Niger October 2022

 There are so many differences here. 15 year olds having babies is a semi regular occurrence. 20 year olds worried about infertility is as well. Long delays in seeking medical attention resulting in much more severe disease. These are just a few of the issues. Today I did a Cesarean on someone purely because they had 2 previous stillborn children. At delivery the baby was limp and barely had a pulse. I thought it was going to die in front of my eyes. And there was no reason why that I could find. Initially in the nursery the baby was still quite weak, but over time she improved. I am not sure I will ever know what was going on with this baby or the previous ones. I am just glad the mother convinced us to just go straight to the cesarean. My time here is winding down and then the trip home. I am not sure if I will be able to post again. If not, hope you enjoyed this little window in to life in a hospital on the southern edge of the Sahara.

My apologies for the long gap in posts.  It has been busy here with Stuart away and the increased call.  Also the internet access is very sporadic.  Since I last posted I have seen another set of twins, multiple cases of malaria a day, several choriocarcinomas (cancers) with severe findings and some severe tuberculosis.  It can all be a bit overwhelming, but God has been guiding me through it all.  The other aspect of the challenge is of course the limited supplies.  We have to check what medications and supplies are available and tailor our treatment to the resources.  For those issues I lean heavily on the long term staff here and the midwives.  Saadi who was in a picture earlier in the blog has been here a long time and is great at guiding me through some of these issues.  And of course Esther is a great resource when I am not sure how to proceed with a case.   I asked Saadi today how many deliveries she thinks they do in a month...

Stuart left on Saturday and Esther was on for the weekend, but now I am on my own (not really, if I need to I can ask Esther, but she is in a different part of the Hospital right now) . I did a Cesarean and a D+C this morning. Then rounds and off to the outpatient clinic. I saw a lot of patients with high blood pressure and some with Malaria. Some have been pregnant several times but not had a live baby. It is hard balancing delivering early to get a live infant with the struggles of prematurity.  At night I was called about 1 am for a newborn that was transferred from another Hospital. The baby had Spina Bifida and we had to stabilize it until it could have surgery to improve its long-term health. It was a full day. PS : the WiFi has been out for over a day and now it is spotty. Data on the phone is no better. Not sure how many more blogs I will be able to do. 

The last time I was in Galmi the local church met in a bamboo structure (you can see the pictures in the blog from 2017). Since then they have built a brick church and a Christian School.  They even have fans on the ceiling! The service is in French and translated in to Hausa. The chairs look the same as last time though. There were two preachers. The first talked about being passionate for God, but how sometimes that means waiting to hear his voice - like David not killing Saul in his sleep but waiting for the right time to become king and Moses living with Jethro for 40 years learning to be a leader and go back to Egypt.  Then there was Singing - mostly in French but some in Hausa and then the second preacher talked on 2 Chronicals 7. After church we had a nice tour through some of the neighbouring towns. There is a surprising amount of agriculture with sorghum onions and tomatoes being just a few of the crops. I thought the sorghum was corn originall...

 It is Saturday now and I have officially been gone for a week (although I didn't arrive in Galmi until Tuesday).  The fellow I am replacing Stuart Ostby just flew out with their family on their way to Dubai.  Esther is on call for the weekend.  The wifi in my house is intermittent at best, so I decided to go to the doctor's lounge.  It is still very slow, but at least it doesn't cut out all together.  Peter - one of the general surgeons - found me in the lounge and asked me to see a lady for him.  This poor woman was 70 years old (looks a lot older) and had a hole between the bowels and the vagina.  However, we are fortunate enough to have a fistula hospital in Niger.  The Danja Fistula Center.  They look after women who have had a female circumcision and those that have had difficult deliveries.  It is truly life altering for these women.  I am so grateful that I was able to refer her on to get the treatment she needed. ...

I have been looking for Saadi the midwife I worked with last time and I just saw her today. She used to run the Maternity floor but now she works in the outpatient department and does shifts in Maternity on the weekends. I also saw the German nurse I met last time who works making sure all the instruments are properly sterilized. It feels good to see friends from years gone by. Speaking of surgical instruments I did my first cesarean on this trip today. It was very straightforward, and the OR assistant I had was Rebekah (I think that's how she spells it). She was great. She obviously knew the procedure very well and the surgery went very smoothly. Everyone is sad though because she is going off to get married and it will be hard to replace her.  After work Esther took me to a shop to buy fabric. I want to replace the shoulder bag I had made 5 years ago, and some other things. I got a nice bright pattern. Stay tuned for more.