Monday, March 11, 2013

First Aid Training

Hot season arrived early this year, and I had forgotten how miserable the heat could be.  I’m sweating throughout the day and most of the night, and the heat sucks up all of my energy.  It’s still cooling off around 5 or 6am, but I’m not looking forward to a couple weeks from now when it will never cool down!  I’m dreaming of being cold in the US next month!

As you may have read in previous blog posts, Ian and I started a Jeune Relais program with Nafadji middle school students last year.  Last spring we trained 6 boys and 6 girls to be health leaders at their school and in their communities.  Our initial training was in reproductive health, family planning, and life skills, and our Jeune Relais spread the information they learned to their peers by presenting in their classrooms and leading health talks in their communities.  Right before rainy season, Ian and I led another training with the Jeune Relais about malaria, and they went back to their home communities for their summer vacation with the homework assignment of teaching the community about the importance of early treatment and how to make neem lotion (a natural mosquito repellent).  We’ve continued to meet with them on a monthly basis to review the material they have learned and to check up on how their health talks have been going.

This past weekend, we went back to Nafadji to lead a First Aid training with the Jeune Relais.  We invited Pat Linn, my Saraya site mate, as a technical trainer since he trained as an EMT and knows a lot about First Aid.  Last weekend, Pat, Ian, and I all made our way to Nafadji the day before the training to meet with Mr. Ngom, our local counterpart for the project.  Mr. Ngom is an extremely motivated English teacher and a great friend, and he has worked hard to keep the Jeune Relais program going after I had to leave Nafadji. 

We were warned prior to coming that the students were having a party at the school the night before the training and that we couldn’t start too early the next morning.  Unfortunately, my hut is right next to the classroom where they always throw parties, so on party nights, I usually get very little sleep.  This night was no exception.  The school rented a generator to blast music until 4am.  Ian, Pat, and I went to bed around 10pm to get a good nights rest before the training, and then the music turned on.  Around midnight, it stopped for about 10 minutes while they fixed a problem with the generator, and we thought we were in the clear.  But then the loud hip-hop music started up again and blared into the night.  Our alarm went off at 7am, and no one wanted to move.

When we saw the Jeune Relais in the classroom the next morning, it was clear that none of them had slept as well.

To liven up the group, Pat asked everyone to get up and do some pushups followed by jumping jacks.  Whenever we felt we were losing the audience, we did some more jumping jacks!

Pat did a great job of explaining what First Aid is and the rules the students needed to follow to be responsible responders when helping the sick or injured.  Along with showing them how to make arm slings and leg splints, he explained the steps that the students would need to take when approaching someone who was sick or injured.  They all learned how to examine someone and make a quick decision about whether to help the patient themselves or get him or her to the health post.  

Pat and his arm sling

Learning how to find a pulse

Teaching the students how to examine a patient

They practiced picking up a patient who needed to be carried to the health post, and they also learned how to immobilize the spine if they found someone who may have a spinal injury.  We finished off the training doing practice scenarios, where we took one student outside of the classroom and assigned him or her a sickness or injury.  Another student was chosen to be the responder who had to figure out what was wrong with the patient and what action to take to help him or her.  The scenarios went well, and the students were driven to prepare themselves to help someone who is injured or sick.

Scenario 1: Maimouna passed out from heat exhaustion

Learning how to carry someone

This was our last training with the Jeune Relais, and Mr. Ngom said that he would try his best to continue the program without us.  It has been incredibly rewarding to work with this intelligent and motivated group of students over the past year, and I hope they retain the knowledge and skills they have learned in the Jeune Relais program.  Many of them want to go on to become nurses, midwives, and doctors, and this program has been a great way for them to learn more about health and get excited about their future careers. 

Jeune Relais

This was the last time I would be in Nafadji with the teachers and many of the students since they will all be on Spring break when I go back to say my goodbyes at the beginning of April.  I started feeling nostalgic and remembering all the great times I’ve had with these teachers and students over the past couple of years.  The goodbyes are already starting, and I’m not sure I'm ready.  A little over 2 years ago, I was terrified of leaving the US and embarking on this crazy adventure, but now I’m terrified of leaving here next month.  When I’m sweating away in my hut, it feels easy to want to be back in the US, but saying goodbye to my family in Nafadji seems impossible.  I still have a month before I leave Kedougou, so I’m trying to stay present.  To keep us distracted, Ian and I have planned a biking adventure for the coming week! 

Thursday, March 7, 2013

Bringing Cryotherapy to Kedougou

As I’ve mentioned in previous posts, the cervical cancer prevention project I’ve been working on with the Chicago-based nonprofit, peacecare (, has been a major focus of my service. In case you haven’t read about it in other blog posts, I’ll give a little background. This project is the pilot project for the organization, started by Dr. Andrew Dykens, and the goal is to partner with Peace Corps Volunteers and a local health structure to create a sustainable program in a health topic chosen by the community. When the team did focus groups in Saraya a few years ago, cervical cancer was the health issue that they wanted peacecare to address. Peacecare doctors did a training of trainers and trained 2 midwives how to train others how to screen for cervical cancer using Visual Inspection with Acetic Acid (VIA). Since then, we have added some trainers and now have 4 women who can train the nurses and midwives in the region how to screen for cervical cancer. We’ve trained almost all of the nurses and midwives in the region how to screen, and the focus of the most recent trip was to train a few people at the hospital how to treat cervical precancer using cryotherapy. 

Before the peacecare team arrived, I had been in communication with the regional head doctor and the head doctors of each health district. They had chosen 3 people to participate in the cryotherapy training, including Fatou Traore, the head midwife in Saraya who has been involved in the project since the beginning. She has taken a leadership role in the project and has been at every training we have done for either nurses, midwives, or community health workers. The night before the peacecare team arrived, Fatou called me and said she had been summoned by the Ministry of Health to another region to lead a training. Now she would not be able to participate in the cryothearpy training. I felt so frustrated with the lack of control health professionals have over their schedules. You can plan a meeting months in advance, but if the boss tells a health professional at the last minute they have to go somewhere else, they have to go. This makes scheduling anything a challenge.

It was a setback, but once the peacecare team arrived, we were determined to carry on and do the 3-day training with the other trainees who were chosen.  Fatou sent a replacement trainee who came from a village in the Saraya health district, and she was motivated to learn. The CO2 tanks made it safely down to Kedougou, and all of the equipment worked!

The theory portion of the training, taught by Dr. Tracy Irwin, on the first day went well.  The three trainees demonstrated their ability to look at photos of cervices that were negative for precancer, positive for precancer, and those that had invasive cancer.  They learned how to decide if cryotherapy treatment was possible for the patient, and they did well during a photo test where they had to decide if the patient was positive for precancer and if the patient could receive cryotherapy.

The day before the training, Tracy mentioned that she needed some sausages for the practicum part of the training, so we went to the “Toubab store” and were able to find some. I was curious about how she was going to use these sausages, and when we began the practicum it made sense! Cryotherapy involves using a special gun hooked up to a CO2 tank and placing the gun tip on the cervix to freeze it for 3 minutes, thaw it for 5 minutes, and then freeze again for 3 minutes. Before the trainees performed the treatment on real patients, they practiced on sausages.

Ouli practicing on a sausage

In order for Tracy to certify each of the trainees, she needed to observe each of them performing at least 10 cryotherapy treatments. This meant that we needed at least 30 women who tested positive for precancer to come in for treatment. In December, Annē Linn and I helped the Dakar-based NGO, PREVENIR, do a mass cervical cancer screening at the Kedougou hospital. Our collaboration with PREVENIR allowed for us to treat the positives that they found during our cryotherapy training in February. From PREVENIR’s screening and other screenings the hospital had done in the past year, we in theory had enough positives for the training. Unfortunately, things did not go according to plan. All of the positives were called or given messages from their village aunt to come in during the 3-day cryotherapy training for treatment. Some of the women never came in, some of them were false positives, and some of them had lesions that were too big to be treated with cryotherapy. At the end of the training, the trainees were only able to do 2 cryotherapy treatments total, which was not sufficient to get certified. The trainees, volunteers, and peacecare team were all frustrated that the team was going to leave Senegal and no one would be able to perform cryotherapy in Kedougou.

We were all feeling discouraged when a woman came in for the last screening on our last day of training. She tested positive for precancer, and she was anxious to get cryotherapy treatment. The gratitude she expressed to the peacecare team and trainees who performed the treatment made us all remember why we were doing this. She had a huge smile across her face after the treatment and told us that health is the most important thing to her. If she doesn’t have her health, she doesn’t’ have anything. She recognized the importance of getting treatment for cervical precancer, and her energy and excitement about getting treatment re-energized all of us. We were going to make this work.

At the PREVENIR screening in December, Annē and I had met a Tamba-based gynecologist who performs cryotherapy. Since the peacecare team had to go back to the US soon, we thought this doctor could be a potential solution to our problem if he would agree to finish the training we had started. The team went up to Tamba to meet with him and discuss the possibility of him finishing the certification of the trainees. This doctor was on board and was enthusiastic about the possibility of cryotherapy treatment in Kedougou. Being from Kedougou himself, he recognized how far women would need to travel for treatment if they could not get it there. We are hopeful that we will have at least one of the trainees certified in cryotherapy in the next few months.

The rest of the peacecare trip involved a lot of strategic planning for the future. Organizing meetings with doctors here can be like herding cats with their busy schedules and lack of response to emails. Fortunately, we were able to get meetings with all of the head doctors, and we had some productive conversations about the future of the program. At this point in the program, peacecare is focusing on how this project can be sustained by the health structure itself when we phase ourselves out eventually. The local doctors and midwives renewed their motivation in the project, and both the volunteers and the peacecare team finished the visit feeling hopeful about the future of the project. The vision is to have cervical cancer screening and treatment available to everyone in the region, and we continue to get closer to that goal.

Working on this project has clarified for me that I want to continue doing work in women’s reproductive health. It has been an incredible opportunity to work with the peacecare doctors and local midwives and doctors on a program that I hope will be sustainable in the future. I can’t wait to continue doing further work in women’s global health as I begin graduate school in the fall. I was thrilled to find out recently that I was accepted to University of Washington’s Masters in Public Health in Epidemiology-Global Health Track program! I’m excited to pursue my dream of addressing women’s health needs around the world!

Wednesday, March 6, 2013

Visitors, Reflection, and Geriatric Gou

February was filled to the brim with visitors, conferences, and softball.  At the beginning of the month, I went up to Dakar to meet my amazing friend Caitlin and her boyfriend, Danny.  After not seeing Caitlin for over a year, it felt surreal to hug her at the Dakar airport.  Danny previously lived in the Gambia for a year, working with the law school in Banjul.  He and Caitlin planned to spend a week with me in Senegal and then head to the Gambia.  When you take into account how horrible transport is in Senegal, a week is not much time, so we had a busy week ahead.

We started off in Dakar visiting Goree Island and eating dinner at a delicious Ethiopian restaurant downtown.  Unfortunately, I had amoebas at the time so had no appetite.  Due to the amoebas, my 13-hour 7-place ride up to Dakar to meet Caitlin and Danny was one with many stops to run into the bush with an irritable stomach.  Thankfully I got on the right medication the day that we left Dakar to head down to Kedougou and started feeling much better.  We took a 9 hour 7-place to Tamba, and then another 4-hour 7-place to Kedougou, getting into the regional house at night.  After a long day of travel, we decided to relax in Kedougou the following day.  We biked to the Gambia River, visited the market, and played Settlers of Catan with some of the other volunteers.   It was fun to share the regional house culture with Caitlin and Danny.

The following morning, we squeezed into the back of a 9-place to get to Saraya.  We greeted the village and hiked into the bush to see Maimouna’s garden, and Caitlin and Danny spent the night in my hut.  

Danny and Caitlin walking to Maimouna's garden

Caitlin and me in Maimouna's garden

A couple of other volunteers loaned Caitlin and Danny their bikes for a couple of days, so we were able to bike the 30 kilometers to Nafadji the following morning.  I forgot to mention the terror of the tsetse flies to them until that morning, and the tstetsies made the ride much more stressful.  We biked in the heat while tsetse flies honed in and continually bit each of us.  Each bite is a painful sting, and then the bite swells up and itches for days.  On previous rides, I’ve thought that if the government could get a hold of them, they would make an excellent torture device.  I’m used to them at this point since I bike to Nafadji often, but it wasn’t the best welcome for Caitlin and Danny.  I felt bad about how painful the bike ride was, but luckily our time in Nafadji was worth it.

We received a warm welcome in Nafadji, and Fily killed a chicken for our lunch.  We blew bubbles with my kids and spent our day hanging out on different people’s compounds.  The village chief gave Caitlin and Danny local names, and Mansa, my host sister, was ecstatic to receive a namesake!  She danced around with Caitlin and showed off her new namesake to her friends.  It was amazing to be able to share my life here with Caitlin.  We’ve talked a lot through email and Skype over the past couple of years, but to actually be able to introduce her to my family and friends here and to connect those two worlds was incredible.

We got attacked once again by the tstetse flies on our way back to Saraya, then waited a few hours on the side of the road for a car to Kedougou and finally hitchhiked a ride on the back of a huge truck.  Transport on this trip was not comfortable, but Caitlin and Danny were flexible and kept their senses of humor along the way.  I think they got a good feel for what day-to-day life is like here.  We took some more 7-places the next day up to Kaolack and stayed in a nice hotel with a pool.  It was a relief to have a shower and a real mattress, and our celebratory dinner that evening was the perfect way to end the Senegal leg of their trip.  I was happy to have been able to spend time with Caitlin and to meet Danny.  It was a stressful week, but we had some good laughs along the way, and I feel honored that they traveled all the way to Nafadji to see what my life here is like. 

From Kaolack, I continued up to Thies for my Close of Service (COS) conference.  I was so happy to see my friends from my training group again since we’re spread out all over the country.  During the conference, we reflected upon our services and started thinking about readjusting to living in the US.  We have all come such a long way in the past couple of years, and I think we all share the sentiment that if we can do this, we can do anything.  I cannot think of one person’s service that has been without challenges, and it was powerful to have all of us sitting in a room together reflecting upon what we have learned.  At the conference, I also chose my COS date and will be flying home on April 23rd!

After the conference in Thies, I took a bus to Dakar with my friends to attend the West Africa Invitational Softball Tournament (W.A.I.S.T.).  Each Peace Corps Senegal region comes up with a theme for their team, and this year, Kedougou was geriatric.  Everyone got into character and had fun yelling at people to get off their lawn.  We by far had the best costumes, but we did not win any of our games (maybe that was due to the fact that we were hobbling around the field).  I love how Kedougou has such a close-knit group of volunteers, and it was fun to all be together in Dakar.

Me, LaRocha, and Katie

Pat and Chip

Gou Crew

Right after WAIST, the Peacecare team arrived in Dakar, and we headed down to Kedougou for our cryotherapy training.  I’ll write more about that in another blog!  It’s been a crazy month, and time is passing way too quickly!