tag:blogger.com,1999:blog-42148727122832644552024-03-05T06:48:32.592+00:00N be taa Mali la...Alexhttp://www.blogger.com/profile/16575531860405747987noreply@blogger.comBlogger14125tag:blogger.com,1999:blog-4214872712283264455.post-33806719746239570362011-07-26T18:11:00.001+00:002011-07-26T18:11:58.115+00:00PatientViewThe month of May was an exciting one for the Mali Health Organizing Project because it offered the first chance to test out <a href="http://www.medicmobile.org/">Medic Mobile</a>'s long-awaited PatientView program. PatientView is a lightweight medical records system that will enable clinics to use FrontlineSMS, the world's premiere open source text-message (SMS) platform, to coordinate community health worker (CHW) outreach, follow patient health status, support in-home care, and gather public health data -- all through a low-cost mobile phone.<br />
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PatientView relies on FrontlineSMS' Forms application to gather patient information from the field. FrontlineForms allows mobile phone users to receive form templates, fill them in and submit SMS messages containing the condensed responses to a central computer server, eliminating the need for users to remember codes in order to send complex information with a single SMS. When submitted, PatientView automatically matches these forms to a patient's file; these records can then be searched by patient identifiers, CHW, form type, or even specific responses. Thus, physicians can review patient histories and submit new patient forms on the computer. Physicians can also retrieve population data (i.e. number of malaria cases), and send text messages to community health workers to provide advice for in-home care or to make a clinic referral.<br />
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Together, these functions create a simple and effective medical records system for small health centers, while also adding the mobility necessary to support the CHW outreach that is often a critical part of expanding health care access in resource-poor communities.<br />
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The Mali Health Organizing Project (MHOP) coordinates one such CHW program, in partnership with two small community health centers in the Bamako slum of Sikoro-Sourakabougou. Serving over 20,000 people with microfinance, women’s education, sanitation, and health education programs, MHOP works to increase healthcare access through a multifaceted approach: encouraging care-seeking by removing financial barriers and increasing health knowledge, while developing low-cost interventions to improve the care provided by community health centers. Action for Health, MHOP's flagship program, aims to reduce Mali's astounding 22% child mortality rate to less than 2% by focusing resources and diagnostic services on the five leading killers of children under five: malaria, acute respiratory infections, diarrhea, malnutrition, and measles.<br />
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To increase prevention and early care-seeking in these families, CHWs make bi-weekly visits to evaluate the health status of each child under five. They help families recognize warning signs and symptoms of the five major childhood illnesses and encourage them to use community health services early and often by providing health education, simple diagnostic services, and referrals to the local clinic for free treatment when the child shows symptoms of a covered illness. To maintain personal engagement, improve community health and make free care more sustainable, indigent families commit to completing volunteer health activities in return for these services.<br />
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At present, the CHW program relies on paper forms to record both home and clinic visits, which significantly complicates the patient referral and follow-up process. The CHWs record every visit and walk these papers to a weekly meeting, where they are reviewed and problems identified (i.e. children who should have been referred but were not, or who were referred but not followed up on correctly). Of these past visit records only the referral record is accessible to physicians when children are sent to the community clinic for care. In fact, physicians in the community clinics currently have no longitudinal medical information for any patient, because visits are recorded solely in a daily log; organized for the purpose of monthly case load reporting and accounting, this system makes it extraordinarily difficult to review an individual patient's care and treatment history.<br />
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Fortunately, with Medic Mobile's PatientView, all of that is about to change. Two weeks ago, MHOP's eleven community health workers were trained to use FrontlineForms on low-cost, locally available SonyEricsson phones. During a short afternoon meeting, the Malian program coordinator and I walked the team step by step through the process of finding, opening and manipulating the application. Then, we sat back as they tested it out, calling us over for questions as necessary.<br />
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At the end of the training, nearly all of the CHWs were able to send a form without assistance. We sent them all home with their phones for practice; a week later, each CHW confidently demonstrated their new skills by sending me a test form. Even Oumou Camara, who reads neither French or English (Bambara is the Malian lingua franca) proudly exclaimed that her son had helped her, and though he may have been a bit exasperated after a couple of hours, she now was able to send a visit form herself! <br />
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Similarly, the training and testing of the PatientView program with the clinic staff went off without a hitch. Eight physicians and nurses at the two community clinics involved in the CHW program convened for two three-hour sessions, working for the first time with the <a href="http://www.inveneo.org/">low-power computers</a> purchased for the program. After a brief explanation of the system and a demonstration of FrontlineForms, we proceeded through a "typical" clinic consultation: searching for the patient's records, reviewing their personal information and medical history, and then filling out a consultation form. Six of the trainees said they had little to no prior experience with computers, but within the first two hours everyone was able to navigate the program unassisted. We spent the next afternoon discussing changes that could improve their workflow and help them provide better care and support to the CHW team. Thanks to the tireless work of lead developer Dieterich Lawson and the rest of the Medic Mobile team, many of these changes have already been made!<br />
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With the initial trainings finished, and final testing underway, we will officially launch the program with the beta release of PatientView in the coming weeks. Using <b>free </b>SMS credit provided by Orange Mali, CHW visit reports are sent directly to the local clinic. When a patient is referred, the physician records the clinic consultation, diagnosis and prescriptions, and follow-up information is sent to the CHW to help the patient complete their treatment and/or return to the clinic on a certain date. If the patient is not referred but has some symptoms (i.e., a day of diarrhea or mild malnutrition), these reports will be flagged for review. In response, the physician can send decision-support messages to the CHW (i.e., rehydration solution / fortified porridge / come to the clinic if not resolved in two days), using the patient's medical history tab to help determine the appropriate course of action. Because critical childhood vaccination schedules are not reliably recorded or accessible, vaccination reminders will also be sent for all children enrolled in the program.<br />
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Beyond improving services along the entire continuum of care, PatientView will make Action for Health more efficient and scalable. CHWs no longer have to spend four hours a week bringing these records to the program coordinator; instead they will be able to make visits to more than 300 additional children and the coordinator will have more time to focus on developing the education modules and volunteer community health activities that improve prevention of these common childhood illnesses.<br />
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To help bring this program to scale after pilot testing, the Malian Ministry of Health's Office of Telemedecine (ANTIM) will help develop a distributed Medic Mobile system. Making records accessible to second-tier referral clinics and hospitals through a national server, a distributed system will facilitate the coordination of other CHW programs across the country and help ensure that patients receive high quality services at every level of care.<br />
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Facilitating everything from in-home prevention, to clinic care and treatment support, PatientView will dramatically aid MHOP's fight against preventable child mortality -- and surely will do so wherever else it is used. We at Medic Mobile and the Mali Health Organizing Project are thrilled to bring this project to life after months of development, and we thank all of our supporters who have helped us along the way!Alexhttp://www.blogger.com/profile/16575531860405747987noreply@blogger.com0tag:blogger.com,1999:blog-4214872712283264455.post-38742406626351126042010-08-08T08:52:00.001+00:002010-08-08T08:55:55.114+00:00Watch Yourself!I am sitting in a lovely house in Lilongwe writing this, contemplating how much different Malawi is from that other M-country in Africa. Yes, Malawi. I arrived here a month ago and will not be returning to Bamako until early September. I haven't written in nearly three months, and clearly, so much has changed! <br />
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It has been an exciting, stressful, frustrating, and awesomely rewarding spring, and I am relieved to finally have a minute to stop, breathe, and write about it. Funny to say now that I have left Mali for awhile, but I can't escape the feeling that I've just started to do the work that I came here to do. As my mother constantly reminds me, that is not entirely the case. There has been a lot of work to do to get MHOP's clinic and Action for Health projects off the ground, and I am very grateful to have had the opportunity to help. Selfishly though, I feel that the launch of the PatientView pilot is different. It is what I came here to do, and I have been itching to do it! Though I know I have had a hand in the successful opening of the Sourakabougou community clinic, the launch of Action for Health, and the ongoing development of our other community programs, there have been many times in the past nine months when I felt a little like I was stuck on a race track, speeding around without getting anywhere. <br />
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Starting out in January with the basics of the CHW program laid out, let me briefly describe the race highlights.<br />
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February: Computers arrived at the airport customs office.<br />
March: Computers languished at the airport customs office.<br />
CHW program launched.<br />
April: Computers rescued from the airport customs office. Wrote the PatientView user manual with the Ministry of Health's e-Health Office and began negotiating our partnership contract.<br />
May: CHW and clinic training! <br />
ORANGE Foundation $$$$$$$$$$$$ for the pilot year's SMS credit promised!<br />
Then system testing...more testing...sleepless nights of testing...<br />
... and finally, on June 20th, the pilot LAUNCHED!<br />
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The community health worker team for <a href="http://malihealth.maneno.org/eng/articles/tags/frontline_sms/">Action for Health</a> has been seeing children for four months now, and more than 300 children have been referred to one of our partner community clinics, where they have received free consultations and treatment. For every patient encounter, our CHWs fill out a paper record to track the child through their in-home, in-clinic and follow-up care. The physicians can consult the paper referral form when the child comes in for a visit, but until now, they had no access to longitudinal medical information (a medical record beyond the CHW's report of immediate symptoms and reasons for referral). With 403 patients (and growing!) in the program, the coordinator has to process more than 800 records each month in order to ensure that each child receives appropriate services and that CHWs can be given proper field support. <br />
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With PatientView, all that has changed. Text message forms are filled out at every home visit and sent to the clinics, where they can be reviewed by a physician and monitored for developing illnesses or treatment problems. When a patient is referred, the clinician can pull up their record and immediately have access to their in-home and in-clinic visit history. They can enter their consultation into the clinic visit form and, with one click, send follow-up instructions to the patient's community health worker.<br />
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So, I feel as though the circling around has finally paid off. We have reached...well, not the finish line, but certainly a checkpoint. The Final Turn. Those of you who spent holidays playing RidgeRacer in your grandmother's basement will know exactly what I mean. In the words of the wisest race announcer to ever grace a PlayStation demo game: "Next corner's tough, watch yourself!"<br />
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For my less evolved readers, I would liken it to reaching the Willamette in Oregon Trail, a joyous event dampened only by the fact that you must now caulk your covered wagon and float it down a treacherous river full of boulders that are ready to splinter your floor boards and drown the last of your family who have not already died of typhoid or dysentery during the arduous journey. <br />
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(Apologies to my more ancient friends...I tried to think of a witty metaphor involving Pong but I just can't do it.)<br />
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Of course, I do not meant to say that the next few months will involve the kinds of crashes that end RidgeRacer careers or a crush a pioneer family's hope of reaching the land of milk and honey. My point is only that starting a program is one battle, and helping it survive, another. <br />
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Co-opting the term from the information and communications techno-lexicon, development folk often talk about the "last mile." Both a useful metaphor and a geographical reality, the last mile is the "farthest endpoint of connectivity," that final leg separating a population from needed services. Mobile phone-wielding community health workers are a last mile solution in multiple senses: using the only type of telecommunications infrastructure accessible, these outreach workers bring primary care to populations who are not otherwise connected to health services. <br />
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Yet, in development work, the last mile is not only a physical barrier, but a temporal one as well. How do you make a project sustainable in the world's most impoverished, inaccessible, and under-educated areas? Keep it simple. Both FrontlineSMS:Medic and the Mali Health Organizing Project are founded on the idea that solutions to health problems must be accessible to frontline health workers. Whatever we provide, it is precisely those under-resourced communities who must bear the cost of sustaining a program, which means the system must be low-tech and easily manageable by people who have more than enough work to do already!<br />
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The RidgeRacer devotee that I am, however, I must say I prefer the "final turn" metaphor to this "last mile" business. It implies a greater degree of unknown, an inability to see the obstacles that lie ahead. Despite how much effort you put into research and planning, the world is always going to surprise you. So we will not be resting on our laurels just yet. I am quite sure that our pilot testing will bring to light many of the problems we couldn't foresee -- my only hope is that we are flexible and responsive enough to deal with them. I know we are. <br />
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Leaving for two months during PatientView's teething period has caused me much anxiety and distress, but I am convinced it is necessary, even good. It is time to put our last mile philosophy to the test. After training our community health workers, physicians and nurses, and setting up the (relatively little) infrastructure needed to support the program, my job here is nearly done! I'm handing over the reins to Dramane Diarra, my colleague and a Sikoro native who has been an irreplaceable asset to MHOP's work in the community. He will now be putting his technical skills to use as the FrontlineSMS:Medic PatientView Coordinator, and I am confident that he'll do a great job. Even so, these next few months are going to be difficult for everyone as we uncover technical and programmatic problems we couldn't plan for or predict.<br />
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So, as tough as it may be, here's to hoping we round the Final Turn intact and on track.Alexhttp://www.blogger.com/profile/16575531860405747987noreply@blogger.com0tag:blogger.com,1999:blog-4214872712283264455.post-23116746226987003962010-08-08T06:44:00.000+00:002010-08-08T06:44:46.281+00:00Yikes!Dear loved ones,<br />
My apologies for my long silence, and the ridiculously belated posting below! I didn't realize I hadn't published that piece until I worked up the courage to look at my blog again (I swear, I've been meaning to write something for ages and ages). I'm a bit ashamed really. Things have been so busy these past few months, and there have been many changes to catch you all up on, so please stay tuned...Alexhttp://www.blogger.com/profile/16575531860405747987noreply@blogger.com0tag:blogger.com,1999:blog-4214872712283264455.post-57228060952465427672010-05-16T21:06:00.000+00:002010-05-16T21:06:40.947+00:00Getting there.When I arrived in September to begin implementing the text-message based medical record program developed by FrontlineSMS:Medic, MHOP was focused on establishing the two things fundamental to it: a clinic and a community health worker (CHW) program. So, I switched gears. I picked up the slack where I could. I spent my first few months writing grants, working on clinic contracts, CHW visit guidelines, developing partnerships with other NGOs and the Ministry of Health, and generally just not knowing what was going on -- but learning.<br />
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I always felt a little uneasy though, feeling as if I wasn't accomplishing what I had been asked to do. The goal was always in my mind: whatever I was doing, I needed to be laying a good foundation for the mobile records pilot in the process. And besides, I kept saying, next month we'll be ready. Next month.<br />
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Soon, however, the CHW program was starting to take shape and I was scrambling to figure out how we could start the pilot when the CHWs began making their visits. By the beginning of 2010, it became clear that -- for various, compelling reasons -- the pilot couldn't launch with the CHW program. Again I had to switch gears. I worked closely with Leona to design the paper records system that could be easily transitioned to the FrontlineSMS:Medic program when all was ready.<br />
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The clinic opened. The CHW program launched. Oh, how anxious I was to get started. It seemed like the time had come.<br />
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But then, Mali pulled a fast one.<br />
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I spent most of February, March, and April embroiled in a customs battle with the most incomprehensible government office known to man. In January I had ordered three super cool low-power computers from Inveneo, a U.S. based nonprofit. Though they arrived two weeks later, they were detained at the airport because we refused to pay a ridiculous 52% import "tax."<br />
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Nearly everyone I knew to ask advised me that there is no import tax on hardware (to be used in health care centers no less); I told that to the customs officer. No luck. I went to the customs office with the military ID of the Ministry of Health's eHealth Director and a handwritten note asking for the computers. No luck. We tried to use a go-between to re-negotiate the price. No luck. I was at my wit's end, and so discouraged -- Mali was showing me an ugly side I hadn't wanted to acknowledge. I felt like the people who should care just didn't.<br />
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Finally, in mid-April, Inveneo stepped in and helped us get the computers out. Now, things for the mobile medical records pilot are finally falling into place.<br />
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Last month, some representatives from Orange Foundation (the largest cellular network provider in the country) came to do a site visit after Erica and I had hounded them for what seemed like ages. The Orange representatives came to learn about the CHWs' work and about how the FrontlineSMS:Medic pilot will help them do it better; our CHWs could not have been more convincing. They were impressed both by the innovation and the need. As we toured the community in their SUV (backtracking every few meters because the road became impassible) they exclaimed about the poverty, the lack of infrastructure, the extraordinary fact that Bamako could be home to a community like this.<br />
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It was almost shocking to see them shocked; you'd think growing up here would mean you knew places like Sikoro-Sourakabouogu existed. But, I am happy we got to show them. Last week Orange informed us that they will be providing the pilot free SMS credit for 2010!<br />
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Mali, I can't stay mad forever.Alexhttp://www.blogger.com/profile/16575531860405747987noreply@blogger.com2tag:blogger.com,1999:blog-4214872712283264455.post-20780430526265550822010-04-12T21:39:00.001+00:002010-04-13T17:36:05.888+00:00Humility, or something like it.A month or two ago, Mike, Leona and I decided to spend a Saturday night watching a dance performance put on by several local high schools. I was interested in seeing what a Malian dance recital looks like and happy for an opportunity to take out my eldest (but younger) sister, Batuma, since the event was respectably close to home. Like pretty much everything I have experienced so far, however, I really had no idea what I was in for when we took our seats before the performance began. The room was hardly full, people were milling about.<br />
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Being the awkward, entitled toubabs we are, we chose good (comfy) seats in the front of the stage and proceeded to ask each other about every five minutes when the show was going to start. After a painful two hours (!) of atrociously loud music and no dancing, things were starting to buzz and a slew of VIPs waltzed in, stopping in front of our seats and looking at us expectantly. Immediately we realized we were sitting in the "invitee" section and hastily jumped up to give them our spots, only to be waved back down. "No, no," they said, "you must sit here. We will find more seats."<br />
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We argued and tried to move, but instead they just asked Batuma to give up her seat and sent her to the back of the room to stand. I was horrified and embarrassed so I tried to go stand with her, but was requested to sit down again and so I slunk back to my choice spot. As the show began, the emcee started collecting money from all the invitees -- a standard Malian practice that includes singing to each invitee and sufficiently shaming them enough to throw money on stage (or raining it over the emcee's head, depending on how baller you are). We started to get uncomfortable because we really did not want to pay money to the emcee considering that we'd paid an entrance fee and that we didn't want to be sitting in their seats in the first place! Then, the man who appeared to be in charge waved me over and so I awkwardly blurted out something about how we didn't know they were the VIP seats, that we weren't sure if we were supposed to pay more money, that (again) we would move if that was the case. Much to my surprise, he said, "Oh no, no that's no problem at all. I'll reimburse you [for your ticket]. You're going to be a judge! " and shoved a paper and pen in my face. Excuse me? A judge?<br />
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None of us had realized this was a competition, and yet all of a sudden I am sitting on the judges panel, peering over my neighbor's shoulder to copy down his scoring matrix. I didn't even know the names of the competitors or the order in which they were to perform, let alone criteria to score a Malian dance performance! I was stunned. To make matters infinitely worse, the emcee then grabbed the mike and introduced the first round of competition -- POETRY! <br />
Oh dear God.<br />
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Full disclosure everyone: I don't speak French that well. I can get by in most situations, but to understand mumbled poetry over a poor sound-system in a room full of teenagers who would much rather be watching their dance teams perform is waaaaaaaaaaaay above my pay-grade. In fact, I could't even be sure it was in French! Frantically, I peeked over my neighbor's shoulder again to see what I should put down for a score...10?.. 5?.. 2? ...I honestly had no idea. I couldn't see his sheet, so I decided to give 7s and 9s depending on the loudness of their voices and prayed to God that we weren't going to have to share our scores publicly. We didn't, thankfully, because after all the performances were over the judges huddled and everyone strongly agreed that the poesie was shit so they weren't even going to choose a winner; the kids got lectured instead. I, of course, agreed as vehemently as the others, quickly hiding my scores.<br />
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The dance portion of the evening was a little less stressful seeing as it didn't require a monumental amound of effort to understand what was going on. Each high school was represented by a dance team, ten to twelve girls and often a few boys, and I was required to give them a score from 1 to 20. What the scoring was to be based on remained unclear, as all the dances looked pretty much the same to me. After the performances, we shared numbers and chose the winners, and I was relieved to find out that I was in the right ballpark. I had managed to fool everyone into thinking I was totally competent.Finally, it was over and no one had found me out! As I made a move to sit down, the head man called me back up in front of the crowd of three hundred kids so that I could award the first place prize. Thankfully it was the high school from my cartier, so at least I knew how to pronounce the name. Oh oh, so awkward! <br />
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And why me?? The theme of the night seemed to be "honors that Alex would like to turn down but does not know how."<br />
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After this uncomfortable evening, and many other similar events, I have decided that buying a plane ticket to Bamako has bought me credentials I never even knew I'd want or need. To be completely frank, I am hardly qualified to be coordinating a pilot program for a community in Mali, let alone to be judging incomprehensible poetry and traditional dance performances! Of course, the stakes for the high school competition were limited to a small prize and my pride. With MHOP, however, the stakes are inconceivable. I can't think about the potential impact of this program (be it a success or a failure) without feeling my stomach turn. In fact, when I first agreed to join the team here, I immediately wanted to take it back. And now that I am here, with the pilot slowly taking shape and making splashes in the Malian government, the implications of my work are stretching far beyond what I had imagined on that day. I was terrified -- and still am -- that I'm not cut out for this work, that I'm just an imposter, a poser with nothing but a bachelor's degree and some good connections. I mean, seriously, who would put me in charge of an actual pilot program? And why in the world would a national Ministry of Health take me even the least bit seriously? Should I be honored? Then why do I want to run and hide?<br />
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Mali is a humbling place. I suppose that is an odd thing to say considering that I am constantly singled out, celebrated, given the time of day, simply because I am educated (and perhaps more so) because I am white. Of course, that may be cynical and completely off-base. Its hard not to feel that way, however, when every day someone draws attention to the color of my skin, the fact that I am oh so out of place. My whiteness makes little children cry (no joke) and young men propose at the drop of a hat. My whiteness is power in a place where many feel powerless. It is the power to get you a visa, to send your kid to school, to find you a job.<br />
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With all of the privilege that comes with my position here, then, why should I claim to feel humbled? After that night pretending to understand what the hell was going on during the dance competitions, and many subsequent conversations with my co-workers, I think I've figured it out. <br />
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Mali is humbling for three reasons. <br />
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First of all, I've worked hard for a very long time to build a resumé justifying my year working for a public health NGO, and yet, no one here even questions it. Characteristics completely out of my control (i.e. my color and my relative wealth) seem to automatically give me a Pass Go card. I have access to places, meetings, and partnerships that would be much harder to get in the States because there I blend in, I have to compete. Secondly, Mali is humbling because despite how much I stick out, many people in my community are still unable to distinguish between me and all the other white females they've ever known. I'm celebrated but reduced.<br />
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Most of all, however, Mali is humbling because even I -- with my limited expertise -- can have an impact as long as I am willing to jump in and play along. I can judge a dance performance, and I can direct a mobile medical records pilot, if only because I have been asked to and people seem to answer my questions when I ask them in turn. It is humbling because many many many people could do this work (most better than I), and yet I am here muddling along, doing my best because there is no one else to do it. Working with FrontlineSMS:Medic, with MHOP, and now with the government of Mali, has apparently never been about me and my qualifications but about the incredible need for these projects to happen with or without my help. <br />
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There. My current definition of humility: to be less committed to your sense of self and how that defines what you can or cannot do, and more committed to doing what needs to be done.Alexhttp://www.blogger.com/profile/16575531860405747987noreply@blogger.com0tag:blogger.com,1999:blog-4214872712283264455.post-3897339532049075892010-04-12T21:37:00.000+00:002010-04-12T21:37:48.233+00:00Better Long than Dead.<i>Possibly my new favorite phrase in Bambara, "better long than dead" is a response to "long time, no see" or something to that effect. Considering that I haven't posted in quite some time and that my last post left things a bit unfinished, I thought you might be wondering how I am getting along. It's been a long time, folks, but that's better than forever, right?</i><br />
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On January 26th, my mom did come, and I don't think I cried again until we said goodbye in the Paris airport.<br />
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I'm laying outside this evening, on Sunday the 12th of April, watching heat lightning flash across the sky and listening to the endless crying, screaming, and laughing of the kids that fill my house. It has been so hot. I woke up twice last night bathed in my own sweat because the power went out, killing my fan. I showered at 9pm, 12pm and 4am, carefully stepping over sleeping bodies as I made my way to the nyegen at the first morning call to prayer. I have a vague feeling that this should feel weird, laying out here, that I should feel out of place. But I don't. Instead, all I can think about tonight is the fact that my mom and Charles were here almost three months ago already, and that I've nearly reached my seven month mark here in Bamako!<br />
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So many things exciting things have happened in the months since my vacation with my mom and stepdad Charles -- Leona launched our Community Health Worker program, I secured a partnership with the Malian Ministry of Health for our mobile medical records pilot, Leona and I took a bus trip to Senegal, we officially opened our clinic and threw a big party -- and in the midst of it all, I think all of this madness is beginning to feel a little bit like home.<br />
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I've started a blog post about my parents' trip: our stay at my house and our adventures in Bamako, the bus trip to Segou and the pinasse on the river there, our car ride to Mopti and then the three-day hike in Dogon Country, our stop-overs at the mud mosque in Djenne and the eco-tourism resort on the river near Segou, and then...PARIS. It was all so fantastic, so frantic, and somehow still relaxing. I think I had forgotten how peaceful it is to be surrounded by people who love you, even when the world is crazy and spinning as usual.<br />
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It was a really special trip for me, but as I try to write about it, I'm finding that I don't have much to say but to recount our activities -- and I am not sure you'd find it all that interesting. We certainly did things I'd never done before, but Mali is so familiar to me now that I don't think it was quite as meaningful (in an intellectual sense) for me as it was for my parents. So, I think I'll follow Leona's lead and ask my mom or Charles to write a guest post about their experience here. For my part, however, I'd like to say that of all the amazing things we did during their whirlwind trip, the two nights we spent with my host family will probably be the most cherished. I was so happy to share my day-to-day experience with them, and to introduce them to the people that have so wholeheartedly welcomed me into their home. And, of course, everyone loved them. My mom and Charles did their best to cross the (double) language barrier, mostly by waving their hands around and laughing whenever someone talked to them. It was great.<br />
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I'm pretty sure they didn't like the food much (moni, saga-saga and tô), and they didn't find the bucket bathing too enjoyable, or sleep that well on Pedro's bed with my clothes rolled up for pillows (despite the fact that I generously loaned them my fan), but in the end I know it was worth it. When we returned from Dogon Country to say a final goodbye, Ami gave them a beautiful (fuschia!) comforter and left my mom in tears. <br />
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But, maybe I should let her tell you about that?Alexhttp://www.blogger.com/profile/16575531860405747987noreply@blogger.com0tag:blogger.com,1999:blog-4214872712283264455.post-53850224214749316782010-03-11T11:03:00.001+00:002010-03-11T11:16:11.858+00:00I don't like this game anymore.<span style="font-size: x-small;"><i>The story I want to tell you, and those involved, will not be done justice by my words; I have no intention of spinning a good tale or making a caricature of their lives. I debated long and hard about whether I could even tell this story in good faith and finally came down to this: the truth of the matter is that it is the truth. or at the very least, it is a thread in the common experience of women and children living in poverty here and all over the world.</i></span><br />
<br />
I've been carrying around several things to share with you in my head for the past month and a half, never getting past the first few sentences of each because there always seems to be something else that needs doing. Where, where, where did the "winter" go?? March is full-on here, and with it the kind of heat that boils my water during the day (oh what I would have given for hot showers back in December...) and drenches my sheets at night. <br />
<br />
Part of the whirlwind that has descended upon my life here in Bamako is a direct result of the amazing Mali--Paris vacation I had with my mom and step-dad at the end of January. I could not have asked for a more pleasant, relaxed, and paradoxically jam-packed fifteen days with the two of them. To be honest, it got me through. After the honeymoon of Bamako living wears off and all that's left is the endless dirt and dust, sharing that dust with two of the people you love most in the world is like a breath of fresh air. I guess, in the same way, this blog allows me to shake off a little of the dust of my life and share it with all of you.<br />
<br />
So before I too excited and tell you about all the great times my parents and I had here, I need to say is that living in Bamako the way I (and hundreds of thousands of others) live is not fun, not really. After a few months, the high of being on a new adventure slides into the drudgery of a daily life so far removed from any semblance of my "comfort zone" that thoughts of it rarely even surface. The opportunity, then, to be with people whose only care is to know <i><span style="font-family: inherit;">where I am</span></i> allowed me to step outside my experience enough to appreciate being here all over again. <br />
<br />
In the weeks before their arrival I had begun that downward slide in earnest. Work was stalled; friends were leaving Mali and me with an endless eight months to go; the happy blur of Seli Ba-Thanksgiving-Christmas-and-New Year's was over and gone, and so was all my chocolate. The frigid morning bucket baths, the pathetic light in my tin-roofed room, the fearless cockroaches, the hike to work, the chants of young children and catcalls of young men, the hack-inducing Bamako haze, the weekends of market-ing and saluer-ing and hand-washing clothes and rice and peanut sauce <i>again</i>...it was getting to be too much.<br />
<br />
And then it got worse. I came down with the flu and everything went to shit.<br />
<br />
While I was sleeping off my fever one Saturday morning, a neighbor gave birth -- in her room, by herself -- at only seven months. Sick with a jaw infection and too poor to fill the prescription given to her at the community clinic, she had subsisted for fifteen days on millet porridge. Later she explained to me that the inflammation had been so bad that, unable to swallow, the liquid had come back through her nose. Of course, <i>I wish I had known that</i> so I could have purchased her medicines and maybe prevented her miscarriage. But, unfortunately, there we were: a baby two-months premature, a weak mother who had given birth on a straw mattress in a dirty, sweltering room, a family that seemed disturbingly resigned to this tragic state of affairs, and me -- someone with the resources to do something.<br />
<br />
So, of course, I promptly freaked out. Should I take her to the hospital? immediately? but what about the baby? How would we transport them? by moto? No way -- can she walk? Christ, I don't know. She seems okay, conscious, aware. What if she's hemorraging and I have no idea?<br />
<br />
I searched for words I've never used in French, let alone Bambara, fumbling along as Ami translated. Mariatou, are you still bleeding? A lot? Does it hurt? A lot? And the baby?! Oh God, what do I look for, what should I ask? Is she feeding? How often? Do you know you if you are producing milk?<br />
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Had we been in the United States, the infant would have been whisked away to an intensive care ward where she would have been hooked up to IVs and placed in a sterile incubator to keep up her body temperature -- something she can't do herself. Being, instead, in an impoverished neighborhood of one of the world's poorest nations, the baby's risks of hypothermia or infection were astounding. I was terrified.<br />
<br />
We need to keep her warm, I said (as if her mother didn't already know). Keep her against your skin. Can I take you to the hospital? We need to go to the hospital.<br />
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I consulted with my co-workers and called Hawa Gaku's son, a resident at a local clinic. "If it is not an emergency, try to get her to come in tomorrow morning," he said. "I will look at the mother and child then and write a referral for hospitalization if necessary." <i>But. But. Isn't this an emergency?? </i><br />
<br />
She didn't want to go, she was afraid the doctor would be angry with her for not filling her prescription, for not making pre-natal visits, for being poor. Ami convinced her that we had to go, and the three of us walked the mile and half to the clinic the next day. We wrapped the baby against her chest under layers of sweaters, despite the 95°F heat. When we arrived, the doctor examined the mother and child. Mariatou was doing well, but the infant's temperature hovered at a hypothermic 92°F. He said hospitalization was necessary, but if the mother wan't sure that her family could bring her food during her stay then maybe it was best to try and care for the baby at home. My heart sank.<br />
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Prescriptions in hand, we went on our way. <br />
<br />
Okay, I thought. We can make this work. Then I realized that it was <i>me</i> who was going to give this child the antibiotics. Oh oh oh...I have never ever ever felt less prepared for anything. I have never been more scared. The antibiotic oral suspension she was prescribed were supposed to be refrigerated after mixing (is that some sort of cruel joke?), and the directions said the vitamin drops should be diluted in 8 oz of milk or juice. 8 ounces? That's like a quarter of her weight in fluid. Should she even drink fluid that isn't breast milk? Shouldn't the fluid be warm? What the hell am I doing?? I don't want to play doctor anymore.<br />
<br />
She took the antibiotic just fine as I slowly droppered it into her tiny mouth. When I started with the vitamin solution, however, my heart stopped. I droppered more than I meant to and she started to cough. She coughed with her whole body, and seized. I gave the mother a terrified look. Is she breathing? I watched her lungs, her diaphragm, praying they would move rhythmically again.<br />
<br />
Mariatou took her from me, pulling on her toes and sucking the air from the top of her head. In my mind, I was screaming. THAT'S NOT GOING TO HELP. OH MY GOD I KILLED YOUR BABY. Your precious baby. Frantically, I put my mouth over hers, breathed slightly and but then stopped short --- I had absolutely no idea how much air her lungs could support. Oh god oh god oh god. Please. She coughed and seized for thirty seconds longer (or was it an hour?) and then started to breathe normally again.<br />
<br />
Oh god. Oh god. Thank you.<br />
<br />
No more medicine today, I said. I'll just make things worse. Mariatou assured me that it was okay, that she would be fine, that she'd keep the baby warm. I smiled weakly and shut myself in my room, feeling like I'd jumped off a building was just now picking myself up off the ground. What the hell was I thinking? I didn't want to be here anymore, it was just too much.<br />
<br />
I wish I could pretend that the story ended well. I wish I could tell you that the rich white girl swooped in to save the day. I didn't. The baby didn't survive through the evening, and her family buried her that night without much ceremony. She was nameless, because babies are given their names on the seventh day -- but Mariatou said she had wanted to name her Laurel, after my mother. Break my heart.<br />
<br />
I didn't see her cry, maybe she had expected it. She'd lost babies several times before and she had others she could barely feed.<br />
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Selfishly, though, I did. I cried because I don't like death, because I wanted to be the one to help. I cried because I couldn't stand myself, getting off on "living in Africa," romanticizing this place and my place here. I cried because I had held abject poverty in my hands and couldn't do a damn thing about it. I cried because this is someone's reality and here I am pretending to be a part of it.<br />
<br />
I cried because I wanted my mom. <br />
Thankfully, she was on her way.Alexhttp://www.blogger.com/profile/16575531860405747987noreply@blogger.com5tag:blogger.com,1999:blog-4214872712283264455.post-40744576332454629972010-01-21T18:38:00.000+00:002010-01-21T18:38:25.296+00:00Surviving the holidays in Mali. (Yes, I am alive and well...)<div class="separator" style="clear: both; text-align: center;"><br />
</div><i>Okay. So one of my New Year's resolutions was to blog more often. I'm (half)convinced that the fact that it has taken me until January 21st to post has everything to do with the crazy-busy weeks we've had trying to get prepared for our pilot launch and nothing to do with my resolve, but hopefully I can prove it to you in the weeks to come. I have lots of new and exciting things to share, but first a quick recap of the holidays...</i><br />
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These past weeks have been a whirlwind of fête-ing, working, working, and fête-ing some more. As you know, we celebrated Thanksgiving à l'Americaine and then Mali's equivalent, Seli Ba, descended upon the country -- hundreds of thousands of sheep gave their lives for several days of mutton meals.<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN9duk9lgWE5klIgv0DQnMJfna70HDY-8RxOpHEOUkhOfCX9OzeRrpnNu2bzNIJL2ilvtqu9A01BT_DJTS7ksYdLq5pES03x9dd_txhZaR6TssiCO7Z4EY5E2VuXsdZmWSt3VGYrUDWRfa/s1600-h/DSC00729.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN9duk9lgWE5klIgv0DQnMJfna70HDY-8RxOpHEOUkhOfCX9OzeRrpnNu2bzNIJL2ilvtqu9A01BT_DJTS7ksYdLq5pES03x9dd_txhZaR6TssiCO7Z4EY5E2VuXsdZmWSt3VGYrUDWRfa/s320/DSC00729.JPG" /></a><br />
</div><div style="text-align: center;"> <span style="font-size: xx-small;">yes, I helped...</span><br />
</div><div style="text-align: center;"><br />
</div>After capping off the holiday with a lovely breakfast of sheep's head soup, I gave my own silent thanksgiving that it was finally over and we could go back to eating Rice and Sauce. (Note to self: protein is an evil drug capable of making one say regrettable things.)<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3kaacmNlE10kaH29XKnXGG6gbzS1kjopuPyzpdtJA7hNiJ3yjgxMgMtB1Kanb0gapOP3kxHoKAAzUGwonb3Ph6toGHoWI5Fxp32Ln1CtbyyK6dhqPXYPresMrN6OiYWUGM4jTkONa9TQk/s1600-h/DSC00742.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3kaacmNlE10kaH29XKnXGG6gbzS1kjopuPyzpdtJA7hNiJ3yjgxMgMtB1Kanb0gapOP3kxHoKAAzUGwonb3Ph6toGHoWI5Fxp32Ln1CtbyyK6dhqPXYPresMrN6OiYWUGM4jTkONa9TQk/s320/DSC00742.JPG" /></a><br />
</div><div style="text-align: center;"> <span style="font-size: xx-small;">happy photo à la malienne</span><br />
</div><div style="text-align: center;"><br />
</div>All in all, Seli Ba was a joyful three days of brightly colored bazin outfits, loud music, young children offering blessings (for small change), and endless saluer-ing. Such fun.<br />
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Just a few short weeks later we said our tearful goodbyes to the wonderful, brilliant and hysterically funny Alex Ruby. After six months with MHOP, tirelessly coordinating the (endless) clinic construction and development, Alex left us in mid-December for the cold days of Washington, D.C., and an impressive tour of medical school interviews. It is a lucky school that can snag this kid. (Yes, I'm talking to you Harvard.) We all miss him dearly, and wish him all the best! Obvi.<br />
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</div><div style="text-align: center;"><br />
</div>Suddenly it was only days until Christmas, and Leona's lovely parents arrived for a visit! The three of them went off on a tour of Dogon country and Devon and I found ourselves all alone. No problem, we had big plans. Both of our mother's families celebrate Christmas in the tradition of their heritage (me Norwegian and she Polish), and so we eat smoked fish, pickled herring, and pickles on Christmas Eve -- and we weren't about to let Mali stop us from carrying on the tradition! We also decided that each of us would contribute one of our most traditional dishes. Devon chose sweet cheese pierogis and I the Norwegian rice pudding that has been our Christmas Eve staple for generations. My grandmother taught me the recipe -- rice, sugar, salt, vanilla and obscene amounts of condensed milk -- and on this second Christmas without her (she passed away Easter of 2008), I was intensely proud that I could carry her tradition here to share with Devon and my surrogate family.<br />
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I woke up early on Christmas morning to inform Ami that I'd be doing the cooking for our midday meal, but that I might need a little guidance on how to prepare the rice since it certainly wasn't going to be as easy as opening a bag and boiling some water on the stove. She gladly taught me how to clean the rice, first by rhythmically shaking out all the bran, then by picking through the grains for rocks and bugs, and finally by washing in a complex succession of buckets and bowls. Never having cooked rice over a wood fire, I happily accepted Batuma's expertise as she helped me get the whole business set up. Julgröt isn't that far removed from the Malin <i>seri</i> (sweetened, watery rice porridge) that is eaten regularly for breakfast, so it wasn't too hard to explain what exactly I was intending to do. Of course, I had to make a few modifications to my grandmother's recipe. Malian condensed milk is so thick and sugary that it is intended to be diluted several times to make sweet milk but it worked perfectly. One and a half cans of the stuff, two kilos of rice, two gallons of water, a handful of salt, a pinch of vanilla flavored drink mix, and we were cooking!<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-o5NfkN-eBdC08q9jNyWO78Oqe4Q1cDe9sWD1tSrUC7pHi-FHZ88nwSZSaVZfw8Mde4pyV3pSRpUs4F_KfDjMJjTBqRsEWrSI09j6xl4Y_WvWtJNJ20zUwrqkuBNdzFnfz7G37wOSA7qz/s1600-h/DSC00868.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-o5NfkN-eBdC08q9jNyWO78Oqe4Q1cDe9sWD1tSrUC7pHi-FHZ88nwSZSaVZfw8Mde4pyV3pSRpUs4F_KfDjMJjTBqRsEWrSI09j6xl4Y_WvWtJNJ20zUwrqkuBNdzFnfz7G37wOSA7qz/s320/DSC00868.JPG" /></a><br />
</div><div class="separator" style="clear: both; text-align: center;"><span style="font-size: xx-small;">julgröt over the open fire </span><br />
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</div>And, wow, was it a hit. Not that I was particularly surprised, seeing as Malians have a somewhat disturbing love affair with rice and sugar.<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpn2rGMIDRLvHzufKsPw6n26Aw2Sp4znWU6zdgorcvD8S8e9EN9IAVfzWjAhn8ahU-5R1p58StOqXHlsvRI-BYufW4FKDG8vbgfqeLQhsxoHZsC3IOiJQWPBuPH7-10j-Mfumq2G80nmOt/s1600-h/DSC00872.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpn2rGMIDRLvHzufKsPw6n26Aw2Sp4znWU6zdgorcvD8S8e9EN9IAVfzWjAhn8ahU-5R1p58StOqXHlsvRI-BYufW4FKDG8vbgfqeLQhsxoHZsC3IOiJQWPBuPH7-10j-Mfumq2G80nmOt/s320/DSC00872.JPG" /></a><br />
</div><div style="text-align: center;"><span style="font-size: xx-small;"> kady tested, kady approved</span><br />
</div><br />
My family, Devon and I gleefully devoured the stuff, and by the time I returned from our meal of (passable) pickled herring and (delicious) pierogis at Devon's house, the entire pot was scraped clean. Sure, there was no snow, no carols, no Santa stockings, Christmas trees or cookies. In fact, until that first bite of julgröt it didn't feel even remotely like Christmas. But the delight of sharing some of my traditions with this wonderful family who has unquestioningly welcomed me into theirs (note the photo of me helping to slaughter our sheep), filled me with the love that only Christmas can inspire.Alexhttp://www.blogger.com/profile/16575531860405747987noreply@blogger.com1tag:blogger.com,1999:blog-4214872712283264455.post-56194073876086397972009-12-03T12:22:00.001+00:002009-12-03T13:33:43.201+00:00No, seriously, THANK YOU!<b>We won! We won! We won! We won! We won! We won! We won!</b> <b>We won! We won!!!!</b><br />
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You may have thought I was being a little tongue-in-cheek with my last post, but I want to assure you that this truly has been the most thankful of Thanksgivings I have ever had the chance to endure. Okay, so endure may be a little strong, but after three days of feasting on Seli Ba leftovers (including a lovely sheep's head soup for breakfast!) I think its a fair statement.<br />
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In all seriousness, here at MHOP we have 343 wonderful reasons to give thanks this holiday season: you, you, you, you, you, you and you! (x49). We were amazed, humbled and ecstatic to discover that our Global Giving campaign beat the competition with an incredible $38,151 (and counting...) from 343 unique donors. With the matched funds and the $10,000 bonus, we raised $61,723!!<br />
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</div><div style="text-align: center;"><span style="font-family: inherit; font-size: xx-small;">Our team with the CSCOM de Sikoro-Sourakabougou board, after signing our final contract. </span><br />
</div><div style="text-align: center;"><span style="font-family: inherit; font-size: xx-small;">Y</span><span style="font-size: xx-small;">our donations built the building, and now they will also allow us to pilot Action for Health in it!</span><br />
</div><div style="text-align: center;"><span style="font-size: xx-small;"> </span><br />
</div>I am overwhelmed with gratitude for all of you who have ever contributed (some of you more than once!) to support our programs. Thank you, thank you, thank you. I hope you are swelling with pride at this very moment, because you are as much a part of this work as I am. While walking from our clinic to the office, participating in our lively meetings/debates, writing our mobile record forms or planning our next CHW training I am thanking you. Sweating on the sotroma, noshing on rice and fishy sauce, scrubbing the seven layers of dirt off of my toes, I am thanking you. (Okay, so occasionally I might be swearing at you but I don't really mean it, I promise.) You are the reason I am here and I can never be thankful enough for that.<br />
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So, today, tomorrow, everyday... THANK YOU!Alexhttp://www.blogger.com/profile/16575531860405747987noreply@blogger.com0tag:blogger.com,1999:blog-4214872712283264455.post-56895282344942459962009-11-27T18:07:00.000+00:002009-11-27T18:07:59.257+00:00Thanking You.<style type="text/css">
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</div><span style="font-size: small;"><i>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 <a href="http://www.globalgiving.com/projects/actionforhealth-prevent-90-of-child-death-mali/">GlobalGiving.com</a> for more details, and contribute today.</i></span><br />
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<div style="text-align: center;">-----------------------------------<br />
</div><span style="font-size: small;"><i><br />
</i>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...<br />
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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.<br />
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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!<br />
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Ay. So many things to be thankful for, sheep included. <br />
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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.<br />
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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 <a href="http://picasaweb.google.com/akharsha/Thanksgiving#5408519859316891506">Thanksgiving meal</a> on a card table with a two-burner gas stove and no sink? We did!<br />
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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.<br />
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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! <br />
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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.<br />
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And, as a special birthday treat, we had apples with wine and cheese to start!<br />
Now that is something to be thankful for.<br />
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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.<br />
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Things I am Grateful For this Thanksgiving:</span><br />
<ol><li><span style="font-size: small;">Fresh vegetables from the market.</span></li>
<li><span style="font-size: small;">Bleach.</span></li>
<li><span style="font-size: small;">How I Met Your Mother. </span></li>
<li><span style="font-size: small;">Bug nets and Doxycycline.</span></li>
<li><span style="font-size: small;">My feet. (I've paid them back for all the abuse they've taken during my 8k work commutes by <a href="http://picasaweb.google.com/akharsha/Thanksgiving#5408485588667656818">painting them up</a> nicely for Seli Ba)</span></li>
<li><span style="font-size: small;">Chocolate I packed from Trader Joe's.</span></li>
<li><span style="font-size: small;">Trader Joe's.</span></li>
<li><span style="font-size: small;">My fan.</span></li>
<li><span style="font-size: small;">People who laugh (kindly) when I try to talk to them in Bambara.</span></li>
<li><span style="font-size: small;">People who actually try to the teach me Bambara.</span></li>
<li><span style="font-size: small;">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.)</span></li>
<li><span style="font-size: small;">Luna Bars.</span></li>
<li><span style="font-size: small;">Skype.</span></li>
<li><span style="font-size: small;">Signed Malian contracts. (We finalized ours with the CHAG and the ASACOSISOU this week!)</span></li>
<li><span style="font-size: small;">Finished clinics!</span></li>
<li><span style="font-size: small;">The phrase, “It could be so much worse.”</span></li>
<li><span style="font-size: small;">Laughs with my families...here, there and everywhere.</span></li>
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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 <a href="http://frontlinesms.com/">FrontlineSMS</a> and <a href="http://medic.frontlinesms.com/">Medic</a>, my hard working MHOP colleagues / Thanksgiving feast partners-in-crime and finally all of those who helped me get where I am today. <br />
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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. <br />
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Aw ni ce kosebe kosebe.<br />
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<i>*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?</i></span>Alexhttp://www.blogger.com/profile/16575531860405747987noreply@blogger.com0tag:blogger.com,1999:blog-4214872712283264455.post-62376475044919535482009-11-27T17:36:00.000+00:002009-11-27T17:36:01.806+00:00N filadin be min? Sofie, where are you??<div style="text-align: center;"><b>Happy Birthday Sof-a-lof. </b><br />
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</div>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 <a href="http://sofiecuador.shutterfly.com/">stupidly gorgeous</a> 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. <br />
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<div style="text-align: left;">Okay, fine...maybe not <i>better</i>.<br />
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</div><div style="text-align: center;">Age 20: my first birthday without Sofie.</div><br />
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.<br />
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<div style="text-align: center;">Age 23: my first birthday without Sofie OR candles.<br />
</div><div style="text-align: center;">But, I did have my first apple in ten weeks! <span style="font-size: xx-small;"><span style="font-size: small;">Glorious.</span> <br />
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</div><div style="text-align: center;"><span style="font-size: xx-small;">(Sorry Lewis, I jinxed it!)</span><br />
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</div><div style="text-align: left;"><span style="font-size: x-small;"><i>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 <a href="http://www.globalgiving.com/projects/actionforhealth-prevent-90-of-child-death-mali/">Global Giving Campaign</a>. 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! </i></span><br />
</div>Alexhttp://www.blogger.com/profile/16575531860405747987noreply@blogger.com2tag:blogger.com,1999:blog-4214872712283264455.post-13135554887852275532009-11-23T14:24:00.002+00:002009-11-23T15:09:41.287+00:00Bee toga ye I ko: Everybody leaves their name behind<div style="margin: 0px auto 10px; text-align: center;"><br />
<div style="color: black; text-align: left;"><div style="margin-bottom: 0in;">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 <i>ever</i><span style="font-style: normal;"> 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. </span> <br />
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</div><div style="font-style: normal; margin-bottom: 0in;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgixMzzH_zhuX45XVXX3BPx3CY9Egof6fl0PbFT4GYNfe3lgV4yBM2kTtpGbjdM7LwCyTRyneb_PxbC8qexjrDCBzuKE-p0hX1SfFF-aV8sGlAlia9ad2Mhmaxb76djSKt0_MJ-ltPfQbK3/s1600/DSC00345.JPG" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgixMzzH_zhuX45XVXX3BPx3CY9Egof6fl0PbFT4GYNfe3lgV4yBM2kTtpGbjdM7LwCyTRyneb_PxbC8qexjrDCBzuKE-p0hX1SfFF-aV8sGlAlia9ad2Mhmaxb76djSKt0_MJ-ltPfQbK3/s320/DSC00345.JPG" /></a>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 <i>ji-tigis</i> have to push a cart full of <i>bidons</i> 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.<br />
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</div><div style="font-style: normal; margin-bottom: 0in;">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!<br />
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</div><div style="font-style: normal; margin-bottom: 0in;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHErv-wNV7PNj7_8p7lggYszlMuQMZNWqnXItPSli-rCGrSr0Wz-XHYtUIYzIywXf5VUCjcRr-ddGLYjegm3AGgHIWSytNxWwEOa-ZkcJ2RVvm3gBPl8GKP5GUsxS7lKlQEwr2RO4IoThl/s1600/DSC00353.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHErv-wNV7PNj7_8p7lggYszlMuQMZNWqnXItPSli-rCGrSr0Wz-XHYtUIYzIywXf5VUCjcRr-ddGLYjegm3AGgHIWSytNxWwEOa-ZkcJ2RVvm3gBPl8GKP5GUsxS7lKlQEwr2RO4IoThl/s320/DSC00353.JPG" /></a>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.<br />
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</div><div style="font-style: normal; margin-bottom: 0in;">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 <i>and </i>rinse?), chasing the little kids, <i>causer</i>-ing with the eldest while making <i>dute</i> (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. <br />
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</div><div style="font-style: normal; margin-bottom: 0in;">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. <br />
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</div><div style="font-style: normal; margin-bottom: 0in;">I learned, for example, that the secteur-tigis actually <i>do</i> 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 <i>javelisation </i>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. <br />
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</div><div style="font-style: normal; margin-bottom: 0in;">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. <br />
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</div><div style="font-style: normal; margin-bottom: 0in;">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.<br />
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</div><div style="font-style: normal; margin-bottom: 0in;">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.* <br />
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</div><div style="font-style: normal; margin-bottom: 0in;">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 <i>denkonli</i>. While Islam does not have a baptismal ritual <i>per se</i>, the naming ceremony serves to welcome a new child into the community in much the same way that a Christian baptism does.<br />
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</div><div style="font-style: normal; margin-bottom: 0in;">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 <i>baptême </i>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. <br />
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</div><div style="font-style: normal; margin-bottom: 0in;">Much to my surprise (though I should have learned by now), morning meant <b>morning</b>: at 6:00 a.m. I awoke to the sounds of gravelly voices and shuffling chairs. <i>They are getting an early start, </i>I thought.<i> </i>By 6:30 a.m. I bolted upright in bed, realizing that the voices had reached a critical mass. <i>There have got to be twenty men in my courtyard! </i>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! <a href="http://picasaweb.google.com/akharsha/BabyAdama">So I did</a>.<br />
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</div><div style="font-style: normal; margin-bottom: 0in;">Fifteen minutes and a baby naming later, the men filed out the door and the real <i>denkonli</i> 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.<br />
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</div><div style="font-style: normal; margin-bottom: 0in;">In Bambara, <i>denkonli </i>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.<br />
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</div><div style="background-color: white; color: black; font-family: inherit; font-style: normal; margin-bottom: 0in;"><span style="font-size: xx-small;">*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.</span><br />
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</div><div style="font-style: normal; margin-bottom: 0in;"><span style="font-size: xx-small;"><span style="background-color: white; color: black; font-family: inherit;">**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!</span><br />
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</div>Alexhttp://www.blogger.com/profile/16575531860405747987noreply@blogger.com0tag:blogger.com,1999:blog-4214872712283264455.post-87723672623882616022009-11-02T00:11:00.001+00:002009-11-02T00:12:45.947+00:00Are we inside or outside? These and other questions from a Malian perspective...<i>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.</i><br />
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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.<br />
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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 <i>TalesFromeTheHood</i> 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. <br />
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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.<br />
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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.<br />
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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.)<br />
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Despite my failed search, our team spent the day on Wednesday discussing the many differences between Malian and American cultures. Drawing from “<a href="http://www.claremontmckenna.edu/math/alee/extra/American_values.html">The Values Americans Live By</a>,” 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. <br />
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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? <br />
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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, <i>your life</i> 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. <br />
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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.<br />
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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.<br />
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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? <br />
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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.<br />
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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 <i>dugutigi</i> (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 <i>secteur-tigis</i> 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.Alexhttp://www.blogger.com/profile/16575531860405747987noreply@blogger.com0tag:blogger.com,1999:blog-4214872712283264455.post-77388904264639759242009-10-02T17:01:00.106+00:002009-10-04T15:57:25.136+00:00Toubabu!!<div style="margin: 0px auto 10px; text-align: left;"><a href="http://localhost:49367/65b7dc7387732c6a766851d2e9786e35/image111.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><br />
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</div><div style="margin: 0px auto 10px; text-align: center;"><b>In Bamako, they call me <i>toubabu</i>.</b><br />
<b>The West African term for foreigner (read: rich white person), toubab is thought to be derived from the Arabic word for doctor.</b><br />
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Wait. They call me doctor?<br />
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The little children scream it as I pass by on my way to work in the morning, along with cries of “bonjooooo” or “bonsoir,” irreverent of the time of day. They chant "Hawa, Hawa, Hawa," the name of the most recent white girl to leave the Mali Health Organizing Project and laugh when I tell them my name is Fanta Simaga. <i>N togo Fanta. N jamun Simaga.</i><br />
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I am writing this first post on the evening of my seventh day in Bamako, because after a week here I think I might actually have something to say about this place. My journey here has been long and full of doubts – when I wasn't consumed by the MCAT, I spent my summer agonizing over whether I am actually capable of helping MHOP and the community of Sikoro-Sourakabougou, or not. Seven days in and I am certainly no less sure, but at least I have a better idea of what it will require!<br />
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But before I launch into all that...don't you want to hear about my trip?? <br />
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I arrived in Bamako last Wednesday morning at 2:30 a.m., after a two-day layover in Casablanca, Morocco. I also had a day in New York City, which I spent riding the subway, hauling my fifty pound carry-ons across Central Park, meeting Anna (our executive director), enjoying a delicious meal with the lovely Susan Matheke (an artichoke, a gooey cheesy omelet and perfect french fries, if you must know) and visiting her niece on the Upper East Side.<br />
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Casablanca was my first adventure traveling completely alone in a very foreign country. My French was timid and awkward but I managed to fend off “valets” who wanted to help me with the bags I couldn't carry or who offered to make “a special trip” to my hotel (despite the availability of a free shuttle). The airline put me up the nearby Hotel Atlas, with comp'ed meals and free <i>weee-feeee</i> – which made checking in with the family wonderfully easy! I meant to spend the second day in the city, looking at mosques and visiting colorful markets, but I accidentally slept for fifteen hours! <br />
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I had just enough time to get on the wrong train to Casablanca so that I could wander aimlessly around a very unpicturesque part of town. (I should have taken the one to Bab Marrakech. <i>Be-ah-be, il m'a dit!</i>) Nonetheless, I had a lovely, awkward time. I was able to pick up some spices and cheese for the MHOP folks, and when I was 5 dirham short I even managed to ask the lady to cancel the second box of vache qui rie. Thank god for small successes. <br />
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After missing the 5 pm train back to the airport and high on my recent brilliant performance in the grocery store, I decided to ask a gentleman if he could tell me where to find a post office. I've got to mail the rest of my thank yous! (FYI: For those too disorganized to finish all their thank yous before leaving on a year-long trip to a country with a shaky postal service, JFK will not mail anything for you once you get through security.) <br />
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Anyway, after asking for directions and telling him that I had a train to catch, he walked me around to four different stores unsuccessfully trying to find postage to the States. I thanked him, hoping to go on my solitary way. No such luck. He walked me back near the station where we spent ten awkward, silent minutes sitting next to each other on a bench and when he finally asked for my “MSN,” I had to make one up in order to exit gracefully. To the owner of akaneh72@jmail.com: my apologies.<br />
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</div><div style="text-align: center;"> <span style="font-size: xx-small;">Casablanca: </span><span style="font-size: xx-small;"><span style="font-size: xx-small;">waitin</span>g for the train to the airport <br />
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</div>At 2:30 am on Wednesday, Royal Air Maroc touched down in Bamako, Mali. <br />
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I gathered my 100+ pounds of luggage and made my way to greet Devon and Alex – my new colleagues at MHOP. Of course, I managed to get myself into a very sketchy situation on my short walk to find them! Sidelined by a man who I thought was Adama, one of the Malian coordinators, I almost went off with a nefarious taxi man. It was a blur of French and Bambara, but when he explained that we were going to a hotel to wait for a call from the people expecting me, I quickly realized I had made a mistake! Thankfully, Devon and Alex came to the rescue.<br />
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The taxi man still had my luggage, however, which instigated a raucous debate between several drivers over who would drive the three of us back to Sikoro. After much screaming in Bambara and Devon's adept bargaining, we managed to break up the fight. Unfortunately, the winner of the argument was the owner of a clandestine taxi, which ensured that we would be stopped by the police on our long ride home. Bamako has an 11 pm curfew, after which you must carry proper identification and offten, I'm told, the police will ask you for whatever document you don't have, demanding a small bribe. This night was no different, but Alex and Devon skillfully talked their way out of a “ticket.”<br />
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By 4 a.m. we pulled up to my new (temporary) home across from <i>le kare</i>* in Sikoro.<br />
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</div><div style="text-align: center;"><span style="font-size: xx-small;">le kare, or pig corner</span><br />
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The compound of Hawa Gaku and her son's family is relatively nice for the Sikoro neighborhood. They have a paved courtyard with a sideyard for some sheep and a <i>ngeyen</i> (latrine/bathing room). In a semi-circle facing the courtyard are individual living areas: Hawa Gaku lives on one side, Fanta, Mamadou and their three-year old, Papa) on the other. I am in the middle, with the family <i>bonne</i>, Masata, next door and Alex Ruby in the farthest corner next to Fanta. <i>N togo ma</i> – my namesake, Fanta Simaga gave me her name when I arrived.<br />
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<span style="font-size: xx-small;">my first night</span> <br />
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</div>My room has a cement floor and mud brick walls, and has a bed, net, and trunk that Anna, our executive director, left behind. About 10'x12', it is comfortably large and has an adjoining empty room that Devon sleeps in occasionally when her host family locks her out for missing curfew. Hawa Gaku is much more familiar with Americans than most Malian families -- when we arrive home too late and have to wake her, she just stands topless in her doorway laughing at our silly ways.**<br />
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Ahhh, Bamako.<br />
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<span style="font-size: xx-small;"> A new drainage system in Sikoro, built by a local NGO</span><br />
<a href="http://localhost:49367/65b7dc7387732c6a766851d2e9786e35/image131.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" border="0" height="210" src="http://localhost:49367/65b7dc7387732c6a766851d2e9786e35/image131.jpg?size=320" width="287" /></a>I'm learning quickly that the comforts of the Gaku home–the electricity (yes, I love my little fan!), the clean <i>ngeyen</i>, the private trash pick up, the family bonne–are signs of wealth in Sikoro. In this northeastern corner of Bamako there is no sanitation service or municipal dump, making waste a major public health issue. Neither is there running water, and so we buy tap water (bleached) in big kilo containers and pour it off into buckets for cleaning, drinking and cooking. Bathing with a cup in a 4'x4' latrine is by no means luxurious, but I am grateful that at least my water has been bleached! Many families in Sikoro do not have access to bleached (tap) water, making diarrhea and dysentery leading causes of child mortality.One of our current projects thus includes the <i>javelisation des puits</i> (bleaching of wells) for target Sigida Keneyali families.<br />
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I have spent the last week trying to get adjusted to life here. Many people do not speak much French, which makes buying food and getting around a bit more difficult! Alex and Devon have been extraordinarily helpful. Devon has been here a year and so she knows how to navigate the many blind alleys of existence in Bamako, and speaks French and Bambara with surprising ease. Alex arrived in July, and has let me become his sidekick during his work as clinic coordinator. We've had several adventures around around town (buying a cell phone, taking the sotroma and bani bus) and he has been helping me get settled at Hawa Gaku's home.<br />
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I haven't had a lot of traditional Malian food yet, because Devon, Alex and I cook at our office or go out for dinner. It's pretty easy to find baguettes, rice and pasta, and there are cucumbers, melons, tomatoes, onions, eggplant, peppers, peanuts and peanut butter, green oranges, and dried (or quickly drying!) fish in the Sikoro market right now. Most of the restaurants in the area serve some mix of egg dishes (meat scrambles), Lebanese (falafel, humus), Vietnamese (spring rolls, bahn mi sandwiches), “Western” food (hamburgers, fries, pasta), and kebabs. Nothing extraordinarily exotic! I did try tô with okra sauce the other night at a Senegalese restaurant, and found it to be pleasantly Maggi-fied -- but still slimy, of course! Maggi is the ubiquitous salty seasoning that imparts a lovely MSG-umami to many Malian sauces. Yum!<br />
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<span style="font-size: xx-small;">cooking in the office</span> <br />
</div>Tuesday morning, however, I joined Hawa, Fanta and the crew for breakfast. They were having <i>moni</i>, a very soupy millet porridge with sugar and lime. It tastes like a sweet and sour porridge tea with tapioca pearls. Don't worry, Annette, I still prefer lumpy cream of wheat with milk any day!<br />
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</div><div class="separator" style="clear: both; text-align: center;"><span style="font-size: xx-small;">from left: random lady, Hawa Gaku, me and Papa, family bonne, Fanta</span><br />
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</div><div style="text-align: center;"><span style="font-size: xx-small;">drinking <i>moni</i></span><br />
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Afterwards, Papa and I played the “bite your finger and say ayi” game, and the “call the toubab names in Bambara that she can't understand game.” Great fun.<br />
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My other “firsts” of note this week:<br />
<ol><li><b>My first <i>sotroma</i> ride.</b> The cheapest form of transport, sotramas are hollowed out 12 passenger vans that serve as a mini-bus system. They can be extremely hot and crowded, often carrying 20+ people!</li>
<li><b>My first Bambara lesson</b><span style="font-size: small;"><b>:</b> </span> <i>I ni ce. I ka kane? N se. Somogo be di? Toro si tu la. K'an ben.</i>..(Hello<span style="font-size: xx-small;">/thank you</span><span style="font-size: x-small;">. <span style="font-size: small;">How are you? Good/damn right. H</span></span>ow is everyone? No problems with them at all! Goodbye.)<br />
</li>
<li><b>My first MHOP meeting entirely in French.</b> Ay.</li>
<li><b>My first “husband” excuse.</b> My fake wedding band is working wonders.</li>
<li><b>My first night of <i>boite</i>-ing.</b> Devon, Alex and I went dancing at the “No Stress Club” with her boyfriend and some other Malian friends.</li>
<li><b>My first ginger popsicle from the market.</b> <i>Gingembre glacee</i>, you saved me from heat exhaustion and dehydration. Now just don't give me amoebas!<br />
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<li><b>My first sweltering Bani Bus ride.</b> After waiting on the bus for 45 minutes, I was soaked in sweat and Alex's hands were pruny! (Need proof? Check out my Picasa photos.)<br />
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<li><b>My first clinic visit and CHAG meeting.</b> Stay tuned for more details...</li>
</ol><br />
And finally,<br />
8. <b>My first real inkling that this project will be so much more than </b><br />
<b> what I had planned!</b><br />
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The group here is incredibly dedicated, but working in Sikoro presents many obstacles. There is so much history, so many intricate relationships between the members of this community, so many cultural differences and so few resources, that I am quite sure this challenge will be much more than I bargained for! In Sikoro I know I will always be a toubab – but over the next months I hope to become one in only the best sense of the word.<br />
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<i>*Le Kare is Bambara for Pig Corner. The term refers to a nearby pig pen, which is highly unusual in Bamako. As a predominately Muslim people, most Malians do not eat pork; this family chooses to raise pigs because they are much less likely to be stolen, and can be sold to a handful of restaurantsaround the city.<br />
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** Malians take a very conservative stance on the upper leg, as showing skin above the knee is considered highly sexual. Breasts, on the other hand, are displayed relatively freely. Public breast-feeding is very common, and older women may occasionally be topless around the home.</i>Alexhttp://www.blogger.com/profile/16575531860405747987noreply@blogger.com1