Bamako, Mali 10/07/2010

The trek home...

The OR boxes were picked up in trucks. Everyone packed and moved into two rooms - mine and Deb's large room for the women, and Jacques and Richard's room for the men. Pam and Barbara stayed in their room, and Kristin alreadly left last night, so it was not too crowded.

After relocating, we all had to get our bags packed and downstairs to get weighed and loaded to take to Air France in town. We rode taxis to Air France to get our bags checked in. Those of us going to SFO had to check in our own bag and 2 of the large OR boxes. Everyone else checked in their own bags.

There were many last minute jaunts - to the museum, to the river, to the market. Several of our co-workers from the hospital came by the hotel to say goodbye. Most of us had dinner at the bar, final packing, and then onto the hotel shuttle at 7:45 pm. Last minute forgotten items, jumping on and off the bus, and then off to the airport. Still much lightening all around, and very slow traffic.

The airport was a-buzz, as usual. Oumar met us all their and said his goodbyes, as did Jacques, who will be staying for another week with Pam.







Since rebuilding a new airport, the many shops that were there with local music and items were gone, replaced with duty free, perfumes, and expensive import items. Too bad! We got our iPods out, put on our ted hose, drank the last of our water, and fine-tuned for the long trip.



We were finally all herded downstairs to another security point, the piled into an Air France bus. This sat for a long time with the motor running (diesel fumes) in the humid heat, and after about 1/2 an hour, it was getting very uncomfortable. Finally the bus pulled ahead, made a u-turn, and stopped at the plane, which was about 100 feet away. Ridiculous! One poor woman had to step aside on the tarmac and got sick to her stomach. It was quite a scene.

We left at 10:45 pm for Paris. It was interesting to look out the window and see how Bamako ends and then it is dark in all directions. Not a light anywhere!

Five hour flight to Paris, which was very empty, then a long layover for most of us. Barbara left to get the Chunnel to London, and Deb had a gate remote from the rest of us, so we lost her too.

The remaining nine of us moved on to the gate area, got some breakfast, and took naps. Marion found a center piece at the cafeteria that suited her nicely.



Richard left for NY, and Scott went on to Boston. The SFO Seven got on an Air France flight that was PACKED and left late. Ten fatiguing hours later we were spit out at SFO, over two hours late. That left Marion and I late for our flights, so we grabbed our bags and ran. I don't know how things fared for Marianne, but I missed my flight. While I was in line, Sarah showed up - she had missed hers too. I got booked onto a 7 pm flight.

Finally I got to the gate, got on an earlier flight as the last standby, and my bag made it too. When I got home, the door opened, and the misty, cool, and sweet air of the redwood forests by the sea greeted me. I closed my eyes and drank it in and my journey had ended. I was met by my son and my parents, and we had a meal of Chinese food - salad, tofu, and greens. YUM! I finally got to see my dog and cat - a very furry and kissy reunion.

Then I had that feeling - it was over so fast! Did it even happen? The dream-like state of memories. I hope these musings and photos will help us remember the time, energy, and gratification of what we get to do, and the many people who came as patients to give us that privilege. Looking forward to the next trip, but this team really raised the bar and will be a tough act to follow. Thank you all!

Bamako, Mali 10/06/2010

Our last day. A few simple patients, packing up, banquet, and goodbyes to our hosts.



For our last day, we had a few "simple" patients that we feel comfortable leaving after their surgery. Two were cleft lips, one was a finger release, and as one of our surgeons got sick, she is taking down time and we canceled a couple of cases. Two patients needed dressing changes, and then we began to close down.



Pam will stay for another week and do dressing changes. She is our hand therapy specialist and has had several patients of her own that were not surgical, as well as forming the splints and care plans for some of the hand surgery patients. This young patient is a few days post-op and is having her dressing changed and wounds checked.



Pam and Moussah at work. Moussah became essential to our work, helping with instruments, getting oxygen, cleaning up, and running errands. I like that this photo has a glow around him; he does have an aura about him!



The young patient who was having her dressing changed was there with her mother, who was covered in a black burka with only a slit for the eyes. I did not notice her for quite awhile; she was both quiet and nearly invisible with her total covering. It really seemed like the burka put her in stealth mode. I felt bad to have not spoken to her while talking to her child. I was truly astonished at how unnoticeable it made her.

There have been alerts regarding increased terrorist concerns in Europe, and supposedly it has been in part caused by the ban on burkas in France. If a woman wears a burka in public, covering her face, she will be fined 150 Euros. If a man is found to have forced a woman to cover her face, he will be fined 30,000 and a jail term. There seems to be much support for this across Europe; we'll see where it all goes. Supposedly in an attempt to protect women, but what about religious freedom? Very complicated.



This is a photo of the child's leg that had an abscess down to bone and needed a gastrocnemius (calf muscle) graft. It is healing very nicely.



Adios, Bamako!



Our great circulators Sarah and Marion kept the autoclaves humming, and organized most of the pack-up, among other feats of nursing amazement.



The ORs have been broken down, the patients have been safely tucked away, and now to our thank-you banquet. This is a photo of our pediatrician, Scott, and our hand therapist, Pam.



Recovery nurses Vickie and Lorry.



Roommates nurse Sara and coordinator Manon.



Wisconsin anesthesiologist Deb and surgery fellow Richard.



Richard and other surgeon Kristin (Barbara still recovering).



Coordinator extraordinaire Jacques!



Certificate awards for our helpers.



Anesthesia team: Deb, Diede' (local resident), Bonnie, and Steve.



Oumar and Bonnie, after his recognition.



The friendly guard at the gate, seeing us out.



Several of us went to La Terrasse afterwards and continued to visit. Lightning all around, but no rain. The air felt wonderful and cool.



The guys - Scott, Steve, and Jacques (missing Richard).



Anesthesia team again: Bonnie, Steve, Deb.

Bamako, Mali 10/05/2010

Long day, but a good one.



Everyone changes in the morning in various places, and today all the women were to be found in the supply room. I could not pass on a "girl shot"; Deb (anesthesia), Kristin (surgery), Manon (coordinator), Sarah (nursing), Pam (hand therapy), Marion (nursing), and Barbara (surgery), with me (Bonnie, anesthesia) down in front. Missing are our two PACU nurses, Lorry and Vickie. There is not much luxury to these trips, and we all share and cohabitate like a big camping trip. Usually two persons to a room, and a chance to get to know another team member that much better by sharing hotel space.

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We have all noticed how stoic and brave these children are. They do not seem any less afraid than other children, and some do throw a total fit when we take them back (all done without sedation), but many others swallow their fear and hold it in, possibly betrayed only by a small tear, a trembling lip, or a shake. Imagine how it must feel to be taken away from one's family by people you have never met, can't understand, and all you may know is that something is going to be done that will probably hurt.



We try to anticipate the supplies we will need and bring what will be used. The patients who are finally signed up may or may not fit with the exact packing for the trip. Some things run out, and other in excess may either be left or returned, as are the "hard" items like monitors, suction, and surgical tools. We had so many local trainees come to help, watch, and assist that we ran out of gloves and had to ask them to bring their own. Manon, in her own sweet way, made a note to request everyone please bring their own supplies if they want to scrub and watch.



This little boy came back for a dressing change, and it was determined that he had to come back for a cleaning and some repair under anesthesia. He had not eaten or had anything to drink, so he was ready to go. Unfortunately, a break in cases did not come for him for about five more hours. During this time, his father sat in the entryway with his son on his lap. His son fell asleep, and the man did not move, not taking a break or getting water.

A while later, after a few hours had passed and the little boy had wakened, the boy was sitting on the floor coloring and the father still waited. I offered to sit with the boy if the father would take a break and go for a walk to get a drink and a rest. He reluctantly agreed, saying the boy did not like to be with anyone else. I insisted, sat down with the crayons and the boy, and the father finally ambled off.

After about five minutes, the jig was up and the boy began to look around and started to cry. I tried and tried to distract him, make faces, and get him to smile, but only made things worse. Luckily, at about this time, Oumar walked in and saved the day. He scooped the boy up, swung him around, and made little noises that comforted the boy. As I caught this photo, Oumar looked askance at me as if to say, "How am I doing?" Great, Oumar, perfect.



The father returned, the patient was eventually done, and all worked out well. Meanwhile, I noticed this adorable little girl, twirling and running about. As soon as I came out and looked, she crouched and got very suspicious. Turned out she was one of our next patients, and knew it would soon be her turn.



Comic relief: her brother got into the act. Not about to be outdone by her sister, he came over for a photo too. He seemed to be enjoying the whole scene, especially since he was not in line for surgery!



As if two such gremlins aren't enough of a handful, the mother turned around and here was this little face. Nestled safely next to his mom's back, he had the same engaging grin as his brother, then became very intent when he saw the camera.



Now sister is inside being readied to go, and the suspicion is back. Luckily Chuck has placed her on his lap, mama is nearby laughing, and her look says it all. She sees me in my scrub suit and funny hat and she knows I mean trouble.



Finally the day is done and we all crowd into a great Thai restaurant, owned by a Belgian man and his Thai wife. These meals are very restorative, giving us time to decompress, relax, and close the day. What a great team!

Bamako, Mali 10/04/2010

Our last Monday. Busy day.



Throughout Bamako are open troughs through which the water flows. There is much trash and debris in them, and it is a public health issue. Where does one start to provide infrastructure for a city? My guess is that a water treatment plant with underground drain pipes and sewers would help with many problems here. Clean, potable, running water - what a luxury!



Sweet, smiling, confident and trusting mom with crying baby. Little girl was to have her hand fixed, and she was so cute. Many of the hand problems that we repair change a hand from non-functional to useful. Not all end up looking like a normal hand, but the thumb function in opposition to the fingers, and the grasping function of the fingers might be provided. Suddenly they have the potential to function with two hands, which may mean they can work, provide basic functions at home for themselves, and embrace their world.



Steve with beautiful mom and baby.



Her tiny hand being grafted with her own skin. The fourth and fifth digits were fused to her palm from birth and would not open. She will hopefully be able to grasp now with all fingers.



This one year old boy was fast asleep with his mother. I scooped him up and got him to sleep without him ever waking. Not a peep! Made my job easy.



This little baby had amniotic bands, which constrict a limb from birth and prevent normal growth. Only a few months old, hopefully she can catch up on some of her growth and lose the swelling in the left foot. She was crying and fussing, so our coordinator Manon wrapped her up on her back like the locals do and the baby quieted right down. Nice and close!





This was the first time we unwrapped this most difficult release and graft of the popliteal space. The knee was almost fully flexed and the child had to be carried everywhere, not even able to sit. Now at least he can sit and hopefully with time get his leg to open out. Mostly clean, it was redressed and we will check it again before we go. Pam, our hand and splint specialist will be here one more week and can check on this patient as he needs it.



Looking closely at this child as he had his dressing changed, I noticed the buttonholes were tied with string. Can you imagine being too poor to afford buttons? We had one earlier during the first week with string on the belt loops of his pants; he had no belt.



The guerney we were using fell apart, so we have had to start using a litter (stretcher). The patients get transferred from the recovery bed to the stretcher, and then are carried out.



This young man was the first on the stretcher. He had come back for a dressing change with anesthesia, as pulling the gauze off can be very painful. We all told him after he was done what beautiful eyelashes he had. He wanted to see his photo, stared long and hard at himself, and then smiled. Nice end to the day.

Bamako, Mali 10/03/2010

Today was my day of naps. I woke up early, made coffee, and checked my email. My eyes began to get heavy, so I curled up in bed and was asleep before I knew it. Then the phone rang and the lady at the desk said there was a man here to see me. I went downstairs to the lobby, and it was a patient from two years ago. He had a photo of him after his operation, and asked me about each care-giver in the photo. He had had his lip repaired by Roberto and was quite happy with the result. I think he had a tumor on his lip, was a professor of history, and a very sweet middle-aged man. Anyway, he got to see myself, Scott and Jacques, and I told him the rest of the team was not here this year. But we will let them know!

About the same time, the rest of the team arrived back from their trip. Stories abound, and all went well. Lots of touring, shopping, and tales - good and bad. Overall a great outing, and everyone well.



After lunch most of the group went shopping, which I had done to my limit yesterday, so I stayed home. Got another nap! Went downstairs to visit, two people were swimming in the pool, and we all made plans for dinner.

For the first time, the team split up. Some went for dinner at a traditional African restaurant, and the rest of us went for Thai food. Problem was the restaurant was closed. Not a problem for long, as we walked next door to the Appaloosa, a Tex-Mex restaurant (can you IMAGINE?).

Texas auto plates on the wall, popcorn and nuts for snacks, waiters with corny-looking cowboys hats (black), and blonde caucasian waitresses. Menu of many beers, Italian, pizzas, burgers, BBQ, and Lebanese. Very odd. I got spaghetti as did Deb, two others got pizza, and the other two had burritos. Everyone was happy!

Taxi ride home, and crash again. Got a good photo of the room, which has two rooms with sinks - one with a toilette, and one with a shower. Lots of options!

Bamako, Mali 10/02/2010 Wedding

Oumar and Massaran's wedding

The rest of the team made an interesting outing to Mopti - flew via plane, 4-wheel drive to the caves and villages, long ride over "roads" to hotel, and then home early Sunday. Pam, Chuck, and I stayed back to go to Oumar's wedding. It was a magical event.

The invitations explain the whose who - It is Oumar and his best friend marrying their fiancees at a double wedding. Oumar is marrying the sister of his best friend. All but Oumar's femme are doctors, and the extended families are large.





Pam, Chuck and I loaded into Moussef's taxi. He is always good for a wild ride. I'm not sure his brakes are long for this world. Last week he took a crowd to dinner, and they ran out of gas on the way back. Had to push the car and fuel up. Never a dull moment.

The beginning of the ride always starts out with bartering. How much will the ride cost? Will he wait for us or come back? A few growls and laughs and the deal is done. Chuck always wins. The ride is about 1/2 hour, and we think the president is driving somewhere as many streets are blocked off for his security. This brings us down many side roads and an up close view of some of the dwellings.

The wedding is to be held at the Baobab Hotel. There is a large circular space with a grass roof that looks very much like the South Pacific. A few smaller circular grass-covered areas with tables are about the garden. Many chairs are set up in a circle around the large space for viewing the ceremony.



Everyone is dressed to the nines. There are three beautiful girls, two of whom are twins, who seem to be flower girls. Sisters and friends are bridesmaids.



We got there right at about 3:45 pm. We waited quite awhile, and then the wedding party arrived. First was Oumar's friend and his wife-to-be. Everyone was so well-dressed and handsome.



Next came Oumar and his wife-to-be. Massaran was beaming, as was he, but in between Oumar looked a bit tired. We know how hard he has worked the last week, but he managed to keep smiling. They all marched into the large covered area and sat at a long table side by side.





This little girl's hair caught my eye. Her mom was busy with two other children, but they were all behaved and curious. I saw a few babies passed around across the crowd, and not a peep from them. The sense of family here is very large, and many people are called "brother" or "sister" who may not really be that close a relation. But the more the merrier!



The wedding party sat at a long table under the covered area, very much like a conference. They were sitting for the ceremoney, and at one point passing and signing papers.



The audience was very colorful and interactive. We were all allowed to come up on the stage area to take picture, say hello, and mingle a bit.



During their time at the table, a griot was singing to the couples, almost like a roast. I could understand when the names were said and a word now and then like "lion" (in French), but Bambara was used and in the singing tones, I just could not understand. But the crowd would respond with joy at various intonations.
http://en.wikipedia.org/wiki/Griot



After the wedding, everyone wanted to congratulate the wedding party. Smiles all around, more from the griot, and more music from the DJ.



The wedding party came down to the grass for photos with their families. I caught Oumar looking at me, pushing through the crowd. He was very happy, and Massaran so beautiful.



Dr. Kaeta was there with his group of surgeons - Zacharia, the residents and interns. We looked for them later, but could not find them.



Then the wedding party left. Apparently they went to have dinner with the grandparents. Oumar's parents are in another location, and they are going to repeat the whole ceremony again in a week's time. He is having a busy break from his studies!



The guests all remained behind at the hotel. There was a DJ who was playing Malian music, some with a Hip-Hop quality, and there were many girls and young women who were dancing. They were all laughing and being silly. I was enjoying all the colors, the many hats, and the interactions between family members. It was a very sociable, tight-knit crowd.





There were four very beautiful women who appeared to be like bride's maids. Two were sisters of Oumar's bride, and two were her friends. The three of us pale folks were sitting under one of the covered areas at a table. The ladies came over to pamper us and be sure we were taken care of, bringing drinks and making a visit. They even posed for photos, and then insisted on a silly shot. Girls just wanna have fun!





Another sister of the bride came over and sat with us awhile, chatting in French. I was doing all I could to keep up and understand, and she asked me if I ever talked. It was taking me too much brain power translating to say anything back! She was very sweet.



After dark the wedding party returned and the food was served. We were served a platter of food on what was the size of a cafeteria tray. Stripe of noodles down the middle, and on the left beef, and the right chicken. Three forks were placed on the noodles, and we were to dig in and feast! It was more than enough food for six people. Pam and I did not eat, so Chuck got to fill himself to the brim.

Oumar and Massaran made their rounds to each of the tables to greet their guests, as did the other couple. It is a very wonderful tradition, and made us all feel welcome and appreciated. Nice to get a chance to see them up close as man and wife.



Soon after this our trusty chariot Moussef came to bring us home, and I fell into a deep sleep. Hurrah - Sunday sleep in!