Monday, June 28, 2010

Portrait of a Patriot in Mali

I haven't been able to watch any of the World Cup games in my village, soccer being an activity exclusively reserved for men. When the games are on, all the men congregate at the different televisions around town, and I sit with Sitan or Banta, wondering what the score might be and keeping an eye out for Adama's moto for news of the results.

But Saturday found me in San for the America v. Ghana game, and a couple other volunteers and I walked over to the neighborhood bar to watch the game. Bars are also male-dominated in Mali -- in fact, during our training, Peace Corps reminded the male volunteers over and over again that the only African women they would find in bars would be prostitutes (many of whom are Nigerian women who have been trafficked here). Every single one of them. San is a bigger town, however, and although I wouldn't like any of my colleagues or friends from my conservative Muslim village to see me in a bar, its fairly acceptable for us to frequent the bars in San.

As Esther and I walked to the bar, I couldn't figure out which team to support. My own country or the last African team still in the game? Either win would be a victory in my book, but I knew how depressed my Malian friends would be if Ghana lost. Everyone had set their hopes on the Ghanaian team.

We arrived at the bar to find a mix of Malian and Ghanaian men already settled in. At first, the banter was friendly. But after Ghana scored its first goal and the men had downed a couple of beers, the environment began to change, and my sentiments with it. As the men grew drunker and more obnoxious, suddenly, I knew which team I wanted to win: America. They shouted and swore at America. One man put his face in front of Brad's, blocking his view. Ghana is going to win! He shouted. Ghana is the best! Ghana is a rich country, he continued, much richer than here -- there is everything in Ghana, he said, refusing to move. I had walked into the bar prepared to support Ghana, but as the game came to a close, I was on the edge of my seat, desperate for America to score again.

It was an experience not singular to Saturday's game. While I have never thought of myself as being particularly patriotic, whenever I am confronted by critiques of America and the West which seem unfair to my ears, I am immediately ready to claim that America is the best country on earth. I go so far to the other side that my words astonish even me. And yet sometimes I feel that taking such a contradictory point of view is the only way I can impress upon my community that we toubabs are not who they think we are. I adore Mali, but I don't think I have ever loved America as much as I do while living so far from her.

Tell me Americans don't know how to work, and I will swear that no one works harder.
Tell me Americans hate black people, and I will insist that racism is close to extinction.
Tell me Americans never say hello to each other, and I will assure you that we greet every stranger who walks by.
Tell me Americans are all rich, and I will do my best to persuade you that we all sleep on the street and starve.

Okay, maybe I don't go to quite such extremes, but its close. When I get that patriotic urge, there are two impulses going on in my mind.

The first is a feeling of defensiveness. I am the only American to stand up for not only an entire country, but also all of the Western world. I am also being evaluated by people based on their identification of me as an American and Westerner. So if someone says all Americans are wealthy and can afford anything, that means I can too. If someone says all Americans hate black people, that means I do too.

The second is a frustration over the incredible stereotypes that exist of Americans and Westerners in general. I can imagine that Africans would feel similar frustrations faced by Americans who assume that there are zebras and elephants running through their villages every day, that every African is beyond poor, and that they all practice voodoo.

After the soccer game ended, Brad and I walked out to the jeers of the those celebrating Ghana's win in the bar. We jokingly said we would support whoever played against Ghana in the next round. The impulse to be so defensive and patriotic is a fascinating one to me. Its an impulse that I can't quite believe I've experienced the next day. And its easy to see how powerful that impulse could be if you let it take over.

Thursday, June 24, 2010

Postscript: Two Steps Forward, One Step Back

Yesterday, Dr. Mary Alleman from the Center for Disease Control (CDC) in Atlanta and Dr. Tounkara, who works with the World Health Organization (WHO) here in Bamako, spoke to a small number of Peace Corps volunteers assembled at Tubani So, the Peace Corps training center not far from Bamako.

This Friday, health workers all over the country will head out door-to-door to begin yet another polio vaccination campaign. The CDC and WHO are working in cooperation with the Malian Ministry of Health in hopes to eradicate polio in Mali. Since 2008, Dr. Alleman reported, polio has begun to surge in West Africa. Starting in Northern Nigeria, it has now reached all the way up the West coast of Africa north to Mauritania, frustrating health workers internationally who had thought they were close to eradicating polio completely in Africa.

When polio cases began to pop up in Mali in 2008, health organizations took the cases seriously and the door-to-door campaigns began in a hope to contain and stop the spread of the virus.

But what about routine vaccinations? Why have they taken a back seat, while polio vaccinations have stormed ahead, irregardless of the cost and burden it places on local communities. Why were Malian health centers suddenly without access to the vaccinations vital to preventing outbreaks of other diseases, like measles, yellow fever, and tetanus?

Dr. Tounkara stood up to answer my questions. In 2009, he said, Mali's partner organizations and donors stopped buying Mali's vaccines in the expectation that Mali could now handle the financial burden of buying vaccines on its own. However, that same year, the cost of vaccines went up and Mali was unable to pay for enough vaccines to cover the entire country, leading to the lengthy shortages we experienced in my village.

This year, Dr. Tounkara said, Mali has been able to pay in full and the shortages should be over.

They haven't ended in my village, I said. The system is breaking down, and its terrifying to watch.

Dr. Tounkara took down the name of my village and promised me to look into the problem. I hope he finds some answers.

Saturday, June 12, 2010

Two Steps Forward, One Step Back

During my first few months in my village, Mapha, the vaccinator and I would go out to neighboring villages three times a week -- he to vaccinate the babies and I to weigh them and give nutritional advice to their mothers.

The clinic in our village serves 25 other villages -- the closest of which is 3km away and the furthest over 15km. Under the Malian national health care system, villagers living less than 5km away from the clinic are required to walk to the clinic on fixed vaccination days -- Tuesdays at our clinic. On the other days of the week, the vaccinator should be going out to the more distant villages to give them their vaccinations.

And that is just what Mapha would do. He would start off early on his moto, a bag packed with his register and single-use needles, and a small cooler tied to the back of his moto filled with ice boxes and polio, measles, and yellow fever vaccines. When I went with him, he would ride a little slower on the sandy dirt roads so I could keep up with him on my bike.

During those early months, Mali was new to me and I was new to Mali. I could barely tell a mother her baby was at a healthy weight in Bambara and kept turning to Mapha, exasperated with my own limited Bambara and dependent on Mapha to help me give nutritional advice to the women.

We would arrive in a village and head for a central village meeting location, one with a bit of shade provided by stacked millet stalks or a big tree. Before we had managed to set up and hang the baby scale, the area would be full with fifty women and their screaming babies. At one small village, the town crier began his rounds of the village. In his loud voice, over and over, he announced that the white doctor had come, much to my horror and Mapha's amusement.

Mapha knew everyone and would alternate between screeching laughter -- his head thrown back -- reprimands and looks of disapproval that scared me with their severity when a mother had gotten behind in her child's vaccination schedule. The mothers all knew him too -- go easy today, Mapha, they would say. When the babies would start to cry after the shots, the mothers would point at Mapha. Mapha minen, they would say, Mapha's bad.

But then, perhaps 10 months ago, the vaccines disappeared. Mapha would go to San to get the vaccines to discover that there were none to be had, not only in San, but all of Segou, and maybe even, the rumor went, all of Mali. When the vaccines would come, it was never enough. They would be finished in one day, and the mothers would beg for us to just vaccinate one more child as Mapha tried to explain that the vaccines were simply gone -- boloci fura banna peuw.

After our Monday night radio shows Adama and I would have to announce that vaccinations would not be taking place the next day so that women wouldn't walk 10k to arrive at the clinic at 7am. I retired my radio show on the importance of vaccinations completely. Mapha no loner rode his moto out to the neighboring villages, staying behind to play cards outside the clinic. When we would receive vaccines, the crowd at the clinic would be so large we could not hear each other over the noise. There were fights and more than one black eye among the women over who had arrived first. The pushing and yelling got so bad that I began to dread the days when we did have vaccines.

No one can tell me exactly what the problem is or where the fault lies. At first we thought it was just a problem of getting the vaccines to Bamako and then the regional capitals and then to San and finally to us. But everyone I talk to says the vaccines are in hard to come by everywhere. Then there was the unconfirmed rumor that the Malian government had simply forgotten to order vaccines for 2010, thinking for some reason that the 2009 vaccines would last for two years. And finally there is the logistical problem that there are more people and more babies coming to the clinic for vaccines than the Malian government planned for based on birth certificates in our area.

Meanwhile, every couple of months, in Mali and much of West Africa, a huge door to door polio vaccination campaign takes place, funded by international donors. In every community in Mali, community health workers walk from compound to compound, administering an oral polio vaccine and marking the left-hand pinky finger of each child under five who receives the vaccine. There are t-shirts and paychecks for the community health workers go back and forth to each household, making complicated symbols with chalk on mud houses to signify whether all the children of the house have been vaccinated. There are unlimited boxes of the polio vaccine and white SUVs head into every village to monitor the progress of the campaign.

I am confident in saying that every child under five in my village has received the polio vaccine at least five times, but almost all babies are now behind in their vaccination schedule, if they have started it at all. Its a long walk to our village, and there are some villagers from the outer villages that Mapha has not seen for months. After working so hard and so long to convince villagers of the importance of vaccines, suddenly, Mali and the international community have dropped the ball. How can the polio campaign be so well organized and regular vaccines forgotten?

Those severe looks Mapha used to give? Now he just gives them to me, because we know the mothers are no longer at fault for being behind in their children's vaccinations.