Showing posts with label cholera. Show all posts
Showing posts with label cholera. Show all posts

Monday, July 19, 2010

Eating With My Hands

To preclude accusations of “cultural imperialism” the educational philosophy of the Peace Corps is all but one of cultural relativism. We are supposed to teach the people of developing countries about which new varieties of sorghum offer the highest yields, how to start a business and manage their accounts, sometimes we work in the classroom as math and science teachers – but we’re supposed to teach only objective truths and we’re explicitly not supposed to tender criticism of our host country’s indigenous culture. Understandably, few self-respecting nations which have lived through the humiliation of Colonialism – particularly those nations which have suffered under the yoke of French overlords who appointed themselves mission civilatrice and sought to discredit and dismantle the beliefs of tribal heritage – would now petition the United States to come and tell them that their culture is wrong.

However, maintaining a position of absolute political correctness is impossible when the prevailing practices in a given field are in fact objectively wrong. When Malians greet me bo swaat 8 in the morning, when bus drivers have filled their car beyond the legal maximum capacity and tell me to cough up more cash so they can bribe the police, when people ask for leaves from my lemon tree so they don’t feel guilty about not buying real medicine for their child in a malarial coma, it would be a disservice for me to just go along with the prevailing practices of this culture and not criticize the way people live in this country to their faces. Of course a liberal would argue that all of the above are the muddling of Western modernity, so all of this present-day African nonsense can be attributed to the corrupting influence of French colonial rule. But some of the most self-defeating customs which people follow here were established long before there even was such thing as a France, it would be obtuse for thinking people to subscribe to the absolutely non-judgmental broadmindedness of mushy-headed liberalism and tell themselves “it’s not wrong, it’s just different.”


Perhaps the most difficult custom for a mushy-headed liberal to digest is the way that Malians eat – because it is an objective truth that the traditional way of eating is one of the most significant vectors of disease transmission in this society. Malians by and large eat their food with their hands, and so long as they are eating with family or friends they eat with their hands from a single communal food bowl. Most Malian men tend to livestock and spread their manure over the fields, almost everyone wipes their butt all women wipe their children’s with their left hand; somehow or another over the course of the day their hands are likely to come into contact with fecal matter. Hardly anyone ever washes their hands with soap, so when Malians eat with their hands from the communal food bowl they share and consume each other’s fecal germs. Hence the primary reason why giardia, dysentery and all other forms of severe diarrhea are endemic in this culture is the purely cultural factor of how one brings food to one’s mouth.

When I arrived in Mali for Peace Corps Training, the language and cultural teachers collected me and my fellow trainees into groups of six, sat us around big aluminum bowls of zamé: fried rice with chunks of beef, cabbage, hot peppers and onions. The object of our lesson that day was to learn to eat our lunch with our hands. This task was not so daunting for a dedicated multiculturalist such as myself; I had spent a month in Sri Lanka where I learned the Indian subcontinent’s method of folding one’s four fingers into a V-shape to scoop up a mouthful of rice and sauce and pushing it towards one’s mouth with the thumb – the Sri Lankan finger scoop method could be so refined that at the end of a meal an apt practitioner should have their palm perfectly clean. In my prior experience, eating with my hands was something exotic and worldly.

“Exotic” – yes, but “worldly” is not the first word that usually comes to mind as a Westerner watches Malians eating with their hands. Unlike the Sri Lankans and their graceful finger scoop, a Malian is wont to grab a heaping handful of rice with their right hand, squeeze it in their palm, open their mouth as wide as they can and place their palm to their bottom lip as they shove the handful of rice into their gaping gullet, then thrust the entirety of their four fingers deep into their mouth so they can suck off every last drop of sauce. If they are the staple dish of grayish-green millet goop called toh, Malians will cup their hand a little more as they dip the millet goop balls into a separate bowl of sticky sauce made from baobab leaves, dried fish and peanut oil – the sucking of the fingers remains the same. All of this is done as quickly as possible with no conversation between wolfing down handfuls of food, because the faster one eats the more they can consume. After they have eaten their fill, a Malian licks his or her saucy hand clean in a manner not unlike that of a cat preening the fur on their head.

I went with the flow as I tried to integrate into the family of Karitie Sanogo and Durcas Dembele and their Minianka subgroup of the Bambara tribe. I found eating with my hand sloppy, and it was quite impractical if I was eating lunch alone and trying to read a book. But when I sat down with a group of men around the communal food bowl, I thought “When in Rome…” and shoveled away. I feared that eating with a fork or a spoon would set this hairy, light-skinned Jewish boy apart as an even more distinct Other.

Cheap aluminum forks and spoons are widely available at any sizeable market for no more than the price of a small box of tea, so there were some times though when I wondered how Malians had never developed the custom of eating with utensils by their own initiative. On special occasions Durcas would cook spaghetti seasoned with a bit of tomato paste and a heaping volume of peanut oil, and since food here is served directly from the kitchen with no time to cool off people would begin to dig in while the oil on the spaghetti was still scalding hot. The oil would be so hot that even the old men with their thickly-calloused hands would be wincing at the touch. And long strands of spaghetti are not designed to be eaten manually; every time the men around me would reach down for another painful handful they struggled to shove eight inches of floppy, steaming noodles into their mouths – at least half of the spaghetti strands would be dangling out of their mouths as they chewed, splattering hot burning oil all over their faces and all over their clothing. All of the men seemed to be in such pain and discomfort that it was hard to believe that any of them really enjoyed eating this impractical delicacy.

After a few experiences with this nonsense, the third time that Durcas prepared spaghetti I came equipped with a fork and showed them a much more efficient way of twirling it into practical, bite-sized portions. “You see, not long after the Italians learned how to make spaghetti they invented these things called forks so that they could it without burning their hands and making a mess with the sauce.”

“Maybe they eat with forks in Italy” I was reprimanded, “but here in Mali we eat with our hands.”

“Suite yourself” I thought, and twirled my spaghetti with a fork as all the other men in the family continued scalding their hands.

So long as we weren’t eating spaghetti covered in scalding-hot oil, I thought that eating manually from the communal food bowl didn’t have to be a bad thing, for I could use every meal as a forum to inculcate proper hygiene by washing my hands with soap and water and insisting that every man I ate with do the same. This should be no minor formality in a society of people who wash after defecating by sticking their left hand up their asshole, scrape their rectum with an extra-long pinky nail, and then flush their asshole clean with water from a plastic teapot. Malian culture stresses that anal cleansing is to be conducted exclusively with the left hand – “the good hand”, and that one eats with only the hand on the right – “the rice hand”. But all of this business about separating the right hand from the left comes to naught only a few seconds after anal cleansing when Malians “wash” both hands with only water from that same plastic teapot which was up their asshole only moments ago. Before eating from the communal food bowl, they will pass a calabash or tin can full of water around in a circle starting with the eldest so that everyone can mush their left and right hands together in the increasingly-filthy water. In this culture where just about everyone is completely ignorant of modern germ theory, people think this is actually a hygienic practice.

The fact of the matter is that the prevalent Malian “hand-washing” practices is one of the primary reasons why the population of Mali suffers from more giardia and dysentery than almost any other culture in the world, it goes a long way in explaining why 2 out of 5 children in this country die before the age of 5 and why life expectancy is only 45 years for men, 48 for women. If a circle of men are mushing their shitty hands together in the same calabash of water then after the calabash has gone around everyone has the fecal matter of other men on his hands. And if these men are then eating with their hands from the same bowl of rice or toh, over the course of a meal they are most likely consuming each other’s fecal matter. The Minianka village in which I have lived for two years is an unwittingly coprophagic culture, for a person to eat with their hands from a communal food bowl without having adequately washed their hands is to directly subject other people to the consumption of human feces.

I don’t think that it is going too far out on a limb to say that traditional Minianka eating habits are not just distasteful to the cultural norms to which I am accustomed but objectively wrong. Let’s say that I had in my possession a syringe containing Ebola – wouldn’t it be immoral for me to inject it into an innocent bystander and infect them with the deadly virus? Or if someone knew that they were infected with HIV, wouldn’t it be immoral for them to exchange bodily fluids with another person and subject them to that deadly disease? Knowing that the consumption of human feces is a surefire way to make someone sick, wouldn’t it be wrong to furtively slip a fresh stool from a cholera patient into someone else’s milkshake? How about if someone with dysentery wipes their ass with their hand and then puts his hand in someone else’s rice bowl? Even if someone has yet to be diagnosed with a particular malady, in this day and age when (at least in the Western world) people understand how diseases are transmitted it is unambiguously wrong to engage in practices known to spread serious illness. Ignorance might obviate moral culpability, but it does not change the fundamental wrongness of a practice which inflicts harm upon others.

Where the Peace Corps Volunteer comes into the equation to break the cycle of disease and poverty is to simply eat with the people and still live up to our own standards of cleanliness. Accepting the fact that the Minianka villagers of Sanadougou crouch around a communal food bowl to eat with their hands, I made my point of washing my hands with soap before eating and insisting that all the other men eating with me do the same. I even bought this nifty plastic contraption to replace the calabash so that everyone could wash their hands with a clean, non-toilet plastic teapot over a receptacle without dirtying their hands in other people’s filth. I was eating with the Director of the elementary school Karitie Sanogo and two bachelor teachers Lazar Balo and Boubacar Coulibaly – if there was anyone in this society who could understand proper hygiene it should be this literate elite – and even if they preferred to not wash their hands with soap they grudgingly obliged to accommodate this foreigner’s eccentric ways.


That is not to say that I didn’t have any trouble getting my eating partners to wash their hands. Karitie and the teachers were generally cooperative, but they would have guests come to eat from the food bowl on a regular basis. When we passed the soap and water around the circle, guests would usually just rinse their hands with the water and mush them together like usual. I would nag them about the soap, and they would usually retort, “In our country, we don’t wash our hands with soap – we wash our hands with water.”

“I know – and that’s why so many people in your country die from dysentery. In my country, no one ever gets sick with dysentery – it just doesn’t happen because we wash our hands with water and soap.”

Some men simply refused. “SHUBAGAW!!!” they hollered – “evil sorcerers”. Though they publicly identify themselves as Muslims or Christians, the people in Sanadougou cling tenaciously to their animist superstitions; not knowing anything about germs or viruses, they believe that illness and disease come from these evil sorcerers' black magic spells. And according to ancient lore, washing your hands with water protects oneself from such malevolent witchcraft – soap, however, negates water’s protective powers and renders one vulnerable to sorcerers and their evil ways. Grown adults seriously believe in this twaddle, to such an extent that they would raise the tone of the conversation into a shouting match.

“NO!!! I REFUSE to use soap!!! EVIL SORCERERS!!!”

“Evil sorcerers ARE NOT REAL!!! THEY DON’T EXIST!!!

At this point in the conversation, Karitie would look his guest sternly in the eye and lash them in Minianka “If you’re going to eat with the American, you have to wash your hands with soap. Just do it.”

In a society where old men are considered to be a depository of all knowledge and wisdom, people thought it was downright subversive for 24-year-old me to tell a 50-year-old cekoroba how to wash his hands. This went for anyone. Even on the occasion when the chief of the village or the Mayor of the entire Commune would come to eat with Karitie and me, without batting an eyelash I directed the upper crust of society to scrub their hands with soap. And they were duly offended. No one likes to be told that they’ve been eating shit their entire life – let alone by a foreigner half their age.

I ate like this for about a year, getting in fights with Karitie’s houseguests and winning so long as Karitie was there himself to provide the moral support. But on some occasions he would be gone on business and I would be eating alone with the teachers Lazar and Boubacar – neither of which had any desire to be cursed by evil wizards any more than the next guy, they were only washing their hands to humor their boss. One night Lazar looked me defiantly in the eye, mushed his hands in a pot of water and plunged them into the bowl full of rice, “You can’t make me wash my hands with soap.”

“You’re right. And I can’t eat with you, because I don’t want to eat rice with your shit all over it.” I got up and walked home to cook dinner by myself. Durcas was so thoroughly insulted that I had walked away from her afternoon’s work that she gave Lazar an earful; from then on before eating he would dip his hands into the soap dish while casting me the stink eye.

I put up with this shit for quite a while, but after a year of struggling to convince my eating partners about the merits of soap from time to time I would still find myself running to the nyegen with giardia. I was filtering and treating every drop of water that went into my body, so the only way I could possibly be getting giardia was from the food I was eating. I began to watch the other men eating from the food bowl more closely, and I realized that that a lot of them were merely feigning to apply soap; most dinner guests – and Lazar of course – were meekly touching the bar of soap with the tip of their forefinger and calling it a day. Apparently they thought that hand-washing with soap was just some sort of Tubab eating ritual (though it isn’t – we don’t eat with our hands from any sort of communal anything). No matter how many times I tried to explain how soap actually has chemical properties which detach particulate matter from one’s skin and kill the microorganisms which cause diarrhea, they thought that I was just spouting off American mythology equivalent to their own folklore about witches and wizards. No matter how hard I tried, it seemed that science, reason and the moral power of example had no use on these people – and that for me to eat with my hands from a food bowl meant that I would inevitably be eating other people’s feces.

I thought long and hard about this. Eating from the communal food bowl was more than just a ritual in Minianka society. Even though conversation has nothing to do with it, eating together with another person is the most basic social activity which I could partake with another Minianka man as a sign of friendship and camaraderie. To be a part of this society meant eating with the same food as them, to eat from a food bowl with another is to treat them as one’s equal. To eat alone would be interpreted as a strong demonstration that I truly wished to set myself apart from this society.

I called to seek the wisdom and sagacity of my elders, and my dad recounted a conversation we had had when I was a senior in high school driving around New England looking at colleges. I had made a point of checking out schools where Greek life was small to nonexistent, because I didn’t want to be faced with the choice of either joining a fraternity or having no social life.

“Don’t worry about it, Zac, even if you go to Dartmouth or Cornell that doesn’t mean you have to join the Deltas. There are better ways of creating lasting bonds with friends than running some dehumanizing hazing gauntlet.”

“If I did want to join a fraternity, what would I have to do in order to pledge?”

“Let’s put it this way: if you’re invited to join a secret society and you’re told you have to eat a brother’s feces, just say nothing more and walk away. If you have to eat someone’s shit in order to be a member of a society, there can’t be any compelling reason for you to be a part of it.”

Thus I concluded that I could no longer eat from the communal food bowl.

I came to Karitie and Durcas’ house one day with my own plastic bowl and explained that from that day onwards I could only eat alone. They really didn’t know what to make of it – no one had ever done or said anything like this before. I didn’t have the heart to explain to them the real reason why I couldn’t eat from the men’s bowl, I feared they would interpret it as a grave insult and they would disregard anything else I had to say. So I offered a little white lie that my doctor told me I needed to lose weight and that I should start exercising portion control: “It’s not that I don’t like eating your rice and peanut butter sauce, it’s that I love it so much that if you put the whole bowl in front of me I’m going to eat the whole thing!”

But Karitie and Durcas are intelligent people. Eventually they figured it out.

For the rest of the year, guests to their food bowl would make a stink about me eating alone. People would accuse me of being an elitist or a racist; they would ask “You think you’re better than us?” I didn’t want to make a big deal of it, but in regards to the very significant matter of hygiene I certainly did think so – I knew so, it was a fact.

And eventually I realized that since I was eating by myself, and conversation has nothing to do with the Malian eating ritual anyway, I might as well bring a book or magazine with me to read while I ate from my private food bowl. But it was difficult to turn the pages when I had peanut butter sauce all over my right hand, so I started bringing a spoon with me to all of my meals. Eventually I dropped the eating with my hands business altogether, because I had discovered a much cleaner, more efficient and hygienic manner of bringing food to my mouth.

The more I thought about it, there is really no compelling reason for me or for anyone else to eat with their hands, that it’s simply a primitive practice employed by those cultures who have yet to embrace modern sanitation. Hand-washing with soap is a harm-reduction practice which can reduce the spread of disease among cultures that eat with their hands much like if heroin addicts were to shoot up with clean needles instead of sharing them – but the harm can be eliminated if people would stop shooting heroin altogether. I resolved to never eat with my hands again.

Once I started eating with utensils again, Durcas remarked that I was “eating like a Tubab.”

“No matter how long you look at it, a tree stump will never turn into a crocodile”, I replied. The one and only proverb in the Bambara language means that some things just don’t change.

And eventually I noticed that Karitie, Lazar and Boubacar had given up on washing their hands with soap. It was plainly obvious that they had been going through that charade the whole time to humor me – not because they were actually serious about adopting this practice. Despite a whole year of my lectures about the giardia, the fecal-oral cycle and disease prevention, the most educated men in the entire community were still content to be ingesting each other’s fecal matter.

“No matter how long you look at it, a tree stump will never turn into a crocodile”, Karitie said.

I was really disappointed with this outcome, both with my host family and with myself. I interpreted it as my greatest failure in two years of Peace Corps service.

The people of this village requested a Peace Corps Volunteer to help them build the capacity to improve their water and sanitation, so the United States government decided to take this former lifeguard with three years experience testing and chlorinating the pool water, they trained me to build concrete wells, latrines and wastewater receptacles, and sent me to Sanadougou. With the help of the Water Committee and my expert mason counterpart, we secured roughly $6,000 in USAID , NGO and private donor grants to build 112 latrines, 96 soak pits, 3 infiltration trenches and 6 top-well platforms in families’ homes, we built a row of latrines at the secondary school, we built a row of latrines at le Bureau de la Mairie, we even repaired and reorganized a broken solar water pump-to-tap system so that the people of Sanadougou could enjoy clean, potable drinking water. After all the work that we did, Sanadougou is now a visibly cleaner place. Though I have no way of compiling exact statistics, our work to improve this community’s infrastructure should lead to a significant decrease in the transmission of diarrheal diseases.

Though as I prepare ready to leave for America, I fear that all my work has come to naught because I wasn’t able to make a dent in Sanadougou’s eating habits. The World Health Organization estimates that if people would only wash their hands with soap it would reduce the incidence of diarrheal disease by 43 percent. Even if Engineers Without Borders were to expand the solar pump-to-tap system and bring running water directly to every family’s kitchen, even if some charity were to give the people of Sanadougou a lifetime supply of bottled Evian so long as people keep on eating the way that they do now they are still going to be consuming each other’s shit. Until people in Mali are willing to change their habits, giardia and dysentery are going to forever remain facts of life and children in this town are still going to die from simple bouts of diarrhea.

The fact of the matter is that sometimes tree stumps do, in fact, turn into crocodiles. There’s a word for this phenomenon: “progress”. Hundreds of years ago, the disparate Slavic tribes from which I am descended, the Franks, Teutons, Angles and Celts all lived in earthen huts, they farmed the little food they had with simple hand tools made of iron and wood, they lived in poverty not unlike that of the present-day Miniankas. They didn’t have toilets, they didn’t have toilet paper, and they ate their potatoes with their hands, so the tribes of Europe suffered from endemic giardia and dysentery and they had a life expectancy about as low as that of the Miniankas today. But sometime around the 10th century the French and Italian nobility popularized a simple technology which made eating all the more cleaner: the fork. It took a few more centuries for the peasants and lowly serfs to follow in kind, but eventually all the people of Europe adopted this new custom which not only made eating easier and more pleasurable but also reduced the incidence of disease.

There was also a time in the not-so-distant past when Europeans didn’t quite understand disease transmission either; they thought that sickness was spread by the Devil, the cold and the wind. There was a time when angry mobs massacred Jews by the hundreds because they could think of no other explanation for why the plague had come to their city, they burned so-called witches at the stake for causing outbreaks of cholera – very few Westerners took the time to question whether the spread of disease had anything to do with the complete and utter lack of sanitation in the cities where people lived amongst and ate and drank their own filth.

Now America, Europe, Japan, Australia and all the countries of the developed West have established a culture in which it is absolutely unacceptable for people to eat most foods with our hands, we all eat from our own separate bowls and separate plates with our own separate sets of utensils. And even though a surprising number of Westerners are not conscientious about washing their hands on their way out of the bathroom, we have developed our cultural habits to the point where even if you invite someone over for dinner and they did have microscopic pathogens crawling all over their hands, it wouldn’t really matter because at no point over the course of the meal is your guest ever going to put their hands in your food. As a result, giardia, dysentery and cholera are all but nonexistent in Western societies, it would be a freak occurrence if a child were to die from diarrhea, and we can expect to live to a ripe old age in our late 70s. It is only a rare occasion when someone falls so sick that they cannot work, and since we are so much healthier and more productive we have so much more wealth and a superior standard of living.

When I try to explain this to Malians, they typically respond along the lines of “Well, you Americans are healthy because you have so much money and you can buy so much more medicine” – they think that every time we contract dysentery we just pop some expensive pills and that’s the end of it. I insist that Americans don’t ever contract dysentery to begin with and few will believe me – gastrointestinal disease is simply accepted as a fact of life in these parts. More worldly Malians might understand that everyone in America has flush toilets and tap water in their home, but they can still attribute that to our superior wealth – it seems that no one is willing to be critical enough of their own culture to realize that maybe our superior health has more to do with our superior hygiene and superior methods of disease prevention, and that they could improve their own health if only they adopt new methods of eating.

The people of Mali have a choice; either they can overcome the pagan superstitions about evil sorcerers and start washing their hands with soap, or they can start eating from separate food bowls, or they can start eating with forks or spoons or chopsticks or spatulas or flat-nosed screwdrivers - anything besides the hands; even better, they can adopt some combination of all of the above. Or they can continue what they’re doing and forever remain mired in this endless cycle of disease. This kind of change is not something that white-skinned NGO workers can do for them – changing the habits and customs of Malian culture is something that only Malians can do for themselves. And when they do take this great leap forward, the people of Mali will finally understand that development is not just about building roads and factories but that it is also about changing behavior, that positive change doesn’t require massive foreign aid and that it can be done on the cheap or for free, and that the future of their society truly rests in their own hands.


Sunday, December 7, 2008

Calling All Soapmakers!

As a Peace Corps Volunteer serving in Mali, I am doing my part to improve water sanitation on the village level. Due to the utter lack of infrastructure, the vast majority of Malians have nothing to wash with other than well water often contaminated with giardia, amoebas and other parasites transmitted via the fecal-oral cycle. This is among the reasons– and without a doubt the most easily preventable one – why juvenile diarrhea is endemic and 25 percent of all children in Mali die before age five. It is also the reason why I would like to enlist American pharmaceutical companies such as Unilever, Colgate-Palmolive, Jergens, Proctor & Gamble or Estée Lauder to help fund the construction of hand-washing stations at Mali’s public schools.

Here in Mali the most widely-practiced sanitary practice is that people wipe with their left hand and eat with the right. After going to the latrine and before eating people will rinse their hands with tin can full of water, but when one has fecal germs on their left hand and they just get it wet and mush it around with their right hand, and then they pass the can of now-filthy water to the next person to “wash” their hands, it kind of defeats the whole purpose. Add the fact that Malians eat with their right hands from a communal food bowl, and it is not very difficult to understand why giardia, amoebas, cholera and dysentery are so widely transmitted.

The most feasible, cost-effective means for Malians to mitigate disease transmission and improve health conditions is something quite simple: washing one’s hands with soap. It doesn’t sound very profound, but the Malian Ministry of Health has invested a good deal of its resources organizing adult education programs and broadcasting public service announcements to persuade her citizens to undertake this basic hygiene practice. It should be any easy task. Soap is cheap and readily available; most Malian women are in some way, shape or form involved in the collection of shea nuts or the cooking of shea nut butter which is used to make soap.

Malians use soap made from their shea nuts to wash clothes and dishes, but oddly enough very few people use it to wash their hands. Animist beliefs shared by many Muslims and Christians extol the benefits of washing one’s hands with only water to protect against malevolent spirits, and many people believe that using soap would render them vulnerable to sorcerers’ evil spells

Though a number of Malians are trying to do away with these superstitions and espouse modern sanitary measures. Karitie Sanogo teaches his first-grade students how to conduct basic hygiene practices like washing their hands. To Westerners this might sound like condescension, but when most adults believe in the black magical qualities of soap the fact is that the only way majority of Malian children will ever be taught to protect themselves from fecal-oral diseases is through the public school system. Sanogo explains that he tries in earnest to teach his first-grade students the virtues of soap, but it is difficult to instill modern hygiene in impressionable minds when they cannot even practice their lessons into their daily routine at school.

There are brand new latrines at the elementary school, but there is no place for the students and teachers to wash their hands when they are done. So the headmaster would like to construct a hand-washing station. A hand-washing station would consist of two plastic barrels with spigots raised to a reachable height for children by a concrete structure. Most importantly, each station would be made with a soap dish so that every time a child walks from the latrines back to class they would have an obvious and unavoidable opportunity to wash their hands with soap.

The most difficult aspect of projects like this is not their construction per se, but rather their financing. If I wanted to build just one or two of these hand-washing stations, I could acquire funds from U.S. A.I.D. or the U.S. Embassy. Though what I have in mind is on a somewhat larger scale. There is a program known as the Peace Corps Partnership which allows Volunteers to work on projects financed in whole or in part by private individuals, NGOs or corporations. In this sense capitalism is not just a means unto itself but can be used as a means to humanitarian ends.

I would like to petition one of the aforementioned corporations to establish a fund for Peace Corps Volunteers to construct hand-washing stations throughout Mali, or even Africa at large. Much of this shea butter cooked from Malian harvests is consumed locally, and in recent years Western companies have begun to purchase Malian shea nut butter to manufacture gourmet soap, moisturizing cream, shampoo and conditioner. I would like to argue that those companies which earn hundreds of millions of dollars of profits selling shea butter products have an ethical obligation to invest a negligible fraction of those profits into promoting the hygiene of those populations at the bottom of their supply chain.

Even from the rational self-interest of a profit-maximizing firm investment in hand-washing stations is beneficial in that they are meant to create a whole new generation of consumers of soap. The fact that tens of millions of people in Mali and elsewhere actively refrain from washing their hands with soap should be seen as a lost consumer base which can be captured with a bit of public education and investment in simple sanitation infrastructure. Even if the company does not sell its products in Malian markets, the good publicity which such a humanitarian campaign would engender could certainly help to establish a favorable reputation among socially-conscious consumers.

This is a win-win proposal which would benefit both soap producers and the people of Mali. So please, if you happen to work for a company that makes shea butter soap, shampoo or moisturizer, or if you know anyone who does, please drop me a line. There are a number of Peace Corps Volunteers in Mali who would like to put together a joint venture.

Tuesday, December 2, 2008

Living By Ethiopia's Sewage Canal

As much as Mali could use some work on its water sanitation, conditions in Ethiopia's capitol city are much, much worse.

Monday, October 20, 2008

Operation Sphincter Plug

If you read any literature from the United Nations, World Health Organization, etc. the most widely-used statistic to measure the development of water sanitation infrastructure is the “percentage of the population with access to clean water.” My village of Sanadougou has one water pump which filters out particulate matter, guinea worm larvae, amoebas and giardia cysts – so according to UN/WHO criteria, 100 percent of Sanadougou’s 4,426 inhabitants have access to clean water. And so now everyone is parasite-free and perfectly healthy and there is nothing left for me to do here.

… Just kidding. The Japanese foreign aid agency which funded the construction of the primary school in town was certainly benevolent and forward-thinking in their construction of a water pump and filter next door. So when elementary school kids are thirsty they can drink clean water, and so can I and the few people whose houses are right next to the filtered water pump. But water is surprisingly heavy, and to draw a bucket of water every time you have to take a drink, cook a meal, clean the dishes, do laundry or water the garden, and carrying 50 pounds of water on your head for any distance is an onerous, tedious task. Asides from the cluster of families whose houses are in the direct vicinity of the school, very few people in Sanadougou ever bother to walk all the way to the pump and back.

I would say that 95 percent of the people in town drink well water. And when I say a well, I don’t mean a raised cement-brick structure with a cover and a pulley. When I talk about a well in Mali, I usually mean a hole dug in the ground with water in the bottom – slightly discolored water which looks like the pond you swam in at summer camp. Most people have their own well in the family compound, which means that it is situated on the dirt floor probably equidistant from the kitchen, the chicken coop and the donkey stable. So when your typical Malian is thirsty, the nearest woman drops a bucket into the hole in the ground, pulls it up and drinks whatever is inside. Sometimes people just crouch down in the nearest mud puddle, cup their hands and slurp up the contents.

Hence even though everyone in Sanadougou technically has “access to clean water” provided by the most state-of-the-art Japanese-built pump, if people prefer to drink from their neighborhood mud puddle, the concept of water sanitation here is really little more than a figment of the imagination of some bureaucrat sitting in an air-conditioned office in Geneva. And likewise, it is not very difficult to understand why diarrhea is after malaria the most lethal cause of infant mortality in this country. Some nights when I can smell the telltale sulfur wafting in the air, if I can gauge the direction from which the wind is blowing I can tell precisely which of my neighbors has giardia – my olfactory hypothesis at this point is approximately 70 percent of the good people of Sanadougou.

Some old, dead white guy once said that “Politics is the art of the possible.” My mission over the next two years is to design and implement an affordable and feasible plan to reduce the number of people in this village suffering from water-borne diseases, and methinks that the most doable stratagem within my reach for reducing the number of children who die from dehydration before their parents carry their tiny bodies to the clinic next door in vain is to concentrate on combating diarrhea. The threat of HIV/AIDS, cancer, tuberculosis, African river blindness, and even Al-Qaeda in the Islamic Maghreb pales in comparison to the threat to Malian well-being posed by diarrhea, and so it is this doer of evil towards which I am for now concentrating my labor. And so I call my current campaign Operation Sphincter Plug.


I am absolutely anal retentive (pun intended) about what I drink, so any drop of water which gets anywhere near my mouth – unless it was previously in a boiling teapot – comes first from the Japanese water pump, then I filter it again with my own personal two-tiered charcoal filter to be doubly protected against undesirable water-borne organisms, and then I treat it with an ample dose of chlorine bleach. If the Republic of Mali could purchase one of these babies at maybe 50 bucks a pop for each and every one of its 11 million concitoyens, then cholera, dysentery, amoebas, giardia and every single malady which leads to juvenile diarrhea and infant mortality would plummet. However, the World Bank’s inflation-paranoid lending policy has commanded that Mali keep government spending to an absolute minimum – thus no such program could conceivably exist so long as their development policy is restricted to the free market orthodoxy of the Washington Consensus.

I could also organize the farmers of Sanadougou to put aside all of the profits from their peanut and cotton harvests from now on, spend none of it on food and medicine and instead put those profits away in one of the local banks which does not give out interest, and pray that maybe 80 years from now there will be enough accumulated enough capital to construct a new water pump in the center of the village. If this plan works, then the World Bank would be very pleased as the invisible hand of capitalism develops without government interference.

Accepting the fact that people are going to drink from their wells until a more convenient source of water appears in their family courtyard, and acknowledging the cruel realities of my financial constraints, the first forward offensive of Operation Sphincter Plug to eradicate juvenile diarrhea in the village of Sanadougou has been rather modest. Since I can't buy everyone their own personal two-tier charcoal water filter, I am endeavoring to replicate the chemical reactions which occur in the bottom tier of my charcoal water filter: chlorine bleach treatment, a method which works against microscopic pathogens but not larger parasites like guinea worm. I am spending most of my time now going door to door and talking to housewives about how they can treat their well water with chlorine bleach available at any every butigi (the Malian equivalent of a bodega).

Though the concept of microscopic pathogens is not widely understood – many people believe in witches and warlocks – there is a Bambara term banakise which means “bad seeds”. Nobody seems to know what these “bad seeds” are or where they come from, but they are undoubtedly very, very bad. Every Malian I talk to accepts that banakise - whether created by nature or by black magic - can cause sickness. I am never going to be able to get people to stop believing in sorcery, but I’m not a missionary and I don’t care if people believe in ghosts or goblins or the Easter Bunny so I’m not even going to try. Without challenging people’s beliefs or skimping on the science, I explain that chlorine bleach kills the banakise. So far people seem to be receptive to the idea, and they are much more receptive to my suggestions in regards to treating water with chlorine bleach than they are to washing their hands with soap.

I am also trying to teach people how to treat their wells each month with a larger amount of bleach, and this is tremendously more difficult as it involves math. In order to treat well water with the appropriate amount of bleach, one must first ascertain the volume of water in the well. As anyone who has ever taken a junior high school geometry class could probably figure out, this entails measuring the diameter of surface, measuring the depth of the water with a rope tied to a rock, and calculating the volume of a cylinder. Using the Bambara words for “depth” – dunya - and “diameter” - fie, one calculates the volume of well water with the formula
V = d x [π ( f2 / 4)].


Some people in town can understand this concept very well; i.e. people who use math on an everyday basis such as the math teacher, the doctor, carpenters. But the majority of people in Mali are illiterate. I don’t mean illiterate as in people who get their news from the graphs in USA Today – I mean illiterate illiterate, as in people who sign their name with an “X” - if they even know how to hold a pencil. Though the schools in Sanadougou are free of charge, many people simply don’t go because their family needs them to herd cattle and till the peanut fields, and therefore illiteracy is simply a fact of life. In a society where the ability to read and do math beyond simple arithmetic is quite rare, to many people the expression: V = d x [π ( f2 / 4)] is absolute gobbledygook. And so I am engaged in the tedious process of doing the calculations for every family's well and writing a table so all that they have to do is measure the depth of the well water.

That's not all. If you think that it might only be difficult to explain the concept of measuring volume in cubic meters, try explaining the concept of what a meter is. Few people besides carpenters even have any means to make a precise measurement - a peanut farmer who makes the equivalent of 400 dollars a year has little reason to invest in a meter stick. So for many families, I have actually made them meter sticks by simply taking a flat board or pole and copying the hashmarks on my own.

At this rate, I will have explained the treatment of well water with chlorine bleach to every household in Sanadougou in one year; if everyone to whom I teach this practical water sanitation method actually employs it, maybe - just maybe - the number of kids in this village who die from diarrhea-induced dehydration will decrease. Now if only I could convince everyone to wash their hands with soap...