Bamako, Mali - Bonnie MacEvoy, anesthesiologist: On our second day, a little boy wandered into the operating area and was giving out handshakes and hugs. He was not due to have surgery, just curious and friendly. His visit set us up for a great day.
Bamako, Mali - Bonnie MacEvoy, anesthesiologist: The last patient of the day was met by his mother, who appeared to have a sibling on her back. However, the baby on her back actually belonged to the mother of another patient. This woman was comforting the baby simply to help the other mother. It was such a loving thing to do, even though 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 mother a break. It's nice to end a long and hard day of work with a scene like this.
Bamako, Mali - Bonnie MacEvoy, anesthesiologist: The recovery room nurses have adopted several nursing students to come and work and learn with them. These lucky students have two very capable and dedicated nurses to teach them. Here is Vickie at work, doing well with lecturing in French.
Bamako, Mali - Bonnie MacEvoy, anesthesiologist: 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 glitches, 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 re-focused his energy from crying to problem-solving: "Who ARE these people?"
Bamako, Mali - Bonnie MacEvoy, anesthesiologist: As the days go on, more of the local medical workers start to show up wanting to participate in the day's procedures. Today, we anesthesiologists got to meet two of our local colleagues and share some ideas about how we do things. Always very interesting for all parties involved.
Bamako, Mali - Bonnie MacEvoy, anesthesiologist: Today was a long day for everyone. We started with an early breakfast and then made 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 thier 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 expresses many thanks. As our team leader Dr. Steve Parker said, "Dr. Keita always welcomes us with his big arms."
Bamako, Mali - Bonnie MacEvoy, anesthesiologist: To share all of this with such a capable team of dedicated, like-minded, interesting and delightful professionals is itself a gift. Where do they get these people?!! I always come home from these trips a bit changed, with more knowledge and experience learned from my colleagues. I also feel restored and appreciative of the work that we get to do.
Bamako, Mali - Bonnie MacEvoy, anesthesiologist: I would be remiss if I did not mention the adorable children and older patients. They come with such hope and high expectations 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 them and understanding their lives and struggles. They are incredibly brave to hand themselves over to total strangers from an alien culture. This simple element of trust is something that bridges many boundaries.
Bamako, Mali - Bonnie MacEvoy, anesthesiologist: To help bridge the linguistic divide, we have translators who translate between English to French, 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.
I noticed that when Zacharia (one of the translators) went from French to Bambara, 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, 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 training is conducted in French. There were no Bambara words to cover subjects at the end of 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 alive in the medical profession.
Bamako, Mali - Bonnie MacEvoy, anesthesiologist: Some of us went to tackle the task of building an OR suite from the ground up (except for the walls, which were already there) - recovery area, clinical office, supply room, sterile processing, cleaning and sink area, 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 others 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 wound 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.