Encounters with the Malian Health System: I don't have Malaria

So, full disclosure, I am a bit of an idiot/rebel/risk taker when it comes to malaria prevention. I have tried, over my 7 years of traveling in Africa, to take my malaria meds. I have tried both Malarone and Doxy (I am too scared of Lariam because I had a couple of friends have very bad experience with it). However, I have never been quite able to complete the recommended dosage. When I took doxy in 2003 - it ended up building up in my stomach. Now, as I try to take Malarone - it gives me an intense headache and literally knocks me out and puts me to sleep for hours. This isn't conducive to getting fieldwork done. In addition, most people around me (Malians) don't take any malarial preventatives, I have opted for the strategy of developing a natural resistance. This- i know is dumb. The CDC website throws red flags everywhere: Do not try it at home. However, it has worked for me up until now.

I found myself in a regional capital - far from "toubab" health care providers in Bamako. It's rainy season aka mosquito season and I live in the mosquito quartier and while I live with a mosquito net - I happened to accumulate a couple hundred bites on my legs just from walking around/taking the occasional beer by the river. I came down with some ambiguous symptoms: nausea, headache, cough, fatigue. I tried to do my due diligence and decided I should find out if I maybe had malaria. After 2 days of symptoms - the image of a cerebral malaria induced stroke was plastered in my head and I told my host family I wanted to get tested.

One of my host sisters - Fatou - who is also one of the prettiest Malians I have ever seen - took me to a health clinic where an aunt had a friend who worked as a doctor. Every bureaucratic encounter I have had in Mali has started and ended like this - find a relation who works in the appropriate office or who knows someone who does and avoid wasting 4 days there trying to get service. It was quite a sight - us on a moto and every guy in town waving to her as she road by. We went to recommended office #1 - which was actually the center for social and economic development (but somehow housed nursing classes) and the known acquaintance was not there. So then we walked to a rather sketchy looking clinic (peeling paint, open windows everywhere, lots of pepople waiting outside) - we learned that the doctor who the acquaintance knows was not there. So finally in checking with a 3rd semi-acquaintance we headed to the actual hospital.

All patients pay $2 to be seen (this charge was $1 until recently). Then you get in a long line in an outside courtyard next to the doctors air=-conditioned consulting rooms. Luckily, we had another connection and skipped the 20 person line and met with a doctor someone knew who was in the surgery consultation center. I told him that I, unlike most toubabs, was not on preventative meds - and he recommended I get a test at the laboratory - which had a 45minute turn around.

So back on the moto (again dodging police officers trying to flirt with Fatou) - we went to the laboratory - which was clean and friendly. I handed over $4 and the nurse sterilized a cotton swab and pricked my finger and put the blood on a slide. I waited for the 45 minutes and then they handed me my results. No counseling, no results, - just a sealed envelope. I asked the nurse if I could open it and he shrugged. I opened the results and to my happiness it read: negative!! Triumph of my immune system. We returned for a courtesy visit to the physician and he confirmed my non-malarial status. I instantly felt better.

Most Malians coming hours and hours on foot or donkey or moto don't know doctors who help them to skip the lines. They sit outside in the sun after their journey. I watched some doctors speak in French although they were capable of communicating in local languages. To their defense, I am sure they are working crazy hours and dealing with many illnesses that their supplies/equipment is unable to heal. I am scared of hospitals in general. I can't imagine what this experience must be like for people who leave their village and travel to such a foreign place. I salute all my friends working to assist and improve the health sector in Mali and across Africa. Mali recently moved from about 6th worst to 12th worst on the human development indicators. We've got a long way to go.