Hannah Dee

Each city has its paradoxes. In DC, there are homeless people huddled on the same streets that are lined with the multimillion-dollar homes of the country's elite, and the harsh contrast between rich and poor is an inescapable feature of the nation's capital. In Dakar, those contrasts are even more glaring. Perhaps it is because I am a visitor, and we view other societies through a sharper lens than we view our own, but Senegal's paradoxes have come to define my perception of this colorful, bustling, contradictory country. Horse-drawn carts fight for the same road space as gleaming Mercedes, and the same women who dress in immaculately tailored, vivid dresses may have nothing to feed their children.

In my neighborhood, young boys, some no older than six, approach us on the streets with nothing but tin cans and pleading eyes. Their clothes are often dirty, their faces streaked with dirt. Beggars, some with their legs atrophied and useless from polio, often sit alongside the route to our school. Meanwhile, many of the houses in the neighborhood are beautifully constructed three-story homes with mango trees in the garden or vine-covered balconies overlooking the dusty roads. Most families employ at least one full-time maid, and security guards are scattered throughout the community.

In my neighborhood, and the other neighborhoods like it, people have jobs ranging from doctors to store owners to the universally ambiguous bureaucrats. As American university students, however, we are living in a bubble of prosperity in a country where the unemployment rate hovers around fifty percent. Despite the marbled mansions along the coast and the comfort of our neighborhoods, the fact remains that, for the most part, the economic system is fundamentally broken.

A trip to a market here is like a chaotic trip to the past, a past, that is, with abundant 'Made in China' labels and honking taxis. Marché Sandaga, the largest downtown market, consists of streets crammed with vendors selling every good imaginable: peanuts, statues, jewelry, fruit, shoes, even underwear. A single street may have five rows of battered wooden stalls. As obvious foreigners, it is impossible to walk anywhere without groups of young men accosting us and steering us toward their shops, while people shout at us in Wolof and French: "You are my first client!" or "I will give you a good price, a very good price!" There are so many vendors, many of them selling the exact same goods, that it is impossible to understand how anyone makes any money. Indeed, it would seem that for many vendors, working at a market is not so much a steady job as an attempt to do something, anything, in a country where jobs are so hard to find.

Senegal's economic situation is intimately related to its education system, and this, too, faces immense obstacles. A major university of Dakar, Université Cheikh Anta Diop, has a capacity of about fifteen thousand students. Sixty thousand students are currently enrolled. There is no shortage of hardworking youth, but the educational system is often strikingly ineffective at capturing that potential.

Some policies that appear, on the surface, to support the country's education and future development goals may actually impede Senegal's future growth. The government, for instance, offers scholarships that allow its most promising youth to attend university in France. In theory, these students will then return to Senegal to work for the government for ten years. In actuality, there is no way to enforce this contract, and no guarantee of a government job. The end result is that the state essentially sponsors its brightest youth to permanently leave the country. I have seven host siblings, and all of them had the opportunity to receive advanced degrees in Europe in fields ranging from engineering to law; only two returned to Senegal. Salaries here are notably lower than in Europe and the United States, and the result is a perpetual brain drain. Until relatively recently, doctors in Senegal received only a couple of hundred dollars per month, and when we visited a public clinic in Dakar the doctor spoke wearily of his many colleagues who left chasing wealthier lifestyles in Europe and North America.

Perhaps nothing embodies the contradictions of Senegal more than the recently erected African Renaissance Monument, which was unveiled this year to symbolize the cultural and economic emergence of Africa. The controversial 27 million dollar statue stands gleaming on one of highest points of the city, overlooking the ocean. This monument, mean to represent Africa's strength, was built in North Korea. And from the top of the statue, visitors have a prime view of Dakar's five-star hotels, and its slums.

"In the last month, has he had a fever? A cough? Chills? Diarrhea?"

The response was "Yes" to all. The little boy's nose was running as he stared up at the group of foreigners wielding clipboards. Our translator kept firing questions at the boy's mother: "Has he had a headache? Did you take him to the clinic? Do you think he had malaria?"

We were conducting a malaria survey in a village four hours away from the capital. My group reached thirty children, all under the age of ten, and of those thirty, twenty-nine suffered from at least one symptom of illness within the last month. At the compound of one family, every child had bloody urine, an indicator of intestinal worms; at others, the children had sores on their heads or rashes on their backs.

There was a dispensaire, or a clinic, in that same village, and malaria treatment was free (or at least, free according to the law). Treatment for other diseases ranged from being free to a few dollars, the price someone would pay for a new pair of shoes. Yet of the thirty children, only seven had gone to the clinic that past month. Perhaps more tellingly, nine children had been taken to a guérisseur, a traditional healer.

Our survey was far from comprehensive but it did provide insight into the crucial role that traditional beliefs play in sectors such as public health in Senegal. Although Senegal is 95 percent Muslim, traditional beliefs and customs from before the introduction of Islam still have a strong influence in the country. Though that influence is less evident in urban centers such as Dakar, many people still believe, for instance, in the power of spirits. Evil spirits are often thought to cause illnesses and deaths, and children often have gris-gris, or protective amulets, tied around their waists to ward off these evil spirits. Meanwhile, people frequently turn to traditional remedies before they turn to clinics and modern medicine.

In the three months I've spent in Senegal so far, I have been struck by the degree to which religion and traditions permeate life here, and the health sector is certainly not exempt. As with so much in Senegal, the role of religious or traditional beliefs in health is marked by paradoxes.

On one hand, certain traditions can be a difficult force to overcome in efforts to improve community health. Beyond the reliance on traditional healers, female genital mutilation or cutting is still widely practiced in certain regions of the country. Although the Koran makes no reference to female genital cutting, and it certainly doesn't suggest it, many people believe that the practice is justified by Islam. In fact, the Demographic and Health Survey of 2005 found that, despite its illegality, more than a quarter of women are affected by FGM.

On the other hand, religion can play a crucial role in the improvement of Senegal's public health. Senegal's HIV rate, for instance, remains below one percent (compared to DC's rate of at least three percent). The influence of Islam is a crucial reason behind this relatively low rate. Not only does Senegal have comparatively conservative social norms, but religious leaders also have a key voice in the fight against the spread of HIV. Muslim leaders, for instance, preach about HIV in mosques and include AIDS education in religious teaching programs, and both Christian and Muslim organizations preach tolerance and provide support for those affected.

Unfortunately, improving Senegal's public health depends on a lot more than garnering support from religious leaders. In a country where the average person can expect to live into his or her fifties, the health situation is intimately linked to the economic situation. The average yearly per capita income is below one thousand dollars a year, so a medical treatment of a few dollars is often beyond the means of a family. As we were leaving one of the village compounds during our malaria survey, one of the older men called out to us in Serer. The man was smiling, but we were struck by his words, "Can you cure me of my sickness of not having any money?"