So we've been here at the training center for two weeks for our in-service training, and gnawing our hands off. The excitement of being with 60 Americans all day for two weeks quickly wore off as we realized with horror that there was no nap time! Barely even time for even tea between our packed schedule of technical lectures and language classes, field trips and administrative sessions designed to remind us that we are, in the end, owned by the government. But at nights we pitch a fire, and hopefully someone pulls out a guitar and harmonica as we sing soulful recreations of Beyonce and Outkast to the drum of an upside down bucket. Or maybe we spark up the hookah and toast some pumpernickel bread using a rake (we all could sure use the fiber), enjoying the comraderie of people who are just slightly crazy enough to live in a mud hut for two years in West Africa.
Luckily I've gotten out of the walls of the Training Center into Bamako a few times, where we dance feeling uncomfortably modest next to the blue eyeshadowed Malian prostitutes. Finally we head home to the sound of the 5am call to prayer, waking up at 9am to grab ice cream before heading back to sessions.
Even though I never felt the urge to see him in the US, a bunch of us decided to go to the Sean Paul concert, a fundraiser for Malaria prevention. It turns out Sean Paul is as bad in Mali as he is in the States. As he finally stepped on stage about 4hours after his promised arrival, the Gendarmes started to grow anxious looking at the rowdy crowd, and started to push us all. We moved like cattle, and in the rush I lost one of my shoes. Thankfully I found another on the ground, albeit an inch lower, and we hobbled our way to the exit right as a chair was thrown. A wise exit, and a warning never again to go to a big concert here.
And so as IST comes to an end, off I go to hike through Dogon country among the villages carved into the mountains.
Thursday, December 17, 2009
Friday, December 4, 2009
A moveable feast
While short, this week at site was chockfull of excitement. I came at the start of Seliba (Tabaski), a Muslim holiday celebrating Abrahams sacrifice of a ram instead of his son Ishmael (yes, the Koran places Ishmael, not Issac, in the knife's path - an interesting deviation from the Torah). In the days right before seliba, herds of goats and sheeps seemed to appear out of thin air: blocking the streets of the teeming markets, nipping at my feet on the bus ride to village, trying their best to get into my yard by gnawing my wood gate. As I walked into my host family's concession, the slaughter was already beginning. On a tarp over the sand I watched as the goat was killed, skinned and cut into intricate shapes, taking it apart with surgical precision. I'll spare you the details. Over the next two days I ate a myriad of interesting, seemingly inpalatable body parts. Out came entrails flavored with Maggi, tounge, pancreas and lung (?) amid peanut sauce and potatos, a very gluey hoof, and a majestic bowl full of grilled goat's head. The last was (alarmingly) delicious. Grotesque, yes. But there is some beauty to this idea of sacrifice, a long forgotten acknowledgement of our need to kill these beasts for our own life. Until now I never quite grasped the disconnect that is present in cultures where access to proteins and micronutrients is a daily given. When most of the villagers can afford meat only every other week, if that, each part of that animal becomes an opportunity for their children to grow strong (cue the Lion King's Circle of Life). Yes, here even the gluey hoof is useful and worthy of attention, and damn good protein. Killing with love.
The rest of my time was spent in the usual way. Mornings at the health center weighing babies, painting murals, or just chatting with the patients, health workers, or the usual characters that just, well, hang out. Afternoons hiding from the sun, reading or listening to the BBC on my shortwave radio, getting water, etc. Since the cold season is approaching (despite the 90 degree afternoons), in the evenings everyone huddles around the bonfires pitted in the middle of the yard, drinking their tea and listening to radio. The hilarity has been lost on me as my body temperature has apparently switched to Sub-Saharan mode. The other day, shivering in my sweatshirt, I looked at my thermometer, which was at an embarrasing 65 degrees. I am sure it is snowing in New York by now. I can't really understand that.
The other night, as I headed to my hut for my usual 9am bedtime (what else is there to do with no electricity?) I heard drums rumbling somewhere in the dark village. The next day the beating started again, and I finally discovered the donkiliyoro (dancing place), where the young village women and some men were gathered in a circle in celebration of an engagement. The women were feverously dancing in front of the three drummers, their hands thrown up behind their back and their torsos bent - birds of paradise in vibrant flower prints. The three men pounded their djambes (drums) with "snares" made of pieces of scrap metal, in front of a small bonfire which softened the drum, creating a deep bellowing sound. Soon, almost on cue, the three women would move out and a new group of girls would twirl in, dancing synchronously as the crowd began a call and response song. They danced and sang with such enviable ownership. This culture, these traditions are not the dusty cliche of their grandparents. It is theirs and they create it with each village dance, with the rhythms that have been drummed for centuries. The headwraps flew and panye (wrap skirts) adjustments were made as the party raged on through the night. I went back to my hut around 10pm, finally falling asleep to the rhythmic beats of the drums.
The rest of my time was spent in the usual way. Mornings at the health center weighing babies, painting murals, or just chatting with the patients, health workers, or the usual characters that just, well, hang out. Afternoons hiding from the sun, reading or listening to the BBC on my shortwave radio, getting water, etc. Since the cold season is approaching (despite the 90 degree afternoons), in the evenings everyone huddles around the bonfires pitted in the middle of the yard, drinking their tea and listening to radio. The hilarity has been lost on me as my body temperature has apparently switched to Sub-Saharan mode. The other day, shivering in my sweatshirt, I looked at my thermometer, which was at an embarrasing 65 degrees. I am sure it is snowing in New York by now. I can't really understand that.
The other night, as I headed to my hut for my usual 9am bedtime (what else is there to do with no electricity?) I heard drums rumbling somewhere in the dark village. The next day the beating started again, and I finally discovered the donkiliyoro (dancing place), where the young village women and some men were gathered in a circle in celebration of an engagement. The women were feverously dancing in front of the three drummers, their hands thrown up behind their back and their torsos bent - birds of paradise in vibrant flower prints. The three men pounded their djambes (drums) with "snares" made of pieces of scrap metal, in front of a small bonfire which softened the drum, creating a deep bellowing sound. Soon, almost on cue, the three women would move out and a new group of girls would twirl in, dancing synchronously as the crowd began a call and response song. They danced and sang with such enviable ownership. This culture, these traditions are not the dusty cliche of their grandparents. It is theirs and they create it with each village dance, with the rhythms that have been drummed for centuries. The headwraps flew and panye (wrap skirts) adjustments were made as the party raged on through the night. I went back to my hut around 10pm, finally falling asleep to the rhythmic beats of the drums.
Thursday, November 26, 2009
Running water
A good month. It started with Halloween - the insanity of such a frivolous, fabulous holiday magnified by the bewildered Malians as we stepped out of the Kita house dressed as super heros, millet stalks, Bush taxis and a vertitable cast of characters. Kristen and I went as two mut huts, complete with a broom shoved on our heads for our straw roofs. Costumes slowly stripped away as the night blazed with dancing, plastic bags of gin and hulahooping. There is such a luxury that comes with letting your strange Americaness float comfortably among other Westerners, flinging off the awkwardness that cloaks you in village as you fret to cover your knees and respect the cekorobas (old men). Speaking of which, I heard a fantastic Malian proverb the other day:
"You can jump over the old man's excrement, but you can't jump over his speech."
After Halloween a few of us jumped into Bamako for a few days. I had an HIV awareness meeting to attend, and we tried our best to soak in the Bamako goodness: ice cream, diet coke, chinese food. The post Halloween party was still roaring there, and we spent most of our time at our friends house, talking amongst the carved watermellon jackolanterns and the persuasive call of the Mosque next door at prayer time. Heading back we bumped into a fellow Kita friend and hopped on the night bus back to Kita, where the three of us squished into a two sear row as goats wrapped in sacks whined on the roof above us. When I came back I discovered that my computer had contracted a nasty virus - too many dirty flashdrives. Its out of commission until I get back to Bamako for training in December.
Despite my anticipation at returning to village - laughable Bambara, annoying children and ego challenges looming ahead - I reached the pink tipped millet fields and friendly straw roofs with a sigh of relief. The relief was short lived as I ran straight to the toilet, beginning my two weeks of contemplating the ingenuity of the Bambara word for diarrhea, konoboli (running stomach). Between bathroom trips though I was able to begin the incredibly uncomfortable experience of my Baseline Survey. My humility soared as I asked the chief of the village if he had heard of STIs and, not realizing I was talking to the Imam (Moslim priest), I asked, amid a cloud of 20 children, if he knew where to buy condoms. Still, I left each family with a sense of purpose, and I am ingraining my purpose into this village as I try to understand what my role is here. A representative for the Women's Association came up to me and asked if I could help them create a women's garden, which should be an interesting project. Thankfully my site mate is an environmental volunteer, so hopefully we can get that project started together.
The usual sadness still greets me at the health center though. A woman 8 months pregnant finally coming in for her first pre-natal consultation, so weak due to her severe anemia her husband finally gave her the money to come. As we put her on an IV a grandmother holds her one year old grandson convulsing with cerebral malaria, and she is screaming "Oh Allah!" over and over through glassed over eyes. We try to put an IV in the child's tiny hands and feet but can't find a vein with his extremities bloated with edema, the body's desperate attempt to keep hydrated depsite malnutrition.
As my language becomes more coherent, I have finally been able to make friends here, a task that is harder than it seems as many people either see me as a bumbling awkward outsider who can't understand a word or are trying to see how much they can get out of me. I think I might pull my hair out if I hear "Where is my present?" one more time. Still, I try to remind myself that manners is as cultural as anything else. And with real friends I am starting to have some real conversations about living here. As Soliba and I discussed the difference in families in our countries, I tried to explain why it was not only okay but even (fully aware of my Western ethnocentricity) better to have less children (7 is the average for Malian women). She was incredulous when I told her that americans have 2-3 children on
average, and asked me:
"But what if one of your children dies?"
From an isolated point of view this logic seems flawless - the more children you have the more they can work for the family. This is also one of the values that is written in the Koran. And since almost a quarter of children die before the age of 5, this loss must be accounted for. My limited Bambara tried to
explain that children in the US dont die as often because their
parents have fewer children, and can take better care of each one. But
who am I to tell them to reject their culture, and how do they grasp
that they can slowly get themselves out of poverty by having less
kids? (this is arguably the key cause of their poverty and the world's
food crisis).
Such a sad reminder of this vicious cycle of poverty and tradition.
Poverty perpetuated by tradition, naivety.
(Is this their leaders fault, or the population that doesn't ask for better?)
A need for stability through tradition perpetuated by poverty.
(Is this our fault?)
This shouldn't be something anyone should get used to.
After two weeks and many bathroom trips I headed back to Kita and discovered that I have a stomach parasite. Not really a shocker. We spent a few days with our tutor under the guava tree as I got through the intense anti-parasitic medicine which made my water taste like metal. Me and my friend jumped on the 1am bus to a big Thanksgiving gathering with tons of other PCVs. We made 20 pies, killed 5 turkeys and filled a bucket with fruit salad, another with stuffing and mashed potatos. The next day, despite our food and whisky hangovers, 12 of us decided to head to a nearby waterfall. All of us somehow squeezed into a sedan, and I spent the two hour trip with the clutch awkwardly in between my thighs. When we passed the Gendarme (police) stop a few people climbed onto the roof, ducking renegade tree branches as we bounced through the path as if on a dried up narrow river bed. We teetered on the narrow bridge made of a few bamboo branches stuck together and hiked, following the sound of the water. The waterfalls were incredible. We climbed up the rocks, hoisting ourselves up with vines, and jumped off the rainbow tinted waterfalls into the shimmering pool 20 feet below. Beautiful.
"You can jump over the old man's excrement, but you can't jump over his speech."
After Halloween a few of us jumped into Bamako for a few days. I had an HIV awareness meeting to attend, and we tried our best to soak in the Bamako goodness: ice cream, diet coke, chinese food. The post Halloween party was still roaring there, and we spent most of our time at our friends house, talking amongst the carved watermellon jackolanterns and the persuasive call of the Mosque next door at prayer time. Heading back we bumped into a fellow Kita friend and hopped on the night bus back to Kita, where the three of us squished into a two sear row as goats wrapped in sacks whined on the roof above us. When I came back I discovered that my computer had contracted a nasty virus - too many dirty flashdrives. Its out of commission until I get back to Bamako for training in December.
Despite my anticipation at returning to village - laughable Bambara, annoying children and ego challenges looming ahead - I reached the pink tipped millet fields and friendly straw roofs with a sigh of relief. The relief was short lived as I ran straight to the toilet, beginning my two weeks of contemplating the ingenuity of the Bambara word for diarrhea, konoboli (running stomach). Between bathroom trips though I was able to begin the incredibly uncomfortable experience of my Baseline Survey. My humility soared as I asked the chief of the village if he had heard of STIs and, not realizing I was talking to the Imam (Moslim priest), I asked, amid a cloud of 20 children, if he knew where to buy condoms. Still, I left each family with a sense of purpose, and I am ingraining my purpose into this village as I try to understand what my role is here. A representative for the Women's Association came up to me and asked if I could help them create a women's garden, which should be an interesting project. Thankfully my site mate is an environmental volunteer, so hopefully we can get that project started together.
The usual sadness still greets me at the health center though. A woman 8 months pregnant finally coming in for her first pre-natal consultation, so weak due to her severe anemia her husband finally gave her the money to come. As we put her on an IV a grandmother holds her one year old grandson convulsing with cerebral malaria, and she is screaming "Oh Allah!" over and over through glassed over eyes. We try to put an IV in the child's tiny hands and feet but can't find a vein with his extremities bloated with edema, the body's desperate attempt to keep hydrated depsite malnutrition.
As my language becomes more coherent, I have finally been able to make friends here, a task that is harder than it seems as many people either see me as a bumbling awkward outsider who can't understand a word or are trying to see how much they can get out of me. I think I might pull my hair out if I hear "Where is my present?" one more time. Still, I try to remind myself that manners is as cultural as anything else. And with real friends I am starting to have some real conversations about living here. As Soliba and I discussed the difference in families in our countries, I tried to explain why it was not only okay but even (fully aware of my Western ethnocentricity) better to have less children (7 is the average for Malian women). She was incredulous when I told her that americans have 2-3 children on
average, and asked me:
"But what if one of your children dies?"
From an isolated point of view this logic seems flawless - the more children you have the more they can work for the family. This is also one of the values that is written in the Koran. And since almost a quarter of children die before the age of 5, this loss must be accounted for. My limited Bambara tried to
explain that children in the US dont die as often because their
parents have fewer children, and can take better care of each one. But
who am I to tell them to reject their culture, and how do they grasp
that they can slowly get themselves out of poverty by having less
kids? (this is arguably the key cause of their poverty and the world's
food crisis).
Such a sad reminder of this vicious cycle of poverty and tradition.
Poverty perpetuated by tradition, naivety.
(Is this their leaders fault, or the population that doesn't ask for better?)
A need for stability through tradition perpetuated by poverty.
(Is this our fault?)
This shouldn't be something anyone should get used to.
After two weeks and many bathroom trips I headed back to Kita and discovered that I have a stomach parasite. Not really a shocker. We spent a few days with our tutor under the guava tree as I got through the intense anti-parasitic medicine which made my water taste like metal. Me and my friend jumped on the 1am bus to a big Thanksgiving gathering with tons of other PCVs. We made 20 pies, killed 5 turkeys and filled a bucket with fruit salad, another with stuffing and mashed potatos. The next day, despite our food and whisky hangovers, 12 of us decided to head to a nearby waterfall. All of us somehow squeezed into a sedan, and I spent the two hour trip with the clutch awkwardly in between my thighs. When we passed the Gendarme (police) stop a few people climbed onto the roof, ducking renegade tree branches as we bounced through the path as if on a dried up narrow river bed. We teetered on the narrow bridge made of a few bamboo branches stuck together and hiked, following the sound of the water. The waterfalls were incredible. We climbed up the rocks, hoisting ourselves up with vines, and jumped off the rainbow tinted waterfalls into the shimmering pool 20 feet below. Beautiful.
Wednesday, November 4, 2009
Wednesday, October 28, 2009
Yesterday was another torrential rainstorm. Fanta grabbed me with words of "old woman" and "fever," and we went to see the old dying woman. We met up with Sangare, the doctor, who gave the unsuprising diagnosis - malaria - which is literally ravaging our village this time of year during the rainy season. We found her under bright purple sheets sown with green flowers, her shallow breaths contrasting with the feverent pumping rain. When it died down for a moment, she got up and walked, shakily gripping the walls as we sat shelling peanuts. As she reached the nyegen she looked back vacantly as the wind played games with her green headwrap. Her grip on the mud wall seemed to teeter between worlds, her stare exhausted and vacant. The next day I went out to the peanut fields with Fanta and a few other women. Our hands and heads and backs were filled with gourd bowls, radios, water jugs and little girls. We sat under a tree and pulled the peanuts from the roots as we exchanged warm but confused sentiments about farming and the village. Our picinic lunch of fresh sweet milk with millet and cut cucumber was refreshing, and I finally felt welome into this community of strong women, even though they make constantly make fun of my smooth uncalloused hands and lack of a husband. We left as again the black clouds rolled in, and ran the last half kilometer to the village as the rain slowly crept up on our heads.
I returned after the fields to give my blessings to the old woman, and then went to sit with Nasira as she cooked dinner - peanut sauce and to (ground millet patties) over a mud fire pit. The next morning the old woman had died. Fanta had no tears as she told me - she went on pounding millet. Of course, she had eleven children, another wife and a husband to feed.
I returned after the fields to give my blessings to the old woman, and then went to sit with Nasira as she cooked dinner - peanut sauce and to (ground millet patties) over a mud fire pit. The next morning the old woman had died. Fanta had no tears as she told me - she went on pounding millet. Of course, she had eleven children, another wife and a husband to feed.
10/13/09 ? I am losing track of the days...
Today I woke up after dreams of lying in Central Park listening to Belle and Sebastian with Gabby, a Starbucks white mocha frappaccino in hand. I was shocked to find myself under a mosquito net and a straw roof, listening to the donkeys morning wheeze. And there is no jarring sound like the donkeys first sounds in the morning - raggedly sucking in air in a tension filled shudder, and as soon as it seems like the poor malnourished beast's lungs have collapsed, it haws out a shrill choked exhale. Most of the day was spent in my usual way: mornings in the health center weighing babies, afternoon tea with the CSCOM staff, cooking lunch and studying Bambara as a crowd of aimless children stare at me, the evening tea and chat sessions followed by dinner with my host family. Still, I felt I was looking at my village through raw eyes, everything highlighted by the vibrant blue and yellow outlines that my anti-malaria medication fabricates. This is where I live? These are my neighbors, my friends, my co-workers? These straw huts with the swirling squash and cucumber vines - this is my home? What a strange, beautiful, simple world to be living in, so unlike the crisp, metallic New York! Even though the people asking me for money piss me off, the children laughing at my terrible Bambara is exasperating, and I haven't quite figured out how to successfully carry my water buckets on my head without getting soaking wet, its wonderful to live so intimately in this village. And despite the frequent loneliness that comes with being an outsider, and my (daily) efforts to get the children away who constantly swarm to my house (which is facing the school), I am amazed at how much I've integrated into the community in a month.
One thing I've been doing alot of is baby weighings at the CSCOM. During vaccination days on Mondays, women of the surrounding villages come, and I've tried to take this opportunity to weigh the 30+ babies there. In addition, almost daily children come to the CSCOM, for whatever reason, who are obviously malnourished. I've found that about 8 out of 10 children I've weighed are malnourished, either moderately or severely. Plumpy Nut, an ameliorated peanut butter distributed by UNICEF, has been a really helpful way to ensure that they are getting their daily protien and vitamin quota, which is so lacking in the typical Malian diet of rice and millet. But the French charts and guidelines are contradictory and confusing to me, and even more so to the other healthcare workers who seem to arbitrarily prescribe the peanut butter and make unconfident suggestions to the clueless parents. There is definitely something to the argument that literature and funding is great in terms of aid to developing countries, but taking the time to actually train the health workers in the rural villages is desperately needed, and inherently more sustainable than throwing money at a problem.
Saturday, October 17, 2009
Where There is No Gynecologist
Preventing cervical cancer in low resource settings
By Dina Carlin
"Women are not dying because of diseases we cannot treat...they are dying because societies have yet to make the decision that their lives are worth saving."
-Dr. Mahmoud Fathalla, former president of the International Federation of Gynecology and Obstetrics
In a country where female reproductive health is barely on the agenda, cervical cancer is an example of how modern medicine has stopped short in Mali, largely due to the low availability of resources. Each year there are 500,000 new cases of cervical cancer worldwide, and more than 80% of these cases occur in developing countries (1). According to the World Health Organization, cervical cancer is the most frequent cancer developed in Malian women, with 1,336 new cases each year. Meanwhile, 1,076 cases of cervical cancer in Mali each year result in death. These figures are projected to double in the next 15 years (2). While these statistics are sobering, cervical cancer happens to be one of the most preventable cancers with even infrequent screening. A household condiment, it seems, may be the answer.
The development of cervical cancer, caused by certain strains of the sexually transmitted virus HPV (the Human Papiloma Virus), has been strongly linked to socio-economic status. The increased prevalence of HPV in developing countries, as compared to rates in developed nations, is linked to a comprehensive list of factors, including access to sexual education, age of first sexual intercourse (25% of Malian women have sex before the age of 15), and availability of medical resources. However, the high incidence of cervical cancer is in large due to the lack of access to preventative healthcare. It is estimated that 21.5% of women in West Africa are infected with HPV, and this number has been climbing. In developed countries with fluid, accessible medical technology, the 'Pap' smear, a standard part of a gynecological exam, followed by colposcopy (laboratory analysis of cervical tissue) are well established methods to screen for HPV and precancerous cells. In addition, a vaccine that prevents two strains of HPV most frequently associated with cervical cancer has recently become widely available, albeit expensive. These efforts have led to sharp decreases in cervical cancer worldwide, with the exception of Sub-Saharan Africa. The high cost of these procedures, untrained and inexperienced healthcare providers, and the need for follow-up treatment create obvious barriers for impoverished countries such as Mali.
New procedures for diagnosing cervical cancer have been founded on the need for inexpensive screening methods that require minimal training and single visits to the health center. Since cervical cancer generally develops slowly, screening every 3-5 years, sources say, can have a significant impact in reducing mortality (3). While not as effective as the Pap smear, and certainly not as empirical as cytology, VIA, or visual inspection of the cervix with acetic acid (also known as household vinegar) is a groundbreaking alternative for the developing world. An alternative is VILA, visual inspection with Lugol's iodine, which is a slightly more expensive alternative. It involves only spraying the vinegar or iodine on the cervix, where the precancerous cells turn white in the case of vinegar, or brown with iodine. The simplicity of this procedure involves almost no equipment other than vinegar (widely available in most butigis) or iodine, and can be administered by any health worker.
Treatment for cervical cancer is key, as 95% of cases become fatal within two years. While treatment options vary, one of the cheapest, easiest and quickest treatments for cervical cancer is cytology, which involves "freezing" the cervix using carbon dioxide or nitrogen dioxide, killing off the precancerous cells. Most of the materials are locally available, the training is minimal, and the 15 minute procedure can be carried out by non-clinicians such as Matrons. In addition, it has a very low rate of complications, with cure rates of 85-91% (1).
So what do we do now? Since sustainability is key, working towards training healthcare workers such as Matrones to screen and treat cancer would decrease the impact of this highly destructive cancer. Finally, education and screening initiatives, with the aid of NGOs such as Prevent International Cervical Cancer Now (www.pincc.org) or the Alliance for Cervical Cancer Prevention would help bring the issue of cervical cancer to the national spotlight. Turning to simple and accessible technologies such as VIA and cryotherapy can create the foundation for effective preventative care in reproductive medicine. With all the tools available here in Mali to fight cervical cancer, it is time to decide to take action.
1 Sanghvi H., Lacoste M and McCormick M (eds). (2006). Preventing Cercical Cancer in Low-Resources Settings: From Research to Practice. Report of a conference in Bangkok, Thialand, 4-7 December 2005. JHPIGO: Baltimore, Maryland.
2 WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). (2009). Human Papillomavirus and Related Cancers in Mali: Summary Report 2009. [Accessed October 2, 2009]. Available at www. who. int/ hpvcentre
3 Sankaranarayanan,R.,Budukh, A. M. and Rajkumar, R. (2001). Effective screening programmes for cervical cancer in low- and middle-income developing countries. Bulletin of the World Health Organization. WHO.
By Dina Carlin
"Women are not dying because of diseases we cannot treat...they are dying because societies have yet to make the decision that their lives are worth saving."
-Dr. Mahmoud Fathalla, former president of the International Federation of Gynecology and Obstetrics
In a country where female reproductive health is barely on the agenda, cervical cancer is an example of how modern medicine has stopped short in Mali, largely due to the low availability of resources. Each year there are 500,000 new cases of cervical cancer worldwide, and more than 80% of these cases occur in developing countries (1). According to the World Health Organization, cervical cancer is the most frequent cancer developed in Malian women, with 1,336 new cases each year. Meanwhile, 1,076 cases of cervical cancer in Mali each year result in death. These figures are projected to double in the next 15 years (2). While these statistics are sobering, cervical cancer happens to be one of the most preventable cancers with even infrequent screening. A household condiment, it seems, may be the answer.
The development of cervical cancer, caused by certain strains of the sexually transmitted virus HPV (the Human Papiloma Virus), has been strongly linked to socio-economic status. The increased prevalence of HPV in developing countries, as compared to rates in developed nations, is linked to a comprehensive list of factors, including access to sexual education, age of first sexual intercourse (25% of Malian women have sex before the age of 15), and availability of medical resources. However, the high incidence of cervical cancer is in large due to the lack of access to preventative healthcare. It is estimated that 21.5% of women in West Africa are infected with HPV, and this number has been climbing. In developed countries with fluid, accessible medical technology, the 'Pap' smear, a standard part of a gynecological exam, followed by colposcopy (laboratory analysis of cervical tissue) are well established methods to screen for HPV and precancerous cells. In addition, a vaccine that prevents two strains of HPV most frequently associated with cervical cancer has recently become widely available, albeit expensive. These efforts have led to sharp decreases in cervical cancer worldwide, with the exception of Sub-Saharan Africa. The high cost of these procedures, untrained and inexperienced healthcare providers, and the need for follow-up treatment create obvious barriers for impoverished countries such as Mali.
New procedures for diagnosing cervical cancer have been founded on the need for inexpensive screening methods that require minimal training and single visits to the health center. Since cervical cancer generally develops slowly, screening every 3-5 years, sources say, can have a significant impact in reducing mortality (3). While not as effective as the Pap smear, and certainly not as empirical as cytology, VIA, or visual inspection of the cervix with acetic acid (also known as household vinegar) is a groundbreaking alternative for the developing world. An alternative is VILA, visual inspection with Lugol's iodine, which is a slightly more expensive alternative. It involves only spraying the vinegar or iodine on the cervix, where the precancerous cells turn white in the case of vinegar, or brown with iodine. The simplicity of this procedure involves almost no equipment other than vinegar (widely available in most butigis) or iodine, and can be administered by any health worker.
Treatment for cervical cancer is key, as 95% of cases become fatal within two years. While treatment options vary, one of the cheapest, easiest and quickest treatments for cervical cancer is cytology, which involves "freezing" the cervix using carbon dioxide or nitrogen dioxide, killing off the precancerous cells. Most of the materials are locally available, the training is minimal, and the 15 minute procedure can be carried out by non-clinicians such as Matrons. In addition, it has a very low rate of complications, with cure rates of 85-91% (1).
So what do we do now? Since sustainability is key, working towards training healthcare workers such as Matrones to screen and treat cancer would decrease the impact of this highly destructive cancer. Finally, education and screening initiatives, with the aid of NGOs such as Prevent International Cervical Cancer Now (www.pincc.org) or the Alliance for Cervical Cancer Prevention would help bring the issue of cervical cancer to the national spotlight. Turning to simple and accessible technologies such as VIA and cryotherapy can create the foundation for effective preventative care in reproductive medicine. With all the tools available here in Mali to fight cervical cancer, it is time to decide to take action.
1 Sanghvi H., Lacoste M and McCormick M (eds). (2006). Preventing Cercical Cancer in Low-Resources Settings: From Research to Practice. Report of a conference in Bangkok, Thialand, 4-7 December 2005. JHPIGO: Baltimore, Maryland.
2 WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). (2009). Human Papillomavirus and Related Cancers in Mali: Summary Report 2009. [Accessed October 2, 2009]. Available at www. who. int/ hpvcentre
3 Sankaranarayanan,R.,Budukh, A. M. and Rajkumar, R. (2001). Effective screening programmes for cervical cancer in low- and middle-income developing countries. Bulletin of the World Health Organization. WHO.
Wednesday, September 30, 2009
En Brusse
Well, my first two weeks at my village have gone by, and I know this will be so much more challenging than I realized, and so full of beauty, friendship and rewards. I am already losing track of the days in this web of the Brusse. Sometimes it feels like I can turn my head in so many directions and still find myself plastered to the same spot; the same children with the same illnesses, the same sanitation deficiencies and the same lack of expectations. The language of simplicity though, while from an outside view is banal, creates such complex layers of relationships. They use charcoal fires in lieu of covalent ovens, and gather around the shaky radio broadcast in the pitch black. And yet they are, as a whole, one of the most vibrant and happiest people I have known. It is cliche, but they have nothing but each other to care about.Back here in Kita, the 9 of us met up to celebrate getting through the first hump of living off the grid. It is a relief in a way to speak english and feel comfortable in my American skin. It is sometimes difficult, at site, to remember that you are in fact capable of normal social interactions. There is no challenge to the ego like your 12 year old host sister asking you, day after day, if you washed. I gulp down the cynical urge to ask her how often she cleans herself (or just her hands) with soap - and anyway, sarcasim is a concept unsupported in the language here. Instead, I manage an agitated/amused giggle at my sister's strange brand of hospitality, pointing to my wet hair. At this point, I wouldn't be suprised if she asked me about my bowel movements. Privacy, personal space, alone time - these concepts dont quite register with Malians. Enthralled with the novelty of having a white person so intimately joining their space, I have found that the one time I can acutally be alone is locked in my hut, drowning out their calls to me over my wood fence with my headphones. Each day, as hard as it is to leave the safety of my cool mud walls and wonderful english books, I push myself out to wander about - yalayala - through the snakelike paths around the fields and huts, stopping here and there to have tea with the breadmakers, joke with the boutigi owners about taking them back to America with me, or draw animals and portraits with the children. Right now, the feverent rainstorms has made my village overflow with vibrant green fields, and the plants literally sprout out overnight and have drowned the "path" to my cell phone service spot: a little worn down clearing in the middle of the cornfields.
The other day I saw my first natural birth. It seems that almost all deliveries here are made in the middle of the light, dramaticly lit by oil lamp. Of course it is because these women must wait till their husbands get home to get permission to go to the CSCOM, and the state of being 9 months pregnant does not excuse you from pounding millet, chopping wood and pulling water from the well. I remembered this girl from her pre-natal consultation last month. She had just turned 16. She looked petrified, her eyes as big as moons as she yalayala'd around the room, her amniotic fluid dripping down her leg. When she was dilated, the matrone jumped on a table behind her and began pushing down on her belly with all her might, as her mother and her sister, each with an infant strapped to their backs, held her legs open above a jagged plastic bedpan. She was completely silent through the hour long process, the only sign of her pain were her tears gathering in a puddle on the floor and one or two grunts. After my matrone pulled the baby out, she grabbed him by the feet and hit and shook him, yelling "Kuma!" (speak!), laying him down to clear his passageways and pump his chest. The baby was alive, but was almost as silent as his mother. She hardly seemed happy or suprised, as if this was all she had expected; and here it is. Today, talking about my experience with my friend Dave, he pointed out how distinct the difference is between their access to healthcare and ours. If any one of us PC volunteers have any medical issue that surpasses the normal gamlut of moderate bacterial and parasitic infections, we would be shipped straight to Washington, DC. Not even the best hospital in the whole country of Mali would be able to provide the adequate healthcare that we not only covet in the US but expect. Here, in brusse, this woman was lucky to have access to a health center where they clean their tools with bleach - most of the surrounding villages near me don't even have a maternity. The beauty of the 360 vision you gain from living in this village web is you can understand the problems here from so many levels, and try to find solutions that doesn't involve throwing money at them.
And more than anything, it is so incredibly challenging establishing my place in this village with this huge lanugage gap. Most of the people in the village speak a different minority lanugage than Bamabara, called Malinke, and it is frustrating having to be led around like a child. But, I have found that art is an amazing vehicle to teach, and out of my restlessness I painted a mural of the food groups at the CSCOM.
Overall it is great, and I am learning that Mali is a country of contradictions - happiness in simplicity and misery in deficiencies, love and happiness through family and community and imprisonment by it. And I am happy I am here to create even the smallest bit of moderation.
Wednesday, September 16, 2009
Swearing In
So as of Thursday I became an official Peace Corps Volunteer! After a greuling week of seminars at the training center and a very intimidating language exam (who knows how I passed...), we finally finished training. The swearing in ceremony was at the American Embassy, where we sat dripping in our Malian gear and pretended to understand the lovely French speech given by Madame Ambassador. The rest of the day was spent poolside at the American Club, where we got ready for our huge swearing in party. We all piled into a few clubs in Bamako (probably the most American thing about Mali), met up with tons of current PCVs, and were still roaring at 3am.
Right now I am in Kita, soaking up all the indoor plumbing, VHSs and market vegetables I can get before I plunge into my village. On Friday my sitemate Kristen and I will head to our nearby villages. While the thought of having to get by with my fractured Bamabara only with the only English speaker a few miles away is pretty frightening, I am so looking forward to finally making myself a home after living out of a suitcase for the past two months. Looking back on training, I am so struck by the unbelievable people I have met here -both PCVs and Malians - and am continually impressed by the immense value that volunteerism has in this country. Yes, it has been fun learning how to turn human urine into fertilizer, trekking to our boutigi for the occassional cold drink, and all crowding together to watch the occassional Flight of the Conchords off one of our laptops. But the dialouge I have had with so many volunteers and those who have worked with the Peace Corps had been one of such optimism. It is definitely energizing, and important to remember that even just sitting and having tea with my neighbors and comparing our cultures is progress. Dooni dooni (little by little...)!
Right now I am in Kita, soaking up all the indoor plumbing, VHSs and market vegetables I can get before I plunge into my village. On Friday my sitemate Kristen and I will head to our nearby villages. While the thought of having to get by with my fractured Bamabara only with the only English speaker a few miles away is pretty frightening, I am so looking forward to finally making myself a home after living out of a suitcase for the past two months. Looking back on training, I am so struck by the unbelievable people I have met here -both PCVs and Malians - and am continually impressed by the immense value that volunteerism has in this country. Yes, it has been fun learning how to turn human urine into fertilizer, trekking to our boutigi for the occassional cold drink, and all crowding together to watch the occassional Flight of the Conchords off one of our laptops. But the dialouge I have had with so many volunteers and those who have worked with the Peace Corps had been one of such optimism. It is definitely energizing, and important to remember that even just sitting and having tea with my neighbors and comparing our cultures is progress. Dooni dooni (little by little...)!
Sunday, September 6, 2009
End of homestay
Today I said goodbye to my homestay family, possibly for good. Yesterday, we had a going away party outside my house as I donned the beautiful Malian dress my family gave me the night before. As much as I was burning to get away from the streets that flooded with rivers of sewage, smoldering trash piles and the incessant “Je-ne-ba!” (my Malian name) screams echoing wherever I went, it was surprisingly difficult to leave them. Amidst the chaos of bags and water filters this morning as all of us PCVs met at my concession for our pickup, I sat with my family as they told me how much they would miss me. Last night my brother Allou told me how I had “shown him the kindness of humanity,” and that he “now believes that people can work to do good.” He told me that he always thought of the white man as arrogant, violent and greedy, but that I have been an example of “true equality.” It was heartfelt and touching. This morning my mother Jeneba (my namesake) sat tearing – even with the few phrases I had strewn together in our sporadic conversations, we shared a wordless bond. My host sister Fatoumata hugged me as she ripped off all her jewelry and placed it on me, joking that I was going to take her adorable baby Abdul with me (I was tempted). I was really blown away by the openness and gratitude of these people who had bathed and fed me these past two months. This is truly a culture of endless, uncompromising affection. But I think when everyone is struggling to fill their babies bellies, there is no need for callous walls.
Baby weighing day
So, I have been here for almost two months, and I cannot believe how quickly training has whirled by. As scared and unprepared as I feel to go alone to my site, I am amazed at how much I can convey to my family, and I am slowly beginning to piece together their conversations. Theres nothing better than being able to joke, a key social factor here among the different ethnic groups. “I be sho dun!” – “You are a bean eater!” Somehow, still hilarious 7 times a day. (Yes, the fart joke has its rightful place here in Mali).
The other day we did a huge baby weighing session in my courtyard, the 6 of us working in an assembly line, taking down the names of the crowd of women, two of us weighing the babies, and three of us counseling the mothers on their babies growth progress. 2 ½ hours and 130 babies later we put the last squirming baby into the snowsuit like balance roped to a vegetable scale. We compared their weight to their age, and separated them into the healthy green zone, the moderately malnourished yellow zone, and the life threatening red zone. Much to our surprise (and dismay), about half of the babies ended up in the yellow zone, and we tried in our best Bambara to tell them that they needed to improve their child’s protein and vitamin intake, as “their strength is little.” Still, there were about ten in the red zone, tiny things with shrunken in bellies and absent expressions. Those who were severely malnourished we sent immediately to the health center and urged them to improve their babies nutrition now. We also urged all of the children’s mothers in the yellow and red zone to return the next morning, where we did a huge ameliorated porridge demonstration with about 60 women. We showed them how to add protein and fruit juices to increase the nutrition of their carbohydrate dominated diet. As much as we tried, we still felt the large disconnect between the mothers and ourselves.
The other day we did a huge baby weighing session in my courtyard, the 6 of us working in an assembly line, taking down the names of the crowd of women, two of us weighing the babies, and three of us counseling the mothers on their babies growth progress. 2 ½ hours and 130 babies later we put the last squirming baby into the snowsuit like balance roped to a vegetable scale. We compared their weight to their age, and separated them into the healthy green zone, the moderately malnourished yellow zone, and the life threatening red zone. Much to our surprise (and dismay), about half of the babies ended up in the yellow zone, and we tried in our best Bambara to tell them that they needed to improve their child’s protein and vitamin intake, as “their strength is little.” Still, there were about ten in the red zone, tiny things with shrunken in bellies and absent expressions. Those who were severely malnourished we sent immediately to the health center and urged them to improve their babies nutrition now. We also urged all of the children’s mothers in the yellow and red zone to return the next morning, where we did a huge ameliorated porridge demonstration with about 60 women. We showed them how to add protein and fruit juices to increase the nutrition of their carbohydrate dominated diet. As much as we tried, we still felt the large disconnect between the mothers and ourselves.
Site Visit
This week I finally saw the village I will be living and working in for the next two years. We first stopped in Kita for a night, where the three current volunteers were waiting. We made a big Mexican dinner and wandered around the city for a bit, met all the officials and roamed through the market. The next day we climbed into a rickety blue van where we sat on rice sacks with about 20 other Malians (not to mention a few boys and hanging on the side and two goats on the roof). Slowly we plodded, as the tin roofed houses began to give way to straw covered huts, and soon those almost disappeared as we passed by rolling fields of mango trees and cornfields and wild African bush. Two hours later we arrived at our villages (not to mention the 20 minute tire change). My concession has two huts and a private gated area in between. Privacy is something I find I covet here, as everything is so communal even the concept of personal space is not quite understood. I met my coworkers at the health center and sat in on several prenatal consultations. It was shocking to see so many young women – 15, 17, 20 with a toddler on her hip – walking into the health center. It is difficult to detach myself from comparisons. At 22 I cherish my independence and the thought of a family seems far in the future. I wonder if these women find happiness in the communal family love that is so valued here. But I can’t help projecting my Western assumptions that a women deserves to do more than raise her 7+ children and live at the whim of her husband and his other wives. Or at least let them enjoy the last of her childhood!
Thursday, August 13, 2009
8/7/09
So I’ve been here for exactly a month now, and I am constantly amazed at how one can adapt to a new home. As my internal body temperature has become adjusted to the constant heat, so has my temperance adjusted to the slower pace of Africa, and the subsistent lifestyle that values each loaf of bread as a part of their delicate, if fleeting, communal economy. I love my three times a day bucket baths, my saving grace after hours in the 110 degree heat, my nighttime flashlight lit conversations with my host family (which still consists of many blank stares and awkward language misunderstandings), and cold sodas from the boutigi. We finally received our mountain bikes last week, and a bunch of us took a ride down to the Niger River and the adjacent canals, where we sat and watched the men pull sand and the occasional fish from the river. It is always refreshing to get out of our village, which seems to grow in children, goats and trash piles each day, and visit the neighboring areas which are all much calmer, to say the least. We have gone to the neighboring village with Peace Corps volunteers several times, where there is great rock climbing with beautiful views of the surrounding villages. Sometimes it is really frustrating to see the practices of some of the villagers, and as a trainee and not yet a full PC volunteer, it is difficult to assess my place to institue the changes I hope to work on soon. No, don't let your children run barefoot through urine-filled soak pits, festering with nitrogen-fed algae and shistosomaisis! Do not feed your infants tea and coffee instead of breastmilk! And no matter what I've told my host family, they still believe that ground millet three times a day will somehow make their children strong; instead, you see their children protein deprived with the telltale pot-bellies. We spoke with UNICEF the other day about possible regional collaboration to improve latrine use and water sanitation, which could be an interesting initiative. I am hoping to speak with them in a few months for a possible regional initiative for diagnosing and treating cervical cancer. One thing I am realizing though is that I really need to work closely with my community before engaging in these loftier goals.
Gender and development is another area that I am really looking into at the moment, which would really tie into my work at the Community Healthcare Center, since my Malian co-worker is a Matrone (much like a midwife/nurse). There are some staggering statistics concerning women: for example, the average Malian women has 7.2 children (compared to the American 2.3 children per woman!). As polygamy is common here (my host father has two wives), you can imagine what kind of pressure exists both physically and financially on Malian families. Education on birth spacing and family planning is a major component of easing these stresses. Another sobering statistic is the widespread acceptance of female genital mutilation (or excision) - 95% of adult Malian women have undergone some form. Apart from all the other aspects of the affects of FGM on women, from a health standpoint this practice is extremely dangerous. While paying close attention to cultural sensitivity, I am hoping that, with time, I can work towards educating my villagers on these issues.
Last week the health volunteers visited Fana, a nearby city, where we were given a tour of the radio station, radio broadcasts being a useful vehicle to educate a large population on healthcare issues. After that, we went to the HIV/AIDS (or VIH/SIDA) clinic. We could not help noticing the discouraged affect of the doctor, as he told us of the overwhelming stigma that AIDS has in Mali, and the minimal national governmental support for the disease. The frequency of AIDS in Mali is actually one of the lowest in Africa, affecting 1.6% of the population (even lower than in the US, 1.7%), but these numbers are misleading as HIV testing is extremely uncommon. While international aid has been invaluable in providing free HIV/AIDS treatment and support to those affected, the majority of the population is still largely ignorant and/or skeptical of the disease. Many Malians simply do not believe the disease exists at all, that it is just a manifestation of the international aid organizations to make money, or have other ideas about its origins (contracting HIV through condom use, for example). After visiting the clinic, one of only 8 currently operating in the county (although 11 more are opening around the country in the near future), we visited a community of HIV positive individuals. After shaking their hands and joking with them, they told us of how their home communities had demonized them, forcing them to fight their illness without their families. Before we left, they thanked us several times for our courage – the courage to shake their hands and look past their disease, and treat them as people worth fighting for. After visiting Fana, I was speaking to my 25 year old host brother about his understanding of AIDS, and he told me of the widespread denial of the disease. It really does bring the relative access of information and sympathetic healthcare we have in the States into perspective.
This week at the training center has been a blur of classes on agricuture, water sanitation, safety, cultural training, etc., and tomorrow we are going to a nearby village to work on community assessment with a women's association. On Sunday I am visiting my permanent village for a week, followed by two more weeks at my homestay before I complete my training. I will be in a small-ish village of 7,000, about two hours from Kita, a pretty central city in the Kayes region (Mali's Western region). It is definitely "en brusse" (aka quite rural), but there is another volunteer about 5k from me, and another is 8k. I am really looking forward to beginning my real work here.
Gender and development is another area that I am really looking into at the moment, which would really tie into my work at the Community Healthcare Center, since my Malian co-worker is a Matrone (much like a midwife/nurse). There are some staggering statistics concerning women: for example, the average Malian women has 7.2 children (compared to the American 2.3 children per woman!). As polygamy is common here (my host father has two wives), you can imagine what kind of pressure exists both physically and financially on Malian families. Education on birth spacing and family planning is a major component of easing these stresses. Another sobering statistic is the widespread acceptance of female genital mutilation (or excision) - 95% of adult Malian women have undergone some form. Apart from all the other aspects of the affects of FGM on women, from a health standpoint this practice is extremely dangerous. While paying close attention to cultural sensitivity, I am hoping that, with time, I can work towards educating my villagers on these issues.
Last week the health volunteers visited Fana, a nearby city, where we were given a tour of the radio station, radio broadcasts being a useful vehicle to educate a large population on healthcare issues. After that, we went to the HIV/AIDS (or VIH/SIDA) clinic. We could not help noticing the discouraged affect of the doctor, as he told us of the overwhelming stigma that AIDS has in Mali, and the minimal national governmental support for the disease. The frequency of AIDS in Mali is actually one of the lowest in Africa, affecting 1.6% of the population (even lower than in the US, 1.7%), but these numbers are misleading as HIV testing is extremely uncommon. While international aid has been invaluable in providing free HIV/AIDS treatment and support to those affected, the majority of the population is still largely ignorant and/or skeptical of the disease. Many Malians simply do not believe the disease exists at all, that it is just a manifestation of the international aid organizations to make money, or have other ideas about its origins (contracting HIV through condom use, for example). After visiting the clinic, one of only 8 currently operating in the county (although 11 more are opening around the country in the near future), we visited a community of HIV positive individuals. After shaking their hands and joking with them, they told us of how their home communities had demonized them, forcing them to fight their illness without their families. Before we left, they thanked us several times for our courage – the courage to shake their hands and look past their disease, and treat them as people worth fighting for. After visiting Fana, I was speaking to my 25 year old host brother about his understanding of AIDS, and he told me of the widespread denial of the disease. It really does bring the relative access of information and sympathetic healthcare we have in the States into perspective.
This week at the training center has been a blur of classes on agricuture, water sanitation, safety, cultural training, etc., and tomorrow we are going to a nearby village to work on community assessment with a women's association. On Sunday I am visiting my permanent village for a week, followed by two more weeks at my homestay before I complete my training. I will be in a small-ish village of 7,000, about two hours from Kita, a pretty central city in the Kayes region (Mali's Western region). It is definitely "en brusse" (aka quite rural), but there is another volunteer about 5k from me, and another is 8k. I am really looking forward to beginning my real work here.
Sunday, July 26, 2009
Back at the training center, I've never thought I would feel so grateful for wonders such as toilet paper, phone service, and fans. The last two weeks (has it really only been that long?) have been pretty real. As we came into our homestay village, we were greeted by the villagers who had set up a huge celebration in our honor. As we walked out of the van, they grabbed us to join their dance/drum circle, which was a great way to meet the villagers. The village I am in is relatively large, which has its advantages - namely a small farmers market and the occasional cold soda at our local Boutigi - but it also means that each morning there are hundreds of people yelling "tubabu" ("white person") as I walk to class, and I am usually followed by a cloud of twenty children - the Tubab parade. I am living with the Chief of the village (the Dugutigi), and my host family is incredibly accomadating and tries their best to speak with me in a sort of French-Bambara-English creole. I am woken up each morning to the donkeys and goats outside my door. I am quickly getting tired of rice with peanut sauce, or the dreaded "to," a millet ground into a stonelike mound and covered in slimy okra sauce. We try to do yoga most afternoons - authentic Bikram sweat yoga in the 90degree heat - and even managed a full sun salutation in the sweeping rainstorm. The language training is really intensive, but I am amazed at our progress after less than two weeks, and I can actually put coherent sentences together. Friday night our village had a great "soiree," with a dj spinning drum and bass and Malian techno through a generator. We tried our Tubab best, but were in awe watching the amazing rhythm of the Malian youth.
At training, we finally has some great sector specific training, which reaffirmed my purpose here in Mali. We learned how to weigh and measure babies to monitor their growth and nutrition. Child malnutrition is one of the worst epidemics here, and with a population where 50% are under 15 years old, it is desperately needed. Some eye opening statistics: 27% of children in Mali under 5 are underweight foor their age (10% severely), and 38% of children under 5 are underheight. Pre-natal and neo-natal health is also a real need, with a 10% infant mortality rate. We also put together a health survey in Bambara, which I will compile during the first three months at my village. Tomorrow we will go to Bamako, the capital city, and then back to my homestay village.
At training, we finally has some great sector specific training, which reaffirmed my purpose here in Mali. We learned how to weigh and measure babies to monitor their growth and nutrition. Child malnutrition is one of the worst epidemics here, and with a population where 50% are under 15 years old, it is desperately needed. Some eye opening statistics: 27% of children in Mali under 5 are underweight foor their age (10% severely), and 38% of children under 5 are underheight. Pre-natal and neo-natal health is also a real need, with a 10% infant mortality rate. We also put together a health survey in Bambara, which I will compile during the first three months at my village. Tomorrow we will go to Bamako, the capital city, and then back to my homestay village.
Tuesday, July 14, 2009
To the village
So I am leaving my training site tomorrow and will be going to my homestay village, which is a bit outside of Bamako, where they speak the local language Bambara. I am staying in the village Chief's house, which will be both exciting and intimidating, since my Bambara vocabulary right now consists of four greetings. I will be in the village with ten other volunteers, and will be there until September 10th, when I will move to my permanent post. The homestay village is where I will get my intensive language and cultural training, and I will be completely immersed in Bambara.
These past few days have been pretty interesting. Right now its finally raining - its been hot and extremely humid the past two days here, so it is definitely welcome. Training has been great so far, but it really feels alot like summer camp, and I really look forward (with a bit of trepidation) to leaving for my homestay village tomorrow. The training has been really varied, and weve had classes on language, cross cultural and diversity issues, our technical field training, and even a two hour class on how to deal with gastrointestinal malaise (which is, apparently, inevitable). The training is mostly done by Malian Peace Corps staff as well as with current volunteers who are really trying to prepare us for life "en brusse" (in the village). Its undoubtedly been a learning experience - from the tragic fall of one of my Birkenstocks into the deep, dank neygen (toilet, aka a hole in the ground), to learning the polite way of eating with your hands around a communal bowl, learning how to fix a bike tire, and trying to understand the different gender roles and respectable behavior. Alot of our training is focused on how to be well integrated and respected in the community, as well as how to stay healthy an d safe. We had a cultural festival on Sunday, where the Malian staff and local vendors came and performed music, made food and sold some Malian clothes.
So tomorrow will surely begin the real culture shock, as I will be living and interacting with Malians, learning how to filter my own water, washing my clothes, and learning a language that I have had no experience with. As I will not have internet, I won't be able to post for about two weeks. Until then!
These past few days have been pretty interesting. Right now its finally raining - its been hot and extremely humid the past two days here, so it is definitely welcome. Training has been great so far, but it really feels alot like summer camp, and I really look forward (with a bit of trepidation) to leaving for my homestay village tomorrow. The training has been really varied, and weve had classes on language, cross cultural and diversity issues, our technical field training, and even a two hour class on how to deal with gastrointestinal malaise (which is, apparently, inevitable). The training is mostly done by Malian Peace Corps staff as well as with current volunteers who are really trying to prepare us for life "en brusse" (in the village). Its undoubtedly been a learning experience - from the tragic fall of one of my Birkenstocks into the deep, dank neygen (toilet, aka a hole in the ground), to learning the polite way of eating with your hands around a communal bowl, learning how to fix a bike tire, and trying to understand the different gender roles and respectable behavior. Alot of our training is focused on how to be well integrated and respected in the community, as well as how to stay healthy an d safe. We had a cultural festival on Sunday, where the Malian staff and local vendors came and performed music, made food and sold some Malian clothes.
So tomorrow will surely begin the real culture shock, as I will be living and interacting with Malians, learning how to filter my own water, washing my clothes, and learning a language that I have had no experience with. As I will not have internet, I won't be able to post for about two weeks. Until then!
Friday, July 10, 2009
Je suis ici!
So I've arrived here at the Peace Corps training center outside of Bamako, after a day (only?) of travelling. The Philadelphia orientation was brief but definitely brewed my excitement. After hours and hours waiting at the airports in Philadelphia and Paris, with our backpacks strewn across the terminal, irrecognizable from the mounds of sleep-deprived bodies (not to mention the 13 hours we spent in the air) all 66 of us landed in Mali. As soon as we stepped off the plane, the humid dusty air hit us (80 degrees even though it was after dark), and I felt that immense, excited jolt of realization that I was here to stay, for awhile at least. We waded through the chaos that is the tiny Bamako International Airport, which was just big enough to fit the people in our flight and the mounds of bags. We finally found our luggage, and were greeted by seasoned Peace Corps Mali volunteers who slightly intimidated us with their flawless Bambara. They threw our bags on top of several serious looking jeeps, we piled in the back, and off we caravaned Tomb raider style through the city, past the shanty towns and suprisingly clean metropolitan areas of Bamako. And here I am at the training center, which has electricity, fans and shower heads! What a luxury. Today we learned some of the interesting nuances of the Malian culture, including the intricacies of handshakes and the horror of using your left hand to do anything but, er, clean yourself. It really is amazing how much pride Malians take in their appearance; the women wear the most beautiful clothes everyday. I've started the malaria pills, which I swear is giving me some fun perceptual changes (extreme depth perception and color contrast after affects). The other side effects include "vivid dreams" and some other fun things. I will be here for a few days and then I go off to my "homestay" village where I will live with a few other volunteers with a host family for the next nine weeks before I am sent off to my village post. So far so good! More to come.
Thursday, June 25, 2009
Purpose! Adventure! Movement!
So here I go - I've never been much of a public writer, but I am sure that having a blog will be the best way to let all of you lovely people stay up to date with my adventures. Two weeks until departure, and its been quite a whirlwind since I found out five weeks ago. Theres been so much to do, so many people to see and moments to absorb and preparations to, um, prepare. I've been wildly packing for the trip, packing up my house, downloading books (thank you kindle/dad!), and bouncing from Long Island to Brooklyn to Manhattan. And through all of this I feel such immense excitement and a feeling of wholeness - I am ready to leave the academic world of "conscious inertia" as Doestoyevsky puts it, and move forward with action. So why am I giving up a comfortable, air conditioned life in NY to go and live in a developing country for over two years? Because I know that this one time in my life I have the freedom to live and work in a foreign country, and share my knowledge and interest in medicine with a population where it is not as easily accessible. I hope I can really make an impact on the healthcare in my area, and create a program that is sustainable and relevant. I hope I will better my French, learn a new language, paint, listen to Malian music, meditate, meet wonderful people and experience a new culture from the inside out.
So for those who would like to know a bit more about Mali (summarized mainly from Wikipedia and the Peace Corps welcome book):
Mali is a landlocked country in West Africa, bordered by Algeria, Mauritania, Cote d'Ivoire, Burkina Faso, Niger, Senegal and Guinea. It is about twice the size of Texas. Through it runs the Niger and Senegal rivers in the south, where most of the population lives. The ancient Ghana, Mande and Songhai empires controlled much of the trans-Saharan trade through the Niger river (many traded through the famous city of Timbuktu). The northern region is mainly comprised of the Sahara desert. Mali has a constitutional democracy which was established in 1992, and is considered one of the most politically and socially stable countries in Africa. The national language is French, but many of the population speaks Bambara. The population is mainly Muslim (90%), but there are small populations of Christians and traditional animist religions (and apparently a few Saharan Jews!). Mali is know for its music (check out Amadou and Mariam, they're good!). The Peace Corps have been in Mali since 1971.
If you want to know more, you could, well, look at Wikipedia yourself, or check out these other resources:
https://www.cia.gov/library/publications/the-world-factbook/geos/ML.html (CIA World Factbook)
http://geography.about.com/library/cia/blcmali.htm (a great map of Mali with facts)
http://news.bbc.co.uk/2/hi/africa/country_profiles/1021454.stm (BBC country profile)
http://mali.usembassy.gov/ (US embassy in Mali)
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