The Toubab Effect

Intervention studies take into account factors that could potentially muddle a relationship between two variables of interest. For instance, if you want to know whether exercising is related to weight loss, you also have to consider what and how much a person eats. If a man exercised every day but ate twice as much energy as he needs, you're likely to conclude that exercising doesn't make a difference in his body weight, but dietary intake would have a confounding effect on the relationship.

In our study here in Dakar, we're dealing with the Toubab Effect. (Toubab being a term for white person.) In general, I'm quick to pick up a youngster who needs attention ... until said child starts howling at the sight of my face. (I try not to take it too personally.) It's pretty amusing to watch everyone's reactions to my approaching a youngster who clearly would rather not be cooed at by a scary foreigner. Given that, I only wander in and out of view as needed while we're filming the children eating the cereal, lest they get distracted and decide to stop eating in protest.

The Senegalese study staff from the university get the biggest kick out of referring to the stations at the study site as "Station Anthropometrique" (where the kids' lengths and weights are measured), "Station Alimentaire" (where the cereals are fed to children), and "Station Toubab" (where the other Toubab and I sit and enter the data into the laptop). The lead staff member from the university brought in some beignets (delicious, doughnut-like balls rolled in sugar) for the team yesterday morning and warned me that I need to gain some weight if I am going to find myself a Senegalese husband here. When I told her that I went to the tailor on Saturday to drop off the material I'd bought here and to have some pants made, she replied, "I hope they're a tighter fit than those pantalons you're currently wearing!" and started cackling. I can't tell whether she's like this at baseline or whether it's her pregnancy-induced loss of a filter, but she's a riot.

I took a "Survival Wolof" class over the weekend which armed me with the (many) basic greetings, all of which I tend to use at once. I've already discovered wider smiles and surprised facial expressions in response to my attempts at saying hello in Wolof. I've heard of taxi drivers dropping the fares for folks who greet in Wolof rather than French. Although securing a safe ride from point A to B is a greater task than negotiating the fare: while riding in a taxi recently, when the driver pulled into the gas station I casually glanced at the ignition and then again at the ignition. It was hotwired (and probably had parts stolen from other cars)!

We've since found a friendly, reliable taxi driver named Babacar to take us to the clinic each morning. He drives a new-ish Peugeot, with seat belts all around, and sent a friend of his to pick us up when he was out of town one day last week. I got a bit confused when I said to his buddy, "You're a friend of Babacar?" and Buddy replied, "Oui, Pape is my brother." Pape? Pape who? I thought it was Babacar. But everyone seems to be called Pape here. And brother, even if no relation.

Apparently, names are a universal source of confusion. Once Babacar returned, I loved the text message he sent to let me know when he had arrived at my building: "Saly, j'ai arrive." Poor fella, confused by my Toubab name!

Yoff, Chez Moi

Views from the roof deck of my new digs, and of soccer matches on the beach! Dakar-Yoff is a fishing village right on the water, north of downtown Dakar. It's close to the airport and since there's no curfew for flights you hear planes at all hours of the day and night, but otherwise you can only hear waves (and occasionally, bongo drums or the barking of stray dogs). It's pretty sweet.

Getting the study going

This past Wednesday, we started the sensory trials, where we feed children the fortified cereal and assess whether or not they like it. It's a full morning at the study site, a clinic downtown. The coordinator and I drive from our neighborhood (Yoff) at 7 am down the Corniche to Medina and meet the local study staff from the University Cheikh Anta Diop of Dakar (UCAD) at the clinic, where we set up and anticipate mother-infant pairs arriving anytime after 8 am. I'm in charge of portioning out the cereals and making sure they're correctly randomized (one is high zinc, one if low zinc) for each subject. We spend the morning filming mothers mixing the cereal and feeding it to the infants and it's pretty funny to watch some of the kids' faces. There are some absolutely adorable ones, too. Given the energy of the children, the quick pace of tasks to be done while mothers are present, and all conversation in French (or Wolof, but I have only learned the equivalent of "Hi, how are you?"), there's never a dull moment.

We finish up by about 1:30 in the afternoon, and then enter the data from the handwritten forms into the computer database, clean all of the materials and get paperwork and materials ready for the next day. The mother-infant pairs come to the site each day for three days, and then we begin another group tomorrow. It's exhausting but I like the hands-on nature of the work and the interaction with the subjects and local staff.

Yesterday I went downtown to do some shopping with a couple of new acquaintances here - I bought some linens and cotton fabrics to have some clothes and sheets made, as well as a couple of household items. I looked at a couple of apartments that would have been fine for me, but then a colleague of mine in the office offered for me to live in her spare room for the 6 months I'm here ... the same apartment where I stayed in November (i.e., the apartment on the beach!), so I have a place to call home and only need to get a few things to feel settled. For now.

Just excitedly anticipating Obama's inauguration in 2 days ... !!!

Watching the waves

I have yet to tire of seeing the ocean. I don't think I ever will. I pinch myself that I get to see it everyday here, and listen to the waves every morning and evening. I can eat breakfast on the patio that overlooks the ocean and watch the swells. There's a surf school down the road, but I have my doubts about swimming in this water since certain areas have sewage draining directly into the ocean, such a shame. This past week, I've walked along dirt roads in the neighborhood where I'm staying and have glimpses of the ocean between homes, and I often just stop and stare. There's a fish factory at the end of a driveway and I can't help but think what a gorgeous bit of property on which it sits.

There's also a beautiful highway - the Corniche, it's called here - that connects the northern and southern parts of the city. The road runs parallel to the ocean and passes by a lighthouse that sits atop a hill, a mosque, embassies, and beaches where every morning groups of men are exercising.

We take the Corniche every morning to get to the study site and I watch the sunrise from the taxi. There's a certain peacefulness in the early hours of the morning by the ocean, but by the time we reach the clinic downtown, the city is fully awake and bustling with energy. I smell smoke from fires over which women are cooking, see shops opening with tools, batteries, and plastics for sale inside the shacks, vegetable stands set up, people peeling oranges on wheelbarrow carts, and watch goats eating from piles of garbage. We dodge traffic - taxis, minibuses, horse-drawn carriages, and mopeds. It's a bit of sensory overload at 7:30 in the morning but I enjoy seeing the different parts of the city through the sites we visit for work.

Zinc fortification

My first day at work was anything but the typical orientation day that I've had at other jobs. I jumped right into the study-in-progress and drove with the project coordinator to Les Grands Moulins (LGM), the largest flour miller in Dakar to fortify a small batch of cereal with zinc for the study. LGM produces flour for 70% of Senegal and it's an enormous operation. There's a baking school upstairs from where we were working that morning, and I learned how to scratch the tops of the baguettes before they went into the oven - cutting lines into the tops of the dough using a knife - and I got a kick out of it, simply because there's clearly a technique to it that separates the professionals from someone like me. We hung around a bit, hoping that the bread would be finished before we had to leave, but no dice that day.

We brought with us 4 buckets of locally-produced infant cereal that is an iron-fortified complementary food (meaning it's fed to infants who are breastfeeding and eating solids) and mixed in two different quantities of zinc (so that we'll have two cereals: high zinc and low zinc) using a cement mixer that's never been filled with cement. I was partially covered in flour by the end of the morning but it was fascinating to see how's it done since food fortification is a low-cost approach for providing essential micronutrients.

Dakar, for a longer stretch

Dakar is one of the prettiest places, dotted with hibiscus flowers and bougainvillea, the Atlantic Ocean surrounding the city, and views of the water peeking out from unlikely places behind construction sites. It's the western-most point in Africa and sunny practically every day, although surprisingly chilly and very windy this time of year. I actually feel a bit unprepared for this kind of weather, since all I can remember is how uncomfortably hot I felt for most of the fall. But now it's like the perfect weather in coastal California - minus the wind - pleasant by day and cool enough at night to warrant an extra layer. The wind is an element of its own, especially in a place as dusty and sandy as Dakar, with largely unpaved roads that end up as mini dust storms when the wind picks up. I laugh at myself naively thinking that I wouldn't need help with housekeeping and laundry, but after seeing how quickly clothing and everything becomes filthy after walking along dirt roads I've reconsidered. Most expats here and mid- and upper-class Senegalese families hire day maids and cooks to create jobs. One guard at the house even said to me, "When you find your own apartment, if you need cleaning, my cousin is available," which shows how much people depend on such income.

My flight from New York arrived at 6 in the morning in Dakar, and the city lights stood out after flying across the ocean in the pitch black of the night. The Dakar airport is apparently well-known for the shocking effect it has on first-time visitors: everyone descends from the plane onto the tarmac and packs into a bus that takes everyone to the main terminal, then everyone swarms to get a landing card and go through immigration before picking up luggage and loading it through an x-ray machine. One might be exhausted from the sheer number of people pushing through the line at this point, but the real fun begins the minute one exits the terminal. Men yell out, "Taxi? Taxi? Madam, taxi?" and insist on following you even if you decline. Five or six will surround your cart of luggage and pick up your bags and carry them for you unless you are firm enough in saying that you don't require their help. One of the organization's drivers was waiting for me and was a friendly face to see amidst the sea of hecklers. While he went to get the car, 3 or 4 others asked if I needed a taxi and followed me to the car and loaded my luggage, despite the driver shooing them away. I reached into my bag and grabbed a few American coins - all I had accessible - and gave it to them just so they'd give me some space!

It was hard to leave Seattle after a few weeks of visiting family and friends during the holidays, but I've been welcomed warmly here and folks in the office where I'm working seem happy to see me again. I'm really excited about the projects I'll be working on and am happy to be in Dakar for a longer period of time. I'm rather amazed, too, but how much easier it's been to return to a place that I've visited before, in comparison to the first time I touched down in Africa, in Dar es Salaam, when everything was utterly overwhelming - the heat, the chaos of traffic, the sheer number of people everywhere. Not that it's easy, but it's not the shock of everything being new.



Franklin is the resident dog at the home where I'm staying until I find a place of my own. Such a good dog and the nicest daily welcome wagon!