Gaia Vaccine Foundation

Dear friends of GAIA,

After a week in Mali, I have returned home. My body is here, but somewhere, behind my retinas, a change has taken place and my view of Providence has been irrevocably altered. I look at clean streets and solid sidewalks and bright streetlights and I miss the families that should be gathered there, sharing dinner by lamplight. I miss the children that – if this were Bamako – would be turning somersaults in the dust by the side of the road, the bicycles transporting crates of chickens, and the rows of chairs full of bodies watching soccer by communal TV. Driving down street after street here in Providence, there is not a single donkey standing in an intersection. There are no baskets of oranges, no stacks of brightly colored plastic teapots, no curtains of sneakers hanging by their laces from store fronts, by the side of the road. Crossing the bridge over the river, I do not compete for space with big green bashis filled to the brim with smiling people, who laugh at the slightest provocation and share smiles as we edge forward, in endless traffic together. Horns do not honk. Policemen do not whistle. Diesel fumes do not fill the air. This city, on this side of the ocean that divides us, is silent. It is night time in Providence. The people who live here are locked in their houses. The mullahs do not sing out the hours of prayer.

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Hello

Another day in Paradise – although you’d be hard put to know it if you had just landed here from Mars. What makes this heady mix of mud, and joy, and neglect, and wild abandon into Paradise is so hard to describe.

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There was a donkey in the courtyard that night. The donkey stood, calmly chewing its cud, in the corner. I could see him behind the chief, out of the corner of my eye, behind the two counselors sitting with the chief on his purple plastic prayer mat. I sat listening to what they had to say, listening to the back and forth of French and Bambara. The donkey chewed quietly. The sky was full of dust. The courtyard was full of straw and dirt. The children were clustered at the chief’s feet, listening to us speak. There was a French to Bambara, Bambara to French rhythm that sounded like prayers.

We were talking about what Brown University students found when they came to work in the clinic in Sikoro, this summer. Besides the women who were too poor to pay the five dollars to deliver their babies in the clinic, besides the children taking care of children, and besides the lack of clean water and food, the students found that the women of Sikoroni wanted desperately to learn. To know more. To find out about HIV. To talk about it. And they made songs that they sang and the students captured those songs on film. They sang about the children begging on the sidewalks, about the poverty bringing HIV to Sikoroni. One of the women named Bintou made a song about what she learned. She sang about the girls ‘walking alongside the road” and the HIV that they bring home. That’s the song that I played to the chief from my shiny metal laptop with the large screen. I played Bintou’s song.

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There’s much that can be said in a sidelong smile. That’s what I had from Fanta Siby Diallo, the head of the DRS (Direction Regionale de la Sante) today at the end of our meeting, where we finally were given the OK to proceed with building our clinic. As she said, she’s really not the building expert, and she advised us to consult some, but she didn’t see why we couldn’t just get started! Words sweeter than honey, if you ask me! Of course, we agreed that the DRS would also get involved in doing a “survey” of Sikoro sometime in the future, and that Tounkara, our director, would come in and work on the survey with the team at DRS, and I told them we’d have to put it in the budget, but don’t hold your breath – what’s important is that we have a green light to proceed. Success! The groundwork laid by Sophie, and the hard work of Tounkara – when you think that we were at the bottom of a deep dark hole just in April (only 17 patients, no formal paperwork, a director that was to be fired, and Mme Diallo at the end of her rope). Thank you Sophie, thank Tounkara, thank you board for your patience as we worked this through. We have the “paper” we have the “green light” we’re going to meet with Guide and the Mayor of Commune 1 before I go, and if all goes as planned, we’ll be starting to build the Hope Center clinic on September 1. Hence the smile, and the comment by our most wonderful Diallo who has been our guardian angel over the past months – “we women need to stick together”. A sidelong smile, and a hug. We’re blessed. As Sophie would say “Champagne!”. or was it “Chapeau!”. I say BOTH!

Meanwhile we’ll be working on a Plan D’Action that will need to be approved by the DRS and the CSLS about the HIV care we’re providing, and we’ll work with the PNLTB on our plan to do cough monitoring. Data is getting entered slowly – Maggie has surmounted massive computer problems and downloaded a new version of Labtracker across that electronic smear that is the internet stretching between a very wet Bamako and Ground Zero right in the Haight. What possibly could be more perfect than that? I can see the bits and bytes streaming right out of the great big glass windows of Dan and Mark’s office overlooking the epicenter of AIDS in San Francisco (from years past, having shifted to this side of the globe, since then), circling once, before they take off towards the East, flying over a Providence that is shutting down for the day, and the wind whipped ocean, and the storm crossed Sahel, and around our mango tree, and into our garden, and into the blue plastic linksys box that Matt bought for us . . . Labtracker is here, Maggie has the data, and as I sit here (next to the dog, who is quietly ecstatic to be lying next to me on the couch) I can see her across the room typing furiously. . . Thank you Labtracker, and Mark and Dan – if all goes well, and the red rivers of mud do not keep us trapped in our garden, we’ll sally forth tomorrow to feed data into the computer and tell you all about the results.

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Maggie went to the Hope Center clinic with Mamou and worked on labtracker, entering data. Sad to say but the data is pitiful. It is filed on bits of paper and collected in a pile in a three ring binder. There were only 28 patients in the binder, but 52 are being followed. I’m going with her tomorrow to find more. Then we’ll go up and see Dao at the Point G clinic and get the information that is missing. Rama is sick but she held together for the meeting with the peer educators- seven of the 11 came to the house today to give us their reports and get paid. We went over the 5 points of Here Bolo and they loved the T shirts and visors, and they posed for pictures (hopefully Maggie will send). Thanks Elizabeth and (brother!). We talked about the project and the results at the clinic so far – a big INCREASE in HIV tests and people testing positive for other STDs – which means the message is getting out there, folks are getting the message and the link between STDs and HIV and they are coming right on in. This is so exciting! We told the peer educators we were proud of them. They asked for the smaller condoms and after a back and a forth about that, and laughter about how the Americans were too big – all the while knowing that what we were really talking about were the small foil packets that easily fit in your pocket and are somehow ‘cooler’ then the ones we give them now.

My favorite event today was the meeting with the TB program folks. We met with them and explained who we were, talked about the TB/HIV infection and the cough monitoring program and and our hope that we’ll be able to get that set up at some point this year. And then we were introduced to the head of the national department of health, a man called Dr. Ibrahima Bamba.

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We were up with the sun today making coffee in the wonderful coffee machine that Sophie left behind full of hope and plans for the day ahead. First things first of course – which meant a quick turn around the hippodrome (horse track) sharing mud and puddles with all the little boys of Bamako who were up and at’em bright and early too. It was marvelous to run in that big open space – the only place in Bamako where you can see the hills beyond and the sky above and you really get a true sense of the vastness of this space that is Mali (Check it out on Google Earth and you’ll see). This is bigger than Texas and I mean it. And about as much to get your arms around.

By that I mean it has taken us forEVAH as they say in Rhode Island to get the official OK to start our work on building the HIV clinic in Mali – as many of you know we planned to start building more than 12 months ago- but bureaucratic delay and paperwork got in the way and so I am delighted to say that today – we brought our official “papers” to a meeting with the Sikoro ASACOMSI (the committee that runs the clinic at Sikoro) and they called the builders to come speak to us and as soon as it makes sense – now it is up to us to decide – we’re going to go ahead and start building! The builders today said they only need to know two days ahead and they can start. . . the Centre d’Espoir (Hope Center) clinic will be built in 4 months. Did I really say that? I can’t believe it myself. We are moving mountains in Mali by sheer perseverance. As Sophie would say – we are the queens of ‘tetue”.

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We’ve arrived in that soup of humidity, dust, wood-fire smoke, mud and beauty that is Bamako. Kara (GAIA Mali Director) and Karim (Ousmane’s lab) met us at the airport and loaded our boxes of condoms, research supplies and medicines into Ousmane’s landcr cruiser. It took us almost an hour to cross Bamako because it was just 10 PM, the time when the semi trailers that are waiting at the edges of the city can come in and unload their loads. So our crossing of the Niger and the city was as efficicient as wading through a herd of buffaloes. We were surrounded by huge lumbering beasts, stacked two containers high (or so it seemed) and wrapped in blue tarp and bungee cords. Besides the buffaloes, the streets were full of people and carts and kids and bicycles and the inevitable goat or two. It was magic. It was Mali. We’re glad to be here.

After what seemed like forever (and catching up on all the news) we arrived at the clean, bright Maison GAIA where the first of many surprises awaited us – Nido is pregnant! (oh boy). For those of you who don’t know Nido, she’s our guard dog (left behind by GAIA volunteers two summers ago). She’s a beauty and now there will be more Nidos. The next surprise was a much better one – the news (that Kara kept back, smiling like a Cheshire cat, until just before he went home for the night) that GAIA has an off fficial approval to build an HI HIV clinic in Mali fr from the minister of health! This is huge, and it means that we can finally, if you can believe it, start building that clinic. The center of Hope. The Hope Center Clinic / Centre D’Espoir in Sikoro, Mali, a place as far from Providence as your imagination can carry you.

I’ve been all over the world in the past few weeks. Mali, Paris, Toronto. You would think that the travel itself would be disorienting. But the distance from here to Mali hits me the strongest when I go take care of patients in my clinic in Providence. My ability to access tools and medications that make my HIV patients better has a profound effect on my actions. I know that I can prolong life, and even save lives, with a few simple interventions.

That knowledge and certitude contrasts sharply with the attitudes of doctors caring for patients who are dying from HIV and AIDS elsewhere in the world. Why does their attitude matter so much? The Global Fund and the Clinton and Gates foundations might make drugs available for HIV/AIDS, but it’s going to take a lot more to address the hopelessness that affects doctors and caregivers who are just learning about HIV and how to treat. They simply don’t believe that AIDS patients can live long lives. They don’t test, and treat, because they cannot see a future.

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