31 August 2005


I am seriously freaking out over here in Mali. Due to a rainstorm here, ironically enough, the internet has been VERY SLLLLOOOOOWWWWW. Also, no one here has CNN (while not the best means of media coverage, at least it is something). I still have two friends, both former roommates of mine, who stuck it out in our old house on St. Mary and CampI hope they are all right. Thus if anyone hears from Jason Cundiff, MD, a surgery resident at Charity Hospital, or Dan Johnson, M.D (he is a 4th year med student at Tulane, thus he has not earned that period yet) then please let me know ASAP. also, I need info on the following:

- I get conflicting stories about Charity and Tulane Hospital. What is the REAL situation there?

- What about the supposed rising flooding? Has it hit Uptown yet, especially on the Riverside of St. Charles?

- What about St. Mary and Camp?

- And last, what about N. Rendon in Mid-City, the same block as Pals near the old Whole Foods on Esplanade?

As far as contacting people, text messaging works fine. I have listed some sites whereby you can text people from the web from pretty much every wireless service known to man. This helps especially if you do not have text on your cell phone. I have not listed all of the sites, just the first 30 or so I found on google. I hope this helps.

God Bless New Orleans,


28 August 2005

God Bless New Orleans

Well, I was intending to use this beautiful Sunday afternoon in Mali to talk more about life in general here in Mali, the people I have met, the crazy, other worldly sights I have seen, and other such thoughts. However, my mind and my thoughts are with my friends in New Orleans, who are bracing for the sting of Hurricane Katrina. Since I have been living in New Orleans, there have been at least 5 tropical storms/hurricane scares, 2 of which I have evacuated for. My first ever experience was my first week of school at Tulane while I was earning my MPH. The first two days of school were cancelled, and yet nothing hit New Orleans. A few months later we were hit with another scare, one which forced us to evacuate to Memphis. Nothing really came of it though. During my first year of medical school in 2002, our first round of exams were cancelled due to a hurricane scare. Last Fall, while on my OB/GYN rotation, Hurricane Ivan was headed right for New Orleans, and forced us to evacuate to Houston. While that storm missed New Orleans, it did cause some minor damage.

Before I left New Orleans at the end of June, the nascent hurricane season had yet to rear her ugly head anywhere in the Atlantic. I recall packing up my belongings and storing the non-essentials that I really didn't need while I was in Africa at my cousin Mary's house in Mid-City. She allotted me some storage space in the first floor/basement of her raised double shotgun (New Orleans version of a duplex which is so named because you can shoot a shotgun through the front door, and the bullett will traverse the house and exit the back door). I recall pessimistically thinking that this might be the last time I would see any of my stuff, my old house on St. Mary, or possibly even some of my friends whose bradaggio is bigger than their brains, as I had the nagging suspicion that a hurricane would hit while I was away, and wipe out the city that I so loved. I hate being right (maybe). . . .

While this post is being written about 24 hours before Katrina will hit, I cannot expunge the thoughts of my "other home" from my worried soul: experiences I have had there (Mardi Gras, Jazz Fest, parties on the street), people I have met (classmates, best friends, lovers found and lost), the sights, sounds, and smells of an eclectic, hip, lost, treasure chest of a city, one that has somehow managed to live and breathe anew with each hurricane that endangered it. Somehow, New Orleans will find a way to survive this one; it has before, and it will again.

New Orleans, I salute you, I miss you and I wish you well my stoic friend.

Inshallah (God Willing),


25 August 2005

What it's all about. . . . My friends in the village. Posted by Picasa

Bon appetite. This was breakfast one morning in one of the villages I will be working in. Can you guess what it is? Fear Factor, here I come. Posted by Picasa

The Hospital at Point G. Posted by Picasa

Trojan Man it is not, but I think it gets the point across.

Marche (market) in downtown Bamako. Note the mobylettes, Mercedes, and shantys. Posted by Picasa

Downtown Bamako from halfway down Point G. My Dad thought it looked like Iowa. You decide. Posted by Picasa

New Beginnings, New Challenges

Well, it seems that my goal of publishing at least once a week has already fizzled. I guess I could blame it on the following:

  1. No internet for 3 straight days, even at the great expense of the NIH

  2. 3 days of figuring out how to format my fucking blog the right way

  3. moving into a new house with only dial-up connection, on which I have limited access anyway

  4. and just plain laziness

  5. All of the above

No, really, a lot has happened that I want to tell you about, and I will seriously try to update at least once a week, if not more (Haa-haaah in voice of The Bully from the Simpsons)

So, as the description that accompanies my GQ/Abercrombie photo at right states, I am here officially as a National Institutes of Health Fogarty/Ellison Overseas Fellow in Clinical Research. The real title should be NIH Fogarty Fellow, which is what I tell people, but that is an issue we are currently working out with the leaders of the program, to let the Fogarty name stand for itself like the Rhodes Scholar or Fullbright Scholar does, etc., etc., blah, blah, blah, but that is a topic for a different day. So, the NIH is the government institute that pretty much sponsors and oversees most of the major research that is occurring throughout the US and internationally. There are 27 Centers at the NIH (National Cancer Institute, National Instiute for Allergy and Infectious Disease, National Heart, Lung, and Blood Institute to name a few). Well, the main center that handles all International research is the Fogarty International Center (FIC). For those of you dying to get more info, here is the FIC website (www.fic.nih.gov). So, the bigwigs there realized that there really were few programs geared toward international research for young scientists. The FIC fulfilled that need by establishing this fellowship, predominately for medical students, but also for PhD candidates as well. It is in its 2nd year, and sponsors 27 fellows in 18 countries. For a more information and complete list of countries involved, please see www.aamc.org/students/medstudents/overseasfellowship/start.htm.

This past year there were 125 applicants, of whom they interviewed 50, and chose 30 from those. To be honest, I have ABSOLUTELY NO idea how or why they chose me. That is something that is of constant debate amongst my family and friends. Whatever the case maybe, I am here working with the Center for Vaccine Development at the University of Maryland-Baltimore (CVD-Maryland) under the tutelage of Dr. Chris Plowe, and the Malaria Research Training Center, University of Bamako, Faculty of Medicine, Pharmacy, and Dentisty, under the direction of Dr. Ogobara Doumbo. My main work will be with the Malaria vaccine trials currently under way here. I say trials because Mali has 2 different vaccine trials occurring with 2 different groups: one sponsored by the NIH’s own Vaccine Development Branch in Doneguebougou, a hamlet about 30 minutes from Bamako, and the other sponsored by my mentors from the CVD-Maryland in Bandiagara, a small village in the Dogon region, about 720 km away from Bamako. My role is not entirely clear at this point, but based upon what last year’s fellow did I will be one of the study clinicians in each of the trials (Insert Big Gulping sound here). That means that I will be involved in performing clinical assessments of patients enrolled in the trials, performing blood smears to assess for Malaria parasites and performing analysis of blood samples to assess for proper responses to the vaccine, providing health care for all non-vaccine related issues to participants families, and learning about providing good quality health care in settings that lack the many of the amenities that we take for granted. It sounds like a rather daunting task, and it is, but I am definitely up to the challenge. I have been looking for something like this for my entire life, and I am now living the dream so to speak.

(Aside: There is a problem with the above scenario: I kind of came on board right at the tale end of both vaccine trials; the Bandiagara trial ends in 6 weeks, Doneguebougou ends late Nov. Luckily there is another trial that is supposed to begin starting in Bandiagara in the Spring barring no unforeseen problems. But this is Africa, and this is clinical research, so something (or someone) always changes the plan at the last minute. My one saving grace is that I will spend at least the last 3 months of the Doneguebougou trial to get a sense of what this crazy vaccine world is like, so I have that going for me which is nice. Bandiagara is a whole other issue, and I will keep you updated about that periodically. . . )

So you may be saying to yourself: “Well, he is getting all of this clinical background and stuff. How does that relate to clinical research?” Good question. Working on the vaccine trial by proxy affords me the opportunity to see the development and implementation of the protocol (i.e. script that dictates how each participant will be randomized, what clinical measurements need to be measured, how they will receive the vaccine, what specific days the participants need to return to the clinic for follow-up, etc. Some of these protocols are hundreds of pages long. I am supposed to receive the Doneguebougou protocol soon, so that should make for some light reading. . . ), working closely with the village elders and committees that ensure patient rights and confidentialty, internal analysis of data to ensure patient safety, and thousands of other tasks which I haven’t learned about yet.

I will also gain said clinical research experience by designing and implementing my own study. From the get go, I wanted to have something to call my own, something that I can walk out of here with and say “This was how I spent my National Lampoon’s African Vacation!! (Hmmm, I smell sequel people. . .) Luckily I have a background in epidemiology (well, what that really means is that I took some courses in grad school in something that resembled epidemiology to qualify for a MPH and “worked” for a couple of years as an “epidemiologist” [note the “quotations” here people]) to help me out. I have a couple of ideas floating around, and the next few weeks should help me iron out those issues.

So now that we have the boring stuff out of the way, just what have I been doing the past 2 and a half weeks you might ask:
  • Working in the Parasite Diagnosis lab learning techniques to diagnose Malaria (i.e. thick smear/thin smear, staining, and identification)

  • Attending rounds with the Heme/Onc service 2x per week

  • Met with the principles of each unit here at the MRTC to discuss possible studies that I could accomplish during my brief journee here.

  • Getting accustomed to Mali
As for that getting accustomed thing, I moved into one of the study houses “aka villas” in the heat of the capital, the Garden District of Bamako if you will. It will serve as my home base while I am not living and working in the field, either on the vaccine trials or on my own self-designed project. Perhaps the coolest thing about my new house is it is within walking distance to the coolest restaurants, bars and nightclubs in the city. I have had dinner out in that area every night this week and I can honestly say that it is not that bad. Since I do not have access to a driver after 6:00, I walk every where. Now, for the unititiated, the walk would seem daunting: next to no streetlights; many, many mud piles; garbage and raw sewage in the street; BMWs parked next to trash heaps and shanties; security guards everywhere guarding their respective houses; feral dogs running wild; toads that croak incessantly, and in my opinion are saying “Shittt,” “Shittt,” “Shittt”; and thousands of other little things that make it so unique. Now, normally in any other city in the world I would be scared shitless and insist on driving. But for the most part, I feel very safe, and I have made friends with the security guards along the route. Luckily I had some initiation to this sort of living on the wild side in New Orleans!!

For any of you who have lived overseas, especially the Peace Corps folk, people who can afford a house also find ways to afford drivers, gardeners, security, and nannys for their children. Well, no children yet, but there are the other 3 acoutrements at my house. The drivers are cool, and speak absolutely no English, except for the old standby Malian-attempt-at-English phrase: “Hello, How are you? I am fine. You are nice.” My house is nice, BUUTTTT: the only downside is that it is an office during the day. The CVD-Maryland owns the house and uses it as their HQ. Thus whenever the study doctors are here in Bamako, they work there. Whenever my boss, Chris Plowe, comes in with his team from Maryland, they work and stay there. It has taken some getting used to, and there are some subtle housemate issues that are slowly getting worked out, but nonetheless it is home and I am content. I have a couple of ideas about pimping out my room in the back, once the leak in the window and wall is fixed. There is also an unused patio in back that has a lot of potential, so that will also become part of the Chez Craiger.

Well, that is about it. Expect more in future posts rather soon. And I am still working out the issues with the picture sharing capacity with this new program, so bear with me.

Love Life, Enjoy Liberty, and Be Happy,


16 August 2005

Ready to conquer Malaria Posted by Picasa

14 August 2005

Craiger finally in Mali

I am sitting on the front porch of the guest house at the Malaria Research Training Center on a Sunday. It is only 85 degrees or so outside right now, and I am enjoying a cup of hot tea (when exactly did I become British?), attempting to begin to write this manuscript, so to speak, of my time here in Mali. First, some logistics. I kind of envision this as an attempt to share my thoughts, observations, and impressions of what I hope to be a long career living and working in 3rd World Countries. This blog will be my external source to you, my family and friends, of the thoughts and ideas I have jotted down in my internal source, a journal given to me by my Mom just before I left. While I cannot share every thought, random idea, or observation with you during my time here, I sincerely hope this blog will act as a surrogate, a portal if you will into my experience here. I encourage all of you to write emails to my Tulane account (cconard@tulane.edu) for questions, to shut me up, or for my autograph. I hope this new picture sharing tool I am using that accompanies this blog site will also allow you to view pictures. I am still learning how to use it, so please bear with me.

Now for the fun stuff. After a rather exhausting 24 hours of travel (16 in the plane, 8 hours in layover), kids screaming in the middle of the night somewhere over the Atlantic, long tarmac waits, and a rather insane arrival at the Bamako airport, I arrived at the MRTC guest house. I had intended to spend at least some time in Paris, but alas the "intelligent design" of Charles de Gaulle airport did not afford me that luxury. We finally left the terminal around 4:00 or so and boarded a bus that took us to the plane. We waited on a hot, sweaty, bus full of Malians who, like most Africans, don't believe in cologne or deoderant. As we sat there, we watched Malian prisoners (most likely illegal immigrants) get boarded onto the plane before us. At that point I knew I was in for an adventure;"What the hell am I getting myself into?" I remember asking myself. Otherwise the trip to Bamako was rather uneventful. Perhaps the coolest thing was watching the Sahara desert unfold before my eyes, no visible human dwelling to speak offor hundreds of miles. It is rather humbling to know that such places exist.

The first thing I recall about Bamako as we landed around 9:30 pm local time was the lack of lights. Normally there are thousands of lights near a city. Here, the capital of this mostly desert/sahel/savannah country, there were very few. The Bamako airport was rather small, and after a short taxi to the disembarkation point, I got a sudden wave of anxiety and anticipation. "Here we go CJ." As I stepped of the plane and onto the stairs, my first wave of African air hit me. I have often heard people who have lived in Africa say that they miss the smell of Africa the most; I now see why. Here is my description of it: a sweet smell of pesticides; a tinge of dry, desert air; a hint of body odor; and the smell of burning wood flavored with some form of spice unknownst to me. God I hope I never forget that smell.

The walk to the terminal was rather short, but the scene that awaited me inside will forever be etched in my memory. First off, outside the plane, right off the steps, there was a military-looking van waiting for some dignitaries to disembark. As I walked by they gave quizzical looks to the beleagured American who was entering their country. The terminal lay only a few hundred feet away from the plane. A rather small building, it was rather unimpressive from the outside; what lay on the inside was larger than life. Customs is essentially the entire terminal. 2 small cubicles with customs agents inside are the only thing that block ones entrance into Mali. As I got in line, I felt like I was in a movie. Some of the passengers walked right past the security check point, gave the woman on the other end their white immigration pass, and got their luggage. Others were escorted to a small cubicle to the far left that read "Visas," and within a few minutes were on their way. While I could not entirely decipher what went on in there, I am sure some form of currency and/or bribes were involved. Those of us without such connections (or better yet too stupid to realize that you didn't have to wait in line) remained there for quite a while as the only immigration clerk present carefully checked each passport and visa for the proper paperwork and clearance.

On the other side of Customs a sea of men in green uniforms clamored to get our attention. Being new to the game, I thoughtnothing of it until one older gentleman waved to me from across the line. I thought he was my Malian counterpart Moctar, who agreed to pick me up. I waved back, with the thought that I was at least guaranteed someone who spoke English and who had a car to drive me to the airport. After a rather uneventful Customs interaction (What, no strip search for Americans, no brow beating for living in their country for a year?) I found my "friend," and rather enthusiastically greeted the Man Who Must have Been Moctar. Needless to say he was not Moctar. He gave me a quizzical look, and started speaking to me in what I could only believe to be African French or the local language of Bambara. Realizing my mistake, I quickly moved on to pick up my bags, politely avoiding the seemingly thousands of other men who similarly were vying for my attention, and walked out the door.

Previous international experience had told me that I was bound to loose at least one or two pieces of luggage, at least temporarily. Luckily, the travel gods spared me this time, and I collected all of my checked baggage: 2 bags and a trunk which has accompanied me on every international experience thus far. Suffice it to say that it did not make the journey intact. Whether the TSA assholes saw an opportunity to inspect a footlocker going to Africa or a haphazard baggage handler at CDG thought it prudent to practice his 60 lb weight toss for the World's Strongest Man Competition I will never know, but the lock was busted INTO the trunk itself, one of the latches had fallen off, and the left side panel was indented. Luckily all of my supplies (i.e. speakers, books, firearms, and heroin bricks) made it intact, but I am afraid my trustworthy trunk is toast.

I finally was able to locate my Malian contact outside, who had waited patiently for an hour for our plane to finally land, and we drove to the Malaria Research and Training Center at Point G, the village on top of the escarpment (plateau) overlooking Bamako. The half hour drive
to the guest house offered me a chance to see this lively African city at night. The best way to describe it is through some creative imagination on your part: Imagine driving down the Interstate within a major city, and approaching an exit. The increased numbers of light posts serve as a guide to help you navigate the exit ramp. There are light poles every 15 feet or so, and not much is in between them. THAT exact scene is downtown Bamako at night, except there are some scattered buildings strewn about rather haphazardly. These buildings are for the most party impromptu shanties that serve as either homes or businesses for the rather predominant informal economy. People were scattered throughout the streets, sitting and chatting, playing checkers, or gathered in multitudes around a television set watching either one of the many pirated DVDs that are everywhere in Bamako or the one Malian television station.

Cars here are of all types and brands (Ford, Toyota, BMW, Mercedes Benz; thankfully no Hummers yet!), yet of all the street traffic, the motos, or mobylettes, take the cake. They are of all type and brand, some new, some old; patched together with wires and roadside paint jobs. They weave in an out of traffic at speeds that would make any motorcycle driver on the Isle of Mann in Ireland jealous with envy!!. They have little to no consideration for the cars that dwarf their size by 5 to 1. Not wearing helmets is rampant, which perhaps lends to the fact that moto accidents account for more roadside deaths in Mali that any other type of motorized vehicle.

Let's not forget the green vans that ferry people to various locales within Bamako. Large enough to fit 10-15 people, they resemble a stripped-down version of a Volkswagon mini-van, with no side doors, and few seats. Local Malians tend to prefer this mode of transport than the Bush taxis which are also predominant. Little more than yellow and green pieces of painted metal held together by string, four "tires" (if you call pieces of rubber that have at least some semblance of a round shape a tire) that provide forward movement, and a lot ingenuity, they have a smaller capacity than the green vans, and tend to be a lot more cramped.

The ride up to Point G was dark. As we rode in a seamless circle for what seemed like hours, we finally reached out destination: Le Faculte de Medecine, Pharmacie e Odonto-Stomatologie (FMPOS). It is nestled right off the road on its own grounds complete with security guards, burros, and goats guarding the premises. It was founded in 1968 as the Medical School. A few years later they added on the Pharamacy and Dental Schools as well. The Hospital is right next door. Originally built by the French over 100 years ago, it serves as the main referral hospital for the country of Mali. (See subsequent ramblings on attending rounds with the local MDs there and the appearance of the grounds). The MRTC is located further down the path toward the gradual cliff that marks the end of the Point G escarpment. Housed in 4 buildings, it is one of the National Institutes of Health's International Centers of Excellence. The NIH first gained a foothold here in the early 1990s, and has since built not only a rather impressive physical infrastructure (5 NIH buildings in addition to the older FMPOS buildings on the campus), but more importantly a cadre of scientists, anthropologists, computer esperts, and physicians who are now worldwide experts in the field of Malariology. The original labs are now being renovated and restocked with equipment from the NIH. It truly is an impressive site, and is the envy of many universities in West Africa.

The guest house is located on the grounds, and is a rather nice oasis. There is a full-time cook that prepares local Malian dishes for lunch and dinner. A large dining room/living are adorned with local Malian furniture, donated books from previous inhabitants, a TV with 1 channel, and a VCR. The individual guest rooms are dormitory style, complete with JC Penny bought furniture and other acoutrements. Perhaps the coolest thing is the grounds that surround the house. I will let the pictures speak for themselves, except to say that during the late afternoons I feel like I am in a tropical oasis, far away from the problems of modern society; with the sun setting, and a great view of downtown Bamako and the desolate, green hills that surround this ancient city, I really feel like I am in Africa.

I have only really ventured into the heart of the city twice thus far with a group of students staying at the guest house. 2 were working with a group of biologists and geologists from UC-Davis on a GIS/GPS mapping survey of Anopheles sp. habitat (Anopheles is the only genus
of mosquito that harbors malaria), 1 was from Cornell working on lab techniques for her nutrition and malaria project, another was an undergraduate from Notre Dame, here on a Kellogg grant to learn lab techniques and work on genes in malaria that confer resistance to many of the drugs that are currently in use, and the last a rising 2nd year from Tulane, an friend of mine from my Trop Med courses. The first day I arrived I accompanied my Tulane friend to the Marche, or the Central Market. Truly an experience I will never forget. I could not
help but imagine that this was how these people, our ancestors, have been selling goods for generations. The colors, the smells, the sounds, the people, and the products being sold are a sensory overload, and a simple decription will not do it justice (See later entries.) During this first Marche visit, I only purchased a pair of Malian sandals which I have thus far put to good use. (Aside: Malians wear sandals 90% of the time, even during rounds and in the lab; Ahhh, I am in heaven!!) The key for my next visit is to go with a local Malian, and have them barter for the best prices.

The other major excursion, aside from a quick dinner downtown a few times, was last Satuday. A small, red brick road runs between the Medical school and the hospital, and serves as a pedestrian path from Point G to the outskirts of downtown Bamako. I had heard from my advisor that it could be dangerous, as the area where the road ended was in a sketchy part of town. We decided we would chance it, and we braved the rather steep path down to the city below. It got real steep at spots, with few footholds, but we made it. We got a lesson in local life when we saw local women walking UP the path, balancing about 20 pounds of goods in baskets on their heads all the while walking either barefoot or in thin flip-flops! Needless to say it made our "leisurely stroll" pale in comparison. We walked for what seemed like miles until we ventured upon one of the nice hotels in the area. A cold local Malian beer at the rather posh bar in the hotel whetted our parched throats, which were dry from all of the dust and car fumes. We then set off the opposite direction to a local restaurant that one of our hiking mates had dined at the previous weekend.

The Bla-Bla bar is the gem on the Bourbon Street of Bamako. Decorated with tasteful local art and sculpture, locals, ex-pats, tourists, and future malariologists alike can dine on kabobs made of the local fish delicacy (Capitan), chicken, or beef with an assortment of side dishes including fried plantains and vegetables, and sip on libations of all kinds and flavors. As soon as I entered, I decided right then that this would be one of my frequent haunts during my sojourn here in Mali. We then ventured to a local bar about a half block down the street. As we walked onto the patio and saw the expanse of the bar, I could not help but envision the Half Moon, the local bar near my old house on St. Mary's in NOLA. The clientele, the dirty seats, and the simple bar that only served large and small Castel, the Budweiser of Mali (No joke here: It is nicknamed the Queen of Beers!), brought back memories of many cheaps Abitas drunk at the Half Moon. It served as the perfect end to the day of exploring Bamako on foot.

I have much more to say about my work here during the next few months, the people I have met, and my general impressions, but that will have to wait for the next entry. Le diner a 19 heure is fast approaching, and I have yet to play a game of checkers with the guard that sits outside of the guest house. He is a skilled player, and I am sure I will beat him at some point while I am here.

Until next time, Love Life, Enjoy Liberty, and Be Happy.

Au revoir,