The First Lady of Guinea

I am in Conakry now, doing all my Close-of-Service stuff, and I came across this photo from Save the Children's "Race for Survival" event back in October.

Save the Children and Mme. Djene Kaba Condé

The First Lady of Guinea (in the light green shawl) invited us to stop by and greet her while she was visiting Kankan, so of course we went. Outside in the courtyard of the house there were a bunch of very intimidating-looking security guards with big guns, and a bunch of little kids who gawked at me entertainingly, and inside everything was very calm and quiet and fancy. Everyone was really nice and the First Lady, who has her own philanthropic foundation, seemed legitimately interested in Save the Children's work in Guinea and Mali.

It was a neat morning - not every day one gets to meet a First Lady. 

Meetings

Shortly after I arrived in West Africa, I was told by an older PCV to always bring a book, my cell phone, and plenty of credit to any meeting I attended, so that I'd have something to keep me busy. I remember being slightly put off - it seemed so disrespectful, I imagined that I'd want to be attentive throughout any meeting to which I was invited. But that was before I found out just how long it can take for a meeting to get started here, and also just how long it can last once it gets going.

Disclaimer: It is often worth it to go to meetings, and important things do happen at meetings, so it's good to pay attention. It can also be helpful to have something to do for the hour or three before things get started, and to have something on hand to help you stay pleasant during the more frustrating parts.

That being said, here are some things that I would include if I were making up a game of Guinean Meeting Bingo:

• Things starts at least two hours later than scheduled 
• A host country national complains loudly about how nothing ever starts on time 
• A host country national complains that the punctual people aren't giving others enough time to talk
• At least six cell phones go off 
• At least two people answer calls and have a conversation about how they are in a meeting
• Someone hands out plastic folders containing gridded notepads and blue ballpoint pens
• There are at least three fake fruit and/or fake flower bouquets in the room
• It is approximately 95°F/35°C in the room but it feels so much hotter
• The guy in front of you falls asleep in his chair
• A local official shows up, accompanied by an armed soldier, to declare the meeting officially started
• Lunch is served at 3:30 PM or later
• Someone hands out cans of tepid orange Fanta
• Someone asks if you are married 
• The power goes out and it takes at least 20 minutes to get it sorted out
• A long period of time is spent reading text from PowerPoint slides
• A supposed professional says something wildly inaccurate, i.e. "Fistula is a women's problem caused by HIV."
• Someone says "We are running very late so I will be brief..." and then talks for nine minutes
• Someone says "We have already thanked everyone many times..." and then thanks them all again

Oh, meetings. I can't say I'll miss them, but I will miss commiserating about them and trading never-ending-meeting stories with friends and co-workers, at least a little bit. 

The Other West Coast

A couple weeks ago eight of us set off on the long journey from Kankan to Komsar for a Close-of-Service (COS) conference. We filled up our own "taxi" station wagon and made good time on drive from Kankan to Conakry (only 18 hours!) and then a Peace Corps bus took us the rest of the way.

While were in Conakry we got to see the impressive solar eclipse - Sarah J.'s mom had been thoughtful enough to send solar viewing glasses called Eclipsers so we could actually look at it -- they looked a lot like mirrored 3-D glasses, the kind with paper frames. Everyone looked very retro-futurist, all lined up on a rooftop, little mirrored eyes all pointed up to the darkening sun. It was a fun day.

The next day we arrived at a very nice (by Guinean PCV standards) hotel in Komsar, a coastal town just on the edge of a wide swath of mangroves. This COS conference was really for the G21 group of Volunteers - the 21st group to come through Guinea - but they were kind enough to include the three Response Volunteers who'll also be departing early next year.

G21 in Komsar

COS conference is where PCVs (and PC Response) start getting prepped for re-entry into American life - there was a lot of discussion about paperwork and benefits, some good sessions aimed at reflecting on our service, and strategies for dealing with the inevitable onslaught of people half-interestedly asking "So, how was Africa?"

It was a really good conference - the sessions were good, the general mood was relaxed and happy, the rooms had water and electricity in the evenings (for the most part), the food was fine, and there was a pool. A pool that grew increasingly murky with each passing day, but everyone still had a good time. G21 is a remarkably pleasant group of people - they play chaise-ball (a highly spirited pool version of basketball but with chairs instead of baskets), they had an awesome group t-shirt, and they all chipped in to give a very sweet gift to their training manager (a Kindle, because he likes to read and libraries are not a thing here.)

All the questions I had about COSing as a Response Volunteer were answered, I worked on my resume and got all the forms I'll need - medical, legal, financial and so on - to fill out before I leave Guinea. Even with all the D.C.-mandated PowerPoints and going over paperwork, it was a really enjoyable week, and it made me feel like my departure is right around the corner.

(People took many more photos, but they haven't been uploaded yet, so more on that later.)

"Race for Survival"

As a part of Save the Children International's global EveryOne campaign Save the Children/Guinea organized a "Race for Survival" event to raise awareness of child survival issues and to advocate for policies that benefit maternal and child health, such as increasing national spending on health and supporting access to essential health services. 

While a lot of progress has been made of the last decade, Guinea still has a relatively high infant mortality rate. For every 1,000 children born in Guinea, 126 will not live to age five. For comparison, in the United States, about 8 children out of 1,000 will not make it to age five, and in countries like Sweden, only 3 out of 1,000 children will die before age five. (UNICEF, 2011) So, there's a lot of room for improvement. 

The first day of the "Race for Survival" in Kankan consisted of a gathering of decision-makers and prominent community members, including the Governor, the Head of the Health District, representatives from various NGOs and partner organizations. The guest that everyone was most excited about was the official representative of the First Lady of Guinea, accompanied by a man from the First Lady's charitable foundation. 

The "Family Photo" from the Day of Advocacy

I didn't take any of these photos, but the guy who took my camera did a good job, and seemed to be completely comfortable about getting in there for close-ups. You can see me, or the top of my forehead, anyway, it the upper left of the doorway in the photo above. Below from left to right, we have the representative of the "Parlement des Enfants" children's group, giving a speech for the local radio, my supervisor, Fatoumata D., who is fantastic, and my colleague and same-name "tohoma" Adama D., who was in charge of getting the Day of Advocacy together. 

 

Below, left to right, are the Honorable Governor of Kankan, me, and the Official Representative of the First Lady. (They both were very polite but we didn't actually talk much. 

The Fancy Table

(One of the things that I love here is that the floral bouquets that are generally used to decorate tables and offices and whatnot are usually made with fake fruit instead of fake flowers. The little blossoms above are actually small, fake, upside-down peaches. There were two others made with apples, and in the market I've seen everything form chili peppers to bananas - someday I want to buy a mixed-fruit bouquet, but they're actually kind of expensive.)

The next day the relay-style "Race for Survival" was held at the Kankan stadium. (Save the Children held similar events were held in countries all around the world on the same day.) Local school kids raced from prizes, local officials showed up, there were radio and TV reporters, and some of my Peace Corps friends came. Michelle, below right, even got to hand out some of the prizes! Cellcom, a mobile phone company sponsored part of the event, which is why there are big red umbrellas out on the field for no practical reason.

There were speeches made about child survival and maternal health, t-shirts were given out, a military band played, the kids were all really happy, their parents were all super proud, and everyone had a good time. 

Fun fact: Lily, on the left in the photo on the right, was the wonderful who brought my fancy shiny new computer with her when she came to visit her friend (my neighbor) Michelle.

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.