Niger October 2022

I have seen my last patient in Galmi. Goodbye to Stuart, Nadine and Marie. Goodbye to Esther. And the Midwives and everyone else. There are too many to mention and you have all been so welcoming. I got to do one more Cesarean today and hear one more newborn cry. That just never gets old. I got some advice from Peter (from Ontario) about a restaurant for tomorrow in Niamey (along with a hand drawn map). Peter (from California) and I got some bread from Evelyn (thank you again) and my medical license finally arrived 😊 Tomorrow (Friday) I am on the SIMAir flight to Niamey and Saturday @ 0345 I fly out to Istanbul. Then a 12 hour flight to Vancouver arriving around 4 pm Sunday. It has been an amazing trip and Esther has already tried to invite me back next year. I am not sure if I can make that happen, but I will never forget this place. 

 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. 

  There were triplets born at the Hospital yesterday. The waters broke for the first baby and there was an increasing chance of infection.  Unfortunately they were only 31 weeks old.  Fortunately they are all doing well so far.  There are 2 girls and 1 boy.  We are inducing a lady that has had 2 previous stillbirths and it has been going on for several days.  She has had a previous cesarean and we don't want to push it too much, so I will be doing her cesarean tomorrow.   I had a nice chat with the OBGYN who will be leaving Saturday to go to a conference.  I didn't know this, but their family was told they wouldn't be able to go unless they could find a replacement.  It feels even more special that I was able to help them having heard this.  They are a lovely family with young children and lots of missions experience.  It is so invigorating to see people so committed to the Lord and serving His people everywhere....

Running around the landing strip   Today was my first full day of work at the hospital.   I started early by getting out for a run. After days of sitting in an airplane it felt good to get some exercise.  After that the devotions/bible reading with the Sage Femmes (midwives) started at 0800 and then rounds.  Fortunately there are 3 OBGYNs working at the moment (the one I am replacing leaves for Dubai on the weekend). There is also a family doctor with extra training in Obstetrics and Gynecology.  Esther has been here the longest and I followed her around today so I am being eased into the routines again.  We saw a woman who had a cesarean for an infected pregnancy, an ectopic pregnancy, and a lot of patients with hypertension.  There is also a specific type of cancer that affects women that seems to be VERY prevalent hear.  I hardly see it at home, but they are always looking after 2 or 3 woman with it here.  Someone has speculated it co...

I flew from Niamey to Galmi today via SIM air. It was a straight forward flight and we arrived at about 1030 in the morning. Evelyn is the manager and she had everything ready when I arrived. I met David, the fellow I am replacing and he gave me a tour around the Hospital. It all looks pretty familiar but it sounds like they are pretty busy with patients right now. There is also another OBGYN Esther that has been here longer and is going to orient me around 3 pm. The next 3 nights I am being hosted by other missionaries in their home for dinner. That will make it easier for me to get aclimatized. If you look to the left of the road just above and to the left of the centre of the picture you will see the gravel landing strip. It looks like I am on call on Thursday so tomorrow will just be a regular clinic day. Esther did walk me around the whole hospital complex. It looks mostly the same, but there are a few changes. It seems like there are more perso...

 Between lay overs and cancelled flights it took 36  hours, but I am finally at the Guest House in Niamey.  I think the tiredness caught up to me and I got a bit anxious when my flight from Addis Ababa to Niamey wasn't showing up on the displays in the Airport, but it did board from the gate on my boarding pass so all is well.  The airport in Niamey has been updated somewhat and it looks nicer.  Once again glad that I can speak french and talk to all the officials.  Because I got a "Visa Volante" they will be keeping my passport for 24 hours, but apparently this happens all the time, and Crystal from SIM in Niger will be collecting it back for me soon.   It was raining in Niamey when I arrived.  I have never been to Niger in rainy season (and this still isn't really it), in fact this is the first day of rain I have ever seen in my 3 trips here.  My luggage arrived in spite of all the flight changes so thanks again to the wond...

Flying in to Addis Ababa Well, I'm not there yet and it has already been an adventure.  I flew Turkish airlines this time Vancouver - Istanbul - Niamey.  The flight to Istanbul was fine (for an 11 hour trip). However, when I arrived in Turkey I found out my flight to Niamey was cancelled for the day. The easiest way to reroute me was through Addis Abba (Ethiopia) with a 10 hour layover arriving in Niamey the next day @ 2 pm.   Fortunately I had a very helpful Turkish Airline employee who organized this for me and made up a new baggage tag (so hopefully it will arrive when I do).  Thank goodness for wifi in Airports, so I could let the people in Niamey and Galmi know I would be almost a day late.  Trying to find a secure place to sleep for a few hours.  I have already been invited to a Canadian Thanksgiving dinner, so looking forward to that.  More when I can.

 Well, my bags are packed and I have made it through the airport lines.  Now begins the trip.  I will be flying to Istanbul with a 2 hour layover and then on to Niamey.  I will be staying there overnight and then flying out to Galmi the following morning.  With the time changes etc it may be a while before I post again, so thank you all for your prayers for safe travels, and I will let you know as soon as I can when I have arrived safely.  Happy Thanksgiving to the Canadians.  John.

I received an email from World Medical Missions on June 8th asking for help in October, so I will be going back to Galmi in Niger from October 8th to 30th. For those of you that don't know, I was there in 2016   https://johninniger2016.blogspot.ca/  and again in 2017  https://johninniger2017.blogspot.ca/ for some reason blogs come up with the last post at the top, so you will have to scroll a long way down and go to a previous page to get to the start.  I am looking forward to connecting again with people I have worked with before and making new connections.   I want to thank my wife Sylvia for being so understanding and agreeing to me going back again.  I want to thank my Colleagues at the hospital for taking up the slack while I am away.  I also want to thank Dr. Darin  Cherniwchan for all his advice on travel medicine, and Robin Caldwell for her legal aid.  There are a host of others - thanks to you all.  I will be trying to post...