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!

Bamako, Mali 10/02/2010

Saturday in Bamako. I am only getting html language for photos, so cannot see to arrange. Sorry for the miss-match with the text; I'll fix that after I get a better connection.



We saw Pam briefly downstairs and got a photo of her with the Taureg man who sells his wares in the lobby. He put his head scarf around his face and got in his best nomadic Taureg pose with Pam. He is very sweet: says hello each morning and gives a report on his children. I showed him a photo of my sons, and he gave me a frame that his son made to put it in. His only request was, "Just come back and buy something, I give you good price."



Went with Chuck to discuss the banquet to be held at the American Club, which is part of and near the Embassy. Chuck is quite the horse trader! We arranged for a meal to be had with those who have hosted us here as a way to say thank you. Moussef waited for us outside the gate. When we came out, there were two beautiful young girls on their way to the Niger River. They posed for me, then ran off laughing and holding hands.



On the way back to town, I got a photo of a poster at the convention center. Gaddafi had been here for the celebration of the 50th year of independence, and the poster refers to him as the "guide de la revolution". The taxi driver started waving his arms and called Gaddafi a crook.
http://en.wikipedia.org/wiki/Muammar_al-Gaddafi



A view of one of the streets out my window. Not paved, no sewers or infrastructure. So poor. I can't imagine life without safe, running water, but here it is a fact of life for most of the people. Things slowly change, but it takes money, organization, and control of corruption. Apparently someone at the hospital is under scrutiny for charging the government for things that were not done.



Women as well as some men carry most loads on their head. They often use a flat pad that helps give a level place for the item, as well as offering a bit of padding for the head. Sometimes they do not even hold it, and may stack items one or two high - even cans of petrol. Some people may be seen with carts, but these are probably too expensive for the average person, and the rutted and pot-holed roads are not very forgiving.



Chuck and I went to the N'golo Nina market. This is the largest market in town for wares, and many of the artists can be seen making items. This first store we saw is a hardware store, with boxes of nails on display on a table and other items hanging from the walls. No electrical tools, and no lumber yard.



I feel bad bartering with anyone, but it seems to be an expected part of the transaction. Nothing is labeled with a price, and they often start at three or more times the price they are willing to give. This young man had to call his "brother" to check on a price, which added to some of the pressure and tension. But whenever you walk out the door, the phone comes out again and a new price is approved. For the earrings, which this same man made himself, I could bargain with him directly. Makes each purchase take a long time, but when both parties are satisfied, the deal is done.

The "streets" are narrow, crowded, and busy. Around each doorway is a dirt floor with someone working, wares displayed around the walls and small shelves, and a brother or two to make the pitch.



This man was carving wood items, and holding them with his feet. He had all his fingers and toes, so he either knows what he is doing or is very lucky.



This young man is a delightful Taureg who had never seen himself in a photo. His name is Moustafah and he was making metal ware "for his family". He said money is just paper in the desert, and he wants to buy tea and chocolate to take back to Timbuktu for his family to use to trade for things. He showed us his head scarf and robe that he had folded up in his stall (see first photo above for example). He seemed very proud of his heritage.



Chickens. In crates, carried by hand alive, boxes of them. They are all pretty scrawny; I'm sure they are free range to eat what they can find. Seems to be one of the most popular meats other than fish and beef (not much pork in a Muslim country).



Another street.



On the way home, we walked. It was interesting to see the various streets, shops, and the bustle of life away from the hotels. The sky behind us had turned very dark and a wind began to blow. It was clearly about to open up. The wind began to stir up the dust and sand, and if I smiled or said something, my mouth was filled with grit. Wished I had Moustafah's head scarf!



While hustling home, we were behind a young woman with a tiny baby on her back. She had him covered completely, either because of the size or the blowing sand, or both.



Finally the rains started to pour and we scampered across the streets just in time to make it to the hotel. In spite of the rain, it was very hot and it felt good to have a wet shower and a clean towel. Each piece of luxury is noticed and appreciated!

Bamako, Mali 10/01/2010

Fridays are usually lighter days to avoid having patients needing close attention over the weekend. Most of the team is planning a trip to Mopti and area NE of here; I am staying back with the coordinator Chuck (or Jacques) and the hand therapist Pam. We are planning to roam the city and go to Oumar's wedding. I wouldn't miss it!




One of the patients today especially struck me. He had a bad burn on his foot, but the good care under the guidance of our nurse educator Katie (at left, with PACU nurse Vicki) gave him a clean wound that could be skin grafted. This patient is five years old, and like many of the children, sat quietly on his parent's lap, but upon closer inspection I could see a tear brimming over and running down his cheek. He could not speak English or French, so we could only mime to him what to expect, and I could never erase the look of confusion and fear on his face.

When the time came, he climbed off his father's lap and started to hobble with me. I immediately realized that it was painful for him to walk and picked him up for a ride, but not before I could tell that if he had to walk into the OR, as little as he wanted to, he was going to do so. Such a brave little guy, and we are not even using the pre-operative sedation that we do in many other situations.

These kids are amazing. They spend most of their early life wrapped close on their mothers' backs, and have such a close sense of personal space. When we hold them in our lap to breathe them to sleep, rather than kick, push away, and have a tantrum, they give in and lean into us much sooner and closer than I am used to in U.S. They wander all over the neighborhoods as soon as they can walk, and have large extended families that include neighbors and friends. Very different sense of trust and community. There really have been very few children who have fought us, and it humbles me to watch them be so stoic through this experience.

There is an anesthesia resident who comes and spends time with me and I am learning so much about how they do things. His fund of knowledge is very good, but what they have to use is very limited. He asks very many good questions, and in the process it provokes me to think about how we do things, and especially if maybe we need to approach the patients here a bit differently than we do.




The chief nurse, called Major, has been very helpful with care on the ward. There are many here who function with us as part of the total team, and without whom we could not do the job well. It has been amazing to come together with them and partner for better care of the patients.






Everyone leaves in the morning at 5 a.m. I'll report on their trip when I hear about it, but for now it will be the three of us having adventures in Bamako.