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Senegal trip 2007-2008
This winter we traveled to Senegal for 2 weeks, for another eye-mission trip. It was organized by my friend’s son, Mark, who has been living there for a year with the Peace Corps.
Senegal is a country in West Africa, a former French colony. It’s population is 12.5 million, and rapidly growing, like all other 3rd World Country’s. Out of this, nearly 5 million lives on less than 2$ a day, and 3 million on less than 1$ a day. It’s GDP per capita is 1500$, the 21st out of 53 African countries. Senegal regained its independence in 1960. Over 90% of the population is Muslim.
We arrived to the capital, Dakar. We stayed a day to rest, and walked around the city. There was not much to see, at least in the Western sense: No pretty neighborhoods, no museums or historical monuments or parks. Some parts of the beach are nice, but by the time we made it there, it was dark. The people are extremely friendly, though, just walking up to us and starting a conversation, many times without the intent of wanting to sell us anything. It was the time of “Tabasci”, a Muslim holiday celebrating Abraham's sacrifice of Ishmael. It is the most important holiday in Senegal. People prepare for it for weeks, having new clothes made and buying and preparing food. Those who can afford it sacrifice a sheep, and people are spending 3 days with visiting family and friends, praying, eating, and relaxing. So Dakar was basically empty because of Tabasci, which we did not mind, as it was much easier to get out of the city the next day.
We were heading to a town called Bakel, which is in the Northeastern part of the country, close to the border with Mauritania and Mali. As a general rule, the further away a place is from the capital/the port on the ocean, the less developed it is. And Bakel was about 17 hrs ride by car from Dakar. 8 of us crowded into a Toyota Land Cruiser, and we put most of the baggage – mainly the mission supplies-on the roof. The back 1/3 of the car was also taken up by bags. When we believed that it would be impossible to fit even a pin more into the car, the driver stopped and loaded 2 huge boxes of fish inside, squeezing us together even more. (His Dakar wife acquired it and his other wife in Tambacounda, far from the ocean, was selling it with a big profit.) Our 14 hr trip to Tamba was not boring: After a few hours on the horrible road full of huge potholes, the fish packets fell apart, and the fishy liquid started to leak into our bags, and shoes, and started to smell terrible. The bags started to fall off from the roof (luckily the operating microscope stayed), and we had to stop and retie them several times. We were looking for a volunteer next to the road for about 10 kilometers in the dark, shouting her name, and finally she squeezed herself into the car too. Then we got a flat tire, but we miraculously arrived around midnight.
Peace Corps is an organization of the US government which is supposed to promote peace and understanding in the world. Their goal is to aid the people of developing countries, and also help to grow the individual volunteer. (I think it is much more useful in the latter function.) It is also good PR for the US. The volunteers are screened carefully, and after being accepted into the program, they undergo a 3 month long training course where they learn one of the local languages and basic skills for their assignment, which is either agriculture, business, health or environment. Then they are placed into a hut in a local village without water or electricity, completely on their own, to make the best of their situation, for 2 years. (The village has to request the volunteer.) Most volunteers we worked with had been in Senegal for over a year, were in their 20s, and interestingly, about 2/3 were women! They all had a good but difficult time there. Most of them gave up the idea of making a significant difference in the lives of the locals after a few months-for which I cannot fault them, the situation there is nearly hopeless in every way-but they stayed on anyway, because they enjoyed being there.
Sunday afternoon we arrived to Bakel, our final destination. We were staying in a decent hotel (by African standards), right across from the hospital. There was water and electricity, and no bugs! Though someone used to Western comforts would have been a bit bothered by the lack of sheets/blankets (it got cool at night), broken everything, and the rotten fish smell seeping through the door which did not close…
We set up the clinic and the operating room in the “hospital”. It was an ideal place for the mission, as there was plenty of space, but the hospital seemed nearly completely empty: There was only the concrete building with rooms, some with iron beds, some without. We saw hardly any nurses and patients, and no doctors. (Except for the ophthalmologist, Dr Kane who was helping us.) I was explained that they have serious problems attracting staff, as it is an underdeveloped area very far from the capital, and the weather is extremely hot: during 4 months in the summer it gets between 120-140 F, one of the hottest places on Earth. During these months it is impossible to work, people are just trying to survive. (Not everyone succeeds-the weak and sick die.) Also, the salary is very low, Dr Kane makes 100$ monthly. (I had a feeling he lived on tips, just like it is in Hungary, but I never asked.) In contrast, an ophthalmologist we met in Dakar who works in the Health Ministry-and does nothing according to Dr Kane-had a huge Mercedes!
The hospital also had no supplies whatsoever, except for IV fluid, pre-made packs for C-section, and some medicines. No autoclave, gauze, sutures, even gloves. Luckily, we were prepared for this and took everything with us from the US.
Next day we started working. There were plenty of patients, the organizers did an excellent job with advertising. Also, Dr Kane screened over 1000 patients for us and found over 100 surgical candidates with cataracts. There were 15 of us, 11 Peace Corps volunteers, 2 more college students from the US, a nurse and myself. As only 2 of us were professionals, I had to train the rest of the crew on the spot, but they picked it up pretty fast. They were triaging patients, were responsible for crowd control, checked vision, acquired missing supplies, (quite a challenging task in Africa!), distributed eyeglasses, made up the surgical schedule, prepared patients for surgery and were circulating nurses in the OR. The Peace Corps volunteers also served as translators-they all spoke French and one more local language: pulaar, wolof, bambara, soninke, mandinka. The clinic was a total “Babel” –but it was still lucky that most patient spoke only these 5 languages out of the 36 spoken in Senegal! This multitude of languages and the consequent extreme difficulty in communication is one of the major causes of underdevelopment all over Africa. It was nearly impossible to get through to patients information about their condition, about cataract surgery or about anything else – but we tried anyway. Informed consent in Africa has a totally different meaning. For instance, cataract cannot be translated-in the US, we explain patients that the human eye has a lens in it, like a lens in a camera, and the cataract is a cloudy lens-but these people have never seen a camera. They have no words for different kind of eye-diseases; also, it was impossible to relate to them the prognosis of the surgery-they do not understand percentages. After a few frustrating attempts of trying to explain if their prognosis is good, fair or poor, we resorted to “Inshallah!” – God willing they are going to be able to see.
One more note on the language-difficulties: Even if one speaks well a local language-as some volunteers did-it is nearly impossible to translate many things from our language. For instance, the locals have only a few words to describe a whole range of positive and negative emotions we probably have hundreds of words for; for sad,upset,depressed, angry,tired,outraged,frustrated,homesick they have only one word! (Probably they do not even feel these differentiated emotions.) Also, their thinking is concrete, they do not have abstract ideas, and they are unable to generalize, like a child in our culture. This is the attribute of mostly illiterate societies, and is very difficult for us to understand. I had a conversation with a village chief, I tried to find out for how long adobe houses last in general-if they have to be rebuilt yearly or they last for decades. He had trouble understanding the question, so I pointed to one of his houses, and asked him for how long it would stand. Still no answer. I asked then when it was built-he said 6-7 yrs ago. So when will it have to be rebuilt? He looked at me as I was an idiot- When it collapses, of course!
The work went relatively smoothly, we operated on 60 patients with cataracts-the majority was bilaterally blind-and on 5 eyes with trachoma. After the first week, the surgical schedule was completely full, so we had to triage bilaterally blind patients and send quite a few away. This was extremely difficult and demoralizing. We tried to choose the younger ones, but this was no easy task, as most people there do not know their age; so we decided on the basis of their looks. I caught myself thinking while having to send away a completely blind person: ”It is not so bad being blind here in Africa, the community is very strong and takes care of you, you do not really feel like a burden to society….” – the mind’s capacity for self-delusion and making excuses is unbelievable!
We had several challenges during surgery, rarely or never encountered in the US:
Running out of sterile supplies and having to resterilize everything, even used gauze, power outage,(luckily we had a converter from car battery to microscope), patient getting a seizure on the operating table, bug crawling onto sterile surgical field, microscope falling on patient, etc-but we successfully overcame these.
Most of the patients could see well after surgery, though interestingly very few of them showed any emotional reaction after we removed the eye-patch. After repeated questioning and checking they admitted that they see now, and some even cracked a smile after some encouragement. (I experienced a similar reaction in Ghana.) We hypothesized that they became very stoic with all the suffering they endure routinely in Africa; they also needed some time to get used to the new situation. Those patients who returned 4 days after surgery showed a bit more satisfaction with their vision; some of them smiled and thanked us.
We saw many patients with horrendous problems we could not help: End-stage glaucoma, people blinded by trachoma, (which not only is blinding but extremely painful), multitude of eye-injuries, river-blindness, botched surgeries by other doctors, etc. Most of these cases could have been prevented or cured if Senegal had a healthcare even like East Europe. We saw a little girl with eye-cancer spread through her body. I was very surprised to see that quite a few people had cataract surgery by “couching” – an ancient, several thousand years old practice when the local witch-doctor pushes the cataract into the back of the eye with a needle, without anesthesia. This leads to severe eye-pain for several months in every case, and results in blindness in 50%, the rest 50% will see a little better after the procedure. That people are still willing to go for this in the XXI century is a shame, it shows the hopelessness of the blind and the total lack of eye-care available there.
I tried to train Dr Kane but this was mostly unsuccessful; my difficulties with him symbolize one of the major problems of the 3rd World-the lack of even the basic education on which one can build further knowledge. I wanted to show him websites to learn from, and there was a computer and even internet, but he could not even pass the punching in the password stage, even after several training sessions. He had an old but well functioning microscope, which he did not understand how to focus or change the bulb, and I was unable to teach him, as he lacked even the basic knowledge for this-he never saw a camera or had to deal with anything working with electricity in all his life. I think he was of average intelligence, and I probably would have had similar difficulties if someone tried to teach me the details of sorghum cultivation or herding cows. We also tried to explain him to practice suturing under the microscope with used sutures on a surgical glove-something I used to do for many hours when I was a resident-but he did not grab the concept of “practicing” and asked us what was the point of suturing a glove, was it torn?
On Sunday we visited Mark’s village called Bema. Its population was somewhere between 3-500 people, depending on whom I asked. It is very impolite in this society to ask about the number of children one has-it is like asking how much one makes. For this reason, it is very difficult to asses the population everywhere in the country. The village looks as it probably did hundreds of years ago-mostly adobe huts with grass roofs, no running water, no electricity. There are a few wells, and a few concrete buildings. The villagers live on subsistence farming, growing millet, corn, sorghum and a few fruits and vegetables. There were also a few emaciated goats and cows. Because of the recent climate change, the rainy season, which usually lasts for 4 months, this year lasted for only one, when all the rain came down at once, causing severe flooding and washing away the crops. After the rainy season is over, it is extremely difficult to grow anything, as the soil is hard and infertile, and watering is nearly impossible. We visited a garden maintained with the help of a volunteer-it was the size of about 50x30 yards, and needed 12 hours of watering daily to keep the plants alive. (2 people watered for 6 hrs each.) The water came from a “well”-a deep hole in the mud, from where water had to be pulled up with a bucket on a rope. Also, the well had to be dug out weekly with a shovel, as it collapsed. No wonder that in these circumstances agriculture is not booming. The village - as most other villages - is largely supported by 20 villagers who live and work in France, and send money home. Without them, the locals probably won’t be able to survive.
We were greeted by the village chief and his family very warmly; they organized a band for us and we danced; they also cooked us an excellent lunch. I noticed a huge, ambitious-looking concrete structure being built at the perimeter of the village – I was explained by the chief that it is a mosque being built by villagers, the money coming from France. Would the money be better spent by building wells, a water reservoir or an extra school building? No, the villagers want a large mosque as a status symbol, so they would be envied by other villages, and that is what the guest-workers give the money for. Difficult to understand.
Polygamy is common in Senegal, as it is a Muslim country, and it has the highest polygamy rates in West Africa.1/3 of married men have more than one wife, and about half of the women live in polygamous marriages. When a man marries the first time, he has to sign a document stating if he intends to take another wife in the future or not. (So it cannot come as a surprise for the first wife.) I read in a book about social Darwinism that polygamy is better for women and worse for men than monogamy (especially the serial monogamy with divorces and remarriages we have in Western societies). The argument was that in polygamous societies “good-quality” men – who are making a good living, hard-working, not abusive, good-looking, respected by the community, etc – can have several wives, but “poor-quality” men who are lazy, poor, violent, abusive, sickly will end up having no wife at all. Also, for a woman it is better to be provided for by a good man, even if she has to share him with others, than not to be provided for and abused by a bad one. I found this logical but difficult to believe; everyone I talked to in Senegal corroborated this theory: In the villages there are quite a few “useless” men who ended up alone. Still, polygamy is on the decline in Senegal, especially in large cities, and several educated people I talked to had only one wife.
I learned some extremely interesting things about the rural society from the volunteers: Their sense of community is very strong, the extended families take care of all its members, children, elderly, the sick. The social norm is to share everything; they do not collect things from themselves. If one is asked for money, food or anything else by someone else-even if it is a stranger-he is obliged to hand it over if he has it! (But people usually do not abuse this, they ask for things only if they really are in dire need.) They do not sell their animals even if they or the animals are starving, as they would be expected to share the money with their extended family, and virtually nothing would remain. They rather let the animal die. If anyone comes and stays with them-family member, refugee, stranger, even a white person, - they would house and feed him for free as long as it is necessary. They place the interest of the community above the individual-the total opposite of our individualistic society! This system has its drawbacks though-no one is really motivated to work hard or save for the future, as everything has to be shared anyway-real communism in existence? This sounded completely unbelievable to me but everyone I talked to corroborated it. This selfless society probably developed in a Darwinian way – I was told if it weren’t so the landscape would be scattered by corpses during the hot season or during famine.
In spite of the terrible poverty people live in Senegal, they did not seem unhappy to me. (Except of course most of our patients.) I asked the volunteers if they thought the Senegalese are in general more or less happy than we are in the US. They all agreed that they joke and laugh much more than us and that they are about as happy as us; one believed they were happier. They all agreed that it is because the people here “do not know any better”, but still it was difficult to believe.
It is strange to admit, but these 2 weeks in Senegal were one of the happiest times of my life, I cannot explain why. I know that the help we gave is less than a drop in the ocean, but I still feel that it was not only to make ourselves feel better and lessen our bad conscience for living as well as we do, but it was real help.
We reached the Moon and came back,but we find it troublesome to cross our own street and meet our neighbors
Posted by: retro jordan 7 | November 06, 2010 at 02:56 AM