Dr Carol's reflections on the trip

Carol writes:

The time seems to have gone so quickly this week — I can hardly believe our Senegal Mission training is over. Everything has turned out better than I had hoped for: our 13 students were eager and attentive the entire time in spite of the 12 hour training sessions. Friday was our “Graduation” so after our morning devotion and our review of Thursday’s material, the students were assigned to create a program demonstrating what they had learned. They put on a cute skit with a CHW visiting a home in which the son had poor hygiene and bad health habits. Of course, his mother took the rap for not training him properly! Fortunately, he saw the light and then performed a rap song about how the “agente santé communautere” had taught them what they needed to do to be healthy. They received rousing applause from all present and we hope to put it on ”Youtube” with a link to our blo., After receiving their certificates of completion of the first part of the course, with hugs all around they left for their villages.

We were greatly blessed by the students’ involvement and commitment to all aspects of training, especially to the social justice issues we addressed each evening. Before dinner we spent one or more hours discussing community, mental health, education, substance abuse and finally domestic equality (and whether men were justified for beating their wives for infractions such as spending too much time on their cell phones!) I think they will remember that discussion a long time — it went on for three hours. I think Tom had tremendous impact when he said that men who were arrested for domestic violence were considered cowards to beat up on someone weaker than you are(!). I think everyone participated in that discussion, with the older men and all the women agreeing that beating a woman never helped to “educate” her as to her responsibilities.

We had a nice evening out together Friday with Pastor Paul and Mama Kittie, Dr Bashir and Pape and Dionsenour and Nancy’s sister Karen at an African restaurant with a special “ethnic” night representing Madagascar. Only Tom was unable to participate, being the third of our group to have been struck with “Idi Amin’s revenge”. We had to pack in the dark when we returned to the guesthouse due to another power outage and had only about 3 hours sleep before Dionsenour returned to take us to the airport for our flight home, which was uneventful.

I am convinced that we accomplish vastly more doing these CHW trainings than we ever were able to accomplish with the village clinics. The ability of the CHWs to have an ongoing teaching relationship with the villagers and their ability to monitor and manage chronic health conditions is a critical part of health management that can’t be accomplished by episodic village consultations by either mission teams or the wellness team in Senegal. In my opinion, it should be much more effective and much less costly to provide the CHWs with the support and the supplies they need with the Wellness Team as backup than continue to rely on the episodic Village Consultation model of health care.

Friday graduation

Our students have graduated the first stage of the three-stage training to be community health workers in their villages. Today, we had a long review of everything we had presented for the week, followed by a pair of skits the students put on to show their understanding and the kind of resistance they anticipate. After that, one student sang a rap song he had composed to honor us and honor the post of community health worker in the village! It was very fun.

We then had a number of speeches (what graduation doesn't?) followed by presentation of certificates and handshakes all around. Cameras were popping and I am sure someone will post a photo or two of the entire class with their certificates. They are very proud of what they have accomplished.

At the same time, the team is proud of its work. Several of us learned about and taught subject matter we had never encountered before, because much of what we covered is drummed into us from childhood. Everyone on the team did a great job of stirring the students into interactive sessions and arranging for activities to reinforce teaching techniques.

The remainder of today will be shopping (mostly picking up custom orders from various places visited the day we arrived). Then we have a special dinner at a restaurant before retiring for the evening. At 4:30am we will be aroused and will reach the airport sometime around 5:15am for our flight to JFK at 7:30am.

We are tired and happy, but certainly looking forward to returning to our families and homes. Senegal has been warm and the people have been gracious - as always - and our work is complete for this week. Now we are heading back to the north to await the coming of Spring!

-- Tom

Thursday-What a day!

Today was jam packed with excellent programs from morning until night. Our group has developed into a cohesive "family". We have delved into the most important public health issues as well as extremely personal issues of social justice. All of the members have shown great courage and openess. I have always believed that it is possible for individuals to change the world for the better. Now I am convinced that these CHWs will employ their knowledge and passion to do sustainable good work in their villages. Looking forward to tomorrow, our last day of this phase of the training. Here is a picture of Tom and two of our trainees doing a demonstration of effective teaching techniques.

Wednesday

We had a good day, covering food preparation, nutrition, substance abuse, and dehydration. Presentations included two skits and a bingo game - so we had fun with the students. Tomorrow we will be covering malnutrition, recordkeeping and exercise health. This is a short posting because we are all tired and ready to hit the hay.

-- Tom

Happy birthday Mohammed! And some sad news ...

Carol writes...

Tonight the Muslims are celebrating Mohammed's Birthday (Mawlid). It is 10pm and the local Muslims (about 10 of them) are gathered around a microphone about a block away and have been singing continuously over the loudspeaker for 90 minutes. I'm wondering if I call the police if they will arrest them and shut them down for making a disturbance on a worknight. ;-)

Our sad news is that Lisa had to leave us for a family emergency. After getting word mid-day yesterday, and a night of reflection, she decided to go home and has just left to catch her jet. Kathe and Tom went with her to make sure there was no problem getting on the flight on such short notice. We wish her and her family the best and will pray for them. All of our students have been very empathic also and have blessed her as she leaves us. We did squeeze in her topic of "Education" this evening so she had the opportunity to encounter them as a teacher. She has been invaluable with her teaching experience for us all and has been lavish with her praise and we all hope that we have an opportunity to work with her here again.

Our experiences with this class of students have been extremely positive. Even the women have been outspoken and engaged from the very beginning of our classes yesterday. We are teaching dialogically so the students get ample opportunity to relate their experiences and contribute feedback. We continually urge them to teach back what they have learned.

Today was our most "hands-on" day, with Jean doing a very engaging program on caries and tooth decay--she used "disclosing" liquid to show them their plaque, Nutella on her fingers to demonstrate flossing and nail polish remover and Karo syrup on a strofoam cup to show how caries are formed. Pretty advanced teaching for an Occupational Therapist! We also had our SODIS day for Judy and Jean to teach water purification, and Jean and Lisa taught Tippy-Tap for handwashing, both of which were enthusiastically received. Tom did his usual, excellent techning about human waste problems and latrines, which triggered lively discussion about how the villages were dealing with these problems.

Last night Dr. Bashir had the class in an uproar as he taught malaria. He talks so fast that he seems to forget whether he is speaking English or French and I think at one point Pape was translating French to French. Finally Pape gave up and just came over to our group to translate "privately" into English. Both Nancy and Lisa want to marry Pape. They have not yet proposed to him but I think it may be the first time two women would ever have agreed to share one man from the outset. Unfortunately he is Christian, so it isn't going to work.

The students seem to be very appreciative of their learning experience. Today I was trying to ascertain what the "norm" of education was here in Senegal and was surprised when I went around the room and found that almost all of them had "lycee" experience--some of them as much as 13 years of education (though in some cases they had had to repeat years because of not passing the exam. This seemed to be very common.) I commented that they all seemed to be very dedicated to education and they agreed that that was certainly NOT the norm in Senegal.

I am so very pleased with how the Community Health program is going here at the United Methodist Church in Senegal. I hope that we can continue to support it.

Tuesday, Late Afternoon

Yesterday was exhilirating!
We began our first in a series of five days with the 14 Community Health Worker trainees.
After another fun icebreaker where the group tied ourselves in knots and then carefully untied the jumble, the true work began. I was so impressed with the collaborative nature of the learning process. Members of our team presented information on topics such as the roles and qualities of the CHW, an overview of microbiology, vectors involved in the spread of disease, and malaria. I did an evening presentation on mental health. The format included lecture, discussion, hands on, interactive games, and role play. Everyone in the room was engaged and participatory. It was an extremely rich experience. We are all learning so much from each other. The mutual respect is palpable.

Monday morning

The curriculum steps off in earnest today, with Carol and Kathe covering microbiology, disease vectors, and malaria. Last night, the group gathered and introduced themselves. We then talked about "community" and all the meanings that we associate with that term. After dinner, the team retired for the night.

During the night there were evidently a couple of noisy incidents outside our domicile; however, this reporter has no first-hand knowledge thereof. I did sleep later than intended and had to rush to avoid holding up the team.

One important note for readers is that posting to this blog is restricted by regular power outages here in Dakar. No one has a solid knowledge of why the utility service cuts power, but it is a daily event for hours at a time. Rumors range from the high cost of imported fuel for the power plants to preserving power for construction projects downtown intended to feather the sitting president's retirement nest. Whatever the reason, we may be posting irregularly, so please do not be concerned if we miss a day.

Breakfast is over and the group is gathering for the first class, so I will sign-off.

-- Tom

Worship, lunch and work begins

Sunday in Senegal. We started the day at 8:30 breakfast in the Nord Foire chuch as we discussed logistics for setup later in the day. We then traveled about 15 minutes to the Grand Yoff church for the always exciting and spirit-moving worship experience with our Senegalese brothers and sisters. Singing, praying, more singing, exhortation, more singing, more praying - I always wish that I could bottle this experience so that my church could feel how eager and excited the African church is about the Good News. Pastor Marie Agnes gave a rousing and deep sermon on Jesus' teaching, in Matthew 5:21-37, to approach God's purpose by exceeding the letter of the law. During the service, Carol was introduced and expressed our thanks for their hospitality and prayers for our mission. The congregation was enthusiastic and warmly greeted us before, during and after the service.

We went to Karen and Malcom's home after the service to enjoy a wonderful luncheon with them. Sitting on the veranda at pool-side, amidst the green garden, looking out over the ocean, we relaxed and talked with them about a range of Senegal subjects. Some of us started to fade and stretched out for a nap, but at 4pm we rallied to return to the Nord Foire church to set up for the evening.

So now we are each hard at our tasks, arranging furniture, handouts, name tags, etc. I can feel the energy building. Eleven of the students stopped by on their way to their accommodations and were all smiles and waving from the van. Later this evening we will have dinner and then hold an ice-breaker session on community.

-- Tom

Saturday-First Day Here

The flight landed just before a beautiful sunrise. It was good to be together at the airport briefly with everyone before spending a day catching up (with the 6 hour time change). The weather was sunny and warm. This evening I attended an event at the French Cultural Center, a lively multimedia presentation with video, recorded music and live kora music. The kora is a beautiful 21 stringed West African guitar/harp instrument. Some of my other favorite things here are the traditional ginger drink, yassa (a Senegalese chicken dish made with black pepper and onions), the ocean, and the colorful fabrics worn by both men and women.
Tomorrow we will worship together and then Karen and Malcolm will host the group for a sumptuous lunch, including homemade chocolate cake.

The team is now together

This morning (at 7am local time), Judy, Stacee, Lisa, Kathe and I found Carol, Nancy and a host of others outside the Senegal airport terminal - as planned. This ended a long day of travel, and travel delays, which began around 6am Chicago time (noon local in Senegal). The leg to NY was uneventful until we were at JFK - when it took 35 minutes of waiting to get off the plane. With about 45 minutes until boarding for Senegal, we snagged lunch as we could. The leg to Dakar was only 6 1/2 hours - but we left 30 minutes late because the plane had a flat tire. Another hour in passport control and we made it out with our luggage intact. Some of us felt like zombies by that time.

We napped and then had breakfast this morning at the Nord Foire church. Shopping followed, from which I eventally opted-out and returned to our rooms to nap again. Later, we will go to Kittie and Paul's home for dinner.

Tomorrow we will travel to the Grand Yoff church in Dakar for Sunday worship.

The weather is sunny and in the mid-70s.

Time for my second nap.

-- Tom

Sabbath

Carol writes:

Friday was a day of rest for me--after being awake for over 36 hours in transit I went to bed at 10pm last night and stayed in bed until 8am. The plan was originally for me to teach beading to Christine and the sewing instructors today while the Wellness team went on a medical "consultation". But TIA (This Is Africa) so first Kittie decided to stay home with us, then Christine decided to go away so I delayed the lesson to next week, then we convinced Jean to go on the consultation to see what it was like, then the van broke down so Jean stayed home, then the van was fixed by noon so Dr. Bashir came to pick up Jean and off they went. I'll let her tell her story tomorrow (it's 10pm and they're still not back.) Meanwhile Pastor Paul went to the church and Kittie and I solved the problems of the world together, then went to the beach and sat under the cabana in the wind and froze. We came back "home" at about 5pm and rested and read until Paul returned. After another hour of solving the problems of the Senegal mission we went out to dinner (I have to admire Paul for being willing to drive here. I think it's a crazy madhouse, but he says he does it in self-preservation, for the independence and to reduce the time he spends with Pastor Bleck driving!) When we returned Jean still wasn't back so we're waiting up to see the shell-shocked look on her face when she returns from the village and to help her start to process all that she has experienced today. Kittie and I will be getting up at 5am to pick up the rest of the team at the airport and see to what extent they need decompression after their travels. Together we will plan our weekend activities prior to starting our CHW training program Sunday evening.

-- Tom

Flight to Dakar

I am traveling to Dakar separately from the group because I used miles. The South African Airways flight from Dulles to Dakar is pleasant. I have a row to myself, and the service is top notch. I look forward to connecting with the group when I land in Dakar. Our flights are scheduled to arrive at the same time, today (Saturday) at 6am.

I still recall my first experience at the Dakar airport in 2003, when I looked around and realized that I was the only white person in "baggage claim". That was my very first brief window into the experience of being "the other". Today when I land, Karen and Malcolm will be there to give me the loving treatment that they are famous for. I will be staying with Karen's family, about 15 minutes away from where the team is staying.

I am excited to work within the new model-training Community Health Workers (CHWs). On this flight, I am preparing my training module on mental health/mental illness. It will be fascinating to dialogue with the Senegalese CHWs on Tuesday night about what they see, how it is perceived in this culture, and how the CHWs could be agents of positive change in the treatment of people whose mental and emotional health is challenged. My initial task will be to listen, ask the right questions, and learn about the particular shapes and forms that mental illness takes in this community. I anticipate that there will be many commonalities as well as some distinctions.

One thing that has become clear to me on my two previous trips to Senegal is that paradigms, attitudes and behavior norms are not necessarily transferrable between cultures. That is my favorite part of this adventure-to be reminded, open minded about the humbling truth that all reality is subjective. Each perspective has validity and must be respected. I am intrigued by the the interplay between the ubiquitous human qualities, common to all of us, and the clear differences that exist between cultures and subcultures. It echoes the nature nurture controversy that will never be resolved. Why are we the way we are? Maybe that's why I believe in God.

When resources (such as food) are scarce, electricity is unreliable or nonexistent, everything changes. Adaptive traits prized in one culture may or may not be valuable across all cultures. On the other hand, qualities such as compassion, honesty and loyalty foster thriving communities no matter where we are on the planet. I am curious to see what messages and perceptions on mental health are pervasive among the Senegalese people.

These thoughts and questions fill my mind as the plane races across the Atlantic at a velocity of 570 miles per hour. The stars out the window of the plane are incredible! So many! They must be there all the time, but I just can't see them.

Although I have been off coffee since June, I used a little caffeine this morning to make it through the time change. What a zing! Someone's going to sleep well tonight.

2010 CHW Class is an Unqualified Success!

We received the following message from Carol late Thursday. (Note to readers: "Kitte" is Kitte Messer, United Methodist missionary in Senegal who is a nurse. "CHW" is a "Community Health Worker" - the people we have trained and will be training).

Jean and Kittie and Dr. Bashir and I have just returned from the village of Sebi Ponte after spending the afternoon at the home of CHW Aissatou Samb with 9 of the 12 trained CHWs. I have to admit I had very low expectations because I didn't want to be disappointed, but I was completely blown away by their industry and interest. At least 11 of the 12 have been working regularly in their village as community health advocates (one has acquired a job in accounting and still attends meetings when he is able). They have met every two months since their "graduation" at one of their homes with an extensive agenda and minutes kept and several public relations coups to report:

1. One CHW accompanied a young woman with abdominal pain to the hospital and was given significant status when he produced his CHW certificate at her admission for a miscarriage.
2. Another CHW accompanied a laboring woman and her husband to the local birthing center and subsequently to the hospital when she developed a severe hemorrhage. He was also able to obtain reprieve from the extensive hospital expenses for the family.
3. A third CHW was able to document a reduction in cases of malaria in his village after his instruction in the use of insecticide treated bednets for prevention of malaria in comparison to other neighboring villages.

The CHWs requested additional training and refresher courses in a number of subjects and have also applied to the local health board in Theis for approval of their CHW association. What they need most from us is some sort of authoritative badge or card which would give them more authority from other local health institutions, some sort of local/regional or NGO funding for medications (which many of their constituents cannot afford, ie, treatment for malaria or other contagious diseases) and access to IBNs (insecticide treated bednets). I hope to be able to recruit GBGM to assist us with these very reasonable needs.

In sum, I was convinced that our approach here is the future for health in Senegal, having given our CHWs tremendous confidence in their ability to assess and assist patients and assist other health personnel in their communities. I am immensely proud of them, gratified by their ongoing enthusiasm and their desire to improve the wellbeing of their communities.

Carol and Jean have arrived

I said goodbye to Carol at O'hare at 9:00am Wednesday and she arrived in Senegal around midnight Chicago time (6:00am local). She reported in via email:

Best trip we've had so far--both jets only half full--Jean got the whole row to herself and slept all the way to Dakar. Avoid the line we usually go through immigration--that guy is maddeningly slow. He never finished with the first people in line after we had bailed and gone thru one of the others--along with everyone else on the flight. Everyone is anxiously awaiting your arrival--and the weather is beautiful--as advertised. Off to Theis now to meet the CHW Class of 2010!

-- Tom

What's in the sack?

I have to laugh every time I think of my first mission trip when the TSA agent opened my suitcase to find 100 plastic speculums. She zipped that puppy up real quick. Now that baggage is just x-rayed or sniffed or whatever, I wonder what they'll think of my can of cornstarch (for a virus transmission game) or the four jars of homemade jalapeno pepper jelly I have stuffed in wild animal puppets to give as gifts--not to mention the makeup kits with the beads. My fellow travelers have a panoply of odd items also. I had to review with Tom what I put in his baggage (13 BP cuffs, 8 glucometers, several boxes of EKG paper for Dr. Bashir, a large package of toothbrushes from our dentist.) I am reminded of the first time we returned from Senegal and I told each of the members of the team to just take a bag from the pile, assuming they would be x-rayed. Instead an agent at the gate quizzed each one of us on what was in our bag ("Uh, clothes?") It's an adventure every time we go.
Jean and I will get off the jet Thursday morning and go directly to Theis where we will meet with the 2010 CHW team to debrief them on their experiences in their public health mission this past year. I hope to hear some good stories from them (and I hope I don't have to make too many changes to the program as a result!) Friday will be our day of rest--and I'll teach the instructors from the Women's Skills Center some new beading techniques. Then we'll be back at the airport early Saturday morning to welcome the rest of the team and find out how they fared with TSA.

Getting the band back together...

It is Winter in Chicago - that must mean it's time to return to Senegal and follow our passion to help our UMC missionaries to bring health and well-being to the Senegelese people!

Like last year, Dr Carol and team are going to be growing community health workers from volunteer members of several rural villages. These volunteers are enthusiastic to make a difference in the health of their villages and we are eager to teach them skills to succeed. Carol has spent the past year honing a curriculum and recruiting a team to deliver it. Last year, she was blessed to be accompanied by expert instructors with whom she had partnered in Panama. This year, she has attracted a new team that has studied and discussed the approaches it will take to our charge.

There will be eight of us. Carol and Tom are returning from last year. Stacee, Kathe and Nancy are veterans of at least one past Senegal trip when Carol ran clinics. Lisa, Judy and Jean are first-timers with us, though they have each had experiences just as exciting as we expect to have in Senegal together!

Carol and Jean will be leaving two days early as an "advance team" expressly to meet with last year's students and hear how they have done with the skills taught to them. That will be a warm reunion! From what they report, Carol and the missionaries will adjust some of the support logistics and perhaps the curriculum for this first week of training. The remainder of the team will arrive on Saturday, February 12th.

In preparation for this trip, we have been blessed with contributions and prayers from many, many friends. Carol has made beaded necklaces to sell for support of the housing expenses for the volunteers in Dakar. Carol and Kathe together made 100 pipe-clear mosquitos to sell at $10 each to fund bed nets for children. Free-will collections have been taken. The time for departure is fast approaching. We ask to to continue your prayers for our trip and its success.

-- Tom