The Rihannas of Seasonal Malaria Chemoprophylaxis

"Sadio, you tricked me!" my host sister Diabou announced as she approached me with both narrowed eyes and a smile.

"What?"

"You didn't tell me that my picture was going to be everywhere!  Everywhere I go people are telling me that my children and I are on their pamphlets.  Even in the village where I grew up!  Even in Sanela!"

"I did too tell you that!  When my friend who speaks Pulaar came with her fancy camera, I explained that I had been asked by people in Dakar to take pictures to help with their malaria prevention campaign. I told you that the pictures would be all over Senegal."

"Well I forgot.  And you said about the poster, but I or really understand that every person was going to see it.  People from Kondokhou  and even Sanela have told me that they saw my picture. I would have tied my headscarf better and made myself pretty."

"Diabou, you look beautiful in the pictures.  And you look like a good mom because it shows you giving your kids the medicines to prevent malaria.  Be excited!  You just became a celebrity!"

"A what?"

"Basically, you're Rihanna."  With that, the narrowed eyes disappeared, and she ducked, laughing, back into the cooking hut.
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In May I had the fortunate to be asked to attend a workshop with the National Malaria Control Program and other partners to plan for the roll out of a Seasonal Malaria Chemoprophylaxis (SMC) program in the 4 regions of Senegal where malaria is the most prevalent.  I learned an amazing amount participating in this national planning process, and this month, I finally got to see the intermediate and final planning steps as well as the actual launch of the program.  I supervised the training of the community health workers in one health post and then supervised the implementation in several villages.  Seeing a project from start to finish was really interesting, and I think will be extremely valuable in future global health work endeavors.

SMC distribution in action

Yummm Amodiaquine!

SMC is the administration of preventive medicine for malaria in areas where malaria has seasonal peaks during the months of those peaks.  The World Health Organization estimates that SMC can reduce the incidence of malaria within the target age group by 75%. Community health workers go house to house to administer the first dose of the medicine to all children under ten.  The mother is instructed how to give the necessary doses for the second and third day. The medicines protect the child for one month, after which the cycle was repeated.  This was supposed to roll out in July, but due to problems with the medication  manufacturing, it had to be delayed until November.

Maybe it was the delay that made Diabou forget about the pictures.  At the national meeting, I was on the communications committee, and I was commissioned to take a series of photos to be used for the campaign, since I actually live in the setting where the program is taking place and apparently could more easily capture the village scene.  We needed photos for a poster and for a reminder booklet for the health workers who would be implementing the distribution.  I asked my friend Ashleigh who had a sweet camera and takes great pictures to come help.  She recently left us for Amerik and then Cameroon, so I'm grateful to have had the photo shoot adventure.

There is a community health worker who lives with my host family, so he got to play the part of the health worker.  He even changed into his World Malaria Day t-shirt for the occasion.I didn't give Diabou much advance notice of the exact timing of the shoot precisely because I didn't want her to go put on a bunch of makeup and become a scary clown (as she tends to do for holidays)--they wanted a realistic scene.  

Let's be honest.  The primary goal of this blog post is to showcase the modelling talent of my host family.  They are basically Rhianna.

There they are! SMC Campaign poster at the Saraya Health Center.  Slogan: Let's protect our children from malaria.

Brochure to be left with each mother to explain the campaign and how to administer the meds, and the guide for the health worker

Dosage differs by age group, so photos of Mamadou, Oumou, and Sambaly served as reminders of what children of the different age groups look like--people rarely know exactly how old their kids are. 

We took headshots of all the kids that were around that day. They didn't all make the cut since there are just three different age groups, but the photos are so great that I wanted to post them here anyway. Here's Kounadi. 

Samouro is thrilled to see her face all over town on the poster and pamphlets.

Kharifa!

Step by step guide: Identify the children under 10, get clean water, make sure the child has eaten, crush the pill for kids who can't chew, leave the meds for days 2 and 3 with the mother, mother administers remaining meds

More step by step guidance.

This is my favorite picture that was taken that day.  The English translation of Toumany's shirt is: Defeat malaria.  SMC is definitely a tool that can lead to the eventual accomplishment of that goal, and it has been exciting to be a part of it.

October 2013: Month of Specula and Cervices

It’s been looming since the beginning of my involvement with the peacecare project.  Prevalence study.  A massive, yet exciting undertaking.

Peacecare, which pairs Peace Corps Volunteers with academic medical centers in the states (thus the semi-confusing name) has been working in the Kedougou region for the last few years to build a comprehensive cervical cancer prevention program.  They have trained midwives and nurses to screen for pre-cancerous lesions of the cervix using VIA (Visual inspection with Acetic Acid) and brought Cryotherapy equipment to Kedougou in order to treat any lesions that are found during screenings.  They have trained a small team of midwives to themselves continue to train others in VIA and have started to work with the region on developing a policy for cervical cancer prevention.

To gain support for the program at the national level, it was decided early on to conduct a prevalence study of cervical cancer and dysplasia throughout the region in order to demonstrate the magnitude of the issue.  Doctors and the states and here in Senegal decided together on a methodology of a randomized cluster study where mass screenings would be conducted in randomly selected villages.  In order to get a sample size that could be representative of the entire region, 40 villages were randomly selected, with a total of 738 women aged 30 to 50 targeted to screen throughout.

To be able to screen that many women, more midwives and nurses needed to be trained to perform the screening method.   At the beginning of this month, we worked with the midwife trainers to train every female practitioner in the region, to give a refresher course to those who had been trained by peacecare in years past, and to provide an orientation to cervical cancer prevention and the study to all the male nurses stationed in health posts whose villages had been selected for the study.  It was an intense seven days of back to back trainings, but I was blown away by the quality of the midwife trainers and the impact that training of trainers programs can have.

 At the training, we worked together to figure out what was feasible to accomplish on the study during the peacecare team visit during the last two weeks of the month.  Because of the visit’s proximity to Tabaski, the biggest Senegalese holiday, mass screenings had to be limited to the last five days of the team’s time in Kedougou.  Each post took one or two days for screenings, and the district team committed to organizing outings to the selected villages.  When the peacecare team came, they spent a few days in Saraya and then split up to go to accompany midwives in each of the three health districts in the region.

Of course, there were many things that went wrong, but development work is all about finding solutions.  In the Saraya district, we conducted screenings in 8 villages in 5 days, screening 96 women in the target age range, and finding 6 women with precancerous lesions that were referred on to Kedougou for treatment.  That puts the prevalence of dysplasia at about 6% at this point in the study.  It was exhausting, but a great start to a study that will provide results that will be very important in the realm of women’s health in Senegal.

The following is a piece that I wrote for peacecare’s trip blog.  The blog, with contributions from other volunteers involved in the project and the doctor, residents and med student that came on the trip can be found at: http://uicgch.blogspot.com/?view=classic   

  

In the brief moments of calm that surface here in there amongst the madness of the prevalence study, we have snuck in conversations regarding the strategic planning for peacecare’s work in Senegal and the role of Peace Corps volunteers in these different strategic advancements.  My contributions to these questions have come to be based off of the following thought:

No matter what specific role we have, the greatest contribution that I have made as a Peace Corps Volunteer to the peacecare model is the relationships I have with our Senegalese counterparts and the communities within the Saraya Health District.  This has become especially apparent to me throughout the last month as we prepared for the prevalence study by either training or refreshing every midwife in the region on the IVA visual screening technique, and then in the launch of the prevalence study itself.

My fellow volunteer Chip pointed out in a previous blog post from this trip that much of the project planning in Senegal takes place at the last minute.  I would actually take it a step further and say that a lot of the planning and logistics takes place after the last minute, when you should have left for the mass screening already and you realize all the things that are still left to fix.  These are the moments where, without relationships to fall back on to find solutions, some things just could not happen.

When we arrived in Saraya with the peacecare team to find the cellphone network out across the entire department, I knew I was going to have to utilize both my legs and the rapport I have built over the past year and a half to get things rolling. When organizing teams of midwives for the mass screenings, we had to go to their houses to confirm their readiness for the next day’s outing.  An NGO that comes in with no knowledge of the local partners and where they live couldn’t do that.

When we couldn’t call the community health workers in the outlying villages to let them know we were coming, we had to rely on our partnership with the community local radio station.  Fortunately, this partnership is so strong that I have the ability to go and interrupt almost any DJ’s show in order to announce the next day’s outing to the health workers and women of the village.  (The strength of this relationship can also be exemplified through the fact that , on the radio station’s sixth birthday party last month, the Peace Corps Volunteers were presented with the liver of the cow slaughtered for the event.  My husband Patrick said that when he brought the liver to Kedougou the next day to share with the other volunteers, no one in the car batted an eyelash at the giant organ he was holding in his lap.)  In addition to my frequent interruptions of radio programming, I would send messages with people I knew from these villages who happened to shop up in Saraya.  I have spent a great deal of time traveling and working in the small villages surrounding Saraya, and it paid off to know who could get the word out. 

The mornings of outings, I had to rely on my knowledge of who could be sweet talked into loaning us their roll of cotton or box of gloves so that we could leave at a somewhat early time (“We’ll pay for it later, we just really need the gloves right now!”) Understanding the goals, motivations, and limits of different individuals got us going, even when people we were counting on to organize things were sick or called away.

Some relationships are earned, and some are gifted by quirks of the Malinke culture.  Upon arriving in Saraya last May, I was given the name Sadio Tigana.  My host mom is my namesake, and the namesake bond is strong—strong enough that we are in many ways considered to be the same person. For example, her children call me mom.  At one of our mass screenings, I was able to overcome the reluctance of my host mom’s adult daughter to get screened not by explaining the benefits of screening but by telling her “I am your mother, and you must do this for your health.”

The relational aspect of peacecare’s work is one of the things I appreciate most about the model.  In my view, the friendships formed and sustained through the biannual visits and the partnership with Peace Corps Volunteers have done as much to advance cervical cancer prevention in this region as the technical training.

Playing with the babies of midwives isn't necessarily work, but those relationships go a long way.

Elodie, a nurse and one of my best friends in Saraya practices the visual screening method during the training.

Identifying whether a cervix has a precancerous lesion or another pathology.

Two midwives do a roleplay of the counseling involved with cervical cancer screening.

Certified in the theory of Visual Inspection with Acetic Acid.  Now all that's left is the practicum, which midwives were able to complete during the launch of the prevalence study.

Andrew and Michael get a chance to try eating with their hands as we share lunch with a community health worker in one of the villages selected for the study.

P.S. Included in the many things I learned this month are the plural forms of the words speculum and cervix.

Taking it Personally

It had already been a memorable day when we rolled into the health center that evening.  Memorable in both a bad and good way.  Our car had broken down about halfway into our voyage into the deep bush to conduct malaria testing sweeps of five villages that are serving as comparison sites for our active early diagnosis and treatment project.  The project had reached its midpoint, and we needed to see whether the proportion of the population with symptomatic malaria was any different at that point than in the project villages. 

After some hot and frustrating spent time waiting on the road, we finagled some creative hitch hiking and successfully made it to four of the five villages.  In the village where I went, the health worker treated 26 people for simple malaria.  The meds are very effective and given for free by the government, and I love accompanying health care workers as they sweep the village looking for anyone with symptoms, administering rapid diagnostic tests, and treating positive cases on the spot.

The car still wouldn’t start when we made it back to the breakdown site that evening, and the hospital had to send an ambulance to pick us up.  On the ride home, my exhaustion started manifesting itself in random giggles, and I announced I had the tired jollies.  But as we rolled into the health center, I was concerned by what I saw. Two of my neighbors were standing next to the night guard. Siriman, the patriarch of the family we refer to as our second host family, had had a stroke several years ago and rarely leaves home at night—he wasn’t there just to hang out with the guard.

I jumped out of the car and went over to them. “Bebe is sick,” Moussa told me, his face somber, a contrast with the sly grin he usually exhibits. I had last seen Koumba, the four year old girl they referred to as Bebe, a few days before at a neighborhood gathering to prepare a big meal for our soccer team as they got ready to face their cross-town rivals.  She had been lethargic and wouldn’t even smile at me, a rarity. I had told her mom Oumou to take her to the health center—this time of year, any time a kid isn’t acting normal, it’s safe to assume they have malaria.

I started to head to the other side of the health center where the hospitalized patients were, but Moussa grabbed my arm and pointed me in a different direction. The motorcycle storage shed had been converted to an overflow area with two beds. I saw her lying in one, flanked by her father, and her namesake, grandmother Koumba. As I approached, I could hear her labored breathing before I even saw her up close, hooked up to an IV, her small body heaving with each breath. “Thank God they finally brought her in,” I thought.     

“Dobotala?” I managed to squeak.  This is the standard thing to ask any Malinke who is sick or injured. It literally means, “Did some come out of it?” the it referring to the sickness. The standard answer is to say that yes, some came out of it, no matter whether you are actually feeling better or not. But this time, the elder Koumba just said, “We are here.”

I sat with them for a bit longer on a dusty bench before getting up to take care of some things from the day’s outing, assuring them I’d be right back. They were stupid things like paying for the gas and driver for the ambulance that had picked us up. Nothing that couldn’t wait. I was so naïve. Even after having seen two small bodies carried out of that place that week, I didn’t know.

I came back ten minutes later, having gotten distracted telling stories of another day full of adventure in the bush to the nurse from that area, who loved hearing about us getting wildly lost and caught in a rainstorm. Pat’s posture and red eyes gave it away before anything else.

“Did she die?” I asked. As I heard my own voice, I was incredulous at how flat it sounded. This was just not any child, but someone dear to us, someone we had thought of when we chose presents to bring back from the US, someone who was a presence in our daily lives. But that’s shock, I guess. This was the day I had been terrified of for my entire service.

Pat’s eyes flooded.  He had taken my place on the bench, watched her father Omar tell her “dondin, dondin” as she continued to struggle to breathe. Little by little. Then her breath stopped and her eyes rolled back. Omar had sighed with relief; he thought she had finally relaxed. Pat had to tell him that his little girl had died.

I couldn’t do anything but repeat, “I just can’t believe it.” In English, in a whisper, as my own tears started to fall. We had spent the day getting meds to people in villages that are nearly impossible to get to, and now this had happened to a family who lives a five minute walk away from the health center.

“Stop crying, you two,” Siriman admonished in our direction. To Pat, he added, “Ibrahima, there are women present.” We couldn’t stop. “It is God who gives life, and God who takes it away. What can you do?”

I have heard the wail several times before, the signal of death echoed by women across the town. But I have never heard the original wail, the first sound of a mother’s grief. I couldn’t see Oumou as she howled, but the sounds of grief were distinct enough to create a mental picture that will continue to haunt me. The sound simultaneously evoked several emotions. Guilt. How could I have possibly walked away in her last moments? Deep sorrow. There can be nothing worse than losing a child. Raw rage. Why the hell did they wait so long? Indignation. How can we live in a world where the 50 cent cost of a consultation can be too big of a barrier to access  care?

I’ve watched so many kids get malaria over the past two rainy seasons. I have yelled at my host family for delaying in taking kids to the health center. But the kids I know have always been fine in the end, to the point where I had started to wonder whether I had been overreacting. 660,000 children die from malaria every year, approximately one every minute. That minute it was in Saraya, and Bebe turned a horrifying statistic into a horrifying personal reality.

 Much of my Peace Corps service has been dedicated to fighting malaria, particularly in getting early treatment to those who contract the disease, despite the arsenal of prevention efforts. Back in August, the director of Peace Corps Senegal came to visit us in Saraya and accompanied me supervising an active sweep of a village. He talked about how important the project is, how it can serve as a model in preventing child deaths across the continent, showing that it’s possible to play offense instead of defense. When he talked about the project’s importance, I was gladdened to realize that there was nothing I would change about the way we were implementing the project or the work I was putting into it.  I had been giving it my all to this fight against malaria, without knowing who was watching.

But the fight became personal that night. I am taking malaria personally, and the gloves are off. I am channeling my sorrow and rage into this work. Because, Siriman, that is what I can do.

Bebe, second from right, with a present brought to her by my friend Kara on her visit last November.

There and Back Again

If you look through my journal, the majority of my entries start with an excuse about the reason that I have gone such a long time without writing.  It apparently has become the same thing with my blog.  The thing is, I have so much to write about from the past three months, and it’s been hard to know where to start.  The PECADOM Plus malaria project scale-up was launched in July, and so much happened during the five days of the project launch (which may well end up being the most important five days of my service) that I spent about 6 weeks journaling about all of the crazy incidents that could have blown everything but miraculously didn’t.  I didn’t want to forget a thing, but I knew it would be too much detail to blog about.  Even with all that time journaling, I didn’t even get to day 4.  There will be a blog post about it all and what came after, but not this one…at this point, I might as well wait for some results, and we just completed the midline evaluation of the project, comparing the 15 project villages with the 12 comparison villages that we could get to during the height of rainy season, so midline results are coming soon.

Right after the project launch, our dear friends Marija and Michael Crosson came to visit, and I am hoping that there will soon be a post written from their perspective of the wonderful time we shared in Kedougou (hint, hint, you two). After their visit, it was only a matter of making it through Ramadan before we were to embark on a journey to a strange land: America. 

Picking the dates for this trip home was a tricky business.  We had to go home early enough to be able to spend time with my sister Jill, who started a teaching job in Wyoming, and late enough to be attend two very important weddings, one where I was an usher and another where I was a bridesmaid.  There were birthdays and family reunions, and, of course, the fact that we were trying to schedule all of this in the middle of the implementation of the malaria project.  The project entails low level community health workers doing sweeps of their village each Monday to test for and treat simple malaria, so we arranged the trip to miss as few Mondays as possible in order to maximize our potential for supervision of villages throughout the five month project.  Fortunately, our good friend and close neighbor, Karin, has been highly involved with the project since its beginnings on a smaller scale in our friend Ian’s area last year, and she took over the coordination, no problem.

Because I have thoughtful and inquisitive friends and family, I was put in a place of reflection about my time in Senegal and at home almost constantly during our time in the states.  The airport in New York brought several surprises.  I was amazed by the diversity surrounding us as we waited for our bags in order to go through customs and then equally amazed by instinct to carry my huge duffel bag on my head.  We were blown away by prices and found ourselves converting dollars into West African Francs (this beer is 5 mil???) 

Our first real meal was during our strategically planned overnight layover in Minneapolis.  Kara picked us up at the airport and drove us to a dive bar that was filled with familiar faces and featured the Juicy Lucy, a hamburger where the meat is infused with cheese.  We had heard of this Minneapolis delicacy in the food-fantasy –filled weeks leading up to the trip and made the request.  It was delicious, and I have no regrets, even though my I later learned that my stomach had basically forgotten how to process meat, and Pat and I spent most of the night alternating turns in the bathroom.  It should be noted here that on the way to the airport in Dakar, our country director, who kindly dropped us off, warned us that, once stateside, we should not talk about our intestinal issues in polite company.  That first night made the warning difficult to adhere to.

Often throughout our time at home, people asked me if it was weird to be back.   I had fully expected it to be, but I guess a year and a half in West Africa, no matter how significant, can’t erase 18 years in one house in Montana.  It was shockingly easy to slip back into such a comfortable way of living.  I did appreciate every single hot shower, however.

I know it will be hard when we make the real transition back to America in just over six months.  But for this visit home, we were able to just focus on seeing people we loved, being in the mountains, eating delicious and nutritious food, and enjoying the general glory of America.

I know that a lot of people who read this blog were people I saw when back home, so I’ll stop with the reflections here and just let the pictures (and captions, I guess) do the talking.

I left my site on the evening of Korite, the second biggest holiday (notice my fancy outfit).  This was not the plan, but since the lunar calendar is not exact, it's the way things worked out.  It turned out that it was next to impossible to get a car to the regional capital, and another volunteer and I had to throw down to pay for a police car to take us.

The voyage took four days from our home in Senegal to our home in America, but with such a welcome crew, who can complain?

Family pictures at my Grandpa's 91st birthday party--I've got some stellar cousins..

Grammy!  We'll be back just in time for her 90th birthday next May.

My sister was able to come up for a few days before starting her teaching job, and her boyfriend Bret was able to join us for the weekend.  So good to be all together.

The familia at our cabin, one of my favorite spots in the world.

Hiking with Mama.

Lava Lake with Emily.

Pat's Mom's family had a family reunion on Hebgen Lake.  Somehow I grew up an hour and a half away and have never been there.  This photo is the fifth or so in a series where I can't seem to keep my eyes open, so it's that I'm really surprised here.

Natusi, Emily's dog, gets a good view of the lake.

The moutain mornings were so cold!  It was so fun to be able to bundle up!

We drove through Yellowstone on our way back home from the reunion.

Wearing shorts and showing my knees in public really took some getting used to.

Hot potting in the boiling river!

Demonstrating the skills I have learned in Africa.

First of two wedding weekends.  Back to Minneapolis for my college roommate Kara's wedding.  Weddings are the best.  So many good people in one place to celebrate love.


One of the highlights of my trip home: surprise rendition of Toto's Africa just after Kara and Dan were pronounced husband and wife.  Rachel Reckin is a rockstar for pulling this off.

Wedding weekend number two!  This time we drove to Tacoma for another reunion with some of the best people around.  

So honored to be a bridesmaid in Kerri and Jame's wedding.  Kerri is one of my dearest friends from PLU.  You know you've been gone for a long time when your friends get engaged to people you haven't met yet!  Fortunately, I approve in a big way.

There were so many good times I didn't get pictures of.  A whirlwind trip back to Missoula, where every hour was booked with a date to catch up with someone fantastic and we realized that we felt just as home there as in the Gallatin Valley.  Game night with my mom's friends, whom I have adopted as my own.  So many good meals.  A 30th birthday party.  A pedicure when I still had henna on my feet, and my pedicurist didn't have a clue what to do with me and basically rubbed the tops of my toes raw, laughing all the way.  We were exhausted from our efforts to try to spend good time with as many people as possible, but we didn't come home to rest.  We knew what would rejuvenate us, and it did.  Thank you to everyone who was a part of that rejuvenation.

When we got back to our hut, this jungle of a yard awaited us--this had been dirt when we left.

This is what you get for leaving during rainy season: a bunch of weeds and a banana tree that is thriving.  All of our clothes also smelled like mildew.

So it's back to the grind.  Except for here, the grind means finding ways to make it down ridiculous roads, made almost impassable by the rains to measure the incidence of malaria in my project's comparison villages and training midwives to screen for cervical cancer.  There's nowhere else I'd rather be.

Xa wulu, Xa faxa: Entering and leaving the world

"Ritual is necessary for us to know anything." -Ken Kesey

Rituals give meaning to life.  For me, observing and participating in rituals have been a great window into Malinke culture, times when old traditions come to light in this modern world.  In the past few months, I have felt closer to the rituals associated with birth and death because of their proximity to Sira Diaby, my neighbor, Peace Corps designated community counterpart and closest Malinke friend.

Sira gave birth to her second baby boy on May 3.  I spent quite a bit of time in the maternity ward of the hospital with her after the birth, and was several times struck anew by the harshness that life can bring sometimes.  She shared a room with several other women, had to bring her own sheets, and bathed standing on a patch of dirt behind the administrative office building, with only a wrap skirt I held up for her for privacy.  I felt so uncomfortable watching such a dignified woman recover from giving birth in such an undignified set of circumstances, but the hospital has no means to improve these conditions.

After she left the hospital, Sira spent one week in isolation with the baby in her mother in law's hut.  Even though her leg was cramping and her foot kept swelling, she refused to go to the health center to let the midwives examine her because of the belief that if she is seen by certain eyes before the baby's first seven days, the baby will die.

On May 10, the Koulio took place.  This literally means "head shaving", and is a baptism and naming ceremony.  Some people do it big and kill a goat and have music, but since Sira's older baby hadn't done that, they kept it simple and just did the ceremony and gave rice paste to the guests.  I have been to many a Koulio, but I usually show up mid-morning.  This time, I came early to help Sira get ready and was thus exposed to all of the rites that are performed before the big crowds arrive.

Sira preparing for her big day.  Her big day, you ask?  At Senegalese baptisms, the focus is much more on the mother than on the baby.  Women get very dressed up and often wear immense amounts of bright make-up and take lots of glamour shots.

A pre-baptism ritual wherein a bowl of water with traditional herbal medicine is placed next to some burning straw and sprinkled onto the straw to create an ash with medicinal powers for the protection of the mother and the baby.  Next, the piece of gourd bowl to the left is stomped on by the mother.  It is a woman in the nimakhalo group of the caste system (metal workers, story tellers, leather workers, all determined by last name) that carries all of this out I'm not exactly sure what all of this means, and when asked, people have a hard time explaining the "why" of the different elements of the rituals.

In Senegal, babies are almost always carried strapped to their mother's back.   I didn't realize until attending this part of the baptism that they don't nyoun (carry on the back), until the seventh day.  Sira held the cloth behind her, and a knife was dropped through the space three times.  After that, the other women helped to balance the baby on her back (the babies eventually become trained to balance themselves during the strapping--it's amazing to me).

After a while, more and more people began to arrive and the washing head shaving began.  Here, Sira looks on as the baby's head is shaved, with the pieces of his hair collected for yet another small ritual later on.  After the head is shaved, the baby is held up, and in a much more casual manner than you would think, the name is announced.  Karamba Danfakaha.

At baptisms, party favors are always plates or balls of deego, a kind of paste with a playdough like texture, prepared the day before by female friends of the family from pounded beans or rice.  I don't really care for it but it would be an insult not to take it...I just wish that everyone didn't offer it to me.

Depending on the family, these rituals can then turn into a big party with dancing and a feast or can be more low key like this one.  The important thing is that the baby is named.  And with my favorite Malinke name.  Ay, Karamba.

***

While I have been to more baptisms that I ever thought possible during the course of the last year, until this week I had never been to a funeral.  Neither of these events have invitations, but it feels much more comfortable going to a baptism of someone I don't know than to go to the funeral.  I have gone to greet the families of several people who have died, and I have heard the wail, the shrieking of women after a death is announced.  But I had never felt comfortable staying and observing an entire funeral rite.

When I got back from a weekend camping on the border of Guinea, I stopped by to greet my family and upon asking for my host-mom and namesake was told that she was at the "bandula".  The official word for "to die" in Malinke is "xa faxa", but "xa ban" is used more often.  It literally translates as "to end".  So I was told that my mom was at the place of the end.  It followed that the Immam, my friend Sira's father and the religious leader of the community had died the previous evening at the regional hospital in Kedougou.  This was a funeral I needed to attend.

I changed into nicer clothes and approached the Diaby compound.  A tent had been set up in the street outside the compound for the overflow, and I took a seat amongst the women there and tried to take in what was going on.  I have never been in such a somber atmosphere in my site.  A small group of women was cooking in the sun, and I was surprised to see that they were finishing the meal so early in the day (it was not even noon, and meals at big gatherings like this are usually not ready until 3 or 4, necessitating a pre-lunch during a quick break from the festivities).  I saw my host mom emerge from the compound to help with the process of dividing the rice from the. giant cooking pots into bowls for the guests to eat out of in smaller groups, and I went to greet her.  In return, she handed me a giant piece of meat (the closest thing I have seen to a steak in the region of Kedougou).  She mistook my bewilderment as a reaction to how hot the meat was, so she  gave it to another woman who had a spoon with the orders to accompany me and the meat.  The spoon woman didn't even blink at these orders, while I had no idea what was going on or where I was being accompanied to.  I followed her dumbly into a neighboring compound and then into a hut where she left me all alone with a sleeping baby.  I'm usually suspicious of meat in Saraya, but this was actually quite good, and I chuckled as I ate it with my hands, just me and the baby in this hut whose owner I had never met.  After more than a year here, I can still get caught off guard.  

Emerging from the hut, I saw groups of people crowded around bowls of rice and meat, each summoning me to join them as I passed.  It looked like people were returning home after they ate, and I joined my host sister Mballou on her walk  back to the family's compound.  I had actually never met her before--she had walked 13 km from the village where she lives with her husband's family, joining the scores of mourners who had descended upon Saraya for the funeral. 

Things got started again at afternoon prayer time.  I donned a headscarf and headed towards the mosque, but it was so full that I just stopped and sat with the crowd of women lined in the small strip of shade provided by the cement wall across the street.  After a while, crowds emerged from the mosque.  I have never really seen Malinkes cry before.  Some women were doing the wail, and some openly weeping.  I heard one woman sob, "He taught all of the people of Saraya".  The men accompanied the body from the mosque to the graveyard (the location of which I had never known before), while the women sat in and around the Diaby compound waiting, some crying softly to themselves.  The men returned, and the benedictions began.  I had imagined this part of the process to be a simple receiving line, each person saying the blessing that I had memorized before coming over: Allah mu yamfama kela aye (May God forgive him).

Instead, men from each major family in Saraya and men from other villages each took turns proclaiming blessings on behalf of the village or last name they were representing, their words echoed by a griot.  This lasted a really long time, and I had made the unfortunate choice of not bringing any water.  I waited it out, and went into the compound to try to find Sira.  I approached her, took her hand and mumbled my memorized blessing; she opened her mouth to speak but couldn't find any words.  Even when you know the official thing to say, there is no right thing to say in any culture.  But rituals help.

“This is what rituals are for. We do spiritual ceremonies as human beings in order to create a safe resting place for our most complicated feelings of joy or trauma, so that we don't have to haul those feelings around with us forever, weighing us down."

-Elizabeth Gilbert, Eat, Pray, Love

This Senegalese Life

When I think back on how drastically different everything seemed to me when I first came to Senegal, it is hard to believe how normal everything has become.  My moments of “Holy cow, I live in Africa…this is my life” are much diminished.  Though I do make an effort to maintain a sense of wonder, I have adapted to this new normal.  Patterns of a typical day have emerged.  Welcome to a day in the life of Annē Linn.

I am a huge fan of sleeping in, however, despite my talent for it before joining the Peace Corps, I typically wake up around 6:30.  We sleep outside whenever possible because of the heat, so it’s usually a combination of sunrise and the noise that wakes me up.  What noise, you ask?  Mostly goats.  I had no idea how crazy goats were before coming to Senegal. People don’t tether their livestock, so they are free to roam about making their ridiculous sounds that have inspired many a game of “Goat or Child”.  This Youtube video provides a very, very accurate rendition of my daily alarm clock. 

Upon getting out of bed, the number one priority is to get water.  This is not as simple as it may seem.  Our site has serious water issues (they basically chose the worst village possible to transform into a Departmental Capital—rapid population increase+very limited groundwater=very bad situation).  At the height of the dry season, water from the water tower only came on in the town’s outdoor taps for about a half an hour each day, if at all.  There are huge crowds of women at every tap—thankfully they usually let us cut to the front because we fill just fill up our small buckets.  It’s not the carrying the water on my head part that’s difficult (at this point anyway—at first it was incredibly hard), it’s calculating when the water will come on and where to get it that can get tricky.  We pay 25 CFA (about 5 cents) per bucket, but that water is worth more than the gold that has brought thousands of people to an area without the geology or infrastructure to support them.

Waiting for the water to turn on--got their before the crowd this particular morning

The next morning calculation is when the fresh bread will come in from the Pulaar bakers on the outskirts of town in a cardboard box on the back of a bike that is not capable of going in a straight line .  Sometimes this coordinates well with the water timing, sometimes not.  Breakfast is the only meal we do on our own, and I have come to really cherish it.  Sometimes we buy bread and take it back to our hut, sometimes we go to the little breakfast shack next to our family’s compound.  I don’t have much of an appetite later in the day when it’s so hot, so I really try to have a big breakfast.

Ousman preparing breakfast for the miners waiting for cars to  Kharakhena, the most recent gold mining boom town

Other morning activities include brining our bedding and mosquito net inside—it’s annoying to do every day, but totally worth it to sleep outside.

Mosquito nets...they protect against a lot more creepy crawlies than just mosquitoes

I usually give myself until 9 am to enjoy the cool mornings.  We brought a French press from home and get coffee sent from Amerik (thank you, loved ones), and I have really come to appreciate these small reminders of home.  Pat and I usually take this time to read individually or together, from the Economist (which, since Pat had a subscription in the US, we get delivered to Kedougou in an incredibly timely manner compared to the rest of our mail and for now extra charge), New and Selected Poems by Mary Oliver, Guerillas of Grace, or the Book of Common Prayer.  It is this time of quiet that prepares me for the day and whatever challenges (work-related, cultural, or physical) the day may bring.

Then, it’s off to the office.  Since we really don’t have set work hours, I made it a priority to try to work outside of our hut.  That way, our hut feels more like home and I don’t have to feel like I should be working if I’m there (I don’t always succeed at not feeling that way).  The shade structure outside a building known as the Colonial Room that the health district uses for meetings and trainings has everything we need: electrical outlets (electricity is on in the morning from 8 to 12), shade, a table, and a collection of broken chairs that we can stack in order to make two functional chairs.

Where the magic happens

I had noooooo idea how much of my Peace Corps service would be spent on my computer.  In fact, Pat and I were only going to bring one computer between the two of us,  but then, my father-in-law gave me the amazing going away present of my own lap top.  Good thing he had more insight into how much screen time my service would entail.  I spend the mornings preparing and revising budgets, creating training outlines, writing grants or project reports, endlessly editing study protocols, emailing district or regional health staff or Peace Corps administration, scheduling (and rescheduling every time) different components of projects.  And blogging every once and a while, of course.

We work until about 1:00, when we head home, drop off our computers and grab spoons, and head over to our host family’s house for lunch.  Waiting for lunch is prime playing with kids time.  Lunch is usually rice with a leaf or (if we’re lucky) peanut butter sauce.  The family gathers around three different food bowls.  We are with the young adult crowd, while the grandparents/grandchildren and students from outlying villages that lodge with our family each have their own bowls.

Around the foodbowl (this is a way fancy meal with veggies and meat in honor of my parents' visit--not typical)

After lunch, it’s time to figure out how to get through the hot part of the day.  This is the time of the day when we do most of our sitting around with our family and neighbors, usually drinking tea or shelling peanuts.  Lots of people take naps, but I have lost my napping ability as well as my sleeping-in ability–-I just can’t get my mind to turn off.  Afternoons are the hardest part of the day for me.  I think that as integrated as I’d like to think I am, I can’t get deny some of my American ways of thinking.  I want to do work-ish things from during the day and have the evenings off.  So then, during the afternoons, it’s hard to really relax, and I find myself thinking constantly about productive activities I can be doing to fill the time instead of just sitting around, which is what everyone does.  It’s also just really hot, which doesn’t make anything easier.

Sample afternoon activity: our neighbor Bintou teaching us how to make a tasty snack out of Baobab fruit

In the late afternoon, I like to hang out around the hospital.  The hospital staff congregates under their shade structure then (their timeline is different than the Malinkes—they are all from cities and therefore tend to eat lunch much later) and I can usually count on tracking down the people I need to talk to about different things at that time.  I have recently started learning Wolof in earnest (mostly so I can understand the conversations flying around me under this very shade structure), and the hospital staff is a group of very enthusiastic teachers.  

It starts to cool off around 6.  And that means basketball time.  There is a great group of teenage boys and a few health staff that play every night, and I have started playing with them whenever I have time in the evening.  It is such a blast—gotta love team sports.  The rules for half court are a bit different on this side of the Atlantic, so it took me a while to understand what was going on every time the ball was taken out (or not), but I’ve got the hang of it.

After basketball, I take a bucket bath and head to my host family’s compound for dinner.  This used to be a race in order to get there in time to watch “A Castle for Two”, a ridiculous(ly good) Colombian telenovela dubbed into French that everyone was super into, whether they spoke French or not.  That show ended, though, and was replaced by one I haven’t been able to get into, which is ok since now the days are longer so basketball doesn’t before the time slot anyway.

Dinner is usually varying combinations of rice, peanut powder and oil.  One person holds a flashlight as the meal is shoveled down.  People retreat from the food bowl to their evening sitting positions—the students in front of the TV, waiting impatiently for the news to end so that they can switch it to music videos, the kids falling asleep in their clothes on the stick beds.

We sit for a bit and then return to our hut, despite the protests to stay and “xa sumun” (to stay up late talking).  Evening is a time we try to take for ourselves, reading or watching a show for a quick escape back to America.  We set up our outdoors sleeping set up and collapse under the mosquito net.

This progression of days is the backdrop to most other posts I’ve written.  Here, as in anywhere, days go by slowly and months speed by.  I have grown to find comfort in the daily routine, knowing a little bit of what comes next in a place that, no matter how adapted or integrated I am, can always manage to surprise me.