T minus 7 days

May 22, 2009 by healingnumenor

The exodus of my expat friends from this place continues, and I will join their ranks soon enough. One week from today I leave Uganda. I intend to spend time updating my blog now and throughout June detailing experiences and trips. So very many to share.

In the meantime, I continue to work on SAS analysis of a data set looking at TB recurrence and alcohol use in preparation for a scientific poster, drafting portions of the paper based on study results of the trial on which I have been coordinator, and organizing myself for re-entry to the U.S. Goodbye parties and last minute shopping dot the calendar as well.

As after many experiences in life, I think “home” and time will show me how this year has changed me. Suffice it to say, I think a substantial change occurred.

SEHC Week of Action – Makerere University

May 14, 2009 by healingnumenor

I had the chance to participate in 2 of the 6 days of the Makerere University Students for Equity in Health Care (SEHC) chapters’ Week of Action. Its main objective was “to pass on the knowledge and skills acquired from the East Africa Health and Human Rights Leadership Institute to the health professional students under training.”

Speakers spoke about health & human rights connections on Monday and Tuesday. I presented “Advocacy: Successes and Challenges” on Wednesday, May 6 using the 10 Steps of Advocacy template Physician for Human Rights (PHR) taught me and then mapping each step to my recent involvement with the anti-TB medication stock-out campaign.

On Thursday, I attended AGHA (Action Group for Health, Human Rights, and HIV/AIDS) advocacy officer Roselyn Davina Vusia’s presentation “Health and Human Rights Status Quo, Gaps, and Way Forward in Uganda. She discussed relevant international and national law to capture the scope of the legal right to health. She then gave an overview on the elements of a right to health: Availability, Accessibility, Acceptability, and Quality (AAAQ). At the end of her talk, SEHC leadership demonstrated “equity” as they put it. The SEHC Medical chapter distributed medical supply donations from U.S. PHR Leadership Institute participants Neil Chalwa and Mona Singh to the 3 health professional schools, Anatomy Department, and Microbiology Department.

Medical, nursing, and paramedical students went to Katanga BEUPA school on Friday afternoon for a tour and to give some school supplies. Saturday night SEHC held a fundraiser dinner at the Jeliza Hotel. A few local officials from Katanga were invited as well as the teachers. I left to do some work in Kenya on Friday, so I had to miss Friday and Saturday events unfortunately. Hopefully, Herbert Kayonga, out-going SEHC medical president can write a comment to this post on how Friday and Saturday went. Stay tuned…

As PHR-Loyola chapter president in 2007, I had no idea that I would be able to one day see the SEHC Week of Action at some point, a cause our chapter fundraised for that year during our own AIDS Week of Action.

BEUPA Katanga School Project

April 26, 2009 by healingnumenor

After my daily morning research study team meeting on Friday, I met some Makerere University medical student leaders from the Students in Equity for Health Care (SEHC) chapter. The chapter has its Week of Action coming up on May 4-9, 2009, and I have been attending some of their organizing meetings.

The SEHC Week of Action is similar to the ones put together in the U.S. from the student chapters of Physicians for Human Rights. In fact, when I was chapter president of PHR in 2006-2007, we sent some money we fundraised to PHR explicitly for the SEHC chapter in Uganda. The week will consist of lunch time hours talks around advocacy and health & human rights issues in Uganda and community volunteer time in Katanga on Friday, May 8.

I went with SEHC members Herbert, Juliet, and Diana to visit a school in the Katanga settlement, a slum literally across the street from Mulago hospital. The SEHC students sponsor a weekly Friday porridge meal for the children and are looking to increase their involvement in the community even more with this year’s Week of Action focused on the children of Katanga. The experience reminded us once again of the immense poverty and challenges of the poorest Ugandans.

Here is a concise background of BEUPA and this particular BEUPA school, which is one of about 75 in Kampala District. This information comes from a proposal/protocol prepared by SEHC for Bucknell University’s undergraduate Globemed chapter:

Background of BEUPA

BEUPA is a learning centre found in Katanga providing basic education to direly indigent children. The centre was started by Kampala City Council (KCC) in conjunction with GTZ, a German Development Cooperation in 2000.  However, this GTZ – KCC venture was only a five 5 year program ending in 2005.  After the end of the venture, the BEUPA project was handed over to the community in Katanga.  Katanga being a slum, it is inhabited by majority of people living below the poverty line (living on less than US$ 1 a day).  The people therefore are in continuous socioeconomic crisis and could not maintain the project. From 2006 to date, the BEUPA is being run by a volunteer family, which is also at the moment almost giving it up.

 

From the inception of BEUPA to date, they have been providing basic education in Mathematics, English and literacy with an aim of imparting basic knowledge to the children. The children are divided into three groups depending on the age groups, and more so, how knowledgeable they are when they report to BEUPA.  These groups are in three classes.  Class I is a beginners class, Class II for intermediates, and Class III for those portraying an above average literacy potential.      

 

Background on the children at BEUPA

The total number of children at BEUPA varies from 50 – 100 pupils aged between 5 and 17 years of age.  Due to their poor socio-economic background, these children cannot afford the Universal Primary Education (UPE) that is not apparently free as it was stipulated to be in Uganda. 

 

Majority of these children are orphaned by or are living with HIV/AIDS, with some of them being the eldest children at their homes thereby having to head or take care of their families. Most of them are casual labourers, working part of the day, to supplement income for their families. The average child starts to work at the tender age of 8, being involved various activities jobs like collecting scrap metal for sell or selling foodstuffs on the street.

Receiving a single meal in a week at BEUPA, the highest attendance at BEUPA is noted that day.  The children come with firewood to cook the porridge.  The maximum attendance is noted that day a cup of porridge is served for the children at BEUPA.  This is because majority of the children live on only one meal a day (usually supper), and the day they are served with porridge is the only day of at least two meals.  The meal served is just, made of just 3kgs of maize flour to feed the entire population of the children attending that day at BEUPA.

The centre is run by three volunteer teachers from the community.  The volunteer teachers open the centre in the morning and close at noon, particularly because majority of the children come to school when hungry and cannot stay till evening on an empty stomach.

The story runs a bit deeper. GTZ pulled out in 2005 because KCC misused the aid money. The city council then became the sponsor of Katanga BEUPA school. At first KCC distributed a 50,000/= (~25) monthly “allowance” to the school but that ceased in 2006. Since then the teachers have been essentially volunteers. They have been promised to be put on a government payroll; however, this payment has not come to fruition. Unsurprisingly, KCC has not been able to find any outside donors.

The teachers in part credit Joseph, a previous SEHC president, and SEHC writ large as two of the reasons why they are still there. He came across the Katanga school and mobilized more Makerere health professional students to get involved with activities like soup kitchens and distribution of clothes donations to the children. Subsequently, the SEHC chapter formally committed to the community.

We met two teachers, Janet and “Hajjit,” who are volunteer teachers. They said the biggest challenges  for them come from kids from the poorest families in Katanga. These children typically eat one meal per day at 6PM, if that. Since they do not eat in the morning, they often fall asleep during class and have short attention spans because they are hungry. The children study up till noon and then go home for the day. Normally, they would be going home for lunch and then return, but since many do not get lunch and because the school has no funding, the day is only 1/2 day long.

The class used to be 60-80 students in size but after the necessity to introduce a quarterly fee of 5,000/= (~$2.50) per student the class size dwindled to the current 40 children. Yes, even $2.50 was too much for some children’s families or school was not enough of a priority in light of another needs or uses of money.

During our meeting with Janet and Hajjit, we met a Katanga resident, “Hajj” (a common nickname given to Muslim men here), who had generously donated the land on which the school was built. He has kept the land free as long as the school continues to be productive in light of its constraints. A kind, slight man, we all thanked him for his generosity and he thanked the SEHC students for their work.

The school technically can teach students 5-18 years old but most of them are at the younger end of the spectrum. Janet and Hajjit were explaining to us how the adolescents do not come, in part because they feel shame for not being able to read and write at their ages. Additionally, children need to find work at a young age as you read in the background, often collecting metal scraps for money in some rough parishes and zones of Kampala.

Originally, one of the long term goals for these children was to streamline them into vocational technical work. The teachers even had apprenticeships lined up for that segment of education after school years 1-3. But BEUPA Katanga did not have funds to pay the vo-tech trainers, so this idea went unrealized and the kids have since had to fend from themselves.

Some children when they finish the BEUPA school graduated into P5 of the UPE (the supposedly “free” education) and move upwards, but they are few. As we walked to the school, children who should have been in school were running all around having a fun time with friends. Many live with relatives who came to Kampala with parents living in the villages. Others are orphans. Most are low priorities in terms of access to family support.

Micronutrient deficiences, lack of access to funded education, and non-ideal family situations are among the barriers these children face. At one point I saw a likely drunk/high adolescent girl swaying outside a window of the school, eyes staring me glazed with an awkward smile. The kids in the class were joyful but a bit restless. These teachers and kids deserve more resources.

SEHC has the following objectives in its proposal:

Broad objective

To improve the functionality of the BEUPA project

Specific Objectives

1.       To improve the delivery of basic education at BEUPA, by providing material support, and intellectual support

2.       To regularize the attendance of children at BEUPA, by providing at least a daily cup of porridge

3.       To improve the health status of the children at BEUPA through VCT, de-worming, and provision of basic diagnosis and medication

4.       To pave way for a constructive exit strategy for the children at BEUPA

Walking around Katanga, I kept seeing an all too familiar scenario. Immense poverty, raw sewage, children running around, overcrowding and a muddy landscape that rain storms probably wreak havoc upon every time. And like in Nairobi or in major cities in Brazil, India, etc., these slums are minutes away from the opposite end of the economic spectrum. Garden City mall is 2 minutes drive down the road bordering Katanga and Mulago Hospital. I go to the gym there, watch movies at the cinema, and often eat and shop. Traveling from Katanga to Garden City the road is flanked by the two wealthiest parishes of Kampala, Nakasero and Kololo. Poverty may hide sometimes, but it is not far away.

BEUPA Katanga relies on the generosity of others. I myself believe in the power and place of civic action and the work of groups like SEHC in the poorest places. But the honest truth is that SEHC should not need to exist if the public sector worked more equitably in the health and education realms. Educated and healthy people would be more likely to succeed and have a chance to be upwardly mobile in the business, service, and manufacturing sectors. This realization of the common good in these areas (and I say this as the debate continues in my own country) has not yet been actualized and corruption and avoidable inefficiencies are partly to blame for the present situation in Katanga.

Thankfully, SEHC does exist in light of reality. If you are interested in helping SEHC’s work financially or gifts-in-kind (chalk, crayons, basic English and math workbooks) let me know and I can get you in touch with AGHA (Action Group for Health, Human Rights, and HIV/AIDS) for coordination, a Ugandan partner with Physicians for Human Rights that I have worked with on medication stock-out campaign and leadership training institute, the latter which I will blog about soon. I can also forward on SEHC’s proposal. I hope to go back to this Katanga school before I leave Uganda this time, and if so, I will take pictures.

Mali #12: Journey back

April 20, 2009 by healingnumenor

Have you ever looked up at the twilight sky and seen the alignment of a planet or the moon, maybe a familiar constellation, and remembered seeing the same orientation somewhere else under vastly differently circumstances? Essakane at night

I experienced that feeling a week later back in Kampala, my home away from home. Venus aligned with the crescent moon shone brightly at twilight, and I was brought back to Essakane immediately. I had a bright smile as I climbed my hill of a driveway still missing Mali.

A few memories came back. The peace of the desert… Essakane down time

The friendship facilitated by a cup of tea… Tea tea tea

The stories that stoic yet friendly eyes tell in the desert… Moussa

An ancient rite only salt can tell…

Salt: up close and personal. By Jenn Hallock

Salt: up close and personal. By Jenn Hallock

Friendship in the big city… NYE

The solitary footsteps of a scarab beetle soon to disappear in the desert wind… scarab

And so have my footsteps come and gone in the amazing desert, a desert scarcely aware that I came. Nonetheless, my memories and dreams will often linger there for all my days to come.

I’ve always been fascinated by those who feel rooted to a place, for whom wanderlust is a pathology of the soul. All I know is that my trips allow me to unearth parts of myself that I’ve long since buried as dead, showing me who I can be. They are, in many respects, processes of rebirth. – Kira Salak in The Cruelest Journey: Six hundred miles to Timbuktu

Mali #11: Djenne and the road to Bamako

April 19, 2009 by healingnumenor

We left Essakane, a place where the world was what was only around us, a place where we disconnected from the expansive reaches of the Internet or mass telecommunications, a place of music and mind-wandering and comradeship.

We arrived back in Timbuktu for breakfast and paid a quite melacholic, but in Tuareg fashion, stoic, good-bye to Mohamed. Driving out of the city, I knew that I was leaving a place with a firm sense of identity, history, and in many instances poverty. Despite the US travel warning or probable warnings from some Tuaregs to other ones in Mali about us Others, the threats and fears of different identities interacting went unrealized at Essakane while the converse prevailed – friendly interaction and relationship-building.

More and more people within it have problems defining their own identity, of determining their own social or cultural affiliation. They feel lost, and are increasingly susceptible to the suggestions of nationalists and racists, who tell them to regard the Other as a threat, an enemy , the cause of their tiresome frustrations and fears.” -Ryszard Kapuscinski

We left through the city arch and arrived at the port. I had romanticized the whole notion of the salt caravan since learning of it and really wanted to purchase some raw salt. And then I stumbled upon loads of it at Timbuktu’s port very much to my satisfaction! We had some more tea with Moussa while waiting for our ferry and then headed across the Niger river to the other side.

Salt with a story

Salt with a story

On the road of utter desolation (no people, sandy air, gnarled trees) we continued south towards Bamako from Timbuktu port to Douentza. Randomly, farkas (donkeys) would be sitting in the road in numbers and patterns to the degree we were driving as in an obstacle course!

Donkeys like the road. Other animals run when we come.

Donkeys like the road. Other animals run when we come.

We gave a ride to a Sardinian hitchhiker who spoke French and Italian but not English. So… to communicate, Jenn and I spoke to him in Spanish, which he did speak. All in Mali. Fun permutations like this make traveling all the most entertaining.

At one point we came up behind the Bandiagara escarpment before sunset.

Approaching the Bandiagara escarpment

Approaching the Bandiagara escarpment

The view was absolutely stunning. Peul and Dogon men and women walked on the road as we passed, often with baskets atop their heads or men herding animals. Listening to Malian music only accentuated the experience as we continued driving. And I have seen immense amounts of car dust before in both Mongolia and Peru, but never have I been so caked in dust after this particular car ride! People cluttered the main highway during the night and we often had some close calls. I can imagine how dangerous the roads are for all people involved.

We stayed overnight in Sevare and headed to Djenne the next day. Djenne is essentially an island with the world’s largest mud mosque.

Mosque at Djenne

Mosque at Djenne

It was originally a 12th century building, a palace if I recall correctly. We took a tour of Djenne by foot, wandering in narrow alleys and learning about the Tukulor style, Moroccan windows, and Sudanese interior designs of building. The mud humps at the top of some homes indicated the number of children born to that particular family.

Humps represent number of children in home, style has 3 influences

Humps represent number of children in home, style has 3 influences

We learned about the bogolan style of cloth dying, famed in Djenne in particular. Leaves are boiled to make the greener hues, while tree bark is boiled for the darker colors. Not surprisingly, we made some purchases. At the bogolan demonstration we had, Jean engaged in some le cousinage which I have described in an earlier post. The Peul woman seemed entertained by it.

We crossed out of the island and stayed at a nice but not-yet finished hostel. Jess, Jenn, and I climbed onto the roof of the Moorish styled manor and watched the sunset over Djenne as we talked about the trip and life in general.

Group awaiting dinner at our hotel

Group awaiting dinner at our hotel

We ate that night and learned why our group guides along the way always ate together (meaning of different ethnic groups) and with their hands. Communal eating in Mali means “leaving differences aside at the bowl.” And they didn’t used knives and forks because one does “not use plates/utensils because the meal is about the community, not the person.” I had never heard such an explanation before, and it made my reflections on Tuaregs eating with Dogon and Bambara more meaningful.

The next day we drove to Bamako, passing calabash fields, women separating chaff from the grain with the wind, road signs about AIDS awareness, genital excision, and polio, and cars stripped to their very framework. Waste not. Back in Bamako we started the post-partum blues of an amazing trip coming to an end. First, we had a tasty dinner at Le Rabelais and stayed out late on our last night. I distinctly remember dreaming about the desert that night, the nomads protecting us.

On January 14th, the day of departure had sadly come. Mitra and I made sure to get our fill of pain au chocolate and jus du baobab. Jess’ neighbor (an iman at the small mosque there) invited us all for a tour the next day of the Koranic school and main Bamako mosque, but Mitra and I had to get to the airport so we could not go.

Jean drove us to the airport and after some complication at check-in we gave him a hearty farewell. The sun had just set as we boarded, the aircraft door separating us from the hot, dry air one last night. I had a row to myself on the flight to Nairobi so I could lay out, sad to leave Mali, but even more thankful that I had been able to go.

Mali #10: [Interlude] Evolution of a turban

April 16, 2009 by healingnumenor

Captured by Jenn Hallock

Mali #9: Essakane

April 16, 2009 by healingnumenor

After our expedited tour of Timbuktu, we hopped back into the 4×4s and started the 2-1/2 hour drive out of the city, a drive into the harsh terrain of the Saharan desert.

You have to leave the city of your comfort and go into the wilderness of your intuition. What you’ll discover will be wonderful. What you’ll discover is yourself. -Alan Alda

We drove past Tuareg children and men, many who waved and others who stared. I could only wonder what they were thinking.  How long will this foreigner onslaught last? Will I meet one of them at Essakane if I go? What do they understand about this place? After heading on the gravel road north we were diverted (for security reasons) to another “road” – and by road I mean sand path. The new path provided far more entertainment as we jumped dunes and briefly found ourselves stuck attempting to summit one.

Sometimes your 4x4 gets stuck in rural Mali

Sometimes your 4x4 gets stuck in rural Mali

Up until this point, the sand was a dishwater blond filled with thorny bushes. This landscape dramatically changed one particular summit. In front us, the bleach white Saharan sand of Essakane welcomed us to the southern tip of the Saraha desert proper. A white concrete stage stood off in the distance and one extremely random cell phone tower not too far from it. These fixtures stay year round, signs of the human touch in a land seemingly bereft of it.

Stage in the far background

Stage in the far background

Mohamed had secured a close, safe camping spot for us and we met our 24h guard for our stay, an older gentleman with a wicked looking stick that looked like a convincing deterrent to theft!  (We had opportunity to watching him chase hawkers away on many occasions.)

Our camp for 3 days

Our camp for 3 days

In the afternoon on that first day, some of us walked along the ridge of the big dune facing the stage. A couple of Tuareg men faced Mecca around the time of prayer as we passed. I looked around at a brilliant world – mountains in the distance, fine, white sand for miles and miles, and the more-than-occasional stoic, hard-to-read Tuareg on camelback.

Peace in the desert

Peace in the desert

A camel promenade led by the Tuaregs and then some West African music followed by speeches about the festival kicked off 3 of the most unique days I have had traveling. On that note, I do not know exactly how to describe these 3 days, how to divide up the experiences. But here goes an attempt which is painfully abbreviated as I reflect on memories months past.

Camel race commencing the event

Camel race commencing the event

Picture 1,500 people, mostly Tuareg and West African but with a substantial number of European (and sparse American) faces in the crowd. Imagine dancing along to Salif Keita, one of Africa’s most famous music artists with Tuareg children huddled next to one another all around you. Meanwhile, the sun is setting, creating silhouettes galore. Sunset set

Camels are in the crowd with a Tuareg father and son watching the stage. West African tones with subtle European/Moorish influences fill the night sky in a land where the nearest settlement is farther away than the eye can see. If you can start to picture some of these things, then you can begin to immerse yourself in the desert.

Spheres of influence intersecting

Spheres of influence intersecting

Groups from Mauritania, Burkina Faso, Morocco, Mali, Libya, and Niger dazzled us each night with a prelude before dusk from local Tuareg groups off the main stage. Guest performances by a Brazilian guitarist and a Dutch woman brought slightly less enthusiastic applause, but applause nonetheless, from the Malian crowd.

Time was a relative notion in that remote desert landscape with young people from another world. Yet it was there that the gap between cultures was naturally bridged.” -Jolijn Geeks on a trip to Mali

How did we spend our daytimes? After eating breakfast at our campsite, we would walk, read, relax, or go around with one of the Tuareg guys, all who become friends of ours quickly. When you hear desert, you may think of the heat. In fact, we spent more time chilled than hot. I would wear a wool sweater and coat comfortably until 10AM and then again after 5PM. Between those times it would get very warm. I have to say, putting your bare feet in the sand at dusk, even late at night is one of the most relaxing, primal feelings.

An ad hoc market went up with brilliant wares and some kitsch. We frequented it and became known, especially since there were so few Americans there, as in no more than a dozen as far as we could tell after 3 days. The travel warning had done a good job staving off people as we were told 6000 people attended last year compared to this year’s 1500.

Some of my favorite evenings were spent around a bonfire, drinking the grin with the group. To keep warm, we all huddled together closely each night. I think that’s another thing that humanized the experience all the more. By humanized, I mean the friendship and affection brought people together closely and quickly. Part of it was functional – warmth from the cold of the desert evening, but part of it was just because of friendship and trust.

The group huddle-cuddle

The group huddle-cuddle

It’s interesting really – Tuaregs and Bedouins are known for their supposed ferosity and stolid nature. But become friends and you see another world, a world of kinship, loyalty, and affection. A simple satisfaction in the routine of our days with Moussa, Mohamed, and the others made leaving difficult.

Cousins Moussa and Mohamed

Cousins Moussa and Mohamed

Tuareg women had far less visible presence at the event. Any reason why would be speculative, but they, like the men, were friendly, joyful, and extremely close to the other women in their group. When they led music, the characteristics of their voices truly mesmerized me.

Wonderful tones of the Tuareg women

Wonderful tones of the Tuareg women

It was the typical illusion of space – the belief that whatever is far away is different, and the farther away it is, the more different it is. -Ryszard Kapuscinski

Melancholy lingered in the air on the incredibly fun last night. Sally, Mitra, and I from our group stayed up the latest with the guys. Moussa had me practice some card tricks. Mohamed gave Mitra, Sally, and I jewelry gifts, an extremely generous gesture, especially in light of his family’s difficult economic situation. I think the most moving part of the entire visit with Mohamed and the guys happened when the normally reserved Mohamed said to me, “You are my brother.”

Brothers in Mali

Brothers in Mali

For 3 days we were.

In [the trade routes of the Silk Road, the Amber, of the Saharan] people encountered each other at every turn, exchanged thoughts, ideas and goods, traded and did business, made alliances and unions, found common aims and values.. Each person discovered in himself at least a small particle of that Other, believed in it and lived in this conviction. And so the three possibilities always stood before him whenever he has encountered an Other: he could choose war, he could fence himself in behind a wall, or he could start up dialogue. – Ryszard Kapuscinski As far as the eye can see 

 

TB drug shortage redux

March 17, 2009 by healingnumenor

I wrote about the TB drug back in December: http://healingnumenor.wordpress.com/2008/12/10/tuberculosis-medication-shortage/.

I wish I could report the situation was improving. In fact, it has worsened. Yesterday, one of the doctors mentioned at a research meeting that the drugs were out in the National TB/Leprosy Control Programme (NTLP). Some of our doctors have dual roles in our research center and at the NTLP. Our research participants have access to medications. However, most TB patients are not enrolled in studies.

I’ll briefly explain the regimens and then the shortages.

TB medications: S=streptomycin; E=ethambutol; H=INH; R=rifampin; Z=pyrazinamide

New TB patients get either: (1) 2 months E+H+R+Z then 4 months H+R; or (2) 2 E+H+R+Z then 6 months H+E.

Retreatment TB cases typically get: 2 months S+E+H+R+Z then 1 month E+H+R+Z then 5 months E+H+R.

Mulago Hospital TB Wards 5&6/NTLP Clinic see about 25% of the nation’s TB burden and about 200-250 TB patients per month. The shortage is especially worse in Kampala then in some rural areas. (We’re ranked 16th in the world for TB burden in the 202/212 countries that report TB cases.)

As of this morning we had:

(1) NO R+H+E formulation for pediatric TB patients.

(2) 2-month initial phase of E+H+R+Z for only 12 patients.

(3) Only 15 one-month boxes of E+H+R for the retreatment TB cases.

(4) Hundreds of H+E but…..they were all expired.

(5) 1300 vials of streptomycin. However, given that it would have to be taken with E+H+R+Z (see #2 above) in the retreatment regimen, the surplus is of practically no use.

Later in the day, I found out that the Daily Monitor had a blame-game story on this: http://www.monitor.co.ug/artman/publish/news/Uganda_in_TB_drugs_shortage_81681.shtml.

I’m not in the position or have the knowledge to offer more on who is at fault than the story does, but off the record I have some hunches. Anyhow, the focus needs to be on the solution and future prevention of shortages as numbers of patients continue to suffer.

I emailed two human rights organizations after my tour of the NTLP pharmacy with one of the doctors and the pharmacist there. Tomorrow morning I am going to the NTLP clinic to see what it is going to be like to tell patients they have TB but that we can’t give them the medications. Tomorrow afternoon I am talking with a reporter and on Thursday there will be a press conference on drug shortages in general. I’ll post how these all go. Click on the comments below for an update.

Mali #8: Timbuktu 2/2

March 10, 2009 by healingnumenor

We started the drive over some dunes to get back to the road to Timbuktu. En route to the museums, libraries, and buildings on our walking tour of Timbuktu, we first stopped at the city tourist office to get our passports stamped. (Apparently there is a club in New York City that requires a stamp of Timbuktu to get in, but we could not find anything on the Internet to support that guidebook assertion.) Dust swirled around the streets and corners. Tourists and local residents dotted the streets, the latter occasionally obviously annoyed with our heightened presence in the town. Most stared with curiosity and kindness.

"Well" of "Bouctou" meaning "Large Navel"

"Well" of "Bouctou" meaning "Large Navel"

As we wound through the corridors of ancient streets, winds of history whispered around the corners. Unimpressive in stature, yes, the city still had a presence unique to itself despite all the warning we received in person and from the guidebooks that Timbuktu could be let down for many tourists. Our first stop brought us to Djinguereber, West Africa’s oldest existing mosque built. Built by Moussa, he paid for its construction with 200kg of gold according to our guide. It can hold 1,500 people, and unfortunately, we were not allowed to enter.

We continued on to the Bibliotheque de manuscripts al-iman Essayouti. This library nestled in an abode building across from the Djinguererber mosque houses so many scripts/scrolls. One scroll displayed in a glass case depicted Ramadan, Tabasky, and the pilgrimage to Mecca (Mohammed bel-Sharif, 15th century). Many manuscripts were found 6m buried for protection during old wars. If the father of one of the stashes had not left the location, so many of the manuscripts would have disappeared forever. Indeed, more are still uncovered. One of my favorite manuscripts functioned as a star map (14th century). Other manuscripts depicted issues surrounding law, inheritance, call to prayer.

Celestial map

Celestial map

We left the library and started learning a bit about architectural symbolism in Timbuktu. Some door and window style find there origins in Morocco. “Jealousy windows” functioned to deter men from eyeing married women as the jealousy window would be used after marriage.

Jealousy window

Jealousy window

At this point, you may be wondering what Timbuktu (Toumbouctou) actually means. “Tom” means “well” and “Bouctou” refers to the woman’s name (meaning “large navel” who found the well here a long time ago. History likely became legend, legend became myth, and so the story goes.

We continued on passing the house of 19th century explorer Gordon Laing before we arrived at the Musee Tombouctou Municipal. The supposed Tom of Bouctou was in the courtyard as well as representations of how milk and water were stored. A small museum held some artifacts of the local cultures over the ages, such as the heavy bangles placed around the feet of some women to prevent them from wandering away, we were told. Yikes.

We left and briefly walked into the former home of Heinrich Barth, another explorer. I bought a small beautiful, colorful illuminated manuscript with the  opening quote in Mali #7  written in Arabic from a talented artist. We walked a little more, passing the door outside one of the mosques that legend says will harken the end of the world if opened.

Door harboring the end of the world

Door harboring the end of the world

We left it shut. But we returned back to the car and opened that door, a door that when shut would next be opened in Essakane at the Festival au desert. The excitement continued to mount…

Mali #7: Timbuktu 1/2

February 6, 2009 by healingnumenor
Salt comes from the north, gold from the south, money from white man’s country; but God’s words, holy things, interesting tales, we can find them only in Timbuktu. -not attributed (from Timbuktu)-

After the camel ride I mentioned in the Mali #6 post, we ended in the encampment of Mohamed and some of his extended family members. I first talked with Abu, who is akin to a servant for the family. I had just read days earlier about mistreatment of the Bella by some Tuaregs in a book by Kira Salak (The Cruelest Journey)(http://en.wikipedia.org/wiki/Human_rights_in_Mali#National.2FRacial.2FEthnic_Minorities), but after a somewhat thorough private Q&A, it seemed he was very happy with the family. He appeared healthy and well-fed (which is not a small observation because many of the Tuareg men, although imposing appearing in their clothes, are rather emaciated if you see their arms). Abu had been working with the family unit for the past 8 years and hailed from Araouane in a more northern part of Mali. He gets a chance to visit his siblings there sometimes, too.

The idea of the salt caravan captivated me immensely and my desire to travel on one has grown since. I spent some time asking Mohamed about it in depth with the help of Jess translating from French to English. Every year around March, Mohamed and other Tuaregs make the caravan to Taodeni to the salt mines. (The caravan season runs March through April.) It is just over one-month round-trip there and back by camel to get the salt and chevre. And what a trip it is as told to me.

Before they leave on the voyage, Tuareg women sing a song for the men. A group of 3 Tuareg men (typically each 27-28 years old) will travel with 500 camels up north. Because of the Saharan heat, Tuaregs in general travel by star and moonlight only. Since there are no roads for the caravan, the guys use the stars as their guides. In Taodeni each camel is loaded up with 4 blocks of salt (depicted in a later post) at about 2 kilos mass per block. This salt is mined by some of their family members. When the caravan returns to Timbuktu, traders and residents buy the salt and the rest travels down river to larger market centers. Women and children stay in the desert encampment while the men follow the animals and go on caravan.

Tuareg women providing the music

Tuareg women providing the music

Abu Hadi is the name of the star the men track to get to the mines. They use a different star to guide them to Mauritania where they trade agate stone from Mali for fabrics and yet another star to travel to Morocco.

Before they can go on the caravan, men undergo “education.” They receive some home schooling in language and math. As boys, they have to successfully herd goats and sheep. Next they are taught to learn to navigate by the stars and read them. After successfully passing this rite of entry into manhood, they can go on the caravan.

Traditionally, the men must complete 3 round-trip caravans before they can marry. A man’s parents select the wife for their son. Most women “cost” 2 camels but a “good woman may cost 4-5 camels.” As you can imagine not all of the arranged marriages end up in bliss. In terms of divorce, Moussa, Mohamed’s cousin, told us that women inherit everything and stay with their family when divorce occurs. The husband leaves. Men or women can initiate the divorce. Men do not have multiple wives we were told, though I don’t know to which groups this applies. Men are typically 30-32 when they get married and women much younger at 18-20.

In terms of religion, Tuaregs can be Christian, Muslim, some drink beer, others only tea. The Tuareg identity, therefore, is not essentially tied to religion, though most are likely Muslim.

Before the infamous drought of 1973, the Tuaregs enjoyed great wealth. Since then when herds of animals were decimated, they have lived in quite a bit of poverty. Now, some like Mohamed and his family members, live near (but not in) Timbuktu to make money selling jewelry and providing tourism. He gently emphasized that they would prefer to live away from the cities. This last point particularly latched onto me for the rest of our trip there. Mohamed was a gentleman and professional in his guiding, yet all the time I knew this was not an ideal set up for him. Despite his closeness to us during the trip, he had a degree of detachment. You could see it in his eyes, not in his actions towards us. There was something melacholic, stoic in their gaze often and under the deep indigo robes, his thin arms, limbs bore the marks of poverty. Despite the latter, tourism was not the ideal answer. It made sense after a few days in the desert. I’m not simply being romantic about it, but it moves you in a silent, bizarre, peaceful way. The superfine sand between your toes. The stillness. Beautiful stillness. The cool touch of the sand at night, it’s warmth by day. Expansive sky. Magical stillness.

We prefer the desert because it is calm, tranquil. -Mohamed, our guide

When we arrived at the encampment of Mohamed and family by car/camel, we were greeted by drum playing from the women. Mohamed danced, then I danced with a few others in our group. The flames from the solitary fire lept as singing and dancing took over the encampment. Shadows of other individual Tuaregs in the distance caught my eye every once in awhile. Abu served us the grin – the three teas I have mentioned in other posts. We ate a dinner then of couscous stuffed lamb and topped it off on our plates with a sauce made with the lamb’s liver, intestines, and carrots. Rice/millet pancakes accompanied the fare.

Dinner at the hands of the chef

Dinner at the hands of the chef

The men opened “shop” for a defined amount of  time, opening indigo cloths displaying necklaces, bracelets, rings, and gazelle bone pipes. Each mark on the jewelry had symbolism and I mapped out the symbolism of many of the items including a men’s bracelet and necklace I bought. The Tuareg passport necklace served/serves as a way for Tuaregs from different lands to identify from which city other Tuaregs come. After a time, they packed up shop and we continued hanging out with them. I liked it – defined marketing time and then shop was closed. We were still a bit of a shy group, so we talked among ourselves while the men huddled against one another around the fire telling riddles to each other and our guides. The women had already retired for the evening. The stars shined brightly, the desert sands reflecting the moonshine.

Men around the fire

Men around the fire

I woke up in the middle of the night for nature’s calling. My headlamp shined on one area after a short walk from my tent and caught dozens of eyes reflecting at me. First, I created a differential list of what animals they could be. Irrationally in my sleep haze and unable to remember if hyenas were in the desert (they are not at all) I FREAKED out and started running away to a different area, but I didn’t shout. Phew. The next morning I found that a herd of goats were placed behind a thorn scrub fencing centered around a shrub. Yes, that is correct, I ran with an adrenaline rush from goats. [Insert your laughter and comments here].

The next day we left the Taochouk Tuareg encampment of 1000, a geographically large place where Mohamed said, “we keep our hearts close but tents far” from one another. Timbuktu had some history to reveal to us before we were to head to Essakane.