Tuesday, April 29, 2008

It's really hot.

The hotness.

It is so hot.
It is so hot that…

My bar soap has liquefied.
My hut is a boulangerie.
My bucket water is too hot to wash my hands with (one of my trainees actually burned herself when using the loo).
I have visions of jumping into my family’s freezer.
The egg that broke in the plastic bag cooked slightly while in my purse.
You can’t touch anything metal.
Children can no longer go barefoot.
I wake up at midnight in a puddle of my own sweat.
I’m drinking almost 3 gallons (yes, gallons) of water every 24 hours.
We are making applesauce in a Nalgene bottle using only sunlight.
The World Meteorological Organization said that “ for the week of March 21st, Matam, Senegal (next to me) was the hottest place IN THE WORLD).
I’m looking forward to frying an egg on the concrete in my shower.
I daydream about instigating mass migration to the coast.

And finally…

My thermometer read 136 F at 4pm yesterday (in the sun) and it’s only the end of April. In case you’re wondering, May is the hottest month, which means that yes, it will actually get hotter.

As a COSing volunteer recently texted me,
“This place is so hot it doesn’t deserve to be inhabited.”
I agree.

New trainees

After almost a year at site and adjusting to solitude, this past month I’ve been around people nonstop. Immediately after Amanda’s 12-day visit, I was supposed to host a study abroad student at site. But because I was so ill I couldn’t leave the regional house (literally couldn’t be away from a toilet for more than 30 minutes…gross right?). I was with volunteers most of that week and then went straight to Thies to help with the training of the newest group of trainees the following week. Then I rode back up with them after several days and hosted them at my site for 10 days of “Demystification” or what is now called Community Based Training. They took language classes, shadowed my work, saw the schools, dipped mosquito nets, helped in a garden, and basically were exposed to all the elements of life as a PCV.

It’s so strange to feel like the seasoned, experienced volunteer when I still feel so unsure and infantile sometimes. I cannot believe how quickly the past 13 months has gone by! I’m already starting to plan my next step post-Senegal. I wonder now if the other volunteers felt that way when I came in last year?

It feels great to be able to talk endlessly about my experience though. The trainees have endless questions and it’s so encouraging to hear myself talk about my work, my family, my community, and all the little mishaps and hiccups I’ve been through that seemed so horrible at the time but that now just don’t even phase me. And their energy has fueled me. They are fresh and have new ideas and come with all different skills, and experiences and I am learning from them just as much as they are learning from me. And they are opening my eyes to things in my own town that I either didn’t know or didn’t notice before.

I also realize how far I’ve come, and how much I have learned, about Senegal, about the Peace Corps, about myself, my community, and other volunteers. And how far my Pulaar has come! I had forgotten what it felt like to not be able to communicate beyond the simplest greetings. I had forgotten the tears, and frustrations I went through in language training. With the newbies here I have realized how much I’ve grown and how invaluable this experience has been. I feel so proud of myself, for getting this far, for surviving, and well, for really doing pretty well. And of course I’m sure that I will not truly realize how much I’ve changed until it’s over and I am in another job, community, and country.

It feels good to be able to lead the new trainees through what can be such a scary and uncertain first experience at site. This new stage is just wonderful. They seem to be so relaxed and flexible and willing to jump into anything and go with the flow. My group of trainees are just the best! (Yes, I do hope they read this and smile). I’m so impressed with how they take the heat and the discomforts in stride. I mean, there are 6 of them (plus a trainer) staying in my compound and my tiny “boulangerie” of a hut (as the trainer nicknamed it). The heat is stifling (mid-130s in the direct sunlight, about 118 in the shade), and they are just learning the language. They seem to really already understand the value of a smile and the ability to laugh off minor annoyances. And while I know how tired they are they are making valiant efforts to practice their Pulaar as much as possible and integrate and spend time with my family and friends even though they’re exhausted.

I feel as if I’ve known them all forever. I guess that’s the nature of the Peace Corps though. You are thrown into such an intense experience with strangers and expected to become instant friends/family, and you do. You really only have each other to rely on. While there are others at home to provide a listening ear to cry to, at the end of the day, your site neighbors, and your stage mates are your best support network and no one will truly be able to understand the challenges we go through unless they too have been through it.

I think that this is my worst fear/anxiety. That even though I have such a supportive community of family and friends at home, that I will always feel slightly misunderstood, or that I will never fully be able to share the profound impact the Peace Corps has had upon me. And I need to accept the fact that I probably won’t. Maybe this has been on my mind a lot more because I have been surrounded by others, but I think it’s more likely that I am getting close to my vacation at home and I’m starting to get nervous about it, about being home, and the reverse culture shock. At the same time, I’m worried about having NOT changed enough. Like I’m holding myself to too high of a standard.

Maybe I just have too much time to think.

It feels great to be starting a new chapter of my service. It’s exciting that part of that new chapter is helping other volunteers find their way and embark on their own “toughest challenge they’ll ever love.” I’m still thrilled that I have.

Saturday, April 12, 2008

Links to Amanda's Photos

Here is the link to my most recent visitor's pictures from her trip. Amanda's photos are mostly the same as mine, but her captions are hilarious. (She is much wittier than I). Check them out and enjoy!


Senegalese Doula!

I finally got to be a doula in Senegal!

It was so wonderful to attend/help with a birth that wasn’t on the side of the road, and that was carried out under the supervision of skilled medical professionals. There was so much less pressure on me, and so much less anxiety.

One of the women from my mother’s group, Hawa, was very pregnant at our last meeting. She stuck around after the lesson was over and we talked about her upcoming birth and my sister brought up the fact that I had been a doula in America. Hawa’s eyes lit up and she asked me somewhat jokingly if I’d be willing to help her through her birth when the time came. I said of course and told her very seriously that she MUST call me, at any hour of day or night and I would come running and escort her to the health post and stay with her throughout the entire birth. I wasn’t sure if she would call, but I really hoped that she would.

6am on one of the 3 days that my visitor was in my town, I got the call.

The two of us threw on clothes and sprinted out the door to her house. We met her on the road to the health post. She told me she had been having labor pains for roughly three days but they were now getting much more intense and she knew the baby was coming soon. (This was her 4th). She and I and Amanda (my guest from home) and Hawa’s friend and fellow group member, Mairam, all walked the 10 minutes along the dirt path to the health post in total silence with her. I held her hand and offered my arm as support when the contractions came and she had to stop and breath or lean against a wall.

Now in Pulaar culture (not sure if this is true of all of Senegal) women are expected to give birth silently. Crying, or yelling is seen as a sign of weakness.

So the majority of the walk we spent in silence, Amanda and I flanking Hawa with Mairam walking alongside, silently mumbling her morning prayers. Not once did Hawa cry out, she just whimpered softly to herself. I mentally timed the frequency of her contractions by noticing her face and the few times when she paused to rest because the pain was too intense to walk through.

What struck me most was the power and the intensity of the intimacy I felt among these women. I was reminded of the book The Red Tent (see PC reading list) and the cherished moments, and secrets the women shared under the tent.

I thought about this shared bond, the work ahead of us, and the strength of this courageous woman who was about to bring her baby into the world. I felt reverence for Hawa, for all mothers, for women, for the gift of a womb, and for that private moment that the four of us shared-two young single American women, and two older, Senegalese, Pulaar mothers, walking silently, arm in arm down the quiet sandy streets in the early morning light, before the heat of the day. Them in their traditional Senegalese dress and head scarves, and us in our t-shirts and long skirts.

I don’t remember feeling anxious. I felt secure, confident, slightly hurried, but mostly honored. I was honored that she trusted me so openly to accompany her and attend to her through this difficult and frightening journey.

I was pleased to find that the midwife on duty was my friend. One of the ones I liked the most. She had helped my counterpart give birth and I knew we were in capable hands (as capable as can be for such a basic maternity ward).

My thoughts were going a mile a minute. I was trying to notice every detail but simultaneously give Hawa all of my attention. Here I was finally getting a glimpse into the “quality of care” that I had studied at LSE in my reproductive health course. I didn’t want to miss anything. Granted I’ve seen quite a lot just by hanging around the health post, but this was the first time I would have the chance to see the whole process up close.

I remember feeling relieved that it was so early and that it wasn’t a busy vaccination day. The health post was practically empty which would mean some privacy. The midwife, Nabou, told Hawa to get up on the exam table (in the first room where the registration desk is). She sat at the desk and filled out some paperwork while I helped Hawa lay down. Nabou examined her briefly, and felt her belly, which was visibly pulsating with every contration. To hear the baby’s heartbeat Nabou used a funnel pressed flush up against Hawa’s belly and her ear at the other end. She asked how long Hawa had been in labor and when Hawa said three days, Nabou scoffed and asked her why she hadn’t already stopped by for treatment. Hawa corrected her saying that she had and that they had given her a prescription (for what I’m not sure) and had told her to come back when the contractions were closer together. Then we moved her into the delivery room.

It’s a dirty, stifling hot room with a back door, a sink, and two very basic, very dusty padded, metal tables with stirrups. Mairam was sent to the pharmacy with a list of things that she had to buy for Hawa: gloves, tubing, a syringe, a bag of glucose for an IV drip, gauze pads, and various medicines that I did not recognize. I learned that you really have to have someone, often several people to accompany you and help you at the health post. I learned that if you don’t have the money for the necessary supplies, the health post will pay for the medicines and you just have to pay them back. I was actually pleasantly surprised by that.

To get the money Mairam first had to go back to Hawa’s house and then to the pharmacy. I practically had to bite my lips off to keep from offering to pay for everything. I knew that she could get the money, I just had to be patient. Also, that would start a terrible trend and I could envision the line of women coming to me for money when they had to go to the health post. I told myself that it was enough that I was there with her, and that if I hadn’t been no one else would be. I discovered later that typically they don’t allow anyone else in the delivery room and that they made an exception because, well….I’m a toubak, and they knew I had had some experience, and mostly because the midwife was a friend of mine. That and I’m sure they knew me well enough by now to know that if they had tried to kick me out, I would have pitched a fit and stayed anyway.

Mairam was gone for about thirty minutes during which time Nabou was getting terribly impatient and kept yelling at Hawa for Mairam’s slow pace. I went outside and told Hawa’s aunt and my sister (who had both showed up at that point) to bring cloths and fabric to wrap her and the baby up in afterwards, and sheets to lay on the post-partum bed. Meanwhile Nabou was getting things ready in the delivery room. Washing up, setting up the IV drip, etc. I was focused on Hawa and helping her through each contraction which were getting more and more severe and coming about every minute by that point. She vomited once, and luckily I was there because I got her the trashcan in time. (I’m sure she would have been yelled at had she vomited on the ground). I mostly just stood by her, holding her hands, giving her my body to hold onto, cooing to her that her body was strong, her baby would soon be in her arms, and that even though she was tired it would all soon be over and she would be able to rest. The only thing I could think to do to make her more comfortable was to wet a packet of tissues from my purse with the ice water Amanda and I brought with us and hold it on Hawa’s forehead. She kept telling me how tired she was. She never complained about the pain, only how tired her body was. She continued to let out long sighs and whimpers, calling quietly to “Nenam” meaning, “my mother.” It surprised me that she did not call out to Allah, but to some other grand feminine force. I remember thinking how beautiful that was and realizing that birth really does connect all women.

It was definitely a challenge to try and coach and soothe her in Pulaar, but I did my best and I remembered that it didn’t really matter what I said as long as it was soothing and repetitive. I settled on telling her that she was strong, she could do this, to breathe and that soon her baby would be in her arms.

(I also realized in that moment that this was now the fourth birth I had ever attended, and that none of them had been in my native language! The two in the states were in Spanish, and then these two in Pulaar. I sighed to myself and thought about what a relief it would finally be when I could be a doula in English!)

Nabou set up the IV and now there were roughly three other midwives bustling about, chatting amongst themselves and getting things ready. There was a lot of activity for such a tiny room and it was a struggle to keep Hawa focused and for myself to try and ignore the midwives and focus only on Hawa.

As the contractions came closer together and more severe, Hawa did start to cry out some. I didn’t even think anything of it, but one of the midwives came over and scolded her. Saying that she needed to stop crying because people outside could hear her! I was appalled. But I kept my mouth shut because I didn’t want to risk being asked to leave. The midwives explained to me that they gave Hawa Pitocin to increase the contractions, saying that the baby was tired and so was she and they needed to get the baby out right away. The baby was nearly crowning when one of the assistants starting violently shoving on Hawa’s stomach. Now I’ve heard of this before when the mother is tired, but it looked incredibly painful and they certainly weren’t timing the pushes with the contractions. They kept yelling at her to push even in between contractions, and Nabou was scolding her for not keeping her legs open enough. I felt so helpless and wanted to be in 3 places at once, to hold her legs, and simultaneously be at her head to hold her hands. Nabou kept yelling at her to push even between the contractions (which is pretty much counterproductive and a waste of energy). Hawa was definitely crying out at this point and so overwhelmed by all the different directions and things happening to her. Finally the baby was crowning and instead of having the head come out in one contraction and then waiting for the next one to ease the body out, Nabou pulled him out in one go, with one massive yell from Hawa.

The moment he was born and I saw him I burst into tears. I looked over at Amanda (who had come in to watch during the last few minutes, her first birth ever!) and we were both teary eyed, she was trying so hard not to cry because I had told her it was culturally unacceptable, but I definitely couldn’t help it. With tears streaming down my cheeks I told Hawa it was all over, she had a healthy baby boy, that she did it, praise be to God, may her son be in health etc etc. Nabou smiled at my tears. She wrapped him up in a cloth and laid him on the next table over! Hawa didn’t even get to look at him! She put the vitamin K drops in his eyes to avoid infection, and then just left him there, alone on the table wrapped in a dirty cloth, with the hot sandy air and flies coming in the door. I asked if I could give the baby to Hawa and Nabou said no, that she knew that in America we put the baby immediately on the stomach, but here they waited until the mother was in the other room and cleaned up and resting. I couldn’t help but be angry and confused, with how nicely Nabou was speaking to me throughout the birth, and how mean and impatient she was with Hawa. As she worked to get the afterbirth out, Nabou yelled at Hawa repeatedly to open her legs and scoffed “oh come on, how many births is this for you? Open your legs, so I can finish.”

Hawa lost a lot of blood and was pretty disoriented. Nabou had to kneed her uterus to get the excess blood out and to get it to contract back up. I pointed out that getting her to breastfeed right away would help with that, and again offered to bring the baby over, but she refused. After Nabou finished cleaning her up, the other midwives came in and wrapped her up in cloths, scolding her (yet again) for not bringing a pair of red underwear (or any at all) to act as a diaper to stuff the fabric into. They made do with the fabric she had brought and tied it in a diaper-like fashion around her, changed her clothes and we moved her into the next room to lay on the bed. Her aunt still hadn’t showed up with the sheets for the new bed, so she was yelled at again. At that point I had been over to pat the new baby boy and coo at him, and Amanda and I were the first ones he saw when he did finally open his eyes.

I helped lay Hawa down in the next room. And realizing that the baby was now ALONE in the delivery room and no one seemed to care, I yelled to the new midwife on duty (Nabou’s shift had ended by then, and she practically ran out of there) that I was bringing the baby to Hawa. She said fine and so I carried the little baby boy to her and laid him next to her to let her look at him for the first time, roughly 30 minutes after giving birth. She was so tired, and initially refused to, but I insisted that she breastfeed him and told the midwife to encourage her to also. I sat with her on the bed, watching and making sure he was latched on correctly, which he did almost instantly, with gusto! Amanda sat across from us on the next bed and we smiled at each other, both of us totally unable to process all that had just happened. Hawa’s aunt brought Hawa a steaming hot cup of coffee. I rolled my eyes and told her that she should also drink water if possible. (I know now that arguing over coffee is useless even though it’s crazy to me to want coffee over water after being so dehydrated, but that’s how it is here). At least she was breast feeding and was healthy. I sent Hawa’s aunt out to get her some ice water, to which she asked if it was okay that she drink cold water. I said of course, and then explained to her the importance of getting her hydrated (hence the IV drip) and why immediate breast-feeding was so crucial. She nodded her head and seemed enthusiastic about my help.

I asked Hawa what she was going to name him and she said she was disappointed it was not a girl because she would have named her Binta, but that she wanted to name him after my dad! Again I nearly cried and thought that perhaps Shel might be a difficult name for a Senegalese kid, so I settled on Barry. Senegalifrenchified it sounds like (MbaarY). She seemed happy with that so I’m expecting that will be the little guy’s second name. Children here are given several names so it will probably be used as a nickname mostly just by his mom. But now both my mom and dad have infant namesakes! Cool huh? I keep telling them that now they HAVE to come visit.

We sat with Hawa for another 20 minutes or so and at her urging left to go home and have our own breakfast. It was about 10am by that point and Amanda and I were both starting to feel pretty exhausted and dehydrated. So we made the windy, sandy, hot trek back to my house and sat down for coffee and muesli. My family was thrilled that we had both been there and gave us both all sorts of praise.

Around 11am I called my sister and asked if she had gone back to the health post. She said that no she hadn’t and that Hawa had been transported by ambulance to the next hospital and that there had been complications! I was so upset, and of course in Pulaar there aren’t sophisticated medical terms so all I knew was that she was “tired and missing blood.” I took that to mean that she hadn’t clotted properly and was still bleeding. Her whole family had raced to the next town to be with her so there was nothing Amanda and I could do but wait. We said we would call back in the afternoon and see how she was.

I fretted the entire time. We spent the day making doughnuts with my family for the little soirĂ©e we had planned that afternoon for Amanda’s last day, as a thank you for having her. But I was so distracted and anxiously awaited my sister’s phone call. Finally around 2pm I called and talked to Hawa’s husband who said that she was indeed better, but that she had to stay overnight and would be back tomorrow. I was relieved, but still anxious.

I told my Yaaye and she said something that almost made me cry. I told her how relieved and happy I was and how anxious I had been all day, and she just looked at me and said, “Binta I know. I could see it in your face all day. I knew you were scared and worried. I was watching you make doughnuts and you were so distracted and your face was pained. It’s because you are so good and you care so much about your family and your Senegalese family. I spoke to Binta earlier about how upset you were. We were all worried and now we can all be relieved together.” I almost hugged her. How wonderful that she knows me well enough to know what I’m feeling even better than I do!

So Hawa came home the next afternoon and is now healthy and happy. I am so disappointed though because I had to miss the baby’s baptism because I am sick with amoebas + some other horrible bacterial stomach infection + a head cold at the regional house. I could not even travel home and instead spent a week holed up at the house feverish, watching movies, eating soup, and running to the loo every 30 minutes. Yuck. I’m so bummed. I of course called to explain why I couldn’t be there, but it was really a big deal to me to be there, and if I possibly could have made the drive I would have, but it was out of the question to be away from a bathroom and on public transport for 4 hours. I plan on showering her with gifts when I do get back though.

But, my good friend Mairam, who is part of another family totally unrelated to me, and who are my dear dear friends, just called me to tell me that one of the women in her family gave birth to twin girls yesterday!! She was HUGE and I told her that she was having twins. Everyone thought I was crazy, but I insisted. Mairam told me that she is naming one of her girls after me! Hooray! My very first namesake. I’m so honored. But I’m irritated because I have to be down helping with the training for the new volunteers, and am AGAIN going to miss the baptism, but Mairam said that they would postpone it until I came back because they couldn’t imagine me missing it and they didn’t want to have it without me. What an honor. Especially, because it is so important in their culture to hold the Baptism on the seventh day.

These births (and my interaction with the breastfeeding mommy-see previous entry) have absolutely refueled me and helped me out of my mid-service slump. They’ve reminded me of the connections I’ve made in this community and that my work and my presence is valued and respected and needed.
And what an honor.
What an honor to be included and trusted in some of the most important moments of people’s lives.
I am so lucky.


I affected change!

I have concrete proof that something I did, something I taught, some piece of information I transferred actually produced results that improved someone’s health! It was one of the most inspiring, uplifting moments I’ve had in country.

About 2 months ago I was at my friend Mairam’s house and I met a woman with a brand new premature, very sickly looking baby. We talked about her baby being so skinny, and I asked if she was breast-feeding. She of course responded yes, and then she proudly mentioned that she was also feeding her cooking oil! (An unfortunately very common practice here). I told her very nicely that no, she did not need to give the baby oil, that the reason the baby was sick was because she was feeding her oil, and that all the baby needed was breastmilk. I explained to her what was in her breast milk and that it had all the sugar, and water, and vitamins and antibodies (‘the vitamins to kill germs’) that her baby needed. I didn’t think much of the interaction until I saw her again recently when Amanda and I went to greet that same family.

There she was with her baby. I asked to hold her and noticed that she looked a lot better! She had put on some weight, her eyes were tracking better, she seemed livelier and more alert. I told her mom that to which she responded, (to my extreme delight)…

“Well Binta, I stopped feeding her oil. I’m only giving her breastmilk now. Breastmilk ONLY. Just like you told me to!”

I almost burst into tears. I get goosebumps just thinking about it.

That I contributed to the health of her baby by giving her information, by taking five little minutes to just sit and speak with her nicely and give her a little advice, and not yell at her, and encourage her and tell her that she was a good mom….and to have her come back and to physically SEE the progress her baby has made and have her mom tell me that it was BECAUSE OF ME! I am over the moon about the whole thing.

There it is, everyone always says about development work that “if I can just help even 1 person than it’s all worth it.” Well you know what? Checkmark on that one.

And the thing about that interaction is that you can’t quantify it. I can’t write that on a resume, or even in my quarterly report to Peace Corps. It’s not a specific “project” or a health talk, or a class. I was just in the right place at the right time. And because I’m always looking for a chance to talk about health issues when sitting around, I finally made a difference! In some ways it seems like such a trivial victory, but it will make a difference in her life, and her baby’s life, and her future children’s lives and hopefully she’ll tell other people and so on and so forth.

That’s how change starts right? With one person. You just have to plant the seed. I finally have proof that I did.