sene-gal

One year ago, I left my hut in Senegal with so many worries. I was worried I would never feel so inspired, that the babies would never know how much joy they brought to me during the first years of their lives, that I would forget who I was and who I became from my experience.  I battled my worries upon coming home by making my apartment look like Senegal entered it via tornado, and by diving right away into the world of academia.  

I realized that while I had become a more practical and critical thinker when it came to public health; some of the optimism and sunny outlook I had on life had been darkened, not disappeared but gone into hiding. I think this developed from the realization of the vastness of the public health problems I saw that were growing at a rapid pace. I was so frustrated that the small battles that I was trying to fight did not always win, that people frame public health successes in so many different ways and I saw that not all of them were what they seemed.  Becoming a more practical and critical thinker has become useful in my new academic career, but in some ways my positive worldview, the impetus for entering this field, went missing. 

Studying for my Master’s of Public Health was something that I needed to do for my career. I had a list of skills I needed to acquire and knew that Emory was known for teaching students the skills and providing connections I needed and tools to work in global health, specifically humanitarian response and program management.  I am acquiring these skills from some of the big shots in public health. I am learning the rules of research and the importance of the words ‘iterative’ and ‘capacity’. More importantly, I am questioning myself as a public health practitioner and figuring where I fit in this puzzle of working towards a healthier and just world.

Last week, I attended an ‘ethics dinner’ that was organized by a second year student.  The goal of the event was to discuss public health ethics and how the conversation about ethics should fit in as researchers and practitioners. I thought this activity would make me give up, because the conversations about our motivations for working in public health come with some tough questions. One student spoke about how she was from a poor country and that is why she was in global health, and did not understand what our place was as westerners to be working there. What is my motivation? Sometimes when I am asked to reflect on these questions and cannot give an answer, I contemplate quitting and using my newly acquired skills in statistics on Wall Street.

Tonight, I attended an event celebrating the career of one of my favorite professors, Dr. Stan Foster, who is a global health legend.  In front of 500 of his closest friends and colleagues, he reflected on his career of 50 years and counting of working to eradicate smallpox, to improve the health of American Indians, to working as an inspiring professor and mentor to hundreds of what he calls ‘learners’ (students). The resounding message that stayed with me was the key to his success in ethical and successful global health service is his optimism and relationships with his colleagues, communities in which he worked, and family.  After the talk, over a glass of wine, I asked him if he felt like a ‘total celeb.’ He replied by telling me the important part of his whole career is that he is now here with friends.

As I was walking out of the building in my sparkly bowtie (which everyone got to honor Stan’s impressive bowtie collection), my friend Daouda, who works as a nurse in the area in which I served in Peace Corps, called from Senegal. He had heard what happened at the marathon Boston, my hometown, and was so worried about my family and me and wanted to make sure I was safe.  I hung up and thought to myself, this is why I am in global health. It is not about and ‘us’ or a ‘them,’ it is about friendship. It is about us being citizens in this global community, about worrying about each other and working together to make this world a healthy peaceful place.  I biked home in my fish dress and gold bowtie thinking that I have my optimism back, but with it a responsibility to question the decisions I make in my work and commitment to measurable public health work with ‘science and heart.’  

The other day, I went to Nafadji to say by last goodbyes. These will be described in a different post. This post will tell the story of Tambadian Danfakha and the Sorolu. A couple of days before I came, my toxoma (namesake) called me to tell me my baba fell and hurt his leg. I asked if he was okay and she said someone went to Saraya to get medicine from the pharmacy. This made me think he just had a bad bruise and got some pain killers and was fine. Upon my arrival in Nafadji, Sarr, the nurse at the health post told me he thinks that it is probably broken, as he cannot move or put any weight on it and he is going to try to get him to get x-rays. Where is the closest x-ray machine? There is technically one in Saraya at the new hospital that is not open yet because there is no electricity. I saw some once in Kedougou, but they were outdoors, not plugged in or in use. There is a machine in the hospital in Nenefesha, which is a hospital built by the first lady in a village outside Kedougou, but I hear there is no radiologist. So he would basically be forced to go to the Tambacounda hospital in the neighboring region which would take about seven hours to get to from Nafadji and to get an ambulance to go there would cost more money than anyone has to spend on something when you can’t even know for sure if he would need that level of care. So what did he do? The family called the Sorolu in Dambala, a traditional bone healer. My host dad paid for the gas for someone to drive a motorcycle to get him in his village and paid him, which is a fraction of the bills that would add up going in the health system here. What does this guy do? I am not positive because nobody would let me stay and watch him, but what I do know is that there was cream used and no pain killers and that I have never heard an old man scream so loudly in my life when the sorolu was in there putting my host father’s bones back into place. (And I needed anesthesia for my ankle break, I am pathetic apparently). Did it work? When I left he was sitting up, looking completely shell shocked. Which was not the ideal way to say by last goodbyes to him, but he was sitting up which is something. I guess he would not get so much business if what he did doesn’t work so we’ll see what happens as Tambadian has time to heal. In this case who knows, traditional medicine may have won over the system which is clearly lacking in their orthopedics department.

So in the end, all that talk and the elections were done swiftly, democratically and transparently.   Everyone thought Wade was going to do something crazy and stereotypical as political leaders in West Africa, but what did he do the night of the election before the results were even official? Congratulated Macky on his win. Take that world, peaceful elections in Africa. Wabam.

As for Saraya, I barely noticed the election that day, besides everyone’s pink fingers.  Even though Wade took the majority of the town of Saraya, nobody seemed too upset about the situation, and to the contrary, all my friends who voted for Macky Sall were elated.

http://allafrica.com/stories/201203301091.html

Now down the road in Mali, now they just cannot get their business together.  Being so close to the border, I feel like I am hearing more about the coup d’etat in Mali than about the elections in Senegal. (Don’t worry though, no violence up in here Mali is big, that stuff is not going on here). But they just opened that nice bridge over there, all the better for people in Mali to flee with I suppose…

http://allafrica.com/view/group/main/main/id/00016297.html

During our COS conference, our safety and security officer, Mbouille, told us that in the last months of our service, that we would be more likely to do crazy or ‘dangerous’ things.  Now, most the people with whom I biked from Saraya to Kedougou in the middle of the night with are not leaving in the next couple of months like I am, so maybe we all just do crazy things all the time, the people of Saraya surely think so.

We have all been talking about doing a moonlight ride for a long time.  The road from Saraya to Kedougou, the regional capital is brand new and really nice to ride on, especially when the weather is cool. Now, in Africa, when is the weather ever cool? Nighttime only.  So we decided to do it, wait for a full moon and bike 60 kilometers in the middle of the night.

Last week, nine of us met up in Saraya and had the restaurant make us peas for dinner (when else am I going to be able to request exactly what you want to eat the morning of at a restaurant? Never).  Then I put on what I am going to call my biking costume which made me look super cool (yellow bike jersey? Yes, I have one, gift from a 15 year old boy), and we all loudly in a line left the town at 9:30pm to bike in the light of a full moon.

Even though I had a lego man headlamp attached to my helmet in case, I did not need it at all.  The moon was bright enough for us.  It was beautiful in the cool night to pass by sleeping villages, well all except for Pondala which was hoppin from a wedding.  Between villages it was incredibly peaceful and we were only passed by a few trucks.  Downhill at the bridges we had this cool breeze where I was so cold for a minute I got goose bumps which are few and far between in this place.   Who knows what those truck drivers thought, passing by nine toubabs (Especially at shirts off o’clock) biking 60 kilometers in the middle of the night.

When we arrived safe and sound at 1:30am, we were tired, followed by wired 30 min later when we had to party in the resting full moonlight.  Crazy you call us? Maybe, but it sure was fun.

(photos to come)

Nothing has ever been done about the prevailing problems in Saraya. It is a frequent point of discussion, but infrequent point of action, until today.

I noticed the men around my age gathering yesterday in very intense discussion, which does not occur very often among the Malinkes, it is generally pretty calm around these parts.  I heard that they were planning a march (greve-o, in Malinke-fied French) in the village for the next day to bring the issue to the people that matter, the Prefet, who represents the central government and the mayor.  I did not think much of it because I sort of assumed that it would be exactly those 20 20-somethings who would march, because in my experience here, the people of Saraya are not the most politically active bunch.

I was so wrong.  The next morning, the village shut down.  None of the stores, restaurants, breakfast ladies, market ladies, nothing was open.  There was a road block and no cars or trucks could get in or out, and starting at the end of the village, were hundreds of members of the community, men, women and children with signs and chants and symbolic empty buckets of water on their way to the Prefet.  The group marched around the entire village until their arrival at the Prefet, which is a large secure building.  They entered and explained to the Prefet (who, may I add is not from Saraya and is not Malinke, so his heart is surely not in Saraya) the problems that they want fixed.  Of course, the police stood by as did the Red Cross volunteers with their stretcher, you never know.

The goal of this demonstration was not a vague message like ‘end corporate greed,’ it was a statement of clear, concrete basic needs of the community that are possible to achieve; access to clean water for all is a human right.

The demonstration was overall well organized, peaceful and I believe impactful.  I was moved to see the community coming together and realizing that they deserve basic things in the village.   So far, nothing has been said but my mom, Sadio Tigana says that she will not rest until the problem is fixed.

Coincidentally, at the end of this month, World Water day is coming up. I always noticed these days from working and studying global health, but never truly noticed the importance of awareness of these problems until I was forced to be aware after not washing my hair for a week, or just merely needing to spend time worrying about where I would get water for the day.  Maybe my family and friends at home could try doing everything one day with just one bucket of water, or getting it from the hose outside instead of the tap and carrying it indoors(One benefit- no pushups needed when regularly carrying full water buckets).Or everyone could work on spreading the word and awareness that water problems are prevalent, not just in Saraya but all over Senegal and the developing world.

http://www.unwater.org/worldwaterday/faqs.html

Saraya has many things: sidewalks, restaurants and a brand new middle school building, but it is difficult to appreciate these things for people who are spending all of their time and energy trying to find basic things like water.

Every other day, I am up by 7am and waiting in line with my two buckets, surrounded by ladies with many more buckets than I have that serve for drinking, bathing and cooking for their entire families, and who are arguing about whose turn it is at the tap because it is going to close at any minute.  The tap, which comes from a water tower that is filled by a gas-powered generator every other night, is only open every other day and lately for only an hour and will cut out any minute without warning.  Lately, they have not even been following an insufficient but at the very least predictable schedule, so really nobody can ever rely on the fact that there will be water from the tap down the street from my house that serves many families.  There is one other tap in the village (population around 6000 during school year).

Other options include three pumps, one of which is broken and the other two not only break often but are located on the very outskirts of the village.  Without a cart or bicycle it is very difficult for transporting filled buckets.  In the rainy season, there are many wells but most of those have dried up by now. With the growing population, the situation is becoming more and more exhausting for women and severe because people do not have access to the water they need.   Saraya is built on a sheet of bedrock, which makes well building very difficult and risky because once you hit that rock, your well is done and you just spent that money building a well that will never reach water. (Good place to build a village eh? Good job who ever Sara is…)

The problem also affects the hospital in which I work.  They are often forced to take an ambulance to a neighboring village and pay for that water when there is not enough at the hospital.  There is also a brand new hospital built by JICA (like the Japanese version of USAID) waiting to be opened, but there is no access to water there yet.

Additionally, Saraya has electricity access from 5pm to 1am.  As a departmental capital, the population believes that there should be access to continuous electricity in a growing town for it to begin to develop.  Also if Saraya did have continuous electricity, the pump that feeds into the water tower could potentially be run off of electricity instead of a gas generator.

For me, the water problem is an inconvenience; I wash my hair less often, sue me.  But for the women that have to provide water to their families for basic things like cooking and drinking, the problem is quite segerin. (exhausting).

So far, all that news of the looming violence that was to break out in Senegal on Election Day was totally wrong.  Not that I expected to see violence in Saraya, but on Election Day the whole country kept itself together.  I went by the school where the elections were taking place, and people were standing in LINES, QUIETLY. Those are NEVER words I would use to describe events in Senegal.  I took photos to show people for the next time we have mosquito net distributions.  Maybe the whole police/soldier presence quieted people down.  The Saraya Red Cross volunteers stood by with a first aid kit in a stretcher in their official vests, luckily looking totally bored.

That night on the television news, they started announcing raw numbers from every voting office, which took a really long time because many voting offices have only about 200 voters.  They said the exact number of people voted for each of the 14 candidates at all the voting sites.  As boring as that sounds, I for some reason became addicted to the TV, and there weren’t even graphics like CNN would have on Election Day.  Wade won the Saraya district hands down (not sure if handing out cash to people or giving pounding machines to villages had anything to do with that).  But in the rest of the country, the results were more mixed up and none of the candidates achieved 50% of the votes.  On March 18^th, there will be a runoff between the top two candidates, Wade and Macy Sall.  So is this transparency and peace for real or is this the calm before the storm? We’ll see on next episode of Sene-gal.

Senegal is quite the tiny country. A lot of people have not heard of it, especially people who work at the bank you have to call and tell them you are out of the country (sene-whaaaT?).  Anyways, a lot of the reason why people do not know much about it is because it is historically not one of those African countries that have some work to do in the democracy department, which many African countries are.   So now I was surprised when my mom texts me telling me that the election drama in Senegal is making it to newspapers in the United States.

The story is (now I am going to be as neutral as possible because one of our jobs as representatives of the U.S. government is not to express opinions on politics), that the president now, Abdoulaye Wade, has been president since the year 2000.  I was thirteen years old back then (the good ol days).  Additionally, his age is up for debate but the consensus is that he is around 85 years old, going on 86 in a couple of months.  His second term is up (the constitution changed a couple of times saying how long a term is, from seven years to five, and back to seven), and the National Assembly said he could run for a third term because the latest seven year rule did not count for his last term. Many Senegalese people think that the fact that he is allowed to run at all is totally bogus and are quite fed up with his antics while in office.

In the past couple weeks leading up to the election which is set for this Sunday and has 14 candidates including Wade (and not including famous musician Youssou Ndour who ran but had a couple thousand ‘illegible signatures’ so was disqualified), there has been many violent protests throughout the country. And by saying throughout the country I mean mostly around Dakar and the bigger cities like Thies, St. Louis and Kaolack.  In Kedougou, the only signs that there is an upcoming election happened last week when Wade came to Kedougou and the guards at our house would not let us out because apparently there was some rock throwing.  Otherwise, safe and sound down here in the bush.

Coming down from Dakar the other day, I witnessed some fires and road blocks and was not permitted to move around the city by Peace Corps, who is keeping us informed of any violence and telling us to stay in our villages where it’s safe (don’t you worry folks).  But it will be interesting to see the results next week.  A candidate has to get 50% of the vote to win, and with 14 candidates, it is likely that they will have to call a second round of votes the next month. (There was also one time when Wade tried to change that to 25%, the people did not agree).    Another interesting thing that I have noted is that many of my friends that are not from the area in which I live. Any teacher or health worker in this country is in the affecté system which means very few teachers or health workers live in the place where they are from.  Many people did not fill out the paper work or get approval to vote in the village in which they work, and are not able to go home to vote. With the violence and protests, it is difficult to travel around the country anyways.   I would think that this will prevent a lot of the educated population from voting at all.

So will Senegal be able to keep its reputation of being one of the few West African countries with a peaceful and working democracy? Stay tuned and we’ll find out together.

Some interesting articles/videos

http://allafrica.com/view/resource/main/main/id/00030652.html

http://allafrica.com/stories/201202201120.html

http://articles.boston.com/2012-02-20/news/31080252_1_opposition-activists-militia-dakar

This month, we had the pleasure of hosting the Peace Care team again to continue the fight against cervical cancer and to strengthen the skills of the local health workers in a sustainable way. The team in Saraya was thrilled to see two of our returning members, Andrew and Tracy and excited to meet the new members, which included two resident family physicians, one family physician and faculty member at UIC, a med student and two people who made up the communications team to work on informing the local population about cervical cancer.

Aside from some setbacks that should be expected working in the developing world, such as having cars with no gas because of a fuel strike, then gas but no cars because of a car accident, the trip was a success.  We refreshed the workers that have been trained in the visual inspection method to look for precancerous cells; tested women in four villages for cervical cancer and had more meetings to plan for their next trip.  The next steps are to train health professionals in cryotherapy, which is a procedure which involves freezing off precancerous cells from the cervix (similar to wart removal), and expanding the program in neighboring regions.

At the end of the trip, we had the opportunity to meet with a team in Thies (a big city outside of Dakar), who is doing a similar program with one of the public hospitals in Dakar (mostly funded by outside partners).  The program there has been very successful and touched many women.  Professor Diop, the doctor heading up the program hopes to expand it into neighboring regions as well but has not yet found funding to expand.  Eventually, he said he would like this program to expand to the whole country.  At first, one might think that our program with Peace Care would be doubling the program being run top-down, but Professor Diop encouraged us to continue.  If they cannot yet find funding for a neighboring region that is much more affluent than other areas of the country, Kedougou is not going to see the benefits of that project for many, many years.

See below the blog post I wrote for the Peace Care trip blog.  You can also find more information about the Peace Care program here: www.peacecare.org

As Peace Corps Volunteers, we have a lot of experience in dusty and bumpy car rides and the occasional bout of vomiting and diarrhea that are unexpected and come with no explanation.  This makes us pretty tough cookies, but unfortunately we are not also doctors and cannot provide the education to healthcare workers that our Peace Care team can, so we have to teach them the skills of us volunteers and go into the bush. Which for today included skills in tying scarves around our heads and faces to avoid dust, how to sit properly in the back of a pickup truck and how to go to the bathroom when there is no hole to go in (this village only had one latrine, otherwise just private peeing spots).

Today, we took half the team to what I often call ‘the end of the line,’ a village with a population of 200 called Toubacouta.  It is over 60 kilometers away from Saraya and 7 kilometers away from the closest health post in Missirah Dantila, which also happens to not have a midwife in the area…or a roof for that matter.  Not only are there no boutiques where one could buy a soda or a cookie in the village, but there is no health structure.  We were very resourceful and set up a cervical cancer testing room in the hut of the community health worker, Mamadou with 2 desks from the school (made out of bamboo fencing) and a mattress.

Because this village is removed from the general health infrastructure aside from a community health worker that focuses on malaria prevention and treatment, most of the women in the village had never had a prenatal consultation during their upwards of 8 pregnancies, rather had a chance to have a gynecological exam.  Because of this, there was much more hesitation for the women to come get VIA than in the other villages that had a health post and a skilled birth attendant or midwife who not only provides things like prenatal consultations, but also education on the importance of women’s health.  Many of the women refused to get VIA because they said they were done having children, they had to ask for their husbands’ permission (who lived in other villages), had to leave to go pray or cook.  The women who did agree to the exam did not allow the male nurse who serves the entire area around his health post, in the room.  The team was only able to test about seven women.

Aside from not testing very many women, the village was still very happy to have guests and made many friends.  Emily got a name, Diancounba Dansokho (which she still cannot pronounce) and some of us even received new friendship bracelets.  As we returned to Saraya, everyone was very happy to be able to buy soda, squat over a proper hole and take a nice bucket bath.

I just returned to site after quite the whirlwind of activities in Dakar and Thies.  First, we had All Volunteer Conference, where all 250 Senegal volunteers plus more from other West African countries came together to share best practices and projects.  After this, was the West African Invitational Softball Tournament, or appropriately, WAIST, where I wore a sweet outfit that looked like League of Their own and ‘played’ softball and went to prom themed parties because sometimes Peace Corps is just high school 2.0.

Finally, we had our Close of Service Conference in Thies.  My entire ‘stage’ or training group, all 39 of us (started at 42), got together for the very last time to begin the process of leaving Senegal and returning to the everyday life in America.  This conference was a mix of learning how to fill out paperwork (yes, because Peace Corps is part of the U.S. government there is a lot of paperwork), how to say goodbye to what we called home for two years,  and how to stop picking our nose and talking about our bowel movements in public.  Unfortunately, this conference did not include lessons on how to use iphones or kindles.

These three days, while lovely to be with our group again (there was a lot of crying and cuddling happening, obviously), was incredibly anxiety inducing for me.  While sometimes I say only three months to go, sometimes I need to say I still have three whole months left.  I still have two big projects to finish, reports to write, and babies and friends to spend time with. On top of that, we had anecdotes from former PCVs who said it took up a year to feel ‘normal’ again in the United States.  Thinking about being ‘that kid’ who will not stop talking about living in Africa to all of her friends makes me feel nauseated, and the thought of catching up on two years of movies, drama with friends and of cell phone technology is giving me an ulcer.

Of course, we idealize America as well.  The land of milk and honey as we call it in Peace Corps Senegal. I am going to be able to drive to the store to buy anything.  The other day I was telling my friend LaRocha that I am sad that I will not have my Nokia Cell phone with the flashlight in America, and she said Leah, you will always have lights in America, there is electricity, you flip a switch. That made me real excited. Plus of course being back with the people that I love and miss very much.  But am I idealizing it too much? Who knows, I think the expression the grass is greener will apply fully here.

What I do know is, and again why COS conference is so important is that the people with whom I trained will be right there with me. We will be able to call each other while hiding in closets to talk about our bodily functions and get pedicures together. These last few months I will spend not only attempting to live in the moment, but how to keep my stories from the past two years alive in my heart, even while eating salads and ice cream on the couch in an air conditioned room.