A lot of catching up to do

I'm in Niamey to start the bureaucratic crunch that signifies the imminent end of my Peace Corps service in December, and I've been thinking about the work I've done here. We're supposed to find ways to "quantify our experience" that will help us "sell ourselves" to the work force in the US. I will do it, for the sake of my supervisors here who need the numbers, but dammit, I am resisting in my heart.

I do like to share with YOU guys what I do, because you don't ask for Anticipated Outcomes and Number of Participants and Percentage of Participants Who Benefitted and blahhhhhhhhh. Since it has been awhile since I filled you in---

The classroom! Green doors! I'll get more pictures on here, with kids, because the kids are the whole point, asap.

School has started, at last, even though a lot of the kids are still spending their days in the fields to bring in the last of the harvest. We haven't opened the new classroom yet, for two reasons- one is that the headmaster is insisting that he arrange a ceremony to appreciate all of the donors (that's YOU!), and he hasn't been able to find a date that all of the officials in the region can attend. (And I really hope that he never does, because I don't want a ceremony. But I'll do it, for him, because he says it's important. "This is Niger," he said, "and in Niger we have ceremonies".) So, okay. The second reason is that I've asked the contractor to return and do some more work on the doors, which were installed funkily and need some work. That should be cleared up by the time I get back next week!

Here is Habi, holding her daughter Samsiya, on the day they were released from the hospital in Illela. Habi's husband Shaibou is sitting on the left.

You know how it can be hard to write about something that you really care about? I feel that way right now but I'm still gonna get this out-- Word has been out for a long time in my village that I am available to connect mothers of severely malnourished babies with treatment centers in our region. You guys have heard about that work from the blog- you know about Habi and Samsiya, and the others. In the last couple of months, mothers started to bring their babies to me, just to look and see if I could tell if they were okay. Other mothers who I'd visit and advise to seek help were likewise much quicker to go get it- just a couple of weeks ago I ran into one such woman, Jemila, on her way to a feeding center south of us Tajae- she told me she'd been going weekly ever since I encouraged her to take her son there. I didn't even know she'd started going, and when I saw her son I didn't recognize the kid! That was really cool.

I started to realize that maybe, somehow, the stigma about severe, life-threatening malnutrition ("tamowa" in Hausa) is starting to change in my village. Instead of feeling intense shame and staying home, mothers seem to be taking action and getting themselves and their babies to the clinics. And it seems to help if someone is there to give them an extra push, encouragement, and basic information about what they can expect. I have filled that role for some women, and it's been, I think I can say, the most important thing I have done in my time in Niger.

Last month I talked with several women's leaders in the village to figure out a way to transfer the responsibilities that I've taken on to others, so that there is always someone to provide that supportive role to mothers. Narba and Ana, the main women's leaders, presented a plan to the larger community- about 200 women- and picked four women from the village (two from the east side and two from the west- they're so on it) to act as what I refer to in my head as The Baby Patrol.

The women- A'I Mano, Haja Kalau, Rabi Masali, and Salamu Anza- have the following responsibilities: to know what severe malnutrition looks like, to be on the lookout for it in their neighborhoods, to be available to mothers who want to show their babies to someone in private, to provide accurate information about the local services available for tamowa, and to accompany women to local clinics to get services and/or referrals from the nurses there. I met with the Baby Patrollers last week to go over some basic information, and arranged for a nurse from a neighboring village to come down and give them a training about how to recognize severe malnutrition. I think he'll come in November...

So, that's what I've been up to. That and trying to get ready to come home to my other home, in Oregon. It's going to happen soon, and as much as I love home, leaving Niger is going to SUCK. But this post is long enough already, so I'll save that conversation for later. Or for never, or for Just in My Head.



Shaibou and Habi, each with Samsiya

Updates

Updates on the ladies and co. Habi and Samsiye are home and doing well; they visited the Concern-run feeding center on Monday and got a week's supply of special baby power-food. (It's called Plumpy Nut, and it's basically peanut butter.) Salamu and Abu Zaidi are still in Illela along with Hawali and Abu Lawa'asu, and all of them were in high spirits, really happy to see me this morning. They have changed so much--even in the last two weeks--the mothers look more confident, the kids are smiling and showing off their newly-acquired cheeks, and I feel proud being a part of their progress. I sent another woman up yesterday: Saddi and her son Abu Lawani. They were settled in this morning; nurse Hajara was just about to look them over and see where the best place for them is. I suspect that Abu Lawani has something else going on besides malnutrition, but I don't know for sure. Hajara will figure it out.

I want to add that of the four women who have come to Illela this year from Foloa, three of them are visited regularly by their husbands. Only Hawali's husband hasn't come; he is on work exode in Cotonou, Benin. Last week when Habi was released, her husband Shaibu bought three eggs for Hajara as a thank-you gift. That was pretty cool...

An unfathomable mix

My parents and my Peace Corps friends have asked me if I think these women with malnourished babies would be going to the hospital if I weren't going with them. There are a few answers to that question, depending on the woman and her circumstances. One answer is no, or not until it's too late. We lost two babies, that I know of, last year because of this. I can't claim to explain it or understand it- it is an unfathomable mix of shame, pride, negligence, and ignorance.

Another answer is yes- Salamu, for example, was already on her way to get help. The other answer, which I think is more common, is an in-between-yes-and-no. Women recognize that their child is suffering, and do what they can (in the middle of the Sahel, how easy do you think this is?)- and depending on what they feel they can or cannot do (given the restraints of their marriage, their other children, their responsibilities at home) they may or may not consider going to the hospital as an option.

In Hawali's case, Gwallo had seen the baby, suspected severe malnourishment, and came to find me because she knows that I've been helping some mothers out. Hawali wanted to come, right away, and is prepared to stay at the hospital as long as she needs to, no questions asked. I don't know why she didn't/couldn't go earlier- surely her son has been looking this bad for weeks. But. She's here now, and that's what counts.

PS: A weird thing happened yesterday- after seeing Hawali and her son. In the village I saw a tiny, tiny, tiny baby goat laying in the sand on its side-- I honestly thought it was a cat, it was that size--, panting, with its eyes closed. People were walking all around it like it was nothing. I just stopped in my tracks. Karima was there, and I asked her if we could help the goat- you know, either feed it somehow or kill it, because it was clearly born way too early (last night, and its twin was born dead). She laughed at me, and lord knows how I managed not to burst into tears right there. I was able to cough out "I guess we deal with these things differently where I'm from" before stumbling away. All I wanted to do was scoop up that little goat and run for it, but I didn't, because that's not how they do things here. I hate it when "how we do things here" is so hard for me to accept. Karima said that they'll leave it alone until it dies. Sweet, wee little cat-goat, alone in the sun. I feel a little better about it now that I've told you. Why did I cry for a goat and not the sick baby? I don't understand.

Illela, again

And here I am...again! Probably would've come to Illela anyway to see Habi and Salamu and their babes, and then ended up bringing another woman and her baby this morning too. Enter Hawali and her son, Abdu Lawa'asu. But first- the really good news- Habi and Samsiya get to go home! Samsiya is now bright eyed and has a round face, and Habi is radiant and relieved. The two of them will come home with us in the truck this afternoon. So that leaves Salamu and her son Abdu Zaidi, who is also looking great. I never knew you could get chubby cheeks in 6 days; apparently, with Hajara's attentive help, you can. I wouldn't be surprised if Salamu gets to come home next week.

Hawali, the new arrival, is a gorgeous young mother. A few days ago, Gwallo came over and said she wanted me to visit her that afternoon (you may remember Gwallo- she's a firecracker on the grain bank committee and I've mentioned her here before). My first thought was 'aw shit, what have I done now?' I thought I was in trouble...I almost didn't go to her house. But I did, and she sent for Hawali, who brought her son, who is very sick. He's 9 months old, and has the familiar signs and history of malnutrition/dehydration/illness that ruin little kids here: diarrhea that started 2 months ago, causing severe weight and water loss. To try to speak objectively- these babies come to resemble insects more than they resemble babies. Fragile little limbs, ribs, no butt, thin skin hanging off of their stick legs, hollowed eyes, skull...I will not take pictures of the sick babies, but I'll send some of the recovered ones. Deal?

So- you know the drill now, if you've been reading these entries for the last few weeks. Pack everybody up and head to what I am fondly referring to in my head as Hajara's Haven. Hajara, nurse of nurses, who knows when to yell at you and when to praise you. I think this woman may be an angel. Scratch that, she is. Hawali and her son are settled in the infant malnutrition ward, and I'll swing by to see them again before leaving Illela. Hajara warned them that they will be there for awhile; Abdu Lawa'asu weighs 4.4 kg and should weigh 6, so he's got a ways to go.

An unplanned trip to Illela (Part 2)

9/17/09

So. This morning was the longest time I've spent at the infant malnutrition ward. There are five women staying there right now: Habi (in her 3rd week!) with daughter Samsiya, Salamu with son Abu Zaidi, and three women with their babies from other bush villages. One of the women has eight month old twins; one is a normal weight and well developed. The other, a little boy, has bright eyes and seems alert but weighs less that 2 kilograms. While these women stay at the hospital, they are under the stern but compassionate eye of Nurse Hajara. Hajara administers medicines, weighs the babies every day, tells the mothers when and what to feed them. Depending on the age and ability of the babes, they are fed fortified milk, or a peanut-butter like paste, or a combination of the two. Babies who won't drink are force fed; babies who will eat eventually get fed bits of fish and egg. When they reach a weight and health that Hajara approves, they are allowed to go home. Everything is paid for by the government.

When Habi came with 5-month old Samsiya 2 weeks ago, the top of Samsiya's skull was so sunken in you could have filled it with a half cup of water. She weighed 3.8 kilograms (sorry guys, how much is that in pounds? 8?). Today I got to watch Hajara weigh her again- she is now a whopping 4.0 kilos and will be released when she makes it to 4.3. Hajara said that Habi is the best of all of the mothers at making sure Samsiya is getting better. I was really, really happy to hear that. Salamu was smiling this morning; Abu Zaidi already looks better. She told me today that he had passed out three times yesterday, and she thought he had died. But now he's drinking canned milk and getting a whole smorgasbord of medicines and vitamins. It is too soon so guess at how he will do, but I sure do trust Hajara, and I think she'll know what to do for this babe. Habi and Samsiya will probably be home within the week, and hopefully Salamu and Abu Zaidi won't be far behind.

Some of you who read this blog last year may remember that September, October, and November were hard months for mothers and babies. One difference this year is that women seem more aware of where they can get help. It could be my imagination, but I think that perhaps some of the negative stigma- associated with revealing that your child is malnourished- is fading in my village. I hope so. I'll probably write about this again; I sure think about it a lot.

An unplanned trip to Illela (Part 1)

I wasn't planning on coming to Illela today, although I did want to
come up here sometime soon to visit Habi and Samsiya at the hospital.
What happened was: yesterday evening at about 6, an older lady found
me at Narba's and asked me if I'd take another woman and her son to
the hospital.

I got up to go see what was going on; it turned out the woman and her
baby were already sitting in a truck on the road.  The woman, whom I
recognized but didn't know that well, had tears all down her face and
was holding her son, a tiny bundle on her lap.  Someone handed me a
note from the nearbly clinic; it had "severe malnutrition, admit to
hospital immediately" written on it in French.  People were all around
us, staring at her and watching me to see what I'd do, shouting advice
like "Throw your bike in the back, you can come back in the morning!
You're in charge of things like this, you should go!"

I didn't feel like I could just jump in and go. Maybe if I had had
even 10 minutes to get ready, I could've.  But the driver was revving
his engine, impatient.  What I decided to do was run back to my house,
grab some money for the woman, Salamu, wrap it in paper, run to the
truck and give instructions on where to go when she got to Illela.  We
got Hajiya, the older lady who came to find me, to go with Salamu.
They sped off.

I joined them this morning, via my bicyle.  When I got to the hospital
I found a whole crowd of people from our village: Salamu and her son,
Abu Zaidi, plus Hajiya, and Salamu's husband Sa'idou and one of his
friends, all together with Habi and little Samsiya.  My village is
filling the infant malnutrition ward!  Not exactly something you want
to feel good about.

But.
If it's the truth that there is infant malnutrition,
which it is, then it IS good that the women are getting help.

Green: Generally Food Secure
Yellow: Moderately Food Insecure
Orange Highly Food Insecure
Red: Extremely Food Insecure
Black: Famine
Gray: No Data

Here is the FEWS map for the way things stand in Niger now. Compare it to the map from July and you can see the difference. Foloa is in the yellow zone. Although harvest season is beginning, we now face the most difficult season for infant malnutrition.

Today

Today I am in Illela, site of a new internet cafe. I came to accompany a woman from my village whose 5 month old daughter is severely malnourished. They'll stay at the hospital here until, well, until the girl is better, hopefully.

My friend is Habi; her daughter is named Samsiya, after me.

Where Narba was

11/30/08
You might have noticed that Narba's name wasn't on the list of the women who came to the training, although she is one of the grain bank committee's presidents. The reason she couldn't be there was because her granddaughter died that week. And the reason that her granddaughter died was, to my eyes and my understanding, because of severe dehydration and starvation. It's difficult for me to write about this, and so I haven't written about it to anyone. I haven't written a single letter to anyone for this whole month, because I'm unsure of what words to use to describe what is going on in Faloa and Niger right now. I hate not telling you about it, because it's been part of every day of my life for weeks now. But I also hate telling you about it, because I don't think you will understand. That's not fair of me, so I'm going to try.

The big picture, which is easy to explain: By this time of year, people-- farmers, meaning villagers, meaning my people-- have been working their bodies, hard, for six months straight. They have used their bodies and nothing more than a few handmade hand tools to turn sand into fields of millet, sorghum, and beans; they have battled acres of weeds with their backs bent over in 120° heat, they have spent weeks harvesting giant bundles of heavy stalks of grain, they have clocked hundreds of miles on their feet that are either barefoot or in crappy flipflops, and for a month of this- all September- they did it without food or water, for Ramadan. As the doctors at four of the clinics and hospitals that I have visited in the last month have explained to me, by this time of year, nursing mothers' bodies are exhausted and broken, and they stop producing milk. Babies who weren't weaned yet get weaned abruptly, and babies who weren't ready to be weaned yet get weaned anyway. They are given more water than they would normally drink, which results in higher incidences of diarrhea. And that, for a baby, or a kid even, in this country, is close to a death sentence. I wouldn't have, couldn't have, believed it before coming here. But it's real, and it's been happening all around me this month, and I have never felt more helpless, devastated, or furious.

Narba's granddaughter, Foziya, was about 16 months old. When I left the village in early October to help with Peace Corps training, she had a fever and I put a damp cloth on her hot little body. When I returned at the end of the month, I didn't recognize her, except as a child that I could've seen on the news in a report about famine or war. By then I think she was not entirely conscious. She was just bones in a small, rigid shape on her mother's lap. I sat with her mom, Dela, and Narba, and the other women in the family in their hut- I knew they were there because that's what you do when you are waiting for a person to die. It was confusing and shocking and upsetting, and I didn't know what to do, or if I should do something, or if I could. I told Narba, please let me take her to the doctor, but Narba said that it was in God's hands. Foziya died in the evening, and the wake lasted for the next three days.

So that is why Narba couldn't come to the training. I sat at the wake in the mornings and all evening after the training was over each day. I am a part of this family, and I felt like it, and my presence was never questioned.

I'm not sure what else to tell you about, because Foziya's story is the first in what has become way too many children who have died in this village. I can't just list off these names like that's all they are, names. I don't want to do that. They're a lot more than names, they're babies that I am used to holding and carrying around when their moms are pulling water, they're babies that were learning to sit and walk and talk. It's so messed up, it's not fair, it's the cruelest thing in the world that this is true. My friend Mariama, who is lovely and clever and whose daughter Harira was born the week I moved here, is now walking around without her baby on her back, with her breasts leaking milk. Mariama is healthy- she wasn't weaning Harira and didn't have to, she had plenty of milk- but Harira got diarrhea, and even though Mariama took her to the clinic-- three different clinics, all hours of walking away- they couldn't help her. They didn't help her, and her beautiful baby, whose picture I've taken a hundred times, died in less than a week.

As this has all been happening, I've been struggling to understand it and working to find out what the options are for mothers- where can they take their babies, and what help can they expect to get? The two closest clinics have one person on staff at best, who's not usually there, and who just hands out oral rehydration salts like that's going to fix everything. The clinic in Tajae is better, but gets absolutely flooded with people. I've been there a lot lately-- I've started going with women, because they like it when I come, and I think it makes it easier for them to go. I started going a few days after Foziya died, because one of the kids who is closest to my heart started really going downhill. I know I've told you about him before-- Rahman, Zuera and Salla's son, another grandson of Narba's. He's the kid who always toddles up to me yelling 'habba!' and who squeals when I lift him high in the air.

Rahman is 18 months old, and was still nursing until October, when Zuera's milk dried up. Rahman started getting diarrhea, and throwing up, and he started to refuse to eat or drink. He'd been like this before I got back, and was losing weight and acting listless, limp. Zuera and I went to Tajae, where they gave him antibiotics, but he didn't get better. He lost his baby cheeks, his eyes started sinking farther and farther in his head, and the skin on his legs hung like paper. He just got worse and worse, so we went back. We went on a Wednesday, which is when an Irish NGO called Concern sets up at the clinic and administers a whole lot of help- all for malnourished kids. I'd never seen them in action before, and I was overwhelmed and grateful to the point of tears. I mean, you walk into this big cement building and it's full of hundreds of women holding on to their skinny babies, waiting in lines to have them weighed and measured, and then to get a week's supply of high calorie super-nutrient life-saving food. It takes courage to take your kid, you know? They want, like every mother, their child to be healthy. But it's still hard to get the guts to take them, because everyone sees you and sees your sick baby.

Zuera and I were told that Rahman was "broken", and that if he refused to eat the special food at that instant, they would write him a referral to the Concern Hospital in Tahoua. He wouldn't eat anything, and so Zuera and I returned home with him to ask for Salla's permission to take him to Tahoua that afternoon. And you know, this was really strange and disorienting for me, because I don't have authority over this child, or his parents, and if Salla didn't agree, Rahman wouldn't be going to the hospital. It was painful for Salla to decide- he was surrounded by all of the women in his family, yelling and watching, and there I am, terrified he's going to say no, and then he does, he says no. He said no, because he heard that if your child dies there, the hospital doesn't give you your child's body back. I was devastated, and Zuera started crying (people don't cry here), and the women went crazy...I told him, okay, let me call them and ask them if that is true, because if it is true, I understand. But he really didn't want me to call them, and he excused himself and consulted with some other men, and then he gave us permission.

Relief.

Zuera, Rahman, and Narba ended up spending nine days at the Concern Hospital in Tahoua. The doctors showed them how to force feed him highly nutrified milk, and they were kept on a strict feeding schedule every hour. I visited them there twice, and got to see Rahman get better and better. Everyone in Foloa knew he was there, and constantly asked me if I had any news. When they finally got released, Rahman had his chubby cheeks back and even started smiling every once in a while. He'd been back for four days before I left to come in to Konni for Thanksgiving, and he seemed better each day. He still qualifies for the supplements given out in Tajae every Wednesday, so he and Zuera and I will keep going, along with the other five or so women from Foloa who have started going. Last week, a new mom joined us, Tahira, with her son Aziz. Going with them, and helping to connect them with doctors who can and will help them, makes me feel less helpless. I feel like I finally know where to go, and I'm getting to know the doctors. Best of all, women who felt helpless can see Rahman and how much better he is. And that is what really matters.