Sunday, October 30, 2011

Bean sandwiches and mosquito nets.

This is going to be a picture post, so I may as well start out with a photo of the best breakfast there is in all of Senegal. Ladies and gentlemen, the bean sandwich!

Seriously the best thing ever. SERIOUSLY.

For you folks at home who want to make your own, make sure you spice the beans heavily and slather the whole business with mayo. More adventurous eaters will want to follow my lead and add spicy pasta, scrambled eggs, fried potatoes and onion sauce to their sandwich as well. Oh, and it's not a proper bean sandwich if it's not wrapped in discarded newspaper or something, so save your trash!


Several weeks ago, I posted something extremely brief about how excited I was for the upcoming month and promised a full report on it when I came back from the travel. That post was never written, and probably never will be. At least not in the way I had intended to write it. I'm afraid to say too much about it, because that month produced the type of happiness you suspect could be easily crushed by too many words and too much reflection. Good thing I took some pictures to share.

It ended up being an intense month. I started out in Thies, where Peace Corps/Senegal has our training center, for the Stomping Out Malaria Initiative's second boot camp. Staff members and volunteers from across Africa came together to learn more about what we can all be doing to eliminate malaria in our communities. Putting together this training was a little exhausting, but it was worth it to meet the incredible people who attended. I feel privileged to be working side by side with men and women from so many countries, who all believe so firmly in our goal.

I had to leave boot camp a few days early, though, to help supervise a big mosquito net distribution in the southeast corner of Senegal. Peace Corps volunteers and some of our national and international partners were headed to the community of Saraya, outside of Kedougou, bringing a few thousand nets with us.

These distributions are insanely complicated. They begin with a community census, when trained community health workers go from house to house, hut to hut, and count the number of beds and other sleeping spaces (mats rolled out on the floor, stuff like that) that don't have nets.

Health workers enter every hut to get an accurate count of the number of sleeping spaces.

After all this data is validated by a committee of village dignitaries and health workers, the nets are all counted out and divided up. Each one is opened and the name of the new owner and the date and location of the distribution are written on them. When the big day dawns, people are already lined up at their distribution points to collect their nets.

Community health workers in Saraya getting the nets ready for distribution day.

Waiting for new mosquito nets in Saraya.

Every distribution is accompanied by a talk about how to properly use and maintain these mosquito nets. The community health workers will follow up in the weeks ahead by going from compound to compound again, making sure that people have hung their nets correctly and teaching them about the symptoms of malaria. Finally, after some internal evaluation, the distribution effort is done. Using this method, Senegal will have covered 10 of its 14 regions by the end of this year. And that, my friends, is what universal coverage of mosquito nets and malaria education looks like.

A family sitting beneath their new mosquito net.

If nets are being widely used in a village, it benefits every individual within the community: mosquitos have less of a chance to pick up the parasite that causes malaria and pass it to another human host. So if you have about 80% of a community sleeping under their mosquito nets, you'll cut the incidence of malaria roughly in half, and mortality will is reduced by about 17%. Not a bad deal, since a distribution costs about $.50 per net after the cost of the nets themselves. Yep. Fifty cents. And those nets aren't exactly costly either.

It wouldn't be business as usual in Senegal if the car bringing us in to Kedougou hadn't broken down one late afternoon, after the whole distribution was finished and I was getting ready to come back to Dakar.

The guy in the hat and sunglasses said I wasn't allowed to help push-start the car, so I stayed inside and took pictures.

In my current job, I help other people makes things happen. Distributions, trainings, other malaria projects. I don't get out much these days, and I don't get to use my own hands for much beyond typing and drinking too much coffee. In fact, although I had been arranging the budget and putting mosquito nets in cars down to Saraya for weeks in advance of this distribution, I hadn't been sure I'd get to travel to be a part of it.

But I'm glad I ended up in Saraya for this distribution. The volunteers and the Senegalese health workers who were involved astonished me on a daily basis with their eagerness, compassion and energy. Besides, check out this river!


I think a lot these days about how a few small things in my life could have been just different enough to have kept me from ever joining the Peace Corps. It would have been so easy to stay, to take a teaching job, to keep going in that old direction. There wasn't anything in my life to make me particularly unhappy. Nothing was missing. Things were good. Joining the Peace Corps and coming to Senegal was maybe kind of an act of madness.

But now I have this whole other element in my life, like a color I had never been able to see before I came to Senegal, or like an entirely new way of putting the same old words and thoughts together, an entirely new way of living. This color, this feeling is with me all day, as I do my office work, as I shop for vegetables in the market, as I live this life. And it's with me every night, loud and clear as the call to prayer.

The work in Saraya was some of the finest work we can do, and it brought me some of my happiest days and nights in country. The best days are the days that are full. The best nights are the nights when I go to bed sunburned and sore, with a light heart, a full stomach, and the knowledge that I have done a good thing well. This is all I want. Let me not live a day past my ability to feel this way. Not an hour.

Love and guts,

Tuesday, October 11, 2011

Not a real post.

I haven't been tending this blog in the way I like for a couple of months. That will change soon, for sure. And for now, how about a version of the essay I'm submitting with my grad school applications? I promise it's more like a blog entry than an app essay is. Oh academia, I want to come back to you. Kinda-sorta-sometimes. Anyway, I'm not sure that this is less interesting to you than what I usually post. So here it goes.

My time with the Peace Corps in Senegal has completely changed the way I envision spending the rest of my life. I had studied philosophy and been focused on an introverted, academic future before I became a volunteer. Joining the Peace Corps was supposed to give me a temporary break from that life, a chance to learn to use my hands a little and to see a new part of the world. But I spent two years in a village of 300 people as a health volunteer, and now I work in Dakar, Senegal’s capital and largest city, on malaria prevention and education initiatives. I have come to believe that a life of service is more important than the life of the mind.
As a Peace Corps volunteer, I saw the people the village as my constituents. I listened to them, learned what they considered to be their greatest health-related problems, and worked with their abilities and resources to try to find solutions. Sometimes I could bring additional resources of my own, whether through grant writing or the technical training I received when I became a volunteer. But no matter what the project, I always wished that I could do more, pass along deeper knowledge, and serve the people of the village better. As I thought over what it would mean to serve better, I began to focus on the practice of medicine as my means.
There was also, always at the back of my mind, a thought that there was some sort of obligation I had to meet. It wasn’t my obligation as an individual but rather my obligation as a representation of a type: privileged enough to have been well educated from early in my life, free enough to join the Peace Corps after college, and inclined to think that I am not entitled to live a life of suspended, isolated ease simply because I was born in a First World country.
My sense of this obligation grew as I saw the residents of what I came to think of as “my” village in Senegal fall ill from preventable diseases or die from treatable ones. It seemed wrong, especially when the victims were children. And what compounded this wrongness was that the children of my host family, whom I love, were not particularly special. Special to me, yes, of course. But my host sister Thian, now almost four, who has survived malaria and diarrheal and respiratory diseases, is not one in a million. She’s one of millions. I could – and did – help Thian by teaching her mother about insecticide-treated mosquito nets and oral rehydration solution therapy. That’s something, and I’m glad I could be there to do it. But there are lots of children like Thian, and their needs are greater, more systematic, than I feel qualified to meet now.
When I joined the Peace Corps, I remember thinking that the task ahead would be like cleaning a very messy house, maybe one that had been flooded or damaged in an earthquake. If you stepped back and looked at the whole of it at once, you would feel as if you were doomed to be cleaning up the mess forever. But if you stopped in the first room you reached, picked up one book and put it back on the shelf, you would have made a start. One tiny job would have been completed. And so I told myself, “Do the job in front of you – for now.” I kept my focus on particular projects and people and events, and I tried to ignore the bigger picture as much as possible.
I think I’m ready for that bigger picture. I want to understand disease and be able to fight it on an individual level – on the level of one person, one patient. I think perhaps that I want this so deeply because of Thian and the other members of my host family in Senegal. Living with them, seeing them struggle with malnutrition and disease, has left me believing that disease will never be an abstraction for me, will never be something whose story could be told entirely by the tabulation of morbidity and mortality statistics.
But I also want to be able to see why some diseases attack the poorest countries in the world, why they thrive there, and what we can do about it. In my mind, great opportunity comes with great obligation. And maybe our obligations are greatest toward those with the least opportunity.
It’s hard to escape my background in philosophy, so I’ve been inclined to think of these statements about obligations and opportunities as universal maxims. But I am realizing now that they serve perfectly well as guiding lights. At this moment, these beacons have led me to desire to pursue a career in medicine, with a concentration in global public health.
It will be very hard for me to leave Senegal. I have a life here, and a family, and a job that allows me to do good work. But if by leaving I can take a first step toward a career as a doctor, I will be grateful and come eagerly to the new studies and pursuits. Thank you for your consideration.