Saturday, November 28, 2009































More Photos

The maternity ward at the hospital in Thies


The mama/baby packets....Thanks Bethany et al!


Jane Ann showing displaying the contents of said mama/baby pack to its recipient


Separating our supplies at the house. There were 3 clinics to give to.




Walking to the clinic






Thursday, November 26, 2009

Factoids


#1. Senegalese don't use toilet paper. It's water and your left hand, kids.

#2. Senegalese children shake hands! It's so charming, I can't resist them even with sandy, sticky hands and runny noses. They would walk over to shake hands and I would melt every time. It should be noted, this applies to any child old enough to walk. If a Senegalese child can walk they will walk over to shake your hand.

#3. Most women still wear traditional clothing, all made by one of the many tailors in town.

#4. Donkey drawn chariots are used frequently. A woman arrived at the clinic in labor on one.

#5. Senegalese love Barack Obama.

#6. Senegalese are experts at recycling, reducing and reusing. They would put any self respecting American environmentalist to shame. The main motivation is that they don't have a waste disposal system or landfills and can't afford luxuries such as paper towels even if they were available.

#7. There is a very high rate of polio (or some deforming disease) in Senegal. There were many severely handicapped people even in the small town of Mboro but these people are treated well by everyone in the community.

#8. Africa is expensive. There. I said it. It was over $2 for a dozen eggs, bananas were about $ .75/pound and a lady tried charging me $3.50/pound for green peppers at the market. Granted, they always try to give you the Toubab (whitey) price but some of these prices were the ones we paid AFTER haggling.

#9. Select areas of Mboro had running water all day. Our house only had it at night. Sometimes it would turn on at 6 pm. Sometimes it would turn on at 10. Power outages were common.




















#10. We washed our clothes by hand. I think everyone in Mboro did as well.
#11. Senegal is predominantly Muslim and in Mboro they had a call to prayer 5 times a day starting just before sunrise. They prayers were piped through loud speakers so you could hear the call anywhere in town. People kept prayer rugs with them at work and home.

#12. Polygamy is legal in Senegal and a man can have up to 4 wives.
#13. Senegal has a low AIDS rate...only 2%. Not bad for Africa.

#14. There is a belief in at least some parts of Africa, Senegal being one of them, that having sex with a virgin will cure AIDS. This results in the frequent rape of young girls (there was one at the clinic who was only 5 years old) and many countries have billboards and posters up trying to debunk this myth.

#15. The mosquitos there carry both malaria and dengue fever. The ones carrying dengue bite mostly during the day, the ones carrying malaria bite mostly at night.

#16. Most African slaves brought to America were brought from Senegal. About 3 million of them were held and processed on the Isle de Goree a short ferry ride from Dakar.

Wednesday, November 25, 2009

Things Get Better


After the first few brutal births we were able to take over management of the births we attended! Woo hoo! The night watchman would walk the half block from the clinic to our house and shout into our windows in French that there was a birth and we'd all crawl out of our mosquito nets and into our scrubs.



The group of women that stuck it out to the end were amazing and we all worked really well together so most of the births went smoothly but not just on our account. Senegalese women are very stoic, usually have lots of kids...8 or 9 and they have enormous pelvises to boot. As they say, you could drive a truck through them. That said, some things are universal. Childbirth in Senegal is no walk in the park. Just like anywhere else in the world, every woman who believes in a God begs him for mercy in the throes of natural childbirth. It's like that.



The mothers we worked with were very sweet and we were touched at how they took to us despite the language barrier. They are so used to coming in to give birth without the support of family or friends, being hit, yelled at and treated poorly but just because they are used to it doesn't mean that they don't want and need the kindness and support any woman wants in labor. When we started doing massage and counter pressure they took to it immediately and we got to be part of some really nice births.

Baobab Trees

The Baobabs - The Tree of Life


Baobab trees are very eerie looking and in addition to being Senegal's national symbol, they're used for nearly everything under the sun.

Boababs are fat-trunked trees that are native only to Madagascar and North-Western Australia. They have been known to attain girths of almost 30m, with a diameter of about 9-10m. It is thought that boababs live up to 2,000 - 6,000 years.

The bark of the African baobab tree can be used to treat fever and combined with another plant was used toprotect against malaria. Leaves and roots are used for medicinal purposes, primarily gastric and chest complaints.
The Baobab is also to be considered an aid to fertility. Infertile women place their hands on the tree and promise to either offer sacrifice, or the naming of their child after the tree in return for fertility. Breaking the promise results in the death of the child. Different parts of the tree can also be taken to enhance fertility or induce an abortion.

You can also eat it! The seed kernels are eaten raw or roasted, and are a highly nutritious food source and the bark can be ground into a powder for flavoring food. The leaves of the baobab were traditionally used for leaven but are also used as a vegetable. Its fruits and seeds are also edible for humans and animals. The pulp of the fruit, when dried and mixed with water, makes a beverage that tastes similar to lemonade. The seeds, which taste like cream of tartar and are a valuable surce of vitamin C and calcium and were used to protect against illness, were traditionally pounded into meal when other food was scarce.

The Boab's bark contains a fiber that is used to make string, rope, fishnets, twine, cords, sacks and clothing and the gum of the tree can be used as glue. Other products such as soap, necklaces, rubber, musical instrument strings, waterproof hats and cloth can be produced from the various parts of the baobab tree. The bark of the baobab tree has to be removed to obtain the fiber but the baobab tree can regenerate the loss of bark if it is cut away.


Baobabs can be used for shelter, as they develop hollow trunks. A hole is carved in the trunk to form a door, the soft pulp removed and a fire lit inside to dry out the hollow. The bark grows around the cut and over the internal surface of the tree, which is unharmed by the excavation. Or if you wait long enough...after 1000 years the trees naturally hollow.
In the early pioneering days, Boabs were often temporarily used in this way to contain prisoners. Grates were fitted to the openings, the prisoners put inside and the grate locked.

In Senegal they are sometimes used as tombs for Griots (or village storytellers and keepers of heritage). We saw one of these trees at the wild animal reserve we visited. The tree was 900 years old, the trunk had hollowed out and we peeked in one of the holes at the base and there were human bones and skulls. !!! Our guide told us that people were sometimes buried in the trees if they didn't work the land because if they didn't work the land they didn't deserve to be buried in it.


This Baobab has been converted into a bar! I didn't see it personally, I just found this pic on the web but it says the tree is 6000 years old, 155 feet in circumference (takes 40 adults to hug it) and is 72 feet high. That’s a big tree.

Poste de Sante or Mboro II


Nina on labor support


This woman wanted to hold onto someone. We all took turns.


Baby!!



Baby!!



A picture at the clinic where we spent the most time; Mboro II. The door is in fact being held open by rocks and the bucket belongs to the woman in labor. They all brought in buckets with the when they came to the clinic in labor. They brought old skirts to wrap the baby in and clean up postpartum, then they would take their placentas home in them.

Mboro
















Mboro, Senegal
















Tuesday, November 24, 2009

Welcome Aboard


Our first few births were a harsh introduction to birth in Senegal and made us realize why we were there. We saw women very roughly handled, slapped, yelled at, gagged and held down. We saw unnecessary, painful and risky interventions, incorrect diagnoses and general mismanagement of births. Senegal is really ahead of the rest of Africa in a lot of ways but so much of their care still lacking.



The first labor I took part in was attended on a hot day in a small, dirty one-windowed room. When we arrived it seemed as though things were going at a normal pace. It was the woman's 3rd baby, she was already dilated to a 7 and finished dilating within an hour which seemed very normal to us but we were only there to observe and the Senegalese attendants were concerned about her progress and about the baby's size. I admit, her belly was huge but with these ladies...it's hard to say how much of it is actually baby because their high carb diets produce rivers and lakes of amniotic fluid. That sounds like an exaggeration, but trust me it's not. These women's water would break and leave us nearly ankle deep in fluid. It's like that.



Either way, the attendants weren't satisfied with the progress and started a pitocin IV drip to speed things up but not once did they checked the baby's heart tones so we started checking. Pitocin can stress babies out and make their heartrate drop dangerously low. Soon after the IV was started we noticed that she was having really long contractions and pretty soon, contractions that didn't stop at all. On top of that the midwives started pushing on the top of her uterus with all their body weight (fundal pressure is the technical term) to try to help but really, it was only adding insult to injury. We couldn't find the baby's heart rate at all which could have been because the contractions were so hard but we were starting to get worried now as well and they decided to transfer her to the clinic in Tivouan.



They got an ambulance there and we piled in the back with the woman and a few of her family members and went toTivouan. Her contractions didn't stop for the entire 30 minute ride. The ambulance didn't provide oxygen (which would have helped the baby) because they said the woman was fine but Jane Ann (the supervisor) and I had a feeling the baby wasn't doing well. Once we got to the health center I wasn't sure why we had come. They didn't have C-section capabilities let alone an OB. Once we got her into the delivery room we tried listening for the baby and didn't find anything. The baby had died in the ambulance but the midwives there still seemed unconvinced and after another hour we transferred again, this time to a hospital for a C-section. When we arrived there they also listened for the baby and heard the uterine artery and since the mother's pulse had risen to 120, they mistook it for the baby. Jane Ann took the mother's pulse while they were listening with the fetal monitor and the heart rates were the same. Still, they didn't realize the baby was dead until it was born by cesarean 4 hours later.



Senegal has high infant and maternal mortality rates so death is very much a part of their lives and they are very stoic about these losses but you still can't minimize it which was why we were there: to share information and practices that could reduce these rates but it was complicated.

Cuckoo for Cocoa Puffs and Our Language Dilemma

The language dilemma was a big dilemma and it was hands down the most frustrating aspect of the trip.

Setting the scene; there were originally 7 women in our group. 2 supervisors and 5 others. One supervisor spoke a little French, the other was really good at speaking very loudly in Spanish in hopes of being understood and one of the rest of us spoke French. In fact the reason she was brought on board was because she spoke French. She had never been out of the country and had attended only 5 births or something like that. So she was our main source of translation.

Unfortunately she was also very mentally and emotionally unstable. We didn't know until we started making calls to her husband because she was being so difficult to deal with that she is extremely bi-polar and had postpartum psychosis (the kind where you want to kill yourself and/or your baby) for which she was hospitalized for 2 weeks. We all felt for her but she was really started to cramp everyone's style and made it really difficult to work.

We didn't make it through the first day before she started arguing in circles with other members of the group then throughout the next few days she started meeting random men and telling them where we lived and having embarrassing outbursts at meetings we were attending as guests. Ugh. So after 4 long days of her blowing up at us and making the group feel vulnerable by how freely she gave out money and our housing location we kicked her out of the program. She did not go out without a fight but push had come to shove and things improved by about 500% after that. No kidding. Except that we no longer had a translator. But she had refused to do that anymore within the first 2 days anyway, so no loss, really.

Monday, November 23, 2009

Welcome to Senegal


Dakar International Airport. We de-planed on the tarmack, entered the airport and just like that we realized that we should become obligate nose breathers for the duration of our stay. These are words of wisdom for anyone spending time in Senegal, be it 3 weeks or 3 years, there should be no breathing through the nose as it is bound to end only in watery eyes and dry heaving. Places have smells, Senegal's happens to be of one variety: offensive. That didn't spare us the cruel irony of smelling like Africa ourselves. It took a few days of eating Senegalese food, breathing Senegalese air, sleeping on Senegalese mats on the Senegalese floor and sweating buckets but in the end it had dominated and we smelled like Africa. As the French who left their language in Senegal would say...c'est la vie.
It took a couple of hours to get out of the airport as Delta had lost one of my boxes of supplies and, of course, the Senegalese men at the baggage claim curb needed adequate time declare their love and ask for our hands in marriage but we finally made it out and onto the road to Mboro. The drive took another couple of hours. We were pulled over by the police who constantly need to be paid off. It sounds as if it would be a quick process, giving them money, but it took a surprisingly long time. Vendors are privy to this bit of information and take advantage of the long police stops, hanging out with cashews and oranges to sell. The girl pictured was selling oranges.