Wayyyyy back in December when I began my needs assessment in Kulari, one of the issues that was brought to my attention was in-explainable and sudden deaths. When there is a funeral in village, it is a very large event. People from all around the village gather in all black, ‘wailers’ are present, and if the person was very well known and generally a man, many people gather at the mosque. Death is also just a lot more, for lack of a better word, casual around here. It is another reason why women tend not to talk much about or even deny their pregnancies. Death is just common. With that being said, it is really easy to get information about the deceased person and not considered very insensitive to inquire. So, I would ask. The answer I would get was not satisfying though, because it was often just, “He didn’t wake up.” or “He collapsed in the fields today.” A thirty-five year old man should not just be collapsing in the fields dead.
Later on during my community integration period, I spent a lot of time shadowing HM, my CHN from my previous posts. When individuals come in for a check up, it is always procedure to check blood pressure. Everything became very clear when I began to see the trend. Young and old men and women alike came in with blood pressures upward of 200/90. For those of you that don’t know, a healthy blood pressure should sit at 120/80.
Systolic blood pressure is the top number and it measures the force of blood against your artery walls as the ventricles of your heart contract and blood is pushed out to your body. Diastolic blood pressure is the bottom number, measuring the force of blood against your artery walls as your heart relaxes and the ventricles of your heart are allowed to fill.
I realized, eventually, that most people in my village are walking heart attacks. Hypertension is something you can’t really see, so my community members didn’t even really understand what was happening to their bodies. Constant complaints of chest pain, head pain, fainting, and so on riddle the people of my village. With the lack of understanding, many fits of fainting or convulsions are attributed to simply being a women and it is very common to experience these ‘supernatural fits’. When these women have their blood pressure taken, you can bet that they are reaching sky high numbers. Many of the ‘mysterious phenomenons’ that are treated with traditional medicine sometimes are often signs of hypertension. From strokes and paralyzing as a result to vision problems to even sexual dysfunction, the ties are there but the understanding is not.
Long story short, the past few months have been an attempt to raise awareness about hypertension. This has included weekly blood pressure screenings open to the public, mural painting, anatomy and physiology education sessions, and a hypertension fair put on for three days!
Wednesdays, at the clinic, we offer free blood pressure screenings. It has been very successful in reaching women consistently about their blood pressure. We are able to not only take the readings, but give one on one health counseling and prescribe blood pressure medication if need be. Because many of the women come week after week, it has been beautiful for evaluation and analyzing what measures are actually helping. It is a little bit different doing screenings here versus when I would screen in the states. The suggestion to ‘exercise at least thirty minutes a day’ becomes irrelevant often times, especially now that it is rainy season and everyone is working very hard in the fields. I have been happy to help my family with their farming, and I have seen first hand that these men, women and children have to walk miles to get to their land and then spend the entire day tending to their crop. Physical activity is a necessity here. So what is causing so many people to be experiencing such extreme blood pressures?
I can really only do as much as I am educated on, so I took the rout that I am most familiar with. Food. What are we really eating every day, and how much of it are we consuming? Nutrition is everything when it comes to our bodies from physical health to mental health to genetics and so on. Generally, we eat mostly carbs in the Gambia. A lot of carbs. About 11% of the population of the Gambia is food insecure causing malnutrition rates to be increasing and currently sitting at 21% of the population being chronically malnourished. One thing that I wish that people from back home would realize is that malnutrition doesn’t mean that you are not eating, it is the lack of nutrients. Malnutrition is the lack of macro and micro nutrients in the diet. Trust me, we eat here. However, the diet is mostly rice, millet, and maize. Lipids and dietary energy is almost always reaching the upper limit of recommendations while protein remains at the lower end. Then comes the heart of the whole issue. Sodium.
Sodium is a huge dietary issue. A single person in my village consumes about 3-5 times more salt than the daily recommendation…and that is just salt. Then, we add in Jumbo, Adja, and Magi, three very common spices used in most meals and made completely of msg and sodium. The argument? It provides iodine traces. For a family of ten, almost two cups of salt will be added to the food bowl. Then add in pounded dried fish also containing salt for the drying possess and then seasoning. I once calculated the number of sodium servings that was added to my lunch. We feed around 23-27 people in my compound. How much sodium do you think was added? Take a guess. Don’t cheat now. Got it in your head? There was enough sodium for seventy people in our food bowl. SEVENTY. Could this be the evil that is causing 25 year old women to experience chronic hypertension?
Thus developed Kulari’s first ever blood pressure fair.
Of course, no project ever goes as planned or on schedule. The day we were supposed to have day one of the fair, a village development group mandatory meeting materialized in the clinic and lasted three days and the Indoor Residual Spray Campaign was going on all day which included all of my male counterparts. Ain’t no thang in the Gambia, however. Our all day fair just became a night program. Peace Corps Volunteer necessary characteristic: flexibility.
Day one consisted of gathering the women’s group to explain their role and give them the information that they were going to have to relay during the fair during a mass cooking demonstration. Thank God, my good friend Teresa and her two counterparts traveled to my site from their Fula village over the river to co-facilitate this program. They really helped make my vision a reality not to mention, Teresa is a nutrition guru. Of course, HM, Wujari (my community health worker), and Ismaila (my community representative), where at the training, as well, after a full day of IRS campaigning. The help is always appreciated when we are having a training in English, Pular, Mandinka, and Sarahule. Aloso, because of the meeting and the IRS campaign, we had people from outside of our village attend the fair, which was really neat!
We all gathered in one my friend’s compound and cooked traditional Gambian dishes while discussing what blood pressure is and how it effects an individual, salt content, use of Jumbo and other seasonings, how to reuse the water that you cook veggies in to not waist nutrients, how long to cook vegetables, oil content, how to utilize and increase vegetable consumption, foods to lower blood pressure, and additional spices such as garlic that can be both cost efficient and replace added artificial seasonings. All the women were able to practice their own health talks, and it even attracted others from the village to inquire about what we were up to. It was so much fun and most importantly, everyone loved the food.
Day two was the official blood pressure fair open to the public. Outside, we had a “Pin the Heart on the Person” game shaped after the popular American game, pin the tail on the donkey. This was done in an attempt to give a small anatomy lesson as to where the heart is located in the body and how it connects to the blood flowing within the body.
The next station was set up by the mural with a salt display and how an unhealthy artery prohibits blood flow.
Inside of the clinic, I facilitated blood pressure screenings. Everyone that got their blood pressure taken also received a small bracelet. These bracelets actually were very effective in getting other people interested in what was happening, and many more people came to the following weeks screenings telling me about how they had seen people with the bracelets and were told about the blood pressure initiative. In fact, the week after our fair, the majority of people who came to the screening were men. Health initiatives are often looked at as a ‘women’s thing’, so I was so excited to see that men and women involved in the program reached out to the population that doesn’t normally show up! Pretty cool.
While I took BP, the women cooked, danced, sang, and educated. Both nights, we cooked traditional, common dishes with our own subtle health twists. The first night we cooked rice with a green potato leaf sauce and ground nut (Derre). The second night we cooked rice with a peanut sauce and eggplant (Domada).
The turn out was wonderful, the food was delicious, and, get this, the women refused to put ANY Jumbo into the last night’s dish. In fact, that has rolled over into some of my friend’s food bowls. I have women telling me and showing me their meals and how they are cutting all of their salt in half. The message we gave was not to completely eliminate salt, although that would be great. Asking something like that is unrealistic. Instead, we encouraged to start slow. Just cut your Jumbo usage in half and only use a half a spoon of salt per person in total for lunch and dinner. One women even told me that she didn’t use any jumbo in the dinner she made that night!
It is so hard to know if what we do here will have a long term effect, is sustainable, or will be carried on in our absence. However, I consider it a huge accomplishment to have gotten the conversation started. To have women at the market talking about blood pressure, asking me when they can come in for screenings, going to the hospital to be prescribed medication on their own and taking it correctly, and actually understanding what is going on in their bodies to some extent is huge! I am so thankful for everyone who made this happen in Kulari and how open and willing my village is to my crazy shenanigans.