And so it is over. I am currently sitting in the counter-culture coffee is shop Coffee Exchange in Providence RI, sipping on an unsweatened tea while other students burry themselves in books and old white men discuss the New York Times front page.
It is quite frightening, how quickly one can forget Africa, how it is so easy to slip back into one’s old routine. The two worlds I have seen are juxtaposed almost beyond the point of comparison—two lines in different planes. I just am afraid that I will forget, because it is so easy to slip back into the comfort that has been my life for the past twenty years.
When I got back to Brown, my friends all asked me: so how are you holding up with the culture shock? They are a little late though because the culture shock did not come in Providence though but rather in Paris. Between leaving Bamako and coming back to Providence, I decided to extend my layover in Paris for one week and explore one of the world’s greatest cities. We took the red eye out of Bamako and arrived in Paris at about 6am. Going through customs, in a sleep deprived haze, I think to myself: why are there so many albinos here?...Oh wait…I’m in Europe…They’re white.
After saying good-bye to Julie, I brave the Paris metro alone with my 27 kg suitcase. I get off a stop too late for my line transfer, and ascend the steps. I find myself in a completely deserted square, Notre Dame, bathed in the perfect yellow light of dawn rises above me. I am alone with the most famous gothic cathedral. Talk about surreal.
My first day in Paris I spent wandering around the streets, a bit like Baudelaire. The contrast was incredible, to go from one of the 5th poorest countries in the world to one of the five capitals of world. The two worlds were so different; it was almost impossible to compare the two as it might have driven me to insanity. I floated along, taking in the beauties of Paris. It was only the smallest details that forced me into comparison. One girl at my hostel was wearing jelly sandals identical to the ones all Malian boys would play soccer in. What was a fashion statement of youth to her were the only affordable sport shoes for these boys.
I am also infatuated by the rental bicycle system in Paris, perhaps because of how many transportation problems we had to deal with in Mali. Throughout the city there are bikes that you can rent if you have a metro card. What a public service I thought: What a great example of how governments can actually provide for their people and not just leave them hanging. I, as a tourist there for one week, had an assured cheap means of individual transportation.
Other things: the joys of stop lights, paved streets, pedestrian walk and don’t walk signs—all these little things.
And yet, despite all of these differences, I found more similarities than I was expecting. Just as Malians go out at night to take tea and talk about the day, so too do Parisians—except they go out to cafés and drink wine. This habit of communal culture I find to be beautiful and yet it is lacking in American culture.
I was sitting reading my book outside at night and two bugs land on the page. I swat them away, then realize I don’t have to because they are not mosquitoes and so not harmless. Then I realize I miss the mosquitoes.
And yet of course there was the opulence, the variety and cost of Parisian life. My first night there I went to one of those local cafés and ordered a café au lait. Much to my surprise it cost 4 Euros, which is about 5.7$... WHAT?!?! I was not expecting that! I mean this was a tiny coffee, probably 8 oz. I mean it was really good, but that is about what we paid one of our translators in Mali for a day’s worth of work.
It was only in leaving then that I realized what power I really had in Mali. It was a power that I had not because I was white, but because I had enough money to fly away. I was not ‘powerful’ because I was American; I was ‘powerful’ instead because being American meant that I had money.
In our last conversations with our Malian friends, the topic came up several times: why is Mali so poor? It is not in the midst of a civil war or famine, and yet it consistently underperforms in major socio-indicators. In our conversations, I seemed to focus on issues of social capitol: the 90% illiteracy rate, the poor health of the population. Yet the Malian’s we spoke with (who were highly educated and healthy and yet had meager employment options) tended more toward explanations of an old stagnated government and a continued ‘hidden’ imperialism from Western countries.
What is the right answer? Is there a right answer? The field of development studies seems to be notorious for proving that theories fail rather than that they work. I obviously have no answer; if I did I would be writing a book right now rather than a blog.
How than can I make these two worlds that I now live in mesh—this coffee shop I am sitting in on Wikenden with the late night tea gatherings in the unpaved streets? Can I make them mesh, or must they live independently in my mind, as they are so different? In fact, how can the two exist together, how can they be so much apart of the same world? How can people here in Providence not know about what life is like in Mali (people in Mali are very aware of what life is like in western countries from all of the movies and TV shows)? I do not know how the two can exist together, or why I deserved to be born into such privilege.
Being back, people have asked me: so is TB BOLO program effective? Do you think you made a difference? The program in itself is young and still have kinks to get straightened out, though I am happy that Julie and I helped straightened out a few. As for making a difference, on a grand scale: no. This was my first time in Mali, and so much of it was me learning about the culture and what it means to be Malian. I could not just come in with my Western Idea of what to do and impose upon people who obviously know their own lives a lot better than I do. Instead of claiming that I have made sweeping changes, I take pride in the anecdotal evidence—of individual people that we have helped.
And so this may be the end of my writing on this blog. I may have some sort of revelation that I absolutely must post in the future. In the instance that this is my last post though, I would like to thank you all for reading, I hope you enjoyed learning about our experiences as much as I enjoyed writing about them. I also hope that the blog proved to be humorous when necessary and I hope that you found some new fresh kernel of thought to chew upon.
Mali may not be quite as far as I thought though. As I was sitting in Coffee Exchange writing this, Habib Koite came on. I froze, shocked back, while the coffee shop conversations continued around me.
Kambe
Lauren
Saturday, August 15, 2009
Wednesday, August 5, 2009
Quote of the trip
"It is going to be so strange going back to the first world and have men pay so much less attention to us"
-Julie
-Julie
If the dress doesn’t fit, pin it
And so our stay in Mali comes to a close. The survey’s are finished, the reports remain to be written, and several last minute meetings are in store for us tomorrow. We leave tomorrow evening and I am in by no means ready. Usually when I leave a place, I get a certain kick in my stomach and I start recording ‘lasts’ in my head: last time I will see someone, last night, last dinner, but here: no. On no level of any sort of consciousness am I ready to leave this place. I have become accustomed to it. I am not even at the point where I can say I will miss it terribly because I have not yet realized I am leaving.
The idea of leaving though has given me a certain ‘do or die’ attitude, because if I don’t do something now, I won’t have the chance again. This philosophy has led to several interesting situations: primarily, I managed to convince Julie it would be a good idea to witness a birth at the local clinic we work at in Sikoro. I then talk with the Sage-femmes (i.e. mid-wives) and ask if we can witness a birth. One woman looks me up and down and she seems to be judging me on the fact that I have never carried a child. She hesitates, and then invites us to spend the night with her at the clinic to watch a birth.
Julie and I return at 6pm the next day to spend the night. The clinic is bare except for a young man and squat women recording numbers from vaccination campaigns. We sit down, and wait. And wait for about 3 hours watching Malian television. At about 9pm it suddenly dawns on me that I have no idea what I am doing. In no way am I prepared to watch a life come into this world. I have not reached that level of maturity. I turn to Julie and explain my minor panic attack, and propose we leave—she seems rather relieved at my revelation. I then quickly stand up, explain to the squat woman that I have a terrible headache and so unfortunately will have to watch a birth another night. I then proceed to run away.
Looking back on it, it was probably good we didn’t go through with spending the night to watch a birth. We had nothing to bring to the table, we have no medical experience, we don’t know any of the Sage-femmes at all really. In fact, we would have been tourists to a birth.
It seems that so much of my time here I have worried about fitting in. At the beginning of my time in Mali, I was afraid to go out on my own, as I did not want to disturb Malian life. I was afraid to take pictures, as I did not want people to think I was just another American tourist.
Now though I realize, any attempt for me to fit in is utterly futile. I am white, I am American, and I can never walk down the street in Mali without getting some sort of special attention—whether is be kids crying out Toubabou (white man) or taxis honking to get a fare. I cannot fit in, and so I should not try to change what is essential about me. However this does not mean that I should stop trying to understand and learn from what is happening around me.
In fact, because Julie and I don’t fit in, we made it onto one of two of Mali’s television channels. Saturday night we wend out to watch one of our friends, Ba, sing. We thought she was going to be singing at a small bar or a local club, but no. We enter into the Palais Culturel to a theatre full of people arranged in sections. Each section was holding up sighs such as B12 or B6. After several minutes of confusion and eavesdropping on others conversations, slowly it begins to dawn on me that we are watching a game show. Ba will be singing in the opening act, and then the competition will begin.
The show consisted of 6 women who were fighting for the title of the women who best espouses the traditional qualities of a wife of a king. The show seemed to be an attempt to preserve Malian culture in face of modernization. The values they presented were that of subservience, respect and kindness (at least as far as I could tell, it was all in Bambara.) What was crazy though was the contrast between how boisterous and crazy the women were in the audience cheering for their ‘candidates’ and the tranquility of the candidates on stage. The voting process also seemed to reflect Malian culture in that the populaces vote did not win. Though people would text in who they wanted to keep on the show, this only counted for 50% of the ballot. The other 50% was decided by the ‘King of Mande’ and his counselors.
The audience was crazy, everyone dancing, banging on Tam Tams, and old water jugs. At one point in the melee, I look over, and there is this camera about 2 feet from my face. I become extremely self-conscious and start telling myself: just look ahead, act natural. Don’t look at the camera, don’t look at the camera. I look at the camera and smile painfully. Apparently, the cameramen like to zoom in and take long pauses on the 2 Toubabous in the room.
Kara informed us later that he had seen us on TV and we looked great. I laugh at the comment. Though I am rather excited to have had my debut on Malian television, I am not so much excited that the only reason I was on TV was because I am white.
It is strange that when I feel more at ease, when I feel more at ease with myself, I take my camera out more. Julie and I and one of our friends spent two nights in Segu, the ancient capital of the Bambara kingdom and a current economic hub of Mali and a MVP (Millennium Village Project) site. During those short days, my camera made more appearances than it has all trip. Perhaps this is because here in Segu I am officially a tourist, I am ok with standing out and looking ridiculous. In Bamako however, I am trying to get work done, and so I am afraid that by taking out the camera I become less of a worker and more of a tourist.
Segu in itself though is stunning. It is on the Niger and from Segu’s port you can take a boat all the way up to Timbuktu (which takes about 3 days). Julie and I attempted to take a much shorter journey in a pirogue to the other side of the Niger. Before we got in to the boa though, a slick looking boy came up to us and told us that Toubabou’s couldn’t take this pirogue for 150CFA (about 35 cents); we instead had to take a private boat from the other side for 7500CFA. Naturally, being college students, we decided to pursue the cheaper option and climbed into the pirogue. The boat filled up with people and wood and chickens and I think a motorcycle. As the crew began to push off, a man waded through the water and presented his license from the office of tourism to us. He promptly asked us to get out of the boat. I jumped out a little too enthusiastically and got my jeans soaking wet. It turns out that we Toubabou’s can’t take the cheaper option out of respect for the people who live here, because this ride is a joy ride for us, but it is a way of life for them.
The Piroque
The trip to Segu was absolutely stunning, the place so weighted with history. The means of getting back to Bamako though is another story in itself. For any writer currently suffering from writers block I highly suggest they take some public transportation in the developing world. I guarantee they will leave with a good story. For example, we left Segu to go on a day trip to the Bridge of Markalla, about 40km away. The bridge was built in the 1940’s by hand using forced labor. About 4,000 people died in constructing the bridge. To get to the bridge we jam our way into a public taxi. As we start out, the taxi man is obviously looking to pick up other fair, though at this point I could not imagine why—the taxi was already full.
In returning from Marakall to Segu, we get in a normal taxi with space for 5 people. Except there aren’t 5 people in the car there are 8: 4 in the front and four in the back. I have the joy of sitting in the back next to a Malian woman about twice my size. The front window is completely cracked and the doors have all lost their handles. As we start off down the road, I begin to plot favorable reactions and possible escape routes in case of an accident. Fortunately, I did not need to use any of these possible escape plans, however we did have the misfortune of a flat tire in the middle of nowhere and the second misfortune of this very sketchy taxi man not having a spare. After waiting around for a couple of hours, another taxi man in an equally sketchy car gave his spare tire to us and we were on the road again.
However, the joys of developing world transport do not stop with public taxis. One really must experience the charter bus. After we missed our first bus in the name of lunch, and after we sat at the bus stop for about 4 hours, we finally caught a charter back to Bamako. The bus is completely packed and with no air conditioning. This lack of circulation remedied by leaving the buses door open. I manage to grab a seat near the front. I look to my left and notice that the boy sitting across from me is holding a box full of pigeons that are not making a sound.
Malian bus rides coincide nicely with Malian philosophy as far as I can tell. There are many rest stops in the Malian bus ride, and each rest stop is accompanied by food. When the bus pulls over, a horde of venders crowd around the bus—sometimes entering—selling everything from hard-boiled eggs to cakes to edible roots and milk. This might be silly to write, but I could not help by think of how much I would hate that job: sprinting up to buses to make a single sale, selling things to people that they don’t really need, and to watch them drive away again while you are let behind to make the next sale.
Going back to the idea of fitting in, Julie and I had some Malian clothes made for us. We came home, or at least I came home from the tailor, giddy like a little girl, clutching at the dress. Yet when I put it on, it fits alright, only the chest is huge. I had never thought myself to be particularly deprived in that department, but in this top I am practically swimming in it. Julie’s too doesn’t fit quite right, one pange is too long, another shirt too wide. I take of the dress in anger, throw it on the bed, then come back five minutes later, put it on and pin in the extra fabric. You’ve got to work with what you’ve got I suppose.
It’s fairly similar to another sight I’ve seen a lot in Mali: little boys riding men’s bicycles. At first, I thought to myself: wow that is rather strange that all these boys are borrowing bikes from their older brothers, and then I realized that they don’t have bikes for children here. The boys are just working with what they’ve got.
So I can’t blend in here, the dress will never fit perfectly. And so I realize that I should stop worrying about standing out because of the way I look or dress or act and just be myself. I might not be able to fit into a Malian tailor’s idea for a dress, but I certainly can rock the pinned one I am wearing right now. And though I may not ever be able to walk down the street like a Malian woman, that doesn’t mean I still can’t bring something valuable to the table.
The idea of leaving though has given me a certain ‘do or die’ attitude, because if I don’t do something now, I won’t have the chance again. This philosophy has led to several interesting situations: primarily, I managed to convince Julie it would be a good idea to witness a birth at the local clinic we work at in Sikoro. I then talk with the Sage-femmes (i.e. mid-wives) and ask if we can witness a birth. One woman looks me up and down and she seems to be judging me on the fact that I have never carried a child. She hesitates, and then invites us to spend the night with her at the clinic to watch a birth.
Julie and I return at 6pm the next day to spend the night. The clinic is bare except for a young man and squat women recording numbers from vaccination campaigns. We sit down, and wait. And wait for about 3 hours watching Malian television. At about 9pm it suddenly dawns on me that I have no idea what I am doing. In no way am I prepared to watch a life come into this world. I have not reached that level of maturity. I turn to Julie and explain my minor panic attack, and propose we leave—she seems rather relieved at my revelation. I then quickly stand up, explain to the squat woman that I have a terrible headache and so unfortunately will have to watch a birth another night. I then proceed to run away.
Looking back on it, it was probably good we didn’t go through with spending the night to watch a birth. We had nothing to bring to the table, we have no medical experience, we don’t know any of the Sage-femmes at all really. In fact, we would have been tourists to a birth.
It seems that so much of my time here I have worried about fitting in. At the beginning of my time in Mali, I was afraid to go out on my own, as I did not want to disturb Malian life. I was afraid to take pictures, as I did not want people to think I was just another American tourist.
Now though I realize, any attempt for me to fit in is utterly futile. I am white, I am American, and I can never walk down the street in Mali without getting some sort of special attention—whether is be kids crying out Toubabou (white man) or taxis honking to get a fare. I cannot fit in, and so I should not try to change what is essential about me. However this does not mean that I should stop trying to understand and learn from what is happening around me.
In fact, because Julie and I don’t fit in, we made it onto one of two of Mali’s television channels. Saturday night we wend out to watch one of our friends, Ba, sing. We thought she was going to be singing at a small bar or a local club, but no. We enter into the Palais Culturel to a theatre full of people arranged in sections. Each section was holding up sighs such as B12 or B6. After several minutes of confusion and eavesdropping on others conversations, slowly it begins to dawn on me that we are watching a game show. Ba will be singing in the opening act, and then the competition will begin.
The show consisted of 6 women who were fighting for the title of the women who best espouses the traditional qualities of a wife of a king. The show seemed to be an attempt to preserve Malian culture in face of modernization. The values they presented were that of subservience, respect and kindness (at least as far as I could tell, it was all in Bambara.) What was crazy though was the contrast between how boisterous and crazy the women were in the audience cheering for their ‘candidates’ and the tranquility of the candidates on stage. The voting process also seemed to reflect Malian culture in that the populaces vote did not win. Though people would text in who they wanted to keep on the show, this only counted for 50% of the ballot. The other 50% was decided by the ‘King of Mande’ and his counselors.
The audience was crazy, everyone dancing, banging on Tam Tams, and old water jugs. At one point in the melee, I look over, and there is this camera about 2 feet from my face. I become extremely self-conscious and start telling myself: just look ahead, act natural. Don’t look at the camera, don’t look at the camera. I look at the camera and smile painfully. Apparently, the cameramen like to zoom in and take long pauses on the 2 Toubabous in the room.
Kara informed us later that he had seen us on TV and we looked great. I laugh at the comment. Though I am rather excited to have had my debut on Malian television, I am not so much excited that the only reason I was on TV was because I am white.
It is strange that when I feel more at ease, when I feel more at ease with myself, I take my camera out more. Julie and I and one of our friends spent two nights in Segu, the ancient capital of the Bambara kingdom and a current economic hub of Mali and a MVP (Millennium Village Project) site. During those short days, my camera made more appearances than it has all trip. Perhaps this is because here in Segu I am officially a tourist, I am ok with standing out and looking ridiculous. In Bamako however, I am trying to get work done, and so I am afraid that by taking out the camera I become less of a worker and more of a tourist.
Segu in itself though is stunning. It is on the Niger and from Segu’s port you can take a boat all the way up to Timbuktu (which takes about 3 days). Julie and I attempted to take a much shorter journey in a pirogue to the other side of the Niger. Before we got in to the boa though, a slick looking boy came up to us and told us that Toubabou’s couldn’t take this pirogue for 150CFA (about 35 cents); we instead had to take a private boat from the other side for 7500CFA. Naturally, being college students, we decided to pursue the cheaper option and climbed into the pirogue. The boat filled up with people and wood and chickens and I think a motorcycle. As the crew began to push off, a man waded through the water and presented his license from the office of tourism to us. He promptly asked us to get out of the boat. I jumped out a little too enthusiastically and got my jeans soaking wet. It turns out that we Toubabou’s can’t take the cheaper option out of respect for the people who live here, because this ride is a joy ride for us, but it is a way of life for them.
The PiroqueThe trip to Segu was absolutely stunning, the place so weighted with history. The means of getting back to Bamako though is another story in itself. For any writer currently suffering from writers block I highly suggest they take some public transportation in the developing world. I guarantee they will leave with a good story. For example, we left Segu to go on a day trip to the Bridge of Markalla, about 40km away. The bridge was built in the 1940’s by hand using forced labor. About 4,000 people died in constructing the bridge. To get to the bridge we jam our way into a public taxi. As we start out, the taxi man is obviously looking to pick up other fair, though at this point I could not imagine why—the taxi was already full.
In returning from Marakall to Segu, we get in a normal taxi with space for 5 people. Except there aren’t 5 people in the car there are 8: 4 in the front and four in the back. I have the joy of sitting in the back next to a Malian woman about twice my size. The front window is completely cracked and the doors have all lost their handles. As we start off down the road, I begin to plot favorable reactions and possible escape routes in case of an accident. Fortunately, I did not need to use any of these possible escape plans, however we did have the misfortune of a flat tire in the middle of nowhere and the second misfortune of this very sketchy taxi man not having a spare. After waiting around for a couple of hours, another taxi man in an equally sketchy car gave his spare tire to us and we were on the road again.
However, the joys of developing world transport do not stop with public taxis. One really must experience the charter bus. After we missed our first bus in the name of lunch, and after we sat at the bus stop for about 4 hours, we finally caught a charter back to Bamako. The bus is completely packed and with no air conditioning. This lack of circulation remedied by leaving the buses door open. I manage to grab a seat near the front. I look to my left and notice that the boy sitting across from me is holding a box full of pigeons that are not making a sound.
Malian bus rides coincide nicely with Malian philosophy as far as I can tell. There are many rest stops in the Malian bus ride, and each rest stop is accompanied by food. When the bus pulls over, a horde of venders crowd around the bus—sometimes entering—selling everything from hard-boiled eggs to cakes to edible roots and milk. This might be silly to write, but I could not help by think of how much I would hate that job: sprinting up to buses to make a single sale, selling things to people that they don’t really need, and to watch them drive away again while you are let behind to make the next sale.
Going back to the idea of fitting in, Julie and I had some Malian clothes made for us. We came home, or at least I came home from the tailor, giddy like a little girl, clutching at the dress. Yet when I put it on, it fits alright, only the chest is huge. I had never thought myself to be particularly deprived in that department, but in this top I am practically swimming in it. Julie’s too doesn’t fit quite right, one pange is too long, another shirt too wide. I take of the dress in anger, throw it on the bed, then come back five minutes later, put it on and pin in the extra fabric. You’ve got to work with what you’ve got I suppose.
It’s fairly similar to another sight I’ve seen a lot in Mali: little boys riding men’s bicycles. At first, I thought to myself: wow that is rather strange that all these boys are borrowing bikes from their older brothers, and then I realized that they don’t have bikes for children here. The boys are just working with what they’ve got.
So I can’t blend in here, the dress will never fit perfectly. And so I realize that I should stop worrying about standing out because of the way I look or dress or act and just be myself. I might not be able to fit into a Malian tailor’s idea for a dress, but I certainly can rock the pinned one I am wearing right now. And though I may not ever be able to walk down the street like a Malian woman, that doesn’t mean I still can’t bring something valuable to the table.
Thursday, July 30, 2009
Being Men in Mali
“Another man is just the façade of another you.” That, more or less, is what our friend Samassekou told us as we took tea in Sikoro, reflecting on a weekend full of cross-cultural laughs. After going out with the peer educators as usual on Saturday morning, we were invited to another “balani,” or block party, up on the plateau of Sikoro. In the midst of a cluster of mud brick houses, perched high above Bamako, music blared out of huge amps and a DJ pumped up the crowd. We set up camp with a couple of the peer-educators about fifty yards away from the dance circle, where we periodically retreated to take tea in between bouts of dancing. I was charged with the extensive ritual of making the tea, and spilled about half the tea pot in the process. Meanwhile, Lauren won her place in Sikoro’s dancing hall-of-fame, taking on three men in a dance-off in front of dozens of avid watchers. Ever since, we’ve been greeted by quite a few strangers as the “dancing toubabous!” Toubabou’s may not be able to dance the Malian jig, but they can, we proved, dance in their own way.
On Sunday, after a morning of taking surveys, we accompanied Samassekou and Ablo to a Malian wedding reception. We were surprised to find ourselves on a rooftop surrounded by seated men. “Where are the women?” we asked. The men pointed down to a gathering the next block over, where we could make out a large group of women dancing to live Malian music. We became very self-conscious and asked why the men’s and women’s parties were separated. The men shrugged. They said both groups just seemed to prefer it that way. But what about the groom, we asked. Didn’t he want to be with his bride? It turns out a bride in Mali does not even attend her own wedding reception! Rather, she must hide her face from the public for a full week before emerging as a married woman. Which brings me to another realization – our entire time in Mali, we have been treated like men. Sitting at the men’s grains, joining the men’s marriage party, and looking forward to careers without childbearing in the near future, we have much more in common with the men here than the women. Our friend told us one day that women here need a man to help them make decisions, but we (Lauren and I) were different, we were on a “another level.” So you think we were just born that way? we challenged. But I’ll save my tirade on gender norms for another day.
Later that day we sat for hours drinking tea (which I successfully made this time) on the Plateau overlooking Bamako. We laughed about our differences. Here, for example, it is rude to pass someone in the street without going through the extensive Malian greeting. But when it comes to saying goodbye, Malians tend to just up and leave without warning. We explained to Ablo and Sam how surprised we were when, during our first week, they had left our house so abruptly. Had we done something to insult them? We had racked our brains and even asked Karamoko about it. It turns out that the extensive process of leaving that we are used to (checking the watch, rattling car keys, explaining apologetically that one has to get back because of such and such, and then continuing to talk for 15 minutes on the way to the door) is just NOT the norm in Mali. Case in point: Mali’s lengthy hello’s are simply substituted for Americans’ lengthy goodbye’s.
On the work-front, things are moving right along. Last week we attended a training session organized by Group Pivot, the national health education organization, in conjunction with PNLT, the national tuberculosis program. It turns out that GAIA is somewhat ahead of the game with TB peer-education, and we presented the TB-Bolo education model (literally “TB hand”), which uses the five fingers of the hand as a mnemonic of important TB-related messages. The NGO representatives at the meeting expressed great interest in borrowing our model - our peer-educators may even be summoned to teach other educators how to use it!
We are almost done with our surveys, which evaluate baseline knowledge of TB in the community as well as the efficacy of the TB-Bolo education program. Aside from that, our other main project is an effort to streamline TB detection in Sikoro. We have found that though tuberculosis treatment is “free” in Mali and available at the local level, there are substantial hidden costs to initiating that treatment. A patient who suspects himself of tuberculosis must first have the means to see a doctor at the local health center, and then must make three trips to the referral center in order to undergo TB diagnostics and start on treatment. TB-Bolo has worked to break the first barrier by minimizing the cost of a visit at the local health center for TB suspects, but this is just the tip of the iceberg. Many patients who get referred to the hospital for TB tests are “perdues de vue” – lost from sight. Even those who do make it to the referral center are sometimes turned down, because the lab there is at full capacity. So we are now trying to bring TB diagnostics to the local level, in order to save patients those three trips, and keep possible TB cases from falling through the cracks. After visiting personnel at all rungs of the healthcare ladder, we have found a wide consensus that sputum analysis for TB detection should be brought to the Sikoro health clinic. Today, we got the head of the national tuberculosis program on board. Once the lab is furnished with a microscope, we are told, the service can start to happen in a matter of weeks!
Sadly, in a matter of weeks (one week, to be exact), we will no longer be here to see the outcome. The end is creeping up way too fast! I have grown to love this landlocked little country. The only complaint I have is the itch of mosquito bites on my ankles. And the marriage proposals, annoying as ever. Count of proposals: Lauren – 4, Julie – 4. Latest one was a police man. Thank you Sophie, our adoptive mother, for fighting off the suitors!
K’an b’u fo.
Julie
On Sunday, after a morning of taking surveys, we accompanied Samassekou and Ablo to a Malian wedding reception. We were surprised to find ourselves on a rooftop surrounded by seated men. “Where are the women?” we asked. The men pointed down to a gathering the next block over, where we could make out a large group of women dancing to live Malian music. We became very self-conscious and asked why the men’s and women’s parties were separated. The men shrugged. They said both groups just seemed to prefer it that way. But what about the groom, we asked. Didn’t he want to be with his bride? It turns out a bride in Mali does not even attend her own wedding reception! Rather, she must hide her face from the public for a full week before emerging as a married woman. Which brings me to another realization – our entire time in Mali, we have been treated like men. Sitting at the men’s grains, joining the men’s marriage party, and looking forward to careers without childbearing in the near future, we have much more in common with the men here than the women. Our friend told us one day that women here need a man to help them make decisions, but we (Lauren and I) were different, we were on a “another level.” So you think we were just born that way? we challenged. But I’ll save my tirade on gender norms for another day.
Later that day we sat for hours drinking tea (which I successfully made this time) on the Plateau overlooking Bamako. We laughed about our differences. Here, for example, it is rude to pass someone in the street without going through the extensive Malian greeting. But when it comes to saying goodbye, Malians tend to just up and leave without warning. We explained to Ablo and Sam how surprised we were when, during our first week, they had left our house so abruptly. Had we done something to insult them? We had racked our brains and even asked Karamoko about it. It turns out that the extensive process of leaving that we are used to (checking the watch, rattling car keys, explaining apologetically that one has to get back because of such and such, and then continuing to talk for 15 minutes on the way to the door) is just NOT the norm in Mali. Case in point: Mali’s lengthy hello’s are simply substituted for Americans’ lengthy goodbye’s.
On the work-front, things are moving right along. Last week we attended a training session organized by Group Pivot, the national health education organization, in conjunction with PNLT, the national tuberculosis program. It turns out that GAIA is somewhat ahead of the game with TB peer-education, and we presented the TB-Bolo education model (literally “TB hand”), which uses the five fingers of the hand as a mnemonic of important TB-related messages. The NGO representatives at the meeting expressed great interest in borrowing our model - our peer-educators may even be summoned to teach other educators how to use it!
We are almost done with our surveys, which evaluate baseline knowledge of TB in the community as well as the efficacy of the TB-Bolo education program. Aside from that, our other main project is an effort to streamline TB detection in Sikoro. We have found that though tuberculosis treatment is “free” in Mali and available at the local level, there are substantial hidden costs to initiating that treatment. A patient who suspects himself of tuberculosis must first have the means to see a doctor at the local health center, and then must make three trips to the referral center in order to undergo TB diagnostics and start on treatment. TB-Bolo has worked to break the first barrier by minimizing the cost of a visit at the local health center for TB suspects, but this is just the tip of the iceberg. Many patients who get referred to the hospital for TB tests are “perdues de vue” – lost from sight. Even those who do make it to the referral center are sometimes turned down, because the lab there is at full capacity. So we are now trying to bring TB diagnostics to the local level, in order to save patients those three trips, and keep possible TB cases from falling through the cracks. After visiting personnel at all rungs of the healthcare ladder, we have found a wide consensus that sputum analysis for TB detection should be brought to the Sikoro health clinic. Today, we got the head of the national tuberculosis program on board. Once the lab is furnished with a microscope, we are told, the service can start to happen in a matter of weeks!
Sadly, in a matter of weeks (one week, to be exact), we will no longer be here to see the outcome. The end is creeping up way too fast! I have grown to love this landlocked little country. The only complaint I have is the itch of mosquito bites on my ankles. And the marriage proposals, annoying as ever. Count of proposals: Lauren – 4, Julie – 4. Latest one was a police man. Thank you Sophie, our adoptive mother, for fighting off the suitors!
K’an b’u fo.
Julie
Wednesday, July 22, 2009
Things I do to make my mother worry
Sophie buying quite hot bread
At the artisans marketI have adopted recently the rather bad habit of sitting outside at night to working on my computer. This being winter in Mali (which doesn't mean it is necessarily cool, today it hit 90 degrees F, but that every so often a monsoon rain comes through) there are a lot of mosquitoes, which means I have a lot of mosquito bites. Now if I were a sensible person I would go inside and so avoid risking getting Malaria from these mosquitoes. Yet it is so beautiful outside and mosquitoes are apart of life here. It is as if, as Julie said this afternoon: we finally feel settled here. Now entering our fourth week in Mali, life has taken on a certain ebb and flow that we have become accustomed to.
That is not to say that we have completely gotten in the grove. Sunday night, we noticed that something was being set up at the 'hidden football field' just up the road. I initially thought it was a wedding of someone quite important (Sunday=day of marriages, and there are a lot of marriages!). So Julie and I ventured over to check it out in tang tops and jeans. We start walking up the street and soon Julie says to me: "Lauren we need to turn back. All the women are veiled here." Now though Mali is 90% Muslim, most women walk around without wearing a veil. We run back home, throw some tiny scarves onto our head (I am a little out of practice with tying a veil and my scarf was too thin, so the bun of my hair was sticking out, talk about awkward) and venture out again.
As it turns out, Sunday was the celebration of the day that Mohamed ascended into the sky. Julie and I join the crowd that is amassing toward the stadium. There are street vendors of prayer beads, prayer rugs and verses from the Koran. We file forward, toward the woman's entrance (men and women had separate entrances and also separate places to pray within the stadium). At the threshold I hesitate for a moment, thinking what am I getting myself into. Several women, as if seeing my fear, beckoning us foreword, saying 'you are welcome' in Bambara.
We enter. The football field is already full of people who must have been sitting there for hours. The men are so far away I can hardly see them (I was a little too shaken up to start a feminist tirade about how there is no such thing as 'separate but equal'). Julie and I sit down at the back, trying to be as discrete as possible. I am hyper-aware of the fact that my hair is showing in the back and that my scarf does not really count as a veil. The women around us seemed quite frankly to be accepting of the two semi-veiled white girls who just sat down, one laid out a rug for us to sit on.
Then the service began. At first I thought this was something similar to an Easter Sunday Mass, something that happened in every cartier of Bamako. It was only later I was told that we were hearing the head Prophet of Mali speak: Idira. The sermon was long, I mean I haven't sat through church service recently, but this could not help but remind me of a puritanical sermon that goes on the whole day. We came in at about 10pm and left around 1am, at which point the service was still going strong. Later, we were told that the service probably went to about 3am. The head preacher would speak a line or phrase (in Bambara, so I couldn’t understand) and a second speak would cry back. It almost put me in a trance, the two voices, and the dirt field full of sitting people.
Typically, I try to avoid talking about religion with Malians. People seem not to care if you a Christian or Muslim or what not, as long as you are something: which poses problems for me, the agnostic. Tonton (the doctor at the CSCOM) asked me the other day if I was Catholic. I should have said yes, just to play it off, but instead I stutter and said, "no I'm Christian" (which is in itself a lie). Tonton looked at me and said "Just like that, just Christian?" I felt like I was looking respect in his eyes. "You should try Islam," he said, "it is a very good religion."
My mother will probably cry in anguish when she reads that.
Perhaps there are some things that I can never understand or become a part of in Mali. Last week, Julie and I had a long discussion with one of our peer-educators about excision (aka. female circumcision). I have never actually had someone sit down with me and argue for the benefits of female circumcision. It is so strange because I respect him so much and his opinion and yet I disagree so strongly with him so strongly. I can't even say that 'we agree to disagree,' that female circumcision is an important part of culture and society in Mali. I just wanted to look him in the eye and say "Can't you see that you’re wrong! Can't you see what you believe is hurting and subjugating to women!" But you can't just do that, so we debated, and he felt just as strongly as I did, but in the opposite direction.
Disagree to disagree then, on this.
Saturday, July 18, 2009
Let's Dance
Long time no blog, apologies! I could say it is because work has picked up, since we are now in the full swing of surveying. Maybe it is also a sign of our growing social life, as we visit and get visited by more people in the area. But it is mostly a sign that I’ve succumbed to Mali time, the heat of the day dictating when I can work and when I must sit on my bum and do absolutely nothing, not even blog. Those times of day are reserved for napping, sipping tea, or just listening.
Some quick updates:
- We have become the groupies of a bunch of Malian musicians. Our “in” is named Mamadou, a member of Habib Koite’s world-famous band, who happens to be very close friends with Sophie. Madou is one of the best tama (or “talking drum") players in the world, and his entourage is full of young musical talent. We hang out in little nightspots that are the equivalents of smoky jazz clubs but with Malian music instead. The music is way over my head, but I love it.
- The other night we accompanied Madou to a sort of block party in the neighborhood he grew up in. Madou set up a DJ system complete with amps and a mic, and at least fifty children of all ages gathered. It’s amazing how music can get these kids going! Dancing ensued, by age group…Lauren and I joined the older girls group, and Lauren wowed the crowd with her sick dance moves. But no moves were quite as impressive as those of a young girl and boy, neither of which could be older than ten, who broke it down in a dance-off at the end of the night. Beyonce could learn a thing or two!
- We started shadowing TB rounds in Mali’s biggest hospital, called Point G. Complete with white-coats and face masks, we toured the TB ward and listened to the medical team’s debates about treatment regimes for their patients. The hospital’s campus, perched on a steep hill overlooking Bamako, has some resemblance to Stanford University, very open and flowery. However, the world inside the wards is much more dismal. Even in Mali’s leading medical institution, tree branches are tied to the hospital beds to hang up mosquito nets, and a single aspirator is shared among several hospital buildings. The TB rounds last Tuesday were ended prematurely when a storm hit and rain started slapping down the hallways. Moving from one patient’s room to the next, we thought the wind was going to carry us off the hill!
Now for some Lessons Learned in Mali:
o Don’t give your phone number to friendly men. Lauren has been our guinea pig, having shared her number with quite a few individuals during her few days of owning a phone. Lauren has now grown accustomed to getting about 10 calls a day from EACH of her 4 doting men.
o Don’t use bug spray at mid-day. It may keep the mosquitoes away but – believe it or not – flies LOVE IT. Yesterday, when I was attacked by flies shortly after my spraying, we conducted a little experiment. We sprayed a nearby wall with bug-spray. Sure enough, the flies zoomed to the wall like magnets, and I’m talking significant numbers here. I guess poison for some is candy for others.
o Don’t eat, or touch people, with your left hand. It’s known to be the one you wipe with (here where the concept of TP is somewhat bizarre)
o Don’t give anything to kids unless you have that same thing for all of them. As Lauren and I were walking to the CSCOM the other day, I took some pictures with some smiley kids, and gave them some of my water to drink. I told them they could keep the bottle…but in their eyes I told this one guy that HE could keep the bottle. For the next two kilometers, these kids were on our tails, asking “ou est MON cadeau” (where is MY present?) By the time we reached the health clinic, we thought we had lost them, and began our meeting in the safety of a closed office with one of the doctors there. But about half-way through the meeting, the same kids were reaching in through the window shouting “Mamou!” (my Malian name), and one even came in the door from the other side, not letting up until the doctor scolded them in Bambara. I felt awful and humiliated. Lesson learned.
Best recipe yet in Mali: Sophie's crepes with caramelized mangoes. To die for.
-Mamou
N be bilenman kanu
Thursday, July 9, 2009
The places inbetween
Blo and his family
Looking down from Ngomi into SikoroI had the great honor of working with someone today who deserves the highest of praises. Though I may have met several prestigious people who control health policy and sit in nice leather chairs through Annie, though each of these men and women are smart and dedicated to their work, none of them has impressed me more than Blo. Blo is a peer-educator for GAIA’s TB Bolo program and a Malian equivalent of a Nurse practitioner and he really rocks the boat.
He met us as 7:30am at the local clinic (the CSCOM), after having spent the night on call at the local hospital (the CSREF) and the day before that giving out vaccinations. He then offered to walk with us up to his village Ngomi instead of driving so that we could see the scenery. And what a scenery it was! We started walking out of the valley, up the hills behind Bamako. I must admit, but I did not think that Mali was going to be this green! We walk up into the hills, over one of Bamako’s trash repositories (why the dump is upstream of Sikoro I do not know) toward Ngomi—the last ‘Cartier’ (i.e. district) of Sikoro.
Once above, our, or rather Blo’s work began. He was doing a special one-on-one TB Bolo outing with us. He proceeded to bring us around to all the TB houses and suspected TB houses in the village. I just can’t sing Blo’s praises enough, and not to sound too much like a Kristof column, he and one other woman were this village’s only direct link to medicine as we know it. He knew each of the houses; he knew everyone and took care of them.
When we visited one old woman with Blo, I nearly lost it and broke down in tears. Well that’s not true, in retelling her story I nearly lost it and broke down in tears. She had been given a ticket by Blo to go down to the CSCOM for a TB test after coughing for years. Since she couldn’t afford the 450 CFA round trip on the public-transport (about 1$) she decided to walk to the clinic. On the way, she got so tired and couldn’t stop coughing that she nearly died on the side of the road. Since Blo was not around, she had a traditional healer come and help her back up to Ngomi.
We all talk about access to care issues, but that adds a whole new level to the conversation.
Despite that though, there was still hope. Blo gave her another ticket, and said that this time he would be the one to take her down on his motorcycle to the local clinic for testing. He was so calm and self-assured and just well caring. He told us later that in every action you do, do it with courage—and I must say he follows his own advice.
Then we began the descent back to Sikoro, and what a descent it was. We stepped into a Sotrama—think an old VW bus with the interior carved out—and held on . My first impression of being in a Sotrama was that I was going to die. It was a bit like being on a make-shift roller coaster at summer fairs, except there were no seat belts, and it was real. With each second that passed coming down the hill I remained amazed that the back half hadn’t fallen off yet.
Back in town though, we walked. We walk a lot here, though Malians don’t and think we are kind of weird for walking. Besides the fact that we don’t have a car/ motorcycle/bike to get around in and we don’t feel like emptying our pockets for taxicabs for each instant, we walk because we feel so much more ‘in it.’ There are so many interactions you can just miss by driving. Today, for example, in walking home we just said hello to two women on the side of the road. It turns out that the two women are Griots and the next thing we know they started singing us a song of welcome!
Kambe,
Fatimata (Lauren)
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