Diet Pills for Africa, Rap Stars, Missionaries and Human Sacrifice

LETTER: July, 2009

 

“You’re different from other Americans,” Alvaro remarked.

“How so?”

“I met some Americans here who thought Spain was in Mexico and that Spanish people eat Mexican food.”

“You’re kidding.”

“No, I’ve met many Americans who think that Europe is a country and Paris is the capital.”

 

Walking through the winding stone alleys of Hombodi with Alvaro is a uniquely entertaining experience.  Everyone, from small children to the venerable elderly suddenly go from walking normally to limping, hunched over rubbing their head.  “Alvaro!  I’m in so much pain,” they point to the afflicted body part they’ve chosen for today’s performance.  “Do you have any medicine?”  Alvaro curbs his displeasure and suggests they visit the doctor when the hospital is open tomorrow.

 

A pharmacist working with a Spanish NGO, Alvaro spends his days at hospital that is part of a joint Italian-Spanish venture.  As seems to be the trend with the Italian NGOs, the hospital is actually a massive compound, a fortress on the edge of town, requiring 15 minutes just to follow the perimeter wall to the entrance.  I’ve seen similar Italian fortresses, now abandoned monuments, in remote parts of Niger and Mali.  Alvaro’s job is not at all what he had imagined.  He sorts through medicines donated to the NGO by various corporations: a giant quantity of expired or almost expired diet pills, blood pressure medicine, and other medicines aimed to keep the overweight denizens of the developed world alive for as long as possible�"the irony is not lost on Alvaro working in Mali where malnutrition hovers around 30%.

 

“It’s a tax break for the corporations,” I explained to the mystified Alvaro.  “They donate expired diet pills to Africa then write it off on their taxes.  The World Health Organization as well spends a tremendous amount of resources in wading through inappropriate medicines, but in the end no one does anything to curb the corporate opportunists.”

 

That day, a Malian doctor was attending, the medicine was not free, the place was vacant and Alvaro has nothing to do. The Italian doctor is on vacation.  When he’s attending, the medicine is free, and there is usually a line of 30 people, a large number for a tiny village, at any given time waiting for treatment. Alvaro finds himself dispensing medicine to the same people every week.  “They say the pill for their head gave them a stomach ache and they need new medicine,” Alvaro said wide eyed and exasperated, “and then I see the pills at the market, laid out on a cloth in piles, no labels, all mixed up.  There’s no control!”

 

I felt a little insensitive openly laughing at Alvaro’s distress, but insensitivity never stopped me before. “Think of it this way, man.  You’re working in micro-enterprise!”

 

Medical missions are (in my less-diplomatic opinion) generally a shady enterprise.  Doctors arrive to dispense medicines and change “behaviors” through health “education” as if treating people like dogs who need to be trained has ever or will ever do anyone any good.  Meanwhile, Western medicine is very much a product of centralized wealth and the unique version of science such wealth perpetuates. It is perceived as “modern” and prized by the locals�" the appeal of seeing a doctor in a white lab coat and taking pills is more like driving a shiny car with new rims than about efficacy and human health.

 

Back in Bamako I had been invited to attend a discussion on health care organized by French medical students working on local health initiatives, as well as a handful of Malian doctors.  The students wanted to confront Mali’s major health problems, as well as learn from traditional medicine.  There was discussion of French efforts to scientifically verify the efficacy of locally used herbs, so they could be patented and sold, dosed appropriately by French corporations.  Non-herbal remedies and conceptions were the source of contention�"for example, how do medical professionals educate people who think that epilepsy is contagious and caused by spirit possession?  The debate seemed to be oriented between students who felts science was necessary to verify traditional medicine, and others who had a kind of New Age conception of energy that they applied to Malian traditional medicine.  Finally, one of the participants wanted to know what “the American” had to say about health care, since I hadn’t said a word the whole discussion.

 

“I think there are two things we are leaving out of the discussion. First, I think it’s important to recognize that both illness and treatment have a social context and social meanings be you in France, the US, or Mali.  It’s not just about whether treatment works or how it works, but about what it means socially.  Second, there is the question of the political economy of medicine.  People who refuse western medicine in favor of traditional medicine may be making a wise economic calculus. But as well we should realize that in changing the traditional medical system to a western one we are creating markets for western pharmaceutical companies.  Money that previously went to a traditional healer, who valued the environmentally sustainable production and harvesting of herbs, is now leaving the community and going to multinational pharmaceutical companies.  When the value of herbs is scientifically verified, the harvesting is transformed into ecologically unsound monocultures, and mediated through western laboratories to bring westerners the medicine in familiar pill form�"at the cost of local economies and ecologies.  Its this economic transformation that may drive the ‘development’ of health care systems more than anything.  In the US, the pharmaceutical companies control all of the research, design the protocols that doctors are to follow, and are in charge of the tragically inadequate research on side effects.  The cost is both the physical and economic wellbeing of Americans�"in addition to having a malfunctioned healthcare system that discriminates between the poor and the rich, that in its very development privileges the sale of pharmaceuticals over human health… 50% of all debt in America is medical debt.  That’s why I find it particularly horrifying that USAID has sponsored ‘philanthropic’ programs to teach Malian hospitals administrative practices. Why would you wish American health administration on anyone, much less one of the poorest countries in the world?”

 

An awkward silence followed.

 

In Hombodi, Alvaro was much more welcoming of my crazy opinions. “You know every day no one has anything to do because they are unemployed, they are just laying there, taking a nap. Do you think that people could do more to fix the situation?” There is a fine line in balancing apparently contradictory ideas: that economic structures are beyond the control of the poor, and that they shouldn’t be held responsible for their poverty, but also (unlike anthropologists) respecting human agency and ingenuity and recognizing and empowering people’s ability to confront their own poverty since they are the only ones with the political will to change things; the powers that be seem to be more interested in creating poverty than alleviating it. 

 

“What do you want them to do?  Maybe you should give them more medicine to sell in the market,” I responded with a smile. “There’s only so much money running through Hombodi.  Working harder isn’t going to create more, it’s just going to create a scramble, more intense competition for the same amount of money. In Vietnam, competition is intense, making it miserable to walk down the street as people are willing to follow you for hours to get you to buy a tacky tourist T-shirt. I’d much rather everyone just take a nap.”

 

As we passed some children they opened their hands and happily cried, “Cadeau! Cadeau! [Gift! Gift!]” They weren’t taking a nap. Whether or not to give children gifts is a much debated subject among tourists.  Obviously, people could use money and we have it, and you can’t fault a generous Tubabu for helping someone out.  A Tubabu, by the way, is the local name for white people, and children often point and shout in amazement “Tubabu!!!” kind of like a game of slug bug, or a biologist excitedly spotting a rare bird. At any rate, this particular type of random gift-giving transforms the way white people, or Tubabu’s are seen. A tubabu then becomes someone who shows up in Africa and will give you money and maybe pens if you ask them for it.  Why or what the hell the tubabu is actually thinking (and why they prefer to give pens) remains somewhat of a mystery. Consequently, not asking would be a terrible waste of an opportunity for a free pen or some spare change.

 

In Hombodi, the occasional gift-seeker is gentle, and somewhat endearing, unlike the aggressive throngs of children and insistent “guides” you find in the extremely touristy areas.  Some of the children are very sophisticated in establishing a rapport, helping you carry things, and creating elaborate stories, like needing money for a soccer ball for a soccer tournament.  I fondly remember working with homeless children in Indonesia to enhance their begging strategies with music, or watching children in Vietnam teach each other to walk as though they have polio or some sort of serious disorder so that they will become more successful in begging.  If you’ve ever tried it, however briefly, you know that begging is hard work.  However, giving gifts to random children asking for money is very different than offering alms to the poor.

 

There is a complex interplay of psychologies between the Western tourist and the African touree.  First arriving in Africa, many tourists carry an image of abject poverty combined with a sense of guilt and responsibility.  Africans are seen as in need of charity, and the tourist does not have the sophistication to note differences in livelihood strategies, living conditions, and know the social meaning of a gift, what is appropriate to give at what time and to who.  Meanwhile, as a massive source of money in an otherwise tiny economy , tourists send shockwaves through the social and economic systems. Charity and/or patronage is certainly needed, and gifts are appreciated by everyone-- however tourism inevitably transforms a place.

 

A great deal of literature examines how eco-tourism destroys the ecologies that it aims to exhibit, through infrastructure, roads, human waste, the consumption of food�"basically the Western lifestyle that consumes more resources in a day than a local farmer does in a year is transported into the heart of a fragile ecological system.  Tourist institutions, hotels, resorts and even backpacking hostels become communities of their own�"the traveler goes to experience one hotel after the other.  Its an experience I have enjoyed in the past, and backpacker culture is one I enjoy, but its not an opportunity to experience other ways of life.  When tourism attempts to reach that experience, the institutionalization of what should be organic experiences has serious side effects. Like eco-tourism, institutionalized ethno-tourism has its corrosive effects.  In tourist centers, guides armed with traditional totems (either stolen from or bought from villages and stripped of their local meaning) offer to take you to a Fula/Tuareg/Songhai or whatever village to see the people.  While they manage to make it sound like visiting friends, ultimately it is an institution of touring Tubabu coming in streams to see the ethnic people.  Alvaro reported visiting a “typical Tuareg village” with everyone in tents selling handicrafts and performing music only to find out later that the Tuaregs had left the area long ago, and the village was only in existence as a tourist exhibit.  While I would argue that tourist-Tuaregs are no less authentic than the isolated desert variety (the Tuaregs would violently disagree), tourism has certainly created its own, new reality out of tourist expectations.

 

In the end, both tourist and touree psychology create barriers to forming genuine human relationships.  While the tourist must be seen as a commodity by locals to benefit from the tourism economy, the tourist is primed to treat potential friends with suspicion.  The danger here is replicating the American paranoia that makes the United States such a miserable place to live.  Studies have shown that Americans have no (or very few friends) as opposed to the rest of the world�"or even in America during earlier, less developed times.  As a Hobbsean and Freudian worldviews infect the popular American consciousness, we view human nature as somehow bad, primal and opportunistic�"curbed only by strong, upstanding institutions like the judiciary or the church.  While we eliminate cooperation and social welfare from both the government and social life in favor of policies and social institutions that that support intense, unregulated market competition�"we turn around and act like it’s human nature that has made us selfish and opportunistic and society that keeps us in check when the opposite is true.  Republican governance and republicans whispering in the ears of conservative religious leaders and conservative talk radio create the selfish “human nature” they denounce.  The point of this crazy liberal tangent is to note that in the US, Americans work hard only to hoard their money behind picket fences, suspicious of anyone who might talk to them on the street, staying at home to watch television alone�"but the rest of the world isn’t like that.  In Bamako, 20 people pile onto a bench to watch Marina in the street, any good is a public good, friends rely on each other because there is an intense interdependence necessary for survival. But when an American comes to visit another country, the neoliberal mentality, combined with racial tensions, heightened when surrounded by children asking for “cadeau”s and guides pushing to make a new friend, only further isolates the American from genuine relationships.

 

Tourist psychology is a careful balancing act.  If you are not careful, people may steal from you.  They may be friendly because they see you as only a quick source of money.  On the other hand, if you don’t leave yourself open to getting to know each other, you lose the opportunity to develop deeper, if imperfect, mutual understandings. You have to take the good and the bad together.  We all have an angle, whether we admit it or not, but behind that angle, understanding and solidarity is still possible.  Ultimately, I make a bad tourist�"I’m more interested in hanging out with random people I meet than seeing sights.

 

In Hombodi, I met two backpackers from Seattle who were travelling through Africa for a year, “couch surfing” with peace corps members in one remote village to the next.

 

“You’re from the Midwest?” one replied shocked.  Their only encounter with non-coastal people had been recently, where they stayed in the only hotel in Ghana largely filled with young people from a Baptist church from Georgia.  “I didn’t know people actually talked like that,” he said amazed, “I thought it was only on television.” Tourism isn’t the only institution that operates on this dynamic of relationships complicated by money.  The youth group had arrived with giant boxes of soccer cleats and soccer balls, passing out gifts indiscriminately to poor Africans (or at least Africans they had decided were poor by virtue of the fact that they were rural and African) the small village their church was conducting its mission. Referencing the constant requests for gifts, the backpackers conducted an angry analysis: “It’s those motherf#$ers that are ruining it for the rest of us!”

 

Having had the (unpleasant) experience of being forced to watch an Evangelical church in action here in Mali (Gaban insisted I videotape his service), it’s interesting to see how wealth and religion interact. Displays of wealth are central to the church service, and the theme is often oriented around how if you are pious you will be successful, the Bible is re-interpreted with Jesus as a powerful figure with an attitude, who didn’t take s**t from anyone.  The general implication is that participation in the religion will solve your material problems, as your material problems are linked to your spiritual ones.  Showing up in Ghana with nice new soccer equipment helps support that image.  The suggestion is that maybe Americans are wealthy because they are Evangelical and favored by god… and maybe you are more wealthy than other villagers now that you have nice new clothes to show for your conversion.  Emulating the wealthy has long been an important survival strategy�"Save the Children are famous for their “positive deviant” approach in which they identify the strategies of children who have been more successful and work to teach other children the same strategy.  However, when wealth is a product of poverty�"gambling at the casino may place you in the presence of opulence, but it doesn’t mean you are going to become the millionaire that walked out yesterday.  Ultimately, it was your loss in attempting to become rich that made the rich man rich.  The same emulation that works so well in some contexts seduces the poor to participate in neoliberal religious and economic systems that will only hurt them.

 

Similarly, the appeal of commercialized African American style (*not* my beloved underground hiphop) has similar elements.  Rap videos are replete with diamond-studded women, expensive cars with shiny rims, and rap stars with gold chains throwing money at the screen.  But there are always opportunities to twist style into new meanings.  Izac’s Peul-rasta-rapper style fuses traditional melodies with improvinizational refrains like “Selfishness is no good.”

 

As well, religion can be mobilized-- in some contexts-- to provide much needed social services and more importantly, political solidarity for social change.  That said I’m glad that the name Cisse game me, “Soma Doumbia” is free of monotheistic religious inflections, be they Christian or Islamic�"though it ties me to the less reputed animists.  Regardless, I find myself continually pressured to come to any given evangelical church.  Islamic hints at conversion are more gentle�"“would you like to learn how we pray?”  “If you aren’t Islmaic, how will you marry a Muslim girl?”

 

Most of the devout Islamic people I have met appreciate religiousness of any sort so long as it monotheistic-- in fact, the Islamic faith believes Jesus was a prophet-- they just think the church manipulated the bible from god's original intent, so god told Mohammad what to write word-for-word to set things straight and thus we have the Koran.  Muslims pray several times throughout the day, and I have often been invited to pray in a Christian fashion alongside them.  So it's kind of awkward for me to explain that i'm not very christian. While I’ll be the first to admit many people do very good things under the banner of religion, religion still makes me very uncomfortable. I'm not a big fan of religion because I don't believe god supports discrimination, and discrimination and exclusivity are often fundamental to the church community's operation. Religion's relationship to homosexuality is case and point for why I don't think religion and God really have much to do with each other-- an opinion that should I should share with caution.

 

In nearby Senegal, 5 gay men working for a nonprofit that worked on AIDS prevention were thrown in prison for public homosexuality.  They were given 7 years, above and beyond the usual 5 years, and their nonprofit was described as a place where anything could happen, and was "probably a brothel." Ultimately they were released since it’s the homosexual sex act that is illegal and not the identity itself, but the message was clear.  Mali is much more accepting, homosexuality is not illegal, and recently the internationally acclaimed musician, Salif Keita, announced that support and encouragement from the homosexual community early in his musical life was central to his becoming a successful musician today.

 

But as variants of militant monotheism compete for people’s souls, animist traditions are alive and well in Mali.  In a very poor neighborhood in Bamako, people crowded around me to have their palms read.  It really was exhausting.  When I had completed a particularly positive reading, a woman asked, “Do we need to make a sacrifice?” When I said no, a shocked murmur passed through the crowd of women.  Having heard of me, an actual genuine Soma that lived in the neighborhood was interested in exchanging knowledge�"he would initiate me as a true Soma if I would teach him what I knew. I learned secrets I have promised not recount, but there is much I can say.

 

Soma’s are not often very wealthy, they work menial jobs during the day and perform their duties as a Soma on the side.  They do not receive direct payment for their services, though they often receive gifts.  In order to acquire a gri-gri (usually a magical leather amulet, worn across the chest or as a belt) for example, you must bring a chicken to the Soma, who kills it as a sacrifice to the fetish, and uses the chickens blood to conduct his magic.  The chicken is then offered to the poor to eat.  The magic of gri-gri, be it protection from evil spirits, to bring money, is about the specific relationship between you and the fetish mediated by the possession of the gri-gri. 

 

The Soma took me aside to give me a demonstration.  He asked me to focus on a pen, hold it and think of my desires.  He then took the pen and entered into a trance, marking a complex of curved lines and
“X”s. When the soma looks into the future, be it via throwing cowrie shells, or writing scribbles on a piece of paper while in trance, he sees possibilities not certainties.  In order to ensure that the future happens, or to make it happen faster, a sacrifice is required.  Sometimes the sacrifice is herbs, sometimes a chicken, sometimes a goat�"the greater the intervention, the greater the sacrifice.

 

Incurring the favor of fickle gods through sacrifice has been a part of Greek and Roman pantheism to indigenous religions of the Americas to various animist religions in Africa.  Malian animism is not unrelated to the Yourba religion of Nigeria, which became Voodoo when brought to Haiti via slaves.  However, today in Mali, the names of the gods are kept secret.  The Soma establishes the relationship between the fetish and the supplicant, and instructs the supplicant on the specific sacrifice needed.  Not performing the sacrifice exactly as demanded is dangerous�"the fetish may get angry, and your life may be shortened.  Meanwhile, the fetish may demand greater and greater sacrifices to avoid tragic fates ore enable wonderful things to happen.  Whether human sacrifice occurred or not, it is alive and well in the form of popular legends.  Everyone knows the story of Djenne, known for its mosque, the largest mud structure on earth.  Now scrambling with tourists and those wishing to profit from them, in an earlier time a Soma had warned that Djenne would fall victim to relentless rains and be destroyed�"the sacrifice demanded was a daughter, a girl who was an only child.  The most beautiful girl in the village was then buried alive in Djenne’s cemetery, and the rains were avoided.  Contemporary examples in urban legends continue. According to his neighbors, a trader in Severe became successful by offering his son as a human sacrifice.   Today he is incredibly rich has many stores in Mopti and in the Ivory Coast.

 

I decided not to sacrifice the goat and passed on my opportunity for true Soma-hood.

 

While individual cases certainly vary�"neither diet pills, free pens from tourists, evangelical hymns, nor human sacrifice seem to be counteracting the poverty in Africa, deepening daily with international economic and political exploitation.

 

Nouhoum, a brilliant young man from Bamako who studied at Yale, is on his way to my house. A genuinely nice guy, Nouhoum works for IPA or Innovations for Poverty Action.  Economic analysis developed (and then patented by) Professor Dean Karlan at Yale University, IPA ‘s tools are revered and sought after by major international foundations.  This patented technique has made Dr. Karlan a great deal of money.  In fact, we are going to lunch, navigating rocks and mud of Bamako’s streets, lined with half-finished concrete houses and thatch huts, in Neuhoum’s shiny silver Jaguar.  I’ll catch you all later.

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[Red Raven]

is that all? or you just thought of stopping abruptly?
'50% of all debt in America is medical debt. That’s why I find it particularly horrifying that USAID has sponsored ‘philanthropic’ programs to teach Malian hospitals administrative practices. ' - something new i have learnt today. i may want to dig more about it from sites. comparing to the world you have introduce, i can say we are very lucky. in my part of world, we hardly need pharmaceutical medicine. we have herbs growing wildly for almost all sickness though the house and building still pleads for electricity. its a very interesting , informative and vast read if i may comment. thank you so much. i really like your work. as always your beginning ideas are always catchy and luring for for readers like me.