Malnutrition, Ebola, Malaria, Oh My!

repairing an old malaria bed net

For those of you who have been anxiously awaiting updates on the actual technical work I do in Senegal, today is your day! My official title in Peace Corps is a Preventative Health Education Volunteer with a focus on malaria, child and maternal health, and water and sanitation. When I first arrived in my village, just about everyone (myself included) was a bit confused about my role in the community. If I’m a health volunteer, where are my prescription pad and medical supplies? If I’m an education volunteer, why am I not formally partnered with the village school? Above all, why would any white-skinned American move to rural West Africa if not to build new buildings, distribute free supplies, or just hand out cash money?

nutrition - where's the veggies?

The role I play as a health worker has slowly become more defined during the past sixteen months (although some people are still just waiting for the cash). The most pressing health issue that I see in my village is malnutrition, which presents in a cycle. Babies are born small and underweight, and then grow into girls with nutrient poor diets and lives of hard physical labor who then become pregnant while their bodies are still developing, resulting in the birth of a new generation of small babies. The cycle of malnutrition is like that rambling sentence of a description –convoluted, unrelenting, and difficult to get a handle on. It’s also heartbreaking.

the fattest new baby I've seen in a long while

“I had never been an emotional sort of person, but now I felt all my defenses against sadness being stripped away,” recounts Ecuadorian Peace Corps Volunteer Moritz Thomsen in his book Living Poor. I feel the same way when, prying into the lives of my family and community members, I find that every woman has felt the impact of malnutrition on their pregnancies, their babies, their births. You’d be hard pressed to find a woman who has not experienced the death of a child whether at birth, during the first few days of life, or the first months and years. I have been alongside these women long enough to experience a handful of these deaths myself and believe me when I say my heart has broken every single time. What is my role in these situations as a health worker, as a friend, as a daughter?

weighing babies! whee!

The Senegalese Ministry of Health’s response to the situation has been to implement monthly growth monitoring events in which all children under two years of age are weighed and measured. These events have a long history in my village and are conducted with admirable regularity and with high attendance rates. Once a month all the moms trek to the health hut where my (unpaid) counterpart weighs the babies and tracks their progress on a color-coded chart – green for healthy babies, yellow for moderately malnourished, and red for severely malnourished. I was duly impressed by these events but noticed a glaring problem while talking to the women afterwards – not one could converse to me about the health status of her baby.

the nutrition map

I realized that the mothers viewed malnutrition as a problem that only doctors can identify and solve, not an issue that women themselves have control over. But how to shift the feelings of accountability and responsibility to the women taking care of the babies? I made a map. Women who never finished primary school, which is the vast majority of mothers in my village, felt unqualified to read the charts tracking weight. I simplified the record keeping down to one piece of construction paper per baby per month on a big map of our village. It’s great for women to compare and contrast the different households and different individual mothers. Now at our baby weighings women linger and chat, posing theories about why certain babies have lost or gained weight, offering advice to mothers of struggling babies, and smiling over the good health of their own children. The map great for the health workers too, as it facilitates the tracking of malnourished kids over time and geographically.

monitor lizard for lunch!

The nutrition map is an example of one small scale project I have enacted to combat one of the large scale problems facing my village. I’ve learned to be proud of small changes and find meaning in my daily conversations about various health topics. 

Also - Ebola in Senegal. Thankfully it has not spread past the one isolated case in the capital city. The upside of Ebola's presence in country is that people are more excited than ever about hand washing. The downside of Ebola's presence in country is that villagers are no longer eating so-called "bush meat." Aka I've been watching the fattest monitor lizards crawl all around my backyard and no matter how much I salivate, my family refuses to kill and cook them. Rats! I appreciate that they are heeding public health warnings, but personally I am mourning the loss of one of this season's tastiest treats.