Because you have to do something right? This is one of the most fundamental challenges in development work generally, as far as I can tell; that is, knowing or deciding what to do. The problems aren't usually too hard to identify. They are like this: People are uneducated, suffering from preventable illnesses, hungry, poor.
But figuring out just what to do about them is not an easy task. There are many many schools of thought about how to help, or even if helping helps. On one end of the spectrum you have thinkers like the author of the book Ishmael, Daniel Quinn, who says that subsidizing or giving away food to countries that cannot produce their own is the worst thing you can do for the world and cumulative human suffering. In my darker moments this line of logic does not seem entirely erroneous. On the other end of the spectrum you have your more lazy, less involved aid organizations. The ones that literally dump bikes off the back of trucks as they drive through villages, and parachute bags of rice out of airplanes as they fly over the Sahel.
Obviously I think we need to be somewhere in the middle. This means engaging people in poor countries, holding them responsible, and pushing them to innovate and progress, all while supporting them. This is why the Peace Corps is such a widely respected organization. I don't see any other groups that get close to the level of engagement that we do. And this is because the Peace Corps does not box itself in. I can work with private individuals, large companies, or public/government institutions. It is up to me to decide where I want to be working, where I think I can do the most good. The Peace Corps also puts more emphasis on local language learning than any other aide organization that I have ever heard of, which allows us to make the choice, so that we can work with people who have never gone to school.
All of this allows us to take a nuanced approach to what we are going to do about malaria.
Malaria is an especially big problem here in Kedougou. We have the highest rates in all of Senegal. This is due of course to the climate, (more rain here) but equally to the lack of infrastructure, education, financial means, and access to health care.
For years the Peace Corps program regarding malaria was pretty standard, and could be summed up like this: Education, and supply chain management. Volunteers did causeries, which are like group discussions led by a volunteer, about the importance of sleeping under a net, how to wash and fix them, about mosquito life cycles, and about what to do if you do get sick. Then they would also work with health structures to try and ensure that they all had plenty of malaria medication.
Good straightforward work. But it wasn't really changing anything very quickly. Education always helps, but they needed something more proactive.
Then, about 5 years ago, the Senegalese government began a program called Pecadome in the region of Kedougou, which is a contraction of the french Pris en Charge a domicile. Which basically means Person Responsible at the Home.
Pecadome did one thing that was not happening previously, it put training and medication in the hands of people living in villages without any kind of health structure. (Dar Salaam is an example, there is no kind of gov infrastructure at all there.) These people are called Desdomes. Desdomes need to have one specific qualification: That they are present and available in their village all rainy season. They come to Kedougou for training in how to evaluate sick people, test for malaria, administer the medication for simple malaria, and organize transport to a health structure in the case that the malady has progressed to cerebral malaria.
The idea was that people in the village would then go seek out help with the Desdome the moment that anybody got a fever. Better safe than sorry, and getting the treatment for simple, non-cerebral malaria is free, whereas if you wait until it becomes cerebral, it is much more expensive, painful and risky.
But, contrary to the government's expectations, this was not really happening. Not as much as they were hoping that is. People, especially poor, uneducated subsistence farmers, are very slow to go seeking out medical care. This is for a few reasons. One is that they simply aren't used to it, and it hardly occurs to them as an option, even if they know that in theory they could go find the Desdome. Second is simply that they may not understand the program. Third is that they might be used to seeing seeking out medical attention as a risk: They assume it will be expensive, and are intimidated by health structures and government programs.
But, three years ago something started to change, and this change was precipitated by Peace Corps Volunteer driven innovation. This right here is when/where the Peace Corp's unique level of engagement becomes really crucial. Volunteers were able to understand the problems with the current Pecadom system from the ground level because they were living and working in these tiny villages that are without any official health structure. If the Peace Corps only assigned volunteers to work in big offices and hospitals, as many other organizations do, this innovation may never have occurred.
The change was a relatively simple, yet brilliant one. Pecadome-Plus (that is a French Plus, ie plooous) The plus in this case indicates a slight change that makes the program more proactive. Rather than just staying in their domiciles and waiting for people to come to them, now the desdomes have a second, more important role, to do sweeps of the village once a week. That is, to visit every household in the village and ask, "Is there anyone here with a fever?" The village women's group is also supposed to play a role, networking to help streamline this work. And this simple change, of taking the program to the villagers, has changed everything. Pecadome-Plus has had some major statistical impacts in the regions where it has so far been implemented, and the Senegalese Government has big plans to expand this program to other regions. Peace Corps role is to help train the Desdomes in the -Plus part of their job, and monitor and evaluate the program as a whole. Last year I worked with 3 differentDesdomes, in 2 different parts of Kedougou, one of which was a very remote area. This year I will be working the same circuit. I look forward to it.
Malaria is terrible, so we have to do something right?
But figuring out just what to do about them is not an easy task. There are many many schools of thought about how to help, or even if helping helps. On one end of the spectrum you have thinkers like the author of the book Ishmael, Daniel Quinn, who says that subsidizing or giving away food to countries that cannot produce their own is the worst thing you can do for the world and cumulative human suffering. In my darker moments this line of logic does not seem entirely erroneous. On the other end of the spectrum you have your more lazy, less involved aid organizations. The ones that literally dump bikes off the back of trucks as they drive through villages, and parachute bags of rice out of airplanes as they fly over the Sahel.
Obviously I think we need to be somewhere in the middle. This means engaging people in poor countries, holding them responsible, and pushing them to innovate and progress, all while supporting them. This is why the Peace Corps is such a widely respected organization. I don't see any other groups that get close to the level of engagement that we do. And this is because the Peace Corps does not box itself in. I can work with private individuals, large companies, or public/government institutions. It is up to me to decide where I want to be working, where I think I can do the most good. The Peace Corps also puts more emphasis on local language learning than any other aide organization that I have ever heard of, which allows us to make the choice, so that we can work with people who have never gone to school.
All of this allows us to take a nuanced approach to what we are going to do about malaria.
Malaria is an especially big problem here in Kedougou. We have the highest rates in all of Senegal. This is due of course to the climate, (more rain here) but equally to the lack of infrastructure, education, financial means, and access to health care.
For years the Peace Corps program regarding malaria was pretty standard, and could be summed up like this: Education, and supply chain management. Volunteers did causeries, which are like group discussions led by a volunteer, about the importance of sleeping under a net, how to wash and fix them, about mosquito life cycles, and about what to do if you do get sick. Then they would also work with health structures to try and ensure that they all had plenty of malaria medication.
Good straightforward work. But it wasn't really changing anything very quickly. Education always helps, but they needed something more proactive.
Then, about 5 years ago, the Senegalese government began a program called Pecadome in the region of Kedougou, which is a contraction of the french Pris en Charge a domicile. Which basically means Person Responsible at the Home.
Pecadome did one thing that was not happening previously, it put training and medication in the hands of people living in villages without any kind of health structure. (Dar Salaam is an example, there is no kind of gov infrastructure at all there.) These people are called Desdomes. Desdomes need to have one specific qualification: That they are present and available in their village all rainy season. They come to Kedougou for training in how to evaluate sick people, test for malaria, administer the medication for simple malaria, and organize transport to a health structure in the case that the malady has progressed to cerebral malaria.
The idea was that people in the village would then go seek out help with the Desdome the moment that anybody got a fever. Better safe than sorry, and getting the treatment for simple, non-cerebral malaria is free, whereas if you wait until it becomes cerebral, it is much more expensive, painful and risky.
But, contrary to the government's expectations, this was not really happening. Not as much as they were hoping that is. People, especially poor, uneducated subsistence farmers, are very slow to go seeking out medical care. This is for a few reasons. One is that they simply aren't used to it, and it hardly occurs to them as an option, even if they know that in theory they could go find the Desdome. Second is simply that they may not understand the program. Third is that they might be used to seeing seeking out medical attention as a risk: They assume it will be expensive, and are intimidated by health structures and government programs.
But, three years ago something started to change, and this change was precipitated by Peace Corps Volunteer driven innovation. This right here is when/where the Peace Corp's unique level of engagement becomes really crucial. Volunteers were able to understand the problems with the current Pecadom system from the ground level because they were living and working in these tiny villages that are without any official health structure. If the Peace Corps only assigned volunteers to work in big offices and hospitals, as many other organizations do, this innovation may never have occurred.
The change was a relatively simple, yet brilliant one. Pecadome-Plus (that is a French Plus, ie plooous) The plus in this case indicates a slight change that makes the program more proactive. Rather than just staying in their domiciles and waiting for people to come to them, now the desdomes have a second, more important role, to do sweeps of the village once a week. That is, to visit every household in the village and ask, "Is there anyone here with a fever?" The village women's group is also supposed to play a role, networking to help streamline this work. And this simple change, of taking the program to the villagers, has changed everything. Pecadome-Plus has had some major statistical impacts in the regions where it has so far been implemented, and the Senegalese Government has big plans to expand this program to other regions. Peace Corps role is to help train the Desdomes in the -Plus part of their job, and monitor and evaluate the program as a whole. Last year I worked with 3 differentDesdomes, in 2 different parts of Kedougou, one of which was a very remote area. This year I will be working the same circuit. I look forward to it.
Malaria is terrible, so we have to do something right?
