Merci Beaucoup

I don't think I've commented on this blog my thanks to all my supporters. You're all great and I thank you for your continued encouragement and support. I especially want to thank my bible study group. I shared with the teams/missionaries that you played a big part in getting me to Mali. The group hosted a garage sale to raise funds for my trip. It not only raised the funds I needed to go to Mali, it also was great fun and great comaraderie: a spirit of friendly good-fellowship. Thanks Susan, Mame, Ann-Marie, Jan and Nancy! The missionaries also thank you. 

Reflection on Education

Malian schools have a unique way of teaching. The kids are typically taught by memorizing the content. They are very good audible learners, unlike many of us who are visual learners. This is a challenge because they don't learn 'critical thinking' until much later, like high school age. To give an idea of the impact of teaching: The kids learn, in French - 'to cross the road, always look left first'. So they simply memorize the statement, in French. A young girl was asked the day before her test if she's nervous about her exam. She said she wasn't because she knew the question... and answer. 'always look left'. So her mom asked her the question in Bambara. Which way do you look before crossing the road? The young girl didn't know the answer. She could only answer in French, by what she memorized! (but didn't know what it meant!)

In fact, when the hospital hires new nurses, they allow 6-9 months for the nurses to learn the clinical basics. They start to develop more critical thinking methods as they face new clinical challenges.

And talk about a challenge in hiring nursing staff! There is a requirement that the nurses be Christian. Also, there are few who are trained and that live in Koutiala. Nurses will often move to their husband's town to work, so it's a challenge keeping staff for long. This is why the Pediatric unit hasn't officially opened. They don't enough trained nurses and staff!

I added a Wordle to the title page of this blog - check it out. It takes all the words from the blog and sizes them according to how often they are used. Cool look!

Back in the US

That's a long way from home. Friday we left the guest house in Koutiala at 8am. Barry and Terry took us back. It was a nice drive, but long... stopped in Segou at the mudcloth place. I notice some updates and new styles there - very  nice. (the pic shows the dies they use on the cloths - all natural, from leaves or bark - tres jolie!)
We also had lunch in Segou, close to the river and market. And yes, the beads beakoned me - Terry did a great job negotiating for me and it turns out I got a great deal (at least according to what they were charging for similar beads at the Bamako guest house). Luba & Ter - you'll love them! The restaurant was good too - a little upscale this time and the beef brochettes were tender and delicious. Then, it was off to Bamako - another 3 hours. We were able to drop off our luggage at Air France (downtown) - that was efficient... and saved us the queue at the airport. So we had time to explore a bit in Bamako. It was a different guest house this time - this one was closer to the main market which we explored prior to dinner. Remember that I said the Malian people are so gracious and friendly... well, we saw another side in Bamako. First of all, as a bigger city, the people aren't as friendly and few say hello, like they ALL do in Koutiala. Secondly, we busted them bigtime. We were admiring/watching a lady make and cook their version of an empanada - they looked delicious - pastry stuffed with beef, onion, half egg, folded over, then deep-fried. She even used only her right hand to make them (they don't use their left hand around food). Some young men were watching us watch her (did I mention the men are the ones sitting around) and commented "white people are stupid". Well, little did they know that Barry is fluent in Bambara. He couldn't hold back and spoke to them in Bambara, defending us. They were so busted... and everyone laughed. We hope they got the message.

Dinner was good. Barry and Terry sure have taken good care of us! After a quick shower, we were off for our 11:40pm departure to Paris.The flight was fine - I even slept.

All flights headed to the US are under greater scrutiny and screening. Pat downs and bag inspections are the norm. Security even required me to play my African drum (he smiled and wanted more :) and to have a sip of water from my water bottle. It was a reasonable wait at CDG, Paris - 3 hours.

Then it was the long haul to Seattle (10.5 hrs). I was fortunate to get some sleep and watched a couple of movies. So, all was fine and we landed an hour late due to delays in Paris (it was cold there, -1degC). It's good to be home, safe and healthy. That was 36 hours 'on the road'. That's very dizzying... (if that's a word). While I felt OK, Peter described me as 'vacant' that day of arrival. After 11 hours of sleep, I was rested. Gotta get back on to this time... welcome home!

I'll continue to blog with additional reflections, as they come to mind. My heart and mind are still in Africa.

Last Day at the Hospital

Wrapped it up today and we think the nurses will do great with the ultrasound systems in the rural clinics. The Malians are such gracious people. It's been so great to return... and they want us to come back.

Remember I said there were 8 babies born in 48hrs?Well, I was wrong. It was in about 14 hours! Needless to say, they were busy. Today, the lady with the large right ovarian mass came in for surgery. The cyst (benign) turned out to be 43 lbs (20 kg) and was intact. I'll spare you all the photos on this, but I must admit they're very interesting. Fascinating!

It was Thursday market again, so of course, very busy in town. We always plan on 'driving around' to get to the hospital. That's because the main road is filled with vendors and commercial activity. Anna, Kay and I headed into the market - ready for more mayhem.

Off to Bamako to catch our return flights. Will have lunch and market time in Segou (on the river Niger) and then drop our luggage off at Air France. Flight at 11:30pm... I'll catch up soon...

Kay's Birthday

It's Wednesday... one more day of training to go. Tomorrow will be graduation day - the students will receive a certificate of completion of this course. We celebrated Kay's birthday today. Anna made birthday cake.

Busy at the hospital today - I peaked into Labor & Delivery in the morning. Normally there are 2 beds (not even a curtain inbetween). This time there were 4 women in labor - one just delivered. They just pull in an extra stretcher when needed. I later saw this lady and her newborn on a mattress on the floor in the hallway! Yesterday, a woman on her 15th pregnancy (no live children) delivered a healthy term baby. So, after a very quiet weekend, 8 babies arrived in the past 48 hrs.

This woman and her premature baby was worthy of capture. Aren't they precious! And twins having lunch...

Tuesday Potluck

Just had a nice potluck dinner with the CMA (Christian Missionary Alliance) gang - small group of about 30. The Canadians were well represented with the team from AB, Barry (Manitoba) and me.

Olive gave a tour of the hospital today to the newcomers, so I tagged along. The hospital has a fascinating history. It opened about 5 years ago. On the day it opened, they had no idea whether anyone would even show. They had 15 patients show up! And just prior to getting the OK to open, the ministry of health du Mali had to give the final approval. The group found out at 11pm on Wed evening that the minister would come and inspect the hospital at 9am on Sat. (!!) ... and she didn't want to see any evidence of construction material. Well, this lit the fire and about 75 people/missionaries/family/anyone cleaned the place spic and span. Saturday morning came and the hospital got a clean bill of health!

The hospital gets about 2 cargo containers of medical equipment and supplies a year... just come see the warehouse! The hospital continues to grow. They have delivered over 5000 babies (they deliver about 180 babies/month) and have done over 1000 surgeries. And right now, that's with 2 doctors (1 OB/Gyn, and 1 Peds). They are very grateful for all the volunteers that come!

Je suis fatigué... a bientot!

Monday

Some great progress at scanning at the hospital today. The students are really improving and they will certainly be adding more value to the rural clinics and villages. Each clinic is doing 60 - 100 ultrasound scans/month. They refer 3-5% of the patients to a hospital. Not all of them come to Koutiala because it's too far. They will typically go to the nearest hospital. These are the clinics:

Centre de Sante: Famorila (Allaye), Farakala (Abel), N-Torosso (Pierre), Baramba (Youseff), Sanekuy (Francois)

Our walk today took us through the neighborhoods - very busy... lots of people, especially kids who would follow us and insist on having their photos taken. I still haven't figured out a way to have them smile while taking the photo. Their smiles are beaming afterward though when they see themselves in the viewer - just love these digital cameras! They love it too.

A team arrived today, from Canada (Grand Prairie - Beaverlodge, AB). They're a work team and a cook. Welcome Mel, Doug, Danny, JJ and Anna! I'm sure the hospital will find lots for them to do - construction, roofs, cabinets, plumbing, tiling, etc. They're here for 3 weeks.

Sunday already

In Mali a week already! Wow, time flies. We went to Bethel Bible School for service this morning. It's conducted in both French and Bambara. Gabi, a missionary in Baku translated for us. The energy was great. And then, in true Sabbath fashion, we had a relaxing day... by the pool. Oh, did I mention that before? The pool is new since our last visit and quite a reprieve from the city and the heat. So, overall, not a bad way to spend Sunday.

I wanted to capture some other notes:
The employees at Women and Children's Hospital in Koutiala make $3/day
The power has been interrupted daily. Quite an inconvenience, but the locals take it in stride. The hospital has generators to keep the OR going.

It's just past cotton harvest time. You'll see bails/mounds of cotton roadside. It's Mali's greatest export. I hope to get a tour of the factory in town this week when another team comes in. These bails are in a field, walking distance from the guest house. The seeds are crushed for linseed oil. And yes, I've done a little more exploring of their fabrics - I just love them! The colors are intense, fresh and bold. The women at church wear their Sunday best and they look fabulous.

We take walks everyday to explore the neighborhood and trails. The people are very friendly and it feels very safe. It's very dusty and dry. The women work so hard.

It Takes a Village

We had lectures today for a couple of hours. The students are asking GREAT questions, and are really understanding the value of ultrasound, when to refer and why we're teaching them all these things. I think they were weary of my questions on placental location and amniotic fluid volume (they were focusing on measurements and sex), but now have a better appreciation of why these things are important - indicators of risk. Then... they started telling us some great stories:

Allaye had a small patient (45kg) at term with twins. He was concerned of complications at delivery due to her small size and wanted to refer her to the hospital in Segou (closest hospital). The husband wouldn't agree due to the cost (in this culture, men make all the decisions - see earlier blogs from last year for more). So... all the women of the village conspired and said to the patient 'start screaming when you go into labor'. btw... any outbursts/emotions are normally frowned upon here (women are silent during labor & delivery). With the signal (screaming) ALL the women went to the husband and put pressure on him so that he would take her to the hospital. It quickly all came together and she was taken to the hospital and delivered (by C-sesction) 2 healthy babies.

Abel had a patient who was at high risk for complications at delivery and who could not afford to go to the hospital in Sikasso. The fetus was in transverse lie at 8mos and also at 9mos. With the hospital 40km away, she couldn't afford to go. Fortunately, Abel had funds from the clinic that he redirected towards getting her to the hospital and picked her up himself and took her. She also had a successful delivery.

At Pierre's clinic in N'Torosso, he saw a woman with twins at 29 weeks who was already dilated 2cm. He refused to take her in the clinic due to the high risk associated with this early stage. The women was forced to another hospital/clinic for delivery and fortunately, had a good outcome. Pierre, with the help of ultrasound was able to make a sound decision (no pun intended) to help save these babies and mom.

Isn't this fascinating! Ultrasound has become more than a diagnostic tool for them. The 'proof' from the scans are forcing social change within the villages and best of all savings these precious lives! The diagnoses and referals that the nurses are making are garnering respect for the clinics. Patients are noticing and as I said earlier word travels quickly here. These clinics even have Drs from other clinics refering patients to their clinic! Wonderful! Bravo!

It's Friday

A good day today - I didn't make any little boys cry.

Lots of progress today with scanning - it's great to see. Once we got them to not answer their cell phones in the middle of scanning (!) and spending inordinate time on determining fetal gender (all the patients ask and want to know)... they were very focused. Notice the external monitor they use in the clinic - the patients love to watch the ultrasound. In fact, it has increased their business - word travels quickly in the villages! Bill and I were invited to join the students for a traditional Malian lunch today - I really enjoy it. It was with fonio (like couscous) with a peanut sauce on top - we don't ask what kind of meat it is. Alleye's brother's wife, who lives in Koutiala made it for the group.

Dr. Dan gets all sorts of unique Ob/Gyn cases here. The stories he tells are fascinating - as Melody expressed, she could listen to him for hours. You would never get the pathology in the US (mostly cuz patients get treated earlier). He had a woman come in with a large fluid-filled mass in the abdomen - turned out to be a large cyst - drained ~50lbs of fluid!! He's NEVER seen anything like it (maybe 20 - 25lbs). He also fixed (surgically) a woman with a vaginal septum (who couldn't get pregnant). He was feeling pretty good about it because she'd now be able to conceive (very important in this culture). So when he stepped out to tell the husband, Dan told him in Bambara, that everything is 'finished'. The expression of the husband turned to alarm (thinking his wife had died - very similar word)... until the nurse quickly responded that the surgery was finished (and successful), and that his wife was fine. Oh... the language challenges!

I didn't have my camera on me today for a great shot. I peeked into the OR to see what was going on - Olive had just stepped out (she had just delivered a baby 12 min ago in the room next door). Dr.Pierre was doing a C-section with Dr.David. Right next to them, in general contractor clothes and boots was one of the construction guys taking video! In the OR! Only in Africa!

We're eating well here - notice how my discussions turn to food a lot?! Pizza tonight. Prior meals included chow mein, pork roast, spaghetti. We're on own for making breakfast and lunch. We miss you Paula! Paula cooked for us the last trip. But they do supply all the ingredients - the baguettes are very good, lots of eggs and fruit. The bananas are amazingly sweet.

Thursday at the Hospital

Another good day at the hospital. We scanned many patients in the morning and continue to do assessments of our student's progress. Pierre is fantastic - I'd put up him up against any sonographer in the US (he was trained 2 years ago). Abel & Alleye (our students from 10 mos ago) are doing well and this refresher will be great for them. Youseff - well, what can I say... he's not quite grasping some of the basics. And Franscois - very bright and as the newest one to learn ultrasound appears to be very sharp and picking up quickly.

Some interesting notes from the hospital today: 1. I saw a rat scurry around the corner and under a door into an examination room. Keep in mind that the hospital has open-air hallways to the clinic rooms and offices   2. I kept making a little boy cry. The first time I saw him, he was rather surprised and taken aback, then cried. Mom & sister laughed. The second time I walked by them (they're waiting in the clinic), he was laughing/crawling with his sister, looked up and saw me and started bawling... and scurried over to mom. (she's laughing again). I apologize and take off. Then... again... I walk through another part of the clinic and this time dad is there with him & sister/mom. He sees me and starts bawling again. Mom & dad laugh. Poor kid. OK, he was about 1. I heard that Malian parents tell their kids that white people are like the 'boogie-man', coming to get them. That is why some kids are so afraid of us.

In the market today (Thursday is the big market day), I kept hearing 'bobo'. It means 'white person'. And here again, a little boy was really not certain about me. I walked past him and greeted him - the parents were encouraging him to say 'ca va', but he was too shy. I walked on through the market and then the father brings the boy right in front of me and he starts bawling - I really have a way with the Malian boys!

What's so fun about this is the Malian people are very good natured and friendly, and love to laugh and joke. How nice! I only wish my French was better, or that I could speak Bambara. More tomorrow.

Off to Famorila

Today is a holiday - Army Day (Independence Day from France). Another surprise for us, since we thought we'd be scanning patients and training. And as a result, there is no clinic due to the holiday. Like I said earlier, you need to be prepared for anything! So, as before, it became a lecture day. Bill released me and I joined the group going to one of the rural clinics - Famorila. It's a 3.5 hour drive there - approx 2 hours on paved road and then the rest on bumpy dirt roads - or shall I say paths? That was fun - 7 people in the Jeep, 3 of whom needed move closer to the front after a while. Yup, that was me. It was long 8 hours today. (and fyi... that number keeps growing - Claire said it took 10 hours  :))

The countryside is beautiful and changing. Near the river were lots of palm trees, yet as we headed more east the landscape moves to forests of the Baobob tree and brush - and very flat. There has been a tremendous amount of deforestation due to erosion over the past few years. This clinic is oftentimes not passable during the rainy season (July - Sept).

This clinic was chosen because it is one of the best run - Allaye Coulibaly - our last year student gets the credit here. They were extremely hospitable for us. The clinic was open for patients and the nurses (midwives) came in - did I mention this was a holiday? They were very gracious to answer lots of questions and show us around - I have lots of clinic photos to share.

Then... they invited us for lunch! A typical African meal - (fonio)couscous topped with a sauce (and some meat) in a large bowl that we all ate out of. We didn't do it in true African fashion though - we were given spoons! That was so special, and yummy!

Well, that's all for now. I'm sure I'm missing lots of details, but will continue this everyday.

Day 1 at the hospital

The morning comes early... we're off to the hospital for 7:30am worship. It's so great to see so many familiar faces. Within devotion time the entire team was introduced to the group. Bill and I both received a warm welcome back with clapping hands, and the African handshake with our friends. They are so thankful to have us back. I'm so thrilled to be here again!

The morning was fresh and warm... for us. All the locals are complaining that it's cold and are donning fleece jackets. Me, I'm the one with the sleeveless top. I'm not sure of the temp in the morning (low 60s F), but it becomes toasty very quickly. ~ 95degF.

It's great to see our students again - they're all doing fine. We have one new student, Francois. In total we'll train 4 students. So we spent the morning scanning clinic patients and then did a quick introductory lecture in the afternoon. There is tremendous change at the hospital - lots of progress! Two more buildings (one of which was under construction during our visit 10 months ago) are up and third came up within the last month. A team from Indiana is here (for 3 weeks) putting up the structures. It's really come a long way!

Great to be back in Mali

Ah, the smell of the African air! Arrived safely, on time and we all got our luggage - quite a feat! After the mahem getting the luggage we were off to the guest house and crashed for a few hours. The goal was to be 'on the road' by 8am for the 5 hour drive to Koutiala. And again, luckily it's a paved road - though in many areas the driver must navigate the potholes, goats, sheep, cows, donkey carts and motos. Lunch was in Segou - a good place to have fish (from the Niger river). 

Dan & Marcie had us over for dinner, which was great... but I soon found myself drifting off. The jet lag was overwhelming... which is why I haven't been able to start this journey blog. The next evening, we lost power in the guest house... so no wireless. In Africa, you must be flexible and adaptable... anything can happen.  I'll catch up with today's great events in the next blog.

Ready to go!

Well, the bags are packed and we're ready to go... do you feel a song coming on?

Bill is handcarrying one of the Sonosite systems that is destined for one of six rural clinics. The imaging on these portable systems is great and certainly provides the information the nurses need to make referrals to Koutiala hospital. The units are battery-powered via solar panels - very efficient! After this trip, 5 of the 6 clinics will be trained and fully operational with ultrasound. One more to go!

Besides sending teams like us all over the world in areas of high poverty, Medical Teams International is often first on the ground in disaster recovery. You may have heard that several organizations from the Pacific NW have sent teams to Haiti to assist in the disaster recovery - among the first in the air was Medical Teams International! If you're planning on donating towards these efforts, and are looking for a great organization, I'd highly recommend Medical Teams International. They're great! The link to their site is http://www.medicalteams.org/sf/home.aspx  or through the logo on this blog's title page. And no, I'm not encouraged or paid to say this. I've been very impressed with the entire organization and more than 97% of donations go directly into the programs.

Next note will be from Koutiala...  Tooro te (Tohdoh tay)... that is, All is fine.

Going Back to Koutiala, Mali

I can't believe we are less than a week away of returning to Mali! I feel so blessed to be invited back to continue with the ultrasound teaching program at Koutiala Women's and Childrens Hospital. In case you missed the link on the title page, here's the link to the hospital:    http://www.koutialahospital.org/   The team there has done a nice job describing what they do there - take a peak! It is very exciting for me to go back and see this fine group of servants and to see what progress our prior students have made.

We will be accompanied by our team Africa leader, Debbie Doty. In addition, a team from the Harvard Medical School of Global Health (I'll need to get the official title later...) is joining us to do a program assessment. This team consists of Melody, OB/Gyn physician and researcher and Claire, a researcher. Claire speaks French and Bambara (from her time in Mali), so she will be VERY helpful! We look forward to their input and analysis of this program.

So, we leave Seattle on Saturday. Debbie, Bill & I will meet Melody and Claire in Paris, on route to Bamako, Mali (the capital). We will arrive in Koutiala on Monday afternoon. Can you spell looonnngggg journey!