PC Senegal 2011 - Day 8 - Happy Birthday Peace Care!

by: Andrew Dykens at: 2011-01-21

Assalam aylaykum, Bonjour, tout le monde, heera siita, an wali jam, naka wa suuba

One of our hosts, Dr Isaac Manga, ended the day for us yesterday on a high note. He gave an extremely interesting and informative lecture on malaria, including the clinical diagnosis and management as well as discussions surrounding the epidemiology and health system approach. We were quite intrigued and very impressed at the system that is in place here, in Senegal. The treatment of malaria is quite well decentralized such that community health workers are able to not only diagnose but provide medications, as well. This is critically important in low resource areas where the ability for patients to travel can be quite restricted. In many countries patients must travel to the regional hospital to get medications for malaria. There has been some thought in the past that providing this form of decentralized management could result in resistance to the medication because of problems such as patients not completing regimens. However, the community health workers are taught and directed to observe all therapy (similarly to tuberculosis management) so that the risk of developing resistance is very minimal. In addition, I was reassured and encouraged to learn that there is no problem with corruption (in terms of selling medications that should be freely available – in some places this is done to supplement income to health workers that may not be well paid, or not paid at all at times). The degree to which the population at large is educated on the freely available medications discourages this practice and, at the same time, encourages early health system utilization. It was a terrific lecture, and we learned a great deal.

Today, we are back to it. As I currently write this, a portion of the team and several of the trainers being trained are performing a VIA, cervical cancer screening. From my perspective, it is quite exciting to see this training occur and today is the last day of the training of trainers. We will be discussing, with the trainers, their perspective of incorporating this methodology into the current health system, to ensure sustainability. We were able to have many discussions of this sort prior to arrival with the Peace Corps volunteers as well as with Dr. N'diaye, the lead physician here, but we are continuing the conversation as it is critically important to find the manner in which the integration of the new screening process into daily practice and data collection will be the most likely to be maintained. We will, as well, take up the challenging conversation of management of positive findings. Undoubtedly we will (during our time here, or after the UIC team leaves) find precancers and overt cancers. The difficulties of working through the system in place will be discussed and we will ensure that every woman's welfare will be considered thoroughly. In addition, we hope to ensure that there does not develop any type of stigma around the diagnosis within the community. We will be discussing this with those being trained, as well.

As I am now getting back to this writing, these discussion were, indeed, quite lively, and very encouraging. We have full buy-in from those participating and we will in all likelihood not have significant difficulty ensuring sustainability in consideration of implementation into the health system. Of course, our Peace Corps volunteers will greatly assist us with the oversight of this component after our departure, through the coming months, and we may need to adjust the details of the plan somewhat from time to time. These "growing pains" will be inevitable, but it is comforting to know that our philosophy is in line with theirs.

Well, we have, as well, been quite honored today, in another sense. This morning the United States Ambassador to Senegal, Marcia Bernicat came to visit us at our training site, along with the Peace Corps Country Director, Chris Hedrick! Wow! What an honor and surprise. She took the time to thoroughly listen to the details of our project and model of collaboration with the Peace Corps. She expressed that she was impressed with our approach and wished us the best of luck in moving forward. She mentioned that she hoped to discuss our project and model with others, as well. She took the time to meet the hospital staff and posed for several photos. It was terrific, as well, to see Chris again. I was honored to be able to stay with his family during my site visit in May 2010. He has been an incredible support for the project and organization overall and, today, once again, reiterated his support. His openness to our project and encouragement has been extraordinary, and I really can't overstate the degree to which Peace Corps' infrastructure, integration, and trust has been invaluable to the progression of the project.

Today ended our teaching sessions for the training of training component. I am proud and appreciative of our team. Tracy Irwin's experience has been invaluable in teaching this topic and my residents, Melody and Paulette, as well as Nora have really been involved in the educational component. Their advancement over the past few days of relating information in creative ways and through translation has been quite impressive, from my perspective. I am looking forward to seeing the newly trained trainers take the lead role next week. I am looking forward to learning from them, as to their manner of relaying information effectively.

Well, I will end by announcing Peace Care's One Year Anniversary. Happy Birthday, Peace Care! Founded January 20, 2010. It has been quite a year and I am looking forward to what is to come.

Of course, I want to tell my wife and daughter how much I miss them. Lauren and Sevi, I'll be home soon.