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.