Finishing Strong

There is a friend of mine who always tries to make sure that he ends a project with at least as much enthusiasm as he started it. He likes to say he wants to “finish strong”. A good attitude. I am hoping I can achieve this in my final 24 hours here. Trying to have plans in place for all the patients I am
leaving behind, and thanking everyone here for making me feel at home even though I am a “Short Termer”. Did you know they consider anything under 2 years to be short term? Doesn't sound like it to me. I am also on call today, so we will see how my night goes. There may be some last minute hand over rounds Wednesday morning. I must admit, I will not miss the 0500 call to prayers. I have not needed an alarm clock the whole time I have been here. They are even up before the roosters! I suppose it is like living beside the train tracks, after a while you get used to it.

On rounds today I was able to make some plans for the patients I am leaving behind. Christopher has the list of patients and it should help with the transition. I also spoke to Joe the General Surgeon, and he is happy to look after the complicated surgical cases. We had a bit of a debrief of my time here, and it was good to put it in perspective.

I will leave a few things behind. Some clothing, some personal
OR stuff, and of course a lot of friends. Several times the question has come up as to whether I will return, and I would like to. There are some things that I would need to have better organized at home to be able to do this.

This may well be my last blog, as I have 2 travel days after this, so if it is, I hope you the reader enjoyed it. It is my first time bogging (as I said at the very beginning), and I learned some things about it along the way.

Someone just posted some videos of Galmi Hospital here:

https://vimeo.com/user45679319

2 Timothy 2:15

Do your best to present yourself to God as one approved, a worker who has no need to be ashamed, rightly handling the word of truth.

PS: I am going back - look here: 

So much left to do, so little time

I am in to the final 48 hours of my stay here, and there are some things left unfinished. I only know a few words in Hausa – Gaisuwa (pronounced Sannu) means Greetings – Sai wata rana means good bye – Ciwon means pain - Babu ciwo means there is no pain. Definitely not enough to work without a translator! My french has improved, but there are still words I have forgotten, and words I never new. On the other hand, I did get another hysterectomy done today, and got some more patients seen in the clinic. I was very glad for the surgical equipment that I was given to take along as I was able to use some of it the case today. It made a difficult case a little easier. I almost have the outpatient protocols figured out, and Saadi doesn't have to remind me too often what is routinely ordered for each trimester of pregnancy. I also wrote out a list of all the patients and their diagnoses and treatments so it will be easier to hand over to Christopher on Wednesday.

Part of the Nigeriens (it is with an “e“ not an “a“ in Niger) being able to earn money is some of the women cleaning house and doing laundry. It is sort of expected that you will have someone do this at your place to allow then to earn a wage. The women that comes to my home on Mondays and Thursdays has a small child. Today when she said hello in french, I started to ask her about her daughter and how old she was. Then I realized that she knows as much french as I do Hausa. It was OK, I got to say hello to her daughter. Later when I went to go out and get the laundry of the line, I realized she was using Grasshopers to pin the clothes up. Just joking, she was using clothes pins, the Grasshopper was just along for the ride.  He looked like the type that I saw roasted in the market place!

The Orthopedic Surgeon is also leaving soon, and he was lamenting the fact that there will be cases He cannot get to because of time limitations. The power saw is broken (no not the makita kind) so he is having to do it all by hand, and that has slowed him down a lot. Also there are some cases that will just take too long, and won't fit in to the schedule. He comes back every year to do more.

Speaking of power saws, I walked by the maintenance yard and the shop today. They were working on the hospital trucks, and were building something that looked like shelving in the shop. There really is room for everyone to get involved here.

Ecclesiastes 3:1
For everything there is a season, and a time for every matter under heaven

Hausa Church

I am not on call today, so I can go to Hausa Church in town. It is not far, just across the highway and a few minutes walk west. You go through an entrance way that is fine for me, but if you are over 6 feet tall, you are going to have to duck. The building itself is made of panels of bamboo held together with twine. They have some tree branches that have been used for posts and beams on the inside. It is maybe 20 to 30 feet square. They have 4 or five rows of 6 patio chairs each with an isle down the middle. Church starts at 0900 with welcomes and introductions and some prayer. Then there is corporate prayers with many people praying at the same time (mostly in Hausa). Then there is singing (in french) followed by some more prayer and then the sermon. The preacher today was both tall and broad shouldered. He actually had to move the pulpit because he was hitting his head on the roof. He preached in Hausa, and a second person translated in to French. He was very enthusiastic and full of conviction. The service ended a little after 11 and we walked back to the compound.

Today was a quiet day in the compound, time to catch up on bible reading, and catch up on sleep. At 4 pm I was off to the CC to practice the worship songs for tonight's service. The Orthopedic Surgeon Graham is doing it all tonight, playing piano, giving the sermon, and praying for communion. Sunday is also the day when Mame announces the arrivals and departures for the week, so I will be saying good bye to all my new friends here.

Matthew 18:20

For where two or three are gathered in my name, there am I among them.

Early Thanksgiving

So the fourth Thursday of November is Thanksgiving in the US (no not the day before the Black Friday Sales). We are celebrating a bit early here in Galmi partly because of the guests we have, and partly because it works out well logistically. Dr. Zoolkowski quoted Abraham Lincoln to me about the creation of Thanksgiving as a National Holiday. You can read his full speech here:

http://www.abrahamlincolnonline.org/lincoln/speeches/thanks.htm

The most quoted line (I think) is:
I do therefore invite my fellow citizens in every part of the United States, and also those who are at sea and those who are sojourning in foreign lands, to set apart and observe the last Thursday of November next, as a day of Thanksgiving and Praise to our beneficent Father who dwelleth in the Heavens.

But I also like:

And I recommend to them that while offering up the ascriptions justly due to Him for such singular deliverances and blessings, they do also, with humble penitence for our national perverseness and disobedience, commend to His tender care all those who have become widows, orphans, mourners or sufferers in the lamentable civil strife in which we are unavoidably engaged, and fervently implore the interposition of the Almighty Hand to heal the wounds of the nation and to restore it as soon as may be consistent with the Divine purposes to the full enjoyment of peace, harmony, tranquillity and Union.

For my American friends:

Thanksgiving (French: Action de grâce), or Thanksgiving Day (Jour de l'action de grâce) is an annual Canadian holiday, occurring on the second Monday in October, which celebrates the harvest and other blessings of the past year. Thanksgiving corresponds to the English and continental European harvest festival, with churches decorated with cornucopias, pumpkins, corn, wheat sheaves, and other harvest bounty. English and European harvest hymns are sung on the Sunday of Thanksgiving weekend.

Thankfully for me, rounds went well this morning, and I was able to enjoy breakfast with a full table at the Zoolkowski home. The pancakes were whole wheat with corn meal – if you haven't tried it you should! There were also camel rides today (see I told you), and some people visited the shops in Galmi.

Dinner is at the CC and everyone contributes something to the meal. Remember the bread from the baker? That's my contribution.

1 Thessalonians 5:18

Give thanks in all circumstances; for this is God's will for you in Christ Jesus.

Human Development Index

So apparently (according to google/wikipedia) Niger is only the 4^th poorest country in the world.

However it has the lowest Human Development Index (HDI). The HDI is “a composite statistic of life expectancy, education, and per capita income indicators, which are used to rank countries into four tiers of human development. “ So you could probably say Niger has the lowest standard of living in the world. In case you were wondering, the countries that are poorer than Niger are: (lowest) Malawi, (second lowest)Burundi, and (third lowest)Central African Republic. I will be celebrating American Thanksgiving on Saturday, and there are a lot of things I have to be thankful for.

I am also thankful that today on rounds the baby I delivered the night before with forceps is happily breast feeding with Mom. The lady with the Cesarean from yesterday is healing well, and one of our premature babies had gained enough weight to be discharged and return weekly for follow up visits.

I did see something the other day that raised my eyebrows for a second. I expected insects (lots of them) and I expected that you would have to use something to kill them, I guess I didn't expect that force required to kill them would be quite so extreme. Fortunately they have lots on hand at the Co-op which is open Tuesday and Friday from 1430 – 1530. You can buy lots of stuff there – everything from pringles to peanut butter. They even have ice cream treats!.

Did I mention they have a swimming pool here in Galmi? Quite a luxury given how scarce water is. Well they do. Not Olympic size or anything, but they do give the staff children swimming lessons on Fridays. Water here is often sold in little baggies about the size of a sandwich bag. The nick the corner and suck the water out.

Also on Fridays is movie night. The early feature is an episode of the Andy Griffith show, followed by “A night with the King”.

Psalm 107:1

Give thanks to the Lord for He is good. His love endures forever.

0207

That would be 7 minutes after 2 am, for those that don't use military time. That is when my day started today. Dr. Zoolkowski has kindly lent me a dual sim cel phone while I am here, and that was the time that it went off. The ring tone is seagulls, so I thought I was having a dream about the shoreline. By the time I grabbed for the phone they had already hung up, but the call log said it was maternity so off I went. A lady had been in labour since last night and had not progressed well. When I arrived she was fully dilated but she was having trouble pushing and the head was only about ½ way down. The baby's heart was starting to dip with the contractions, and there were some concerns about early distress. The decision was whether to do a forceps or to go for a cesarean section. At 2 in the morning the resources here are less than what they would be during the day. Everyone has to be woken up and come in, and things do not tend to move quickly. Also it looked like this had been a problem for a while. On top of that a cesarean for a first time mom is a very big deal here. They do not always heal as well, and the uterus can rupture in the next pregnancy. Often women labour for days before coming in to hospital, so avoiding a cesarean can be life saving down the road. With all this in mind we did go ahead with a forceps delivery. It was not an easy one like the previous lady with 10 other children, but she now has a live baby girl, and she is recovering well.

After that, I decided to forgo my run this morning and sleep in a bit. When I arrived to do rounds there was a second lady who was not progressing in labour, only this time she was not as far along, and the cervix was not fully dilated. She had a few other children as well. We decided that she should go to cesarean. Because of how things work here, it was going to be well over an hour before the cesarean, so I went ahead and did rounds. There were no other significant concerns, and at the end of rounds I was able to do the cesarean for a baby boy. Mom and baby are well.

Pharmacy Department

Smells Delicious!

The plane came in today rather than yesterday, and there were several visitors along with some
supplies for the pharmacy. After we dropped off Dr. James Owens at his new residence we headed to the pharmacy to drop off some medications. Then Dr. Zoolkowski and I headed back to his favourite baker to pick up some bread for Thanksgiving dinner (I get to celebrate twice this year). You could smell how fresh the bread was, and we had a lovely aroma in the Land-C
ruiser all the way home.

Best Baker in Town

The MSF transport was by again today – I see where they have a strict “no assault rifle” policy for passengers.

I am starting to plan for my transition away, and am thinking of what I have to do make the handover as smooth as possible. Fortunately the people here have been through this many times, and the midwives are well trained.

Jeremiah 29:11

For I know the plans I have for you, declares the Lord, plans for welfare and not for evil, to give you a future and a hope.

Hump day.

Hump day – the day people go riding the camels. What did you think I meant? Actually I was talking with one of the other doctors about camel rides yesterday. It is apparently the touristy thing to do. My touristy thing to do is take pictures. I'm not saying I don't want to ride a camel, just that it is further down on my bucket list. Wednesdays are however special for several reasons here: 1) they have cinnamon buns at the CC (which I think stands for community centre or centre communitaire). 2) Right after the cinnamon buns, the traveling butcher rolls up on his motorcycle to sell you meat of the back of his bike (literally). Wednesday is also market day in Galmi. All the tents are set up and you can buy any of the local produce, fabrics, and other interesting wares.a It is also often the day the SIM plane arrives with new missionaries and takes others back to Niamey. I will be on that plane next week Lord willing.

We always pray before we start rounds in the morning. A good way to start the day. After the prayer and before we started rounds they asked

me to see a lady that had been stuck at 9 cm for 2 hours (so she was almost fully dilated). She had had 10 other vaginal deliveries and this was her 11^th baby. When I examined her she was fully dilated and ready to push, but for some reason she said she couldn't. I was able to do a forcep delivery that went very smoothly and she delivered a healthy baby boy. We will talk to her about family planning. For the most part, rounds went well. There is one lady who will have to go back to the OR because her sutures came apart, but everyone else seems to be doing well.

Then I went with a couple of the women here to see the market for the first time. They were buying fabric, but we also looked at clothing, food spices, and other interesting items. Like may other places, bartering is the norm here. One of the women spoke fluent hausa so she was able to barter well for the prices. They also bought spices and some lettuce. You can buy all sorts of fruit, and if you are so inclined roasted grasshoppers. I thought the chickens they were carrying around were dead, but then one clucked at me. I don't know how they get away with carrying them by their legs like that.

I saw another chameleon on the path between the hospital and the homes. This one moved a little bit faster, but was still pretty slow. Funny feet, funny eyes. What else can I say.

Ephesians 3:20,21

Now to him who is able to do far more abundantly than all that we ask or think, according to the power at work within us, to him be the glory in the church and in Christ Jesus throughout all generations, forever and ever. Amen.