Monday, May 23, 2011

Firsts.

May 2011!! I am in my parent’s house in London right now. We spent two days in Bamako, then we sent three days in my site, then one week in a Moroccan surfing town, and now we are in London as a family until June 3rd. This blog was written from site in April because I had to write about when I went to the president’s house and when I delivered my first baby. (That part is kind of graphic and really sad because the baby was dead and I wrote the part right after… my apologies for the most depressing blog ever) I also had to write about Cary’s visit to my site because it was really fun.

To start from the beginning, on April first I went to my friend Lizs site because she had organized an AIDS awareness bike ride to three small villages and her own in cooperation with two non profits. There were six Peace Corps volunteers, three nonprofit employees, and a few doctors. We rode bikes to these villages and then spent a few hours watching their traditional welcoming ceremony, dancing, talking about aids, and then testing people. Of the 4 villages, only three people came back positive. It is crazy that there is someone with aids in Lizs village. Getting treatment is not easy though. It can only be obtained in a village south of Lizs, though it is free. I wonder about the quantity of it though, and where it comes from. We also handed out cards to urge people to get conunseling, no matter what the result of their test. I don’t think that the results are entirely accurate though. Not everyone was tested, out of fear or what not, and most importantly it wasn’t the most vulnerable population which came out. Liz’s town is a truck stop, an area notorious for the spread of aids. Truck drivers sleep with women in these towns and if one of them has aids, he spreads it like wild fire along the truck route. We didn’t test them though or the prostitutes. I think this is really important and I would love to do it again next year where we only focus on bars and the people at them.

Then I went to Bamako for a few days to do some work and then Cary and I went to my site together April 6th to April 11th. This was really fun; I introduced him as my husband in hopes of setting an example to my village of a healthy American relationship. Cary cooked and cleaned and I hoped that this would make people notice. It seemed only to make women judge me negatively though as a slave driver of sorts and they would tell me constantly, “Awa, Fabure is tired, he should rest and you should be cooking and cleaning and doing his laundry.” It was all in good fun though and it made for a really entertaining week.

Now I have been back at site a few days since all this, trying to get my soak pit project done in the next two or three weeks. But today I was walking home after some rounds of nagging people to dig their soak pit holes to get my nail polish and go back over to my friend’s house because she and her girlfriends wanted to paint nails. But then I saw fode and the doctor sitting on a bench so I stopped to say hello. As I was walking over there, I was again intercepted by an old lady I had never seen before saying that her stomach was hurting. I said ok well Adama is right here, let’s ask him. Turns out, it wasn’t her stomach that was hurting but it was another lady who was pregnant. I was ecstatic, thinking that this was finally my chance, the moment i had been looking forward to forever. Her friend had just gone to the doctor’s office 4 k away by bike; I guess someone actually did know that something was wrong. But we walked over to her house to find her sitting alone in a room with a toddler next to her. I sat in there for a while fanning her and giving her water through her contractions while we waited for a moto to come to take her to the maternity. When we got in, we set her up on the delivery table and got her situated. I don’t know if the matron, the old lady, already knew that things were bad at this point. But as we examined her I noticed that something was already protruding, I assumed it wasn’t the baby’s head. But as the contractions intensified and as the delivery progressed, it was in fact a head that came out. A silent head with a strange shape. The matron must have known now that things were bad. The head was stuck and for ten minutes she pulled and pushed on the silent out of place head. She slid a bed pan under the pregnant womans body to collect he blood. She made the pregnant woman reposition but this put the baby’s head at a strange angle, and pushing against the bed pan. She must have known it was dead by the way she was handling it, at this point only working for the mother. The mother was still silent through and through, fighting the contractions that hardened her tired body. Finally she began to get a hold of the shoulders and get the torso out. I should have known it was dead but you never want to believe that something is dead and I didn’t know what signs to look for nor did I have another birth experiences to compare this against. The baby was laying there, blue and still and silent. I passed her the suckers and other tools I deemed necessary and she looked at them and at me and touched the babies skull-less head and the brain that was not attached and the clearly broken spine that seemed to protrude from the back in a way that could not have held the head on. Then she looked back at me blankly, the only way that she and I could effectively communicate. The mother just stared, still having contractions. I hoped there was another one in there. Just the placenta came out though. She tried to get me to cut the umbilical cord but I told her not today. None of us were wearing gloves, so as much as I wanted to get close, I was afraid. And that was all. I hung around while she cleaned things up a bit and the woman got off the bed and wrapped the dead baby up in cloth. Her friend came over with a smile that one has when you expect to see a new baby. Her friend started crying. I hugged her and cried with her, two actions foreign to Malians, as the old lady berated her for not having prenatal consultations. She said that she couldn’t get them because she didn’t have money. I walked home with her carrying a bucket of blood and afterbirth while she carried a bundle of clothes and her friend carried the dead baby ahead of us. Like a silent funeral procession. I walked rubbing her back and she cried in the street. We got back to her house and she sat in her room. She had a few friends doing things in the room with her so I went back to help the matron lady clean up. I was actually intending on running home but saw Fode and Adama in the distance so I made a quick detour in the maternity. She commented to me how ridiculous it was that this woman didn’t get prenatal consultations. Unfortunately its part of a bigger problem, one that I am supposed to understand and attempt to alleviate at least a little. We went to the woman’s house to give blessing together. She was sitting alone in a room with the dead baby still wrapped up. I don’t know what will happen next. I was torn about what to do so I sat with her a second and then left, gave some more blessings, and went home. As much as I wanted to stick around and see what the matron would say, I couldn’t.

Update to Donors

This is an email that I sent to a donor group. It is a basic summary of what I am doing as well as the thank you letter and I just figured I would post it for the basic update information.

Dear NMPCA,

Thank you so much for your generous donation of supplies and your monetary donation! The village was so excited about it and it was much appreciated. Once I arrived in village, I showed the donated supplies to my teacher Fode and he and I set up a meeting with the village chief. He in turn told all the elders and the health committee leaders. The following Friday afternoon we had a ceremony in his special meeting hut. We laid all the goods out in the middle of the room and we all sat around the edges. Each elder went around saying how thrilled they are that people care and have not forgotten about the maternity, like the last doctor did when he disappeared. The village chief thanked the NMPCA and Americans in general for all the nonprofit work that has been done in this town. The donation included everything that we needed as far as nonprescription items go. Already I have directed a few mothers to the maternity to have the doctor give them bandages and antibiotic ointment for burns and infected cuts on their children. With the $50 donation, I have bought a few mosquito nets that we give to pregnant women who come to prenatal consultations. I am working on finding a constant source of mosquito nets right now, as they are $5 each and this is too pensive.

However, the maternity is still facing challenges. Our doctor left about the time I arrived and we still have not found a new one. I have left the search up to the village, and they say that they are on the trail of some good motivated doctors in Bamako who may come out. I am more interested personally in the search for now matrons and midwives. We had a few but I have never met them. My teacher Fode told me a few weeks ago that he fired them because they were never working and there was no point in paying them. So now the hunt for a new matrone is on, and this one is more promising than finding a doctor. There is one in my market town 4 kilometers away who may move out here. Village initiated discussions have begun. We currently have one basic illiterate midwife but she is very old and one is not enough. Especially since she cannot do prenatal consultations or register births. Currently, the doctor in training and I have done a few prenatal consultations but I am trying to discourage this, because first of all I don’t have training and second of all, no one will be here to do it when I leave so it is not sustainable. This elderly mid wife is really great though and sometimes she invites me to deliver babies with her. Unfortunately the last one that we delivered was a still born. It was disturbing to find that the cause of death was declared as lack of prenatal care and poor birth spacing, which really tells me that I desperately need to figure out this prenatal consultation situation. I have started talking to my teacher Fode about what it would take to send a girl from m village to matron midwife training in our regional capital 25 kilometers away though this idea is just in the beginning stages now and I don’t know if it is actually possible.


Since then, I have received funding from USAID on a project to help fight malaria. Malaria season has just now begun with the early rains. I received funding to build 30 soak pits in my village in the first round and then I estimate I can do about 10 to 12 more with left over funds. Soak pits are holes dug behind the bathroom which collect the waste water. The bathrooms are similar to out-houses but they are spare mud buildings. Usually, this water drains out the back into a giant puddle. Mosquitoes and germs breed in these pools of dirty water, and sometimes children can be seen playing in or near them and animals drink the water. Soak pits are a solution to this. We dig a hole one to three meters deep and fill it with head sized porous volcanic rock. Then we extend a pipe from the back of the bathroom to the hole. Next we build cement slabs with rebar inside which we place on top and then seal the sides with cement. It looks better, decreases malaria, and eliminates these pools of standing bathroom runoff water which carry disease and parasites.

In addition, we are still doing frequent baby weighing and formations on oral rehydration drinks. I plan to start talking to my friends about condom use, birth spacing, and birth control options after my vacation this month. Peace Corps offers kits for this with demonstration aids. Once I have a routine down, I will then move onto bigger groups and class rooms where I will teach general health topics.

Thank you again for you support and interest in Tegue Coro. They are very aware of your efforts and are excited to see Greg again next time he visits. I will keep you updated as our search for maternity staff continues and how work is progressing with the multiple projects going on. My parents and sister visit me this week and we will all go to my village together, so a big celebration has been planned and we will do more work on the soak pits and do a baby weighing. I hope all is well in America and I look forward to sending the next update!

Best,

Emily Albert

WWS Letter

This is one of my letters to Mr Coghlans 7th and 8th grade class as a part of the World Wise Schools Program. Mr Coghlan did delete some of the more controversial material about FGM before distributing the letter to his students.

Hello!

I hope all is well in Florida and that you are all getting ready for a great summer. This will probably be my last note to you all for this school year, as I will be on vacation for the next month. My parents and sister are coming here on May 11th, and then we will spend a few days at my site before heading out to Morocco for a week and then I will go home with them, to England where my parents are living right now. So I won’t be back until June 4th and I assume that you guys will be enjoying your first days of summer vacation. For those of you going onto Nease or whatever high school they send you guys to now, feel free to contact me if you ever do projects on Mali or Sub Saharan Africa. I would love to help and give you first hand information and pictures on whatever topic you’re studying. My email is epalbert9@gmail.com, and if you lose that, Mr. Coghlan has my contact information as well.

I wanted my last note to be a bit of a shocker so that Mali will stay in your mind and so that your ears will perk up if you ever hear it mentioned on the news or in conversation. I went through my Gender and Development Hand Book for this and took out some of the statistics. Peace Corps does a lot of work to help women become equal members of society in rural villages and learn to respect their own word as much as the word of a man. These statistics and the many others seem unreal especially when compared to those of America.

First I will start by discussing the female role in the government. Currently, there are only 15 women in the 147 member National Assembly. Accordingly, there are six women in the 29 seat cabinet, five women on the 33 member Supreme Court, and three women on the nine member Constitutional Court. In my village, all power positions are held by men. The mayor and all his employees are men, as is my village chief and all the people he invites to meetings to discuss important matters. In general, women do not hold powerful positions in the government or in the public sector. Women constitute only 15% of the national labor force. In the US, women account for 46.8% of the work force.

As I told you in a previous letter, it is not uncommon to see men beating their wives or to see people beating children. Domestic abuse is a crime, but not illegal. Police are reluctant to intervene as this is a ‘private family matter’ and Malian culture sees a very distinct line between private and public issues. Women are not very likely to report abuse because that could just make it worse, by provoking their husband or angering the police. They fear that this would be grounds for divorce and in that case, they would be unable to support themselves and their children.

During the 2006/2007 school year, 58% of Malian children attended primary school (51% of girls and 66% of boys). 99% of men and women in the US over age 15 can read and write, but in Mali only 53% of men can and 39% of women are able to. The Malian school system is facing many challenges and I unfortunately don’t see it improving on a national level in the near future. Mali is currently investing in infrastructure, and allowing China to loan them money to build roads and improve Bamako.

Women face many issues when making decisions about reproductive issues. They often do not have the knowledge or access to birth control and family planning information as we do in the United States. Even more concerning is that women often do not have skilled attendants present when they are giving birth and rarely receive postpartum care. I have helped deliver babies and it has always just been me and this very old illiterate midwife. The last baby we delivered was still born and the cause of death was determined as lack of prenatal care. Another factor could be that she had over nine children already and that her body was too tired. In Mali, there are 113.66 deaths per every 1,000 live births. In the United States, there are 6.14 deaths for every 1,000 live births. Access to STD testing is limited for both men and women, but even more so for women because a female doctor would be required. The fertility rate in Mali is 7.3 children per woman, as opposed to 2.06 children per woman in America.

The legal age for marriage is 15. To get married before the age of 15, you must have parental consent and the permission of a judge. However, judges will create false documents allowing a child to married. The rule is irrelevant in my village though, because few people know their real age. Just last night I had a conversation with Fodes family where one of the boys thought he was ten, and this ensued in a ten minute discussion of how he couldn’t be more than eight, so they compromised on nine. Another reason that this law in ineffective is because in village, a girl can be married to a boy even at age 9, and then she will live with her new mother in law until she is able to have children. In most cases, the man is at least ten to twenty years older than the woman, especially by the second, third, and fourth wife. This is an issue that I try to bring up often in conversation, by saying that I am 22, not married, and without children. They all are shocked and tell me that women in my village are married by age 12 and then begin having children at 15. A few days ago I did a prenatal consultation on a 15 year old in her second pregnancy. The first baby died, though I don’t know how. She had her first prenatal consultation in Bamako though and her papers exam papers said she was 19- my suspicion is that she lied while in Bamako to avoid judgment and problems. The early age at which women begin having children and then the frequency at which they have them causes problems in their 30’s and 40’s when they are onto their 10th pregnancy or so because the body is simply tired. A few weeks ago with the elderly illiterate midwife and I delivered a baby to a 40 something year old woman and it was a still born, cause of death was that she had too many children too close together and a lack of prenatal care.

Prostitution is also an issue which faces young boys and girls working in large cities. Prostitution is legal and I believe that most men participate. I know that when men in my town go to Bamako, they will usually meet up with other women, though they choose to call them ‘girlfriends whom they pay’. Children between the ages of 12 and 18 are most vulnerable, especially those who work as street vendors, domestic servants, are homeless, or are victims of child trafficking. Prostitutes are most commonly found on borders, transportation routes and in mining areas. The country has a rape law which defines 18 as the minimum age for consnsual sex, though this is inconsistent with the legal age to marry. Many of the women whom I give prenatal consultations are under the age of eighteen or had their first child before then.

Most shocking is that 95% of women in Mali have undergone female genital mutilation (FGM). There are no laws prohibiting FGM, though non profits are working hard to eradicate the practice. FGM is preformed on women from the age of six months to the day before their wedding. The practice is harmful and potentially deadly for the young girls. It can result in hemmorageing, infection, the spread of blood borne diseases, and difficulty in child birth, not to mention general pain and discomfort and frequent infections for the rest of their lives. The practice continues because it is deeply rooted in their culture. FGM is believed to help preserve a girl’s virginity and bless her with many living babies. FGM Is prohibited in government funded health centers, but my maternity for example has no government funding.

Lesbian women and Gay men also face many challenges. I have been in Bamako and accidently come across anti-gay rallies before. But the police have prevented gay activist rallies, even when the activists used the angle of supporting AIDS/HIV awareness. There are no publicly gay or lesbian organizations in the country, and they are actually illegal because the government states that they exist for an ‘immoral purpose’.

Overall, Mali is much different than America. In America, we have access to as much information as the world can offer and we have the right to make our own decisions and access to a fair and honest legal system. I think that we are very lucky to have been raised in a free country, especially since so many right now are fighting for that very right.