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Not One, Not Even One: A Memoir of Life-Altering Experiences in Sierra Leone, West Africa
In 1978, Nancy Edwards left as a CUSO volunteer for Sierra Leone, where she spent three years working as a community health nurse and two years evaluating primary health care programs. Her stories of village life convey the ravages of tuberculosis; threats of witchcraft; and tragedies of deaths related to pregnancy, childbirth, and newborn tetanus. She celebrates local advocates for health improvements-mothers, traditional birth attendants, and village health committees.
Acutely aware of her role as a cultural outsider, the author reveals how she learned about the power of ancestors and the women's Secret Society among the Mende people. Four decades after her arrival in Sierra Leone, Edwards comes to grips with her stance on the cultural practice of female circumcision. She takes us behind-the-scenes, describing how her West African experiences shaped her life and research career.
Though steeped in hardship, tension, and conflict, Not One, Not Even One is buffered by humour, heartened by breakthroughs and shifting perspectives, and propelled by fierce hopes for the future.
Acutely aware of her role as a cultural outsider, the author reveals how she learned about the power of ancestors and the women's Secret Society among the Mende people. Four decades after her arrival in Sierra Leone, Edwards comes to grips with her stance on the cultural practice of female circumcision. She takes us behind-the-scenes, describing how her West African experiences shaped her life and research career.
Though steeped in hardship, tension, and conflict, Not One, Not Even One is buffered by humour, heartened by breakthroughs and shifting perspectives, and propelled by fierce hopes for the future.
318 pages, Hardcover
First published February 1, 2022
2 people are currently reading
7 people want to read
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Displaying 1 - 19 of 19 reviews
April 22, 2022
A ‘must-read’ for anyone contemplating or undertaking community development work, whether domestically or in another country. Nancy’s narrative brought back many memories of the time I lived and worked in Haiti in the mid/late 1970s. Many of the same concerns, doubts, fears and as well the same desire to do and accomplish something concrete that would in some way and some day, contribute to improving peoples’ lives. Thank you, Nancy, for sharing your experiences and reflections.
James Chauvin, former Director, Global Health Programs/Canadian Public Health Association (retired)
James Chauvin, former Director, Global Health Programs/Canadian Public Health Association (retired)
June 1, 2022
Not One, Not Even One is a beautifully written memoir. Nancy Edwards, a barely out of school nurse leaves her middle-class Canadian home to work in Sierra Leone as a volunteer for Canadian University Services Overseas. Her role seems straightforward – to improve outcomes of maternal health.
She quickly and painfully learns that barriers to maternal health are deeply interconnected to issues of poverty, power and control, cultural practices, funding, geography, and structural government.
It is a story brimming with humility and honesty about her own powerlessness to make change in the face of these tangled obstacles. However, little by little, change does take place as women and perhaps more importantly, their community elders receive, accept, and internalize prenatal prevention, modern childbirth practices and postnatal care.
Her ability to build relationship with the local people, especially without adequate local language, speaks to the author’s warmth and genuineness of care. Her ability to describe these relationships and their impact on her are heart-warming yet, at times, difficult to read. I couldn’t put the book down and am recommending it as a must-read for my book club.
Wendy Nordick, Ph.D.
She quickly and painfully learns that barriers to maternal health are deeply interconnected to issues of poverty, power and control, cultural practices, funding, geography, and structural government.
It is a story brimming with humility and honesty about her own powerlessness to make change in the face of these tangled obstacles. However, little by little, change does take place as women and perhaps more importantly, their community elders receive, accept, and internalize prenatal prevention, modern childbirth practices and postnatal care.
Her ability to build relationship with the local people, especially without adequate local language, speaks to the author’s warmth and genuineness of care. Her ability to describe these relationships and their impact on her are heart-warming yet, at times, difficult to read. I couldn’t put the book down and am recommending it as a must-read for my book club.
Wendy Nordick, Ph.D.
July 11, 2023
Not One, Not Even One is a rich and compassionate memoir by Nancy Edwards. As a young volunteer with what is now known as Canada’s Cuso International, Nancy spends five years in remote villages a country of which we have little news: Sierra Leone. She makes her home with villagers, learns of their challenges, and becomes aware of the nuances of their culture.
Public health is a critical concern for the villagers, especially maternal and child health in such impoverished and remote conditions. Nancy navigates the intricacies of tribal power and bureaucratic systems. Life is a constant shimmering ocean of peaks and troughs in the waves of everyday concerns. She recounts the breadth and depth of successes and failures as everyone strives for better health outcomes.
So much of our news of the Global South is superficial with images of picturesque poverty or horrific destruction with captions the length of sound bites. Not One, Not Even One is a compelling journey by a sensitive and resourceful young woman determined to listen and learn and assist others in achieving their goals of a better life.
We cheer with Nancy when progress in health and education move lives forward. She shares with us how friendships are woven into the fabric of village life. Her years in Sierra Leone mark her indelibly and set her on a course to a lifetime of work in public health.
Not One, Not Even One has arrived at a time when discussions are escalating about Global North and Global South relations as well as increased concern for Indigenous people globally. This book would be an excellent and worthwhile selection for book clubs eager for more than conventional approaches to learning about others with whom we share this planet.
Merle Kindred, PhD
Cuso Volunteer: Jamaica, Guyana
Public health is a critical concern for the villagers, especially maternal and child health in such impoverished and remote conditions. Nancy navigates the intricacies of tribal power and bureaucratic systems. Life is a constant shimmering ocean of peaks and troughs in the waves of everyday concerns. She recounts the breadth and depth of successes and failures as everyone strives for better health outcomes.
So much of our news of the Global South is superficial with images of picturesque poverty or horrific destruction with captions the length of sound bites. Not One, Not Even One is a compelling journey by a sensitive and resourceful young woman determined to listen and learn and assist others in achieving their goals of a better life.
We cheer with Nancy when progress in health and education move lives forward. She shares with us how friendships are woven into the fabric of village life. Her years in Sierra Leone mark her indelibly and set her on a course to a lifetime of work in public health.
Not One, Not Even One has arrived at a time when discussions are escalating about Global North and Global South relations as well as increased concern for Indigenous people globally. This book would be an excellent and worthwhile selection for book clubs eager for more than conventional approaches to learning about others with whom we share this planet.
Merle Kindred, PhD
Cuso Volunteer: Jamaica, Guyana
January 10, 2024
Nancy Edwards' experiences as a health care volunteer with CUSO in Sierra Leone in 1978 fostered a lifelong passion and led to a career in international health. The challenges undertaken to volunteer for such work are brought into focus with sensitivity, humour and moving stories. Navigating the cultural disconnect between traditional healing and Western practices was formidable.
Edwards worked as part of a team trying to lower the high birth mortality rate by persuading Traditional Birth Attendants (TBA) to undergo training in modern midwifery practices, as well as listening to and respecting what they had learned through their own experience and incorporating it in a cooperative effort. The task was immense. Identifying and locating TBA’s was a large undertaking. Logistics were complicated by the remoteness of many villages, the absence of records, the vicissitudes of weather and the mindsets of local chiefs. Working around superstitions and continuing belief in witches added to the complexity. Tetanus was a major factor in the high birth mortality rate, but Edwards records a breakthrough when a traditional women’s society agreed to make the vaccination part of their initiation ceremonies. Other areas of these ceremonies, including FGM were impossible to discuss in those days without sabotaging the whole project.
Edwards returned to Canada in 1980 determined to become a researcher in the field of global health and epidemiology. When Sierra Leone’s civil war in 1991 blocked further research plans, she redirected her PhD topic to maternal and child health among immigrants and refugees living in Ottawa. “These women’s stories kept my global health research light lit.” Edwards’ story also draws us into the intricacies of trying to get funding for international research on topics not immediately recognized as important. Here, you can see our own cultural biases became apparent. There were also the adventures of gathering, transporting and analyzing data gathered from remote locations.. Further work led to researching collaboration with people around the world including China.
This is a fascinating and important book. I read it with gratitude and thankfulness toward those who have chosen to make it their life’s work. Proceeds from book sales will be donated to international development organizations that support the education of girls and women in lower-income countries. Edwards website is an excellent resource for following the progress (or setbacks like civil war, HIV-AIDS and Ebola) in this area, and learning what took place after she returned to Canada. It becomes so obvious that education is at the heart of the matter. https://www.nancyedwards.ca/
Edwards worked as part of a team trying to lower the high birth mortality rate by persuading Traditional Birth Attendants (TBA) to undergo training in modern midwifery practices, as well as listening to and respecting what they had learned through their own experience and incorporating it in a cooperative effort. The task was immense. Identifying and locating TBA’s was a large undertaking. Logistics were complicated by the remoteness of many villages, the absence of records, the vicissitudes of weather and the mindsets of local chiefs. Working around superstitions and continuing belief in witches added to the complexity. Tetanus was a major factor in the high birth mortality rate, but Edwards records a breakthrough when a traditional women’s society agreed to make the vaccination part of their initiation ceremonies. Other areas of these ceremonies, including FGM were impossible to discuss in those days without sabotaging the whole project.
Edwards returned to Canada in 1980 determined to become a researcher in the field of global health and epidemiology. When Sierra Leone’s civil war in 1991 blocked further research plans, she redirected her PhD topic to maternal and child health among immigrants and refugees living in Ottawa. “These women’s stories kept my global health research light lit.” Edwards’ story also draws us into the intricacies of trying to get funding for international research on topics not immediately recognized as important. Here, you can see our own cultural biases became apparent. There were also the adventures of gathering, transporting and analyzing data gathered from remote locations.. Further work led to researching collaboration with people around the world including China.
This is a fascinating and important book. I read it with gratitude and thankfulness toward those who have chosen to make it their life’s work. Proceeds from book sales will be donated to international development organizations that support the education of girls and women in lower-income countries. Edwards website is an excellent resource for following the progress (or setbacks like civil war, HIV-AIDS and Ebola) in this area, and learning what took place after she returned to Canada. It becomes so obvious that education is at the heart of the matter. https://www.nancyedwards.ca/
June 13, 2022
The title of this memoir reflects the heartfelt sob of a mother who had borne eleven children. When asked how many had survived infancy, she replied “Not one, not even one”.
It was the cry that generated Nancy Edwards’ drive to improve care for mothers and babies in Sierra Leone.
Nancy Edwards’ memoir can be an eye-opener to anyone who has wondered why it is so hard to improve health in other countries – and equally, in rural and isolated areas of our own. As I read it I realized how narrow my own vision is, derived from my own experiences and my own culture. Nancy was able to show me how the beliefs and expectations of the people she was serving were molded in exactly the same way by their own sense of history, family and culture. Only with experiencing some of the same hardships (although very much softened by the support of Western organizations) could she begin to appreciate their resilience.
Beginning with her anticipation of arrival in Freetown, the capital, we accompany her through the initial culture shock, her discovery of her own resilience, and her development of understanding and respect for the people and their way of life. She shows us why so-called “modern” concepts of disease and medicine were incomprehensible to them. Understanding their traditions and the basis for them led to an appreciation for their social structure. Working within the existing hierarchy made it possible to bring about measurable improvements in the quality of maternal and newborn care, and reduction in mortality.
Sadly, war, disease and personal circumstances intervened to deflect the arc of progress and keep Nancy from returning to Sierra Leone, but the lessons she learned there acted as guides to her further career, working in international health and then in nursing education and maternal health initiatives in rural Canada.
Anyone interested in health care, here or abroad, will find this book a source of inspiration for meeting the continuing challenge of ensuring mothers throughout the world will be spared the heart-wrenching experience of that mother who had seen every child she bore die in infancy..
It was the cry that generated Nancy Edwards’ drive to improve care for mothers and babies in Sierra Leone.
Nancy Edwards’ memoir can be an eye-opener to anyone who has wondered why it is so hard to improve health in other countries – and equally, in rural and isolated areas of our own. As I read it I realized how narrow my own vision is, derived from my own experiences and my own culture. Nancy was able to show me how the beliefs and expectations of the people she was serving were molded in exactly the same way by their own sense of history, family and culture. Only with experiencing some of the same hardships (although very much softened by the support of Western organizations) could she begin to appreciate their resilience.
Beginning with her anticipation of arrival in Freetown, the capital, we accompany her through the initial culture shock, her discovery of her own resilience, and her development of understanding and respect for the people and their way of life. She shows us why so-called “modern” concepts of disease and medicine were incomprehensible to them. Understanding their traditions and the basis for them led to an appreciation for their social structure. Working within the existing hierarchy made it possible to bring about measurable improvements in the quality of maternal and newborn care, and reduction in mortality.
Sadly, war, disease and personal circumstances intervened to deflect the arc of progress and keep Nancy from returning to Sierra Leone, but the lessons she learned there acted as guides to her further career, working in international health and then in nursing education and maternal health initiatives in rural Canada.
Anyone interested in health care, here or abroad, will find this book a source of inspiration for meeting the continuing challenge of ensuring mothers throughout the world will be spared the heart-wrenching experience of that mother who had seen every child she bore die in infancy..
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May 3, 2022As an epidemiological and global health colleague of Nancy Edwards for four decades, I read this compelling and exceptionally reflective autobiographical sketch of her time in West Africa with special interest - not the least becuase I too spent a similar amount of time with CUSO in Tanzania, as a primary care physician and trainer of Medical Assistants, just a few years earlier. The book does not disappoint, because of both its rich recollections of a very demanding life there for a young and newly minted Canadian nurse, but also because of Nancy's talent for thoughtful reflection on trans-cultural issues that relate to the challenges of providing health care, and of living and working in a setting very different than one's home. In particular, Nancy's stories of how complex the local Mende culture was for health issues, and the often related (for the Mende) spirit-world around them, evokes many past cultures, including our own a scant few hundred years ago. Above all, it is Nancy's humility in the face of this often (for outsiders) discouraging African way of accepting preventable illness and injury fatalistically, which sets the book apart. It also gives us much to contemplate now, many years after we had all hoped - as idealistic volunteers, "strangers in a strange land" - that the health status of poor African villages would have been by now substantially improved. Rather than laying blame for this global failure of foreign assistance over four decades, Nancy's sage and sensitive observations help us to better understand that the determinants of health have very deep cultural roots, typically not readily amenable to outside cultures' efforts to change them. It is a lesson worth repeating today.
Prof John Frank, University of Edinburgh; Professor Emeritus, University of Toronto
Prof John Frank, University of Edinburgh; Professor Emeritus, University of Toronto
November 3, 2022
At the age of 25, Nancy joined CUSO. She was posted to Serabu, Sierra Leone, where she taught community health nurses and contributed to a primary health care program. Her three years as a CUSO volunteer in Sierra Leone is the launching point for this excellent book.
Nancy also describes another two years in Sierra Leone doing field research after her Master's degree in Canada.
Nancy's inspiration for the memoir was an older Mende woman who had no living children, "not one, not event one". Nancy describes the tragic circumstances faced by this woman and so many others with poignancy, humanity and jarring realities. These circumstances are the inspiration for the book's title. My book club enjoyed the book and especially this opening story.
Nancy's stories in this book are inspirational. Some stories are humorous, while others are heart breaking. She provides a first-hand look at the ravages of tuberculosis, threats of witchcraft, the tolls of newborn tetanus and the tragedy of maternal death. Characters in the book include traditional birth attendants, chiefs, village health committees, mothers and nurses.
Acutely aware that she is a cultural outsider, Nancy reveals how and what she learned about the power of ancestors and the role of the women's secret society among the Mende.
This book will be of interest to many readers; those who have spent time living or working in a lower-income country, those who crave to do so and those who prefer to learn about such experiences from the sidelines.
Highly recommend for book clubs with lots of issues for discussion.
This book should be required reading for public and population health programs.
Nancy also describes another two years in Sierra Leone doing field research after her Master's degree in Canada.
Nancy's inspiration for the memoir was an older Mende woman who had no living children, "not one, not event one". Nancy describes the tragic circumstances faced by this woman and so many others with poignancy, humanity and jarring realities. These circumstances are the inspiration for the book's title. My book club enjoyed the book and especially this opening story.
Nancy's stories in this book are inspirational. Some stories are humorous, while others are heart breaking. She provides a first-hand look at the ravages of tuberculosis, threats of witchcraft, the tolls of newborn tetanus and the tragedy of maternal death. Characters in the book include traditional birth attendants, chiefs, village health committees, mothers and nurses.
Acutely aware that she is a cultural outsider, Nancy reveals how and what she learned about the power of ancestors and the role of the women's secret society among the Mende.
This book will be of interest to many readers; those who have spent time living or working in a lower-income country, those who crave to do so and those who prefer to learn about such experiences from the sidelines.
Highly recommend for book clubs with lots of issues for discussion.
This book should be required reading for public and population health programs.
February 12, 2023
This book would interest anyone studying or working in the field of global health, or who intends to do so in the future. Describing her volunteer experiences in 1980's in Sierra Leone this Canadian nurse shows how some issues remain resonant today. In the global field of RMNCH (reproductive, maternal, newborn and child health) much remains to be done. The author goes into detail about her work, creating a picture of her challenges and successes with honesty and humility, often asking herself thoughtful questions about motivation and purpose while working across cultures. She also shows us how her youthful volunteer experience led her to become a professor of nursing with a lifelong commitment to advancing global health.
As a former volunteer myself, (albeit in the education sector in a different African country,) I could relate to many of her stories about challenging living conditions and the trial and error of learning to work effectively across cultures with Indigenous and traditional leaders to achieve health outcomes. Nancy Edwards love for the people and the country of Sierra Leone infuse this memoir. Her poignant poem Not One, Not Even One is a thread that grounded me in understanding the compassion that has guided her life work.
As a former volunteer myself, (albeit in the education sector in a different African country,) I could relate to many of her stories about challenging living conditions and the trial and error of learning to work effectively across cultures with Indigenous and traditional leaders to achieve health outcomes. Nancy Edwards love for the people and the country of Sierra Leone infuse this memoir. Her poignant poem Not One, Not Even One is a thread that grounded me in understanding the compassion that has guided her life work.
December 21, 2022
A fascinating read that will increase your understanding of living and working in a foreign culture. The author drew me in from the beginning sharing the feelings she had as a 25-year-old Canadian woman landing in Sierra Leone in the 1970s to begin a three-year adventure as a CUSO volunteer and community health nursing tutor which got extended to 5 years as a researcher. Nancy vividly paints the picture of the country, her experiences, and the conflicting thoughts and feelings she had as a young health professional working to improve primary health care alongside traditional healers and local health beliefs and practices. The experiences she shares demonstrate how being thrown into a new culture makes you aware of your own beliefs, values, and biases. The photos woven throughout the book make the reader’s experience even more vivid.
A recommended read for anyone thinking of pursuing development work and for those who enjoy learning about different people and cultures.
A recommended read for anyone thinking of pursuing development work and for those who enjoy learning about different people and cultures.
April 28, 2022
I loved this book! I also embarked on a volunteer assignment in Sierra Leone in the 1980's as a recently graduated physiotherapist. Nancy Edward's book brought back many memories of the daily joys and challenges of this work and of living in a country so different from what I was used to. I was especially impressed with Nancy's ability to portray a way of life without being judgemental or patronizing, highlighting the roles of power, resources, and culture as determinants of health and well-being. This book is a must-read for anyone considering a career in international development. It is also a lovely story of an idealistic young person's journey from CUSO nurse volunteer to professor and leader in global health in Canada.
September 12, 2022
This book grabs you from the first chapter and throughout the whole book. Nancy Christine Edwards does a great job at outlining and explaining the kind of important work that she and other aid workers were doing at the time with it's trials and tribulations. She does this from both a professional and personal standpoint, which I find makes the book even more enjoyable. I particularly enjoyed how even though she writes about the way she and her colleagues were trying to educate and help the local people, she also makes sure the reader understands how much the local people taught them back. Not One, Not Even One is a book about compassion and respect for your fellow man. It's about overcoming challenges and still keep the hope up.
March 21, 2023
Nancy’s Memoir took me on an exciting trip into another world and time. Her meticulous descriptions based on well-kept notes and photos paint a detailed and realistic picture of the life and work in Sierra Leone in the 1970’s.
I admire how Nancy had wisely recorded everyday life, encounters, details of colleagues, local health challenges as well as wider village life and societal structures. Nancy was able to stay humble, curious, and respectful in such a different and demanding environment.
One the other hand, the multitude of events, names, and practical details make the Memoir text rather matter of fact and also somewhat laborious reading.
All in all, I warmly congratulate Nancy for such an impressive and informative Memoir!
Arja R Aro
I admire how Nancy had wisely recorded everyday life, encounters, details of colleagues, local health challenges as well as wider village life and societal structures. Nancy was able to stay humble, curious, and respectful in such a different and demanding environment.
One the other hand, the multitude of events, names, and practical details make the Memoir text rather matter of fact and also somewhat laborious reading.
All in all, I warmly congratulate Nancy for such an impressive and informative Memoir!
Arja R Aro
May 7, 2022
A different type of travelogue. Nancy recounts her adventures as a young idealistic nurse who travels to improve the world. She finds herself in a place which is very different from what she ever imagined. Openness to others, humility and humour allows Nancy to learn and thrive in the face of the many challenges and frustrations that are part of her daily life. Her work in Sierra Leone transforms her. Through her story, we grow like she grew, and learn to appreciate the wisdom of people with a different lived experience. And while her life’s trajectory did not go as planned, she keeps her idealism and imparts the insights she gained to improve the health of people in other places.
June 15, 2022
Nancy's Memoir presents the challenges, work and learning opportunities she experienced in her CUSO posting with a reality that leaves the reader moving through the pages totally absorbed. Her years in Sierra Leone were foundational to her successful career in education, research and international development. Readers considering international work will be awakened to life with sparse and unstable amenities, cultural influences and harrowing travel experiences but Nancy portrays it all as a positive adventure.
March 17, 2023
This book carried me along as a result of Nancy Edward' compassion and intense concern for the country people of Sierra Leone but also her willingness to be clear, honest and open about the personal and systemic challenges of living, working and pursuing research in a low income country.
Having some knowledge and experience of Sierra Leone I agree with the author's characterization of that country, the people and issues. The book should be on the reading list of anyone intending to live and carry out research outside of their own academic environment.
Having some knowledge and experience of Sierra Leone I agree with the author's characterization of that country, the people and issues. The book should be on the reading list of anyone intending to live and carry out research outside of their own academic environment.
January 31, 2023
Dry. If I hadn't had to read it for a book club, I would put it in my DNF pile. A lot of writing about the organizational part of her journey and not too much on her actual experiences. I am sure there is a confidentiality issue and I understand that. I would have enjoyed reading more about the daily lives of the people then having read so much about CUSO.
July 2, 2024
This is an engaging, informative, and thought-provoking account of a career in community health, starting with as a volunteer in Sierra Leone, and concluding as a respected professor at the University of Ottawa.
September 28, 2023
In the late 70s, Edwards left Canada to work as a community health nurse in Sierra Leone. It was never going to be a permanent move, but the impressions those years left—those are permanent.
The decades between the experience and the writing of the book are the book's strength and its weakness both. The benefit of that long time, of course, is that Edwards has had years and years to think on her experiences, understand them in context, and think over what was effective and why—and what was less effective and why.
Should we ask women to boil their families’ drinking water? That was a sure-proof way to decrease rates of gastroenteritis, but boiling water required firewood. Firewood had to be carried from farm to village. I consumed almost three litres of drinking water a day, more when I walked to the villages. I did the simple math. A polygamous household of ten adults required at least 30 litres of drinking water daily. That was one and a half jerry cans of water, which had to be carried from water holes to villages or farms. It was beyond unreasonable to expect women to boil that much water on three-stone fires, and in what? They had two communal household pots—one for rice, the other for plassauce. Boiling all drinking water was both the medically right and impossibly wrong message. (128)
Edwards clearly understands the limitations of her work in Sierra Leone, and the book is stronger for it. There are some things that she couldn't answer then and can't answer now, and as much as I love questions with answers...I prefer it when people understand that they don't have all the answers.
Some of the research Edwards did—because she spent time in Sierra Leone not just as a nurse but also as a graduate student doing research—has such unexpectedly sad results. That is...you can expect some sad statistics, given time and place and context (maternal mortality rates, etc.). But there's also this: Paul and I put the completed baseline questionnaires in green garbage bags and locked them in the wooden cupboards of the Bo-Pujehun project office. As far as I know, nobody ever looked at them again. During interviews, families had shared their raw emotions about live births, stillbirths, and deaths of women and children. Responses had been recorded in tick boxes, with a few words of explanation sometimes entered in the margins. Each event had been converted to a single, data-entry keystroke and then anonymously summed and buried in the calculation of health status indicators. Locking the questionnaires in dark cupboards metaphorically silenced the fulsome stories of hope and joy; of sorrow and tragedy. (258)
I so hope that someday such interviews can be done again in similar communities, but with the goal of (with informed consent, obviously!) recording and sharing the full stories rather than just the bare data. No shade to Edwards' research at the time, of course, just that there's so much that can be said in oral histories and personal stories that can't be captured in tick boxes. I said above—and I think this is relevant to this theme about personal stories—that there are upsides and downsides to the long time between Edwards' work in Sierra Leone and the writing of this book—the downside is that it's harder to get full portraits of the people in the story when those memories are decades old. I'd have loved to get a better sense of more of the individuals Edwards lived and worked with, more of a sense of their stories and individual lives. It's a fascinating book regardless, but one to go in looking for more of a broad-strokes, data-driven perspective than one that focuses on individuals.
The decades between the experience and the writing of the book are the book's strength and its weakness both. The benefit of that long time, of course, is that Edwards has had years and years to think on her experiences, understand them in context, and think over what was effective and why—and what was less effective and why.
Should we ask women to boil their families’ drinking water? That was a sure-proof way to decrease rates of gastroenteritis, but boiling water required firewood. Firewood had to be carried from farm to village. I consumed almost three litres of drinking water a day, more when I walked to the villages. I did the simple math. A polygamous household of ten adults required at least 30 litres of drinking water daily. That was one and a half jerry cans of water, which had to be carried from water holes to villages or farms. It was beyond unreasonable to expect women to boil that much water on three-stone fires, and in what? They had two communal household pots—one for rice, the other for plassauce. Boiling all drinking water was both the medically right and impossibly wrong message. (128)
Edwards clearly understands the limitations of her work in Sierra Leone, and the book is stronger for it. There are some things that she couldn't answer then and can't answer now, and as much as I love questions with answers...I prefer it when people understand that they don't have all the answers.
Some of the research Edwards did—because she spent time in Sierra Leone not just as a nurse but also as a graduate student doing research—has such unexpectedly sad results. That is...you can expect some sad statistics, given time and place and context (maternal mortality rates, etc.). But there's also this: Paul and I put the completed baseline questionnaires in green garbage bags and locked them in the wooden cupboards of the Bo-Pujehun project office. As far as I know, nobody ever looked at them again. During interviews, families had shared their raw emotions about live births, stillbirths, and deaths of women and children. Responses had been recorded in tick boxes, with a few words of explanation sometimes entered in the margins. Each event had been converted to a single, data-entry keystroke and then anonymously summed and buried in the calculation of health status indicators. Locking the questionnaires in dark cupboards metaphorically silenced the fulsome stories of hope and joy; of sorrow and tragedy. (258)
I so hope that someday such interviews can be done again in similar communities, but with the goal of (with informed consent, obviously!) recording and sharing the full stories rather than just the bare data. No shade to Edwards' research at the time, of course, just that there's so much that can be said in oral histories and personal stories that can't be captured in tick boxes. I said above—and I think this is relevant to this theme about personal stories—that there are upsides and downsides to the long time between Edwards' work in Sierra Leone and the writing of this book—the downside is that it's harder to get full portraits of the people in the story when those memories are decades old. I'd have loved to get a better sense of more of the individuals Edwards lived and worked with, more of a sense of their stories and individual lives. It's a fascinating book regardless, but one to go in looking for more of a broad-strokes, data-driven perspective than one that focuses on individuals.
July 16, 2022
I thoroughly enjoyed reading this memoir. I was drawn into CUSO volunteerism by Nancy's passion and vivid emotive descriptions of individuals she met in Sierra Leone. She was only a few years ahead of me on our life paths; it felt like I was tagging along on the author's journey beyond the Serabu hospital compound on "motorable" roads and along foot paths over log bridges and through lush tropical jungle to villages. Although, by the time I was 64 pages in, the number of snake incidents & encounters had already surpassed my comfort level eeek!
Evidence of Nancy's open-mindedness is on every page as she describes direct, primary, public health practices and cultural rituals. It was insightful of her to recognize the power of Mende beliefs and rituals; it was the key that unlocked what today we would call, "buy in" by the locals of Western maternal and child health care, e.g., sterilization of tools, immunization, and treatments.
My frustrations and impatience with bureaucracy might have been greater than the author's candid remarks -- as she sought approval under tight funding deadlines to conduct research of traditional birth attendants and government trained midwives -- for no good purpose, since we were young then and didn't grasp how massive change takes time. Luckily, Nancy's mentor was a beloved wise woman.
Evidence of Nancy's open-mindedness is on every page as she describes direct, primary, public health practices and cultural rituals. It was insightful of her to recognize the power of Mende beliefs and rituals; it was the key that unlocked what today we would call, "buy in" by the locals of Western maternal and child health care, e.g., sterilization of tools, immunization, and treatments.
My frustrations and impatience with bureaucracy might have been greater than the author's candid remarks -- as she sought approval under tight funding deadlines to conduct research of traditional birth attendants and government trained midwives -- for no good purpose, since we were young then and didn't grasp how massive change takes time. Luckily, Nancy's mentor was a beloved wise woman.
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