Sustainability

The peacecare (www.peacecare.org) team has arrived, and we’re working in Saraya on the cervical cancer prevention project!

Development work is generally a slow process, and most volunteers wont see the results of the behavior change they’ve worked on during their service.  With the cervical cancer prevention project, I’ve been able to see the head midwives training other midwives and nurses in how to screen for cervical cancer, and I’ve watched them screen.  When we go to a village for a screening, we are not only able to educate the community about cervical cancer, but the midwives are able to counsel women who test positive and put them on a list for the cryotherapy treatment which will be coming in February.

Today, a huge theme of the day was sustainability.  The goals of both Peace Corps and peacecare are to implement sustainable projects and programs that are chosen by the community.  A major component of the cervical cancer prevention project is that it can survive without the support of peacecare and Peace Corps.  Head Midwives have been trained to train other midwives and nurses in how to screen for cervical cancer using visual inspection with acetic acid (VIA), and today we trained them to train other trainers.  With the high turnover rate of midwives and nurses in the region, it is important that incoming health workers can be trained in VIA. 

We’re in the process of beginning a prevalence study in the region, and working out the logistics of the study is complicated.  The goal is to screen 3000 women in the region in the next 6 months, and we need to have enough women who have tested positive by February to train midwives in cryotherapy treatment during the next peacecare visit.  The hospital is busy working on campaigns for many health issues, and getting cervical cancer on the docket is a challenge.  We also still need to train 30 more midwives in VIA before we can begin our mass screening campaign.  Organizing trainings and getting them done before deadlines has been a challenge.  Time works differently here, and it’s thought of as more circular than linear.  There’s not a high sense of urgency, and people tend to be very fatalistic.  If Allah wants something to happen, it will happen.  The idea that humans have the power to impact change is not a commonly held belief since most believe everything is up to Allah.  When trying to organize trainings and meetings, the laid back idea that “it’ll happen” is frustrating when exact dates can’t be set.  We need to get both midwife trainings and the campaign done before peacecare’s next visit at the end of February, so being the American that I am, I want concrete dates and a specific action plan.  Not having either can be frustrating.  I know it’ll all get done eventually though, and being flexible and patient is part of the Peace Corps experience.  Since the idea for the project came from the community, the local doctors and midwives are motivated to do the work.

An issue that came up in today’s meeting was how we plan to fund the prevalence study and the future of the cervical cancer prevention program.  The idea is that the funding would eventually come from the government in order to be sustainable once peacecare and Peace Corps leave.  In today’s meeting, one of the midwives mentioned that almost all of the funding that the hospital receives comes from outside sources (NGO’s and mining companies).  This begs the question, how sustainable are these programs?  We’re still working out the issue of funding and hope to come up with a solution that will allow for the program to be self-sustaining without our continued support in the future.

While sustainability can be hard to achieve, I commend peacecare for making it such an integral part of its work.  Many NGO’s will throw money at a project and then leave without a thought to whether they have created lasting development.  For example, a Japanese NGO built a state of the art hospital outside of Saraya.  This hospital is beautiful, and when you step inside and see the high tech equipment, you feel as if you’ve stepped into a hospital in the US.  The NGO funded the construction of the hospital and equipment, but it is up to the government to provide electricity and water to operate the hospital.  The hospital has been finished for almost a year now, and it is still not operational.  Power and water are a significant problem in Saraya, and I’m not sure when or if this hospital will ever open.  Every time I pass this hospital on my way in or out of Saraya, I think about how tragic it is that all that time and money went into building a hospital that can’t be used.  The question of sustainability is crucial before beginning a project, and that is something that peacecare does extremely well.

I’m really enjoying this peacecare visit to Kedougou, and it’s been great to get to know the new team members.  They’re a hearty group and have done a wonderful job of following cultural norms and staying flexible and open.  Tomorrow we have an off day and are planning to do some fun local activities like making tea and going out to the fields!