Health Concerns in Mali

I have been weighing the pros and cons of writing and posting this blog post. First, I wanted to give a better glance into the life of the average Malian. To show their daily habits, or in many cases, the lack there of as you will shortly see. Second, it is a way for me to express some of my daily frustrations in improving sanitation practices in my villages. In a way that will also tell you about a really awesome behavioral change I saw last week. This post isn't meant to make fun of or criticize Malians. It also isn't meant for you to cringe your nose and criticize. Hygiene is not something taught in Mali, in school or otherwise. So my note of basic health problems along with very short notes are below followed by a success story.
1. Few people wash their hands when coming from the latrine. No toilet paper here. Just your left hand.
2. Few people wash their hands with soap before cooking.
3. Few people wash their hands with soap before eating. Everyone eats from the same communal bowl with their hands. They then feed themselves and babies with their unwashed hands.
4. Few people wash their dishes with soap.
5. Most people drink water from wells without using bleach to clean it. They also drink water from the stream sometimes. Chances are high that I would be puking my guts out within hours of drinking unfiltered water and would probably have amoebas in no time at all.
6. People wash their clothes in the stream.
7. People shit in the stream. What is my upstream is your downstream, but the problems this brings about doesn't change anyone's behaviors.
8. Women stop breastfeeding their children, no matter what their age, if/when they become pregnant.
9. People do not sleep under mosquito nets. They do not take any form of prophylaxis to prevent malaria, and from what I can tell, they have never heard of mosquito repellent until I teach them how to make it. Malaria kills so many every year, and it is a terribly painful illness, yet nothing is done to prevent malaria by the average Malian. A new initiative is being started in Mali so that, for every two people in a concession, the family will get one mosquito net. The upshot is that is should help with malaria, but it means people are doing nothing to help themselves without an NGO or the government stepping in to do all of the work for them. Malians are so used to getting things for free. It has become an expectation to get paid to attend a formation (paid to learn in Mali, pay to learn in America), to get free handouts at the health center, etc. It is very frustrating and undermines their ability to help themselves.
10. Women give birth in their home or on the concrete floor of the maternity room at the health center. This space is then cleaned with the equivalent of laundry detergent and some water by her friend. The nurses wear a glove or sometimes even two gloves with aiding the women in giving birth.
11. Children are allowed to crawl on the ground where cows, sheep, donkeys, goats, chickens, etc have just walked, and, more often than not, shat.
12. Trash is thrown wherever you stand. In my yard, in your yard, it doesn't matter. Wherever you are, there is your trash can. I get annoyed when people eat mangoes in my yard and spit the skins on the ground. I just want to yell, “You know, I have to clean that as soon as you leave!?”
13. All people blow their nose by covering one nostril and blowing into the wind. They use one finger to wipe the excess snot from their nose, which they then wipe on the wall of their house, the school, or their skirt or pants.
14. Never once have I seen somebody covering their mouth when coughing. Cough on a baby, food, or just in the air where 10 people sit.
15. People use sticks to clean their ears.
16. They use larger sticks to clean their teeth. Toothbrushes and toothpaste are nearly nonexistent. Most people have rotting teeth and maybe only half the amount our mouths are capable of holding because of their constant intake of sugar in tea or porridge. Teeth are stained from tea, but they are also caked with plaque.
17. Female genital mutilation is practiced on 95% of women. The immediate risk of this procedure is huge. It is illegal in Mali. It is the older women who perform the “procedure,” typically with a razor. When performing multiple procedures at the same day, they do not always use a new razor or clean the razor. That is only the immediate risk and says nothing of the long term risks and consequences.
18. Many people practice open defecation. They do not have a latrine with a hole. They have a short 4 wall room where the ground is no different than the ground outside of wall where they urinate. And it just sits. Or drains out of the hole in the wall where people and animals walk. They go out to their fields to do anything more than that. Then when it rains...well, shit, literally, everywhere.
These are the problems I came up with in five minutes of brainstorming. Like I said, I have a success story to share, which is the main reason I chose to write. There is a village 5km from where my village is. The NGO CLTS or APTC in French does a presentation in villages throughout the country. They come into the village and do several demonstrations. They hold up two plates, one with shit on it and another with food on it. The flies then fly from one plate to another, and they talk about what happens when people don't cover their latrines or their food, namely that people end up consuming poop. They discuss the benefits of latrines to open defecation; a cleaner village, fewer flies, improved health.
The results of this presentation in the village was outstanding. I was invited to come and look at the results. I went with my General Secretary, in part because he is extremely excited about this program and would like to do it in my village as well. We walked throughout the village to check out some of the 68 new latrines the village made all by themselves. They used the traditional method of using latrines, in which you dig the hold, lay tree branches on the surface, and then cover the branches with dirt and sand to form the ground. Every latrine had a covered hole. They all have soak pits. This is a hole dug outside of the latrine where bucket bath water drains to in order to be absorbed or to evaporate. This prevents mosquitoes from breeding in open water and increasing rates of malaria in the village. There was soap inside or sitting just outside the latrine as well as a selidaga, water container for cleaning hands after each trip. People have constructed trash cans, short circular containers made out of dirt like their houses and latrines where they burn the trash. All of the animals have been moved to the exterior of the concession walls so their feces is outside of the house. The piles of wood used to cook have been moved to the exterior of the halls to keep bugs out. Women wash clothes outside of the home to prevent standing water in the house. The wells are covered so dirt and insects can't get in the water.
They understand how to improve their living conditions. They talk about washing their hands with soap and water. A few days after checking out the latrines I returned to teach the women how to make soap. I did a demonstration with them. I put my hand in cooking oil, which is also used to make the soap, and then I began to shake each woman's hands. I asked them what was on their hand. I told them that the oil was like germs, and that germs are spreading when you shake hands. We talked about other times in which they need to wash their hands with soap and water. Malians make a special sound to show they are listening and that they hear you. Noises came from all of the women as we discussed these things.
It was the first time I have brought up the subject of washing your hands with soap and water with a Malian without being immediately laughed at. The. First. Time. Since arriving here. It felt so nice to have people understand I actually had a point instead of thinking some white girl who thinks she knows everything is telling them what to do. The reason I could do this was because CLTS is a program put on by Malians so it is Malians stigmatizing unhealthy habits instead of an outsider. I'm so glad it is a program done by Malians for Malians, and that this village showed they could do this all on their own. Moussa wants to get this project going in my village and I want to help, but also want to respect their ability to help themselves. Right now my biggest goal is to make sure that we actually getting around to doing this activity in my village.
I never would have thought that getting people to defecate in a hole in the ground and to wash their hands with soap would become one of my biggest concerns during my service, nor did I know it would be such a challenge to do, but it's nice to see a kid reach for the soap before dinner at night or to hear the matrone lecture her daughter about using the latrine and washing her hands before eating. Very rewarding.