Category: Updates from Mali, Summer 2006
Postcard from Dr. Annie DeGroot
This cannot be the same world and only five hours away. I am sitting in the bright light of a August morning in Paris writing you one last postcard about our last day in Bamako. Only last night we were picking our way through the mud outside the airport in Bamako, shouldering our way through the throngs at the departures hall past boys changing euros and men selling bootleg CDs (hoping for one last sale) and ladies balancing their carryons on their heads and this morning, we are here. A few hours, a few centuries, away.
How to explain this gradual imperceptible shift that occurs in midflight – somwhere above the straits of Gibraltar, that makes what seemed so beautiful and proud in the heat and the dark of Bamako seem so garish and odd on the tarmac in Orly? The dresses that the women purchased for this occasion: damask from the looms of eastern Europe, hand-dyed pink and indigo in big pots in the Medellin market, pounded by hand with wooden paddles in dusty huts in the backstreets until the fabric takes on the sheen and stiffness of silk, beaded and embroidered by hand, embellished by west African beauty, look tawdry and overwrought here. The baggage delivery belt serving our flight speaks volumes: overstuffed duffels wrapped in packing tape and well-worn suitcases are mixed in with simple plastic sacks containing someone’s life belongings and tagged with AirFrance baggage tags, with cardboard boxes hand-sown into cast-off rice sacks, with recycled carryalls and simple boxes (full of mangos we think) tied with twine, with plastic sacks of corn, husks and all.It seems so strange to see this here, and yet so wonderful and so right and perfectly harmonious in Bamako.
A Postcard from Mali
We were up with the sun this morning and ran out from the guest house where we are staying and along the red dirt track towards town. At the cliff drop, there was a beautiful view of the Niger and the flat lands beyond to the South. The river is wide, and brown, and overflowing. I have never seen Mali so green, and now I understand why it is so. This is the rainy season. This is rebirth, renewal and hope for plenty.
The path down the cliff was already full of people making the trek to the hospital at the top: women in long blue cloth dresses with ready smiles. Men in blue uniforms wearing the thinnest of flip flops picked their way down between the stones. At the break in the cliff we turned East. East towards Mopti, Timbuktu, and beyond.
Ali Bicki’s Initial Reaction When Arriving to Mali
When I arrived in Mali at 9 PM, it was completely dark out, and still incredibly hot and humid. I drove ‘home’ to the GAIA house with wide eyes, absorbing as much as I could during my first hour in Africa. Over the next few days, I did not become more accustomed to my surroundings; commonplace daily activities, such as shopping in the “marches” for dinner, never ceased to provide me with stories to bring back to the house. I have been working with Jared Meshekow in Dr. Daou’s office at Chez Rosalie to organize patient data that can later be used for research purposes. The existing forms are being compiled into Lab Tracker, a program that tracks patients’ reactions to certain drugs, marking their effectiveness against AIDS in the body. During my next three weeks in Mali, I hope to provide the clinic with a reliable organizational system that will benefit them in the future and learn as much as I can about the Malian culture as well.
Ali Bicki
Moses Brown School ’07
Thinking about Mali
I am sitting in Providence thinking about Mali – not just miles but centuries and distances more ethereal from Bamako. There are no donkeys waiting patiently for their burdens in the streets nor are the same streets full of impromptu lagoons or cars that are stripped to their bare bones having been marooned there for decades. There are no children playing with wire facsimiles of toys, wearing shreds of clothing. There are no dogs skulking at the fringes of the road, watching for flying stones, no beggars with twisted limbs creeping along the sidewalk on low carts with wheels nor are there whole families bedding down in front of shuttered stores for the night, with stones for pillows.
There are no sudden rushes of rain, nor the verdant splendor that comes afterwards nor red earth to contrast with the green nor the joy of being that is everywhere. That beauty is Mali. That joy of being that is everywhere in Bamako is uniquely Malian. That joy of being is abundant despite the lack of food, and clothing, education and certitude of health. Despite those deficits, in Mali, there is abundant joy to share.
July 22 Labtracker Update
Update for the Week
This past week I spent working with Rajiv and Malick at Cesac clinic and at Point G as well as doing work with LabTracker. It is my pleasure to report that Dr. Dao of Point G is doing a stupendous job with LabTracker. I was astonished to find out that he has 497 patients in his computer. Not only were they in his computer, but he was using the program it’s fullest capacity, taking advantage of all of features. I also spent time doing the legwork regarding the EMR Mali publication. I am working on putting together a format a questionnaire which I could email the clinicians and obtain an electronic response. I am also considering making up an online survey program and having all of the statistics completed for me once all of the clinicians have finished the survey. There is good news on the Malick and Rajiv front, but I will let Rajiv fill you in. GAIA will be quite happy and I’m sure their proposed program is not only plausible but its a shame it wasn’t thought up sooner. I have also been working with Geekcore and learning how we could possibly team up in the future on projects.
Hêré Bolo Update
This week, Here Bolo kicked off its first week of peer education training. Due to the overwhelming interest in the program, the program was expanded to include 20 peer educators – 13 men and seven women, rather than ten. Training took place over three days from Tuesday to Thursday, and was conducted by Dr. Malick Kone, Ramatoulaye, and Maddie DiLorenzo. Maddie administered a pre-assessment survey on Tuesday and a post-assessment evaluation on Thursday in order to assess the peer educators’ knowledge of HIV prevention and treatment. While Maddie has yet to fully analyze the data, she has briefly scanned all of the surveys, and found that the majority of the participants have a pretty good basic knowledge of HIV prevention and treatment both before and after training. However, Maddie did notice that pre-training, participants still held some common misconceptions about HIV – such that one could tell if a person was HIV-positive by looking at them or that one could catch HIV by kissing someone. The sessions were also characterized by a great deal of debate as men described their reluctance to wear condoms and women described their reluctance to breastfeed despite their knowledge of the benefits of these practices. Therefore, the peer educators’ mission will be to not only educate others, but to address the gap between HIV knowledge and preventive practices in Sikoro.
Perhaps the best part of the program has been the peer educators’ enthusiasm for their work – each day’s session ran at least 45 minutes over time as the peer educators asked questions and began practicing for the upcoming Balonie de l’Espoir, which will take place in Sikoro on Saturday, July 29. The Balonie is a celebration dedicated to educating the Sikoro public about HIV prevention and treatment practices, and will feature all peer educators performing skits that illustrate the five points of the Here Bolo program: hope, identity, transmission, marriage and family, and community. Malick, Ramatoulaye and Maddie will dedicate the next two weeks to planning this event. Beginning on August 1, Malick, Ramatoulaye and Maddie will begin tracking each peer educator’s progress as they begin to educate others in various parts of Sikoro.
July 17th Labtracker Update
Update for the Week
This past week, I visited Point G, Cesac, and Gabriel Toure. There is good news for two of the clinics and not so great news for the other. After visiting with Dr. Dao (at Point G), he had reached the maximum capacity of his patients. He was busy at the schedualed meeting (due to unforseen circumstances) and reschedualed for this coming week for inhouse training. At that time, I plan to update his software, and license agreement for LabTracker. Clinic 2, Gabriel Toure. Also good news, Dr. Yousouff Toure has done a meticulous job of maintaing his EMR. As of right now he has over 200 patients. Each of which are entered beautifully into LabTracker. I am throughly impressed. Now the bad news, Cesac has done absolutely nothing. I feel that giving the computer to the Pharmacist was a bad idea. After talking with Malick about this, we’re going to start anew (after we speak to the chief of medicine) and give the computer to a physician to track the patients.
This week, there were 16 CD4 count results that came in to the clinic…as Malick and Daou had each of the patients in the office, I was working simultaneously to get their results into the computer. It worked out extremely well, and I felt very accomplished because approximately 80% of the patients with the most recent test results were patients I had already put into the computer from a few days before. After I finished that, Malick and Daou were pretty incredulous that I had done it that fast! I tried to explain to them that soon they will be able to work just as fast on the computer…but I’m pretty sure a bunch got lost in translation.
July 9th Hêré Bolo Update
This week, Ramatoulaye and I met and revised the curriculum, which I translated into French and corrected with Sophie’s help. Maddie sent the revised curriculum (in French) to Annie along with 12 pre and post assessment questions (also in French) a few days ago. On Friday, Maddie and Ramatoullaye had a meeting with possible peer educators, but there was some conflict because the peer educators are under the impression that they were getting paid throughout the year (something we never said) and that we needed twenty, rather than ten peer educators. After much discussion with Malick, Sophie, and Ramatoulaye, we have decided that it would be best to stick to our original plan to use ten highly motivated people to be peer educators. However, we do feel that some compensation is necessary to motivate them to attend training – so we were thinking of offering 1500CFA/per day per person rather than tee shirts to all peer educators who complete the five day program training. With this compensation will also be the firm understanding that this compensation is only for the five days of training, and that once the peer educators receive their certificate of completion, they will be working as voluntary GAIA peer educators disseminating information to groups of people at Sikoro clinic and other places to be determined.
Malick, Sophie, Victoria and I also met Mme Diarra, the warden of the women’s prison on Friday, and she would love to have us come implement Here Bolo. We are thinking of running Here Bolo there the week of either 7/23 or 7/30. Once we finalize the dates, Malick and I are going to meet with Mme Diarra again to take a tour of the prison and discuss any remaining logistic concerns.
July 9th Labtracker Update
Last week I spent time in Sikoroni with Ali Bicki. I went through and cleaned Dr. Daou’s computer. Which I am sorry to say must have had a small accident. The last time I was there, the screen casing was broken on the IBM. It’s still useable but it has seen better days. I was at Geekcore last week for an entire morning remedying a problem with Sow’s computer. The OS became corrupted and everything failed. After about 5 hours the computer was back in shape and ready to go. I’ve also been back and forth from Dr. Sow’s office . Working with him and trying to get a feel as to how I could best use Labtracker within his clinics and smoothing out GAIA’s connection with his district in Bamako. As in my last email\, he had me do rounds in his building with Norton and Labtracker. I spoke with Hank head today, It was a great conversation, I think we can finally get LT on the ground here in Bamako. Thanks.
Jared Meshekow
Boston University
Labtracker Project Overview
Labtracker Project
Jared Meshekow founded GAIA at Boston University in 2005. He currently enrolled in Boston University’s B.S. / M.P.H program concentrating in Human Physiology and Epidemiology. He has been involved with GAIA, the Providence chapter, since 2002. In the summer of 2004, with six donated laptops and an initial subscription to the LabTracker® Software system, Jared traveled to Mali take part in a pilot program to test the utilization of LabTracker, a unique program which allows for the tracking of HIV-positive patients, medication usage, lab-results, and other relevant medical data. This application is extremely effective, providing a preliminary basis in which large amounts of clinical information can be isolated and analyzed. Currently, He is in Mali implementing the continued distribution of the LabTracker® Software. His responsibilities consist of training clinicians to use LabTracker to maximize the electronic patient record system, translating the LabTracker system to French, and working in conjunction with GeekCore to set up an improved medical data info-structure within the city of Bamako and beyond. With a functional Electronic Medical Record (EMR) system in Mali, clinicians will be able to provide superior healthcare to patients. The LabTracker system will function as the keystone in the construction of a national wide electronic medical record system, a necessity in providing the best healthcare possible.