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. 

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.

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. 

Work Stuff: Baseline Survey and Potential Work Projects

Before I begin working on any projects in my village I have to do a Baseline Survey and lay out an Action Plan for my service. There are three main neighborhoods in Salémata and the Quartier Mosqué, my neighborhood, has approximately 61 family compounds. So far I've  taken my survey questionnaire around to almost all the compounds in my neighborhood and a few in the other two neighborhoods, and people have been really helpful and receptive. I did my survey in Pulaar, and I asked things like how many people live on the compound, where they get water, if there's a latrine, and about the communities health challenges and resources. I'm currently setting up an Excel spreadsheet and getting ready to enter in all that data -- sometimes life in Africa exactly as exciting as life in any office in America.

Once I get all my baseline data organized and sorted out I'll have a better idea of what projects I'll propose in my Action Plan, but here are a few things I could work on that people I interviewed suggested:

Latrines: It's nice to have a toilet, even if it's a pit toilet, and many people here do not. Diarrheal diseases, like amoebic dysentery, are a major cause of suffering and death here, and a lack of latrines contributes heavily to that problem.

Malaria: Malaria is still a huge problem here and I'll definitely be working on finding ways to reduce malaria in my village. Having a training on making neem lotion, and to teach others to make it, There are Long-Lasting Insecticide-treated Nets, indoor spraying,

Reproductive Health: From basic human anatomy to ways to prevent infections to reliable family planning options, there's a need for accurate information about reproductive health, especially for young people. There are many people who have a lot of good knowledge about health, but here's also a lot of misinformation out there - for instance, I've had several people tell me that pregnant women shouldn't eat foods rich in vitamins because it will make the baby too big and cause difficulties during childbirth, which is both untrue and potentially very harmful to mothers and children.

Nutrition: From underweight babies to iodine deficiency, there are a lot of food and nutrition issues in my area. Promoting moringa gardens, use of iodized salt, and having workshops on basic nutrition and how to make simple enriched porridges to help malnourished kids recuperate are a few examples of potential projects.

Here's some more info on the Preventative Health work that Peace Corps Volunteers do in Senegal:

• Malaria
• Preventing HIV with Youth Theater
• Community Latrine Projects
• Moringa

Postcards

These are actually photos of postcards. Everyone in Peace Corps/Senegal calls these large vans "Alhams," short for "Alhamdoulilahi," which I'm pretty sure means "Thanks to God" in Arabic. Many Senegalese people call them "Njig Njai" because a guy named Njai owns a large percentage of Senegal's large van fleet, and he had his name painted across the front of most of them. If I have other options (Sept-Place station wagons, certain buses, my bike) I usually avoid Alhams. They're slow, usually totally overcrowded, and break down a lot.

An Alham, Njig Njai, oto on, un mini-bus, etc 

There are traditional Bassari villages in my area, and Initiations happened in May. I went to part of one right before I installed in my site and took some pictures, but this one's really nice. It's an impressive event, even though I was only allowed to watch the dancing part, not the stylized fighting part.

Bassari men in Initiation masks

Language Seminar

I just got back into Kédougou from a language seminar in Bandafassi, a village about 60 km from where I live in Salémata. Houssey, my Peace Corps Pulaar teacher, came down from Thiès, the other people from my training group came in from their villages, and we all had three days of semi-formal language class. PCV Patrick hosted us, (and he really was a very, very gracious host) we went on a nice hike up to a Bedik village in the hills above Bandafassi and his host sister cooked some fantastic lunches.

Just to give you an idea of where all things are happening, Salémata is the "A" on this map, and Bandafassi is the "B," the city of Kédougou is "C," and Dakar (where all the political protests and everything were happening last week) is "D."

In case you were wondering, it takes about two days to get from Salémata to Dakar, so I'm a long ways off from any of the protests, and even when things get hectic in Dakar nothing really happens in the village, which is nice.

PHOTOS: Bandafassi Language Seminar 

Back to Salémata

It's been a busy morning, but I got all my paperwork printed off, picked up most of the stuff on my shopping list, and am ready to head back out to village for a few weeks.

Other than some serious laptop issues, it's been a very nice little visit to town. It was good to have a change of scenery, eat some pasta and ice-cold pineapple soda, and I had a good time staying with Melanie, one of the volunteers who lives right right near the Kédougou Regional House. Now a couple of us are just hanging out for a few hours, waiting for the next car back to Salémata to round up enough people to justify making the trip out to village.

I'll be back in wifi-territory by the end of the month, take care 'til then ~

Lessons Learned

In no particular order, here are a few of the things I have learned so far:

1. I've been told that the giant, scorpion-looking spider things (which are attracted to light and come skittering in around my feet when I turn on my headlamp at night) are harmless, but the caterpillar-ish centipede things (which I have not seen yet) have a nasty, poisonous bite.

2. My neighbor Sully was right about the Salémata Health Center having fantastic food. Last week (when I came to observe a 10:00am sanitation presentation that didn't wind up starting until 2:30pm) they invited me to have lunch with them and they served delicious rice and fish and vegetables.

3. You really can't buy vegetables in Salémata. Aside from a few sad little tomatoes and onions that sometimes show up at the weekly lumo market, you have to go 80 km (50 miles) to buy them at the market in Kédougou. Or plant a garden yourself.

4. Pulaar grammar and vocabulary is all sorts of fun. Jangugol means "to read," "to study," and "to learn." So no one really has any idea when I'm being a serious student and when I'm relaxing with a good book. Which and be both good and bad. Also, Pullo Fuuta has 24 classes of articles, meaning that there are 24 ways to say "the." It gets even better when you throw "these" and "that" and "this" into the mix...

5. I have come to think of 'cold' as a flavor. As Cady knows, it it currently my favorite flavor. Along with 'Snickers.' (I was not a huge fan of Snickers before, but I have recently realized that they are fantastic. And also almost entirely unavailable outside Dakar.)

4. My host brother was right about how much easier it is to fetch water by strapping the covered bucket on the back of my bike than it is to carry it on my head.

5. It was maybe not the best idea to read As I Lay Dying straight through in one ungodly hot afternoon. It put me in a strange mood and set me up for a series of extra-strange social interactions.

6. According to some people, my life here sounds just like Little House on the Prairie, except with a hut, and in the hills, and in Africa, and with texting. (I never actually read Little House on the Prairie, so I will have to take their word for it.)

7. Infinite Jest is long.¹

8. I am really lucky to live in a village (almost more of a town, really) that has a bean sandwich lady. And extra-extra lucky that the beans are pretty tasty.

9. I can be needlessly difficult and contrarian at times. Particularly when I am hot and/or hungry. (This isn't so much something I have learned so much as been made more vividly aware of over the last few weeks...)

10. If everything goes well it takes three hours (squished in between a girl with two live chickens and a man holding a very small baby) in a van-type vehicle for me to get from Salémata to Kédougou. Yesterday everything went well, alhamdoulilaye.

________

1. In Senegalese culture it's really incredibly offensive to eat things in front of others without sharing (but serious nose-picking is ok) and people will not decline to eat half your Clif bar, bean sandwich, etc, if given the opportunity. If people have something they want to eat then they do it in their rooms or in some other non-public space, and so I frequently do the same, holing up in my hut to eat a secret apple or packet of Biskrem,^a especially since lunch is often not until 2:00pm. Also, I don't yet feel comfortable openly using my laptop or iPod in village, so I only listen to music and podcasts at night and at naptime, and pretty much hide in my room whenever I have laptop-based work to do. Given all this daily pseudo-secrecy, combined with the fact that I have an assumed Senegalese name (Adama Hawa Souaré) and often pretend to be married or engaged, Infinite Jest is maybe not the worst book to be reading at this particular time in my life.^b 

________               
                   
a. Biskrem is an extremely tasty chocolate-creme filled cookie, produced by Ülker (a Turkish brand owned by the Yıldız Holding group) and wildly popular in Senegal, West Africa. 
b. Apologies for all this footnote business to everyone except for the three of you who I am mostly sure will find it amusing.

My Life in Acronyms

Tomorrow our Community Counterparts (CCs) and arrive at the Thiès Training Center for a three-day Counterpart Workshop (CPW) where we'll do official introductions, have some halting and awkward getting-to-know-you conversations, and talk about the work we'll be doing as Peace Corps Volunteers (PCVs) over the next couple years.

So, what are Community Counterparts? Well. As far as I can tell, when a village or town has decided that they want a PCV and Peace Corps (PC) has decided that it's an appropriate location for a PCV, the community gets together and chooses a couple people to be our work partners. The idea is that they can show us around, explain village norms to us and our bizarreness to the village, and just generally facilitate our integration into the community. They'll also help us communicate, especially at the beginning when our language skills are still basically "Thanks to you! You have peace! Peace only! I am called Adama in Senegal! I come from America! Senegal is pretty! It is hot today! Hot, hot hot!"

My counterparts are two Senegalese men, I met them during my Volunteer Visit (VV) to Kédougou and they were really nice. One is Gilbert, a very kind and slightly spazzy guy w,ho manages a campement, a little group of rustic guesthouses for tourists, and the other is Jean-Jacques, the Infirmière Chef de Post, (ICP, the head nurse at the local health post) who I only got to meet for a few minutes on account of his busy schedule.

I have some paperwork to do to get ready for CPW, so I should go do that now.