Mali, Malaria, and Craiger

Kambe Mali

2006-05-12T17:25:00.000Z

So I am seated on the front porch of the guest house, soaking up some last minute rays of sunshine and blasts of heat. Today is my final day here in mali. I have many mixed emotions right now. I am happy to be leaving, but also sad to leave such and interesting and wonderful place. Work wise it was not what I expected, but culturally and personally it was incredible. It will take me many days, perhaps months, to figure out this whole thing called the Fogarty Fellowship, and what exactly my experience has taught me. I will never forget this experience, the people I have met, the things I have seen, smelled, heard, felt, and tasted.

I will have a lot more to talk about in a few weeks when I am home. For now, I am going on a 3 week trip to Morocco, Spain, Portugal, and 3 days in Paris. It will serve as a great way to end the fellowship, and to get re-acclimated to something related to the American lifestyle.

In the meantime, I will leave you all with one parting thought: Africa, and especially Mali, is more than just a place on a map; It is a state of mind.

Match Day 2006

2006-03-20T17:24:00.000Z

Match Day was March 16, ironically the same day that we started vaccinating. Match Day can best be described as either the best or worst day of your medical career. Today, all the 4^th year medical students around the country find out where they will be completing their residency training. For all of my former classmates at Tulane, it is day that none of us thought would ever arrive. It is the culmination of 3 and a half years of hard work and sacrifice. For many, they will get one of their top 3 choices for residency training; for some, they will be training somewhere they never thought they would be training.

The Match works like this: 4^th year medical students select their specialty and apply to a central Residency Application service that processes all of the applications. If the program they are interested in is likewise interested in the candidate, the student is invited for a day long visit to the hospital and an interview. After all interviews have taken place, the student ranks the programs he would consider training at from highest to lowest. The residency programs likewise rank the candidates highest to lowest. A computer analyzes all of the data from all of the students and programs and creates a Match list. A Match occurs when a program on the student’s list is matched with the student’s name on the program’s list of desired candidates. The Match is set up so that the student is given preference over the programs. I do not think I did the program justice here by attempting to describe the process; needless to say it is a complicated process, and a dreaded one, but all medical student entering residencies have to go through it.

As I was in the village when the Match happened, I did not find out the results until Saturday afternoon. I was visibily shaking when I went to the Tulane Med website, and read the list. I was so excited and surprised at the results. My classmates did very well, thank God.

I just wish I could have been there for the party and the celebration. I have attended the Match celebration in New Orleans a few times, and it truly is a huge party. And given this year's circumstances, many thought there would be no medical school at all, let alone a match. Were it not for the dedication and devotion of our deans, Drs. Krane and Kahn, none of this would have happened. Congratulations to all of my former classmates on their respective matches!!

2006-03-20T17:18:00.000Z

The vaccination team. You might not recognize the lone white guy in the picture.

2006-03-20T17:16:00.000Z

A hard earned lunch after a long morning.

2006-03-20T17:13:00.000Z

The ever challenging process of taking blood from a toddler. Very, very tough job, as you can see here.

2006-03-20T17:12:00.000Z

Identifying patients for screening. That is Kimate in the back making sure this child was who he was supposed to be.

Vaccination day!!

2006-03-17T16:22:00.000Z

After months and months and months of waiting, we finally had our first day of vaccination!! It went as I expected it: a little disorganized, getting things done last minute, and anti-climactic. I had been waiting for this day for so long that when it actually came and was over, it seemed like nothing at all. But it was still incredible!!!

We invited 21 of our screened patients who satisfied all of our requirements for inclusion and exclusion into our trial, of whom 18 would actually get vaccinated. My role that day was one part clinician (assisting the Malian doctors with the clinical assessment) and 5 parts logistics man, mainly the cameraman. Part of the confusion that resulted the day before dealt with the camera. The study site camera stopped working, so I volunteered the use of my digital camera to take the participant’s photos. The plan was to hand off the camera to the researchers in charge of clarifying identification, but for some reason it would not work for them. So, I was given the task of photographer for the day. It was fun taking pictures of the kids we would vaccinate. The hardest part there was trying to get them to smile. There is not the same photo-crazed climate as in the US, so every single child had the look of sheer unhappiness on their face, despite Zanble’s efforts. Away from the camera, I assisted the Malian staff with the clinical evaluations pre and post vaccine.

We were able to vaccinate our desired number of participants, some of which would receive the malaria vaccine, and others of which would receive the active control vaccine, Hiberix (which protects against a bacteria called Haemophilus influenza, one of the leading causes of strep throat, ear infections, and more seriously, pheumonia and meningitis, in children). True to most drug/vaccine clinical trial, none of us knew who received what. This allows us to evaluate everyone without prejudice to what they received.

From here on out, the work is mostly follow-up. Each participant must return to the clinic on a set schedule for a clinical evaluation and occassionally lab work to make sure the vaccine has not affected their health in ways that cannot be measured by signs and symptoms alone. About a month after their first vaccination, they will receive a second vaccination. The purpose of this 2^nd vaccination is to boost their immune system response to the particular protein on the malaria parasite that our vaccine is targeting. After that 2^nd vaccination, they will continue to return to the clinic periodically for clinical evaluation and lab work for the following year.

Perhaps the most important part of the follow-up will happen when my fellowship period is over. In addition to their regular clinic days, we will be also be periodically evaluating their malaria status during the intense transmission season here (mainly August - November) to determine if they are adequatelyprotected or not. Sometimes, people can be infected with malaria, but not show symptoms of disease. We hope to see if this is this occurring in these patients. We also expect the participants to come to the clinic at any time for any complaints or illnesses that come up, as part of their compensation is complimentary medical care during the course of the study.

Lastly, I feel it is important to clear up one imporant point. I think people need to realize that we are just getting started with our understanding of the immunology of malaria and in the vaccine development process, and we have a long way to go before we have a marketable malaria vaccine. There are many, many issues that need to be addressed (i.e. type of vaccine target, falciparum vaccine only vs. vaccine for other types of malaria, genetic diversity of malaria, target population (kids vs. travelers), etc.) before we can say we have an adequate vaccine.

2006-03-10T16:18:00.000Z

No, that is not the moon. The dust from the Sahara even blocked out the sun.

2006-03-10T16:17:00.000Z

View of said dusty/fogginess from our front porch on our compound.

Foggy Bottom

2006-03-10T14:12:00.000Z

Headed back to Bamako for the weekend for a little R&R and to get my life in order. Sunday will mark the 2 month countdown to the day when I leave Mali, 12 May 2006 at 11:55 pm on Air France. Hmmm, is someone ready to leave???? Honestly, it has more to do with being ready to start the rest of my life (aka the rat race that is 4^th year medical school, loans, and that little thing of what the hell to do with the rest of my life) than wanting to leave Mali. I keep wondering if and when I will come back here and in what capacity. Again, answers to questions like that are impossible to predict, and if it was meant to happen it will happen.

In other news, I woke up on Wednesday morning, and it was very, very foggy outside. Seeing as we are in the dry season, fog should not be hitting us right now. When I walked outside, I could barely see 5 feet in front of me, and I started coughing non-stop. I then realized what was happening. There are 2 main winds that accompany the dry season. The first happens right at the end of the rainy season, and is called the Alize. It comes from the south, the Atlantic, and blows cool, dry air North. Around January or so, the wind changes direction, and the Hamartan blows hot, dry air from the Sahara Desert South. Occasionally, there are huge sandstorms that accumulate massive amounts of sand, and the sand is carried in the atmosphere South. This manifests itself as a extremely dusty, fog-like cloud that hinders visibility, causes massive eye and respiratory problems, and lingers for sometime weeks. Well, this is exactly what happened Wednesday. I am not sure when visibility will return and my cough will go away, hopefully soon.

International Women's Day

2006-03-08T16:10:00.000Z

One of the lasting memories I will have of Mali is the seemingly strength of the women here. With out a doubt they work 2 times as hard as the men do: collecting water, cooking, taking care of the children, selling goods at the market, and even working in the fields. All the while they have a constant smile on their face, laughing and joking around with other women.

So I thought it was fitting that they celebrated International Women's Day with a grand conference and party. President Amadou Toumani Toure attended the event along with other dignitaries at the Palais du Congres in downtown Bamako. A unusually light day at the clinic (10 patients all morning) and nothing else to do after 10 am allowed us to watch the proceedings on TV (the one “luxury” we have in the village, despite the fact that it is only 1 channel, the government run ORTM). Some of the great singers of Mali came on and performed, skits were performed in the local language, Bambara, and the biggest thing, the president spoke. He gave his usual address, marking the great strides Mali has made in women’s rights, and made some blank promises to improve their lives even better.

The one theme that is common not only to this one day of speeches and mild celebration but to most of the functionaries (i.e. government workers) and politicians in general here is “empty promises.” They always promise to do better, to do good for this one particular group they are speaking at or attended a meeting at, and in the long run, nothing will really change. Even some of my Malian colleagues noted their dismay at this, and I could not agree more. I guess we will all just have to wait and see what will really happen with all of these promises aside.

So, this last digression really toke away from the message that I got from the day’s celebrations: that women, the Givers of Life, deserve some recognition from their hard work and sacrifice in the name of family. But this begs the question: does that mean that the men of the world will ever lift a hand and give his wife a break and do her choirs for her?????

Ali Farka Toure

2006-03-07T15:58:00.000Z

Today, one of Mali's musical sons died from complications of heart disease and diabetes. To Mali, it is comparable to the death of Elvis Presley or John Lennon. Farka, as he was known here, was the first African to win a Grammy Award in 1993 for his compliation "Talking Timbuktu" with Ry Cooder (of "Buena Vista Social Club" fame). And he didn't stop there. He then won another Grammy in 2006 in his compliation with the coura whiz Toumani Diabate "The Heart of the Moon." He has been described by his friends as a true nationalist, someone who adored all things Mali. To wit, he even owned and operated a hotel in his hometown of Niamfunke, near Timbuktu.

His declining health in the past few months prohibited him from touring and playing here in Mali, so I never got the chance to hear him play live. The non-stop tributes played here over the past couple of days serve as an adequate, albeit not-exactly-the-same, subsititute for a live performance. I highly encourage all of you to check out his music and see why many beleive that West African music, and Malian music in general, is the progenitor for our blues and jazz.

My fellowship begins, finally

2006-02-27T10:55:00.000Z

So, the next few posts will be an attempt to describe my family's visit to Mali. Words and pictures cannot do justice to such an incredible journey, but it will be an attempt. Inshallah (God Willing).

In other news, I am happy to say that after 6.5 months of anxious waiting, I can officially say that my fellowship has started. Feb 13 we had our initial investigator meeting to discuss the protocols and processes for the upcoming Phase I/II malaria vaccine trial in children 2-3 years old in Doneguebougou and Bancoumana. Briefly, clinical trials are set up as follows:
Phase I are the safety studies, to ensure that the vaccine/drug is safe and will not cause harm to the individuals who receive the vaccine/drug. for international studies, this usually starts with giving the drug/vaccine of interest to healthy volunteers in the country from which the drug/vaccine is sponsored (in our case, the US.) If the research shows that the vaccine/drug is safe, then it is tested in people who are exposed to the illness on a continuous basis (i.e. a malaria endemic country like Mali). Here, we have already conducted Phase I studies of this vaccine in adults in Doneguebougou, and the results show that it is promising. The purpose of this Phase I study is to make sure that it will be safe for the future recipients of this vaccine, children. Typically, these studies involve few participants (30-40) so if the vaccine/drug is not safe, we will not be causing too much harm.

Phase II studies are efficacy studies, meaning we want to make sure that the vaccine/drug does what it is supposed to do. In our case, we want to ensure that the vaccine will mount a proper immune response against our particular vaccine target, which is common to all the malaria parasites that cause the most illness here in Mali, Plasmodium falciparum. These studies involve greater numbers of individuals, to ensure that the vaccine will have an effect in a larger population.

Phase III studies are really a combination of Phase I and II on a massive scale, typically hundreds to thousands of participants. In general, malaria vaccines are no where near this point yet for a variety of reasons. Typically, assuming the results are favorable, the vaccine/drug of interest can then be marketed and distributed en masse.

Phase IV studies are surveillance/follow-up/post-marketing trials to ensure that the vaccine/drug is still safe. For the most part, once a drug/vaccine passes the Phase III stage, it will remain on the market for a while. Occassionally though, the drug/vaccine may be pulled, due to deleterious side effects that where unknown or not demonstrated in earlier trials. The most notable and recent example of this invovled the pain relievers Vioxx and Celebrex, which were initially noted to be wonder drugs, and after further research (i.e. Phase IV studies) shown to be associated with cardiac arrythmias in patients who took those drugs.

so, normally there is a long gap between each phase of the process, sometimes as long as 2 years between Phase I and Phase I studies. In our case, we are combining the phases in a unique clinical trial that will piggy-back a Phase II study on top of a Phase I trial, pending favorable safety results of the Phase I trial. It is a complicated structure that I am not allowed to discuss for confientiality and security reasons, but suffice it to say that if all goes well, we will essentially have results 2 years earlier that using the traditional system. Inshallah.

So, with that boring lessone over with, let's get back to the official beginnings of my research fellowship. So, the Monday we had our investigator meeting, I was battling the beginnings of some type of cold/flu/bug, which made this 8 hour day unbearable. The next 5 days were then spent recuperating from my illness and waiting for the green light to start the consent process of the villagers who would participate in our study. In true Malian fashion, I got word Friday night that we would start the consent process Saturday morning. I quickly packed a bag and headed out to Doneguebougou early the next morning. Since my knowledge of Bambara is essentially nill, my role was really as an observer, to see the process in action. I was impressed with the teams efforts at maintaining the integrity of the consent process in a manner that is consistent with studies that I have participated in the U.S. However, the process took 45 minutes to an hour in some cases to cover the 7 page consent form. But, in the world of clinical research, all of that information sharing is necessary.

We had finished consenting our first group by Sunday afternoon, and now were waiting to start the screening process. The purpose for screening is to determine which potential participants meet our inclusion and exclusion criteria for the study. All potential participants who have given their consent must undergo a thorough past medical history and physical examination, laboratory testing, and other sampling to ensure that their general health is intact. We were told initially that this process would start that Monday. But again, this is clinical research and this is Africa, so we waited for 4 days before we were given the green light to start the process. Now mind you that this is an African village about an hour outside of Bamako. There is no internet, cell phone service that is limited to a 5 square meter area near the vaccine clinic, one television station, and no other research activities going on. So needless to say that those 4 days were spent chillin' Mali village style. I read a book, wrote some of my upcoming blog entries, listened to BBC Africa on the radio, and did not much else. So by the time Thursday rolled around, I was eager to start screening.

My role in the screening process was that of "study clinician." I was partnered with my friend Guindo, one of the Malian study clinicians. It was our job to perform the past medical history and physical examination on each potential participant. Since our vaccine will be administered to children between 2-3 years old, the examination is made more difficult with mostly uncooperative kids. Given my interest in pediatrics as a career, I was up to the task. Without getting into specifics for confidentiality reasons, I am happy to say that my medical training at Tulane was key in my diagnosis of some cardiac and intestinal maladies in the children that we screened (I plan on talking more about this later in a future blog entry). After an exhausting 2 days of screening, I was happy that my fellowship is finally happening.

The next step is vaccination. Right now we really do not know when this will start, Inshallah this week. When it does, rest assured that I will be right in the thick of things when it does. In the meantime, I will be back out in the village, chillin' Craiger in Mali style.

Conards in Bamako

2006-02-27T10:54:00.000Z

So how exactly does one explain the most significant travel experience of one’s life?  I will tell you it is difficult, and I do not think that words can do it justice.  In the next series of posts, I will attempt to describe my family’s visit to Mali, which I will call the Conards in Mali 2006. . . . . .

It all started last July, right before I left for Mali.  A few days before I departed, my parents emphatically described that they would come visit me in Mali at some point during my stay here.  Initially I took that as a pipe dream, but encouraged them anyways. Over the ensuing months, their initial statement became more of a reality.  This time, they said that they would bring over my brother and sister as well.  The initial discussions included a grand African adventure, with a week in Mali, a week on safari in East Africa, and a week at the pyramids in Egypt.  Time and cooler heads prevailed, and the grand vacation was paried down to just Mali.  What happened during their visit would be up to me.  After a few months of stress, many phone calls, and many discussions with friends and travel agents alike, I came up with a pretty good itinerary.  Come the middle of December, the dates of the Family Conard visit to Mali were set (28 Jan – 9 Feb), as well as most of their itinerary.  It was then a matter of waiting until the big day they arrived.

The month of January went by a lot slower than I had imagined, partly for work reasons, and the rest for anticipation for my parents visit.  When the day finally arrived, I was beside myself.  I knew that they all would be exhausted from their roughly 30 hour journey, but nonetheless happy to be in Africa and with the Craiger.  They stepped out of the insanity that is the Bamako airport, haggard, but happy to be here.  I had arranged for a 4x4 from work to pick them up and to chauffer us around town for the next couple of days.  We went directly to my house, where thankfully there were enough beds for everyone.  After a celebratory glass of wine/beer, we toasted the upcoming 12 day journey and our family.  We then reviewed our itinerary again just to make sure everyone was on board with it.  The one idea that I tried to instill was that this was Africa, and that plans always change, and they seemed OK with the itinerary I had set up:

Conards in Mali 2006 Itinerary

28 Jan:     Arrive Bamako-Senou
     BMP villa
29 Jan:     Tour of Bamako
Museum
lunch at Maiga’s house
Gran Marche and Artisan’s Market
Dinner at Santoro
BMP villa
30 Jan: Visit to MRTC
Doneguebougou (lunch)
Visit to Mande Hotel Pool
Finalize travel plans
Dinner at Bla-bla, drinks with friends in Hippodrome
     BMP villa

31 Jan:     Fly to Timbuktu (CAM Air)
Tour of city
Colombe Hotel (223.292.14.35)
1 Feb:     Visit city
Camel tour of Timbuktu
     Possible visit to Taureg encampment
Colombe Hotel (223.292.14.35)
2 Feb:     Leave Timbuktu via 4x4, head to Mopti
     Hotel Kanaga (223.243.05.00)
3 Feb:     Explore Mopti
     Scott to Bamako via private hire 4x4
     Head to Sevare
     Mac’s Refuge (223.242.06.21)
4 Feb:     Explore Mopti/Sevare
     Possible Piroque ride
     Chill at Ambedjele
     (Scott pre-flight check in and to Airport)
     Hotel Ambedjele (223.242.08.37)
5 Feb:     Chill at Ambedjele
     Private hire 4x4 arrive from Bamako
     Drive Sevare to Djene
     Hotel Tapama (223.242.05.27)
6 Feb:     Market day in Djenne
     Explore Djenne-Debo
     Drive from Djenne to Sangha
     Gite de le Femme Dogon (223.244.20.13)
7 Feb:     Explore Sangha and Falaise
     Drive Sangha to Bandiagara
     Hotel Kambary (223.244.23.88)
8 Feb:     Explore Dogon Country near Bandiagara
     Drive Bandiagara to Segou
     Hotel Djoliba (223.232.15.72)
9 Feb:     Drive from Segou to Bamako
     Pre-flight Check in at Air France
     Last minute errands
     Dinner at Sahara
     Airport 9:00 pm

The next morning we dined on mangoes, croissants, Starbucks coffee from the states (talk about heaven!!) and Guava juice.  We then headed out to the main market here in Bamako for their first experience.  If there is one thing that quintessential Africa, it is her markets.  The sites, smells, and feel of the markets here are Africa, and most of the things I planned were around the market; Bamako, Timbuktu, Djenne, and Pays Dogon are all parts of Mali that have incredible markets.  Needless to say our first experience was unlike the others we had during our stay.  True to the Bamako market experience, we were harassed the second we arrived.  About 10 different men surrounded us, asking us what we wanted, and that they could guide us around.  Walking through the crowded cloth market (it was my idea that they could find cloth they liked to have made into shirts/pants by my friend who is a tailor), the Conard Caravan increased to roughly 15, if you included the Malians trying to make a buck or two.  In the process, we got the first of many propositions for my sister’s hand in marriage.  One Toureg man offered 30 camels for her!!  It was a tough sell, but I figured we could use the extra money and lighten our travel burden by one person.  After an hour and a half, I could tell that perhaps my desire to have my family experience the African market was too much, both for them and for me, the translator and bargainer.  Needless to say it was exhausting, and we left more or less happy for the experience.

We then headed over to my friend Maiga’s house for lunch and a chance to experience life with a Malian family.  Granted, this was Maiga’s Uncle’s family, but one who he considers as close as his own parents.  I have described my experiences at Maiga’s before, and this is very similar to that.  Good food, good friends, and an incredible chance for my folks to recharge and get used to Africa.  My sister got one of her trip wishes (“to play with African children” as she called it) and I got a much needed nap.  My dad gave a geography lesson and my Mom played the role of Mom: playing, scolding, and laughing.  After lunch, we had the “barbeque,” aka dinner: bbq sheep, with salad and plantains.  My parents raved about it.  We left Maiga’s full and rested after a great day.  I was eager to get to our next destination, the first of many “Sunset beers” that I had planned.  The one spot I thought was perfect was closed, so we ended up going to one of the most expensive hotels in Bamako.  We somehow were able to get into the restaurant that looks over the river to open up early, and sit near the balcony, looking at the sunset over the Niger.  It was an expensive venture, but one that was necessary.  We went home that night and just chilled as a family, something I really missed in my many months away from there.  I showed them my pictures, we chatted about home and laughed.  It was truly a good night.

The next day was the “work day,” meaning it was the day I was going to show them where I worked, meet some of the folks I work with, and then head out to Doneguebougou, my village home for the first 3 months I was here and my current home for my remaining 3 months here.  After a late start, classic Conard style, our driver arrived and we were off.  We drove by the market I by my vegetables and other foodstuffs at, and my parents almost had a heart attack.  I explained to them that I was alive thus far, so it must be good for me, no??

We arrived at Point G, the location of the National Hospital of Mali, the Medical school, and the Malaria Research and Training Center.  My friend Maiga met us there, and we took a quick tour of the facilities and the Guest House.  My parents were rather impressed by the facilities, and could not believe the flowers and tropical vegetation that was present.  I explained to them that everything there was planted by Dick Sakai, one of our administrators who hails from Hawai’i and who dabbles in horticulture.  After our tour, we headed out to Doneguebougou, my village.  Now, my parents lived in the wilds of Arkansas, New Mexico and Montana for about 10 years, so I figured they would be used to bad roads.  I think the suburban life they have lived over the past 25 years has made them soft.  Now, I will be the first to admit that the road from Kati to Doneguebougou is horrible.  You really can’t call it a road, more like a path that happens to be wide enough for a 4x4.  And to make matters worse, we had one of the more aggressive drivers with us, so the ride was even more bumpy and back wrenching.  They survived OK, I think.  The previous week I had arranged for the cook to make Tiga dega, a peanut sauce dish that is hands down the best Malian rice and sauce dish.  Well, for some reason, it tasted like shit.  Even I could not finish my whole plate.  Luckily, the freshly picked mangoes made up for it.  I then took them on a tour of the facilities here, including the vaccine clinic and the local clinic that we staff.  Needless to say, that my mom and sister, both nurses, and my dad, who helped build a clinic, were taken aback by the conditions here.  They were impressed by the vaccine clinic, but were rather surprised at the conditions of the local clinic building.  . . . .

The best part happened next.  After our tour, Maiga had arranged for us to visit the village chief.  On our short walk to see the chief, we encountered practically every child in the village.  Needless to say that my Mom and sister were rather happy about this encounter, and passed out practically all of the bon-bons (candy) they had brought with them.  We finally reached the chiefs compound.  He was seated outside with 2 of the village elders, waiting for our arrival.  We sat down, exchanged greetings and names, and started our conversation.  In classic Malian fashion, the patriarch of the family does all of the talking.  So, my ever loquacious dad gladly was ready for the task.  He talked about his background, his desire to visit Africa (particularly Timbuktu) ever since he was a child, and his fascination with this village.  According to Bambara tradition, everything he said in English was translated in French by Maiga, who spoke to Cossa, the village guide who works at the village clinic.  Cossa then translated everything Maiga told him to Bambara to the head elder, and then the First Elder told the chief everything.  When the chief responded, the process reversed: Chief in Bambara to the First Elder, he in Bambara to Cossa, Cossa in French to Maiga, and Maiga in English to my father, and by proxy, to the rest of us.  I am sure that somethings were lost in translation along the way, much like the telephone game we play as children.  During this whole process, I could just imagine what the chief was told: My Dad would say: “You have a nice compound here,” to which the telephone-translation game might have yielded “Your wife looks like a cow.”  (I am just imagining that of course.)  The whole encounter was incredible, and one my parents later on that night said they would never forget.  One of the conversation pieces was about my parents desire to educate others back home about Africa, especially the African Americans they work with who have never had the opportunity to visit Africa, and thus my family’s desire to take pictures to show their colleagues what Africa is like.  The chief gave his permission to take as many pictures as possible.  And in true Conard style, we did.

The Family Conard left Doneguebougou satisfied with the visit.  It was easily one of the most non-touristy things they could have done.  And after a long drive back, my parents were ready for the sunset beer at the Hotel Mande, a “resort” on the Niger River.  Dinner that night was at a bar called Bla-Bla, the place with the best Grilled Capitaine (local freshwater fish) in Bamako.  Later that night, we went next door for a drink at one of my favorite bars.  The idea here was to give my folks an appreciation of the nightlife here in Bamako.  The thing that would have topped it off would have been a visit to one of the Malian night clubs, but we had an early and very important day the next day: our flight to Timbuktu, and the start of the rest of our voyage!!!. . . . .

2006-01-22T13:46:00.000Z

Here is the Christmas camping crew.

2006-01-22T13:45:00.001Z

The pool at the bottom of the waterfall. It was FREEZING cold, but it felt good anyway. And, so far, no Schisto.

2006-01-22T13:45:00.000Z

A pensive moment on Xmas eve. Note the cheap beer to my left. That is known here as a bili bili ba (large).

Poor showing for the Craiger

2006-01-22T13:08:00.000Z

All-

So 5 posts in two months is not the greatest showing. I mean, one would think that moving back to civilization would afford one more time to post. I guess it is one part actually having some work to do, and 5 parts laziness. I promise I will do better.

So a friend of mine told me about this website for downloading/sharing pictures. It is called Flicker, and I will have a site before you know it. I will let you know the URL very, very soon.

Besides the Christmas and camping thing, there have been some other developments as well:

I am happy to say that after 5 months, I finally am starting my fellowship research, you know, the reason why I decided to take a year off. In a subsequent post I will describe all of the trials and tribulations of my work time here thus far, but I am in a good mood this afternoon, and I don't want to dwell on the negatives to spoil that mood. Suffice it to say that I am doing lab-based work in an Immunology lab here. The work is interesting (looking at the immunology behind severe malaria among other things), but the pace at which it is going is beyond belief. if there is one thing I have learned by doing this fellowship, it is patience.

My family is coming in 1 week to visit me here in Mali. I have a great itinerary planned for them, which includes many of the main sites in Mali that I have yet to see myself (Timbuktu, Pays Dogon, etc.) They will be here for 12 days, and I hope they enjoy it.

I am rapidly approaching my 6 month anniversary in Mali (4 Feb). I can't believe how fast it has already gone. I am debating extending my stay here in Mali by a month, or leaving, and returning later in the Fall. My decision will depend on 2 factors: if the projects that I am planning have a chance in hell of being done in June/July and if I can leverage some money to return. We shall see.

So that is about it for now. I promise to post more often, not only describing my work and such, but also just life in general. I truly love my experience thus far in Mali, and I would not change a thing (except for that research/work part).

Cheers,

Craig

Christmas in Mali

2006-01-02T20:55:00.000Z

Let me start out by saying that this was my first ever Christmas away from home.  I knew it would be a tough day, and I am glad that I chose to leave Bamako for the weekend leading up to it.  As far as New Year’s, do I have a story for you. . . .

First off, Christmas.  My American friends Carlos (a Harvard MD/PhD student at the NIH this year studying Leishmaniasis), Matt (the director of Geek Corps, an USAID-funded organization that assists with technology development in 3rd world settings), Ludovich (a friend and colleagues of Matt’s from Chad) and I decided to go camping for Christmas weekend.  We had heard of a waterfall/camping area outside of a small village called Siby about an hour north of Bamako that would be perfect.  After a hellish Friday morning packing and buying last minute items at the various markets throughout Bamako, we finally headed out in the early afternoon.  We finally made it to Siby about an hour later.  It was a small town that has recently seen the assistance that tourist dollars can bring: t had a newly paved road, clean streets, and nice “hotels” along the road that backpackers can stay in for $3 a night.  While the allure of a hotel with mud brick ovens, err, I mean rooms, was tempting, we elected for the camping near the waterfall.

We each had to pay a tourist tax of $2 before heading out to the bush.  Once there, we got “directions” to the waterfall.  We were told that it was 17 km from the main road, and to keep going straight.  We had multiple offers of “guides,” but we were stupid Toubabs who thought we knew what we are doing (“Guides, we don’t need no stinkin’ guides” I thought to myself, but yet again, I refrained from saying the oft quoted line).  In retrospect, we should have gotten guides.  We left the main road at 4:00 and started off toward the waterfall.  Well, the villagers in Siby must have a different definition for straight in Bambara than we, ‘cause there were at least 4 different forks in the road that really complicated the driving.  After stopping about 10 times asking various villagers in the mountains for the directions, and once asking a hot, young, French, Peace Corps-esque girl, we finally reached our destination at 5:45.  Mind you sunset here is about 6:00 pm.  We got out of the car, and heard the faint sound of water amongst a rather large rock face.  We slowly walked to the sound of falling water, and we found the Perfect Campsite.  There was not a lot of water, as we are now in the beginnings of the dry season, but there was enough to make us take notice.  There were natural steps that lead down to a rather large pool of crystal clear water.  There were a few smaller waterfalls scattered about, one of which formed a natural faucet and sink.  Many large plateaus with few edges or bumps could be found near the natural sink.  There was even a built-in fireplace, with 3 walls and a large floor for the wood.  We determined we were in camping heaven, and no other camping spot would ever rival that one (Pictures to document said greatness are forthcoming).

After taking it all in, we realized that our most precious resource (i.e. light) was fading fast, so we rigged up our mosquito nets and mats on the ground, collected firewood, and set up camp.  By the time the light was gone, we were sipping on cold 40s of the local beer, and getting a fire going for dinner.

Surprisingly enough, the bugs were not a problem.  Mosquitoes were non-existent, and except for a gnat swarm around dusk, we were free and clear, to the point that the mosquito nets were not really necessary at all.  If it were not for the cool temperatures overnight and The Craiger sans sleeping bag, I would have slept without it, but in the interest of staying warm, I elected for the confines of the mosquito net.

As far as food, we ate like kings.  We packed Matt’s 4x4 full of food and alcohol, and all of the acoutrements that go with it.  For dinner the first night we had Kraft Mac and Cheese with this Italian Beef like main course (beef with peppers, onions, garlic, and other spices) and the ubiquitous Malian watermelon for dessert.  A similar dinner was had the next night, with the Italian beef dish again, this time served with cous-cous.  Our mini-bar consisted of a wide variety of aperitifs and alcohols (rum, vodka, gin, cognac) along with 40s.  We were definitely camping in style.

The next morning (Christmas Eve), we arose around sunrise, started making breakfast (Grits with the Italian beef leftovers from the night before, French Press coffee, and Bloody Mary’s!!) and enjoyed the cool air before the heat of the day came.  Around noon, Carlos and I went exploring the area.  There was not much to look at.  If it were not for a villager we met about a half hour walk down the main road from our campsite, we would most likely have gotten lost.  He was a local farmer, and showed us his fields of mangoes, papaya, pineapple, bananas, and peppers.  I felt like I was in a tropical paradise, better yet, on the Island where they film “Lost.”

After our 2 hour trek, I was exhausted and hot and dirty.  One view of the pool at the bottom of the waterfall and I knew I had to jump in.  While the doctor in me screamed ”Schistosomiasis,” the Craiger in me jumped in anyway.  It was very cold, but very refreshing.  In fact the cool water soothed my fears of the dreaded Schisto (FYI: From what I have read after the fact, the diminutive snails that carry Schisto prefer stagnant, warm water; this pool was moving and COLD.  To my health. . . .).  After my quick swim and tuna sandwich, I dreamed away the rest of the afternoon on a shaded rock.  Now this was how we were supposed to spend Christmas Eve.

We wanted to make a huge bonfire that night, so in the twilight of the late afternoon, we gathered wood, and a lot of it.  I am sure we could have found better uses for that wood (Inshallah) but the “Christmas Eve Bonfires to End All Bonfires” had to happen.  I elected myself as bonfire man, being the lone Eagle Scout of the group.  Right at sundown, we started the masterpiece that was to become of our bonfire, and magnificent it was.  So great it was that we had many locals stop by and admire our pyrotechnical abilities.  They Oooohhed and Aaaahhhed at its glory.  I hear that they will talk of this fire for years to come; the day that Zanble Niare, the Toubab who came to rid Africa of the scourge of malaria, made the Great Fire.

All kidding aside, one of the most incredible moments I have ever had occurred later that night.  After a few hearty Rum and Cokes, and the occasional Cognac to clear the sinuses, the four of us suddenly found ourselves silent for about 5 minutes.  I am not sure what the others were thinking about, but my thoughts were of home, and how much I missed my family and being home for the holidays, which in my mind is the true meaning of Christmas.  Just as I was imagining my house decorated for the holidays, I noticed my friend Matt reading from a small leather-bound book.  I broke our respective quiet contemplations, and asked what he was reading.  “The Bible.  I am looking for the Christmas story.”

I perked up, and asked him to read it aloud once he found it.  A few minutes later, he approached, the book open to the Book of Luke, and said: “Nah, you read it.  I would rather hear it.”

And so I began to read the story of Jesus’ birth.  I could not imagine a more perfect setting: a bonfire giving off an almost sun-like glow and heat, a clear night revealing a sky beyond imagination, and 4 new friends, Christians all.  It was truly a powerful and unforgettable moment.

The next morning, we slept in, and had a traditional American breakfast: Scrambled eggs with peppers and onions, coffee, Bloody Marys, and 600 mg of Ibuprofen to ward off the evil spirits from the night before.  We reluctantly broke camp shortly afterward and headed back to Bamako about noon.  Despite the ensuing week of gastro-intestinal unpleasantries for most of us, I could not think of a better way to spend Christmas in Mali.

New Year’s on the other hand. . . .

Christmas in Mali

2005-12-23T11:42:00.000Z

So, this morning, we are heading out to Siby, a popular ex-pat place to go camping. It looks to be a good weekend of drinking beer, hiking around, and exploring some waterfalls. We plan to return Sunday afternoon and explore the Ex-Pat Christmas party deal. It looks to be interesting. I will post some pix once I get back.

Just wanted to wish you and yours a Happy Holidays. This will be a weird Christmas, as it will be my first EVER away from home, but all is good.

And lastly, the Top 5 reasons why Christmas in (a hot, Muslim country like) Mali Rules:

1) Presents, what presents.
2) Not having to shovel 2 feet of snow off of your driveway.
3) No annoying Christmas Muzak.
4) Not having to talk to every single relative in your entire extended family.
5) No Christmas commercials that start at Thanksgiving.

Peace and Joy in this Holiday Season,

Craiger

Worst travel experience ever??

2005-12-02T21:11:00.000Z

So let me tell you a little story about perhaps the worst travel experience imaginable. To start off, it was not decided that my Malian colleague Maiga and I would even go to the Multilateral Initiative on Malaria (MIM) conference until late October or so, and even then we found out through a third party that it was going to happen. So once we finally were placed in contact with the necessary people, things started to roll. Then about a week and a half before we left, problems started to occur. They could not find hotels in Cameroon, they could not book travel within Africa for us, and reimbursement issues abounded. So that week and a half before the trip I spent traveling back and forth from my village (a 2 hour trip each day) emailing and calling via the internet the travel company in D.C. that was responsible for our trip to get the travel plans and accommdations down. Finally, paper tickets in hand and reservations secure, we were leaving on Sunday, Nov. 13 at 10:30 bound for Abidjian on Air Senegal, then to Douala on Kenya Air, and then to Yaounde (the capital of Cameroon and the location of the conference) on Cameroon Airlines. The driver picked me up at 7 am and we got to the airport at 8. We were told that the plane had not yet arrived, and that it should arrive shortly. We waited until 10:30, still no plane. 1:00 pm, same thing; 3:00 rolls around and they usher upstairs for a free lunch before the plane arrives. I start to smell a rat at this point, but hey, this IS Africa. Finally at 5:30, after 9.5 hours waiting, they finally said “the plane will not show up today. The next best thing we can do is get you to your destination on Wednesday (the conference started Monday and ended Friday!!).” There were 10 of us from the Malaria Center who were on this flight, 7 or whom had seats booked through the same travel agent, the other 3 bought by the conference committee in Cameroon as sponsored delegates. So, my boss, Dr. Thera, a calm Malian normally, was irate, and demanded something better than what was offered. They politely said no. I offered up the idea of the Air France flight that night to Paris and then to Douala, and the lady said the plane was full (After the fact I found out that that flight is never full and when the African airlines screw up and not have a plane available, they rarely want to use Air France flights because it is too expensive for them to accommodate passengers on those flights!!!)

So, we were able to call our travel agent on the phone on a Sunday night no less and book us passage anyway he could to Cameroon. Well, the best way to get there was on Royal Air Maroc (aka Morocco Airlines) to Casablanca, a 16 hour layover there, and then an overnight flight to Douala, and then a Cameroon Air flight to Yaounde, the conference city. That itinerary would get us in at 8:00 am in Yaounde. So, we decided to do it. We all go back home for some much needed rest before the overnight flight. The driver comes back to pick me up at 12:00 am (the flight is at 3:30 am) and we arrive at the airport. Finally we board the plane. People, Royal Air Maroc kicks ass. They have good, solid planes; decent food; they give you socks, an eye mask, decent pillows, and nice blankets; and the stewardesses are HOT!! Well, despite the early am departure, we arrive in Casablanca at 7:30 am. I was not looking forward to the 16 hour layover in the airport, but I felt I could deal. As usual, there really is no communication between the people in charge and the minions. In this case, we were not to stay at the airport: Royal Air Maroc was going to put us up in a hotel for the day until our flight that night!!! Ahhh, Casablanca, a city I have always wanted to visit. Well, we arrive at the hotel reservation area in the airport, and they have no record of our reservation. My boss explains the situation, and things get ugly. The guy behind the counter actually says, in French: “Listen, I am not trying to be discriminatory here because you are all Africans. . . . .” I mean, the fucking nerve. Finally, a supervisor was called and the situation was cleared up. We hopped in a minivan and headed out to Casablanca! I was so excited I could hardly contain myself!! I let out a “Yeaaahhh” in the car, much to the amusement of the Malians and our Moroccan driver.

Casablanca is, unbeknownst to me, a HUGE city, something like 3 million people. It is the economic hub of Morocco. Imagine Paris or London with an African/Arabic feel to it. Cars everywhere, people hustling and bustling about, truly a modern city. Well, let’s just say that we happened to arrive on the worst day possible: there had been a drought in Morocco for the past 9 months. Guess what the first day was they had rain in over 3 months was?? Yep, you guessed it, the day the Malians and the random American arrived. And we are not talking mild drizzle, we are talking serious downpour here. And to top it all off, it is November in an area with the same latitude and weather as Baltimore, MD, so it is freezing out. All of my warmer clothes are in my checked bags, so it is a little miserable out, but I am in Casablanca!

After a little sleep, I get some Moroccan tea from the downstairs café to warm up, and wait for my colleagues for lunch. As a general rule, never, never ask a tour company person or a desk clerk where the best food is. Our tour guide from the airport recommends this little cantina with “great fish.” We decide to check it out. We get there and look at the menu, and there is not one traditional Moroccan dish. It is literally all fish; Imagine Arthur Treacher’s with a Morrocan/Mediterranean décor. So, since it is pouring outside, we decide to stick it out. It was OK. We then found a cozy little Moroccan tea place near the restaurant. Really, really good. We then headed back to the hotel for our bus tour of the city before returning to the airport. Like I said before, a really cool, chic, cosmopolitan city. And to top it all off, it has a really cool oceanfront area which I can only imagine is hopping during the hot summer months. I must go back there for longer, and when it ain’t raining.

So, we are supposed to leave Casablanca at 6:30 and arrive in Douala at midnight. Well, just to screw with us, the plane decides to have a minor “mechanical malfunction” and we must wait for a while. Finally, at 11:00 pm, the plane finally starts boarding. Luckily, the plane is not full, which means stretching out over 3 seats is a possibility. Giddy up!! After another incredible flight on Air Maroc, we arrive in Douala at 4:30 am. There is only one slight problem: I do not have a Visa. We were told there would be someone there from the MIM conference to help with Visas during normal business hours. Well, assuming normal business hours are not 4:30 in the morning in Cameroon, we were in for a slight problem. And sure enough, I was put in airport jail, literally. Perhaps one of my favorite movies is “Honeymoon in Vegas.” In that movie, Nicholas Cage is trying to win back his fiancé, Sarah Jessica Parker. At one point, he is in line to buy tickets to Hawai’I to rescue her, and he is bothered by a slow customer. He gets so aggravated, he is told to calm down, to which he responds: “What are you going to do, put me in airport jail??” People, I am here to state outright that said airport jail does exist. For me, it was a room the size of a small bedroom with thick, concrete bars on one wall. The room outside of the “cell” was normal, and there was a small sitting area for others, including your research colleagues who are snickering uncontrollably at the American in jail. Meanwhile, I am in the cell with 3 other Africans who I have no idea why they are there, but look meanacing enough to scare the shit out of me.

Well, after 2 hours and some gentle bribing on behalf of my boss, I was able to get my Visa and get the hell out of airport jail. We hurried upstairs to check on our flight to Yaounde. Just to keep the fun times rolling, the flight was cancelled. . . . We were now stuck in Douala at 6:30 in the morning with no way to get to Yaounde. It was humid as shit outside, we barely slept, I just got out of jail, and the sun hadn’t even risen yet. Well, someone from afar must have seen our sorry sight of a research team and decided to have pity on us just for a moment. At 8:00, a shuttle bearing the words “MIM 2005” showed up. I wasn’t sure, but I could have sworn I saw a heavenly glow shining on the white van. . . . We approached the driver like thirsty desert dwellers, asking, more like begging for a ride. He said he could not, as he was there to pick up one other passenger who was arriving in a few hours. “A few hours?” we said. “We are 7 and we are ready to go now!! Is there anything you can do?”

After some mild cajoling, he agreed, and we all boarded the bus for our 3.5 hours drive to Yaounde. It was a nice ride, from what I remember of it. The lush, tropical paradise of Douala gradually becoming the more mild, temperate Yaounde. We finally arrived at our hotel, 53.5 hours after our original departure time. What a relief I felt. But somehow, I knew things were not over yet.

We all showered up quickly, and headed towards the conference at the Palais de Congres, a huge conference center on top of one of the many hills that adorn Yaounde. It looked nice from the outside, but it could definitely use an upgrade. We arrived with the hustle of the second day of the conference already underway. We arrived at the registration table, money in hand (750 Euro for me!!! Don’t even get me started here), ready to register. The woman handling the on-site registration was not there at that time, so we had to wait. Meanwhile, 10 others were behind the table, doing nothing. I will never truly understand this continent. Finally she shows up. “Oh, sorry, we are no longer registering conference participants.”

I could not believe my ears. “Excuse me?”

“We have no more materials to hand out, and we have no more badges. I am sorry. You should have registered before hand.”

I am about to either burst into tears or strike this lady. Thankfully, neither of the two happens. I explain our situation and still nothing. There are others in the same boat as I, and we all get frustrated. Then, my anger level gets really high. I am really pissed off. Finally the conference organizer walks over and discussed the problem with us. Evidently, they had ordered 500 extra bags for the conference that never arrived. As far as the badges, that was our only entrance into the conference. He finally agreed that allowing all those who came to have access to the science at least. So we got badges (I felt like saying “Badges, we don’t need no stinking badges,” but I am afraid my overused phrase from “Blazing Saddles” would fall on deaf ears) but no food coupons, no access to the socials, nothing. It truly sucked.

Luckily, the people giving out the food and drinks did not hear about the food coupon thing. So, in the mad rush to get “lunch,” people just grabbed and went. Well, lunch was really a small finger sandwich, an orange, and a warm beverage. Luckily for me, they ran out of non-alcoholic beverages, so all they had to drink was warm, Cameroonian beer!! So, at least that made my day.

The rest of the conference went well. The science was very interesting and I made some incredible contacts. I even ran into some friends of mine from Tulane! Truly a random coincidence. The unfortunate part was that the conference organization was lacking. On top of the registration fiasco and the lack of good food, the conference talks ran late, talks did not start on time, the press were annoying. Despite that, I had a great time.

Leaving Cameroon was another fiasco. So I am supposed to leave from Douala, as I was told by a source who will remain nameless, that it was a better international hub. I signed up for a conference shuttle to pick me up at my hotel around 4:30. I waited, and waited for the shuttle, but got no response. Another driver showed up for a shuttle to the Yaounde airport, and I asked him about my shuttle. Of course, my question fell on deaf ears. I did call his supervisor, who had said they told the hotel that the shuttle would be moved up to 3:00 pm and that they were to tell all passengers about that!! Well, I was stuck. I was furious, and told the guy that I had a flight leaving Douala that night. He said my only option was to take a taxi and take the bus from Yaounde to Douala. I was even more furious and told him that I would do as he suggested as long as it should be them who came to pick me up and drop me off at the bus station and pay for my ticket. Somehow, he agreed. Within 5 minutes, a driver was there and I had a ticket to Douala. Now, perhaps one of the sketchiest roads in Afriica is the highway between Yaounde and Douala, and it is doubly worse at night. I prayed rather hard that my young American ass would be OK. The trip ended up being pretty uneventful, except for this charlatan/traveling salesman peddling traditional medicine cures. Truly an interesting guy, but a quack.

Well, I arrive in Douala somewhat near the airport, and take a taxi there. I go through the check-in and realize there are not too many people there. I start to wonder if something is up, and sure enough it is. There is a gaggle of people waiting over by the Air France office, talking with someone. Turns out Air France overbooked out flight by 30 people. The flight was overbooked leaving Yaounde (unbeknownst to me an option) and when they arrived in Douala, they had to kick off people in economy to make room for the First Class and Business passengers!! Well, they put me up in a shit bag motel near the airport, and I got a chance to see Douala, at least for a little bit. I had no way of contacting my parents, my friends in Houston who I was going to see, nor the Dean of the Tulane medical school with whom I had arranged to give a talk to the students. Somehow, I found the only Internet Café open in Douala on a Sunday, and was able to reach them, somehow. I then spent some time at the artisan market, looking for a particular mask that I had seen earlier. My shrewd bartering techniques I had learned in Mali paid off, as I found the mask I wanted, plus some smaller ones for a damn good price if I do say so myself.

I finally made it back to the hotel, and hopped on the shuttle to the airport. Well, when I arrived, the line for my flight was out the door already. This was at 7:00 pm for a midnight flight. I begrudgingly get in line, and for a while I never think I am going home. Luckily the Air France agent that helped us the night before, ushered us in front of the line, even in front of the First Class passengers, much to their dismay, and got us processed. We then had to go to another line to get our ticket and check out bags. We then proceeded to another line to pay our airport tax. After that, another line to get our boarding passes for this flight, and then another line to get our boarding passes for our connecting flights in Paris. Well, there was a problem with my flight, so I had to stand in another line to get that straightened out, and then back to the original line to get my boarding passes (Mind you it is humid as hell there and no A/C, so I am sweating like a dog). I then proceed to another line to pick up my reimbursement for Air France fucking up the night before (~ $200 cash) and then finally to the gate. Well, just to fuck with me one more time, the guy checking boarding passes at the entrance to customs said my bag was too heavy. I explained to him that I had been in line since 7:00 pm, and no one before him had said my bag was too big or too heavy. He insists, and I insist. Finally, someone has to mediate, and I lose. So back to the original line to check another bag. Then back to the line in the back of the airport to get a new luggage tag for that bag. Then finally back to the asshole pre-customs guy, who finally waved me through. Then it was off to customs, to check passports and visas (which they originally thought was false, but luckily the woman I had paid off to get me out of airport jail at 6:30 am was there to nod and that was that!!), and a thorough check of all of my baggage. I finally arrived at the gate at 11:00 pm, 4 hours after I had arrived at the airport. Can you believe this? I think I should win some kind of award for this, if one even exists.

Thankfully, my flight to Paris and then to Houston was uneventful, and I slept like a baby. Now I just had to deal with New Orleans. . . . .

New Orleans: Proud to Call it Home

2005-11-26T14:43:00.000Z

All-

I am sitting at my favorite coffee shop on Magazine St. on a beautiful Sat. morning. It's around 8:30 or so, and signs of a new day are happening. Never in my wildest dreams did I think I would be doing this. I would have preferred to stay in Mali the full 10 months with no return trips to the states, but alas circumstances beyond my control prevented that. I am very glad I came back, even if for a short period.

New Orleans is the same, but different at the same time. As I stipulated in my previous post, my old neighborhood is fine. My old house in the Lower Garden District suffered moderate damage to the roof due to wind, and the subsequent rain caused some water damage. My roommate Jason, a Surgery resident at Charity Hospital, decided to stick out the hurricane with his dog, and had a hell of an experience. Water leaked in the house, a fire next door that burnt down 4 houses and yet spared ours, gangs of thugs looting, dead bodies floating on Claiborne, national guard troops everywhere: experiences that were not for the lighthearted. Well, I visited my old house, and it does not look the same. We have this huge magnolia tree in the front yard that survived, this peace of shit tin structure in back that is still there as well. The house is an absolute mess: 1 part Jason, 10 parts the 10 Hondurans hired by our landlords to fix up the place. I left some big ticket items there (couches, TV, electronics, my awesome bed, etc.) that are somewhere in the pile of shit that is my former house of 6 years. My bed is missing, but the box springs are still there, and someone is sleeping only on that. Turns out that the Hondurans decided to "guard" our stuff next door after they were kicked out of our house after setting a fire that destroyed half of our kitched!!! My bed, my roommates computer, half of our kitchen appliances were next door. We ended up catching them red handed and made them take it back. Whatever problems I had with my Spanish recently suddenly improved dramatically, as I was rather emphatic in my threats to call Immigration and the police. But, it eventually got resolved. Shortly thereafter, my old landlords laid it on us that they were going to start renovating the place on Monday, and we had to remove all of our stuff before that. Well, with no available storage facilities for 500 miles (no joke here!!) I decided to take only my bed and one of my couches, and leave the rest to whomever wanted them. I had some decent stuff, it is just a shame I had to get rid of it. Oh well, c'est la vie.

My cousin's house in Mid-City is a different story. The drive over there revealed a part of the city that is very slow in recovery. Few cars on the roads, mounds of debris festering on the tree lawns, huge Oak trees lying on their sides. Entire streets were sectioned off with Yellow tape, forbidding people from entering. My cousin's house itself still has no power, no water, no gas. The house is officially described as a raised double shot gun (i.e. the main living quarters are upstairs and 2 different families can live on either side of each other). It was freezing when I walked in. A few of my belongings were on the floor right by the door: 2 stacks of public health and medical school notes, 3 stacks of review books, a dictionary set and my favorite leather satchel. Of those belongings, only the dictionary and leather satchel are things I really wanted: I never got around to recycling the notes before I left. As far as the books, they were (and still are) a part of a grand scheme to make some money when I returned, as I was going to sell them to some unsuspecting underclassmen. What about my anatomy books (Netter, Rohen), my Medicine textbooks (Cecil's), and my other books?? And my keepsakes? My dress-up clothes? My pictures? A brief walk to the stairs that lead to the basement would reveal the answer.

I donned a mask and gloves, picked up a flashlight, and descended to the unknown. The smell of mold was evident still, even with the sheet rock peeled back to reveal the skeleton of the house. Piles of garbage were everywhere. I saw about 10 black garbage bags on shelves. I knew those had to be mine. I picked up each one and started the process: A bag of crappy t-shirts I was going to donate anyway; a few sweaters that are now multi-colored from bleach cleaning; pictures in small, black binders that are stuck together, but have a cool, psychadelic rainbow ring around them; a bunch of soggy files that I now must throw away. There was also a table with a tarp over it that revealed even more stuff, all of it not really essential: linens, school supplies from my old desk, random crap from my dresser, and a large storage container with my nice clothes (suits, dress shirts, etc). There was also another large box with a label on it that said "donate." That seemed to be the general theme of my rescue operation: things I wanted are gone, things I was going to give away are still there. It is a shame, but c'est la vie.

I guess the biggest thing I have garnered from my trip home is that New Orleans will never be exactly the same as it was before the bitch that broke the levees. Invariably, it will be a smaller city. Plans are in the works to make part of the areas with the most flooding parks and buffer zones from the river and lake. The poor and disenfranchised who were forced to evacuate and who are now living in other cities on money from a different government agency than before may never come back. A quote I read in The Times-Picayune a few days ago summed up the demographics here rather well: "The majority has become the minority, and the minority has become the majority." Before the hurricane, New Orleans was 67% African American. Now, it is only about 20%. Will the cool, funky culture ever return? Will the politicians get off their asses and forget about their cronies and start thinking about the real people this thing affected? Will Craiger stay here for residency? Only time will tell. For now, we must band together as New Orleanians and work to make this city better.

A New Orleans I Do Not Remember

2005-11-24T19:42:00.000Z

New Orleans is different, and yet the same. Driving around the streets here in Uptown reveal what appears to be the vibrant city I left almost 5 months ago: bars, restaurants, coffeeshops thriving with business; rich housewives driving their SUVs and shopping at the boutiques; cars occupying every parking spot along the funky, vibrant Magazine St. Unfortunately, my old stomping grounds on Magazine St. provide a false sense of the utter reality here. The reality is that we are an island in a sea of despair. Drive a mile or two away, and it is deserted. Yes, there are some signs of life in these areas, but very little. Refrigerators wrapped with duct tape line the streets, debris from houses 4 feet high adorn the tree lawns, signs of destruction both subtle and grand are everywhere. At night, driving along a main artery of the New Orleans throughfares (Claiborne Ave.) reveals vast sections without power. These are the neighborhoods of the disefranchised, vestiges of a city that care forgot.

Life is a trickle of what it was. "Will it ever be the same?" I find myself asking myself all the time as I look for signs of the old New Orleans. It has to be. I long for the past, I am astonished by the present, and I am hopeful for the future.

Brief Update from Cameroon

2005-11-18T11:57:00.000Z

So it has been a while since my last post, and rightfully so. I am currently in Yaounde, Cameroon for the 4^th Multilateral Initiative on Malaria (MIM) conference, which started Nov 13 and ends today. To make a long story short (I will fill in more details later) I spent basically the week and a half before this correcting previously arranged travel arrangements for the conference. What a pain in the ass that was. Then, there was the pain of the travel itself: 53 hours of travel, layovers, and connecting flights, a day in Casablanca (!!), airport jail in Cameroon, and finally arriving at the conference with no record of my registration!! Despite all of this, I have learned a lot and have made some rather valuable contacts, and the more and more that I think and work in this field, the more and more I would like to do this as a career.

So, I head back to the states on Saturday evening to begin a week of fun and clean-up in Louisiana. It will be a good visit, as I have recently found out that some really good friends of mine will be there, and I can at least get some New Orleans culture while I am there. I plan on updating this blog a lot while I am there, so please keep checking it out.

Peace

Ramadan is finished

2005-11-08T16:39:00.000Z

Ramadan officially ended last Wednesday, 2 Nov 2005. I really cannot believe it has been a month since I decided to try this crazy fast thing. Just as I was getting used to it, the temptation of having 3 meals a day, guiltless trips to the refrigerator for a beverage, and caffeine during the day got the best of me, and I am now whole again. I have been back to normal eating habits so to speak for the last 5 days now, and I am still getting used to eating again. I think my GI system is still adjusting to all of this food. What follows are my last days of the fast and some general things about Ramadan that I hope to take away from the experience.

I broke fast with my Malian colleagues in the village on Tuesday evening (1 Nov) for the last time. It was good to be with them for the end. They urged me to keep doing the fast in subsequent years, and I agreed with them. However, there was a small problem with our idea of “last break fast”: there was still a chance that Ramadan would continue for another day. The reason being that there needs to be at least one full day between the last moon sighting of the previous moon cycle and the first moon sighting of the next moon cycle (the official end of Ramadan). The issue here was that the moon was still barely visible as of Monday, meaning that Wednesday might be another day of fast before Eid al Fatr (the Feast of Ramadan) could begin. I was a little demoralized after hearing that, but I was vowed to finish this fast to the end. I would have stayed in the village that night, but my PI (i.e. my boss) from Maryland was in town for the week, and I had to return to Bamako that night to work with him on some issues. So, as we drove into Bamako, the driver and my friend Guindo (one of the other doctors) decided to have a beer downtown. We ran into Guindo’s brother at the bar, who told us that someone in Timbuktu had seen the moon that night, and Eid al Fatr would be Wednesday!!! (Aside: Some other Malians think that the Malian government may have had a hand in this, as they did not want the party to be on Thursday, because then they would have to give everyone Friday off as well for a gian 4 day weekend. Ahhh Mali) Well, needless to say that one beer became several as a celebration, and I enjoyed the night out with my Malian friends.

I spent Ramadan morning on the front porch of my house in the bright sunlight guiltlessly eating a grapfruit, bread and jelly, and tea. I then went over to Maiga’s family’s house (See the Best Meal Ever post) to eat lunch. Yet again, a phenomenal feast: Poullet Yassa (chicken in lemon and onion sauce) over couscous, fruit for dessert, Malian tea, and Wejila (a bread dish from Timbuktu that is out of this world good). I then spent the rest of the afternoon and evening with Moctar, one of the administrators at the MRTC. He invited me over to his parent’s house, and then we drove around Bamako visiting his relatives. See, on Ramadan, it is customary for the younger generation to visit and “pay” ones respects (i.e. leave money) to one’s extended family of cousins, uncles/aunts, 3rd cousins once removed, sister’s aunt’s nephew, you know. We must have visited 5 homes that evening. They were all full of kids and family’s just chillin’. I ate like a champ, and probably too much as I think my stomach had adjusted to eating smaller amounts. I made it home that night content that I had accomplished something I had never thought I would be able to finish.

Physically:
I weighed myself on the scale in Doneguebougou on Tuesday night, the last day of Ramadan.

Final Ramadan Fast weight: 75 kg (~ 165 pounds)
Pre Ramadan Fast weight: 83 kg (~ 183 pounds)
___________________________________________
Total weight loss = 8 kg (~ 18 pounds)

I look and feel better than I have in years. I feel that I have more energy, more mental capacity (which was not much to begin with in the first place!!), and better posture. I have a general sense of well being that I have not felt in years.

Spiritually: While doing the fast, I was determined to pray more. I set out to pray roughly the same number of times as my muslim colleagues (5 times a day) but I ended up praying 3 times a day (right after breakfast, in the afternoon, and after dinner). I found myself feeling more relaxed, more in tune with who I am after praying. I also felt closer to God that I have in a long time. I even attended mass once in downtown Bamako at the main cathedral there. The mass was entirely in French, and I understood about half of it. But Catholic mass is pretty much universal, so I understood the basic of the prayers and incantations.

Lessons Learned

So you may be asking what I learned from this experience:

That self-control is very difficult, especially when it comes to something that we need (food, water), not necessarily want or think we need (a new car, alcohol).

The Muslim faith is an incredibly devout, passionate group who are grossly misunderstood by the rest of the world, especially Americans. Their devotion to their faith should serve as an example to all. They say that the key to successfully navigating the difficulties associated with Ramadan is ones faith, faith in that their beliefs will guide them through the hunger, thirst, and outright exhaustion they feel. Just imagine if we all could extrapolate this to our problems in our own every day lives??

Fasting the Ramadan way is an incredible way to loose weight, regain energy, and understand ones limits.

Water is a precious resource, and we must do our best to preserve it. And you realize this when it is 92 degrees outside, and you cannot have a drink of water!!

Faith in oneself, despite the life’s temptations great and small, is the key to a healthy, happy life.

Craiger likes being skinny again. . . .

2005-11-03T18:27:00.000Z

End of the trip (Note the newly 15 pounds less Craiger and the beard to tote).

2005-11-03T18:25:00.000Z

View of the village from the pirogue.

2005-11-03T18:24:00.001Z

My driver (Fa-Fa) and his brother Amadou.

2005-11-03T18:24:00.000Z

My pirogue.

2005-11-03T18:23:00.000Z

Remind you of anywhere in the U.S.??

2005-11-03T18:22:00.000Z

Cool shot of classic Sahelian architecture with French architecture justaposed.

2005-11-03T18:21:00.001Z

The mountain of pottery I mentioned earlier.

2005-11-03T18:21:00.000Z

Me and some of my Peace Corps friends (classic Peace Corps ratio- 5 girls:1 guy)

2005-11-03T18:19:00.000Z

Cool just-after-sundown shot of the river and its denizens.

2005-11-03T18:18:00.001Z

Almost sunset along the Niger.

2005-11-03T18:18:00.000Z

Recently, some French businessmen wanted to increase tourism on the Niger. So they decided to bring in jet skis. I thought this picture of the jet skis (new school) with the guy pushing the pirogue on the right (old school) was right on the money with the problem with this.

2005-11-03T18:15:00.000Z

Pirogue (aka canoe) on the Niger River in Segou.

2005-11-03T18:14:00.000Z

Picture of people selling trinkets outside of the bus windows.

Ramadan- Week 3

2005-10-29T17:44:00.000Z

A few updates from my last entry on Ramadan:

The entry “The Best Meal Ever” happened the weekend before Ramadan started, so I have been pretty much faithful to the fast thing (See other post on Segou).

Today marks 3 weeks of Ramadan.  Only 7 more days to go.  I have never felt better.  I am able to concentrate more and get more accomplished as I have become more accustomed to the fast.  However, depending on the quality of the meal the night before, I have good days and bad days, just as the cook seems to have good days and bad days.  I have had only one “holiday” from the fast (my 2 days in Segou) and surprisingly I did not put on that much weight from the experience.

I just weighed myself a few minutes ago after clinic, and I am now at 76.5 kg (~ 168 lbs).  So in the 3 weeks I have done this fast, I have lost a total of 7 kg (~ 15 lbs).  This is the lowest I have weighed since my Freshman year in college, 1994).  Now, I will say that the scale I am using probably has not been checked or re-scaled in a while, so I am not sure how accurate the reading is.  But my initial weight of 83 kg was made on that scale, so I am using that as my point of reference.

I started to read the Koran to fully get the Ramadan experience.  It truly is an inspirational book.  I have only covered the first 20 pages or so, and it kind of reads like a morality tale.  I will fill you in one more as I read it.

The foot infection has now healed up.  I think I also have an alternate explanation for its occurrence.  According to some of the Peace Corps volunteers I have met, cracked heels and soles are a common occurrence in West Africa.  People don’t really wear shoes in the village, they mostly just wear cheap sandals.  Thus, the feet are constantly dry, and thus crack.  Since I have been in Mali, I, being a HUGE fan of sandals, decided to adapt to the local customs.  Suffice it to say that I wear sandals pretty much every day.  So, hence the cracked heels and soles on my feet, and the infection.

I have done some reading online about the physiology of fasting.  Suffice it to say that all of those old wives tales about starving yourself to loose weight as being bad is actually not all that true. While fasting, your body is forced to rely on its own stores for energy: fat, glycogen, protein.  The initial weight loss you see in any diet is predominately water weight.  After that, you start to loose body fat, as that tissue type has the greatest amount of energy than protein and sugar.  In this type of fast, you are losing water and fat, as you are using up your water stores to stay cool throughout the day and you are burning your fat stores after your body has already used up the nutrients and energy from the meal you ate at night.  This is just basic info from what I have read, and I continue to read more, so stay tuned for even more info.

I am not sure what this whole Eid al Fatr thing is about at the end of Ramadan, but Maiga and I have already spoken about it and we will experience Eid al Fatr in Bamako with his family, which from previous experience, means delicious food from Timbuktu. Yes, indeed.

Segou

2005-10-28T16:45:00.000Z

It is a little after 9 pm, and I just finished dinner. I just got back from the Malaria training center, waiting for a ride to Doneguebougou and having to wait according to the Malian Mathematics I have alluded to earlier. I am rather exhausted from the weekend, and for good reason.

I decided a few weeks ago that I wanted to get out of Bamako for a while and see another part of Mali. I consulted my guide books for a small town, on the Niger River, that would do well as a visiting spot. One of the researchers I worked with recommended Segou, Mali’s second largest city. It is nestled about 230 km from Bamako and sits right on the Niger river. From what I had read in the guide books, it sounded like a jewel that is overlooked for her more popular cousins Mopti and Djenne. I decided then that Segou would be my destination.

I was all set on arriving to Segou alone and checking it out on my own when a chance encounter with a Peace Corps volunteer this past Friday night who had worked in Segou mentioned that her friends were all there this weekend, and that they would serve as great hosts. Not one to overlook a chance to meet some new people, I got her friends’ numbers and gave them a call. I agreed to meet up with some of them for lunch on Saturday right after I arrived. Perfect. . . .

Well that chance encounter ended up becoming a late nighter as we met some other Americans and enjoyed the local night club on the Bourbon St. of Bamako. Surviving on 4 hours of sleep and fasting for Ramadan did not make the morning any easier. I ended up rolling out of bed around 8, somehow packed a small bag, and made my way to the main road to get to the bus station. Naturally, I thought the station was somewhat close to the downtown area, but I was wrong; it was on the other side of the river. I arrived, not really sure what the hell I was doing. This was partly due to the lack of organization at the bus station and my hangover which was in full effect at that point. I found the main terminal and paid for my ticket to Segou for the 9:00 am bus: only $6!! At that point, a few strange occurrences bode either a good omen or bad karma about my trip. First, I saw a man wearing a New Orleans Saints sweatshirt. He was standing near what I assumed to be his shop (aka informal shack selling trinkets). I approached him and asked to take his picture, but he refused. Then a few minutes later, I saw a man wearing jeans with the New Orleans Hornets emblazoned on the front thigh. Given the reaction the previous guy made, I did not ask for his photo. I could not believe my eyes: 2 different Malians wearing paraphernalia from my city at the bus station in Bamako, Mali. What are the chances? The third happenstance was perhaps the most weird for me: I was sitting down on a bench in the open air seating area (there was a roof over our heads) and noticed a small frog hopping right towards me. He stopped right between my feet and, I kid you not, pissed and shat right there in front of me and then kept hopping along. I will leave that one alone for you all to ponder.

So, as I alluded to in a earlier post, time in Mali tends to run on its own schedule. I factored in that we would not leave the bus station on the 9:00 bus until about 9:45 or so. Well, surprising enough, we started to board the bus at 9:15. I couldn’t believe it. The bus was interesting: It looked something right out of the 70s: brown upholstery, red, brown and yellow curtains on the windows. There were air conditioning vents along the sides, so I figured there might be a chance for a little A/C. I found an empty seat, hoping the bus was not full; of course, it was. Perhaps one of the only large women in Mali happened to sit right next to me. She carried her bag on her lap and her Carmen Miranda sized bunch of bananas under the seat in front of us. Needless to say, I had a tight fit. By about 9:30 or the bus was pretty full, and I had anticipated that we were ready to go. I was wrong. We sat on that bus until 10:30, with no A/C (apparently those vents are for show only), no windows. It was like a sauna in there. And, in case you don’t know, African’s aren’t known for their use of deoderant, so you can imagine the smells eminating from the bus. I kept telling myself as I tried to ignore all around me: this was the experience I was looking for, and that it would be something interesting to share one day.

So finally at about 10:30, a pudgy Malian with a cigarette in his mouth sauntered on the bus and took his seat at the driver’s chair, making sure to hike his pants up before he did so. He reminded me of a New York cab driver lost in Mali. Finally we leave. Even some of the Malians on the bus were complaining, and the bus driver shouted back in Bambara some kind of invectives to them. We were finally on our way.

The guide books said to expect a 3 hour drive to Segou; given what I have thus learned in Mali, I was expecting something more of a 4 hour drive. The landscape is not much to be desired. It is the start of the dry season, so a lot of dead brush along the road and a lot of browns and tans creeping up alongside the few remaining green patches of shrubs and trees. We were traveling on the only main paved road/highway in Mali, the same road that I am sure I will be taking to head up to Bandiagara and Tombouctou. There were a number of small village alongside the road that I am sure sprung up after the road was developed. It seemed like we stopped off at each road side village, and the villagers there scrambled to the bus, shouting and screaming at us to buy something they had to sell: water in sealed plastic bags, fruit, trinkets, soda, etc. We also seemed to be supplying enough charcoal to supply the Malian army, because at each stop, we seemed to accumulate more and more, to the point where the aisle was stacked with 50 pound bags of charcoal. If an accident had happened, I am sure it would not have been pretty to escape.

After a 4 hour bus ride, we arrived in Segou. I cannot tell you how happy I was to be there. The view from the bus showed it to be a smaller version of Bamako, but a lot less busy and more pleasant. The French influence was evident everywhere: the streets, the houses and buildings, everything had the stamp of a French colonial town. We arrived at the bus station, and I walked the 4 blocks over to the Hotel Djouliba where my Peace Corps acquaintance was waiting for me. I looked and felt like hell, so after I freshened up, I joined her and her friend for lunch. (Side note here: I had fully intended to keep the fast thing going, but there is actually a stipulation in the Koran that allows you to break the fast when you are traveling as long as you add on more days to the end of the month to make up for lost time: Ummmm, I don’t think I will take this whole fast thing THAT far). I had an incredible lunch: Exotic salad (chicken, tuna, mangos, papaya, lettuce, thousand island type sauce) and a Castel. My Peace Corps colleagues were going down the street to the Hotel L’Auberge swimming pool. I had yet to check in to my hotel (Hotel Esplanade), which was on the river and not far from the action. After checking in, I joined them poolside (Following their suggestion, I said I was a Peace Corps volunteer, and got a mad discount on the price of drinks and the pool). What a pimping place. There were already other Peace Corps volunteers there, enjoying a much needed respite from village life. After a few Bili Bili Castel’s (aka 32 oz. beers) my hangover was definitely gone.

We decided to freshen up and move the party to the Hotel Esplanade bar on the river for a sunset beer. This bar was a small place right along the banks of the Niger. It had ample seating for the 6 of us (myself and 5 Peace Corps women) and the beers were very, very cold. We saw some of the sunset, but clouds obstructed a clean view. It was very peaceful and relaxing, and it reminded me of many a sunset evening spent along the Mighty Mississippi, the Big Muddy, in Uptown New Orleans, post-medical school exams, sipping cold Abita Ambers and hanging out with friends.

The party continued back at the Hotel Djouliba, where it was Pizza Night: you make your own Pizza in a brick oven. I dined on a Hawaiian style pizza and a small carafe of cheap South African wine, which was the staple alcoholic beverage for the whole group. We then explored one of the local Malian bars, The Tempest. It was just like the seedy Malian bars I have been in Bamako: dark, a few lights, cold, cold beers, and little seating. After that, we went to the only night club in Segou: The Mobasa. Pretty much the same fare as the last bar, except outside and with more seating. Ramadan kept the local crowd at home, but the place was kicking with the Peace Corps regulars and the random medical student from Tulane.

It is really hard to describe “The Perfect Day.” Different people have different definitions of what it means for a day to be so: chilling at the house, visiting friends, good day at work, etc. For me, The Perfect Day was on Sunday in Segou. The Peace Corps girls had convinced me to stay an extra day as the “newbies” were coming in that day to check out the area for the first time (the new class of volunteers had just arrived on Sept 23) and they had planned a party for them complete with dinner and a local band. I woke up feeling surprisingly spry and good for the number of beverages we had consumed the night before. Plus, it was 8:30 am and I had the whole day to play. I met up with some of the ladies for breakfast at the Djoliba (see a pattern developing here. . . .). Again, incredible: yogurt, mueslix, orange juice and coffee. Fantastic!! I then borrowed one of the Peace Corps bicycles and took a bike tour of Segou.

Truly, a beautiful town. I started out by the river front, rode past my hotel and made it to the pottery section. There were easily 1000s of pottery pieces for sale, and more arriving as I perused their stock. Low on cash and with no easy mode of transport, I opted out of buying something, promising to return later to purchase. The architecture around that area was quite stunning: Neat little Sudanese houses made from the red clay of Mali, classic French style architecture, Arabic-influenced, mud houses. It was rather incredible. I continued along the river and made it to a main road of sorts. Huge, French style mansions rested on both sides of the road, upon which huge trees created a canopy of sorts for the street. I swear it reminded me of somewhere I had once lived. Hmmmmm. . . You decide.

After the street, I made it to the main road and continued to the downtown area of sorts. This is where Segou becomes Mali’s second largest city: traffic, markets full of vendors and buyers, small banks and government offices. I decided that I had seen enough and decided to venture back to the Hotel Djoliba to drop off the bike and somehow make my way onto a pirogue (aka canoe) to cross the Niger River. I ran into the only Peace Corps guy there that weekend and asked him to introduce me to one of his shady friends who had connections. I somehow was able to con my way onto my own private pirogue for only $6!! I made it down to the water front with one of the shady friends and found my equally shady boat. It looked sturdy enough from the outside at least. We set off with myself, the pirogue driver (Fa-Fa) and his little brother (Amadou). The current is strong even as you get out about 20 from shore. Even though our destination, a small fishing village, was directly across from the port, we had to go upriver about ½ mile and then attempt to cross so as the current would help us a little. Overall the trip was about 45 minutes. We got to the other side and walked around a bit. It was oppressively hot then, so we sat in the shade and enjoyed some Malian tea with the pirogue driver and his family. While the family invited me to stay with them for the night, I politely said no, and made the long trip back to the other side. Not one for being passive on a boat, especially on a canoe, I asked the pirogue driver if I could help him paddle. He said yes. The 45 minuted trip over lasted only 17 minutes coming back. As we pulled in, the entire port seemed to stop and watch the Toubab paddle, something I think they have never seen before, as most tourists prefer someone else paddle for them.

I then hiked back to the hotel and jumped in the pool with some of my Peace Corps friends and some of the new volunteers. The Bili Bili ba Castels sure went down well after a long day. We then all met up for dinner back at the Djoliba, and went to hear a local drum band at the sketchy Malian bar we had frequented the night before. The sounds and the feel of the band reminded me so much of New Orleans. We ended up shutting the place down, and I crashed hard back at the hotel. It was tough saying goodbye to my new friends in Segou that night, but something told me that I was to return very, very soon.

The best meal ever

2005-10-16T19:11:00.000Z

The best meal ever

So on a recent lazy Sunday afternoon, after a small breakfast of tea and French cookies, and reading “The Life of Pi,” I got a phone call from Maiga. He was returning my missed call from earlier.  He said he was going over to his Uncle’s house in Bamako, and wondered if I wanted to go.  One of the senior researchers who helps run the Fogarty Fellowship was in town for the week on a site visit, and he was already on board with coming.  His uncle was on his month vacation from work as a WHO officer in the Comores (an island nation sandwiched between Madagascar and mainland Africa) so there would most likely be many, many people there to meet and hang out with.  It sounded awesome, an experience that I could not pass up.  He showed up at the house in a yellow Mercedes Benz taxi, and off we went to pick up P., the Fogarty guy, at his hotel.  When I asked Maiga where in Bamako his uncle lived, he said it was near the river.  Hell, everything here is near the river.  After a long ride on our side of the river, we crossed the river to the other, newer side of Bamako.  Bamako is essentially 2 different cities.  On one side, the more traditional, older, more polluted city (that’s where I live, go figure);  The other side, newer, more modern, cleaner air, “better” living. After about a 45 minute cab ride, we finally reached his uncle’s house.

It appeared small from the outside, but once we entered the front gate, it grew exponentially in size.  There was a good sized courtyard with some children’s toys, a few palm trees, and some motor bikes. We entered the main house, which was full of people.  The men were all seated on small mattresses, some covered with brightly covered cloth, others with light pastel colors.  They were talking amongst themselves, and dressed in the traditional Malian garb typically reserved for family gatherings and special events.  They were talking in a different sort of tongue that I was used to, one that sounded rather Arabic.  They were speaking Songhay, the Malian dialect from the North of Mali (think Timbuktu), the epicenter of the Maiga clan.  I could smell something cooking in the courtyard in the back that made my stomach growl and snarl something fierce.  We sat down after some basic introductions, and talked like men.  More like they talked, and P. and I pretended to know what they were talking about.  After a while, I zoned out.

2 of Maiga’s little cousins were there.  They treated him like their own personal jungle gym.  Evidently, they are all real close.  Maiga regards his Uncle and his family like a second father, as they took care of him while he underwent his extensive education to become a physician.  The room was decorated spartanly with artifacts from the north of Mali and some pictures.  It was rather roomy and I really felt like home there.

After about an hour or so, they called us to dejeuner (lunch).  Most of the family meals in Mali involve small circles of men arranged by pecking order in the family.  The elders and the main bread winners in one, the next younger ones, and on down.  I think most Malians believe that westerners must eat at a table, with a fork and spoon and knife, proper-like, while the Malians eat sitting cross-legged using their fingers to eat.  They offered to have us sit at the table, but both P. and I decided to eat as they did (After a while, P. decided to go with the plate and fork).

So where are the women you might ask?  Seated away from the men, in a different room, eating what they can while they clean up and prepare the dessert.  Hmmmmmmm. . . .

People, this was perhaps the finest meal I have had in Mali, perhaps for a very long time.  It was a relatively simple dish, according to Maiga.  Chicken falling off the bone in a stew/sauce sort of dish.  The sauce had carrots, potatoes, onions, some pepper, and the best spices I have tasted in a very long time, along with a hint of lemon.  I was very impressed.  At first, before I took my first bite and was sizing up what I was about to eat, I thought it would be very similar to everything else I had eaten before: rice with sauce with little taste.  The first bite was nirvana in my mouth.  Spices I have not tasted in months tickled my tongue and the back of my throat.  Taste spread over my tongue and my mouth, awaking taste buds that had lay dormant for weeks.  I continued to eat and devoured everything in site.  I felt like I had finally reestablished the avorous appetite for which the Craiger is known.  I began to eat like a man possessed.  Maiga could not get over what he was seeing.  We had eaten many meals at Doneguebougou, and never had I eaten like this.

Soon after, dessert came out.  It was a very simple dessert, fruit: oranges, banana, watermelon, and some mango.  I devoured those like a champ, and rested afterward.  I was very, very content.  After the meal, we rested on the floor with the other men, drinking the traditional Malian tea.  It truly was one of the best meals I have had in a very long time.

Malian Math Made Easy

2005-10-16T18:57:00.000Z

The book “Life, the Universe, and Everything” states that the answer to said title (aka life, the universe and everything) is 44.  Well, one can ascribe a similar mathematical model to Mali.  I have found that I can figure out 2 main aspects of life here by applying a little 4th grade math (thanks to Mrs. Roach at St. Ann’s) and a little algebra (thanks to Mrs. Sapporito at Gilmour Academy).  The examples given all ascribe to the same pick up and drive from Bamako out to Gone Gougou.:

I had an excellent Sunday morning and early afternoon, walking around Bamako and its markets, swimming in a hotel pool, catching a movie, and simply, living.  Maiga had called me around noon and said he had arranged for the driver to pick me up “in the afternoon” at the Malaria center here.
“About what time do you think?”
“Oh, I don’t know.  I will let you know.”
So does that mean 1 hour or 4 hours?  I have learned from talking to Maiga and other Malians that there is a simple equation to derive what time they actually will do something from the actual time they say it will happen.  The equation is thus:

Actual time = time stated + 4-5 hours (Equation 1).

Equation 1 has been tested about 10 times, and it has not failed.  So, after getting off the phone and as I tried to plan out my day, I figured the driver would pick me up at around 4:30.  I arranged for a taxi to take me up the escarpment (bluff) to Point G where the Malaria center is located.  I did email for a while, figuring the driver would arrive around 4:30 or so.  I finished my work at around 4:25, and waited outside.  At 4:45, he showed up.  I love math.

We had 4 errands to run before we were to go to Doneguebougou:

Pick up my bag from my house

Buy gasoline for the generators

Stop at the drivers house to pick up some of his things

Buy beer, bread, and watermelon for the group

So, time for the 2nd Equation that explains all Malian life. This one derives how long it takes you to run errands from a starting point (i.e. ones house) to and end point (i.e. back to the house or to Doneguebougou) based upon the number of things you have to do. The caveat to this is that this equation is irrespective of the type of errand: running to the store, waiting in line at the bank, getting gas, etc., all receive the same weight. The equation is thus:

Time to complete an errand = # errands x (45 minutes - one hour) (Equation 2.)

With this said, from Point G to Doneguebougou (factoring in the extra 30 minutes from Point G to Doneguebougou), one would expect our errands to take minimum 2 hours 30 minutes to a maximum of 3 hours and 30 minutes. This would mean in real time, that if we left at 4:45, we would arrive in Doneguebougou between 7:15 – 8:15. Sure enough, after running all 4 errands and after finishing the last errand near Point G, we arrive in Gone Gougou at 7:45. Who says you can’t use math in your everday life. . . .

Craiger does Ramadan

2005-10-16T18:37:00.000Z

Ramadan, the Muslim holy month of fast and introspection, started on Oct. 4.  I was unsure what it exactly meant, and how I was to react to it.  I had never really thought about the muslim religion, so I didn’t really know what to expect.  Initially I thought that I would not fast, as I was not Muslim, and thus had no reason to do so.  A chat with one of the Americans who works at the MRTC who was a former Peace Corps volunteer here changed my thinking.  She said that it built a sense of comraderie with the people of her village who were muslim, and it allowed her the chance to experience  and understand the Muslim religion.  I thought about her words for a while, and then decided to go for it: I decided to fast.

Oct. 5th was the first day I fasted.  The fast works like this:  You wake up around 4:15 or so and have breakfast with some tea, bread, fruit (sometimes), and water.  You stop eating at 4:45 or so and are not allowed to eat or drink ANYTHING until 6:20 in the evening, or for roughly 13 ½ hours.  At that time, you break fast with a small bit of tea (aka Lipton bag tea) with lime and sugar, dates, and raisins.  You then gradually sip cool-to-warm water and then gradually eat larger and larger amounts.  You also continue to drink water throughout the night to replenish what you missed during the day.  Of course, the muslims also pray 5 times a day like normally, but during the month a little bit longer.  The process repeats for the entire “month,” or better said the cycle of the moon from the New Moon of Ramadan to the next New Moon.  At the end of Ramadan there is a huge feast and party called Eid al-Fatr.

So, I decided to try this whole thing out.  The first day was hell.  We had a “good” dinner the night before, and I went to bed feeling a little nervous.  Waking up at 4:15 in the morning to eat is not easy, and it is nearly impossible to go back to sleep.  What follows is a description of my first day doing the fast (recall, no food or water during daylight hours):

“Clinic just finished, and I am tired.  43 patients between 8:00 am and 12:30.  I only got about 5 hours of sleep (4 hours between going to bed and breakfast, and only 1 hour from about 4:30 to 8).  It is hard to concentrate.  I am very thirsty, and I have slight hunger pangs.  My thoughts are fuzzy, and my ability to type is definitely diminished.

It is now 4:00 pm.  I woke up from an hour nap as a way to kill time, to avoid thinking about food and drink, and lastly to catch up on sleep.  I am now trying to read an article I downloaded the other day on malaria vaccines.  It is very, very hard.  Words seem to mix together, concentration is at a minimum, and my typing is even worse than before.  Thirst is the hardest part.  My throat is dry, as is my mind.  I have a slight headache, like that of my hangovers (a sign of dehydration).  I cannot wait for 6:20.

It is now about 7:30, and I feel alive for the first time all day.  I had tea with sugar and lime, dates, raisins, and small amounts of water.  About half hour later, we ate dinner (some meat with a ton of French Fries, some rice with sauce, and some oranges I had bought the day before).  There is nothing like breaking the fast after about 13 hours of NPO except some water.  You feel alive again, as if you awoke from a deep sleep, and are finally aware of what is around you. You feel alive during that half hour or so after you eat. Your body then gets back into your usual state.  You can write again, speak again, think again, be again.”

So this same cycle of no food and water during daylight hours continued for me for 2 more days.  On Day 4, at around 1 o’clock in the afternoon, I got up from my chair, and fainted.  This has happened before to me when I was younger, but not in a long time.  The doctors there said I was out for only a couple of seconds, and I regained full capacity shortly thereafter.  They thought well of me for trying the fast with them, but they thought it was better that I not do it.  I told them I thought it was rather important, and that I would make an amendment: no food, but some water during the day.  They were skeptical, but agreeable.

After my fainting episode, I decided to approach this whole thing methodically:

Breakfast at 4:30: orange, banana, bread/croissant, water, and half a granola bar that my parents sent from the states.

During daylight hours, one 6 oz. cup of water in the morning and one 6 oz. cup of water in the afternoon.  NO FOOD at all.  Half hour to an hour nap to kill time and catch up on lost sleep after breakfast.

6:20- break the fast in the traditional way: tea with lime and sugar, dates, raisins, and sometimes oranges.  To replenish my water stores, one 8 oz glass of water every half hour for the rest of the night.

This regimen has suited me well for the past 10 days.  It is hardest when I am in Bamako for a day or two, and staying at my free room at the office with no one to share in the misery of the fast.  But, somehow I do it.

Health wise, I feel great.  I weight 84 kilos when I started (about 184 pounds).  After 14 days, I weight 80 kilos (about 176).  With means I have lost 9 pounds.  Not bad at all.  The only other issue is that I have this nasty foot infection on my left foot.  I think it is a nasty case of athlete’s foot that caused cracking and blisters to form.  It first started on my right foot, and now my left.  My right foot is essentially healed after about 10 days of treatment, but my left foot is worse than the right ever was, and there are about 5 blister-like sores there.  So I am now walking with a slight limp.  It looks like they are healing well, but slowly.  Otherwise, no issues.

Probably the biggest gain I have received is the comraderie from my fellow researchers in the village.  I live with about 10 other researchers: some doctors, some lab technicians, some clinical coordinators.  When I first arrived to the site in early Sept, there were some growing pains and some funny looks here and there.  I felt isolated from them.  As it became apparent that I could not work on the trial that was ending there and I worked vigorously to change that, my isolation increased.  Compound that with my less than adequate clinical experience there, after a month, I was at wits end with them.  After a while, they grew on me and I on them.  However, it took the experience of Ramadan and fasting with them to really change their conception and thoughts about this American living amongst them.  I have noticed completely different reactions to me now.  We are like a fraternity so to speak of researchers living and working in a spot that is close enough to civilization that we can get provisions when we need them, yet isolated enough that we feel we must rely on each other to get by.

I have 14 or so more days of Ramadan remaining.  I have become accustomed to the fast, and now am able to function better than at the beginning.  I hope to learn more about the muslim faith during this time, and a little more about myself and what I am made of.  I think I will somehow make this a yearly thing, like a cleansing of sorts.  Of course, if this were a true cleansing, I would do this thing sans alcohol.  But, as the Bambara saying goes, Doni doni ne tere geh. (Little by little, my friend).

Sundown prayer

2005-10-16T18:30:00.000Z

The eeriness of the Sundown chant calls to everyone, whether you are Muslim, Christian, or pagan. It’s a haunting sound; guttural, melodic, and yet soothing. You are instantly drawn to it, like a bug to light. You feel its power deep within you. You are forced to introspect about life and everything in it; you find yourself pondering, questioning, wondering. You are forced to think of things larger than yourself. It’s power, it’s center, it’s meaning becomes you, even if but for a moment.

Followup to previous post

2005-10-16T18:28:00.000Z

DO NOT READ THIS POST UNTIL YOU HAVE READ THE PREVIOUS ONE

Perhaps the hardest part for me happened next.  After we saw 10 more patients, clinic was done for the day.  We ate lunch, and didn’t talk about the incident at all.  It was very hot that day, and I decided to take a nap.  I woke up about an hour later, and began to write about the incident in my journal.  At about 4 or so I walked out of our house and saw some of the Malian researchers sitting near the same tree a few hours earlier I had sent the patients waiting to be seen.  Maiga, the Malian Fogarty Fellow, had arranged a meeting that afternoon with the village chief, so I was ecstatic about that.  H. was sitting hearby, and I told him that I wanted to attend the little girls’ funeral.

“I have already do that.”
“What do you mean?” I asked.
“The funeral happen after lunch while you nap.  I attended for two of us” he said in his broken English.

I sat dumbfounded, speechless.  With tears in my eyes, I started to yell at him, telling him that I was just as much a doctor for that little girl than he.  I actually tried to save her, while he sat by and did nothing.  I cursed at him for what he did, and got up and walked away.  I felt like running away, never to return.

A few seconds later, Maiga and H. approached me, and H. apologized to me in French.  Maiga, translating, said he did not think about the situation with the funeral the same as me and nor did he think of me as a doctor at that time.  After seeing what he saw in the clinic, he now thinks of me as a colleague, and he apologizes procusely.  I accepted his apology, and that was that.  I asked if I could go to the cemetery and say goodbye.  I was told that in Mali, you do not go back to the cemetery to visit the dead after the funeral.  Like most things I have learned here, I accepted it, and moved on.

It has been exactly 37 days since this happened.  I still think of S. every day I see a little baby in her mother’s arms in the waiting area at the clinic in Doneguebougou or on the streets of Bamako.  I look at each face to see if looks similar to the one that I saw that day, to be sure that I never let one like that slip away again. Now that I have had some time to reflect on the experience and seen how medicine is practiced here, I question if I was the one who was wrong in how I treated S.  Life is precious anywhere, but death is accepted differently in different cultures.  In addition, I realize that my initial reaction to my colleague was overly harsh.  He was practicing medicine according to the type of medicine available to him.  He is a good physician who I still work with at the clinic, and someone who I trust infinitely.  He and I are rather close friends now, and we never speak of the incident, like it never happened.

From time to time when no one is around after clinic, I find myself searching for the page with her name on it.  S.’s name still has an asterisk by it, and is one of a thousand other names in a ledger on a desk in a small medical clinic in West Africa.  But for me, Souleymane is more than just a name; she is a real person, a little patient that I could not save.  I am haunted by her.

Everyone Knew But me

2005-10-16T18:21:00.000Z

The following story happened on my first day at the village clinic where I am working on the vaccine trial.  It has taken me a while to come to grips with it, hence the delay for posting.  Not a day goes by that I don’t think about the patient in this story.  I picture her face every time I see another one like her, wondering if it is her and that what had happened was some sort of bad dream or story I had read that happened to another doctor who had worked in Africa.  While the following story may seem frankly formulaic, like it was an amalgam of stories that you have read about elsewhere or had heard about on an infomercial for African children relief, it actually happened exactly as described.  I have often heard doctors describe that certain patients will leave an indelible mark on their lives, both as physicians and as humans.  For me, one of those patients will be Souleymane.
__

Patient #43 was a beautiful young baby girl, swaddled in colorful Malian cloth and lying rather quietly in her mother’s arms when they entered the small clinic room.  We had already seen about 40 other infants and young children just like her that day, my first in Doneguebougou as a “doctor.”  They all had the same complaint – fever – usually mixed in with some other common complaint (headache, diarrhea, cough, etc.)  In this clinic in this little corner of Africa, this meant malaria.  There was nothing to suspect that there would be anything different about this little baby girl.

You could tell the mother was very proud of her baby in the way she held her head high up near her shoulder and cradled her carefully in her arms.  You could also sense that she was rather worried about her recent infection from the quiet concern I read from the mother’s face.  I remember the infant’s small, angelic face, her seemingly perfect dark skin, and the pink dress she was wearing.  I also remember seeing many small, handmade bracelets and anklets on her wrists and ankles, a sign that she had visited the traditional medicine healer in her village.  When I saw this little “perfect” infant as she lay in her mother’s arms, I knew something was very, very wrong.

Her mother said her name was Souleymane (S.) and she was 9 months old.  They came from a village about 10 km (about 6 miles) away called N’gara.  She said S. had a bad fever and chills for a couple of days, and suddenly this morning was not responding to her when she tried to wake her. So, she begged her husband to accompany them on the walk to the clinic in Doneguebougou.  Neither the mother nor I have any idea what time she arrived at the clinic that morning, but it was already about 12:15 when we saw her, and we had been seeing patients since 8:00 am.

At first glance, S. was not acting like the other babies I had seen before her that day and for that matter ever before.  She just laid in her mother’s arms, not moving and staring off into space with these deep, big, brown eyes that resembled those of a doll.  Within the first minute of arriving, the Malian doctor I was working with that day (H.) and I immediately had the mother lay S. on the exam table, the same table that was covered with an orange cloth that had already been drenched with the sweat, dirt, and some urine from the 42 earlier patients.  I recall thinking that it was not right that we place something that seemed so perfect on such an imperfect spot, but this was not the time to worry about perfection.  After we removed her dress to examine her, we took her temperature (40.5 degrees C, or 104.9 degrees F., a dangerously high fever for an infant) and did a quick physical exam, knowing full well that we probably would find nothing of significance but still suspected the worse.  We also noticed that S. was flaring her nostrils and using her chest more than normal, a tell tale sign that little S. was in respiratory distress.  I also moved her head from side-to-side to see if her eyes stayed fixed looking straight ahead (which is normal) or followed the direction I was moving her head (which is not normal); her eyes followed my movements, a very, very bad sign.

H. and I had the same reaction to our brief exam and he anxiously told the mom to quickly go outside and wet her head wrap with the cool water from the spicket a few feet away from the clinic.  As she returned, H. called in the father to tell both he and the mother that their baby had to go to the hospital immediately because of the possible drastic consequences of cerebral malaria, of which this was most certainly a classic example.

While he was doing this, I attempted to wrap S. in the cool head wrap.  As I supported her little head in my left hand and tried to wrap the cool cloth around her with my right, S. stopped breathing.  I felt her pulse and couldn’t feel anything.  I startled a bit and H. instantly looked at her and in a weak attempt at CPR, awkwardly pushed on her chest a few times, and weakly blew out air through his mouth in a way that made his lips putter, as if to help her breath from a few feet away.  He knew what had just happened.  The mother and father, watching everything we had been doing to their daughter, somehow both knew what had just happened, and started to wail.  For those first few seconds, I had no idea what just happened; everyone seemed to know but me.

A few seconds passed before my instincts finally kicked in and I thought of the steps of CPR.  I knew that they had emergency drugs and oxygen in the clinic building next door that was to be used in case one of the vaccine trial recipients went into anaphylactic shock after receiving the vaccine.  I asked quickly if we could use that equipment to revive her, and H. told me no, that “There was nothing we can do.”  After he said this, I pushed him rather briskly out of the way so I could get near S., almost knocking him down.  My instincts now were in full gear, and I started CPR for the first time ever in my life on a live patient.  I had no mask to cover her face to prevent me from getting any infection she might have, but I ignored that small detail.  I put my lips over her little mouth and nose to help her breath, and did the breaths and compressions in the order that I had practiced up-teen times on a plastic dummy.

At this point I was a machine, immune from everything occurring around me.  Neither the mother or father’s wailing nor H.’s staggered look fazed me.  I remember thinking “I don’t give a fuck if you say I can’t use the emergency equipment, I am going to use it anyway.”  After about a minute of altering breathing and compressions, I felt a tap on my shoulder.  It was H. telling me to stop.  I remember turning around and staring at him, tears slowly welling up in my eyes, tears of both anger and sadness.  The machine suddenly stopped whirling, and the human returned; I then realized that my attempts were futile.  Everything that I had ever been taught up to that point no longer mattered; I now knew what everyone else in the room had already known for some time.

I looked down to the floor, and then back at S.’s naked body.  She still had the face of an angel, and the appearance of a life-like doll.  Her big, brown eyes were still open.  I will never forget the way she looked just then: at peace.  I reached up, and closed her eyes, like I had seen done so many times on TV and in movies, and never on a real person.  I remember her face and forehead were still warm, full of the warm blood of a life that was now suddenly and prematurely gone.

The mother and father continued to wail hysterically.  H. scolded them (I think) for crying, and I yelled at him for yelling at them.  The tension and the utter reality of the situation hung thick in that small room for a few seconds.  I felt I had to do something.  So I brought the parents to the treatment room, and sat them down.  I then picked up S., wrapped her up in her mother’s cool, colorful cloth and carried her into the next room and handed her to her father.  I saw the father first proudly look at his daughter and then start sobbing hysterically.  Feeling invasive, I walked out quietly and closed the door, which shut with a loud thump, providing a rather grim tonality to the situation.  H. was silent, looking off into the distance.  I looked at him for answers, expecting my colleague to console me and tell me that I had done a good job.  Instead he looked at me and said “Wow.. . . .   Wow, wow, wow.”

I was beyond myself at that point, and walked out the door of the exam room into the outdoor patio that serves as the waiting room for the clinic.  There waiting for me was a crowd of about 10 mothers with their children, every single one absolutely silent, looking at me in a way as if I were to blame for what they knew had just happened.  There I stood, in my newly ironed long white coat, as helpless as the little girl that had just died in my arms.  Not being able to communicate to them in their native tongue, I looked out across the dirt of The Compound and pointed to a tree that was far away from the clinic building.  They somehow understood, and one by one got up and walked in silence to the tree I had pointed to.

After the last perspective patient had left the patio, I walked to the side of the clinic building, hidden from sight from everyone present.  I dry heaved, and then again, but nothing.  Tears welled in my eyes as I leaned against the side of the building and bent over, struggling to make sense of what the fuck just happened.  I began to curse my colleague for not allowing me to do more with the emergency equipment.  I cursed him again for what I perceived as his lack of judgment.  I cursed the family for not bringing their daughter in sooner.  I cursed the whole country for being so backwards.  And finally I cursed myself for agreeing to come to this fucking country and in thinking that I could actually make a difference; who the fuck was I kidding?  What the hell was I doing?  Why did I come here again?  Why did this happen at this time, in this place, to this child?

I sat there for what seemed like eternity, but in reality was more like a minute.  I got up, wiping my face as I walked back to the clinic.  While I was gone, H. had arranged for a relative of the family who lived in Donegue to come help them.  After about 5 minutes, the family left out the front door of the clinic and down the steps toward the main entrance.  The relative was in the lead, followed closely behind by the mother and father.  The father walked with his head down, holding his little baby girl tightly against his chest with both arms, her limp body covered from head to toe in the wet cloth that usually adorns his wife’s head.  The mother sobbed as she walked next to her husband.  I stood watching the unfortunate triangular group from the window of the very exam room where that family’s world and my world were forever changed.

I stared at the family as they walked out the main gates and disappeared into the small mud brick huts of the village.  I saw the workers of The Compound gathered near the entrance look back in my direction.  I saw the looks of the mothers and of the infants and children who I had just instructed to move away from the clinic stare blankly back at the strange white man with the long white coat that was looking out the small window of the clinic.  To this day I can only imagine what they were thinking.

When I turned around, H. was writing down S.’s information in the book that we use for record keeping.  I looked over his shoulder as he wrote.  When he finished, it looked like every other entry in the book, with the exception of an asterisk by her first name.  Dumbfounded, I asked what would happen next.  He said he would tell the team later what had happened, and that would be that.  I asked him if anything like that had ever happened before at the clinic, and he said no, that was the first time ever.

We sat in silence for a few more minutes, both trying to make sense of what had just happened.  I breathed in deeply and let out a deep breath, and asked him: “Ready for the next one?”

“Yepppp,” his lips puttering slightly.

Patient #44 was a . . . . . .

2005-10-05T14:16:00.000Z

A little Malian tea for your hangover?? Seriously, the most addicting substance on the planet: Malian Tea taken in 3 doses. These are 2 of the doctors that I work with (Guindo on the left, Kimate on the right) on the vaccine trial.

2005-10-05T14:14:00.000Z

The Self-Proclaimed-Craiger dancing much to the amusement of the children of the village.

2005-10-05T14:13:00.000Z

Some of the kids from the village down below and the researchers strutting their stuff to the music.

2005-10-05T14:12:00.000Z

Malian Independence Day at The Compound in Doneguebougou. Notice the Guiness-in-hand.

Holy S--- I'm in Africa moments

2005-10-05T14:07:00.000Z

So many times I find myself having these “Holy Shit, am I really in Africa?” moments.  From walking the 3 blocks from my house in Bamako to the main road, looking at the goat and sheep yard where they sell the animals.  Watching people carry chickens upside down by the feet while maneuvering their moto through the insane traffic of Bamako.  Another example deserves some more explanation:

It’s Friday, 23 September.  It is the day after Malian Independence day.  Still recuperating from a nasty upper respiratory infection, I pretty much sat on my ass all day, learning how to do “The Stare,” an art that my Peace Corps friends here told me that I was sure to master before I left Mali.  Basically, you are so bored and/or non-committal that you stare off into space looking at absolutely nothing.  Adding to the excitement of Doneguebougou today was the oppressive heat: it was fucking hot out today.  Thus, it was ripe conditions to practice the art of The Stare.  I was just kidding about all of that staring off into space stuff.  I did some reading, both for work and to finish a book I had started the day before about some secret organization that ruled the world and wanted to buy a small nation so they could have a seat at the UN (It was called “The Business” by Iain something and was OK and brought up a couple of interesting points), some work with Maiga, and some cataloguing in the pharmacy for my upcoming, self-proclaimed and self-acclaimed take over of the medical operations here.

So, after finishing up said work and as I started to read under the shade of one of the small trees by our house, I saw one of the helpers in the pharmacy help wash this goat (mouton) with Bafily, the local young man who helps out around The Compound.  I thought it was one of those random things  that I see everyday that I question for about a second and then dismiss it as “Oh yeah, I am in Africa.”  To me, I thought the goat was a pet, as there are freakin’goats everywhere on The Compound grounds, and they were simply giving it a wash like they would wash a dog.  Well, a few minutes later, Maiga says: “OK, time to go kill the mouton.”  I jump up like a kid at Christmas, grab my camera, and am determined to watch this whole bloody process and catch it on film.  I will spare you the gory details, but I will share some of the 38 moments that I caught for eternity on digital film.  It was a pretty gruesome site to watch, especially the actual blood-letting part.  But after they started to skin Mouton, I was instantly transplanted back to my 1st year anatomy lab, trying to make some anatomical sense to this animal: the multiple levels of fascia, a muscle here that looks and functions like the rectus abdominus, the aorta, the liver, pancreas, etc.  It was incredible.  Then watching how they used every part of the animal for cooking, except the distal part of the legs (i.e. the wrists and hooves).  They had a big pile of Mouton parts, and subsequently spread it out amongst the people at the camp: the headmaster of the school, the cook’s family, the guard’s family, a little to our village elder who helps us, and the rest (about 1/3) of the muscle and innards we kept.

Soon after, they made a small charcoal fire, and grilled a half slab of ribs, the rump, and one of the thighs.  They then spread this spicy bouillon/salt mixture on top of it while it BBQ’d.  The smell was incredible.  I could not wait to dig into that damn Mouton.  With much aplomb and after cooking the shit out of that meat over the charcoals, they cut it up, and added a different type of salt concoction and we dug in.  It was truly THE gastronomic feat of my trip to Mali thus far.  Luckily, there were still some beers left over from the celebration the previous night .  There is nothing like eating free-range goat, freshly-killed only a few hours earlier in somewhat “sanitary” conditions, and sipping on cold beer with your friends and co-workers in the front yard of your compound in the middle of nowhere in West Africa.  “Holy Shit, I AM in Africa.”

Malian Independence Day

2005-10-05T14:06:00.000Z

22 September is Malian Independence Day.  That day, 45 years ago, Mali became independent from French rule.  The day itself has a feel that combines Thanksgiving Day, the Super Bowl, and our own Fourth of July all into one.  Usually people are spending the day with their family and friends at their homes.  Since we were all far away from that, we had our own celebration of sorts.

The night before Malian Independence Day is the big celebration as far as alcohol and going out is concerned.  Since I was recuperating from my Upper respiratory infection, I was in no mood to go out and so wanted to get the hell out of my house in Bamako that I had just spent the last 4 days recuperating from.  Maiga had called and said that he was heading out to Doneguebougou and that he would talk to me in a couple of days.  I asked him, rather begged him, to take me with him, as I was feeling better and had to get out.  He reluctantly agreed, and he came to pick me up around 8:30 or so.  As always, we had a few errands to run, which included picking up some alcohol for the group back at The Compound.  That turned out to be an hour and a half ordeal as we waited at the bar right before the turn off to Doneguebougou for some friends of the guys.  Well, there was alcohol there, so why not partake.  Usually this bar is dead whenever we stop by to pick up “provisions” for the group.  This night it was far from dead.  There were motos everywhere, every table was full, and there was much merriment.  According to Maiga, many of these people were devout muslims who allow themselves a little merriment once in a while.  There was definitely much merriment to be had.  I laughed a little at what I saw: normally subdued Malians dancing about, enjoying the effects of the evil alcohol; emphatic conversations in Bambara that some could consider to be yelling, but most likely chit chat about the government or football; Malians dancing to their jazz- and blues-infused local music.  After a while, we were finally on our way to The Compound.  Once we arrived, there was already much merriment afoot.  They had a table set up on the mini-porch outside the front door with a boombox playing all sorts of toons.  About 10 of the villagers were there dancing away.  We showed up, and the party really got started.  The beer was flowing, the music kicked into high gear.  I was still feeling a little worn out from the past week, so the Craiger took a back seat much to the dismay of my co-workers there.  I did dance to a few songs, but not with the same fervor that I usually partake.  It was hilarious to watch my co-workers not only drink alcohol, but dance and enjoy the moment.  After being there about an hour, it seemed the entire village showed up.  I think I counted about a hundred people: from kids to adults, dancing, enjoying their Independence day.  At about midnight, I called it a night, but a hard core group of about 20 decided to keep the party going, and keep it going they did.  The stereo for some reason, could only play music at the loudest setting, which permeated into every room in the house.  It was tough to get to sleep.  They kept playing the music until about 6:00 am the next day!!  Talk about hard core huh?

In the morning, the hard core and the soft core stumbled out of bed and slowly made it to the television which had been set up in a small courtyard with shade.  By the time I showed up, about 75 people were already there watching the festivities that takes place every year in one of the major cities in Mali.  This year, the president and the whole country it seemed was in Sikasso, about 200 miles to the Southeast.  There was a big parade with all of the cultural groups of Mali, musicians, various ethnic groups, etc.  It reminded me a lot of the Macy’s Thanksgiving Day Parade that I have watched part of every year as far back as I can remember.  While there were no floats, there was some colorful commentary in West African French, cultural discussions and demonstrations, and of course, the coup de gras, the military parade.  Mali is very proud of its military. It has an Army, small, small Air Force and, well, that is about it.  No Navy (it is landlocked don’t forget), no Marines (I can’t really picture Malian Marines yelling Hoo-Ahhh), no Coast Guard (see the landlocked thing again), and no Office of Homeland Security (Hmmmm).   After the parade, people usually feast for the whole day with their family and friends, trying to nurse their hangovers from the night before.

Well, after the parade, it is eating time.  We had little food, and we had to wait until that night to have our dinner anyway.  The one big event that night was the Super Bowl of Mali, the final deciding game of the year for the Malian Cup of Football (Soccer).  Literally, I think the entire village showed up to watch the match.  I strolled in a little late, but as always, was able to find a seat right up front, as the Malians insist the Tobaboo gets everything (I am really, REALLY getting used to this treatment here!!).  You could tell by watching that the 2 teams were incredibly talented, but they were not exactly World Cup quality, nor even major European Club football quality.  I was impressed by their play, but they made some mistakes.  It was obviously a rather heated match, as both teams had their staunch supporters who hooted and hollered throughout, wore their teams colors, etc.  It was a hell of a game.  It was 0-0 after the first half, then both teams scored a goal within 5 minutes of each other, and the score was knotted at 1-1 after regulation.  The score remained tied after 2-15 minute overtime periods, which left it all to shoot-out.  Both teams missed at least one, so it was then up to the goalies.  The yellow team goalie scored, but the red team goalie shanked it left, ending his teams hopes for the championship.  Half of the village erupted in thunderous applause, the other half left in disgust.  I could also hear pockets of applause from elsewhere (supposedly there are some folks with power in the nearby area that have black and white TV; ours is the only color).  Some were ecstatic, others felt each others pain and walked away.  I, the only white person out of about 99 other denizens of Doneguebougou, watched with amazement at my little pocket of the world, and couldn’t help but take part in the revelry.

Typical day at Donegue clinic

2005-10-05T14:05:00.000Z

Typical day at clinic:

Up @ 7. breakfast at 7:30, initially only bread and tea.  Now more fruit added, coffee occasionally.
8:00 clinic starts.  Many patients wait in the small waiting area outside of the main consultation room, sometimes spilling out into the open area outside the clinic building.
8 – 1:00 see 40-50 patients between the Malian doctor, me who assists, and occasionally the aide (village elder/assistant to the elder)
Typical consult: Graph paper book with lines drawn to separate the columns: name, sexe, age, race, village, occupation, temperature, symptoms/complaints, GE result, diagnosis, treatment given.  No other record.  Difficult to follow-up with care.
1:00-2:30/3:00- lunch and downtime.  Usually take hour nap. Write in journal if time.  The first 2 weeks were pretty much spent in Bamako every afternoon working on the study, so journal writing took a back seat.
2:00-7:00- travel to and from Bamako, getting provisions, and/or work on study there.
The 2 days we did not go to Bamako the first 2 weeks, we played soccer with the locals.  Truly and unforgettable experience (see later posts)
7:30- dinner
8:30-10:30- work on protocol
11:00- have beer (Guiness.  The first day I got there I asked for a Guinness, and they have supplied that for me for the past 2 weeks.)
12:00 or so- bed and read for a while

My first patient

2005-09-26T21:49:00.000Z

She was an elderly women, most likely in her 60s (Many people have no idea what their age is. We must use some creative questions to get a good idea: How many harvests have you seen? Who was the chief when you were born? For children: how many moons have passed? How many teeth does she/he have?). Our lady had a leathery face that cracked whenever she smiled. She had very few teeth, but a beautiful smile. The elder, Coussa, took her blood pressure and recorded it on a crumbled, well-worn piece of paper she kept in a plastic bag. Evidently, they used patients logs to record their BP whenever they came in. Impressive I thought, they are more with-it here than some places in the states. She was here today because she had some headaches and she wanted a refill on her BP medicine. When I heard the words “BP” “medicine” “refill,” my heart sank a little. Huh? Here I am, in the middle of nowhere, and this lady needs her BP meds refilled? What about the weird tropical diseases? What about the different pathology I kept hearing about? I was dumbfounded. I quickly realized that everyone suffers from hypertension, even older women in Mali. Just do your job, and you will be fine. So, when I saw her medicines, I jumped a little. She was on Lasix and methyldopa, 2 drugs that are hardly ever used to treat hypertention in the US. I asked Maiga after she had left why those two drugs, and he said that was what they had available in the pharmacy in the clinic. I was floored. Every medical governing body in existence recognizes that hydrochlorothiazide is the first drug of choice to treat hypertension. It is cheap and very effective. Why was that not being done here? I had some work to do and some questions to ask, but after clinic.

The next stream of patients were pretty much representative of what I see everyday at the clinic: 6 month – 9 year old children with fever, headache, and weakness (signs of a malaria attack) compounded by some kind of upper respiratory infection or diarrhea. And what do we do to these patients you may ask? We pretty much get a thick blood smear on every child that comes in with fever or history of fever. Which makes sense as studies have shown here that 80% of the causes of fever in children are malaria. What does not make sense is giving them an anti-malarial drug before they even know if they have malaria or not. I suspect that about half to 3/4 of the patients we order a thick smear on have malaria and get the appropriate treatment. What about the rest though? They are told once they are seen by us to get the thick smear and get the medicine and that is it. No waiting around for the results to confirm if they have malaria. It really is rather sad and it frustrates the hell out of me. But what can I do? I can change the system. But that will take time, which I have a lot of.

There are some other problems I have with how the clinic is organized and run, which I will not get into here. Suffice it to say that the Craiger is on the case, and I hope to have a better clinic up and running soon.

First Day as Gone-Gougou doctor

2005-09-26T21:46:00.000Z

9/5/05
Maiga and I had morning bread (no butter, jelly, jam, spread of any kind) and tea (some Lipton-like brand but with Arabic writing on it, with sugar), talked a little on how the clinic worked and such, and then we were off. I remember thinking “Holy shit, how does one use a stethoscope again??” as we walked to Maiga’s office to get our equipment. He had seen my short white coat, and said that wouldn’t do, and handed me a crisp, freshly clean LONG white coat for my use in Doneguebougou. I remember the first time I tried it on, I had these strange thoughts of “Holy Shit, I am a doctor now,” anxiety, and pure fear. I also remember thinking that John Carter would be jealous. Maiga had an extra stethoscope for me because like a dumbass I had forgotten my own back home in Hippodrome.

We walked the short 50 feet or so from the vaccinations clinic to the other clinic, and greeted a mob of anxious mothers and their babies. The scene was truly one of utter chaos. Mothers wearing one part traditional Malian garb (multi-colored sarongs with hair scarves), one part Western t-shirts that ranged from football (aka soccer) apparel to I Love New York to Best Grandma in Texas. Their children were either at their side, looking up at the Toubaboo (White Man) with a look of both fascination and fear, or on their backs, wrapped with a thin sheet-like material to secure the baby to the mother. The mothers looked at the two of us, and appeared relieved, but I had the suspicion they were not too sure about the Toubaboo. I received all kinds of stares: puzzling, infatuation, scorn, wonder, indifference. The clinic “guide” (aka the village elder who assists the clinic as a nurse and pseudo-purveyor of order while we are there) had already made a list of names, and handed it to us. We walked in, saying the traditional “Ini-Sogoma,” found our chairs, and started seeing the patients.

The clinic building could not get more basic if you tried. Imagine if you will a building made of concrete. The front area is the “waiting area”; there are a few benches that align its walls, and some scattered chairs. Directly behind that is the “treatment” room. There is a bed in the back left corner for patients that require procedures. A shelf and a metal closet is on the back right filled with medicines and basic equipment. I have not had a chance to explore what resources are at hand yet; that I hope to do soon. The room immediately to the right of that is part storage, part second treatment room. It is rarely used, which is a shame, because it has a lot of potential use.

The consult room is in the front right. It is exactly how I had pictured it. It is small, about 10 foot x 8 foot (aka 3 meters by 2.5 meters), and is rather spartan. It is painted a deep color blue, and dirt is caked on the walls in varying patterns that make it appear as if it were part of the design. There is a desk along the back left wall with various notebooks, stethoscopes, a BP cuff, a ruler, antibiotic cream, plain white paper, and other things which I have yet to really look at yet. There are two chairs on either side of the desk, and fan in the far part of the room near the door that leads into Treatment room 2/storage room. There is an exam table with a thin single foam mattress with a floral pattern on it, and a thin orange sheet that covers the mattress. The table looks and feels old, and it is too high up for patients to get on and off. We hardly ever use it, as the physical exam is a joke: quick listen to the lungs and heart, feel the belly, and order the usual regardless of what we find. I find the whole thing very frustrating sometimes.

Typical day at clinic

2005-09-26T21:45:00.000Z

Up @ 7. breakfast at 7:30, initially only bread and tea. Now more fruit added, coffee occasionally.
8:00 clinic starts. Many patients wait in the small waiting area outside of the main consultation room, sometimes spilling out into the open area outside the clinic building.
8 – 1:00 see 40-50 patients between the Malian doctor, me who assists, and occasionally the aide (village elder/assistant to the elder)
Typical consult: Fill in graph paper book with information: name, sexe, age, race, village, occupation, temperature, symptoms/complaints, thick smear result, diagnosis, treatment given. Ask brief follow-up questions. Do a quick exam. Dish out meds. Call next patient.
1:00-2:30/3:00- lunch and downtime. Usually take hour nap. Write in journal if time. Read pleasure book or read medical textbook on patients I have seen.
3:00-7:00- travel to and from Bamako, getting provisions, and/or work on study at the site. Run and/or play soccer with the locals. Truly and unforgettable experience (see later posts)
7:30- dinner
8:30-10:30- work on protocol, clinic revisions, talk with study staff about questions
11:00- have beer and chat outside in the elements (usually Guinness. The first day I got there I asked for a Guinness, and they have supplied that for me for the past 2 weeks.)
12:00 or so- bed and read for a while.

Life is what happens. . . .

2005-09-18T18:07:00.000Z

All-

So, recall in my last post that I had these plans to write a shitload of stuff into my blog, go the the pool, shop, etc.? Well, I think the old saying is correct which says: "Life is what is happening when you make other plans." Whether it was the long night partying on Friday (until 6:00 am) or destiny, I woke up with a fever, body ache, and general malaise. I somehow walked home from my friends house I crashed in, feeling like death. Go figure: I am in Africa, where diseases that have never existed in the U.S. or haven't existed for years, and what is the first disease I get: a common cold. The Peace Corps volunteers and other expats I have met have said that the colds here knock you on your ass for days. I am experiencing that now. There is a small chance that I have malaria, and I will get that checked out tomorrow.

So in the meantime, I feel a little better than yesterday, but still not 100%. I will try to at least post some more meaningful, heartfelt, gritty, no-holds-barred posts in the next few days, before I return to Gone-Gougou for work.

In the meantime,

Be good,

Craiger

Gone-Gougou or Bust

2005-09-16T16:05:00.000Z

All-

I am alive and mostly well. I realize that is has been a while since I last had the chance to write. While it has been immensely liberating to not have the internet and phone at an arm's length away, it has been difficult to keep in touch, share my stories, and know what is going on in the world. It has been a mentally, physically, and emotionally challenging time, and one that I will never forget. I am finally getting used to the ropes, have my room in the Doctor's Quarters slowly pimped out, and living life Africa style. I will be in Bamako all weekend, so expect some posts real soon. I have some stories for you.

Craiger

Gone-gougou beginnings

2005-09-10T21:39:00.000Z

I woke up on the Sunday I was to finally leave for Doneguebougou. Still heartbroken after what happened to New Orleans, I needed the respite. I was looking forward to settling into a place without a landline, without Internet, without sparse cell phone reception, a place to unwind and just be. I went to the Broadway for a good breakfast before I had to pack and buy some last minute provisions. What was initially supposed to be a leisurely breakfast turned out to be an hour and a half affair. Once I got my food, I woofed it down, as I was already running late and had to get back. I left feeling a little sick and pissed off, but I remember saying “What the fuck, this is Mali afterall.”

I packed up and my friend Maiga showed up just as I was finishing some emails. We loaded my stuff into the back of the driver’s car and off we went. Little did I know that during my rush to pack I forgot 3 of the most important items I needed: my watch, my white coat and stethoscope. Hello McFly???? Turns out they were "running late" and I would have to wait until later that week before I could get those provisions. Anyway, we headed out to the market to pick up some provisions (water, bread, the usual suspects). After about another hour or so of driving around, we were finally off. Just as we left Bamako, past Point G, I remember feeling a release of sorts: no more pollution, no more crowded, nasty streets, no more annoying people selling you shit. I was ecstatic. Just as we were about to pull off the main road to head to Donegue, we stopped off at a bar. It was a quaint little place, with a big tiki hut type roof and corrugated tin for walls. It was called the Rio Grande. I half expected to see little conchitas running around and such, a mariachi band, and Margaritas abound, but no. they had 3 beers (Castel, Flag, and Guinness) and some liquour. They ordered me a Guinness and a Castel for the driver, and we were off.

The Donegue road is horrendous. It is full of potholes, sudden drops, boulders; it is not really a road, more like a trail that can loosely serve as a road. The bumps seemed to become less of a problem as I slowly downed the Guinness down as we drove.

We finally arrived at the site right at around sunset. There were a throng of people near the car park, I thought to greet me. The were all sitting down. I thought, Gee, that is nice. Turns out they were watching a European Cup Soccer match, and I was just another researcher from Point G who happened to arrive during the match. I remember getting many weird looks from the 40 or so villagers who were there watching the TV, kids and adults alike. After I settled in to the sleeping quarters, I joined them watching the match. I forget now who was playing, but I remember rooting for the team everyone did not want to win. What a way to win the crowd, ehh?

The village itself is nestled on a hill that has a small river that runs just near it. The road that took us to the village runs West-to-East, with the village proper to the South and the NIH compound to the North. It is sandwiched in between the school to the right and the marche (market area) to the left. It is a fenced in area about a full football field in both length and width. There are a number of buildings on it:
Personal quarters on the left
Vaccine building in the middle
Clinic on the right
Kitchen and generator in the back.

I still cannot believe this compound exists here. It seems so out of place. Here you have this modern complex with electricity next to this quaint, clean, perfect little African village, complete with the huts and everything. It is just a weird dichtomy that I think I will never get used to.

My first meal at the site was rather familiar to me: Spaghetti with meat. While there was no tomato sauce perse, there was a small amount of spice added to it, and the meat was few and far between. It was edible, and I rather enjoyed it. Dessert was homemade tapioca (milk plus rice). Very, very good. After dinner, we all chilled outside, chatting and watching the stars. I have not seen stars like that in a very, very long time. Sitting there, in the pale moonlight, stars seemingly more abundant that the people on earth, hearing a language I could not yet understand, I felt at peace. I went to bed that night full of excitement, fear, and restless. I had a thousand questions spinning through my mind, but no answers to them. I finally drifted off to sleep, completely unaware of the emotional and physical roller coaster that would be the next week of my life.

Leaving for Gone-Gougou

2005-09-03T21:40:00.000Z

All-

I am heading out to Doneguebougou tomorrow afternoon. I start my clinical work as a study clinician Monday morning (Gulp!!). Not sure what exactly that means, what I will be doing, how I will be doing it, but I will get by somehow. I am also in the process of planning a drug efficacy study (medspeak for how well patients respond to a drug) on a new antimalarial drug combination that the government of Mali recently adopted as first line therapy. The new combination contains a drug that has been widely used in Chinese medicine for centuries to treat fevers, and only recently isolated and used to treat malaria. This drug, Artemisinin, has shown to be very effective in other countries, and only limited studies have looked at its effectiveness here in Mali. It has also been shown to be even more effective when used in combination with other anti-malarial drugs, even some medications where resistance is high (e.g. chloroquine). It will be a relatively short study and one that will involve from my end: study design, IRB approval, clinical work, laboratory work, and learning about molecular epidemiology, which is a fancy way of describing how health is affected in populations at the molecular level. It is great for me because I will see the whole scientific process in action. A lot of logistics have to be worked out, but it is doable in the time frame I am here. I am very, very excited, about this opportunity, and will keep you updated.

In the other big news, the hurricane has come and gone, and the aftermath that has hit my beloved city is heartbreaking. Everyday I think about what is happening there and the possible short-term and long-term consequences. I guess I will just have to wait and see, and leave the rest in Gods hands. It is so easy at this stage, once the intial shock wears off (if it ever does wear off), to start examining the response and how our leaders are coping with the problem at hand, and putting blame on someone or something. My simple response to that is forget the past, learn from our mistakes, and focus on the living and the future. New Orleans and the entire Gulf South region will make it out of this, albeit at a pace that is congruent with the lifestyle in the Deep South (i.e. very slow). We just have to wait and see how things turn out.

Anyhow, gotta get packed and get ready for tomorrow, and have one last beer at the Terraza before I head out to the bush, where luxuries such as beer and music and everything in between do not really exist.

Love Life, Enjoy Liberty, and Be Happy.

Always,

Craiger

2005-08-31T21:55:00.000Z

All-

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,

Craiger

God Bless New Orleans

2005-08-28T16:18:00.001Z

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),

Craig

2005-08-25T17:27:00.000Z

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

2005-08-25T17:26:00.000Z

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.

2005-08-25T17:24:00.000Z

The Hospital at Point G.

2005-08-25T17:23:00.000Z

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

2005-08-25T17:22:00.000Z

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

2005-08-25T17:21:00.000Z

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

New Beginnings, New Challenges

2005-08-25T17:10:00.000Z

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:

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

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

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

and just plain laziness

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,

Craiger

2005-08-16T22:33:00.000Z

Ready to conquer Malaria

Craiger finally in Mali

2005-08-14T19:43:00.000Z

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,

Craiger