Blogging as an RPCV: Belated World Malaria Day

Well, as of April 17th, I officially gained the status of Returned Peace Corps Volunteer, and as of 2:40 am on April 29th when Bozeman welcomed us home with a blizzard that made it impossible to land the plane for nearly three hours, I physically became an RPCV. I still have more to write about, however, and I really hope that whatever I end up doing next is interesting enough to keep blogging about, because it turns out I really enjoy it. But for now, being that today is the last day of World Malaria Month only 13 days after my Close of Service date, I'm going to take the opportunity to write about the project that has dominated most of my waking hours over the last year: PECADOM Plus.

In past blog posts, I wrote about a fellow volunteer's idea of paying a small wage to low-level community health workers to conduct sweeps of every household in their village once a week during rainy season to seek out any suspected cases of malaria (typically identified by fever, headaches or vomiting), administer a Rapid Diagnostic Test (RDT) and treat any positive cases on the spot. An existing program called PECADOM had already trained these health care workers known as DSDOMs (French acronym for home-based care providers) in rural villages to administer the tests and treat simple malaria. Ian called his active version of the model, where the DSDOMs actively sought out the patients instead of waiting for them to seek care themselves, PECADOM Plus. In 2012, Ian and his counterparts conducted a pilot of the model in one village and saw amazing results. By the end of the rainy season, the point prevalence of symptomatic malaria in the project village was 88% lower than that of two neighboring villages with the passive PECADOM model.

Rapid Diagnostic Tests were introduced in Senegal in 2007.

With results like that, it was clear that a larger pilot was necessary to see if the same effect could be seen with a larger sample size. As Ian prepared to finish his service around this time last year, he and I started to work with local health officials and the National Malaria Control Program to design a scaled-up pilot of the model. Dr. Youssou Ndiaye (the Chief Medical Officer of the Saraya Health District at the time) and I co-authored a research protocol to submit to the ethics committee of the Senegalese Ministry of Health and prepared to scale up the project to 15 intervention villages with the active sweeps and 15 comparison villages that would retain the original passive model. From the beginning, it was all a bit daunting, but I fortunately had an amazing mentor in Dr. Julie Thwing, the CDC's Technical Advisor to the Senegalese National Malaria Control Program for the President's Malaria Initiative.

The region of Kedougou. Project villages in red, comparison villages in blue, and health posts in green. The Saraya Health District is the most spread out health district in Senegal.

 The 2013 rendition of the project rolled out in early July, a time picked on account of a) the fact that the 2012 pilot had started in late July and the prevalence was already quite high--this year we wanted to start earlier on in rainier season to try to keep the point prevalence from reaching as high, and, b) a ton of Peace Corps Volunteers come all the way down to Kedougou for the 4th of July, and we would need one volunteer to supervise the sweep in each of the villages in the intervention villages.

Training of volunteers for the project launch

The days of July 7-11 were definitely the craziest of my Peace Corps service. We needed to supervise the sweeps in the 30 intervention and comparison villages along with a training of women in the intervention villages on the signs and symptoms of malaria and the importance of early treatment in order to facilitate the sweeps and encourage early treatment seeking.

When those days were all over, I honestly couldn't believe we had managed to pull off the launch. All of the health district's cars/ambulances were having mechanical problems, so I had to beg Peace Corps to send a car, which came through at the last minute.  Right as we were leaving Saraya to disperse to the project villages, they told me that since the DSDOMs had only been trained and not installed, none of them had tests or medications.  Then one of the DSDOMs informed me that he had changed the village he was living and working in (this is ridiculous, since it is the village that selects the person to be trained to care for them). We got that sorted out, grabbed meds to bring to the villages, but of course realized by the time we got to the first health post that we had forgotten the thermometers in my hut. One DSDOM who met us at the post volunteered to ride his motorcycle the 30 km back to Saraya to get them. While we waited, the clouds darkened and darkened: I still had a 25 k bike ride ahead of me, and it started raining right as I left. My phone rang every five minutes with either volunteers or DSDOMs with questions about exactly what was supposed to happen. Then it stopped ringing and I realized it had fallen out of my pocket back on the trail. I had assigned myself supervision of the one village where I hadn't been able to contact the DSDOM since the training several weeks prior, so I had no idea if he was expecting me. But, the beauty of Senegal is that you can show up anywhere with no warning without knowing a soul and they will be thrilled to feed and shelter you. I finally got there at dusk, and if the DSDOM and his family were surprised to see me, they made no sign of it. After supervising the training and the sweep, I started to bike back in to the health post, thinking that any moment the Peace Corps car with Pat in it would meet me to take me back and prepare for the comparison village sweeps of the next three days. It turned out that the car missed the turn onto the tiny bush path where I was and went all the way to another village on the Mali border. I was already back at the fields surrounding the village with the health post by the time they met me.

Photo time with the Satadougou DSDOM after the women's training. This village is waaay out there on the Mali border. 

Satadougou DSDOM training women from the village on how to recognize symptoms of malaria and the importance of early treatment seeking.

That's just a small taste of the shenanigans of the PECADOM Plus launch. During the five launch days, both the Peace Corps car and the one remaining district cars broke down at different times, and it rained nearly every day, turning the roads into rivers. Two volunteers from outside the Saraya area who were supervising one comparison village walked into a compound where people were burning mercury to process gold, which freaked them out enough that they left the village and we couldn't use the data. Fortunately, due to another mix up involving a nurse inviting way too many DSDOMs to participate, we still had 15 comparison villages. At one point, I was preparing to send a volunteer with a DSDOM to his village to supervise him, and another DSDOM asked me, "Has this guy ever even done a rapid test?" To which he responded, "What's a rapid test?" Turned out that his supervising nurse was in Mecca for the Hajj, so he had never been trained, and was not ever supposed to be a comparison DSDOM. He had somehow just shown up, gone through the orientation and never said a word.

No big deal, just a river in the road.

Taking advantage of cars going to remote villages, the health district sent nets with us for the Universal Coverage distribution that took place soon after our project launch in all villages in Kedougou

This craziness is what makes Peace Corps Peace Corps. The bulk of my job was figuring out how to adapt to unideal situations. But we pulled it off. Sweeps were conducted and supervised in 30 villages. The project was launched. At that point, the prevalence of symptomatic malaria in both sets of villages was approximately 1.1%. Sweeps continued every week after in the intervention villages. For the next five months, I coordinated supervisions of the sweeps, both through the supervision we had set up through the health district and supplemental supervision by Peace Corps Volunteers for research quality purposes. Sweeps were conducted on Mondays in most villages, which meant that I would call each of the DSDOMs on Saturday mornings to check in with them and make sure they had tests and meds for the upcoming sweep. I was worried that checking in each week would annoy them, but in Senegalese culture, calling super often just to greet is a preferred communication technique, and they loved it. Every Monday that I was free, I would bike to a project village to supervise a sweep myself--I really wanted to know intimately how things were going in each village to be able to understand the final data when it was ready for analysis.

DSDOMs hard at work conducting active sweeps

In September and November we went back to the comparison villages to compare the prevalence of symptomatic malaria. Whereas in July, before the program, the point prevalence had been the same in both sets of villages, in September (half way through the rainy season), the prevalence was 2.5 times higher in the comparison villages than in the intervention villages. By the time the program ended in late November, the prevalence in comparison villages was sixteen times higher than that of the project villages. From supervising closely throughout the project and monitoring the data from the sweeps each week, I had sensed that the active model was making a difference, but I was blown away by the difference we saw at the end of the program. In all of the 15 villages, only six cases of symptomatic malaria were found on the last sweep!

At baseline, both sets of villages had relatively low prevalence of symptomatic malaria, except in this village where Pat supervised. It was a tiny village, but they found 19 cases...over 15% prevalence. Fortunately, after that first sweep, the prevalence quickly dropped and stayed low the rest of the rainy season.

Doing this scaled-up pilot showed that this active model really is both feasible and effective. There had been concerns that weekly sweeps for a five month period would be too much for a DSDOM to take on, but our DSDOMs as a whole completed 89% of their possible sweeps. Only ten sweeps total were missed because of gold mining, whereas, when we went out to the comparison villages in November, only 8 of the 15 DSDOMs were in there villages--all the others had left to mine gold (in the intervention zone, nonetheless!). It could be that the active role (and the accompanying payment) provides an incentive for the DSDOM to stay in the village and be accessible to those who need care. The other big concern about the model was that people would wait until the sweep to get seen instead of seeking out the DSDOM when they first got sick. I was delighted to find that the DSDOMs actually consulted the majority of their patients during the week using routine surveillance rather than during the active sweeps. What I observed was this: in doing the sweeps, the DSDOM starts a virtuous cycle in which he proves that a) he was competent as a care provider, b) the medication is effective, and c) the medication, contrary to widespread misconception, is free, all factors which encourage early treatment seeking on behalf of the community.

After the project period, I spent most of my time going to all of the health posts in the district to find the village of origin of every case of malaria in order to look at the incidence of both simple and complicated malaria at the post level. From 2012 to 2013, both simple and complicating cases originating from project villages decreased more than cases from other villages in the catchment area of the intervention health posts. More evidence that this model is really good! For a cost of just over $1 for person protected, it's very cost effective for these kinds of results. There is a debate about whether or nor community health workers should be paid or should work as volunteers. In doing this work, I have come down strongly of the side of: pay them for the work they do! If they have an actual task, like a weekly sweep of their village, they must be paid to complete the task. As I was preparing to leave Saraya, one of the DSDOMs called me and said that he had never known the value of his work as a DSDOM until this year--it was one of the comments that touched me most as I wrapped up my service.

In early February, I was invited to present the findings to the National Malaria Control Program, which was a huge honor. Pat and our friend Karin Nordstrom, who were both huge in leading the implementation of this year's program, came with me, along with the nurse and community health worker who helped design the original pilot and one of the DSDOMs. I was really happy with the presentation--the NMCP members were really engaged and asked great questions. A few weeks later, I got word that they were interested in scaling up the model to the entire region of Kedougou. Right around the time I was leaving, they got funding for the scale-up, and the model will be deployed in approximately 150 villages. I'm so proud of everyone who was involved in this project and so excited to see where it goes. If we want to reach the goal of near zero malaria deaths by 2015, I think this is a really promising approach in high endemic areas, and it has been an honor to work with people at all levels of the Senegalese health system to show the promise of the PECADOM Plus model.

Our team of presenters at the National Malaria Control Program

Definitely the biggest deal presentation I've ever given

Most of the DSDOMs from this year's project. It was amazing to see what these men, most of whom had very little education, were capable of doing in their communities when empowered by this model for malaria detection and treatment.

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Time to Say to Goodbye

The thing about Peace Corps is that it lasts for two years. You know that going into it. It seems like a really long time. And you fantasize about it ending--with the end comes eating delicious and healthy things whenever you want, escaping the 110 degree heat, not getting constantly called out and asked to give people things or deal with horrendous public transport situations.

But then it actually ends. And it's awful. Pat described yesterday as one of the hardest days of his life. We had been trying to make it known for a while that we would be leaving Saraya on April 10th. But still, some people were surprised as we made the rounds to the compounds where we had really gotten to know people. The goodbyes to the littlest kids and the oldest adults were hardest. Will these kids that we've loved so much remember us? Will these wisened old ones who have taught us so much be around if we make it back some day?

We said goodbye to a lot of people yesterday. According to Malinke tradition, we asked them for for forgiveness for anything we may have done and forgave them in return. We blessed each other (well, they know a lot more blessings then we do, so it was a little one sided; the most fervent blessing was that we would receive a child as soon as possible). And we shook hands with our left hand--the taboo hand, the poop hand. I heard this ritual described as doing something wrong so that you have to see each other again and do it right.

Over the last few days, we had a goodbye dinner at the hospital and a goodbye lunch at the bar that Pat's counterpart opened several months ago. We prepared a goodbye radio show where we greeted everyone we had ever worked with or known, all with carefully chosen farewell-themed songs in the background. (Since that show, the Blind Boys of Alabama have been singing "This may be the last time" over and over in my head.) We did it all the best we could, but it still didn't prepare us to leave. We were leaving people with no assurance of ever seeing them again, we were leaving the puppies that were born under our bed 3 weeks ago,we were leaving a place that has become home, and we were leaving a way of life. It was different than any goodbye I've ever experienced. Goodbyes accompany change, but this will be the biggest life change. Bigger than coming here. Coming here, it was temporary, and we knew we would be coming back to the life we knew in the states. But leaving this life, with its difficulties and joys...this, we will never get back.

Pat and I with our namesakes and host parents in front of the family compound (which a grandchild recently labelled with our names)

For two years, I went by the name Sadio Tigana, a name that carried a lot of weight in the community of Saraya. It tied me to an amazing woman and to all of the relationships she had formed. For two years, I carried my daily water on my head from a tap several compounds away to my hut. For two years, I was a radio celebrity and could go to any village and be known once someone heard my voice. For two years I spoke a language I had never heard of prior to arriving in Senegal. For two years, I participated in every activity possibly with our host family and neighbors--baptisms, weddings, funerals, hut-raisings, hut-demolishings after a fire. For two years, my love of the people of Saraya grew until it burst yesterday during our goodbyes. "Don't cry," we were told. "Crying means it will be a longer time. Just bless." Some of those telling us this were hiding tears themselves, even though Malinkes rarely cry.

Allah mu nioxojela sonoyala. May God ease our seeing of each other again.

We are leaving the region of Kedougou at a tumultuous time, with an Ebola outbreak just across the border and gold-related bandit attacks on the rise. But it is also an exciting time. Next week, the new hospital that sat shining and unopened during our entire service will open its doors with an inauguration conducted by the president. It is never a good time to leave, but it is our time to leave. We are looking forward to exciting things coming up. After a summer of playing in Montana and travelling, we will head east, and Patrick will start a Masters in Public Affairs at Princeton in August (as for myself, my plan is to be determined, and I'm trying to be ok with that).

I'm looking forward to having more control over my nutrition but will miss knowing exactly where my meat comes from. I'm looking forward to running water but will miss knowing to the cupful how much water I use. I will not miss the heat or the dust. I will miss being greeted aggressively by toddlers racing to throw their arms around my legs. Let's be honest: I'll miss feeling like I'm really important. I'm afraid that, once we settle in, life in America will be so easy that it will be boring. I will miss my family and friends (both Senegalese and other volunteers) so dearly, and I pray that I'll call as much as I have promised to.

There are so many feelings right now, and it's exhausting. Now just one more week to slog through the final paperwork and health appointments, and we'll earn our "R" and become Returned Peace Corps Volunteers. Our replacements will come in May and take our friends, our family, our work. (We met them last week, two female volunteers, one health (a Masters International student from Tulane!) and one community economic development. Fortunately, we really liked them, which makes all of this a lot easier to know we're leaving Saraya in good hands.)

We don't know if or when we'll be back. All we know is that we were here. It was hard, it was wonderful. I have no regrets.

More Poems I Want to Write

White Heron Rises Over Blackwater by Mary Oliver

I wonder what it is that I will accomplish today

If anything can be called that marvelous word.

It won’t be

My kind of work, which is only putting words on a page,

The pencil

Haltingly calling up

The light of the world,

Yet nothing appearing on paper half as bright

As the mockingbird’s verbal hilarity

In the still unleafed shrub in the churchyard-

Or the white heron rising over the swamp and the darkness,

His yellow eyes and broad wings wearing

The light of the world in the light of the world-

Ah yes, I see him.

He is exactly the poem I wanted to write.

In June 2012, I wrote a blog post inspired by this poem and by the images striking me at the beginning of my service. Now, a week before I leave my site, there are different images filling my mind, spilling out of me in the form of tears, bursts of laughter, and, now, words: the poems I want to write.

The wobbling legs of the crew of toddlers in my host family’s compound who race to greet me and be the first to throw their arms around my legs.

The two lines on the pregnancy test and the wide eyes of the young teenager who came to me in search of medicine for when you haven’t gotten your period.

The streaks in my vision for hours after standing in the rain to watch the lightning.

The circle of ash and rubble where my neighbor’s hut had stood just the day before.

The solemn face of the chief of Khossanto as he pronounced that he would make it illegal to burn mercury without the retorts we had extended there.

The bottle of water with floating sticks that I was instructed to drink to cure my stomach ailments.

The red rock of the Spires jutting out of the mountaintop as we approached and looked for a place to camp.

The flow of women with empty basins towards the water tower on days when the water cuts out extra early, their looks of desperation increasing with every dry faucet they pass.

Flakes of gold in an outstretched palm.

The seven-foot cobra literally snaking up the dry waterfall.

The sealed labia of a woman undergoing cervical cancer screening and her contorted face as the speculum entered her radically mutilated genitals.

Seny’s grin as I make a tricky shot on the basketball court.

The parade of men walking home from the mines at dusk in Kharakhena, the red dirt covering them a stark contrast to the gold they had been seeking.

The gang of girls singing in the neighboring compound, straightening up and switching to the national anthem once they realized we were filming.

My real mom and my host mom pulling away tearfully from an embrace that spoke the words they could not speak to each other.

These are exactly the poems I want to write.

A Rose and a Thorny Situation

She called to me with a shy smile from outside the maternity where I was sitting with women waiting to be screened for cervical cancer last October. I put down my papers and joined her outside, where Patrick and some of the doctors from peacecare were loading up a hospital car to go do a screening in a neighboring village. She pointed at Pat and Dr. Dykens, “Who are those men?” she asked with a lilting Nigerian accent.

“That’s my husband,” I said, quite defensively, thinking she was looking for a potential client.

She shook her head and pulled me out of view of the other girls who were waiting for their required monthly checkups. “My name is Rose. I’m looking for someone who can help me. I thought maybe those white men…I am tired. I don’t want to do this work, I don’t want to be in this country.” She pulled out her identity card from her wallet. It was from Mali. She pointed to the occupation: hairdresser. “I did not come here to do this work. Hairdresser is what they told me. I’m looking for someone to help me find other work.”

I looked her in the eyes and asked a novice question: “Were you trafficked here?”

She shushed me and pulled me even farther away. “Don’t use that word. I just need help. I’ll do anything, cooking, cleaning, plaiting hair. I just don’t want to be here.”

I felt hit by a ton of bricks. This was by no means my first interaction with a sex worker (known around here as les nigeriennes,or keme naani (the malinnke for 2000—the price ($4), or, at the hospital, or PS for professionelles du sexe). I had seen them often in the big gold mining sites and in Saraya—they stand out as the only women who wear pants and makeup. During my first afternoon interpreting for a midwife on sex worker consultation day, I had to tell one girl she was pregnant and miscarrying and another that she had HIV. When Saraya’s first bar had opened, just one week prior, the owner for some reason thought that the best way to get the party started would be to truck in sex workers from Kharakhena. What resulted was one of the most bizarre scenes of my Peace Corps service: 20 prostitutes dancing provocatively while hundreds of children from Saraya looked in from the street in utter shock and amazement.

This time, however, was the first that I had been directly approached for help. I had suspected that many of them were trafficked, but here was someone who really had been and was reaching out to me. I felt overwhelmed with the responsibility of that. I gave her my number and said I would look into ways to help her. At my hut that evening, I scoured the internet for information on how to help a woman trafficked into the sex trade. I went to the websites of all the major organizations: International Justice Mission, Half the Sky. My heart beating, I clicked on the “resources” tab, only to find links to things like “Start an advocacy organization at your church”. There were absolutely no resources for people in a situation where a real person needed help. I don’t know if I’ve ever felt so hopeless.

Over the next few days, I called and emailed everyone I could think of that could give me some guidance and got almost nothing concrete—email contacts that bounced back, links to organizations that worked in Nigeria but had nothing to do with Senegal. Finally, Pat came back from another cervical cancer screening in Khossanto, one of the biggest gold mining zones, where he had explained the situation to the head nurse and had been given a lead: an organization called La Lumière that had received a contract from the UN to work with trafficked girls in southeastern Senegal. It took me quite a while to track down a legitimate phone number for the organization, and in the mean time, I came back to my hut one night to find Rose waiting under my shade structure. I hadn’t been able to be in touch with her at all, and I had begun to worry that all of my searching for help for her wouldn’t every work out if I didn’t see her again.

To be honest, it freaked me out to have her seen at my house. She had clearly had to ask around to find it, and it was a bit scary to know that people might suspect I was helping her. Those who traffic women aren’t the nicest people, and I didn’t want my home involved. Pat had travelled to Thies, and I started having dreams that pimps had come to my house. I told her about the research I had done and about La Lumiere and started to learn a little more about her. She had only been in Senegal for about 2 months after having first been brought to Mali. She was afraid to go back to Nigeria without being able to bring money home to her family and wanted to find a non-prostitution job anywhere else.

I eventually got ahold of La Lumière’s office in Tambacounda, and they referred me to a guy named Francis who could help her out. They explained that they had a center in Kedougou where they could bring the girls and help them get their paperwork sorted out to bring them back to Nigeria. Once they were back, the program would fund them to get job training. It seemed like a really sweet deal. I called Francis to verify, and he started yelling in English, “Where are you? I can come and get you!” I had to explain to him that I was not in danger and that I wasn’t even with Rose. There is no cell phone service in Kharakhena where she was living, so it was just a waiting game for her to come to Saraya so we could talk.

In the mean time, I went to a friend’s village to help with a youth empowerment event and forgot my phone in Kedougou. Another volunteer who knew the story explained the opportunity to her when she eventually called, and through a ridiculous sequence of communications, it was decided that Rose would come into Kedougou the following day. I got back to Kedougou and confirmed the plan with Francis, who I had met along with Peace Corps’ safety and security advisor. During that meeting, he had said that center was not available but that he would find lodging.

When Rose called me to tell me she was on the way, I felt so triumphant. We were actually helping her! I called Francis to let him know, and he informed me that a) he was in Tambacounda (four hours away) and couldn’t help her that day, and b) that I would have to figure out lodging for her for the several weeks she would stay in Kedougou. My euphoria dissolved instantly. Things had just gotten shady.

Together with Pat and some other volunteers, we decided that we could finance her lodging for the night while we figured out what the heck was going on. We then called Francis back to demand that he meet with us as soon as he arrived in Kedougou that evening. Pat and I met Rose at the garage and took a taxi with her to a campement that we thought would be a quiet and out of the way place. That preconception was based on the week last year when Peace Corps rented out the entire campement for our youth camp. It turned out that on all the other weeks of the year, it sports a happening bar with numerous Nigerian prostitutes. So much for getting away from that environment.

We awkwardly got a room with her and sat inside (Pat propped the door open with a chair to indicate that there was no funny business going on). We sat and sat and sat, waiting for Francis. It got more and more uncomfortable and stressful. First, we realized that she had not understood that the plan was for her to work with the embassy and go back to Nigeria.  She was absolutely convinced that if she went back, then the government would publicly shame her and show her picture in the newspapers and on TV. She couldn’t bear for her family to know that she had been a prostitute. We tried to assure her that this would not happen, that she didn’t even have to go back to her family until she had gone through job training and made some money. But she was freaking out. She told a story of a time when she was still in Mali, where people from the Nigerian embassy had come looking for girls who had been trafficked, and they all ran out into the bush to hide, but a young girl got caught. It was this girl who had told them about the media exposure. I still couldn’t believe that could be true and tried to reassure, but really, what do I know about how the Nigerian government treats returned trafficked women. I would think that the UN’s involvement would provide some protection though…right? We also learned that she had actually paid off her madame and was free to leave, which was a huge relief regarding our own safety. She still had been quite secretive when she left Kharakhena though.

Finally Francis came. It turned out that he wasn’t even an actual employee of La Lumière but rather just the president of the local Nigerian Association. We were all quite suspicious of his constantly changing story, but Rose agreed to stay (and had a friend she could stay with so that Pat and I wouldn’t have to foot the bill) to hear him out. We had to go back to site, and we left Kedougou praying that it would all work out.

Several days later, Rose called and said she was still in Kedougou and that Francis was a great deceiver. The next time I came into the regional capital, I found myself in a bedroom with four sex workers as they got ready for the night. Rose handed me her phone, which she had set up to play a French version of Alvin and the Chipmunks to entertain me. As she got ready, she told me that she had heard that there was an opportunity for girls to go to Kuwait to get jobs cleaning houses and that’s what she was going to try to do. I begged her to be careful. It sounded like a similar opportunity as the one that had brought her here.

In the end, she just went back to Kharakhena. All that drama, and she is where she started. I, however, ended up more confused, less naïve, and, for a while, pretty convinced that the world was a horrible place.

Around the time I was feeling that way, I came across this prayer from Ted Loder’s collection Guerrillas of Grace:

Sometimes, God, it just seems to be too much: too much violence, too much fear; too much of demands and problems; too much of broken dreams and broken lives; too much of war and slums and dying; too much of greed and squishy fatness and the sounds of people devouring each other and the earth; too much of stale routines and quarrels, unpaid bills and dead ends; too much of words lobbed in to explode and leaving shredded hearts and lacerated souls; too much of turned-away backs and cowardly silence, fiery rage and the bitter taste of ashes in my mouth.

Sometimes the very air seems scorched by threats and rejection and decay until there is nothing but to inhale pain and exhale confusion. Too much of darkness, God, too much of cruelty and selfishness and indifference … Too much, God, too much, too bloody, bruising, brain-washing much. 

Or is it too little, too little of compassion, too little of courage, of daring, of persistence, of sacrifice; too little of music and laughter and celebration.

 A while ago, I wrote and received a grant to enhance Saraya’s existing condom distribution network to better target sex workers. The project was put on hold because of my crazy schedule and the maternity leave of the midwife who I was going to be working with. We finally started it up in January, and the last few months have been crammed with training bartenders (the primary lodgers of the sex workers to distribute condoms) and doing health and lifeskills talks with sex workers in the big gold mining sites and in Saraya as they wait for their monthly checkups.  Overall it has been a really positive experience. Fatou, the head midwife, said that after we did a talk on STIs, the girls have been more willing to let the midwives actually examine them, which felt like a huge victory. It’s encouraging to know, after my failed attempt to make a difference in Rose’s life, that it’s not impossible to positively impact these girls. It’s a crazy world we live in, with a lot of messed up things. But there is always room for the little positive things that make things just a little messed up. I hope.

Les Linns en Voyage, guest post by Patrick

From December 18^th-30^th, my whole family visited us in Senegal. We traveled, ate local food, relaxed, threw Frisbees, drank Gazelle (a local beer contained in .63 liter bottles that tastes like a mix of Corona and Coors light), visited Saraya, & basically cruised from one end of Senegal to the other.

Some highlights:

Picking everyone up at the airport—like all flights into old Leopold Senghor Airport, they disembarked almost 2 hours later than the posted time, but we were ready with reading materials. When we finally saw Mom, Dad, Matt and Emily walking out into overcast but still harshly bright Dakar, I just started laughing. It was so fun to see the most familiar people in the world to me in such a crazy place. At least one dude was eagerly trying to co-carry someone’s bag, and none of them had ever seen a Wolof taxi stand in action, with tall chauffeurs shouting in an harsher than German but rounder than Portuguese language. Hugging everybody and helping them carry their bags to the relative calm of the broad street, I still just couldn’t believe they were finally here. Anne and I had been planning their visit since about November 2012 and it was a struggle to not talk constantly about what was going on around us. I’ve heard some truism about tourists who’ve spent a week in a new place will explain its customs as if they were born there; longer term visitors speak with less assurance, and long-term imigres are at once most and least certain about what drives social currents and what they mean. Having just reached that medium term-visitor mark (living in Senegal for almost 2 years), I was self-conscious about coming across as a complete know-it-all and tried to let my family deal individually with their own first impressions of a place so different from the US, a place where shoes are usually removed before entering a room, even if it’s a mud hut with a dirt floor; where trash (grocery bags, drink wrappers, discarded car tires) are raked into a pile and burned, right next to houses, schools, restaurants; and where walking down the street in your town of residence you are treated like a movie star, people don’t ask for autographs but they sure know who you are and they’re ready to throw the red carpet down for you no matter the circumstances—they don’t just do this for Peace Corps volunteers, visitors from one village in another village receive the star treatment too. In any case, everyone saw what they saw and thought what they thought but they’ll always know what we mean when we refer back to this or that from our time as Peace Corps volunteers.

First Senegalese meal: everybody was so tired after almost no sleep and too much travel but we went to our favorite Senegalese food joint, a rice shack near the beach that has such flavorful ceebou dieun (oily, spicy rice with fish, carrot, turnip, potato, tamarind and leaf mash). People had conked out in the hotel room after settling in, so when we finally arrived at this rice shack the couscous was gone, so we were stuck with the famous rice and either chicken, or maffe (peanut butter sauce), or ceeb dieun. Luckily, our tired trek to this joint wasn’t long, the place is just across the street from our hotel. Mom was intent that everyone use hand sanitizer and lo and behold none of us got diarrhea that day. It’s the small things that make life sweet.

Visit to slaves’ last view of Africa: 

we gathered our strength--mom and dad were looking so bleary eyed, but they put on a brave face, and we booked it to the ferry terminal across town to visit Goree Island. It was a race. We found our seats on the ferry just minutes before it unmoored. 
The island is a terrible, sad place. The send-off point for hundreds of thousands, maybe millions of people whose lives were violently destroyed in the Americas. Hollywood movies that deal with slavery usually include the term mandingo in film dialogue. Mandingo is the Anglicization of the name for Mande language speaking people who were sought by slavers for their strength and endurance. Anne and I live in a Mande community in Kedouguo and it hurts to imagine the flip side of the pre-civil war African American experience, that is the experience of my host family’s ancestors who were terrorized by slavers for centuries. Some say the reason West Africa is the most underdeveloped region on earth is that of the millions of slaves taken to the Americas, most came from West Africa and most were also strong, healthy people—many were leaders of their people. So, visiting slave holding rooms and seeing the last bits of ground in Africa that slaves would ever see is a haunting, important experience and I was proud that my family was so insistent to visit Goree. Our excellent tour guide walked us all around, Dad almost fell asleep in the island cathedral but we eventually got to a café with coffee and our hides were saved. After everybody got a strong injection of caffeine we moved on, bought some cool sandpainted art and headed back to the mainland to eat dinner at one of the great spots in West Africa, the French Cultural Center, with delicious hamburgers and a stunning ambiance with a giant fromagier (Kapok, cousin to baobab) tree growing in the center of the restaurant.

Dakar garage: our first full day together in Senegal, we skipped town and headed to Mbour, city of sand. Getting there required a visit to the old, giant Dakar Pompiers garage—a city block-lot with no signage but full, completely full of chauffeurs, sept-places (old Peugeot 504s), car rapides (bread trucks with bench seats welded in that seat 30-odd passengers), and people who grab your baggage from the taxi and haul it to their buddies sept-place then ask to be paid—all before you even know where you’re going. It was a little stressful getting everybody together in the garage because our taxis got separated in the traffic jam en route from the hotel and our two groups unloaded from our taxis in the middle of the sea of sept-places and had to swim through the crowd and hope we’d meet up in the right place.  As luck would have it, we made our ways to the same car without misplacing any baggage and soon sped off toward Mbour and our nice hotel on the beach. 

Warang: after a couple days in Mbour, we found ourselves in a village to the south called Warang, home to a famous Belgian local fruits liquor distillery. We spent the evening at a tiny open-air bar right in the middle of a Baobab grove with a stream running through, sampling spirits distilled from the tastiest fruit on earth. Thinking of all of us together making merry in the charming setting still makes me smile. Peace Corps volunteers have been good customers there so the Belgians give us and our families a nice discount—we left with a full box of bottles. Mom, Emily, Anne and Matt took a waiting car and Dad and I hitch hiked back to town.

The beach: playing Frisbee with Dad, Matt and Emily is always the most exercise I get on vacation. Unfortunately the water was a little too cold to jump in but the sun wasn’t too hot, mid-90s tops, so we didn’t even need to jump in to cool off; a little shade and a boisson did the trick. Of course a beach vendor dude decided he was in love with Emily and was really annoying trying to crash our party but he ended up arranging a nice mini-van to take us to Kedougou so it was mostly worth it dealing with him.

Kedougou!: we got to Kedougou in time to sit by the pool and relax the afternoon away. The Bedik hotel/campement is far and away the nicest place to stay in the region and we enjoyed the luxury—air conditioning, showers, actual mattresses (vs. foam pads) and a restaurant with tasty salads. We went tout de suite to the Peace Corps regional house and ate a tasty dinner with the other volunteers. The next couple days were all about Saraya. Our hut was dusty and so was the town but everyone had admirable attitudes. I would have loved to read their minds as they saw our hut and family compound and the places where we work and hang out. It looks completely normal to us but it was completely new to them. Sad news greeted us on the way to Kedougou; a good friend in Saraya passed away, so our first day in town was spent at the funeral. The next two days we made the most of our time, trekking out another Malinke village called Sanela for data collection for the malaria project we were finishing up, eating Saraya food, drinking mostly cold Gazelles at my counterpart’s new bar/conference room, and just being together.
 It was so fun for me to have my entire immediate family together in a new place. It makes me really look forward to the vacations we’ll have in coming years. Our last day in town Anne and I through a tulungo (charity feast) to celebrate the family visiting and musicians came from three separate villages to mark the occasion which included dancing, sitting under a neem tree and haggling with the Saraya concert master about how much to pay the diverse stakeholders in a local music happening (it’s surprisingly complex). Anyhow, the music was great and even Dad and Matt danced. I wish we could have stretched that day out longer—for so many months I’d been picturing my family in just that situation, looking forward to making Matt dance and getting a kick out of seeing Emily on the dance floor and just having a ball with Mom and Dad—but just like that, the music ended and we had to get on the highway back to Kedougou because it was Christmas Eve and we didn’t want to miss the evening Mass.

Christmas Eve: our dinner went a little late and by the team we got to the Catholic church for Mass the sanctuary was full. So we stood outside and tried to comprehend the echoing French service and tried to sing along a little with tunes we recognized, and all did our best not to fall asleep on our feet. That evening we had an important discussion about the inter-religious harmony that contributes to Senegal’s special status as a beacon of peace in West Africa, and the next day was Christmas!

Christmas was wonderful. We woke late, and had a slow morning that proved that even in hot, dusty West Africa Christmas still feels like Christmas. We took it easy and made it to the regional house in time for a tasty, fun Christmas brunch with delicious quiche, white elephant gift exchange and Frisbee. Another day I wish we could have put on pause but days in south Senegal are really short.

 

Dindefelo: the day after Christmas we got going late because Anne was really sick but we eventually took an adventure trip to the waterfalls on the Fouta Djallon plateau. 

The details were exciting. In any case, we made it to Dindefelo in time to relax in a scenic eco-campement under the overgrown cliffs that look like Jurassic Park. We could hear baboons and chimps hoot and hollering in the woods. The next day we hiked, relaxed and recovered from hiking. So sadly, these days passed too quickly too and before you know it we were heading back to ‘gou to gear up to head north again. The route back to ‘gou was exciting and time consuming for different reasons. Our turn around was fast as can be and soon we were trucking through the national park with wild lions and native elephants! And that night we stayed in gorgeous Oassadou eco-campement on the Gambia river. Another night and day I wish could have been paused. This is a place with hippos in the water below the restaurant and a forest full of baboons all around.

Tolkien-town: we persevered through another day of hard traveling and made it to the petite cote village of Toubab Dialaw in time for a sunset and tour of the whimsical and strange group of connected hotels that seems designed to be a fantasy movie setting. We dined, Matt instructed me in new rubic’s cube moves, Dad talked about how he wanted to do a longer self-guided trip through the Niokolo park to look for lions and such, 
Mom was annoyed that our rooms didn’t really have running water but she was tickled to be together and got us thinking about how soon we would all be together again, but in Montana. (This trip left me with a touch of senioritis. I was honestly pretty jealous to see how everybody could just up and leave and head back to the comforts of life in the States.) And, Emily kept up her encouraging conversational style and got us to talk about how we were really feeling about the prospect of finishing in just a couple months. Goodbyes: heading from Tolkien-ville to Dakar was a huge letdown. Dakar is just an intense, busy, kinda stressful place, and our attitudes were a little sabotaged by a terrible 7-place driver and a non-existent Air France check-in staff. We had a delightful afternoon in Dakar planned but because we couldn’t check bags in early at the airport our plans for seeing the giant Dakar market were dashed! That is a pretty typical Dakar outcome but it was harder because this was goodbye and we were primed to take it personally because the fam’s eminent departure was just really hard to accept. Most days of Peace Corps are much like the day before, so the difference is magnified between a day with your whole family together and the next almost 5 months apart. We made the most of things, I ironed out my feeling of being victimized by the Air France staff, and we ended up having a super pleasant early evening at a bakery and then at a restaurant on the westernmost point in Africa. Then we gathered everyone and everything up, said tearful goodbyes and hugged everyone a bunch of times and sent them off to an extremely different leg of their vacation, a trip to Paris, France and get togethers with one of my best friends and a groomsman, Aurelien. Anne and I spent our New Year’s Eve in Dakar, the family spent theirs under the Eiffel Tower, and from then on the time has flown and now we’ve 30 days left at site and then we’re packing up and heading home ourselves. My family’s visit was such an important milestone in our service giving us something to look forward to and on which to look back fondly. It let us share important realities of the low-income world with people who were so interested to better understand the inequalities present in the world, gave us a chance to introduce our family to the host family that has been so generous and kind to us over the last two years, and just made us feel so valued. Thanks guys and see you so soon!

P.S. This is Annē now. 

After the event I’m about to describe happened, Ed kept saying that he couldn’t wait to see how I would describe it in the blog. So here it goes:

As we were walking through the hyperstimulating fish market in Mbour, with one of a kind sights, sounds, and definitely smells, we were stopped by a group of fisherman who wanted Matt, Ed and Pat to help them push their boat up the beach. Matt handed me Nancy’s camera and plastic bag with market purchases.  As I was taking pictures, the bag fell open and dumped things out onto the beach. I was putting the contents back in the bag when a teenage boy came up to me. My first thought was that he had seen me struggling with the bag and thought I needed help. That is what my experience in Senegal for the past nearly two years had me believe. But then I felt his hand on the camera. We locked eyes as we both realized what was happening. We struggled over it for a few long seconds before he wrenched it out of my hands. To explain what happened next, I have decided that he must have been on drugs, because we all know I’m not very strong. Nonetheless, in an act that Matt deemed “Epic Annē”, I grabbed his other arm as he was getting away and punched him in the back as hard as I could. He dropped the camera. (I am now convinced that eyewitness testimony is absolutely unreliable, because apparently Emily caught the camera when he dropped it, and I don’t even remember her being nearby.) At that point I remembered how to say “thief” in Wolof and yelled it as loud as I could. The fishermen the menfolk had been helping converged on him and carried out their own form of justice, which I actually thought was pretty harsh since he didn’t actually succeed at the crime. News travels fast, and people nodded approvingly and even clapped as we headed up at the beach. I’m typically more lauded for my language abilities than my fighting abilities, so I at first assumed they were stoked about my Wolof skills. Then I saw someone acting it out and realized that they were clapping for my scrappy camera recovery.

In the end, I’m just glad that it happened to me and not one of Pat’s family members. It definitely has made me more wary of strangers (particularly people coming up behind me). I don’t like feeling on edge, but it’s probably  better to not be so naïve. I’m also glad that it turned into a great story about my heroism and not a huge downer of an anecdote about the time Nancy’s camera got stolen.

Well, Ed…what do you think?