More from Koutiala Hospital

Early morning at the hospital with everyone starting to check in to be seen.

Donating blood..... we will not be able to donate in the US for 3 years after a trip to Africa.

Kadia, one of the first patient to be treated for ALL at the hospital, arrived for her final chemotherapy visit.  She is an example of the amazing things that can be done through donations to the Cancer Fund at Koutiala Hospital.  What a happy day for this little girl!

Adama (Burkitts) along with his mother and sister.

This little boy with severe bowing of his legs (Blount's disease) has been repaired in Niger and is back for a recheck of his casts.  Dr. Brett is very pleased with the results.

The cancer patients and their families seem to stick together at the hospital.  Many of them have been at the hospital for months.  The risks of infection during intensive chemotherapy make it difficult and unsafe to return to their home villages.

Even the young girls carry their baby sisters around.  Nice hat to keep the head warm on a "cool" day.

Sheri with one of her favorites, Kadia!

Covered in dust all of the time....

Malian tea

Tea is a major part of Malian culture and it is hard to go through a day without several different "tea times".  You will not find fresh coffee in Mali, only tea.  I have been on a quest this trip to discover the process of making perfect Malian tea.  I bought a traditional tea pot in the market and then was gifted the small coal burner.  After getting some green tea today and small shot glasses (used for multiple steps in the process), it was time to try it for the first time.

The teapot goes right on top of the coals and gets extremely hot very quickly.  The pros can swing the charcoal burner around 365 degrees at a time to get air to the coals and increase the heat.

Once the tea has steeped it is time for the process of adding the sugar and then starting the pouring steps that involve pouring from as high as you can to produce a "head" on the tea like you would expect in a good beer.  You pour into the glass, then back into the the pot, then repeat multiple times to mix in the sugar.

 The youngest MacLean, Silas, was a big help with the sugar.... some for me, some for the tea!

Updated photo of the tennis court, now 1/4 finished and moving on a typical Malian pace.

 Tonight we had dinner with one of Brett's pediatric nurses Esaie.  On the way to dinner, we stopped to pay respect to the family of another nurse from the hospital who recently had a death of an elder family member.  Paying respects to the family is a very important part of this culture.  We visited the family "compound" and went through a complex process of greetings.

 Young girls playing in the courtyard.  The one on the left wants to be a doctor when she grows up and then one on the right said she wants to move to France.  The country has so little, but the children still dream big just like ours.

 Greeting the family.  Seats are brought out for us to stay a while and talk.

Baby Ruth!

 Tonight we had a traditional Malian meal with Esaie and his family.  The food was placed on each one of the small tables in a large bowl and then we ate with our hands out of our section of the bowl.  The food is really amazing... rice, beef, cabbage, onions, tomatoes.  After dinner we sat around the courtyard talking about the day and enjoying the relative "cool" of the night.

Church in Koutiala

2 Corinthians 5: 16-17

"So from now on we regard no one from a worldly point of view.  Though we once regarded Christ in this way, we do so no longer.  Therefore, if anyone is in Christ, he is a new creation; the old has gone, the new has come!"

This verse really spoke to my heart as we were worshiping today in a strange language and with people who, according to the world, look very different than us.  We were warmly welcomed over the loud speaker and we shared the common bond of sinful people who have gathered together to accept the saving grace of Christ.  What other bonds do we need?

 Church choir.... lots of swaying, good percussion in the background.

 Church parking

 The entrance to the church with a few elderly women outside.

 Sunday school class

 The story of creation told in Bambara with illustrations

 The gentleman in the blue shirt with white collar has the job of waking up any church members who start to doze off during the service.  This is a well accepted practice at every service.

 The congregation is separated between the women and men.  Sheri sat with us on the men's side so that she could translate.

Picking up the kids from Sunday school.

"All of my children die before the age of 5"

First of all, I would like to let everyone know that Mali is a good place to have a birthday!  I started the morning with Sheri MacLean's homemade cinnamon buns and then over to the hospital to play with some of the kids and to look at some slides in the lab.

This post will hopefully shed some light on the importance of sickle cell screening in Mali.  The common history that the medical team gets with a new child with sickle cell disease is that multiple children (historically) have died in that family before the age of 5.  We are hoping to change that course moving forward by screening and providing proper treatment.

This beautiful little girl's mother died from sickle cell disease and she now lives with her aunt.  Her father lives in the capital city (Bamako) and does not typically comply with the plan from the medical team.

 This little boy's brother was screened as an infant and tested positive for SCD.  His older brother then tested positive and is now followed in the screening program.

 Brothers with SCD.  The father is wealthy but refuses to fund the needed therapy for treatment and prevention.  We will continue to provide the treatment for free and hope to convince him of why it is necessary in the future.

 This little girl with club feet was in for some fine tuning of her brace.  You can tell that she is wearing at home by the way that she was falling asleep during the process.

 Jo with Karie.... if you look at her dossier (chart) below you can see that 3 of 8 children have died at a young age from likely complications of undiagnosed SCD.  Karie is now getting the treatment that she needs with the hope of limited complications in the future.

 The chart of Yacouba (above) shows that 6 out 9 children have died under the age of 5 (noted as DCD).  Yacouba was the first child discovered to have SCD.

This little girl has the worst anemia out of all the children that were seen in the program today.  She lives in Segou (several hours away) and therefore has not yet been started on the controlling medicine hydroxyurea.  We hope that the family will think about moving her closer to Koutiala so that she can receive the care that she so desperately needs.

Dinner with Joseph

Yesterday afternoon we went to the market to pick up a few items and then we walked the 2 miles back to Brett and Sheri's house along the main road in Koutiala.  We heard lots of kids calling out "Tubabu" and several of the little ones wanted to come over for a "photo ta".

 Joseph Kamate, the Malian nurse in charge of the sickle cell program, invited us over for a traditional Malian meal.  He wanted to honor us by putting out his best things, including plates and silverware which are never used to eat by Malians.

 Jo's little girl Sophie.  She was named after Jo's mother who died when he was young.  It is respectful to name your child after a deceased parent, but in this culture you are being disrespectful if you actually call them by that name in daily practice.  They call her Mami.

 Sophie had a great personality once we got her to warm up to us!

 My birthday present from Jo.... a small coal burner for my new Malian teapot.

Screening for stroke risk

This brother and sister with sickle cell disease were the first patients that I saw during my last trip to Mali and also the first to start taking the controlling medicine hydroxyurea.  They have done much better since starting the medication and traveled to the hospital today for evaluation of their risk of stroke by ultrasound of the brain.  This is a standard test in the US for sickle patients from 2 to 16 years old and when it is abnormal shows that the child has a 30% risk of stroke per year.  We were blessed to have an ultrasound machine donated for the clinic and I packed it in for this trip.  Joseph, the Malian nurse in charge of the program did a great job starting to learn how to perform the procedure.

Three brothers with sickle cell disease.

Kristen, one of the peds nurses, with Chaka who lost both legs from a severe infection.

 Adama (Burkitt lymphoma) with his green Mercedes truck

 Getting all of the TCD equipment together

 Dr. Sumila!

 Teaching Joseph the brain ultrasound technique

The baby in this picture was diagnosed with sickle cell through the screening program and then her older siblings were screened afterwards and also found to have disease as well.