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.
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| Playing with the babies of midwives isn't necessarily work, but those relationships go a long way. |
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| Elodie, a nurse and one of my best friends in Saraya practices the visual screening method during the training. |
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| Identifying whether a cervix has a precancerous lesion or another pathology. |
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| Two midwives do a roleplay of the counseling involved with cervical cancer screening. |
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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.
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Anne, this is incredible. thanks for sharing your words, it's amazing to hear all the things you are experiencing and doing. You and your work are in my thoughts often!
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