• All clinical testing of Group 1 participants has been completed and the statistical analysis of the results is in full swing.  The data include six extensive clinical evaluations of each participant taken over a period of nine months. The data include values of CD4, CD4%, Hemoglobin, Body/Mass Index and viral load of each participant.  We are also in the process of evaluating the pre and post levels of Interferon-alpha for these participants. Although presentation of these results will have to await publication or presentation at the scientific conference that will take place in August in Bamako, we can say at this point that we have seen some encouraging trends regarding the use of LDN to stabilize the immune systems of HIV+ adults, particularly in regard to the CD4%.  This measure is proving to be a more stable indicator of immune system health than the absolute CD4 count itself, very much in agreement with many other HIV studies that have been published recently. Thirty-eight of the original 57 members of this group finished the program (just meeting the protocol’s requirement for sample size) and data from eight others who almost completed the protocol will be used in the final analyses of the results.
• The clinical testing for Group 2 participants (HAART medication only) and Group 3 participants (LDN plus HAART medication) will be completed by the end of March as planned. This means we will be conducting an intensive analysis of the results of all groups within a few weeks. This will enable a quantitative comparison of the efficacy of LDN in combination with the HAART medications relative to the HAART medication alone.  Forty-two members of Group 2 will finish the complete protocol and 44 from Group 3, more than is required by the protocol for statistical validity.  Combining these results with the analysis of the LDN-only Group will provide us with the information we set out to discover three years ago!
• Seven of the eight ongoing Council Groups have now been completed and the eighth group will have its final session this month.  In all, 61 men and women participated in these ongoing groups each of which met monthly for at least nine months. We are in the process of digesting the more than 75 evaluations that the various council leaders prepared after each council so that we can make a comprehensive report about the council program. Suffice it to say at this point, that we are amazed at the openness of communication about intimate matters that the groups have provided participants in the clinical study. Many men and women have been able to talk about health issues, the empowerment of women, the stigma of being HIV positive, and sexual intimacy in ways we could not have imagined considering the traditional patterns of the Malian patriarchal culture. It is clear that when given the opportunity to share sensitive information and deep feelings in a safe environment, many people are ready to seize the moment whatever the limitations of their cultural mores. The written comments from the facilitators have been illuminating–and inspirational.
• The Mali professional team is preparing several papers for a large scientific conference in Bamako in August.  The papers will include two on the basic results of the clinical study, one on how LDN affects the immune system the way it does, one on the results of the council program (GECP) and one on making LDN available in Mali (and eventually elsewhere in Africa) for both adults and children, once the clinical study is completed.  Widespread availability has always been a part of our long-term vision in conducting this program. In particular we are now exploring what steps will be necessary to make LDN available to HIV+ Malian infants and young children in cream form.
• On the financial front, the monthly cost of the program has dropped to an average of about $4,000 now that the clinical testing is coming to a close and the council groups are ending. Our estimate for the support needed from March 1 to the program’s completion on July 31, 2010, is $12,000.  A large portion of these funds will be used to do the comprehensive analysis of the data and the preparation of the scientific papers. We are deeply grateful for the more than 100 donations—large and small–from more than 75 donors that we have received since the program started in 2007. To help us complete the funding, new donations from previous and new supporters will be greatly appreciated.
• We will be posting additional news soon.



However, we have news to report!

Enrollment in all three groups–LDN only, LDN and HAARV meds, and HAARV meds only–was completed at the end of July (171 participants in all). With that milestone passed, the program will definitely complete in early March of 2010.  The other piece of good news is that more than 80% of the testing has now been completed. That means 80% of the CD4 and hemoglobin tests that are done six times on each participant have been completed. For each participant, these tests are done at the start of the clinical period, after 15 days, and at the end of the first, third, sixth and ninth months. Most of the testing will be done by the end of this year with only the last few enrolled participants still undergoing testing in early 2010.

Meanwhile the GECP council groups have continued steadily with about 65 participants in the monthly meetings at any one time. As participants complete their nine-month clinical testing and leave the protocol, new participants have joined the councils. There are both men’s, women’s and mixed councils going, with attendance remarkably high in the majority of circles. The council discussions have dealt with the basic issues surrounding HIV/AIDS plus other issues of general importance. These topics include dealing with the HIV/AIDS stigma (within and outside the family), how to convince partners to commit to protected sex, experiencing the freedom that comes from acceptance of the illness and the possibility of healing, the empowerment of women to protect their health and to express their feelings in intimate matters, whether it’s better to marry someone who is also HIV positive, how to generate enough income to feed the family and so on.  The groups have been lively and remarkably open for a society in which intimate communication between men and women is virtually non-existent.  Obviously, at least many of the program participants were ready to break through long-standing Malian gender cultural barriers.  We are now beginning to analyze the semi-quantitative evaluations of each council provided by the council facilitators.  There are now six council leaders working in Bamako, all of whom have been trained by us and have been leading councils now for at least a year—some more than two!  The success of the council work has been encouraging and gratifying.

The formal analysis of the CD4, hemoglobin and interferon-alpha data will have to wait until the testing is completed. However, a preliminary review of the CD4 data shows a few trends:

• Unavoidably, there are uncontrolled variables in the study, primarily because Mali is the second poorest country in sub-Saharan Africa—with a poverty rate that is currently increasing. This affects many issues including the dietary habits of participants, participant compliance with taking the meds, the prevalence of other infections and illnesses besides HIV/AIDS, etc. These factors may explain why, thus far, it appears that taking LDN alone is not sufficient to increase the CD4 levels for most of the HIV positive individuals in our study.  However, the LDN does seem to prevent some participants from large drops in CD4 count and from developing AIDS symptoms over the short haul (nine months). Whether this is significant has yet to be determined.  We plan to compare the change in CD4 count for the LDN-only group with the 80 count average yearly loss that the literature reports for HIV positive individuals who are not being treated at all to see if the change in CD4 levels in the group taking only LDN is significantly less that this level. We will have to wait until early 2010 to make this determination.
• The participants who are taking LDN and the standard HAART medication and those taking just the HAART meds are showing significant increases in CD4 count. How much of this increase is due to the LDN and how much to the HAART medication cannot be fully determined until after all the testing is completed.
• We also plan to look at the CD4 percentage as a measure of the strength of the immune system rather than just the CD4 count alone. Recent studies indicate that the percentage of the CD4 cells to the total white count may be a more useful and stable measure of immune system strength that the CD4 count alone.  We will also be looking into more complex measures of immune system strength that includes hemoglobin and other data available in the study.

Apart from whatever the final statistical results turn out to be, it is already clear that we have learned a lot about implementing an LDN protocol—the first such quantitative clinical study for HIV+ anywhere in the world, as far as we know.  This in itself will contribute to LDN being accepted into the medical community and we trust will spur further LDN studies in other countries. Another significant plus to the study is that efforts are already underway to arrange for LDN to be available in Mali once the study is completed next spring. This will be a boon to the population—and not only for those who are HIV positive.  From Mali, the availability can spread to other African countries.

On the financial front, the current monthly budget is running about $5,700, so we have to raise about $40,000 to cover the final seven months of the program. This will include all the analyses and writing of papers that will follow the end of the clinical study next spring. As always, we will greatly appreciate whatever support readers of this web site can provide, as our own funds are virtually tapped out. We want to thank all those who have supported this program, both financially and through their efforts to inform both the medical profession and potential users of LDN of the medication’s enormous potential for strengthening the immune system.

They say that smell is the most primitive of the senses and transmits our memories more than any of the others. As soon as the plane from Addis Ababa landed in Bamako and we disembarked into the waiting bus, the familiar scent of burning wood surrounded us. By the time we reached the terminal a moment later, we were home…glad to be in Mali again after an unexpected 17-hour layover in Ethiopia.

We didn’t see Seyni Nafo until we left the terminal but there was no problem at all in recognizing him. He looks exactly like his father, Alfa, and, at six-foot two, stood out in the crowd of welcomers, phone card sellers, money changers and taxi drivers. We hugged warmly, finally glad to meet this unusual 28 year-old with whom we had been working at a distance for more than two years now. Seyni has acted as our coordinator/translator during all the weekly phone conferences this past year and is now in Bamako more or less permanently after getting his MBA in Montreal last summer. Over the next few weeks, Jaquelyn, Seyni and I were inseparable, he acting as our translator, driver and personal assistant. Seyni has single-handedly kept the LDN Project alive since its inception by Dr. Bihari more than five years ago, acting as his family’s agent in getting the original medical team together and keeping the Project alive even when Bihari and his associates were not able to make it happen. He is quite knowledgeable now about both the medical and cultural/social (council) aspects of the Project, and a champion of eventually getting LDN produced here in Bamako for all of Africa.

Seyni Nafo and Jack

Within days, Seyni felt like one of our older grandchildren or perhaps our youngest son. We had many intimate conversations about his family and the Mali Culture. Having lived in Canada for so long gave him the ability to connect us to the local culture in a powerful way and made it possible for us to more easily transcend most of the cultural differences that had remained before this visit. Partly because this was our third time in Mali and partly because of Seyni, we felt an integral part of the team here. Gone were the “Mr. Jack’s” and the offer to carry my briefcase. Kisses on both cheeks, repeated twice in the local (French) custom, were offered to both Jaquelyn and me this time. Vigorous hugs from the men also abounded. We are part of the family now.

After being denied entry at 3 am into the hotel at which we had reservations because of a large Pan-African Medical Research Conference in Bamako, we found another place to stay for a few days. Unfortunately, the alternate hotel was infested with mosquitoes. We were dive-bombed every night and, within two days, Jaquelyn had 17 bites on her face alone! It turns out the Mali Government has been seeding the clouds here to increase the supply of water—but this practice has also extended the wet season and increased the population of mosquitoes…and thus, in turn, malaria. We were told by a specialist that a few months ago there were 200,000 children in and around Bamako who were infected but had no access to hospital care. We noticed a significant increase in mosquitoes this time and were glad we had (for the first time) decided to take prophylactic medication. Fortunately, we were able to transfer to the hotel of our original choice after a few days, which provided a significant improvement in the situation.

The goals of this trip were clear: 1) meeting the full enrollment of the Protocol by activating the intake of patients into the program from new sources, as well as continuing with the old ones;
2) clarifying the analysis of the CD4 data (that describes the status of participant’s immune systems and thus their ability to avoid AIDS symptoms, despite their HIV+ status); and 3) to spread the word about LDN and council further within the local “health culture.” All the meetings that have taken place these past few weeks were in support of these goals.

Doctors Carine Kunde and Issiaka Dembele

The major center for HIV/AIDS treatment in Bamako is called “CESAC,” and we have spent a good portion of our time during this visit bringing their doctors and social workers into the fold. The CESAC staff took the council training we offered this trip (see below) and agreed to start their own councils as part of the cultural/educational portion of the Protocol. We expect CESAC to provide at least 70 and perhaps 80 percent of the remaining 99 participants we need to complete the enrollment. The current number of participants stands at 72 or about 40 percent of the 171 needed. The group of HIV+ patients receiving only LDN is now more than two-thirds enrolled, so it is the two groups of patients who will receive the standard HAART meds and either LDN or a placebo that are still heavily under-enrolled. This is where CESAC should help us out enormously. The inclusion of CESAC in the already large team gathered here has also spread awareness of our Protocol—both the medical and council portions.

For example, during a meeting with the Minister of Health for AIDS and Nathalie Momo (who coordinates the council program along with Joseph Camara), we found Mr. Senn, with whom we had met two years earlier, much more aware and interested in our Project. The Mali Government is expanding their AIDS awareness program at the community level, organizing health workers in each of the nine regions into which Mali is divided. We talked with Senn about the possibilities of LDN being made available after our study is completed. With the cutting back on many AIDS projects that is taking place now (to give greater emphasis to other diseases) the potential of the less expensive and more easily implemented treatment that LDN provides is even more important. When we discussed council being used in Mali at the grass roots level for both education and healing, Nathalie’s enthusiasm rubbed off on Mr. Senn. If the council work should really take hold in Mali, it would be another example of how the world-wide council community is helping many people to “remember” the old ways. “Dare`” (council) started in certain traditional cultures of Africa a long time ago.

A highlight of the many meetings, most of them logistical and financial, was listening to the council leaders describe their experiences with the three groups that have been ongoing, some for as long as nine months. Here’s a part of my report after that meeting:

Joseph, Nathalie, Khalil Dicko, Seyni, Jaquelyn and I gathered in Joseph’s office at CNAM. It was the first full meeting ever about the council program and it was a gem! The office is air conditioned, which considering how hot it is here now in the middle of the day, was a goddess send. I asked about the status of the groups:

The GECP Team: Joseph, Nathalie and Khalil

Council 1 (Joseph) has been going for nine months and has 5 men and 2 women. There are two couples in the group; everyone is Muslim. All seven members of the council are taking LDN only. Council 2 (Nathalie) has 6 women in it and has also been going for nine months.
Council 3 (Khalil—who, like Nathalie, is also a doctor) has been going for five months and has 4 men in it. All of these participants are in either Group 2 or 3 of the Protocol. Council 4 (Joseph). This group will begin with 2 men and 2 women and will start in December. Stories abounded:

• After a difficult start, attendance has stabilized. It was not easy in the beginning. Now some of the groups actually meet in between times! Nathalie’s Council actually went to a concert together.
• Learning to maintain confidentiality has been a challenge because of the stigma attached to being HIV positive.
• A member of Nathalie’s Council started off depressed that she was HIV+ but as she opened up during the first meeting, her depression lightened and her CD4 count went up impressively for her next blood test. LDN and council seem to be quite a combination.
• Two of Nathalie’s women are widows, one from AIDS who didn’t even know her husband was ill. This is, sadly, not untypical. However, slowly the sense of stigma is fading in the groups, month by month. In particular, there has been a break-through in telling family members, “I am HIV positive.” After a whole year of silence, one of Nathalie’s women finally told her family after the third group meeting.
• One of the couples in Joseph’s oldest council has been a focus of a battle for months. She is a nurse and economically self-sufficient. He is out of a job and feeling a lot of shame. She is really angry that he infected her and won’t appear in the group when he does—so they alternate. The group itself has taken on the role of mediating between them, encouraging them to heal their marriage. They have both promised to appear for the next council!
• Having children comes up a lot in the groups. It is a complex issue. As the LDN helps them to feel better they want children, not to mention that LDN is also a good fertility agent! But there is a one-in-four chance of a child being HIV+ when both parents are– unless the parents work closely with a physician and take special supplements around the time of conception. It’s an ironic twist that, if a woman becomes pregnant, she has to leave the program, so the women wanting children are torn and most are waiting until the Protocol is complete.
• Women’s empowerment has come up in the groups, although not at first. The major factors in the continued suppression of women are economic dependency, followed by religious beliefs and practices.
• Generally, the men are willing to use condoms and the women are getting stronger at asking their men to wear them. “But if he gets excited and out of control, I couldn’t stop him,” one woman said both with a smile and a sigh. The single men generally are looking for HIV+ women with whom to connect. This gives them more freedom in sexual contact, of course, but it is also a sense of tribe.
• In one group there is a painter who stopped painting when he found out he was HIV+ and dropped into depression. After several group sessions, he is painting again!
• In the men’s group, one man started off down and resistant. He lost his wife and job as a result of becoming HIV+. But after several groups he slowly came around and now he is a missionary for other men, including urging many in his community to get tested, use condoms and join a group.
• The primary forces that have helped the groups to work are perseverance and word of mouth. The existence of the councils is getting around.
• It became clear as we talked that a support group for facilitators is needed. This is not surprising as the stories they listen to are intense. The stigma of HIV/AIDS adds to this need in significant ways.
• Nathalie has several young HIV+ women who want to form a group. Neither is in the Protocol. She is looking for a few others to add so she can begin one focused on youth. Nathalie’s enthusiasm is beautiful to experience.

In connection with our second goal, we have generated enough data now for preliminary analysis—and the results are promising. After six months, the majority of patients receiving LDN only are showing a stabilization in their CD4 count. Since Bihari showed that it takes this length of time for LDN to work its magic, we are hopeful the data from recently enrolled participants will re-enforce these results. We are also going to correlate our CD4 data with the nutritional status of patients through their body/mass index, since it is well known here that CD4 count is quite sensitive to nutritional status. Many of the patients are poor and cannot afford a good steady diet, so this aspect of the analysis is important. We also plan to correlate our CD4 results with hemoglobin status and eventually with the Interferon-alpha measurements that will be available at the end of the Protocol.

Although looking at the data of these LDN only patients was interesting, what really turned us all on was comparing the results of those patients taking LDN and the conventional HAART meds with those taking the HAART meds and a placebo. This is the critical “blind part” of the study. We have only a dozen patients in these two groups at present but the results are striking. In the LDN plus HAART group, and after only three months, the CD4 count of every person increased! The sample is small but if this trend continues, it would appear that the two medications have a synergistic effect that increases the potential of each in preventing HIV+ people from developing AIDS—thus confirming Bihari’s original hypothesis. The role of LDN in creating this promising (but preliminary) result is further re-enforced by looking at the group of patients receiving the HAART meds and a placebo. After three months the average CD4 count for these patients actually decreased. This suggests that LDN is playing an important role in stabilizing the CD4 count for those taking both medications. Over the next several months we will have the opportunity to confirm (or not!) these promising results as full enrollment in the Protocol is achieved.

Finally, we feel compelled to say more than a few words about what happened at our two-day council training, mostly arranged to spread the word about LDN and expand our Cultural/Educational Protocol to the CESAC Staff. Here’s my and Jaquelyn’s report completed a few days after the training, which took place on November 28, 29 at CNAM:

By the time the training was to take place we had signed up 13 people, who broke down into three groups: the doctors and social workers who were new to the Protocol and would be leading councils—five from CESAC and two from CNAM; four old timers; and several outsiders who were invited because of their interest in finding out more about LDN and council. These included a representative from the Health Minister’s Office and a leader of the Solthis NGO in Bamako that is doing a lot of educational work in Mali’s villages. The 16 of us were rounded out by Seyni, Jaquelyn and me.

The training was supposed to start Friday at 9:00 am, at which time we arrived at CNAM to find out that the regular conference room was taken over by another meeting. We found the alternative meeting place to be cozier, with a smaller rectangular table and even a controllable air-conditioner! Directly outside the conference room was a small patio where the coffee breaks and lunches were served. Adjacent to the patio were a number of large shade trees under which several families lived in small mud buildings. Just beyond that was the CNAM fence and a row of ramshackle homes made out of corrugated metal in the style of the South African townships. When we finished the training on Saturday, Jaquelyn noticed a family sitting under one of the trees watching a television set that was placed on one side of the large trunk. The mother, several small children and an older man (father or grandfather) who had helped with the lunches were all watching raptly. The television was abandoned in the excitement of having their picture taken and so had to be photographed separately!

The Family Under the Tree

We finally began the opening council at 10:40—after the coffee break–cell phones going off regularly with a great variety of signals. I suggested everyone turn them off, to no avail. Everyone always answered their phone, partly because many were physicians and partly because it is the custom. Seyni, our translator was no exception and periodically our translation capability disappeared on us and we had to wait. Finally, we had our first taste of non-chaos as people spoke their names, what they meant, their nick-names and how they felt about it all. There was a great deal of laughter. After a little history of council and how it all began in Africa, there were many questions for Jaquelyn about LDN, which was unfamiliar to the new members of the group. No five minute segment passed without at least one person getting up abruptly to go outside to answer their cell phone (pushing their chairs back with a scraping sound on the concrete floor that could awaken the dead). We gamely held the container as best we could. By the time we got into how to set up a council, we were in free-for-all conversation, with some people objecting to the use of a talking piece (“It will never be accepted in Mali; it’s against our religion” (which turned out not to be the case). Others said, “we already do this,” which we discovered was because of a complete confusion between counseling and counciling. By noon we had fully engaged Nathalie as a co-leader which helped—but we still had a long ways to go.

After lunch of very free-range chicken, salad and potatoes, the real agenda became fighting for council’s life against an attitude of “I don’t need anything new on my plate. We finally agreed to call council “listening circles” –Group a` Ecoute. Nathalie, Jaquelyn and I began to wear the group down with our positive stories and the experiences of the people in the groups already in progress. A key doctor from CESAC, who was sitting across the table from me and who has started out posing many questions and arguing that council would not work for their patients, began to study Jaquelyn and me more closely. I caught him giving us that “what-are-these- people-really-about look” and then “I can feel that they’re into something that is compelling to them…so maybe I should give this a little of the attention they’re asking for.” Perseverance is a warrior trait.

We ended on time and told everyone what to expect on Saturday, not having a clue who would return– if anyone! The day had been one of the most chaotic and unpromising training days I had experienced in a long time. But we arrived sharply at nine again…to find only one woman from CESAC in the room. Saturday is their day of rest and a few slept in and told us so. However, by ten everyone had arrived—to my delight and surprise. The opening check-in was attentive, with everyone using the talking piece with a light-hearted respect, just as Jaquelyn had suggested the day before. After the coffee-break we dropped into a gem of a council with the theme: “Tell a story from your childhood in which you confronted the traditions of your family and culture in a way that created conflict and shame.” The above mentioned doctor from CESAC—bless his heart—started off the council by telling a long life-story about circumcision. He had been born in a Muslim Culture in which male babies are circumcised at birth but went to school in another African country where the circumcision ceremony takes place much later in a boy’s life. The shame that plagued him for years shaped his life. His choice of topic opened a doorway into the kind of material that comes up in the councils with participants in our Program. He obviously knew exactly what he was doing and, with that story, became an ally. Others took his lead and soon we were on our way.

We talked more about setting themes with story prompts and ended the morning with the exercise of talking to new patients and inviting them into a council. After a lovely lunch of carrot salad, red rice and the traditional “capitaine’ fish, broiled perfectly, we moved into men’s and women’s circles. Even with all the food, no one got sleepy. The men went outside in the warm afternoon to have their circle. The sounds of children playing and the more pungent weekend wood-burning smells filled the air. I began by asking the men if they had experience being in men’s circles and was delighted to be told of the “grin” tradition (pronounced, “grieu”). It is an old practice in Mali for men to form small circles that can last their whole lives and that meet regularly, sometimes several times a week. The men are totally open in these circles, support each other, often talk of their wives and even start enterprises together. Malian men seem to be able to talk intimately with each other but far less so with their women. No one in the circle seemed to know where or how the grin tradition arose but it goes back a ways, obviously.

We formed an instant “grin” with the theme: “What can men do to help the cultural changes needed to stop the HIV onslaught—particularly in regard to men and women communicating more intimately and the empowering of women. Stories abounded, including trying to get mothers to overrule their husbands and bring their children, sick with AIDS, into regional hospitals. Only 40 out of some 250 are being treated in one city not far from Bamako. An NGO initiative to change the situation collapsed because the tradition that men possess/own their women is so strong the women would not rebel. The story-teller felt the needed social/cultural changes would take the urbanizations of the people and a new generation emerging. I responded that HIV won’t wait that long.

The main themes that emerged were men’s fear of women and then—for more than 45 minutes–the tradition of genital cutting of girls. These stories became a matrix for the whole need for cultural change. I spoke about the young educated Chad woman who returned home to make a film that changed her village’s genital cutting practices. Another man spoke of having to leave his “culture” because he would not let his daughters be circumcised. The whole use of the word, “circumcision” for women is questionable, as it gives it a tone of acceptance in comparison with the male counterpart. The two practices couldn’t be more different, both in terms of health and sexuality. A doctor told a few horror stories about young girls coming into the ER bleeding. I suggested finally that it is men’s fear of women’s sexuality that lies at the root of the practice—and many other similar patriarchal practices. The idea was a bit novel to the “grin” but they took it in. We all understand that it is the older women who continue the practice—and that men are going to have to play a large role in bringing it to a halt.

Meanwhile, in the women’s group with Jaquelyn, the main topic was the importance of woman’s empowerment. She heard a typical story of a family with one girl and 4 boys in which the boys went to school while the girl stayed home to do all the house work and so remained uneducated. If a boy was asked to do house work, other villagers surrounded the house and chastised the mother, saying they had heard that she was the “chief” of this house and it was not acceptable for a boy to do “woman’s work.” Clearly resigned to tradition, one older woman insisted these patterns could never change. Another older woman who was educated and able to support herself told of the price of choosing not to be married. She was called a witch, told she had demons inside of her, and was ostracized by family and fellow villagers. The women in the circle agreed that, if a man married a woman his mother did not like and was told he had to choose between his wife and mother, that 98% of the men would choose his mother. When a woman was kicked out by her husband and tried to go back home, her family would force her go back to him, telling her to be a better wife, to cook better, clean more, and be more obedient to her husband. Divorced women are seen as undesirable in Mali and traditionally cannot marry again. Many divorced women whose families have no role for her as housekeeper or caretaker turn to begging or the sex trade in order to survive and support their children. The estimate for HIV+ infectivity in prostitutes is 90%. We have been saddened to see women on the streets with their begging bowls while nursing their babies.

One younger woman said she had decided not to marry, that she did not want this situation for herself, but knew she had to be very strong, as there was no acceptance of unmarried women in Malian society. She stated emphatically that education was the only way for women to ever gain independence in a country where only 17% are literate, and very few of those are women. All agreed that, without more independence, women were not able to protect themselves from getting infected with HIV+. Jaquelyn as usual was impressed with the spirit and strength of women living in such a society, and encouraged them to start women’s groups and try to help the society move toward more equality for women.

We drove back to the hotel with Seyni exhausted but satisfied. Council was definitely alive and well– and becoming an inseparable part of the LDN Protocol. We dreamed that together they would be part of a future “New Medicine.”

We have finally cleared some significant hurdles (see below) and in just this past two weeks have enrolled 11 new people, with at least that number ready to be enrolled this week. We should be approaching 50% enrollment by the second or third week of August and full enrollment by the end of September. This spurt of activity is very encouraging after a very slow April, May and June. This is what happened:

1. We had to adjust the CD-4 criteria for inclusion in the study to reflect new HIV/AIDS standards and also to broaden the range for the group of participants only receiving LDN. The range for this group is now 350 to 600 mgs. The CD-4 inclusion criterion for the two other groups, one of which receives both LDN and the HAART meds and the other only the HAART meds are defined by a CD-4 count less than 350. Individuals with any signs of AIDS symptoms (based on a clinical evaluation at intake) are excluded from the protocol even if their CD-4 count is above 350 mgs. Getting these important changes approved by the Mali National Board of Ethics for Health and Science took time.

   These changes have increased the rate of enrollment in the Program significantly

2. The capability to enroll participants at one of the two medical facilities involved in the Program (Point G Hospital in Bamako) was seriously curtailed by the lack of testing facilities and office space for the Program Co-Principal Investigator. As a consequence a third facility, “Centre de Soins. D’Animation et de Conseil pour les personnes vivant avec le HIV/AIDS” (“CESAC”), has been added to the program, supported by two of its intake staff members. This addition also had to be approved by the Mali Authorities and, again, that took time.

   Now that CESAC has been officially approved as an intake facility the rate of enrollment should increase by at least 15 participants a week

3. The stigma of being HIV positive, particularly before the onset of any symptoms is still a powerful force in the Mali Culture. Many HIV + individuals do not come in for testing until they have symptoms and by that time they are no longer eligible for the Program. We have suggested the Mali Team initiate a stronger outreach program but, even this type of activity met with a lot of resistance since the Team is concerned that publicity will keep people away. The stigma issue is a world-wide dilemma and we are planning to ask Mali Authorities to step up their national campaign when we next visit Mali in November. Meanwhile, the medical and GECP teams are doing their best to get the word out in an informal manner.
4. There have been 17 participants enrolled in the LDN only Group for three months now so we are beginning to collect important data for this third of the eventual 47 participants in the group. Nine more participants have recently been added to this group as well, so it is now more than half enrolled. Enrollment in the two other groups is slower for the reasons mentioned above.
5. The Gender Education and Communication Program was initiated in March and April with two council-groups involving both men and women. The discussions have been lively and remarkably open and honest. The cultural issues involved with the HIV/AIDS epidemic are being discussed along with issues of intimacy among men and women. The participants who have come forward to join the Program seem to be at the progressive edge of the Mali Culture. That Malian men and women—albeit a still small number—are beginning to talk openly about family, gender and even sexual issues is most encouraging and we trust this core of people will spread the word to friends and family in a way that will support the enrollment of new participants and the initiation of additional council groups in the near future.
6. Because of the delays in the Program, it was necessary to adjust the budget and financial agreements with the Mali Team to avoid significant cost overruns. This has been accomplished with their full cooperation. The existing team has absorbed the salaries of the two new staff members from CESAC by agreeing to a uniform 4% salary cut. In addition, the whole team has formally agreed to continue working on the program after March 31st of next year—without compensation—even if several more months are needed to complete the clinical program. We are pleased with this agreement and feel the Mali and US teams are working as a unified intercultural entity.
7. Assuming no significant surprises arise, the new budget indicates we will need just under $114,000 to complete the program—a third of the total. A revised detailed budget has just been posted on the “Donate Now” page of the web site. We invite all of our past supporters and those newly interested in the Mali Program to make a contribution soon, so that we can meet our goal and complete the first quantitative clinical trial of LDN as a way of preventing HIV+ individuals from developing full-blown AIDS.

It has not been an easy road to travel–and we have learned a lot this past year and a half–but now we feel the team is functioning quite well and the program is poised to accomplish the original vision.

After several months of gaining approvals from Mali Health Officials (the need for one of which was unexpected due to a new Health Minister) and clarifying various protocol details, the LDN Research Program is now in full swing. The team of doctors and support people has been working together since September; we have been conducting weekly phone conference calls with the Leadership Team since the first of the year; and everyone’s enthusiasm is growing as we actively recruit participants for the program.

Part of the Leadership Team

For Drs. Bihari and Gluck (in New York) who have been pursuing LDN in the treatment of HIV/AIDS for more than twenty years and trying to get the Mali Program going since 2000, this is a exciting moment. For Malians like the Nafo family who have been instrumental in getting the Mali Project going for many years and Seyni Nafo in particular (now getting a graduate degree in economics in Montreal) this is a particularly auspicious time.

As of the end of February, the group of people who will be getting LDN only should be at least half enrolled and the group receiving both the anti-retrovirals and LDN, and the group receiving just the HAART drugs could reach full enrollment by the middle of April. That means we could be getting preliminary results from the study by the end of the summer and almost certainly by the time we return to Mali in November.

The first of the council groups that are the core of the “Gender Education and Communication Project” will start this week. We have decided to begin with separate men’s and women’s groups in order to get the council program off the ground as effectively as possible. The lack of cultural traditions that support open dialog between men and women—including husbands and wives—is so prevalent that it will take some time before mixed council groups are likely to be successful. The mixture of polygamous and monogamous marriage that is the current scene in Bamako adds to the challenges involved in achieving open dialog. We are hopeful, however–and so are the trained Mali facilitators–that mixed groups will eventually be possible, hopefully well before the end of the program.

Another piece of exciting news is that Jaquelyn has been asked to be a speaker at the 4th annual LDN Conference, which will be held this year at the University of Southern California in Los Angeles on Saturday, October 11th.. This conference deals with the growing role of LDN in the treatment of a variety of illnesses including: MS, Crohn’s Disease, Fibromyalgia and, of course HIV/AIDS. LDN is also showing up increasingly in the treatment of cancer, diabetes and many other illnesses where a stronger immune system can play a major role in healing. We continue to feel that LDN will play an increasingly important role in the “New Medicine” that works directly to strengthen the immune system rather than dealing primarily with the suppression of symptoms. Jaquelyn will present whatever preliminary results are available from the Mali Program in October, as well as discussing her ongoing and successful use of LDN in the treatment of autism. We are also hopeful that the Mali Project Principal Physician Investigator, Professor Abdel Kader Traore` will be able to participate in the October meeting.

Various people have been asking us about how LDN works and why it is remarkably (almost miraculously) effective in some situations and less so in others. There is a growing amount of basic LDN research going on at major universities (Stanford, Pennsylvania State University) and some of the mechanisms that make LDN so useful are beginning to be understood. Here’s a brief summary of what we know at this time.

Naltrexone is an opiate antagonist widely used treating opiate drug and alcohol addiction since the 1970s. It has been FDA-approved since 1985 and is now available in generic form as well as in the brand name ReVia in 50mg tablets. At the regular dosage for treating addiction (usually less than 150 mg a day) Naltrexone blocks the euphoric response to opiates such as heroin or morphine as well as alcohol. At its ultra small doses (less than 4.5 mg a day) LDN acts as an immune system booster/modulator.

Opioids are endorphins which are known from extensive recent research to operate as the principal communication signalers of the immune system (called “cytokines”). Opioids create immunomodulatory effects through opioid receptors on immune cells. The immune system works in two basic ways: “Th1” cells promote cell-mediated immunity; “Th2” cells induce immunity in and through the fluid systems of the body. Simplistically, the inability to respond adequately with a Th1 response can result in chronic infection and serious illnesses such as cancer. An overactive Th2 response can contribute to allergies and related syndromes, and plays a role in autoimmune disease (such as autism and HIV/AIDS). The Th1/Th2 balance is a critical measure of the health of an immune system. A large body of research in the last two decades has pointed repeatedly to the opioid secretions that our bodies generate as playing the central role in the beneficial orchestration of the immune system.

When LDN is given (only once daily as a capsule or crème) between 9 p.m. and 2 a.m., the pituitary is alerted and the body attempts to overcome the opioid block with an endorphin elevation, staying elevated throughout the next 18 hours. This timing is important as it works with the circadian rhythm to put out the needed endorphins between 2-4 am. The endorphin elevation, in turn, tends to normalize the immune system with virtually no side effects or toxicity. Naltrexone, even at full dosage, is considered very safe, has never been reported as being addicting and is not contraindicated with any medication except, of course, narcotics (e.g. painkillers), as it may lower their effectiveness. It may slightly offset the benefits of steroids when given simultaneously but we hear from many people now who are using both that they are doing so without any problems while they wean themselves off of steroids. Studies in human cancer patients show that LDN acts to increase natural killer cells and other healthy immune defenses, and hundreds of multiple sclerosis patients have totally halted progression of their disease for up to 8-10 years or more since they started using LDN regularly. Photo: An Up Close Glimpse of Naltrexone (Courtesy of Michael W. Davidson, Florida State Univ.)

So, briefly said, the major therapeutic action of LDN is the restoration of the body’s normal production of endorphins in those with autoimmune diseases such as HIV/AIDS. We trust that the Mali Program, now fully underway, will show conclusively that this restoration is significant enough to prevent the vast majority of HIV + individuals from developing full-blown AIDS.

Children Playing at the Mali Center for Disease Control

After a productive meeting of the core team with Ousmane Koita at the University, during which many of the remaining details about the intake of HIV positive participants in the program were discussed, Carine said she wanted to visit us at the hotel before we left. She arrived with Ibrahima and Tounkara, a travel agent friend of his whose English is excellent, to discuss the need for more medical equipment for the Project. We were not ecstatic about adding the $5,000 to the budget, but there was little choice. As the meeting wound down, Carine lifted a black plastic bag she had set down discretely by her chair and said she had some gifts for us. The sudden movement into the ceremony of celebrating the honored guests is an important part of both the Muslim and Bambara (Mali’s indigenous culture) but we were still caught completely off guard–and that was before we even saw what was in the bag.

First she pulled out a small cloth pouch and gave it to Jaquelyn. Inside was a lovely necklace with large amber and ebony beads separated by small blue and white spacers. “Ebony represents purity,” Tounkara offered authoritatively and we all smiled. “She is the essence of the pure feminine,” I offered and the men nodded vigorously. Carine blushed. A few moments later, Jaquelyn found ebony earrings that matched the necklace hiding in the bottom of the pouch. She was delighted with her gifts!

Next Carine took out a roughly framed picture—well, actually it was a sand painting done on Mali cotton that looked like a figure eight with a circular disc emerging from the left side of the upper loop and a similar disc on the right side of the lower one. Both discs looked the head of a cobra. The sand painting was done in various shades of brown using sand dyed with natural colors. Mali is the second highest producer of cotton in Africa, after Egypt, Tounkara explained, as he went on to tell us how the sand paintings are done in a ceremonial way, a way that very much resembles the work of traditional artists that have come to The Ojai Foundation over the years.

Then Carine pulled out a small instrument—actually a beautifully detailed model of a traditional Malian 21-stringed instrument called a “cora.” Tounkara explained that the instrument is widely used throughout the “Mandingo Empire,” which includes Burkina Faso, Mali, Guinea, Gambia and Senegal. He said the songs sung with cora accompaniment are both sacred and popular throughout these countries. Ibrahima promised to get me a CD of cora playing (and did on the last day of our visit). He told Jaquelyn to put it on the phonograph every night when she was cooking dinner. When she told him that Jack did all the cooking, Ibrahima shook his head in disbelief and, laughing said, “The man is not to cook in Mali.” Then he looked at me with a teasing light in his eyes and said, “Then you put the CD on every night.” I promised him I would.

By this time Tounkara was on a roll now and couldn’t resist going on about the cora. “In the 12th Century there was a King called Soundiata Keita who was paralyzed for 14 years. He arose finally from his paralysis while listening to the cora—and since then the instrument has been played for Kings down through the years.” The conversation then turned back to the cobra and the meaning of the snake in the Bambara (Mali’s indigenous) tradition. Carine filled us in on this one: “The word for snake is “sa” in the Bambara way, she said, “and means a baby is coming, a new creation is coming.” We all agreed that the baby was the LDN/council program. There were hugs goodbye between Jaquelyn and Carine and effusive handshakes among the men. The gift –giving ceremony left us feeling royally treated.

The following day we toured the laboratories at CNAM that are involved in the Project and talked with the project staff whom we still hadn’t met. Joseph and Carine took us around, slowly from the Infectious Disease Clinic to the Pharmacy and finally to the Intake Clinic specifically for AIDS, where all the participants for the Project will be screened. The slow pace of the tour soon made it clear that we were all prolonging the inevitable farewell. We stopped at one point to take pictures of a group of children who spend a good part of their life at the Health Center because they are part of families that are dealing with leprosy or some other infectious disease (see photo on this home page). A pang of sadness accompanied that realization and we told Carine of our feelings as we stood finally at the rough iron gate at the entrance to the Health Center. She smiled a strained smile that I couldn’t resist and asked her if I could give her a hug goodbye. She nodded; it was a hug of mutual gratitude and respect. Then she looked at me and said, “The GECP is a good program; thank you.” I could have wished for nothing more as I watched her embrace Jaquelyn vigorously and then added two kisses on both cheeks.

Motobou, our loyal driver, took us from CNAM to the University for a look at the computer equipment that had finally arrived in Bamako from America. It was just before noon, now on our last day in Mali, and the mid-day traffic was at least tolerable. Motobou zoomed through the narrow, market-lined, dirt streets, using the few wide Boulevards in the city whenever he could—very unlike what we had experienced two days earlier on our return from the farm at rush hour. On that day, we actually lived through a real live gridlock—the kind one imagines will happen someday in Los Angeles, when cars fill the streets in such a way that no one can move. The gridlock happened just a few blocks from the hotel and it finally took Motobou getting out of the car and directing traffic himself to extricate us from the full Mali Mess that lasted almost an hour.

Jack & Jaquelyn with Motobou

We must tell you a little about the visit to the “Farm,” for it was the only time we had the opportunity to get out of the city, both during the current visit and the one of last December. (We had already promised Tounkawa that we would spend a week with him travelling on the Niger, camping out in the desert and visiting Timbuktu when next we returned to Mali.)

Our host family, the Nafo’s, owns the Farm and is Alfa’s place of retreat from his banking business and the smoky intensity of Bamako. It’s about a half hour drive west of the City, through Bamako’s suburbs and then a rural village whose homes are made of mud and topped with thatched roofs. We drove, slowly this time, through the village near the farm, avoiding chickens and children playing in the dirt streets with old tires and soccer balls. We could feel Motobou’s pleasure in returning to the village, anticipating the opportunity he was going to have enjoying a few cigarettes with his friends under the mango trees that surround the Nafo farm house. He had bought half a pack of Pall Mall’s near the University, the vendor giving exactly the number he wanted and putting the rest in another empty carton for the next half-pack customer.

We were greeted at the Farm by Bouba, the oldest son of Alfa and Mimi Nafo. Bouba—32 is married and has a handsome young son. He lives on the Farm most of the time and was covered in mud from working with the irrigation system when he greeted us. “I can stay here for months and never miss going into the City,” he told us many times as he led us around the Farm’s twelve acres, planted in citrus, maze, onions and eventually rice as well. They also have both dairy and meat cattle—the variety that has long curved horns and are native to Chad. Farming is a tough business in Mali. The cost of seeds, planting and labor, not to mention the land itself makes it hard for small farmers to compete with major importers from the Far East. Rice from Indonesia, for example, is cheaper in Bamako than Mali rice. Nevertheless, Bouba and the Nafo family plan to do their best to improve this situation over a period of time and become competitive. While Bouba was giving us a tour and primer on Mali agriculture, his wife was having her hair braided, a ceremonial event that Jaquelyn captured in the photo below. Water is not a problem, since the farm lies along the Niger. The River is deeper west of Bamako, perhaps 20 feet in spots according to Bouba, and still as wide as when it snakes its way through the capital city. The entire Farm is irrigated by means of a complex system of concrete trenches and an old pump that was leaking badly but still loyally bringing the river water to the tress and paddies. The afternoon taste of the world outside Bamako made us hungry for more.

Mali Village Beauty Shop

Our Friend and Hostess, Mimi Nafo

Mimi Nafo finally overcame the Air France strike and the Bamako Airport reopened just in time for her to return from Paris and for us to see her on our last afternoon. We shared a joyous few hours with this significant member of our Mali Family—and, once again, received gifts as is the custom in the Bambara and Muslim traditions. Early in the morning on the ninth of November we left for the Airport, only to find that the plane that would take us to Casablanca for the long Atlantic flight from there to New York was going to be delayed several hours. We decided it was our sadness about leaving Mali that conspired to keep us on the ground and dozing in the airport until six am. The city was just awakening as the plane took off at dawn. The Niger was just visible through the haze.

Jack standing at the bank of the Niger River

The material below follows on the “Report from Mali” that has been posted on the home page these past few weeks. This first part of our blog can be found in the Archives Section of the Web Site—or just use the above link.

Towards the end of the council training, Abadou explained to us about cola nuts as he held two in his hand. One is the size of a large walnut and has beautiful brown and yellow-green markings. He said that was the female cola. The male cola nut is smaller with mottled dark brown and red markings. Apparently, both nuts grow on the same tree. Abadou and others explained that cola nuts are used in many ceremonies to bring good luck and to keep the bad spirits away. The discussion about cola nuts gave us a deeper glimpse into the practices of the culture we are visiting—and to whom we were sharing the practice of council.

Jesse Jessup and Amber McIntyre- with Marten Turkstra translating–had traveled from Cape Town to Bamako last May to introduce council to the group here. It was a strong challenge for them, breaking ground in a culture that has forgotten that council started in the distant past in Africa as “Darè.” Now Malians are not used to speaking openly and honestly about intimate matters and the May training had to break new ground to open up the possibilities that council might play a role in stopping the spread of HIV infection through education and the empowerment of women. Our courageous South African Team left Mali feeling they had hardly made a dent in the cultural resistance of their trainees, but it turned out they had underestimated their own talents as trainers—and the power of the process.

The ten people gathered around the table in CNAM’s conference room with us on November 2nd and 3rd had been meeting monthly since the South African trainers left and had all embraced council to varying impressive degrees, along with the Project Principal Investigator, Professor Kader, who was also with Amber, Jesse and Maarten in May. The opening check-in on the first morning made it clear that council was alive and well in Bamako. There was no candle and no talking piece when we started, yet the sense of ceremony was present. The good humor in welcoming us and the training opened our hearts and we soon plunged in to sharing the goals we had for the two days. Our translator was an eager young man in love with America, recruited at the last minute when the daughter of our host family here found herself stuck in Paris due to an Air France strike and then the temporary closing of the Bamako Airport for repairs. Abdoul wears two American flags in his lapel and yearns to continue his education in the States.

The first day of training focused mainly on how the council facilitators are going to invite people to join the council program. We broke up into pairs, with the “A’s” pretending to be new participants in the program who have just been told they were HIV positive and were being invited to join an ongoing council by the “B’s.” The pretending game was new to them, so it took a while to get rolling. With a lot of support from us, the game soon started coming alive. Playfulness, even when the situation is serious, is still a great ally of council. But the highlight of the day was when we broke the group up into men and women and went more deeply into issues of faithfulness, trust, and the shame associated with finding out one is HIV positive here. Our goal was to see how the facilitators handled the imbalance of power between men and women in the still polygamous Muslim Culture.
Although the women loved being alone, and immediately took to Jaquelyn’s ease with them and her feisty spirit, they still tip-toed around the big issue of the lack of ability of most women to shape their intimate lives. Without entering into judgment–a real challenge–Jaquelyn brought them back again and again to the gender unbalances inherent in the spread of HIV.

Meanwhile the men had a great old time, after a slow start. Jack decided to use the format of a response council, so he could encourage each man to go deeper with gentle questions. He was given ample evidence that men were not about to give up polygamy by the Muslim men present, although the discussion of sharing intimacy with two or more wives had its humorous moments that seemed universal and reminiscent of young men in the US talking about dating more than one girl at a time. The only Christian man present made a passionate plea for monogamy and the group ended with many affirmations about how important it was going to be for the facilitators to remain completely non-judgmental about the intimacy practices of their council members.

We enjoyed the harvest of the men’s and women’s circles the following day during the check-in council. The women all wanted to meet alone again and the men shared how new and useful it had been to talk about intimacy issues openly. When one of the facilitators picked up a pen and suggested we use it as a talking piece, we naturally thanked him profusely and used the moment to launch into a discussion about the kinds of ceremony with which they might all be comfortable. We spoke of creating a special and comfortable setting for council and we even talked about setting the Field. You might imagine that it took some time to translate that word, “field,” appropriately into French, but we did, and by lunch time we had recast the five intentions—confidentiality was elevated to an intention for obvious reasons—in a Malian way that worked well for us all.

Speaking of lunch, they fed us all royally both days, with a huge catered meal that included fish on Friday and fried chicken the next day. The chicken was of another variety than we were not used to—it was actually biologically different—and had the texture of chicken jerky. The fish was Threadfin from the Niger River and was delicious. Fried yams, salad and good French bread rounded out the solid food. They also served huge bottles of zira fruit that is a specialty in Mali. The dried fruit is ground into a powder and when mixed with water is amber in color. When cold, it’s quite tasty—unlike any other drink we have ever experienced.

On Saturday we talked about other forms of council, conflict resolution and heard wonderful stories about everyone’s family. We even got into the coyote spirit that is so important in the Native American Council Tradition. It turns out they know the coyote energy well in Mali. This spirit is carried by the Koroduga—the little people of the Spirit World—that give you a hard time if you don’t honor your ancestors sufficiently. Malidoma Somè talks eloquently about these spirits in his wonderful book, The Healing Wisdom of Africa. In his Burkina Faso tradition (that country is just to the south of Mali), these other worldly spirits are called Kontomblè, We also discovered the analogous phrase to “Ah Ho” in the Native American tradition, which is a way of saying “Amen” or “I’m with you,” when someone says something that really touches you. The word in the Bambara language (the native tongue here) is “Awo” and means virtually the same thing. Council is truly universal.

By the end of the second day we felt like a family. The women were very affectionate with each other and included Jaquelyn in their practice as the training went on, holding her hand when they walked together, and greeting her and bidding her farewell with kisses on both cheeks. With Jack, hand shaking was all their enormous respect for elder men allowed, but calling him “Mister Jack” was their way to show affection and love at the same time.

It was at the closing council that Amadou had shared his cola nuts with the circle and, when we suggested we use both as a talking piece for the final round, everyone was delighted. We had come home, full circle, using one of their ceremonial objects as the talking piece. At the end of the council, both of us were hoping that Amadou would gift us with the two nuts—and he did!! We told them that council was in good hands in the program and really meant it. The group picture says it all. Awo!!

The other highlight of our second week in Bamako was an invitation to join the CNAM staff during a visit of the Minister of Health for all of Mali. We sat with the Staff around a huge table and heard ourselves praised (in French) for bringing the program to their country. Later on we were told he also praised the US Government for sending us. Needless to say, that amused us no end.

The Niger River is fuller in October than December with marshy fingers reaching into both shores of the City. Small traditional boats, resembling gondolas, ply the River looking for fish. The two bridges connecting the two parts of the City are, as usual, crammed full of cars, motor bikes, bicycles, hand pulled wagons and people on foot carrying huge loads on their heads. We are always touched by the women carrying huge bunches of bananas that way—with babies on their backs. A smoky pall hangs over the city at dawn, burns off in the hot sun by noon and then returns the next day. The scent of burning wood is everywhere.

The first three days we had a different meeting each day–the first alone with Professor Kader, the Principal Investigator on the Mali LDN Project. We met in the lobby of the Hotel; it was the first time we had all met, as he had been out of Mali when we were here before. Dr. Kader, regally dressed in blue robes, turned out to be cordial and congenial, not at all formal as we might have expected. He made us feel right at home discussing the program in general terms and then going over a few decisions we had yet to make about personnel and medical equipment. The three of us moved into “team” energy quickly and by the end of an hour or so, were talking as if we had been working together for years. When we invited him to have dinner with us at the hotel, he declined with gusto, indicating that he had to get home and that it was his job to play the host. It was an auspicious start for our 16-day visit.

The following day, we met with the full leadership team, including Ousmane, our old friend from December; Ousmane is on a tear now trying to get a malaria program for young children off the ground. Malaria is the prime killer of children in Mali, and is a far more serious problem than AIDS at this point with about 50 percent of children getting infected during the rainy season. It is a terrifying problem. Besides Kader, the leadership included the clinical coordinator, Dr. Carine Kounde, the two coordinators of the GECP–Nathalie Momo and Jeseph Camara–the administrative coordinator Ibrahima Traore’ (also a physician) and several others. Nathalie and Carine were dressed in traditional robes and literally sparkled during the meeting. Nathalie kept everyone laughing with her (French) sense of humor, none of which we understood in the usual sense. Her spirit was enough for us, however, and we fell in love with her on the spot. Professor Kader, Ousmane and a few others intermittently translated for us, so we were not entirely lost, as we all discussed various aspects of the program. Laughter abounded; everyone was clearly delighted to be present and part of this program. We felt like honored guests. It was as if a dream had come true right in the room with all of us there to celebrate; The dream had been shared by many people in the US and Mali; some had been dreaming for years. It’s a big dream–one that could save the lives of many, particularly the young children whose plight had been what had turned Jaquelyn into an African crusader several years before…and had brought us now to this large, land-locked country in sub-Saharan Africa.

The third meeting took place the following day at CNAM, the Mali Health Center that is their equivalent to our CDC, and where we had met with the leadership the day before. This group included all the council facilitators that our colleagues Amber McIntyre and Jesse Jessup from South Africa had trained last May. There are seven, in the group, four men and three women. Carine joined us as well in order to insure full coordination between the clinical and cultural portions of the program. We gathered in a warm room on the CNAM campus, which is also the location of Bamako’s leper treatment center. We saw many of the patients that day, children among them, who come to the tree-filled center regularly for treatments that are keeping them alive.

The meeting with the council facilitators was encouraging, despite some difficulty in understanding each others’ languages. After getting to know each other a little, we went around the circle with the question: “How do you feel about council?” The answers could have come out of the hearts of any circle of new facilitators anyplace in the world. They had completely “gotten” council, saw its potential to help change the gender patterns of their culture–and were also very clear that a new form of council practice would emerge that honored Malian traditions—and particularly confidentiality. To be HIV positive in Mali–as it is all over Africa– is still a huge stigma, so we added confidentiality to the four intentions of council on the spot. It’s going to take our full ingenuity to implement confidentiality. If a man has two or more wives—not unusual in Bamako–none of them can be assigned to be in the same circle for fear they would discover that each is infected. The facilitators smiled at our reaction to this challenge and treated the situation in a “business as usual” manner but there was no doubt that the game has to be played. We asked them many questions about what they wanted to learn during the two-day training that is to take place the following weekend–and got lots of good answers. With Nathalie’s and Joseph’s good natured help, the training should be a great success. What was quite clear was that we are going to be trained equally with the Malians in the nuances of council–African Style.

The following days were filled with meetings: an official from the Ministry of Industry to open up the possibility of building an LDN manufacturing capability in Bamako to supply the LDN after the clinical program proves its efficacy; a long meeting with Ibrahima to go over budget details; and then a flurry of meetings trying to find a translator for the weekend training. The one we had planned to use had been trapped in Paris due to an Air France strike and further kept from coming home by the temporary closing of the Bamako Airport for repairs. The meeting with Ibrahima was spiced delightfully by a Malian tour guide (who came as a translator) who spoke English well and charmed us with tales of his town by the Niger and stories from his childhood.

No report from Mali would be complete without commenting on the Bamako driving experience. There are no traffic lights in the city; policemen handle the big traffic circles, but otherwise you’re on your own. We have been assigned a driver to get us from one place to the other and these men must go through special aggressive training—necessary to entering the flow of motorbikes, people on foot and other cars—and the Green Buses. The latter are the major mode of getting around. There are hundreds of these little vans, most of them looking like they’re held together by hope. People jump on the vans while they’re still moving and drop off the same way. The near misses between vehicles are normal—everyone laughs when this happens. We have yet to see an accident and trust we are under the protection of whatever Spirit keeps the Bamakians safe.