Hektoen International

A Journal of Medical Humanities

Of starlit huts and Sahelian sand

Sara Buck
Chicago, Illinois, United States

Car rapide by Ferdinand Reus, originally posted to Flickr
Car rapide
by Ferdinand Reus, originally posted to Flickr

Landing in Dakar airport, the Air Afrique flight from New York hummed into the humid night air. Having traversed the nocturnal waters of the Atlantic, our plane descended upon the capital city, its sparse lights glittering along the coast and the nearby Île de Gorrée as if lava were streaming down a recently erupted volcano. The cabin doors opened, and the city greeted us with the sound of farm animals mingled with the weight of the muggy night air, the ocean, and distant traffic, an illusion that masked the reality of the urban sprawl that surrounded us.

I lugged an enormous suitcase and backpack into the tram that carried us across the landing pad to the terminal. O’Hare and JFK seemed like urban metropolises compared to the Dakar airport; nearly empty, the building was a densely humid, sleepy village whose single convenience store and restaurant were closed for the night. The only signs of life emerged from the tired, but deadly serious and armed customs agents who insisted on searching my tightly packed and somewhat disorganized bags. The silence of the airport’s interior left us unprepared for the market-like atmosphere that awaited us immediately outside. Beggars and taxi drivers surrounded our group of thirty-four, “Madame! Madame! Taxi?” “Donne-moi une petite pièce!

Little orange, white, and blue “Alhums” cut through the mayhem and pulled up to the curb. Windowless and beaten by the Dakar traffic, the sun, and the Sahelian sand, these so-called car rapides were affectionately named “Alhums” by Peace Corps volunteers because they were always decorated with the word Alhumdulilahi, or “Thanks be to God”—a thought that any passenger surely had if he managed to safely arrive at his destination in one. Piling into this colorful, rattling tin can with my colleagues, I felt overwhelmed by the stifling heat and the nearly consummate darkness of the city. The moisture clung to the filthy, decrepit buildings, slums, and shacks that lined the route nationale, allowing only for a chorus of insects to emerge from the tropical soup as we left Dakar.

We rumbled towards Thies, where we were to spend the next three months training as either rural health or small business volunteers. I was disoriented by the enormous change in my surroundings, having left the fall breezes and perpetual city light of Chicago for Senegal’s capital city. It was a feeling that I would revisit a few years later when I returned home to the United States. But I had first to establish myself here in Senegal: three months of pre-service training (PST) and two years of Peace Corps service still lay before me.

Hanging gourd by Sara Buck
Hanging gourd
by Sara Buck

Three months flew by, and, having completed PST, I found myself traveling again into unfamiliar territory. Accompanied by my friend John, who was continuing to another village, I was deposited by a beaten Citroen station wagon called a sept places (labeled for the seven passengers it typically carried) to inhabit Sanghare Coly and the small mud hut that my village family had constructed. Arriving with my luggage and a few other essentials that I had acquired in the nearby town of Vélingara, I muddled through the greetings to the amusement of the villagers: No mbad-daa? Tana alaa? Honoo bandu-ndu? Honoo bengu maa? Honoo galle maa?

I soon learned that whatever plans I had outlined for the day could never be so pressing so as to neglect saying hello to even perfect strangers; for as the only foreigner for miles, I was a stranger to no one. With each question, I would patiently wait for the sing-song Pulaar response, Jam tan, Jam tan, Jam tan, Jam tan. Everyone, of course, was in peace. Everyone was always in peace. Even my “uncle” Demba, the brother of the village chief (my host father), would eventually proclaim “Peace only” as he was quickly and quietly decimated by a liver cancer for which he received only Paracetamol for pain and the occasional saline IV infusion for rehydration.

But Demba’s story was yet to be written into my own. Armed with three months of classes in health education, the Pulaar language, and workshops on “Senegalese” culture and volunteer life, I was thrown head-first into a formerly nomadic culture in an area whose small herds of cattle, sheep, and goats, peanut fields, and simple huts hardly resembled the stories of the Fulani empire, which had caved under the pressures of colonialism at the turn of the century. The hot season’s seemingly barren landscape and accompanying Harmattan winds gave little indication of the lush verdure of the rainy season to come. I was left to speculate how these farmers would produce the corn, millet, sorghum, and peanuts that would provide the household sustenance for the year. And how would this land produce the cotton that provided for the average Senegalese household expenditure of $550 per year?

Coton colors by Sara Buck
Cotton colors
by Sara Buck

Having spent part of my childhood near the vast farm fields of Kansas and Illinois, I felt my shoulders relax as I gazed out the backdoor of my hut to watch the sun rise through the leaves of a mango tree, which remained green despite almost three months without rain. This generous tree, whose fruit provided comfort during the hottest months of the year, contrasted starkly with the golden field grass that quickly disappeared within the hungry maws of roaming cows, sheep, and goats. This timeless haven, however, was a stark contrast to the world of schedules and outcomes that I had recently departed. I soon grew frustrated at my own ineptitude with the complexities of Pulaar and village politics, entire days of picking leaves for the dinner’s sauce, and long hours of drinking morning, afternoon, and evening tea with the men.

But here I was, named anew by my host family after a daughter who had emigrated from Senegal to Spain. This new Dieynaba Balde, the Pulaar incarnation of Mohammed’s wife Zaynab, felt like a babe in the savannah, confronted by the failed project of a previous volunteer—a boutique that had closed after members of the village had spent the money to restock the merchandise. There were also the rumors regarding how the local pharmacy’s funds had been ransacked by the health post committee. Other rumors suggested that the nurse who had previously been posted there had vaccinated entire families with water and sold expired medication at ten times the cost of the genuine item. This nurse, who, as punishment, had been reposted to Vélingara, was replaced by a new nurse, Niang.

Niang could not speak the local language, but he was blessed with a sense of ethics that not only prevented him from eating the pharmacy funds, but also drove him to reinstitute certain hygienic practices, such as using sheets on the hospital beds in the poste de santé. Sitting with sometimes 30-50 patients in a morning and bombarded constantly by medical emergencies in their homes by any of the 14,000 constituents they served, these often Wolof-speaking nurses in the bush led a solitary life that often seemed to drive them to corruption or extreme neuroticism. Moreover, my living stipend at $1,750 a year was equivalent to what they earned and shared with countless relatives who depended on them for support. Niang was an honest, hardworking sort, but the cards were certainly stacked against him. I did not envy his position.

These first days, indeed, were dotted with millet pounding, peanut cracking, and oceans of potent frothy shots of sugary green tea, interrupted by questions like, Hodum ko woni? What is that? Honoo o wiyo? How is that said? Initially, members of my village would come to watch the new foreigner pull water and wash clothes until their pity would move them to take the clothes from my inexpert hands. As the rains began to transform the landscape into the fertile abundance that sent everyone into the fields with their tiny hoes, my simple salutations of no mbad-daa? became simple discussions of hygiene and ndiwu reedu. “Running stomach,” or diarrhea, led to the distended stomachs, protruding ribs, and skin problems from which malnourished children in the area would often suffer, like so many places where open wells provide the drinking water.

Peanuts by Sara Buck
by Sara Buck

I looked forward to the vaccination tournées in the bush, sometimes transporting Mariama, a health relais, on the rear rack of my blue Trek single-track mountain bike. We travelled over the bumpy, muddy trails to visit plump breast-fed babies and incite them to tears in order to protect them from polio, diphtheria, tetanus, measles, mumps and rubella. The year was filled with special tournées sponsored by various organizations: special vitamin A supplements, oral polio vaccinations, and mosquito net dipping with permethrin, a loathsome chemical that always burned my arms no matter how carefully I tried to protect myself. Every so often, Niang would inform all of the volunteers of the dates of the upcoming drive, followed by a small informal workshop on the upcoming activity. The supplies would arrive, and we would ride out into the bush walking from compound to compound, the families willingly offering their babes or nets to receive our various potions.

The life of a health volunteer was one project or education drive after another, often through collaborations with a never-ending collection of non-governmental organizations, the aid organizations—the UN, World Vision, the Bill and Melinda Gates Foundation, Tostan—that are synonymous with the idea of “development,” an activity with no discernible end in Africa. From gardens to vaccinations to vitamin supplements, each of these organizations rode into one town or another hawking this or that program to resolve the ills of the targeted populace. What always struck me was that the real underlying cause of the chronic illness, the poverty, was never addressed, and yet it was the proverbial elephant in the parlor.

For our first educational workshop, Tintou, the health post pharmacist and my closest ally, helped me organize a discussion of hygiene using a collection of glass jars containing water, water and sugar, and water and Coca-Cola. Introducing the idea of microorganisms, we explained that just like it was impossible to see the sugar in the second glass of water, it was impossible to tell which water was clean or dirty based on sight, causing diarrhea and malnutrition. We went on to explain that putting bleach in water and washing hands with soap were two ways to eliminate illnesses caused by these invisible pests. Certain that the concept had been adequately explained, Tintou asked for questions. Mariama approached me and simply asked, I already know that I’m supposed to wash my hands before meals and bleach my water, but what should we do, Dieynaba, if we just don’t have money for soap and bleach? It was a question that would revisit me again and again.

It’s a simple question, with no simple answer. Looking back, I recall wanting to live in Senegal in order to know what it was like to be poor. Instead, I left realizing how rich I was. Even in my one-room mud hut, whose furniture consisted of a bookshelf, a trunk, a folding wood chair, and a bed, my belongings were only rivaled by my village father, who kept the majority of the family’s worldly possessions in his hut for safekeeping. Knowing this, I still guarded my personal effects as jealously as if they were something that I could not live without.

Musical interlude by Sara Buck
Musical interlude
by an anonymous French tourist

Living and working out in the bush, there were times when I was supremely lonely. My small collection of books, various tapes and CDs sent from home, the BBC Newshour reliably gracing my shortwave morning and evening, these things gave me a sense of home in a strange environment. But the years passed, transforming me in turn. My musical tastes changed from pop to mbalax. My pastimes changed from reading alone to sitting around the campfire listening to my host mom tell Br’er rabbit stories or Pulaar jokes. And as my possessions gathered dust from their existence in a dusty savannah, I wondered if it was worth jealously guarding these items whose usefulness would expire prior to my return home—as dust-clogged electronics and books are not so highly prized in the US as they are in Senegal. I especially wondered whether or not it was worth maintaining such a collection of wealth in the face of people who lacked basic necessities.

Between work and travel, I increasingly spent time on the road in Senegal, coming to and from Sanghare Coly to work with Tintou and organizing bicycle tours promoting women’s health, girls’ clubs, fundraising. On occasion, I would venture into the countries that lined Senegal’s borders. Perhaps I would be lost with a friend in the Gambia and ask for cold water, mino falla mbuubdam, from a Pulaar man. This man might subsequently translate my request into English for a Cuban doctor, who could understand the English of Pulaars better than that of Americans. In the bush anything was possible.

Sleeping on roofs and the occasional river bank, sharing beds with other volunteers, and trying to nod off while squeezed into a tightly packed sept places with eleven others as we traversed the mountains into Guinea, I could no longer maintain the illusion of my independence. Sometimes I felt that I was simply in the hands of god, or Inch Allah, as we would say when making plans. Everything would happen, God willing. And yet I clung to the idea of independence; for even in my apparent poverty, I was quite rich, and I wanted to justify the discrepancy. I knew that, should illness and danger of any kind arise, I would be evacuated by helicopter and provided with the necessary healthcare, while neither adequate nutrition, nor even basic routine care existed for the vast majority of this population. Why me? What makes me so special? I often wondered. I’m not sure that I’ve answered that question. Certainly my work as a nurse and case manager in Chicago have not clarified the answer.

The return to Dakar for my flight home was nothing like my arrival. Over the years, my time in the bush had transformed Dakar into a land of plenty, teeming with beaches, nightclubs, and air conditioned five-star hotels. But the city also revealed the subtle beauty of beachfront urban slums coupled with the colorful energy and chaos of the Sandaga market and syncopated synchronicity of Friday morning prayer at the Grande Mosquée. It was a luxury vacation for volunteers in the rural parts of Senegal and other parts of West Africa.

Colorful, breezy, and teeming with traffic, exuberant people, and markets that overwhelmed the senses, the opulence exhibited here in the form of the guarded mansions and BMWs was a refuge from the questions that confronted me in the village. When my friend Mike dropped me off at the airport for the last time, I sat at the bar, luxuriating in a Flag beer before I headed for security, looking over the landing pad, almost imagining the shimmering Meridien hotel standing above the nearby beaches at Ngor. Days ago, a starlit hut in rural Senegal, today, a day in the urban star of the Sahel, tomorrow, Chicago, a city that glitters throughout the night.

SARA BUCK, RN, is currently an MSN/MPH candidate at the University of Illinois at Chicago. Having initiated her studies in English and French literature, her travels in West Africa ignited her passion for healthcare, which she pursued as an HIV case manager in Chicago prior to returning to school for nursing. A yoga teacher and avid cyclist, she is deeply committed to furthering self-care among healthcare providers. She is also interested in community strategies for improving health and end-of-life care. Sara is an associate editor of Hektoen International.

Highlighted in Frontispiece Volume 3, Issue 1 – Winter 2011

Winter 2011



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