Kambe Mali

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

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!!

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

A hard earned lunch after a long morning.  

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

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

Vaccination day!!

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.

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

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

Foggy Bottom

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

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

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

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

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!!!. . . . .