Latest Photos From Mali

PFP volunteer Stephen Katz has just sent us more great photos taken during our recent mission to Mali.

Dr. Lilly – From The Village

Well, I just couldn’t resist the need to record our last work day’s experiences, as it seemed that all of our other experiences led us to this. Dr. Ben Aboubacar, the Chief Medical Officer for the Millennium Development Goals in Central and Western Africa, really knew what he was doing when he saved today for the last.

Thankfully, I had recovered from the previous day’s situation, thanks to a nice dinner at our hotel and a relatively good night’s sleep. The “capitaine” is a fish from the Niger river, and the local way of preparing it was delicious – roasted in a thick and spicy tomato and onion sauce. We were joined by the head of local development projects for the MDG and by a lady friend of Ben’s who happened to be in town. She was a Malian physician who was with an NGO from Geneva which was working to help women with fistulas from the bladder to the vagina, rendering them grossly incontinent, and making them social outcasts rejected by even their family. This is a complication of obstructed labor in childbirth, and can be prevented by having a trained midwife assist the delivery or direct the woman to a facility for a Caesarean section. It is a great social as well as medical problem in underdeveloped countries and is one indicator of the level of health care. Dinner on mission trips has always proved to be one of the most interesting and enjoyable aspects of medical work overseas – you never know whom you’ll meet.

A fairly early start helped again, because as Ben had said earlier, the roads for today’s trip were not good. We headed out initially to see the Referral Health Center in Markala, a larger village on the south bank of the Niger. It was particularly important, because it was the site of the large dam that serves as a major bridge across the Niger in Mali. It was a two lane affair which also served herded animals, pedestrians and vehicles. We had had a previous incident that morning with a very large group of animals blocking the road for about five minutes, but this time too, the herds had the right of way. We had to wait until they had cleared the long bridge before we were allowed to pass. In the areas with no grass, the malnourished cows are particularly pathetic, really just skin hanging on bones. Know how to tell the sheep from the goats? The haughty goats have their tails up in the air, whereas the humble sheep walk with their longer tails hanging down.

The hospital again reflected the African preference to have a complex of independent one story buildings for each service, separated by trees for shade and allowing good ventilation – both very helpful in the African heat. Interestingly, the hospital has a Malian government director but is medically staffed by the Chinese, who have provided a team for a two year rotation for forty years! This dates from Mali’s former socialist government, which had ties with the Soviets. They were doing a reasonable job, though none of them except the one interpreter spoke French, and no one spoke the local language.

And then the adventure cranked up a notch. We left the paved road for the roughly ten mile ride down the red clay bumpy road to the Millennium Village, Dioro. We had received a call that they were waiting for us, as we had gotten a little behind schedule getting details at the hospital. The driver was trying to make up time, which made it impossible to get any camera shots of the countryside or take notes. But the sights were staggering. Bright, clear sunshine following yesterday’s rains gave the colors more intensity, and the area had a greener look. Standing pools of water were used as places to wash (clothes and bodies). Tiny villages of sun dried brick and mud plaster rectangular houses had replaced the stick and straw circular houses. The small mosque could always be identified, the small minaret having a squared off tower with construction logs sticking out near the top. Leafy tree branches were placed in the biggest pot holes to give a warning. Agriculture was again a throwback to centuries before, with single or teams of oxen pulling a plow, and men and boys bent over using a short-handle hoe. Millet, sorghum and rice were being planted, and there were irrigation canals from the adjacent Niger in a few places . Men again wore long robes, with a turban that often covered their neck and face as well, leaving only their eyes exposed to the wind, sun and dust. Frequently using dark colors for their clothing, they were a formidable site. The women often had dark tattoos on their fingers and hands. All of this was compatible with their desert and nomadic traditions.

We were glad to finally reach Dioro, a clean village similar to the ones we had seen on the road. The community health center there was very well run by the single doctor, and Dick was very impressed by the records which indicate a high quality of care given. They are, of course, extremely limited in terms of equipment and supplies, but the monitoring and treatment of patients seemed quite good. We were then escorted to what I had heard so much about before, the meeting under the tree with the elders of the village. We sat in chairs around a small table and had a delightful and fruitful meeting with the association of elders which supervises the medical center. There were a couple of people in various types of training from Bamako there also. These older men, some of whom were quite tall, were an imposing group, some with stern, intense expressions, and others actually quite open and friendly. They made the point that if they only had more provisions, they could accomplish so much more. Utilization of health care facilities is only around 15% in Mali, reflecting not only transportation/access issues and their inability to pay for care and treatment, but also ignorance and lack of confidence in what was available. Malaria is the biggest killer in these countries, with respiratory infections and diarrhea also major problems. HIV/AIDS only has an incidence of less than 2% in this conservative country. After a much appreciated soft drink, we were back on the dusty road again.

One final set of surprises. I had met Professor Malouf Keita when we toured Gabriel Touré, one of the two university hospitals in Bamako. He was wearing a sporty Rotary shirt, and when I mentioned I was in Rotary, he insisted I join him for their Friday evening meeting. It worked well with our schedule, so I was delighted to have such a unique opportunity (as well as the chance to have a “make up” meeting while I was away, as Rotarians will understand). But we received a call en route back to Bamako from Professor Keita, telling me that there was also a GI conference in the same hotel that same afternoon. Unfortunately, we were not able to get back in time, but it actually worked out well anyway. The conference was winding up with last comments when I arrived to meet him, and he insisted on introducing me and calling on me to make some comments. I decided not to comment on hepatitis B, the subject of the conference, and just made a few remarks about the MDG and PFP’s role. We then shuttled quickly to the Rotary meeting which was just beginning. There were about 25 black and white female and male Rotarians and four guests. I made the same comments again, but then the Professor went on to amplify the Millennium activities, referring to the TV and newspaper coverage of the donation of the container of medical goods, my Rotary club in Norfolk, our hopes for a relationship with his pediatric department and PFP, etc. The usual Rotary activities and banter followed, and the meeting ended with everyone standing to sing in parts a moving Rotary song which I had never heard before. Their singing really put us to shame! But the professor wasn’t through – he then remarked that he knew it was late (though he didn’t know it was another day without lunch and only the classic French coffee and rolls for breakfast) but why didn’t we try to rejoin the GI conference for a quick supper. We were in luck, as there was still lamb and couscous left, and we all had an enjoyable time chatting together. What a day!

It was hard to sleep that night, with so many ideas racing around in my brain. But Dr. Ben had one more opportunity in mind for us. Dr. Ousmane Koita is a brilliant young researcher here in Bamako, having completed his PhD at Tulane University. He has developed since the year 2000 an extraordinary complex of sophisticated molecular biology laboratories to study malaria, sickle cell anemia and AIDS, as well as plant parasitology. An AIDS vaccine is one of their major goals, but they are doing research in the Millennium Village regarding these diseases, in addition to their other work. It was a totally unexpected finding, and it left me feeling really thrilled that such important work was being done right here. We hope we can find ways to partner with them in their studies. What a way to wind up this phenomenal experience in Senegal and Mali. Now it’s on to make some of the hopes and aspirations created by this exploratory mission a reality.

Edward L. Lilly, MD, FACP

Latest From Dr. Lilly in Mali

Segou, July 26

We decided it would be safer to leave very early, rather than drive at night, after our very full and demanding day on Wednesday. Wednesday morning began well, with an enjoyable visit to the brand new embassy. After the embassy bombing in Addis Ababa, it seemed best to build a new embassy in undeveloped areas outside of the city, allowing better security and open space around the building for surveillance. The public affairs officer gave us an interesting tour, highlighting a “visual grio” project, which taught 12 year olds about photography and let them shoot pictures of their environment. The professionalism was astounding and the images very moving, but it should not be but so surprising in a country which has such an impressive history of artful photography. The Chrysler Museum was very pleased to recently acquire a famous 50′s work of art photography from Mali.
We visited the national school which does most of the training of nurses, technicians, midwives, etc., although there are an increasing number of private (commercial) schools also. The school was modest when compared to the four story institution which the Japanese had built in Senegal, but it also suffered from the same problems of disrepair and neglect which are so common in Africa. We had a good laugh when the assistant to the director noted that our CEO, Ron Sconyers, Dick and I were all three retired from our primary jobs, and he wondered if he was too young to be a part of PFP!
The last meeting of the day was the kicker, though. We were asked to attend a called meeting of the coordinating committee of the health wing of the Millennium Development Goals for the Bamako district. These were doctors and ordinary citizens who agreed to help with the supervision of the project. Well, it turned out to be a hornet’s nest! After we had made our presentation and given out a one page summary in French of our PFP brochure, it was opened up for comment. The director of the health district (a very capable MD-MPH) was in charge, and she was hit by tough question after tough question, sometimes with a lot of passion and intensity. They are so frustrated by the overwhelming lack of resources for equipment and competent personnel. It was a real lesson in participatory democracy, and we were all worn out (especially her, I’m sure) by the process. But it helped us focus on what we can realistically do in this context, where there are so many critical needs and problems.
We had to get away this morning by 5:30 am, in order to get to the other Millenium City, Segou, in time for our 9 pm meeting with the governor. It was an interesting experience, to say the least. In the flat countryside, with low trees, lightening really does provide quite a spectacle in the vast African sky. But as the rains started up in earnest, things started to deteriorate quickly. The land does not drain well, and the rain from last night in the area was still standing in the fields. The closer we got to Segou, the worse it became, finally with widespread flooding through the villages and over our road. I really got worried when even Dick said he didn’t like the looks of things. At one point there was a sharp drop off to the right of the road, resulting in a dramatic waterfall of muddy water for a distance of a couple of hundred yards. We wondered if our Toyota SUV Landrover was up to the challenge, but to make a long story short, we arrived OK. The villages, several composed of large vertical stick houses with conical straw roofs, and others of blocks covered with mud plaster, gave an ancient appearance to the countryside, though it also reflected the real poverty of the country.
We didn’t have time for breakfast before we left, so we stopped on the road for some snacks from the shacks. We had a boiled egg and some bread, and we were glad to be able to get some mineral water. We got a cup of coffee and some more bread and jam in town after our second morning meeting (courtesy meetings with the governor and mayor), and that was the food for the day. I am waiting for the restaurant to open in our small and rustic hotel, and I’m really going to be ready for supper. Restaurants here usually don’t open until 8 pm. We have not had lunch except a few times during this trip, as the meetings are hard to keep on schedule and often run over. Africa time is much more flexible anyway, so we have just had to learn to be flexible too.

We finish up tomorrow with a visit to the two Millennium Villages near Segou. Our leader has told us we need to get an early start, as the roads are not good. But then it’s back to Bamako in the afternoon, where we hope to finish up our reports and catch up on the email before we begin the three day process of flying back home on Saturday. Airline schedules in Africa have been cut back, so flights are less frequent, and multiple day trips are often the rule. So this may be my last entry in trying to give you a little sense of what our trip has been like, not the stuff of our official report! It has been a mind altering experience for which I am extremely grateful. We grow so much personally when we are pushed out of our usual routine and are forced to do what is required in a situation. It makes me realize how resourceful people can be, and that is the hope which sustains me when I consider the challenges which Africa faces today.

Dr. Ed Lilly

Digging In In Bamako

Monday morning arrived with a very full schedule in store for us – nine separate meetings before it was all over. We started with the Regional Health Director’s Assistant, as she was in China, to obtain his support and to facilitate easy relations with the various government medical personnel we would meet. We then went to two each community clinics and reference centers. The next step was a tour of one of the two university hospitals’ pediatric department. PFP will probably have more impact here, as they are eager to establish specialty areas within the department (GI, cardiology, etc.). We evaluated their national prosthesis center, but found that it was really first class in every respect and did not need our involvement.

All of that traveling gave us a good opportunity to see the central areas and suburbs of Bamako. I think we saw some of the most challenging medical situations, as the community clinics were generally in a bad state (outdoor building with a hole in the floor type toilet, goats roaming, enormous potholes in the road, few supplies or instruments of any type). The exception was one center in which the salaries are paid by the local commune, which participates in the decision making. It was a good example of how important it is for people to have a sense of responsibility in enterprises like this, giving them pride of ownership and illustrating participatory democracy at work.

The architecture in Mali is really distinctive, reflecting the ancient Kingdom of Mali influences. Large building often have pointed tower-like corners, sometimes with a cleft in the middle, giving the appearance of a fortress. The government buildings we visited were small and cramped, with little air conditioning and a really worn appearance. But as we were riding out into the suburbs, we saw this enormous governmental complex of white towering buildings in the fortress style, some 15-20 in all. They are just overwhelming, sitting there on the banks of the River Niger and sparkling in the sun. All of the other buildings we have seen look like the colors of the dessert, shades of tan and orange. Large statues of an elephant, hippopotamus and a bull are placed in prominent round-abouts (far more efficient than stop lights – and the drivers are surprisingly courteous).

Well, it wouldn’t be a trip to a developing country for me without a spell of something. I think Mark Twain said he had never been very careful about what he ate when traveling, as he figured the various bugs would just have to fight it out for themselves. My digestive tract had been warning me for a couple of days, and today the battle broke out in earnest. I actually had to leave a meeting at the WHO, but after a nap and some medication, I am feeling better.

Today (Tuesday) has been interesting. We met the governor for this region at his office, just a courtesy call with this tall and authoritative figure, who wears a military looking uniform. Then we went on to the National Director of Health’s office for a more substantive meeting, also a large, stern and imposing person. But we again found looks could be deceiving as he was a very thoughtful and hard working pediatrician, who was quite concerned about the childhood and maternal health issues which are such a large part of the Millennium Development Goals. By the time we arrived at the WHO building, I was wondering whether it would be feasible to go to the meeting. I held out for about twenty minutes before the sweats, cramps and weakness made me feel faint. The others went on the meeting at the MDG office for a briefing, and to evaluate the medical shipment, but I was glad the hotel wasn’t far away.

Tomorrow, we’ll have meetings with the USAID folks and the Embassy, followed by visits to training sites, the UN Development Project and coordinators for the regional health facilities in Segou, the next and last city on our visit to West Africa. Stay tuned!

Edward L. Lilly, MD, FACP

Images From Mali, July 24

Photographer Stephen Katz, who has volunteered to document many PFP missions, sent back these photos from our current mission in Mali, with many more to follow in the next few weeks.

(Pause the slide show and roll over an image to view caption.)

A River Runs Through It

As I reflect back on the day, looking out over the Niger River, dotted with small canoe-like boats with net wielding fisherman, literally casting for their livelihood, it I am reminded that in some ways we take the work we do too much for granted. I am the fortunate one, being able to be here in Bamako, Mali when a container filled with donated medical supplies and medicines arrives and to hear first hand the praises and thanks from local health officials for the difference we have made with this seemingly simple gesture. But you soon realize the enormity of it all when the “Gouverneur” (of this French-speaking nation) convenes a press conference tha attracts more than 20 journalists who are eager to know more about why these “Americans” are here. This is “medical diplomacy” at its finest–taking the best talent and treasure that America has to offer and demonstrating our caring compassion for the vulnerable and the impoverished–regardless of religion (in this mostly Muslim country); race, gender, politics or geography. As I look into the eyes of the dozens of young kids who excitedly watched as we opened the container, it makes me realize what it is we do and why we do it. While the Niger runs through Bamako, a river of another kind, one of selfless concern for those less fortunate, runs from Physicians for Peace into countries like Mali where that river brings an almost surreal connection between those who have and those who have not.

Ron Sconyers, CEO, Physicians for Peace

Dispatches from the Edge

I arrived in Bamako, Mali late last night (via a circuitous route through Philadelphia and Paris.  The lengthiness of my travel offered by an opportunity to catch up on some reading.  Most notably was CNN correspondent’s recent chronicle “Dispatches from the Edge.”  Amongst the other tragedies of life he reported (tsunamis in Indonesia, war in Afghanistan and Iraq, Hurricane Katrina) he recounts through insightful and thoughtful detail the heavy burdens of counties like Rwanda, Somalia, Sudan and other African nations in dire need.  For me, en route to Mali, reported by the United Nation’s as 175th  out of 177 countries on their “quality of life” index, it put it all into very real context.  I arrived at the airport to a crush of eager (put polite and inoffensive) cab drivers all eager for my fare.  I was fortunate to have been met by Dr. Ben from the Millennium Development Project who has been the gracious host of Drs. Lilly and Brown this past week in Senegal.  He’s an amazing and inspiring young doctor charged with a huge task for West Africa.  We had precious little time to talk but am looking forward to today when we meet with the Governor and others to plot our strategy for health care education here.  I’ll forgo for now any “color commentary” as Dr. Lilly has proven himself to be a most worthy journalist, as you will note from his entries below. More to follow.

Ron Sconyers, CEO, Physicians for Peace

Heading for Africa

Tomorrow, I leave Norfolk, Virginia for Bamako, Mali via Philadelphia and Paris. As the CEO of Physicians for Peace, it is always a privilege to join our selfless volunteers as they work to bring medical education to some of the world’s most vulnerable populations. And Mali certainly qualifies as a country with a vast population of unmet needs and scarce resources. You know you’re not “in Kansas anymore” when you have to start an 18-day dose of anti-malaria pills before leaving home. Mali, like so much of Africa, is sadly victim to a huge malaria epidemic…as well as so many other tropical diseases. We hope we can help ease their huge burden of inadequate health care. I’ll report my adventures as often as I can.

Ron Sconyers, CEO, Physicians for Peace