August 03, 2006
Balanie and Bolle
After weeks of work and teaching, the pilot of the Here Bolo project culminated in the Balanie de L’Espoir, which took place in downtown Sikoro. Each peer educator brought something unique and different to the celebration as they talked about how hope, identity/testing, transmission, marriage and family, and community relate to AIDS, and how knowledge about these points could be used to conquer HIV. Around four o’clock, people began to trickle down to the goudron, and by five o’clock, it was packed. Dr. Kone opened the Balanie, introducing Ramatoulaye, Bay (my new colleague) and myself. Although Dr. Kone, Rama, and all of the peer educators spoke in Bambera much of the time, I understood each person’s message perfectly through their emphatic gestures and strong voices. While I drafted an initial script for the Balanie that corresponded to the program curriculum, I gave the peer educators a lot of liberty in how they wished to convey their message, and they each did a spectacular job. My favorite interpretation was done by one of Aleema, one of our female peer educators, who held a condom and thrust it in men’s faces when talking about fidelity. Overall, the Balanie was a great success. However, since a few peer educators are medical/nursing students and have exams in August, the program will not resume again until September. In the mean time, Bay and I are preparing folders with all of the necessary materials - the curriculum, a list of each peer educator's responsibilities, etc. - so that Dr. Kone and Ramatoulaye will be able to easily begin work again in the fall.
This week, Rama, Dr. Kone, Bay taught the program at another site – Bolle, the women’s prison in Bamako. I have to admit I was a little apprehensive of teaching in the women’s prison when it was first proposed as a site, but after I met with the warden, Madame Diarra, I was immediately convinced that not only was it a great idea, but an enormous opportunity. I first met Madame Diarra at the beginning of July with Dr. Kone and Sophie Sprecht (a member of the GAIA Board), and she is an incredible woman. She explained to us that the majority of the inmates at Bolle are former prostitutes, and that she is working to establish each inmate’s economic power so that they won’t have to turn to prostitution again upon release. Thus, Bolle has programs that teach women a trade, and the prison runs a soap-making and fabric-making business. I visited the prison for the first time two weeks ago, and the center where I am working looks nothing like a prison at all (the high-security center is located elsewhere). The prison actually resembles a small village – there is a large compound that houses a day-care center, a classroom, and the bedrooms are dormitory style. Because the majority of the women are illiterate and very few speak French, we are running Here Bolo as a lecture series rather than a peer education training program at Bolle. When Bay and I speak, Malick translates from French to Bambera for us, and the women have responded very well. At the end of yesterday’s session, many of them asked where they could get tested for HIV, so Dr. Kone, Bay and I are meeting with Madame Diarra tomorrow in order to take steps to set this up.
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July 28, 2006
Conflicts at the Clinic
I guess one thing that I have discovered from spending time in Mali is that development really cannot happen overnight. No matter how much you plan, or how much money you have, something is bound to go wrong, and you just have to be able to adapt to it. There is also so much diplomacy involved, and if you step on the wrong people's toes even once, a project can be finished. For example, last week, Dr. Malick Kone, the director of GAIA in Mali, arranged to have an HIV expert from Point G Hospital, Issa Kone, come to the clinic every Thursday to write prescriptions for people's HIV meds and to provide free HIV transportation to and from the clinic. However, Dr. Daou, the director of the Sikoro clinic, was really offended when Issa Kone showed up on Thursday because he felt like Malick was trying to supercede him, so he ordered Issa to leave the clinic although there were dozen of patients waiting for medication. Even though we have now entered into negotiations with other doctors and it looks like the program will still happen after all, I am just so frustrated because so many of the arguments here are so pointless, especially because they are driven by people's egos. Daou called me into his office after his argument with Malick Kone and Ramatoulaye and started explaining the situation to me in French, and I listened to him, but I was just thinking, "Why are you telling me this? Why aren't you speaking with Malick? Why do you have to make everything so difficult?" Despite anyone's good intentions, it seems there is always an obstacle.
Yet despite the administrative struggles at the clinic, the staff is incredible, particularly the sages-femmes (midwives). This week, I had the opportunity to watch them in action when I spent the night at the clinic with my friend Victoria, a graduate student from BU who has been helping the sages-femmes all summer. We arrived around 10pm and were shown to our quarters for the night - a small narrow mattress on top of a barren concrete floor. After a pretty sleepless night, Vic and I were feeling pretty disappointed because there had yet to be a birth, but around 7:50am, we noticed a woman hobbling towards the Salle de L'Accouchement (Birthing Room) Vic and I hurried after her, and the sage-feems quickly mounted her onto the cot. When I entered the birthing room, I was shocked at the lack of medical equipment - the room consisted only of the cot the woman was placed on and a table with a scale and some medical instruments on it. I have to admit that I was nervous - how, I thought to myself, are the sages femmes going to pull this off? However, I would soon learn that the sages femmes had just all that they needed - they began talking to the woman in soothing tones and she pushed without more than a whimper. Within 20 minutes, there was finally noise in the room - but it was coming from a beautiful, newborn baby girl. This was the first birth I had ever witnessed, and it was very quick and very clean. I think that the Malians have the right idea about childbirth - women don't come to the clinic until it's necessary, and labor isn't the long, drawn-out process it is the United States.
The Balanie de L'Espoir is tomorrow in Sikoro. Today's rehearsal went very well, and I think that it should go off pretty well. What makes me the happiest is that some of the peer educators are really enthusiastic - one of them in particular, Francis, has come to the clinic every morning without fail since training to help us out - so I'm hoping that if we can set up the proper infrastructure, the program should be able to continue throughout the year. Obviously, monitoring progress will be difficult as I will be back at Brown, but another Brown student, Caitlin, is staying in Mali until January, so I'm hoping that if she works with Ramatoulaye and keeps me in the loop, I will be able to monitor the program and do the things necessary to keep it going.
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July 20, 2006
I have been incredibly busy with La Main de l’Espoir since my last post. Last week, we finished training the peer educators, and now we are preparing for the Balanie de l’Espoir, which will take place on July 29. The Balanie is a celebration dedicated to educating the Sikoro public about HIV prevention and treatment practices, and will feature all peer educators performing skits that illustrate the five points of the Here Bolo program: hope, identity, transmission, marriage and family, and community.
Working in Mali is both incredibly frustrating and incredibly rewarding, but in the end, the rewards far outweigh the frustration. Any frustration I have stems from the fact that things are simply so much harder to do here – people are frequently late or don’t show up for appointments, materials are impossible to find or far away, and despite the fact that I speak French, I often have difficulty communicating with people because they speak Bambara. Yet despite any occasional frustration I have, the peer educators’ enthusiasm last week made everything well worth it. Each session ran over at least 45 minutes because people were asking so many questions. I also gave the educators a simple 12-question pre and post-assessment test on their HIV knowledge at the beginning and the end of the program. While I have yet to fully analyze the data, I have found that the majority of the participants have a pretty good basic knowledge of HIV prevention and treatment both before and after training. However, I noticed that some participants still held some common misconceptions about HIV - such that HIV-positive people couldn't appear healthy or that one could catch HIV by kissing someone. The sessions were also characterized by a great deal of debate as men described their reluctance to wear condoms and women described their reluctance to not breastfeed despite their knowledge of the benefits of these practices. Therefore, the peer educators' mission will be to not only educate others, but to address the gap between HIV knowledge and preventive practices in Sikoro. After the Balanie is over, Malick, Ramatoulaye and I will begin tracking each peer educator's progress as they begin to educate others in various parts of Sikoro. I believe that if the proper infrastructure can be set up and sustained, the program will be really effective. On the last day of training, we began to practice for the Balanie, and people really came alive when they began performing for their peers.
Besides running Here Bolo, I will also be collaborating with Mme Diarra Assetou Koite to implement Here Bolo at the Bolle Women's Correctional Facility in Bamako beginning on July 31. I met Mme Diarra two weeks ago with Dr. Kone and found her to be a very admirable woman – we discussed AIDS programs in Mali and how they need to be tied to alleviating poverty in order to be effective. Today I visited Bolle with Ramatoulaye and it was one of the most interesting places I have seen in Bamako. I will admit that at first I was really apprehensive – I was picturing large, dirty, stone cold cells filled with women in agony. However, what I was shown instead were compounds that almost resembled dormitories – there were open courtyards where women could talk to each other, and there was actually a day care center for women who were incarcerated when they were pregnant. While there is a separate building for more serious criminals (I did not see this building on my tour), many of the inmates at Bolle are former prostitutes, so their sentences are short, and their incarceration is the direct result of poverty. The system that has been set up at Bolle is actually really interesting in that all of the inmates can financially support themselves with small jobs such as making soap or cloth, so they are slowly preparing for rehabilitation in the community. Bolle also has a real classroom, and some of the women are starting to learn French which is SO important, because it is impossible to get a really good job without French proficiency here. When we run the program, it will be primarily in Bambera, but it is good to know that I will be able to communicate with out first 10 peer educators on a basic level.
Outside of work, I have been enjoying Bamako enormously. Meeting and working with Ramatoulaye is probably one of the best things that happened to me this summer. Last Friday, I met her brother, Mohammed, who actually now lives in Queens and went to St. John’s on a basketball scholarship. Talking to him about Mali was interesting because this visit is his first time back in nine years. It seems that happens with lots of people who leave the developing world – while one can understand perfectly why someone wouldn’t want to go back when they had been living a life of poverty, one also wonders how anything will ever change if people don’t return with their new skills to help their country.
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July 11, 2006
Le Premier Jour de Formation
Today was a truly wonderful day. After many months of planning, we finally kicked off the first day of Here Bolo (the Bambera translation of La Main de l’Espoir) and began training 20 peer educators – 10 men and 10 women. This is more than we had originally anticipated, but much better, because it means we will have even more capable people working to educate others in the Sikoro community.
I was a little nervous when we began training because although my French has improved drastically since I have arrived here, it is still not the best. Furthermore, although most of the peer educators began talking in French when asking questions or making comments, they often launch into Bambera mid-sentence, so I had difficulty always understanding what was going on. Luckily, I had Dr. Kone and of course, Ramatoulaye, to assist me, and they translated from Bambera to French when necessary, so I was kept in the loop.
What pleased me so much about today is that everyone was really and truly engaged. Although the training was scheduled to last from 3pm to 5pm, we ended up staying until 6pm because the peer educators asked so many questions and were truly interested. This gives me hope that the program has the power to be sustainable and last after I leave Sikoro – I feel that people are truly invested in it. One thing that I also learned today and throughout my work designing the project is that it is necessary to step back and let the Malians take charge of the program. This is the only way it will truly become their own. When we first began training today, I had planned all of these points that I wanted to make, but quickly realized that it was more important to let the peer educators talk – to let THEM ask questions, and to let them discuss the issues at hand. I am also so lucky to have Dr. Kone and Ramatoulaye work with me, not only because of their wealth of knowledge, but also because they are Malians, and have been able to help me make others take the program and curriculum seriously. It was great to see that all of the peer educators liked the curriculum and the mnemonic. When I was designing the curriculum, I was concerned that it may or may not be culturally relevant, and I also wanted to make it easy to remember and easy to teach. The five points taught by the mnemonic are “Hope,” (thumb) “Identity,” (Index finger) “Transmission,” (middle finger) “Marriage, Fidelity and Family” (ring finger) and “Community” (both hands together). After the program training is completed, all peer educators will be responsible for going out and teaching the mnemonic to other members in the community. Any one who learns the curriculum will be told to come to the Sikoro clinic for a free HIV test, and if they can recite the five points of the program curriculum properly, they will also receive a free “Here Bolo” tee shirt. Ideally, I would like to have each peer educator educate 10 people before I leave Sikoro – which would be wonderful, because then 200 more people who have the knowledge to prevent HIV and past the knowledge onto others.
Today’s lesson, “Hope.” was basically an introduction, and emphasized that hope is knowledge, which allows for HIV prevention; hope is access to medical treatment; and hope is research for a future HIV vaccine. Tomorrow, I am giving all of the peer educators a simple 12 question survey to evaluate their knowledge about HIV, and I will then administer the same survey at the end of the program to assess their progress. Listening to the peer educators ask questions and discuss HIV today was incredibly interesting because even though they are some of the most educated and respected people in the community, they still weren’t clear about basic facts, such as the difference between being HIV+ and having full-blown AIDS. I think they were all pretty shocked to learn that Ramatoulaye was HIV+ - many of the men looked pretty unnerved when she took out her medication and passed it around.
Outside of the program training, I have been having a truly wonderful time in Bamako. This past weekend, I spent Saturday with Ramatoulaye and had lunch at her house with her entire family went to her niece’s first birthday party and to a concert with her and some of my other friends in the evening. I enjoy working with her so much, and am happy that we are becoming friends outside of our collaboration on Here Bolo. She is going to take me to work with her this Thursday at Point G Hospital, where she works as an HIV educator and counselor, so it will be really interesting to see her at work. I am also going to be spending a few nights at the clinic some time next week to help my friend Victoria assist the midwives with births.
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July 06, 2006
Round III - Chez Clinique
I haven’t posted for a long time as it has been a very busy week. La Main de l’Espoir has been coming together really nicely. I spent most of this week revising the curriculum and identifying our first ten peer educators (five men and five women). Tomorrow we are meeting with the chief of Sikoro and the ten peer educators before we begin the program next week. I am so excited to finally get started after planning for so many months.
Besides working on La Main de l’Espoir, I have been spending a lot of time working at the Sikoro clinic. All of the staff are very compassionate and professional, so I really enjoy working there. I'm especially excited because my friend Victoria (a BU grad student) and I are going to spend a few nights there during the next few weeks to help out with childbirths. However, while I really enjoy working at Sikoro, it gets frustrating at times. First of all, people are RARELY on time, and they are not just 15 minutes late, they are sometimes up to two hours late. Secondly, there are very few complete medical records for any of the patients at Sikoro, which makes it incredibly difficult for doctors to follow up after prescribing a course of treatment. For example, even though GAIA buys formula and clean water for the HIV-positive women, the majority of the women I saw at the clinic were breastfeeding their babies, which puts their babies at a very high risk for catching the disease. Lastly, I just don’t agree with some of the medical practices I have seen thus far. For instance, when nurses perform HIV blood tests here the nurse ties the tourniquet on the patient’s arm, injects the needle and then LEAVES THE TOURNIQUET ON WHEN SHE DRAWS BLOOD!!!! Each woman looked like she was in an incredible amount of pain, and understandably so, because it took forever for their blood to flow out of their arm into the test tube. The cases at the clinic are definitely unlike anything I have ever seen before – on Monday, a five-year-old child came in - born HIV+ with malaria and “saggy pants” (loose skin around the abdomen and legs that actually resembles saggy pants). The child looked like it was only one and a half or two years old because it was so malnourished and it was just writhing around crying. It was pretty devastating to watch - I don't really think there is anyhing they can do for it. What was even worse was I was standing there with Ramatoulaye and she said to me, "Thats what my baby looked like" (all of her kids died from HIV complications).
Life outside work has been really great. On Sunday, we went to Dr. Kone’s niece's wedding reception which wsa wonderful. At Malian weddings, they serve all the food for the table in a big bowl, and everyone grabs it and eats with their right hand (in Malian culture, one reads, writes, eats and greets people with their right hand. Supposedly, one touches his wife with his left hand – and it is considered incredibly rude or vulgar to eat or wave with your left hand!). It was a Christian ceremony (surprising given that 90% of the country is Muslim) and there was a live band so we got to dance a lot which was fun.
My first Fourth of July outside of the U.S. proved to be quite the adventure. Our friend Jacob, who works for CARE, told us that the U.S. Embassy in Mali sponsors a free Fourth of July BBQ for Americans at the Marine House, so some of my friends and I got directions from the Embassy and headed over around 4:30. However, we ended up driving around lost for an hour and a half only to finally arrive at the Marine House at 6pm to discover that the had BBQ ended at 3pm (you think they would have told us this on the phone??!!). The Marines felt bad so they let us in anyway and we played volleyball while running away from this massive tortoise (random, I know) they had on the grounds. Of course, on the way back, one of the cabs got a flat tire, but we finally made it to Broadway, an American diner where we had hamburgers and French fries – it was the first time I had had meat since I came to Mali and it was so good!
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