Friday, January 30, 2009

Infant Emergency

Up until this moment, I thought I had seen malnourished children. I thought that I could handle sick babies, and undernourished laboring mommies. I thought that I had had all the heartbreak I could take when one of my namesakes (a twin, five months old, I think she was a Down’s syndrome baby) died last fall. My first baby death.

I was wrong.

While I was in Thies, working with Operation Smile, providing translation and logistical support to the post-op nursing staff, I had the most devastating experience to date. I almost can’t write about it to this day because it affected me so profoundly.

It was the last day that I was working with Operation Smile, during the last hour of a 13-hour shift. I was exhausted, but too excited about the work that week to notice. I had been on my feet, non-stop, barely eaten and hardly hydrated, but I was running on excitement and a love of feeling useful.

All of a sudden, one of the young Op Smile volunteers came in to get one of the nurses I was working with.

“Sandy, we need you out here quickly, a woman brought in a really sick baby.”

We rushed over. There was a Pulaar woman, sitting in a chair holding a tiny bundle. When we unfolded the layers of material, I gasped and felt dizzy and sick to my stomach.

There he was, a cleft palate, underweight (possibly even premature) 6-day-old baby boy. Not even old enough to be named yet. He was so tiny he wasn’t even the length of my forearm. All the skin on his body was peeling off in handfuls. He was lying in his own feces, with huge red, throbbing soars on his inner thighs and groin. He was so dehydrated and malnourished that he couldn’t even cry to express his distress. He was simply too weak and periodically would just make little breathy whines.

The nurses immediately took action.

Suddenly there was a flurry of activity while the three of them tried to find something to make into an infant IV. All I remember is seeing the panic stricken look on their faces and one of the nurses pleading with the surgeon in charge “If we don’t do something right now, this baby is going to die!”

Then I was sent to the storage room (the operation brought all of their own supplies) to look for an infant oxygen mask. I was thrilled to have a task, as standing there staring was totally useless.

I ran back from the storage room, mask in hand, and discovered that the surgeon had made the call to send the little guy to the local infant care wing of the hospital to be treated by Senegalese nurses. He was right, in that the operation was leaving the following day, and would have to no way to monitor him, and that ultimately, they needed to treat him locally. This of course devastated me, knowing the conditions of these hospitals. I sighed a little bit with relief though thinking that I would be able to tell myself that he’d be fine, and I wouldn’t have to get attached to this one.

Wrong again.

“Caitlin! You need to go over there. The woman who brought him in only speaks Pulaar. You need to translate.”

“Shit…I’m on it.”

I ran over there, clutching the infant oxygen mask, naively thinking it would do some good.

I arrived on the heels of the surgeon and his wife who had brought the baby to the baby ward.

It was like night and day, coming from the “little America” that Operation Smile had created in the wing the hospital relinquished to them, and going into the baby ward of the Senegalese regional hospital.

There were probably 50 women and their babies crammed into a dimly lit cement room the size of my parent’s living room. Beds were everywhere, and there were multiple mommies and babies to each bed. Women sat on the floor, leaned up against the beds, and crammed onto the few available chairs, waiting by their sick kids, looking tired, unsure, anxious, and bored.

We brought him in with a flurry of activity. Three of our local Senegalese counterparts (two doctors and one nurse) who were working with Op Smile came in to assist and help transition him over to the nurse in charge of the ward. She of course was in the break room, watching television and not attending to any of the patients. The Op Smile surgeon asked me

“How old is he?”

“Six days” I said. “He was born on Saturday.” I took a breath and asked hesitantly, “do you think he’ll be okay?”

“He won’t make it,” he said matter-of-factly.

My heart sunk. My mouth went dry. This was what it felt like.

This was what all those doctors from Drs. Without Borders and the International Red Cross went through constantly. I felt discouraged, knowing that I was letting myself get too attached, get too invested in this one life. But I was absolutely powerless to stop myself. As the nurses and doctors prepared, I leaned over him, pet his tiny head, tears streaming down my cheeks and whispered,

“Come on little baby, don’t die. You can make it. Fight for me okay? You’ve got to fight baby. Fight.”

It sounds like some cheesy line from a Hollywood film starring some gorgeous Hollywood starlette who goes to the 3rd world for the first time to “help people.” But that’s exactly what it felt like. Except that this wasn’t a movie. I couldn’t save him. In fact, I could do absolutely nothing for him. I was helpless and terrified and alone in a room full of onlookers.

Now came the horrible part.

I was already, overwhelmed, exhausted, and panicked by the state of this little guy. We shoved over another toddler to make room for him on part of one of the 1950s style hospital beds. The doctors hooked up the oxygen mask to an available tank (I was amazed that it even existed) and we tried to position it on his little face so that some of the oxygen would actually get to him. He was so tiny the plastic practically covered his entire head and face leaving huge gaps for the oxygen to diffuse into the room. Wheezing all the while in an attempt to cry, the doctors began searching for a vein on his tiny little arm.

They searched and searched.

They tied rubber strips around his arms to bring the blood to the surface. They found nothing. They pricked him repeatedly. Nothing. They tied rubber strips around his legs, hoping that his feet would be more promising. They failed. After ten minutes, they agreed to shave his head and start looking for a vein there instead. He was simply too dehydrated to administer an IV normally.

This is when I really started to lose it.

Here he was, cleft palate, malnourished, near death, lying in his own feces, premature/underweight, 6 days old, being poked and prodded repeatedly just at the off chance we might be able to save him, or at least stall death for a few precious hours. They jabbed him over and over, still nothing. He gasped in soundless protest.

A cockroach the size of his foot ran over his naked exposed sores and legs. I nearly gagged.

The nurses and doctors moved him to a countertop with “better light.” Another ten minutes went by. They shaved his head, pinched his skin, poked him with a needle, and waited for blood to show. But the second they pulled out the needle to try a new spot the blood would come rushing out. Great. He was so freaking dehydrated they wouldn’t even be able to save him from dehydration. It was sick. I was losing it.

By now tears are streaming down my face and neck. Stifling my sobs and wiping my tears and nose on my t-shirt, all eyes are on these doctors and I. The other women in the room are all mumbling sounds of sympathy and blessings, realizing how grave the situation really is, and probably feeling thankful that their babies don’t look as bad as ours. The light is so dim they can barely see. Realizing that I have my cell phone, I feel a moment of pride at my momentary usefulness and turn on its flashlight.

Finally, after about 20 minutes, success! They found a vein and they got the IV going. The two nurses moved him back to the filthy, dusty, cockroach infested bed.

The moment they put him down, the IV came out.

“NO!” I shouted.

I knew that I was being unreasonable, that they wouldn’t give up, that in this culture I shouldn’t show this much emotion, but I was too tired, and too devastated to care. I gave in to my sobs. I ran out of the room, pushing past people, blinded by my tears. I collapsed against the wall outside the entrance, trying to hide myself as much as possible behind a bench. I wanted to indulge in the wretchedness of it all. I was despondent.

I sat there and sobbed. I sobbed and sobbed. I sobbed for this little baby, for all the babies like him, for the unfairness of it all, for myself and my helplessness. I sobbed because I just needed to let it all out.

I must have sat there for a good ten minutes. With no end in sight, a Pulaar woman heard that I spoke Pulaar and she came up to me and put her arm around me. She spoke softly and slowly, but firmly to me in Pulaar. She shushed me gently. She told me that I was good, that I had a good heart, because I cared so much for this little baby, but that I was scaring everyone. She said that I was scaring the woman who had brought him (not his mother…or she lied out of embarrassment), and I was scaring everyone around me. She shushed me kindly and firmly and helped me to my feet. I don’t know why, but somehow she was able to shut me up almost immediately. I just needed a figurative slap on the face. She was right. Crying wasn’t helping anybody. I dried my now red swollen eyes, and marched back inside. I hadn’t even asked her for her name.

There he was, lying in that same spot, still in his shit covered cloths, but attached to an IV!
I was ecstatic.
The nurse came up to me, “See? We got him hooked up, it’s okay.”

I spent a few moments talking to the woman (supposedly a neighbor) who had brought him in, explaining what had happened, and why he was so sick. Now that he was “stable” I could take a few more moments to ask her some questions and chastise her/the mother a bit for waiting so long to seek medical care. They know better, and they know when their children are sick and this behavior was entirely unacceptable and that now it was too late and he would probably die. I told her that if not immediately, then in a few weeks, or months, because he would be too weak to fight off any infections or other illnesses. I was not mean, or rude, just firm and clear. I know I made her feel ashamed though. That was not my goal, but I needed her to share in my sense of urgency.

Apparently what had happened was because he was a cleft palate and lip, mom had no idea how to nurse him. Cleft palate babies can’t suckle properly and the milk just dribbles right out of their mouths if they can even manage to “latch on” well enough to express milk. Moms have to learn to squeeze their breasts and aim the milk towards the back of the baby’s throat so that it stays down.

Because the health post workers have little training and there are minimal resources, they kept shifting the mom of the baby around to different health posts. One told her to go to Dakar. She said she didn’t have the money, so she waited, went back a few days later when she still couldn’t feed him and they told her there was an American medical mission doing operations on cleft palate babies in Thies (closer to her house and much cheaper). So she came to us thinking we could “fix” him. Obviously major surgery on an infant that tiny and malnourished was impossible. She had waited until he was practically on death’s doorstep. Although I can’t imagine a feeling so awful, a large part of me thinks she was just going to let him die. She had no idea how to care for him, and had let him dehydrate for six days. In six days this little baby had probably not even had a spoonful worth of fluids each day.

When I finished speaking to her I spent a few more minutes cooing over him, pleading with him to make it, to survive. Then I found the nurse and told her to change his dressings, and warned her that I would come back to check on him in an hour.

I returned to the post-op room and cried some more to the sympathetic nurses. They hugged and consoled me, but I could tell that they were far better at not getting attached than I was. It wasn’t that they didn’t care (quite the contrary), it was just experience. They’ve been there, dealt with so much fear, anxiety, and emotion, that they were just better able to handle it.

I finished up my shift amidst more sympathetic cooing from other PCVs, patients, and nurses, and I gathered my strength for a final visit to Baby Boy.

I went into the room and the woman who brought him was nowhere to be found. There he was, his IV almost empty, still lying in his own feces. Not making breathy whine, just awake and lethargic. The nurse of course was in the break room, snacking and watching television.

I put on the best fake smile I could muster,
“Hi again. The baby’s IV is almost empty, would you come change it please? And he really needs to be changed, he’s filthy and his whole body is infected.”

She indulged me, was perfectly cheerful and got up quickly. She put up a new bottle of IV fluid and reassured me that she was going to change his cloths right away.

It was time for me to leave.

There was nothing left for me to do. I had half a mind to stay there all night, willing him to live, to fight, and to pester the nurse to care for him. I had a fight with myself. I told myself to be reasonable, that I couldn’t behave this way every time I encountered a sick baby. I told myself that it’s okay to go the distance, and I had, and that I needed leave for the sake of my mental health. The next day I had to hold a film screening in Dakar and I would have to trust that I had done everything in my power to help Baby Boy.

I kissed him on the forehead and left him a miniature stuffed koala bear (I had had attached to my jeans belt loop for ‘flare’ during the mission). I shook the hand of the woman who had brought him, and accepted her blessings. I clasped my hands together, held them up in the air (a sign of thanks when you can’t shake everyone’s hand) and said goodbye to the room. I walked out…never to see the little guy again.

I was sure he was going to die.
“Tonight, tomorrow, or next week even” I thought to myself.

I called another PCV as I walked out, sobbing again, and explained the whole story.

We were all meeting up for a fellow PCV’s birthday dinner. I knew I was going to be a downer, but that I couldn’t be alone at the training center. So I went. I was glad I did because it was the distraction, and comfort that I needed.

I also called a friend from home, wanting to hear a sympathetic unjaded voice. Even though he felt powerless to do anything to console me, I realized that sometimes you just need someone to say,
“Oh my god. That’s awful. I’m so sorry. That shouldn’t happen. I’m sorry.”
As I spoke with him, the angry phase kicked in.

“Fucking CARE damnit! Why didn’t she care? Where is her sense of urgency? What’s WRONG with people? Why wasn’t she panic-stricken and trying harder to keep her child alive? What’s wrong with her? Just…just GIVE a shit!” I swore into the phone.

I of course knew the answer to all of those questions, but sometimes you just have to let it out. I knew the lack of urgency and powerlessness stemmed from the fact that women here expect to lose children during their lifetime. They know that they have a very high chance (1 in 21 in Senegal) of dying in childbirth. (It’s about 1 in 8,000 in the USA, just to give you some basis of comparison).

Everyone else loses babies, why should this mommy be any different? It was all in God’s hands anyway right? They have to tell themselves that if God wants their baby, then he is going to take him or her. If they let themselves be inconsolable every time, people would just die of heartbreak. It’s their coping mechanism. They’re trying to survive too.

I also think that part of the apparent “lack of urgency” is that women have no reproductive rights. They have no choice in the timing, or frequency of their pregnancies. It’s taboo to use family planning and half the time they don’t get much say in who they’re married off to. They are literally baby-making receptacles.

Can you imagine? Birthing your 6th child with a man you never liked, knowing that maybe this time you will have a complicated delivery and bleed to death? I know that every mother loves her baby, but there’s got to be some kind of animosity towards the babies, and relief at not having another infant to carry on your back when your last one has just been weaned.

And that’s just healthy babies!

Imagine having a handicapped/deformed child in this society? It’s such a burden on the whole family. There are no institutions in place to help a busy, uneducated mother with 5 other children raise a special needs child like that. They certainly would never be able to afford an expensive surgery for him if it weren’t for missions like Operation Smile.

After we hung up the phone I felt a lot better.

I went back into the restaurant. We all threw back a few GnTs, shared a delicious meal and fell into bed at 10pm. As I drifted off to sleep, I reflected on the absurdity of it all. I thought about the dichotomy of being raised and ultimately going home to a world of privilege, while working in a world of destitution.

I fell into a dreamless sleep, exhausted.

The next morning I went to Dakar, and held a film screening at one of the fanciest private schools in the country, the International School of Dakar, for high school kids of the wealthy expat community. Talk about polar opposites.

When I got to Dakar I called another PCV and discovered that in fact, by some kind of miracle, Baby Boy had not died that night!

He was alive and fighting and still hooked up to an IV. I was amazed. Relieved and amazed. But I was still disappointed. I knew that the next day the mission would pull out entirely and I would never hear about Baby Boy again. I can only hope that he’ll make it. But not just survive, I hope that he survives, becomes fat, and well nourished, and doesn’t die from malaria, or an intestinal parasite, or some horrible infection. That he goes to school and lives a long and prosperous life.

The reality is that that won’t happen. Baby Boy, like millions of babies before him and after him, don’t stand a fighting chance at life and will more than likely perish before their fifth birthday.

I apologize for my frankness. I’m just being realistic.

I need to go to nursing school…

All in a day's work

There are a lot of unquantifiable activities that PCVs do that profoundly change our communities and our lives, and yet are not appropriate for official documentation in our administrative reporting system.

The births I’ve attended for example, I would classify as this kind of activity. They were informal, spontaneous, one-on-one experiences where I was able to “educate” others by living by example. When I worked with the midwives and matrons I was able to expose them to a much kinder, gentler, and even more effective way of coaching women through labor. While I can’t measure the lasting effect of, or ensure transference of any of the behaviors I demonstrated, I hope that at least some of my techniques rubbed off on them.

Today I had a similar experience. It will probably take most of my energy for the next few days, and yet I can’t “get credit” for it. Such is the life of a PCV.

I came home from the weekly market, psyched about buying my week’s worth of bananas and eggs for my breakfasts. I sat down with my sister and our neighbor who is 9 months pregnant. We were talking about when she was due, and I was making sure she was planning on delivering at the health post and not at home. We talked a bit about her due date, how her pregnancy was going, and I let her know that no matter what time of night, she should call on me to be her doula and I would stay with her through the whole thing.

As we talked, my sister mentioned to me that one of our neighbors was being forced into marriage by her mother and had been on hunger strike for 3 days as a result. Forced marriage is illegal, but unfortunately quite common in Senegal, and especially in this region. Girls, especially girls who have never been to school, don’t know that they have resources, that there are people who they can call, who will hold a mediation with the families and will protect these girls from an unhappy life as baby-making receptacles, away from their families, at the beckon call of a husband they don’t love. Maybe it sounds incredibly dramatic, but that is the reality for many a girl/woman in this region of Senegal.

They began to speak in hushed voices. They explained to me that she had been forced into marriage last year and was sent to live with her husband against her will. She spent a miserable month there, and came home, vowing never to return. A year has passed and her mother has been pressuring her to go back, saying that she will abandon her for the rest of her life for disobeying her and shaming their family. Still she refuses and recently the argument has come to a head as her mother is threatening to send her back and she refused to eat in protest to prove her point. She has vowed that even if her mother beats her, kicks her out of the house, or abandons her for life, she will never go back.

Turns out that her husband, is old, I mean really old. And stupid. But he’s got money. Her family is poor. Super poor. They figured, they’d marry her off and then she’d bring money to the family. And he did. He paid the family a ton of money, and off she went, against her will. She ran away once, and finally they forced her to go. He already has a first wife, a super old woman, and many children. All of whom are even older than her and have already had children! Gross huh?

I made it quite clear to my sister that this was unacceptable, that it was in fact illegal, that she was an adult and could not be forced to return. I let them know that I was angry, and then I zipped off to my room to start making phone calls.

Here’s where it gets messy. Seriously, it’s a problem with no end…It will just frustrate you, so if you’re up for it, keep reading. If not, then stop now.

I called my good teacher friend who was a guest panel speaker at my girl’s leadership conference who works to prevent forced and early marriage. She was thrilled I called and gave me a couple of phone numbers. One of which was the phone number of the regional children’s rights lawyer in the regional capital. He is the one in charge of all the cases relating to children including female genital cutting, forced marriage, and abuse. A wonderful man, he called me back immediately after receiving my thorough and slightly anxious message. He explained that because she was 18 years old when she was forced into the marriage, and was now 20 years old, that there was nothing he could do. She was out of his jurisdiction and technically under the law, she was an adult and made the decision to go and consummate the marriage. All he could do was offer to hold a mediation with the family if that’s what it came to. He said that she should start taking the steps to divorce him. She’s an adult and has the right.

I called for her to come to our house and explained that I had already called my friend who works at the court and explained her situation. I told her I could call him right away so that he could give her advice.

To my surprise and dismay, she refused. She absolutely refused. She said she was too scared to get officials involved, that if he came to her house he would find out that her husband gave her family the money and that she technically “consummated” the marriage, and he would side with her parents. Of course that is not true. She has the right to leave him if she wants. Under the law she can divorce him, but her family would probably shame her forever. Some choice huh? She also said it was unsafe to call him because if he came to her home than her family would be shamed because everyone would know that she involved the authorities.

I tried for a good hour to convince her to at least talk to him about good strategies, my sisters translating the parts I couldn’t quite get out carefully enough in Pulaar. But she is too na├»ve, scared, and vulnerable. She still refused.

Her strategy? Run away. Great.
That’s not going to do any good except piss them off more, and put her in danger. Where is she going to run to? When they find her they’re just going to beat the crap out of her. Then what?

I told her that I would be happy to talk to them if she thought it would help. They are planning on sending her on Sunday (though I think they’re lying and it will actually be Saturday so she won’t runaway again). She is already ready to runaway early Sunday morning. Tremendous.
I tried my best to convince her that what needs to happen is a conversation. That their way of thinking needs to be changed first and foremost. They need to be told that they are not allowed to treat her that way.

I know that coming from me it will probably just seem meddlesome so I sought the advice of another teacher friend who lives in my neighborhood who also participated in my girls leadership conference and has experience intervening in these kinds of situations.

She was only slightly helpful, in that she was very realistic about the entire situation, but discouraging. She told me that the girl should never have accepted the marriage, that rather than piss off her parents she should have sought out the proper authorities and refused. Or, that she should have agreed, gone and married him and then pissed him off and been a bad wife until he divorced her and avoided the pressure of her parents altogether. Hmmm….

Not exactly the best advice.
For one thing it takes an incredibly strong woman to be able to handle that kind of situation. To first realize that you have resources and support networks to help you, to stand up against your parents, to resist the temptations of a wealthy arrangement when you’re dirt poor (however disgusting he is), or then to accept all these things to save face and refuse the advances of your husband and isolate yourself in your new family and be so disagreeable that he divorces you.

Uhg.
It makes me sick to my stomach just thinking about how convoluted, complicated, and not in her favor all these things are.

Family is everything here. Of course her parents are not allowed to kick her out and abandon her, but they can still make her life miserable, and cut her off entirely. She’s never been to school. What options does she have? I don’t even think she knows that she’s allowed to divorce him.

That’s where I come in.

I am treading as carefully as possible. It is a risky thing for me to be doing, as they are my neighbors and there are many people in my community who would be furious with me for interfering, but of course I am anyway. It’s the right thing to do. That and I’m crazy stubborn J but most of you already knew that.

Where it stands now is that I’m waiting with bated breath for this weekend to see what goes down. She wants to try to deal with it on her own this time. If they still try to send her afterwards then I have her permission to bring in the authorities. Meanwhile I’m trying to convince her that she has the right to divorce him.

My own sister didn’t even know that!? Women literally believe that they don’t have the right to even divorce their husbands! They are kept so far in the dark that it’s as if they perpetuate their status as second-class citizens. Of course, the law is on their side, but of course they still have to deal with all the familial repercussions of their actions, and the gossiping, isolation, and fighting that would ensue in their family and community networks.

All that is left is to have a sit-down with her parents. I am perfectly willing to be that person, but she has to ask me first. I am not going to march in there and risk breaking ties between our two families unless she asks me too. Also, it’s tricky because I would probably need a translator and that would mean involving someone else.

On the plus side my new contact at the court is kind of the awesomest contact yet. He was so helpful on the phone, had endless patience, and really thought over the whole story. Bottom line: he gives a shit. That is hard to find, especially among men with influential positions out here. He invited me to the courthouse Monday so that he can give me his information and documents that explain the best techniques for stopping forced and early marriage, the breakdowns of the laws, and how to hold mediations, who to contact etc. PC doesn’t exactly give us much training on this stuff and I figure that at least this way, maybe if I can leave the information for other volunteers in an organized manner, they will know the steps to take before it’s too late for another young girl. If the word gets out, my neighbor will be able to tell other girls that there are institutions in place to support them, that maybe next time this guy’s phone number will be passed from hand to hand in secret between girlfriends, and one of them will be courageous enough to fight and save herself from a forced marriage.

So that’s how I spent my day yesterday. I met with the school director to discuss my replacement volunteer, I went to the market, and spent the whole afternoon trying to change the world, one forced marriage at a time.
Granted I failed, so maybe it was all for naught…but I haven’t given up yet. I’ll keep you all posted.

Now, if only I could figure out some way to justify this time and energy as work for my Close of Service report…

Update!

I know I know, I’m sorry. I haven’t written in FOREVER.

You had all probably given up on me by now, but it’s funny how cyclical my PC service has been. I really needed the blog at first. I used it as a way to share, vent, reflect, and process all the experiences I was having. Then towards the middle, I was sick, had fewer stories, went to America, came back and spent a few months working in Dakar. In Dakar I was busy busy busy, keeping Western hours and working like crazy on the tree nursery making instructional video and holding screenings of our women’s education/empowerment documentary.

In November I was busy with a girl’s leadership conference, then my parents came to visit, then I was working with a medical mission in Thies, Operation Smile, then I went to NYC for the holidays and a wedding. Now I’ve been back for several weeks, the cold season has been glorious, and is in fact beginning to end (about 100 in direct sunlight today…tragic) and I have less than 3 months left!

Let me say that again…I have less than 3 months left! That’s crazy! I came out here in March 2007! It seems like yesterday I was crying, packing, calming the butterflies and mentally preparing for the unknown. Turns out the PC slogan is right on the money. It has definitely been the toughest challenge I’ll ever love…and then some.

Now that the end is near and I’m preparing for “the next step,” I find myself drawn to writing again. I have a lot of stories I’ve been saving up that I hope to plug in sporadically. I hope that you will all forgive my extreme tardiness and helter skelter order.

So what is the next step for me? Nurse Midwifery School! I’m super excited about it. (Not necessarily the whole application, prerequisites, and 3 more years of school part), but the end result is what’s going to get me through. Coming into the Peace Corps I knew that nursing was a possibility. I even considered putting off the PC to become licensed, but ultimately I decided that nursing school would always be waiting. I was unattached, adventurous, and desperate to spend a prolonged period of time in Africa. And it was the perfect experience to give me some clarity. In fact, 6 women from the group of volunteers I came in with are going to apply to nursing school next year! 6 out of 35 people! We’re already joking about creating our own traveling RPCV Senegal medical mission.

Between all of the medical emergencies and births I’ve witnessed, and the horrifying conditions of the medical facilities and lack of training of local health workers out here, I am more confident than ever that the nurse midwifery path is the right one for me. I need tangible medical skills so that I can continue working in Africa/the developing world and have something more concrete to offer than just a development background.

I want to work to train local health care workers and speak to communities with authority on their medical problems. I’m constantly frustrated by my lack of medical knowledge and inability to diagnose problems. Probably 3x per day someone mentions not feeling well, or points out a child’s skin infection and asks me what to do about it, what it is, or if I have medicine. Of course my basic knowledge is semi-helpful and most things clear up on their own, or can be solved by going to the pharmacy, or the health post, but people are always discouraged when they know that I am a health worker and all I can tell them is: “Wash it well with soap and water, or drink lots of fluids…and then go to the health post.” They’ve heard that song and dance. They want to know what the huge festering pus scab is behind their daughter’s ear, how to prevent it, why it keeps coming back, and exactly what medicine they need to treat it. I just don’t have that kind of training. Not that basic germ theory, nutrition information, and first aid don’t help clear up a lot of things, but my classes and tips to people would carry a lot more clout if I was actually a licensed health professional.

People are scared of the workers at the health post because they treat them horribly and they are not well trained. I’ve heard horror stories of people bringing in sick kids and the nurses just sitting there refusing to get up and help, making tea, and getting angry for being badgered during “break time.” My own sister once went to the health post with false labor pains and was told that she would deliver within the day, was given Pitocin (to speed up and make contractions more forceful) and SENT HOME (a HUGE no-no), only to be in tremendous pain for hours. At which point my brother called the Dr. and he had her rushed to the nearby bigger hospital where they gave her a counter medicine, or at least monitored her until the pain stopped, and she went home…only to give birth 19 DAYS LATER!! No wonder people don’t go to the health post until they’re so sick it’s too late. The place has a reputation…you only go there to die, because often people wait so long and are so sick beyond the capacity of the local health workers that they do die.

Point is, that all of these kinds of experiences have just cemented my desire to be a health care professional. Sometimes I wish I had just listened to my 6th grade self when I declared that I wanted to be an OBGyn, but you know, sometimes you have to go on and do other things to end up right back where you started right? (Does that even make sense? My English is seriously lame these days).

While I was working with Operation Smile providing translation support, I met some amazing nurses and even though I wasn’t “healing” anyone per se, I just adored caring for the patients and answering their family’s questions. The results were immediate and the families SO appreciative that I felt on top of the world, and SO useful!
I pulled 13 hour shifts for multiple days in a row, cried some, laughed a lot, watched a couple of surgeries, and ultimately fell in love with the profession. Granted I want a bit more responsibility and want to be able to be a midwife and deliver on my own, but the medical mission was just a taste of what is to come.

I’m applying to several different schools with accelerated BSNursing/MSNursemidwifery programs, all over the country. I’m going to spend the late spring and summer months taking billions of prerequisites and studying for the GREs like a madwoman. I am allowed to leave country as early as April 11th at which point I am going to go straight to DC and the East Coast and do a brief tour of schools and of course visit a whole lot of people I haven’t seen for two years. I am a little bummed that I’m not planning a huge Close of Service trip, which many volunteers do, but I’m antsy to get started on these classes. If it turns out that I complete them ahead of time then I can always travel later I suppose. I’ll be back in Cali for the summer, taking courses at UCBerkeley through August and working to get my official doula certification so that I can start getting more experience attending births.

Then who knows where I’ll end up for school?

It makes me nervous knowing that I will have to be in the states, in one place for roughly 3-4 years. After spending the past three years abroad (London and then Senegal), I am terrified of getting too comfortable living the cushy American life and forgetting all that I’ve learned out here. At the same time I also yearn for luxury, to be clean, comfortable and healthy, and for the freedom from constantly worrying about scorpions, dysentery, malaria, child abuse, the heat, malnourished children, and death. I am eager to be off mefaquin (woohoo!) and to stop being a constant source of entertainment. I am looking forward to being just another face in the crowd, but it also terrifies me that maybe no one will want to listen to my stories, and I simply won’t be able to shut up about Senegal.

I am anxious and sick to my stomach every time I think about leaving my host family, but I also can’t wait another second to see dear friends from home. I know I’ll come back to Kanel eventually, but who knows when? My host father is 81 years old…who knows how much longer he’ll be around? I have pledged to come back if I eventually get married…someday…and hold a mock Senegalese wedding ceremony, and I mean it now, and don’t want to lose that conviction.

I keep repeating to myself…

I will be back someday. I will call often. I will send letters, pictures, and packages. I will not forget the Lam family and the town of Kanel who have done so much for me.

The whole thing is just so heartbreaking. In some ways it’s worse leaving here than it was leaving the states two years ago. At least then I had a time frame. I knew I would be back in two years time. I have no idea when I’ll be able to come back to Senegal.

At this point it’s all my family can talk about. They are obsessed with the countdown and telling me how much they are going to miss me. It makes me feel good, but it’s difficult to concentrate on all the projects I still have to finish up before I can leave. I just want to spend my time sitting around with them and my closest friends, soaking up all the sights, sounds, smells, and joyous moments and commit them to memory.

I have asked PC to replace me with another volunteer, an Environmental Education volunteer, female (at my family’s request), who speaks French. That will make it easier for me to send things and stay in touch, but my family keeps saying that no one will be able to replace me, and that they almost don’t want anyone else! Very sweet.

In any event, I’ve got two more weeks up here, then it’s down to Thies for GAD meetings and a GAD conference, then the West African Invitational Softball Tournament over President’s Day weekend, and the all volunteer conference, our Close of Service conference, and medical appointments, and then two friends, Lisa and Wendy are coming to visit for 2 weeks! Yay! They leave March 7th, then it’s back up to the desert for 3 weeks to start wrap things up and say my goodbyes. By April I’ll be in Dakar finishing film stuff, and then it’s home to America for good!

It really has all gone by so quickly I can’t even believe it. I am so lucky. It’s been such an incredible experience. Sure it’s been trying and almost unbearable at times, but the highs have been more rewarding than I ever could have imagined.

Looking back, I truly would not trade it for the world.