Under the Mango Tree

Gus Ruchman - Senegal


January 25, 2011

I had waited for this moment for over three months. Kaay nu waxtaan. Come, let’s chat.

When I received the rather hazy details of my apprenticeship, I was told that I would be making “awareness” visits with community health workers in the greater rural area of Sangalkam. That was the first and the last time I heard about such an opportunity until very recently.

I consider the past two months an extended experiential job training period (see previous blog post). I have learned and improved some very basic healthcare skills and had the invaluable opportunity to make acquaintances in the local medical network while observing the day-to-day successes and failures of patient treatment and information at the Poste de Santé. Now I am embarking on new adventures.

At the end of last week I discovered that, contrary to my previous lack of observation, several staff of the Sangalkam Poste de Santé as well as health workers in other villages do participate in a program sponsored in part by USAID in which they inform small groups about malaria risks, pathology, and prevention, as well as issues surrounding prenatal health, etc. Each person working for USAID does this twice a month, attempting to reach a minimum of about 20 people total, and is paid a motivational stipend of 5000 CFA (around 11 USD) per “causerie.

On Saturday afternoon I traveled up the road to Noflaye to meet Mansour, my doctor-friend there, to attend my first causerie. After a detour that took us through a hole in the wall (literally) to find an old woman, wait for her and Mansour to pray takkusan, take her blood pressure, and get Mansour’s payment of a small satchel of eggs, we were on our way to the meeting.

When I headed back to Sangalkam at sunset I had seen and heard quite a bit. Mansour used a series of 20 large, bound illustrations provided by the government of Senegal (in conjunction with organizations such as UNICEF and WHO) to educate nine women about sibiru, about which they knew shockingly little or nothing, or were misinformed.

Monday, however, was my first official causerie with staff of the Sangalkam Poste de Santé. I returned to Noflaye with Mariganne to meet up with another Poste woman as well as Mansour. Mariganne and I walked through parts of the village that I did not know existed, arriving at the mango tree, which stood in the center of a large sandy area. Slowly but surely about 12 women gathered on a large multicolored mat. They socialized as only Senegalese women can socialize, and soon the essential part of the meeting, several rounds of àttaaya, was underway.

Working on a typical schedule based on punctuality, we only started about an hour or two “late.” With no visual aids present the representatives from the Poste asked questions of the women, attempting some group participation as a learning tool. Of course for every question there was a responsive uproar of commentary, only about a quarter of it related to anything in the realm of health, making it difficult to proceed with something similar to efficiency. For every passerby there was another uproar of extensive greetings crucial to Senegalese interaction. As the sun lay low in the sky, trash burned in a large pile nearby and children fought and screamed, only to be torn apart and beaten even worse by a few women who temporarily left the causerie. Still, we nudged our way through information essential to reducing malaria risks.

Later, as Mariganne and I walked back to the main road through groves of mango trees that, once again, I did not know existed, I tried to get a grasp on the efficacy of these “chats.” Mariganne, who has been working with USAID for several years, claims that she used to see a disturbing number of pregnancies that resulted in the death of the infant, mother, or both, due to complications with malaria, but that the frequency of such tragedies has significantly declined. Having left both Noflaye causeries with doubts of any tangible impact saturating my brainwaves, this was shocking and delightful news.

I got home after dark. Mariganne and I waited for a long, long time by the side of the road, trying to catch a ride back to Sangalkam that we never ended up finding. Ultimately we walked, her carrying a large sack of green beans that we picked up for another sage femme worker at the Poste de Sante, me lighting our way with the flashlight I keep in my backpack.

I had a lot to think about. I had a lot of planning to do. I had a lot of sleeping to do. But I would do all of it knowing that I could be optimistic—an emotional commodity around here—about the potential for chats under the mango tree.

Gus Ruchman