Since five weeks I'm in Mali. For my medical study, I'm spending some time in different hospitals, like I did in Ukrain last year. On my way to West Africa I got the chance to visit Casablanca. There I met a dutch woman with whom I visited the big mosque, where I, of course, wasn't allowed to enter as the praying started and she was robbed by the women who silently showed her the interior. After this great experience (it's a beautiful place at the border of the ocean after all), I took my second flight to Bamako, where I arrived half past three in the morning.
After a three days introduction, arranged by my two dutch friends who live here, I went to a tiny village 80 kilometers from the capital. Here there is no electricity, nor running water, leave aside internet. It could have been a different planet.
I stayed there for two weeks in which I discovered the african way of finding out what disease one has and prescribing medication. The catholic sister sneered upon the patients, to get to know what problems they had, whereafter she directly proclaimed a diagnose and prescribed without any explanation medication against three or four diseases, often malaria included. Very efficient; no need for electricity, a few batteries excepted.
Except for this catholic sister, who actually has a good heart too, the people in this country are extremely generous. Maybe it's because they have a lack of food now and then. They just keep filling you up with meals, up to five a day. I prepared for hunger in africa; now I'm more aware of obesity...
As a white man you seem to be treated like you're from a higher level. You always get the only/best chair and the first tea, what is very important here. I have hardly seen any beer in this village, but I drunk loads of tea almost solidated with sugar. My neighbour always arranges someone to get drinking water from the pump for us and many things like that. It gets annoying very soon.
A strange experience is that your colleague's own child turns out to be hospitalized because of malnutrition and his second wife has died already, that another colleague's mother, sister and brother need to visit the hospital on one day and he himself got malaria the same evening and to see all those mothers, who are younger than me.
The second day of my stage I jumped at the back of a motorcycle (death cause number one) to help to vaccinate some kids and pregnant girls in an even more remote village as where I lived. One of the mothers asked in bambara if she could be my wife. I would get the child for free... There are many 'fertility accidents' here. Abortion is legal in Holland (I'm not speaking about my point of view on this subject), but it is way more practised in country's like this and under much worse conditions, just because doctors are not allowed to do it. I don't even want to talk about female excision, what is practised at close too hundred percent in this region.
For the rest I just watched how consultations were performed and wrote some administration for them. The most interesting hositalized case was a girl of whom I actually thought she had died. She was lying on here stretched out arms (must be good for your belly muscles) with her legs over the border of her bed. She had been in this position since the day before. We weren't able to reach here, but she turned out to have blood pressure. She stayed like this for four days, until she was referred to the capital, where I went the day after.
Now I live around fifteen kilometers away from the capital. I'm travelling one-and-a-half hours twice a day to get forth and back to my hospital. For four weeks it's no problem, but it shouldn't have last any longer. I'm not used to getting up at quarter past five in the morning. Those african party's in the evenings, always with the same very bad loud music and annoying dj's, are stealing my nights.
Here the stage is even more interesting, thanks to the doctor I'm joining. He, and his four other stagiars are talking a lot of french together and he is doing his best to explain me clearly about the symptoms, diagnosis and underlying processes. The first day going there I was lost and arrived there after four hours of filthy busses and wandering in the sun. After being introduced I couldn't understand many of the explanations, although his french was very clear. At half past eleven, during the visit of the hospitalized, with fourteen white coats in one room, he was telling me that headache, transpiration and vomiting were the cardinal signs of malaria. At that very moment I had an headache, was the transpiration starting to exagerate above normal amounts and couldn't I longer wait to admit to my need to vomit. I ran to the toilet (hole in the ground) and did my thing, after which the doctor frightedly asked whether or not I used anti-malarials. I knew it were just those fried cookies I bought on the street; I already thought they were a little to white to be healthy when I ate them.
Two other days we went to some smaller clinics in the neighbourhood to check if their vaccination refrigerators and administrations were held properly, what gave me the opportunity to see how things work on a lower scale.
Last thursday I had a look at the nursery for women's diseases and pregnancy, which were both bigger than general medicine and children's medicine together. I'll know what specialization I'll practise when I'll work in the tropics.
In general I can assure I'm having a great time and an unreplaceable experience.
Email to friends, June 2008
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