The unexpected, life-changing lessons that came from meeting “otherness” in Mali.

By Rodrigo Bazúa, 2017-2019 HEAL Site Fellow

Holding my new passport in my hands, I couldn’t believe it – I was going to make it, I was finally going to Mali! It had taken a lost passport and the failed delivery of my Malian Visa for me to spend a whole week running all around Chiapas, and even visiting the police station; but with just one day left before my flight, I acquired my new passport and could finally set off for my Site Exchange, an opportunity provided through my HEAL Fellowship.

My visit to Muso, one of the HEAL Initiative partner sites, couldn’t have been better timed. At Compañeros en Salud (CES), where I work and serve as a HEAL Fellow, we are currently redesigning our Community Health Workers (CHW) Program. We are changing from a model that supports patients with specific chronic diseases and pregnant women through accompaniment to a model that supports every household in our communities, carries out proactive case finding and early detection of patients, and incorporates health promotion activities. This is a very similar program to the one that Muso has championed in Mali and I was hoping to take away some key lessons. I ended up learning much more than what I had originally expected.

Dr. Sidiki (left) and Dr. Bazúa (right) in a health post.

Mali represented a whole new world for me, both culturally and socially. This was my first time in West Africa, a Muslim country, and a country whose citizens have a perceivably homogenous skin tone. Accustomed to the highly race-related socioeconomic hierarchy that exists in Latin America, the United States, and Europe, I was astounded that I could not predict a person’s social status just from the color of their skin and was shocked to realize how race and economic dynamics have been so unconsciously marked in my head – so normalized.

My experience in Mali also revealed medical and health-related differences. It was interesting to see the differences in the burden of disease between Mali and Mexico. Malaria, acute malnutrition, and diarrhea were major causes of child mortality in Mali, whereas chronic illnesses comprise the major burden of disease in Mexico.  Additionally, the health system in Mali is still highly dependent on foreign aid, and free healthcare is not available.  Although I had read about the terrible effects that the Structural Adjustment Policies have had on the health of the poor, I was shocked to see health posts without patients. User fees severely deterred patients despite their dire need for care, and this showed me the horrors that public-health policies can create if they are not designed under the idea that health is an essential human right.

The way that Muso responds to the health needs of the population they serve as well as the way they harness and complement the best assets of the existing public health systems impressed me from the moment I set foot in Yiridimaio – the fast-growing slum on the outskirts of Bamako, whose population Muso serves. I was able to see and experience every step of what is involved in their CHW program, from visiting households with the CHWs and their supervisors, attending their weekly meetings, and talking to their patients to visiting Mali’s biggest hospital and interviewing Muso’s leadership. They walked me through all the steps that have made it possible for them to reduce the child-mortality rate in the region from 154 deaths per 1000 live births in 2008 to 7 deaths per 1000 live births in 2015.

The reduction of child-mortality is impressive by itself, but to walk under the burning sun of the desert landscape with the CHWs such as Astan Nyiguibá that have made this reduction possible made me realize how human connection will always be an essential element of healthcare. Ms. Nyiguibá regularly visits each household of her neighborhood to offer her services if there’s anyone who suffers from illness. She also carries out health-promotion activities, such as discussing dental health with families she visits. Each household that we visited welcomed her warmly, and everyone knows her name. They also know where she lives and have her cell phone number registered in case any health necessity arises in the future. She told me that her work is a big source of meaning and purpose in her life and that she feels deeply proud for being able to serve her community. With the support and appreciation from her supervisors, she finds her work especially valuable and enjoyable.

Muso lives up to the highest values in global health. Their CHWs are able to do such impressive work because the organization is structured in a way that highlights patients’ needs and opinions, which then helps CHWs serve their patients to the best of their abilities. This experience has not only reaffirmed my commitment to serving the underserved, but it has also showed me that we can always strive to be better and should not take comfort in thinking that the work we are doing is good enough. In CES, we are now restructuring our CHW program based on my experiences with Muso. I cannot imagine that we could have made the same changes in the administrative structure, the supervision model, and the activities that the CHWs carry out without the inspiration Muso has given me.

Rodrigo Bazúa is a HEAL fellow and served as the Community Health Programs Coordinator and Clinical Supervisor with CES.