The Market and Kids

It was another great day in Koutiala. Paula and I explored the streets and market of downtown Koutiala. It was bustling with activity. The covered market was a maze of multiple vendors selling everything from cookware to fabrics (including tailoring), to shoes and produce. To escape the hustle and activity, we headed across the main street (one of 2 paved roads in Koutiala) toward the neighborhoods. The families live in what looks like a compound and could house many generations and families, along with the cows, goats and chickens. There appear to be individual family rooms. This courtyard is typically gated and fenced with mud walls.

We had a lovely experience when we headed down a street where we saw some kids - gotta get pictures, you know. Upon asking if we can take photos, kids came out of the woodwork... all screaming to have their pictures taken. They love to see themselves in pics. Needless to say, we got some great ones. We got invited into the family homestead... and the kids were relentless in wanting their photos taken. So cute.

We also drove out to Pesabe to see the mud temple. This temple is of the same mud construction as the one in Djenne, which is famous. It was interesting, and here again, kids came from everywhere wanting their photo taken... and anything else we had. Any bonbons? The kids are fascinated with Jeanie, and her blonde hair.

We also took a walk around our neighborhood and found ourselves on a path through the field, across a dry creek and into a mango grove. It was beautiful and very quiet - a nice reprieve from the noise and activity of the city. We also came across a soccer field (dry and dusty dirt) where a team of older kids (U21+?) were practicing - running and doing drills. Two things Malians are passionate about - soccer and the elections.

Paula was off the hook this evening, as we were again invited out for dinner to the guesthouse managers home (Bob and Becky - missionaries) - very nice!

The Culture

I had to share this excerpt from Jeannie's (neonatal nurse) blog, since she captures the culture so well. Enjoy!

"Life is sure different here. I spend most of my days hanging out in the delivery room, watching woman after woman go through labor and give birth. Here are some of my observations:

Most of the women here have been circumsized, which leads to extra pain and birth complications. The women here are expected to be stoic and not cry when they are in pain and most of them accomplish this silent birth. Of course an epidural or even an occasional pain med is out of the question. The mothers ( the fathers are no where in sight) do not seem very happy when they first see their baby. I have been told that is because so many of them die and they are afraid to get attached. But after a day or two the attachment is there. In the non-complicated births, the mother will stay one day sleeping on a stretcher with her baby at her side and be discharged the next day. If the baby needs to be observed or treated, he will stay in a bassinette or home-made incubator next to the mother's stretcher until the baby is well enough to go home. The mothers do all the care except for IVs and medicines.

Babies do not wear diapers. The cost is $1/day. Another $2 if the baby needs oxygen. The baby will not be released until the bill is paid. When a baby dies, as many of them do, the mother is not supposed to cry. I witnessed 4 nurses yell at a grandmother start to cry as she watched us being unsuccessful in resussitating her baby. She stopped crying immediately, because that was what was expected of her. I snuck a hug to her when no one else was looking. It must sound to you as if I do not like these people, and that can not be farther from the truth. They work hard, with very little rewards, they make the most of their life with what little is offered, and they have welcomed us with open arms."

Flexibility is Key

Anything can happen and we continue to remain adaptable. We just found out that Monday is a National holiday - to celebrate Mohammed's birthday. Most of our patients are Muslim, so the clinics will not be open. So... plan B... Monday will be more lecture rich and we'll do general abdominal work. So, today we scanned OB patients ALL day... we must have had done 30 - 40 patients. The women have been so gracious and patient to wait their turn.

We had anticipated completing the training next Friday and since we need to travel that day (earlier than expected), we have lost that day. We're adapting to assure our trainees receive the training they need. They are doing very well, so we are confident they will be ready to put their skills to use in their clinics.

So, it's Friday. Already one week. Yikes, I wish it could slow down - this has been so great.

And the weekend is upon us - while some will go into the hospital Sat morn, Paula & I will go in to town to explore. I'm interested in the fabrics (ala table cloths), Malian mud cloth (dyed with their red/brown soil, dark bark and bleach in fabulous patterns) and wandering through the market. We may also get to an old mud constructed temple.

Thursday in Koutiala

We had yet another fullfilling day at the hospital. We scanned several patients in the morning with our students. They are progressing so well. Some challenges were thrown their way as some pathology cases presented. It kept us alert, too. And, as usual, Bill delivered a stellar lecture in the afternoon.

Hot facts: 38 babies have been born so far this month. And it's the 5th! The women have multiple (up to 8 pregnancies) during their lifetime. In general, one out of four children will live past 2 years. Culturally, women may take several days to bond with their newborns, as neonatal mortality is so high post delivery.

It's a quiet evening for us. Paula cooked a great meal and we're taking some time out.

Day 2 of Training

Wow, another great day at the hospital. We start each day with hands-on scanning with our main students, Abel Kone (Farakala Clinic) and Alleye Coulibaly (Farmarila Clinic). Youssouff Dembele will be joining us for the hands-on portion for a refresher. The other trainees Drs. Pierre, Luther and Yohanna join us in the afternoon for the lectures. They have received training and scan tres bien. Daniel (Dir of Admin) has also joined the group. We're finding more people expressing interest in joining us and learning about this exciting new technology that they have already seen make a difference in the care of their patients. Our new students are very bright, eager to learn, grasping the concepts quickly and studious. They were outside the scanning room with their French Obstetrical Ultrasound book, before we got there in the morning.

We couldn't do all this without Dr. Dan Nesselroade. His passion for ultrasound is contagious. He does spirited translations for us... boy, we wish our French was better! He continues to expand the use of tools to explain some complex ultrasound principles... i.e., baby doll to show fetal position; he used the baby doll's cap to represent the placenta... and even placed the doll within a napsack to represent cephalic presentation. Too funny. We had some laughs today after he asked Marci (his wife) to bring a French loaf of bread (and knife) to explain how ultrasound takes tomographic images... and what we see is only a slice (get it?)... ahhhmmm... a 2D image from a 3-D object (fetus). This concept is complex, but very important to understand - the mind must process/translate what we're seeing. So there was Dan, slicing the bread in the transverse, sagittal, coronal and even oblique planes to demonstrate what is seen in the 'slice'. Wonderful.

Dr. Dan has been instrumental in setting up this program. At the end of this training, 4 clinics and the hospital will offer ultrasound. This will be followed up with up with 2 more clinics when the solar power is configured. This is something for Mali... and could certainly expand... to other countries and this center could be the Center of Excellence for Africa. And while difficult to prove, it has already had an impact on maternal and fetal mortality. What a blessing!

It's market day in Koutiala tomorrow, so we hope to take that in...

Amazing First Day

Wow, what a day at the hospital. It started with devotions at 7:30am. It's in French and Bambara, so we were fortunate to have Teri translate for us. The singing was great. Following this, we went on Rounds with the medical team - quite the stories and they are almost at capacity.

For the ultrasound training, we have 2 nurses from the village clinics, very eager to learn. They were amazing in quickly picking up the concepts. In addition, the formerly trained physicians will get a refresher. Dr.Pierre is very good!

The highlight for me today was the opportunity to observe 2 babies being delivered... within a minute of each other. Olive was amazing in managing these events, with her 30 years of experience.

More stories and details tomorrow... now... I hope to catch up on my sleep...

The Long Journey

We've arrived safely in Koutiala, Mali. It's a long way from home. Travels included 9.5 hour flight to Paris, 8 hour layover, 5 hour flight to Bamako. From landing and throughout our time here, the missionaries have been outstanding - so gracious! The organized chaos at the airport was manageable and we were lucky to get ALL our luggage and quickly. We were escorted to the guest house and crashed. The next day was full - breakfast with the local missionaries, change our money, drive to Segou for lunch on Niger river (very beautiful) and then off to Koutiala (total 5 hour drive).

The drive was fascinating - in general it's very dry, red soil, with some areas a little more green. The baobob tree is bare at this time and most fields have been harvested, and dry. Not a lot of 'wildlife', but tons of goats on the roadside... everywhere. They were grazing on the harvested cotton (seed) that would fall on the roads when the cotton is transported for processing. They would move off the road quickly with the sound of the horn. The sheep were just not as bright.

There are several groups of teams at the guest house in Koutiala - an IT group (from Omaha, NE), a warehouse/building team and us, the medical team. Dr.Richard Wong (Ob/Gyn), Jeannie Russ (neonatal nurse), Paula Berry (our cook) and Dr. Marks and me.

We had a lovely celebration and potluck, with 55 people over shortly after we arrived - what fun to meet the missionaries and their families. They are amazing people.