This trip was particularly exciting because the team was bringing Cryotherapy, a simple treatment method appropriate for the treatment of most precancerous cervical lesions that involves freezing the lesion with Carbon Dioxide. It is considered the most practical treatment method for low resource setting. Previously, to get treated for precancer, you had to go all the way to Tambacounda (four hours and a prohibitively expensive trip away), so bringing the equipment to Kedougou and training a doctor and two midwives here to use it was a big deal.
Making sure the equipment works after the long trip down to Kedougou. |
The head midwife at the Kedougou hospital practices identifying whether a lesion is appropriate to be treated with Cryotherapy. |
Practicing cryotherapy on sausages before moving to actual cervices. |
A fellow Peace Corps Volunteer in the Saraya district
recently told me that she wants to get a tattoo of the Malinke phrase “dondin,
dondin”. As for myself, if I didn’t have
this phrase tattooed into my brain, I think I might go crazy with the continual
challenges and frustrations of development work. What, you may ask, is this magical phrase
that allows an Americans in Senegal to keep it together? It is simple: little by little.
If you ask any member of this trip how they expected these
weeks to go, none of us could have predicted the bumps in the road that we
ended up encountering. One of the three
trainees we had selected to learn cryotherapy (and arguably our first pick due
to her leadership in the project thus far) was summoned by the Ministry of
Health at the last minute to lead a week-long training in another region. Even though we had found thirty women who had
tested positive for precancer during previous VIA screenings and had arranged
for them to be treated during the training (ten for each trainee, the
requirement for certification), only two cryotherapy procedures were
performed. Some women were false
positives, some had precancerous lesions too large for cryotherapy, some had
chosen not to wait until the training and had gone to another region for
treatment, and some simply did not come.
As a result, we were not able to certify anyone in cryotherapy. Upon
arrival in Saraya for Quality Improvement (QI) meetings, we learned that not
only were some of the key midwives absent, but so was everyone else who had
started the QI process last year.
Hurdles of this magnitude, not to mention the fact that the
arrival of the peacecare team coincided with an early beginning of the hot
season and temperatures above 100 degrees, are frustrating, discouraging,
overwhelming. Having now been in
Senegal for nearly a year, I have become quite familiar with these kinds of
obstacles that pop up and hinder the progress of my progress. While I was not expecting the specific issues
that have arisen during this trip, I would have been shocked if nothing of the
sort had come up. Such is the nature of
development work. If it were easy, the
whole world would be the first world. It
can be so easy to get discouraged when your hardest work does not produce the
results that you had hoped and planned for.
That is where “dondin, dondin” comes in.
I have found that most of what being a Peace Corps Volunteer
consists of is adapting to un-ideal situations.
Additionally, I have found that doing that requires a dondin, dondin
approach, taking on one thing at a time and making slow but steady progress
forward. This peacecare team has done an
extraordinary job of this.
An action plan has been created to liaise with the
gynecologist in Tambacounda (four hours from Kedougou) in order to complete the
cryotherapy training procedure. He has
accepted to do this, and logistics will soon be in the works. The days initially intended for meetings with
key personnel turned into productive strategic planning conversations between
volunteers and the visiting peacecare team.
Marathon meetings at the end made up for time lost during the week when
key local personnel came back from their travels. An action plan has been created for concrete
next steps and meetings with those who did not make it back in time. Dondin, dondin. Adapt and take action.
As we move forward with the project, which is so
comprehensive, it is easy sometimes for me to start feeling dizzy as I think
about facilitating all of the moving parts.
But, again, dondin, dondin. Day
by day, things get done. In Malinke greetings, when someone asks you how work is going, the appropriate response is, "Mbaxan (I'm on it), dondin dondin."
We just
finished creating our action plan with Dr. Ndiaye—assurance of completion of
cryotherapy for at least one trainee who started, training of all of the
midwives in the region who have not yet been trained to do screening, preparing
an aggressive communication plan, carrying out a prevalence study, integrating
quality improvement into the program, writing a report for the Ministry of
Health, working to integrate cervical cancer into routine reproductive health
care. It’s a lot. It makes my head spin. There will be obstacles. There will be a lot of obstacles. But dondin, dondin, we will move forward
toward the goal of a sustainable and comprehensive cervical cancer prevention
program in Kedougou.