The Double R

My Peace Corps Service began when I arrived in West Africa in March 2011, and today I officially completed my Close-of-Service (COS) and am getting ready to head back to the United States of America as a Returned Peace Corps Response Volunteer (RPCRV).

Three stops, two plane changes, 9,500 miles (15,200 km)

Finishing with my Peace Corps service and leaving West Africa is bittersweet, but I'm also really looking forward to seeing family and friends back home. My paperwork is done, my flights are booked, my good-byes have been said, I'm mostly packed, and I feel ready to go.

Adieu, Peace Corps ~

And now I'm somewhat at a loss as how to wrap things up. I feel grateful to have so many wonderful and supportive people in my life, and could devote an entire blog to thanking everyone - relatives, friends, neighbors, colleagues, drivers, host families, Volunteers, complete strangers - who has helped me out, mailed me things, fed me, given me gifts, sent me messages, kept me company, or wished me well. So many thank-yous.

For now, I'll just say that I hope you enjoyed the blog, and I wish you and your family good health, good luck, safe travels, and a very happy year. À la prochaine!

Last Week

When I arrived in Kankan there were five Peace Corps and Response Volunteers in Kankan proper, but as of today I am the only one left. A few months back Katie K. had to go home for medical reasons, and then, in December, people started to COS (Close-of-Service). Sarah J. left in December, and then last week Kenny D., followed yesterday by Michelle. This is my last week on Kankan; next week I'll be in Conakry, filling out my COS documents and making sure that I get all the many kinds of clearance (Medical, Financial, Property, Administrative, etc) that one is supposed to have before leaving the country as an RPCV (Returned Peace Corps Volunteer) or, in my case, an RPCRV (Returned Peace Corps Response Volunteer).

Photo courtesy of Michelle

Happily, I am still not alone - pretty much everyone at the office is back from their holiday break, the daughters from the Sidibé family down the street are back from Conakry, and PCVs Sara T. and Yé don't live too far from the city of Kankan and will be by this week. Also, the trainees (known around here as stagiaires) that will replace some of the departing PCVs in the region are out on their site visits right now, and will come in to visit Kankan at the end of the week.

So, the coming days will be all about wrapping up loose ends, saying good-byes, giving farewell gifts, packing things up, and just generally getting ready to hit the road. I hadn't been looking forward to making the rough, dusty, two-day bush taxi trek to Conakry by myself, with all my baggage. (It wouldn't have been the end of the world, but it wouldn't have been a day at the spa, either.) Luckily for me, one of the PCVs has family visiting and they'll be headed back to Conakry this coming weekend and offered  to let me ride along. It will still be a rough, dusty, two-day drive in a rented bush taxi, but there will only be a few us in the car, instead of the usual nine (plus babies plus sometimes chickens), so I'm pretty happy about it. 

Stray Cats and Google

Even amid the ongoing saga of Guinea's legislative elections, the United States Government shutdown has garnered quite a bit of attention around here. Peace Corps and Peace Corps Response Volunteers are considered "essential" (insert joke about what-are-they-going-to-do-stop-paying-our-salaries-ha-ha), as are Peace Corps medical and security support staff. The most direct impact that the shutdown has had on my daily life (other than inspiring worry that by the time I get back to America there will be nothing left but stray cats and Google) is that people keep asking me to explain why my country is such a spectacular mess and I keep not even knowing where to begin.

On Sunday I went downtown to buy soap and vegetables and whatnot and lingered in a boutique to watch an early-afternoon newscast about the slow-motion circus-train-wreck of current American politics. After the segment ended, one of the vendor guys turned to me and, in a bemused voice, said "What is the matter with them? Don't they want people to have health care? This is going to be really bad for the economy." I sighed and shrugged in agreement and said "Pffft... politicians..." and was met with sympathetic murmurs; Guineans know what it's like to have a dysfunctional government, more than I ever will, probably. I think they're often just slightly aghast at how a nation as wealthy and privileged and well-established as the United States seems embarrassingly unable keep it together. As are we all, I suppose.

P.S. You may have already seen this delightful hidden message from the National Weather Service. Secret acrostics are an underutilized means of communication. Can we please pay them already?

Pilot Project: Community-Level Contraception

There is a huge unmet need for contraception in Guinea. Pretty much everyone here loves babies, but women often aren't able to space out their pregnancies or to stop getting pregnant once they have the number of children that they want. Especially in rural areas, too many girls and women are injured or killed by complications from pregnancies that are too close, unwanted, or high-risk. Using contraceptives for birth-spacing and avoiding unwanted pregnancies means healthier babies and healthier mothers, and in a culture that really values having children that message is appealing to a lot of people. Unfortunately, actually getting contraceptives can be difficult, especially for women living in rural villages without health structures. There are efforts to increase access, including launching programs to recruit and train people who are literate, responsible, and respected in their communities to be Community Health Workers (CHWs). These CHWs are able to serve as a accessible resource for information, advice, condoms, contraceptive pills, and referrals to local health structures. 

Photo courtesy of Save the Children/Guinea.

Save the Children launched a pilot program to improve and expand access to contraceptives by working with the Ministry of Health to recruit successful CHWs and train them to administer DMPA, a contraceptive injection better known as Depo-Provera. (DMPA is safe, reversible, extremely effective and lasts for three months at a time - not having to take (or hide) packets of pills is really appealing for many women.) Aside from safely giving an injection it is really important to make sure that a women is eligible (not pregnant, no relevant health problems) and understands the risks and benefits of DMPA. The CHWs were trained about reproductive health issues, effective communication methods, reporting and evaluation, when to make referrals to medical professionals, and how to minimize the risk of infection. A lot of work also went into communicating with local authorities, community members, religious leaders, village chiefs, husbands, and health professionals, so that people understood what the project was all about and to raise awareness about maternal morbidity and mortality in Guinea.

By all accounts, the pilot project was successful: when it was added to the other contraceptive options available in their villages, many women opted to switch to DMPA, and other women who hadn't used contraceptives before opted to try it. Women who tried DMPA reported that they had been advised about common side effects and nearly all reported a high level of satisfaction, even when they had experienced minor side effects. The biggest problem was that supply chains are really unreliable in Guinea "and ruptures of stock" are really, really common. (Stock-outs are really disruptive, not just for contraceptives, but of all sorts of medications and supplies.) There were no reports of serious side effects or infections, and all the women surveyed at the end of the pilot phase reported that they were planning on going back for their next injection, which says a lot. 

Photo courtesy of
Save the Children/Guinea.

Photo courtesy of
Save the Children/Guinea.

The Save the Children team presented all of this (and much more!) in Conakry last week, and it was really interesting to watch the response to presentations and to listen to all the questions and feedback. Despite the mountain of evidence demonstrating the many benefits of reversible long-acting contraceptives like Depo-Provera and Intrauterine Devices (IUDs), it can still be a touchy subject – even in the U.S. we can’t seem to figure out a way to make them affordable and widely accessible.

There seemed to be a lot of interest in the project, and a lot of support for better access to reproductive health services in general, which was encouraging, and I'm hopeful that I'll be able to work on the project as it continues on the next phase. 

Roadtrip!

Last week I went to Conakry for some meetings and a workshop held by Save the Children (SC). It’s a long and bumpy ride, but I was in one of the SC/Ministry of Health cars, so it was a much faster and more comfortable ride than it would have been on public transport – I got my own seat and everything.

The drive out wasn’t so bad. Once we’d cleared the flats of Upper Guinea there were low mountains and rocky cliffs to admire. Everything is excessively verdant this time of year, rivers are full, waterfalls spill over rock-faces, and there’s flooding in some lower-lying areas. (Looking at all the water made me think of the view from the airplane when I landed in Guinea in June – the approach to the Conakry airport starts over the Atlantic and then comes in low over a delta covered in serpentine loops of water and what looked like mangroves and deep mud, and it just goes on and on until you start to wonder if there really is a city and an airport and a runway.)

Aside from the scenery, the most striking thing about the drive was the number of broken-down trucks and wrecked cars, frequent reminders that my borderline phobia about in-country travel is not really so unreasonable.  Thanks to the nice car and good luck we made it to Conakry in about 14 hours, and I was very glad to get dropped off at the Peace Corps office/transit house to stretch, take a hot shower, and get some sleep. The rest of the week was mostly filled with meetings at the NGO Jhpiego’s Conakry office and at the Ministry of Health. The main event was SC’s presentation of the results of the Community-Level Contraception Access pilot project that they’re hoping to expand over the next few years, and it went really well. 

Upgrades & Updates

While I was settling in to my rooms I pondered various keep-everything-off-the-floor strategies. Oatmeal-can furniture legs didn't seem appropriate (or tall enough) and commissioning tables just to hold up my suitcases isn't included in my living allowance. Then I realized that there was a whole fleet of chairs in the conference room and under the stairs, and that solved my little problem quite nicely. 

Chairs are much classier than old Quaker tins. 

Also I put up some photos and postcards and color swatches cut from the Pantone stationary set that I bought on my way out of California but have not yet used for any actual letter-writing. Maybe this weekend will be the weekend that I find the post office and send some test letters to see if the U.S. has started accepting mail from Guinea yet. 

In other news, I am not sick (knock on wood) and had a nice time over the weekend, reading, doing yoga podcasts, and checking things off my to-do list. Ramadan kind of puts a damper on things en ville, but the Catholic Mission was open for business, and I met up with a few of my PCV neighbors for dinner there. I had loko, which is fried plantains, and a “hamburger”, which turned out to be a hard-boiled egg wrapped in spiced ground meat (beef?) and thoroughly grilled, like a barbequed Scotch egg.  We were joined by another American I met last month in Conakry; she's doing a three-month internship in Guinea, working on the same maternal health- and family planning-focused MCHIP project as I am, and came through Kankan during a field visit trip. It was nice to talk shop and good to hear about what she's been seeing at health structures around the country, as unpleasant as some of those things are.

Things are starting to pick up around the office, which is nice. I've got documents to read, people to meet, Peace Corps reporting files to fill out, and things to prepare for upcoming meetings and conferences. Office life is about as exciting here as it is anywhere, but wondering how long the power will stay on keeps things interesting. 

Peace Corps Response

In just a few hours I'll be headed to the airport, on my way to begin a Peace Corps Response position with Save the Children, serving as a Health Program Specialist in Kankan, Guinea. It’s a nine-month assignment, and I’ll be supporting the current Maternal and Child Health Integrated Program (MCHIP) that’s being funded by USAID and led by the non-governmental organization (NGO) Jphiego.

Kankan, Guinea, West Africa

MCHIP activities focus on strengthening family planning services, increasing local capacity for reproductive health services, and increasing the quality of care provided at the community level. As a Health Program Specialist, my main responsibilities will be to provide regular monthly updates on program activities in Guinea in English and French, to work with local staff to improve work plans and budgets, and to help coordinate the development of a Public Health and Nutrition Program. It will be a big change and a lot of responsibility, but I’m really excited about working with Save the Children, about spending some more time in West Africa, and about eating avocados for breakfast every day. (Among other things, Guinea is renowned for having beautiful terrain, nightmarish roads and absolutely fabulous fruits and vegetables.) 

I should have regular internet access in Kankan, and will be doing my best to update this blog regularly. That's all for now; I'm off to savor one last breakfast in America, triple-check that I have my passport, and get on that plane.