Friday, November 27, 2009

Thanking You.

If you are looking for a special way to be thankful this season (or need to find a great birthday present for yours truly), please consider continuing your support for our work here at the Mali Health Organizing Project. From now until midnight on December 1st, any donations given through Global Giving will be matched by 50%. In addition, the Global Giving Campaign will be giving out a $10,000 bonus to the organization that raises the most funds from the most individual donors. That means that if you can only give the $10 you saved this morning on your Black Friday purchases, you can help us win an extra $10,000! That is your gift matched 1000%! Please check out our page on for more details, and contribute today.


I can't be sure, but I don't think I have ever shared a taxi with a sheep before. Then again, I certainly haven't shared a Thanksgiving and my birthday with a major Malian holiday before either. The most elaborate Islamic festival of the year, Eid al-Adha (Tabaski, or Seli Ba), happened to coincide with Thanksgiving weekend this year, making this perhaps the most celebrated few days in the last century.  So here's to that...

Seli Ba (literally Big Party) is the second festival after Ramadan, during which each family slaughters a sheep and feasts for several days. Many Christians will be familiar with the story of Abraham's near-sacrifice of his only son; Eid al-Adha commemorates this event, honoring Abraham's strong faith and God's grace to provide him with a sheep instead. As we planned our Thanksgiving, so too were Malian families feverishly gathering the requisite goods.  Over the last few weeks, sheep have been appearing literally everywhere. This morning, I saw one on a moto. Yesterday, there was one in our office courtyard (and, yes, sheep poop on our doormat)! And even better, the night before that, a sheep shared our taxi home.

On Thanksgiving eve, the girls and I made a special trip to the ex-pat grocery (they have cheese!) to scout out the key ingredients we can't get in our local store. We found cranberry sauce and cream of mushroom sauce look-alikes, picked out some cheap wines, crackers, and custard powder for an attempted pumpkin pudding, and splurged on some Camembert for hors d'œuvres. After our quasi-successful shopping trip, we piled four across into the backseat of a taxi. I slammed the door, and all of a sudden we were pelted with the hooves of an angry animal stored in the trunk. Taxi-tigi, saga be?  Is there a sheep in here? Awo. Saga be!

Ay. So many things to be thankful for, sheep included.

Many Malian families (like mine) are too poor to afford even the cheapest 40,000CFA sheep (roughly $90), and so we will likely be relying on the kindness of others to provide the meat on this festive occasion. It is a point of pride for the community that every family be well-fed, and I am thankful for the opportunity to share in the generous spirit of the season. My family was able to give my host family 15,000 FCFA, a gift of thanksgiving for welcoming me so warmly into their home, and so I think we will all be eating well tomorrow!* Or at least, they will. I am not so sure I can eat another morsel after our Thanksgiving assault yesterday.

Here in the land of rice and fishy sauce, we decided we were going to do this Thanksgiving right: chicken*, green bean casserole, mashed potatoes and gravy, sweet potatoes, pumpkin pie and Devon's famous lemon curd. So good. So hard. I know, I know, you spent all day slaving in the kitchen too – but have you ever cooked an entire Thanksgiving meal on a card table with a two-burner gas stove and no sink? We did!

I walked to the market early Thursday morning to get green beans, onions, potatoes, garlic, yams and some pumpkin-like squash, but we had to time the meal so that everything would be ready when the street-side rotisserie chickens were done in the evening. We started cooking at noon, bleaching and peeling our vegetables, boiling our squash for the “custard.” Then we set in on the potatoes, mashing them by hand with some garlic, powdered milk and butter (nearly melted after an hour out of the grocer's fridge). And though there were no marshmallows to be found, I managed a pretty decent rendition of sweet potato casserole by glazing yams with butter, sugar and honey. Yum.

Unfortunately, the cranberry sauce we bought had chicken fat and veggies in it, and the mushroom sauce was just a little too French to make a decent Campbell's stand-in. I did my best to salvage these dishes, whipping up a mean relish from some dried cranberries I'd saved from some home-bought trail mix and creating some creamy green bean goodness from powdered milk, flour, soy sauce and Maggi seasoning. To top it off, we dipped onions in flour and fried them. Take that, French's!

The dessert menu was equally delicious, if a little goofy looking. Thanks to the Malian heat and our distressing lack of a refrigerator, our pumpkin custard never really set. Nonetheless, the flavors were pretty right (thanks to Leona's mini spice collection). Pumpkin-ish, creamy, nutmeggy goodness. And Devon mixed up a lemon curd from limes, butter, sugar, and eggs, which we served on butter cookies from the store. Yea, we did it.

And, as a special birthday treat, we had apples with wine and cheese to start!
Now that is something to be thankful for.

In all seriousness, my Thanksgiving was truly blessed. Being in Mali has given me many new (and sometimes unusual) reasons to give thanks. I swear, I will not bore you with stories of little starving children who have made me realize how lucky I am to have grown up in a home that could provide enough good food to grow my body and mind strong; I won't tell you that living in a desperately poor country has suddenly made me grateful for my superior education, my quality (if expensive) healthcare, my hopeful future. To be honest, I was thankful for those things already. Living here, I have realized its the smaller things that deserve my thanksgiving.

Things I am Grateful For this Thanksgiving:

  1. Fresh vegetables from the market.
  2. Bleach.
  3. How I Met Your Mother. 
  4. Bug nets and Doxycycline.
  5. My feet. (I've paid them back for all the abuse they've taken during my 8k work commutes by painting them up nicely for Seli Ba)
  6. Chocolate I packed from Trader Joe's.
  7. Trader Joe's.
  8. My fan.
  9. People who laugh (kindly) when I try to talk to them in Bambara.
  10. People who actually try to the teach me Bambara.
  11. The endless pots of seri, moni, sweet potatoes and sugared tea that my host mother plies me with in an attempt to fatten me up. (Um, she gave me six potatoes last night – after Thanksgiving dinner.)
  12. Luna Bars.
  13. Skype.
  14. Signed Malian contracts. (We finalized ours with the CHAG and the ASACOSISOU this week!)
  15. Finished clinics!
  16. The phrase, “It could be so much worse.”
  17. Laughs with my, there and everywhere.

In addition to all these small things, there is one huge thing that I am honored to give thanks for this holiday season. Specifically, I am thankful all of those who have made  my work here possible: the brilliant minds behind on FrontlineSMS and Medic, my hard working MHOP colleagues / Thanksgiving feast partners-in-crime and finally all of those who helped me get where I am today.

So as not to risk forgetting a name, suffice it to say that if you are reading this, you are on it. You encouraged me when I was terrified by this decision, pretended to believe me when I said I was ready, comforted me when I confided that I wasn't. Your generosity of spirit (and wallet) has sent me half way around the world to do work that I have always hoped I could do, and now I am quite sure that it would never get done without you. Behind every success there are a thousand hands. So, thank you.

Aw ni ce kosebe kosebe.


*Of course, I would love to give my family much, much more, but gift-giving in Mali is an intricate practice and I am slowly trying to figure out where my boundaries are. My family discussed the merits of buying them an entire sheep, but as a volunteer living on roughly 2,500FCFA ($5) a day, I am hesitant to set that kind of precedent. What do you think?

N filadin be min? Sofie, where are you??

Happy Birthday Sof-a-lof.

Yesterday I turned 23, approximately 5 hours and 10 minutes before my lovely twin sister, Sofie, did.  Ha ha. Ha. Now don't get down on me for rubbing it in her face -- she got to spend her day in the stupidly gorgeous mountains of Baños, Ecuador, eating three different Thanksgiving/birthday meals and being generally awesome. What a jerk. My Malian Thanksgiving/birthday was infinitely better, if only because it happened first.

Okay, fine...maybe not better.

Age 20: my first birthday without Sofie.

I used to tell her that the first ten minutes of my life were the best ten minutes of my life, because I didn't have to share them with her (yes, she cried); but after living those 1,440 minutes of birthday yesterday without her, I swear I take it all back. Sofie, I love you. Happy birthday.

Age 23: my first birthday without Sofie OR candles.
But, I did have my first apple in ten weeks! Glorious.

(Sorry Lewis, I jinxed it!)

Just don't know what to get me for my birthday??? Well, if a huge shipment of Luna Bars and chocolate isn't in the cards, how about donating $10 to MHOP's Global Giving Campaign. All donations will be matched by 50%, and we have four more days to raise the most funds from the most individual donors, winning us a $10,000 bonus!

Monday, November 23, 2009

Bee toga ye I ko: Everybody leaves their name behind

It is 9 a.m. and I am sitting in my new courtyard. Watching the children chase each other around, I'm realizing that if I had any hopes of ever sleeping in they've just been stomped on by fourteen pairs of pint-size feet. Michael Jackson videos are playing loudly in Pedro's room across the compound.* The memorial DVD is a permanent fixture here; I have now resolved to teach the kids a better phrase than “beat it, just beat it!”....I think “Annie are you okay?” might be equally disturbing, but unfortunately “ABC, 123” didn't make it onto Michael's best of list.

So, here I am. I moved to Ami Keita's compound last weekend, excited to fully settle in somewhere a bit more permanent. I now live in Sourakabougou, distinguished from Sikoro by the longer hike up rocky hillsides and thus the greater inaccessibility of basic services. My water, for example, now costs 20FCFA per gallon (double the 10 FCFA I paid Chez Gaku) because the ji-tigis have to push a cart full of bidons up a rocky path. And while the MHOP clinic waits to open, the nearest Centre de Sante Communautaire (CSCOM) is roughly a 35 minute walk down nearly impossible terrain for someone critically ill.

But oh the view! It is gorgeous up here, looking out over the valleys of Bamako. You can even see the new MHOP clinic in the distance!

In the morning, the sun rises (really, I'm not kidding about the sleeping in bit) over the hill to the east and bathes the houses in a soft glow. Partway up the hillside, my home is nestled between two winding paths with compounds above and below. Like most things, this has its pros and cons. The view is expansive in all directions and being able to see other people certainly helps me feel connected, but to be honest, is this really necessary while showering? Two girls got a good view of a naked toubab yesterday afternoon, and so I think I will be taking the rest of my daylight bucket baths sitting down. Still, with the early morning sun peeking over wall, even the view from the nyegen is as gorgeous as the rest.

In my first weeks here, I have taken my first tentative steps towards family integration: learning names (oh there are so many – Ami alone has eleven children!), helping with the laundry (did you know toubabs can scrub and rinse?), chasing the little kids, causer-ing with the eldest while making dute (Bambara's version of du thé) and yes, even demonstrating my painfully awkward moonwalk. I don't consider myself a funny person, but here I can't do anything but make them laugh.

Basically, I like it so far. And it may be preemptive to say, but I think living here is going to make my work here more meaningful and more effective. I will certainly learn Bambara much faster with nineteen (twenty? twenty-one?) children hanging around! Perhaps more importantly, however, I have a feeling that living in Sourakabougou will help me stay connected to the people that we intend to serve. I have learned more about this community in the two weeks I've been here than I had the past two months.

I learned, for example, that the secteur-tigis actually do things for the community. My only interaction with dugu- and secteur-tigis thus far has been at ceremonial meetings to kick off MHOP projects (like our javelisation campaign) or to get their formal support for our programs, so I had a sense that perhaps the post was more symbolic than anything. Not so, at least not in our secteur. The day after I arrived Ami took me down the road to (re)introduce me to ours, and he was in the middle of organizing a road construction crew. Of course, the toubab got taunted to come help; but she certainly enjoyed laughing at their shocked faces after stealing someone's hammer and driving in a big spike.

I have also had the chance to learn more about traditional family structures and their health care concerns, something I have been hoping to do since I arrived. Ami's story is not unlike that of many women in this community: 44 years old, Ami has given birth to fourteen living children. She has seen twelve of them survive past age nine, and then lost her eldest son to an unknown illness. As I pressed her for more details, Ami simply told me that he went to the clinic and they could find nothing wrong – he died three days later, at age twenty. Her eleven surviving children age from three to twenty-five or twenty-six, three of whom have married and begun to have children of their own.

I met one of these grandchildren the other evening, a tiny boy tied onto the back of his mother in a customary sling. Shocked to learn that he was five years old, I listened quietly as Ami explained that he had recently suffered from a mysterious illness that left him six inches shorter (I didn't believe it until I saw a picture) and unable to walk or lift himself up. Polio? Non. Meningite? Non. Paludisme? Non, non, non. There have been (thankfully) few times so far that my poor french has left me completely bereft of words, but this was certainly one of them. Even English words would fail me.

After detailing her family's history, Ami launched into a confusing tale involving a local witch and the death of a young boy in the neighborhood. Though I may have missed a critical element of the story, I think she was insinuating that her children's deaths were also precipitated by witchcraft of some sort or another. Coming from a woman who has had some formal medical training (she nearly received her nurse's aide diploma, and has been trained as one of our community health workers), this story made me realize how deeply embedded animist beliefs and traditional medicine are in this community.*

For all the perseverance of these practices, Malian culture is still dictated by and large by Islamic traditions. Thus far I have not been privy to many of Islamic rituals, save the prayers that men practice five times a day; my female (and non-muslim) self is not allowed into mosques. By the grace of living with a large and welcoming family,however, during my first few days with Ami I had the honor of witnessing one of the more sacred rites of passage: the baby naming ceremony, or denkonli. While Islam does not have a baptismal ritual per se, the naming ceremony serves to welcome a new child into the community in much the same way that a Christian baptism does.

It wasn't until the eve of the ceremony on his seventh day that I was even aware that the little boy had been born. I was quasi-introduced to his parents (tenants in the compound) when I arrived, but the babe was kept in their dark room until he greeted the world with a proper Muslim name. Pale and tiny, the women joked that he could be my son as easily as one of theirs. I christened him Toubabu, and we laughed. I was told that the baptême would take place the next day. The morning was for the men, who would arrive to offer gifts, prayers and to choose the child's name; the afternoon would be celebrated by the women.

Much to my surprise (though I should have learned by now), morning meant morning: at 6:00 a.m. I awoke to the sounds of gravelly voices and shuffling chairs. They are getting an early start, I thought. By 6:30 a.m. I bolted upright in bed, realizing that the voices had reached a critical mass. There have got to be twenty men in my courtyard! I quickly got dressed (forgoing my paigne-clad morning trip to the nyegen), threw a scarf on my head, and peeked out the door. Twenty men? Try forty, sitting beneath our beautiful big tree and already partway into their first prayer. I tried to slip out my door unnoticed, but I'm not sure I have done anything unnoticed since I first set foot in this country. This time was no different. Thankfully, the men just smiled, the griot gave me a handful of dates and told me to take pictures, dammit! So I did.

Fifteen minutes and a baby naming later, the men filed out the door and the real denkonli began. I was invited into the mother's room where she and the baby had awaited the official seal on his existence on this planet. Baby Adama is here to stay.

In Bambara, denkonli literally means “baby head shave,” and certainly lives up to the name. The grandmother (in this case an adopted one) bathes the baby and then puts a razor blade to his soft little head. After his head was bare, they collected the hair and wrapped it up with the umbilical cord for safekeeping. And if he hadn't been crying already, he was about to – she swiftly gathered his tiny hands and feet as if she were tying a hog, tossing him into the bath. Then she picked him up by each of his limbs and shook him out as if he was a ragdoll, deftly ensuring that each of his joints was properly aligned. Of course she had a practiced hand, but I have to say it was a little frightening nonetheless. I think I am beginning to understand why they say being born in Mali is a dangerous thing.

*Pedro's real name is Amadou (or Mohammed, or Mohammadou, Mamadou, Madou...) but apparently was so nicknamed because he was a hefty child. I, personally, am thankful that he has a unique name, and I am willing to bet he is pretty happy that Pedro stuck rather than “Michelin,” as he was first called.

**The hills of Sourakabougou are widely regarded as some of the most sacred animist sites in the region; I was not surprised to learn that we have a few sorcerers in our midst! Our newest stagiere, Awa Ouattara, is currently conducting a field study on the relationship between traditional and western medicine with a young woman from Portland State University (yay PDX!). Stay tuned for a special post on this fascinating topic in the near future!

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Monday, November 2, 2009

Are we inside or outside? These and other questions from a Malian perspective...

It has been exactly one month since my maiden post, but so much has happened during these past weeks that I am overwhelmed at the thought of writing a second! To make my task easier (and hopefully more meaningful for all of you) I have decided to take this opportunity to reflect on what it means to work collaboratively in a cross-cultural setting.

When I arrived in September, MHOP was struggling to reach a consensus with the CHAG on the issue of their re-elections. CHAG members were upset with our team, as the notion of elections suggested we did not like the work that they were doing. Some members even hinted that we were out to publicly humiliate them. Moreover, several members expressed serious concerns that MHOP has not delivered on its promises – intimating that the CHAG would unfairly take the fall for our failures during their elections. These conversations distressed us greatly, primarily because MHOP remains committed to local participatory governance and secondarily because the thought of failing the community is a difficult one to bear.

As many in “development” circles like to claim, MHOP is committed to working with (not for) the community we serve to ensure that our solutions are responsive to local needs and local capacities. But what does that mean? Buzzwords or not, how do you give them substance? Aid blogger TalesFromeTheHood has some interesting suggestions and critiques, here, where he discusses his experiences working with international development agencies. Community-driven projects take on a whole new meaning when the community cares less about microloans and more about securing AK47s to protect against warring neighbors.

Thankfully here in Bamako we don't have to tread that particular line, but that doesn't mean there isn't one to tread. So what about us? Is it enough that we have Malian staff in our core team, and that we have catalyzed the formation of community groups (like the CHAG) to assist in the design and evaluation of our programs? If we do not work effectively within those groups, if we fail to recognize our own biases or to be vigilant that our intentions match their interpretations, we risk trivializing the very core of our mission.

Now let's be honest for a minute and admit that in terms of development NGOs, MHOP doesn't play in the big leagues. We are not the kind of organization that can deliver 100,000 bug nets in under a week, or even two. We alone cannot provide free care for everyone, and we certainly cannot do it yesterday. But with a two-year CHAG partnership under our belts, a trained Community Health Worker team and a new community clinic receiving its final coat of paint, is it fair to say we are keeping up our end of the deal? Yes, most definitely, yes. We are working as hard as humanly possible to make our projects a reality and we have achieved a lot where others have not. Yet, part of “our deal” is to support the community to work for their own change, and so the fact that the CHAG has interpreted any of our project ideas as promises suggests that we are not fully achieving this higher goal. To improve, we  decided to begin within our staff.

I googled “cross-cultural communication exercises, management, africa” on Tuesday in a last ditch effort to help Devon pull together an intercultural training program for our new MHOP team. Over the past three weeks Dramane Diarra (community coordinator), Awa Ouattara (intern), and Leona Rosenblum (community health worker program coordinator) have joined us, making last week's team training the perfect opportunity to begin a conversation about cross-cultural collaboration. Unfortunately, the google-verse contains very little that addresses inter-cultural communication between Africans and Americans. (For future reference, however, if you are interested in working in Japan or China, you're in luck! Hundreds of well-paid agencies can offer you trainings on bridging the East-West divide. Go figure.)

Despite my failed search, our team spent the day on Wednesday discussing the many differences between Malian and American cultures. Drawing from “The Values Americans Live By,” an interesting piece by L. Robert Kohls, we shared our views on things ranging from punctuality, competition, freedom, and privacy or personal space. It was an enlightening experience and offered me the chance to reflect on the many hidden biases or paradigms that affect my interactions with Malians.

One major area of conflict in our office concerns time. As Americans, we expect that our time be accounted for or justified. I, for one, have always had a job where I punched in or out because I was being paid by the hour (or minute, or even second). I am used to judging my performance as both a function of its quality and of the time the task required. But how often do you think about what it means – what it really means – to talk about “spending time” on something, as if time was a thing to be used or dispensed as one pleases?

Sure, everyone knows that “African time” runs slow; but the cultural divide is not really about pace. Here, time just is. The day passes as you pass the day -- your meals, your loved ones, your life takes precedence over the ticking clock. Thus, my Malian colleagues were shocked and appalled by the suggestion that we log and justify our “work hours.” From their point of view, a job well done is a job well done, regardless of the amount of time it required. And when it takes you two hours to travel across town because your taxi blew its tire, or a month and a half to track down our clinic dossier, the logic of this view becomes clearer.

Of course, the differences in our conceptions of time has become somewhat of a trope in stories about Africa. While true, I want to be clear that many other things are similarly confounding and that at their core, neither “side” is wrong or right. To illustrate, let me describe our most recent adventure with the clinic construction crew. Mr. Maiga, the construction foreman, visited our office last week with a packet of paint chips to decide on the colors for the interior and exterior walls of the clinic. Excited that we're nearing the end of construction, we happily reached an agreement that the interior would be painted in dual tones, with reddish brown on the bottom and tan on the top, while the exterior would be a uniform deep red to help disguise dirt. We x'ed our preferred paint colors and he went on his way, asking that we stop by the clinic later to see a sample and make the final decision.

Two days later, Alex Ruby and I trekked up to the clinic with cameras in hand, hoping to okay the colors and get the final painting started without delay. When we arrived, however, we were surprised to find dual tone samples painted both on the outer walls of the clinic and inside the clinic rooms, and no deep red color to be found. After much debate, we discerned that the “interior” of the building is considered to be everything that is covered by the veranda, regardless of whether it is actually inside a room or not. Hmmmmm. As we say in Minnesota, that's different. But, really, when you are under a covered area and yet not in a room, who is to say whether you are “inside” or “outside”? It is something I never would have thought to ask but now serves to remind me that when working across cultures, there are no stupid questions. Making one's own definitions and interpretations explicit is critical to avoiding deep misunderstandings.

Cultural differences, however, cause more than just logistical friction. And when we work with the CHAG and evaluate the design of our projects, we must continue to remember that values differ and ideals are often lost in translation. For example, I recently had to quell some righteous feminist indignation when Dr. Diak suggested that the “health actions” completed by male members of the household should count for every child, while those completed by mothers only count toward their biological children. (If that's confusing, remember that Islamic polygamy is widely practiced in Mali, therefore households may include up to four mothers.) Arms crossed, nostrils flaring, I stopped him. I was appalled by the sheer iniquity of it – why should the men's actions be more valuable than the women's?

Dr. Diak patiently explained to me that asking men to do more than that would require they designate their actions towards specific mothers. That system could not only create significant family discord if fathers favored certain wives over others, but it would also likely dissuade men from participating at all. Women are the primary caregivers in Malian families and so if it means just as much for a man to contribute as it does for a woman, then there is no incentive for fathers to participate. My reaction against this design was instinctive but, ultimately,  I think Dr. Diak is right. To be successful, our program must consider carefully the economics of family life here, working within the system as it currently exists. If our ultimate goal is to encourage community engagement and co-management of healthcare, then perhaps my feminist sensibilities will have to take a back seat on this particular ride.

Similarly, while we had initially hoped to hold popular elections for all CHAG members, in light of their extreme resistance and our consultations with Sikoro's dugutigi (village chief), we may have to re-evaluate our designs. When we make a final decision regarding our selection process, we will again have to weigh very difficult issues: is it a compromise of our values to have the elected secteur-tigis choose their own CHAG representatives, or is that an expected (and accepted) form of community participation in the Malian context? In navigating these challenging waters, I trust that we will stay true to our mission to both work within the community and to improve it. And the simple fact that we are tackling these unsettling questions gives me hope that we are who we say we are: a community-driven organization.