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ANNOUNCER: This is a production of Cornell University.
SPEAKER: Good afternoon, everyone, and thank you for coming to the 2009 Colloquium Series for the Cornell Institute for Public Affairs. This colloquium is also sponsored by the Cornell Global Public Health Program, Cornell Health International, and the Cornell Student Society for Public Health. I'd like to introduce our speaker today, Kris Holloway, who is the author of Monique and the Mango Rains- Two Years with a Midwife in Mali.
Monique and the Mango Rains is the true story of the life and death of a remarkable West African midwife, seen through the eyes of a young Peace Corps volunteer, who worked side by side with her, birthing babies and caring for mothers in a remote impoverished village. It is a rare tale of friendship that reaches beyond borders to vividly and irrevocably unite another woman's world with our own.
Kris Holloway served as a Peace Corps volunteer in Mali, West Africa from 1989 to 1991, where she met her husband, John Bidwell. She holds a Master's degree in public health from the University of Michigan, where she focused her research on maternal and child health. She has used her unique background in writing, public health, and development to further the mission of numerous nonprofits and educational institutions, including Planned Parenthood, the National Priorities Project, the University of Michigan, Springfield College, and the Greenbelt Movement International.
She currently works as the Director of Institutional Relations at the Center for International Studies, a fabulous study, live, explore abroad organization. She is a confirmed Francophile, loves chocolate, and sits on a physio ball while at her computer. She lives in North Hampton, Massachusetts with her husband, John, and their two sons. Thank you.
KRIS HOLLOWAY: Thank you. Can everyone hear me with these mics? No? Yes? All right, let's try again, is that better? You can hear? All right. So I spoke to a large and wonderful global health class this morning. And I want to greet you in the same way I greeted them, because in large group gatherings, or even in small group gatherings in Mali no business is conducted without greeting each other first.
So what I want you to say-- so if I say [NON-ENGLISH SPEECH] that means hello in Bambara, which is a language spoken in Mali. So if I say to you [NON-ENGLISH SPEECH] and you're a woman, you respond by saying [NON-ENGLISH SPEECH]. So let's practice that. All right, so if you're a woman only, say [NON-ENGLISH SPEECH].
AUDIENCE: [NON-ENGLISH SPEECH].
KRIS HOLLOWAY: Now, if you're a man, you say [NON-ENGLISH SPEECH]. All right, let's practice. [NON-ENGLISH SPEECH]. So now we'll do it all together. So I'm going to [NON-ENGLISH SPEECH]. If you're a woman, say [NON-ENGLISH SPEECH]. If you're a man, [NON-ENGLISH SPEECH]. All right, [NON-ENGLISH SPEECH].
AUDIENCE: [NON-ENGLISH SPEECH].
KRIS HOLLOWAY: Thank you. Thank you. And we would go, we could go on and on with the greetings. But we'll keep it at that. So I'm really thankful to be here, so close to International Women's Day. And that's sort of what I want to talk about a bit today, because I know a lot of you have a background or an interest in policy and public policy.
And I really want to also talk about one African woman's life, because I think all good policy has individual people and real people in mind. And the relevance of this day, this sort of International Women's Day or International Women's Week, and I know that there's a lot of students that are sponsoring a summit around this this weekend, and it sounds fabulous. And there's a lot of women, Jeannie Moseley and Marsha Greenberg, who've helped bring me here today. And I really want to thank them for all the organization that required.
And all this work is really grounded for me in the day-to-day work and life of women and men in small dusty villages scattered throughout West Africa, where the poorest of the poor live. And where I lived for two and a half years in the Peace Corps, almost two decades ago now, '89 to '91. And where my then boyfriend and now husband and I return as often as we can.
Needless to say, most African women have not heard of International Women's Day, and would probably find it a bit silly, or would be too busy hauling water, or pounding millet, or caring for their children to notice. Most rural women that I know in Mali don't have watches. And they don't read. So they don't use calendars. I mean, calendars are mostly made of paper and paper is quickly eaten by termites.
And anyway, calendars are a way of really marking linear thinking. And for them, time is really anything but linear. It's a cycle of days, of months, or years, where seasons determine what is done, or not done, what is planted, or what is fixed. And births and deaths occur with a regularity that really only those people who lived in places in the developing world can really understand.
How would these women know what day it was? That it was March 8th? They would probably like an extra pair of hands for their work rather than a day of celebration or recognition. But a little bit about International Women's Day. It was honored for the first time in 1911 in Northern Europe. And these women and men campaigned for women's right to work, to vote, to be trained, and to hold public office.
So today, many women across the world have indeed achieved these rights. So please, if you're a woman, hold up your hand if you work and are paid for that work. How many of you vote or have the right to vote? How many of you are trained or educated for the work that you're going to eventually do? How many of you men support your wives, sisters, mothers, or daughters in their work or in their education?
So I would venture to say that almost everyone in this room has probably raised their hand. So these women and men back in 1911 really started something. However, today, in some parts of the world, two thirds of the world's uneducated children are girls, and two thirds of the world's illiterate adults are women.
Almost all of these occur in the developing world, and the grand proportion, many of them, in sub-Saharan Africa, where Mali is located. A woman dies every minute in childbirth or pregnancy. Most of them in sub-Saharan Africa. Two in five children die before they reach the age of five in sub-Saharan Africa.
So International Women's Day is really tied to the UN Millennium Development Goals, which most of you have probably heard of. Those eight goals established in the year 2000 by the UN General Assembly to address the issues of global health and poverty. And there's a lot of talk about them now because we're at the midpoint. They're supposed to be achieved by the year 2015. So we're at the midpoint now.
And there's a lot of different commissions that are assessing the progress towards the end. And one of these reports, a 2008 report, by the Economic Commission for Africa, said that Africa has fared the worst among all the regions of the world. African countries are not on track as a whole. However, there are some bright spots and parts of Mali represent one of them.
So let me tell you a little bit about this country of Mali and how I came to know it, since many of you probably haven't heard of Monique [? Dumbeley. ?] So I went to Mali when I was 22 years old. It was back in 1989. And when I found that I had been accepted into the Peace Corps and that I was heading to Mali, I was ecstatic. Why? Because I had studied in France and so knew one of the language that was spoken in Mali. Mali's a former French colony.
I was an environmental science major in my undergraduate career and I was being sent as a natural resource manager to stop the spread of the Sahara Desert, plant trees, do agro forestry cropping that enrich the soil. And three, I had taken a class my senior year taught by a woman from the Ivory Coast, and I was fascinated by the culture in West Africa.
Little did I know that I would meet my husband in the Peace Corps. One of those little known benefits. So beware if you're thinking of Peace Corps and plan to stay single. I'm not the only one. But truth be told, probably within six months of arriving in my small village of Nampossela, I had shirked almost all of my official Peace Corps forestry duties because I met this woman, Monique, the local midwife and health worker. And I began to work with her.
So I hope through our brief time together today that you get to know her a little bit as a midwife and as a friend, and see from the inside some of what village life is like for a woman in Mali. So before we go into this first reading, I want to set the scene so you can imagine life in the village. I know many of you are returned Peace Corps volunteers or have worked overseas, and you're going to see a lot of similarities there.
So I want you to imagine that it's about 7:00 at night, so it's not quarter of five in the afternoon. And that it's about 90 to 95 degrees, so a little cooler than it's been during the day. And you're walking along a village path. And the horizon is absolutely huge, because there's nothing to tarnish it. There's no electricity. The only light comes from a flashlight, a lantern light, or maybe a candle.
And that horizon is also huge because the buildings are all built by hand, by mud brick, so they only really go up as high as someone can reach. So you're walking into the village and you can smell roasting nuts on the air from the sauces as people cook dinner, and the smell of firewood, because all cooking is done outside over an open flame. And you can hear women pulling water up from wells, which is how you get water in Mali. There's not running water in the villages.
And goats and people are coming in, donkey carts from the fields, coming back to eat. You walk into your family compound, and you sit around this large bowl that's been placed before you on the ground of tow, or millet porridge, and you're about to dig in with your right hand and enjoy the meal, when your friend Monique asks if you'd like to attend a birth with her. And you think about it for a minute, because you know that a woman's lifetime risk of dying in childbirth in Mali is one in 12. But off you go.
"How long has the woman been in labor," I asked. "Since early this morning," Monique said. Her flashlight traced a yellow stain on the dark earth. A scorpion moved under a rock. I have been with her at the birthing house most of the day. "So will she give birth soon?" I asked. "God willing," Monique said, "You'll see, there will be no rest for your Monique tonight."
"How old is she," I said, jogging a couple of steps to stay next to her. "17." I was glad to be with Monique. She was not only the villages midwife and sole health care worker, but she was also my assigned host. At 24, she was only two years my senior, but I was in awe of her knowledge and ability. "You're sure it's all right if I come along? You know, I've never seen a birth." "Of course, of course," she said, smiling up at me from beneath her blue sequined headscarf.
Her voice always seemed poised to break into a belly rich laugh. "A woman is always welcome at a birth, Fatoumata," Monique explained, using my newly acquired Malian name, "And I am glad your first will be here with me." Monique's face was youthful, sweet really, a brown symmetrical disk with arching eyebrows, widely spaced eyes, and a slightly upturned nose, making her look like a kid.
She was stocky and walked with confidence. Her green plastic flip-flops barely visible beneath her wide flapping feet. Strapped to her back with a cloth tied over her breasts was her 3-month-old son, Bazille, fast asleep. Monique opened the door and an overpowering stench made me wince and pull back. Monique went straight in, but I needed to linger outside for a moment in the fresh air.
The pale and bloated moon was surfacing through the leaves of a mango tree, casting a faint light on the decrepit building. "Fatoumata, where are you?" she called. I took a deep breath and crossed the threshold, the tin door wobbling as I shut it behind me. So here I was in Mali, a 22-year-old single white woman from the corn center of Ohio, Grandville, Ohio to be exact.
I had avoided pregnancy and childbirth at all costs up to that point in my existence, had no interest in giving birth, or really that much interest in babies. I had a four-year private college education. I was a native English speaker who knew some French, a righteous vegetarian, with beautiful, smooth, uncalloused hands.
And here was Monique, 24 years old, a black African woman betrothed to her husband at the age of five. She had had three children, one of whom had died of malnutrition. She had a sixth grade education, nine months of medical training, and was the sole midwife and health care worker for about 8,000 people.
She was a native Miniyanka and Bambara speaker, who also spoke French. So French was the language in which we mostly communicated. She was a gleeful goat eater, a devout meat eater, with calluses like M&M's on the palms of her hands from all the work that she did.
I felt as if I was drowning in the smell of flesh, body fluids, and leftover food. Shut tight, the building was like an oven, baking all the secretions and juices into a rank casserole. But here, despite the oppressive heat, women found a rare taste of privacy in an otherwise communal world. In fact, the birthing house was one of the few hallowed grounds where men were not allowed to tread.
Jutting from the left wall and dominating the birthing room was an immense concrete block that served as a delivery table. Its gray bulk illuminated by a single lantern suggested a sarcophagus. On top of the bare scrubbed surface, a naked woman crouched, strained and pushed, her black skin shining in the dim lantern light. Another woman sat beside her on the slab, supporting her.
The wall behind them had a large, worn greasy spot, where countless backs and heads had writhed and reposed. Monique stood near them watching. Folded carefully on the floor lay a large square of colorfully decorated cotton cloth, [? Opania, ?] the traditional garment that Malian women wrap around their waists as a skirt. Set out beside the dented trunk that served as a supply cupboard was a plastic tub for the afterbirth, a medical kit in a tin box, and a frayed birth ledger. So this was childbirth in rural Mali in the late 20th century.
So Monique was not only responsible for helping women bring their children here, but she also helped women keep their children here. So she was also the village health care worker, the community health care worker. And in Mali, what that meant is doing a lot of health education and health prevention work.
Monique was the only woman in the village who had ever been to school. And she had stopped at a sixth grade education. So the written word was not available to her as a means of educating people. It was the oral, the spoken word, that she had to use. So she was really gifted at singing and songs, at interpersonal dialogue, at facilitating group discussions, and really listening to what women and families were telling her.
So a lot of the work that we did had to do with oral rehydration therapy for diarrhea, malaria prevention, and how to treat it when someone did get malaria, around the importance of vaccinations, and also of making nutritious baby food. So when a woman weaned her child, they didn't go straight to adult food and that they only drank really clean water.
Another thing that we did a lot of was weighing babies, as it was one way-- these women had these charts with different colors that sort of could show where their baby was in terms of weight for their age. And it was a way that women could understand if their child was in good health or not. And we could really monitor if someone-- if a child's weight was going really down or really up and have that opportunity to talk with her.
So the next reading that I want to do is at the clinic in Nampossela. Nampossela population of about 1,400 people in my village. And it was a separate building from the birthing house where we attended births.
The last woman of the day was someone I hadn't seen before. She took a small, tightly bound bundle off her back, and I gasped as she unwrapped it to reveal her child. Skeletal, his eyes bulging from their sockets, he seemed barely alive, but for the flush of fever. His scalp was almost bare. His hair, the scraggly filaments of an old, old man. Around his gaunt neck dangled to [NON-ENGLISH SPEECH], or personal fetishes for protection against sickness inducing evil spirits.
The woman was not from my village of Nampossela and had no baby weighing chart. She said her child was two years old. "Weigh him carefully, Fatoumata," Monique said to me. I picked up his body, as brittle and hollow as a worn shell, afraid he would crumble in my arms. I'd read that two out of five children die before their fifth birthday in Mali. But now, I felt it.
"5 kilograms," I announced, just over 11 pounds. He made soft mewing sounds when I took him out of the sling, as if he would cry, but could not spare the energy or the tears. Monique spent a long time talking with the mother. I watched, switching my attention between Monique and the near lifeless child. When the conversation was over, the mother gathered up her boy and began walking at a brisk pace toward the road. Monique stood still, watching her.
"What's wrong with him?" I asked. "He's had many attacks of malaria over the past few months," she said, "It's caused severe anemia and now diarrhea. He's also malnourished The mother didn't know what to do. She hadn't heard about malaria prevention and drugs. I told her she must go now to the hospital in the larger city of Cu Chi Allah. It's only their medicine that can help. But even then, I doubt he will survive. She's waited too long. I can do nothing. I don't have IVs, I don't have serum. These women must bring me their children before they get so sick. Then, I have ways of helping them."
So Monique was clearly facing a lot of the challenges that we think of when we think of either Mali, or West Africa, or Africa. And I think when we work in public health, we know a lot of those challenges really well, the challenges of poverty, of health, of corrupt governments, But there's so much wonderful community health work that is going on in Mali, and in West Africa, and in Africa today.
And that's the part that I want to speak to. And I have such hope for what's going to be happening on that continent because I knew Monique, and I saw the power of an ordinary woman, with a sixth grade education, and a great sense of humor and commitment, and the extraordinary things that she was able to accomplish. And I know how many more thousands of women just like her are there across West Africa doing the work. And we need to hear their stories. And we need to access their knowledge.
So as you can imagine, my work with Monique had a huge effect on me as a person. I came back from the Peace Corps, and Monique came and spent a month here in the States with me, which I could talk about forever. And I went to public health graduate school when I came back, and got my degree in public health, because I was so inspired by the work she was doing. And really saw the importance of public health practice, and policy, and work.
I had my two children at home with midwives. And I do not come from a line of hippie women, or people that tend to do alternative health practices. So this was quite something for my family. But again, because I saw the power of what a woman's body could do, even when that body was on a seventh child and malnourished, the power of midwives.
And Monique and I stayed in touch for many years through cassette tapes, we exchanged cassette tapes-- there weren't cell phones or email-- and through a lot of long letters together, for eight years. And then in 1997, she got pregnant. She had been forced to go off the birth control pill for probably what was medical and political reasons. And she was pregnant with her fifth child at the age of 33. And was really exhausted, she was doing amazing work, but way overworked.
And so she wrote and said can you please help me find a way to stop having children. The use of a condom was not going to be a solution in the relationship she had with her husband. And neither was the birth control pill. So we were in the process of researching more permanent forms of birth control.
We were looking at Depo-Provera, which is hard because she would need to get the shot every four months and they require refrigeration. There wasn't refrigeration on the village level for anything. We were looking at Norplant, which can be put in for about five years. And we were also considering tubal ligation, which she would have had to have done in the Ivory Coast or probably in Senegal.
And I was working on these solutions with her when I got a letter from her cousin, who is also a village health care worker, letting me know that she had died in childbirth. She died, and her fifth baby, a little boy, died as well. So this book really grew out of that trip back in 1999. And the stories that the midwives, and her family, and the other women in the village, and in the community told me.
And I realized that if I didn't write this book-- I might not be the perfect person, maybe, clearly, I'm not the perfect person to write it-- but if I didn't, there was no one else who was going to tell her story. And if a woman dies every minute in childbirth in the developing world, it can start to seem like that's normal. And if we don't know someone who's had-- who died in that way, maybe we won't be outraged by it. So I had to write her story.
And to get back to the changes that we still see in Mali, Monique has done, did a lot, of great work. And there's a lot of great work continuing because of her. John, my husband, and I went back to Mali, not this past December, but the December before, and really were able to witness the great work that continues because people were inspired by her.
There's a clinic called Cabinet de Soins Monique, or Clinic Monique, as we're calling it-- sassy title-- which is a clinic that her cousin, the health worker, started in her honor in 2004, and which book royalties and donors helped to fund. There's actually a group of women in the audience who helped raise $15,000 that I received a couple of months ago, by coming together as women and donating 100 bucks, 1,000 bucks, 10 bucks. No gift too small, no gift too big, we like to say.
So women around the country donating money and book royalties have built this clinic. And now, we're just getting the solar panels to get it running, starting to retrain the midwives, and starting to get the surgical equipment. It's not my idea. I'm just helping to fund it. Monique's sister has now become a midwife in her honor, and is working in an HIV-AIDS orphanage.
Monique's three children are all in school and university, pursuing a degree and an education, and a chance at an education that their mother simply never had. Her sister, Angel, also just got married. She is Catholic. Her husband is Muslim. And she just got married at the age of 32 to someone that she loves. And that's a huge change for Monique's family.
So there's so many good things happening in Mali today because of this one person who made a difference and affected people. And to get back to those UN Millennium Development Goals, to get back to that policy, what are the things that Monique did?
So goal number three is to promote gender equality and empower women. Monique was the first woman to use birth control, the first woman to go on the pill and to talk about it openly with families, about putting spacing between children if they didn't want so many children. She was the first woman in the village to demand a salary for her work.
She was the first woman to have an official position. And her salary at first went to her father-in-law. And we were able to allow her to get her salary herself, which had such a beneficial effect on the nutrition of her children. And she also demanded that her daughters, not only her son, but her daughters also attend school.
What's happening in Mali on a global level with these UN Millennium Development Goals? In 1997, 2.3% of all legislators in the Malian parliament were women. Now it's 10.2%. And in the United States, we have about 15.6% women. So they're going to pass us soon, is the writing on the wall.
In 1997, only half as many girls were in school as boys. Now, 75% as many girls are in school as boys. And even though that percentage of the population is still small compared to a lot of countries, it's growing. And as we know, education is one of those magic bullets in terms of health and in terms of development. And I guess empowering and having choice over what one's life looks like.
Goal number four is reducing child mortality. What Monique was doing was the baby weighing, and the infant nutrition, and the health education and prevention that empowered families to take control of their own family's health. What's happening now? In 1997, 2.5 out of every five kids died before the age of five. In 2007, it's 2.17. Not that much difference, but it's heading in the right direction. And as much as we can trust these large numbers and these large studies, at least it's going in the right place. It's going to take a while to change.
Goal number five, improving maternal health. Monique delivered thousands of women safely every year. Not every year, over a course of a lifetime, hundreds, 200, probably a year. And she was the first to address the issue of female genital cutting, and address it in a way that had respect for the culture, but also question the really horrible health effects of it on the women that she attended. She was able to kind of bring those two worlds together, which is harder to do in an issue that's culturally ingrained and that we Western women have such a visceral reaction against.
And then in terms of those broader goals, what's happening in Mali? In 1990, there were 1,200 per 100,000 deaths, 1,200 deaths per 100,000 live births. In 2005, the last time I could find data, it was 970 per 100,000 live births. That's a really big change. And even though in the US, it's around 11, so there's a long way to go, that is still a change in the right direction. So things are happening. And a lot of it is because of good policies that support the community based health workers on the ground.
So people do ask me a lot when I'm here in the States why do you raise money? Why are you so concerned about the health of people in Mali? And why are you putting so much energy into this book, or into this clinic when we have so many problems right here at home? We are hurting here in the United States. Why don't you focus your energy here? And God spoke and said that would be a bad idea.
So basically, I come back to them and I say where do we draw the line? If community is the people that we-- you don't mind if I keep going, do you? I'll try not to short circuit everything with my enthusiasm next time. So if community is defined as the people that we love and care about, and are therefore responsible for, where do we stop? Do you decide that outside of Cornell University's campus, you're going to stop caring about people?
Do we stop at the border between Ithaca and the next community over, maybe between New York and my home state of Massachusetts? Or maybe at the US border? I think we really have to redefine who we consider our community, who we consider our sisters and brothers to be. And I think many of you in the room, who have committed yourselves to international development work on some level are the people that need to do that.
I know a lot of times when we talk about policy, it can stay in the realm of ideas and sometimes lose the people. And I speak that way because I have a degree in policy too. And I think it's really important that we don't do that in this case. And I think this new way of seeing, you know where do we lend that extra pair of hands, who do we consider our kin, is critical because the impact extends far beyond Clinic Monique and far beyond Mali.
In the current financial crisis, we all feel it. But it is particularly hard for the poorest of the poor. We are still in the top 95% of all of the people on earth in terms of wealth and health. So imagine what for the poorest of the poor this might mean. it takes effort extra effort when we ourselves are pinched, and stressed, and exhausted, and feel like we have nothing left to give.
Archbishop of York John Sentamu spoke last September at a UN event in New York about addressing this midpoint of progress towards the UN Millennium Development Goals. And he spoke about the $700 billion US bailout that was then planned and now a reality for banks and financial institutions. And he said, and I quote, "One of the ironies about the financial crisis is that it makes action on poverty look utterly achievable. It would cost $5 billion to save six million children's lives. World leaders could find 140 times that amount for the banking system in a week. How can they now tell us that action for the poorest on the planet is too expensive? It's not that we lack the resources-- it's not that we lack the resources, we lack the courage."
But I think that perhaps you folks here in the room have that courage, and you're willing to lend that hand, and really extend who you care about, and to really examine how policy can include community workers, can be used by them and developed by the people. And I think you have the power to work with community members and help them demand rights, to demand full participation. And as Bill Moyers puts it, "To dignify people so that they have a chance to become fully human."
And what would-- you know, I'd like to imagine what the image of Americans overseas would be, which isn't all that great, and the image of others here be, if we used our ideals and our convictions, and clearly our great brains, if you're here at Cornell, and our money, to strengthen communities across the world.
So this last piece that I want to read to you speaks more to that joy of being in community, and that sweetness of knowing you're going to leave a place. So this is the last night that I spent in my village before I had to leave.
Night came swiftly, as it always does when the day is not long enough. My senses seemed acutely aware, trying to absorb all the sights, smells, and sounds of this place to better remember the paths, the homes, the faces, and the words.
Light from the waxing moon shimmered on the straw of the village roofs and washed over the ground. The heavy humidity of weeks past had broken and the night was remarkably clear. The sky was clean. The rippled grunts of goats and foghorn bellows of cows merged with the murmur of human conversations.
From the distance floated a melody of wooden flutes punctured by an occasional shout. The musicians were gathered in the common to warm up, lightly striking the [? balifo ?] and sounding the rich tremors of the [? jembe ?] drum amid the squeals of the young. "Are you ready, Monique?" John, my boy friend asked. With a sigh, Monique piled the pots in a corner, covered the remaining food, affixed her headscarf and walked with us toward the door.
"Tomorrow is the day you leave," she said, "I think that it can't be true. It will be a hard day, Dick," Monique said, adding emphasis. She held her hand out in front of her, as if admiring her fingers. She found a cuticle to pick. I chose to pull a loose thread from my sleeve. The flutes grew louder, their sound flying above us like chasing birds.
The [? balifo ?] player ran his fingers through the notes as if they were children at play. Rising clouds of dust from stomping feet filled our nostrils. They billowed skyward, reflecting light against the deep azure night. It seemed as if all of Nampossela had emerged for the festivity. Young and old, healthy and sickly, women and men, groups of teens and pre-teens dressed in their finest glowed with anticipation and filled the square between the steps of the Catholic church and the courtyard of the mosque, not far from the [? Fatich ?] House.
Here god in all forms kept watch over the energetic children and the relatively sedate adults. John, Monique, and I gathered along the outside of a large circle and attempted to peer over the swaying heads of the bystanders and glimpse the dancers. Bazille, Monique's son, almost two years old, was grunting and struggling on her back, wanting to be put down.
She plopped him on the ground, and beside the densely packed moving feet and clothed knees, the mass was impenetrable. His face contorted in frustration, his cries drowned out by the music. "Do you want to see, Bazille?" John yelled. He kept whining. John hoisted him up and held him high. He squealed and yelled, his squirming finally settling down a bit, as he became entranced with what he saw. [NON-ENGLISH SPEECH]
Our names rolled and rustled through the crowd as people cleared a place for us. [NON-ENGLISH SPEECH] a muscled boy called out as he walked the perimeter of the performance space and pushed the crowd back. A dancer needed his space. He jumped toward the stars, kicked out his feet, landed, and flipped out his legs again, each time sending himself higher and higher, beating the earth with his feet as he alighted.
Sometimes the music seemed to follow his lead, flowing and conforming to the motions of his body. And sometimes he adjusted the rhythm of his leaping according to a subtle shift in tempo. Within minutes, the dancing boy was spent and took to the sidelines, breathing heavily. His show was not in vain. Girls pointed and looked in his direction while talking to one another behind cupped hands.
Groups of girls clapped and two-stepped in unison, until two broke into the middle. As the flutes played, they circled each other. If boys were a show of brute strength, girls were a show of poise and finesse. Their moves were less histrionic, but just as intense. Their footwork was rapid and smooth, like the wings of a hummingbird. They undulated their bottoms and shoulders in quick movements.
They looked at us, they mimed, looked at us, they gestured and low bows, before returning to their friends. By now, I had begun to dance in place. I walked forward to the rhythm and the crowd formed a space around me. Fatoumata dancing was always a spectacle. I moved, and jumped, waved, and grooved. The crowd laughed and hooted, delighted. I looked at the circle, at John holding Bazille and at Monique.
I ran and grabbed her hand, pulling her into the melee. The swaying crowd cheered widely. I heard our names yelled over again, and over, above the quickening beat. Monique tried to pull away, but was weakened by laughter. Her headscarf fell as she lowered her head to the ground, as if willing her feet to move. She'd never danced before.
But her feet did move. Her long toes splayed, her feet pivoted on their heels, and then she shook, a stirring that extended up to her knees. She stayed bent at the waist, pulling so hard against my grip that should I let go, she would tumble into the rows of onlookers. For a few seconds, the earth felt the tempo of her feet.
And then, just as suddenly, they stopped. Monique cackled, and let me pull her further into the fray, stood up with hands raised in the air and called, "Mercy, mercy." She had danced. In front of the whole village, she had danced. We ran laughing, with John and Bazille close behind, carving our way through the bodies, away from the circle of music. I caught my breath and Monique regained her composure, tying up her headscarf and tightening her panya.
John handed a stunned Bazille back to his mother. How quickly we escaped the glow and frenzy. From the outside looking in, it seemed to confined to hold such energy. A gathering of people in a tiny village, a jubilant speck, just south of the vast Sahara. I savored the feeling of being here, of knowing this place. Thank you.
[APPLAUSE]
So any questions about Peace Corps, policy? I'll do my best to answer them. Don't be shy. Yes?
AUDIENCE: I was just curious, you talk about Mali and your experience, but what is it like in other African states, villages, cities, [INAUDIBLE] and East Africa? In terms of people [INAUDIBLE], You had an isolated experience. But I'm assuming that there are lots of different iterations of [INAUDIBLE].
KRIS HOLLOWAY: So the question is are there other people who go to other places, especially in Africa, and have a similar experience of integrating into a community? Absolutely. There's a lot of organizations, like the Peace Corps, UN volunteers, global volunteers. I mean, the opportunities now are almost endless. Some are better run than others.
And I think-- when I speak to groups-- and are there any returned Peace Corps volunteers in the crowd? So what do you say? Similar experiences? I sort of find others, Gambia, Philippines, where were you?
AUDIENCE: Madagascar.
KRIS HOLLOWAY: Madagascar.
AUDIENCE: Ghana.
KRIS HOLLOWAY: Ghana. And when I speak with other returned Peace Corps volunteers, I'm actually amazed that we have so much in common about our experience, regardless of where we lived, maybe because a lot of us are in rural communities. And so I think there's a lot across that's similar.
I think I was especially lucky in Mali, because they're such a nonviolent society, and because I got to know this woman, Monique, who could really serve as that sort of easy cultural translator for me, which a lot of people don't have. Does that answer your question? Other questions. Way in the back.
AUDIENCE: [INAUDIBLE] your transition coming back? Like, did you find it harder than [INAUDIBLE].
KRIS HOLLOWAY: So the question is what was my transition back here like, and was it harder than going over? The transition is still happening. So I think reverse culture shock, or coming back to your home country is almost always harder than going over. Because going into the country, sure, it's different, but you're there for a confined period of time.
And a lot of the problems you witness, but you don't really own. But coming back to this country, this is our place. And we're kind of responsible for the mess that we may be in. And so I think it's always harder to incorporate that back into the home country. Did you find that in Ghana, as well, coming back and living here?
AUDIENCE: [INAUDIBLE]
KRIS HOLLOWAY: I think also some of that, and in some of the global health classes I've spoken to, there's a lot of-- when students have studied for a certain amount of time overseas, and we were talking about what we missed most from those cultures that we were in, and there was a lot of similarities around-- I mean, it may sound trite, but friendliness, openness, people willing to help other people, the pace of life.
And there's a lot of the beautiful elements of being human and being in a human society, that in many ways, we've lost here in the United States because of our materialism, and because of our fast paced life that we go at. I think it can be a lot easier to connect when you're not going 10,000 miles an hour. I mean, I text, I Facebook, I operate as fast as everybody else. But I really miss some of those elements of just community.
And in a place where there aren't material items, you rely on humanity. So humanity and human relations are the art, and the science, and where you put your energy, not in obtaining a material thing to meet a certain need. So I think I'll always find that hard living here. Though there are things here, like health care, that I actually really appreciate. Other questions, yeah.
AUDIENCE: [INAUDIBLE]
KRIS HOLLOWAY: That's a good question. She's saying do I wish that I had done my MPH before I went over, rather than having the experience be my inspiration for it. And I see someone shaking her head. I think it would have been a different experience. I think there's something really wonderful about not really knowing what you don't know. I think I had an amazing amount of just sort of open eyed courage, because I didn't have huge expectations of what I was going to be able to accomplish.
I didn't have-- I think if I went with an MPH, and if I went now, for example, the projects I would be doing would have a lot more goals, a lot more objectives. I probably couldn't switch them as easily. So there was something really nice about being there for some help, but also reciprocity, learning another culture, or having a cultural exchange, which is really important.
So I think it would have been a different experience. And when I think about what is the effect I had, and did I make a difference, I don't know. I mean, I'm one person. But I do know that there are people in Mali that I love. And that they love me and we really care about each other, and we help each other. And I think because deep and lasting change always happens in relationship, I think.
When you look at how you've changed, it probably came out of a hard experience, or people that changed you, probably a professor, a parent, a good friend. And that deep change happens in relationship. And that allowed me to have that relationship, because I wasn't coming in here and telling people what to do, which I think I'd be more likely to do the more advanced degree I had, or that would have been the expectations put on me.
Obviously, when John and I go back to the Peace Corps, which we do intend to do together, it will be a different experience. And I hope that some of that, just ability to be in community, and not be put on some level where the expectations are really enormous, is still avail to me. But those of you have MPHs and advanced degrees, still go, still go. Don't let that be a deterrent. Yes--
AUDIENCE: You referred to the fact that she originally wasn't getting the money directly, the payments were going to her father-in-law. Could you speak a bit to some of the issues in relation to the health care system and in any ways in which Monique's life and her struggles and your relationship with her confronted or had to deal with the health care system was not helpful also [INAUDIBLE].
KRIS HOLLOWAY: So the question about the health care system and what were the struggles that we had to encounter. And I think a lot of the struggles we had had to do with sort of a lack of rights or a lack of control over the determinants of health.
So for example, Monique was the first woman in the village to have an official position. And the village was not used to thinking about a woman's work as equal to money or payment. And so she got her salary. But rather than her getting it, it was given to her father-in-law, because he owns her. And own is too harsh a word in English to use, but really she belonged to that family. So he got the money.
And unfortunately, he didn't spend it in ways that benefited Monique's children. So they would have a sauce of very weak water when she was making enough money to add those extra vegetables that maybe you had to pay for, because they were coming from further south in the Ivory Coast, for example. So we had to work really hard with the different village powers that be to convince the village to give her payment for her work.
And luckily, a man, who was her boss in the larger town, actually really wanted her to get her salary. So it really wasn't so much a gender thing down along the line. And she eventually did end up getting her salary for herself. And throughout the years had to constantly kind of finagle that in her own family structure. But she still got money, which was amazing.
And the midwife, who is now in the village, receives her salary herself. So clearly, there's some fundamental shift in thinking that's happened. In terms of other barriers, the care of children is in a woman's world. So in Mali, work is very gender stratified. So women take care of the children. Women cook the meals. Men plow the fields. Men repair the homes.
And so a woman might bring her child in who's very sick, and we might say, hey, he needs to go to-- you need medicine in a larger town, or you need to get more protein into this child. You've got to get some peanuts. And she'd say my husband won't give me any of the money. Or my husband ate all the protein rich foods and I don't have any.
So a lot of the barriers were faced in the power relationships in the home. And a lot of the work that Monique needed to do is really talk to women and men and let both genders be a part of that solution. Sometimes that worked, sometimes that didn't work. So another project we worked on in Mali was doing a field of beans and peanuts that were just to be used for baby food.
So when the dry season came, because it only rains about three months out of the year in Mali, so right before the rains come again, there's not a lot of food. And it's really the time of hunger. And the way that one eats in Mali is the men are served first, then the women, and then the children.
So if the men need all the pieces of meat and the protein, there's not a lot left for the kids. So what the women wanted to do is just have a field just devoted to raising beans and peanuts that they could then put into a powder and have in those hunger times. And that worked really well.
So in terms of the other problems in the health care system, again, who's accessing the health care, and who are the decision makers about how you get transported to that health care system and how you get money for what's being on offer. And the fee for service is very hard, because most people don't have money.
So there was a lot of bartering. Monique would get a chicken, or she would get some bananas, and then give out money. And then of course, she'd run into problems because she can't pay the main Malian government with bananas for medicine she's used. So there's a lot of ways that the Western monetary world and the more traditional village system of trade and barter clash.
The other pieces that were missing is certainly transportation. Transportation was always an issue, especially for a woman in an emergency. And the clinic was always understocked with supplies. All of a sudden we'd get 1,000 syringes, but no serum to put in them. So the supply lines, there wasn't like here, where you run out of q-tips, you order more, and they come.
So all that kind of that supply and demand, really the infrastructure wasn't in place to make that happen easily. So therefore, all that health prevention work became really important because if you didn't prevent it, you may not be able to do anything about it, an illness, when your child actually had it. Does that answer your question? Yeah. Yeah--
AUDIENCE: I wonder if you could speak a little more about what Monique's concerns about genital cutting, how she approached it.
KRIS HOLLOWAY: So the question is about female genital cutting and what Monique-- how Monique approached it. And basically when I was-- have most of you heard-- raise your hand if you've heard a female genital cutting, just so I know. OK, so most people. In Mali, female genital cutting, the form is type two, which is excision, which means the clitoris and the inner lips of the vagina are cut off.
So that's not the most extreme form, which is practiced more in eastern Africa with the infibulation, where the labia majora, the outer lips are cut off as well. And then a woman is sewn up. So it can be very hard to go to the bathroom or to have your period. Obviously, intercourse is difficult. So in Mali, the practice is still about 96%, 98% of women undergo this procedure.
There's no basis for it in religion. Sometimes the Bible or the Koran is used to support it, and great books can be used to support many atrocious things, as we know. But there's nothing in either one of them. And so it's somehow an indigenous practice to Africa. They're not really sure where it started. But it can certainly be used as a way to control a woman's sexuality, to make sure a daughter is virginal, et cetera.
But what I was shocked by in Mali, once I realized what I was seeing, because I don't know how many of you have seen vaginas giving birth, women giving birth, but that region looks completely different anyway. You know, it's just completely different. So I wasn't exactly sure what I was seeing, because it was dark in these birthing huts. But I soon realized that there was something going on.
And we had touched upon it lightly in Peace Corps training, but FGC 20 years ago, really wasn't talked about a lot like it is today. And so I talked to Monique about it and she was shocked because she thought every woman in the world was excised. Why would she think any differently? Just like we're shocked thinking that the practice happens.
So one, she couldn't believe that I was actually in an unexcised woman and that that was a possibility. Because the belief there, in Nampossela, was that the clitoris would become a penis, and a woman would have not only uncontrollable sexual urges, as all men clearly have-- it's a joke-- but she would not be able to give birth because the penis would get in the way.
So that was huge for her, because she's like, oh, my gosh, I can't believe this. So luckily, I could get materials from a group in the larger city, the capital of Bamako, that was a Bambara group that had started to talk about female genital cutting. And like in many countries, it is those outlying villages around a city where a lot of the sort of initial thought change happens.
So they were going into villages and talking about female genital cutting. So I got those cassette tapes and then some pamphlets in French and Bambara, and we read them together. And she really realized that her experience as a medical practitioner was that that scar tissue, when a girl's 10 or 11, does not stretch, and it does not help the birthing process.
And she saw that over, and over, and over again. And so she was finally being able to say, oh, OK, here's this medical knowledge, and now it fits into this greater knowledge that I'm exposed to. And so at that point, I sort of stepped back. It is such an emotionally charged issue and not something that I wanted to grapple with in my village. I think because it is the older women, the grandmothers and the mothers who are the staunchest supporters of it.
And maybe we'd label that is internalized repression here. I don't know, but it's done out of the greatest love. Because the one thing a girl is born to do in Mali is to become a wife and to become a mother. That is the greatest honor and the one job. And if they're not excised, they can't do that.
So any practice that's done out of that that deepest love is hard to change and also really precious. So part of what the work being done now that Monique started to do in Nampossela is to talk about, with that excisionist, the woman in the village who does the cutting, who is an older woman, and one of the few positions of power and prestige that a village woman can have.
So the woman who does the cutting, to talk about retaining her position of honor, keeping the gift giving of the chickens and the [? kolan ?] nuts and the [INAUDIBLE], the millet beer, and to keep the ritual of passing on the knowledge of becoming a woman and a mother, like a bar mitzvah, if you will, but not doing the cutting, or doing just a ritualistic nick.
And that is [INAUDIBLE], or Healthy Tomorrow, is a group in Mali working on that. There's also a lot of social marketing happening through public radios. When I was in Mali before the coup d'etat, or during the coup d'etat, in '91, there was maybe one community radio station. Now there's probably two dozen. It is a main means of communication.
And it's perfect, because it's still really an oral society. In fact, they use it for announcements. When John and I went back last year, they were like, oh, we knew you were coming. We heard it on the radio. It's really weird. So they're using it as a way to talk about female genital cutting, to get Imams, the Muslim religious leaders to talk, how there's no basis in the Koran. To get women, like the president of-- the wife of the president, [? Amadou ?] [? Turei, ?] is a midwife. So she can get on and talk about health issues.
So that social marketing piece is happening. And also now some of the Malian legislators are actually lawyers, women lawyers, and they're looking at personal injury law and seeing if excision could be classified under that. And it's controversial because some of the-- some countries when you put things into the law, they just go underground. And they just result in excision happening to younger people or in unhealthy ways.
Just like abortion in the states. If you outlaw it, the rich will find their way to get a healthy one and the poor will get sick, and they will do it in a dangerous way. So there's a lot of controversy around whether it should come from a policy or legal level. So that's what I know about female genital cutting and what's happening in Mali. I think it's going to change. And I hope that not all the beauty of the culture of becoming a woman changes with it. Yeah--
AUDIENCE: Could you tell us a little bit about when Monique visited the US?
KRIS HOLLOWAY: Sure I can tell a little bit about Monique's visit. How we doing time wise? We're doing good, OK. So I have to digress for a moment when I talk about her trip to the US, because asking her to come to the United States was something I really longed to do. When it was the end-- and please feel free, if you have to leave, just walk out. I won't be offended or anything.
So many people in Mali really want to come to the United States. They view it rightly or wrongly as paradise, like that place you want to go to. And those of us who live here know it sometimes is and sometimes isn't. But I knew I didn't want to leave my village and not know that Monique was going to see my people and meet my villagers back home.
And so I got permission from everybody I needed to and raised the money from my hometown to bring Monique to the States. So there came one night when I was going to ask her if she wanted to come to the States with me. And so we're sipping Ovaltine, sipping Nescafe, and I was like, OK, Monique, you know we have to go in a bit, but would you like to come and visit me in the States for a month. You can come and visit me in the States for a month. We have the money to do that.
And she looked at me and she said, "Fatomouta, if you wish it, I will come." Like this. I'm like, wait a minute, you know, that's not the response I expected. I said I have permission from the village chief, from your father-in-law, from your father. We have another midwife who can come and sub for you. [INAUDIBLE], the village health care worker is going to be able to do the village health care work.
You know, like all these things that I thought she was worried about. And she said, "You know, Fatomouta, I just don't know if I can hang on that long." And I said, "What do you mean, hang on that long?" She said, "Well, you know, I've seen how high planes go in the sky. And you've told me how far it is from Bamako to New York. And I've only ridden a moped like 12 kilometers. I can't possibly hang on that long." I said, "Monique, you ride on the inside of a plane." And she said, "I'm going."
So the proof, she's the bravest woman on the planet. Is that not courageous. She said yes to riding on the outside of a plane between Bamako and New York, OK? Unbelievable, unbelievable. I think she figured if I could do it, she could do it, you know. I love that image though, I love that image.
So she had a wonderful time here. I mean, we did New York City, Washington, DC, and Central Ohio, because really, what else is there? But you know, I didn't want to do the whirlwind tour. I wanted her to-- obviously, she landed in New York. We had a good friend there that was fluent in French. So that made sense. I wanted her to see DC. But then I just wanted her to have time just to hang, because it would be the only vacation she ever got. That's it. There's not really vacation time in Mali, you just work all the time.
So she had a month of vacation. And she loved the grass. It was April. And she's a devout Catholic. So we celebrated Easter in this Episcopalian church that John's uncle participated in. She was blown away. She said, oh, my gosh, this-- you know, the stained glass windows, and the carpet, and the organ. She's like god is really here. Because we have all these physical ways that we can celebrate faith.
There, it's wood, and steel, and mud. You know, she loved it. And she loved the flowers. She was blown away, went up to the top of the World Trade Towers. She was blown away at the pace, you know, the cereal aisle, you know, blown away by that. Just like we are. And she really enjoyed-- so she loved the flowers, she loved the rain, loved meeting my family. Wearing pants, going out to all these different places where she could wear what she wanted.
And I think on a deep level, she was shocked by the effect she had on people. She was so nervous coming here. And I wanted her to speak. And I always had to translate. But I wanted her to talk to colleges, and universities, and church groups, and all of that. And the response from people was they were blown away at the work she was doing. And I don't think she knew that she was that special.
There wasn't a lot in her life that said, wow, you are really an amazing person. And so I think she absorbed some of that. And I think that was beautiful, and yet also hard, because she went back to the same job in the same place. I think the thing-- she loved pizza. She didn't know how she was going to survive without pizza, and strawberries with whipped cream.
She rode the Batman roller coaster at King's Island, loved that. Loved dolphins, loved driving the cars. I mean, you know, she just embraced everything. You know, can imagine, this mid-wife from West Africa riding the Batman roller coaster and loving it, loving it.
I think the things that she had a harder time with was definitely the pace. Being inside, like we'd walk in our neighborhood, and it was beautiful weather, and she'd say where is everybody? There's just nobody out to greet, there's nobody outside. And it's true. There wasn't anybody outside. We live in our houses, right?
And we were talking earlier about the illusion of inside versus outside, how we're all really outside. We are outside, on the surface of the Earth. And she did not like how old people were treated. In Mali, to say [NON-ENGLISH SPEECH] or [NON-ENGLISH SPEECH], that means old man or old woman. And it's an honor to be called that. It doesn't translate well back here. Hello, old woman, you know.
But there, the elders are so important, and they're such the center of the community. And here, she couldn't really greet the elders of Grandville. And my grandparents were in Minneapolis and in Portland, Oregon. We didn't have time to see them. She's like that's just wrong. We went to a nursing home where some family friends were. And she thought it was horrible. The idea of nursing homes is horrible.
And it's like, OK, so we get upset about female genital cutting. Maybe we should get a little bit more upset about the number and the care of our elderly in nursing homes. But I think it's easier to get upset at practices that are farther away because they're easier to simplify, and objectify, rather than ones that are right here, living with us, and we know how complicated they are.
I try to imagine having my mother-in-law move in with me. You know, that would be hard. Not that she's in a nursing home, god love her, god love you, Betsy. But it would be hard to have our extended family with us, and how busy our lives are, and the way our society is structured. But I think about that a lot.
She came to my bridal shower. She loved that. So anyway, that was-- and she never really thought-- I get asked a lot, like did she want to stay here. And she didn't. She really knew what she had at home. She loved the clean food. She loved the fact there were multiple places to get clean water inside a house. All the spigots that she could get water from, and then the idea of a dishwasher, or the idea of a washing machine for clothes.
I mean, she can see the hours that she would have to do other things, right? But she never wanted to stay. I mean, she missed her life, and her kids, and she loved her work. As hard as she worked, she absolutely loved it. So she never-- I was never once-- I mean, maybe a little tempted to keep her here. But really, no. She was ready to go, even though we weren't quite ready to have it be over, in terms of not seeing each other.
AUDIENCE: One more question?
KRIS HOLLOWAY: One more, OK.
AUDIENCE: I was curious about, I guess the cultural sensitivity training that you received as a Peace Corp volunteer, to call it that for lack of a better word. And how that compared to the actual experiences that you had there. [INAUDIBLE] And maybe how you've seen that progress over the years, like how [INAUDIBLE] has changed from what it is today, [INAUDIBLE].
KRIS HOLLOWAY: So the question is about sort of cultural sensitivity, or cross cultural training in the Peace Corps, what was it like, to get that training. What was that training about, and then did it kind of work on the ground, and what it might be like today. So we got a lot of cross-cultural training. And most of it just on the ground.
I mean, we did a lot of reading beforehand. But it's kind of like when you're in it, you can really understand. So a lot of that happened in the three months of in-country training. And then certainly that crossed over into life in the village. And I think nowadays it can almost become overdone and overly analytical.
We have so much knowledge that we can kind of think that we have to be absolutely perfect at like if somebody from this culture comes, or if I'm going to this culture, I really need to know, do I hold two fingers in and only stand on my right foot, or-- we can think that we have to be perfect or somehow we're going to offend people or be bad at what we do.
And I think that's true to a certain extent. But I think the biggest thing is actually cultural humility, that just to not presume that our way is the right way. And those aren't easy to tease out. But if we always just go in with an idea of respect and listening, that's the biggest gift that we can give.
And when I do talk with medical practitioners, they're always wondering well, what if somebody from Laos comes in my office here in the United States, what if someone from Ghana, how do I know how to treat them. And as we're talking, we realize you're not going to be able to know every single culture or people inside and out, so just ask. Are you feeling comfortable? You seem a little nervous? What do you think? Or is this OK if I--?
And so, so much of it just comes down to just being a respectful, kind human being, which we all have the capacity to do. So that's what I kind of come back to. I'm sure that the Peace Corps training now has way more cultural sensitivity training that even I had. And I'm sure it's really good. I found the training to be really good. But I don't think-- I think it's even more important just to be humble, I guess. So thank you.
Kris Holloway, author of "Monique and the Mango Rains: Two Years with a Midwife in Mali," spoke about her experiences as a Peace Corps volunteer in West Africa from 1989-1991, during her March 5, 2009 visit to campus as a Cornell Institute for Public Affairs (CIPA) Colloquium speaker.
Holloway has used her unique background in writing, public health, and development to further the mission of numerous non-profits and educational institutions including Planned Parenthood and the National Priorities Project.
CIPA's Colloquium Series engages participants in discussions of issues facing public affairs and public policy professionals.
