It is with great pleasure that I post this next post from America! I know I just went on a rant about the Visa process, but it still feels nice to be home.
Although it happened weeks ago, today I’d like to talk about my amazing opportunity to visit Mali. I was invited by one of the most amazing people I have ever met, Dan Kim. He’s an American-trained pediatric general surgeon and after some years of practice the states, he followed his calling to practice in a very rural institution 5 hours away from the capital (4 if you drive as fast as Dan).
Anyways, this unique experience came about by word of mouth. He was in contact with his people at Cincinnati Children’s who called the peds ENT team there to discuss a couple complicated airway cases he had. There were discussions about trying to get the child (children) to the US for treatment but the reality of that is daunting. One of the fellows there (a friend of mine from the interview trail a couple of years ago) remembered I was in Ethiopia and reached out to me. When Dan reached out and asked me to come to Mali to evaluate these patients, I had absolutely zero hesitation. Not only do I love adventure and trying new things, but the idea of flying around Africa to teach the skill I’ve taken my whole life to learn is also blissful to me.
The adventure that actually occurred, I could have never predicted.
Dan was able to give me some detail about the patients ahead of time, so I had a pretty good idea of what we had to do. Thus, I collected some vital airway equipment that we had in Mekelle and headed to Addis to catch the flight to Bamako, Mali. I was doing everything by the book, even taking the time in the airport the morning of the flight to register my airway equipment with customs, so on my return flight, there would be an official stamp allowing this equipment back into the country.
With that accomplished, I proudly walked up to the ticket counter to check my bags. The Ethiopian Airlines lady looked up at me, then thumbed through my passport and then back up at me, then to her computer, then finally to me again with an anxiety-ridden facial expression. “Sir,” she began, “I’m afraid I can’t let you on the flight because you need a travel visa to Mali.” Using my American smug ignorance, I told her that I have a US passport and with that, you just get a Visa on arrival. She showed me her computer screen that stated the opposite.
Seeing that this was Saturday morning, I hesitantly enquired how to obtain the Visa. “Go to the Mali embassy here in Addis with the correct paperwork. But you need an appointment and they aren’t open today. And it costs $130”
The bowel-twisting sense of anxiety began to work its way into my chest. A tight sensation including a mixture of fear, disbelief towards my own ignorance, and anger towards how much money I just wasted.
I hurriedly called Dan, fully understanding it was 5am on a Saturday morning there. He answered clearly from a deep sleep and listened to my slightly judgmental dilemma. He confirmed what the lady at the counter had told me and reiterated that I needed to have obtained this ahead of time. Not helpful Dan!
He made a call and then called me back. He said he could send someone to help me at customs in Mali and perhaps that could get a Visa there. So, I went back to the lady and asked how I could get on this plane. She handed me a sheet of paper which absolved Ethiopia Airlines from the responsibility of me getting detained and deported in Mali’s international airport.
I smiled as I signed the sheet and took a picture as a souvenir. What am I getting myself into now?
The 7-hour flight was uneventful and I focused on creating lectures for Mali and Black Lion hospital when I returned home. It was a good way to keep my mind off the real possibility of me being detained in a Mali airport jail. By the way, this was a Boeing Max 8, the day before one crashed leaving Addis headed to Kenya.
On arrival to Bamako, our huge jet was the only in the entire airport. We walked down the stairs and were forced to wash our hands with some mysterious foul smelling white viscous fluid. While doing so, airport officials in traditional Mali clothing barked orders to us in French. I took 4 years of French in high school and haven’t used it since. This was going to be rough.
In my best broken French I explained that I didn’t have a Visa and that someone was supposed to meet and help me obtain one. The tall, obese Mali guard looked at me with disdain, snatched my passport away and yelled to get the attention of another man. More concerned with the fact that she took my passport, I followed her directions only by following my passport into the hands of another man.
Standing within a group of another 20 people essentially stampeding each other to reach the window to speak with the guard, I stood in the back silently. Trying to analyze what was happening and keeping a mental picture of where my passport was behind the glass barriers. I was anxious, but honestly speaking the peril I find myself with my patients in Mekelle is way more dire than this situation. If they rejected me, I’d sit in jail speaking broken French until the next flight to Addis arrived.
About 10 minutes later, a big intimidating guard slammed my open passport on the window and called my name with a strong French accent. I quickly came to face him through the window and he motioned me to come around back.
He opened a door into a holding cell and invited me in, alone. 30 seconds later he sat down and thumbed through my passport just as the Ethiopian Airlines lady did earlier that day. I had already crafted a series of French sentences to explain my predicament and just as I went to regurgitate them, he looked up at me and in perfect English, said: “so you don’t have a Visa.”
I immediately handed him a letter written in French to explain why I was there, to help out Dan on a medical mission. After quickly reading, he looks up and says, “OK, give me 50 dollars.” Left without any real options, I obliged as he wrote on a receipt paper. He smiled and told me this receipt would get me out of the airport and back in when I was ready to leave.
I hesitated a little, remembering that the real visa costs $130 and I only paid $50. But he looked up again and said “allez.” I slowly walked out, expecting to be detained again. Showed the one guard my receipt and he let me through. I turned to look at my fellow plane members that were still all in line in customs. I collected my bag and walked out. As I walked out, I was greeted by the guy Dan had sent to help me through customs….ha.
I just got through customs faster and way cheaper than if I had done it the legal way….this is why corruption persists, it’s way easier.
I was picked up from the airport by the son of the CEO of the hospital I was about to visit. He took be to a local guest house and left me there. The ride over exposed me to the heart of Mali, Bamako. The paved streets were all dusted red as we passed alley after alley of the poor and struggling. The infrastructure existed, but compared to Ethiopia’s capital Addis, Bamako reminded me more of Mekelle. Just like Mekelle, it was clear whatever money the government had, it wasn’t being used for basic infrastructure.
A couple of hours later, Dan arrived driving a big van chauffeuring a group of doctors from the states that had just completed a mission. We all went out to dinner at a local hotel before they boarded a flight back home to the states. At the entrance to the hotel, we passed through one gate as it locked behind us. In front, was another locked gate. The guard stuck with us in the center confirmed we weren’t carrying anything large enough to threaten a group of people and opened the 2nd gate to let us pass.
Dan explained that recent terror attacks on westernized hotels in Bamako have left behind an intense level of security. Sitting on the lake, the haze of dust obscured the view of the other side as mosquitos swarmed, deciding which of us was most tasty.
The dinner was honestly delicious (I guess I remnant of French cuisine) and we departed to drive the group through the traffic-laden streets towards the airport. Afterward, Dan and I returned to the guest house for much-needed rest.
The next morning we started our trek towards Koutiala. As well as in Ethiopia, I love driving through the country side. It’s informative and fun to watch the evolution of society as we get father and father from the capital. Westernized clothing and business are replaced with tradition and markets. We headed north only to divert east when nearing extremist-controlled northern Mali. This is actually a really dangerous place to live or visit. Kidnappings for ransom are common the terror attacks in the recent past were very deadly.
4-5 hours of checkpoint and tolls later, I had extracted Dan’s recent history to better understand the path the lead him to this small village in Mali. A story best left for him to tell. When we reached our destination, we drove off the singular main road, weaving through haphazardly placed houses to arrive at Dan’s house.
This place was stunning and completely designed by him and his family. He led me first into a massive guest house, easily large enough to house a dozen people. After dropping my stuff off, we hopped in his other car and headed the 2-minute drive to the hospital.
This was a very small hospital compared to Ayder in Mekelle. Composed of a half dozen small, open-air buildings, it was clearly a community hospital. He ushered me into the peds building. We rounded on the various sick children in rooms with 3-6 beds. Each equipped with a mosquito net (malaria was indeed endemic here).
This is were my admiration for Dan really began to build. As I heard the stories of each sick child and watched him interact in both French and the local language, I began to realize that he is what doctors should be.
One of the general surgeons in my residency used to tell us “Surgeons are doctors who finish their training.” I always used to think that was a bit pompous, but I never actually thought that was true. But here, in the middle of nowhere in Mali, Dan embodied that concept.
From congenital respiratory disease to burns, to trauma, to osteo, to malaria, to unknown wasting syndromes, to appendicitis, he was in charge of the medical care of every child. Flanked only by the ambitious and eager nurses, he managed the care of at least 30 children over the next hour.
Following this, he invited me over to his beautiful house, connected to the guest house. Here, I met his 3 extremely intelligent and well-behaved children and his wife. They treated me to a wonderful meal and although his house was designed as a traditional Mali house, I feel like I was transported back to the states. I felt at home and never wanted to leave! Not to mention it was the best food I’d had since coming over to Africa. Seems like a grandiose statement to make, but I make it with confidence. Korean lettuce wraps with marinated beef…holy crap.
Anyways the remainder of the week was a lot of the same spectacular hospitality and medicine. We performed cleft palate surgeries, removed congenital head and neck lesions and performed some complicated pediatric airway surgery.
The best of which was a young man who suffered a strangulation injury of some sort which evidently injured his larynx resulting in complete stenosis of the glottis and subglottis. He was given a tracheostomy as a life-saving measure.
We don’t often (or ever) see this type of stenosis in the states since when the injury occurs, we intervene and manage the airway before it stenoses. This often requires a prolonged period of intubation and critical care which is impossible in most places in Africa. Thus, most of these children and adults are given tracheostomies and sent out into the world, fingers crossed that they survive the Russian Roulette that is having a tracheostomy in the bush.
So, the idea of attempting to re-cannulate this scarred airway is a difficult task that would likely involve major reconstructive surgery. Even if we were able to somehow create a new hole for the airway, how would it stay open. The scar would just re-form and collapse the airway. But, if we were to get lucky, it’s the best shot this kid has at a semi-normal and safe life. So we did just that. Forcefully created a new airway through the scar and stented it above the tracheostomy. Only time will tell if we get lucky.
After 3 wonderful days of surgery and hospitality, it was time for me to return to Ethiopia. Thinking I’d have trouble once again with my visa, I showed customs my receipt and they just kindly ushered me in. The flight home was uneventful.
On returning to Addis, I spent an extra day with the Black Lion residents to lecture about airway management and to perform surgery on a massive lymphatic malformation in an infant. This would be the first of a monthly arrangement I have with the capital’s training center to expand the education of otolaryngology – head and neck surgery in Ethiopia. I love my life.
Global Head and Neck Surgery 
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