As I enter the choke point in traffic just in front of the big Halles de Bamako market, my phone rings. I check the caller ID and realize I have to answer even though I’m in traffic. It’s Assana asking if I am still coming tonight. “Yes, I’m still coming,” I tell him, “I’m sorry I am late, but I am on the route.” Ok, he says and hangs up, not wanting to waste any more credit than necessary. I make it through the crazy intersection (luckily I’m turning right, not left) and out of town to the more open road. Twenty five minutes later, I enter Banankoro and keep my eyes peeled for the small gas station that I use as a landmark to prepare for my turn off leading to the CSCOM. I have been to the health center enough times that I know where to turn, but I like that when I look just beyond the station I can just see the little building on top of a small hill, the red cross denoting a ‘dogotoroso’ (doctor’s house) poking up above the gas station and the roadside boutiques and confirming I am headed in the right direction.
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| A Sotrama (public bus) that I saw one day just in front of the Halles de Bamako... disguised as a Limouzine! |
I turn left onto a dirt road and down shift into second gear as the terrain gets bumpy. I steer the car through a crumbling cement gate that seems to serve no purpose other than to guide me and remind me where the “road” is. At the top of the hill, Nanaisha, the midwife, and Doumbia, the technicien de sante*, seem to be waiting for me. They are seated under the hangar outside the CSCOM with a few other villagers. I stop the car and greet them… “Good afternoon. How are you? How is your family? And your children? It has been a little while!” They return the greetings, and after a minute of this exchange, the attention shifts to my car. It is the second time Nanaisha has seen it, but still she is excited and amazed that I am driving. “You’re going to give it to me when you leave,” she says. “Sure,” I say. “I’ll give it to your for $2,000!” We both laugh and she gives me a high five of a hand shake, sealing the joke between us. I apologize that I can’t stay long because I need to get to Salif’s house soon, so I hop back in my car and make my way a few hundred meters down the main road to the Coulibaly compound.
As I enter the compound, I greet the family members milling around the courtyard. This will be my first night in my new home away from home in Banankoro. The Coulibaly family has been extremely generous by offering me a room anytime I come to the village to work (if only it was so easy to find a place in Bamako…. ). This concession is home to Salif, one of the community health workers for the prenatal education program I work with. He lives just near the main road with his parents, his wife, their four children, several of his brothers, a gaggle of young kids, and a handful of other people who are most likely related, but I’m not yet sure how (and I may never be). Papa Coulibaly offers me a chair and after exchanging greetings, he begins to tell me about how bad the Maiga’s are**. I beat him at his own game, however, by asking how the Maiga’s can be bad if they bring gifts… and I procure a cheap plastic bag that contains a kilo of bananas and a kilo of sugar. A grin appears on his face and he begins to hand out bananas to the children and show off the bag of sugar. “Aissata brought all of this sugar!” he announces, “Now we will really be able to drink good coffee,” he adds to me as an aside (Malian coffee is really just watery powdered milk with a lot of added sugar and just enough instant Nescafe to make it slightly brown).
I go through the greetings with other family members and ask the children if they want to eat bananas. Then I ask if they like to eat bananas. My Bambara abilities nearly exhausted, I ask where Salif is. “He is in the garden. He will be back soon,” I am told. I sit patiently, proud of all the things I just asked in Bambara and actually a little bit surprised by what I am able to understand and say now. The high continues as I realize that Papa Coulibaly is concerned that I’ve left my car outside of the concession near the road. I agree to move it and he tells me he can do it. Unable to really refuse this old man who is giving me a home, I willingly agree and we go out to the car together. I unlock the door and help him adjust the seat… he checks his mirrors and starts the engine on the first shot (sometimes it takes me 2 tries when the car hasn’t been used in a while). We reverse and make it in to the compound with little difficulty, but lots of fanfare as the whole swarm of children from the compound follows us and a crowd of outsiders is attracted as the old Malian man drives the strange toubabou in her little car.
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| My room 'chez Coulibaly' in Banankoro |
We get out of the car and I carry my backpack into the small but pleasant room where I will stay the night. When I return to the concession, Papa Coulibaly is motioning me over to show me something… it is his ancient driver’s license! He used to be a chauffeur, he explains to me, and sure enough, there are his certifications from the 1970s saying he can drive even the big trucks! The best part is that his birthday is listed as “envers 1945” (around 1945), so he is not quite as old as I might have guessed. After a moment inspecting the old driver’s license, Salif arrives and my attention shifts again to greetings and then chatting with him. I learn about his wife and his four kids- the oldest is 15 and the youngest is 4. I didn’t even think he was married!! I guess he is aging better than his father… I learn a little more about his family- he is one of 11, and I think he tells me that his father has four wives. This is when my Bambara begins to falter. I ask questions and get responses that are unintelligible. The pride that I felt a few minutes earlier fades to frustration and disappointment. I realize how far I really do have to go and that this living situation will be the real key to truly learning Bambara! These language skills will be necessary for communication, but things move slowly enough that I can ask and point and ask enough times to begin to understand the words for things.
Assana, the local school teacher and my liaison, arrives to greet me. Dinner appears in two large bowls- one for the men and one for women. Everyone gathers around them except for me… “It’s toh,” Assana explains for me. I noticeably hesitate before telling them in Bambara “N be se ka toh dun” (I can eat toh!). Clearly they sense my lack of enthusiasm and after a brief exchange, Assana announces to me in French that they will buy me something else to eat… what do you I want? I protest, but the decision has already been made, so I at least convince Assana that I will go with him to find some dinner. Salif and I set out with his daughter, Kadiatou, in tow, and I said a silent blessing for Assana for saving me from toh! We end up following Assana to his house where his mother sellings rice on the corner. While Assana washes up, Salif and I sit down in the courtyard to wait. Shortly after, a TV appears and a crowd of children gathers. Assana emerges from the “shower” and hooks the TV up to some kind of generator that was loudly operating behind his set of rooms and a great color picture appears on the TV. So, we sit for 20 minutes watching a Brazilian soap opera dubbed in French that almost no one can understand. The highlight of the program is when I get the chance to hold a cute baby that everyone is cooing over…. But my excitement is short lived. While enjoying cute little Sadio, she lets loose, and due to the lack of Malian diapers, I get to wear baby pee on my dress. “Don’t worry,” Assana assures me. “Here in Mali we consider this a good sign of luck that soon you, too will have children.” Great… just what I was hoping for!
We return home, and I convince Salif that I shouldn’t eat alone in my room and settle for eating alone under a tree a few feet away from the others in the compound. I eat my rice with peanut sauce and then find my bucket of warm water waiting for me in the “bathroom.” I smile as I look up at the stars and dip my hands into the warm water to wash my face, arms, and feet. But, my smile quickly fades as the warm water dries and I realize how chilly it really is outside at night! Before I head to bed, I am treated to a practice lesson on malaria prevention during pregnancy. Salif is scheduled to do an educational session the next morning, so he gets out his stack of images and explains them to me. I find myself buoyed by the fact that he gives me correct information (as far as I could understand in Bambara), though none of it is very complicated. I don’t get the feeling that the lesson will be too engaging, and I try to ask questions to get more information and to help him practice. After a glass of tea with the rest of the onlookers, I excuse myself and tuck into bed in my little stuffy room that smells of kerosene.
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| Salif posing with his images describing malaria (in colorful outfit) |
The next morning, I wake up and head straight to the negen (bathroom… a structure of 3 ½ dirt walls without a roof that has a hole in the middle for using the bathroom and a hole in the back where wash water runs out), wrapped in a piece of pagne fabric. It is quite chilly out, and the other compound occupants are dressed in various pieces of warm clothing- kids in old reindeer sweaters, men in hats and jackets, women in oversized old sweatshirts. I get a lot of looks that say “look at the crazy toubabou” as I wait for some hot water and wash myself before dressing for the day. Maybe it’s not normal to wash in the morning? Once I’m clean, I eat my bread and drink my milky sugar coffee water and before 8 am it’s off to the CSCOM.
When we arrive, not much is happening, so I chat with Nanaisah and begin to greet women as they arrive. At around 9am, Assana decides that enough people have gathered and he instructs Salif to start the educational session. The women gather round, moving chairs and benches around a giant pile of expired medical supplies and trash in order to get a view of Salif as he talks and me as I hold the pictures (ever the lovely assistant). I try to get the ball rolling by giving my best “Aw ni sogoma” (“Good morning!”) and greeting the women. Usually this attempt at Bambara gets a laugh and wins some support if nothing else. My ploy seems to work, and the women appear to listen to what Salif is saying. From what I can gather in Bambara, the explanations go well, although they are none too engaging or in-depth, as I predicted. Much to my dismay, no one has questions at the end of the presentation and I am too nervous to try to pose a query in Bambara.
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| The animatrice from Marie Stopes giving a lesson on IUDs to women as they wait for vaccinations |
The real eye-opener comes as our presentation is follow by a woman from Marie Stopes International, visiting the CSCOM to do a program on family planning and specifically on IUDs. She carries on for nearly thirty minutes- talking, asking questions, showing examples of family planning products. The numbers of the women and babies increase, and now they even become engaged in the discussion- laughing and asking questions or shouting out answers to the instructor’s inquiries. Even Nanaisha, the midwife, gets involved in this “causerie” and spurs the women to laughter, leaving me wondering about what she said and frantically noting this question in my handy dandy notebook.
By the end of the Marie Stopes presentation, at least 75 women have assembled based on my estimates, and the area beneath the hangar is teeming with women and babies all bundled up against the cold (that seems to be diminishing pretty quickly, if you ask me…. ). By now, there is a constant din of noise: fussing, suckling, cooing, crying, the occasional shout, and lots and lots of coughing. The vaccinator, Ali, begins vaccinations by calling the first lucky baby’s name. I look at the table covered with haphazard stacks of small and large cards in pink and yellow and wonder about the organizational system- is there one? How is he keeping the records straight? How on earth do they know who is next?? These questions don’t seem to be bothering the many women waiting outdoors with babies on their backs and no chairs to sit in.
I adopt a similar air of confidence in the “system,” and take my place next to Ali. For the next several hours, I follow his lead and act as his assistant. I weigh babies and shout their weights to him as he administers vaccines to other children who cry in their mothers’ arms. Sometimes he instructs me to give the babies an oral polio vaccination (2 drops on the tongue) or a Vitamin A supplement. In these cases, I rip open the plastic ampule with my teeth as Ali does and squeeze the flavored gel into a baby bird mouths. After I weigh the baby and give my oral supplement, Ali gives the child a shot in the theigh, records it, and we move on. It’s a bit hard to use the sling for chunky babies or those who want to bend their legs and resist, then sometimes, they’re top heavy and tilt forward so it’s hard to get a good reading of their weight! I also eventually work out a system where I give the polio or Vitamin A after Ali gives a shot because this way the child is already crying and I don’t have to struggle to the little one to open its mouth!
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| Ali recording a vaccination as mothers look on. The big mountain of boxes and trash in the background is all expired and used medical products! Something must be done about this! |
After a lot of weighing and poking and squirting of oral supplements, Ali disappears. The crowd that has been shockingly patient and calm up until this point begins to get restless and I begin to get impatient, too. I escape a mother accosting me about why her daughter didn’t get weighed even though she’s less than six months old and make it to the nurse’s room in the CSCOM. Ali and his daughter are hiding out inside eating- taking their time even though women are outside waiting without even as much as a place to sit! The mood changes when we finally get back to business and when a woman’s name is called, she rushes to get the baby off her back and find the quickest path to the table in the center where we’re working. “You’re the next contestant on The Price Is Right!”
The routine begins to get old and I am getting tired of fussy babies and yelling weights to Ali and trying to figure out which child gets polio, which gets Vit. A, who needs to be weighed… I get the feeling I am just supposed to be picking up on these things. I am amazed that Ali doesn’t have the children’s actual birthdates recorded… he asks the ages and then uses me to help calculate the birthdate based on the age in days. While trying to do mental math, I look around me and do a little more mental calculating… at any given moment, I can probably see 10 visible breasts busy feeding or pacifying babies. I see two kiddos playing with old plastic packaging near the mountain of expired and used medical supplies that I have vowed to myself will be removed before I leave Mali. Finally, we are down to the last 25 or so… there is a moment of complete silence which is utterly bizarre, and then the noise starts in again. When we make it down to 10 moms, Ali starts picking up cards, reading them, and sending the owners home. He has run out of vaccines and they will have to come back the next month for the next vaccination day. I get the sense that it’s not urgent.
* A technicien de sante is like the equivalent of an LPN in Mali. A Technicien Superieur is like an RN. They both go through three years of training after high school to become health professionals. The biggest difference is that a Technicien Superieur's training is a bit more rigorous because he or she has actually graduated from high school and passed the BAC (a type of degree). Techniciens de Sante only have to prepare the CAP, a professional diploma, which does not require as much high school or as much rigorous preparation.
**Papa Coulibaly says that Maiga's are bad because Coulibaly's and Maiga's are joking cousins. Joking cousin relationships ease ethnic tensions in Mali and members of specific ethnicities (certain family names belong to certain ethnicities) joke with other ethnic groups. Everyone jokes with the Coulibaly's (this name is the 'Smith' of Mali)! The most popular series of jokes is telling people that they eat beans (and thus fart a lot). You get the idea-- it's quite fun!
