Ups and Downs

Now I’ve certainly worked on public health and development projects before, and I’ve learned that they can be frustrating, inspiring, dissillusioning, heartwarming and heartbreaking all at once. But I’ve never been quite so in it as I am here in Mali. Here, as committed as I am to MHOP’s vision and projects, the organization’s successes feel like my own, and the stumbling blocks feel like personal attacks. This leaves me on a perpetual roller coaster ride.
One day we are celebrating receiving a $20,000 grant that will go towards funding Action for Health, and toasting the completion of our part of the construction of the clinic.

The next we find out that though we had an accord with the government to build the maternity ward and provide water and electricity for our clinic, the regional health ministry has been sitting on our file for two years, and now claims that we have to begin again with a whole new request that can’t possibly receive funding until 2011.  I watch my colleagues take this news calmly, and somewhat resignedly. Some of our Malian team members mutter that they always said we should never depend on the government, obviously they wouldn’t come through, it is time to find a new source of funding for the maternity. Inside, I am worried and angry. The monologue in my head runs something like: How can this be? Didn’t they promise to pay half the costs of building the clinic? Didn’t we base our work on those very promises? Isn’t MHOP all about connecting slum residents with the government? If we end up having to fund it all ourselves without help, doesn’t that make us just like any NGO who plops down to distribute social goods until, one day it leaves? Does this undermine everything we stand for? How can everyone be taking this so calmly?”

Suddenly, a few days later, we are at a meeting with the deputy head of the Childhood Foundation (Fondation de l’Enfance), President ATT’s own charitable giving organization, telling them our woes. They agree with us that funding for CSCOMs (Centre de Sante Communitaires) is a variable, difficult business, and that ours should certainly be funded. After foreigners have come all this way and given money to help out, it is just unimaginably rude that the government doesn’t come up with their share! They offer exactly the help that we were hoping for, suggesting that if we bring them a letter from our local Community Health Association of Sikoroni-Sourakabougou (ASCOSISOU) explaining the funding mishaps and our need for the maternity ASAP, they will be glad to forward the letter to the higher ups in the Regional Health Office and even in the National Ministry of Health who have the authority to put our clinic on the list of emergency funded projects for 2010. There I am, back up the roller coaster, feeling good and as though we may actually get the job done.

My fellow Americans tried to warn me that working here seems to mean a never-ending series of varyingly dire crises, but I couldn’t really understand what they meant. Until, that is, I arrived in the midst of a different crisis, lets call it the CHAG-astrophe. The CHAG is the Community Health Action Group that is at the core of MHOP’s community based philosophy. As representatives of the community of Sikoro, the CHAG gives us guidance on what programs they think we should focus on, and then gives us Sikoroni-sensitive advice on how to run them. Unfortunately, somewhere along the line there had been a misunderstanding. MHOP had always believed that in order to be representative of the community, the CHAG had to be an elected body. To start things off, we had asked members of the community who already had a relationship with our projects to serve on the CHAG until we got established enough to hold real elections. And yet, this summer when elections were proposed, the CHAG was shocked/dismayed/angry and finally, refused.

Luckily, I wasn’t here yet when this crisis began, or it would have been a definite low on the roller coaster ride. By the time I got here, we seemed to have found a solution: instead of being elected, the CHAG members would be selected by the elected District Leaders. The plan was discussed with the District Leaders and the Dugutigi (Village Leader) of Sikoro, and when we presented it to the CHAG at my first meeting with them, they all agreed with the new idea. It seemed like I had arrived just in time for the upswing on this particular crisis, as we wrote up a new contract for the CHAG with very specific election terms and prepared to put the whole thing behind us at the next meeting.

When the day of the meeting arrived, Dramane, one of our Malian colleagues, read each clause of the contract aloud, and then translated it from French to Bambara. The murmuring started as he read about the per diem amounts meant to defray travel costs and lost work time at home for meeting attendence. As he continued on, the murmurs turned to shouts and the whole meeting broke down into a lot of yelling in Bambara, smacking the table and storming out then storming back in. Through a few French words thrown in and my broken Bambara, I ascertained that they were refusing to sign the contract unless we agreed to pay them higher per diems for attending trainings, and agreed to pay a per diem for any day that they participated in any community health activity.  How can it all be coming down to money?  The plunge down the roller coaster was swift.

I was left feeling very frustrated, wondering what was the point of focusing on community involvement, if in the end those who we thought were the heart of the organization are just in it for the (negligable amounts of) money? I slowly began to realize that this is, in fact an opportunity.  We have the chance to start fresh we new members of the CHAG, properly elected or selected from the get-go, with clear contracts emphasizing the volunteer nature of the work, a clean slate as it were.  Possibly the beginning of another ascent up the crisis coaster.  But it is another blow to my, obviously naive, vision of what the processes of working here would be like. It is hard, sometimes, to maintain a clear perspective on what is happening happening here on any given day. Sometimes it is skewed by the frustrations of daily negotiations.  But sometimes it is easy to see the problems and the desperate need for solutions, and then I am reminded that people who live here in Sikoro really do understand it all and explain it much better than I can.

Because when I returned home last night, Korkos, my host “dad” although he can’t be more than 30 years old, began telling me how important it is to have a CSCOM in the community.  “Health, education, and sport are the three most important things to provide the community with,” he said.  Even if you say, hey, we don’t live here, we shouldn’t mess with the business of the people living over there, you still should worry about those things.  If you don’t provide that, then really terrible things can happen.  Last year, there were two women who tried to make it to the CSCOM in Sikoro to have their babies and couldn’t get there in time.  One of them, my mother helped her have the baby right outside here. The other, her husband went to go find a taxi, and while she was waiting she felt like she had to pee.  She went into the nyegen, and while she was going to the bathroom, the baby came and it fell in.  By the time the firefighters came to get it out, the baby had left this world.”