Djenne Mali

I arrived in Djenne which is the one of the cultural and intellectual capitals of Mali. Founded in 800 AD it was a huge trading center for gold, ivory, lead, wool, kola nuts etc from the south where the goods then went north to Timbuktu and Northern Africa and Europe. There has been activity reported here since before Christ although archaeologists do not know why the empire fell apart.

One of the highlights is the weekly market (photo) and another Grande Mosque that has been declared a World Heritage Site by UNESCO.

Mopti Mali

After returning from Dogon I spent some time in Mopti Mali where the Bani river and Niger river meet. The city is formed by 3 islands and is known as the Venice of Mali. It was great to be around water again and I spent some time cruising the waterways during sunset on the wooden local boats. The river plays a large role in the livelihood of the community for transport and fishing. As I walked through to the docks it was a surreal experience to see the baskets of dried fish commingling with cut up fish heads, scraps of cassava and fumes from the passing diesel trucks. The town had a greyish tinge to it and it was amazing to see the contrast of the brightly colored merchandise on the boats with the dark murky water.

The old mosque is famous here and is the backdrop of the old town. I inquired about a bus to Timbuktu from here since it is only a days journey. The situation in the region is very shaky right now due to Tuareg rebellions and Al Qaeda having a strong foothold in the region. They have been known to kidnap tourists and even a few months ago a British man was kidnapped and executed. So, alas my trip to Timbuktu was off and I headed to Dejenne.

Dogon Country-Kani Kombele and Kani Boso and Teli

The next village was Kani Kombele and this would be our base for the next few days. It was market day in this village and I spend a long time observing the market and the wares people had brought from neighbouring markets. There were mostly women gathered with babies contently dangling from thier backs. They were selling okra, millet, grapes, groundnuts (the Dogon Variety is very black), onion, spices, clothes and Bobaob tree sauce. I wandered through the market and was able to see the wonderful mud mosque with Sudanic curves poised next to a watering hole.

We set up camp and then headed for a 6 plus KM climb up a plateau. This was a small village of about 200 people. We passed bathing children on the way and arrived to a group of kids at the top of the plateau. There sat the oldest Baboab tree in the region which is very important to the people because it is used for many purposes: the bark is used for making rope, the branches are used for firewood, the fruit and leaves are eaten.

I spent some time pounding millet with the local women and talking the the chief about the health of the children. On a millet only diet the children looked malnourished and we discussed geographical and financial barriers to health for this population

After hiking back down I rested into the rooftop of the mud building and had couscous and millet beer for dinner. I watched the stars dance overhead accompanied by the full moon.

The next morning we headed out for Teli where the village is half Muslim and half Christian. It was a larger village where one could head up into the cliffs to see the older part of the village. The view was beautiful and was a spot where the old chiefs watched over the village. After this village we headed back to civilization-content and exhausted.

Dogon Country-Dijibombo

After arriving in Sevare I rented a guide and a motorbike and headed out for a few days in Dogon Country (Pays Dogon). It is an area of Mali that was difficult to colonize due to geographic reasons and the life and culture has remained untouched for centuries. Here's a wiki link for more info on the culture (click here)

Heading out of Sevare we passed donkey carts, women carrying fire wood from the villages (photo), other motorbikes, and the occasional sparkling 4 x 4 landcruiser blazing by. The scenery changed from the Sahela to mountainlike plateaus suurounded by errupting trees. Other people appeared less and less until we were the only two winding down paths into Dogon country on roads only big enough for the bike. I couldnt help but be reminded of motorcycle diaries.

We arrived at the first village called Dijibombo. Pointed huts lined the mud structures along the village. There were used to store the harvest in with the women's silo containing 4 chambers (beans, rice, millet, and peanuts) and then men's containing 1 (millet). We walked around the village and saw the places where the elder men had disussions (which was purposely made so no one could stand up during the discussion) and places where women did animal sacrifices with the cheif when they wanted a baby and were having difficulty concieving. Although traditionally many of the villages believed in animalistic religions, they had mostly converted to either christianity or islam now.

I had an interesting conversation with the cheif (photo) and we found each other very amusing. He began the conversation telling me he had 4 wives and asked what I thought about it. I asked if it was ok for me to have 4 husbands and he laughed and said it was not ok because if more than one man wanted me at once, they would fight. Women however do not fight. Also, he claimed, there are more female births in the village than male births so men must marry multiple women. I asked him why there was a difference in the number and he told me to ask Allah. I asked the cheif for the number of Allah and we had a laugh.

After random banter we shared some Malian tea which is drank in 3 courses. It is black tea brewed thrice: the first time is strong like death, the second time good like life and the third time sweet like love.

Bankass to Sevare

After eating a big and resting we crammed into an old station wagon and head to Bankass on the way to Dogon country. We were squeezed in this tin box which torpedoed down dirt roads. It felt like a small child pushing an altoid box through gravel a little too fast.

However, it was amazing to see the lightening crackle through an otherwise dark and dry desert. It would sporadically illuminate and allow me to catch glimpses of mud huts on the side of the road and small shops. Feeling the storm dancing alongside the road--sometimes near and sometimes far was incredible. Once we landed in Bankass, we slept on mats on the terrace and watched the storm roll in.

In the morning I took a bush taxi to Sevare where I was instructed to meet Baba Peace Corp. The bus was full of people and little goats nibbling at my ankles. I met an interesting man who prepared public health reports for the government and we had interesting conversation ranging from how muslim polygmy was dangerous for HIV infection rates to Female Genital Mutilation.

Although HIV rates seem relatively low in Mali in comparison to neighbours like Cote d'Ivoire, muslim polygamy plays a unique role in stigma and transmission of the disease. He told me about a story where a family member who was an older brother passed away. Later he found out it was from AIDS and that his wife (4th one) was infected. As customary when an older brother passes away, his wife was given for marriage to his little brother. He had a dilemma since he could not disclose the HIV status of the woman to the parents but he also did not want to see the little brother die the same way. We discussed the role of the health care workers and how one can not change a culture but there are practices that exist that are counterproductive to making the population healthier.

Leaving Burkina Faso for Mali

After some delay leaving Burkina I was finally able to catch a bus north to Ouahigoya. It was a great ride as I watched the scenery change to the Sahel. When I arrived there I was told there was no point in going to the Malian border because it had just closed and there was no direct bus.

In the morning at 6am I stood at the bus stop waiting for the bush taxi to fill to contine onto a town called Koro in Mali. Eventually the bush taxi was full including 2 US diplomat employees and a group of Peace Corp Volunteers. The journey was supposed to take 2 and a half hours plus border formalities to go 60 km. Five minutes after departing we had our first stop for mechanical malfunctions. The bush taxi ended up stopping a total of 6 times over the course of the next 8 hours for various reasons ranging from flat tires to broken rotors. Every breakdown was in an even more remote place and we ended up dispersing like spilled water for shady spots under large trees in the Sahel. I had heard transportation in this region was tricky but this was bordering on insanity.

When we arrived at the Burkina exit point it was literally a concrete building in the middle of nowhere. After the formalities we headed into Mali. I expected the Malian arrival post quickly. We passed wild donkeys; camels and mud buildings and mini sand twisters before finally arriving to an encampment. There was not much more than a large white semi circle tent and I thought certainly this could not be the border. I gave my passport to the official upon exiting the vehicle and half an hour later was summoned to the tent. One could not stand but rather crouched over two formal officials sitting at a desk. They stamped my passport and I was officially in Mali. Little did I know there were still many breakdowns to follow.

The last breakdown was 6 km from Koro and after waiting over an hour with a little water left we decided to take our chances and walk it. However; the driver refused to give us our packs. At that moment the taxi for the peace corp kids arrived and I caught a ride into town with them.

Meeting with Adama on Water Issues in Burkina

On my last night in Burkina I was finally able to meet with Robins contact who is on the National Committe for dams in Burkina. He was a very kind man with smiling eyes and he invited me to his home on the outskirts of Ouaga for a great discussion. I thought it would be an interesting experience to talk with him about water issues in the country; especially water access and santitation.

Currently he said about 10 percent of the population has access to clean and safe water nationwide with 40 percent in Ouagadougou. Most people are collecting water from wells that have a large amount of contamination with schistosomiasis; guinea worm; giardia; etc:

The solution is obviously investment from the public sector in water but when the public sector fails at this what is a country to do with 46 percent of the population in extreme poverty according to the UN index. Currently there are projects with the World Bank by adding Ventilated Improved Pits (for the wiki link click here ) They are essentially composting toilets with gas chambers and are being implemented in many schools. Grants are being given to provide the slabs and chimney.

Most of the water usage in going for 1st irrigation 2nd water supply and third for fishing and 4th electricity . From October or November to June the rivers do not flow well and there is a natural drought. There is a need for damming so the people can continue to farm and live with 3.5 million hectares cultivated in the country.

When we discussed solutions to some of the problems of access to water issues he said education of the people plays a major and often neglected role. The people need to know how to prepare water for drinking and there is also a cultural component of use. The people must demand this of the government. When I probed about some of the negative consequences of damming he said that this is only an issue with the people in more developed countries. The people here strive to live and water is how they live.

Thanks Robin for the wonderful chance to meet with him.

International Conference on TB

Ok So I am going to indulge my Public Health portion of me on this post. Sorry if this post is a bit fragmented in my thoughts... I am trying to beat the cybercafe clock.

So; after some sneaking around and lots of determination I was able to attend the 17é Annual Conference on Tuberculosis and Respiratory Diseases that was offered by the African Union on TB (Jen I would like to dedicate this post to you); Here is a link to the sponsoring website (http://www.theunion.org/news/more-than-530-delegates-attend-17th-africa-region-conference.html) The conference was attended by over 530 people; many leading researchers from across Africa and WHO AFRO, His Excellency Blaise Compaoré, President of Faso, and the Chairmanship of Seydou Bouda, Minister of Health, ( photo of me and the MOH). I made some great contacts and made friends with a great group of handsome Ethiopian researchers (photo). I even met the team of researchers that I will be working with for my dissertation research from Orange Free State South Africa.



The issues surrounding TB are very dynamic and the implications of Multidrug resistant TB (MDR) and extremely drug-resistant tuberculosis (XDR) could really devastate countries. It was originally believed that the resistance was more of an issue in Eastern Europe but every country in Africa with the ability to diagnose MDR has found it. There are relatively very few effective drugs to treat and cure TB right and with mass migration of people for economic and political reasons this is a problem the continent has to deal with on the whole.. not just each country.

The health systems play an enormous role in causing drug resistance; lack of appropriate access to testing, treatment and diagnosis within health systems are causing ineffective disease management with many patients not returning for treatment, coupled by difficulties in monitoring and evaluation.

Imagine if a patient falls sick with TB; they would first have to access a care provider (this could mean a long, expensive journey). Often times the patient would wait hours in a crowded hospital waiting room where TB could easily spread; The clinic would have to possess the ability to see if the patient has TB, MDR TB, or XDR TB and prescribe the appropriate drug regimen and take the needed precautions. Assuming the medicine is both economically and logistically accessible to the patient he or she could then begin treatment. After a certain amount of time the patient would need to return again to see if they are responding to treatment; If they are not responding the 2nd line drugs must be available to treat the patient. The staff must be present to counsel the patient in the importance of being compliant. Many factors need to come together to successfully control the spread of TB in Africa.

HIV co-infection adds another dimension to the problem with the need for integrated management and diagnosis. I see strengthening the health systems as an ideal (yet not quick) solution to some of these issues. I have yet to understand the perfect balance between decentralization of the health system and strengthening of the periphery but I think I am not alone.

The role of community is also important to combat the stigma around TB. In some communities TB is viewed as a sexually transmitted disease and people do not want to come forward with it.

Overall the conference was a great platform to showcase some of the successes and challenges from TB programs across Africa and to emphasize the need for increased monitoring and evaluation, diagnostic capabilities, commitment from the international and national levels, access to medication and ,of course, strengthening of health systems.

First Days In Ouaga

Upon arriving Henris family were so nice and opened up their home for me. His 4 year old nephew Razak is a doll. His sister took me around town on her motorcylce and showed me some of the beatiful crafts of the area. The bronze work, batik and sculpture are very impressive. While visiting the artisinal center I noticed they were making bags for the 17th annual conference for the African Union against Tuberculosis and Respiratory diseases. I thought it would be a great opportunity to attend.

That afternoon the rains came very hard while we were at the center and we were trapped for a few hours under the monsoonlike rains. Luckily, we were next door to a vendor of instruments and I received a few hours of training on an instrument called the kambè lè ngonni. Its a pentatonic string instrument similar to a banjo with a bass feel to it. Super nice.

On the way to Burkina Faso

My internet access has been a bit limited so I will try to back step a bit; I left Accra for the 16 hour bus ride to Tamale in the northern region of Ghana. Before I left I made a guestbook for Japhets guesthouse and presented it to him as a gift. It is meant for people who come to visit his NGO to write their experiences and share them with future visitors. He loved it and I headed off on my journey north.


The landscape changed dramatically and I had a good first hand experience on the buses not running on a schedule; Everyone has an opinion on the best way to get to Ouguadougou. While I waited for the evening to arrive I went to the cultural center and was able to catch some dancers from the northern Ghana region practicing for an event. It was incredible to see the clothes, colours and stories with the dances.

Then I tried to make my way to Burkina Faso. First one I tried was to catch the night bus that will make an unofficial stop in Tamale and see if there is space; After spending a few hours attempting that and not suceeding I decided to get a hotel for the night and try again to take a few buses across the border. After trying at a few hostels it seemed they were all full. My taxi driver took pity on me and offered me his sofa in the modest one room home with no running water or electricity; I arrived and his wife offered me some fufu and I crashed.

In the morning when dawn had just errupted I headed down the rural road to find the bus stop. I arrived and took the next bus to Bolgatanga on the border of Ghana and Burkina Faso (previously called Upper Volta). I took a bush taxi from there to the border where I walked across. It was a long dusty road with vendors lining each side and I began to hear French spilling off the peoples tongues. It was a little surreal walking across the border because I wasnt really sure where it was.

Once I arrived, I caught the first bus for a 3 hour ride to Ougua. The people on the bus found me very interesting and tried very hard to communicate with me in the regional language. They even pulled out a Bollywood movie (I am starting to love the Universality of Bollywood). I phoned Henris sister and arrived in the hot sun of Ouguadougou;