My only prior trip to Mauritania was in 1987 when I visited the capital, Nouakchott. Having spent over two decades since living in or visiting 30 other African countries, I was not excepting to be surprised. However, from the time we left Senegal last Thursday – my home for the past eight years – to arriving back today, it was a constant source of amazement. Who could have known that all that separated me from a vastly different country was a ferry ride across the Senegal River?
The road between Nouakchott and the border with Senegal is the major economic lifeline of the country but it is hard to imagine that this narrow strip of macadam, eaten away by sand and salt air, regularly covered with sand dunes, and filled with bone-jarring potholes, is what facilitates commerce between two countries; the overall impression is a sparsely populated moonscape.
We stopped at a few places along the way to chat with villagers, so Nick could interview a lactating camel, and finally to visit a health center in the largest town between Nouakchott and Rosso.
We arrived unannounced and were graciously welcomed. The staff was patient with our myriad questions ranging from obstructed labor to timely initiation of breastfeeding to vitamin A supplementation. What struck me the most was the vast distances people have to travel to access to health services – they routinely come from over 30 miles away. The head of the clinic reported that they held outreach campaigns for vitamin A, de-worming and vaccinations every six months. I smiled, as HKI has long been supporting these “Child Health Days” in the countries where we work thereby transforming the way child survival services are delivered. In fact, a former HKI colleague who joined UNICEF was instrumental in making these days happen in Mauritania.
While these outreach campaigns left me hopeful, I was concerned when we started to talk about infant and young child feeding practices. On the positive side, the head of the center and the obstetric nurse knew about the essential nutrition actions framework – including initiating breastfeeding immediately after birth and exclusive breastfeeding for the first six months. On the other hand, they were adamant that all women accepted and practiced this advice with no exceptions. HKI recently led a situational analysis of infant and young child nutrition in the Sahel, and available data show that only 41% of women practice timely initiation of breastfeeding and only 11% practice exclusive breastfeeding through six months.
Part of the battle is won – health staff understand the importance of these nutrition actions, but more needs to be done to ensure mothers adopt these behaviors at a much higher rates. We need to understand what the obstacles are and work with mothers and their communities to find solutions.
After our visit at the health center, we arrived in Rosso to take the ferry back to Dakar only to find that the next one would not leave until 3:30 which did not allow us enough time to make it back to Dakar before nightfall. Our handler, who had helped us cross the border on Thursday, arranged for us to rent the ferry for our own semi-private passage across. Perfect, except I had no cash left. Some creative problem-solving on the part of our handler – he negotiated with a shopkeeper to loan me the cash – and we were on our way! After a quick stop to find a functioning ATM, our handler went back to make good on my debt and we were able to make it to Dakar in time for dinner.
My trip left me thinking a lot about Mauritania, but I don’t have too much time to reflect, as we head off to the airport tomorrow for a 7:45 am flight to Niamey – capital of Niger.