Saturday, August 27, 2011

Coming home

 The kids surprised me with some welcome home signs on the door!  I arrived in Atlanta last night at around 7pm and my parents (along with Allison) drove to Atlanta to make the ride back with me.  We got back to Greenville about 11:30 last night.
 The girls were excited to see their gifts from Africa.... carved animals and colorful bracelets!
 These bracelets are worn by lots of the Malian children (and adults).  Allison liked her bracelet as well (thanks Sheri :)

Glad to be home!

Wednesday, August 24, 2011

Leaving Koutiala

It is hard to believe that my 11 days in Koutiala have come to an end.  I feel blessed to have been able to  work alongside such resilient people and definitely feel that I received more than I gave.  The sickle cell screening project is off to a good start and should be able to move forward for all new births at the hospital.  I now have a better understanding of the obstacles for treating sickle cell and cancer in this harsh environment.
Today Brett and I made the 5 hour drive from Koutiala to Bamako.  There were a lot of potholes along the way from all of the rains, but we made it safely to Bamako without any issues.
 Kadia, the young girl being treated for leukemia, lives right off the main road on the way to Bamako so we stopped in for a quick visit.  She was outside having her millet porridge for breakfast.
Amos, her brother, spotted Brett's car right away and came running.  You can see him up by the bumper with a shirt and no pants (or diaper).
 Amos loves the car....
 ....and wanted to go for a drive.   He was not happy when we had to leave:(
 All of the village kids watching us leave.
 It is hard to believe how much money was spent on this mosque when people are starving all over Mali. The courtyard of this structure is made of marble and the domes are made of thousands of small tiles.

 This is the hospital in Bamako which is situated on a hill overlooking the city.  We had an appointment with the head of the sickle cell center which is in the lower left hand corner of the picture.
 View of Bamako and the Niger river.

The meeting with the director of the sickle center was very productive.  They are likely going to let us send confirmatory testing on all the newborns that we pick up with sickle cell disease or trait.  I am hopeful that they will do this testing for free.  In turn, we will keep track of all of the data from the Koutiala Hospital screening program and send periodic updates to the sickle cell center.

Tomorrow we will go on rounds with the pediatric oncologist here in Bamako and get his take on cancer treatment in Mali.  My journey back home will start tomorrow night and I will arrive in Atlanta on Friday  evening.

Thank you to everyone for following along with my trip!  Your prayers were definitely felt over the last 11 days.  My goal was not only to showcase the great needs at Koutiala Hospital, but also to highlight the amazing ways that God is working in this place.  If you are interested in continuing to follow along with the journey of cancer treatment at the hospital, you can check out Sheri's blog:
This blog showcases each child that has been treated for cancer at Koutiala Hospital to date.  

Tuesday, August 23, 2011

Random pics from the last days at Koutiala Hospital


This little boy was treated for malnutrition and now is looking great!  He is wearing a  shirt that is the same style as the one I wore to the church at Zamblala.  He looks a bit more authentic than me!
This baby was treated for a severe skin infection called staph scalded skin and after antibiotics he is looking much better and will soon be heading home.
This boy was diagnosed with a congenital tightening of the last part of his large intestine that led to back up of his stool and inability to eat (Hirschsprung disease).  He required surgery to bring his intestinal drainage out through his abdomen and will have more surgery to reconnect all of his hardware later.
This infant is severely malnourished because his mother has poor milk production.  In Mali, the extreme heat combined with poor nutrition makes it difficult for some mothers to keep up with the needs of their child.
This little girl was standing with her mother outside of the hospital yesterday morning waiting for things to open up so that she could be seen.  It is obvious by the look of her face that something is seriously wrong.  She had swelling over her entire body and her urine showed that she was losing large amounts of protein.  She was diagnosed with a kidney disorder known as nephrotic syndrome (likely minimal change disease for all of those medically inclined).  She was started on steroids and will be followed closely.
Mamadu, our new patient with Hodgkin lymphoma, was back today for day 2 of his chemotherapy.  We took the bandage off of his biopsy site and the healing looks good.  He will need about 5 months of chemotherapy.
This is the 9 year old girl with sickle cell disease who received my blood yesterday to help with her dropping hemoglobin and worsening pain.  She was better today, but not quite as strong as I expected after getting strong blood like mine!  No color changes yet!
Sheri with her buddies Mussa and Bala outside of the "inpatient" part of the peds hospital.  Mussa (on the right) had a huge abdominal tumor that had been growing for years prior to his first visit to the hospital.  He is receiving intensive chemotherapy for Wilms tumor and is currently doing well.
Two brothers with sickle cell disease (HbSS...the worst type).  The older brother, Muhamed, had been diagnosed with sickle cell in Bamako after having severe pain episodes.  The younger brother, El Hassan, had not been tested for sickle cell until we drew his blood and ran it on the electrophoresis machine.  His sample showed that he also has sickle cell disease.  He was started on penicillin and given special vaccinations to prevent infection.
This cute little girl....
....has a congenital area of hair loss and scarring (cutis aplasia congenita) that was present at birth.


Mussa enjoyed juggling withe me today.  He looks good is his pinstripe suit!
Baobab tree.... these trees are an amazing part of the landscape here in West Africa.  They can withstand this harsh environment.
Salif, the young man that runs this gas "station" down the road from the hospital, was treated for a chronic compound fracture of his femur from a work accident.  The open wound with bone fragment coming through the skin had been present for over 2 years.  He finally came to the hospital for treatment.  After clearing up infection and removing the bone fragments, a skin flap was placed to cover the wound.  He still walks with a limp, but is now able to function.
Smoked caterpillars in the market today....no, I did not try any!  I did like the fact that she had them separated out into individual servings on the plate.

The market in Koutiala.

Monday, August 22, 2011

Leaving my blood in Koutiala


 A 9 year old girl showed up at the hospital this morning complaining of diffuse pain.  We were already planning to run multiple screening samples for sickle cell disease today so we added her blood sample to the run.  Her test showed hemoglobin SC, a type of sickle cell disease that is usually milder but can have exacerbations.  She was in severe pain and her hemoglobin was dropping (Hb of 6), so a transfusion was necessary.  She is Apos, which is my blood type, so I gave my first pint of blood in Africa.  The Malian lab guys jokingly asked me if she would turn white after receiving blood from a Tubabu (white person).  I replied that it would be a slow process, like Michael Jackson.

 Allison, I promise that they used a clean needle.
Riding home from the hospital on top of the MacLean's car.

Church in Zamblala

  Francois (on the left) just started his maintenance therapy for leukemia and he has been at Koutiala Hospital for the last 7 months!  My patients with leukemia typically go home after the end of the first full week of treatment, but in Mali the infectious risks are much higher and several of the oncology kids have come back to the hospital with severe illness after going home.  Francois has been living at the hospital with his grandfather this entire time.  His father has been working and his mother has been taking care of the house and the other children.
On Sunday, we gave Francois and his grandfather a lift back to their village which is about 45 minutes away from Koutiala.  The village of Zamblala is also the birth home of Aclay, one of Bretts nurses from the hospital.  He came along for the ride as well.  In Malian culture, you can tell how much you care for a person by the distance that you accompany them along their journey.  The people of the village had heard that we were coming and wanted to show their appreciation by bringing us to the front of the church in Zambala and by preparing a feast for us after the service.  Zambala has the largest Christian church in Mali.

Francois finally reunited with his grandmother after 7 months!
Francois with his grandparents.
Grain storage huts that were the traditional home structures of the past in this part of west Africa.
The church in Zamblala.
Church parking!
Brett was asked to speak about the work of Koutiala Hospital and more specifically about the healing process for Francois.  I wore my traditional African shirt that we picked up my first day in Koutiala.
Gathering after church.
Brett and Sheri are fluent in Bambara and spent some time talking with families after the service.
This is my favorite picture of the trip!  A group of kids gathered around Brett and Sheri's car after the service.  Notice the little boy in the sling worn by his 7 or 8 year old sister.  The kids were all wearing their best clothes.
This is the old church of Zamblala, but it is no longer big enough to hold the congregation... a good problem to have in a predominantly Muslim country!
Sheri with Francois' mother and 2 sibs.
Francois' house.  It may not be that noticeable, but the family had perfectly swept the dirt yard for our arrival.
Beautiful twins in Zamblala.  Twins have a chance to survive in this harsh environment, but an elderly man from the village said that he had never seen triplets survive.
Our lunch was rice with a brown sauce and a mixture of pork and duck meat.  We ate with our right hand (left hand used for the toilet) and tried our best not to make a big mess!  The food was very good and 36 hours later I'm still feeling fine:)
Preparing tea for the guests.  The Malian men like to see how high they can pour the tea from the kettle to the cup (looks like a shot glass) and then back again.  Typically, you have 3 rounds of tea after a meal, while all of the guests sit around and talk.
Onions stored in a cool area near the house.  These onions are grown in the hot season and then will be kept in this location to be used for the rest of the year.
Goat pen in the background.  You can see one goat leaning through the slats.
Typical mud buildings...this opening leads to the chicken coup.
Fat baby!
Saying goodbye to Francois.  Notice his bluejeans with the pink flowers on the bottom.  Malians are not worried about appearance... the boys do not care about wearing pink.  In fact, most of their American clothes come on large shipments from Goodwill.
Gifts for the road from the family.... 2 chickens and a plastic bag full of eggs!
Check out this termite mound we saw on the way back to Koutiala.  Now I know why there are so few wood structures in Mali.
Holding the chickens right before their release into Brett's yard.  Jeremy will take care of them soon!