Some Food for Thought

Over this holiday season I’ve been traveling around Tanzania with my sister who has been volunteering here as a health educator. Though she has been primarily working on HIV/AIDS issues, I of course have been more interested in how this particular African country has been dealing with waterborne diseases. And the fact of the matter is that – just as Tanzania’s economy is experiencing relatively solid growth while Mali is left watching on the sidelines - Tanzania is steadily improving its indicators of water and sanitation while my beloved Mali remains mired in stagnation and disease.

Statistics vary according to the respective methodologies of the World Health Organization, the Center for Disease Control, UNICEF, etc.; and public health statistics are notoriously difficult to measure in the hardly-functional states of sub-Saharan Africa. But the broad picture is clear; though health indicators in Tanzania remain generally abysmal, they are considerably less abysmal in Tanzania than in Mali. Here in Tanzania there is a significantly lower prevalence of diarrhea, giardia, dysentery and cholera; Tanzania has a lower prevalence of death by diarrheal disease, a lower infant mortality rate, a lower child mortality rate, and a slightly greater life expectancy overall.

And in many of the same reports, you will find that only 24 percent of Tanzanians have “access to adequate sanitation facilities” i.e. toilets or latrines. This statistic too is prone to wild estimation and subjectivity, but I think that it may be the most telling. A Westerner might look at this figure and read it to mean Tanzanian sanitation infrastructure is atrocious – I think that would be a fair statement – but they don’t know the meaning of atrocious until they read that only 1/6 of that fraction, a mere 4 percent of Malians have “access to adequate sanitation”. The blunt truth is that beyond the likes of Niger, Mauritania, Haiti, Afghanistan and the very nadir of the most-underdeveloped countries of the world, it is difficult to exceed the sheer disarray of sanitation in the Republic of Mali.

Confined to the realm of pure statistical analysis, one might be inclined to assume that that is the whole story; Tanzanians have more latrines and soak pits than Malians, latrines and soak pits reduce the chance of fecal contamination of the drinking water, therefore Tanzanians have less prevalence of giardia and dysentery and greater life expectancies than Malians. Q.E.D.

But there’s more to it than that. In addition to the existence of water and sanitation infrastructure of the lack thereof, the prevalence of diseases transmitted via the fecal-oral cycle is tied to sanitation practices. Loyal readers of this blog are probably familiar with the fact that Mali’s appalling prevalence of gastrointestinal disease is largely caused by the country’s traditions which entail that the people of that country clean their respective anuses with their respective left hands, they “wash” their hands before eating by mushing their left and right hands together in a tin can of water used by every member of the eating party, and then they eat from a communal food bowl with their respective right hands. Popular Tanzanian anal-cleansing and eating practices are not much better; they generally eat their corn ugali with their hands, very few ever adequately wash their hands with soap, and even fewer use toilet paper or a bidet.

However, there are a few subtle differences. Most notably, when Maasai herders “wash” their hands without soap, they don’t dip their hands into a container of increasingly-filthy water. Instead, the eating rituals of the Maasai culture involve the youngest boy bringing a pitcher of hot water to his elders and pouring it over their hands. Even if they’re not doing a very thorough job of washing their hands, at least they’re not making them even dirtier as the Miniankas are wont to do.

And even though the Maasai maintain the uncouth tradition of eating with their hands, they do not eat with their hands from a communal food bowl. You see, in addition to drinking tea and eating fried potato “chips”, Tanzanians adopted from their former British colonial overlords the practice of eating from individual plates. This – I believe – makes a world of a difference. Even if someone is going to eat ugali with fecal matter-tainted hands and unwittingly practice coprophagy, there is relatively little risk of contracting giardia, dysentery or cholera by ingesting one’s own fecal matter – if there are amoebas in your stools, then you already have amoebic dysentery. The only way to contract fecal-oral cycle-transmitted disease is to ingest someone else’s poo particles – a risk significantly downgraded by a culture that shifts from eating from one shared bowl of food to multiple, individualized bowls of food.

I can only assume that the hygienically-superior eating habits of Tanzanians and their hand-washing practices which at least are not counterproductive probably provide a partial explanation of why this society is significantly less mired in disease than the people of Mali. Of course, this hypothesis would be quite daunting to prove as 1) there is no control group; and 2) if compilations of data on disease prevalence are shaky and “access to adequate sanitation facilities” is much too subjective to ever be analyzed scientifically, any statistic like “the prevalence of adequate hygiene practices” is 100-percent subjective and therefore epidemiologically-useless.

Nevertheless, I suppose that the conclusions are quite clear: cultures that are receptive to amending their cultural practices at least stand a chance of improving their public health and their general standard of living. Conversely, cultures which exhibit little genuine interest in learning how to swim are more liable to sink. If the people of Mali want to sully their hands in each other’s filth and eat with their hands from the same food bowl, then they are going to remain forever mired in gastrointestinal disease.

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 swa” at 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.

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!!!!!


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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.

Upholding and Defending My Own Constitution

In more personal terms, upon my arrival the dugutigi (village chief) let it be known that I ate was to be adopted as a son by a teacher Karitie and his family who live down the road from me. This arrangement could not possibly be any better for yours truly. Karitie speaks fluent French, so he is able to teach me the nuances of Bambara quite well. Besides being the best cuisinière in town, his wife Durukas is also one of the most educated and informed women whom I have met thusfar in Mali – she is an advisor to the Mayor. Their sons Kam and Jafete and their daughter Diko act as my teachers as well; they are helping me navigate Malian youth culture, to fully appreciate American hip hop and Jamaican reggae, and with the their help I have received the worst haircut in my life – I should have known it was a bad sign when la coiffure muttered “I’ve never given a white boy a haircut before.” So in conclusion, I tried to make lemonade out of this lemon of a situation and I shaved my head.

… But I digress. So I reiterate that during the first three months at site I am supposed to take it slow and get a feel for the community in which I am living and working – I’m not just plopping down here and starting to dig wells willy-nilly. Even without constructing a new water pump, merely getting my own house in order and understanding what is going on here is difficult enough for the time being.

My number #1 priority at the time being is to carry out the first imperative of Mission Number 0079 and maintain the Constitution of Zachary Asher Mason. I reiterate that with all of the mosquitoes, flies, ants, beetles, termites, hookworms, roundworms, tapeworms, centipedes, millipedes, crickets, cockroaches, praying mantises, amoebas, giardia cysts, lizards and other organisms who would like to feed off of yours truly and my own supply of nourishment, this is no simple undertaking.

At this incipient stage of my existence as a member of Malian society, my modus operandi has been heavily influenced by the strategic thinking of George Kennan. As the Red Army had ensconced its dominion over Eastern Europe by the conclusion of hostilities in 1945, Kennan realized the futility of attempting to roll back the Communist bloc by sheer force and the dangers which such overreach could impose on America’s immediate national security interests. Likewise, I believe that I must first focus on the maintenance of my direct interests in surviving through September 2010, and even if I do nothing more than strive incessantly to preserve my own health and to contain the spread of water-borne diseases to my own person, the worst that can happen is that the strength of my example will rub off on my neighbors so they might improve their sanitary practices in kind.

The most difficult aspect of maintaining my own health is not the direct hazards of any non-humanoid organisms per se, but rather excluding myself from what water sanitation extension agents refer to as “the fecal-oral cycle”; in other words, how germs get from your poop to your mouth. In Mali, certain cultural practices make this mode of disease transmission rather facile.

As spelled out in the classic Sanitation Without Water – a must-read for anyone interested in the anthropology of anal cleansing,

“A basic distinction between people is that some are ‘washers’ and some are ‘wipers’. There words refer to how people clean themselves after they have excreted. Washers use water, wipers use some solid material like grass, leaves, paper, sticks, corncobs, mud balls or stones (Winblad and Kilama, 1985).”

The vast majority of Malians are what Winblad and Kilama would categorize as “washers”, and though most adults have had extensive practice with the plastic teapot method, from time to time even the most experienced washer inevitably gets a little bit of poo on his or her finger.

If everybody here ate from their own separate plate from their own separate utensils, this would be no big whup; but the traditional method for Malians to eat their meals is for everybody in the family and any guests to share from the same common food bowl – and everyone eats with their hands. And so it is not very difficult for the layman to understand why the fecal-oral cycle is such a common means of disease transmission, particularly for such illnesses which result in the symptom of messy diarrhea which will inevitably get all over one’s fingers such as cholera, dysentery, giardiasis and amebiasis.

The fecal-oral cycle could be easily discontinued if those who suffer from nasty diarrheal disorders were to wash their hands thoroughly with soap after taking a dump and again before eating from the communal food bowl. And that is why every time I sit down to eat from Durukas’ bowl of delicious rice with peanut butter sauce, yams or beans, I see to it that everyone eating with me washes their hands like it’s their job – because it actually is my job.

The very simple practice of washing one’s hands with soap is without parallel the easiest, cheapest, most effective means of reducing the transmission of potentially fatal diseases; however, many people are still reluctant to do so. As continued in the literary masterpiece Sanitation Without Water,

“In all cultures there are taboos surrounding defecation practices. Your enemy, if he gets hold of your faeces, can cause you great harm. Evil spirits may live in the pit… Religion may even lay down rules for cleaning after defecation (Winblad and Kilama, 1985).”

Many times when guests come to dine at Karitie and Durukas’ house, they are taken aback when I tell them to wash their hands with soap. It’s not an economic issue – everyone has soap to clean their clothes and their dishes, for soap is widely available and easily affordable. Pretty much every woman in Mali is involved in the collection of shea nuts and cooking them into shea nut butter soap.

Washing one’s hands with soap is more of a problem of superstition. You see, in Mali people are accustomed to washing their hands with only water, for soap is thought to wash away one’s luck. More specifically, I was told by one man who was reluctant to soap up his hands that if he did, then he would render himself vulnerable to the shubagaw – sorcerers who could then curse him with evil spells. He then lifted up his right hand curled in deformity, explaining that sorcerers wishing him ill transformed into bees and stung his hand to cause its present condition.

I cannot articulate in words just how frustrating it is to try to explain germ theory and disease transmission to someone who believes that sickness comes from magic spells.

So when put on the spot, I have to be blunt, "Today you were working with your father's cattle all day long. And the last time you took a dump, maybe a little bit of your poop got on your hands. You cannot see them, but there are little pieces of poop on your hands. If you dunk your hands in water, all you're doing is getting the little pieces of poop wet. I don't want to eat poop, so if you want to eat with me you have to wash your hands - with soap. I want to see bubbles."

I understand that it is a sensitive topic - nobody likes to talk about ingrained cultural practices regarding fecal matter when they are sitting down to eat. But my host family is on my side, so when push comes to shove they tell their guests that the village wanted a Water Sanitation volunteer for a reason, and that I am right - and that they should wash their hands with soap when they're dining with me or not.

I try my best not to be patronizing, especially with adults. But I don't want amoebas living in my gut, so sometimes spelling out the fecal-oral cycle in graphic detail is necessary when it comes to preserving and upholding my own constitution.