Saturday in Koutiala

Well, it's another warm day :-)

Enjoyed rounds this morning with Robert, while Craig graciously acted as  my interpreter. I "hear" much of the French, but I don't always pick up on the little things, the "little" aspects which provide the true picture of what is happening. So thankful or Craig's willingness to serve. I like seeing the progression of patients, the returning patients for wound checks, and the new babies born in the night. Always better to see improvement.
No C-Sections last night, and I'm on-call today...so the odds are... 2 am...?

After we finished I went to Peds to see how Jason (Pediatrician) and Kristen (Nurse) were doing. As usual, they were having fun :-) We changed a PICC line dressing together, and saw the babies and children. The boy and girl pictured below are here for chemotherapy. They look so much better than when they first arrived - and both are quite the little characters! Jason and Kristen are as well, but that goes without saying :)

You are looking at 2/3 the CMA team here now, and the entire medical team for the 100+ bed hospital, except for two of the Malian interns.

 Normally there would a CMA team of 35-40 plus children. So, it is a small community at present with various vacations coinciding nicely with the current rebel conflict up North. You don't see many "white" faces in the country at present as tourism is ~completely shut down, and most ex-pats are staying away from the country.

I really enjoy the "team" aspect of working with Saskia (Med Doc/OB-Gyn),  Lisa (Nurse/Anesth), Jason and Kristen as they work with the medical Interns and staff in caring for the patients here. I get to work on "both" sides of the fence - Med and Peds - as the surgical consultant. Sounds like a big deal, but in essence it is helping out wherever they can use me :-)

The toughest thing is seeing children when there is little we can do to help. I won't put their pictures in here - it would turn most people's stomachs.

I will remember the 2 y/o who walks on her hands and feet because she can only see out of one eye. Her other eye is completely replaced by a tumor that sticks out 2-3 inches from her head. Can you imagine trying to learn to walk with only one eye?
She rubs the tumor once in a while and starts it bleeding again. Her mom tries to keep the flies off of her.
In my heart I wanted to take her to the block immediately and enucleate the tumor, but the better treatment would be for her to go through the system already set up in Bamako. It sits like a rock in my stomach that we can't do something for her. She is scheduled to leave Monday.

Or the little 3 y/o girl who came in yesterday with a large tumor expanding across her abdomen. She has a scar along her left side, long and narrow. The parents are quite poor, uneducated, and have no idea what kind of surgery she had in the past. I couldn't find a kidney along her left side, and the tumor appears to involve the one kidney on the right. How long will she live? I plan to obtain a biopsy to check, but it looks like there is little we can do for now. She is quiet and looks tired all the time.
I don't wonder why.

Doctors without Borders is around the corner from here. They send us their complicated patients or the ones who may need surgery. I've thought of working with them in the past, but when I see the attitude and care for the children and women at the hospital here, it is an easy decision to work with groups like the CMA. A place where the patients come and are cared for not just physically, but also spiritually. A place where Jason from Arkansas, Kristen from WI, Lisa from IL, and Saskia from Holland are working daily to see a difference made here - for eternity. These medical servants are living from their heart; not just because it is a slogan on a  wall, or a "mission statement", or somebody somewhere thought it would be nice to treat people well. These men and women live who they are - heart, soul, and body - in a place which gives them the opportunity to express themselves so eloquently.

It has been only two weeks since I landed in Mali. The second time is sweeter.
The days may appear mundane sometimes, but then I catch the glint in a child's eye, see a mom wrap their baby closer to them, or watch a nurse patiently explain for the 4th or 5th time what needs to be done...and I realize that it is in the moments that we truly live life. It is these moments that I live for - to see Life and know God is in it all.
Live the moments.

Koutiala, Mali - 


Last post was in Gabon...without much follow up. I'll have to catch that up-to-date soon :-)


Earlier this summer Saskia wrote and asked it I would be able to assist as a back-up surgeon for the Women's and Children's hospital here in Koutiala, Mali. The catch was that there was a coup, then a rebellion up North...all of which upset the country a bit and prompted the US Govt. to suspend all travel for US citizens. It has stayed relatively safe in this section of the country...and now I'm here.


Today I sent a brief update to a couple friends. I decided to use the excerpt following as a post today. Nothing extravagant, but it may give a flavor for the work.

"...Yes, Gao is a bit further north/east - probably about 150 km or more. No disturbances down this way.
There are only 4 singles and one couple left of about 35-40 missionaries not including their children, here in Koutiala, who all work in or for the Women's and Children's hospital. The National staff is still fairly full-tilt, so no worries there.
Thanks for your prayers. Much appreciated.
I'll include a bit of what I shared with my tech, Rhonda earlier today...

"Why Yes! Open Chole's can be fun!! Especially when they are for cholelithiasis and not infection, so good tissue planes and nice anatomy (whew!!). Little blood loss, and an assistant that is brand new, hardly trained except to set up a table, and had never seen a gallbladder. He was excited - calmly excited, as I think he was a bit nervous. It is funny, but "big" cases over here are quite "normal" since nobody knows the difference. I sometimes have to tell the team that it is a "big" case and I need more equipment, otherwise they give me the exact same instruments for a c-section, bowel excision, leg amputation, and cholecystectomy!

I also worked with him to disarticulate a hip and do a leg resection on a lady with Nec. Fasciitis, also removed her dead baby. I think that was a HUGE eye-opener for him. One of my top-5 "worst" cases that I've stored in memory. I don't ever want to do one of those again - and thankfully, will never likely have the chance. She died later in the day. It was her only chance - and if it weren't for the overwhelming sepsis she might have made it. Definitely not a good day on Monday.

...
Hearing what the weather is like there is making me feel a bit guilty. It is hot here, but it is supposed to be hot! My brother wrote me and said he was watering the lawn in front of my house - which means it is REALLY dry. I still see some occasional twigs of green grass around here. Rare though.

Last night it was quite warm as I ate dinner at a Malian family's home. It was typical African, with eating with our hands, and the men inside (where it was warm!!!) and the women and children outside in the cool evening. Kind of wished I was a kid in a way :-) It was some kind of dish made up of a grain, spices and onions, and fish sitting on top of it. Lots of oil mixed in to give the "millet" some substance and make it stick to our fingers.
Afterward we drank a sweet millet/grain type of porridge for desert. Kind of like drinking thick oatmeal, partially cooked, with lots of sugar and a little milk.
Then,...the rounds of HOT Tuareg Tea (the pure tea/sugar combo) poured in shot glasses and sipped loudly (to keep from burning your tongue). Thankfully there was about 15 minutes between rounds to allow the caffeine to kick into place in time for the next shot. Good stuff. 

Jason and our Host

Home around 10:30p in order to put together a lecture for this morning - didn't have any problem staying awake! :-)

Gave a lecture this morning to the nursing students. They seemed to like it. Gives the staff here a break from lecturing as well.

...
Ok - it's quiet here, at the moment. Slow Wednesday. A couple of procedures, barium enema and EGD to do in the next couple of days, and possibly some skin contractures to debride - otherwise only emergent cases expected. So I'm going to work on a lecture or the docs.
"

-- There you go. I know it isn't too exciting. But Life is often lived in the mundane wrapped in eternal perspective.
Thanks, again, for your prayers and I do hope you are having a wonderful summer.
Blessings,
John