Saturday, September 27, 2008
Wednesday, September 24, 2008
THE PHYSICAL IMPOSSIBILITY OF DEATH IN THE MIND OF SOMEBODY LIVING.
It is the title of Damian Hirst’s famous memento mori, rather than the actual shark in formaldehyde, which is the real masterpiece I believe.
Hama, the fourteen year old son of my balafon player, is seen here to the left of the picture. He came here almost every Sunday or Monday during the last season with his brother and his father, and together they made a very good percussion trio. They had been practicing and putting together a lot of new material for the new season, and were to start on Sunday the 12th of October.
But Hama fell ill about a week ago. He had apparently suffered from typhoid fever some time ago, and his intestine had been perforated, one of the side effects typhoid often brings. He was very strong, and had somehow been able to survive and even continue as usual for some time, but finally he worsened and was taken to Djenne hospital where he was operated on two days ago. He developed septicemia, and died this morning at three am at the hospital.
I had been to visit him twice. I can still feel the heat of his skin, when I stroked his forehead- he was burning. I even got into an argument with Keita about it: ‘What is going on? I demanded to know. Why doesn’t anyone do anything? Keita told me not to meddle: he was ‘under observation’, and any treatment given was decided by the physician in chief, who eventually executed the operation. I am not suggesting that he was not given correct treatment. I am simply being toubab about it. I mean death is just everywhere here!
Until I came to Mali death was something that happened to other people. I could count the deaths I had known on one hand: my best friend Jan who drowned when I was five, my school friend Kjelle who died when I was about 30 and then my beloved grandmother, who passed away 13 years ago. That is about it.
But this little drummer boy- I find it impossible to comprehend that the hot skin that I touched two days ago is now already cold and buried. The physical impossibility of death in the mind of somebody living. Yes, you are damn right Damian.
Tuesday, September 23, 2008
The Hand of Fatima, a spectacular rock formation on the road to Gao. There is no reason to show this today if not to cheer myself up: the article I submitted to the Lancet has been refused, politely, by the edtorial team who felt it would be better placed somewhere else. So here it is, somewhere else:
Money can’t buy you love but it can prevent death from malaria
‘Money can’t buy you love’ according to Lennon/ McCartney.
There is a romantic idea in the comparatively well-fed West, still lingering since Rousseau, that money can’t buy you happiness either. Instead this state of wellbeing is supposedly easier achieved in a natural setting untrammeled by the trappings of modern society. Be that as it may, it is universally acknowledged that without physical health, this ‘happiness’ or mental well-being which all people desire is impossible to achieve.
Money may not be able to buy you love or ‘happiness’ in Mali either, but it can certainly buy you effective treatment and even prevent death if you are suffering from malaria. This old menace of Africa is as alive and active now as it was in the days of Mungo Park, the Scottish explorer who was the first westerner to arrive at the river Niger in Mali in 1795. Park’s second African journey was disastrously misjudged as he set out in the beginning of the rainy season of 1805 with a group of young soldiers intending to reach the river Niger and to follow its course to the mouth. By the time they reached the Niger on the 17th of November 1805 Park wrote:
‘'Of forty-four Europeans, who left the Gambia River in perfect health, five only are present alive; namely, three soldiers, (one deranged in mind), Lieutenant Martyn, and myself' .
The rest had all succumbed to ‘the fever’. Mungo Park, a physician by profession, shared the contemporary medical profession’s ignorance about malaria; and the relationship between mosquitoes and ‘the fever’ which ravaged not only his men but equally their African companions had not yet been established. This cause and effect may now have been discovered, and safe and reliable cures have certainly been developed which can deal quickly and efficiently with the disease. However, the reality is that malaria continues to have a devastating impact with virtually unchecked progress each rainy season in Mali.
Surprisingly little has changed for the ordinary Malian since the days of Mungo Park. Malaria is now a disease claiming the lives of virtually only the poor and amongst this group, malaria’s disproportionate impact is greatest on the most vulnerable members of the society with infants, children and pregnant women at greatest risk This inequality is most dramatically highlighted by European visitors who take malaria prophylaxis and the more wealthy Malians being able to access medication available at any pharmacy at the onset of the symptoms, but beyond reach for the majority due to cost.
Exactly the extent to which the situation has changed since the days of Mungo Park is impossible to ascertain due to due to the lack of reliable data. WHO estimates that malaria causes more than one million deaths annually, of which 90% in sub-Saharan Africa . Although the vast majority of cases are never reported, WHO (2006) estimated that malaria was the cause of 9%, of all deaths, 17% of deaths in children under 5 years and 11% of years of life lost in Mali .
The cases that are reported can normally be treated, because efficient drugs are now available. The current level of malaria in Mali is partly due to lack of accessibility to treatment. Mali has a population of 13.5 million , of which the majority live in the rural areas often too far from a health centre. However, even among those who live near a health centre, few can afford the consultation and treatment on offer. Most people in Mali expect at least one attack of malaria a year, each attack potentially lethal if untreated. A full treatment for acute malaria costs the equivalent of 33 E  and it involves intravenous quinine serum every eight hours for up to five days. By comparison, a maid in an African household earns the equivalent of 8E a month while a Malian labourer earns just over 1 E per day. An educated civil servant and a member of the Malian middle class earns around 125-150E a month. This salary usually provides for a family with several children and dependants. Since a sack of rice which may last the family one month now costs the equivalent of 58E, it is clear that to provide malaria treatment is beyond the means of even for the modestly affluent.
There are initiatives to combat malaria  and to eradicate its links with poverty. [6[.The WHO votes a budget for assistance to Mali every year, just as with other African nations. A partnership has been set up for the treatment of malaria where the WHO gives 60% and the Malian government gives the remaining 40% to finance the Malian health initiatives, which includes free malaria treatment for pregnant women, who represent around 5% of the population, and children under five, representing up to 18% of the population. .
The free government sponsored scheme for simple malaria uses a combination of conventional amtimalarial Amodiaquine together with artemisinin derivatives which shows improved treatment efficacy. This same medication combination, although not free for the adult population, is subsidized and costs the equivalent of 1.5 E for a three day treatment, if bought at a state health institution . The consultation charge for an adult at all Malian Health Centres is also the equivalent of 1.5 E, and ca 0.5E for a child. In combination with the cost of the medication, the burden on a family is therefore often too heavy.
Although this medication is effective, frequently reported side effects include fatigue, vomiting, vertigo and abdominal pains which are similar to the symptoms they treat.
At the Centre de Santé in Djenné, although treatment with the government free medication is recommended to parents of a suffering child under five, the parents have often had previous experience of the drug with another child, and refuse the treatment. The purchase of other medication is then suggested which the parents are unable to afford. Parents often do not trust government-sponsored free drugs and do not bring their children for treatment. When and if they finally do, it is often too late, and the child is often already fitting, after which death frequently follows.
Despite the encouraging efforts and generosity of individuals such a Bill Gates who with his Foundation has highlighted the effects of malaria, this disease continues to claim an indecent and inexcusable number of lives in Africa, disproportionately affecting the most vulnerable and disempowered. . Although a coherent prevention strategy and research to develop new anti-malarials is vital, the more immediate suffering of millions could also be prevented through availability of cheap anti-malarial medication, and through the subsidy or waiving of consultation fees for the poorest. Mali might then be better able to emerge from the crippling tyranny of malaria which is so clearly linked to inequality and disempowerment experienced by a large proportion of its population.
Djenné, Mali, July 2008
1. Mungo Park, Letter to Lord Camden, 17 Nov. 1805, in Mungo Park Travels into the Interior of Africa, (Eland Press, London 2003) afterword by Anthony Sattin p.375
2. WHO (2007). Malaria Fact Sheet No94,Fhttp://www.who.int/mediacentre/factsheets/fs094/en/
3. WHO (2006) Country Health System Fact Sheet 2006 http://www.afro.who.int/home/countries/fact_sheets/mali.pdf
4. (21 000 FCFA : the currency of Mali) OMS Bureau régionale pour l’Afrique /Ministère de la Santé du Mali : Guide Formateur/ Manuel de Formation pour Prise en Charge de Cas du Paludisme au Niveau des Formations Sanitaires. (2005)
5. Recent trials with malarial vaccine in the Bandiagara region of Mali have had encouraging results, which provides some hope for the future :Thera MA et al. (Safety and immunogenicity of an AMA-1 malaria vaccine in Malian adults: Results of a Phase 1 randomized controlled trial. PLoS ONE DOI: 10.1371/journal.pone.0001456 (2008).
6. Politique Nationale de Lutte Contre le Paludisme : Ministère de La Santé, République du Mali (2005.)
7. OMS Bureau régionale pour l’Afrique /Ministère de la Santé du Mali : Guide Formateur/ Manuel de Formation pour Prise en Charge de Cas du Paludisme au Niveau des Formations Sanitaires. (2005)
8. M. Diadie, pharmacist, Centre de Sante, Djenné.
Sophie Sarin is an Art Historian and runs Hotel Djenne Djenno in Djenne Mali. She provides health care for her staff and their families, and has therefore become aware of the impossible burden the cost of medicine puts on ordinary Malians.
Monday, September 22, 2008
Friday, September 19, 2008
The water has started to recede- it never reached the high water mark of last year. The rains are nearly over, thankfully, and we are getting ready for the new season, which starts in about three weeks time. Lots of work and lots of difficulties here, putting the hotel into shape after the ravages of the storms and the rain. But all these problems shrink into nothing when I take Max and the carriage for an early evening ride into Djenne, and see the town shimmer in an unearthly beauty, as if painted on a Chinese vase...
Tuesday, September 16, 2008
Tuesday, September 09, 2008
Djenne is an ancient city and many of the ancient traditions are still alive. Here is the Djenne town crier delivering the message he has been commissioned to broadcast. The going rate for a town crier is 1000FCFA for a half an hours tour around the market place and the centre of town. This time it is I who have commissioned him to get people to pick up old plastic bags, a small part of which will be used in the weaving, the rest will be sent to the plastic brick factory in Sevare, run by the Agan Khan Foundation, about which more later, perhaps...
Hark! O burghers of Djenne! Make haste and Bring ye forth in abundance all the old plastic bags ye can lay your hands on for it is decreed that ye shall be paid 50 FCFA per kilo!
or something like that...
Monday, September 08, 2008
I never understood where 'rocket' got its name: now I know. The other new seeds we planted the day before yesterday are all resting and germinating at a normal, sedate ten-days, two week pace, while the rocket is sprouting already!
The seeds are a gift from my friend Kathy (see blog 9 Sept 2007)who sent them from London two months(!)ago. They arrived last Friday to my great joy. So I called kathy, and by Serendipity it was her birthday- and a very significant one too! She is sending some prayers to St. Christopher, the Patron Saint of Floods and Travellers once more on behalf of the hotel. This year all should be fine, but a little saintly supervision is always welcome..
And finally the Great Loom which will weave up to 1.50 m width has arrived from Segou, and it is installed and ready to go. It is another gift from my friend kathy to the new association called MaliMali, which will make lovely things and give people work all going to plan. But everything takes at least ten times as long to organise here... but when I get discouraged Kathy knows just how to cheer me up. She wrote:
'where else could you dream a celestial roof and have it built of earthly matter. Only where you are'.
Thursday, September 04, 2008
Macondo, the town in A Hundred Years of Solitude, existed for quite some years before it was ‘discovered’ by ghosts. It simply didn’t figure on the spectral map, because no one had died yet. In Marquez’s magical realist universe ghosts are not necessarily a bad thing: when Macondo finally ‘received’ its first ghosts it was the final step on the way to taking its place as a fully fledged town- a coming of age and maturity- the entry into a more comprehensive reality.
Djenne Djenno has not yet had any birds- the trees have been too small. But suddenly yesterday towards dusk I became aware of birdsong, and closer inspection revealed a whole gang of little birds in my flamboyant tree. I am not sure they are building nests quite yet, they may just be hanging out doing choral practice. But soon, soon there will be birds nests too, and then I think Hotel Djenne Djenno will have finally grown up and taken its fully fledged place in Reality.
Wednesday, September 03, 2008
I went riding this evening to the ancient site of Djenne-Djeno. It was the last time until perhaps November. The water now covers the green fields and Napo nearly got us stuck in the mud. I have had a few worried enquiries from future guests at the hotel-will they be able to get through? Is the hotel going to be open?
Although it may seem quite alarming, this is in fact quite normal: Djenne is situated on an island in the floodplains of the Niger inland Delta. The fields are supposed to flood, and all is well. It is just a bit muddy and tiresome if one's hotel is built of mud!
But life goes on, and so does our kitchen experimentation. My mother was quite worried when she saw the recent pictures of the Djenne Djenno frogslegs venture. Did I realize that there are poisonous frogs? she wrote. Well, in fact I didn't, so I tucked in without worries in ignorant bliss. When it comes to mushrooms, I do know of course, and I am not about to eat any- nor give you any in your dinner, dear potential guest who might be reading this. But there are some very goodlooking mushrooms around now in the rainy season- this one for instance looks perfectly fine-how can one find out, without putting anyone at risk, whether a mushroom is edible?