Day 1 Bandiagara (16/06/09)

I was woken up by a rooster this morning, which was then followed by the steady thumping of mortar and pestle (not the little mortar and pestles like at home, but big giant ones used to grind millet and other grains). I took my first bucket bath (as in there was a bucket of water and I had a wash cloth, there are also these amusing plastic teapots (I used one to wash my hair)). Then we had breakfast (I’ve become fond of froufrou which is a fried millet fritter). Liz wasn’t feeling well (I think she may have caught my cold, sorry), so she stayed at the house and I went into the clinic with Drissa/Badry (Drissa is apparently a common name so he goes by Badry).

We got there a bit early and there weren’t any patients yet so I just read emails and the news on the computer for a bit. After the patients began to I worked with Dr Kolo. I got to take temperatures, check palor, look up noses and feel for spleen and liver enlargement for the kids in the incidence study (there are 300 kids in the study and about 50 kids come in each day, so it was a lot of kids). Some of the kids found my amusing and other found me terrifying. We were very busy for most of the morning, but by 12:30 it had really tapered off and I went back to the office to see what was up. Thera’s daughters had come into the office and Badry took us out for a tour of the health center. We went across the street and saw the traditional medicine center and the buildings the malaria project used to use. We got to check out the building where they prepare the traditional medicines, it had a very pleasant herb smell (they had medicines for hemorrhoids, hepatitis, cough and some other things that I couldn’t translate. Fortunately the clinic and the tradition doctors (which have formed a union by the way) have come to an understanding that anything serious should be sent to the clinic, especially anything that looks like severe malaria. After the tour we took a little drive around part of the town; apparently the girls’ grandfather was a medical chief in Bandiagara (he passed away a few months ago) and the girls wanted to see where he had lived.

We headed back to the house for lunch; there were specially prepared plates of hard boiled eggs and diced cucumber for Liz and me. We ate lunch (I ate some of the rice and sauce too), then headed back to the lab. There wasn’t much to do in the afternoon, Badry told me I could check my email and use the computer. I surfed around looking at anything I could think of, but I got pretty bored, so I asked Badry if there was anything I could help with. He said they were making the folders for the study participants, it wasn’t “scientific,” but if I wanted I could help (yes please, I would rather do something than nothing). So I put the labels and cover sheets on the binders (apparently they call them dossiers) and as I usually do, I worked quickly and soon ran out of that job. But, fortunately I could then occupy myself with putting the binders in numerical order, then there were some papers to put in. While I was working Badry kept saying that I must be tired and that I could go back to the house and rest (it was only like 6pm, so I could go back to the house and be bored I thought). When we finished everything it was 7pm and I was a bit hungry so we came back and had dinner. After dinner Thera’s daughters tried to teach Liz and I a card game; with my limited French I had a difficult time understanding, so Liz and I were a tandem team. We played a few games then went to bed.

The Road to Bandiagara (15/07/09)

Today was the long ride to Bandiagara. The car was quite full; it was a 3 row seating SUV, but we had 7 people (the driver, Thera, his 3 daughters, Liz and me) and a lot of stuff. I felt a little bad; Thera’s 2 youngest daughters had to squeeze together in the one seat in the back. Surprisingly the roads weren’t bad (at least not till we got closer to Bandiagara), they actually seemed in better condition than many roads in Baltimore (though a bit narrower, which made passing trucks and donkey carts and everything interesting). I think I also learned some of the interesting road signals here: when a car is passing you in the opposite direction you use your left turn signal, when a car is passing you (as in you are slower) you put on your right turn signal, when you are passing a car going the same direction you put on your left signal. Horns are also used here to just let people know you are there, like if you are going fast and are going to pass a car or a donkey cart or a moped you honk first. The horn is also often used to convince animals to get out of the road (to my relief people seem to really try not to hit animals).

We stopped in Segou for lunch at the Hotel l’Indepedence. I had some rather good capitaine (the river fish) and a can of pineapple juice to wash it all down. After wards we continued down Rue de Poisson (which apparently is called that because it’s the route the trucks take to transport the fish from Mopti to Burkina Faso, Ghana, Togo and other countries (I would guess the fish isn’t very fresh by then). As we got closer to Bandiagara the terrain changed from a red clay earth to increasingly sandy soil and the countryside took on an appearance similar to that of the southwest US (not that I’ve ever been there, but I’ve seen pictures). As we travelled through small towns (and by town I mean a collection of mud brick houses and maybe a mosque) I noticed that many of them had a signs for different public works projects, as if each small town were responsible for some project to improve the country. One that struck me as particularly interesting was a town that seemed to be dedicated to reforesting the area. Perhaps this is in an attempt to slow the encroaching desertification (though I wonder how the people survive without farming to subsist on).

We made one more quick stop in Sevare (a suburb of Mopti), which is only 45 minutes from Bandiagara. Thera and Sanoussi (the driver) got out and bought some grilled meat (animal unknown) that we ate later with dinner. After a little more driving we finally made it. Bandiagara has one paved road (Rue de Poisson) it goes in and it leaves, the rest is well a bit rough. The house where we are staying is pretty nice, Liz and I are sharing a room and there’s a common bathroom. So after we settled in for a bit we had dinner with the whole team from the medical center (apparently everyone eats here). The food was good, though not as complex and ample as at Chez Gwadz. I wanted to take a shower in the evening (it had been very hot in the car), but apparently the water for the day was all used up. So instead I just crashed and thus spent my first night under a bed net (not that exciting though).

Bamako Days 18 and 19 (13 and 14/07/09)

We didn't do much Monday and Tuesday. Monday morning we had our long anticipated meeting with Professor Thera (it was supposed to be Saturday, but didn't happen). We discussused our trip to Bandiagara; at first he suggested we fly, but when we expressed that we would rather drive so we could see the country side he agreed and suggested that we go with him and his daughters on Wednesday (he was taking them to see the Dogon country). MOnday afternoon we went to see Moctar (he had emailed saying he would be in by 10am, then Thera had called and he promised to be in by 11:30, but he wound up coming in by 12:45pm). We exchanged money ($1 = 469 CFA) and left with a large wad of bills (its actually a little difficult to exchange because we wind up with large denominations that aren't really good for small exchages). Later in the day we played frisbee with Fredrick (and were apparently a sight to see).

Tuesday we were supposed to meet Thera and Djimde (who had just returned from the US) in the morning and then go to a lecture on the cellular biology of plasmodium (the malaria parasite) at 10am. They hadn't come by 9:55, so Liz and I headed off to the lecture. I appreciate that many scientific words are similar between french and english. After the lecture we bumped into Djimde (I suppose it wasn't difficult for him to identify us). We talked to him for a bit in the lounge at the school and as we were talking I watched the very dark clouds approach. It began ranning just as we made it back to the guest house (I decided to stand outside for a while and watch, the storms here are really something to see). We wasted the rest of the afternoon reading and packing to leave in the morning.

Days 15 and 16 (11/07/09 and 12/07/09)

Saturday we slept in late and in the afternoon went to the artisan market in downtown Bamako. Sanoussi our drive took us and showed us around the market (he also did all out bargaining for us). Where we walked in walked in there was a traditional medicine stand. It was kind of creepy with dried monkey paws and the head of something that may once have been a lion. As we went further into the market there we so many interesting stalls. We went into a jewlery shop (Malian gold is very beautiful and seems to be much more yellow than any gold I've seen before), but Liz and I decided that we were too poor for that. We went into many stores with carvings and textiles and beaded jewlery. I wound up buying a Taureg made necklace (though the one of the men at the shop was puching me to buy more) and later a map of Mali painted onto a piece of fabric. There was a man working a large loom and I wanted to take a picture, but he wanted 1000CFAs (which really isn't all that much, a little over $2), but I didn't have any small change. Apparently here taking pictures is not something done lightly, you need to ask permission and often pay a fee first. There were many amazing leather shops and we were able to watch a lot of the artesans at work. It's interesting, though there's no real recycling here everything is used to its fullest; I watched one man smoothing some leather with an empty coke bottle. We didn't buy much there this time, but we're planning on going back after we return from Bandiagara and before we leave.

In the evening we watched Taxi Driver (that was interesting, there's a huge collection of VHS tapes here) and waited until it was late enough to go out. We headed to a bar with the Swiss entomologist that is staying here. He found it on a cultural website and it was supposed to have local music (which I've still been trying to hear). The drive seemed very long, we crossed the river and I swear we were out of city limits; when we finally got there it was a dive (a local truck stop I think) and the patrons didn't look glad to see foreigner, plus there was no music. So we left and headed to a bar in town that Fredrick (the entomologist) had been to before called Akwaba. It was nice and the music (though not Malian) was pleasant and had a latin inspiration, which Fredrick said was likely due to some influence Cuba had had in Mali some years ago. After a few hours we headed to another bar next door called The Terrace (which Liz and I had been to before), interestingly the bar seemed to be closing down for the night (it was after 2am, though I've been told that's early by Malian standards). Liz was tired (I was too, though I hadn't realized it yet) so we called it a night and caught a cab back to the guest house.

Sunday was a lazy day. We slept in a bit and had breakfast. I did some laundry and we sat around reading to waste the day away. In the afternoon Liz and Fredrick went for a run and after they came back we went out and threw a frisbee in a somewhat rocky field. I have the feeling that they really don't have frisbees here, many people stopped to stare as they walked by. I also got to be the frisbee expert (which was a bit of a surprise), but liz and Fredick picked up quick and we had fun. After we went back to the house and showered and ate left overs. We watched the Great Gatsby and turned in a bit early (still a little tired from the night before).

Days 10 - 14 (05/07-10/07/09 a week in brief)

On Monday Liz and I said goodbye to the MRTC Clinical Lab that had been our homebase for the past week or so. Although we had practiced making and reading slides we didn't have the time to become certified (though we hope to do this in the week we'll have after returning from Bandiagara).






Tuesday we started our visit to the clinic and vaccine trial site in Sotuba (a village on the outskirts of Bandiagara). The village seems rather rural and we learned that is actually used to be located several miles from the city, but al Bamako has grown the villages has almost been absorbed by it. At this clinic they are continuing the monitoring stage of a vaccine (MSP-3). The first day was very hot. In the morning I was with Dr. Mariam (at first she didn't seem to want me there, but she warmed to me). We saw kids with rashs, sinus infections, intestinal parasites, the gamut. But in the afternoon things slowed considerably (apparently all the mothers take their children with them to the market, so there aren't many patients in the afternoon.

For dinner Tuesday night Iesha made us some very delicious fried (I named mine Alton before I devoured him).

Wednesday I had a cold and stayed home from the clinic.

Thursday we nice and cool and there was a bit more to do. I shadowed Dr Alhousienni, who sees patients that are not involved in the trial (the children in the trial get free healthcare). This time I got to see pateints of all age ranges from the village and I also saw my first case of severe malaria in a child (it was remarkable how sick she came in, but after a few hours on a drip of IV quinoline she was much better).

During our visit we also ate lunch with the people from the clinic and it was usually prepared by the wife of one of the clinic workers (I can't say the food was great, but it was definatly interesting).

Friday was our last day in the clinic. It began to down pour as soon as we arrived, which apparently kept patients away until the rain stopped (though it did make the day much cooler and more agreeable). In the morning I was in the lab and got to examine the slides from the few cases of malaria they had that week (it's still early in the season so there aren't many cases yet). In the afternoon we sat and talked with the various people at the clnic. As a thank you gift I gave the clinic a big bottle of hand sanatizer, which theems to be pretty valuable there as most of the examine rooms don't have sinks for washing and the physicians don't wear gloves.
All and all it was a good week that gave us a different view of the healthcare system in Mali.

Day 9 Bamako (05/07/09) (ps.s read this from bottom to top)

This is our lab mentor Agnes. She took us to the National Museum Sunday morning. We picked her up at her house on the way and it was a bit surprising that a person with a PhD in Pharamcy would live in a mud brick house. Here it seems that most of the work that would be done by lab technicians in the US (which doesn't really require a degree) is done by MDs and PhDs here.
At the museum there were several interesting exhibits, though not very much information of the group I find the most interesting, the Tellem people. There was an exhibit of the history of the Dogon, on the movement of Islam into the region and even a textiles exhibit, as well as several models of famous Malian buildings outside.




In the afternoon we made plans to go to the horse race with Izak. It took us a while to get there though because there aren't many taxis. I took this picture of the street outside of the university while we were waiting for one of Izack's friends to come with a car.









(I can't figure out how to turn this picture right side up). We finally made it to the races, but because we were late it was pretty crowded. There are not seating stands so it was a bit difficult to see, but we managed to catch two of the races (though not the final one).
While we were there we bumped into 2 French girls that Izack knew who are doing a rotation in the hospital Gabriel Tores in Bamako. (Apparently in France you decide what your going to do right after high school, so they go directly into medical school, which is 6 years long).









After watching the races for a while we got pretty thirsty and head out to look for a bar near by. Apparently we got special treatment as foreigners because the bar was supposed to be closed off (the street was the president's exit route and was closed off for security). We sat down and had a drink with Izack, his friend, the two French girls and even bumped into another strange character, Omar while we were there. As we were sitting there I looked up and noticed some parachuters coming down, apparently this was the grand finale for the races.










Eventually we headed out and as we were leaving we got to see the President's motorcade go bye. This picture (from L to R) is Izack, Omar, me and someone Omar dragged in. Afterwards I had my first European goodbye with the slightly awkward double check kissing (Omar gave somewhat moist kisses, I'm glad I live in America).

Bamako Days 9 (04/07/09)

Saturday morning we got up early expecting a meeting with Professors Ogobara and Thera at 10 to discuss what we were going to do next in our schedule. However, after we were up and ready to go Liz checked her email and saw one from Thera that said that the meeting would be moved till later and he would call us with the time (which was a bit of a bummer because we were hoping to go out during the day). We waited around and read to waste time. We also did come laundry. It was a bit funny the hot and cold water lines were mixed up, so if you wanted a cold was h you had to set it to hot. Also the dryer didn't work so we hung out clothes over some lines that were stung up outside. With the heat it didn't take very long for the clothes to dry.

After lunch we decided to walk up to Ogobara's office to ask his secretary if he knew what time. He suggested that Ogo would be in after 2pm so we headed back down to the house. On our way out we bumped into Izack and some other people from the drug resistance lab we had visited earlier that week. Izack (who is the one that called me clear before) asked what we were up to and Liz explained that we were waiting for a meeting with Ogo and were going out later with Agnes. Izack insisted that we should hang out with him sometime and he would take us into the city (to be honest Izack makes me a little nervous, we've been warned about guys trying to agressively befriend american girls). Liz said that we were free Sunday and that she had seen something about a horse race on the news. A little while later I got a call from Thera (actually I missed that call because I wasn't carrying my phone on me, so I called him back), who said we would meet in Ogo's office at 4pm. Shortly before 4 we headed up to the office and waited outside for Ogo and Thera. Apparently Thera had called us at 4 to tell us that he was running late, but silly me forgot my phone again and I guess he didn't try Liz's.

Anyways, we waited outside until about 5:20 when Thera came, Ogo still wasn't there so we just started talking with Thera. We decided that we would like to visit one of the local clinic sites before heading to Bandiagara and if possible visit the hospital that's right next to the medical school. Thera suggested that we see two of the local sites to see how the design evolved. Apparently bandiagara is the oldest site (these were all set up for vaccine trials) and two of the local ones are newer and are designed based on what they decided would be most effecient after working in Bandiagara. Ogo came in a little laterand decided that perhaps we should jsut spend more time at one site and see the process of care from start to finish (the physical exam, to examining the lab specimines, to diagnosis and treatment). We decided that would probably be a good idea (plus no one overrules Ogo) so we set up to visit the newest site, which is on the edge of Bamako. There is also an entimology group there so we could also see how they catch and examine the misquitos (there doing some studies right now on the effectiveness of indoor residual spraying) if we'd like. At the end of the meeting we asked if we could have a driver for that evening to go out with Agnes and also for Sunday so we could go to the museum. They suggested the Agnes also go with us to the museum (it seems they are reluctant to let us go anywhere without a female chaperone). I was a little concerned that were becoming a bit of a burden on Agnes and also she is Christian and attends church on Sunday. Agnes was there to meet with Ogo after us and it seems that either she agreed or was forced t o agree to go with us Sunday.

After we left Agnes showed Liz a trail that she could run on if she wanted (which she did for a short while later in the evening). At 8pm the driver came to take us out with Agnes; we picked up Agnes and her friend that we had also gone out with the night before and headed into the city. It seemed that no one was sure where to go or how to get to where we were going, but eventually Agnes insisted on going to a restaurant called "the Diplomat" and after passing it once, we got there. Now don't let the name fool you, the Diplomat was not really as ritzy as its name implied. We got a table near where it seemed the band would play and ordered. I got the fish that Liz had gotten at Bar Blabla with fried plantains. The waitress didn't seem super attentive and messed up a few things on our order, but it worked out ok. There were also to ratherly scantily clad girls sitting on a bench not far from us and Agnes and I laughed everytime "my friends" came into view (I could decide whether or not they were prostitutes, though later I saw them serving food).

Shortly after we got our drinks (and toasted to America's independence) another of Agnes friends came to eat with us, he just finished his medical internship. The food was ok (though I think not as good as Bar Blabla) though a little burned. Interestingly when Agnes other friends food arrived it seemed of much better quality than ours and Agnes joked that maybe he had said he was a doctor and thus got better service. The band started to play some jazz and raggae and funnily (yup not a word) enough they also played Abba's Fernando that we had heard the night before. Although they did play more than just american music, they didn't really play the elusive African music that we were hoping for. After eating and listening to the music for a while we asked for the check. Agnes friend also asked Liz to dance to a song that was sort of reminisent of salsa/cha cha. When the driver came we decided that we were tired and heading back to the guest house. When we arrived back at the guest house we arranged with the driver to pick us up the next morning at 10am to go to the museum.