On having (and not having) all the answers

My favorite song from Somalian rapper K’Naan begins with the line, “And any man who knows a thing knows he knows not a damn, damn thing at all…..”

Contemplating this lyric recently, I realized it is a strikingly appropriate expression of exactly how I feel my time in West Africa has humbled me. Simply put: it seems there is nothing like being assumed to have all the answers to make you realize that you actually have far fewer easy solutions than they think you do. That is, if you have any at all. Being positioned immediately as a change-maker in the community, someone who has been brought in from the outside to come here and to help us, sets you up for self-questioning later on when you begin to wonder who died and made you the expert at everything. Being in this position is both an incredible blessing and, sometimes, a burden.

I am a 24-year old woman who left for my Peace Corps service in Mali at 22, literally within days of graduating from university. Compared to the sorts of jobs I might have landed just out of university in the States, it’s sometimes astounding to me how much immediate decision-making latitude I am given, and how much people just automatically assume that I have the solutions for any problem they throw at me, mostly because I came all the way here from the USA, and why on earth would anyone cross the ocean to live in a mud hut if she didn’t have some world-altering knowledge to share? For some, it doesn’t seem to matter what I’m actually qualified to do: I have been asked to help teach math (Ha! Ha!) and for advice on tree planting and farming (the only farming I have ever successfully done was under the close supervisory eye of my teen host brothers in Mali, and this success was owed to them, not me). You’re American, people seem to think, so you must know. And rather than throw up my hands and say, “actually, I don’t know!” I try my best to help people find solutions. That’s probably the most apt description of the role a PCV feels she must play in the community: “solution-bringer.”

I’ve been thinking about this idea of “bringing solutions to the people” a lot lately, since it is sort of what I have been trying to do in Burkina with the hearth model. The program utilizes community actors and builds on malnutrition activities that are already taking place in the community, but goes a bit further- requires a bit more purpose in its selection of participants, organization, and follow-up In short, it requires that a few key people make a bit more effort than they are currently making. It requires me, the cheerleader of this whole idea, to ask people like health workers and volunteer educators to have a little volonte, as they often say here—a little bit of a will to work, and not always with direct compensation. It’s a request that can be much trickier than it should be at times. But, one figures, it is not too unreasonable, especially if the benefits—want to recuperate some malnourished kids, anybody?–seem like a no-brainer.

However, the process is a bit like trying to sell a new product to people who have never heard of it and may have only marginal interest in it. I feel sometimes like a kid selling wrapping paper (or Girl Scout cookies, or those coupon books….) for an elementary school fundraiser; I know that my potential buyers probably have 35 shiny rolls of last years’ paper still stuffed in their closets, that they think they’ve heard the sales pitch countless times before, but somehow I have to make buying wrapping paper from me seem like the best idea ever. That’s kind of what introducing the hearth is like. Many potential solutions have been brought to the table when it comes to malnutrition. Women are used to occasional culinary demonstrations and to going to the health center to get some free porridge powder if their kids are moderately underweight. So this idea of organizing a program which requires them to come every single day and asks women to actively participate in the recuperation of their own children can be a bit of a hard sell, both for the women themselves and for the health workers who strongly doubt the motivation of women to participate.

That is why, when it comes down to it, my job seems to be as much about community organizing and mobilization as it is about public health. Sure, I am focused on nutritional education, but half of what I do seems to be trying to motivate people to come together, to open parent’s eyes to a new way of looking at the health of their children—to see that it is, in fact, in their hands. This has turned out to be somewhat of a messy process at times. I have had hearth groups where everyone got along, the dynamic was great, and we spent two fulfilling weeks together and I still keep in touch with the mothers. On the other hand, I’ve also had groups that I have had to end after 4 or 5 days because the women simply stopped coming, and there seemed to be no ‘group dynamic’ to speak of. The successes keep me going, of course, but the failures have at times made me question my efforts at being Mother Teresa. I consider myself a very patient person, and I pride myself on getting to know the women on an individual basis, but to put in all the effort and find participation lagging after just a few days can be discouraging to even the most idealistic person.

I wrote in a previous post about the challenges and rewards of investing in people rather than handing out Band-aid solutions, and in the end I still believe highly in the value of engaging the community in creating its own solutions. Those challenges are still there. I still feel like the cheerleader trying to drum up support for something new, not always knowing if people will go along with it or will just think that she’s crazy. At the same time, there are some great moments. My former-participant-turned-friend, Awa Zorome,has returned to help me with the hearth sessions, and few things make me happier than seeing her deliver the message that she’s learned to other mothers. She has even brought a few of her neighbor friends over to my house so that we could cook together. And that, more than anything else, makes me take heart that somehow, someway, the message resonates, one person passes it on, and change does percolate in the community in this (slow, imperfect) way.

Mali and Burkina have indeed shown me how little I know, how few clear answers I have. But I’ve also learned that this is not necessarily bad; sometimes it IS better to come to the table empty handed, to turn things around and to say to people used to being the receivers of help, ‘What do YOU have to teach me?” The value is not in my coming here to simply tell women what they should or should not be feeding their kids; nor is it in my handing out bowls of enriched porridge that I myself have prepared. Rather, the value of my time is found in the exchange, in the preparation and sharing (both literal and proverbial) of a communal meal, of helping one woman at a time see that the tools they need to assure that their children grow up healthy and strong are well within their reach.

The most beautiful moment as a volunteer implementing the hearth is the moment you realize that the program is no longer about you at all—that you have become secondary to the women from the community, who have risen up naturally to lead the process of change. I’m not sure I’ve had one extraordinary moment like this, but I am beginning to see, in small ways, the ripple effect occurring, to see a few women taking the reins, sharing information more and more, establishing a dialogue about nutrition and coming up with some of their own answers. And it’s a beautiful thing.

I may not hold the be-all, end-all answer to any problem. I don’t need to, I’ve learned; I may not know, and you may not know, but when we come together we realize that we know more than we thought we did and can do more than we thought we could. And that realization is the beginning of something very good.

Six months in: Thoughts on work

First things first: my apologies to everyone for having abandoned this blog for awhile. I don’t really have much excuse, considering I can can charge my computer and have regular Internet access. I always say that I really want to capture my experiences in a systematic and regular way. Turns out I’m not so good at the regularity part. But, the good news is that I have managed to keep myself reasonably in Solenzo in the months since my last post, and despite setbacks am still truckin’. And as I’m almost at the halfway mark (!!!) I thought now would be a fitting time to reassure everyone that I’m still alive and kicking, six months in.

 

So today, I wanted to talk a little bit more about what it is, exactly, that I’m working on here in Burkina. My title is officially “Child Malnutrition Specialist,” but like most Peace Corps assignments it’s been largely up to me to define what that actually means. The assignment was developed in response to a major health problem in Burkina: estimated prevalence of acute malnutrition in child under 5 in my region, the Boucle de Mouhoun, was about 13% in 2011. The local Centres d’Education et de Rehabilitation Nutritionelles (CRENs) were developed as a direct response to this persistent health issue. They have done a great deal to ensure that children with severe acute malnutrition receive the special dietary regime and specific care that they need to recover. However, the CREN staff is largely focused on dealing with the relatively small numbers of children with advanced states of malnutrition; many more children in the earlier or moderate stages of malnutrition remain at home in their communities receiving no care or follow-up whatsoever; sometimes their families don’t even recognize their state of malnutrition, especially since many do not take their children regularly to be weighed (once a month for the first year is recommended for all children, but few mothers actually stick to this schedule).

 

While nutritional supplements and weekly follow-up do exist for moderate cases at the local community health centers, adherence to these regimes is often shaky, and the response is weak in terms of actual behavior-change; mothers show up weekly for weighing and to receive rations of porridge powder and/or “chocolat” (the local name for the special enriched peanut butter, Plumpy Nut, that helps kids gain weight); but there is not, as far as I have seen, a great attempt to help them understand the principles of better nutrition and how to sustain the gains their children have made once they have stabilized and are no longer eligible for rations. I sometimes wonder, as I see mothers arguing with health workers about whether their kids need more ‘chocolat.’ whether the whole system sometimes actually discourages mothers from adopting positive nutrition practices. These supplements save many lives, to be sure, but they were never intended as a permanent solution, and yet there are mothers coming back week after week hoping, sometimes expecting, more, even when their children have moved back into the green. Not to mention all the well-nourished siblings getting part of the rations intended for their sick brothers and sisters.

 

Suffice it to say, this approach helps deal with the immediate problem of malnutrition but doesn’t really work as a long-term solution, especially when the community as a whole is not really being engaged. The women of the community once again become passive receptors of help rather than potential agents of change; it is connected to the broader mentality that sometimes develops when international aid dominates a particular sector. That is, how can the outsiders help us? Rather than, what is within our power to do to make positive changes?

 

End rant; at th heart of the matter, the question for me is: what is a Peace Corps volunteer to do about all this? how does one build a community response around an issue that has been dominated by outsider-imposed solutions? Well, the thinking goes, one could start by finding the positive practices, capitalizing on them, and training ordinary women to use these practices themselves and then disseminate them, thus becoming positive models. Voila! Change happens, and a ripple effect begins. That’s the premise behind the whole Hearth (in French, Foyer d’Apprentissage et de Rehabilitation Nutritionelle, or FARN) model. I think of it, in American terms, as a sort of Nutrition Boot Camp. Get a group of women with malnourished kids together. Have them meet every day for 12 days to prepare a healthy, enriched, and accessible recipe utilizing local ingredients. Monitor the kids throughout the process and highlight positive changes in weight, health, or energy. Follow-up with the group within one month by individually visiting each mother, to reinforce the messages they learned and troubleshoot problems. And then, hopefully, use these mothers as educators for future groups of women. That’s the essence of FARN, and it’s a process I’ve now been through twice, stumbling and making changes along the way.

 

While the idea is relatively simple, implementation is complex in ways I didn’t anticipate, and that has required some adaptation on my part. For example, the original Hearth model calls for a “Maman Lumiere” or designated mother who is a positive example for the others. While having a local woman lead the process makes perfect sense from a capacity building standpoint, I’ve found here resistance to the idea that one woman should be held up as a golden example for her peers; she is likely to shy away from such a designation, given the culture. Thus, I’ve found it more appropriate to highlight positive behaviors that I’ve observed mothers engaging in, rather than focusing on the mothers themselves. I don’t have designated Maman Lumieres, but have been using health workers to help me with my messages, and hope to incorporate some of the mothers who have now been through the FARN to become teachers for the others—without calling what would certainly be construed as unwelcome attention to them.

 

Second implementation challenge? Attendance and buy-in of the program by the women, especially since it is intended to be done over the course of two weeks, and women are required to contribute ingredients for the daily meal. In a perfect world (and in the official FARN manual), the process calls for initially visiting each potential mother, explaining the program getting the agreement of both her and her husband, and setting things up with everyone on the same page. In reality, as it is often only me doing the recruiting and as I don’t have a great deal of support in implementation from health center personnel (I’m hoping this is starting to change as more FARNs get under way), such detailed coordination of everything beforehand is not feasible. The best I can do is identify the women we want to target, explain the model with those that show up, and hope that of these, a significant number will see things through to the end. A number of practicalities get in the way from a perfectly-unfolding FARN. Some women bike significant distances, and lose interest after a few days for this reason. Some women’s children inevitably fall sick and miss a handful of days. Others are resistant to the request for ingredients and others only bring corn or millet but no protein ingredients. Still others just seem to show up when they want to, frustrating the others who have managed to make it to all or most of the sessions. And some of the women who are the best participants have children who are not malnourished at all- which brings up the question whether rehabilitation or education is the primary goal of the model. I hesitate to discourage any eager, committed mother, from participating, regardless of the nutritional status of her child. In practice, in a program that requires buy in and relies on the willingness of mothers to be active learners, I am hard pressed to refuse anyone who seems even somewhat motivated.

 

So yes, challenges abound. Probably the one I struggle with most now: health personnel understanding, buy-in, and willingness to make good use of the model. The general mentality of the public health system here is quantity over quality—personnel tend to want to draw large groups to share and disseminate health information, an approach that gives them impressive numbers for monthly reports, but requires very little meaningful personal contact, evaluation of impact or follow-up to see if anyone has absorbed or utilized the message. While there is certainly a role to be played for mass or large-group communication in health, the Hearth/FARN is all about focusing intensely on a small, very manageable group of no more than 10-12, and giving these women the individualized attention they are probably not used to receiving from the health care system. Women are always so surprised when I show up at their compounds for follow-up visits, and sit with them for an hour or more; the quality over quantity approach goes against common practice here. While this is a positive thing, the model is harder to introduce to health personnel for that reason. I often get a reaction from health workers that runs along the lines of, “wow, sounds great. As long as you’re here to do it, because we don’t have time/money/moto gas to do it.” The key phrase being, “as long as you’re here to do it.” This is the one sentence I hope I won’t hear at all by the end of my time in Burkina, but the truth is, I see it as a continual struggle; personnel motivation, and not the motivation of the women participants, has been my single biggest obstacle in implementing the FARN. As word build about the previous FARNs and word of mouth gets out about “my program,” I hope it will shift to becoming not my program at all, but a great potential tool to be used by various health structures in the district. I have no illusions, however, that this shift will happen easily. I’m almost at 6 months, and I’m just now starting to feel like I’m turning that corner where I find my flow work-wise. I’m still doing a lot of cheerleading to move things along little by little, a great deal of effort for results that are not quick to become apparent.

 

This blog was not meant as a litany of complaints about all the obstacles and frustrations I’ve faced in work; I really believe in the FARN as a potential force for positive change as far as nutrition is concerned. In fact, it is my interactions with the women, hearing them tell me themselves what they have learned and what they will change, that energizes me, that reassures me that somehow, all this effort I’m making, all the figurative arm-waving I’m doing and enthusiasm I’m trying to build, will end up being positive in some way. Still, I’ve committed myself to being honest with myself and with others about my experiences—successes and failures. And I have a long way to go before I feel like I’ve achieved any veritable success in Solenzo—I’m not sure, at the end, what I will even define as having been “successful.” If I do 20 FARN groups and engage 200 women in nutritional rehabilitation, is that success, even if no one will continue it upon my departure? Or is it more important that I focus on getting staff trained in how to implement the model, whether they will actually use it or not? These are issues I struggle with.

 

I bring up these questions only to highlight that no change, no matter how small, is achieved without some setbacks in this context. Doing this work, more than technical or language skill or cross-cultural competency, requires epic patience and a high tolerance for the million and one frustrations that you are bound to face daily. But if you can ride it all out, the rewards seem to come when you least expect, and most need, them. One of the women in my first FARN, Sandrine, told me on her 1-month home visit, pride in her voice, that she had been making enriched porridge regularly and she thought her daughter was eating more and had more energy, despite the fact that she had been one of the slower children in the group to gain weight. Hearing these things, and seeing how proud she was of the change, I could only think, yes. This is why I’m here. This is what I came to do. I live for moments like these.

 

And I hope the next six months will bring me more.

Chipping away

On several occasions in Mali, I wrote about encounters I had with deaths that should never have happened—women and children perished from malnutrition, anemia, childbirth complications–diseases that, had they grown up elsewhere than in one of the poorest countries in the entire world, they would never worry about encountering, or at least would never die from. Burkina is really no different from Mali, in that sense. The child mortality rate is just as staggering, if not more so, than Mali’s; an absurd number of women still perish from childbirth.

Needless to say, one develops something of a thicker skin after being constantly exposed to such circumstances. It’s not that each loss that you encounter matters any less, but you realize that breaking down every time not only takes a lot more emotional energy than you have saved up, it also goes completely against the coping style in this culture, which is to keep a stiff upper lip and more or less deal with your sorrows outside of the the public eye. And so I have tried, to the extent that I can, to avoid internalizing the deaths around me. But events often make this difficult.

Mariam was older than most of the children coming through the malnutrition unit, at 5 years old. She had been at the district hospital for nearly a month; her progress had been one-step-forward, -two-steps-back from the start, gaining weight for a few days in a row before falling backwards. She suffered from severe kwashiorkor, a form of malnutrition defined specifically by protein deficiency. Kwash is more complicated than other forms of malnutrition to treat, and there are often complications and diminished function of various body systems as the child’s condition deteriorates. The very fact that Mariam had been at the CREN for so long was a testament to how challenging this condition can be.

We were all worried about her—she had been bouncing back and forth between pediatrics and the CREN, with a bout of severe malaria and another of diarrhea. Still, there was reason for hope. The edema (swelling) of her feet and legs, caused by kwash, had started to go down, and she seemed marginally more active and cried slightly less than she had at first. Often in malnutrition cases, significant amounts of progress can be made after a period of decline, so no one really saw it coming when we arrived one morning to discover that we’d lost Mariam overnight.

Mariam’s mother’s emotion didn’t seem to register on her face as she told me this; she was more or less expressionless., which is why at first I thought perhaps I had misunderstood her when she said softly, Awa, a banna. She died. But then I saw Mariam’s father and some other men from her village who had come to collect her things, and it was clear that, tragically, I hadn’t misunderstood. She was gone. At five years old. Of a slowly progressing, often reversible disease that was just too advanced this time. The two nurses helped Mariam’s family gather their belongings, and as they left the hospital we all sat on the front lawn of the CREN in total silence. Each of us, perhaps, processing things. I can’t speak for them, but I know for myself I could only think: what a shame, what a waste. And then: how can things change? Is it a question simply of knowledge? Or of an underlying attitude? Did Mariam’s parents realize the severity of her illness? And if they did, what delayed their seeking treatment? It felt like the day in Mali when I lost Hamale, all over again.

Coming as I do from a place where the death of any child under any circumstances would be considered a very unusual tragedy, it can be hard sometimes to fathom what seems to be complacency, or at least apathy, surrounding preventable disease and death in places like West Africa. And for health workers, tasked with trying to convince people to adopt healthier behaviors, it’s a particular dilemma because such an environment can breed fatalism, the attitude that there is nothing that one can do except to accept the fate the universe has bestowed upon him. People are not actors in this mindset; they don’ t shape their own futures; God or some other greater universal power does. And while the belief that God ultimately controls things and leads those who die to a happier place sustains and comforts millions in the western world just as it does here, we also have a much stronger safety net in terms of health services, and it is a blessedly rare occasion when we are forced to invoke God’s will as an explanation for an untimely death. In Burkina, it’s a saying most people are all too familiar with. “Allah m’a son,” It wasn’t God’s will. While the need for some comforting or pacifying adage at a death seems to be a universal human need, that little phrase often makes me wonder how often people really internalize the idea that there is nothing they could do to avoid such tragic circumstances. If there is a great and wise higher power who keeps order in the universe, and I personally do believe that there is, that doesn’t absolve the responsibility of humans to make decisions to the best of our knowledge ad ability that will keep us healthy and living.

No problem is ever a matter of one simple factor, though. Changing people’s attitudes and orienting them towards prevention can be powerful, but it won’t do much for a family whose money has run out and whose remaining harvest has to be stretched out over several months so that they won’t starve. For the entire village stricken with drought and barely surviving off of international assistance in the form of food aid. For the woman in a powerless marriage whose husband doesn’t accept her using birth control to avoid a fifth or tenth or fifteenth pregnancy.

Basically, Stuff happens. And here, potentially devastating “Stuff,” from famine to war and civil strife to a host of dangerous tropical diseases, is just plain more frequent. These are realities. To deny them, to assert that a better standard of living and better health would be immediately available if people would just change their mentality, would only serve to demonstrate the privileged and elevated position from which such an observation must come. It reminds me of the debate over welfare reform in the 90s, when some were yelling that if women on welfare would just go and get jobs and stop getting in trouble all of their problems would be over and they wouldn’t be in poverty (completely ignoring the issues of inadequate minimum wages, the economic and social isolation of poor communities, biases in the criminal justice system…). Such a stance is irresponsible and serves to undermine the complexity of such issues as poverty and the societal distribution of wealth.

I’m meandering a bit, but my point is that during my time here I have often struggled to reconcile what appears on the surface to be apathetic or fatalistic behavior that leads to unnecessary illness and death, with conditions that have much more to do with global economies, power dynamics and other factors well outside the realm of influence of your average rural Burkinabe and his family. And as a health educator, of course the irony doesn’t escape me when I’m talking to families about supplying a rich and varied diet during the rainy season, when people are lucky to scrape by eating millet three times a day until the next harvest rolls in.

Yet I know that there are some factors people can and do control—which is why there are also children in the same town who are healthy, well-fed, and without problems. The best I can hope for it to maybe enlighten people, one by one, on the things they can change. The whole question of system overhaul is much, much bigger than me. So I’ll deal with this gigantic problem in the only way I really know how: chipping away at it, piece by piece, person by person. As I said in another entry last year, if I can change one person’s mind…it’s something.

I don’t know and can never say whether changing the minds of Mariam’s parents would have changed her fate. Whether knowing she was ill earlier would have made them act sooner, or whether being able to identify high protein foods would have meant they gave her more high protein foods and thus avoided her illness entirely. The gap between knowledge and behavior is often a quagmire in public health, as the struggle to promote condom usage despite widespread knowledge of HIV transmission (or, in the States, the continued prevalence of high-fat diets despite awareness of obesity as a huge problem) shows.

No one has come up with the perfect answer, and it would be foolish and extremely naive of me to expect that in a 12 month assignment I, the lone foreigner with my generalist degree and all my great intentions, would be able overhaul something as complex as the behaviors and attitudes surrounding nutrition. But, I do believe that once we are able to get some hearth projects going, to work with women on feeding their children with foods that are nutritious and, even more importantly, available to them– we can make a difference with small groups of women, and maybe those women will share with others—and ripples of modest but real change can then start within a community.

As long as there are still Mariams (and there are still far, far too many), there is still work that needs to be done. And for all the frustrations, I’m still glad to be here, in this country of open, generous and hard-working people, chipping away.

Starting over

June 4, 2012

Looking down the incredibly congested, terribly dusty road through Ouagadougou’s Zone du Bois neighborhood feels an awful lot like standing in the middle of downtown Bamako. The chaos. The fine Ouagalais ladies dressed in florescent bazan and full head wraps, sweat already pouring down in the 95-degree early morning. The rude moto drivers who pass within an inch of you without so much as a cry of warning. Vendor ladies selling gateaux and even children yelling, ‘tubabu, tubabu.’ Except this time, I know enough to chase them down and scare them until they run laughing down the street; I know to greet brightly as I pass, though not everyone speaks Dioula/Bambara and so I have to fall back on French.

So it’s not starting over…not completely. Burkina feels, in all the fundamental, important ways, much like Mali. A kindness and openness, vibrant culture, a certain bond over having little and sharing much. And yet, as this first two weeks has shown me, I am embarking on a different kind of adventure—and with the benefit of hindsight, perspective and having “been there, done that,” I am seeing even things that seem familiar to me with fresh eyes.

I arrived last Sunday evening and began my fully packed training the Tuesday after Memorial Day. A lot of administrative procedures and background information were involved as in my first Pre-Service training, although this is much more streamlined—just under two weeks start to finish. Much of my training time has been focused on brushing up on language (getting my French up to speed to work in a professional environment, while also reviewing Dioula, which is essentially the same as the Bambara I spoke in Mali, with a few slight differences) and technical training related to my assignment. I visited several CRENs (Centre de Recuperation et Education Nutritionelle) here in Ouaga to see the type of work they do. We visited two sparkling, bustling CRENs, one run by nuns and the other with large funding from the Protestant church (neither of which, I realized, is much like what I saw at my own CREN, at the state-run district hospital…but I’ll get to that); we observed everything from the mixing of the special UNICEF fortified milk they feed inpatient, severely malnourished babies, to the the education sessions they held for the mothers as they fed their babies spoonful by spoonful, to the pediatric unit which provides backup and treatment for ailments that often accompany malnutrition. I wrapped up the week with some more theory on the Positive Deviance Model for treating moderately (not severely) malnourished children at the community level. This model will be an important part of my assignment, as I’ll be tasked with training community leaders in how to implement a Positive Deviance program in villages.

The brief, two week introduction to everything was actually a relief to me—as any PCVs know, Pre-Service training is not an experience one necessarily wants to repeat, as important as it is. I got enough of an orientation to get to know the need-to-know people at the Peace Corps office, understand the most important aspects of Burkinabe culture, and get a better sense of what I’m here to do. I also had the chance to visit my site, which is at least a 6-7 hour ride from Ouaga under the best of circumstances (ie, Peace Corps vehicles) and much longer on public transport. As a site it’s quite different from Marena, and I’m honestly glad for the change. In a way I felt it would be difficult to be assigned to another small village with a similar dynamic when my heart still aches for the one I left behind.

Solenzo is in fact not really a village at all, but a moderately-sized town, complete with a daily market, several schools, mosques, churches and radio stations, and of course the district reference hospital out of which I’ll be working. The hospital takes care of referrals from some 32 community health centers in the district, does surgeries, and handles high-risk deliveries (Multiples, Ceasareans) at the reference maternity. It is also home to the department in which I will be working, the CREN.

The CREN is where mothers with severely malnourished babies are taken in, after paying a flat fee of around $14, to stay for as long as it takes the kids to recover. This could be weeks, or it could be months, but they are not discharged until they have reached at least the 85^th percentile of weight-to-height ratio. The babies and mothers are provided with beds to sleep in and all of their meals, which are specially planned to be very rich in nutrients and adapted to the child’s current state of malnutrition, so as to slowly bring them back to health and avoid overloading their systems, which can kill a seriously malnourished child. The children undergo daily weighings and medical evaluations; they receive systematic treatment for vitamin deficiencies, bacterial and fungal infections, and malaria. The mothers are required to help prepare meals and are engaged in regular education sessions with the hope that their children will sustain the intensive progress they’ve made in weight gain when they are discharged.

Those are the basic services of all CRENs, but the nuts and bolts obviously vary from place to place and depending on funding and resources. My CREN consists of two small buildings, one the dormitory for the mothers and children, the other for food storage and an office/exam room; and a hangar where the mothers prepare the meals. The entire place is, generally, the worse for wear; furnishings are sparse and, compared to the open, clean, bright facilities we visited in Ouaga, the differences in resources available in the capital versus the far-flung provinces become very apparent. (But that is a whole different blog entry….). In any case, however, its clear that the CREN serves an important need for a small number of kids who are barely hanging onto life. It is also, en principe at least, supposed to be at the center of efforts to address moderate malnutrition by educating communities, and that is where most of my role will come in.

This is what I know about what I’ll be doing as of right now, and it seems like I will be able to build nicely on my experience working at the primary, community level in Mali. I’ll at least theoretically be working more from an organizational standpoint, thinking about strategy and work plans at a slightly more macro level, but I’ll still be able to be in the field most, which I find the most satisfying. And like Mali, although the roads to anywhere are never straight or smooth, I have a feeling this journey through the “land of upright people” is going to be interesting in its own right.

Moving forward

 ”The most difficult challenge is leaving.” –Peace Corps advertisement

As most of you probably know, I’ve spent the past several weeks in America, since we were abruptly pulled from Mali following the coup d’etat there. And these weeks have been an emotional tug of war for me, showing me how much I’ve changed and how some things never do. America definitely was a shock to the system, especially since I never actually left Mali during my nearly two years there. The food is fabulous, my feet and body are amazingly clean and free of dirt, and the hot showers twice a day are fantastic. Family, friends and former colleagues have been warm and embracing, ever generous with their time and couches, and curious about my experiences. It struck me how you can be gone for a large amount of time, come back and life will be exactly as it was when you left it—in some ways that is comforting. There is always something to come home to.

The sadness about Mali still lingers, though. At the transition conference, during our somewhat weepy group counseling session, one of the PC people compared being pulled from Mali to losing your first love—the separation may be necessary, but it hurts like hell, and you will forever compare subsequent experiences to it. That is, as it turns out, an extremely apt description of the emotional tangle that is re-entry under such unforeseen circumstances. I went downtown to go shopping, and aside from being blown away by how excessive our choices in America seem, it hit me that no one greeted me, nobody said good morning, how is your health; there was hardly a glance in my direction on public transport, nor were any random conversations struck up with strangers. I find myself thinking about Mali throughout the day, wondering how my villagers are doing, looking up the latest Mali news. I’ve been in sporadic contact with various friends still in Mali, including my host family, who have assured me that while the situation may be deteriorating on a macro level, things in village are still totally quiet and safe, and life has plodded along as normal. Being plucked out of the life you’d finally gotten used to is jarring, and having to watch from the sidelines with what the country is going through is agonizing.

But, as they say, you’ve gotta keep pushin’ on. And I soon will be. While in Ghana for the transition I interviewed with Peace Corps Response, a program that sends returned PCVs out on shorter term assignments responding to very specific needs. I’m starting a new assignment May 26 in Burkina Faso. Most people don’t have a clue where that is—it’s east of Mali and north of Ghana in West Africa, a small, landlocked country culturally and climactically quite similar in many ways to Mali. The assignment is for 12 months and I will still be working in health, but with a more specialized focus on child malnutrition and training community health workers on malnutrition issues. While I still feel I have “lost my first love,” I am looking forward to this new adventure, to getting more specialized experience, to improving my French, and to getting to know a new country and new people. I won’t get to do the third year in Mali that I very much wanted, but if things calm down enough, I may even be able to visit, and I am grateful for the opportunity to continue my service, albeit in a different place. I’m doing something of a crash course in Burkina, so as I learn more about this country I’ll post!

To everyone who reads this blog regularly, thanks for all your continued interest in my experiences in Mali, and more importantly, ce n’est pas le fin! Stay with me as I explore this new place!  My contact info is the same and I hope to be in touch with many of you in the coming months.

Nobody said it was easy (but no one ever said it would be so hard)

I get the phone call on Tuesday morning, a pre-natal consultation day. Kandia is still on maternity leave and so we the pharmacist and I are tag-teaming it, trying to get through the 10 or so women waiting for consultations at something like a normal pace. The call is from my regional coordinator—we are being instructed to pack our bags and go to Bamako tomorrow, leaving an inventory list at home of things we can’t take with us. This can’t be good, I know. And still, it’s not real to me. I continue with consultations and don’t mention even a word of what I’ve just learned to my co-workers. As if saying it out loud would make it more concrete and thus more painful. As if by continuing on as normal in what I believed could well be the last day in my village would make things easier to deal with.

I go to the market, like I always do on Tuesdays, and I have the temptation to stop and to sit with each individual woman I’ve gotten to know, over the past year and seven months, even those who I’ve only known from the weekly market greeting. Fanta the macaroni lady is there, as is Rokia who sells fried cakes, and Tierno is calling me for a round of tea. They can see something in my face, can probably read that something is unsettling me, but so far I’m still composed. I go through the greetings, how is your mother, how is your father, your kids, your health, your husband. All the normal functions occur, while the only thought my head seems to have room for is, what if this really IS it? What if this is my last chance to see, love, capture this place and these people in my heart? I can’t bear to think of it, and yet it won’t leave me alone.

I find myself going through a blur of motions that afternoon, making the rounds, to the health center, my host family’s, to Fatoumata’s, to Sambou’s. I try to maintain a smile as I give the carefully laid out explanation: All Peace Corps volunteers have to leave sites and go to Bamako tomorrow. When are you coming back? I don’t know. But you are coming back? I pray to return, but I just don’t know. Don’t you think you’re safe here? Yes, yes, yes, this is the safest place in the world for me, here with people who know me and care for me. But can’t you see? This is not my choice. I find myself saying that over and over again. Not my decision. Not my choice. Back at my house, I try and get my mind in order, try and collect the things I need and make decisions about what to give to other people. I do all of this to keep myself from falling apart. If I keep moving, I reason, if I keep having things that need doing, I might be able to postpone that moment of reckoning, the rising tide of sadness I keep pushing away and forcing down.

6:30 rolls around. I need to leave so that I can arrive in Manantali before dark. I know this, and yet, find myself sitting in my yard, with my hut locked up and my bags packed, staring out at the sunset starting, the soft shadows that settle on the cliffs behind my house at this most glorious time of the day, everything bathed in a glowy, pinkish light. Sometimes running on the main road through my village just before dusk, I’d have to stop and just take it all in, the jagged, stately rock formations, covered in mossy green when the rains came but now, in dry season, softly golden in the late evening sunlight. My beautiful home.

My host father Famakan comes by to take my bags ahead of me to Manantali. And behind him are all the women of Sekoya—the women of my host family. My host mom is leading, but Bah, Luntandi, Safi, Morike, Mariyamu, Djoncounda and Ouending are all behind her, toting babies with toddlers close behind. Famakan has clearly told them that I may be leaving for good, and they’ve come to say what may perhaps be final goodbyes.

Seeing this sad procession, the inevitable happens: the tears start to flow. Knowing as I do how supremely awkward crying can be for Malians and how they tend not to know how to react or what to do about tears, I try to choke my own back, but fight a losing battle as I look at the faces around me for what may be the last time in a long while. Safi, about my age and always one more prone to emotion, is quick to follow. My host mom looks at me slightly scoldingly. Stop that crying, she says. You’re giving yourself a headache. She is going on and on on the headache bit and meanwhile the rest of the women in the family have fallen into tears too—quiet ones that they quickly wipe away, but tears just the same. Soon, even she has joined in, and we are all just one big, quietly sobbing mess. And it’s time for me to go, darkness is descending. I take the left hands of each of the women—in Mali taking the left hand means that we may not see one another again for a long while—murmur my blessings, say my “amiina’s,” try not to dissolve right there, in front of these strong women who have taken such good care of me, in front of the growing crowd of concerned villagers.

Im on the path leadiing to Manantali now, but one of the hardest goodbyes is yet to come. My work partner and my friend, Sambou, is there to meet me on the side of the road, one year old Bakary asleep soundly on her back. This is the woman who, though she never saw the inside of a schoolhouse until her 30s and could not read or write at all until last year, represented all I loved about this country. She taught me everything important about Malian culture : a generous spirit, warmth of heart, an acceptance of oneself and others, openness, unsurpassed kindness. She wasn’t even officially assigned to be my work partner, but we simply enjoyed collaborating, whether it was on outreach in neighboring villages or just bouncing around ideas about health ,education and development. When I think of Mali, ultimately I will think of sitting under the stars on a woven mat at Sambou’s with her kids around me, all of us looking at the sky, me thinking of the bigness of the world and my good fortune to be here in this little corner of it, with people I could genuinely call friends.

And now, this woman I have come to call friend, is here in front of me, eyes fixed on the bags strapped to the back of my bike. She utters blessings, not looking at me; I give the responses, trying not to look at her for fear of my own sadness becoming apparent; but then, we do look at each other and we are both crying and I just can’t take it. She has my hand and then I am pedaling away, both of us wracked with a sudden realization of the finality of the situation. I am crying, Sambou is crying, the girls who have gathered by the side of the road are all in tears and all I can do is keep moving. She is still blessing me for as long as I can hear her down the road, yelling at Allah through her tears to give me a safe trip, to protect me and my family from danger, to make it easier for us to see each other again.

I’m pedaling faster and faster, the scene of the village I love fading behind me, replaced by the now-barren peanut fields, grassy hills and savanna-esque trees that dot the landscape now familiar to me. As the tears start to slow I’m able to take it all in: the mango trees that would have been ripe within a few weeks, until we’d be eating mangoes with breakfast, lunch and dinner; the gigantic baobab tree outside of Tintila that I had always meant to sit under for an afternoon, but never did; the donkey carts plodding along the road toting six or seven children; colorful market women coming back from a long day of selling their wares in Manantali. The chorus of adorable kids that meet me on the road in Tintila, every single time, running after my bike and calling “Awa” until they are out of breath and can’t keep up anymore. The place in Nantela where I caught a rickety, slightly-leaking wooden boat to cross the calm, blue-green Bafing many early mornings. My legs keep pedaling, even as the red-orange dust of the road coats the bottom of my too-long pants, even as my head pounds from the crying and the effort of taking in the events of this day, and of the past two weeks.

I know my villagers will all be okay. Malians are good at that whole being okay thing. They’ve done it for thousands of years of famines, regime changes and various uncertainties, and life will doubtless plod along for them as it always has. As for me? I’ll be fine. But no other place will ever mean as much to me, no other place I might reside will ever be as much my second home, as this place. Ebora e ka so, e nana e ka so, the Bambara say. You left your home, and you came to your home. And it’s so true. These people may have no reason to take you, the complete stranger, at face value, to let you into their lives and homes and families, but they do, and they do so because they believe that no one can be a stranger for long. When I have prepared tea for you and invited you to sit with me at my home and we have conversed, you are no longer a stranger, but my friend. And in a place of so little, the bonds of friendship, of adopted familyhood, are the most treasured of all gifts.

There’s another saying that goes, “If you enter into a village and you say you have no father, it is because you have not yet taken someone in the village as your father.”And, I would add, once you do, you’ll find that you’ve acquired a family for life, and across miles and oceans. Anyone would be tremendously blessed to have such a chance. I have. And I will be forever grateful. I’ll cry my tears and then they’ll dry and, like the Malians I know and love, I too will move on. But I’ll never forget.

I’ll end this the way Mali taught me any proper conversation must always be ended: with blessings.

Ala ka Mali deme, Ala ka Marena mogow deme, Ala ka nogon ye nogoya, Ala k’an ka teriya tanga, Ala ka’an bee segin here la. Amiina.

May God help Mali, help Marena. May God allow us to see one another again. May God protect and keep our friendship. May God return us all to peace. Amen.

 

 

 

 

Every Child Deserves a Fifth Birthday…Part I (a primer)

Every Child Deserves a Fifth Birthday

April is Malaria Awareness month, and Peace Corps volunteers across Africa from Mali to Zambia to Kenya are working to build consciousness of what remains one of the continent’s most pressing health problems and one of the most deadly killers of children, especially those under five years old. When Westerners think of malaria, they might think of a scary illness that occasionally befalls the unfortunate traveler, the disease that killed off many a malevolent colonialist or foolhardy explorer, or an ancient disease of the deepest swamps and river valleys of Africa. In all cases, it is something far from their realities. And whatever the narrative may be, it tends to ignore those who truly suffer: young children and babies, who in various eco-zones and climates across the continent are at great risk of contracting a disease which, aggravated as it often is by malnutrition, poverty and lack of access to quick medical care, can quickly kill them. And because these children are our host brothers and sisters, our neighbors’ kids and our little buddies in village, because we come to know them, the suffering malaria causes becomes real to Peace Corps volunteers in a way it rarely does for other foreigners. Which makes the lack of understanding and awareness an all the more pressing issue.

And what a pressing issue it is. “Le palu” or sumaya as it is more widely known in Bambara, is the number-one cause of morbidity and mortality in Mali, according to the President’s Malaria Initiative. One-hundred percent of the population is considered to be at risk of developing malaria. And nearly half (45%) of visits to local health centers by children under 5 were estimated to be malaria-related. All told, USAID estimated that one in five children in Mali die before their fifth birthday—because of this single disease. In effect, 20% of the under five population is at risk of death each year due to a preventable illness.

To be sure, these are all startling statistics, but what affects me most is having seen firsthand the toll malaria takes on actual communities here. I work at the local health center, and starting in June of each year—the beginning of the rains and thus a time for mosquito proliferation—we will see a sharp rise in consultations, and many of these will inevitably be young children. I’ve seen worried fathers and hysterical mothers, holding the hands of their feverish or even convulsing children as a doctor hooks up the IV, already wondering if it may be too late. Already-malnourished kids with severe anemia, exacerbated by malaria, who are too weak to walk home after their treatment and have to be be biked home by their siblings. Even generally healthy, able-bodied adults—my good friend and homologue included–who are incapacitated for days by the illness, alternately shivering and sweating profusely while their family members are forced to take on the extra burden of the work they are unable to do, in the fields and at home. Even when it does not kill, malaria has a huge impact on the quality of life in a country where it is so widespread, causing sometimes very serious acute illness even in healthy individuals, exacerbating such conditions as malnutrition and anemia , and creating a greater burden and demand for treatment than can necessarily always be met by the rural health centers.

What are we doing to stop this killer? Prevention is a major focus of anti-malaria efforts. Mosquitoes have been with us for eons, and will be for eons more. It’s not possible to completely eliminate them, but there are certain environmental factors that we can change to reduce the mosquito population and thus the risk of being bitten and getting malaria (in public health terminology we’d say “vector control.”) Key aspects of vector control include insecticide spraying inside compounds and eliminating areas where water can accumulate and stagnate, allowing mosquito larvae to proliferate. (this last technique has been called into question recently as to how much it actually reduces the mosquito population, but is nonetheless an important hygienic practice and thus still promoted). The fewer mosquitoes, the logic goes, the fewer bites and the less malaria we’ll eventually see.

Beyond vector control, Ministries of Health in African countries are tasked with motivating people to do what they can to prevent being bitten. Such strategies include wearing long sleeved clothing and long pants during evening, peak mosquito hours, and the usage of anti-mosquito body creams or sprays. These have had some success in rural areas when they incorporate natural, locally available ingredients such as neem tree leaves. But the main push has been towards getting every household to own and utilize insecticide-treated bed nets, which greatly reduce the number of bites during sleep, when most anopheles mosquitoes take the opportunity to feed. Insecticidal nets are given away for free to certain high-risk groups at the CSCom, particularly pregnant women, but are also occasionally distributed to villagers by NGOs. While many people report owning a net (and in practice I’ve seen that most houses have at least one), its actual use is often limited to mothers and small children, and even then during hot season many people say nets are uncomfortable and don’t use them consistently.

The final aspect of the prevention approach is targeting pregnant women, for whom malaria can be especially dangerous, as its high fevers can provoke miscarriages, difficulties during delivery, or exacerbate anemia. I help out each week with prenatal consultations, and each involves the woman taking three pills to help suppress the parasite so that she doesn’t become symptomatic and develop problems during the pregnancy (the parasite is in everyone’s blood here; there’s no “getting rid” of it so to speak, merely controlling it so that it doesn’t cause severe problems.) Each woman also gets a free mosquito net and counseling about the need to avoid being bitten as much as possible and to come to the clinic quickly if symptoms of malaria appear.

The other major question is one of access to treatment. While initiatives to get highly effective malaria treatments (Coartem) to isolated rural health centers have improved their availability, there have still been many occasions when the supply at my center has run short and parents have had to wait to get drugs for their children, who are rapidly becoming more ill. And rapid blood tests for malaria, which are able to confirm the presence of malaria parasites and thus identify with certainty the cause of the acute illness, which mimics many other illnesses, are often not available or not used. The strategy in a lot of rural health settings seems to be, when a child comes in with a high fever, with or without vomiting, diarrhea, chills or convulsions, he is assumed to be malarious and is treated accordingly.While this may be the safest approach given the resources available, there is now increased attention placed on performing rapid tests to confirm a diagnosis and thus ensure appropriate treatment and avoid unnecessary and treatment.

Malaria is a complex disease that has claimed the lives of people the world over—at one time, even in much of the developed world.– for centuries, and that’s not going to change quickly or easily for a country like Mali, struggling as it does to keep its people from starving and keep its children alive. But with increased awareness and education, we can make a dent—and maybe start to see small but positive behavioral changes slowly turn the tides in our communities. That is the whole idea behind Malaria Awareness month. And so, this April, we’re blogging about it, talking about it in our communities, and participating in whatever ways we can dream up. No one would argue with the assertion that a disease both so prevalent and so deadly deserves to be a major concern both for public health and, in a broader sense, social justice. This month is about translating that conviction into action, since we know and believe that every child, in every part of the world, should live to see their fifth birthday.

More malaria month blogs (Insha’allah) to come!

For more information on malaria month throughout Africa, visit: http://www.stompoutmalaria.org.

Coup Update

Last Thursday, mutineer soldiers overthrew the government and democratically-elected president of Mali, in response to various grievances against President Toure’s government, but particularly in response to his perceived inaction in helping regain control of Northern Mali from Tuareg rebels. Although the mutineers were lower-ranking soldiers and poorly-organized, they managed to capture several government ministers and drive the president into hiding. Doing so created a power vacuum and reports of some chaos especially in the capital, with a national curfew imposed, state media taken over, and scattered reports of looting and gunfire. (I’ve linked various articles giving the political background and other details about this conflict to my facebook page; I’ll spare you the nitty-gritty here). It all sounds a bit scary, and, once I had internet access, checking up on the BBC and the New York Times, the gravity of the situation became real.

But what did I know of this, and how much of it did I perceive of its severity, at home in my village, hundreds of miles (and seemingly much more) away from all the action? Actually….almost none. With the exception of my teacher neighbors who are devoted radio listeners, there was honestly scarcely a ripple of reaction on the part of villagers to the proclaimed coup d’etat. When I asked my homologue what she thought of what had happened with the President, she looked at me, puzzled, and asked what had happened. Meanwhile, amidst growing alarm on Radio France International and the BBC and a few worried phone calls from America (turns out Julie had heard more about the coup than I knew, listening on late-night NPR in Oregon), women went on pounding their millet and tending to their gardens just as they would any other day. We had a few cases at the CSCom Thursday, including a malaria case and a malnourished kid, and it wasn’t until close to noon that one of my co-workers even mentioned the coup. As an indication of how divorced my village life can feel from any political unrest or instability in the central government, no one with the exception of my host dad made any mention of what was going on in Bamako for the entire day. And to be honest, I forgot about it until my neighbors were arguing about it during their evening cup of tea. The whole rest of the world could crumble around them, it seems, and life in my village would just march on, people putting sugar in their tea and cooking tigedegena and grumbling about the increasing unavailability of phone credit at the local butiki. The village can be very insular in this way, although it is becoming somewhat less so with the advent of cell phones and more villagers traveling. Thus, even having heard about the coup, I had no way to guess how severe the repercussions might be, and no one else seemed to know, either.

In any case, the next day, volunteers were put on lockdown and told to await further word of what to do. Calling my host family and homologue and neighbors to let them know I had to be gone for awhile, the reaction was understanding—you go be safe, honey—but nonetheless, slightly puzzled. Do you think you’re not safe here, with us? Do you think someone would hurt you here? And the answer of course, is unequivocally no—I think in my village is probably one of the very safest places I could be—but it became clear that the situation was more serious than I could have guessed sitting in my neighbors’ compound listening for snippets of information from the BBC. So I had to go, and here we are.

All of the volunteers are safe, and we are all trying to stay abreast of what’s going on and waiting on word of when we can hopefully return to our sites—and the work we left behind. I feel bad, as there was supposed to be a polio vaccination campaign this week, the midwife is on maternity leave, and now there are only two people to handle it. But in keeping in touch with villagers, the overwhelming sentiment is one of wanting me to be safe, of understanding, and of the slightest hint of worry—when are you coming back? Meaning: You are coming back, right? To be honest, the reaction has been affirming—I know that people in my village really care about me, and want to be sure that I’m not leaving them. (I did promise two years, after all, and it’s only month 19).

For my part, prone as I am to overanalysis during stressful situations, I couldn’t help but venture to think about worst case scenarios—what if what if what if. Evacuation? Transfer? What if I had to leave without being able to thank Sambou and Mamu? How would Djeli feel if he came back for vacation only to hear that I’d skipped the country? What about my solar panel project and Kandia’s new baby and the radio show and my garden and Nyaraga’s upcoming wedding and…..and….? All of these thoughts took hold of me, to varying degrees, in the first day or so after the coup, when there was a fair share of confusion and a lot of worry.

Things have gotten a lot more clear, and calm, in the past few days. News is looking up; fears of counter-violence or other threats have remained largely unrealized, with major towns and now Bamako largely back into the daily grind; and while it’s not clear when we will be able to return to our activities, there is hope that returning to normalcy will be possible, although the longer-term effects of foreign aid pullout and this power vacuum are, of course, yet to be seen. Now, past the initial chaos of the coup and more or less stuck in place for the moment, PCVs are faced with the mundane: how to fill up the long hours of the day, how NOT to get sick of or kill each other by the time this is over. Cooking, lying in my new hammock,  watching endless episodes of Sex and the City and Skyping friends have been pleasant enough diversions, although there is no question that I’d rather be…home. In my village. With the people I’ve come to care about.

For now, I’m making the best of the situation, trying to catch up on various things I’ve been meaning to do, and I’m optimistic that we’ll move on from this and in fifty some odd years I will have a fascinating story for my grandchildren.

Why the Coulibalys eat beans…exclusively…all day long

I may have briefly alluded to the importance of family names in Mali previously in this blog, but it occurred to me that I haven’t given the topic much discussion. So I thought I would take an entry to explain a little about how names work in Mali, as they are an important part of understanding the cultural context of this rich, diverse country. This sort of seems like a topic that should have been discussed earlier, but it’s one of those things that I’ve kept learning more about and appreciating more throughout my service.

To understand family origins, one must first understand ethnicity. Mali is comprised of a variety of ethnic groups, which, with a few exceptions (mostly involving the northern Tuareg population) live in essential harmony with one another but take great delight in having a few good-natured jabs at each other every once in awhile. The Bambara make up the dominant group of central Mali, including the area around Bamako and east to Segou, and their language has become the dominant local language. The Malinke (Maninka) and Khassonke occupy western Mali from Kita to the border with (and into) Senegal) and speak languages quite similar to Bambara with minor changes (for example, most of the “f’s” in Bambara become “h’s” in Malinke words). All these groups derive from Mande origins and their languages are mutually intelligible. I am in a Malinke village, and while I still mostly speak Bambara, my ear has over time become more accustomed to hearing Malinke). Each of these groups has their own predominant family names but there is a considerable amount of intermarriage and thus mixing; for example, Keita (my adopted name) is considered one of the foremost Malinke names after the great warrior Sundiata Keita; other names common to Malinkes and Bambaras are Dembele, Sissoko, Diarra, and Traore. Coulibaly is another common Bambara name, but for whatever reason (probably derived from some historical conflict I’m not aware of), everyone dislikes the Coulibalys. Complicating matters worse, many Bambara and Malinke names have male/female equivalents (a female Keita is Soucko, Dembele=Dansira, Sissoko=Sackiliba, Diarra=Kanoute, and so on). Certain families are also known for specific things: Dansockos are traditionally blacksmiths, for example, while Kouyates are griots, the keepers of oral history and Mali’s musical traditions. Even now, if one introduces himself as a Kouyate, he will be asked to sing a song.

The Fulani/Peul/Fula people are nomadic herders throughout west Africa and can be found just about anywhere in Mali. Fulani people have a set of family names all their own as well: Diallo, Bah, Barry, Diakite, Sidibe and Sangare are all Fulani names. Fulani are known for being distinctively lighter skinned and having different features from other groups. although again with considerable intermarriage the difference is not always apparent. They can often be found with scores of cows, and wearing ridiculously large bundles on their heads (They are nomads, after all) but there are also many Fulani represented in the professions.

To the South are Senoufo and Manianka, who share many family names with the Bambaras; and in the North the Songrai, Dogon and Tamashek have their own set of names, which I’m not too familiar with, being on the other end of the country. Nonetheless, all groups (with the large exception of the Tuareg) exchange pleasantries (read: mild degradations) with one another based on a system known as joking cousins.

Joking cousins pits certain families (ie, Diarras vs. Coulibalys) and certain groups (Fulanis versus Bambaras) against one another in what basically amounts to a good-natured, mild-mannered insult contest. Remembering who your adopted “family” gets along with versus who to insult is a task for a foreigner, but for Malians it’s engrained early and the banter is pursued cheerfully, almost automatically. Occasionally these insults can be clever, but most of the time run along fairly worn tracks. A typical conversation with a new acquaintance (as just happened to me this very morning in the hardware store) might go like this.

Me: Good Morning.
Mr. Kante: Good morning. Did you pass the night in peace?
Me: There was peace only. And your family?
Mr. Kante: They are healthy. What’s your name?
Me: Awa Soucko. Of the Keitas.
Mr Kante: Ehhh, Allah! The Keitas are so bad! They eat beans. Lots of beans.
Me: No, the Keitas are good. What’s your name?
Mr. Kante: The best family in Mali! The Kantes.
Me: Kante?! But they are not people. They are donkeys. Go plow my fields.
Mr. Kante (laughing hysterically): I’m not plowing your fields. Keitas are the donkeys!
Me: Don’t lie. You’re my donkey. Where is your cart?
Mr Kante: Ha, ha! I am going to change your name so you will become a Kante!
Me: Not possible. Have a good day.
Mr. Kante; You, too. Eh, Keita! You guys are so bad!

And so on this conversation could go for countless moments until you run out of mildly derogatory comments to make and/or want to leave. Donkeys and bean eaters are the most relied-upon insults, although I’ve also heard various parties deem one another their “slaves” (one insult that, in this post-colonial society and coming from my race-conscious American society, I will never feel quite right making, no matter how many times a good-natured Coulibaly tries to throw that one at me), calling the men of a certain family “couriers de joupons” or womanizers, or saying that members of the offending family are, in fact, not people. (Literally, the insult translates as, “you are not a person,” which to me seems to beg the question what in fact I am….)

I’ve come to really appreciate the significance of the fact the PCVs take on Malian names here, both first names and family names. In a society where ancient loyalties are still apparent, where you could still find an entire village made up of the descendants of one family, knowing who you are, knowing your ancestry is so important. And although I am clearly, and obviously by my physical appearance, not at all a descendant of Sundiata Keita, I find it very telling of Malian culture–and still mildly amusing–that my assertions of being his heir are taken so cheerfully, that the outsider is let in so easily on the joke, if only they are willing to participate in the banter. There’s no “Ohhh-kay, but really, what’s your name?” Just, “oh, you’re Keita. Good!” or “Bean eater!” There’s something reassuring, refreshing in that lack of exclusivity. That’s what I mean when I say that the culture makes it easy to be a volunteer here. Your attitude, your goodwill and best intentions are largely taken at face value; cynicism is rare to be found, and there is always place at the proverbial dinner table for yet another out-of-towner. Names and the joking cousin relationships are just another assurance that, in my calling you ugly or a donkey or my slave, I’m reasserting that you and I, we understand each other. We belong. And Malians aren’t in the least stingy in sharing that sense of belonging.

And so, always and forever, I am a noble Keita.

Help to electrify my health center!

Nutrition Demonstration at Marena CSCom

Dear friends and family,

I’ve served in my village for more than a year and a half now and have seen the pressing health needs that my service, the Marena Bafing Community Health Center, tries to address. Unfortunately, the solar panel batteries that provide electricity to the center have died, and along with this the ability to keep vaccines and certain medicines cold, and the midwife’s ability to handle night births in a lighted maternity, is compromised.

I’m now working closely with the center’s managing committee to raise the funds necessary to replace the dysfunctional batteries. and to restore reliable electrical power were it’s most needed. The community has agreed to fundraise, from within, 1/3 of the cost of replacement. And I’ve agreed to help with the rest.

I’m working with the Peace Corps partnership program (PCPP), which gets the word out about opportunities to donate to small PCV development projects. Please take a look at the link for more info about the project, and consider donating. Every little bit will help us move closer to our goal, and in the long run the health center’s essential work will be able to continue.

I’ve appreciated everyone’s support and interest throughout my time in Mali. Check out the PCPP posting for more information. I ni ce, i ni baraji! (Thanks!)

Link to check out the project and donate:

https://www.peacecorps.gov/index.cfm?shell=donate.contribute.projDetail&projdesc=688-371