Heatlh Care in Mali
These results were then communicated by the Peace Corps Medical Officer in Mali, to the Peace Corps Medical Director for West Africa in Senegal, who then requested authorization from the Peace Corps office in Washington DC to proceed with the needed operation. A week later, 2 weeks after I arrived in Bamako, we received authorization for the operation. It was scheduled the next day with the surgeon.
The operation took place in a clinic, not a hospital. What is the difference? A hospital is a government funded medical facility. It is open to everyone at a relatively cheap rate. Each room holds 5-10 people. They each are seen by a physician for a short time. Required medications may or may not be available. Family members need to bring in meals because no meals are served. There may not be toilets, only holes in the ground shared with dozens of other people. Salidagas would be there, but you can use toilet paper if you bring it. Similarly with soap, you can use it if you bring it. The hospital in Markala had rooms that were dark because the light bulb burned out and was not replaced, and where the windows & screens were broken so mosquitoes were free to come and go.
Clinics, on the other hand, are private medical facilities, with one patient per room, daily doctor visits for the required length of time, and meals served on trays, air conditioning, and cable television (5 stations in French). This particular clinic, Clinique Pasteur, is the elite of the clinics in the capital city of Bamako. Only expats, the wealthy, and Peace Corps volunteers go there. When I expressed concern about the risks of having the operation done in Country, the PC doctor said :”You are not just anybody. All precautions will be taken.” Two of my other volunteer comrades said that they would not allow themselves to be operated on in Mali.
So the day of the operation came. I walked over to the clinic. I like walking, as well as riding my bike. My friend Tim accompanied me, yes, one of those who said that he would never allow himself to be opened in Mali. I was shown to a private room. The PC doctor arrived with a gown, soap, and toilet paper because there were none of these in the room. I changed and then a very gentle and considerate orderly came in a wheel chair to get me. I was wheeled outside. The clinic buildings are connected by external walkways. The operating room was reassuring, similar to operating rooms in the USA.....with a big light on the ceiling, several pieces of equipment unknown to me, and CLEAN.
The surgeon was assisted by a second doctor. An anesthesiologist stood by, just in case. This operation was under local anesthesia only. There was also a nurse, an orderly, and the PC doctor. I felt the several needle pricks for the local, then the warmth of my blood covering my belly as they made the incision. They descended down 3 layers, skin, muscle, and fascia, I felt movement, pushing, pressure, tugging, and something like ligaments or connectors moving. I was scared. The PC doctor held my hand. That helped a lot! Then I heard more chatter and laughing between the doctors. Success! Now they just stitched my up, on layer at a time for a total of 3 layers of stitching. An hour after we started, I was back in my room.
The surgeon came to see me about an hour later, said that everything went well, and that I could move and walk to my level of comfort as soon as I wanted. The next day, I was moved to the PC medical bureau for recuperation, which was estimated at 2 days. After about a day, I began to walk outside. That was a mistake. Several days later, my energy kept diminishing. The surgeon found an infection. So much pus came out that the PC nurse almost fainted. I was put on antibiotics, and the wound was dressed everyday back at the clinic. I started to feel better almost immediately.
The infection cleared up in a few days, and my recuperation proceeded. I am walking short distances now. After about 6 weeks, I can begin to walk longer, ride my bicycle again, and exercise.
So how would this case have been different for a less fortunate Malian? Perhaps they would have ignored the lump. If the pain had gotten worse, perhaps they would have gone to a hospital to have it checked-out, if they could afford it. In Malian hospitals, you need to pay to see the doctors as soon as you walk in the door. No money, no doctor. It is not very expensive by my standards, perhaps $1. But if your entire family of 12 people is living on $2/day, you may not be able to afford it, particularly if a drought denied your harvest this season, and you have not been able to work because of the discomfort in your belly. Perhaps they would have proceeded with an operation. Hopefully everything would go well. If there were complications and they needed medication, they would buy the meds IF they could afford them. Hospitals and clinics do not carry many medications. One needs to go to pharmacies. No money, no medications. These can be expensive. Infection with no medications? We can speculate what the results might be. Developing countries have the highest mortality rates in the world.
Please note my other article on my neighbors death. He stubbed his toe and is dead. I received an operation, then got infected, and I am writing this article to you.
I consider myself to be blessed and very fortunate to receive the care that I did.