Now I Eat the Fish Bones

A plane with 33 new Peace Corps volunteers landed in The Gambia on October 12, 2016. Which means that we have officially been in The Gambia for a year. I’ve recently watched the musical Rent, and so you know what’s coming next. How do you measure, measure a year?

My first few nights in county were confusing. I didn’t know the language, didn’t know the culture, and didn’t really know what I was doing here. I distinctly remember getting my dinner food bowl, rice and fish, and having difficulties eating in the dark. Fish is a staple food here, with access to the ocean and to the river, and is a cheap source of protein. Unfortunately, some of the fish are small and have lots of bones. I remember meticulously picking out each bone and leaving the meager amount of meat in the bowl of rice.

The other day I had the same dinner. Rice with sauce and fish. Not the most nutritious, but it’s what we have to work with. Except this time I was the farthest thing from meticulous. I was tired and hungry and ate all of the rice and fish, only stopping for the larger bones. As I looked down at the empty bowl, I realized that now I just eat all the fish bones.

And it feels like a pretty accurate measurement of a year.

When I got here last year, fresh from Public Health school, I was expecting to engage in some professional studies, data collections and national health campaigns. I thought 2 years was enough time to cure preventable diseases, implement groundbreaking practices, and revamp the health system in this region. I thought I could meticulously pick out the bones and that there would be lots of meat there for the taking.

And now, I just eat the bones. Because Public Health is absolutely not any fancy studies or perfect bar graphs or accurate data collection tools, especially in a rural developing nation. Public Health is going to one compound every day to make sure they’re washing their hands, it’s talking to the woman over and over about throwing her trash in the street, even though we have designated trash disposal sites. Public Health is behavior change, which is so much more complex than anything I could have imagined.

Some days here are very frustrating. People are stubborn, health systems are difficult to change, and at times I feel like I might not really be doing anything. But I’ve learned to take the good with the bad, the fish with the bones, if you will (I’m done with the analogy now). Because sometimes people call me inside their homes to look at their bed nets, or they’ll show me their kid’s health card for me to make sure they’re well nourished. Or if I’m gone from village for 3 days, they’ll scream, “Ali, nemonalla!” (“Ali, I missed you!”) when I get home.

Those are some qualitative things that have changed in the past year. I’ve put things in perspective, made some great friends, and feel really happy and privileged to live here. If you’re looking for some more quantitative changes, check out the data from our compound inspections! I went around the village with our Village Support Group in March and again in September to check for overall cleanliness, handwashing stations, bed nets, and trash disposal. Here’s what we found:

Handwashing Stations
(Note: Handwashing with a kettle and bowl (running water) or a tippy tap and soap is preferable to washing hands in a bowl. It is a traditional practice to have everyone wash their hands in the same bowl, thereby increasing the risk of disease transmission)

Bed Net Usage
(Note: in May 2017 there was a nationwide bed net distribution, so everyone should have bed nets. Now we’re encouraging people to use old bed nets outside if they’re sitting and chatting at night. Bed nets are used to prevent the spread of the mosquito borne disease malaria)

Trash Disposal
(Note: in May 2017, we created 5 designated dumping sites in the village for trash. Before, people would throw it behind their houses or inside their compounds)

Thanks for the support over the past year! Hope you aren’t too sick of getting these updates yet, because we’re only halfway there!

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