Report from Mali – Part One

Mali - Women on a BridgeBoth Alfa Nafo and Dr. Ousmane Koita met us at the Bamako Airport as they had last December–but this time they were not in their white and blue robes but rather western suits and ties. We were here to work hard this time–and so it has been.

The Niger River is fuller in October than December with marshy fingers reaching into both shores of the City. Small traditional boats, resembling gondolas, ply the River looking for fish. The two bridges connecting the two parts of the City are, as usual, crammed full of cars, motor bikes, bicycles, hand pulled wagons and people on foot carrying huge loads on their heads. We are always touched by the women carrying huge bunches of bananas that way—with babies on their backs. A smoky pall hangs over the city at dawn, burns off in the hot sun by noon and then returns the next day. The scent of burning wood is everywhere.

Professor KaderThe first three days we had a different meeting each day–the first alone with Professor Kader, the Principal Investigator on the Mali LDN Project. We met in the lobby of the Hotel; it was the first time we had all met, as he had been out of Mali when we were here before. Dr. Kader, regally dressed in blue robes, turned out to be cordial and congenial, not at all formal as we might have expected. He made us feel right at home discussing the program in general terms and then going over a few decisions we had yet to make about personnel and medical equipment. The three of us moved into “team” energy quickly and by the end of an hour or so, were talking as if we had been working together for years. When we invited him to have dinner with us at the hotel, he declined with gusto, indicating that he had to get home and that it was his job to play the host. It was an auspicious start for our 16-day visit.

Mali Clinical Team with JaquelynThe following day, we met with the full leadership team, including Ousmane, our old friend from December; Ousmane is on a tear now trying to get a malaria program for young children off the ground. Malaria is the prime killer of children in Mali, and is a far more serious problem than AIDS at this point with about 50 percent of children getting infected during the rainy season. It is a terrifying problem. Besides Kader, the leadership included the clinical coordinator, Dr. Carine Kounde, the two coordinators of the GECP–Nathalie Momo and Jeseph Camara–the administrative coordinator Ibrahima Traore’ (also a physician) and several others. Nathalie and Carine were dressed in traditional robes and literally sparkled during the meeting. Nathalie kept everyone laughing with her (French) sense of humor, none of which we understood in the usual sense. Her spirit was enough for us, however, and we fell in love with her on the spot. Professor Kader, Ousmane and a few others intermittently translated for us, so we were not entirely lost, as we all discussed various aspects of the program. Laughter abounded; everyone was clearly delighted to be present and part of this program. We felt like honored guests. It was as if a dream had come true right in the room with all of us there to celebrate; The dream had been shared by many people in the US and Mali; some had been dreaming for years. It’s a big dream–one that could save the lives of many, particularly the young children whose plight had been what had turned Jaquelyn into an African crusader several years before…and had brought us now to this large, land-locked country in sub-Saharan Africa.

Mali LDN Project Council TeamThe third meeting took place the following day at CNAM, the Mali Health Center that is their equivalent to our CDC, and where we had met with the leadership the day before. This group included all the council facilitators that our colleagues Amber McIntyre and Jesse Jessup from South Africa had trained last May. There are seven, in the group, four men and three women. Carine joined us as well in order to insure full coordination between the clinical and cultural portions of the program. We gathered in a warm room on the CNAM campus, which is also the location of Bamako’s leper treatment center. We saw many of the patients that day, children among them, who come to the tree-filled center regularly for treatments that are keeping them alive.

The meeting with the council facilitators was encouraging, despite some difficulty in understanding each others’ languages. After getting to know each other a little, we went around the circle with the question: “How do you feel about council?” The answers could have come out of the hearts of any circle of new facilitators anyplace in the world. They had completely “gotten” council, saw its potential to help change the gender patterns of their culture–and were also very clear that a new form of council practice would emerge that honored Malian traditions—and particularly confidentiality. To be HIV positive in Mali–as it is all over Africa– is still a huge stigma, so we added confidentiality to the four intentions of council on the spot. It’s going to take our full ingenuity to implement confidentiality. If a man has two or more wives—not unusual in Bamako–none of them can be assigned to be in the same circle for fear they would discover that each is infected. The facilitators smiled at our reaction to this challenge and treated the situation in a “business as usual” manner but there was no doubt that the game has to be played. We asked them many questions about what they wanted to learn during the two-day training that is to take place the following weekend–and got lots of good answers. With Nathalie’s and Joseph’s good natured help, the training should be a great success. What was quite clear was that we are going to be trained equally with the Malians in the nuances of council–African Style.

The following days were filled with meetings: an official from the Ministry of Industry to open up the possibility of building an LDN manufacturing capability in Bamako to supply the LDN after the clinical program proves its efficacy; a long meeting with Ibrahima to go over budget details; and then a flurry of meetings trying to find a translator for the weekend training. The one we had planned to use had been trapped in Paris due to an Air France strike and further kept from coming home by the temporary closing of the Bamako Airport for repairs. The meeting with Ibrahima was spiced delightfully by a Malian tour guide (who came as a translator) who spoke English well and charmed us with tales of his town by the Niger and stories from his childhood.

No report from Mali would be complete without commenting on the Bamako driving experience. There are no traffic lights in the city; policemen handle the big traffic circles, but otherwise you’re on your own. We have been assigned a driver to get us from one place to the other and these men must go through special aggressive training—necessary to entering the flow of motorbikes, people on foot and other cars—and the Green Buses. The latter are the major mode of getting around. There are hundreds of these little vans, most of them looking like they’re held together by hope. People jump on the vans while they’re still moving and drop off the same way. The near misses between vehicles are normal—everyone laughs when this happens. We have yet to see an accident and trust we are under the protection of whatever Spirit keeps the Bamakians safe.

2 Responses to “Report from Mali – Part One”

  1. HO to you two and all that you are bringing into this incredible circle of council!!As usual your work and effort are an inspiration to me. After reading your brief description of the latest trip, I am humbled and inspired at the same time. Nick, Eleanor, Shiela and I have just come from Allessio’s Italian where we dined on incredibly fine food, to come home to your message and link to the website! Congratulations on the completion of the site. So I am taken from my tight little world of right now to your incredible adventurous gift of love to Mali. HO. Travel safe and watch out for bikes/taxis/cows,chickens, motorbikes in the roundirounds! Tim P.

  2. Thank you Tim, much appreciated!