Visiting my village's rice fields

 September 29th: It's about time that I make a trip out to the rice fields, because all my people are cultivators. The land around here is famously fertile. Unfortunately, the rains this year started too late and ended too early, so the harvest wasn't too good.

Data collection for water and sanitation projects

My village has a number of wells, in various stages of decomposition. Some have enclosures around them, most do not. These wells are vulnerable to contaminants of all kinds, ranging from organic (bacteria, animal droppings) to inorganic (dust, sand, acid rain maybe). There's a good chance that some of the more common village illnesses, such as diarrhea, are due to unclean water.

My work partner and I spent my first couple of months in village sending out letters to different NGO's specializing in water and sanitation, in the hopes of receiving funding for a project. We're not sure yet what exactly the project will consist of. Depending on the level of contamination, it might be a simple matter of installing metal covers on the wells. Other more complex options include building robinets and waterpumps. Everyone wants a robinet, with good reason: pulling water is hard! But people also want the robinets because it's a status symbol: look how modern we are! Thing is, robinets and pumps require a substantial amount of maintenance and financial investment over a long period of time. I'm not convinced that my villagers have that level of investment at this point. In any case, these projects will involve causeries and trainings on how to treat drinking water for safe consumption. These behavior change activities are the most difficult, but they often have the greatest impact on overall health once they are adopted.

Some of the NGO's asked for data and pictures of available water structures. On September 15th and 16th, my work partner and I visited all the wells in all three villages. We measured the depth of each well and the depth of the water, took pictures, and took notes pertaining to overall cleanliness. We visited 15 wells in all!

A well in Dassilami 

What did we find out? On a positive note, Dassilami Soce has a decent water supply, most wells are functional, and the water is potable(ish). This isn't really the case in Boutilimite and Saroudia, which have a higher proportion of dry or abandoned wells; I was told that several wells gave "unsweet" water, which could either mean that the water is salty or that it is contaminated in some way. With the help of WAAME-USAID, we're hoping to run some tests on water from various village wells, so I'll have more answers soon. 

Here's a disturbing case study. Unfortunately, this is well I draw water from every morning. Early that week, I'd been told that the inside of the well had "fallen", or "collapsed"(translating from Mandinka is hard). I'm not sure what happened, but it does look like the bottom half of the well has lost its outer layer. For a while, we all had to go to another well to fetch water, which was way too far away--if you're lugging two 20 litter buckets full of water. So while the well was in disuse, here's what my work partner and I found: 

Terrifying. 

Fortunately, we found its twin in another well, so it's all good: 

This one in Boutilimite is dry, even during rainy season. A dead well. 

To be continued... 

Training on Malnutrition Screenings

For three days in September, I participated in a "formation" facilitated by the ICP in Karang and a USAID agent.

The target audience of malnutrition screenings, broadly speaking, is children under the age of 5; they are most likely to die of malnutrition-related complications, and to suffer from developmental delays later on in their lives.

The Senegalese government promotes two kinds of activities designed to identify signs of malnutrition in the field.

Causerie on malnutrition

The first, "peusées", targets children between 0 and 23 months. Health relays use a Salter scale to weigh babies once a month to make sure that they are gaining enough weight as they grow older. In the field, health relays have a table showing age correlated to healthy target weights, so that they can see if a child is within a healthy range.

Practice run in nearby Same 

The second kind of activity is called "dépistage", and should take place once every 3 months.  It targets children between 6 and 59 months. Health relays use a "centrisouple" to measure a child's left MUAC (Mid-Upper Arm Circumference). The resulting number, in centimeters, corresponds to a color on the band: green indicates a normal circumference, yellow suggests moderate malnutrition, and red severe malnutrition.

No problems here!

You probably realize that neither of these methods are particularly precise. The point is to monitor children over time, identify problems, offer dietary advice, and refer the most severe cases to the health post.

Most kids in Same were healthy, but one little girl named Awa turned out to be severely malnourished. Especially when compared to her twin, a perfectly normal chubby 2 year old. Awa looked like an emaciated 6 month old, not yet walking and refusing her mother's breast. This little girl was promptly referred to the health post in Karang.

At the health post, children with moderate and severe malnutrition are given calorie-rich nutritional supplements, PlumpySup and PlumpyNut, respectively. Each child gets a certain quantity of packets depending on the amount of weight they have to gain, over a number of weeks. They are asked to return periodically to the health post so that the ICP can monitor weight gain. These methods don't always work out so well, by the way.  I often so my 7 year old sister sucking on a PlumpySup not her own, because kids share the packets between themselves. And most patients don't return to the health post after their initial visit, so we end up loosing track of them.

Back in the field: dépistage and/or pesées. If a child doesn't seem to gaining enough weight, the health relays make enquiries about his or her diet, and make suggestions on how to improve it.

In Senegal, we run against some cultural obstacles to proper child nutrition. First, people eat family-style around a large metal bowl; the most nutrient-dense food items are placed in the center of the bowl. It is generally considered rude for children to reach for these foods themselves. Instead, a well-behaved child should wait for his or her mother to parcel out these items to him. Second, nutrient-dense foods--like meat--are usually only affordable in small quantities, so there's not much to go around. Finally, adults alway eat the best foods first.

(Short anecdote: soon after I arrived in village, I was gifted with a live chicken. It was so fat that everyone in my family ate his fill, "even the children" said my mother. Unfortunately, it is a rare thing for a child to fill up on chicken. Instead, they tend to eat very carb heavy meals, largely lacking in any kind of nutrient.)

So for example, a health relay might encourage a mother to feed her child more protein and fat rich meals. Some locally available foods include eggs, cow peas, moringa leaf, palm oil (usually enriched in Vitamin A). They might also suggest women let children select their own foods from the bowl.

More on this later.

Hard at work