EmVee on the Loose

2007-11-28T13:27:00.000-05:00

Beloved Reader -

I would like to take a moment to apologize for being an absolutely dreadful blogger since leaving Mali. Pathetic, I know. I've spent time in Michigan, several different Mexican states and most recently, Nicaragua... yet I've been a selfish little bunny and haven't shared none of it. Again, due apologies.

Herein, I seek to rectify this embarrassing situation just a touch, by starting with this most delightful and busy weekend. Here goes - hope you enjoy.
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Thanksgiving in Providence, RI
November 2007

The Albina family, plus Derek Layes, boyfriend of the Genie, gathered in Providence for a much anticipated celebration of family and amazing food.
Since Genie moved to Chicago to start grad school, I've been sad for not seeing her as easily and wish I could drive there in four hours like I've been able to drive to NYC for the past few years. I've never actually cared much about Thanksgiving before, but this year felt different, and turned out to be a really great time.

Saturday night found me at the Classical High School Class of 1997 10 year reunion, at Snooker's, in downtown Providence. I'll admit it, I was a touch apprehensive about the whole thing, but when the lights came on at 2:30 am I didn't want to stop hanging out, chatting with folks and catching up on all the amazing things people have been up to in the last 10 years.

Sure, I wasn't the biggest fan of the whole high school experience - it was rough going there at times - but looking back, I was surrounded by some pretty amazing people, and am very glad to know them.

I only wish we could have had more time together. I'm looking forward to the next reunion - and yes, I mean Christmas break at the Wild Colonial.

2006-09-10T22:52:00.000-05:00

This gorgeous poem by Federico García Lorca keeps running through my mind, so I thought best to share it. Enjoy. - mv-

Gacela del Amor Imprevisto

Nadie comprendia el perfume
de la oscura magnolia de tu vientre.
Nadie sabia que martirizabas
un colibri de amor entre los dientes.

Mil caballitos persas se dormian
en la plaza con luna de tu frente,
mientras que yo enlazaba cuatro noches
tu cintura, enemiga de la nieve.

Entre yeso y jazmines, tu mirada
era un palido ramo de simientes.
Yo busque, para darte, por mi pecho
las letras de marfil que dicen siempre,

siempre, siempre, jardin de mi agonia,
tu cuerpo fugitivo para siempre,
la sangre de tus venas en mi boca,
tu boca ya sin luz para mi muerte.

Gacela of Unforeseen Love

No one understood the perfume
of the dark magnolia of your womb.
No one knew that you tormented
a hummingbird of love between your teeth.

A thousand Persian ponies fell asleep
in the moonlit plaza of your forehead,
while through four nights I embraced
your waist, enemy of the snow.

Between plaster and jasmines, your glance
was a pale branch of seeds.
I sought in my heart to give you
the ivory letters that say always,

always, always: garden of my agony,
your body elusive always,
the blood of your veins in my mouth,
your mouth already lightless for my death

2006-09-01T21:56:00.000-05:00

Mi Tio

I have the best Tio in the entire world.

Roberto makes me laugh, makes my life bright and always brings a smile to my face...

He teaches me about politics, life, el verdadero che guevarra, and thinking about him always makes me feel grounded, reminds me of where I come from and who I am...

and today in the Yucatan I learned that I am not the only one
in the know about this amazing man.
Turns out, all of México knows it...
¡Roberto Si Puede!

2006-08-30T19:15:00.000-05:00

México, autre fois

The air here has a palpable quality. Hitting me squarely in the chest as I stepped off the plane, I was reminded bodily by the stifling heat that I am somewhere new, yet known, that I am no longer on African soil. As my body adjusted with deep and straining breaths, I felt the heat wash over me, as the salty smell of ocean air filled my nostrils.

The drive from Cancún to Valladolid – 163 km of delicious and much needed solitude – welcomed me back into a landscape lush with rain and water. Aterciopelados serenading me along the 180 Cuota Route, I was the only car in a tunnel of tall and leafy trees – palms and their compadres waving “Hola” and “Welcome home” with each gust of thick, damp wind.

I was surprised in a way by the miles of uninhabited land between cities. In comparison with the dense overpopulation of Mali, México felt sparse and strange. A Malian bus ride takes eons longer than the miles-per-hour-math would indicate, as stops are made every quarter hour, at each and every small roadside village. I drove almost two hours today without any sign of habitation – an odd feeling indeed.

Arriving in Valladolid, the tall trees gave way to one story concrete buildings, painted in majestic pinks and bright blues, with yellow awnings and crowded stoops. The town center greeted me with its summer time festival air – tourists and tchotchke sellers lining the plaza, competing for space with mangy yet friendly stray dogs and children eternally eating ice cream and long sugary sticks of chile-laced candies.

Amongst those mangy street dogs was one who holds a special place in my heart – my sweet Carlos. By all definitions a dirty and maltreated animal, Carlos and I made a special connection when I was last here, and I hoped to find him again. Our love began one night last January, as I walking home from dinner, and lasted the entire month I was last here. Each time I left the hostel I would find Carlos waiting to follow at my heels, barking at any men or pups who would pass closer to me than he liked. Purell close at hand, I would sit in the Plaza Candelaria for hours, petting and brushing him, attempting to clean his street filth away. I can’t claim full success in the matter, but I gave him what love (and hot dogs!) I could while I was here. I was saddened greatly to leave him as February came to a close, and entrusted his care to my amiga, the Chilean owner of Plaza Candelaria's own Café Kaffe, Doña Annie. When I saw him across the plaza today I called out “Carlos! Venite a la Mamá!” and my sweet little pup heard me and bolded across the square. Needless to say, he followed me around all afternoon, and slept outside the door to the hostel, always ready with a massive smile and a waving tail to greet his Mamá.

I adore the hostel here in Valladolid, La Candelaria, and highly recommend it to anyone travelling in the area. It's clean, cheap, well keep and so inviting. The rooms are light and airy, and I always feel safe and comfortable, whether in a single room or a dorm-style room with lotsa gals in bunk beds. Like most things in America Latina, every possible surface is painted yet another bright color; somehow bright pink and blue walls never feel overwhelming here.

Owned and run by a Nicaraguan family, the place really feels like a home, due to much hard work and a lot of caring on their part. It has a great balance of fun and excitement (interesting conversations over mexican beers with fellow travelers, random guys playing guitars and drums for hours) and the type of quiet, peaceful environment I really need while travelling, particularly while working and getting to Chemáx by 7 every morning. I have sat for hours with Argentines, Israelis, Dutch folks and Morocans, discussing life, love, politics, moderity and global warming alike. And man, the fresh yucatan honey they put out for morning breakfie can't be beat (though the coffee I prefer to skip entirely...).

A thing I missed this summer in Mali is the café culture that is alive and well in México. From the morning till late at night, the restaurants and patio cafés are brimming with life and laughter, with couples crouched over steaming espressos, conversation lasting on till way past my bedtime. I enjoyed spending the evening catching up with Doña Annie and her husband Ariel and all of their friends with whom I spent so many café evenings earlier this year. I told them about Mali and my work there, and how strange yet wonderful it feels to be back in México, to hear my native Spanish strangely accented by my months en francais. Doña Annie has landed herself a spot on a local TV station, doing interviews about the comings and goings around Valladolid, and has asked me to be interviewed about our work in Chemáx. Ah, TV appearances on two continents in as many months… it’s so hard to be as fabulous as me, though I do what I can to get through it. (insert giggle and impish grin here)

And now, to sleep. In the morning I head to Chemáx, to start my work.
More on that to follow….

2006-07-26T06:30:00.000-05:00

Pais Dogon
17 July - 24 July

I have just arrived home from an amazing week in Dogon Country with my bon amies Lindsay and Yakop. We had an incredible trip, met wonderful people and saw such incredible scenary. From Bamako we traveled up to Mopti where we saw the gorgeous pinace/floating home-boats, and the harbor of the ancient city. From there we treked, walking up to 12 K a day, from Bandiagara through village after village, sleeping in lean-tos and mud flat buildings, eating a staple grain and a sandy-sauce each night, fried dough and watery nescafe each morning. Through the cross roads of civilizations, we spent hours at a time staring in awe at the a village comprised of a Muslim sector next to a Christian church and community next to an Animist grouping - amazing to say the least. We climbed cliff faces up and down the escarpment, winding our way into Pygmie homes, their four foot high ceilings telling the history of their kingdom and their demise at the hands of the Puhl (Fulani), who later lost their place to the Dogon. A rich and infinitly interesting history....

Sadly, with only a week left in Mali, and lots of clinical work left to do (I must birth more babes!), I must regretful say that I won't have time to properly blog for a day or two. I beg pardon, and will be sure to update as soon as I can.

Thank goodness for good note taking - I have tons to tell.

2006-07-16T15:31:00.000-05:00

Laundry Time

Here are some pics of me doing laundry in Mali, the good, old fashioned way. It is an exhausting and time consuming process, and never feels like it really gets my clothes that clean, but when it's all you got, you have to love the experience of it. The one thing doing laundry in a bucket has really made me understand is polygamy. Doing this every day, by myself for my whole family?! No ma'am! One wife does the laundry, one cooks, one cleans, one slaps the kids around... when you're doing everything by hand, down to cooking on a charcoal stove (with no lighter fluid, just a lot of fan-action), everything takes about 12 million times longer than stateside. Having a few other wives around here would really be nice. ;)

2006-07-15T18:50:00.000-05:00

Mali Basics

here is some basic info about Mali, gathered from Oxfam, Lonely Planet and many others. Pictures are either my own or from random websites... enjoy!
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Mali is the largest country in West Africa with a land area greater than that of France, Spain, Portugal and Austria combined. Nevertheless the Malian population is a little under 10 million – around a sixth as many people as in the UK. This landlocked country is bordered by seven others. To the west lie Senegal and Mauritania, the Ivory Coast to the south, to the southeast Burkina Faso and to the east Niger. To the north and the north-east is Algeria. The Niger river courses through the country in a life giving sweep, splitting into a vast inland delta before reforming itself to empty into the Gulf of Guinea.

The northern region of the country extends into the treeless Sahara and is almost entirely flat and arid desert. This area makes up almost two thirds of Mali. In the central region of scrub savannah, known as the Sahel, life follows the annual flood of the Niger River. Further south, where rainfall and rivers are more plentiful, the land is marginally more lush. It is here that the capital, Bamako, is situated.

Mali has long functioned as a crossroads between northern and western Africa. As a consequence, the country holds a rich and varied cultural heritage. Mali is traditionally divided in two; the nomadic areas of the Sahara and the Sahel and the agricultural region to the south. More than four fifths of the population live in rural areas. A combination of climate, migration, history, and culture has painted Mali with a mosaic of diverse peoples. To the north are nomadic groups of the Tuareg, of Berber origin, and Moors. To the south is a variety darker skinned peoples. The largest is the Bambara, who live along the Niger River. The Soninkle are descended from the founders of the Ghana empire and live in the western Sahelian zone. The Malinke, descendants of the Malian empire, live in the southwest, while the Songhay are settled in the Niger valley from Djenné to Ansongo. The Dogon live in the north-central plateau region around Bandiagara. The Voltaic group includes the Senufo, and the Mininianka; they occupy the east and southeast. The Fulani herders are found everywhere in Mali where large herds of cattle, sheep and goats can be grazed.

Islam is practised by nine-tenths of the population, animism by most of the rest and Christianity by a small number. Whilst French is one legacy from colonial times, few people speak it and the most common language is Bambara.

History

The Great empires

The area that Mali now occupies came to prominence in the thirteenth century when the first of a series of influential and wealthy empires, the Malinke empire, was established there. Commercial and cultural centrepieces of Africa, these empires dominated trade routes, exerted tremendous influence and became centres of learning. The wealth of the Malinke sultans was legendary. Some estimates reckon that two-thirds of the world’s gold of the time was in their hands. Indeed, when Sultan Kankan Musa, stopped in Cairo, during his pilgrimage to Mecca, in the fourteenth century, he distributed so much gold that its price fell for the next twelve years! Each year 12,000 camels would cross the desert between Mali and Cairo. Trade extended into present day Europe via Morocco and Moorish dominated Spain. This intensity of commercial and cultural interchange with the Arab world and Europe gave international prestige to the newly established and thriving University of Timbuktu. At its height the university catered to around 15,000 students. However, the Portuguese broke the Malinke virtual monopoly of the rich trans-Saharan gold trade, by diverting gold to the coast to exchange for European goods.

By the fifteenth century, in the face of attacks from surrounding groups and the loss of trade to the Portuguese, the Malinke empire gave way to the Songhay empire. Nevertheless, the empire continued to combine lucrative trade with a rich intellectual life. This period ended dramatically in 1594 when competition for the Saharan trade routes precipitated an invasion from Morocco. Timbuktu was pillaged and the university destroyed. The development of rival states contributed to the decline of the empire. The 'convert or die' jihad of El Hadj Omar Tall, leading an invasion from Guinea and Senegal in the mid 1800s, further weakened an already divided land which was unable to resist the final invasion; the occupation of the French.

A French colony

The French incorporated the area of Mali into the vast territory of French West Africa. Mali was to be the bread-basket for the area providing rice for the coastal French colonies and cotton for France. Colonisation heralded significant changes. Bamako was chosen as the site for the new capital. Trade, which had traditionally flowed north across the Sahara to the Mediterranean, was turned back to the Atlantic and Dakar. The Saharan trade routes dried up. To grow the rice for their colonies French engineers used forced labour to build ambitious irrigation projects, rivalling the Aswan Dam in scale. However the French never concentrated on Mali as they did in Côte d’Ivoire and Senegal; its importance lay mostly in its strategic position. No major infrastructure projects were attempted, other than the irrigation project on the Niger and the railroad from Dakar to Bamako.

The colonial legacy

Although life continued much as it had before for the majority of Malians during the French occupation, Malians may remember the French for four reasons.
1. the French discouraged traditional customs such as the dina; a code of conduct by which disputes over land were resolved between pastoralists, cultivators and fishing communities.
2. Malians were conscripted to fight in both World Wars.
3. although only spoken by a tiny, educated minority, French is the official language.
4. the French destabilised the nomadic communities of the Touareg by requisitioning their herds of camels for the first world war effort.

Independence

In the atmosphere of democracy that prevailed after the end of the second world war and amidst increasing calls for self-governance from Mali, the French embarked on a policy of gradual concessions, starting in 1945, that led to independence in 1960. Aware of their limitations Mali and Senegal joined in the federation of Mali but their differences of interest soon caused the alliance to collapse.

Socialism, drought and dictatorship

Led by Modibo Keïta, the same man who had steered Mali to independence, Mali broke its links with France, withdrew from the Franc Zone (a system governing foreign exchange, credit and monetary relations between France and 13 former French colonies) and became a socialist republic. However, the centrally managed economy was a disaster and Mali soon had to rejoin the Franc Zone. Foreign debts and plummeting agricultural production led to the overthrow of Mr Keïta in a military coup in 1968.

That coup heralded 23 dark years for Mali. The Military Committee for National Liberation (CMLN) led by Moussa Traoré, promised to fight corruption and straighten out the economy. The opposite was the case. The dictatorship evolved into a one-party system, the Union Democratique de Peuple Malien (UPDM), which held power until 1991. Mr Keïta died a mysterious death out in the desert, where he was held prisoner. Corruption became an institution; both as a form of government and as a way of life. The situation was aggravated by two extended droughts, in 1973-74 and again in 1984-85. Although the droughts opened up the country to international aid - the majority of the aid disappeared into the pockets of party officials.

Structural adjustment

The military-based government opted for a policy of internal structural adjustment which started in 1981. Adjustment was designed to reform the economy and allow Mali to pay its foreign creditors. The first structural adjustment programme, launched in 1982, was intended to streamline government bureaucracies, encourage investment and the private sector, reduce subsidies and match government spending with government revenues. Many of the economic reforms were necessary but little thought was given to the social costs of adjustment. Deep cuts in government spending on health and education provoked howls of outrage from the people. The weakening of education and health services hit the poor and the most vulnerable hardest.

Transition to democracy

From 1989 a broad-based coalition of social and political groups demanded a multiparty democracy, greater political freedom and full civil rights. Student protests were violently crushed. Meanwhile, the Touaregs were in open revolt in the north of the country and the government came under pressure from mass demonstrations in the cities. A series of bloody clashes between the people and the army culminated in the arrest of the president in 1991. Lieutenant-Colonel Amadou Toumani Touré installed a transitional committee. The transitional body included members of each of the organisations that had helped to bring about an end to the regime of Mr Traoré. They organised a national conference to draw up a new social contract and design a new constitution, held a referendum on the proposed constitution, put in place the rules for multi-party elections, oversaw municipal, legislative and presidential elections under the auspices of international observers and put Mr Traoré in jail. Then, after the democratic election of Alpha Oumar Konaré in 1992, they left office. Mr Konaré, a key figure in the ousting from office of Mr Traoré, has held power ever since.

Political stalemate

However, the economic and environmental crisis did not leave with Mr Traoré. Mr Konaré’s party, the Alliance for Democracy in Mali (Adema), tried with varying degrees of success and failure to tackle the war with the Touaregs in the north.

War in the North

Mr Konaré inherited a delicate and potentially explosive stand-off when he came to power. Rising discontent in the northern provinces had led to an armed revolt by the Touaregs. Since 1900, when their traditional trade in salt across the Sahara was destroyed by the French colonialists, the Touaregs had felt marginalised and threatened by the new world order. They rebelled during the First World War to try to prevent the loss of their camel herds to the war effort and again in 1963; both times the rebellions were violently repressed. In July 1990 an armed attack on government offices in the town of Menaka ignited a widespread Touareg uprising. Equipped by Libya, the Touareg units were mobile and well armed. They inflicted some heavy defeats on the Malian army. The first peace accords, signed in 1991, were soon eclipsed by the fall from power of Mr Traoré. The Touareg leaders grabbed the opportunity to maximise their gains and relaunched the attack. The cycle of violence resumed. Just before the elections in 1992 an uneasy compromise was reached, the Pact Nationale, which made significant concessions to the Touaregs, pledging investment and infrastructure support.

The Pact failed to resolve the situation for a variety of reasons. The break down of law and order, continuing problems with banditry, the issue of the internally and externally displaced refugees (250,000 were living in camps in Algeria, Burkina Faso and Mauritania), the perceived indecision of Mr Konaré and the disunity of the Touareg leaders raised the level of tension to breaking point. According to the terms of the Pacte Nationale the Touaregs were allotted jobs in the army and the civil service whilst other groups were suffering the pains of structural adjustment.

In 1994, the Songhay population decided to act, creating a militia, named the Ganda Koy. What followed amounted to a pogrom which polarised the country with retaliation and counter-retaliation between the sides. The army, rather than acting to resolve the conflict, took sides. When the Touaregs launched their largest offensive by attacking the military base of Gao, the military refused to defend the city or its inhabitants. Instead, once the attack was over, they killed over 200 civilians from a peaceful Touareg community on the outskirts of Gao.

On the brink of civil war, several courageous individuals managed to get the two communities to meet and a fragile peace was established. This culminated with the ceremonial burning of 3,000 weapons in Timbuktu in 1996. As a result of the instability many aid organisations pulled out of Northern Mali and aid projects practically halted for the duration of the unrest.

2006-07-13T18:42:00.000-05:00

Full Moon and the Maternity Ward
disclaimer: this entry includes lots of sad and potentially gross-seeming medical details…

The full moon lit the courtyard at Clinique Sikoroni, flooding the airy space with beams of gorgeous, glowing light. Arriving after dinner, my colleague Megan and I were met at the Clinique's gates by Moustafa, the night guard, who told us to hurry to the Sal de Accouchement (Birth Room). Hurrying in, still wearing our backpacks, we met a grim faced Matron, hands firmly holding a laboring woman quietly pushing on the bed. Douga looked me in the eye and I knew right away that this birth was not a happy occasion. I quickly dropped my bag. Donning gloves from my purse, I approached the table as the child began to crown. Slipping out quickly, the baby was placed at the foot of the table, and was covered in a piece of cloth. With the same quick quietness, the midwife delivered the necrotic placenta, and placed it next to the babe, for me to examine.

The child had been dead in the womb for some time. Just shy of completely formed, his head had collapsed in on itself, and was soft as bath tissue all around. His epidermis was sloughing off from its time in the acidic environ of the dead placenta. So sad to see this wee one, in such a sorry state, without a chance before he could start.

When the doctor came in, I asked him what had happened and he said that the mother must have had an infection, but he did not know of what sort. With no money for the lab work to find out, the air in the room said "Let it Be." The scientist within me couldn’t help but want to know what had happened.

With the young doctor translating my French to Bambara, I asked the woman if:

she had a fever: yes, low grade, for two weeks
she had discharge: yes, lots.
what color?: whitish gray, tinges of yellow, thin liquid.
... and my heart started to sink…
did the discharge smell?: umm, yes…
... ay ay ay...
Did it smell like fish?: oui, poisson, lots of poisson.

heavy sigh.

While a lab test would be needed to know definitively, it seems like an obvious case of bacterial vaginosis, and thus, potential PID. A course of metronidazole or clindamycin would have saved this baby’s life, and saved this young mother much heartache.

It’s so difficult to know why treatment wasn’t sought out or provided, and it felt inappropriate to ask at such a difficult time, lest any implication of guilt be felt. I can guess several reasons why she did not seek treatment. She may have been embarrassed or not have known that her symptoms were indicators of a major problem, she may not have thought that treatment was available had she come to the clinic, and sadly, but obviously, she may not have been able to afford the 1000 Cefa or 2 Dollars for a clinical visit and medication. A sad case, but not an uncommon one…

The child was wrapped in a piece of cloth and left on an empty exam table – rather disconcerting, frankly. It was so surreal how life just went on, how things always keep moving, how women kept coming, and having babies all night…

Understandibly numb, Megan and I went to bed, and got a good two hours sleep before a knock came on the door. Another woman had arrived. Already in active labor, she would stall out at 6 cm and take another four hours to have a normal, happy, healthy delivery. This was a bit of good luck, as soon after her arrival, Kadja arrived, every malnourished, thin inch of her full with twin girls. As we helped her to the bed, checked her dilation and got her as comfortable as humanly possible, another woman came into the cramped room, and fell to her hands and knees on the floor, contracting hard and fast. The Matron looked at me and said "You take the twins," as she knelt to the woman on the floor. Kadja let out a low moan, and I looked over to see a small head begin to crown. Using my limited Bambara to tell her take a deep breath and push, I took the head in my hands and coaxed the first baby out, one shoulder and the next, and suddenly, a writhing pup of a babe was alive and well in my arms, thick with vernix.

Laying her on the fresh cloth on the table at her mama’s feet, I suctioned her nose and mouth and heard a small gasp, and a cry. Excellent. One down, one to go. I showed Kadja her first child, and rubbed her belly down, giving her a moment to rest before the next delivery. Coaxing her again to push, I grasped the cord to check the placenta, and gave a gentle pull, waiting for another crowning. Soon enough I saw another head full of hair, and took hold of it, preparing myself for the delivery. First the head and then a shoulder and then… and then… oh goodness. The shoulder was stuck. As Kadja moaned with pain and overexertion, I started talking to the babe in Spanish, hoping her memory of Babel still held, and that she would hear and understand me. Comprend she did, and as easily as her shoulder stuck, it came loose with a touch of my help, and I took firm held of her small and wriggling body. Laying her on her mother’s bloated belly, I started to suction her nose and mouth. She would not cry or breath. I suctioned again, and again, and still, she would not take breath. With no suction tube in sight, I was at a loss. I got the matron’s attention, and she quickly evaluated the situation. Taking a corner of the cleanish cloth in hand, she placed it over the baby’s mouth and nose, and began to suction by mouth. Three strong draws, and the mucus plug was out of the baby’s throat, and in the cloth. Spitting the cloth away, the matron smiled and gave me a wink as she turned away. These women never cease to amaze me.

As twin number two (they are not named for a full week after birth) took her first breath, so too did I exhale. Babies delivered and in mama’s arms, I turned to help the matron with the next delivery, setting the pace for the rest of the night. Baby number eight was delivered just as the 5:30 am call to prayer rang out. Full to capacity, the new mamas and their new babies rested in the growing heat, while I set about helping the matron clean and bleach the birth room.

Dawn came gorgeous and calm, the air crisp and inviting, with a gentle morning breeze. After a big glass of street-vendor café, filled half way up with sweetened condensed milk, we all took a seat outside to discuss our long and fruitful evening. Shaking hands and hugging, the matron and I had quite a moment. I feel so grateful to these amazing women who let me into their lives, and teach me so very much.

Exhausted, Megan and I finished some final chores around the clinic, and headed home to sleep before our respective afternoon shifts at other clinics, in other parts of town.

And soon enough, to do it all again. To see more first breaths, first births, more pain, more joy. Till then…

2006-07-11T06:44:00.000-05:00

Night Guard at the Maternity Ward
10/11 July 2006

Last night my colleague Alli Bicki (age 17!) and I took a night guard shift at the Clinique Sikoroni, where GAIA is doing our PMTCT work. Arriving in the early evening, we spoke with the Matrons, Animata and Mariam, about their work, about birth in Mali and the difficulties encountered when a birth goes awry. If a woman is in need of a cesarean she must find the cab fare to get downtown to Gabriel Tourre or way up to Pointe G -- at least two to four dollars, a massive sum of money around here.

We also discussed the issue of Sorcery, and the difficulties of the Evil Eye. Women wear strings of myrrh around their waists to both fend off ill will when pregnant, to prevent or support pregnancy and to protect the womb in general. Babies are given bracelets of white beads with a kowre shell in the middle to wear on their right wrist, and their own strand of belly beads as soon as they can after their birth. One must not compliment the baby in any way before it is named, which on their one week birthday, lest Evil be drawn to the babe.

Waiting patiently for birthing women to arrive, we wandered over to the Medical side of the clinic, where we met two young doctors who had just finished school, and were excited about their ER duties. Donning white coats and stethescopes, we entered the exam room, where we found a boy of 20 months, lying silently on the desk cum surgical table. A male nurse, sans gloves, was performing a circumcision while the boy's father held his legs. The boy made no noise and lay perfectly still while a less than sharp tool was used to cut a circle of skin from his tiny body. Perplexed by his lack of blood curdling screams I asked about anesthetics. The nurse informed me that the family could not afford neither pain medicine nor gloves for the procedure, and that the boy was "Taking the pain like a strong African man." Ya right. Faining some need to check his breathing and heart rate, I leaned in close, armed with my trusty Littman scope, nose at the ready, and.... ah, the crisp smell of cheap booze on the breath of an infant. What poverty won't lead people to do...

After procuring gloves from the dispensary - GAIA donated over 70 KILOS of latex gloves this summer alone - I handed them to the attending clinician, and meandered back to the Woman-Side of the clinic. There is rarely a man seen on the maternity side of the courtyard, save the rare husband or father. Women birth alone, without their partner or any familial support. They make little to no noise, and birth without any analgesics of any sort.

At 1 am I was awoken by Aminata - un femme a arrivé! Moving across the courtyard, the moon was full and bright overhead lighting my way to the Sale de Accouchment. Therein, I found Sira, a Bambara woman in the throws of labor. She advanced quickly and quietly, enduring repeat vaginal exams without lubrication, and contractions with barely a moan. I cooed to her in my limited Bambara, and massaged her belly and shoulders, encouraging her to push. All of the sudden the baby crowned, and then I had cause to gasp aloud - the cord was birthing with the baby. The Matron looked up and caught my eye, and I moved down to the end of the bed, taking hold of the bed. With the next push, we found the cord wrapped snugly twice around the baby's neck, and she was cyanotic (blue) from lack of oxygen. As I pushed with one hand on the emptying belly and encouraged Sira to poussée, the skilled Matron pulled the baby out and quickly turned her around in the air, one hand firmly grasping her legs, one arm spinning her silent, tiny body to remove the oxygen-depriving cord from around her neck. Task complete, Mariam placed the baby with a thud on her mother's stomach and began to suction her nose and mouth as I began gentle sternal rubs to encourage the baby to breath. After a few tense seconds, which felt lightyears longer, she opened her little mouth and gave out a scream -- the most beautiful scream I have ever had the pleasure of hearing.

With her child breathing aloud, Sira closed her eyes and melted into the bed, and the plastic garbage bag beneath her which served as a catch all for the messiness of birth. While the matron took the baby across the room to be weighed, I helped Sira birth the placenta, which was, thankfully, all present (retention of placenta can lead, quite quickly, to infection). As soon as she was free of labor duties, Sira stood up, and walked out of the birth room into the room of bed adjoining it. I have never seen a woman get up and walk away after a birth as fast as in Mali. In the U.S. a woman will rest in bed for hours, and in Mexico they were kept on the table to rest for at least ten to fifteen minutes. But not Malian women at Sikoroni, they are up and away as fast as possible. Given the decrepit state of the birth room, one can certainly understand why one would want to flee it toute suite, though it does strike me as remarkable who strong these women are...

The rest of the night went well, no further complication, little sleep for the weary Matrons and tubabu visitors. The morning was went with strong café full of sweetened condensed milk, and tiny balls of fried millet. Eating voraciously, I couldn't help but sigh, and think about how amazingly lucky I am to get to bear witness to someone's first birth, someone's first breath of air, the start of a new and sacred life... to sleep, and tonight, to the clinic autre fois!

2006-07-08T10:36:00.000-05:00

A Request For My Hand In Marriage

Today at the clinic one of the physicians, who knows quite well that I'm married (wearing a fake ring and having a nice little story makes life a lot easier around here), asked for my hand in marriage.

Lui: Victoire, you are to be my newest wife. (said with a laugh and a smile)
Moi: But Doctor, I am already married!
Lui: Where is this husband of yours?
Moi: In the US.
Lui: Well then, he is not here. And I am here. I will be your husband in Bamako, and he, your husband in the United States. What is the problem with this arrangement?
Moi: Sir, I cannot marry you. My husband is a respectable man and would not approve of this.
Lui: What kind of honorable man would let his woman travel so far from his side unattended? No, this will not do. You will be my wife, and I, your Bamako husband.
Moi: Doctor, I, well, no! (giggling as I bumbled through the french) I couldn't possibly be your wife, I...
Lui: Fine then, you present no salient logic, so it is settled, and you are now my wife. Excuse me, I must attend to my patients.

... and thus, my Bamako Husband slapped hands in agreement with the other men in the room, gave me a smile and a laughing wink, and walked away, while I stood in the courtyard, laughing out loud, shaking my head back and forth along with the women present.

2006-07-06T19:44:00.000-05:00

Difficult Veins

This child is typical of the patients I've been seeing at Sikoroni Clinic. This little boy is around five years old (his mom was unsure of his birthdate), and was born HIV infected. His mouth was full of thrush, was dehydrated, had text-book marasmus baggy-pants and acute malaria.

Two nurses, a doctor and I tried to get a vein for twenty minutes. Each time we got a line in and started a slow slow drip, the vein would go. Both arms, both hands, both feet, and finally, his thin skinned little head. All the while he screamed and screamed, which I could only take as a good sign, and a show of his staunch determination to live against all odds.

2006-07-06T19:33:00.000-05:00

Gizmo!

This is our dog, Gizmo, who we're watching for our GeekCorps Colleague Matt, who is on leave stateside. She's a ton of fun, but is scared of brooms and, umm, well, is a total racist. She only barks at black people - and she barks at them a lot.... unless they are robbers, when she hides under the couch...

we have also inherited a cat, who recently beat the crap out of Gizmo. ay ay ay...

2006-07-06T18:56:00.000-05:00

25 June 2006 - Sikoroni Clinic

Dr. Anne DeGroot, the Director of GAIA arrived last night with three other colleagues, bringing the population of the house to 15 (yikes). Today, we went up to introduce me to the staff at the clinic at Sikoroni, a cartier or neighborhood of Bamako with a population of approximately 50,000 people, where we are running a Prevention of Mother-to-Child-Transmission of HIV (PMTCT) program. We are working with the two physicians, two midwives – sagefemmes – and the four Matrons, or Traditional Birth Attendant (TBA) equivalents, who together attend over 1,400 births in clinic, and see scores of other women, who birthed at home, with or without assistance. Luckily, most women who have home births bring their neonates to clinic to be registered soon after birth to be checked by the midwives.

The program is based on an education program run in part by the Malian government, with funding at Sikoroni and two other sites from GAIA. All trainings are led by Malians, in Bambara, the local language, and discuss safer sex practices (for what that’s worth), HIV infection and treatment, and in particular, the basics of PMTCT and the importance of knowing your infection status.

HIV testing is held every clinic day, which is great in that you don’t have a courtyard full of women only getting an HIV test, thus (hopefully) maintaining a better level of confidentiality. Counseling is done by a dedicated staff person, who then sends the woman to the midwife on duty who gives them a coded order for a blood draw, and then on to the lab. My one issue in this process is that the lab technicians leave the tourniquet – a recycled IV tube – on the patient’s arm the whole time they draw, making the blood come out in painfully, grimace-inducingly slow. I asked why they do it like that, and they said that it was how it’s done here… ah, a moment for tact and to not be that Great White Hope that tells Africa how to do things right…. I decided to keep my mouth shut until they know me better, and then we’ll see what can be done to make testing a lot less painful a process.

The results are read in four minutes (!) and all results are given privately, without partners, in the only room with an actual door. I was happy to see that, since there is no privacy to be had in clinic, as exam and treatment rooms alike have nary a bit of cloth dividing those waiting for salvation from the visiting well.

The birthing room is simply and utterly dreadful. With no mosquito nets and no ventilation, it’s not surprising that so many women chose to take the risk of birthing at home. One of my many jobs here is to attend to these sorts of things: the ripped and filthy birthing and exam beds, with their decimated vinyl exposing old and stinking foam, the flies and mosquitoes on birthing women and neonates alike, the lack of clean water and the general decrepit nature of the beast that is the under funded local health center. I’m meeting this week with an NGO that provides bug nets to pregnant women at low cost or possibly free (we’ll see), for possible distribution at Sikoroni. Meanwhile, I spoke with the head doctor, who says that he has installed and replaced nets three times, only to see them gone by morning. A complex situation indeed…

In the time we were at the clinic that morning, six women gave birth, four of whom birth concurrently, all in the same small, dimly lit room.

The rest of the day was spent in the clinic’s central courtyard, playing with the local children, and learning about their lives. What energy! They all wanted to touch my hair, which they then did for over an hour. I left the clinic exhausted, enthralled, angered and depressed and excited to make some small little change in this big big world…

2006-07-06T08:40:00.000-05:00

June 6th, 2006. The Tale of the Broken Front Door

After watching a movie until 2 am, I awoken by my colleague Sophie early this morning, with the news that we had been robbed. Before anyone freaks out, no one was hurt at all in any way, they didn't go past the living room into the area where our bedrooms are.

Yesterday I noticed that the front door that goes from our courtyard (the house is walled... typical expat haven) to the dirt-road/plaza was broken, and couldn't be closed. Something inside me said "something bad is going to happen tonight..." but alas, I didn't heed the rumble, and after the movie, went to bed as usual. Luckily, given that I live with many other people, I am really careful not to leave my things out in common areas, mainly to be polite. Those that had left their purses, cellphone and wallets out in public were not so lucky -- and most of them ahd changed money that afternoon, meaning that hundreds of dollars were taken.

While we do have a guard, the situation has been a problematic one sinced the start. Massa is an amazing guy, and a very attentive, kind guard. Where I have had a problem, and what led us all to have a problem, is that he is 18 years old, and is our sole guardian. He lives here, and is on duty with us 24/7. Literally. He doesn't get official time off to do anything, especially sleep. So yes, Massa was asleep when whomever came in, but man, the kid has to sleep some time! A very frustrating situation. We are making room in our budget to get a nights-only guard, to relieve Massa. While this is in Massa's best interest in terms of his health - and our safety - it means less money for him overall. It's a difficult time around here...

And since I spent the entire morning dealing with this (I am the de facto House Mama... shockily enough), I missed meetings with the prison warden and the Chief of Medicine at the main hospital. Luckily those were rescheduled for tomorrow, but it's frustrating to lose a morning's work. I'm off to the Sikoroni village/GAIA clinic to do overnight guard duty with the midwives who work with our HIV+ mothers. I'll help run HIV tests, work on the new PMTCT protocol, and attend births with the midwives. Hopefully there will be lotsa mamas to make up for my crappy morning!

update:

we looked into talking to the police, and Massa went and hid in his little quarters behind the house when he heard us talkin' about coppers. Turns out that when a house gets robbed, the guard is guilty if no one else is found... which means Mass would basically get the crap beat out of him if we even talked to the authorities. he was genuinely scared. so, obviously, we're not reporting this. man, oh man... i'm not in any way surprised that this happened, it's just been such a bummer....

2006-07-06T08:33:00.000-05:00

Rounds at Pointe G and the Mundial, June 5th 2006

We started our day at Hopital Pointe G at 7 am. Walking through the courtyards that separate the small buildings that house the separate wards, I was surprised to see so very many people waiting for attention. The ER was particularly crowded, given that a surgeon is only available during daytime hours, regardless of the degree of injury or need. While some basic drugs are available, things such as gauze, band-aids, etc. , they must be purchased and brought to clinic by the patients who need them. A difficult situation indeed.

On the infectious disease ward, where I’m working/learning/doing rounds, there were 14 admitted patients in beds and twice as many family members living on mats in the cramped and crowded hallways, bowls of rice and fonio (millet meal served with peanut and tomato sauce) at their feet. Our patients today included a 45 year old mother of 8 with localized tetanus in her left leg, brought about by a fall on a donkey cart. Paralyzed to the hip, our 23 year old Guillen Barre patient was confused and scared, and could be offered little help beyond the continued treatment of her HIV infection.

Most of the ID ward’s patients are HIV infected or have AIDS, and are in-patient due to a comorbidity, such as Tuberculosis or Malaria. The rooms are hot and cramped, the walls are filthy and covered in flies. Some patients have mosquito nets, but the majority do not. Families are responsible for feeding their loved ones, which leads me to wonder how they can provide proper nutrition for such sick people if they can barely feed the well, and what folks without families do when ill. I was impressed with the Malian medical students, who were being quizzed mercilessly. While my French is sufficient to understand most everything being said, I often find myself lacking the vocabulary to respond in French. When asked how to test clinically for meningitis clinically, I could barely get the words out, and had to lift the patient’s leg and neck while bumbling in an interesting mix of Spanish, English and French, with a “I ka kene? How are you?” in Bambara thrown in for the patient’s sake. There was much laughter in that room…

After work the GAIA team went to La Terrasse, on the night club strip here in Hippodrome. Full to the hilt with tubabus cheering on France, Bamako has never felt less… like Bamako. As the cries of joy died down, the winds began to howl.
Stepping out of the restaurant, we were pelted with whips of red-brown sand, sharp and uncaring on our bare arms and legs. And as quickly as the sand storm came, it gave rain to the torrential rains, soaking the roads, slick with oil from unkempt taxis and the sea of dead tractor trails lining the road between the goudron and Chez GAIA. Like a pack of drowned rats, we all but ran down the dirt road, eyes closed against the torrent, fingers crossed in case of racing taxis and motos sans lights. Finally, we made it home, dripping wet, all but collapsing with laughter and glee from an evening spent like wild children, running rampant and unattended in nature’s playground.

A perfect end to my long day at the infectious disease clinic, and tomorrow, to the Bamako prison, where we are beginning an HIV education and treatment project, and to an overnight guard duty with the midwives at Sikoroni Clinic.

2006-07-05T13:29:00.000-05:00

camels and dates

today at the marché my colleague megan's womanhood was bartered for. A seller of poisson offered 50 camels and 50 kilos of dates. What an insult! The bartering began, and sweet Megan was finally offered up for the handsome price of 200 camels and 200 kilos of dates. A fine price indeed. the gentleman bidding for her hand was told that we would consult with her father, a respectable gentleman, and would let him know tout suite if his offer was accepted.

an excellent day at the marché.

2006-07-04T08:55:00.001-05:00

June 4th, 2006

The morning started bright and early with the fujr – the 5:30 call to prayer. I awoke, and wandered outside. I did a double take when I my closed-eyed body told me that I was in Mexico, not Mali. The air was warm, as opposed to the usual broiling, sweet and full of a thin, gentle mist of rain, unknown to me in Bamako. Granted, we are entering the rainy season, but of yet the rain has been nothing but torrential downpours that soak everything in their path by the bucket full. A light dropletty mist was a strange thing indeed. I made coffee and sat outside to enjoy the coolness and calm before heading out to L'Hopital Pointe G with my colleague Lindsay. Pointe G is the name of a neighborhood on a hill, once a fort, walls still standing tall. It also lends its name to one of two hospitals in Bamako and the only medical school in Mali.

A 10 minute walk through our neighborhood, Hippodrome, got us to the guidron - paved road - where the SoTraMa (Societe de Transportation Maliene) Van, packed well beyond capacity, took us to the local market, Marche Medina. Even early in the morning, Mali always seems alive and hard at work -- shops and stands, taxis and coiffeurs, all had their doors open wide, hawkers circulating to pull the Tubabu (White) women in. We walked past the fútbol stadium to the Place du Pointe G, from which we took the cab that might go down as the scariest of my life in terms of mechanical safety. Called a "Requin" or Shark by the Malians, these ancient station wagon pack 8 or 9 travelers in at a time, and feature holes in the floorboards that allow for a particularly spectacular view of Mali's finest dirt roads. Every bump propelled one's head towards the steel-bar ceiling, leading to a deep bend of the thoracic spine, perfected by our fellow travelers.

One of our fellows was a man of about fifty, with a white beard and a matching skull cap, dressed in traditional robes. He asked us about our work, and upon learning that we are hear with an HIV/AIDS focused NGO doing education, testing and treatment work he proclaimed that he knew the only way to end AIDS. He described to us, in English, how the Koran explains that "when a man and a man make sex-love, or a mother and her son making the sex-love" they cause HIV. We tried, futilely, to explain that most HIV transmission worldwide, and specifically here in Mali, is from heterosexual contact, but he refused to even listen. Depressing indeed, and all too common a point of view… though the phrase “make sex-love” is priceless and worth the frustration of the conversation…

Passing the pathetic Bamako Zoo, we headed up and up and up the Point G hill, reaching the pinnacle and the hospital gates. We snuck easily into the gorgeous NIH grounds, and abused of their printers and artic air conditioning. Within the hospital, we saw paper thin men with ashy, hot skin, oozing wounds full of tetanus and gangrene, ER patients being carried on heaving backs, and screaming babies on despairing hips. All of the above were simply covered in flies, as are most things here, from dinner to wounded patients.

We came to Pointe G today to work in the infectious disease ward, where tetanus, malaria, TB, lyphatic filariasis and a host of other diseases flourish, helped along into fullest glory by HIV coinfection. Things were grim, and patients were gaunt. I think that is one of the things that continues to strike me the most, the thinness of the patients. Children with kwashiorkor, marasmus, grown men the weight of children. My general interest in nutrition teamed with my recent work with obese American children has led to a near obsession with learning about the specific nutrient deficiencies faced by our patients, and how local clinicians are working to make things better. More to come when I find so answers to these burning questions…

After rounds on the wards Lindsay and I walked home down the massive mountain. Missing the turn off, we ending up climbing down the cliff side, winding our way through a metal scrap yard, cutting through people’s back yards mumbling “Je me excuse! I ni ce,” – excuse me and I’m sorry. After an hour of walking in the broiling sun, we finally found our way back to the Sotrama, paid our 15 cents, and were homeward bound.

This evening: to the tailors in Badalabougou (another neighborhood of Bamako, across the Niger from here) and on to the Fourth of July celebration at the Embasido Amerikila!
Cheesy, I know, but it’s a great place to get a free meal: hot dogs and hamburgers I come!!

2006-07-03T11:39:00.000-05:00

Marché Medina

There are few things I love as much as a trip to our local Marché. They selling everything from bright cloth and clothes to food and fetishes such as dried monkey paws and cougar heads. The Marché is a chance to really practice my French and Bambara, and to engage with merchants, haggle and just connect. Sadly, while French is the official language, a great number of Malians, even in Bamako, don't speak it. This applies especially to the women, who are often unschooled and generally the least literate. Putting the sadness of this fact away, I always start in Bambara, which makes feel like I'm being respectful and not just demanding French from them. Though, when my Bambara runs out, which it quickly does, there is always a gentleman on the ready to translate for me, so I can talk with the womenfolk - though goodness only knows what they are really translating!

Most of my favorite moments here are those spent in conversation with Malians I meet on the street or in the Marché, hearing about their lives and their work, their children and homes, their daily voyages from country-side to grande citée. These are the moments that nourish me most, that teach me about this culture and its people, and remind me to appreciate my own life more - as well as making me never want to leave Mali!

The market is full of sights and smells, a different one around each cramped and crowded, dirt-floored corner. There is the pervasive smell of incense and frying food, and the repulsive smell of a favorite Malian food - Saga Sage. Made from a dark green leafy plant, saga sage is delicious, if you can manage to disassociate the taste from it's foot-and-rot-like smell that pervades the air during the dredfully slow cooking process.

Most of the market is under cover of tarps, given the propensity of the Malian sky to pour down torrential rain with little warning. Walking out into the sunshine where the fruit and veggie seller come daily from their villages, one if blinded by the brightness outside. The marché is always thick with people, women and children with wares on their heads, kids hoping to make a few Francs by carrying your bags, vendors announcing their product aloud in Bambara and French.

One can find anything you want in Bamako: the tailoring section next to the endless rows of fabrics, spices galore, candies and clothing dye, henna tattoo artists and hair braiders, the plumbers and the moto-mechanics, the piles and piles of donated American clothing... it's really a blast. After the Bambara greeting they always ask where we're from.

I, of course, say Argentina, and the girls have all adopted Argie-status as well, since prices tend not to drop to anywhere near fair market value if you're American (which is fair enough!). The first thing they always say to un Argentino: MARADONA! So we talk about futbol for a minute and then they ask about life there -- it's always such an interesting conversation to hear their opinions about South America, if they've got any past the superior nature of our futbol team...

I love the Marché. It is such an amazing way to learn about the way people live their lives and interact with one another.

What do the Providence Place Mall and the Cambridge Side Galleria say about American culture?....

casablanca in june

2006-07-01T03:30:00.000-05:00

Casablanca, June 20th 2006

My body feels heavy, sleepy from travel and attempts to make myself understood en Français.

After a sad goodbye in Boston, and a two and half hour ticketing fiasco at JFK, I boarded a Royal Air Maroc flight to Casablanca. Morning found me tired, full of amazing lamb dinner, and excited to see the city. With thirteen hours to explore the ancient citeé, my traveling companion Jared and I made a new friend, Brennan Taylor of Arkansas and Carleton College, whose impeccable French made the day a great success. We showered and changed at the airline hotel, and took a cab to the Ancienne Medina – the old marketplace. The streets were wide boulevards, with signs in Arabic and French, and dusty low-awning’ed paths that stood in for streets where there were none. The people clothed in a mix of western garb, high European fashion, and traditional dress, burkahs included.

At a random ATM we were overheard rambling in English, and were invited to dine at a local restaurant. We ordered avocado juice and creamy café, and stuffed ourselves with shwarma and all the toppings. The market was full of vendors, families and children playing futbol. After wading through block after block of cloths, souvenirs, and cheap plastic schlock, we found what I had expected: tables piled high with spices in bright colors, piles of freshly whole, killed fish, cages upon cages of chickens and traditional pottery and handcrafts. In a plaza between the cramped aisles of stands there were people talking and men drinking tea, and a woman sitting on the curb in front of an open fire, cooking soup, replete with fish heads and bobbing onions. Children crowded around her, and drank soup out of small tin cup, passing them to their friends and goofing around. The air in the market was pungent with spices and the smell of fish and onions roasting – pleasant in most places.

After the market we took a Petite Taxi, a micro Peugeot barely big enough for two people let alone four, to the great Mosque. Prayers were just beginning, and I was saddened to see what a backseat Muslim women must take to their male counterparts. While the men filed inside, we stood in silent awe of the religious faith it must take to work to create such a massive dome of prayer. I thought of Chichen Itza and the great European cathedrals, and felt truly amazed at what people will do and built for a God that they truly believe in.

From there, a wander on the beach, where we ate these incredible fried dough balls, coated in sugar, filled with mango paste – yum, I could eat a thousand. The sun set beautifully over the pacificAs evening came, we headed back to the hotel, said goodbye to Casablanca, and readied ourselves for the flight to Bamako…