Dear friends of GAIA,
After a week in Mali, I have returned home. My body is here, but somewhere, behind my retinas, a change has taken place and my view of Providence has been irrevocably altered. I look at clean streets and solid sidewalks and bright streetlights and I miss the families that should be gathered there, sharing dinner by lamplight. I miss the children that – if this were Bamako – would be turning somersaults in the dust by the side of the road, the bicycles transporting crates of chickens, and the rows of chairs full of bodies watching soccer by communal TV. Driving down street after street here in Providence, there is not a single donkey standing in an intersection. There are no baskets of oranges, no stacks of brightly colored plastic teapots, no curtains of sneakers hanging by their laces from store fronts, by the side of the road. Crossing the bridge over the river, I do not compete for space with big green bashis filled to the brim with smiling people, who laugh at the slightest provocation and share smiles as we edge forward, in endless traffic together. Horns do not honk. Policemen do not whistle. Diesel fumes do not fill the air. This city, on this side of the ocean that divides us, is silent. It is night time in Providence. The people who live here are locked in their houses. The mullahs do not sing out the hours of prayer.
It is a heady mix, equal parts diesel fumes and joy, that is Bamako – both intoxicating and addicting. We who spend time there know that the intangible magic is a “joie de vivre”, a contentment that we must struggle to comprehend – because it comes with a degree of physical discomfort (sweat, dirt, hunger, difficulties) that we do not tolerate quite as well. But – it has been said that one’s sense of well being is inversely related to possession of material good – and what gives sustenance to the human spirit is human contact. Bashis full of people, flocks of children, herds of sheep, observers for every event large or small, passerbys that catch you when you fall – Human contact is something that we have by the armfuls in Bamako, whereas, in Providence, when we take full measure of it – even though our streets are clean and our lives are orderly, it would seem that we are not rich in contact, but rather, it is we that are poor.
That is why, fresh off the plane from Mali, my mind turns back to Bamako, even though my body, and my spirt, are here. That is why I am, we are, building a bridge between Providence Mali. When we are in Mali we are eyes open, heart open wide, to the joy that is there. Despite the many imperfections of the work we do in Mali, we feel that we can make a difference. We see that small progress that we made since our last visit, and return to Providence, energized to make it possible to do more. Yet, we cannot but leave part of us behind – and so we return home with a lingering look back. That is the envelope that carries this message – an envelope of regret because we cannot be in two places at once – we cannot be there, in the heat and the dark, and simultaneously be here, doing the work that moves our project in Mali forward. I think I speak for every one of us – every time we come back to Providence from Bamako, we leave behind another piece of our hearts.
And so what of our project, the Hope Center Clinic, the first village-level clinic to provide HIV care in Mali?
The news is good, and that is what I have to share. The last three of the five full days that I spent there (I already wrote you about Tuesday and Wednesday) were full to the top with meetings. Here is a brief synopsis of the days – Wednesday morning we saw Allou Sylla (head of the HIV medical side) who greeted us warmly, and had many suggestions about our work. Allou promised the sky and the stars (another Journees de VIH this January, and more). The visit to Sylla was followed by a visit to Dr. Diallo (Fanta Siby) our champion, who supports and encourages our work in Sikoro, and then across the bridge to see Ousmane Koita (our collaborating vaccine researcher). He showed us the TB “midget” machine (MGIT) from Becton Dickenson and told us the startling news that his rate of detection of TB by culture that was near 80% for samples taken from sputums sent to the public labs, where as the rate of detection for smears (done by the labs) was only 14%. This stunning discrepancy may well be the reason that so much TB goes undetected – if sputum smear (and not culture or PCR with a MGIT) is the standard then many, many patients with active TB are missed. . . pondering this, we headed back across the bridge to the house where we heard Lauren and Julie was enthusiastic about their foray out into the field with one of the TB Peer educators. . .
Thursday morning started with meeting with Groupe Pivot. We met Sangare of Groupe Pivot, who promised TB training for our peer educators. We traveled across the river to Plan Mali (a connection from Providence) and met with the planners at the Plan. We crossed the river again, and headed to PSI where we met Steve Lutterbeck, a towering giant of a man, old friend, and new African – meaning someone who has spent more time in Africa than at home. He’s the one who tested more than 10,000 people for HIV in three months. He spent two hours with me and Sophie and Karamoko, trying to understand what might be the problem holding us back, if we believed so strongly that we had the right vaccine. And then we met for two hours with Malick Sene – the head of the HIV program – he promised to support our plans to do a vaccine conference, and said that he would call a meeting in the near future to discuss TB – at which we’d be invited guests. And then last but not least we went to see our lawyer, who promised to have our paperwork done (for our national NGO status in Mali!) by Monday or Tuesday this week.
Friday looked grey and cool when we got up but the cool quickly turned into a downpour. Thunder rocked the house and loud cracks of lightening made it sound as if the storm was in our living room rather than outside. We were delayed in our visit to Commune 1 to see chief doctor Boubacar Traore but he waited for us, and spent an hour with us talking about how surprising it was that the ASACO (community health committee) of our clinic refused his contribution of two (free) state doctors who were willing to help. More about that later. Then we went down to the far corner of the Commune 1 clinic and saw Dr. Naso, the TB doctor, who was pleased to see us and promised to help our TB project in anyway she could. I wish I had taken a picture – but you’ll just have to imagine her jaunty green head scarf, her broad smile, and her enthusiasm for the students, who will go back and see her soon. We also visited the lab where they do AFB smears (every day but Friday), and then traveled around the bends and turns of the villages in Kara’s ancient car to Sikoro.
Our Hope Center clinic was open but quiet because of the rain. Zoumana Koty, our HIV doctor was in his office. Our patients, HIV seropositive women were making food outside. We talked at length to Zoumana about the responsibility of being the “first ever” HIV clinic in a village, and the opportunities – and responsibilities. We talked about record keeping, and he promised to fill l out the ‘dossiers’ of the patients, so that when I come back in the fall, there will not be a single missing piece of information. Our goal is not just to be the first, but the best village run HIV clinic in Mali. Why not? If we do this important task with anything less than the highest expectations, we will turn back the clock, diminish the chances of expanding access to HIV care at other CSCOMS. We can only succeed because – failure is not an option.
Friday night we held a small dinner at the “Cafe du Fleuve” for our friends – Ludo our IT Geek, and Ousmane our lawyer, and the GAIA team, and Dr. Fanta Siby Diallo (regional department of health), and Youssouf Traore, and his wife Fatoumata who is a pediatrician. Julie Caplow and Lauren Pischel spoke to her about visiting the pediatric ward at Hopital Toure, and she welcomed them. We were joined by the beautiful Nana Haidara, morning news reporter on AfriCable, who wants to do a cable news show on the clinic – Sophie will meet with Habib to entice him to participate in the broad cast, and Nana is already strategizing with Mme Diallo about involving the minister of health. We have so many friends in Bamako – so much good wlll –
Saturday was a blur. We met with the ASACO – I will tell you more about that later. There was a crowd at that meeting – the Chief, our wise man. I gave him the students to take care of in their travels around Sikoro. Our patients. The Elders. The Sage Femmes, The Social worker Baba Diarra. We fit it all in and then rushed off to Air France to register for the flight and to get Kotou his ticket. Kotou, who works with Ousmane, was traveling to Mali with me to do a training at the lab and learn how to do ELISpot. When we found out that he had forgot to bring his passport, he took off in a panic and started running home (several miles away) – his friend had to run after him and put him on a motorcycle. This was his first ever trip on a plane, and first ever trip out of Mali.
The day ended with a long meeting with Sylvestre our new Pharmacist, who is excellent, Rama and Kara. We talked – again – about the fact that we are the first ever HIV clinic —— what a burden and a challenge that is – we have a chance to make a model clinic for others to follow, or we can make a mess of it. I made it clear to them that this is their meal ticket – the chance to make real change, and become leaders for the rest of Mali. I hope that they took that message to heart.
Finally – the long drive through the heat and the dark to the airport. Families gathered around tables by lamplight could be seen by the road. The streets were teeming with people, even though it was already 10 oclock at night. Children, goats, old men with canes, young men in sneakers, everyone was out and about- seen by headlight, and lamplight because the streetlights are few and far between. And then, Kotou and I boarded the big white beast that sat on the tarmac at the Bamako airport and held our breath as it took to the air. Every night in Bamako is dark, so much darker than cities in the US – so we could just barely see the twinkling of battery driven lights, and small fires below us as we left the heat and the smoke of wood fires behind.
Yet another contrast comes to mind. Today – I flew from Providence to Chicago. Looking at the expanse of this great country from the air – its patchwork of fields, planned communities, roads connecting cities, schools and baseball fields, so much order, so much structure and so much wealth – my thoughts turned again to Bamako, and its heady mix of chaos and pure joy.
I miss Mali. It is true. The place stays with you, and the smell of smoke, and the wide smiles. Yes, it is hot and dirty and poor, but there is more to it – some Bamadan magic – that keeps us coming back for more. And so, we’ll build continue to build our fragile bridge – bringing Karamoko and Kotou over, and sending Lauren and Julie back, while Sophie, Mali and I shuttle back and forth – a bridge that out of friendship, and generosity, creates tensile strength. You too should go there, and put your hand out. You’ll get back so much more than you give.
In the meantime, please send this message to your friends – it is about magic, and friendship, and hope. We have created these things through the work we do, together. Let that sink in, while you look for the donkeys in the intersections, and children turning somersaults in the dust.
Thank you for supporting the work that we do. If you want to read more, read the rest of the July 2009 pages in this blog.. . . http://blog.gaiavaccine.org/
and if you would like to contribute now, go here: http://preview.tinyurl.com/GAIA-Donate
and for pictures see: http://gallery.me.com/anniedg
Annie