In case you ever need to talk about “Extremely Bad Cough” in Mandinka….

 In this post, I wrote out the little presentation I gave on Tuberculosis in Boutilimite. Translated literally, “Tooto Jawo” means “Extremely Bad Cough” in Mandinka.

I’ve tried to translate the presentation as literally as I could, so that you can get a sense of how Mandinka people think about the world. When necessarily, I put some additional words in brackets so that the translated text makes sense.

Remember that Mandinka isn’t really a written language: how words are spelled doesn’t matter as much as how words are pronounced. The text below should give you a decent idea of what Mandinka sounds like, if you sound out the words out loud.

N’naata jang ka tooto jawo kacha la. (I’ve come here to talk about Tuberculosis.)

Toto jawo jankaridingo ka sii siso kono. (Tuberculosis [-causing] bacteria live in the lungs.)

Mune mu tamanserolu ti? Saasato ka tooto baké. Ning tooto tambita lun tang ning lulu. Waati do, saasato daajiyo ka yelo soto. (What are the symptoms? The sick person will cough a lot. This cough will last longer than 15 days. Sometimes, his saliva (mucus) will have blood in it.)

Ka tooto jawo tanka, bungolu nyanta yele la le. Fonyo ning tilo nyanta dung na bungolu. Saasato mang nyana daajiyo tupi la daa wo daa. A nyanta daajiyo tupi la poto kono, wala musoir kono. (To protect yourself against tuberculosis, the rooms in your house must be open. Wind and sun must enter the rooms. The sick person must not spit everywhere. He must spit in a pot or a handkerchief.)

Ning nya taamanserolu jee moo kono, I nyanta fo la wo moo yé ayé taa jara bungo. Ning I futata jara bungo to, doctoro be ila daajio juube la masino to, fo jankaridingo be jee. (If you see these symptoms in people, you should tell that person to go to the Centre de Santé. When you go to the Centre de Santé, a doctor will look at your spit [mucus] under a microscope, [to see] if bacteria are there.)

Tooto jawo ka moo faa la, bari ning I taata juna jara bungo to, aning I yé borro ming kunke, I be kendeya la. (Tuberculosis can kill people, but if you go to the Centre de Santé early, and if you take your medication correctly, you will be cured).

Visites à Domicile: Tuberculosis

This month, Alassane is required to do VAD’s on Tuberculosis in 15 random compounds in Boutilimite, Dassilami Socé, and Sarudia. So this Tuesday and Wednesday, we got to work.

A VAD on Tuberculosis aims to do the following: explain the cause, signs, and symptoms of infection; list preventative measures; highlight the importance of seeking out early treatment; explain the process of getting diagnosed and treated for tuberculosis.

Ideally, a VAD’s audience includes the head of compound (always male, safe for rare exceptions), his wife or wives, their children, and any other kin living in the same compound.

(By the way, a compound is delimitated area of land upon which was built several huts shared by members of a same family. But remember that there is no such thing as nuclear family here, so sometimes as many as 30 to 40 people live in a single compound. My compound is pretty small by most measures, because it only houses 12 people: Almamy (my father), El Hadji (my uncle), Natoma (my mother), Awa (my aunt), my nephew and nice, my 5 siblings, and myself.)

These VAD’s have been challenging, though. 1) Now that the rainy season is on its way, everyone is busy prepping the fields for planting rice, peanut, sorghum, and millet. As a result, no one is home, safe for the grandmother and the youngest children (children older than 10 go to the fields). 2) My village has an organized group of health workers who were trained on how to convey information about Malaria, Diarrhea, Tuberculosis, and Malnutrition. The problem is, very few of them show up to scheduled events.

ASCs must submit information about the VAD’s to their supervisors at the Poste de Santé. Whenever Alassane does VAD’s, he is expected to fill in a chart that looks very much like the following:

Place	Date and Time	Head of Compound	Number of people 15 years and older	Number of people younger than 15 years
Sarudia	10-06-2014 9h19-9h25	Barama Sonko	1	0
Sarudia	10-06-2014 9h32-9h36	Adiatou Senghor	5	5
Sarudia	10-06-2014 9h42-9h47	Mamadou Seydi	2-3	2-5
Sarudia	10-06-2014 9h51-9h57	Bouna N’Bas N’Dour	2	3
Sarudia	10-06-2014 10h-10h04	Abdou Foune	1	0
Sarudia	10-06-2014 10h09-10h12	Ablay Seydi	2	4
Sarudia	10-06-2014 10h18-10h22	Mamadou Seydi	2	3
Boutilimite	11-06-2014	Sidi Diuf	8	10

So far, we’ve only been able to conduct 8 VAD’s total, because so few people are at home.

I’m pretty proud of myself, though: I was able to lead a VAD in Mandinka.

Available medication at the Case de Santé

Name	Use	Form	Cost
Paracetamol	Fever	Syrups and pills	N/A
Cotrimoxazole	Infections: IRA (Infections Respiratoires Aigues) and cutaneous infections	Sirups and pills	6,900 CFA/box through the government medication distribution system 15,000 CFA/box through the Karang private pharmacy
Mebendazole	Anti-parasidic	Sirups and pills	220 CFA/box through the government medication distribution system 10,000 CFA/box through the Karang private pharmacy
Ibuprofen	Fever and pain	Pills	N/A
Vitamin C	Fatigue, weakness	Pills and injections	N/A
Efferalgan	Colds, fever	Pills	N/A
Amoxicillin	Antibiotic	Pills	N/A
Iron	Anemia, weakness, fatigue	Pills	N/A
ACT (Artemisinin-based combination therapy)	Malaria	Injections	N/A
Vitamin B12	Anemia	Injections	N/A
Atropines	Diarrhea and vomiting	Injections	20,000 CFA/box through the Karang private pharmacy

All Cases de Santé are supposed to get their medication solely through the government distribution system. Each month, Alassane writes up a list of medication to be replenished and how many boxes of each he needs. This list is dropped off at the Karang Poste de Santé, who then orders the medication from the Centre de Santé in Sokone.

The Case de Santé in Dassilami Socé is supposed to service 3 villages: Dassilami Socé, Boutilimite, and Sarudia. However, Alassane’s patient register indicates that people come from more then 14 surrounding villages for his services. On top of that, he only gets half the amount of medication he asked for from Sokone. Inevitably, he runs out of medication by the 20^th of each month.

At that point, he has no choice but to go buy extra medication from the private pharmacy in Karang, where everything is 3 times as expensive. As a result, he also has to resell this medication to patients at the Case de Santé at a slightly higher price in order to make a little bit of profit. Luckily, patients at the Case de Santé can buy several pills at the time instead of an entire box, so the cost for them is still relatively low. When it comes to syrups, though, they are out of luck: they have to buy the whole bottle.

Information on Tuberculosis

I've been reading a bit about Tuberculosis, since we're going on Tuberculosis VAD's next week. 

Alassane let me borrow a pamphlet he often refers to when dealing with Tuberculosis.

It was distributed by PNT, in collaboration with USAID and Family Health International.  The front cover states in French: “Tuberculosis is a serious disease, but it can be treated. The treatment is free and available everywhere”. From the information therein, it’s clear that the pamphlet is addressed to the general Senegalese population. The problem is that people don’t necessarily know how to read, or to read in French for that matter. And the pictures don’t really illustrate the words very well; they are very generic and poor quality.

 The pamphlet addresses the following questions:

What is Tuberculosis?

- it is an infectious disease caused by a microbe, the Koch bacilli

-the microbe usually takes over the lungs, but can also infect the kidneys, bones, and lymph nodes.

Who can catch tuberculosis?

-anyone, young or old, male or female, while or black, rich or poor.

-socio-economic status or nationality don’t matter

How can one become infected with tuberculosis?

-an infected and contagious person spits, coughs, or sneezes, projecting microbes into the air. An individual who inhales these microbes in a poorly ventilated space is likely to contract tuberculosis.

-Only the pulmonary type of tuberculosis is contagious

Which populations are especially vulnerable?

-individuals in close contact with infected individuals

-children and seniors

-individuals whose immune system is already compromised by HIV, alcoholism, malnutrition, etc…

What are some preventative steps one can take against tuberculosis?

-Airing out indoor spaces to reduce risk of contamination and exposing indoor spaces to sunlight to destroy tuberculosis microbes

-vaccinating infants

-preventative treatment of children under 5 years of age exposed to tuberculosis

-family members of a sick individual should go see a doctor to make sure no one else is infected.

How does tuberculosis manifest itself?

-individuals will not display any signs initially

-once the microbe has multiplied and is active in the body, certain symptoms will arise: a cough lasting more than 15 days, fatigue, weight loss, bloody mucus, fever and sweating especially at night, lack of appetite.

What are the consequences of tuberculosis?

-many other people can become infected, especially those in close daily contact with a sick individual

- without treatment, tuberculosis is often deadly

How does one diagnose tuberculosis?

-analysis of the collected mucus in a lab

How does one treat tuberculosis?

-treatment lasts 6 months, and has two phases

-individuals should take their medication in the morning on an empty stomach

-medication should be taken under the supervision of a ASC, a family member, or of a community agent. We call this a “Directly Observed Treatment”.

-treatment should under no circumstances be interrupted

What should one do if one is diagnosed with tuberculosis?

-take his medication according to the prescribed regiment

-keep medical appointments and allow for regular supervision

-cough into a handkerchief

-eat well.

All these questions are interspersed with blurry and pixilated photos.

1^st photo on the cover

-focus on second individual, who is keeping a watchful eye on the first individual in the foreground (appears to be a patient)

2^nd photo

Smiling family: two grown women and three young children

3^rd photo

A group of seniors practicing holding a handkerchief to their mouths when coughing

4^th photo

A lab technician looking through a microscope.

Projected Projects and Activities

• I'm trying to get a sense of the different kinds of available latrines.

Until last week, the only latrine I had seen in the village was my own. My latrine is outdoors, in the open-air of my backyard. It had a reed fence built around it for privacy. It’s a simple concrete slab with a deep hole in the middle, with foot holds on either side on either side of the hole.

Alassane showed me the Case de Santé’s latrine, built by Pharmacie sans Frontieres; this is the kind of latrine he would like each compound to have.

Then, he showed me a typical village latrine, which is also a simple concrete slab with a hole in the middle. But these latrines aren’t built as well: the hole is not so deep, the concrete slab is not so stable. With the rains, latrines tend to collapse, because they’re dug in sandy earth. And even if they don’t, human waste floats back up the hole whenever it rains. Obviously, this is a huge health hazard. For my work partners, this project is a definite priority, especially with the oncoming rainy season.

My work partner Ben said that there are two possible options for village latrines. The first kind would allow human waste to be used as fertilizer in the fields. The second kind has a removable container, which would be picked up every so often by trucks and disposed of safely. My community originally migrated from a nearby village to take advantage of Dassilami Socé’s fertile fields; everyone here works in the fields during the rainy season. So perhaps the first option would be a good fit for the village. Hopefully, Ben and I will go take a look at these two prototypes soon.

•   My village has also expressed an interest in robinets. As of now, women must make many trips to and from the village wells every day. Their ability to perch these basins full of water on their heads never ceases to amaze me. My village has four functional wells. Boutilimite has three, but two don’t have potable water. Saroudia has four, but two also don’t have potable water. I don’t know what is wrong with the water in those wells; I’ve been told that it is not “sweet”. Instead, they use it to make concrete bricks or to wash laundry. I've been told that robinet water should be sourced from a nearby forage. The price will vary depending on how far the forage is from the village. The first step is to visit the closest forage; Ben and I will probably go together soon.

•       The government conducts countrywide campaigns every 6 months to distribute Vitamin A and anti-parasitic medication to children. It also organizes tourneys intended to assess and address malnutrition in children under 5 years of age.

      Yesterday, I met the new Infermier Chef de Post of Karang. He told me that the anti-parasitic tournée will probably take place between the 10^th and the 13^th of June. The staff at the Post de Santé in Karang works closely with all the Case de Santés under its jurisdiction for efficient and effective distribution. This group of people is called “Fagarou of Karang”.

·      The PNT (Programme National de lutte contre la Tuberculose) wants each Case de Santé to conduct 14 VAD’s (Visites à Domicile) by the 20^th of June. With the help of the village relais, Alassane will visit 14 random village compounds, and look for signs of tuberculosis among their inhabitants. He’ll collect mucus samples as needed, and will send them for analysis in Sokone.

I’m not sure whether tuberculosis is still a problem in Senegal. The new ICP mentioned that each newborn gets vaccinated against tuberculosis within the 1^st month of life. I think it is still prevalent among HIV+ individuals, who are more susceptible to it. According to Alassane, there aren’t many cases of HIV+ individuals in the village, but it’s hard to tell: sexuality in general is a difficult subject to bring up, and we don’t have any hard numbers at this point. Alassane did mention that he had found one case of tuberculosis recently, an older man, who was not able to overcome the disease.

•       Students at the French school will be taking their middle school college entrance exams soon. Yesterday, I visited the French school and offered to help the students study. One of the teachers there warned me that talking with the students might be challenging. Many of them are hesitant to speak in French, because they do not speak so well and are not confident.  I hope that my own struggles with Mandinka will help them feel less intimidated. I’m thinking of also working with smaller groups of children; it’s so easy to get lost when you’re one of 30 students.