DAKAR, February 07, 2017 – Northern Mali has been plagued by armed conflict between various political and religious insurgent groups since January 2012, as a result of a movement to gain independence from the Malian government. The region has long suffered from extreme poverty, poor sanitation, lack of access to quality health care and education, and bad infrastructure. Despite the signing of a ceasefire in October 2015, attacks continue throughout the north. Tens of thousands of people have been displaced, and many medical facilities have been destroyed or shut down due to a lack of health staff and supplies. Timbuktu has the highest recorded prevalence of severe acute malnutrition in the country, as well as the highest under-five mortality rate.
Doctor Michel Mwepu Ilunga is a surgeon who has been working with ALIMA in northern Mali since December 6, 2016. He spoke to us about his first few weeks in the field and the challenges that medical teams face in a region where the needs are huge and ongoing conflict continues to disrupt everyday life.
Tell us a little bit about the current situation in northern Mali.
The security situation in northern Mali, depends on the district, but in general, in the areas where we intervene, it remains very fragile, volatile. In Diré, where ALIMA has its largest base, things are relatively calm, but sometimes marked by fighting or attacks. For example, there was recently confrontation between militiamen in Dire and an armed attack in Bouren Sidi Amar. There are sometimes incidents between rival groups of families.
In Goundam, the insecurity is more frequent in terms of incidents and the problems are more of criminal types, such as robberies, hijacking vehicles, looting shops, stealing cattle and invading villages to steal. These types of incidents really impact our activities because they reduce the movements of our teams who must go each day to the health centers to provide support, in terms of caring for patients, referring patients, supervising staff or going to supply centers. We also see clashes between armed groups, whose identity it is difficult to know. But the biggest challenge is the presence of radical groups in the area, which often ambush national and international security forces, especially on the road between Goundam and Timbuktu.
In general, these incidents don’t target ALIMA or its Malian partner AMCP. Our organizations are well-known in the area and accepted by the population. However, these types of incidents have resulted in the influx of wounded people in the health facilities that are supported by ALIMA/AMCP, in particular in the operating room and surgical department in Goundam. We are faced with a fragile population, deprived, vulnerable to all types of sicknesses.
Can you describe a typical day at work?
As a surgeon, I am like a firefighter ready to act in the face of any emergency. We often encounter patients facing severe, life-threatening injuries, who we must make every effort to provide quality care to, despite our limited resources and challenging working conditions.
The health needs among the population are of several types, including preventive care, such as educating the community about health issues, and curative care, such as surgery. The traumatic emergency cases we see are often conflict-related wounds, usually from a gun or a knife. There are also a significant number of patients who have been injured in car accidents. We also see many pregnant women who have complications during child birth and require obstetric surgery.
For me, the day always starts by checking in on the surgical patients, as well as other patients that have been hospitalized. Surgical consultations happen practically every day and have no specific hours. I’m often asked by various departments for advice, which can lead to surgery. I’m in the operating room almost every day, overseeing various emergencies that might require surgery at any time of day or night.
What do you love most about your work?
Being able to cure patients who otherwise would face a certain death without treatment, helping them return into society, preventing complications that can be severely disabling and early diagnosis, even with limited recourses, are of great pride to me.
Many patients’ stories stay with me. For example, there was a case of a 10-year-old boy with typhoid fever who was admitted with acute peritonitis, a life threatening emergency, due to infection, which affects the abdomen. He was very undernourished and in severe sepsis. It took three surgical procedures and a month in the hospital to recover completely. He recovered not only physically, but also his smile and his “joie de vivre” [love of life] that he had completely lost.
Since 2011, ALIMA has been working with the Alliance Médicale Contre le Paludisme (Medical Alliance Against Malaria, or AMPC), a Malian NGO dedicated to making healthcare more accessible and reducing malaria-related mortality.
In northern Mali, ALIMA and AMCP support 35 community health centers and two district hospitals – including an operating room – in the Diré and Goudam districts in the Timbuktu region, providing free access to health care. In Goudam district, ALIMA/AMCP has improved access to water and sanitation at two sites for internally displaced people.
In 2016, more than 165,000 consultations, 5,500 hospitalizations, 3,600 births, and 433 surgical procedures were recorded by ALIMA in the Dire and Goundam district hospitals.
Photo: Surgery in Boda, CAR. © Sam Phelps / ALIMA