What To Do When Nothing's Doing?

Here's a question for you: If I told you that if you didn't do x, then you risk "y", which could potentially be fatal, is it my job to bail you out when, having ignored my initial advice, you find yourself in a bind? At what point do I get to say "no more", and leave you to deal with the consequences of your actions without my nagging voice in the background?

This is essentially my current dilemma.

X can be anything from washing hands, to vaccinating kids, to treating well water, to going to the doctor when you're sick, to feeding kids nutritious foods, to sleeping under mosquito nets....the list goes on and on and on. And, well, we all know what y is.

It's just not me encouraging folks to practice good health. There are people on the radio who tell them multiple times a day, there are people on TV who tell them, there's a doctor at the local health center who's supposed to tell them, there are classes in the schools to tell the kids, and yet for some reason, they're still not quite getting it.

So where does that leave us? Should we keep banging our head against a wall to get people to change their ways? Or is it true that behavior change takes years, or even generations? Are we planting a seed that's still germinating in the minds of Malians? Or maybe there's something wrong with the way we're approaching the problem?

Hand washing is a good example of a practice that I think Americans accept without a doubt. It's easy for me to observe (easier than family planning methods, for example), non-intrusive, frequent and inexpensive to practice. Or so you thought.

I spent every day of the past week at my health center (something I've never done before) and I got to watch their personal health practices. And guess what I found out: THEY DON'T EVEN WASH THEIR HANDS WITH SOAP BEFORE EATING! This they includes a university trained doctor, and he eats every meal with his hands. One of my best friends is the pharmacist (our friendship being founded on our mutual stubbornness), and we have regular spats about why he refuses to wash his hands with soap before eating. "But Rokia", he'll say, "we've been doing it for years, and we're not dead yet, and we even let our kids drink the dirty water after everyone has dunked their hands in it. And guess what? We're not dead yet!".

This "saving the world" business is not easy. I've been beating myself up a bit recently looking back on the past year, mainly because I don't feel like I've done much with my Peace Corps service. But as I think of things I could do to be more productive and effective, I always end up at the same roadblock: the idea that whatever I do won't change much. Let me try to explain.

I'm the third PCV in my town, the other two having been environment volunteers. They were responsible for, among other things, the construction of a classroom for our school, soak pits for people's latrines, and the formation of a chicken raising group. When I think about these projects, and where they are today, here's what I see: the school is barely holding on because of bad politics in the village, the soak pits are over-flowing raw sewage into the streets because they haven't been properly maintained, and the chicken group fell apart long ago (update: they actually came to me recently and told me they wanted to have a meeting in the near future. My knowledge of all things chicken related is about to expand exponentially!). My villagers tell me they want to get our maternity up and running, but then whenever we suggest doing something, the idea either gets shot down or they agree that it's a good idea, and look right at me to do the work. Oh, and I'm my host families third volunteer (that's 5 years of daily interactions with an American) and they still don't wash their hands with soap. So....what can I do that will change anything in this village? And if my definition of a successful service is creating something sustainable (which hardly seems possible at this point), why would I spend another year here?

Well, let me tell you. First, because despite the fact that sometimes working here makes me want to poke my eyes out, I really do enjoy what I'm doing. My job on a day-to-day basis basically consists of hanging out with people talking about either the differences between America and Mali (we've come to the conclusion recently that "an te kelen ye" -- we're just not the same), and talking to them about their health practices. We eat lunch, I ask for the soap, and make them wash their hands (I actually found out yesterday that lots of people in my village don't even wash their bodies with soap on a normal basis. I believe the exact quote was, "Rokia, I can go an entire year without ever washing my body with soap!" Yes, they're right: an te kelen ye at all), and ask why they don't normally do it on their own. Recently, we were sitting around after lunch talking about nothing in particular, when one of the women started making fun of a specific boy for getting his girlfriend pregnant. Whoops on his part, but what a perfect time for me to bring up condom use and birth control!

As I mentioned, I spent everyday this past week at my health center. It was vaccination week, and since I've decided to shift my midwife clinic project to the back burner for a while, I decided to go help the health clinic folks with their vaccination runs in local villages. I'd done it once before, but it'd been a while. They (the vaccinator who's a woman about my age, and a midwife) rode their motorcycle out, and I followed on my bike. We hit six villages in three days, and I was able to discover really beautiful parts of my area that are especially pretty at this time of year when everything is green and lush. But more importantly, I was able to restore my faith in the local health system in Mali! I've heard stories about arrogant, condescending, and lazy health workers, and fortunately for everyone in the surrounding towns, ours are nothing like those horrors! They're the exact opposite, in fact!

Kadia (pictured left at the training we went to in Koutiala in May), the midwife that went to do vaccinations, has been doing her job for more than 30 years and has been at the clinic since the center opened in the 1970's. Her husband was a nurse there until his death a few years ago. She knows the villagers, and seems to have a really good relationship with them. This past week, a woman came to my village from somewhere up north, and brought her small bodied, huge headed child to be vaccinated. Kadia didn't directly say anything to the mother (which could have been rude, since she had never met this woman), but instead found a man from the family where the new woman was staying, and told him that he needed to do something about this kid before it was too late. She really cares about the women and kids, and seems to go above and beyond the call of duty to take care of folks. Whenever there was a pause in the baby weighing (that was my job -- only got peed on once, which might be a record!), she'd start asking the women about good breast feeding practices. Kadia is doing exactly what we were told that a midwife should be doing in her community!

So why do I stick around? Because I think there are good people here who are stuck in a system that's not giving them the credit or respect they've earned. Because I've made good friends like Kadia who're doing their jobs really well. Because the kids who come hang out with me anytime I'm home are simply adorable. Because my new strategy involves finding something that's already up and running, and adding my energy to the effort. There's no point in trying to reinvent the wheel, right? And ultimately, I stick around because I get paid the big bucks to ask the big questions. So, who's got the soap?