Universal Bed Net Distribution

November was bed net month. It all started with a formation organized by Karang's ICP and an agent for USAID targeting local health relays and ASCs. The formation was intended to familiarize participants with the three steps of bed net distribution: the "recensement", the actual distribution, and the follow-up.

The formation in and of itself wasn't very interesting to me; all the information was clearly delineated in an instruction manual, and the process itself was straight-forward. In addition, most everything was in Wolof, which I don't speak.

Instead of listening, I spent the two day doing what I love best: people watching. When you don't understand a language, you start focusing on body language and intonation instead. Despite--of thanks to--linguistic limitations, there's a wealth of information to be gleaned in this way. It's easier to sense tensions between two men respectfully greeting each other, for example. I also like to analyze how people choose to occupy space in relation to one another. In the Senegalese context, people tend to disaggregate by gender. Whereas Americans like to spread out as much as possible, the Senegalese sit very close together and frequently integrate touch as part of various interactions. The familiarity can also be attributed to their shared social circles, which encompass wide geographic areas and an impressive array of people. Their auditory memory for names is truly incredible.

About a week later, it was time to start "recensement" work. In small groups, health relays visited each compound within a designated geographical area, taking careful note of the number of adults, children under 5 years of age, sleeping spaces, and available bet nets. Each head of household was given a coupon listing his address, nearest health post, a number, and the bed net distribution date.

I was involved in the recensement in Dassilami Soce, Boutilimite, Saroudia, and a neighborhood in Karang. To be honest, it was hard and hot work walking all day under the sun.

Working with health relay Khady Coly in Karang 

I then spent a week and a half labeling bed nets for distribution in Karang. The Senegalese government now requires that every net distributed be labeled with the head of household's name, the number on the coupon given to him, his village or neighborhood, and the date of labeling. This policy makes it hard for people to sell nets given to them for free (courtesy of USAID). This work was pretty tedious and rather thankless.

There were many bed nets...

...and plenty of work to go around 

And, finally, D-day:

Matching nets to coupons 

Villagers crowding the health hut entrance in Dassilami 

Any program with multiple steps practically invites error. Both the ICP and the USAID agent visited each team once a day in the field. However, quality control during "recensement" and the follow-up was difficult. That errors had been committed became apparent on distribution day: some people complained that the relays had missed their house, and others claimed that they had received too few nets. Whether or not this was true, additional labeled nets were located and handed over.

Unfortunately, the follow-up was even worst. Relays are required to visit each household to make sure that nets are hung, that people are in fact sleeping under them, and that the women know how to wash them properly. By this time, both my ASC and I were a little burned out. I didn't protest too much as he dragged me from house to house as quickly as he could. Worst still, practically no one in my village had take the time to hang their free nets.

I was so unsatisfied with my work that I did the follow-up all over again, far more carefully. I finally got most of my villagers to hang their nets. However, are they actually sleeping under their nets? Everyone claims that they do when asked, but I'm not convinced. Most villagers believe that there aren't any mosquitoes during cold season, and that their risk of contracting malaria now is very slim. In reality, many have tested positive for malaria recently. Going forward, I'm going to have to convince them that sleeping under the nets every day, all year round is crucial.

Now, everyone should have a mosquito net. The real work begins now.