Brief Return to the Western World

Instead of returning to the states for vacation this summer, I met mom and dad in France for several weeks of comfortable beds, showers that did not require a bucket, meals that did not consistently include rice or fish and sightseeing in the city of lights and beyond. Although I can’t say the trip was extremely restful, it was an exceptional experience made priceless by the fact I was reunited with mom and dad after 11 ½ months of my African adventure. The first hugs are etched into my mind forever as they are a testament of my ability to survive in a foreign culture without the comforts I had relied upon throughout my life or the daily interaction with family and friends, especially in times of frustration and trouble. Stepping onto the plane to leave them once again was probably the most difficult experience of my life to date but here I am after hours of difficult travel slowly readjusting to life in the RIM.
From the Louvre down the Champs Elysees to the Arc De Triomphe, to the banks of the Seine and the historical beaches of Normandy, to the golden gates of Versailles, the street markets around the Place de la Republique and the gargoyles of Notre Dame – I set eyes on a lot while on French soil. Half of my time was spent exploring Paris and the numerous sights it has to offer, including the Eiffel Tower and hundreds of paintings and sculptures housed in museums across the city, while the other time was spent reconnecting with family in Normandy. With a cold rain falling during most of our time in the north of the country, we managed to visit Mont St. Michel and the D-Day beaches (although I missed President Obama’s visit for the 65th anniversary much to the dismay of the Custom’s Officer at Orly Airport) plus multiple enjoyable visits to the local grocery store and one morning mom and I were pampered with much needed water based spa treatments in Bagnoles. However, the best moments were those spent within reach of my family, huddled up on the couch in front of a roaring fire or sitting around the dining room table for delicious 4 course meals.
In a country where I am rarely alone, I often feel isolated without a concrete understanding of the local culture and my position within it. Here, men and women rarely touch even within one’s family group and interaction is limited between women. Hugs are unheard of and while small children are sometimes kissed on the forehead I have never witnessed kissing between adults not even the cheek kissing common in many European countries. I have come to realize how heavily I relied upon interactions with male friends and basic physical contact with my family and friends. A hug, an extended handshake, snuggling with my roommates on a single bed during college, a hand placed on your back in passing and many more daily interactions are all things that I miss greatly.
While in France I was lucky to see not only mom and dad but Martha Key (a cousin of mom’s) and her husband, Graham, who we stayed with in Normandy in addition to my cousin Becky and her friend Pete who were passing through Paris during my last few days. Both Becky and Pete are architecture majors and so I enjoyed spending much of my last few days discovering hidden parks and interesting buildings scattered throughout Paris while also getting my fill of chocolate mousse and a variety of ice creams on the unofficial chocolate tour.
I was slightly nervous weeks before leaving for France that my French was not sufficient so I spent each night reviewing a few vocabulary words and sentence formation only to land in the airport and realize that most people speak English. Each time I tried to ask a question in French I was usually answered in English, thwarting all plans to show off my improving skills. However I did have the opportunity to impress my family with a little taste of my new language, when I ran into a Pulaar speaking Senegalese man during my last dinner in Paris.
While in Normandy, I was informed via email that the new class of PC Mauritania volunteers were denied visas by the Mauritanian government due to the unstable political situation started with the peaceful coup last August. Although rumors and speculation had been flying for months that this was a possibility since no Americans are currently being issued visas, no one truly believed that it would occur, so now everyone is watching and waiting to see what will happen next. We are told the new volunteer training is merely postponed until after the elections scheduled for July 18th (originally planned for June 6th) but the likelihood of the election date being postponed again is high, so now that I have returned to the RIM the wait continues among increased speculation.

Thoughts on Tradition

A 24 year old girl from my village died last week due to complications from eclampsia. Although she was transported via ambulance to the hospital in Boghe, then Aleg and finally to Nouakchott – the most sophisticated hospital in country – she still died along with her baby born prematurely at 5 months. As I listened to the wails of her mother which were audible for days as they rang throughout the village, I returned to thinking about culture and its intersection and influence on the health of communities and individuals.
Culture is something I have spent a lot of time observing and contemplating over the last year. Adjusting to a new culture is a day-to-day, moment-to-moment rollercoaster and as I learn more about local culture I have found myself becoming more enlightened about my personal culture which is highlighted against the backdrop of a country different in numerous ways. I do not fully understand the Mauritanian culture (and maybe never will) but I am appreciative of many of its elements and of the families who have generously provided food and shelter [free of charge] to me during my stay. Each day I continue to accept the inevitability of many Mauritanian ways although I often do not like or approve of them and have come to turns with the fact that traditions are hard to break, even those which are dangerous to the health or livelihood of one’s family.
This trend exists worldwide – take for example the fact that many Americans and Europeans smoke although research proves that smoking and chewing tobacco can increase the risk of a number of health problems including lung and throat cancer, heart disease, etc. Thus it seems information, although necessary to making an informed decision, is rarely enough by itself to produce behavior changes in people. Change takes a long time and is difficult because one is often working against social and environmental conditioning and thus the benefits of behavior change must be compelling. America is scientifically advanced with studies appearing daily that provide data to encourage healthy living and choices but people still resort back to old habits which are comfortable and often acceptable within the community, so my hopes for Mauritania are limited.
Based on my observations, the biggest health concerns in the south of Mauritania seem to be malaria, schistosimiasis, childbirth and dehydration secondary to diarrhea. Diabetes, heart disease and high blood pressure, cancer and strokes are likely problematic but are often undiagnosed prior to death due to limited health care and no preventative medicine. In America and other developed countries, many of the same problems exist but they are often caught early and treated in technologically advanced health centers leading to a significantly longer lifespan for men, women, and children. Modern medicine continues to progress but the trickle-down into the developing world is long and tedious.
Culture and tradition seem to be exceptionally strong factors in Mauritania. Take for example the acceptable practice of arranged marriages, during which women are often forced into marriage between the ages of 12 and 18 to men often 10 years their senior. The first child is usually conceived within the first year of marriage and within their lifetime women often deliver 7 to 12 children although not all survive into adulthood. Nonetheless, how do you encourage a teenage girl to wait until 19 or 20 to have sex when everyone else in her life – parents, grandparents, friends and peers – are perpetuating an unhealthy behavior. Arranged marriages at an early age are an age old tradition which obviously does not always have tragic outcomes or else the population would have disappeared years ago, so people continue with the behavior because it is expected within the community.
The fairly recent creation of health posts throughout many developing countries has lowered the rate of deaths by providing a place for treatment without having to travel hundreds of kilometers for basic treatment and by encouraging pre-natal exams and allowing women to deliver in the presence of trained health professionals and in theory with increased sanitary conditions when compared to one’s home. The rate of maternal and infant mortality is still uncomfortably high, and it has progressed significantly in the last decade, suggesting more needs to be done in all aspects of health and medicine.
Eradication of malaria is currently impracticable and a vaccination is still unavailable but malaria is often preventable with an appropriate prophylaxis and treatable with a variety of drugs, but both the prophylaxis and treatment are generally expensive for long-term use and in many affected countries hard to find. Thus, programs promoting prevention are important in many countries, including Mauritania, especially since the likelihood of contracting malaria can be significantly reduced with a few simple precautions such as limiting the exposure of skin throughout the night - wearing long sleeves and pants, using mosquito netting to cover windows and doors or sleeping under a mosquito net – or wearing neem cream – a cream made easily out of locally found materials that repels mosquitoes – after dusk. Although the use of mosquito nets has increased greatly over the last decade, little seems to be done to prevent bites from dusk until bedtime, approximately 4 hours later. This practice seems to be cultural and often the activities before bedtime include watching television, napping or generally sitting and talking in the open air – nothing that could not be performed under the protection of a net.
Schistosimiasis in contrast to malaria is unpreventable because life in many African villages revolves around rivers – bathing, swimming, watering plants, washing clothes and dishes- and has done so for centuries, but it is easily treated if caught early. In Mauritania, it is a common disease that leads to high morbidity rate because many people do not seek treatment before bodily damage has started. Symptoms are often ignored or are pushed aside as unimportant until major medical intervention is required.
A recent study by WHO discovered that car crashes are soon going to become the number 1 killer of children in the developing world, bypassing malaria and dysentery. Although Mauritania is a dry country that likely has a slightly lower rate of automobile crashes, it also has no laws requiring seatbelt usage (seatbelts are not even available on most cars), restraining devices for children (children always sit on the laps of parents to prevent having to buy another seat) or limiting numbers of passengers (10 people usually in a car made for 7 or 8), thus serious car accidents likely result in the death or injury of all people involved. Without governmental laws, cars will continue to be overcrowded and children sitting on laps because it is economically beneficial for the drivers. Once again, money seems to be more important than safety when bureaucracy is involved.
How do you remain culturally sensitive while encouraging a population to change deeply ingrained cultural foundations? How do you tell a midwife who began practicing before I was born that many of his/her practices are inappropriate and dangerous, when thousands of her patients have beaten the odds, and survived? How do you teach people to eat more fruits and vegetables when they are not always available or may be unaffordable? How do you encourage a family to limit the number of children they produce when society dictates a big family is necessary for adequate continued existence? These questions and more fill my head daily as I try to change perspectives while attempting to remain culturally sensitive and respect the reasons and decisions behind tradition.