Sunday, January 27, 2008

Rehab and a make-over

The title may sound like the recent tomfoolery of Britney Spears...but no no, I am refering to the training of nurses on how to rehabilitate severly malnourished children and improvements made to the Nutrition Center at the Ansongo CSRef. This is the mural I painted in our office:

Si vous aimez vos enfants, prenez soin d'eux et donnez leur une alimentation équilibrée
"If you love your children, take care of them and give them a balanced diet," reads the French message. But ideally, and as I've already found, the pictures mean more than the words--particularly in an illiterate population. Already we've begun weighing babies in the room rather than out in the hospital passageway and explain to mothers what sorts of foods are important for them (especially if they are pregnant) and for their kids. I'm amused when many have asked, "Mariam, why is the man leading a dog by a rope?" "It's a goat," I say. "Why does the dog have udders?" "It's a GOAT!" "Ohh...a goat. For milk." "YES!"
With patience, everything comes. The technique of rehabilitating a baby under 3kg requires the attachement of a modified IV tube next to the mother's breast to ensure as the baby suckles, it receives vitamin-enriched formula as well as breastmilk:

The danger of exclusively giving small children the Nutriset powdered milk is that the mother's breasts will stop producing. But attaching a tube and having a nurse sit by you while you breastfeed is disconcerting. The baby must be patient and continue to suckle until the suction is sufficient to pull up the milk from the cup. And I have to be patient with the mother trying to take her baby home with her. My new favorite Songhoy phrase: Gaham baani fonda, a ga waato zaa! The road to health takes time!



Action contre la faim (A French NGO) came to give a training on nutritional rehabilitation to all the head nurses at each CSCom in the Circle of Ansongo. I helped give some of the presentations, particularly pushing the use of education and counselling, since that is the large part of the work I do at the hospital. I had a great time with the ACF staff and was particularly amused by the French expat's interpretation of the local "seka seka" dance. Awesome. One evening of the week-long training I went with them to a town 30km up the road to where ACF WatSan workers were giving animations on good water treatment and water-borne illness prevention. They were actually traveling by pinasse from village to village giving the presentations. In the car-ride back, one of the ACF doctors asked me, using the French woman as an intermediary, to marry him. Though he is handsome and smart, I said a flat-out "Non." But he insisted, as did she, that I at least state my conditions. I said at first he had to fly to Seattle and ask my father's permission. He said he would bouff from ACF to buy the plane ticket. I demanded cows and camels, at least 40 head. He is Peulh, and said it wouldn't be a problem...and he'd arrange for the camels. "And I'd get all the milk I'd want?" "Naturally." He replied. I demanded he cook and clean and treat me like a queen. It was entertaining...

The last day of the training we received a petit poids (photographed above) and a severe case:

When Hamil was admitted to the program, he weighed 5kg. He is over a year old. His mother got pregnant when he was only 7 months old, and as soon as she knew of her condition, cut him off of breastmilk. No weening process at all. Women here believe if you continue to breastfeed you'll hurt the growing baby. Untrue. Early or improper weening is the cause of much of the infant deaths before the age of 5 here. I won't even get into why she got pregnant with a 7 month old to take care of...When the grandmother brought him to us, she said he was drinking some goat's milk but mostly just tradition medicines and lipton, or brewed tea. Suffice it to say the mural come in handy...Hamil was severe marasmus. He had candidosis of the mouth, sores on his lips (sign of dehydration), vomiting, and diarrhea. He was wasting away. Only after a few days of antibiotics and creams and our milk he was turning around. It was difficult at first to watch him throw up or reject everything, even just sugar water; but soon he was willingly taking the sippy cup of milk. One evening I had put the porridge on the fire for the mother of the petit poids to stimulate breastmilk production and Hamil comes crawling out of the rehab-room. He had his cup in his hand and banged it aside the cook-stove to get my attention. His appetite had retourned, and in a few days we started the weight gain program. Severe cases are fragile, and Nutriset through UNICEF has provided formula and enriched peanut paste for each stage of recovery. Despite a nagging cough, he is doing so much better and looks less like a tiny old man.

Adiza, breastfeeding above and here, clothed in a much-too large but warm outfit I had her father buy for her, was our petit poids case. I fell in love with this tiny little girl:
She is 2kg. A case of a new mother who had malaria during her pregnancy. So even at one month, Adiza is too weak to really stimulate breastmilk production and hypothermic. Slowly but surely we'll help the mom, Safo, learn to breastfeed and eat well herself and rehabilitate Adiza in the process. I've "slept" at the hospital twice recently to feed these two little ones. I was at total peace eye-droppering milk for Adiza and decided I need to seek a career in nutrition and nursing. She isn't gaining any weight yet, but looking healthier and finishing all her rehab milk. Really, she was just hungry.

I love sitting and talking with the women who gather each day to keep the patients company. We mostly chat about the "road to health" but also about witches and cooking, typical women's-circle topics. I keep thinking how difficult it really will be to leave here.
I know it is but one step; yet the first step in a lifetime committed to convincing people malnutrition is a serious affliction deserving as much if not more attention than HIV/AIDS or Polio. It's more difficult as a condition treated not simply with drugs and injections, but care and patience.

Saturday, January 26, 2008

Conversion

"Eh, Mariama, ni tuubi!" Yelled a shop owner as I was leaving town on the back of a donkey cart. Some others shouted to me greetings, using "koyraboro wayo" "Songhoy woman" instead of the typical anasara. I asked later what tuubi means. In the religious sense, but also clearly cultural, it means "to convert."

The donkey-cart ride, though a cultural experience was less than enjoyable. The poor beast of burden was slow and his master was beating him mercilessly. Blood started to trickle down his backside, and on the next "thwap!" blood spurted back onto me, sprinkling my clothes and glasses with little red spots. Ew.

During our training, a few of the broussey nurses were asking me to convert in order to become a good Muslim wife. I asked why they couldn't become Christian. More blasphemous evidently for a man to leave his faith than for a woman to leave hers.

I gave the "message" on Sunday on Hebrews 4:12-16 and Mark 10:17-31. The word of God as sword judges, severing soul from spirit, flesh from sinew--or in plain terms, cutting away our vices that keep us from a God-centered life. Even good things like a job or serving others are dangerous if they are all-consuming. So it isn't only giving up your riches and following Christ but living a balanced life as an example to those around you. Sanago translated and clarified my French into Bamanakan for the rest of the worshippers. I don't think I will convert anyone over here; or for that matter if I really want to--I simply lead my life as well as I can providing a testimony through my actions. So maybe to me faith without works is nothing?

Thursday, January 17, 2008

The joys of cold season...

...I haven't showered in 3 days. I use a blanket at night. I don't need to carry around a gallon of water. Oh, and I don't get sick of smelling myself sweat.

I ate way too much today. That's a perk of cold season as well, having an appetite. I had tea and bread for breakfast followed by a snack of little millet cakes mid-morning. Porridge before lunch of rice and sauce and then before dinner fish with some fried dough. Still before dinner, Bébé gave me bread with mayo and jelly on it (for those of you who knew me as having a taste aversion to all that is white and comes in dollups like mayonaise, cottage cheese, sour cream, plain yogurt, my tastes have changed). Then there was more pre-dinner of whole milk (mmm...) and finally dinner of rice and beans and then they offered rice and milk! I excliamed, using a new emphatic marker I learned, "Ay gunda to PET!" I'm very very full!

Today I enjoyed watching basketball practice. The girls are really improving. Eight or so are skilled enough to dribble, shoot and score. Impressive after going from no sport/athleticism to this in two months. The coach of the Circle-level youth team (men) asked a few practices ago why I'm not including boys in the program. I told him it is all a step at a time; besides, it's not easy for girls to get any sport training like this. Today he said under his breath, as a girl fumbled with the ball and it went off rolling into the sand, "This is such a waste of time." I heard him, and said bluntly, "Is encouraging young women a waste of time? Hmm?" I think he got my point.

Monday, January 14, 2008

Dinner and a conversation

It's pretty typical for us to chat around the rice bowl now; especially cause Zubbu eats with us and she is talkative.

By the light of the cooking fire we enjoyed a tastey eggplant-onion sauce. I was amused when Aliou shined the torch on my area of the bowl and found I had eaten around the meat morsels. Laughing he says, "Ah yes, this one doesn't eat meat now..." I tried to explain it wasn't the killing of animals, I was just...disgusted by it. I'm glad we have come to a point where I can comfortably express my tastes.

We usually chat in Fronrai--a mix of French and Songhoy for Zubbu who somehow understands French fluently but refuses to speak it--and tonight the subject was the arms trade and gun control in Mali. The siutation in Mali is that there are still arms passing through; still guns left over from the rebellion (the Peace Flame in T2 didn't quite melt them all down); and, guns of retired army men floating about since the dictatorship years. It worries Aliou, because as he started to say, "It's different in civilized countries where..." But I cut him off asking, "You don't think Mali is civilized?" "Eh? Mali? Civilized? Noooo...barely anyone can even read!" He believes with education guns would be used more properly. Um, where are more people killed by guns than anywhere else in the world yet has some of the best universities and educational opportunites? You know where.

He said guns make people more arrogant and more daring, but also feels when a man (or woman) is sufficiently enraged, the can find a way to murder. Aliou was evidently stabbed once after getting in a fight with a co-worker and barely escaped death. He said a Muslim monk came to visit him to pray over him at the hospital. With tears in his eyes he described how the monk blessed him and told him to keep his cool in the future. The monk has by now passed away, but clearly Aliou still thinks highly of him. And after observing Aliou playing 3rd-party diplomat amongst his neighbors and co-workers often, I'm certain he is still following the monk's advice.

Sunday, January 13, 2008

Culinary critiques

Aliou tasted the wijila sauce I had made all on my own and declared I had my diploma in wijila making. I appreciated the praise, but appreciated Zubbu's critiques more. Like the dried tomato powder must be reconstituted in water so the sand in it sinks to the bottom, and dede or fried, spiced onion flakes don't go in either (they turn the sauce blacker). She also thought I could have put more cumin in and a little more date paste. So next time I'll shoot for a masters...

Over dinner we discussed development. Aliou believes the approach of development has been all wrong and has created dependency. Look at the Songhoy, the Peulh, and the Tuareg--three of the proudest ethnicities in West Africa--have been broken by aid. People who would have never accepted a gift without work now come to rely on handouts. Which makes me wonder, and Aliou has brought this up as well, why did the West ever feel these peoples needed "developing"? Maybe they would have been perfectly content left to their own vices. He believes many people are ignorantly blissful here. It's the educated like him who a re the most cynical and jaded and have wants and dreams they sadly will probably never achieve.

He does commend the Peace Corps approach. We care. "You can't help from a distance," he says. "We need to engage youth and use volunteers to spread the word that the establishment is changing--that they won't accept complacency any longer." All right Aliou, now how do we change the establishment?

Saturday, January 12, 2008

Faith and works

This evening I asked Aliou if he thought it was odd the 5 fundamental pillars of the Islam faith (God is unique and Mohammed is his prophet, prayer 5 times a day, trip to Mecca, zakat or alms giving, and fasting during Ramadan) are all but one dependent on action. Doing things. Whereas for me, Christianity is more faith than action. Certainly, most of Jesus' teaching is a call to action; however, the core of the religion is intangible. I asked him if when so much of the religion is obligatory action (to be Muslim you have to practice the five tenets above) it takes away from the value. I am in Africa not going to Church, not taking communion, not studying the bible, rarely fellowshipping, but I am still Christian. My faith may even be stronger when you take all the practices away. Now it is just me and my Lord and my little light...

Aliou thinks works and practice must come before faith. He also said giving is dependent on means--Islam (interpreted by Aliou) says if you don't have the means one year, you can wait until the following year to zakat. But for me it is the opposite; a gift given beyond one's means is so much more meaningful because it is a sacrifice. We did agree genuflecting while praying is important; and that people here don't really practice fasting. They party during the nighttime and start smoking right when Ramadan is over. "You should economize the whole year," said Aliou. He continued to say, "Faith without works is nothing." Maybe Mohammed read a bit of James? Or is Allah/Yaweh/God one? In practice these faiths are incredibly different but many of the same root principles are at work--though in the end it is interpretation that matters.

Disclaimer

All tales, opinions, and attitudes are those Joanna has experienced and subsequently composed. This Blog does not reflect the ideas or policies of the U.S. Peace Corps, its employees and volunteers, at large.