The thoughts of a woman trying to live simply yet abundantly, contentedly yet expectantly, wisely yet adventurously... all for His glory.


two surgeries and a stick shift

I'm working on blogging about my day-by-day experiences in Niger, but the sailing has been a little rough recently so it's been a couple of days since I last posted.  I'm making up for the silence with an exceptionally long post.  Enjoy!

Tuesday (day 6): two surgeries and a stick shift

Spirits are high as we head to the clinic area. We have our first two surgeries of the week today. The rest of the week we'll do three surgeries per day, but seeing as it's the first day we want to make sure that everything works well.
Foure, our first VVF patient of the week in Danja!

When we arrive, Mariama (one of the local midwives working with us on the ward) tells us that our first patient, Foure, is all showered and ready for surgery. The OR team quickly heads off to starting prepping the OR. On the ward, Mariama, Hannatou (one of our translators), and Sarah and I pray with Foure, then walk her across the courtyard to the OR. Before Foure enters we have her step in a bucket of water to rinse the sand and dirt off her feet. Everything in this part of Niger is so sandy that your feet are always filthy, and the water bucket was Sarah's brilliant solution to that.

So she's off. Now we settle down to wait the several hours before her surgery is finished. We have plenty to do--go chat with the ladies under the tree, play with the adorable kids, and even a little nursing work making a plan for when Foure comes back from the OR.

In a western hospital setting, after surgery the patient goes to a recovery room (aka post-anesthesia care unit or PACU) for about an hour to be closely watched (think blood pressure checks every 5 minutes!) while the anesthesia wears off. After the recovery room the patient arrives on the ward where we check blood pressure every 30 minutes for a while, then hourly, then every 4 hours, and so on. But this is Africa, and this is not a hospital--not yet anyway!) Hopefully the hospital will be completed in the summer of 2011.) So the patients will come straight from the OR to Sarah and I on the ward. We ARE the recovery room!

Dr. Steve previously instructed us that our whole time in Niger is meant to be laid back, and he's given us the freedom to do what we feel is right and appropriate on the wards. We both have a lot of experience with VVF patients, so he's also trusting our nursing judgment to guide our practice. In light of this, Sarah's and my sophisticated plan for our post-op patients is this: check her vitals signs when she comes to the recovery room, aka ward. If everything is fine, we'll check her again later. If there's trouble, we'll check her again sooner. We're both confident (arrogant?) enough in our assessment skills to be able to catch any trouble before it actually becomes trouble.

A VVF patient is transferred from the OR to the ward.

After a while we hear people outside the ward, so we investigate, hoping Foure is out of surgery, which she is. She's being wheeled across the sandy courtyard on the stretcher, Greg the anesthesiologist at her side. We settle her into bed, and I check her vital signs according to our plan. And she's fine! Our recovery room plan is working brilliantly so far.

Foure back from surgery and doing well! (And I'm nursing in a skirt and a cap... Florence Nightingale would approve!)
While I check on Foure, Sarah gets Zina off to the OR for her surgery. Then we sit back to chat with the ladies under the tree again. I check on Foure, but she's dry and doing well so I have nothing to worry about.

The recovery room peanut gallery.
The rest of the day goes smoothly and Zina also does well when she comes back from surgery. After Sarah and I get both Foure and Zina settled for the evening and tomorrow's three ladies are brought into the ward, we head back to the guesthouse for dinner.

After dinner, Sarah and I drive back down to the ward to check on the ladies once more before we go to bed. Everyone is doing well, and we tell everyone "se anjima" ("see you tomorrow") before we head back to the car. Again, this is a very non-western hospital occurrence, where nursing shifts are 24/7. I've never left a patient before and just gone home. But there are some local nurses on overnight, and our team has a cell phone so we'll each take nights on-call.

I climb into the driver's seat. I've never driven a stick shift, but I've always wanted to, and now's a good time to learn. One of the unofficial policies Dr. Steve has is that everyone has to be able to drive on the compound. So Sarah talks me through it, I let out the clutch while pushing in the gas, and...success! I manage to stall a few times, of course, but for the most part I love the challenge and it feels surprisingly natural.

So... as the stars start to come out in the inky black sky, I am in the middle of Niger learning how to drive a manual car. Who would ever have guessed?

Just another chapter in this wonderful, wild adventure that God is walking me through!

tomorrow (Wednesday): I think I want to go home


under the tree, into the ward (screening day)

Thanks for your patience with me friends! I arrived back on the ship from Niger last Friday and then we set sail for South Africa last Sunday... I'm writing to you from the middle of the ocean. But, with the comparatively-fast ship internet I can now post pictures! Enjoy!

Monday (day 5): under the tree, into the ward (screening day)

Today the rest of the team arrived: both surgeons and the anesthesiologist. After they'd settled in and eaten a quick lunch, we headed to the clinic area to start screening the women.

We found the women waiting under the tree as usual. Some women had previously been operated on in May and were returned for a check-up; some had been screened previously and were already on this week's surgical schedule; some had simply heard of the fistula center and came seeking hope.

The ladies brought their mothers, daughters, sisters... 

Marouka and Aichatou

We set up our screening area in the maternity clinic, and one by one the women came through to be examined. I assisted the surgeons with the physical exam, handing them supplies and trying to anticipate their needs. We screened somewhere around 20 women, although I am not sure of the exact numbers. 10 will be operated on this week, and some of the others will return for surgery in November when the next VVF team comes.

Screening VVF ladies in the maternity clinic in Danja

At the end of the day we had a surgical schedule made up for the week, and we brought the first two women from under the tree into the ward that night. Similar to on the ship, we had to teach the women how to shower in preparation for surgery the next morning. One of the local nurses working with us explained that for many people in this region of Niger, you are considered clean if you have bathed your face, hands, and feet. This makes sense when you also consider the great distances that many people have to haul their water!

Tomorrow: the first two surgeries!



... more blogs about Danja are coming, I promise! Here's a few pictures of "the ladies" to hold you over until I have a chance to write more.

VVF ladies waiting patiently under a tree for the team to arrive

Some of the women who would have VVF surgery (and some other family members)

A caregiver (aka mom) for one of the VVF ladies--Tuareg tribe I believe. 

Thanks to Sarah for taking amazing pictures of the women!


the blind and the broken

For a while I will have to blog day-by-day about Danja, Niger. So far my time here has been so rich and full that I think you might enjoy some details! 
Sunday (Day 4): the blind and the broken (Hausa church)
There’s something incredibly rich about worshiping with believers in other cultures--each time I do, I see a picture of heaven where every tongue and tribe is represented. 
Church today was in Hausa, the local language. June pointed me to the Bible verses that the pastor was speaking about, but other than that I had time to simply read, pray, and absorb what was going on. 

Worship is more reserved and more laid back here in Niger than the churches I experienced in Benin. Each age group took a turn singing for the rest of the congregation, starting with the children, moving up to the adolescents, then the women, and then the men. But there was none of the booty-shaking, shoulder-pumping, exuberant dancing so prevalent in Benin and Togo. Instead, each group of singers stepped gently from right to left in time with the song.
"Reserved" does not by any stretch mean "boring" or "plain". I wish I could somehow portray to you the resonance of the drums the women played while they sang. As I leaned against the wall behind me I could feel every beat percussing through my heart and pulsing down my veins. One woman in particular had a beautifully haunting voice and I imagined the windswept desert underneath dark, starry skies while she sang. 
One of the ladies here for VVF surgery sat in front of us, and I gained a firsthand knowledge of some of the shame they experience. Just a subtle hint of urine at first, but as the service progressed the smell became more and more noticeable. She strove to keep a little distance between herself and the people sitting next to her. When she stood to sing a damp stain of urine appeared below her right foot, and it broke my heart. But she held her head high and sang nonetheless, a beautiful picture of hope and strength. 
Many of the people filling the church were patients; I saw many with bandages on arms or legs or eyes. I think the only difference at home is that many of our wounds are the hidden, internal kind... sins like pride, jealousy, anger. These wounds are easier to hide, perhaps, but potentially more damaging at the end of the day. I’m so thankful for a God who loves us despite our wounds, and who loves us enough to want to heal us, no matter how painful the treatment may be.
After church was over, I watched a woman let her children wander ahead of her on the path home as she led a blind man. He simply called out and lifted his stick, while she took hold of the end and began to lead him. A little thing, really, but completely beautiful to watch. 
Lord, let me not forget: I too have wounds in need of Your healing, and I too am blind in many ways. 

Come, restore my vision.

Come, heal my brokenness.


work, work, not dare to shirk!

For a while I will have to blog day-by-day about Danja, Niger. So far my time here has been so rich and full that I think you might enjoy some details! 
Saturday (Day 3): work, work, not dare to shirk! 

Walking down from our guesthouse to the Danja fistula hospital for the first time. Alainie managed to successfully carry our medical supplies on her head African-style.

Our objective today is to clean and set up both the operating room and the ward. The rest of the team is due to arrive on Monday, at which point we’ll screen the ladies and make up a surgical schedule. We are using temporary facilities here until the new hospital is built, so all our supplies are packed away in one closet in the OR. Turns out that the closet is also the local party palace for termites! Everything in the closet is covered with red dust, and there are substantial piles of termite leavings/poo. Not to mention that there are definitely bugs everywhere (in our house too, by the way)... spiders, mosquitos, beetles, ants, earwigs, and moths. We unfold the drapes for the surgical table, and insects fall out. We sweep them out from the cupboards. They are hiding between the catheters and the glove boxes... basically everywhere. We clean and bleach everything, and attempt to kill or shoo away as many bugs as possible. 

Ginger, Sarah, and Alainie hard at work double-bleaching the OR.

Next we go to meet the ladies who are all sitting outside in the shade of a large tree. Some of them have been waiting for a week for our arrival, and all have brought mothers and children. They are thrilled to see us and warmly welcome us in Hausa. Of course none of us speak Hausa, but this is one of those times when words aren’t really necessary. 
As a preface to the next little story, let me tell you about the bulls. We often see bulls grazing all over the compound, and we’ve been astounded by the fact that very small boys armed only with sticks are responsible for keeping them in line. Some of the boys look to be about 4 or 5, some perhaps 7 or 8. All are fearless as they boss around these massive horned bulls. So, now for the story. After cleaning everything in the OR and ward, we’re walking up to our house for lunch when one of the bulls starts to follow Sarah and I. Sarah peels off the the side and I walk faster, but the bull keeps following me. At this point I figure that if a small boy can keep a bull in line with a stick, then it’s really all about the attitude and about showing no fear. So I turn around to face the bull and put on my stern face and simply say “no!” The bull stopped, but he also didn’t seem inclined to wander away. At this point one of the boys came charging over, stick flailing madly, and shooed the bull away. Thank goodness for small boys with sticks! 

Staring down the bull who by the way was not tethered. I appear to be smiling for some reason, but it was not amusing at the time.

My favorite part of today was going into town with James, the physical therapist from Australia. He took all of us girls to a local tea “shop” in Maradi which turns out to be a couple of benches under a pink and green umbrella with a tea kettle heating over a small wire basket of coals. Our tea, called “shiya,” comes in shot glasses and is sweet, a touch spicy, and wonderful. We sit on the benches, drinking our tea and watching the people passing by until the owner of the shop comes. He speaks small small (a favorite French-African phrase of mine) English, and proceeds to quiz us on which states we’re from (he’s stumped by Idaho). He tells us that he used to be in politics, but wanted a break so he quit and opened this little tea business. Now he wants to get back into politics, so he’s running to be the mayor of district two in Maradi. After two shot glasses of tea, we’re ready to leave, and we have to haggle with him to allow us to pay him--he insists that we should pay next time, not this time. He finally lets James pay for his tea, but he doesn’t accept money from us girls. I think the notoriety he gets around town for being the tea shop that the white women go to is perhaps payment enough, but I can’t exactly ask him, of course! It was just so wonderful to be able to sit and watch the world go by--something that I miss on the ship.
At the tea shop in Maradi with James and the girls. I wondered if the local Nigeriens thought we were his wives, especially with our matching headwraps!

We end the day by going to the French Club for dinner and a swim. Some of the other SIM missionaries are there with their families, so I chat with them for a long time about living in Niger. As the light fades, we are preparing to leave when someone notices that there are some small lemur-like monkeys in the trees. It’s just dark enough that we have a hard time seeing them, but we watch their silhouettes leap from tree to tree until the mosquitoes finally chase us to the car.
It’s just another normal day around here-- cleaning the OR, a showdown with a bull, tea with an aspiring mayor, and lemur monkeys in the trees. Oh, and let me not forget the sheep in the trunk of the car in front of us as we drove home... the passengers were all dressed up like they were headed to a party when all of a sudden a sheep sticks its head up in the back window of the car, then settles back down again. (Maybe you had to be there to understand it, but it really was hilarious.)
Like I said, it’s just another normal day in Danja. It's just that normal looks completely different here!
Tomorrow: the blind and the broken (Hausa church)


come fly with me

For a while I will have to blog day-by-day (internet access permitting) about Danja, Niger. So far my time here has been rich and full so I think you will enjoy some details! Warning: long post ahead

Friday (Day Two): come fly with me

After a night filled with thunderstorms, we wake up early in preparation for flying to Danja. We don our ankle-length skirts and make sure to pack our head wraps in easily accessible locations, since these things are necessary for women in this part of Africa. Our pilot, Ed, shows up at 7am to pick us up and we head back to the airport again, only this time we pass up all the commercial planes and head for a back hangar. I’ve been anticipating this for months now--we get to fly in a six-seater Piper Saratoga from Niamey to Maradi (Maradi is only 15 kilometers--a quick car ride-- from Danja). 

Ed opens the airplane hangar and proceeds to pull (yes, pull) the plane out onto the tarmac. We’re all a little giddy, seeing this tiny plane that will somehow manage to hold us and our luggage. It's a little hard to scramble into the plane in our long skirts, but we manage. I have the immense pleasure of sitting in the copilot's seat in the cockpit. At my feet are pedals, at my knees the steering console, and above that are numerous dials and knobs. I buckle in and put on the headphones, and suddenly I’m listening in on the chatter between the flight controller and Ed as they confirm preflight details. I am literally giddy with excitement!

Yours truly, "copiloting" the Piper Saratoga. 

Ed starts the propeller, and we taxi to the runway. I can’t help but hold my breath as we smoothly lift off the ground, and the next thing I know I am watching the desert below, dotted with villages with footpaths to connect them. Sometimes the land below is green and lush looking, sometimes bare and sparse, but it’s always beautiful. I think I could watch the land scroll by below for hours. This Nigerien flying experience is such a beautiful gift from God!

An aerial view of Niger (brown part; less developed and irrigated) and Nigeria (green part; more developed).

After sitting with my eyes glued to the window for two hours, we land in Maradi, the second biggest town in Niger. As I step out of the plane I notice that we have an audience of farmers and their children, all watching us curiously. We’re met on the tarmac by Burt, the local SIM director, and a local airport official who informs us (Burt translating) that he would be happy to find us all good husbands. We laugh, and thank him for his offer, but politely decline. Although, on second thought, none of us have been able to find husbands yet on our own, so maybe we do need some help in that department!

After landing in Maradi, but before covering up our hair with headwraps.
We wrap up our hair in scarves and pile into Burt’s truck for the quick drive to Danja. Before we leave the runway, we meet yet another man who asks Burt in all seriousness “where are you going with all those brides?”  Apparently all the single men have been living in Niger all this time... who knew?!?

Burt delivers us safely to the Danja hospital compound, and we get settled in the house of a family home for a year of furlough. We’ve met the other missionaries currently living on the Danja compound-- James from Australia is a physical therapist, and June from England is a nurse. Both are very warm and welcoming, and show us the ropes. In fact, we meet all the missionaries in this area because we're invited/requested to attend a monthly SIM prayer meeting. I'm amazed at the fortitude of these folks--these are the ones who live in the bush, so to speak, treating their own heart attacks (true story) and doing all sorts of other amazing things. It's interesting to meet people who have lived in Niger long enough that they call it home.

Talk about a full day! Once again, I'm exhausted, so I fall into bed, after tucking in the mosquito net, of course. Tomorrow we plan to clean the ward and the OR, meet the women here for surgery, and try to relax a little before the week begins.
Tomorrow: work, work, not dare to shirk! 


there is no 27B

The Danja team after a logistics meeting-- still on the ship in Togo at this point!

For a while I will have to blog day-by-day (internet access permitting) about Danja, Niger. So far my time here has been rich and full so I think you will enjoy some details! Unfortunately I can't currently upload pictures, but will keep trying. Let me try to bring you up to speed, starting with last Thursday, the day I left the ship for Niger.
Thursday (Day 1): there is no 27B

My time in Togo came to a bit of a whirlwind close as I worked my last few shifts and said goodbyes to lots of people, including my good friend Ben from home and my dear roommate Steph from Cambridge, England. 

The Danja team--Alainie, Ginger, Sarah and I--all piled in the Land Rover and proceeded to sit in traffic for a while before finally reaching the airport. Once aboard the plane, I discovered that according to my ticket I was meant to sit in seat 27B... but there was no 27B. Fortunately it was a misprint, but still I had to laugh at such a TIA (this is Africa) moment. 

Our flight from Lome to Niamey, Niger took just over an hour. Definitely not long enough for any of us to process all the goodbyes we’d said, the fact that we were finally going to Niger, or that our time in Togo was over. At the Niamey airport, we stood in lines called “police” and “health” which you might know as passport control and yellow fever card control. After we collected our bags, we had to once again put them through an xray scanner. The duffel bag packed with medical supplies sat in the xray machine for a while, but fortunately no one hassled us about it. 

We were picked up at the airport by the director of the Niger branch of SIM, who took us to a SIM guesthouse for the night. We had dinner with a lovely missionary couple who run the guesthouse, and also with another couple who had spent the last two months out at Danja working on building the new fistula hospital. 

As I settled in for the night I could hardly believe I was in Niger; everything seemed so surreal. It was so hot that I simply lay there sweating for a while, listening to the downpour on our corrugated roofing, before finally falling into a restless sleep.
Tomorrow: come fly with me (in a very small charter plane!)