Golddiggers

All that is gold does not glitter,
Not all those who wander are lost

On Friday I finished my cervical cancer formation in Kita. A photojournalist friend of mine, on assignment from the NYTimes was heading to a gold mining town on the Senegalese border. I decided to tag along with him and our other friend, feeling the need for some adventure, and probably feeling a bit bored with Africa. Well, I definitely got a wakeup call.

So off we went. First we jumped into a rickety old van (bush taxi), and flew as the rain licked our backs to a nearby village where we heard we could get transport the next morning. There we had a hilarious time trying to find out the schedule of the trucks going; each person we asked gave us a different answer with a satisfied grin of self assurance, until after the 30th person we were ready to smash our Nalgenes (damn these reinforced plastics). There was no other option except waiting by the side of the road, and we found a nice spot under the tree and hung out with little children crawling all over us, until we finally flagged down a pickup truck going at 5pm. In we squeezed ourselves into the truck bed, along with 10 other Malians searching for gold.

We rode, all wrapped around each other and literally hanging on for dear life, driving straight through a river and winding through paths in the forest through the dark. We finally reached it the next morning, covered in dust; we could barely distinguish between the Africans and us, all the same color for the moment. We rode down a roller coaster of valleys and streams and saw the buzzing mine below us, thousands of glittering bodies like black coal digging in the hand dug mining holes supported by logs; their headlamps flickered, glowing eyes looking out from the abyss. We drove up again into the hill of the village we were staying in, and here more young men stood in clouds of dust from crushed rocks, while others poured the rock dust through a little water conduit to try to wash out the gold. Finally the gold dust would appear, a few almost invisible shiny flecks in the water that they put in a tiny little metal dish to extract, evaporating all the excess water. If they were lucky enough to gather a gram of gold they sold it on the street corner, opening little paper packets of gold leaf and nuggets that they slid to each other like a drug - not that there is much of a difference, really.

Of course many of the men we talked to told us they had been here for months, a year, and found nothing. Mostly it was sad, a slew of young West Africans in this world of putrid toilet water, sink holes and Obama paraphernalia. Since they found gold five years ago, the tiny village of a few hundred people boomed to a few thousand, with most of the young men who migrated there living in makeshift shacks or thrown together crowded mud huts. You felt a sense they missed the mark – excited by the idea that they could find more than their quiet villages could offer, they ended up here, wasting the money they weren’t earning on street food and prostitutes, family-less but wearing cool American jeans. There was one pump for the thousands of men who lived there, and the streets were spotted with hand dug wells every few feet. The doctors we interviewed told us of the daily deaths due to water borne diseases, exacerbated by a measles outbreak, pandemic STIs and almost no medicine or equipment.

One night we went out for a drink with a Malian we had met while eating our macaroni and goat meat dinner. A tall gorgeous Nigerian woman, about 19, sat down next to us. “I remember you!” she said to me in perfect English, smacking her lined lips. “I saw your hair; I almost went crazy it was so long!” She said the Malian name she donned was Kati, but in the bar she was known as Goodness. She told us how she hated it here; she had been here for about a month, and missed her home in Nigeria. “Maybe I’ll be able to leave in a few months, I don’t know,” she said, disturbed. We asked her about what she was doing here. She told us that a large woman had come to her village, promising to take her to Spain to work in a restaurant. She had went, was put in the back of a truck, and ended up here – a remote mining town. There was no more big woman, only a “boss” that told her she needed to pay him a million CFA (about $2,000) if she wanted to go to Europe. There was only one way to pay that off here, of course. “It was something I had never wanted to do.” Forced into prostitution. Trafficked. I sat with the blood leaving my face, tears in my eyes, as she got up in the middle of a sentence and ran out. My friend went to talk to her, and she told him how she felt stranded. Trapped. No Bambara, no French, no money, no family who knew where she was, no way of leaving. Later, we found out that there were hundreds of them here, all with the same story; none of them have left. Hundreds had died since this ring was started a few years ago. I suddenly loathed every man I saw, the men that forced her here, the dirty men touching their mini skirts with guilty grins, even the one who had taken us here. Because they are all apart of this. And now so are we. This is something we all know about, it happens, it is terrible but it’s always someone else. But to look her in the face was another story.

The next day I went back to Kenieba, a town where a few volunteers lived. I got on the truck, away from the dust covered miners, and they are so lost, the women are so lost, and I needed to be somewhere I knew.

Cervical Cancer Screening Formation in Kita

Cervical Cancer Screening Formation
May 10-14, 2010; Kita CESREF, Mali

Cervical cancer continues to present itself as one of the most devastating diseases plaguing women in the developing world, and despite its worldwide drop in incidence rates due to technologies such as Papilioma smears and colposcopy, it has risen to the deadliest cancer among women in Mali due to lack of access to these tools. To initiate an attack against cervical cancer, a four-day formation was held from May 10-14 to train 35 doctors and 37 matrones from the rural health centers (CSCOMs) in the Cercle of Kita in a process known as visual inspection.

Visual inspection using acetic acid (VIA) or Lugol’s iodine (VILI) is an easy and accessible way to screen for precancerous cells, which when found can be treated to prevent the growth of invasive cervical cancer. Acetic acid or Lugol’s iodine is applied directly to the cervix, and any precancerous cells turn white (in the case of acetic acid) or yellow (with Lugol’s iodine) upon application. These positive results can be seen using a flashlight, and can be diagnosed by any healthcare worker with minimal training.

The first two days of the formation was held with the doctors from each of the 35 CSCOMs in the Kita Cercle, and the final two days was held with 37 matrones from the 35 CSCOMs. Sessions were facilitated by doctors and sage femmes (clinical midwives) from the local CSREF, who had recently received training from Dr. Tekete, a specialist at Gabriel Toure University Hosptial in Bamako. The first day of each training consisted of lectures on the epidemiology of cervical cancer, as well as its incidence occurrence and current available preventative treatment methods. Using visual aids, the participants were trained in the recognition of precancerous and cancerous lesions on the cervix, as well as positive screenings using VIA and VILI and general infections of the cervix. The participants practiced preparing the acetic acid solution, and went over forms used during and after the screening procedure.

The second day of the formation for both groups consisted of practical screenings using volunteers from the CSREF and two of the local Kita CSCOMs in Darsalam and Mardiakambougou. The participants took turns questioning the patients, preparing the solutions, applying the acetic acid and Lugol’s iodine, and assessing the result. Afterwards, they counseled the patient and completing necessary paperwork. The participants were instructed in steps to take during a positive screening, which in general included referring patients to the CSREF in Kita, where they perform a biopsy to be analyzed prior to treatment. Over both sessions 22 women were screened, with 5 positive cases where biopsies were taken to be analyzed.

Throughout the formation the importance of early, regular screening was stressed. Each of the 35 CSCOMs received a speculum, a placental probe, 50 ml of 100% acetic acid and 200 ml of Lugol’s iodine, provided for through Peace Corps and outside donations. All participants were urged to perform these newly acquired skills during their regular practice at their health centers, with an emphasis on screening during regular pre- and post-natal consultations. Finally, the healthcare workers were encouraged to set up regular village-wide screening campaigns, and to continue to ask for help if they are lacking supplies or adequate training. To conclude the training, a questions and answer session was held to ensure comprehension, and participants left with an encouraging assessment of the skills they had gained.






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A pain in the ass

Rising to its reputation, Africa comes along with a whole buffet of exotic medical issues to boast about. I've felt many a surprising spark of envy as my fellow Peace Corps Volunteers relay brave stories: worms crawling underneath their skin, removed with a Swiss army knife; bacterial dysentery announcing its immediate arrival at the beginning of a two day bus trip; your array of intestinal worms, amoebas and other parasitic invaders; and malaria leaving volunteers achy and hallucinating. Our bowel movements are a regular topic of conversation, and, as our saying goes, "you aren't a real volunteer until you've shit your pants." Sadly, I haven't earned that badge yet. Other than a three week long battle with Giardia (parasitic dysentery), I've avoided most of these encounters, ameobozoa and animalia alike. I know, I know, we can't have it all. But alas, I knew this love affair I've been having with mangoes would come back to bite me in the ass.

Yes, thats right. The Tumbo fly, aka the Mango fly, has struck in the most unforgiving of places. It all started when I came back to village, as I sat squirming in the hard wood chairs during my community meeting, a strange feeling of aching on my bottom invaded my already lacking attention. I assumed I had bruised myself in my local Bush Taxi as I tried to balance myself on the hard wood bench during the bumpy ride. On further inspection using a pocket mirror and an unspeakably awkward position, I saw a strange red bump right in the middle of my left cheek, with a black dot in the center. Perplexed, I looked in my healthcare manual, assuming a strange rash of some sort. And there it was. Apparently, the Mango fly is nicknamed for its favorite breeding grounds - damp and warm - which is also well provided by clothes hung out to dry near mango trees. So there in my sun-drying underwear it found a perfect place to lay its eggs. Those eggs were then transferred to my, um, behind, as I wore said underwear as it burrowed into my flesh. The eggs then hatched into larva, creating the unrelenting feeling I was having of tiny pins, exacerbated by the lack of comfortable, cushioned seats. The health manual advised immediate removal. Thanks. As per its instruction, I covered the area with Vaseline, which apparently suffocates the larva, bringing it to the surface. And then I squeezed - pop! - out squirted the larva, finally relinquishing my left cheek from its occupation. I was flooded with relief as I cleaned the empty wound and went back in my hut for a nap, Tumbo fly free, with my wounded part in the air.
And so, well, Africa I really do love you, but right now you are really a fucking pain in my ass.

freefalling

 
Here the old women are the best – toothless and with breasts like empty plastic bags almost touching their belly buttons; their breasts speak of endless babies fed and calmed, babies that crawled all over them as they sat and made soap and stirred iron pots of sauce, gossiping with their co-wives. The wander around quickly now, with careless energy – finally free agents, they seem younger than the women my age, who are slow and heavy with their husbands and children. They are the real liberated demographic here, the shackles thrown away.

I remember the funeral we went to last month – it was three days long, from morning to night. I went two of the nights. Under a hangnail of a moon we sat with the women, our backs pressed against each other in little groups around the wood benches, with the men across from us. The old women greet me with big eyes and hand me a coffee flavored candy, and joke about me carrying babies on my back. Earnestly they ask if I can take their son or daughter with me to America; I smile and say something funny and feel uncomfortable like I do every time. Its all a big joke, but I think sometimes they really do want to come, and it makes me sad. Then out of the darkness one woman begins to sing, a song for the old man who died. She sings a few lines of repeated phrases in a cracked piercing voice that seems to grab at the eardrums and throat, the beginning of a wail that just swells in song and subsides. The crowd of women respond in unison, again repeating a phrase or sound over and over again – la laa allah la – ending in echoes of the reverberating voices. After a moment of silence another woman is moved to sing, and she sounds even more broken, more beautiful.

And today, as I came to Founebas house for our evening talk, Assitan and Salifou, two of her children grabbed my hand and took me off to their grandmother, Magkara. As we sat down she ran in to get me some peanuts, and Fanta, who is about 80 comes bopping in with her one tooth, grabbing my hand earnestly – “Ca va?? Ca va?? Tres bien??” I don! (you dance!) she declares, and starts singing in the middle of a growing circle of children. The usual “lets all look at the Tubab” dance party ensued, while I tried to follow her moves. She looks like shes about to fall and catches herself, arms akimbo and then falls again, and I see she is strangely in control as she sings in this strange dance. I try and it feels great, but I am still awkward. We throw ourselves like ragdolls to the voices of the crowd. Then she does the shoulder dance, as if she’s moving through a crowd, all power and strength. We do the stool shuffle dance together, picking up our wood stools in rhythms. Its the silliest thing I've done in awhile. But I don’t feel like a silly Tubab anymore, with Fanta, and at 80 years old she might just be my favorite person here.