Need a little help? The way we get by, part 2

When I'm sick or need, say, a tetnus vaccination, I usually would call the nearest health center, schedule an appointment, and pay the necessary fees to clinic. When I need to pass an important exam--SATs, LSATs, MCATs, take your pick- I study, appear at the appropriate testing center, and receive my results a month or so later.

In Mali, for both of the above, you call up your friend who owes you a favor. If you're sick, this friend will give you the necessary tetnus vaccination, malaria injection, or IV drip. Never mind not only that he's not only not a doctor, but he didn't finish highschool. And just before or after important exams in my village, you'll find many of the female students frequenting their instructors' houses, often at night.  I don't think it's to make tea.

Last week, I wrote briefly on the micro-view of giving and receiving help. There is something I love about the fluidity of aid between Malians; most 'help' is never considered a big deal the way it is in the US. Yet this same practice which mutually helps everyone get by also has some problems on the macro level.

For certain situations in the US, I'll call a friend: such situations include bringing in my mail while I'm on leave, proof-reading an important manuscript. Yet when I'm sick, I go to a doctor, if I have financial problems, an accountant.  I might not know him or her very well, and I'll have to pay a small fee, but I take for granted that these professionals have my best interests at heart. In the US, I have a basic 'trust' in this impersonal system. And if this system runs afoul, I have faith that bad doctors will not practice for long, that an accountant who steals money will be convicted and appropriately punished.

In Mali, it's not that people don't like strangers or aren't friendly. They're very friendly, in fact. But right now your friend is going to give you an injection that will make your malaria better, and he'll let you pay him later to boot.  In contrast, at the local clinic, you'll pay a fee for the doctor, and then another fee for the medicine. Then there's the fact that the clinic's director didn't properly store the new tetnus vaccine.  And why should I pay for a vaccine anyway, since last year I got that vaccine and mosquito net for free from an NGO?

When you speak with citizens from the USSR or any of Eastern Europe, even today, there is a fear of doctors, lawyers, police--really, any professional- because such public servants were affiliated with a corrupt State, a State which didn't represent the people's interests. In Mali, there is none of this Soviet-style suspicion of public institutions. Rather, there simply were no institutions to begin with. So Madou, a few houses over, just started to set people's broken bones when there was no one else to do it. You didn't pay him, but you did help him out next rainy season by giving him a few bags of millet. And everyone was satisfied, so everyone starts getting broken bones set by him and just repaying him with food or labor. And all the way up to the present, there is still this guy named Madou who sets broken bones--he has no medical training, I don't think he's even literate.  Yet if I broke something, my village would most likely trust Madou over our clinic's new doctor.

But even now, with a set of budding institutions and infrastructure, the informal system still makes more sense to Malians. There are at least two other 'doctors' in my village who dispense medication and medical advice in exchange for repairs on their houses. This means the clinic loses money, which it needs in order to pay salaries and buy medicines. But the clinic will not let you take credit, since giving out credit was how the clinic institutionally fell apart the first time around. So between receiving no medical treatment or having a 'friend' give questionable treatment for free, which should I recommend? Likewise, school teachers are poorly paid or just not paid to start with when a village runs out of money. So a teacher might pass you on an exam since he knows you're smart. Or demand a small fee or 'favor' for passing--after all, you rarely get your own results in the mail anyway, so why study?

Malians have been operating in an environment of poverty for so long that everyone mutually helps everyone else, often with no money attached. But where is the line between 'appriate aid' and 'corruption'? Between quality hospitals, schools, police and an ineffective untrained bureaucracy? In my own village, it's impossible to point people out and say what he or she is doing is purely corrupt and selfish or purely good and altruistic.

So where to go from here? I love the attitude of Malians--that my mother here feeds me free of charge, because she knows I'll buy her bread and develop her photos when I go to the city. I love that I don't have to worry about a dog or a securtiy system because I know my entire village makes sure I'm safe and would punish anyone who harmed me. I love that there is no shame in saying 'I can't do this, come do it for me.'

But I think an improved infrastructure (trained doctors and teachers) will create more confidence in public services. Further, if people begin to make more money and overall literacy increases, Mali will start to seriously attach monetary units to goods and services. Finally, no-strings-attached aid needs to end. Currently, mosquito nets are provided free of charge and the World Food Program provides porridge powder for small children, again, free of charge. This is not only unsustainable, but villagers actually refuse to buy nets or make their own cheaper porridge since they know they can get these commodities for free. I do think mosquito nets should be subsidized and malnourished children given extra medical help and attention. But Mali must start to attach monetary value to goods and services if it ever wants to get out of poverty and dependence on foreign aid.

How to have it all-- the rural warmth and immediateness of personal help? The efficiency and standard of a well organized public institution? And finally, the unbiased oversight to regulate it all? Until that time comes, such is the way we get by in Mali.