Mali's dismal health care system

I'm much better after my bout with food poisoning (most likely salmonella) which brought me here to Bamako where I'm recovering. My confidence has been reassured as to the Peace Corps' ability to deal with health and security emergencies and horribly unnerved at the Malian systems ability to do the same.

I'll provide two examples: The first occurred a few months ago at my regional office of the Ministry of Tourism where I work. One of my fellow co-workers, Justin Dabou, (of which there are only five) fell ill and was taken to the hospital Friday morning. He has a history of high blood pressure and is frequently absent from work for being sick. His condition progressively worsened throughout the day. By the evening, the hospital in Segou was trying to transfer him to Bamako where he could obtain better suited care. This became a huge problem since in Mali you need to pay before you receive treatment (or at least need to demonstrate sufficiently that you'll be able to honor all debts). Being transported to Bamako (a three and a half hour drive west) by what I presume would have been an ambulance costs over 150,000 franc CFA which equates to over $300. $300 is an enormous sum of money for a wealthy Malian let alone an at best middle-class Malian - which is where Justin would fall. To complicate matters further his first wife and only wife (I clarify this as it is possible for him to have up to 4 being in a Muslim country) was in Bamako and unable to handle this matter personally.

Madani Niang, my homologue [counterpart], being the great guy that he is, was at the hospital all night trying to secure Justin's release and transportation to Bamako to receive the increasingly urgent care that he so desperately needed. Around 4am Saturday morning Madani had finally gathered together enough money and was filling out the final pages of forms to get Justin to Bamako when he was approached by the doctor with information that he so often conveys. Justin had passed away. He was minutes from getting in an ambulance to be rushed to Bamako where he could be treated but he didn't make it. He was 45 years old. 45 is just three years shy of 48 - the average life expectancy at birth in Mali.

Justin had gone to collage and even spoke a little English. He had just moved to a new house the week before and his life was looking up... he had so much potential. When I look at him and what he could have done in his life - I see so much that will never be, so much that could have been - should have been. Justin Dabou, may you rest in peace.

The second example happened just last week on Monday the 27th of August. As you may have noticed, I have now been here in Mali for over a year (in fact it was a year and one month on that day). Thus, the new crop of volunteers has arrived and are going through all the trials and tribulations of training - or as we call it: stage (pronounced with a soft g). During part of their two month stage, they visit their future sites for a week to see where they are going to spend the next two years of their life. That week had just come to an end and the stagaires were set to return to Bamako Monday morning. The trouble started when one of them was leaving his hotel to grab an egg sandwich from across the street.

Kyle slipped on some sand on the tile floor and broke his left ankle - a freak accident. He broke a chip off of the fibula (the one at the back near the Achilles not the tibia which is the big one in front). The fracture wasn't even the most shocking part of the problem... he had somehow also managed to completely dislocate his entire foot from the bottom of his leg, twist it about 65 degrees to the left and move it inside to the right about 2 inches. Picture that for a moment. Pretty fucking gruesome and not something you want to have happen to you even in America let alone Mali, West Africa.

The other stagaires called me and I biked over arriving about 10 minutes later. We immediately got on the phone to our Peace Corps medical staff in Bamako (as we are so well educated to do) to asses the situation and get him help. A little while later an ambulance from the fire brigade showed up ready to take him to the Segou hospital. They came rushing in with a stretcher straight out some bad 70's TV show and a walking boot for Kyle's foot. The stretcher wasn't a problem; it was the hard walking boot that concerned everyone. Kyle's eyes lit up and pleaded for us not to let them touch him! You see, his foot was very twisted and there was no way in hell of fitting in that boot – it just wasn't going to and should not happen.

We argued for a good while before they huffed off being thoroughly insulted that we didn't think they knew how to do their job. Um... I don't proclaim to be an EMT or anything close to what would resemble a medical professional but what they wanted to do was not normal. Eventually, another ambulance came to take him to the hospital. This time we had a Peace Corps trusted doctor with us overseeing everything and tensions were calmed. Kyle had taken 800mg of ibuprophen and a hydrocodone for his pain and a car had been dispatched from Bamako with a Peace Corps doctor to bring him back. Things seemed to be improving or at least stable.

I rode with him to the hospital and we went directly into take x-rays. We had been in the room for no more than a minute and the radiologist approached me saying they needed to lift Kyle's leg so they could slide the x-ray film underneath. Sure - sounds reasonable right? Simple, standard sounding procedure... and remember the radiologist had seen the patient for no more than a minute and had but a fraction of the information he need about the situation and Kyle's condition. (Remember at this point all we had were the visual analysis of what it looked like - the fractured fibula and dislocation was what we found out later).

With me standing next to him, the radiologist began to lift Kyle's leg so that he could slide under the x-ray film. He grabbed the upper calf and, to my complete astonishment, Kyle's toes. He was partially lifting this poor man's foot by his toes!!! I didn't have to wait for Kyle's screams of pain to know that wasn't right and attempted to pull the doctors hand away. I couldn't pull too hard as he had a firm grab on the foot and I didn't want to jerk and cause any more pain than Kyle was already enduring. Then to even further incomprehension and with complete disregard for the extreme amount of pain Kyle was already going through - while still lifting his foot by the toes, he proceeded to firmly grab the bottom of his foot by the heel and twist it back into place!! It was so quick there was nothing I could do… but oh my god did it look and sound painful! A few of our friends who had accompanied us to the hospital and had been waiting outside came rushing in when they heard Kyle screaming bloody murder from the pain. Again, I am not a medical professional but that was just not normal - I don't care what you say, there is no way that falls within some standard operating procedure.

That is the main point I wanted to convey - after that everything was pretty calm and just a lot of waiting around for another two hours while we waited for the car (a typical NGO white Land Cruiser) to arrive and transport Kyle to Bamako. Holy crap though - can you believe what that "doctor" did??! Man. Wow. Intense.

There you have it - a few examples of the Malian health care system. As you might gather, when I fell ill just two days later with food poisoning - I had no intention of entering it. I'm not sure what I ate. It may have been a small pastry the previous morning or some salami I'd been sent in a care package but either way the result was far from pleasant. I woke up around 4am running to the bathroom to vomit and did so at least every 15 minutes for the next 6 hours.

By 7 am I gave in and called our PC doctors who called Kathy (the other volunteer in Segou) to send her over and take care of me. She was wonderful and made at least five or six trips to the pharmacy for the necessary medications. These included first some oral Vagolene to stop the nausea and later some in a syringe since I couldn't keep it down and needed to stop throwing up. 4 hours after the vomiting began, my bowels started acting up. Let’s just say I started running to the bathroom to intestinally evacuate with high frequency. Unsurprisingly, I was losing my fluids at an alarming rate and was in need of medical attention. At the last moment the injection kicked-in and I started to shut off one of the valves so I could retain a little liquid.

Again, the PC doctors sent a car from Bamako to pick me up when the severity of my situation was realized. I was promptly picked up and taken in a daze on the 3 hour journey back to Bamako. I've been recovering in Bamako now for an entire week and can just about say today - one week later - that I am 100% back to normal. Peace Corps has its own 'med office' in Bamako where sick volunteers can stay as long as they need when ill. I have done just that and will be leaving tomorrow to return to my life as usual in Mali.