In Service Training

I’ m currently in week 2 of Peace Corps in-service training, just outside of Bamako. IST is done after completing our first full three months in village, with the idea being that now that we have gotten to know our communities and strengthened our language skills, we are ready to start thinking about projects and diving into real work.
IST is as intense as PST was; I’d forgotten how exhausting the constant workshops and lack of control over my schedule can be. Especially after having complete autonomy over where I go and what I do out in village, going back to this highly regimented training brings me back to the blur and tiredness that was PST. Now, though, the training activities have more of a sense of direction, since we are learning directly applicable skills and we understand the context of our working communities, whereas before we had no idea.
Health volunteers spent the first week getting health-specific technical training. Vanessa, an amazing RPCV from Guinea who is now a staff member of the NGO Helen Keller International, came in to spend a full day with us talking about malnutrition, appropriate breastfeeding practices and preventing neglected tropical diseases (like shchistosomiasis and river blindness) that still affect a lot of people here in Mali. The nutrition part was especially useful, as my CSCOM does some baby growth monitoring, but could and should be doing much more to address malnutrition in the area. I hope to make this an important part of my service since I have seen so much malnourishment in my community. We talked about various ways to measure degree of malnourishment (including arm circumference, weight-to-age and height-to-age models), when a child must be referred to a feeding center, and how to encourage mothers to utilize special nutritional supplements–or prepare their own–for their children.
We also spent a few hours talking about breastfeeding. One of the biggest pushes in maternal and child health in Mali is exclusive breastfeeding up to six months of age–the baby must get nothing but breast milk until this point. It’s especially important here since mother’s milk is protective against sicknesses that are very common here, and the sanitation conditions make infant formula and bottles dangerous for the baby (most mothers would not be able to afford supplemental feeds anyway.) As a health behavior, it also capitalizes on something Malian women already do naturally much better than their Western counterparts. Anyone who is here in Mali for any length of time quickly realizes that there is absolutely no taboo surrounding public breastfeeding here. Mothers can feed their babies at their homes, in the fields, during meetings, on public transport…in short, anywhere. I’ve seen more naked chests in my village than I’ve ever seen in my life. In fact, when I explained to my homologue and a few of her lady-friends that American women are often ashamed to breasfeed in the open and will only do it alone in a room in their house, their reaction was a mix of astonishment and laughter. The fact that something so natural would have to be kept so hidden struck them as completely nonsensical. And here, where children grow up seeing all the women they know breastfeed and babies are able to feed for free whenever they like, I can see why.
Thus, there is already a good environment here to promote exclusive breastfeeding. However, there are still some obstacles–like a local belief that some mother’s milk is inherently ‘bad’ or can make the child sick. So building mothers’ confidence in the process is still important, and that’s what we talked a lot about–counseling the mother through some common issues and linking breastfeeding to appropriate weaning and nutrition practices later on.
During the week, we also visited a nonprofit health insurance company (seems like an oxymoron to Americans!) under the mutuality model, where small groups of members collectively pay into a fund that pays for their care when and if they become sick. It’s extremely different from the American, ‘big’- insurance, profit-driven model, but it’s been shown to be able to work in Mali when costs are reasonable, perhaps in part because people think more collectively in general. We probably wouldn’t have much direct interaction with the Mutalities in our area, but it’s important to understand the options in affording health care here when we are promoting health in the community.
We had a midwife come in and walk us through the steps of a thorough prenatal consultation, and I found there were a lot of things that are being left out of PNCs at my CSCOM. As volunteers, our goal is not necessarily to be counseling the mothers directly, but encouraging health staff to be complete and thorough in the information they give, which is more sustainable.
In probably my favorite activity of the week, we planned and implemented a health lesson at a school in a nearby village. My group had the 9th graders, and since we got the older crowd we decided to focus on HIV and contraception. Of course the entire presentation had to be conducted in Bambara and some French, which was intimidating, but the session ended up being fun. Kids were a little taken aback by the strange tubabs at first, but soon became lively. Things turned a little racous when we brought out the wooden phallus for the condom demonstration–but even teens in the States are apt to break into giggles over this.
I was impressed with how much the group already knew, but I think we were also able to clear up some misconceptions- for example, that HIV doesn’t exist in America and only affects Africans. HIV/AIDS is always a contentious issue in Mali even with its relatively low prevalence rate, and especially among the adolescent crowd you’re likely to hear every AIDS conspiracy theory in the book (Westerners put the AIDS virus in condoms, HIV doesn’t cause AIDS….). While some of the time I knew we were just being tested to see how we would respond, it’s hard to separate this from actual belief in these theories, and giving plenty of factual information is the only way to combat the myths. Lessons at the school reach a captive youth audience with critical health information, and are thus a really effective health education tool. I hope to be able to implement regular lessons in the coming months in village.
Saturday brought us a session on the snakes of Mali (joy!), most of which are not poisonous but a few of which are dangerous. (incidentally, a few volunteers had a run in with a 10 foot python one evening along the main road going through Tubaniso…glad I was not there to witness!)
Next week my homologue (service partner) Fatoumata will becoming to Tubaniso for the second part of training, which is focused on a needs assessment process called PACA (Participatory Analysis for Community Assessment) designed to help us work with our village to prioritize issues to work on and determine appropriate project areas. Given that most of the sectors in Mali are pretty unstructured (there aren’t many volunteers doing “9 to 5″ work like teaching English or working at NGOs; we are largely told to decide ourselves what to focus on), PACA can be a good starting point in initiating projects. I’m looking forward to her coming, as I’ve missed being in village–as nice as it is to reconnect with people and speak some English, I really feel as though Marena is my home now. I hope Fatoumata and I both come out of the training ready to hit the ground running after Christmas (I’ll be going to a nearby town to have a little R&R, and to spend time with other volunteers and distract myself from thinking too much about the holiday season back home, and all the snow I’m missing!)