Xajee (Ha-GEE)

While it will, in all honesty, be many months to come before I have the language skills and village connections to start my own projects, I can say for certain that at some point I will be doing something related to Malaria (or xajee in Jaxanke/Malinke).  And so, as an introduction to that topic, I’d like to share a few things about malaria that you probably didn’t know in honor of World Malaria Day.

First, Malaria is one of the oldest diseases known to plague humankind.  Scientists have found the parasite in 30 million year old amber-preserved mosquitoes (Jurassic Park style) and, based on its plant-like organelles, they believe it to have evolved from a plant.  Hippocrates (yes, the same Hippocrates for which the Hippocratic oath is named) is believed to have authored some of the first written accounts of the disease circa 400 BC. His writings describe people ill with fever that oscillates predictably over the period of one or a few days. The fever strikes at night, accompanied by profuse sweating, splitting headaches, vomiting and agonizing muscle aches. It then retreats to near-normalcy, the sweating stops and the aches dissipate, for just long enough to make you think you are have recovered before it swiftly returns to conquer your body again. These are the classic febrile paroxysms that characterize the disease and distinguish it from a myriad of other febrile illnesses.

Second, Malaria is a parasitic disease caused by one of 5 species of protozoa from the genus Plasmodium (although we only have 3 in Senegal) and is transmitted to humans by the pregnant Anopheles mosquito.  This means that only female mosquitoes transmit the parasite (did you even know that mosquitoes had genders?).

Third, as many as 2.7 million people die every year from malaria.  Roughly 75% of these deaths are among African children alone.  This has an enormous impact on African communities as very year many parents have to watch their children die from a preventable disease and in African economies since these children never grow up to contribute to their family’s economic well-being and since malaria treatment and prevention consumes a lot of resources.

The reason that we don’t have malaria in the U.S. is NOT because we don’t have the mosquitoes able to carry it or because it just hasn’t ever crossed our borders.  In fact, Malaria was present in the U.S. endemically until the 1940s when the Centers for Disease Control and Prevention (CDC) were founded with the sole purpose of eliminating malaria as a public health issue.  They mounted a hugely successful campaign to destroy mosquito breeding grounds, spray insecticides, improve housing and educate the public. Their example proves that elimination of the disease is possible.

Lastly, while Malaria is certainly a more challenging issue to tackle in a tropical, resource-poor country such as Senegal, that does not mean that these places are fated to interminably suffer its consequences. It is true that the climate lends itself naturally to the proliferation of the mosquito vector and the parasite itself: excessive rainfall during the rainy season leads to pools of stagnant fresh water that are ideal for mosquitoes to breed in; mosquitoes actually mature faster, breed sooner and bite more frequently in hotter climates; and the parasite itself also reproduces faster in hotter climates, enabling it to be transmitted from one person to the next even faster.  It is also true that in resource-limited settings one must combat a long list of extra complications in attempting to control and eliminate the disease: poor health in the population as a whole as a result of malnutrition and other infectious diseases complicates the pathophysiological course of disease and leads to worse health outcomes; lack of education about the diseases contributes to lack of healthy behaviors that might otherwise help people to circumvent disease (long sleeves, dumping of standing water, use of bednets to sleep under at night); and lack of resources prevent people from investing in home or municipal infrastructure that might otherwise help protect people (screen doors, covered water/sewerage systems, etc.).  But these challenges are not unconquerable and a lot is being done to overcome them.

Senegal is a leader among sun-Saharan African nations for the huge strides it has made in malaria control and Peace Corps Senegal has been a major contributor in the effort. The Senegalese Ministry of Health now supports universal coverage of bednet wherein enough insecticide-treated bednets are distributed to every household for free to cover every sleeping space (distribution per sleeping space was a Peace Corp Volunteer’s idea).  The Anopheles mosquitoes tend to bite between dusk and dawn so protecting oneself from bites during these hours is extremely effective in preventing disease. Several districts in Senegal also practice Indoor Residual Spraying wherein insecticides are carefully sprayed on the inside walls of peoples’ homes to deter mosquitoes from entering at all.  In certain parts of the country, chemoprophylaxis campaigns have also been implemented wherein all children are treated for malaria twice a year, whether or not they have symptoms, in order to decrease parasite prevalence in the general population and thereby decrease transmission. For both the Indoor Residual Spraying and the chemoprophylaxis, Peace Corps volunteers have been instrumental in aiding census efforts during program planning to make sure that everyone who should be included is included as well as in program evaluation to conduct surveys to ascertain how effective the program was.  Furthermore, in Saraya (my village), my Peace Corps ancians put in place a new program that has since been adopted as region-wide protocol that pays community health workers to make weekly sweeps of their assigned neighborhoods.  The health workers test everyone with symptoms and provide treatment on the spot or otherwise refer people to a medical center for complicated cases.  All of these efforts are supported by education campaigns up the wazoo in mass media and in schools (many conducted on the radio or in schools by Peace Corps volunteers).

And the thing is, it’s working.

The northern regions of Senegal, while more arid and perhaps easier to control the disease in, have reached a “pre-elimination” phase wherein they have come so close to stopping transmission that they have to shift control tactics.  They are now trying to actively find and smother the last few cases of disease so that they might interrupt disease transmission for good. In southern Senegal we aren’t quite there yet but new interventions have been demonstrated to decrease parasite prevalence by around 15%.

So if we just keep plugging along...

Maybe, just maybe…

We can stomp out malaria in Senegal.

(Stomp Out Malaria is the name of Peace Corps’ malaria intervention strategy – to read more about it click here)

Big Shoes

A miasma of nervous excitement and eager anticipation descended upon us.  I stood, blindfolded, vaguely aware of all of the other trainees in close proximity who were also blindfolded.  One by one we were taken from the pack by a foreign hand that would lead us on an illogical route filled with circles and double-backs (so as to confuse our sense of direction) and on to a gigantic map of Senegal that had been painted on the asphalt of the outdoor basketball court.  Eventually, the hand would place us on the map in the location where we would be spending the next two years of our lives and give us a manila envelope with answers to all of the questions occupying our minds for the past many months – what our new homes are like, who we would be working with, what we would be doing, etc.  When all trainees were placed, a countdown from three commenced and upon reaching zero we tore off our blindfolds to look down at our feet and see where our futures laid.

I realize that it is impossible to truly re-create that whole experience of eager anticipation for site revelation for you via blog so in lieu of that I have a request. Before you read any further, I would like you to at least do a little drum roll in order to build a little of your own excitement for finding out my site. So…

(drum roll) ba-da-ba-da-ba-da-ba-da…

…

Saraya, Kedagou!!

I. Am. So. Excited.

Saraya is a village of around 3,500 people in southeastern Senegal, south of The Gambia. It is located along a main road leading into Mali which makes it relatively convenient for getting to and from – “relatively” being the key word in that phrase) and it is just 50 km from the regional capital, Kedagou (the capital, like the region/state, is called Kedagou).

Unlike much of Senegal that has been subject to devastating deforestation, we have trees! And animals! On the bus ride from Thiès (or from Dakar) down to Kedagou you actually pass through the biggest national park in Senegal complete with monkeys, lions and hippos!  Plus we have mountains (“mountains” may be a strong word – they are more like big hills) so there are beautiful waterfalls and spots to go hiking!  And, since Saraya-town is the capital of Saraya-department (a department is sort of like a county), we also have a few extra amenities not present in smaller villages including: a prefect who is appointed by the president of Senegal and receives direction from the regional governor on how to govern the department; a middle school which receives students from smaller nearby villages that don’t have a middle school; a health center/hospital (smaller villages have either “health posts” or “health huts” that serve a narrower range of medical needs); some boutiques; some restaurants; electricity (not all day and not every day but usually most days for part of the day); and cell phone reception (yes!).

The majority of people in my village are of the Malinke ethnicity and, as such, speak Malinke (which is basically the same thing as the Jaxanke I am learning) while a small minority of people are Pulaar and speak a dialect of Pulaar called Pulafuta.  However, the people at the health center with whom I will be doing most of my work are what we call affectes, meaning that they are doctors and nurses from other parts of Senegal who have been placed by the government of Senegal in the village of Saraya to fill a need for personnel.  These people often do not speak Malinke or Pulaar but instead communicate exclusively in French and Wolof.  It makes for an extra-complicated patient care process since doctors may not be able to communicate with their patients.  But it also means I get to start learning French too!

Health-wise, just about every big-theme health issue exists in surplus in Saraya: malaria, malnutrition, diarrheal diseases, respiratory diseases, etc. Plus, we have a few extra. Saraya is one of the villages closest to a part of Senegal where gold has been discovered in the past few years and the ensuing gold rush has brought with it a unique set of health issues.  Mercury poisoning from burning mercury during the gold purification process has become a major issue as well as increased transmission of STDs facilitated by fraternization of male miners that leave their homes in search of gold and Nigerian sex workers that have been trafficked to the region.

And if I haven’t sold you yet on how wonderfully amazing and interesting my village is and how perfect it is for me, here is the real kicker.  In the Jaxanke/Malinke language, “ya” (or “yaa”) means “house” and is placed after a person’s name to signify that it is their house. So “Saraya” or “Sara-ya” literally means “Sarah’s house”.

Bam. Perfect.

The only caveat to this is that people in Saraya don’t actually call me Sarah.  Instead, every Peace Corps volunteer is given a Senegalese name by their host family as a part of the process of integration.  So my name is village is actually Diabou (Jah-boo) Tunkara (Toon-kara).

My host parents named me after their daughter-in-law.  In Senegalese culture, naming your children after another family member is almost an exclusive practice.  There are compounds (groups of huts clumped together to support an extended family communal-living structure) that you go in where a majority of men or women across and within generations all share the same name.  My site-mate (another Peace Corps trainee who will also be placed in Saraya to work on community economic development projects) is going to live in one such compound.  In her compound, probably 8 of 10 women/girls are all named Maimuna. And lo and behold, the family named her Maimuna as well. Her namesake is technically her host mother, Maimuna Toure, who is a prominent women in Saraya. She is the president of the women’s group in Saraya, has her own farm, has raised many children, and seems to have a hand in most village business.  She is so well known in fact, that her family is known by her last name instead of the last name of her husband (very rare in this patriarchal culture).  Although I was able to meet my namesake briefly during our volunteer visit (I went to Kedagou for 4 days to meet the current volunteers serving in the region who I will be replacing), I don’t really know much about her other than that she does the bulk of the housework in the compound and she is an alright cook.

A funny caveat of naming in Senegal though is that whoever has a relationship with my namesake, refers to me by the same relationship term.  For example, my namesake, Diabou Tunkara, has 4 children who run around the compound and refer to me as “na” or “mother” because I have her name.  Her husband might even call me “musoo” or “wife” if he wanted to (as has awkwardly happened to other volunteers) but he is deaf and communicates solely through grunts and gestures.

Names are really important in Senegal though.  Children aren’t named until 6 days after their birth when they have their baptism.  They take the last name of their father, like Americans, which you are expected to remember to greet them around town.  For example, if someone greets me:

I Saxuma (Good Morning)            

I am supposed to answer:

Unsi {their last name}, I Saxuma (Good Morning {last name})

Fortunately, most people in my village share 6-ish last names which makes it somewhat easier to guess their name and be polite in a village of 3,500 people who are likely going to know my name as one of two white people in the village, even if I’ve never heard theirs.

Beyond identifying you relative to your father’s family, last names also identify you as a part of an ethnic group and a part of a set of “joking cousins”.  If you meet someone with the last name of your joking cousin (a pre-determined family) they will generally make fun of you for being a bean-eater or goat-thief and you are expected to return the quick quips in jest. I haven’t met my joking cousins yet, and I’m not actually what their last name is, but I’m ready for them...

                All of this name-talk got me thinking though about what exactly is in a name.  What do people expected from the newest Diabou Tunkara?  Do people expect more from my site-mate since she is named after a strong female figurehead whereas I am named after a village-nobody who moved to Saraya from another village? How much does a name make a person vs. how much does a person make a name? I would argue that it definitely goes both ways.

                The volunteers who served in Saraya before me (my anciens as well call them in Peace Corps Senegal) were named exactly after my host parents (they had the same host family) because they were a married couple.  They became the “mini” version of their namesakes: Sago Tigana and Ibrahim Cissoxo.  I can’t say for sure what expectations were set for them upon arriving to Senegal and taking adopting such names but I can definitely say that the legacy they have left for any future namesakes and in general for future Peace Corps volunteers involves filling some big shoes.

On that thread, I’d actually like to make a shout out to Anne (pronounced “Annie” because the “e” has a line over it) and Patrick Linn, my anciens, who completed an extraordinary service and whose memory incites me to the crosshairs of intimidation and inspiration. Some of their phenomenal projects included:

Ø  A malaria project with active case finding that was phenomenally successful and which, after they presented it to the National Malaria Program, has been adopted as region-wide protocol

Ø  A US State Department-supported educational intervention and appropriate technology extension to combat mercury poisoning in gold-mining areas that was also very successful

Ø  STD education with Nigerian sex workers funded by a PEPFAR grant

Ø  Cervical cancer screening training in partnership with the University of Illinois

Ø  A children’s leadership camp

These two amazing people have made a lot of good friends and done a long of incredible work during their two short years here in Senegal. I have rarely felt so humbled or so motivated as I did during the 4 days I spent with them in Saraya, watching them interact with friends and co-workers, speaking both Malinke and French with enough fluency and ease to make jokes and ask all the important questions, being generally so thoughtful and so thorough...  I don’t know how I will ever live up to their example.

I, Diabou Tunkara, have some big shoes to fill.

But I am unimaginably excited to try.

Time

The adventure begins here.  Sixty American Peace Corps volunteers sat with eyes closed, full stomachs, and warm blankets, utterly sleepless on a Delta Airlines jumbo jet bound for Senegal, West Africa.  For a few, the anxiety would wear them down and they would begin to doze but the wide open world of unknowns waiting to greet them on the other side of the sea deemed restful resting an impossibility.  I, myself, slept for just about an hour.  After a taxing week of late nights with friends and family, planning, packing, long goodbyes, and the ever present feeling that I was about to be hurled into a pit of darkness, sleep for a short time was inevitable.  But the excitement and nerves permeated my dreams.

What the hell does it mean to go away for two years anyway??

Since arriving in Senegal (any for many months before coming), all of the trainees have found themselves grappling with and confronting a myriad of fears and anxieties – heat, illness, theft, assault, snakes, spiders, language barriers, etc.  For me however, it is the sheer quantity of time and its opportunity cost that most intimidates me (although I’m not terribly excited about blister beetles and mango worms either).  Constantly I have asked myself what else I could do with two years…

Start a career? Get into a company and start working my way up?... Continue with school? Go for my PhD?... Apply to fellowships that are paid and target the development of more specific job skills?...

The fact is however, I would never be happy if I didn’t do this.  Joining the Peace Corps has been a dream of mine ever since I first found out what it was (Adventure? New languages? Weird diseases? Done. I’m there). If I didn’t do it now, I know I would always wonder: what if?

I truly believe that anything evil or hurtful of violent in this world can only be killed with kindness and that in dedicating these two years of my life to improving livelihoods and cross-cultural understanding is contributing to peace.  Furthermore, I believe that my 20s is my decade for accelerated self-discovery because of the vitality of youth and flexibility of few responsibilities.  And I believe that the challenges presented by Peace Corps service demand volunteers to dig deeply into the foundation of their character and decide what type of person they would like to be; it is an excellent agent for self-discovery.

And so… here I am.  Its 1 am, 90 degrees outside, and I’m hiding from the mosquitoes under my mosquito net in my bed as I write this... sweating... and reflecting on the decision that brought me here and the notion of time.

It is interesting to reflect on the value of my time because as I do it, I am already beginning to see how this way of thinking is the epitome of my American-ness.  Time is thought of very differently here in Senegal.  When you first get to Senegal, the first thing that anyone will do to you is greet you.  And they don’t just greet you. They greeeeeeeeet you.

Peace be with you.

Did you spend your day in peace?

Is it that there is no evil with you?

How are you?

How is you family?

Is there evil with them?

How is your job?

Is there evil there?

How is your goat?

Etc.

A proper greeting can go on for circa 5-10 minutes.  Ten whoooooole minutes of just saying hello.

Now think of how many friends, neighbors, co-workers and community members you run into in a day and think of greeting each and every one.  I calculated that on a typical day living in New Orleans I would have spent around 90 minutes of my day just on greetings (2 roommates=10 min, 3 friends=15 min, 2 acquaintances=20 min, 3 professors=15 min, my advisor=10 min, the lady who sold me a cup of coffee at Einstein’s Bagel=5 min, the person who swipes my card at the gym=5 min, the aerobics instructor=5 min, the grocery store clerk=5 min…). Calculate your time and then ask yourself, “What would I be giving up with # less minutes every day?”

I would say A LOT. For me, 90 minutes is A LOT. That’s my gym time. That’s my study time. That’s my time to run errands or, god forbid, read a book for pleasure.  And if you are American, I’d say you probably agree.  But the Senegalese would say different.  For them, the value of time is not measured in goals accomplished or tasks done.  For them, the value of time is measured in relationships. You can be a shark, first in your class at some big-shot university, flying up the corporate ladder, pockets full of money, breaking ground on new ingenious technology, etc. but you will still be nothing without your family and your community.

Put more simply…

In the US: Time = Money/Goals Accomplished

In Senegal: Time = Relationships

Greetings build relationships.  That is why for the first week of learning my language (Jaxanke), all we learned was how to properly say hello… shake their hand (unless you are a woman speaking to a particularly religious Muslim man who is forbidden from touching women)… curtsy if you are a woman greeting someone you would like to show respect to or avert your eyes if you are a man greeting someone you would like to show respect to… then spit out every greeting you can remember while you still have their attention and be sure to respond to their greetings appropriately as they simultaneously toss them back at you.

This is also why Peace Corps has devised a 3-month Pre-Service Training (PST) program that all trainees must complete before being sworn-in for service.  During this time, trainees oscillate between spending days doing technical training workshops at a central training facility in a big-ish city (Theis) and spending weeks with a host family learning how to integrate yourself into a Senegalese family and begin to build relationships (during what we call “CBT” or “Community-Based Training”).  My day during CBT generally looks about like this:

5:30am: Get woken up by the first prayer call of the day bellowing from the mosque ~100 feet from my house. Go back to sleep.

6:30am: Get woken up by the goat outside my window who cries when the sun comes up and tries to eat my clothes off the clothes line. Go back to sleep.

7-8am: Get up. Wash my face (the Senegalese believe its bad luck to greet people in the morning before washing your face). Greet my host family.  Breakfast with my host mom (aka “Na” which means “mother”) and Kadi, my fellow Peace Corps Trainee (PCT)/CBT site-mate. Usually we eat dry bread or bread with butter and Nescafe with powdered milk.

9-10:30am: Treck across sand for 20 minutes to my teacher's home for Jaxanke class with other Jaxanke-learning Tubabs (white people/foreigners) including Kadi. Treck back across the sand.

10:30am-2pm: Chat with Na. Attempt to study vocab. Help make lunch with host sisters if they are home.

2-3pm: Younger host siblings come home from school for lunch. Lunch with the host fam after forcing them to humor me with proper hand-washing technique. Usually we eat rice and fish (maloo nin yegoo) with everyone except my host father sharing from one big bowl (men generally eat separately from the women and children).

3-4pm: High afternoon heat = nap time.  There is actually a verb in Jaxanke that means “to take a nap after lunch”.

4-7pm: Chat with host dad (aka “Baba” which means “father”) on the front stoop until he goes to evening prayer. He is blind and chatty and loves company.

7-10pm: Help make dinner with my host sisters slash follow them around like a lost puppy because they are so cool and gorgeous and I almost never know what I am doing so I live by their example.

10:30pm: Dinner with the family – often millet or some type of grain with milk or yogurt.  Occasionally we get lucky and have salad with chicken or fish, green bell peppers, and French fries.

11pm-12am: Make fun of my host brother (he is 14 and too cool for school), drink mint tea (called “ataya”) with copious amounts of sugar and served very ceremoniously, and watch Mexican soap operas dubbed in French with everyone in the family room until the mosquitoes get the best of me.  Then retreat to my room to hide under my mosquito net.

12am: Bedtime

8 hours of sleep. 1.5 hours of class. 14.5 hours of relationship building.

I don’t know what all I will accomplish during my time here in Senegal.  I know I will never surrender my American value system entirely and I know there will be days when I want to accomplish things that the alternative valuing of time by people around me will frustrate me.    But I know that these two years will not be for naught. My priorities and values will be tried. And I will make a lot of friends. So that’s something…