On the spur of the moment, Klaus signed up 1½ weeks ago to carry out burn and facial surgeries in Bamako, Mali with an organization called ReSurge! The team of 15 surgeons, anesthesiologists, nurses and pediatricians, arrived on Saturday night for a 2 week assignment at Gabriel Toure hospital – one of two public care settings in this city of 1.2 million. Since I was in Europe anyway, I decided to join for the first few days.
Mali is amongst the 25 poorest countries in the world, and yet socially very rich. The streets are safe and people are welcoming. Like other cities, kids try to sell you phone cards or trinkets or water, but a gentle “non merci” and they don’t bother you further. There is respect for the elderly, a conscious requirement for politeness – one must say “bonjour” or give salaam before engaging in discussion, and a sense of public discipline. The oppressing heat and local culture may prevent the Northern go-getter environment, and music pervades the cultural aesthetic.
In advance of surgery over the next two week, the team on Sunday was devoted to setting-up the operating rooms and screening patients. The hospital is an open architecture African edifice with large verandas, a network of crumbling buildings, and patients waiting on hallways floors perhaps days on end to be seen. Their faces exude patience and trust rather than frenetic activity. They may be seen by a physician today, or they may not, at least they are here.
One stream of activity is the arbitrage of patients. Radio announcements to outlying villages and the city told people about the free service weeks in advance. On Sunday morning, the halls were filled with over 300 people including parents and children. The diversity of the afflictions varies from cleft palates to severe burns that have healed and left the children functionally compromised, i.e. can’t lift an arm or open their hand. The parents likely amongst the poorest in the country sometimes require two translators to get to English – there are 21 local languages and French is spoken widely. They have dressed themselves and the children in their finest clothes and shoes to see the physicians, some of them likely having waited weeks or traveled hundreds of kilometers.
The hospital is not equipped to conduct these types of operations, and so the group brought 37 boxes of anesthesia equipment, gauze, antibiotics, and other essential items. Much of the material will be left behind except the equipment which must be taken back for the next outing. At the outset, the operating room contains two beds, two trolleys and good air conditioning. By the end, the set-up is sufficient to conduct about 6-8 surgeries a day, leading to a total of perhaps 60 cases in the 2 week period.
Figure 1: Klaus and Giem (from Vietnam) having set-up operating rooms
Figure 2: Anne Marie (Netherlands) and Fran (San Francisco) with OR supplies
Figure 3: Improvising anesthesia exhaust
Although poor, this country is not Somalia. The kids are not malnourished, and the affection shown by the family to travel this far for a second chance is inspiring. The children are pure joy. They wait with open eyes and infinite patience likely not even understanding what the doctor will do.
Perhaps the most heart-rending decision is choosing who to treat given the seriousness of the condition and physical ability of the patient.
• A 3-month old with a cleft palate is turned away because she is too small – perhaps next year; sadness envelopes the parents’ face.
• A 4-year old with severe facial burns has a fever and screams for minutes at the touch of the nurses or instruments. He may be too frail to go through surgery, but the risk is taken otherwise he may lose his vision.
• A 6-year old named Aliya with a burn extending down her arm so that her wrist bone is showing, is so calm in the screening room, there is a thought she may not recover from anesthesia, the mother insists she is just very scared.
It would be impossible to treat everyone. As with any volunteer program, the point is to see and heal as many kids as possible with the limited resources of time and money.
In the US, the “Great Generation” went to war believing in the creation of a world which would be a better place for their children. Their offspring, the Baby Boomers and Gen X, twisted the challenge into believing that they deserved a better world, and needed to acquire it at any cost including leaving a worse world behind. This sense of entitlement is pervasive, to the point where there is a prospect that the next generation (those under 5 now) may be poorer than us and inherit a degraded environment.
In Mali, the children and parents in the hospital are not feeling entitled. They have endured a tough circumstance and are thankful for the assistance – they are in no way expecting or believing they deserve support. Perhaps it is privilege in the US that is driving this sense of entitlement. The next blog will be about the distinction between the two terms.
September 26, 2011
