Off to Mali

My time in the Gambia is coming to an end - which is sad - but it does mean that I can now do my long-planned holiday in Mali - which is good - and will finally be headed back to the UK - which is great! So I'll talk a bit about my planned trip to Mali, because that's what I've been researching the last few days.

Mali is described (in the Lonely Planet guide to West Africa) as the "jewel in the crown" of West African destinations. It is also seen as a very significant cultural homeland by the main tribal group (the Mandinkas) in Gambia, so lots of my Gambian colleagues are very excited that I am going to visit their "motherland"...



To start with a main map, which shows sizes, positiions and major cities. I live just outside Banjul (Gambian capital) and my route will basically be Banjul - Dakar - Bamako - Timbucku - Bamako - Banjul, over about 3 weeks, using road, river, train and one plane trip.






Timbucktu is on the Southern edge of the Sahara desert, and is a semi-mythical kind of place mainly because it was enormously difficult for Europeans to reach for several hundred years. I think when they finally got there, they were somewhat dissapointed: after years of expecting streets paved with gold, they found streets that were, well, not paved at all... We might get there too, depending on how the transport works out.




Another very famous landmark in Mali is the mud-built mosque in Djenne - the largest mud-built building in the world, and a very beautiful piece of religious architecture to boot!

Lots of other exciting things in Mali include the music scene in Bamako - thought to be one of the worlds great sources of musical innovation - , trekking in the mountainous Dogon country and travelling along the great river Niger. I should also have a few days in Dakar, the capital of Senegal, which has lots of interesting stuff about the history of the slave trade in West Africa. And both of these countries are theoretically Francophone, so I'll have to dust off my rather rusty French for the inevitable negotiations over the prices of absolutely everything...

So I'm pretty excited about going. My companions on the trip are a funny mixture of nationalities: American, Finnish and Japanese/Canadian, all of whom are working here in the Gambia at various different places. I've been designated "translator into French" and "first-aider" for the trip, and we also have a good musician and a Bamara (main local Malian language) speaker...

Finally flags

Mali's flag




Senegal's flag



As you can see, there is a fair bit of similarity between the flags of the two countries! They are both using the "Pan-Africanist" colours - red, gold, green - which originates in Ethiopia and forms the basic colour-scheme for many ancient and modern African flags, as well as the rastafarian movement!

TB and HIV

I've been a bit bad at writing this blog recently, I guess as I've spent more time out here in the Gambia my "wow" factor on all the interesting things has worn off.
I can only write a brief blog today as I'm off on a trip to Senegal today for a weekend at the beach with Sophie.

I've been doing quite a bit of work on fostering co-operation between the TB department and the HIV department here at the MRC: these two diseases are studied separately here, but in clinical practice here, there is often dual infection, ie someone with both tuberculosis and HIV/AIDS.

The combination of TB and HIV is an important one because these two diseases are essentially synergistic : HIV promotes the spread of TB, and TB is the major killer of people with HIV. The HIV epidemic around the world is one of the main reasons that TB is "making a comeback", especially in sub-Saharan Africa. They interact in a whole bunch of more complicated ways also: TB is more difficult to diagnose in someone with HIV, drug side-effects are more common for both diseases in co-infection, HIV+ people are more vunerable to catching/developing TB ... the list goes on.

This was all put into reality for me this week when I had my first (confirmed) HIV + TB patient. Sadly, he died within in few days of first coming to the MRC - people here often see "western" medicine as a last resort only, and turn up when disease is very advanced. The guy had looked dreadful when I saw him, with all the typical features of both infections. After he died, I then had the unenviable task of explaining to his (only) wife what he had died of, and encouraging her to have HIV testing herself. In some ways, I was breaching the confidentiality of the husband by doing this, but I really feel that you have to concentrate on doing what you can for who you can help.

We estimate about 5% of Gambians with TB may be HIV positive. If you compare this with about 50% of TB patients with HIV in South Africa, you see where the epidemic might be going. In West Africa, it all really depends on action taken over the next decade, but who knows what is going to happen here ?