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. 

Endless Trash

Waste disposal is a huge problem here; trash cans are often non-existent and littering is completely normal. Sewage, garbage, recyclables, food scraps - too often they wind up strewn about on the ground, waiting to be swept up and burned or washed away by rain or just left there forever.

Trash on a beach in St Louis

A typical debris-filled drainage ditch in Dakar

In the U.S. people produce a truly astounding amount of garbage on any given day, but for the most part it's quickly whisked off, to landfills or barges or processing centers or treatment plants, and we don't have to look at it. In Senegal everyone has to look at it. Pretty much all the time.

When I first arrived here the sheer volume of trash was one of the most striking things about the city-scape. When I travel around the country I still get hung up on how much garbage I see by the roadside, on the outskirts of towns, and just generally strewn around on the ground.

One of Dakar's many refuse-strewn lots

Batteries, old clothes, corn cobs, broken shoes, cardboard boxes, empty bottles, old notebooks, used-up pens, animal bones, mango peels, burnt-out light bulbs, candy wrappers, an ocean of plastic bags; anything you could use or grow or buy and then throw away is piled in the great swaths of refuse fanning out around the cities, towns and villages.

A village garbage pile in a field

Litter in a village creek bed

Rubble in a village ravine

People nonchalantly toss wrappers out car windows and drop soda cans right in the gutter without a second glance. For someone coming from a part of the world where littering is not only illegal but considered morally reprehensible, this is profoundly unsettling. It's awkward to watch. When there isn't a wastebasket handy (which is almost always) and no one to come by and empty a wastebasket anyway it's hard to argue with. It's a complicated problem and is difficult to change, but there are many people, PCVs and Senegalese, trying to do just that, with Sanitation Committees and public awareness campaigns and designated trash collection and burning areas.

Trash on a village path

At the end of the day all of this really, really makes a person appreciate the often unrecognized value of well-enforced anti-dumping laws, all that chiding about putting things in the proper bin, and access to an efficient garbage collection service.

The Joys of Transport: Rainy Season

As I may have mentioned before, traveling is by far my least favorite part of living in Senegal. Most of the time Peace Corps Volunteers (like most other people here) get around on what the French would call transport public, which here means transportation that is open to the public (as opposed to private cars and buses) and not "public transport" in the usual sense. The vehicles tend to be dirty, slow, unreliable and rickety, and (with a few exceptional stretches) the roads are often crater-filled, crumbling, or very washboard-esque.

Last month, on our way from my village to Kédougou, the car that my Peace Corps neighbors and I were riding in broke down. It wasn't a total surprise when the clutch fell out of the car floor (the engine sounded like a dying foghorn filled with wrenches) but, as we were nowhere near anywhere, it was pretty inconvenient. Luckily, a guy we know from my village drive by in his truck and wound up taking us (and, somewhat grudgingly, the rest of the passengers) the rest of the way in to town.

Salémata to Kédougou, July 2012 

Several days later, on the way back, we jinxed ourselves by marveling aloud at the lovely weather, the total absence of flooding, the cleanliness of the vehicle, and the competence of the driver. We were thinking that we would get back earlier than expected, have the afternoon to hang out, pull water, sweep out our huts. And then we came upon a big truck, hopelessly mired in a deep and slippery mud puddle, completely blocking the road. Some people opted to wait in the car, some tried to help push and dig and pile rocks under the truck's wheels, and my two PCV neighbors and I decided to walk. We didn't have much baggage and we didn't think that we were too far from Diara Pont, one of their villages. It turned out to be farther than we thought, but again, thanks to a kind man in a sturdy truck, we got a ride in most of the way.

 Kédougou to Salémata,
 July 2012 

And then there's the turnoff in Salémata to continue to the village out toward Oubadji and Kékéressi. There's a small cement bridge there where the road crosses a seasonal stream, or there was until last month. To be fair, the cement part is still there, it's just the road part that's gone missing. 

Kékéressi turnoff on the Salémata Road, July 2012

July 2012 

August 2012

Bigger trucks and less-rugged cars won't be able to go out past Salémata until it's repaired. In the meantime, the mayor and some of the men from around the village stacked rocks and sacks of clay dirt over a shallow area just upstream, so motorbikes and 4-by-4s the ambulance and people on foot can cross without too much difficulty. It's not ideal, but it will have to do for now. 

Of course, despite the terrible roads, the erratic departure times, and the falling-apart cars, I do travel. I go because it's necessary for work, because it's fun and interesting to see new places, and because it's wonderful to visit friends in other cities and villages. I make the most of obligatory trips; while in Dakar, taking care of office-type things, I stayed with my friends Rachel & Emily and their adorable baby boy, and now that I'm in Tamba for a USAID meeting I get to catch up with Emma and Marie, a couple of my favorite PCVs from my training group. After the meeting's over I'll continue to make my way south, on down to Kédougou, eyes on the road and fingers crossed, hoping for the best.  

The Office Moat

This past week I spent a few days at the Thiès Training Center, helping with a few sessions during the latest training groups' In-Service Training (IST).

 

From there I headed over to Dakar, where I'm getting a few things done at the office (meetings, printing, reimbursements for rash-cream, etc) while I'm up here. While it's been lovely to have electricity pretty much all the time, warm showers at the transit house, and plentiful fruit vendors (Plums! Pears! Tangerines! Amazing!) I've also been reminded of why I'd much rather sit out rainy season in a little village than spend it Senegal's capital. 

The Moat: receding, but still very much present.

Dakar doesn't exactly have well-functioning sewers or an effective urban drainage system, so when there are heavy rains gutters overflow, raw sewage burbles up through access holes, and many streets are thoroughly awash with filthy, murky runoff water. Yesterday, after a heavy morning downpour, the water was so deep in parts of the Almadies neighborhood that taxis and other normal-type cars couldn't make it through the reach the main office and the main street by the transit house, where I was, briefly became a frothy river with a surprisingly swift current. Today the water has drained off, for the most part, leaving only the muddled pond that fills the road in front of the office for most of every rainy season here. We were able to get from place to place pretty well, carefully making our way around and over the filthy runoff puddles and streams in an impromptu little game of high-stakes hopscotch. 

No Reseau

I've been having cell phone network connection problems (or no reseau, as they say here) off and on for a few weeks. It's been better the last few days, and now that I'm back in the city of Kédougou my cell phone's working just fine. 

The internet, however, is another story. I'm using a little USB key to connect. I buy credit and log on; today I opted to spend 1000 CFA (about $2 USD) on three hours of internet access, which I can use all at once or in bits over the next three days.  It's really not a bad deal, it's not too slow and I get to use my own computer, which is great. 

Yesterday I biked in from Salémata yesterday -- the rains starting meant that everything was starting to turn green and lovely, but also that the road was muddy, so it was slow and messy going for a few big stretches. It was a good ride, though, my neighbor Jackie took my backpack in on a car and gave me a mocha-flavored Clif Shot packet, which was fantastic. After I got in, washed up, and got over the disappointment of no wifi at the Regional House Tatiana and I made home fries and a big pan of sautéed eggplant for dinner, which was amazing and delicious after all the rice I've been eating in village lately. 

Tomorrow we have a big Malaria Fair and then a big 4th of July celebration, so we're very busy with all the preparations today. I have a bunch of photos I'm really excited about uploading and posting, but that won't happen until things settle down and the real internet comes back, hopefully early next week. 

Malarone!

One of the very first things that happened when I arrived in Senegal was that I started taking anti-malarial medication. People who grow up in areas where malaria is endemic can acquire some degree of resistance to malaria infections, but PCVs definitely don't have any sort of immunity. While there are a places in northern Senegal where malaria is practically non-existent (mosquitoes can't live without water and it's the desert up there) it exists on an epic scale down here in Kedougou, particularly during the rapidly approaching rainy season. 

The go-to malaria prevention drugs in West Africa are doxycycline (doxy, as we call it)and mefloquine (AKA Mephaquin, Lariam). Doxy is an antibiotic, sometimes prescribed to people in America for acne. You have to take it every day and it has mostly mild side effects, like upsetting your stomach and making you more sensitive to the sun, but most PCVs here tolerate it well and for a few it's even helped keep their complexions clear. However, due to an allergic reaction I once had to a medication in the same -cycline family of drugs the Med Office (quite rightly) decided that it was off-limits for me and I was put on mefloquine. 

Mefloquine (one of the generic versions of the much-maligned Lariam) is made of a chemical that disrupts the development of malaria parasites. It doesn't tend to upset your stomach, you only have to take it once a week, and, like doxy, it's pretty cheap. However, in some people it can cause things like extremely vivid dreams, insomnia, anxiety and/or depression. More rarely it can cause hallucinations, odd behavior, and self-destructive thoughts. My first few months on Mefloquine I had bizarre, incredibly vivid dreams (all of Peace Corps in a strange pageant at an Under-the-Sea-themed middle school formal; being menaced by lazy, helmeted urban dinosaurs, etc etc) but that was pretty much it and I didn't mind. 

Then, as the weeks went by, I started getting weirder. Slowly, like the proverbial frog, I went on with my life as a tight, angsty knot began lacing itself around my sternum. Back in America I wasn't exactly an carefree ray of twenty-four-hour sunshine, but I also didn't get all squirrely about making eye contact with my neighbors. It took awhile for me to decide that the anxiety I was feeling wasn't justified (from scary transport to aggravating cat-callers,  there are so many anxiety-making things here) but eventually I listened to other PCVs and gave Med call. It didn't take long for them to decide that I shouldn't be taking mefloquine anymore and (because my -cycline allergy ruled out taking doxy) they set about getting authorization from the Washington, D.C. Medical Office to switch me to Malarone. 

The most valuable thing in my hut. 

They needed official permission from D.C. because Malarone costs a lot of money. The Cadillac of Chloroquine-resistant malaria prohylaxsis medications, it's known for having almost no side-effects, and also for being crazy expensive. Because it's a generic drug Mefloquine is pretty cheap (I think brand-name Lariam can be more expensive) and an entire month's worth of doxy only costs about $10 USD, but Malarone costs about $5 USD per pill, or about $185 USD per month. That's considerable, particularly at a time when budgets are getting slashed left and right. In any case, they sent me a bottle of Malarone, I stopped taking Mefloquine, and after a couple weeks the big ball of anxiety in my chest started to loosen. It took a couple more months for me to really feel like I was getting back to normal, but it happened eventually and life is much better now. There are still plenty of stressful things (student loans, rainy season transport, project funding, garage weirdos, government paperwork...) but they no longer feel like they're consuming me, and I have a new appreciation for what people who struggle with serious anxiety issues have to deal with. 

Also, I was sitting in my hut the other day and realized that the bottle of Malarone I was holding probably cost about five hundred dollars, making it the most expensive thing currently in my possession, worth more than my netbook and my iPod put together.

Mud Wasps

I don't know what these things are called, but I call them mud wasps for obvious reasons, event though I'm pretty sure they're not actually a kind of wasp. They don't bite or sting, but they are always building these many-chambered larvae-caddies on the whitewashed walls of my mud hut. I don't mind them, but this one decided to set up shop right at the head of my bed, and I didn't like the idea of all that buzzing (they're kind of loud) and egg-laying going on just inches from my face while I slept. So, I got out an old spoon and used the end to pry the little structure away from the wall, and to my surprise it popped right off, fully intact.

"Mud Wasp"

Neat. Kind of gross, but neat. 

I felt a little bad about ruining their little home, but they have plenty of other nests set up under my eaves, and I did sleep much better that night.

Bikram Lunch

So, a lot of people in America are into yoga these days, and Bikram Yoga, where people do all that stretching and posing and whatnot in a humid room heated to 105°F (≈ 41°C), has caught on in some places. From what I understand the idea is that doing this is cleansing, that it builds endurance, that it stimulates good stuff in your body, and that it warms up and loosens your muscles. I like yoga and I like steam rooms, and it seems like a fine idea to me.

However, I was thinking about this the other day, when the temperature was about 42°C (≈108°F), while I was perched on my little stool under the mango tree, quietly sweating, waiting for Gaulo and Bailo, my host sisters, to bring over our lunch bowl (steamed rice with peanut sauce, as usual). I was thinking about the heat, and hot yoga, and what we like to call "the face-sweats" (which is happens when you eat during hot season) and how people would react if, after they finished their hot yoga workout, they were presented with a steaming bowl of rich, salty rice and sauce and told to dig in. It's funny, but not the most appetizing thought.

Pre-Lunch Face-Sweat Levels

I've made plenty of hot-season jokes about how I should have called this blog "Bikram Life" but sitting there at the bowl, spoon in hand, perspiration trickling into my eyes and dripping down my calves, "Bikram Lunch" seemed to do a better job of summing it all up.

Back to the Big City

And by big city I mean Kédougou. With all the pre-election protests that were going on in the bigger towns and cities I've been staying in my village, Salémata, where it's been lovely and calm. Right before Election day I did a lot of hanging out under the mango tree, playing with the baby, making things out of paper, and listening to the BBC. (I would like to take a moment to thank the BBC World Service for existing.) As it turns out, voting during the first round of the 2012 presidential elections in Senegal went remarkably smoothly, even in Dakar, and I'm now allowed to come in to the Kédougou Regional House to check e-mail and stock up on oatmeal and all that good stuff.

My sitemate and I decided to bike in to Kédougou today. We've done it before, we left early in the morning and were expecting it to get hot (which it did) but to make it to the house before lunchtime. We were not expecting the little cloud of bloodsucking tse tse flies that showed up on the outskirts of village and stayed with us for about 45 kilometers (28 miles, about halfway to Kédougou). At that point, exhausted from trying to bike and swat flies at the same time, we stopped in the shade of a baobab tree. It was getting hot, and since we'd just been passed up by the transport van that we'd opted not to take, I was regretting having been so enthusiastic about the whole biking thing. Just then, while we were sitting in the dirt next to our bikes, looking sweaty and dusty and fly-bitten and probably more than a little pitiful, a beautiful pickup truck came along and stopped in front of us. The passenger opened his window (Air conditioning! Fancy.) and asked if we were volunteers. We said yes, and he said he worked with the Ninefesha Hospital, he knew the volunteer Kadjabi (our friend Meera) and that she did good work so since we were with Corps de la Paix we were welcome to throw our bikes in the back and hop in the backseat and come to along Kédougou. We were thrilled. And grateful.

Anyway, I made it to the house and now I'll be around the next few days, working on a few things and (inchallah) uploading some photos and catching up on the blog.

Excuses, Excuses

I haven't posted in awhile -- it's been a busy month, internet's been bad,the power went out, we have out of town guests, there was a transport strike, I've been in village, I got strep throat...

streptococcus bacterium

In any case, I'll be in and out of the Kedougou house all week while helping with the cervical cancer screening training project and (hopefully) will catch up with blogging... and e-mailing... and podcasts... and paperwork... and Skype... and laundry... and everything.

NEVERMIND...

...about heading back to village today. This morning, a little after 8:00 am, I biked over to the Kédougou garage (a big dirt parking lot hemmed by tin-roofed boutique warehouses and lunch shacks) and bought a ticket for the next car to Salémata. I settled in with my books for what would turn out to be a futile eight-ish hour wait.

During those hours I ate the Spiced Pumpkin Pie Clif Bar that Santa left in my stocking (which was delicious), rode my bike back to the regional house for snacks and to use the latrine, and made a big impression on a gaggle of older Pular men who grew increasingly impressed as they watched me read three books, one after another.  Those books were Daughter of Fortune, which I really liked, Take the Cannoli [Stories from the New World], which was great even though I'd already heard almost all the stories on This American Life, and Are You There, Vodka? It's Me, Chelsea, which turned out to be pretty much the perfect thing to read after sitting on a narrow bench in a crowded dusty lot all day long.

Around lunchtime I got up and very sweetly told the guy who's in charge of selling tickets that if the car didn't fill up by 4:00 pm I'd need to leave, because after that it would be possible that I'd be arriving in Salémata after dark and my boss at Corps de la Paix forbids me from travelling at night. (That's a real rule, though Safety & Security does make occasional exceptions) As it turns out, I'm really glad I had that little chat, and that I was very polite.  

Eventually 4:00 pm rolled around, and much to the ornery driver's irritation (other passengers were grumbling about refunds and so far had been refused) I quietly got my money back from the ticket guy and rode off to buy a ticket from the Niokolo Transport office, which has a truck that reliably goes out to Salémata on Monday and Friday mornings at 8:00 am. So, sometimes being a toubab means I have to put up with extra hassles, but sometimes being foreign (and invoking Peace Corps rules) seems to make it easier to duck out of unpleasant situations.  Sticking out like a bespectacled DayGlo thumb is a mixed bag.  

Anyway. The water's on for the moment so I think I'll take an outdoor shower, download some podcasts, heat up some soup, make the most of an extra night at the Regional House. And then tomorrow morning I'll actually head back to village. Inchallah.

Work Etc

When I moved into a little mud hut fifty miles down a dirt road in the middle of Nowhere, West Africa,  I was expecting many things. Pulling water from wells. Keeping my knees covered. Extreme heat. I wasn't really expecting that there would be so many Excel charts involved. Volunteer Reporting Forms, surveys, spreadsheets, reports, project planning, funding paperwork... sometimes living en brousse is a lot like living in D.C., just without roll-y chairs or electricity during the day.

This is my hut. And also my office. 

This is my floor. And also my desk. 

If you're interested in what I do at the office, you're welcome to take a look at the Action Plan (English), the Plan d'Action (français), and the Salémata Baseline Assessment that I submitted after my observation period and baseline survey and all that.  Between other project opportunities coming up and all the interruptions that we're expecting around election time, it's hard to figure out what will actually happen when,  but it's nice to start with a plan. 

On the Laterite Road

So, my toe scrape hewaled up quickly and nicely and this morning Little Jess, Tatiana, Jubal and I all biked in from Salémata and now I'm running around, getting my stuff together to head up North to celebrate Thanksgiving (and a couple birthdays) with some other PCVs.

I hope everyone has a very Happy Thanksgiving! 

THIS IS WHY WE CAN’T HAVE NICE THINGS

There used to be a big mirror in the Regional House shower, but someone knocked it off the wall and broke it.

Last month our plastic house French press cracked, and we bought a fancy new glass one in Dakar. It lasted a week and a half before it broke.

We were having a lovely time making delicious banana-and-yogurt smoothies with our slightly-cracked-but-totally-functional blender but then I dropped the plastic pitcher and a piece of the black base part chipped off. We thought it was still going to work, but it didn’t, and we made a huge sticky mess all over the floor. (We use the blender on the floor, under the desk with the phone, because that’s where the outlet is.)

Luckily there are volunteers expecting visitors from the USA pretty soon, and they’re nice people who’re willing to pack replacement blender parts and purportedly indestructible French presses into their checked luggage.

Someone took a photo of that smoothie mess somewhere, I’ll try to get a hold of it. 

Terrible Fuzz

This morning there was a weird little bit of funny stuff wedged under my 'A' key and in the process of getting the fuzz out I think I broke the tiny piece of plastic something that kept that key from jiggling around like a loose tooth. It still works, luckily, it's just irritating, but I guess I'll either just have to deal with it or start being like that guy who wrote and entire novel without using the letter 'E.'

Either way, if you happen to get any messges or e-mils from me now you know why. 

Water.

At this very moment PCV Eric and I are stuck at the Bedik Hotel in Kedougou, eating caramel pops and waiting until it lets up enough for us to ride back to the Regional House. We were using the wifi here (I'm uploading photos of camp right now) because our wifi is still down and right when we were about to leave it started pouring. 

There are definitely worse places to wait out a rainstorm. 

Incommunicado!

So, everything's been pretty good lately, except for the recent lack of internet access and our road being flooded on and off for most of the last week or so.

I'm back in town for a few days and am using a little USB InternetEverywhere key to connect to the cell phone network and get online. 

I'm going to slog through my Gmail for awhile and then will get to uploading some photos and posting some updates. 

Termite (In)Fest(Ation)



Hey, what are those funny little piles everywhere?

Are those leaves?

Oh. Yeah, those are bugs.

And they're everywhere.

For a couple days the Regional House was swarming with termites. They're harmless, and not really that gross, at least not until they start piling up in the shower, shedding their wings and piling up in the corners until you can't even see the floor. The only one who was happy to see the termites was Joseph, the cat, because he likes to eat them by the dozen, which is helpful but also a little disgusting to watch.

Sick Day.

I was sick yesterday. Also the internet went down, then the power went out, and I spent the entire day at the Regional House, looking green and lying on a mat while my fellow Volunteers brought me juice and ORS and checked on my (mild) fever.

I'm feeling much better today, and will most likely go back to village tomorrow. 

Trouble with the Interwebs

Bad news.

This isn't actually my laptop, but you get the idea. Thanks to Senegal's wildly unreliable power grid and all the recent lightning storms something went horribly wrong while I was charging my computer and now it doesn't so much turn on anymore. *sigh*

Luckily there is a somewhat-clunky-but-totally-functional house computer at the regional house, and other volunteers (especially Sully) have been unnecessarily gracious about letting me monopolize their laptops to upload photos and e-mail and everything.

This trip into town has had pretty sparse internet access for everyone, though. The wifi at the house has been sluggish and choppy (slower then cold molasses, one might say...) and frequently unplugged, due to the thunderstorms and lightning strikes that come with the onset of the rainy season.

So, until I can get a replacement laptop or netbook sent over (in a Diplomatic Pouch, doesn't that sound fancy and important?) I will not be able to Skype/e-mail/etc as much as I would like. O well, I suppose.