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A young patient wonders, "Who ARE these people?!"

Who ARE these people?
Originally uploaded by interplast

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?"

Anesthesiologist Skillshare

Malian Anesthesiologists
Originally uploaded by interplast

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.

Our Welcoming Host, Dr. Keita

Big Arms, Big Heart
Originally uploaded by interplast

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."

Restored and Appreciative

Checking on a child
Originally uploaded by interplast

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.

A Humbling Experience

A cute patient
Originally uploaded by interplast

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.

Keeping Medical Bambara Alive

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.

Scheduling Patients

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.

First Day of Clinic

Bamako, Mali - Bonnie MacEvoy, anesthesiologist: First full day in Mali and as always we hold a clinic day.

We got up early for a group meeting before seeing patients and had breakfast in the dining room. I needed to ask for another blanket and some other things for our room. The night shift guy was asleep, or as they say, "on Mali time."

We all marched to the hospital, about two blocks away. We were met with a very loud and chaotic crowd, packed into two long hallways. Of course, if one child comes in to be seen, he or she arrives with his or her mother, siblings, uncle, grandfather, blankets and food for the day.

Ready To Go To Bamako, Mali

Bamako, Mali - Bonnie MacEvoy, anesthesiologist:  I am at SFO now, waiting for my Air France flight to Paris. Everyone starts to show up about three hours early to load the 30 or so boxes of equipment and supplies, plus our own personal stuff. How will the plane get off the ground?!!

An Unexpected Note in Our Inbox

Interplast burn sister
**UPDATE: Here's the photo of the man with his sister.**  As our volunteer medical team headed home after two weeks in Dehradun, India, we in Mountain View, California (where Interplast is headquartered) received the following email from a patient’s brother.  Reading his note made us all a little extra proud to be working at Interplast.

I've already met your team members here in Dehradun.  In fact it was a chance meeting at the Dehradun Airport where I had gone to see some of my family members off to Kolkata. Because of the inclement weather, their flight was not being confirmed. And I was quite worked up since cancellation of the flight meant missing the connecting flight from Delhi to Kolkata. Many such weird thoughts were crossing my mind when I received a phone call from my sister who had also come to the airport and was sitting at the other end of the lounge, she wanted me to come over to her. On reaching there I found her talking to a gentleman. She introduced the gentleman to me as one Dr. Kush.  In turn I also introduced myself.  Dr Kush informed me that a team of specialists were reaching Dehradun just then and he was at the Airport to receive them. He told me that a camp was being organized by an NGO called Interplast. Seeing my sister with burn contractures on her neck and lower lip, Dr. Kush wanted me to bring her to the camp the following morning for a possible corrective surgery.

And thus began my introduction with Interplast. Today, I'm immensely pleased to tell you that my sister was operated upon last Thursday and has since been discharged from the hospital and is recuperating fast. I am really touched by the love and care with which they treated one and all alike without distinction.

I wish to place on record my profound sense of gratitude to the each and every member of the Interplast team for the love and care showered on one and all.

Thank You, Interplast!!

Global Health