Dr. Tane Luna recently conducted an assessment mission for Doctors Without Borders/Médecins Sans Frontières (MSF) in the general hospital in Timbuktu, Mali, in the heart of a very remote area marked by insecurity, where access to care is a challenge for the population. Here, she describes her experience.
It was exciting to discover this program, this hospital, and this team. Exciting and exhausting at the same time. Northern Mali is an area in conflict where access to health care is difficult. It took me almost a day, with a plane that had many stops, to go to Bamako, the capital of Mali, more than 1,000 kilometers [over 600 miles] from Timbuktu. Upon arrival, when you leave the plane, it is 122 degrees on the landing runway and the light is blinding. Here everything is very dry and it's so hot. And all day long we were looking for shade, [or] air conditioning in the surgical ward or in some offices . . .
On the ground, we have a very professional and highly motivated team of international and Malian personnel and the collaboration with the Ministry of Health team is going very well. And they are so isolated that communication is very appreciative; very rich.
A Young and Motivating Program
For all its medium- and long-term medical programs MSF carries out missions, regular support or assessment. The purpose is twofold: ensuring the quality of care provided to our patients and to provide direct support to the medical teams, in addition to the regular communication through emails [or] Skype . . . As part of the Timbuktu hospital, I specifically worked in gynecology, managing the care of victims of sexual violence and the maternal and child health program. It is a relatively young and very motivating program. The only frustrating thing with these missions is that we hardly have time to practice medicine, to spend time with patients.
Years of Conflict
Northern Mali has been in conflict for many years. Everyone is scared to move. This is a very remote area in a very precarious and very isolated situation. The population is scattered over a wide area and is often nomadic. No one travels at night, they avoid long distances, and people do not always have the means to come to receive care from distances of several hours through the desert.
It is also difficult to recruit health professionals to work there. In Timbuktu, our medical colleagues are also isolated and can hardly travel to provide care or counseling to community health centers. During my visit, I met two midwives coming from two different health centers, but it was exceptional that they could come to the hospital.
Serving the Needs of the Population
This is the referral structure for a population of about 900,000 people, although it is a medium-sized hospital. In fact, the “direct” population of the health area is close to 60,000. It is the largest region of Mali, in the heart of the Sahara, with an area equal to that of Spain! The closest reference hospital from Timbuktu is located 400 kilometers [about 250] away.
For four years, MSF has been in charge of five inpatient services with a total of 87 beds in the Timbuktu reference structure. We work in surgery, maternity, internal medicine, pediatrics, and emergencies. The maternity department supports about one hundred deliveries each month, including 15–20 by Caesarean section and about ten consultations per day. The main health problems are quite “classic” for a region with many children. There are numerous cases of malaria and malnutrition, but also other pathologies in general surgery, complicated deliveries, et cetera.
We also provide medical instruments and medicines. As there is no public transport and ambulances cannot move, the volume of activity remains reasonable. To try to overcome these traffic problems, we also support three community health centers in Tin-Telout, Agouni, and Nibkit.
I was impressed by the country, the people . . . the size and potential of this hospital and the quality of care that is given. Midwives are very dedicated, and the emergency department staff is very well organized and very reliable in each intervention. I really hope that the situation stabilizes, because despite all their dedication and even with our support, if insecurity persists, patients will still have many difficulties accessing care.