Mali 2010 - clinics

First full day in Mali, and as always, clinics.

We got up early for a group meeting before seeing patients, and had breakfast in the dining room. I needed to ask for another blanket and some other things for our room. The night shift guy was asleep, on Mali time.


We all marched to the hospital, about 2 blocks away. We were met with a very loud and chaotic crowd, packed into 2 long hallways and filling both sides to standing room only. Of course if one child comes in to be seen, he must come with his mother, siblings, uncle, grandfather, blankets, and food for the day.




Some of us went to tackle the task of building an OR suite from the ground up (walls already there) - recovery area, clinical office, supply room, sterile processing, cleaning and sink area, and OR with tables, vaporizor manifolds, airway/IV/surgical supplies, suction, waste gas scavenge and record keeping. Interplast does a great job of imploding all these items into the boxes we bring, and we must rehydrate them all to life.

Patients come from all over to be seen and hopefully selected for surgery. Some do not have a problem that is surgical (one girl had not spoken in her life), others cannot be safely done with the equipment we have and the time to do it in (extensive burn grafting), and yet more are not things we can deal with at all (club feet).

Patients are first seen by the surgeons: the senior staff, second attending, and the Interplast Webster Fellow. Consideration is given first as to whether the case ought to be done at all (technically), and if so, a plan is devised. We also have along a nursing professor who is teaching local nurses and is in charge of dressing changes and would care, and a hand therapist extraordinaire who treats some post-operative patients and takes others for hand therapy only. One of our translators is a very organized engineer, and keeps all our needs and details running smoothly. Everyone has his/her own niche and essential roles.

Those who are chosen to be scheduled are then funneled to the next room where they are seen by two nurses for hemoglobin, weight, height, vital signs, and photographs for identification on the day of surgery, and then to the pediatrician and anesthesiologist for the final screen and clearance.

Also present are translators from English to French, from French to Bambara, and back again. I did some translating and, other than telling one patient to open his leg and another to give me his teeth, was able to make some headway. Interns, nursing students, orderlies, and some local doctors finished out the herd.

I noticed that when one of the translators went from French to Bambara that he retained the word "minuit" (midnight). I asked him if there was not a word in Bambara for midnight, and he said that before "outsiders" came that the locals only referred to early night (just after sunset), middle night (while sleeping), and end of night, just before dawn. So they simply adopted the new word for the new concept of specific time. This gentleman is a local doctor, and he also explained to me that after the third year of medical training, all must be done in French, that there were no Bambara words to finish the training. He proudly said that he has been the first person in Mali to complete his medical training in Bambara, that he helped pioneer the necessary words and teachings to keep the local language in the profession (Zacharia is in the middle of this picture, between our nurse educator Katie and a local medical intern).

And then, of course, there are the adorable children and older patients. They come with such hope and expectation, and it is a privilege to be able to offer them some help. It is the least we can do in exchange for the humbling experience of knowing of them, their lives and struggles, and their bravery as they hand themselves over to total strangers from an alien culture. This simple element of trust is something that bridges many boundaries.

Lastly, to share all of this with such a capable team of dedicated, like-minded, interesting, and delightful professionals is in itself a gift. Where do they get these people?!! I always come home from these trips a bit changed, certainly with more knowledge and experience from my colleagues, and also a bit restored and more appreciative of the work that we get to do.