A Foodie's guide to Galmi

I was asked about what there is to eat here, and there is a lot! In the booklet in each home there is a “Foodie's guide to Galmi”. There are lots of vendors that come on the compound and sell everything from Papayas (they are bigger than a football (either kind)) tomatoes, pineapple, bananas and plantains, eggs, guavas – they are really good!, etc etc.

There is also someone who comes by once a week with spicy roast chicken and samosas. There is the co-op where they sell delicacies like ice cream and cookies, and that's were I got the rice as well. I do not think there is going to be a problem.

Someone else asked how hot it is, so I took this picture of the thermometer at 10 am.

It is a bit cooler in the evening, and it gets really hot around 2 or 3 pm. There are lots of fans however, and there is even an air conditioner in the bed room.

They actually have a couple of portable ultrasounds, so I have been doing them every day. It comes in pretty useful when it is hard to get a complete history. We can get X-rays, but there is no ultrasound department, so if you want one, you do it yourself. Today we diagnosed twins at 19 weeks. They both seem to be doing well and are about the same size. We also did a dating pregnancy at 9.5 weeks.

There were also some hard things that happened today. We had a lady come in last night who had been in labour at home. The baby had died before she arrived, and she died after childbirth. She was so anemic she couldn't handle the stress of a delivery, probably because of severe malaria. There is also a premature infant in the nursery right now that we are not sure will live out the day. The baby delivered at home, and could possibly have meningitis or tetanus. It also has severe Jaundice and is dehydrated. We are doing all we can and we are praying for this little one. On the happier side (sort of) there is a little baby who's mother died that is very small, and another lady (who may or may not be related) has decided to breast feed this little one. She had not breast fed for 8 years, but the milk came in quite quickly, and the baby is gaining weight nicely.

I am learning a lot more about treating Malaria, or I should say I am learning the Hospital Protocols for treating Malaria. Apparently it was much worse a few months ago in the rainy season, but there are still people walking around with blood levels that would probably kill the average North American.

Here is a goal for today (and the future):

Philippians 4:11-13
I am not saying this because I am in need, for I have learned to be content whatever the circumstances. I know what it is to be in need, and I know what it is to have plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want. I can do all this through him who gives me strength.

The last time I did pediatrics was ...

Did I mention they don't have a Pediatrician or Neonatologist here? Well, that's not completely true, there is someone who does outpatient pediatrics, but apparently unlike back home, the Obstetrician is responsible for all the Neonatology as well. Today on rounds we have 3 babies in the one isolette keeping warm, with a net to keep the mosquitoes out, and being fed with a cup or a nasogastric tube.

There is also one baby with a high bilirubin being treated with phototherapy.

I know very little about this, and as well, we have minimal other methods of treating neonates. We do have some antibiotics, and the Sage Femme are good at starting IVs. I am learning on the job, and coping with the limited resources here.

There are also some diagnostic dilemmas as we call them. I was asked to see a lady today who was passing blood in her urine. A common cause unfortunately is a fistula (a hole) between the bladder and the vagina. It happens if the woman has been in labour for days without delivering. The pressure of the baby's head cuts off the blood supply to the tissues and the walls between the bladder and the vagina die leaving a hole. I was able to do an examination and prove that there was no such hole, and it did not look like it was related to her reproductive organs. I did an ultrasound, and it looked like a mass in her bladder. Fortunately there is a urologist here who was able to look in her bladder and determine that it was just a big clot. We still don't know where the clot came from, and that is part of the problem – not having an answer at the end.

This evening was a church service in the community centre. I packed along my flute so I got to play in the worship music at the beginning. The church service was more of a bible study using Dietrich Bonhoeffer 's book “life together” Today we were looking at Roman's 12:1-8. It is a good reminder of what living in community is all about.

Romans 12:2

Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect.

10 K run on the air strip

So I decided to get up early today and go for a run. The air strip is a few steps away from my cabin, and it is fenced off on all 4 sides, so it is a good place for a run. It gets light around 6:15 and it cools slightly overnight (probably down to the low 20's) so it's a good time to go running. The fenced in area is 900m so it takes a few laps to get 10k in.

Later I went and did rounds. Today I was faced with another sad reality of this type of medicine. The lady that I did the cesarean on yesterday – her baby died last night. I didn't find out until I did rounds the next morning (today). No one seems to know why exactly. The little girl came out screaming, and the apgars were 8 & 10. I was surprised and saddened. The mother is doing well however.

They also don't have a pediatrician here, and they definitely don't have a neonatologist, so when a lady came in with her 10 day old baby that only weighed 3 pounds, they called me for advice. This is definitely out of my comfort zone, but we are doing the best we can.

Today is Saturday so there is no outpatient clinic. I may be able to go around and get a few more pictures.

Really Fresh Mangoes

I can also catch up on reading all their protocols. Internet speed here is about the same as what dial up would have been back at home. They do have a satellite link, but it is spread throughout the whole hospital and all the homes, so the bandwidth is very limited. No streaming of any kind :). That just means it takes a long time to upload any pictures for the blog.

So the community at Galmi has gone over and above hosting me for the last few days, but today it was finally time for me to start cooking for myself. I had rice and eggs and lots of vegetables, so I was not starving by any means. The pots are an assortment with lids that almost fit. It is also a gas range, so getting the temperature just right was a bit tricky. None the less it all worked out.

Philippians 4:13

I can do all things through him who strengthens me.

Getting Settled

So I thought you might like a few pictures of what it looks like around here.  Let's start with my home away from home - number 13 (good thing I am not superstitious)

It's the one on the right.  The path in front of my home looks like this:

and some of the flowers I look at as I walk to work look like this:

The ladies I work with let me take a  picture of them:

They are amazing ladies.  Thanks to Ron Kilius and Superior Medical for the provision of the Dopplers for maternity as well as all the surgical instruments.  These midwives also know their way around an ultrasound machine, and helped me with the processes in the out patient clinic.  I have started to find my way around, and I don't take too many wrong turns.  The size of the hospital is impressive for where we are.  It is sort of a tertiary referral centre for Niger and the surrounding countries. However, it still looks different than the average North American Hospital:

In case you weren't sure you were somewhere warm, there are coconut trees and geckos to clear that up for you.

Anyways, I have to get some real work done, so that is enough for now.  This evening's Movies at the Zoolkoski house are the Andy Griffith Show, followed by the 100 foot journey - looking forward to it!

Matthew 25:40 - And the King will answer them, 'Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me.'

New experiences

I did rounds today on maternity, and it was an eye opener. It seems like every second patient has gestational hypertension (pre-eclampsia) and every fourth patient has had seizures (eclampsia). Saw a 26 week baby in her mother's arms being fed by an NG tube. Lots of them have malaria, almost all of them are anemic. There were 3 sets of twins. One set delivered vaginally at 34 weeks, a second they had to deliver the the second baby by cesarean, and the third set is in labour right now. Also There are 2 patients with cancer of the placenta on the ward right now. It is a truly amazing amount of pathology! The Sage Femmes (Midwives) are very helpful, and the rust is starting to come off my french.

The first surgery quickly turned in to a cancer case, and I was fortunate to have a general surgeon scrubbed with me. With a significant amount of effort we were able to do a good job of dealing with her cancer, but she will need close watching post operatively and then chemotherapy. They have a residency training program here, and the resident that trained with us is originally from Burundi. Apart from his native tongue, he also speaks Hausa (the language here in Niger), French, English, and Swahili. And I think he is in his 20's.

I am being treated really well here, all the staff and patients are very friendly. I have been hosted a few times to lunch and dinner, but I think I will have to start cooking for myself soon. Yes, I know how to cook, just not blue ribbon meals. I am on call to night, so I will not be blogging to long. Perhaps some more tomorrow.

Oh, did I mention the geckos? They are everywhere, and some of them are tiny, but some of them are probably more than a foot long! They all run away when you get close, but I will try to get a picture in the next few days.

Arrival in Galmi

I did not realize how early the “call to prayers” from the mosques is. Must have been around 4 am! Anyways, I fell back asleep and was awoken by my alarm at 6. Trying to adjust to the new time zone. Galmi is 8 hours ahead of Chilliwack – ie it is currently 22:46 in BC and it is 0646 in Niger. The Serving in Missions (SIM) pilot is coming to pick me up at 0730. Then we fly out to Galmi. Read through all the documents last night. Apparently in Niger you have to sign a will if you are serving at the hospital. Nothing that supersedes the one back home, just where you want to buried when you die – you know, routine stuff like that. Anyways – I went to bed early, so I thought I would get a bit of journaling in before the flight. The rest of this will hopefully be this evening before bed.

So Ian (Rideout) who is a pilot for the missionary group picked me up at 0720, and drove me to the airport where his brother Kevin flew me to Galmi in a ****Cessna 182Q models with an SMS deisel engine conversion**** 4 seat prop plane.

It took about an hour to get there, and it was an uneventful trip.

There were a few small villages along the way and some very muddy rivers and creeks.

When I arrived they were just making cinnamon buns, and I got to meet everyone in the main gathering area. No I can't remember all their names, but there were people from the US, New Zealand, Australia, and even another Canadian! I have lunch with one of the doctors today and dinner with another one. Apparently they are glad to have me, as they have a lot of sick pregnant ladies right now.

Apparently the job of the Canadians right now is to cheer up the Americans, as they are feeling down about their country at the moment (can't think of why). That aside, there seems to be a lot of work here, and I suspect I may not be blogging so much. I toured all the areas of the hospital, and this place is packed! Lots of things I would not ever see in Canada. Malaria is very common, HIV is fairly common. Delayed treatment is also a big issue.

Had lunch with 2 other physicians, and we talked about much of what is going on in the medical world, including the erosion of protection for conscientious objection, and the changed in approach to things like physician assisted suicide. I also found out that one of the doctors here has relatives in Abbotsford, and he showed me pictures of hiking Elk Mountain – small world.

The hospital is at least better than the one we were at in Nepal all those years ago, but it still is clearly a third world hospital. Also speaking French is not enough around here, most of the patients speak a local language and so I will be using translators a lot. I will definitely be out of my comfort zone, and seeing lots of things that I have never seen before. Fortunately they have some protocols to help me through some of it. I will need lots of support in prayer to do this well.

As I was feeling a bit overwhelmed, these verses came to me:

Trust in the Lord with all your heart, and do not lean on your own understanding.  In all your ways acknowledge him, and he will make straight your paths.  Proverbs 3:5&6

Almost there

So after the layover in Toronto, it was on to a plane headed for Paris. Then a 3 hour layover and a 5 hour flight to Niamey.

Eiffel Tower and Champs-Élysées From the  plane

The layover in Paris was interesting because in my tiredness, and worry about making sure I got to the next flight, I left my laptop on the plane. Yes I know, what was I thinking? Clearly I was a bit fuzzy headed. To compound matters, apparently it was a national holiday in France, and they were all short staffed. Long story short – the people at Air France did get me my laptop, and I made it to the flight on time. As luck would have it there were two others flying to a different missionary hospital on the same flight. There was another stop after mine in Lome, Togo and they were both going there. She is a nurse and has been to the same hospital once or twice before, he is a general surgeon and is part of a group that all take turns going to missionary hospitals. It made the stop over in Paris seem a little less foreign.

The plane ride was fine, and we landed in Niamey on time. Flying over the Sahara is an experience, and there were a lot of dry river beds.

Flying over Niger

Even when it's dry 29 degrees C is hot! The actually had this big free standing air conditioner in the airport, and I got to stand in front of it at one point through the lineup – nice. They checked my documents for the yellow fever vaccination, and there must have been at least 5 or 6 people that wanted to see my passport. It is nice that I speak the language (French), it made things somewhat easier, although it is clear my french is a bit rusty. There were all sorts of people wanting to be your porter, and the one I was told to look for was not available. He had sent someone else instead. He did find me eventually, and we got my bags. They were slightly the worse for wear, but not seriously so. There was a sign in the airport that would make a lot of people squeamish, so skip the next paragraph if you want to.

So the sign says – if you see this call your health care provider immediately (approximate translation). It was a picture of someones ankle with a long thin white worm coming out of the skin!

Public health anouncement

Never seen a public health announcement like that before. Took a picture, but it didn't turn out so well.

The porter handed me over to another fellow that drove me to the guest house. Typical commute for third world countries, no lines for lanes on the road, everybody makes it up as they go along, lots of horn honking, and scooters/motorcycles in huge numbers everywhere.

So now I am safe and sound at the guest house for the night. Mosquito netting set up, fan running. No internet, so I will have to post this tomorrow. Just wanted to get it all down tonight while it was still fresh.

As I was praying for my laptop to be found and returned to me before my connecting flight, I was thinking of some scriptures. This one seemed to fit the bill well:

Matthew 6:34

Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.