Dondin, Dondin

In late February, a team from peacecare came to Senegal for the second time during my service.  peacecare is a new organization that works on sustainable global health initiatives by pairing academic institutions with Peace Corps Volunteers.  Saraya is their pilot site, and it has been great to be a part of this project, which is to create a comprehensive cervical cancer prevention program.  Until this trip, the efforts had been focused on training midwives and nurses to do VIA (Visual Inspection with Acetic Acid) to detect precancerous lesions at the village setting and to train lower level health workers about the issue of cervical cancer in order to ramp up project communication potential.  (Check out my blog from their September visit if you're interested in learning more: http://www.lineoverthee.blogspot.com/2012/10/peacecare-and-disease-that-sits-in.html )

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. 

Dr. Tracy Irwin, an OB/GYN at University of Illinois-Chicago who is a leader in the peacecare organization posing with Dr. Aziz  Kasse, the leader in cervical cancer in Senegal. It was a huge honor for Dr. Kasse to come all the way down to Kedougou to attend the cryotherapy training and really validated what a big step this was toward protecting women's health.

Peacecare has its own blog, and team members are asked to contribute on each day of a trip.  Representing Peace Corps and wanting to be very honest about what development work is like on the ground, I wrote the following:

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.