have you) get up before dawn to have some breakfast, and then don't eat or drink (or gossip or ogle or whatnot) until around 7:30 in the evening. In my compound, the neighbors come over to pray, and everyone who's been fasting shares bowls of mboyree porridge. I have no idea how it's actually spelled. Ours is made from finely sifted corn flour, and it has little tapioca-like balls in it, and they flavor it with sugar, a little salt, and what I'm pretty sure is tamarind.

Mboyree on a stove. And my toes. 

My host family's great, and since I'm not Muslim, didn't expect me to fast. My host sisters said it would be good to try, just to see what it was like, have the experience, and so I fasted for one day, out of solidarity and partly just to prove that I was capable of doing it. However, not drinking any water all day is pretty terrible for you, and while one day was fine I wasn't about to do that for a whole month.

During Ramadan pretty much everyone on my compound got colds, and a couple people had dysentery last month. Ramadan's hard on your body, especially for people who still do hard labor, like farming, or who refuse to stop fasting when they're ill or pregnant, which unfortunately happens pretty frequently.

Diabou, my youngest host sister, 'helping' cook. 

On the evening before Korité, Kadé, the youngest of my three host moms, was the first in the neighborhood to spot the first sliver of the moon that officially signaled the end of Ramadan, and everyone got all excited and  called out to each other and banged on bowls and pans and, even though I hadn't been fasting, it was still fun.

And then it was Korité. Everyone got all dressed up in their best complets and went around to greet friends and family, giving them treats and bowls of fancy food.

Kids in their new Korite clothes.  

Tatiana/Taki, Little Jess/Aisha, and LaRocha/Adama

This is the complet my host family during Pre-Service Training gave to me. It's not the most flattering thing by American standards, but my village was all abuzz about how good it looked. Little Jess, my sitemate, and Tatiana, who lives in Etiolo, a nearby Bassari village, came by to greet me and my family and hang out for awhile.

My host father Sada Souare and me. 

 And, of course, the food. After weeks of eating very simple lunches at the kids' bowl I was pretty stoked about having a day of nice meals. I hang out and chat during dinner prep a lot, but on Korité I even helped cook a little, chopping onions, chasing chickens away, telling the little kids to get their hands out of the pot.

Mariama Gaulo and Mariama Kesso cutting meat

Korite dinner food prep

For Korité we had fonio and meat with onion sauce for lunch, and meat with beans and bread for dinner. The meat was goat, one of our goats, and it was good, but I'm still a little squeamish about eating little bits that are still very obviously sections of digestive tract. The sauces were pretty fantastic, though.   

Ramadan Food

I know that "Ramadan food" might sound like an oxymoron, but there is a lot of eating involved in celebrating Ramadan. First, there are a lot of people who aren't supposed to fast during the day, such as children, the sick, the elderly, women who are pregnant, breastfeeding, or menstruating, non-Muslims, people who are traveling long distances or doing serious manual labor, and so on.

People, like my host family, who observe Ramadan will get up before dawn to have breakfast, and then fast until seven in the evening, when they'll break the fast by eating dates and having tea and snacks while they prepare dinner. During the day they're supposed to be doing a total fast, meaning that they'll give up not just eating and drinking, but looking at, thinking about, and doing and saying sinful things. As my host mother during Pre-Service Training noted, Ramadan is much harder than the Catholic tradition of Lent. (I wasn't really sure how to go about explaining that I don't do Lent either, so I just agreed with her.)

Ramadan started while I was in Dakar, but it's a pretty big city and aside from a few things (cab drivers charging more and being less agreeable, witnessing a late afternoon fistfight in a roundabout, lots of Ramadan-related advertisements for dates and coffee and things) it was easy to forget that Ramadan was happening.

There were more people out praying then usual, especially on Friday, which is traditionally the day that everyone wears nicer clothes, and the men and the older women go to the mosque for afternoon prayers. On the first Friday of Ramadan we were walking over to the French Cultural Center at prayer time, and the streets were echoing with the megaphones broadcasting the call to prayer and impressively crowded with people praying or heading to the mosque to pray. I'm not sure why so many people were praying in the streets - maybe there isn't enough space in the mosques? Maybe people run out of time and it's more convenient?

Photo Credit: travelpod.com

In any case, today I'm going to go over to the Kédougou market to buy snacks, a bunch of dates as a seriche gift for my host family, and some gresil. I'm not sure what gresil is but everyone tells me that if you sprinkle it around the outside of your hut it repels snakes. (Side note: Last month I saw a couple snakes in my hut. They didn't hang around and they weren't black mambas or anything, but I'm going to get the gresil anyway.)

Tomorrow (after I go to the post office and hopefully finally finally the guy who has the keys to the cabinet where they keep all the packages will be there and I will be able to pick up my birthday mail) I'll be heading back to Salémata. 

Arrivederci!

Sometimes we're adorrrrable.

One of the main reasons I was so stoked to go to IST was because I was looking forward to seeing my PST roommates (Sarah L., Emma, and Cady) again. Sarah and I arrived a day early, and Sarah gathered some flowers for dorm beautification. 

I got my art-type-stuff stuff out, and we had a good time having craft time on a rainy afternoon. 

The bouquet idea was all Sarah L.

I was behind the paper-and-soda-can vases. 

We are adorable. And also look like bridesmaids in a vivid wedding.

We are such a good room-match that we all (totally separately) wore blue outfits to the Five Week Challenge dinner in Dakar last week. Adorable. A little weird, but still adorable. 

All About IST

If you're curious about the Kédougou Region, where I live, or the Pulaar language, which I'm still learning, do check out these links on the Peace Corps/Senegal website, they do a good job of giving you an idea of what I'm doing work-wise. 


As you prob'ly know, I am a Preventative Health Volunteer, and I'm currently at In-Service Training (IST) at the Center in Thiès. The Health Volunteers have training with the Environmental Education Volunteers, so there are about 40 of us total. It's the same group that did Pre-Service Training together, so it's been really fun to see my stage-mates again. 


Fun fact about the Thiès Training Center: our dorm building has two English toilets (meaning American-style, where you sit instead of a squat toilet) stopped flushing last week, so we've been flushing manually, filling up mini trash cans and pouring the water in the bowl.   

On the whole it's been nice to be at the center, though. There's electricity and wifi most of the time, salad with dinner every night, and showers instead of bucket baths. Fancy. 

Back in Thiès!

I'm back at the Training Center after a couple weeks in Darou, and things are still going well. We'll spend the next day or so doing technical trainings (how to do baseline surveys, common illnesses and how to avoid them, more garden training, and so on) and then tomorrow night we'll go back to the villages for a few more days.

I've posted a few photos of my host family and my trip to the beach with the other trainees in my area, and will link to more photos as they get uploaded ~

Pula Fuuta! Pullo Fuuta?

Today we got our language group assignments (which will pretty much determine the region where we'll be placed, and I will be learning a type of Pulaar called Pullo Fuuta (or Pula Fuuta, depending on which handbook you're reading). This means I'll most likely be placed in an Southeast-ish part of Sénégal (I am re-learning how to use all the accent shortcuts, have you noticed?) where there will be lots of wonderful fruit and veggies to eat with my rice and sauce. So far Pullo Fuuta seems pretty cool for a language, nouns aren't gendered and there are only seven characters that completely don't exist in the English alphabet...  Tomorrow, in groups of three, we'll be going out to our homestay families in villages around Thiès for a week of intensive language training. We'll have language and culture classes with our Language and Culture Facilitators (LCFs) during the day and will be eating meals and socializing with our host families in the evening. My LCF is a great Senegalese woman named Houssey, and she'll be coming along with us and staying in the village during the homestay. We each have our own host families (and our own rooms and all that) but since they're trying to ease us into Senegalese culture we'll all be quite literally next door to one another. We'll spend most of our Pre-Service Training in the villages, but will come back to the Thiès Center every week or so for technical trainings and whatnot.

Today we went to the market, where I bought a brightly-colored thin cotton dress, and to the Catholic compound, which is where people congregate to hang out and drink beer. We've all been told several times that it's not acceptable to walk around town taking photos of people and places, so I won't be posting many photos of Thiès outside of the Training Center, but I'll see if I can find some pictures around and post those instead.

In any case, I'm off to pack for the homestay! I'll be back at the Training Center on Sunday evening, but I won't have any internet access until then. Have a lovely week!

Training Center Video Tour!

This is a short, two-part walk-through video tour of the Peace Corps Training Center in Thiès. It turns out that one two-minute clip takes about 137 minutes to upload (no joke) so I'm not sure when I'll get the whole thing posted.

Training Center Video (Part 1)

UPDATE:

Training Center Video (Part 2)

Lariam Dreams...

I haven't had any Mefloquine-influenced dreams yet, but that was what I wanted to call this blog. I reconsidered after seeing that the domain name was taken, and also figuring that it's better to not tempt fate.

In any case, my life in Senegal (both days of it) have been surprisingly pleasant. There are 48 other trainees in my group, we landed in Dakar yesterday at dawn, wedged ourselves into a couple mini-buses and drove off to start Pre-Service Training. As the sun came up we looked out the windows at the sprawl of Dakar and the multitude of crumbling, half-built apartments on the outskirts of town, and then I half-slept through the rest of the drive. The Peace Corps Training Center in Thiès ("tchess") has everything a trainee could want, except for hot showers, but I'd take semi-reliable wifi over hot showers any day. We dropped our bags, had some food and some rest time, and jumped right into orientation and placement interviews. We also had individual medical sessions, where we were vaccinated for typhoid and meningitis, put on anti-malaria pills (I am now taking Mefloquine, the generic for Lariam), and given first aid kits and a stockpile of handy antibiotics and whatnot. My roommate and I decided to stay up until 21h00 (9:00pm) and we passed the time by writing in our journals and complaining about how exhausted we were and then promptly conked out at 21h03.

Today we had a guided tour of the area immediately surrounding the training compound, listened to another introductory presentation, had our French language assessments, and ate spiced rice, chicken and chopped peppers for lunch, which was delicious. Then we did our prep reading for our culture and etiquette session tomorrow, realized that we'd behaved fairly disgustingly at lunch (drinking with our left hands, sitting like heathens, making inappropriate small talk) and were extra glad that we have this week of heavily supervised compound-based preparation before meeting our first host families next week.

I'm going to try to get a "day-in-the-life" style photo album or video up this weekend, and after next Tuesday I won't have daily internet access for awhile, but I'll update when I can. Jërëjëf, ba beneen!