Inspiration

I wrote the following for an article in the Peace Corps Mali newsletter, and liked it enough that I've posted it on here as well. You can learn more about Mali Midwives on their website, http://www.malimidwives.org/index.php

This past April, I assisted two doctors from the Koutiala CSRef on supervision visits to rural maternities. I was asked to do this by a woman named Nicole Warren. I really had no idea who Nicole was - I had heard she had been a PCV in Mali in the 90's and that she ran a small NGO that provides funding for training and supervision of rural matrones in the area. Bouncing along a dirt road on the way to one of these visits, one of the doctors turned to me and said, "Nicole was a volunteer here, and look at what she has done after returning to America. How will you help us once you are finished being a volunteer?" I must have shrugged, unable to come up with a decent response. Part of me wanted to say, "isn't this enough?" while part of me recognized that in some ways, my service is not, could never be, enough. So no, this is not my success story. This is about a woman who’s shown me that Peace Corps does affect you for the rest of your life and that you really can do so much more.

I finally met Nicole Warren when she came back to Koutiala to hold another round of matrone trainings in December.  At this point, I’d gathered a few more details about the project, but really came to understand its purpose during the weeks of the trainings. The December trainings focused on AMTSL  (active management of the third stage of labor), and partographs, while being funded by the small charitable organization Warren founded, Mali Midwives soon to be an official NGO. I spent part of December and January assisting Nicole and a student of hers to conduct research and facilitate the trainings at the CSRef. I was impressed to see the matrones show up early every day in their nicest outfits to discuss their homework, excited to have the chance to get more training.

A little bit of a background – Warren was a volunteer in Mali from 1994-1996. Working with matrones in Mali helped her see the importance of maternal health in the community and in a broader public health context. Her interest tuned to the public health realm, Warren turned to nursing specifically because, as she says, “… nurses collaborate on a plan of care and then are with the person while it is playing out. They’re in that intimate setting where the person is experiencing a birth, a death, an illness.” After getting degrees in nursing, public health, and midwifery, she developed an interest in research on the matrones, and pursued a PhD in nursing.

While working on her dissertation, Warren found that each matrone was all but begging for more help and further training - she found it impossible to ignore that plea. Malian Midwives was born out of the matrones’ need for better training and Warren’s own need to work with and research these women; it was “a way to respond to their request for help after how much they’d helped me”. Nicole Warren founded the organization between 2007-2008 to facilitate continuing education for rural auxiliary midwives. In 2009, ’10, and ’11, it sponsored formations for matrones in a USAID training called “Essential Newborn Care” for the matrones’ literacy and skill level as well as AMTSL. When asked about matrones in Mali, Warren becomes animated and passionate when discussing how once a matrone is chosen, she can’t get out of it and is all but branded, even if she does not receive the training, help, or salary that she needs. These women, who give all they can with the little they’re given, are what inspire and compel Warren.

Today, Mali Midwives facilitates trainings for matrones implemented by the CSRef. Warren is adamant that the trainings are dictated by the needs and wishes of the matrones themselves. Warren envisions bringing the matrones to the level of a skilled birth attendant, an internationally recognized provider position. This requires augmenting the matrones’ skill level and assuring they have an ‘enabling work environment’ – definitely a daunting task. While working with these women, Warren is also conducting research on the needs of the matrones as well as the impact of the trainings being held. This, as she always carefully explains to them, is so that she can tailor the projects to specific needs, create the most effective program, and in the long term support the continued funding and possible expansion of the project. “What I’d like to demonstrate,” Warren explained, “is that if you invest in matrones, you can see a difference in maternal health and neonatal outcomes, that they are the key and are worth investing in. If we could show that in Koutiala, it can be a model to apply to the rest of the country…. If we can learn more about how to recruit, train, and support providers like matrones here, that information could be used in similar settings [internationally]”. It’s a lot of work, but she is certain that it is worth it.

Nicole Warren continues to impress me with her ability to stay motivated and focused on long-term goals to improve the lives and work of matrones in Mali. Before joining Peace Corps, I assumed that after the 27 months, I would just move on to the next phase of my life. Being here, I’ve come to realize that it will not be that easy to let go. Working with Nicole I can see how it is possible to continue your service in a broader sense, and that all of the energy put in to this service can be transferred and maintained after leaving Mali. This doesn’t mean I’m about to apply to nursing school (though, honestly, Warren did suggest it more than once), nor have I come up with any sort of answer for the doctor who asked me what I will do after I COS, but that I recognize that there are available options to nourish whatever it is that drew me to Peace Corps in the first place and that I can chose not to just walk away next fall.  


----------------
A little extra...

As of 2008, UNICEF rated the maternal mortality rate at 830 per 100,000 births, and the lifetime risk of maternal death at 1 in 22. The most frustrating thing about those numbers is that there are very simple procedures that could substantially cut them down. AMTSL consists of 3 steps that a matrone can take to protect the mother from post-partum hemmoraging, one of the major killers of women in Mali. One of these steps is simply to massage the woman and make sure the uterus is contracting correctly. A partograph monitors a woman in labor and if/when she needs to be evacuated to a better equipped facility. When used correctly, this little piece of paper can save lives. It was haunting to see how many matrones at the trainings did not know to take the most basic steps, how few recognized the actual purpose of the drugs they administer to women in labor, how many filled in a partograph with nonsensical marks and numbers. Simultaneously, I was inspired by how intensly these women wanted to learn as well as the conditions they work in. As with any sort of training or class, they became tired, bored, restless. But they were all very careful with any materials given to them, and recognized that learning these things could help them save lives. We talked to women who had not been payed in years, who do their best without important tools and materials, who don't receive nearly enough respect nor support from their superiors and communities. These women are what drive Nicole, and I can understand why.

Between this project and the holidays, I've spent about 2 1/2 days in F. since the 10th of December. I'm heading back tomorrow morning to hopefully stay for a month straight (really, I am so excited to get out of cities and back into my tranquil little village). Most of that time was spent in Koutiala on this project with Nicole and as much as I miss village, I feel so privileged for being able to be a part of a project on the ground that has the potential to affect so many women. I'm still blown away by the motivation and will-power Nicole possesses, as well as her warmth toward all of the matrones. Hopefully that will motivate me in my own projects in the coming months.



It Takes a Village

One evening a couple weeks ago, I was taking a cab back to the stage house in Bamako. As the car pulled up to a stop sign in the middle of the city, the driver rolled down his window to ask a little girl - 3 or 4 years old, I'd guess - where she was going. She said she just needed to cross the street, so my driver flagged down another person to go with her before we drove away. As we continued, I smiled at how Malians automatically look out for children, strangers or not. I realized that situation wouldn't take place in the states not only because the random taxi driver wouldn't take note of a child on the corner, but also because very few young children would be out on a city street corner alone.

Seeing children walking down the dirt paths by themselves is normal in F. I might ask Adiaratou where Ina, her 2 1/2 year old, is and get the answer that she's wandering. Now Ina is still a little young to go off by herself, even by Malian standards, but it's OK because her 5 year old sister and friends are there to hold her hand. Children are let lose in the village because there is always someone there to take care of them, always someone watching. If a young child falls and starts crying, any adults - and older kids - nearby actively assume the roll of care-taker. I should note, however, that unless there is a serious problem, the adults usually just yell at the kid to stand up and go home, or yell at one of their own children to go take care of the one that fell. Still, every child here has multiple people to run to - adults as well as other kids, again - when in need of comfort. Everyone has a family nucleus, but when you step outside of that, you still know everyone around and have little to no privacy from them - they're kind of an extended family. So then you let a child who's still waddling when he walks careen off out of your sight - the village will take care of him, and he'll be back.

I'm fairly certain this is how my village sees me - I'm their adopted child and it's their job to raise me - all of them. They must think that I've grown up in the last 18 months; I no longer get passed around at large gatherings but am allowed to wander and come and go as I please. Still, when they bring out the food I have at least 10 women telling me which bowl I will be eating out of and where I will be sitting. These women are my friends, but they can't seem to help themselves from mothering me as well. I suppose that in some way they are raising me in that this experience is changing me so much. Some days I think of myself as a group pinchpot art project, and they're all leaving their imprint on me. Then again, some days I just think they're all crazy. 


'Tis the Season

A few weeks before Christmas, I spent the night at Bethany's place. We made American food for dinner, brownies, and watched Elf - it was December, after all. And really, I had a wonderful night, besides being uncomfortably full from WAY too many brownies. But as the movie ended, I felt a wave of homesickness building up, rolling towards me. I spent the next few days craving random things - snow, Christmas tree hunting, the smell of evergreens, Christmas lights, all sorts of food and drinks - but mostly missing my family. Elf, like many Christmas movies, has that underlying message that you should spend the holidays with your family (in a loving and forgiving mood at all times, of course). And if I could chose to be anywhere during the holidays, it would always be with my family, hands down.

Celebrating American Holidays is strange here, and each volunteer deals with them differently. I handle Thanksgiving by gorging myself on food and quality time with friends, though this year it was harder, knowing my extended family on my mom's side was all sitting together and I couldn't be there with them. I deal with Christmas mostly by ignoring it, which is easier than it sounds. Think about how much of the holiday season is about the build up. We spend December surrounded by decorations and advertisements (many coyly disguised as well-wishes from major companies), listening and singing along continuously to the same songs each year. Everything is red, green, or metallic and shiny. You're surrounded by men dressed up as Santa and people wishing you happy holidays. We each have traditions and spend a lot of time - whether last minute or not - looking for a 'perfect gift.' Now imagine that's all gone.

That's how my December becomes just like any other month. I never put Christmas music on my iPod in the first place, because sitting in my hut alone, it actually just makes me sad. The plastic ornaments and snowflakes my Aunt sent last year are hanging all year long and have lost their holiday significance. I'm not a grinch or anything - when I'm with other volunteers, I'm more than happy to listen to Christmas music or watch a Christmas movie, but I've found that doing those things when I'm not with other Americans just makes it harder for me.

But before you go feeling sorry for me, let me explain that another way I cope with not being home for Christmas is going somewhere really cool instead. I'm still celebrating the holidays, I'm just trying to do it in a way that I can keep seperate from Christmas in Iowa. Being in Mali, that isn't too hard. Last year, I camped out at some beautiful waterfalls with a small group of friends. This year, I went on a 3 day hike through Dogon country, whcih is considered one of the top 10 hikes to do. In the world. Christmas eve, I was climbing around and taking photos of homes built into the cliffs and then sharing a large, delicious Mali-style meal with other volunteers. This allows me to still enjoy the holiday and not get stuck wishing I was at home. Whenever a volunteer tells me s/he spent Christmas in village, I can't help but be impressed. You can always make it your own, of course - have a party, go to the Christmas service at the local church, hang out with any nearby Christians for the day. But still, I think that would make it so much harder.

So now it's January. The holidays are over, apparently - facebook told me all about how everyone took down their Christmas trees. Like much of my time here, December flew by and I'm looking forward to projects in 2012. I am also really looking forward to spending the next holiday season at home with my family (and I really hope there will be snow!)

Peace & Love
Elyse