Paediatrics Advisor Dr David Green has recently arrived in Koutiala, southern Mali, on an extended visit to one of the largest paediatric programs run by Médecins Sans Frontières. He describes a recent Monday working with the national staff doctors, who share their wealth of experience in the six-year-old project.
“I am working in the paediatric department of Koutiala reference hospital, which is one of Médecins Sans Frontières' biggest paediatrics projects, caring for babies and children under five years old. There are 200 beds – but this number can jump by another 100 or so in the malarial season! I’m a senior paediatrician. I am 54. Back home that’s still young. In Mali it’s the average life expectancy. I’ll stick with the word ‘senior’. The day starts at 7.30 am with a handover in the doctors’ office between day and night teams. We discuss the sickest children, and the deaths. There were two deaths overnight. Children often come to us very late in their illness, usually after having sought help from traditional healers first. After the handover, there’s a quick round of the sickest children.
"Children often come to us very late in their illness, usually after having sought help from traditional healers first"
At 8.30 am (three times a week) I go to the labour ward with Dr Yare, where we’re going over newborn resuscitation with the midwives. We’re building on a neonatal resuscitation training program (Helping Babies Breathe®) that he began with previous Médecins Sans Frontières paediatricians. Maternity care, however, is not part of our mandate in Koutiala; Médecins Sans Frontières is running paediatric and neonatal activities in collaboration with the Ministry of Health inside the Koutiala reference hospital, while maternity and the midwives are managed by the Ministry. Ideally, the labour ward and all newborn care should be seamlessly integrated but, as in a few of our projects, we must work in two different systems and physical spaces. In Koutiala we’re building bridges metaphorically - though there will be some physical building starting soon with Médecins Sans Frontières' most recent construction project, which will hopefully bring the labour ward and neonatal unit closer together.
The rest of the morning is spent visiting the various units in the Médecins Sans Frontières-run service: Triage, Admissions, Resuscitation room, intensive care, paediatric ward, malnutrition wards, Neonatal Unit, Infants ward, Burns unit, Diarrhoea ward and Isolation rooms. My job is to give advice. This is a mature project, running since 2009. The young doctors know their stuff. The exchange of ideas is in both directions! I’m impressed with the team here. Today, a Monday, is the weekly afternoon academic meeting where we will discuss our clinical laboratory. We’re lucky – we benefit from the on-site Médecins Sans Frontières laboratory (blood bank, haematology, bacteriology, biochemistry). Among other things, they do blood cultures (looking for infection in the blood). There’s so much infection that the system is saturated. In the malarial season they will surely be swamped. In the meeting we discuss ways to prioritise who should get a blood culture.
After the meeting I do another tour, and follow up on individual patients I saw in the morning. Throughout the evening and night, doctors on shift at the hospital will call me with any questions they have; barring any emergencies that will require a nocturnal trip to the hospital, I’ll have a good night’s sleep before starting the process all over again tomorrow.”
In Koutiala, in southern Mali, severe acute malnutrition, malaria, diarrhoea, respiratory tract diseases and other so-called opportunistic infections pose severe threats to the survival of children under five years. To reduce morbidity and mortality in a region that has very few health professionals, Médecins Sans Frontières has been providing preventive and curative care in partnership with the Ministry of Health and Public Hygiene of Mali since 2009. In 2015, more than 11,000 children were hospitalised of whom 70% were admitted with malaria.