Everything I ever needed to know, I learned in kindergarten (through 5th grade)

Last weekend I sat in on two days of a training session for community health workers – called relais here in Senegal. The four-day “formation” was organized by a second year health volunteer – Kelly – and was led by a World Vision employee and his assistant. It took place at Kelly’s health post and brought together volunteer relais from all around the post’s catchment area. The training covered the basics of communication – how to introduce yourself to a group, how to ask the chief for permission to hold a causerie (small, semi-informal health lesson), how to do a home visit – and a range of common health topics including malaria, diarrhea, nutrition, respiratory infections, pre-natal care and STDs. A relais’ primary function is to provide basic information and counseling for his or her community, not to practice any sort of hands-on medicine. In the highly decentralized Senegalese healthcare system they essentially provide the same information that web-MD or middle school health classes do in America. Relais are generally volunteers but midwives, nurses and doctors can also assume the role when they perform causeries and general health outreach. The event was really great to see and something I’m looking into doing in my own village, which lacks anyone with such training (limited as it may be). This post isn’t really about the training though, it’s about what I was thinking as I watched many of the participants (mostly the females) during the 8 hour days…

I’m fortunate to have attended a great high school and fantastic university, and I really try not to take those for granted. What I don’t often think about is the education I received before that – especially in my first few years of elementary school. In those years I learned to read and write, to ask questions and to solve problems. Whatever can be said about the American educational system, even our worst schools can usually perform these tasks. Even if all American students aren’t reading at the proper grade level, at least most of them can read. For the majority of my village friends – especially the women – this isn’t the case. I’ve given embarrassingly little thought to the limitations of illiteracy until coming here, since it is certainly something I do take for granted in my own life.

I’ve started to think of all the things I do on a daily basis that would be impossible without the education I received so early on, and how that may explain the behavior of my village friends. It’s nearly impossible to find out what time an event will take place – but without basic numeracy, is it fair to expect the entire women’s group to arrive at the same time? Every day I send and receive a dozen text messages from friends and Peace Corps staff, but even simpler is that I can dial a phone number to call my family – something my host sisters can’t do because they never went to school.

For students who make it through the earliest grade levels and become semi-proficient readers, the Senegalese school system still falls short on other fronts. The problem solving and critical thinking skills so emphasized in my early education – I still remember the math games I played in first grade and red herring word problems we did in third – are completely absent in this memorization and regurgitation heavy system. Granted, the ministry of education just implemented a massive curriculum overhaul that focuses more on critical reasoning and application than rote memorization, but I imagine it will take years for this new style to become the norm.

Back to the training I went to – how much information could you retain from 4 straight 8-hour days of health lectures? How much could you retain without writing down a single word? Or without reading any of the notes on the blackboard? I remembered being in Asia last summer and looking at the signs around me in Chinese, Vietnamese, Thai and Laotian thinking, it’s all just scribbles – that can’t possible mean anything. Fortunately there are some great visual aids available to health workers that can fill in the literacy gaps, unfortunately there aren’t nearly enough to give to every relais so they often must make due with memory alone.

Experts say that the single greatest predictor of childhood health is maternal literacy. After four months in country, I can see exactly why. I’ve seen the community health worker at our neighboring health hut hand two packets of seemingly identical white pills to a young mother and say, give him one of these three times a day and the other one twice a day for a week. No further explanation, no differentiation between identical pill packs, nothing written down. During baby weighings every mother is supposed to bring a health-post issued card that contains all of their pre- and post-natal health information as well as the baby’s vaccination history and weight gain chart. Not that medical charts in the US mean much to the casual observer, but at least I can discern when my follow-up appointment should be or how much my baby weighs. Here the cards are essentially useless to illiterate mothers since health workers take no time (or have no time) to explain what each section means. If pre-natal care, vaccinations, growth monitoring and proper dosage of medicines all require some amount of literacy it’s easy to see why maternal literacy is so crucial.

I’ll stop ranting and end on a positive note. Even though many of the young mothers in Sare Sara missed out on school the first time around, things may be looking up. The organizations that just built the beautiful new community center will be starting literacy classes in October – I happened to wander into a planning meeting this afternoon. Both of the women in my compound – Khady and Coumba – will be attending and I’m hoping to check it out to see if I can get to know some of the young moms a bit better. I think the end goal is to help women make money by running their businesses more efficiently – basic accounting, record keeping, new revenue producing ventures – but I'm hoping there’s a health benefit as well.