Student Encounters of the International Kind: Life in Mali, Africa
Sunday, 26 November 2006
By Chris Alappat, MScPT
Student Representative 2004-2006
Student Corner This section is a feature in Dispatches where students can share their experiences of international travel, physiotherapy placements or volunteer work. Please contact Danielle Levac ( ) and Sabrina Morelli () if you wish to make a submission.
As emerging health professionals, we are faced with numerous challenges and opportunities. Above all else there is a call to make a difference: to use the knowledge and tools we have acquired during our years of study to help those in need. It is imperative not to limit our scope of practice to local communities and hospitals, but instead to broaden our reach to the global community. Canadian physiotherapy students are taking steps to achieve these goals by engaging in international placements, volunteering abroad, forming organizations in order to enact change, and traveling to expand their horizons and document how health care is implemented in developing countries. In August of 2005, Lisa Chau, a recent graduate from the University of Toronto, embarked on a journey to Bamako, Mali, to visit her sister. As a new physiotherapist, her trip was not only a vacation, but a chance to observe how the local population went about their daily lives. The following is a synopsis of her experiences and observations.
Mali is a developing country in Western Africa with a stable and democratic government. The official language is French, and the capital is Bamako. The population of Mali is roughly 10.5 million, with an annual growth rate of 2.2. The infant mortality rate is 121/1000 and the life expectancy is 47. The majority of Malians (70%) are involved in agriculture with the remaining 30% evenly split between the service and industry sectors. Although Mali is one of the 5 poorest countries in the world, Malian’s enjoy a life of relative tranquility in the midst of countries engaged in constant civil strife and revolutions. Unlike the tribal attitude of some African nations, “solidarity” is a key concept to Malians. They tend to utilize group consensus to work out their differences, rather than conflict. Mali's population consists of diverse Sub-Saharan ethnic groups who share similar historic, cultural, and religious traditions. Exceptions are the Tuaregs and Maurs: desert nomads, they are related to the North African Berbers. The Muslim majority, Christians, and those with traditional tribal beliefs live peacefully side by side. People have been quoted as saying, “We are Malians first and all other things second.”
The first thing Lisa noticed upon arriving in Bamako was the hustle and bustle of the place. Cars, mopeds, buses, donkey carts, pedestrians, bicycles, goats and sheep all vie for their piece of the road. The rules of the road appear to be discarded, and near disasters are avoided in the nick of time, while another disaster looms on the horizon. The marketplaces are alive with sounds, smells and colours. However, the cuisine itself is relatively plain, with the staple foods being millet, rice, sweet potatoes, plantains, beans and manioc. Vendors in colourful wraps and distinct headdresses clamour for space to sell their wares. Bargaining is the expected norm, and is encouraged as it builds rapport and both parties usually leave satisfied. Mosques dot the city landscape, regularly calling the faithful to prayers. Living accommodation in Mali ranges from modern buildings to mud huts and nomadic tents. Mud brick is the traditional building material in this part of the world. In nearby Djenne, on the old trans-Saharan route, there are mud-brick buildings and an ancient mud-brick mosque.
Medical facilities in Mali are limited, especially outside the capital, Bamako. Utilizing a stratified system, expensive private hospitals staffed with expatriate physicians cater to the foreigners and local elite, while public hospitals serve the masses. Payment is compulsory for all visits, and if not provided for, services are sometimes withheld. Many US medicines are unavailable, though their French counterparts are often on hand. Rehabilitation services are difficult to find, as all available funding goes to support acute care and management. Poor infrastructure, roads, and inaccessible buildings restrict the day to day functioning of persons with disabilities (PWDs). However, there are efforts in place to decentralize medical services and bring them under the direct management of local communities, groups and regions.
During her stay, Lisa had the opportunity to witness the health care system firsthand. When her sister took ill, she was seen by a private facility. Despite the higher quality of care, errors were made during her assessment, which resulted in her treatment being delayed longer than necessary.
Though Malians enjoy a higher quality of life than their war-torn neighbours, there are certainly opportunities for advancement, especially in the area of rehabilitation. Canadian PTs and students are well-positioned to act as educators, provide physiotherapy services, and work with leaders at the community and governmental level. Student and newly graduated PTs can act as advocates for PWDs and for the PT profession. They can also work in Community Based Rehabilitation programs, which have been shown to be effective in areas lacking in resources, and would be ideally suited to the predominantly rural communities of Mali. Physiotherapists could help to spearhead such projects in alliance with local healthcare professionals. As global awareness increases on the plight of PWDs in the developing world (go to www.400millionr.com for more information), concerted efforts are being implemented to rectify the discrepancies in access to public health and rehabilitation faced by these individuals. Physiotherapy students are encouraged to travel with an open mind and an observant eye, taking note of the availability of and the access to health care systems for people with disabilities in the countries they are visiting. They can also use their newfound skills to take part in rehabilitation initiatives through placements or volunteer work. Through all of these experiences, physiotherapy students are pushing the ever-expanding horizons of international rehabilitation.
