Sunday, December 11, 2011

Examining Vaginas and Birthing Babies

Within the last week I’ve weighed babies, examined cervices, seen a birth, tested blood for HIV, and sat by the fire every night with my host family.  Sometimes I have to stop and think about how different my life is here.  Bizarre, but wonderful.

I did the baby weighing at the health post along with nutrition counseling for mothers with babies who were below the healthy zone.  It’s important that mothers only give their babies breast milk for the first 6 months, and I’ve found that a lot of women say they’re doing that but are not in actuality.  Kaba, the matrone, told me she caught a mother feeding sugary tea to her baby.  One of the men in my village told me that a baby recently died of malnutrition, so I want to make sure I’m able to inform mothers if their babies are underweight.  Infant mortality is high in my village, but I rarely hear about it.  During an intake interview with women for a recent cervical cancer screening, I had to ask the women how many children they had and how many times they’ve been pregnant.  I found that most women would report that about half of their children had died.  This isn’t talked about, but it is a harsh reality that needs to be addressed.  When I had a heart to heart with the man who told me about the infant who had passed away, he also told me that his first wife had died in childbirth.  During my baseline survey, I felt so optimistic about the maternal and child health of my village, but I am now finding that reality may not be as rosy as villagers would like to paint it. 

Three midwives came down from Saraya to do cervical cancer screening in Nafadji.  Earlier in the week, I told the presidents of the women’s groups about the screening, and they spread the information around the village.  On the day of the testing, I walked around the village, trying to get as many women as possible interested in being tested.  During the screening, I assisted the midwife with the screening by holding the flashlight on the vagina while she put vinegar on the cervix.  We both analyzed the cervices and gave the results to another midwife who did the counseling afterwards.  We screened 24 women, and hopefully will soon be able to provide cryotherapy treatment for those who tested positive.  I was worried that it would be awkward for me to be examining women who I know in my village, but it turned out to be fine.  Although I asked Mbamoussa to get tested, and her screening was slightly awkward for both of us since she’s my sister.  I was impressed with the amount of women who showed up, and the screening went smoothly.

With all the work I’m doing with maternal and child health, I’ve been really interested to see an actual birth.  I mentioned this to Sarr a few months ago, and he told me that I could help with one as long as the midwife was ok with it.  The midwife told me she’d call me when the next birth was happening, but somehow it never worked out that I was in village during births.  During the cervical cancer screening, I was in the maternity, and Khadidia, a pregnant woman, came in and was having contractions.  The midwife told her to go home and come back when they were hurting really badly.  She came back right as we were all going into the main health post area to eat lunch, and she lied down on one of the beds in the maternity.  After eating, I went back to the maternity to do an intake interview with a woman who wanted to be screened for cervical cancer, but the other midwives stayed in the health post to relax a little.

All of a sudden, I heard Khadidia screaming from the next room.  I rushed in, and the baby’s head had already started coming out!  Since I had no clue how to deliver a baby, I ran as fast as I could to Madame Diop and told her to hurry over.  By the time I got back to the maternity room, the baby was fully out.  I was amazed at how fast it all happened.  I worked as Madame Diop’s assistant and handed her different tools for cutting the umbilical cord and sewing up an area that must have torn.  We caught the afterbirth in a bowl and gave it to some village elders who came to pick it up.  It was incredible to see the baby girl enter the world.  She kept reaching out and grabbing the air, exploring her newfound freedom.  The birth was very messy and didn't smell great, but it felt so amazing to be apart of it!

Births here are so different from those in the US.  In a US delivery room, I picture a woman with a cheering section beside her, or at least friends and family waiting at the hospital to congratulate her.  This American woman is giving birth in a sterile hospital room, where supplies are readily available, and if anything goes wrong, there are the resources to get the baby out safely.  Painkillers are an option to keep the mother more comfortable, and a nurse takes the newborn to wash it and wrap it in a blanket.  The mother was not expected to bring her own cleaning supplies or sheets for the bed.  After the delivery, the mom is able to rest for a while in the hospital room. 

Here in Senegal, Khadidia came to the maternity just as she was about to give birth.  No friends or family were in the room with her, and the room was far from sterile.  I was racing around looking for a fresh pair of gloves and alcohol.  All the blood was wiped up with the pagne (fabric skirt) that Khadidia had arrived in.  I watched Madame Diop stick a metal hook in Khadidia’s vagina to sew up a tear, without any anesthesia.  After the umbilical cord was cut, the baby was placed on a table and wasn’t washed.  If anything had gone wrong, we were 90k from the nearest hospital that can provide a C-Section, and there are no cars in my village.  Directly after giving birth, Khadidia went back to her home with the new baby.  After seven days, there will be a baptism, where the baby will be given a name.  From what I observed, as long as there are no complications, delivering a baby is very straightforward.  Maybe all these differences I’m mentioning shouldn’t matter as long as the mother and baby go home safe and healthy.  It’s when there are complications that problems arise that the health post is not equipped to handle. 

The following day, the Saraya hospital car picked me up in Nafadji, and we went to Toubacouta, a small village in the bush, to do HIV testing.  We picked Ian and his nurse counterpart up along the way to go to the testing.  Ian and I did the blood tests, and we found a couple positive ones.  The Saraya team includes a social worker who provides counseling to individuals when they find out their serological status.  Fortunately, antiretroviral drugs are free in Senegal, but the treatment for resulting infections is not.  HIV status is not public knowledge, and the hospital is very good about not revealing those who tested positive.  Only a few people at the hospital even know who the HIV positive people are in the region.  The social worker seeks those people out to encourage them to take antiretroviral drugs.

Now I’m back in Kedougou and am about to start my journey home to the US.  Yesterday I biked to Saraya with my luggage strapped to the back, and my back tire blew halfway through the ride.  I flipped my bike over and changed my tire tube with tsetse flies attacking me.  As frustrated as I was, I knew I was on my way home.  Luckily, the second tube worked out and I made it to Kedougou in one piece yesterday.  I had a weird feeling of sadness as I biked out of my village.  I’ve been looking forward to going home for a while, but I really will miss my village while I’m gone.  It reminded me that I’ll be leaving for good next year, and that is going to be incredibly hard. 

Right now, it’s the “cold season” in Senegal, which means temperatures can drop down to 70 degrees.  I know what you’re thinking.  Anyone who thinks that’s cold must be insane, right?  But after adjusting to the climate here, I actually get goosebumps at night and need to wear a sweatshirt, and my family has been sitting around a fire every night before bed.  I have a feeling I’m going to freeze when I land in Seattle!

Tomorrow night, I’ll take a night bus to Dakar, and then the following night, I begin my 30-hour voyage home on 3 different planes with long layovers in between.  I’m so excited to come home for the holidays!  It’ll be nice to eat some good food and hang out with friends and family.  I feel like this trip home has been something I’ve been working towards for so long, since I booked this flight back in May.  I’ve counted down, and the idea of seeing my family again for the holidays got me through a hard time at the beginning of my service.  Now, it’s actually here!  Where did the time go?  I can’t wait to be home soon!

Saturday, December 10, 2011

The Purducken

This post was written on 11-29-11 but I haven't had internet...

This Thanksgiving, we decided at the Kedougou Regional House to make an unconventional meal.  A few weeks before the big day, we were all sitting around, joking about the idea of making a Turducken, which is a chicken inside a duck inside a turkey.  Then someone decided to take it even further and throw out the idea of putting all those animals in a pig to make it even more epic.  And why not dig a huge hole and try cooking this masterpiece in the ground?  I thought it was a joke, but one thing Peace Corps volunteers love is a challenge. 

When I arrived at the house the day before Thanksgiving, Mission Purducken was in action.  All 4 animals had been bought and brought in from various locations.  The live turkey was sent down from Tamba!  All 3 birds needed to be killed, plucked, and cleaned.  That day, we prepared the 3 birds, pig, and stuffing and sewed all the birds inside the pig with wire.  The guys had dug a massive hole and gathered all the materials necessary to keep the coals hot for the 18 hours we were leaving it in the ground. 

Thanksgiving day was filled with lots of cooking, and we managed to make some tasty dishes!  We made mashed potatoes, green bean casserole, stuffing, and gravy.  I attempted to make a cranberry sauce substitute with bissap flowers but failed.  Apparently bissap flowers don’t cook the same way cranberries do, so I tried adding cherry jello mix to stiffen up the bissap juice with no success.  Luckily there were other dishes that worked out well.  Some other volunteers made a carrot cake, cheesecake, and apple pie for dessert.  I was amazed at the food you can make with limited resources!

Around 5pm, we dug up the Purducken!  The guys laid the giant pig down on some tarps outside and began carving into it.  I think my favorite part of the day was when a few of the guys were cutting pieces of meat off to put in giant bowls to serve later, and we all formed a circle of stools around them, waiting for handouts!  They’d throw us some meat and stuffing as we hovered like vultures. 

After piling mountains of food into our bowls, we all sat around the porch, stuffing ourselves.  Since the main staple of our diets here is rice, I think we all went into protein overload!  Just like the end of any normal Thanksgiving, we fell into food comas and clutched our full stomachs, complaining that we ate too much.  The Purducken was a success!

The following day, Ian and I decided to venture off to a small Bassari village in the mountains to check out the crafts they make.  It was Black Friday, so of course we had to go shopping!  We took a Niokolo 90k to Salemata and then biked a hilly bush path out to Echelo, the Bassari village.  One of our friends lives in Echelo, but she was in Dakar for Thanksgiving, so we made the trek out there on our own. 

We had a wonderful time in the village, which had such a different feel than any village I’d been to.  Since Bassari’s are Christian and animist, they have a different lifestyle than Muslims.  After seeing some unique crafts (jewelry, masks, etc), we went over to our friend’s family’s compound for dinner.  For dinner, we were served an amazing chicken and squash dish, and I was in heaven!  As some of you know, I have an obsession with pumpkin, so I was very excited to eat squash!  When we were finished eating, the men reminded us to thank the women who cooked the meal.  That was the first time I’ve ever heard a man suggest that women deserved praise after cooking a meal.  In Bassari culture, women seem to hold much more power in the household, and they are treated with more respect than I’d seen before.  The villagers seemed more complimentary of women and praised virtues instead of pointing out all the faults in them.  Granted, this was only one night in the village, but it seemed like a very positive environment to live in. 

Since the villagers aren’t Muslim, they drink alcohol and are known for their delicious honey and palm wines.  After dinner, we sat around, drinking tea and palm wine.  Ian whipped out some mango gummy bears to share with the group, and we sat around the hot coals, chatting into the night.  The following morning, we rose early and biked back to Salemata to catch a car back to Kedougou.  All in all, it was a fun adventure!

Now I’m back in Nafadji in my last stint in village before I head home for the holidays!  Projects are in motion!  I have 10 enthusiastic women signed up for my Care group, and our first meeting will be in January, when I return from vacation.  Ian and I are working on our cervical cancer screening and are hoping to hold it in both of our villages next week.  We’re also working on a project to train middle school students to become health experts who can lead health discussions with their peers at school.  After we request funding for our project, we’re hoping to hold the training in the spring.  We’re still waiting on our funding request for our matrone training, but we should hear back about that soon!

The babies are getting bigger!  With four circulating around the compound, holding babies has become a common pastime.  We all take turns getting peed and pooped on, since there are no diapers here.  I gave each new mom a baby mosquito net where they can zip the baby into a netted enclosure.  They’ve been using them as places for the babies to hang out during the day to keep the flies off of them.  I often walk outside to find the four baby mosquito enclosures lined up on a mat with the babies inside!

It’s nice to be back in Nafadji!  Tomorrow morning I’ll be weighing all the babies in the village while Sarr does vaccinations, and this Sunday, I’ll be heading to Saraya to do the radio show.  A couple weeks ago, we did a fun radio show explaining what Thanksgiving is!  We described it as a “Toubab Tabaski”.  Probably too soon to talk about colonization, right?

I hope you all had a wonderful Thanksgiving!  I can’t wait to see friends and family in Seattle soon!!!