Tuesday, September 29, 2009

I Say I've Got a Real Solution...

I don’t think that you have any obligation to give to charity. I don’t think that people in Mali have any right to expect your generosity. I don’t believe in Socialism, I don’t believe in hand-outs, I don’t believe that just throwing money at the endemic disease and poverty in this country is going to make anything better. The vast majority of the time, I think that the best thing for Americans to do is to let the people of Africa solve their own problems themselves.

But every once in a while, someone like Etienne Dembele rides his motorcycle up to my gate. He wanted to know if I could help him find a certain “Madu Sogoba” – Dembele had heard that he builds toilets.

“Vous êtes arrivés à la vraie maison”, dit Monsieur Sogoba.

M. Etienne Dembele explained the situation. He hails from the village of Tounto – a 12 km ride from my own Sanadougou. Tounto is a settlement of some 4,000 people who are mostly simple millet farmers. They have a market, a small clinic, a primary school. Until recently they didn’t even have a secondary school – if the children of Tounto wanted to continue their studies to the 7th, 8th or 9th grade they had to wake before dawn at the call to prayer and walk the 12 km to le Diaramana Secondaire Cycle and back every schoolday. Dembele organized the parents of Tounto to petition le Bureau de la Mairie de la Commune, le Sous-Prefet de la Cercle, even their representatives in the national parliament and every NGO they could find to try to build them a secondary school. They all said no. So Dembele spent 4 years collecting funds from the people of Tounto itself and in the last year commissioned some local masons to build the school themselves.

If you’re not really familiar with the customary patterns of development in countries like Mali, the story of Etienne Dembele and le Tounto Secondaire Cycle is about as remarkable as they come.

However, there was one little problem; Monsieur Dembele was able to raise all the funds for a schoolhouse – but he came up short to build anything else. There is no well or pump in the schoolyard, so before class each day kids have to fetch drinking water from the clinic 1,000 meters away. This is a hassle, but it’s doable.

But more importantly, Dembele wasn’t able to raise enough funds to build latrines. So when the 7th, 8th and 9th-graders have to “go to the bathroom”, they have no choice but to just squat in the field next to the schoolhouse. The schoolhouse was built in a pretty open plain by the main road going through town, there aren’t even trees or bushes to hid behind, so these kids are more or less urinating and defecating in plain sight of each other and anyone else who happens to pass by on their motorcycle.

Since there’s no nearby water source, there aren’t even the customary plastic teapots that Malians typically use to wash their hands after they cleaned their butts. Maybe the kids can find some grass or leaves and wipe their hands off. But no matter how hard you wipe your hands with a couple of twigs they really can’t get all the poop or pee or diarrhea completely off their fingers, there will always be some residual germs. And then when they come back to the classroom they’re going to share their scarce textbooks and pencils with all the other students. And of course they’re going to share whatever germs they might have.

Etienne Dembele estimates that 75 percent of all of the students at this school come down with diarrhea over the course of the year, at least 65 percent come down with full-blown dysentery because they have to learn with classmates who cannot go to the bathroom in a sanitary fashion.

The Director of the Secondaire Cycle, Monsieur Fousseyni Sogoba is a generally cheerful young professional in his early 30s. But when he speaks of the lack of sanitary facilities at his school his face contorts into a raging scowl, “My students are children as young as 12, but in the highest grade they are as old as 16, 17 years. The female students are of marrying age, and in our Muslim society it is dishonorable for a woman to be seen undressed by a man who is not her husband. For them to urinate and defecate in the open is the greatest shame. The girls who have diarrhea are condemned.”

The epidemiological hazards of open defecation effect all students equally, but the shame factor hits schoolgirls the most. When girls feel disgraced by shitting in the field for the whole town to see, they simply stop going to go to school – this is especially true when puberty hits and they start menstruating. Though women slightly outnumber men in this society, girls make up less than 40 percent of the student body at Tounto Secondaire Cycle. They make up less than a third of all Secondaire Cycle graduates.

I agree with the Peace Corps philosophy of development which emphasizes those projects which consist of pure education, which require no financial expenditures. But in certain extreme situations, no progress can come about without some significant capital investment – this is one of them.

I told Monsieur Dembele that if he was really serious about building latrines, he had to find out the prices for all the materials we would need and to write up a budget. Two weeks later, he showed up at my gate once again - with a comprehensive budget, typewritten in French. Even after checking all the prices out myself there wasn't all that much to edit. I had never before witnessed this kind of gumption and initiative and professionalism in this country, and to tell you the truth I was downright dumbfounded.

So for the first time in more than a year in Mali, I have agreed to help a local activist fund his project.

Dembele and I have submitted a proposal to Peace Corps Washington to build two first-class latrines - one for boys and one for girls – and three hand-washing stations at the Secondaire Cycle. First the people of Tounto are going to pay a team of well-diggers to excavate the latrine pits. Then after the harvest the dugutigi is going to charge the men of the village out to the fields to gather 100 donkey cartloads of sand, 60 carts of gravel and 12 carts of porous sedimentary rocks. Once these are in place, we are going to Koutiala to buy all of the cement, rebar, plastic tubes, roofing, doors, etc. Tounto is going to pay a team of masons to build the latrines, and I am going to build the hand-washing stations.

Altogether, Tountokaw are paying for 29 percent of the overall cost in labor, transport and raw materials – the labor isn’t just being donated, they’re collecting 170,000 francs (~ $400) to pay the well-diggers and masons, and another 20,000 francs (~$48) to pay for the truck to carry it all from Koutiala to Tounto. The community’s contribution in cash is roughly equal to Mali’s per capita GDP.

And once construction is complete the village of Tounto is going to be responsible for cleaning and maintaining these latrines and hand-washing stations. Most likely the schoolchildren will be doing most of the cleaning themselves. UNICEF provides the school district with some soap, but it is nowhere near enough for these kids' hygienic needs and so parents will be responsible for paying for additional soap as part of the annual school fees. And of course, the teachers will be responsible for teaching and enforcing proper hygiene practices indefinitely.

Despite the drought and the fact that this is going to be a really bad year for all of Mali’s cash crops, the village of Tounto is ready to invest a significant amount of their scarce resources into improving the sanitation at their children’s school. I cannot emphasize enough that in a community as poor as Tounto, this effort is absolutely extraordinary. But they could use some help to pay for the cement, rebar, tin and plastic without which nothing that they contribute can be of any use.

And so, if you would like to donate to a cause which will prevent diarrhea and dysentery and help girls to have an equal opportunity in education, click here.

Update: Apparently so many people donated to fund this project that all of you donors cleaned up shop within 100 hours of it being posted on the Peace Corps website, before I could even bike into the city to post this on my blog. To all of those who contributed, from here in Mali I grant you a big "In'i che kosibe kosibe!!!!!" Thank you very very much!!!!!!

And to those who wanted to donate but didn't make it quickly enough, do not fear - all signs point that after the latrines are built in Tounto, there are plenty of other schools within biking distance of Sanadougou lacking in proper sanitary facilities. Stay tuned!!!!!



It’s somewhat remarkable that I’ve been sitting here in Mali blogging about matters of public health and I’ve managed to go 15 months without addressing the subject of malaria.

For starters, malaria is caused by a parasite called Plasmodium, the most common and dangerous being the Plasmodium falciparum which is carried by female Anopheles mosquitoes.

The Anopheles mosquito is merely a carrier of the parasite and likes to drink fresh mammalian blood just as the tamer mosquito species of North America, but when an Anopheles carrying the Plasmodium parasite feasts on human blood, some Plasmodia backwash through its proboscis into the human blood stream.

Young Plasmodia parasites spend a brief stage in the liver and then mature in the red blood cells where they trade gametes and conduct sexual reproduction. When the red blood cells have become so full with Plasmodia spawn the cellular membranes burst, sending a massive release of new parasites into the blood stream where they in turn effect more red blood cells. Once the population of Plasmodia proportional to the volume of blood reaches a certain tipping point,the human carrier experiences severe fevers and chills in a cyclical manner as each new batch of parasites is released. Unless the human carrier receives proper treatment, the parasite population will continue to expand exponentially, potentially causing the victim to experience delirium, kidney failure, culminating in a coma or death.

Part of the reason why this Water Sanitation Extension Agent hasn’t been able to do much about malaria is that – whereas diarrhea can be comprehensively diminished with the establishment of proper toilets, wells and hygiene practices – the only way to completely eliminate malaria is to completely eliminate water. In the tropics, where there is any body of water from a lake to a puddle that is not flowing at a swift clip, there are almost certainly Anopheles mosquitoes. In any desertous region without any standing water, there aren’t many mosquitoes and there isn’t much malaria – but there also aren’t very many people. So long as human beings are going to cultivate rice paddies and build settlements along rivers and lakes and anywhere that is at all fertile enough to make a living from the land, we are going to have to deal with malaria.

A better reason why I haven’t concentrated my attention on the greatest preventable cause of mortality in Mali and all of Africa is that it’s already received plenty from international development agencies and NGOs. Here in Sanadougou the local maternity distributes mosquito nets to every expecting mother and teaches her how to properly tie it above her infant’s bed and to come and treat it again every year. The community health organization conducts extensive formations on malaria prevention, teaching a mostly illiterate and ignorant audience how to monitor their children and when they display symptoms of malaria to bring them to the CSCOM to receive quinine injections. And PMI: The President's Malaria Initiative – one of the actually admirable legacies of the presidency of George W. Bush – pays for the “Mosquito Killing Wagon”; a truckload of men who drive around to people’s homes and bodies of standing water to spray insecticide, hopefully reducing the mosquito population.

Though my latrine and soak pit construction campaign is primarily meant to curb diarrhea, dysentery and cholera, containing people’s raw sewage underground does carry a secondary benefit of reducing the bodies of standing water. If this campaign ever reaches a critical mass and entirely rids certain neighborhoods of wastewater puddles – which during dry and hot seasons serve as the only bodies of standing water – the village of Sanadougou might experience a significant dip in seasonal mosquito populations and the incidence of malaria.

During rainy season, however, any anti-malarial externalities of Operation Sphincter Plug are nonexistent. There are little sprinkles now and then throughout the year, but the months of June, July, August and September are known as “rainy season” for a reason. When the monsoons come every week or so the thunder on my tin roof makes it sound like a battle’s a-raging outside, the sheets of rain will come down so thick and so strong that they sting my eyes if I dare venture to peer out of my rain jacket hood. Hours later when the storm has calmed to a drizzle, the streets will be so full of storm waters that a mighty creek will have formed, carving a gulley to the floodplains downhill. For days afterwards the landscape will stay pocked with large gaping puddles which render some roads impassable.

During rainy season – no matter how much insecticide America disseminates – there will always be standing water and there will always still be mosquitoes. To be honest, I’m not sure if the spraying of insecticide even does all that much good, because if it’s toxic enough to render a puddle infertile for mosquito breeding, then it can’t be that great for the health of humans when it inevitably percolates down into the groundwater and infiltrates into people’s wells from which they’re going to drink it straight.

Also thanks to the intervention of the international development agency/NGO complex, every woman who walks out of Sanadougou’s maternity with a newborn baby also leaves with a mosquito net. If she has twins, then she leaves with two. If she has many more children, over the years she will still have at least one mosquito net per child – free of charge. Lack of access to mosquito nets is not at all the problem, and one couldn’t say that the women aren’t adequately educated.

Nevertheless, a rather odd thing happens with those mosquito nets. In all fairness, some women diligently act upon la matron’s instructions and string them above their babies. But the vast majority of women put the nets up the first few weeks after childbirth (if even) – and for whatever reason they grow tired of the habit. And eventually Malian women shove these perfectly good mosquito nets away in some corner where they will be nibbled by mice and termites. And this is a better-than-average case scenario; a significant number of women never open their free mosquito nets at all and just hoard them, never to be used.

It is really amazing how in this village where there is truly a mosquito net fairly allocated for many children born over the past 5 years, hardly anyone ever sleeps under a mosquito net. I’ve inquired far and wide why this might be. Economic studies have shown that people who receive mosquito nets for free are significantly less likely to actually utilize their mosquito nets than those people who pay for them in full, or even those who receive heavily subsidized nets and have to pay at least some of the cost. Perhaps the problem is that those who don’t pay for their mosquito net don’t realize its full value – William Easterly writes of women who cut up free bed nets to make lace trimmings for their dresses and wedding veils.

I ask the doctors, the teachers, my host brothers why Sanadougoukaw don’t put up their mosquito nets. They unanimously reply: “People are lazy!”

Thus despite the good efforts of PMI, UNICEF, Oxfam, Save the Children, WorldVision, malaria is still endemic. One could say that the worldwide NGO axis isn’t doing enough and that they should shower Africa with more aid, but it really wouldn’t be fair to blame the continued incidence of malaria on any miserliness of the globetrotting humanitarian-industrial complex. Asides from physically tucking all 800 million sub-Saharan Africans into their mosquito nets each night, I really cannot think of anything more that we the West can do.

One fair argument to make against the distribution of free mosquito nets to new mothers is that it creates some perverse incentives. Everyone I’ve ever spoken to about the subject wants a mosquito net, and there are perfectly good mosquito nets available in every market and many sizable butigis – but the fact that mosquito nets are being given out for free to someone makes it seem foolish for anyone to spend their own money on this basic consumer item. Adults contract malaria and die of it too. And even in my relatively wealthy host family where the parents are beyond their reproductive age and their kids are in their late teens and 20s, they are reluctant to spend money on something that can be gotten for free.

I’m extremely skeptical about distributing free mosquito nets to all people regardless of age, or even distribution at a subsidized price. The standard model sold in markets like Sanadougou’s go for 2,500 francs (~$6). Yes, Mali is a poor country. But a packet of tea costs 200 francs, a kilo of sugar costs 450 francs, a full pack of cigarettes costs 2,000 francs, and a full motorcycle gas tank costs 2,000 francs – 3,000 if it’s a Yamaha. In a small town like this, phone cards are sold for denominations of 1,000 or 2,000 francs. 2,500 francs for a potentially life-saving device is not so unaffordable to explain why so few people here sleep under mosquito nets

One day, after coming down with malaria, my host brother Jafete angrily demanded that I buy him a mosquito net.

“Every time I leave town I pay you good money to water my garden and feed my animals. What’ve you been spending it on?”

“Gasoline, phone credit, cigarettes, tea and sugar.”

“This conversation is over.”

Even if every single person in Mali had a mosquito net and they diligently tied it and slept under it every night, that still wouldn’t solve the problem. Mosquitoes are active so long as the sun is down – and they bite during dinnertime, when people are sitting around at night listening to the radio, and when they wake up before dawn to pray. If you roll over in your sleep and your foot is leaning against the net, mosquitoes can bite through the holes.

At the onset of rainy season, as the proud owner of lemon trees I received a steady stream of visitors who wanted to cut some lemon leaves. According to traditional Bambara folklore, a brew of lemon leaves with certain tree barks into a strong tea serves to protect the drinker from malaria. I saw no harm in it and said yes to all. The lemon leaves are just an old wives’ tale, but there apparently are some bona fide anti-malarial properties to the tree bark – after all, quinine is derived from the bark of the cinchona tree, which was used as a similar remedy by the Quechua people of Peru and Bolivia.

Back in the olden days of Western colonialism, European outposts in Africa went no further than the coasts because those battalions which ventured any sizable distance inland were decimated by malaria. But present day Western neocolonialists like Peace Corps Volunteers can live and work in land-locked Mali only because over the past two centuries modern science has developed a number of dependably effective malaria prophylaxises which inhibit the reproduction of Plasmodia. I most likely have malaria Plasmodia in my bloodstream right now, but the fact that I took my prophylaxis contains their levels to such a minimal number that they can hardly reproduce - and one would not say that I "have malaria".

Even then, a lot PCVs still come down with malaria because the prophylaxis isn’t a cure-all. Even Mefloquine - the first choice prescription for all PCVs - is only effective 95 percent of the time. And every so often there have been Volunteers who intentionally don’t take their prophylaxis because they actually want to contract malaria in order to “fully experience” what it’s like to live as a Third World peasant – last year a Volunteer was brought comatose to the Dakar PC Medical Unit. Official policy states that a Volunteer found not taking their prescribed malaria prophylaxis gets “administratively separated” i.e. sent home.

Since I’ve been diligently sleeping in my mosquito net tent and taking my Mefloquine prophylaxis, I have yet to contract malaria. However, it must be noted that this particular malaria prophylaxis has some significant side effects. Night after night Mefloquine was giving me these extremely vivid, realistic, dark and violent nightmares; a recurring theme involved various permutations of hungry West African night adders, green mambas, crocodiles, musket-wielding cannibals and me armed with only a machete. To refer to these dreams as merely “nightmares” wouldn’t be doing them justice – Mefloquine dreams are so lifelike that it is rather difficult to differentiate between what has really happened in my waking life and what has only happened in my head, and so my memory would store them like actual life experiences and really fuck with my subconsciousness.

Once in the wee hours of the morning I dreamt that my next-door neighbor was chasing me through the woods shooting above my head and just barely missing – and by some luck I managed to ambush him, get a good swipe with my machete just above the shoulder and proceed to hack him to pieces. An hour later I woke up in a pool of sweat, and had hardly rubbed the gunk out of my eyes when I went out to fill my bucket at the water pump - and there my neighbor was, friendly as always, greeting “I ni sogoma!” I struck pallid with terror and curtly raced home without returning his greeting.

Generally speaking, the psychological side effects of Mefloquine were causing me to be become unfoundedly anxious, paranoid even. I could discern a profound change in my general personality - I was bugging out over things that never happened. My reaction to the cheap prophylaxis had gotten so bad that I was engaging in conversation with my cat. I explained these symptoms to my psychiatrist father, who diagnosed via Skype that my malaria prophylaxis was most likely throwing my neurochemistry out of whack; in extreme cases, Mefloquine has been known to trigger full-blow psychosis and manic behavior.

I explained these disturbing side-effects to Dr. Camara. As though I don't already have enough crazy shit to worry about in this country, I could do without the crazy shit that really isn't. For the same reason why they distribute oranges at Hampshire College's acid-soaked Halloween fete, I wanted to change my medication so that these macabre dreams would end.

The next drug of choice is Doxycyclin - which does just as good a job at curbing Plasmodia multiplication as Mefloquine, and falls in the same price range. But in a number of cases - such as my own - Doxycyclin causes whatever matter the user has consumed as their most recent meal to transform into a high-speed projectile.

The only other anti-malarial prophylaxis which the Peace Corps can prescribe is Malarone. Malarone inhibits Plasmodia just as much if not slightly better than Mefloquine or Doxycycline - only it does not carry the negative side effects. The only reason why Malarone isn't the first choice is that it's so prohibitively expensive at $8 per pill per day. It also causes vivid dreams, but they are for the most part wonderful lucid dreams. Now my slumber is full of flying over moutains and doggies and kitties and frolicking amidst blueberry bushes with long lost friends, and when I wake up I can peacefully engage in amateur Freudian analysis and personal introspection.

And I'm as safe as safe can be from malaria.

The same can't be said for everyone else in Sanadougou. There's no way that even the wealthiest people in this village could ever afford to pay $8 a day for top-of-the-line malaria prophylaxis, let alone lesser quality substitutes. The only economically feasible things that your average Malian can do to protect themselves from malaria would be to sleep under a mosquito net and continue drinking lemon leaf-tree bark tee - and most aren't even doing that.

Wednesday, September 9, 2009

The Nyegenmason's Apprentice

(click here for musical accompaniment)

When most people recall the classical economics of Adam Smith, they usually think of his reverence for efficiency achieved by the division of labor, natural pricing determined by the forces of supply and demand, and his ideal of a free market unencumbered by arbitrary tariffs, regulations and monopolies. Conservative politicians love Adam Smith, because they can selectively quote bumper sticker-sized postulations of his to demonstrate why the free market is inherently perfect and the State should do nothing in regards to economic affairs but maintain courts of law and a strong military to enforce private property rights.
Though the craggy old Scot would probably be aghast if he were to trade in a modern Malian market, not because of anything the State is doing to interfere in its freedom, but rather the complete and utter lack of infrastructure needed to facilitate commerce in the first place. For your average Malian merchant to sell her goods at market, she must ride a donkey cart or walk with a basket of those goods on her head down many kilometers of glorified cow paths which can only be differentiated by the rest of the fields by the fact that multiple people and livestock have previously tread there. Even the roads in the capitol city are made of slightly more compacted dirt and mud. There is one colonial-era railroad from Bamako to Dakar and it derails about every other week, the few airports are little more than landing strips, electricity and running water are hard to come by beyond the major cities and even there they are spotty at best. With such inadequate infrastructure, so few goods can be bought and sold, so many deals cannot be transacted to begin with that it is difficult to argue that the anemic economy suffers from excessive government intervention.

The third duty of government, Smith wrote, is to provide “good roads, canals, and navigable rivers” to diminish the costs of transport, break down local monopolies and make all goods sold at market more competitive. He claimed that investment in trade routes benefit the country most of all, for “they encourage the cultivation of the remote” and “open many new markets to its produce.”

Adam Smith theorized that commerce runs most efficiently when pricing is set by natural supply and the output meant to match it – and he despised government subsidies which do little more than artificially raising prices for the benefit of favored industries. Smith would be loathe to see the Crown lavishing taxpayer money on the producers of consumer goods such as corn farmers and rice merchants – the only persons whom such subsidies could conceivably benefit would be the direct recipients and the government clerks who enjoy their political favor. Everyone else loses.

But what would Adam Smith think about subsidizing the construction of toilets?

In the 18th century, tenured professors at the University of Glasgow shat in chamber pots, which servants then emptied out into the streets. A chamber pot was nothing more than a simple utensil which could be easily fabricated by any blacksmith or tinsmith and sold at market for less than a shilling. Smith’s successors in the 21st century now use porcelain flush toilets which are also bought individually, but are connected to the municipal water grid to dispose of sewage at the local wastewater treatment plant. The waterworks, sewers and treatment plants are undoubtedly public infrastructure no less vital than roads and bridges, and the Mayor of Glasgow very non-controversially collects taxes and user fees to keep these units running. But each individual consumer must pay for their actual toilet themselves. Though a porcelain toilet is expensive, per capita income in modern, industrialized Scotland is so high that even a pauper on the dole can afford one – it is unthinkable that the modern British welfare state would have to intervene in this market at all.

But there are no centralized sewer systems in the small villages of the Malian countryside. The undeveloped agrarian economy is so indigent and struggling to provide even more basic needs like food and water that a sanitary toilet is considered a luxury item. Your average Malian builds his own home out of mud and sticks, and there is a good chance that he and his family scurry off into the woods when they have to poop or pee. If Amadou the millet farmer has any mud to spare, maybe he has built a “traditional nyegen” bokeyuro – a walled-in enclosure where one can shit in privacy. If he has found not only ample mud but also sturdy logs, then he can dig a latrine pit so that the bokeyuro fills up less quickly. All of his urine and dirty wastewater flows out into the open street.

In this economy without municipal wastewater management, an adequate toilet is certainly more than just a consumer good for the individual consumption – it is a vital piece of the most basic sanitary infrastructure necessary to maintain the health of the individual user as well as the public at large. Even a family of subsistence farmers who consume all that they produce, who produce only what they consume and do not trade at all in a market economy – who wouldn’t really benefit much from a railroad or a highway – need this sort of infrastructure so that they might abstain from the commerce of dangerous pathogens.

If Mali were a perfectly ideal market, all human beings would be so perfectly enlightened on their own rational self-interest and the free market would be capable of supplying those goods at affordable equilibrium prices without any outside interference. And since every person in this perfectly ideal market would so thoroughly comprehend why it is in their own self-interest to not live amongst their own raw sewage, everyone would build their own sanitary latrine and septic tank on their own volition. In a perfectly ideal market, even the poorest of struggling millet farmers would realize this fact and thus save the roughly 25,000 francs ($60) it costs to build a appropriately modern concrete latrine complete with a soak pit or infiltration trench.

However, judging by the fact that the streets of Sanadougou and every other Malian village where Amadou walks are full of puddles of piss and shit and diarrhea giving room to fly and mosquito breeding and the most nauseating algae blooms, it would be fair to say that the free market has failed on its own terms to provide adequate water/poop management infrastructure.

There are two major factors holding back the Malian latrine construction industry: lack of education and lack of capital. Amadou might have no desire for a modern latrine because he doesn’t understand germ theory and thinks that dysentery and cholera come from evil sorcerers. And even if he were to appreciate the value of a proper latrine, that 25,000 franc price tag for a single concrete edifice represents 12 percent of per capita GDP (Amadou the millet farmer’s annual income). Without a direct investment of fixed, circulating and human capital, the invisible hand isn’t going to wave Amadou’s wastewater away anytime soon.

The Republic of Mali is genuinely concerned about improving the health and well being of her citizens, but scanty revenue flows preclude a massive latrine construction campaign. But what Mali has been able to do is to call up her good friend Uncle Sam to establish a Peace Corps program. And ever since 1972, Uncle Sam has been sending dirty, grimy, sandal-wearing peaceniks like Zac Mason to this country to live in mud huts and farm organic vegetables side-by-side with our Malian hosts as a big anthropomorphic hand of friendship from the American people.

So should Peace Corps Volunteers like me correct this awfully foul-smelling market failure and build adequate water/poop management facilities for the Malian people?

Absolutely NOT!!! If anything is going to last in this unforgiving climate, it must be regularly maintained. If foreigners do all of the work and then leave, none of the Malians whose health depends upon these latrines functioning will know how to conduct maintenance or repairs, even if they did they would feel that they didn’t have to, and when these latrines inevitably break they will remain broken and unusable until the next NGO rolls into town - if ever - to fix them.

So should the Peace Corps pay for latrines and outsource all the labor to local contractors?

NO!!! Now when the latrines inevitably break, when the soak pits inevitably clog, all of the necessary maintenance skills would be monopolized by a select few. Every Malian man knows how to rebuild his mud hut after rainy season, and likewise there’s no better way to guarantee that each individual homeowner can clean and fix his own latrine than if he builds at least some of it himself. Even when technical masonry is needed, they should be there to at least participate in the more menial aspects of the job. This way, when things fall apart the individual will feel comfortable filling in the cracks, emptying out sludge themselves before it becomes such a problem that they need to hire a professional mason.

So should individual Malians provide all of their own labor and Peace Corps just foots the bill?

Still NO!!! If Malians aren’t willing to pony up for their own latrines, neither should Americans. If sanitation conditions and the standard of living are ever going to improve in this country, Malians have to get into the habit of contributing their own resources and investing in their own infrastructure.

So how do I, Zachary Mason, motivate the villagers of Sanadougou to turn off the boob tube, put down their tea pot, and invest their time and energy and pecuniary wealth into building roughly a hundred latrines and soak pits?

I could spend my two years here conducting an educational campaign to sensitize the populace on the virtues of sanitary waste management. Maybe a couple dozen people would ever show up. Maybe by some stroke of divine intervention I would inspire one or two Amadou the millet farmers to save 25,000 francs and invest in a modern concrete latrine and complete with sanitary wastewater disposal. More likely I would waste my breath.

Thus the strategy that I am using to jumpstart the moribund market in sanitary latrines and septic tanks has more to do something about the massive scarcity of fixed capital; to employ a generous direct subsidy program funded with a Small Project Assistance (SPA) Grant by the United States Agency for International Development. According to the SPA Grant formula, for every funded project the people of Mali have to provide at least 25 percent and the American people pay up to 75 percent of the total cost. The people of Mali have more than enough unused land and surplus labor, so in order to spur the development of the latrine and septic tank construction industry, USAID wired some 1,107,900 francs (~$2,500) to yours truly in order to buy a truckload of cement, plastic pipes, plastic sheets, rebar #6 and tie-wire.

I loathe the idea of distributing presents to my neighbors of Sanadougou, but this situation does not have to cast me in the role of Santa Claus. The purpose of this endeavor is to spur Sanadougoukaw to invest their own resources on sanitation, and unless Amadou the millet farmer is willing to pony up, all of those materials are going to gather dust in my storage room. Anyone who wants these expensive materials can get them for free – but receiving this USAID subsidy is completely contingent on whether or not they’ve already contributed the most strenuous, tedious and disgusting parts of the job on their own time.

To catch you up to speed, this is how you go from a bare patch of nothingness to a modern latrine and septic tank:

Step 1: I find a suitable location. It should be someplace close enough to where people spend most of their day so that they can relieve themselves with minimal inconvenience. However, the construction site cannot be less than 30 meters from a well in order to prevent the direct contamination of drinking water. I also have to know that the water table never reaches above 2 meters below ground-level at its rainy season height if it is appropriate to dig a soak pit. Otherwise we have to build an infiltration trench.

Step 2: Amadou the millet farmer digs a hole. This will become the latrine pit where all the shit goes. After about 0.7 meters of dirt, the earth in Sanadougou is composed of about 5 meters of fairly solid sedimentary rock until it turns back to sand again. So as long as the latrine pit is no more than a meter in diameter, a simple pit dug straight down into the rock like this is quite durable even without any cement lining.

Step 3: Amaou digs another, significantly smaller hole with a surface area of at least 1.7 square meters for person who uses the latrine daily. This will become the soak pit.

A dilemma exists for those who want a modern latrine but their current latrine is nearly full; it makes no sense for me to devote expensive construction materials on full latrines which would need to be broken and emptied or abandoned altogether within a short span of time – I demand that latrine pits be at least nearly empty. If someone’s latrine is full and they have no room to dig a new latrine pit, then we have to build over the old one – but first, someone has to empty the latrine pit. If the homeowner hasn’t the wherewithal to jump down into the warm, maggoty muck and remove bucket after bucket of their family’s shit and piss and diarrhea, they have to hire someone to undertake the most undesirable job in the entire world.

But first, my Malian neighbors have to ante up. Granted, they probably don’t have a lot of cash to contribute. But Adam Smith insisted that the definition of capital cannot be limited to hard currency circulating throughout the economy – there is also “fixed capital” i.e. physically tangible tools and raw materials which can be invested to form additional units of capital. To build a nyegen and a soak pit we need a lot of sand, gravel and porous sedimentary rocks; in the city you have to buy those materials, but here en brousse there are ample supplies of sand, gravel and rocks free for the taking out in the fields.

Step 4: Amadou fills his soak pit with rocks.

At this point we call in my homologue Sidiki Sogoba.
Sidiki is a baller to the extreme. He is a fairly traditional Minianka Muslim who has two wives and nine children, he farms millet and peanuts and watermelons and he hunts rabbits with his colonial-era musket. Sidiki is my best friend in town, and the best mason in the entire Commune. He does flooring, roofing, bricklaying and finishing – but his specialty is in nyegen construction. I am his apprentice.

If Amadou gives Sidiki sand and gravel, I give him cement, rebar #6 and tie wire, Sidiki can (Step 5): make a sanitary platform.

A sanitary platform is the keystone to a durable, easily-maintainable latrine. The rebar-concrete slab is built so that it is amply larger than the pit itself, so it can easily support its own weight plus that of whoever happens to be squatting upon it. It would be quite difficult to cause the sanitary platform to collapse if it was installed properly, and even if it did collapse, it is built so that it is easily interchangeable, replaceable and reusable. The sanitary platform is molded with a penis-shaped hole in the middle where the poop and any misdirected pee goes (total coincidence) and two foot-sized pads where your feet are supposed to go to help aim your butt at the penis-shaped poophole (the location of these pads were determined after decades of research by leading scatological projectile physicists). Then Sidiki molds a penis-shaped concrete blob with a rebar handle (this is intentional) so that it fits into the penis-shaped poophole. This is so that the user of this sanitary platform can keep a lid on it at all times when they’re not using it so that flies and mosquitoes and cockroaches and bats do not nest and reproduce in the latrine pit.

After three days of drying and curing, the sanitary platform is ready for installation! Sidiki hauls it over to the construction site via his trusty donkey cart.

At this point, (Step 6) Sidiki and I prepare the rest of the nyegen floor with gravel. Then (Step 7) we take the remainder of the cement, sand and gravel, then mix it all into concrete, and lay a smooth concrete flooring. My dad sent me a level once used by my grandpa when he ran a tiling and flooring company, so Sidiki and I can ensure that gravity pulls any pee that falls beyond the sanitary platform urine catchment flows downhill to the plastic tube.

Up until September 10, 2008, Sidiki Sogoba had been doing Steps 1, 2, 4, 5, 6and 7 by himself on the latrines of Sanadougou’s well-to-do who could afford cement on their own dime. However, since I have taught Sanadougoukaw how to dig a soak pit (Step 3), Sidiki’s nyegens now come equipped with a more sanitary outlet for wastewaters than the adjacent street. So my personal contribution to Malian water/poop management infrastructure construction technology is … (drum roll please)…

(Step 8) I take a plastic tube, I stick it between the latrine floor and the pit of rocks, and then I cut it!!!

And then (Step 9) I take a big plastic sheet and cover up the soak pit rocks and tube. And then (Step 10) I shovel mud on top of everything. This way, when you pee, all of that stinky, possibly schistosomiasis-carrying micturate winds up underground where it can’t hurt anybody. Since all of the potentially contaminated wastewater is out of sight, no flies or mosquitoes are going to breed in human sludge or simply stop for a sip and then buzz off to spread whatever pathogens they find in human drinking water or food. What was once a puddle of fetid disgustingness is now a regular, boring patch of wholesome-looking earth!

Then, finally, the most important step: (Step 11) the owner of this brand new latrine pays Sidiki Sogoba for a fair day’s skilled labor. His current rate is 2,000 francs (about $5) per latrine. This step is very, very important, because even if the most expensive construction materials were paid for with a USAID grant, unless they can do all of the skilled masonry themselves, each individual who wants a modern latrine still has to pony up a sizable amount of his or her own cash. Though this is a heavily subsidized project, no one here is getting a freebie – not on my watch.

In all, if Malians want to build modern latrines under this program, they have to provide all of the land, labor, and raw materials in the form of sand, gravel and rocks – what the U.S. taxpayer is paying for is cement, plastic tubes, plastic sheets, rebar #6 and tie-wire. When you calculate how much work or money goes into digging or emptying the latrine pit, collecting rocks, sand and gravel, and then paying Sidiki for his masonry skills (25 percent of the overall cost), allocating the generous subsidy (75 percent) for manufactured materials does not feel to me like handing out presents – it’s more like just rewards for hard work which benefits not just the individual owner of the nyegen but the health of everyone who lives and works and purchases food in Sanadougou. Especially if the person using this new concrete nyegen already has giardia, dysentery, cholera or schistosomiasis, the new fancy cement formwork isn’t going to help him as much as it is going to protect the rest of society from catching his contagious disease.

Since this is my first project, I conducted it as an experiment in human nature. The SPA Grant from USAID provided me with funds to build approximately 30 concrete latrines with soak pits and an additional 5 soak pits for those rare families who already have concrete latrines. After I received the money in February, I purchased the materials little by little to see exactly how much of a subsidy was needed to bring latrine construction into steady gear. I started with just the plastic tubes and plastic sheeting for the soak pits. So throughout February and March I canvassed the neighborhood, talking up soak pits with the head of every family, measuring the space behind their nyegens where all the icky wastewater flowed and trying to encourage them to pick up a shovel and start digging.

The response was underwhelming. After two months of canvassing, my host brothers did a half-assed job of digging an infiltration trench. And I somehow managed to convince one old man named Issa Dao (the father of the Secretary of the Mayor’s Office – who worked with me extensively in planning this project) to hire some unemployed idlers to dig holes behind his three nyegens and fill them with rocks. After two months of rabble-rousing I had finally found my first customer! So in April I went to San to buy 112 sacs of cement.

The tipping point in this subsidy’s catalyst effect would be the day I rolled into town on top of a truck full of 112 sacs of cement. Mind you, this is a society where the vast majority of houses are made exclusively out of mud. Only the wealthiest merchants and professionals can afford to line their floors with cement, the amount of cement that someone has used to feather their nest is a reliable indicator measure of their wealth and status. A truckload of cement is the biggest metaphorical carrot that these people will ever see in their lives. Once passersby saw what Sidiki and I were doing at Issa Dao’s house, and word got out that I had 106 sacs of cement left to reward whoever dug their soak pits and gathered their raw materials the quickest, it was as though Allah flipped a switch – something just clicked. From April through August, Sidiki and I have so far built 24 out of our quota of 30 latrines. I think we will be done with this SPA Grant’s worth of materials somewhere around October.

This project has also borne its fair share of hiccups. First of all, it seems that this subsidy has its greatest effect in motivating those people who have only a traditional mud nyegen and would like to climb up the status ladder with some cement. Even if it means that they have to dig a soak pit that they really don’t care about, if that’s what it takes they’ll do it. I have had a really hard time convincing people who already have cement-lined nyegens why it is in their best interest to do something about their wastewater – if people can’t grasp the concept of sanitation, a plastic tube isn’t much of a motivating incentive. So far I have only received a smattering of takers: Sidiki himself, two teachers and the “pharmacist” down the street.

If you remember in previous episodes, the “pharmacist” had two of the most egregious plumes of wastewater I’ve ever seen, and I told him that I can’t buy medicine there so long as the nyegenji is flowing and filth flies are buzzing around his wares. And y’know what? He dug a humongous soak pit and diverted all the nyegenji underground! I was totally shocked! …and then the “pharmacist” reminded me of “my end of the bargain”. Fuck. There’s still no way that I’m ever going to put one of his bootleg Chinese sugar-coated chalk placebos in my mouth, but now I make a habit of stopping by the “pharmacy” to buy his wife’s newly-sanitary beancakes for breakfast and all parties seem to be content.

The most tremendous problem is that 4,420 out of 4,428 inhabitants of Sanadougou live in mud huts, I rolled into town with 112 sacs of cement, and I want to use it all to build concrete latrines. I’m building latrines with materials more durable and infinitely more desirable than the mud which people use to make their houses. A lot of people have come up to me and said, “I don’t want cement for my nyegen, I want cement for my house!”

I can feel empathetic to their frustrations, but I can’t really do anything about them – this USAID financed cement is for latrines and latrines only. Every time I have one of these encounters, I try to explain how a concrete house benefits just one family while a concrete latrine with adequate wastewater removal benefits the health of everyone in society – unfortunately, this argument doesn’t get me very far in a society where illness is known to come from evil sorcerers, frogs, and whistling at night. So the only alternatives I’ve come up with are to either 1) pretend I can’t understand their Bambara and change the subject to “So, when are you going to dig your soak pit?” or 2) offer to sell them cement at the price I just bought it for – which they never will; or if they’re really persistent 3) just ignore them and walk away.

When I see a sack of cement I see it turning into a squeaky-clean latrine and transforming the sewage-filled streets into verdant boulevards full of trees and flowers; somehow other people see a sack of cement and see it turning into a motorcycle. A number of people have been frank in demanding “Madu, gimme cement so I can sell it and find money”, “Gimme 40 sacks of cement so I can sell them and buy a motorcycle”. I find such attempts to suborn my Peace Corps service into a gravy train to be so personally insulting that they don't deserve a polite response.

Though I’d rather not make it into a fight, so I craft an appropriately snarky absurdity, “Give me your entire herd of cattle, your sheep, your goats, the entire contents of your granary… actually, no, give me your granary too.” Joking cousins!!! You eat BEANS!!!

But some jerks are actually serious when they demand that I give them cement to resell. I really love it though when they to pull the cultural card, “In our country, when people have wealth they share it with their friends” – because then I get to throw it right back at them.

“In my country, do you know what we call a government employee who takes public property and sells it for personal gain?”

“No, what?”

“A criminal.”

In spite of these challenges, you, United States citizen, deserve to know exactly how the government is spending your hard-earned tax dollars. This is why I, Zachary Mason, Peace Corps Volunteer, believe so strongly in accountability and transparency that I go to painstaking lengths to keep immaculate records of my project budget and expenditures and document all of it online for all the world to see.

I’m making absolutely no exceptions to the integrity of my nyegen project. A number of people have commented on how disloyal I must be since I’ve made 24 concrete latrines in this village – but my host family’s nyegen is still made out of mud.

“I am tremendously loyal to the Sanogos, and I will cement their nyegen. But first they have to finish digging their infiltration trench, go to the fields and find sand and rocks and gravel…”

The fact that Sanadougoukaw have to pay for a sizable chunk of their new nyegen is what makes this project so much more sustainable than if I were just building them for free. In this country it is really easy to tell the difference between what buildings people have built themselves and what was a big fat NGO cadeau – whereas the former will be cost-efficient and repaired on a constant basis because people have already paid for the sunk costs of preliminary construction, the latter will inevitably decay and crumble and no one will put any time or money into it because they feel that they can just wait for the NGO to come back and build it again. The fact that my Malian neighbors have to pay at least 25 percent if they want a new nyegen is the only way to ensure that they have even the most basic semblance of its economic value – the 75 percent subsidy is the sine qua non which encourages them to spend that 25 percent in the first place.

So there are about 500 nyegens in the town of Sanadougou, Sidiki and I have perfected 24 of them, and factoring in the increased rate of construction, work patterns and the rate of population growth, every single nyegen will be cemented and sanitized in the year 2016. There’s no way that I’m going to be able to completely rid this town of icky wastewater by myself. Indeed, I am going to request that Peace Corps replaces me with a new Volunteer when I’m out so as to continue the successful campaign I’ve got going here. The mighty United States Peace Corps will trudge on fighting the Good Fight, but in the end we can’t be responsible for the upkeep of every last Malian’s toilet - after this period of midwifery, the subsidies are going to come to an end and the free market is going to have to finish the job. Hopefully, the valiant struggle of Operation Sphincter Plug shall demonstrate just how clean the streets can be if people just get off their asses and put their back into it, and we can win the battle of hearts and minds and bowels. One day, I can only hope that everyone in Sanadougou realizes the value of sanitation to the extent that their own reasoning is enough motivation for them to save and invest their own money into concrete nyegens and soak pits and contain their own waste. And if they do that, there might just be less flies and cockroaches and mosquitoes spreading pathogens around, people will face less risks to getting sick in the first place, and my neighbors the doctors will be less busy treating shriveled little babies dying from simple diarrhea.