Dr. Tane Luna is an obstetrician-gynaecologist. Born and trained in Malaga, Spain, she now works for Médecins Sans Frontières Australia in the Sydney Medical Unit for Women and Child Health. She conducted an assessment mission for Médecins Sans Frontières in the general hospital in Timbuktu, in the heart of a very remote area, marked by insecurity and where access to care is a challenge for the population.
How was your mission?
It went very well! 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 healthcare 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 1000 km far from Timbuktu. Upon arrival, when you leave the plane, it is 50 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, 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.
What did your field visit consist of?
For all its medium and long term medical programs, Médecins Sans Frontières 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, Skype... As part of the Timbuktu hospital, I specifically worked in gynaecology 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.
What are the main health and access to health care concerns for the population?
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 and 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 counselling to community health centres. During my visit, I met two midwives coming from two different health centres, but it was exceptional that they could come to the hospital.
Can you introduce us to this hospital and Médecins Sans Frontières' action?
This is the referral structure for a population of about 900,000 people, although the size 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 km away.
For four years, Médecins Sans Frontières 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, paediatrics 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, malnutrition but also other pathologies in general surgery, complicated deliveries...
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 centres in Tin-Telout, Agouni and Nibkit.
What surprised or impressed you most during this mission?
The country, the people... the size and potential of this hospital and the quality of care that is given. The meetings also with our obstetrician-gynaecologist, Dr. Bah. He was trained in Cuba and we spent a lot of time talking in Spanish, with his Cuban accent, gently singing tunes of salsa!
Midwives are very dedicated, the emergency department staff is very well organised and very reliable in each intervention. I really hope that the situation stabilises, because despite all their dedication and even with our support, if insecurity persists, patients will still have many difficulties accessing care.