Bamako, Mali 09/27/2010

Today was a long day for everyone. First, we started with an early breakfast, and rounds to see a few more patients who might need procedures. Visiting the wards is always very colorful. The families practically move in - mats on the floor with cooking pots, covers, and various items to care for the sick family member. Sometimes we see them praying and paying respects. No need for nurse call buttons; plenty of advocates all around the bed.

Next we all made our way to the OR and met with the Medical Director of the hospital. He helps host us each year and is a very grateful man. As our leader Steve Parker said, Dr. Kaita always welcomes us with his big arms.


As the days go on, more of the local medical workers start to show and want to share in the day's procedures. Today we anesthesiologists got to meet 2 of our local colleagues and share some ideas about how we do things and drugs we use. Always very interesting for all parties.


We got to our first patient today - a man in his 20's with a scarred finger. He was old enough to understand and able to cooperate, so we did not have to give him anesthesia. He received some sedation, but was awake and cheerful throughout.








What probably made today a relatively stressful day was the fact that clinics, where we see patients to screen and schedule for surgery, were advertised as happening today as well as yesterday. So not only did we have to go through our list of mock emergencies and situations, gear up for our first cases, and work through the gliches, but we also had to run back and forth to another building to get these other expectant patients seen. One little boy could not be calmed but he let me put my hat on him. He still wasn't happy, but refocused his energy from crying to problem-solving: "Who ARE these people?"



Another adorable face - both mom and baby!



The recovery room nurses have adopted several nursing students to come and work and learn with them. Lucky students have two very capable and dedicated nurses to teach them. Here is Vickie at work, doing well with lecturing in French.



In the afternoons, all the families are kicked out and floor-washing begins. Lots of water that waterfalls down the stairs, flooding the paper bags, corn cobs, peanut shells, and bits of paper with it. The men work hard with squeegies, brushes, buckets, and big boots.



The last patient of the day was met by his mother, who appeared to have a sibling on her back. But the baby on her back actually belonged to the mother of another patient, and this woman was comforting the baby simply to help the other mom. It was such a loving thing to do, and the two women had never met. Both had children who were post-operative, but this sweet lady took on the baby to give the other mom a break. It's nice to end a long and hard day with a scene like this.

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.

Interplast team, Bamako, Mali 09/24/2010

09/24/2010 L’aventure commence.

I am at SFO now, waiting for my Air France flight to Paris. Everyone starts to show up about 3 hours early to load the 30 or so boxes of equipment and supplies, plus our own personal stuff. How will the plane get off the ground?!!

Six of us came from SFO; the box mafia!

Travel these days is becoming more and more homogeneous. Even Air France is using the same crummy commissary, the flights are full and over booked, and everyone is getting too large for the seats.

After being up all night flying to Paris, we are all tired.

Landing in Africa always stirs deep feelings in me. There is an earthy, ethereal smell and feel, plus the smoky smell of open fires. It is a bit humid, but nothing like the SE or NE of the US. Just enough to be rich and, well, loamy.

Hotel is nice, as I remember. Mali just finished celebrating the 50^th year of independence, and there are still signs of the event around town. Along the main road are lights in the ground – the curbs, the lane lines, the center dividers. '

This is a very cohesive team. Many who have been to Mali before, many who have worked together in other locations, many who are Interplast veterans. Streamlines the team dynamics. Nice to see everyone here again, to speak and hear the Africans speak French, and I think we are all ready to dig in.