Peace Corps Response: The Adventure Continues

In just five days I’ll be leaving West Africa, but I won’t be gone for long.

I've been offered and accepted a Peace Corps Response position with Save the Children, serving as a Health Program Specialist in Kankan, Guinea. It’s a nine-month assignment, starting in June, and I’ll be supporting the current Maternal and Child Health Integrated Program (MCHIP) that’s being funded by USAID and led by the non-governmental organization (NGO) Jphiego.

Home Sweet Soon-to-Be Home

MCHIP activities focus on strengthening family planning services, increasing local capacity for reproductive health services, and increasing the quality of care provided at the community level. As a Health Program Specialist, my main responsibilities will be to provide regular monthly updates on program activities in Guinea in English and French, to work with local staff to improve work plans and budgets, and to help coordinate the development of a Public Health and Nutrition Program. It will be a big change and a lot of responsibility, but I’m eager to work with Save the Children, to spend a bit more time in West Africa, and to eat avocados for breakfast every day. (Among other things, Guinea is renowned for having beautiful terrain, nightmarish roads and absolutely fabulous fruits and vegetables.) 

As excited as I am, there is a big opportunity cost – I was really looking forward to spending a summer in the Trinity Alps, to finally being around for weddings and birthdays, and to spending the holidays in California. Happily, I will have a long enough break to spend some quality time with friends and family, and the office where I'll work in Kankan is outfitted with electricity and a back-up generator  so it will be a lot easier to stay connected. Plus it will probably be all thrilling and novel just to be in an office, to have a desk and a chair and an internet connection. Who knows, maybe I'll even have running water at home. Fancytown! 

Good Hair and New Friends

A couple weeks ago I got my hair braided for the first time. After my mom got her hair braided in during her visit Mariama Kesso decided that she would also braid my hair before I left. So the day finally came, I bought some meches extensions and she went to work. 

It didn't hurt as much as I'd imagined it would, and it only took about an hour. (Kesso is a pro.) Jackie had had her hair done in her village, Diarra Pont, the day before, and she came to take photos and sit under the mango tree while Kesso braided and braided and braided. 

Jackie asked for her hair to look like the crazy braided mohawk that she's seen on a little girl the week before, and her hair turned out amazingly well. She didn't even need any extensions!

Once we were all coiffed and fancy we put on our complet outfits and headed out to introduce everyone to the Peace Corps Volunteer who'll be arriving in May to install in Salémata. 

Her name is Katie W. and by all accounts she's pretty fantastic. She's still in training but came down for Volunteer Visit (VV), where Trainees have a chance to have village life demystified, meet their soon-to-be host families and counterparts, and just get a little bit of an idea of what lies ahead. During the days leading up to site announcements I fretted and wondered about who would be coming to Salémata. (Would they like living in a rural site? Would they decide it wasn't for them and Early Terminate? Would they be motivated and fun? Would they be as completely exhausted and out of it as I was during my VV?) As soon as I met her my anxieties were all assuaged. She's cool and fun and super smart. She studied Reproductive Health and already has her Master's, her Pulaar is really coming along, she can get by in French very nicely, and, best of all, she handled the ridiculous barrage of information and introductions and hellos and good-byes impressively well. She even brought out a fancy complet and dressed up with us! 

Here are Katie W. and I, and Katie W. with our friend and shopkeeper Wouri, and the two of us with Jean-Jacques, Salémata's head nurse and our Professional Counterpart. On the last day of her VV (and my last day in Salémata) we took the obligatory silly photos in front of the castle with Jubal and Katie O. and Jackie, greeted the Imam and the radio DJs and the neighbors and her new Community Counterpart and pretty much anyone who crossed out path. We drank frozen bissap juice and snacked on packs of cookies and just generally had a lovely day. Our host family prepared an amazing, amazing dinner (fonio and meat and vegetables in a delicious sauce) and then stayed up under the mango tree, just watching Guinean music videos and chatting.

As sad as I am to be moving on, it's a great comfort to know that Salémata is in good hands. Katie W. has a good host family, a beautiful site, and the best PCV neighbors anyone could ask for. As the saying goes, life in Senegal may not be all Skittles, I think she's a great fit and very much hope that she will have a wonderful and rewarding two yeas of service in Salémata. 

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. 

Latrines: A Very Good Thing

During my baseline survey, many of the 62 family compounds I interviewed talked about wanting a latrine. There were some pre-existing latrines in the area, but many of them weren't very sturdy and were susceptible to collapse, particularly during the rainy season.

A partially collapsed latrine

Two years ago the Catholic Mission of Salémata held a training for a group of village masons that covered ideal pit dimensions, durable latrine designs, how to mold a concrete latrine cap, and installing ventilation pipes. So, there was obviously a high level of community interest and available skilled masons, but the high cost and inconvenience of obtaining building materials meant that very few families had actually installed a latrine, and of course, without latrines people are forced to practice outdoor defecation, which contributes to the spread of dysentery and other diarrheal diseases.

All of this led me to write a Peace Corps Partnership Project grant proposal, and with an incredible amount of support from my friends and family in America it was quickly funded. Once I had the means, it was time to go back to the hardware stores in Kédougou where I’d gotten quotes, order the materials and arrange to have them transported the 80k (50 Miles) on a rough, unpaved road out to Salémata. Ordering the supplies was painless, but withdrawing the money from my account turned out to take almost five hours of waiting at the bank. With help from my host family and neighbors we spread the word about the project requirements and held meetings to make a list of participants and a plan for how people would pay their contributions, compensate the masons, and verify that the work had been done. Once all the supplies actually arrived (there were some truck problems and some inadequate stock problems, so it took a couple tries to get everything delivered and ready to go) participants paid their contribution and got checked off on the Chief’s list, and then came in pairs to collect their cement and materials.

Once the latrine building got underway I walked around with the head of the village Sanitation Committee to check in and see how things were going. We chatted with people about the project, talked about different ways to make covers for the hole, and made sure to work the many benefits of hand-washing with soap into the conversation. People were really positive and it was a huge relief to see that the whole thing had worked – latrines were built, awareness was raised, progress was made.

Some of the latrines are totally done and in use, but there are a few people who still need to put up the crintin privacy fencing. Now that hot season is upon us the Bassari craftsmen are starting to show up to the weekly lumo market with sheets of crintin, stools, beds, tables and chairs made from something that everyone calls bamboo, so hopefully the rest of the latrines will be screen in and operational in the next few weeks.

Working on this project has been a fantastic experience. As one of my neighbors said, “Adama, this is a very good thing for Salémata. Your work is good and now we have a latrine in our household. It will be a good thing and the people will see the latrines and remember you. Whenever I look at our latrine I will think of you.” As flattering as that is, this project wouldn't have happened (or would have been much, much more difficult) if people hadn't already been interested in latrines, if there hadn't been trained masons on hand, if my family and friends in America hadn't put on such a successful fundraiser, or if the chief and Sanitation Committee hadn't be willing to do the lion’s share of the accounting and explaining and distribution of supplies, and I’m grateful to everyone who contributed time, energy, and support to the project.

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. 

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. 

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.

Families in Senegal

Just after Christmas my mom and brother arrived from California. After they landed in Dakar they got to sleep for a few hours before piling in to a "sept-place" station wagon for the long drive down to Kédougou. We hired Seydou, one of the best drivers in town, and shared the car with PCV Ilana and her visiting family, which made for a much more comfortable ride than would have been possible on public transport.

We spent a day in Kédougou, where they got to see the market and the tailor and visit the wonderful Regional House. It was great except that this is brush- and field-burning season and the air was thick with smoke and dust. Then we headed out to Salémata, where I got to introduce my American family to my Senegalese family here, which was really great. We spent time just hanging out on the family compound, played with the little kids and chatted with my host parents.

My mom decided that she wanted to have her hair braided and my host sister Kesso (a professional-level hair stylist) was happy to oblige. I made henna from scratch, for decorating my mom's feet and the neighborhood kids' hands, and by the end of the visit everyone said that mom was clearly African now. It was really good to be able to bring my American family by the health center, to see some of the latrines being built, and to meet my friends around town, to have dinner with my friend Maimouna, and just generally to show them my life and work here. We dayhiked to the Bassari and Bedik villages, tried palm wine, saw monkeys, hormbills, and a chamelon. It was abundantly clear that host family was really glad to meet my mom and brother -- I've never eaten so well in my time here, and when it came time to leave they showered them with gifts of baobab powder, fonio grain, shea butter, and local crafts.

From Salémata we headed back to Kédougou (to pick up things from the tailor, belatedly celebrate PCV Patrick Hair's birthday, stroll by the river, where we saw a monitor lizard) and then on to Toubacouta. While stopping for lunch in Kaolack we had the good fortune to run into PCV Dan, who came with us to Toubacouta, showed us around, and was just generally very good company. We kayaked through the mangroves, walked with the lions at the Fathala Park, had several lovely dinners, and lounged our way through some very  lovely sunsets over the water.

After that it was on to Mbour, where we stayed in a great little beachside bungalow-style hotel and enjoyed more than our fair share of the delicious Liqueurs de Warang - Passionfruit, Citrus, Ginger & Bissap (like hibiscus), Corrosol (soursop), Cashew Fruit, and Creme de Warang (choco-cafe-banana cream). After the beach we headed up to Dakar, which is kind of an awful city for tourism (harassment, trash-strewn streets, grime and noise abound) but visiting Goreé Island with PCVs Nic & Ivy and their visiting family was great, as was rooftop dinner with our friends Rachel, Emily & Xavier at a fantastic Ethiopian place.

We met up with my host brother Saliou, who lives in Dakar, where he goes to University. I'd never met  him before (but I have greeted him on the phone when he calls Salémata on holidays and the phone gets passed around) and he turns out to be smart and gracious and a really good English speaker. As Family Time in Senegal drew to a close my mom, brother and I saw one of the loveliest sunsets ever, just off Point des Almadies (the westernmost part of Africa), and then headed over to the airport to drop our mom off for her flight.

All the translating, introducing, arranging transport, long car rides, bargaining and explaining were exhausting at times but I'm extremely glad that my mom and brother were able to visit. It was wonderful to spend time with them, after I get back to America they'll have a much better understanding of my Peace Corps service than they ever could have gotten from photos and e-mails, and it means so much to my host family and friends that they came to visit  from so very far away.