Today I got a long e-mail from Alex and Bri, two of the Peace Corps volunteers (PCVs) I met out in Niger; they were up in Winditan, and I ran into them a few times, and saw one of their friends who was ill. The e-mail was great - I'd been wondering how the anniversary of 45 years of Peace Corps in Niger had gone, and Alex's account was astute, detailed, entertaining, even wry in places. It was the sort of e-mail which makes you feel like you've been living in the next village to someone for the past couple of months instead of thousands of miles away.
At the end, though, they revealed that Matt, the PCV I went and stayed with, has had his Peace Corps service cut short because the US army, which he served with in Iraq before going to Niger, have recalled him.
Matt was and is extremely opposed to soldiering as a career. You can read his thoughts on Iraq and agriculture online; while I was out there he got flown back to New York to talk at a veteran's conference, where he was interviewed by Reuters, and appeared on I think the Today programme.
Recalling him is just crazy, and I'm so damn upset for him I can't even say.
Saturday, 27 October 2007
Wednesday, 26 September 2007
Wake Me Up, Before You Go-Go
Monday 17th
I know I said I wouldn't write again unless something spectacular happened, but it sort of did and, on reflection, the disjointed sprawl of the last missive was a suitable farewell to Niamey only stylistically (one of the best descriptions of the town I've heard was "it's a giant bush village").
Today was really my last day, and has been - entertaining. I met Dr. Marianne last night when she was on call at the private clinic down the road, and she said that she'd take me to the airport, as she was on-call again tonight and so was free during the day. We agreed to meet at 16h. Otherwise, the day was quiet - I spent an hour waiting for two pointless pieces of paper from the internal medicine big chief, most wanting to drill into at first his and then my own kneecaps with boredom. Then a final fling round the local area giving away all the stuff I wasn't going to need, and back for my 4pm rendez-vous with Dr. Marianne.
She was late. I watched some very bad cartoons, and some international Greco-Roman wrestling. She was still late. It reached 5pm. I began to get antsy, not wanting to have to find a taxi just before the end of Ramadan.
I waited some more. At 17:20 I recalled that she had complètement oublié me before, so I went to leave the key at the clinic, feeling a bit pissed off. Happily, I met the watchmen on the way to the clinic and, amid warm farewells, they told me to pay 200CFA (20p) to get to the grand marché, and 300 from there to the airport. This was about one-fifth of what the useless Bradt guidebook suggested.
Walking out with the rucksack felt like the right way to leave Niamey, as it did when the taximan dropped me at a taxi-brousse where a boy in a pink shirt took 500CFA (I was too relieved to be leaving to haggle), loaded my bag, and I climbed in. Midway through the journey, the conductor-boy asked me for the fare. Confused, and with a vague sinking feeling, I explained that I'd already paid 500 to the boy in the pink shirt. The driver scowled. He hadn't passed the money on.
The upshot? Well, you can imagine - I paid another 500. Or so you might imagine - but you would be wrong. What in fact followed was a minute or two's irate muttering in Djerma, followed by the driver - who at this point had not one CFA of my money - giving me my change, and saying darkly, "we'll deal with the boy later". The fare was in fact 125CFA; I gave them double in the end because they'd been so scrupulously honest and not shafted me when it would have been extremely easy to do so.
I did have to walk the final 200m to the airport off the main road and, once inside, deal with a couple of tossers coming up and saying that as I was leaving I had to give them souvenirs of, say, money or my watch, but my day had gone well enough that I was curt and offended-sounding without once resorting to swearing copiously in English.
Then, happily, Dr. Marianne turned up. She explained that she had heard the flight was late and so had just not bothered turning up (NB: she only actually said one of these two things). Her two boys and husband were in tow, and were fun, so we chatted over a Ramadan-flaunting drink in the airport bar. During the course of the conversation, I checked she'd got the note I'd left at the clinic and said the man there had been surprised you were on-call again tonight.
Dr M: "No - it's not me."
Me: "Oh - maybe I misunderstood. I thought he'd checked it - because you'd told me yesterday you were on call again tonight...?"
Dr M: "But I write the rota - I wouldn't put myself on two nights in a row! Why, I'm exhausted!"
Me: "I must have made a mistake."
Dr M: "I have it here - I'll check."
Dr M: "Merde."
Me (glancing at watch, which read 18:58): "What time does it start?"
Dr M: "19:00."
So after some scurrying about and a quick farewell, she wended on her way. It made me feel much better about her having completely forgotten me previously, anyway. And was very amusing.
Check-in was uneventful and surprisingly smooth given that I had expected them to take one look at my e-ticket and throw me out the airport, and it was enlivened by the two energetic kids, one of whom drew in my diary and then danced to Wham! when they came on TV singing Wake Me Up Before You Go-Go. It's a source of some amusement to me that a strictly Muslim country has a main TV channel which not only shows a video featuring George Michael in a tight white T-shirt emblazoned "choose life" about once an hour, but has even adopted a sort of elevator-music version of the song as its theme music. I suspect if they knew of his more recent, non-musical exploits, they might pick a different song...
I was going to write more about how the taxi experience reaffirmed my belief that these are good people, and about how the curtailment of what they can hope for is so depressing, but instead I'll give you a little quote from Alexandra Fuller's rather wonderful book Don't let's go to the dogs tonight:
But our faux-Spanish house, with its stucco walls and its long, cool stretches of linoleum and its vast veranda and its spacious garden, seem, suddenly, exhaustingly, too much.
Mum shakes her head. She says, "I know, Bobo."
"But it's so awful."
"It won't go away." She is watching me stuff plastic bags with clothes. "You can't make it go away."
I sniff.
"It was there before you noticed it."
"I know, but..."
She gets up with a sigh, dusts her knees. She says, "And it will be there after you leave."
"I know, but..."
Mum pauses at the door. "And bring back my plastic bags. We're always short of those," she says.
It's as gentle a reminder as I reckon you could find that just going somewhere, just being somewhere, doesn't change things, no matter how strongly or naively you believe that it might.
As the flight took off, Niamey drifted lazily away from me, a great chaotic raft of white lights surrounded by an ocean of darkness.
I know I said I wouldn't write again unless something spectacular happened, but it sort of did and, on reflection, the disjointed sprawl of the last missive was a suitable farewell to Niamey only stylistically (one of the best descriptions of the town I've heard was "it's a giant bush village").
Today was really my last day, and has been - entertaining. I met Dr. Marianne last night when she was on call at the private clinic down the road, and she said that she'd take me to the airport, as she was on-call again tonight and so was free during the day. We agreed to meet at 16h. Otherwise, the day was quiet - I spent an hour waiting for two pointless pieces of paper from the internal medicine big chief, most wanting to drill into at first his and then my own kneecaps with boredom. Then a final fling round the local area giving away all the stuff I wasn't going to need, and back for my 4pm rendez-vous with Dr. Marianne.
She was late. I watched some very bad cartoons, and some international Greco-Roman wrestling. She was still late. It reached 5pm. I began to get antsy, not wanting to have to find a taxi just before the end of Ramadan.
I waited some more. At 17:20 I recalled that she had complètement oublié me before, so I went to leave the key at the clinic, feeling a bit pissed off. Happily, I met the watchmen on the way to the clinic and, amid warm farewells, they told me to pay 200CFA (20p) to get to the grand marché, and 300 from there to the airport. This was about one-fifth of what the useless Bradt guidebook suggested.
Walking out with the rucksack felt like the right way to leave Niamey, as it did when the taximan dropped me at a taxi-brousse where a boy in a pink shirt took 500CFA (I was too relieved to be leaving to haggle), loaded my bag, and I climbed in. Midway through the journey, the conductor-boy asked me for the fare. Confused, and with a vague sinking feeling, I explained that I'd already paid 500 to the boy in the pink shirt. The driver scowled. He hadn't passed the money on.
The upshot? Well, you can imagine - I paid another 500. Or so you might imagine - but you would be wrong. What in fact followed was a minute or two's irate muttering in Djerma, followed by the driver - who at this point had not one CFA of my money - giving me my change, and saying darkly, "we'll deal with the boy later". The fare was in fact 125CFA; I gave them double in the end because they'd been so scrupulously honest and not shafted me when it would have been extremely easy to do so.
I did have to walk the final 200m to the airport off the main road and, once inside, deal with a couple of tossers coming up and saying that as I was leaving I had to give them souvenirs of, say, money or my watch, but my day had gone well enough that I was curt and offended-sounding without once resorting to swearing copiously in English.
Then, happily, Dr. Marianne turned up. She explained that she had heard the flight was late and so had just not bothered turning up (NB: she only actually said one of these two things). Her two boys and husband were in tow, and were fun, so we chatted over a Ramadan-flaunting drink in the airport bar. During the course of the conversation, I checked she'd got the note I'd left at the clinic and said the man there had been surprised you were on-call again tonight.
Dr M: "No - it's not me."
Me: "Oh - maybe I misunderstood. I thought he'd checked it - because you'd told me yesterday you were on call again tonight...?"
Dr M: "But I write the rota - I wouldn't put myself on two nights in a row! Why, I'm exhausted!"
Me: "I must have made a mistake."
Dr M: "I have it here - I'll check."
Dr M: "Merde."
Me (glancing at watch, which read 18:58): "What time does it start?"
Dr M: "19:00."
So after some scurrying about and a quick farewell, she wended on her way. It made me feel much better about her having completely forgotten me previously, anyway. And was very amusing.
Check-in was uneventful and surprisingly smooth given that I had expected them to take one look at my e-ticket and throw me out the airport, and it was enlivened by the two energetic kids, one of whom drew in my diary and then danced to Wham! when they came on TV singing Wake Me Up Before You Go-Go. It's a source of some amusement to me that a strictly Muslim country has a main TV channel which not only shows a video featuring George Michael in a tight white T-shirt emblazoned "choose life" about once an hour, but has even adopted a sort of elevator-music version of the song as its theme music. I suspect if they knew of his more recent, non-musical exploits, they might pick a different song...
I was going to write more about how the taxi experience reaffirmed my belief that these are good people, and about how the curtailment of what they can hope for is so depressing, but instead I'll give you a little quote from Alexandra Fuller's rather wonderful book Don't let's go to the dogs tonight:
But our faux-Spanish house, with its stucco walls and its long, cool stretches of linoleum and its vast veranda and its spacious garden, seem, suddenly, exhaustingly, too much.
Mum shakes her head. She says, "I know, Bobo."
"But it's so awful."
"It won't go away." She is watching me stuff plastic bags with clothes. "You can't make it go away."
I sniff.
"It was there before you noticed it."
"I know, but..."
She gets up with a sigh, dusts her knees. She says, "And it will be there after you leave."
"I know, but..."
Mum pauses at the door. "And bring back my plastic bags. We're always short of those," she says.
It's as gentle a reminder as I reckon you could find that just going somewhere, just being somewhere, doesn't change things, no matter how strongly or naively you believe that it might.
As the flight took off, Niamey drifted lazily away from me, a great chaotic raft of white lights surrounded by an ocean of darkness.
Thursday, 13 September 2007
The final furlong
Monday 10th September
Well, I have 7 days left, or slightly under, as by this time next week I will probably be touching down in Bamako on the first of the four stops before London. They are the aforementioned Bamako for "technical reasons", as my e-ticket prophetically informs me (I'm still torn between being reassured that problems have been predicted and unsettled by their predictability). The second is Dakar some two hours later, where I'm meeting Toyin and Liz; the third, on the 29th September, is Casablanca, where if the outbound flight is any indication I will spend several more than the two hours I'm scheduled to spend there and will meet someone who will be central to my social life for the next two months, and finally London itself.
To answer the question you would ask if you were here: yes, I am ready to leave. Caitlin (Nigérien name: Yakalu), who's a Canadian Boston University student doing premed there who's in Niamey for four months of language and cultural studies, and who I showed round the hospital this morning, asked at lunch whether I'd stay if I could, which I thought was much harder-to-answer and therefore better way of putting the question. I said 'no' with a speed that surprised me. I could do another couple of weeks in paeds - but even there, where they make an effort, my education would suffer from the overall lack of teaching, and I miss UK *standards*. They have standards here, of course, and I am about to go right ahead and judge them, as ultimately I'm out here and while I may only be a medical student and only essentially a tourist and blah, I believe that not only does that mean I am entitled to judge them, but that it also means that in some ways I must. The "you shouldn't travel to the developing world and *judge* them" is crap - if you come out to the third world and have standards of your own, you have to judge what you find here by those standards. If you can look at the 1 in 4 children who die before age 5 here and call that unacceptable, so too can you look at, for instance, the standards of care in hospitals and call them unacceptable. Of course, in terms of writing elective portfolios, doing one gets you marks and doing the other attracts accusations of arrogant colonialist medical students from a failed sociology student who has never heard of post-colonialism and who would cast my use of 'the third world' in the same light despite the fact that Niger, at least, is not developing in any meaningful way, so 'developing' is at best a lie and at worst an attempt to gloss over this fact. Anyway, I will say that the standards of care here in paediatrics are, given the resources available to them, excellent, and that's largely due to Dr. Roubanatou taking no shit and running a phenomenally tight ship. Having spent many a morning in internal medicine sitting around doing nothing while the head of service there sees his private patients until 11am, that lack of organisation is not acceptable. I never thought I'd say this - but I'm actually looking forward to handover meetings when I get back...
Interestingly, in Pédiatrie A, where the highest standards of care are, all treatment is free because the service covers children up to age 2, and until age 5 all medical treatment is free. By contrast in internal medicine, all the patients are paying and are often regulars at the private clinics of the same doctors treating them in hospital - but standards are catastrophically low. Electrolyte levels go unheeded for whole weekends, cardiac arrests are viewed by many as an inconvenience, and too much is treated as "not cardiological" despite this nominally being a general medical service. It's then not properly investigated, worse yet no attempt is made to diagnose it, and they're just referred on to pay a different kind of doctor. Here, a paying service is not only not a better service, it's exponentially worse.
The NHS must not be privatised, ladies and gentlemen. Those say it would mean better care are liars and idiots, and probably have shares in BUPA.
This morning was interesting. Caitlin had expressed an interest in seeing stuff in the hospital when some of the Peace Corps guys and I ran into her and a bunch of other Boston Uni students in a bar, so she came along to ward rounds; we broke from the round part-way through because I thought it'd be good to get her to examine a 10-year-old girl who'd had heart surgery. So she did, and that was great - as you'd perhaps expect, the kid had more signs than you would find in 20 patients back home (central sternotomy scar, 6cm raised jugular venous pressure, heave, ascites, 8cm hepatomegaly, Graham-Steele murmur which I did have to look up) and is a smiley girl. As we went through the exam, mum not unreasonably took the opportunity to ask questions, which was fine, except that they were the sort of questions someone should already have answered. I told her I'd check her daughter's folder more to verify the diagnosis than in any expectation that there'd be any notes in there, and would come back afterwards. She'd had a valve replacement 2 years previously for a congenital mitral stenosis which had gone unnoticed until she'd developed pulmonary hypertension and right heart failure. The op in France was useful in that it had halted the progression of the disease, but none of the existing damage was going to get better.
Entirely reasonably, mother and daughter both wanted to know if she'll be able to go back to school, or if she'll be able to walk 20 metres without getting breathless, or if she's going to *get better*. This is difficult to handle sensitively in a second language without resorting to the short answer to each question, which is "non". I told her that the drugs, we hoped, would improve things, but that the problems with the heart were not going to get better; that the damage there had been done; that there was nothing really that could be done even in France. I didn't dangle the imaginary carrot of a heart-lung transplantation, because it's in practical terms impossible.
Then there was the man who'd been moved to the high dependency unit (four beds within touching distance of one another) when his sodium hit quatre-vingts-treize (93), the woman who died as we did CPR on her waiting for a defibrillator which never came ("there isn't one" "yes there is, it's in A&E" "we can't use that one - it's theirs" etc) and one of the doctors said "it's hardly worth it" as the woman gasped occasionally, and then asked if she could continue the ward round. There was the Bell's palsy which fell between the "cardiology" and the "everything else" chairs, and was sent for a totally pointless CT scan despite the doctor agreeing it was a lower motor neuron lesion, and so on. There have been bright spots: one was the woman who claimed to have met the queen ("she speaks perfect French, Queen Elizabeth"), and Diana, and who shortly after I'd decided she was barking and allowed just a note of sarcasm to creep into my "oh, really?"s turned out to be telling the truth as she was the Belgian ambassador's wife. There there was Ali's wife, who was the first of several friends-of-friends who I was asked to see, and who sweetly but very rapidly irritatingly called me at least twice a day once she got home after I'd seen her to say "I'm in the best of health now". Hadjara, a friend of Alex and Bri's who came in hardly conscious with a raging fever and quite Seriously Unwell, and who I had a short and unsuccessful battle to get checked out for any cause of post-partum abdominal pain bar endometritis, which she in fact had. She got better over a week or so, and I stopped in five or six times to see her and the three or four family members who'd come with her and were sleeping, as she was, on mats, although where she was in a covered corridor, they were under a tree in the yard. All the kids at Hope House were another, that being an orthopaedic rehabilitation centre whose rather cloying name belies the fantastic work they do. I met Jen, the American who runs the care side of things, and her husband Will through Alex and Bri (again) and went out to see what goes on there a couple of times. They have a network of people around the country who identify kids who might benefit from orthopaedic surgery; they then get an assessment and if suitable are offered part-funded surgery. The family have to stump up I think 30,000 CFA (30 quid), with the remaining 90,000CFA+ coming from PRAHN's budget (PRAHN is the organisation which runs Hope House). After the op they then get physio, accommodation, any orthoses they need and general rehab until they're ready to go home and continue exercises independently. THe kids had the usual glee at seeing themselves on a digital camera, and were mostly working hard to get themselves able to walk again or whatever it was. They see a lot of cases of club foot, equinus deformities, windswept and knock-knees, consequences of polio, even one boy whose problems were probably due to sickle cell disease but who was pretty close to a contortionist, so bizarre were his legs, which sloped slowly outwards from lumpy, barely identifiable knees.
Deciding to drink to drink the tap water and to eat food cooked all morning in fire-charred and sun-baked cauldrons which stand in lines at the edges of the huts and which worm-bellied children with thorny sticks beat the goats away from has also been a positive. For 200CFA - 20p - you can get a plate of rice-and-potatoes with a meat and vegetable sauce which is often enough to see you through the day - although I've mixed in some 150CFA brochettes. These are hot, juicy, salty skewers of meat with deceptively spicy 'pimen' which are excellent for keeping your protein levels up without eating the tube-meat. I have eaten other good food here - wonderful thin-crust, crispy pizzas at Caterina's house, vegetarian peanut sauce at Jen and Will's - but stupid though it may sound, I quite like eating on the street. I know I'm still basically a tourist, and so do they - but the first time you order it amuses the women selling it, and the subsequent times they seem genuinely pleased you liked it enough to come back, tourist or no.
Another reason I've enjoyed doing it is that it reveals what nonsense the scare stories are. Yes, you can get terrible bacterial / amoebic / parasitic / etc. illnesses here - but basically only by drinking water straight from the river. An expat who worked at the water purification service reckoned the tests showed it was safer than in the UK, and even when the goats manage to dip their heads into the cauldrons for a second or two, it always has another hour or so's boiling ahead of it. Similarly, before I came out I rather foolishly heeded the tales of how people here will steal anything because they have nothing which I heard and which were repeated in the crappy, ill-informed Bradt guide to Niger. Not once here have I worried about people stealing things. I have been careful who I've told where I'm living when, on a couple of occasions, I haven't wanted impromptu home visits (as when the Man Whose Moto Wasn't Broken basically tailed me back from the hospital asking about my salary), but equally I've left Nigériens alone in the main room of the flat with umpteen small, pocketable objects in view without worrying about it. It seems so absurd that, in a country where everyone, even the man who runs the computer room in the hospital, tells you that you must come and eat when they are eating and you enter the room, and where people you've just met bend over backwards to help you, and where even knowing how to say hello, goodbye and thank you in Djerma or Hausa provokes grins and approving noises - that we Westerners, the poorest of whom is rich beyond most of their imagining, paint them as thieves. Even though I'm six-two and pretty careful, people have tried to steal my phone before in London; my home was broken into twice in four years, and people famously refrain from eye contact on the tube. No stranger has ever offered me food, and our food problems are not those of protein and calorie deficiencies, with famines which cull great swathes of the population every few years and leave the rest emaciated, aching-bellied, but probably still sharing what they have.
I think I will ignore the stories from now on.
The people, then, are the final thing I will miss. TO give perhaps the best example, one of the guys who plays rugby offered to pick me up and take me to training on his motorcycle, so we swapped numbers and sure enough, Djibo did. Even given the lack of helmets, moto is really the only sensible way to get around Niamey - you can manoeuvre more easily around the rain-dug pits in the roads, you stay cool, and you don't get caught in traffic. He then offered to show me the grande mosquée and the grand marché, and called me up to arrange a time, taking his whole saturday to do it and having me round to his one-room home for lunch. Then the following day we rode out to Kouré, an hour or so from Niamey, and home to the last giraffes in West Africa, which it is otherwise impossible to see without a 4x4 hired for tens of thousands of CFA. I had to fight to get him to let me pay for petrol. There are annoying people here, like anywhere - but overwhelmingly - and from what little I've seen it's the case across Africa - the people, who have nothing, don't therefore want to steal from those who do. Instead, they want to talk to you, to find out what you're doing in their country, to show you the country they live in, to share their food and their culture with you, and they do so by and large while asking nothing in return. So while I perhaps won't miss the medicine, I will miss the people and their generosity both.
Barring something spectacular happening (or my flight being cancelled) I plan to spend my time in Senegal setting Africa to rights with Toyin and Liz, largely on the beach and hopefully with a cocktail of some sort, so I don't anticipate writing any more from there. I will finish one rather dry post of facts and figures which will appear before this chronologically, and may add one with links to photo albums, but this is the last of the genuine missives from Niger.
Normal service will shortly be resumed.
Well, I have 7 days left, or slightly under, as by this time next week I will probably be touching down in Bamako on the first of the four stops before London. They are the aforementioned Bamako for "technical reasons", as my e-ticket prophetically informs me (I'm still torn between being reassured that problems have been predicted and unsettled by their predictability). The second is Dakar some two hours later, where I'm meeting Toyin and Liz; the third, on the 29th September, is Casablanca, where if the outbound flight is any indication I will spend several more than the two hours I'm scheduled to spend there and will meet someone who will be central to my social life for the next two months, and finally London itself.
To answer the question you would ask if you were here: yes, I am ready to leave. Caitlin (Nigérien name: Yakalu), who's a Canadian Boston University student doing premed there who's in Niamey for four months of language and cultural studies, and who I showed round the hospital this morning, asked at lunch whether I'd stay if I could, which I thought was much harder-to-answer and therefore better way of putting the question. I said 'no' with a speed that surprised me. I could do another couple of weeks in paeds - but even there, where they make an effort, my education would suffer from the overall lack of teaching, and I miss UK *standards*. They have standards here, of course, and I am about to go right ahead and judge them, as ultimately I'm out here and while I may only be a medical student and only essentially a tourist and blah, I believe that not only does that mean I am entitled to judge them, but that it also means that in some ways I must. The "you shouldn't travel to the developing world and *judge* them" is crap - if you come out to the third world and have standards of your own, you have to judge what you find here by those standards. If you can look at the 1 in 4 children who die before age 5 here and call that unacceptable, so too can you look at, for instance, the standards of care in hospitals and call them unacceptable. Of course, in terms of writing elective portfolios, doing one gets you marks and doing the other attracts accusations of arrogant colonialist medical students from a failed sociology student who has never heard of post-colonialism and who would cast my use of 'the third world' in the same light despite the fact that Niger, at least, is not developing in any meaningful way, so 'developing' is at best a lie and at worst an attempt to gloss over this fact. Anyway, I will say that the standards of care here in paediatrics are, given the resources available to them, excellent, and that's largely due to Dr. Roubanatou taking no shit and running a phenomenally tight ship. Having spent many a morning in internal medicine sitting around doing nothing while the head of service there sees his private patients until 11am, that lack of organisation is not acceptable. I never thought I'd say this - but I'm actually looking forward to handover meetings when I get back...
Interestingly, in Pédiatrie A, where the highest standards of care are, all treatment is free because the service covers children up to age 2, and until age 5 all medical treatment is free. By contrast in internal medicine, all the patients are paying and are often regulars at the private clinics of the same doctors treating them in hospital - but standards are catastrophically low. Electrolyte levels go unheeded for whole weekends, cardiac arrests are viewed by many as an inconvenience, and too much is treated as "not cardiological" despite this nominally being a general medical service. It's then not properly investigated, worse yet no attempt is made to diagnose it, and they're just referred on to pay a different kind of doctor. Here, a paying service is not only not a better service, it's exponentially worse.
The NHS must not be privatised, ladies and gentlemen. Those say it would mean better care are liars and idiots, and probably have shares in BUPA.
This morning was interesting. Caitlin had expressed an interest in seeing stuff in the hospital when some of the Peace Corps guys and I ran into her and a bunch of other Boston Uni students in a bar, so she came along to ward rounds; we broke from the round part-way through because I thought it'd be good to get her to examine a 10-year-old girl who'd had heart surgery. So she did, and that was great - as you'd perhaps expect, the kid had more signs than you would find in 20 patients back home (central sternotomy scar, 6cm raised jugular venous pressure, heave, ascites, 8cm hepatomegaly, Graham-Steele murmur which I did have to look up) and is a smiley girl. As we went through the exam, mum not unreasonably took the opportunity to ask questions, which was fine, except that they were the sort of questions someone should already have answered. I told her I'd check her daughter's folder more to verify the diagnosis than in any expectation that there'd be any notes in there, and would come back afterwards. She'd had a valve replacement 2 years previously for a congenital mitral stenosis which had gone unnoticed until she'd developed pulmonary hypertension and right heart failure. The op in France was useful in that it had halted the progression of the disease, but none of the existing damage was going to get better.
Entirely reasonably, mother and daughter both wanted to know if she'll be able to go back to school, or if she'll be able to walk 20 metres without getting breathless, or if she's going to *get better*. This is difficult to handle sensitively in a second language without resorting to the short answer to each question, which is "non". I told her that the drugs, we hoped, would improve things, but that the problems with the heart were not going to get better; that the damage there had been done; that there was nothing really that could be done even in France. I didn't dangle the imaginary carrot of a heart-lung transplantation, because it's in practical terms impossible.
Then there was the man who'd been moved to the high dependency unit (four beds within touching distance of one another) when his sodium hit quatre-vingts-treize (93), the woman who died as we did CPR on her waiting for a defibrillator which never came ("there isn't one" "yes there is, it's in A&E" "we can't use that one - it's theirs" etc) and one of the doctors said "it's hardly worth it" as the woman gasped occasionally, and then asked if she could continue the ward round. There was the Bell's palsy which fell between the "cardiology" and the "everything else" chairs, and was sent for a totally pointless CT scan despite the doctor agreeing it was a lower motor neuron lesion, and so on. There have been bright spots: one was the woman who claimed to have met the queen ("she speaks perfect French, Queen Elizabeth"), and Diana, and who shortly after I'd decided she was barking and allowed just a note of sarcasm to creep into my "oh, really?"s turned out to be telling the truth as she was the Belgian ambassador's wife. There there was Ali's wife, who was the first of several friends-of-friends who I was asked to see, and who sweetly but very rapidly irritatingly called me at least twice a day once she got home after I'd seen her to say "I'm in the best of health now". Hadjara, a friend of Alex and Bri's who came in hardly conscious with a raging fever and quite Seriously Unwell, and who I had a short and unsuccessful battle to get checked out for any cause of post-partum abdominal pain bar endometritis, which she in fact had. She got better over a week or so, and I stopped in five or six times to see her and the three or four family members who'd come with her and were sleeping, as she was, on mats, although where she was in a covered corridor, they were under a tree in the yard. All the kids at Hope House were another, that being an orthopaedic rehabilitation centre whose rather cloying name belies the fantastic work they do. I met Jen, the American who runs the care side of things, and her husband Will through Alex and Bri (again) and went out to see what goes on there a couple of times. They have a network of people around the country who identify kids who might benefit from orthopaedic surgery; they then get an assessment and if suitable are offered part-funded surgery. The family have to stump up I think 30,000 CFA (30 quid), with the remaining 90,000CFA+ coming from PRAHN's budget (PRAHN is the organisation which runs Hope House). After the op they then get physio, accommodation, any orthoses they need and general rehab until they're ready to go home and continue exercises independently. THe kids had the usual glee at seeing themselves on a digital camera, and were mostly working hard to get themselves able to walk again or whatever it was. They see a lot of cases of club foot, equinus deformities, windswept and knock-knees, consequences of polio, even one boy whose problems were probably due to sickle cell disease but who was pretty close to a contortionist, so bizarre were his legs, which sloped slowly outwards from lumpy, barely identifiable knees.
Deciding to drink to drink the tap water and to eat food cooked all morning in fire-charred and sun-baked cauldrons which stand in lines at the edges of the huts and which worm-bellied children with thorny sticks beat the goats away from has also been a positive. For 200CFA - 20p - you can get a plate of rice-and-potatoes with a meat and vegetable sauce which is often enough to see you through the day - although I've mixed in some 150CFA brochettes. These are hot, juicy, salty skewers of meat with deceptively spicy 'pimen' which are excellent for keeping your protein levels up without eating the tube-meat. I have eaten other good food here - wonderful thin-crust, crispy pizzas at Caterina's house, vegetarian peanut sauce at Jen and Will's - but stupid though it may sound, I quite like eating on the street. I know I'm still basically a tourist, and so do they - but the first time you order it amuses the women selling it, and the subsequent times they seem genuinely pleased you liked it enough to come back, tourist or no.
Another reason I've enjoyed doing it is that it reveals what nonsense the scare stories are. Yes, you can get terrible bacterial / amoebic / parasitic / etc. illnesses here - but basically only by drinking water straight from the river. An expat who worked at the water purification service reckoned the tests showed it was safer than in the UK, and even when the goats manage to dip their heads into the cauldrons for a second or two, it always has another hour or so's boiling ahead of it. Similarly, before I came out I rather foolishly heeded the tales of how people here will steal anything because they have nothing which I heard and which were repeated in the crappy, ill-informed Bradt guide to Niger. Not once here have I worried about people stealing things. I have been careful who I've told where I'm living when, on a couple of occasions, I haven't wanted impromptu home visits (as when the Man Whose Moto Wasn't Broken basically tailed me back from the hospital asking about my salary), but equally I've left Nigériens alone in the main room of the flat with umpteen small, pocketable objects in view without worrying about it. It seems so absurd that, in a country where everyone, even the man who runs the computer room in the hospital, tells you that you must come and eat when they are eating and you enter the room, and where people you've just met bend over backwards to help you, and where even knowing how to say hello, goodbye and thank you in Djerma or Hausa provokes grins and approving noises - that we Westerners, the poorest of whom is rich beyond most of their imagining, paint them as thieves. Even though I'm six-two and pretty careful, people have tried to steal my phone before in London; my home was broken into twice in four years, and people famously refrain from eye contact on the tube. No stranger has ever offered me food, and our food problems are not those of protein and calorie deficiencies, with famines which cull great swathes of the population every few years and leave the rest emaciated, aching-bellied, but probably still sharing what they have.
I think I will ignore the stories from now on.
The people, then, are the final thing I will miss. TO give perhaps the best example, one of the guys who plays rugby offered to pick me up and take me to training on his motorcycle, so we swapped numbers and sure enough, Djibo did. Even given the lack of helmets, moto is really the only sensible way to get around Niamey - you can manoeuvre more easily around the rain-dug pits in the roads, you stay cool, and you don't get caught in traffic. He then offered to show me the grande mosquée and the grand marché, and called me up to arrange a time, taking his whole saturday to do it and having me round to his one-room home for lunch. Then the following day we rode out to Kouré, an hour or so from Niamey, and home to the last giraffes in West Africa, which it is otherwise impossible to see without a 4x4 hired for tens of thousands of CFA. I had to fight to get him to let me pay for petrol. There are annoying people here, like anywhere - but overwhelmingly - and from what little I've seen it's the case across Africa - the people, who have nothing, don't therefore want to steal from those who do. Instead, they want to talk to you, to find out what you're doing in their country, to show you the country they live in, to share their food and their culture with you, and they do so by and large while asking nothing in return. So while I perhaps won't miss the medicine, I will miss the people and their generosity both.
Barring something spectacular happening (or my flight being cancelled) I plan to spend my time in Senegal setting Africa to rights with Toyin and Liz, largely on the beach and hopefully with a cocktail of some sort, so I don't anticipate writing any more from there. I will finish one rather dry post of facts and figures which will appear before this chronologically, and may add one with links to photo albums, but this is the last of the genuine missives from Niger.
Normal service will shortly be resumed.
Monday, 3 September 2007
Weddings, boiled leaves, and the only civilian rugby team in Niger.
My third weekend in Niger - and yes, this was now a little while ago - was the product of a series of improbable events. On the way to Garbey-Kourou, one of the people I got talking to during the long wait for a taxi-brousse to leave for the ferry was a guy called Issa, who was friendly in a refreshingly quiet way. Where the kids began by behaving towards me as if I were a sort of walking cash machine, and behaving themselves much like the crowbars needed to get into it, Issa was just pleasant, interested in what I was doing, and we talked briefly about the (benign) lump in his right forearm. He said he was coming in to the National Hospital to have it looked at, so I have him my number and talk him to call me when he did if he felt like it.
Which he did, and we had tea when he came in, and he said that I would have to meet his family. This invitation came sooner than I'd expected when he invited me to his younger sister's wedding that saturday. I ummed and ahhed about it for a while, not
being sure if it'd be weird being the only white person there and, indeed, not having met bride or groom - but in the end, saturday morning saw me up at 6am on my second successive trip out of Niamey.
Unlike the Tillabéri road to Garbey-Kourou, however, this one was largely intact barring the potholes which are a feature of every road here except the three bearing signs explaining that the European Union Has Resurfaced This Road For Your Safety and Comfort. Noble sentiments, except that in Nigérien this evidently translates from French to French roughly as "No potholes. Drive as fast as you can." Things did get a little squashed in the taxi when the fifth person got into the back seat on his wife's lap (this was undoubtedly the best way of doing things given the size of his wife's lap); this made eight of us in the car in total, but all in all it wasn't a bad trip.
Issa met me out of the taxi at Sudarey, his village, and after a whirlwind of meeting his sister's and the groom's large extended family in the space of about fifteen minutes, and having all of them pose for photos, we went to the ceremony. This started around 8am, and was held outside under a large thatched roof which was evidently the village meeting area. Neither bride nor groom was present, and while at a UK wedding this is normally an extremely bad sign, it is apparently the norm here, where wedding ceremonies consist of negotiations between the two families, and are sealed before a large crowd of witnesses with the handout of dates to all present (dates here are, like pretty much everything, very tasty but different - they are a little like soft nuts, and need to be checked for small bugs before eating them). I
continued my role as a sort of additional photographer, and as ever the children all wanted to see themselves on the camera - as, come to that, did many of the adults...You may or may not be able to see more photos here.
It was also the second occasion on which I got to eat boiled leaves, a delicacy I first encountered in Garbey-Kourou. During the rainy season, lots of plants spring temporarily to life in the desert and, being both resourceful and perenially hungry, the locals collect their leaves and boil them. Hence the, er, name. Happily, they add a sauce made from ground peanuts, salt, and spices, and they are thus surprisingly good, even when you eat them from a shared bowl with a group of people you've just met. With your hands. It is not hard to see why infection control is a problem here.
I felt part of the day in a way I hadn't expected to, anyway, and the whole thing was an example of Nigériens being welcoming well above and beyond the call of duty.
That afternoon, back in Niamey, it was time for Curious Happening 2. Before coming here, I'd asked pretty much all my friends if they knew anyone who'd been here. Only one - Isanna - replied, saying that she thought her boyfriend Alex knew someone. Sure enough, Alex's friend Nicola had been here - but had now moved on, so he gave me lots of useful advice (well, the thing you really need to do is to see the North, but of course you can't at the moment because of the rebellion and the mines) and the e-mails of Baptiste and Caterina who were still here. So it was that I met Baptiste one evening and explained that effectively he was a friend's boyfriend's friend's friend, and that it was pretty nice of him to ask me around. He's been really helpful - I've been drinking the Niamey water (i.e. tap water) since week two because he reassured me that he'd seen the test results and it was probably safer than in the UK, except after heavy rain when it goes a bit muddy - and when the conversation turned to the World Cup, he mentioned that an Italian friend of his, Lorenzo, played for one of the two teams here in Niger (the other being the army team). So I called Lorenzo (my friend's boyfriend's friend's - never mind), and headed out to the national stadium on saturday afternoon to train with the only civilian rugby team in Niger.
Sadly we weren't actually in the national stadium, but the training was fun - lots of touch rugby with about 20 Nigériens, a handful of expats, and three French nursing students who had just finished a few weeks out in Zinder. The Nigériens were all fit as the proverbial butcher's dog, and one six-foot six monster later turned out to be both a 2nd row and a three-times national boxing champion; happily I was very nice to him on the pitch. Afterwards, one of the team got the French students and I in to the national stadium, where we obviously ran a 100m race which was won by a Nigérien who started about three metres behind the rest of us but was training there when we arrived. I finished a respectable third. We collectively bottled the weightlifting component of the national games, however...
Monday, 27 August 2007
Internal medicine, begging, and cooking dinner
Monday 27th August
Today I started médecine internale, which I had assumed would be the equivalent of general medicine in the UK. How wrong I was. In fact, it seems to be shorthand for neurology / cardiology / whateverthehellshowsupology. Which is fun - and it's quite a relief seeing signs again which aren't just you pinching their tummies and watching the skin fold staying up for about forty minutes because they're so dehydrated. You will be relieved to hear that I pinched not one adult's tummy during today's proceedings.
They have a lot of stroke patients, oddly enough - one tetraplegic who cheerily responded "very well" to the three doctors who asked how he was - and a woman who was in the middle of what I will bet good money was a pretty hefty pulmonary embolism; I will find out tomorrow, I suppose. The head honcho here being a cardiologist, there were also lots of ECGs and a doctor on the ward round who was great at teaching me as we want round, and I think my ECG expertise impressed him at least a bit. It certainly impressed me - I successfully spotted the reverse tick sign of digoxin therapy. Although I was only able to explain this with the aid of diagrams, as I wasn't sure of the French for anything needed to explain it bar 'digoxin' and 'ECG'.
Today was also the day I finally had it with the people here. I've got used to the kids whose only English is "Donne-moi un cadeau!"; I now just go for a curt "non" and then walk briskly off swearing to myself in English and wondering why they feel that tu-toyer-ing me is a good idea in this situation. This afternoon, though, some guy wanders up to me and asks if I remember him. Thinking he might be some shopkeeper I hadn't recalled talking to, I admitted I didn't, and he said oh, I work with you at the hospital! So this is fine, and we get chatting as I'm walking home. Then he drops in that his bike is broken and is at the workshop - and could he borrow 1,000 Central African Francs (CFA) to pay the mechanic. There follows a long and involved discussion of how he lives a long way away and will bring the money to the hospital tomorrow; I show him that I'm only carrying 2000 CFA and say I need them tonight, blah blah blah. I'm obviously reluctant to lend him the money, so he gets a bit shrill - "ah, if you need all this money to eat tonight, then you can't help me now I've broken down". I get a bit pissed off at this point and suggest he ask the mechanic if he can bring the money back to him. He says he doesn't think so. I say, well let's go and see the mechanic. He says, okay.
But then we get ten yards down the road and he changes his mind - perhaps he can borrow a motorbike from one of his friends and go home for the money.
Perhaps you can, sunshine.
The kids are one thing - they've grown up in an environment where looking sweet and asking for presents is, by and large, financially rewarding. They don't, by and large, know any better, and actually the Western governments which pour money into aid work which doesn't attempt to help them work - and probably I'm including a lot of medical aid work in this category - and the tourists who hand out pens and books and candy, are at least as blameworthy as the kids. Adults who lie to you, though, are a different breed.
So still not all sweetness and light, but I had four of Peace Corps lot round for dinner on saturday which was fun. Not exactly haute cuisine, but an interesting bunch - an Iraq vet who's off to NYC to talk about agriculture at a veterans' convention, two vegetarians who'd been living on a commune in Virginia before coming out here, and the last called Lulu - and cooking made the place feel quite homely. And I think the medicine's going to be easier and more varied from here on in...
Today I started médecine internale, which I had assumed would be the equivalent of general medicine in the UK. How wrong I was. In fact, it seems to be shorthand for neurology / cardiology / whateverthehellshowsupology. Which is fun - and it's quite a relief seeing signs again which aren't just you pinching their tummies and watching the skin fold staying up for about forty minutes because they're so dehydrated. You will be relieved to hear that I pinched not one adult's tummy during today's proceedings.
They have a lot of stroke patients, oddly enough - one tetraplegic who cheerily responded "very well" to the three doctors who asked how he was - and a woman who was in the middle of what I will bet good money was a pretty hefty pulmonary embolism; I will find out tomorrow, I suppose. The head honcho here being a cardiologist, there were also lots of ECGs and a doctor on the ward round who was great at teaching me as we want round, and I think my ECG expertise impressed him at least a bit. It certainly impressed me - I successfully spotted the reverse tick sign of digoxin therapy. Although I was only able to explain this with the aid of diagrams, as I wasn't sure of the French for anything needed to explain it bar 'digoxin' and 'ECG'.
Today was also the day I finally had it with the people here. I've got used to the kids whose only English is "Donne-moi un cadeau!"; I now just go for a curt "non" and then walk briskly off swearing to myself in English and wondering why they feel that tu-toyer-ing me is a good idea in this situation. This afternoon, though, some guy wanders up to me and asks if I remember him. Thinking he might be some shopkeeper I hadn't recalled talking to, I admitted I didn't, and he said oh, I work with you at the hospital! So this is fine, and we get chatting as I'm walking home. Then he drops in that his bike is broken and is at the workshop - and could he borrow 1,000 Central African Francs (CFA) to pay the mechanic. There follows a long and involved discussion of how he lives a long way away and will bring the money to the hospital tomorrow; I show him that I'm only carrying 2000 CFA and say I need them tonight, blah blah blah. I'm obviously reluctant to lend him the money, so he gets a bit shrill - "ah, if you need all this money to eat tonight, then you can't help me now I've broken down". I get a bit pissed off at this point and suggest he ask the mechanic if he can bring the money back to him. He says he doesn't think so. I say, well let's go and see the mechanic. He says, okay.
But then we get ten yards down the road and he changes his mind - perhaps he can borrow a motorbike from one of his friends and go home for the money.
Perhaps you can, sunshine.
The kids are one thing - they've grown up in an environment where looking sweet and asking for presents is, by and large, financially rewarding. They don't, by and large, know any better, and actually the Western governments which pour money into aid work which doesn't attempt to help them work - and probably I'm including a lot of medical aid work in this category - and the tourists who hand out pens and books and candy, are at least as blameworthy as the kids. Adults who lie to you, though, are a different breed.
So still not all sweetness and light, but I had four of Peace Corps lot round for dinner on saturday which was fun. Not exactly haute cuisine, but an interesting bunch - an Iraq vet who's off to NYC to talk about agriculture at a veterans' convention, two vegetarians who'd been living on a commune in Virginia before coming out here, and the last called Lulu - and cooking made the place feel quite homely. And I think the medicine's going to be easier and more varied from here on in...
Sunday, 26 August 2007
Semi-conferences and past lives
Saturday 26th August
Today I came into the hospital for 8am on a saturday morning for some nebulous affair which the Big Boss informed us was a three-line whip affair (not in so many words, obviously, as I don't think that translates into French). Doing ward rounds with Drs. Abdou and Fifi was quite pleasant, but at 9 we were summoned to the meeting room, where a lot of abnormally well-turned out doctors were lounging around. Of the qualified doctors, only Dr. Abdou was dressed as he normally is, and we were in fact late as when we were initially summoned he had growled "we'll finish this ward".
We then sat in the meeting room. Until 10am, when a portly man in oversized glasses and his nervous-looking sidekick showed up and began setting up a computer; I say began because the projector was projecting precisely nothing, and the two of them and the Big Boss sat looking confusedly at it and the computer in turn. So I trudged up and, with a definite sinking feeling, turned the laptop on. The Big Boss then refused to let me plug the projector back in, saying urgently that we needed to wait! So I did, and lo and behold, it worked. I sat down.
Over the next 45 minutes, I kept having to go up to the computer, first because they couldn't get the USB key to work. Then the images were missing from it (not much I could do about that one). Then they couldn't get the file to open. I tried everything, buoyed by the Big Boss' invaluable supporting monologue, which consisted largely of telling me to do things I had just finished, telling me what to do on screens I am quite sure she had never seen before, or explaining very slowly such technological intricacies as the loading-progress bar to me (apparently, it tells you how loading is progressing, astonishingly). It was a total joy.
Ultimately, despite the benefit of her vast expertise, the plump man and his sidekick gave their talk without the slides, and everyone sat in the room for two hours to hear a fifteen minute presentation without even any bloody pictures. It made me positively nostalgic for the conference, let me tell you...
Today I came into the hospital for 8am on a saturday morning for some nebulous affair which the Big Boss informed us was a three-line whip affair (not in so many words, obviously, as I don't think that translates into French). Doing ward rounds with Drs. Abdou and Fifi was quite pleasant, but at 9 we were summoned to the meeting room, where a lot of abnormally well-turned out doctors were lounging around. Of the qualified doctors, only Dr. Abdou was dressed as he normally is, and we were in fact late as when we were initially summoned he had growled "we'll finish this ward".
We then sat in the meeting room. Until 10am, when a portly man in oversized glasses and his nervous-looking sidekick showed up and began setting up a computer; I say began because the projector was projecting precisely nothing, and the two of them and the Big Boss sat looking confusedly at it and the computer in turn. So I trudged up and, with a definite sinking feeling, turned the laptop on. The Big Boss then refused to let me plug the projector back in, saying urgently that we needed to wait! So I did, and lo and behold, it worked. I sat down.
Over the next 45 minutes, I kept having to go up to the computer, first because they couldn't get the USB key to work. Then the images were missing from it (not much I could do about that one). Then they couldn't get the file to open. I tried everything, buoyed by the Big Boss' invaluable supporting monologue, which consisted largely of telling me to do things I had just finished, telling me what to do on screens I am quite sure she had never seen before, or explaining very slowly such technological intricacies as the loading-progress bar to me (apparently, it tells you how loading is progressing, astonishingly). It was a total joy.
Ultimately, despite the benefit of her vast expertise, the plump man and his sidekick gave their talk without the slides, and everyone sat in the room for two hours to hear a fifteen minute presentation without even any bloody pictures. It made me positively nostalgic for the conference, let me tell you...
Tuesday, 21 August 2007
Sweetness and light
I am about two weeks behind. The Garbey-Kourou post, and indeed the details of last weekend, are still brewing.
However, I sort of reached my ghastliness limit today, so this will be rather less an amusing things which have happened to me in Niamey which may or may not have involved my nearly blowing myself up type missive. So skip it if you've just got engaged or something, hey?
The ward round this morning started badly. The first patient was a girl at the upper end of our limits - nearly two, and had been admitted overnight with rampant cerebral malaria: she just lay there with her eyes half-open and rolled up slightly into her head. She didn't respond to being spoken to, shaken gently, or to pain (you can press over the eyebrows or the sternum). Her pupils were dilated and slow to constrict when I shone a torch in them. She had bloody diarrhoea. She was dehydrated (but then they all are). Even Dr. Abdou, who normally takes things in his white-capped, funny-pointy-bearded stride, muttered darkly, "c'est grave, ça" several times. The rest of the new patients all have a decent chance - there was one boy with malaria who'd had a brother who'd died at roughly his age from "a febrile illness" who didn't look very well and weighed 6.5kgs at age 2, but no one else in extremis. I left as Dr. Abdou and the final-year student were finishing some paperwork in the admissions ward and went on to the neonates.
The first baby there was a five-day old boy who'd been born prematurely (they *never* know exactly how early here, but I'd guess not too bad - 32 weeks or so?) whose mother was lying on the bed by him. He looked a little grey. He was not obviously breathing.
I checked. He wasn't breathing, and nor did he have a pulse.
The team took it pretty much in their stride. I was expecting at least some attempt to revive him - but no. I guess the resources just aren't there to resuscitate them, and here it is a big deal, of course, but people are used to death. Mum didn't cry; she and the family all had black headscarves on (they cover only the head, not the face, here) within ten minutes, but they were efficient and dignified, even, in the way they dealt with it.
The notes showed that the nursing staff had noted that he was breathing 12 times a minute and had a pulse of 60 since 2130 monday night. This is normal in an adult - but desperately, immediately life-threateningly low in any child under a year, and particularly in a neonate, where a normal respiratory rate is 30-60 and heartrate 120-160. They had conscientously recorded two more readings through the night, both basically the same, with the last about half an hour before we'd got there. The nurse got an absolute bollocking from the Dr. Roubanatou (the big boss) later, not that it helped the kid much.
Then the next child had spina bifida with a lump almost as big as his head on his back and no ability to move his legs, and in the next room there was a baby who wasn't that ill but whose mother looked like something out a horror movie - she shambled in covered in these circular lesions, coughing blood, and with her lips basically wrecked coughing blood onto her scarf sporadically. Apparently she's HIV positive and had got Stevens-Johnson syndrome in response to some of the drugs; I have no idea of the kid's status, but thankfully she isn't breastfeeding and wouldn't be able to even if she wanted to in the state she's in.
The only positive thing was that the little boy with tetanus looks like he's pulling through.
And I'm sick of being asked for money, although on the walk here tonight two boys carrying water got talking to me and taught me some Djerma, then left without asking for anything, so I bought them pains au chocolat from the patisserie. If the biblical storm last night was a harbinger of today, I am taking this as a sign that tomorrow will be better.
However, I sort of reached my ghastliness limit today, so this will be rather less an amusing things which have happened to me in Niamey which may or may not have involved my nearly blowing myself up type missive. So skip it if you've just got engaged or something, hey?
The ward round this morning started badly. The first patient was a girl at the upper end of our limits - nearly two, and had been admitted overnight with rampant cerebral malaria: she just lay there with her eyes half-open and rolled up slightly into her head. She didn't respond to being spoken to, shaken gently, or to pain (you can press over the eyebrows or the sternum). Her pupils were dilated and slow to constrict when I shone a torch in them. She had bloody diarrhoea. She was dehydrated (but then they all are). Even Dr. Abdou, who normally takes things in his white-capped, funny-pointy-bearded stride, muttered darkly, "c'est grave, ça" several times. The rest of the new patients all have a decent chance - there was one boy with malaria who'd had a brother who'd died at roughly his age from "a febrile illness" who didn't look very well and weighed 6.5kgs at age 2, but no one else in extremis. I left as Dr. Abdou and the final-year student were finishing some paperwork in the admissions ward and went on to the neonates.
The first baby there was a five-day old boy who'd been born prematurely (they *never* know exactly how early here, but I'd guess not too bad - 32 weeks or so?) whose mother was lying on the bed by him. He looked a little grey. He was not obviously breathing.
I checked. He wasn't breathing, and nor did he have a pulse.
The team took it pretty much in their stride. I was expecting at least some attempt to revive him - but no. I guess the resources just aren't there to resuscitate them, and here it is a big deal, of course, but people are used to death. Mum didn't cry; she and the family all had black headscarves on (they cover only the head, not the face, here) within ten minutes, but they were efficient and dignified, even, in the way they dealt with it.
The notes showed that the nursing staff had noted that he was breathing 12 times a minute and had a pulse of 60 since 2130 monday night. This is normal in an adult - but desperately, immediately life-threateningly low in any child under a year, and particularly in a neonate, where a normal respiratory rate is 30-60 and heartrate 120-160. They had conscientously recorded two more readings through the night, both basically the same, with the last about half an hour before we'd got there. The nurse got an absolute bollocking from the Dr. Roubanatou (the big boss) later, not that it helped the kid much.
Then the next child had spina bifida with a lump almost as big as his head on his back and no ability to move his legs, and in the next room there was a baby who wasn't that ill but whose mother looked like something out a horror movie - she shambled in covered in these circular lesions, coughing blood, and with her lips basically wrecked coughing blood onto her scarf sporadically. Apparently she's HIV positive and had got Stevens-Johnson syndrome in response to some of the drugs; I have no idea of the kid's status, but thankfully she isn't breastfeeding and wouldn't be able to even if she wanted to in the state she's in.
The only positive thing was that the little boy with tetanus looks like he's pulling through.
And I'm sick of being asked for money, although on the walk here tonight two boys carrying water got talking to me and taught me some Djerma, then left without asking for anything, so I bought them pains au chocolat from the patisserie. If the biblical storm last night was a harbinger of today, I am taking this as a sign that tomorrow will be better.
Wednesday, 15 August 2007
Bad days
15th August
For the last 24 hours, my pleasant life in Niamey has been teetering on the brink of oblivion in a variety of ways, only one literal. First, I woke up with a cold on monday, probably caught from one of the bronchiolitic kids. This is not fun in any situation, and especially not so when there are very few toilets and certainly no toilet paper in the hospital. In a climate where the average temperature this week has been 23-26 degrees at night and 32-35 during the day, with humidity anywhere from 60-90%, it's absolutely absurd to be sneezing and sniffling.
In additiion, on sunday night my gas cylinder ran out as I was trying to boil a few day's worth of eggs, so on monday evening I lugged it down to the nearest roadside purveyor of rusty metal canisters full of butane - here, those Laurel & Hardy Glasgow terrorists might have been able to blow something up other than themselves - and swapped it for a full one. I then carted the full one (which was heavier) all the way back...and couldn't get the regulator which connects it to the oven to screw onto the cylinder. So monday's dinner was cold potatoes from the previous night and tomatoes.
Even worse, now that I had a cold I couldn't boil water for tea in the morning, so I decided to make up for this by having a mango for breakfast instead. It had black bits in and I had to throw two-thirds of it out. Then on the way to hospital on tuesday morning I got caught in a torrential downpour which laughed at my waterproof as it drenched me and the contents of my bag, including my British National Formulary, my French dictionary, and my Hausa notebook (which is admittedly in its infancy). Only the leather-bound notebook Al Walmsley gave me, which I'm writing in now, survived relatively unscathed.
The rain continued in more or less half-hearted fashion until the afternoon, and meant that there were no new patients on the wards (as most won't walk in if it's raining, and can't get in from the villages if the roads are flooded). I therefore devoted the afternoon to getting the gas working - so I carried the new cylinder back to the stall to swap it...but they'd run out of full cylinders, so instead I forked out for a whole new regulator. Back at the apartment, I enlisted the help of the guard from across the street to install it, and we got it working.
So I decided to celebrate by making tea, and found that I couldn't get the valve on the tank open - he'd closed it too tightly. Swallowing my pride, therefore, I went and found him again and explained that I was too puny to open it. Laughingly, he came to open it again, and gratifyingly completely failed to, even with the teatowel I'd already tried. So he took it off, inflicted untold brutality on it elsewhere, and came back with it openable. Now, however, there was an unsettling hissing noise from around the new regulator - so before I made tea (to celebrate), I did as he'd suggested and held a match near the regulator to check for leaks.
It caught fire.
Happily, after one attempt to blow it out which I can only describe as - well - a bit Laurel & Hardy - I remembered that turning the gas off at the valve would probably be a better idea. The unpleasant realisation that I'd just been in a room with a burning canister of explosive gas was bad enough - and the plastics stuff I saw on burns victims in Addis Ababa, for all that they were mostly due to kerosene stoves, meant I was fully aware of how nasty it could have been. However, the overriding emotion was despondency - I'd thrown basically two whole afternoons and about 10,000CFA at something as simple as being able to boil water, and had got closer to blowing myself up than making a cup of tea. Back home if I can't boil water in an electric kettle, I boil it in a pan on the hob; if I can't boil it there someone needs to pay the gas bill. It's a much simpler, and markedly less explosive, equation.
Anyway, I explained this to the bloke at the gas stall who, having been a bit intolerant of the useless whiteboy previously, softened somewhat, and told me to bring the whole thing back. "I myself have seen two of these new regulators do this - bring the whole thing tomorrow; there is a man here who is very good at setting these up, and we'll sort it out. But you mustn't use it in the meantime!" Encouraged by his newfound graciousness if not by the fact that he was selling the gas canister equivalent of driver's side ejector seats for cars, I came home and have just had part of a baguette with tomato, cucumber, and a meat pâté which smelt slightly like dogfood, and a cold beer, all of which have improved the situation enormously.
But if the fridge packs up, I will officially have Had Enough.
For the last 24 hours, my pleasant life in Niamey has been teetering on the brink of oblivion in a variety of ways, only one literal. First, I woke up with a cold on monday, probably caught from one of the bronchiolitic kids. This is not fun in any situation, and especially not so when there are very few toilets and certainly no toilet paper in the hospital. In a climate where the average temperature this week has been 23-26 degrees at night and 32-35 during the day, with humidity anywhere from 60-90%, it's absolutely absurd to be sneezing and sniffling.
In additiion, on sunday night my gas cylinder ran out as I was trying to boil a few day's worth of eggs, so on monday evening I lugged it down to the nearest roadside purveyor of rusty metal canisters full of butane - here, those Laurel & Hardy Glasgow terrorists might have been able to blow something up other than themselves - and swapped it for a full one. I then carted the full one (which was heavier) all the way back...and couldn't get the regulator which connects it to the oven to screw onto the cylinder. So monday's dinner was cold potatoes from the previous night and tomatoes.
Even worse, now that I had a cold I couldn't boil water for tea in the morning, so I decided to make up for this by having a mango for breakfast instead. It had black bits in and I had to throw two-thirds of it out. Then on the way to hospital on tuesday morning I got caught in a torrential downpour which laughed at my waterproof as it drenched me and the contents of my bag, including my British National Formulary, my French dictionary, and my Hausa notebook (which is admittedly in its infancy). Only the leather-bound notebook Al Walmsley gave me, which I'm writing in now, survived relatively unscathed.
The rain continued in more or less half-hearted fashion until the afternoon, and meant that there were no new patients on the wards (as most won't walk in if it's raining, and can't get in from the villages if the roads are flooded). I therefore devoted the afternoon to getting the gas working - so I carried the new cylinder back to the stall to swap it...but they'd run out of full cylinders, so instead I forked out for a whole new regulator. Back at the apartment, I enlisted the help of the guard from across the street to install it, and we got it working.
So I decided to celebrate by making tea, and found that I couldn't get the valve on the tank open - he'd closed it too tightly. Swallowing my pride, therefore, I went and found him again and explained that I was too puny to open it. Laughingly, he came to open it again, and gratifyingly completely failed to, even with the teatowel I'd already tried. So he took it off, inflicted untold brutality on it elsewhere, and came back with it openable. Now, however, there was an unsettling hissing noise from around the new regulator - so before I made tea (to celebrate), I did as he'd suggested and held a match near the regulator to check for leaks.
It caught fire.
Happily, after one attempt to blow it out which I can only describe as - well - a bit Laurel & Hardy - I remembered that turning the gas off at the valve would probably be a better idea. The unpleasant realisation that I'd just been in a room with a burning canister of explosive gas was bad enough - and the plastics stuff I saw on burns victims in Addis Ababa, for all that they were mostly due to kerosene stoves, meant I was fully aware of how nasty it could have been. However, the overriding emotion was despondency - I'd thrown basically two whole afternoons and about 10,000CFA at something as simple as being able to boil water, and had got closer to blowing myself up than making a cup of tea. Back home if I can't boil water in an electric kettle, I boil it in a pan on the hob; if I can't boil it there someone needs to pay the gas bill. It's a much simpler, and markedly less explosive, equation.
Anyway, I explained this to the bloke at the gas stall who, having been a bit intolerant of the useless whiteboy previously, softened somewhat, and told me to bring the whole thing back. "I myself have seen two of these new regulators do this - bring the whole thing tomorrow; there is a man here who is very good at setting these up, and we'll sort it out. But you mustn't use it in the meantime!" Encouraged by his newfound graciousness if not by the fact that he was selling the gas canister equivalent of driver's side ejector seats for cars, I came home and have just had part of a baguette with tomato, cucumber, and a meat pâté which smelt slightly like dogfood, and a cold beer, all of which have improved the situation enormously.
But if the fridge packs up, I will officially have Had Enough.
Garbey-Kourou, Greetings, and the Night Sky
My visit to the bush came about thanks to an evening out on the town with the Peace Corps lot which I've already talked about. It's an interesting organisation - more on that later - and has had a number of unexpected benefits. For example, one of them, Emily, worked at the National Hospital and this has meant I've had someone to have lunch with in the hospital café. She's now back in the US on holiday, as when you sign up for your third year straight as she's done you get a month back in the US. However, before she left - and possibly only because I was able to lend her the final Harry Potter book - she arranged for me to see some fistula surgery, and also took me round to meet one of the US ex-pats at his house, as she'd had a parcel sent from home to him. This was exciting both because I got to see how the other half live (in large, A/C guarded houses with pools, is the short answer), and because he had a dog called - honestly - America, who gets passed from person to person as they move on. Apparently his house was the smallest on the books, but had the advantage of some unexpected wildlife - at one point a noise on the roof turned out to be peacocks from goodness knows where. Anyway, we got talking, and after I'd run through what I was doing, I ventured:
Me: "So what do you do here?"
Him: "Er - I'm the US Consul."
Guess the dog's name shoulda given it away...!
Anyway, another upshot of that night out was a guy called Matt, slightly the worse for wear, asking if I'd come to his village and take a look at the wife of a friend of his who was pregnant and had had abdominal pain for several months. I wasn't sure if he was serious, but evidently he was: he called the next morning to confirm! I ran through the usual disclaimers - I'm just a medical student, she might be better seeing the local doctor - but he countered "Oh, no one really goes to see him. I'll show you when you get here."
So the following weekend I got in a taxi-brousse, that being French for a dilapidated minibus apparently on the point of decomposition and intended to hold 12 but in reality holding up to 20 or so people plus assorted chickens in the cabin and everyone's luggage plus-or-minus a few trussed up and disgruntled-looking goats on the roof. The first of these was in decent shape, and took me as far as a bridge outside Niamey which had been washed out, rather impressively, by the recent storms. To give you an idea of how quickly the water is soaked up by the sandy earth and/or evaporates, I took a picture of the not-so-raging torrent running in the valley. We picked our way across it on foot and got into a slightly dodgier-looking taxi-brousse on the other side, boasting a fractured windscreen replete with a dent consistent with the attempted escape of a goat from the roof. One of the other downsides of taxis-brousse is that they don't leave until they're full, so I had a two-hour wait for the thing to fill up. This was awkward, as the ferry I needed to catch doesn't run between noon and 2pm; in the event I was spared a two-hour wait on the riverbank by our arrival at the ferry at 11:58. Once across the river, I met Matt and we hiked out the 6km to his village.
I already knew he and Alex (his nearest neighbour) were agriculture volunteers, and so I was expecting farms; the reality wasn't quite what I had in mind. The area was essentially scrub desert, and farming takes place in a soil which to my untrained eye looked like a reddish sandpit. Despite excellent rains, the crops still looked vulnerable to pretty much anything. Apparently the real problem is floods cutting channels through fields and washing away whole harvests, along with young shoots getting scorched by the sun or sandblasted by the sandstorms which precede the rains. However, their peanuts were going okay, and are rather fetching plants; Alex's millet was positively huggable (see opposite). The standard layout is to plant millet with beans (which are apparently not beans but legumes, farm-fans) in between to replenish nutrients in the soil (I believe they are nitrogen-fixers). Matt also has several 10 metre-square plots of experimental seeds from various labs trying to breed super-millet, which were interesting - but his main project is Acacia Senegal.
Before coming out to Niger, Matt had served in Iraq, and had got into horticulture when he came out the army; he's off to New York soon to give a talk about it at a Veterans' convention. He's quite evangelical about farming, and intense with it, both in the best possible way! Acacia Senegal has lots of advantages out here - the trees give crops shade, they bind the soil and so make it more resistant to flooding, they release water into the atmosphere, they take nutrients from the deep soil layers which food crops like millet and okra don't reach, they give some protection from the crop-crushing sandstorms, and are themselves a cash crop. Acacia Senegal produces gum arabic, which you can harvest from the bark and sell to...the Coca-Cola company, who use it as a stabiliser in carbonated drinks and chewing gum. Their main supplier is Sudan, but for obvious reasons there have been some supply chain issues there of later - so if Niger can get its act together before the Sudan does, they could have an export besides the uranium (which an expat who works for the EU told me recently they sell to France for the same price per kilo as sugar).
Matt also took me to see the "doctor", who has a nice office on the way to the fields. He proudly showed me his logbook, revealing that he saw about 12 patients a day...in a village of more than 6,000 where I would estimate at least 300 have malaria at any one time during the rainy season. He did explain the healthcare system a little - outfits like his are the local health operations - the equivalent of GPs - except that he's only done two or three years of studying - i.e., less than I have. Then there are the CSIs, which are nurse-run intermediate centres where they decide whether to send you off to a regional hospital or a referral centre like the National. Even the GP equivalents charge - 500CFA (50p) for children aged 0-5, and 800CFA thereafter, plus 400/700 for follow-up visits, although those prices do include any of his meagre supply of medication he deems necessary.
Not so hard, suddenly, to see why no one goes to see him. His treatment options, too, were largely past their best-before-dates, in one case by three years. Even the posters on his wall were - they showed cartoon-style pictures of malnourished children with kwashiorkor (swollen, crying), marasmus (thin, crying) and one normal child (smiling, playing with toys, an inexplicable shade of green). The NGO involvement in local healthcare is that they give him kit now and then, like the posters, scales, and tape-measures, plus they come in and do vaccination runs intermittently. None of it sounded very organised and certainly wasn't getting the access it needed to the local population.
The village itself was exclusively mud huts with thatched rooves; I wasn't completely clear how they stood up to being pounded by rain and flooded, but when things get very bad apparently the bricks at the bottom collapse, making repairing them awkward. The flooding had partially demolished the fence preserving my modesty while using Matt's bucket-shower/toilet hole, too, but there wasn't much to do about that. And it was exciting to have a bucket-shower again. The only exceptions to the two-room mud hut layout are the radio station, which has a building made from Real Bricks, and the mosque, which is about ten times the size of any other building in a 20-mile radius. Apparently the Wazos are perfectly pleasant to Matt - he figures they are mostly preaching to prevent the Christian aid organisations winning hearts 'n' minds - but he does get irritated by greetings. When he doesn't say salaam aleekum to the more extreme local religious sorts (who are thankfully a minority), he is criticised for it, and when he does they criticise him for not coming to pray with them. Thus his standard greeting is "fandagoy", which means "congratulations on your work".
Greeting someone is an involved process in Niger in any language. In French, the standard exchange goes:
Person 1: "Bonjour" (or bonsoir at any time from about 10am on) (Hello)
Person 2: "Bonjour - ça va?" (Hello. How are you?)
Person 1: "ça va. ça va?" (I'm fine. How are you?)
Person 2: "ça va." (I'm fine.)
You can then extend this:
Person 1: "Et la santé?", "Et le travail?", "Et la famille?" (and your health / work / family?), and, beloved of those talking to les blancs, "et la chaleur?" (and the heat?)
The pattern is similar in Djerma and Hausa at least (I can't speak for Tamachek, Peulh, or the other one I've forgotten temporarily). In Djerma, as well as "salaam aleekum", you can say "fofo" (how are you) and reply "bani samoy" (I'm fine), whereupon the same sequence as above ensues; "amaté nrongo" means roughly the same as "fofo". In Djerma, however, the responses translate as "Thank God for...", so when one of Matt's villagers greeted Alex in English, she replied "thank God for the work", and "thank God for the people of Tilley [her village]", and so on. It's rather sweet, but was outclassed after dinner, when we ate fish and rice from a shared bowl in pitch darkness. Afterwards, I was admiring the stars, which were stunning, and Alex explained that the Djerma word for the milky way translated literally as "the full road", because - just as I was doing - when you finished eating, you sat back in your chair and looked at the heavens while digesting your meal. This seems to me infinitely preferable to naming it after a chocolate bar. In a similar vein, Matt refers to the filtered water he drinks as "white-man's-stomach-has-no-strength water" in reference to the number of times he had to get ill before the villagers stopped pressing well water on him.
All the Peace Corps volunteers take a local name, often one given them by the host family they stay with during their induction - so Matt is "Zachariow" and Alex "Medina". Some, though, choose names of their own devising - so there has been a "Han Solo", a "Chewbacca" and one volunteer out here at the moment took the name "Genghis Khan". You may or may not find that funny in and of itself, but the locals heard it as "Gengis kanu", which means literally "bush life is not sweet". Apparently the villagers loved it.
After dinner I went back to Matt's to go to sleep - the only way to do this without a fan (and he doesn't have electricity) is (a) outside and (b) under a mosquito net. The mosquito net doesn't however, protect from other local wildlife like the small scorpion patrolling the yard. He didn't put me in the most restful of moods before bed, so I lay awake a while looking at the stars overhead, clear and bright in the cloudless desert sky.
On Sunday we got up with the sunrise, and went to try to plant some Acacia Senegal - but the locals were waiting for the arrival of some VIP with a car. Matt grumbled that we could just hire a donkey and cart, but after a futile couple of hours waiting for him and failing to find coffee, we gave up and went to do some work in Alex's field. After that - which was about as hard work in the heat as I'd been expecting - she cooked lunch for the three of us, and walked me back to the ferry while Matt went back to get planting. I missed the ferry as narrowly as I'd caught it on the way out, but this meant I got to take a pirogue back across, followed by a taxi-brousse with a door that didn't close and a small boy with half-a-dozen small birds tied unhappily to a stick sitting next to me. The cold water from the fridge back in Niamey has rarely tasted so good.
Me: "So what do you do here?"
Him: "Er - I'm the US Consul."
Guess the dog's name shoulda given it away...!
Anyway, another upshot of that night out was a guy called Matt, slightly the worse for wear, asking if I'd come to his village and take a look at the wife of a friend of his who was pregnant and had had abdominal pain for several months. I wasn't sure if he was serious, but evidently he was: he called the next morning to confirm! I ran through the usual disclaimers - I'm just a medical student, she might be better seeing the local doctor - but he countered "Oh, no one really goes to see him. I'll show you when you get here."
So the following weekend I got in a taxi-brousse, that being French for a dilapidated minibus apparently on the point of decomposition and intended to hold 12 but in reality holding up to 20 or so people plus assorted chickens in the cabin and everyone's luggage plus-or-minus a few trussed up and disgruntled-looking goats on the roof. The first of these was in decent shape, and took me as far as a bridge outside Niamey which had been washed out, rather impressively, by the recent storms. To give you an idea of how quickly the water is soaked up by the sandy earth and/or evaporates, I took a picture of the not-so-raging torrent running in the valley. We picked our way across it on foot and got into a slightly dodgier-looking taxi-brousse on the other side, boasting a fractured windscreen replete with a dent consistent with the attempted escape of a goat from the roof. One of the other downsides of taxis-brousse is that they don't leave until they're full, so I had a two-hour wait for the thing to fill up. This was awkward, as the ferry I needed to catch doesn't run between noon and 2pm; in the event I was spared a two-hour wait on the riverbank by our arrival at the ferry at 11:58. Once across the river, I met Matt and we hiked out the 6km to his village.
I already knew he and Alex (his nearest neighbour) were agriculture volunteers, and so I was expecting farms; the reality wasn't quite what I had in mind. The area was essentially scrub desert, and farming takes place in a soil which to my untrained eye looked like a reddish sandpit. Despite excellent rains, the crops still looked vulnerable to pretty much anything. Apparently the real problem is floods cutting channels through fields and washing away whole harvests, along with young shoots getting scorched by the sun or sandblasted by the sandstorms which precede the rains. However, their peanuts were going okay, and are rather fetching plants; Alex's millet was positively huggable (see opposite). The standard layout is to plant millet with beans (which are apparently not beans but legumes, farm-fans) in between to replenish nutrients in the soil (I believe they are nitrogen-fixers). Matt also has several 10 metre-square plots of experimental seeds from various labs trying to breed super-millet, which were interesting - but his main project is Acacia Senegal.
Before coming out to Niger, Matt had served in Iraq, and had got into horticulture when he came out the army; he's off to New York soon to give a talk about it at a Veterans' convention. He's quite evangelical about farming, and intense with it, both in the best possible way! Acacia Senegal has lots of advantages out here - the trees give crops shade, they bind the soil and so make it more resistant to flooding, they release water into the atmosphere, they take nutrients from the deep soil layers which food crops like millet and okra don't reach, they give some protection from the crop-crushing sandstorms, and are themselves a cash crop. Acacia Senegal produces gum arabic, which you can harvest from the bark and sell to...the Coca-Cola company, who use it as a stabiliser in carbonated drinks and chewing gum. Their main supplier is Sudan, but for obvious reasons there have been some supply chain issues there of later - so if Niger can get its act together before the Sudan does, they could have an export besides the uranium (which an expat who works for the EU told me recently they sell to France for the same price per kilo as sugar).
Matt also took me to see the "doctor", who has a nice office on the way to the fields. He proudly showed me his logbook, revealing that he saw about 12 patients a day...in a village of more than 6,000 where I would estimate at least 300 have malaria at any one time during the rainy season. He did explain the healthcare system a little - outfits like his are the local health operations - the equivalent of GPs - except that he's only done two or three years of studying - i.e., less than I have. Then there are the CSIs, which are nurse-run intermediate centres where they decide whether to send you off to a regional hospital or a referral centre like the National. Even the GP equivalents charge - 500CFA (50p) for children aged 0-5, and 800CFA thereafter, plus 400/700 for follow-up visits, although those prices do include any of his meagre supply of medication he deems necessary.
Not so hard, suddenly, to see why no one goes to see him. His treatment options, too, were largely past their best-before-dates, in one case by three years. Even the posters on his wall were - they showed cartoon-style pictures of malnourished children with kwashiorkor (swollen, crying), marasmus (thin, crying) and one normal child (smiling, playing with toys, an inexplicable shade of green). The NGO involvement in local healthcare is that they give him kit now and then, like the posters, scales, and tape-measures, plus they come in and do vaccination runs intermittently. None of it sounded very organised and certainly wasn't getting the access it needed to the local population.
The village itself was exclusively mud huts with thatched rooves; I wasn't completely clear how they stood up to being pounded by rain and flooded, but when things get very bad apparently the bricks at the bottom collapse, making repairing them awkward. The flooding had partially demolished the fence preserving my modesty while using Matt's bucket-shower/toilet hole, too, but there wasn't much to do about that. And it was exciting to have a bucket-shower again. The only exceptions to the two-room mud hut layout are the radio station, which has a building made from Real Bricks, and the mosque, which is about ten times the size of any other building in a 20-mile radius. Apparently the Wazos are perfectly pleasant to Matt - he figures they are mostly preaching to prevent the Christian aid organisations winning hearts 'n' minds - but he does get irritated by greetings. When he doesn't say salaam aleekum to the more extreme local religious sorts (who are thankfully a minority), he is criticised for it, and when he does they criticise him for not coming to pray with them. Thus his standard greeting is "fandagoy", which means "congratulations on your work".
Greeting someone is an involved process in Niger in any language. In French, the standard exchange goes:
Person 1: "Bonjour" (or bonsoir at any time from about 10am on) (Hello)
Person 2: "Bonjour - ça va?" (Hello. How are you?)
Person 1: "ça va. ça va?" (I'm fine. How are you?)
Person 2: "ça va." (I'm fine.)
You can then extend this:
Person 1: "Et la santé?", "Et le travail?", "Et la famille?" (and your health / work / family?), and, beloved of those talking to les blancs, "et la chaleur?" (and the heat?)
The pattern is similar in Djerma and Hausa at least (I can't speak for Tamachek, Peulh, or the other one I've forgotten temporarily). In Djerma, as well as "salaam aleekum", you can say "fofo" (how are you) and reply "bani samoy" (I'm fine), whereupon the same sequence as above ensues; "amaté nrongo" means roughly the same as "fofo". In Djerma, however, the responses translate as "Thank God for...", so when one of Matt's villagers greeted Alex in English, she replied "thank God for the work", and "thank God for the people of Tilley [her village]", and so on. It's rather sweet, but was outclassed after dinner, when we ate fish and rice from a shared bowl in pitch darkness. Afterwards, I was admiring the stars, which were stunning, and Alex explained that the Djerma word for the milky way translated literally as "the full road", because - just as I was doing - when you finished eating, you sat back in your chair and looked at the heavens while digesting your meal. This seems to me infinitely preferable to naming it after a chocolate bar. In a similar vein, Matt refers to the filtered water he drinks as "white-man's-stomach-has-no-strength water" in reference to the number of times he had to get ill before the villagers stopped pressing well water on him.
All the Peace Corps volunteers take a local name, often one given them by the host family they stay with during their induction - so Matt is "Zachariow" and Alex "Medina". Some, though, choose names of their own devising - so there has been a "Han Solo", a "Chewbacca" and one volunteer out here at the moment took the name "Genghis Khan". You may or may not find that funny in and of itself, but the locals heard it as "Gengis kanu", which means literally "bush life is not sweet". Apparently the villagers loved it.
After dinner I went back to Matt's to go to sleep - the only way to do this without a fan (and he doesn't have electricity) is (a) outside and (b) under a mosquito net. The mosquito net doesn't however, protect from other local wildlife like the small scorpion patrolling the yard. He didn't put me in the most restful of moods before bed, so I lay awake a while looking at the stars overhead, clear and bright in the cloudless desert sky.
On Sunday we got up with the sunrise, and went to try to plant some Acacia Senegal - but the locals were waiting for the arrival of some VIP with a car. Matt grumbled that we could just hire a donkey and cart, but after a futile couple of hours waiting for him and failing to find coffee, we gave up and went to do some work in Alex's field. After that - which was about as hard work in the heat as I'd been expecting - she cooked lunch for the three of us, and walked me back to the ferry while Matt went back to get planting. I missed the ferry as narrowly as I'd caught it on the way out, but this meant I got to take a pirogue back across, followed by a taxi-brousse with a door that didn't close and a small boy with half-a-dozen small birds tied unhappily to a stick sitting next to me. The cold water from the fridge back in Niamey has rarely tasted so good.
The Apartment, Wazas, and the local area
So - the apartment. You already know about the gas cylinder, and thus that I have the ability to cook, which is an improvement over the Catholic Mission where I was previously. The availability of gas is pretty good, certainly compared to Addis, where it was common not to be able to find any for a couple of days. The longest I've seen them not have it for here is an afternoon, and the absence of kerosene burners is undoubtedly a blessing. The apartment also has a shower complete with a hot water tank with an orange light which comes on when you flick the switch by it; this has no discernible effect on the temperature of the water, but I like to pretend it might work. However, as the water is never freezing, varying in temperature with the time of day (cold in the morning, lukewarm following a day's sun), and given that I have no way of knowing if, like the last gas cylinder, the hot water tank harbours murderous intentions towards me, I've stopped using it at all.
The fridge, however, is a glorious duck-egg green, and keeps water, mangos, and the local beer (Flag) deliciously chilly. There's also a brand new washing machine which I was enormously excited by given the absence of laundrettes (à la Addis) or Padmina (à la Vellore), so one of the first things I bought was a large and expensive box of washing powder (German, slightly bizarrely). The blissful feeling as I loaded the machine with dirty clothes and powder in anticipation of gleaming whites at the end of it was deflated somewhat when I pressed the ON button and nothing happened.
It wasn't plugged in, so I plugged it in and pressed the ON button again.
Nothing happened.
It was then that I realised it wasn't plumbed in either.
I briefly debated trying to attach the inflow pipe to the tap, but reasoned that breaking what is clearly my erstwhile landlord's prize kitchen ornament would be bad form. And more to the point, would be significantly more likely to flood the kitchen and add to the list of appliances which have it in for me than to clean any clothes. So I did them by hand in the sink outside, drowning a small legion of ants in the process to cheer myself up.
All in all, however, the apartment is great - I have a view from the balcony over the hut village which stretches along the road in a muddle of thatched rooves, bleating goats, incompetent cockerels (3am is not dawn), and plumes of bluish smoke. Currently the presence of the hut village is ruined somewhat by the presence of what I think in Djerma is a Waza, which amounts to a gaggle of Islamic holy men with loudspeakers preaching to the masses. It's a little like the mad people you can normally find on Oxford Street preaching the seemingly-contradictory message that God loves you but you'll burn in an eternal lake of fire unless you repent your sins. Or perhaps more like the televangelist extremists who are essentially more successful, capitalism-friendly versions of the nutters on street corners, the ones who drive limos, drink champagne, condemn abortion and homosexuality, and hire gigolos on the sly because they know that that is what Jesus would do. Apart possibly from the paying rentboys part.
All the Waza folk do, according to Matt (of whom more in the next missive) is tell people not to trust the white man, and to give them money for new mosques. The former is good general advice (and mild compared to what the US religious right are saying about the non-white man), but roughly a century too late and today is mostly aimed at stopping the locals converting to Christianity thanks to the large number of Christian aid organisations working here. The second is a little harder to stomach, literally given how little food the people here have, but they do at least spend the money on mosques rather than, say, methampethamine.
I wish that they'd SHUT UP, though. It's ten o'clock on a saturday, fer chrissakes.
The apartment is also 12 mins walk from the hospital, five minutes from the best bakery I've found in Niamey, which sells baguettes for 15p which are invariably still warm when you buy them, and seriously good croissants and patisseries which I tend to have a couple of times a week. There are also plenty of restaurants in the area, a couple of general stores/supermarkets (NB: you would be wrong to think of Tesco at this point), fruit and vegetable sellers, and craftsmen hawking their wares.
The prices of most things here go through the roof when you're un blanc - I stopped at one shop on the way back from the hospital and asked the kid behiond the counter how much a bag of dates was. He had to wake up the boss, who was snoozing on the floor by the counter on his mat.
Kid: "How much are these?"
Proprietor (rubbing sleep from his eyes): "700."
Kid (to me): "They're 700."
Proprietor (following the kid's gaze): "Ah! They're 1250."
I laughed, thanked them, and left.
The souvenir-hawkers aren't so bad - their first price is invariably outrageous, but accompanied by the disclaimer that "we can discuss the price - and I'll do you a good deal." Although they are pretty expert - one moment of weakness and you find yourself getting absolutely robbed blind - I've hit on a surprisingly effective counter-strategy. I just say that as I'm here for two months, all I want to do for now is see things and get an idea about prices. I then stick steadfastly to this position as they say that I can buy something small today and the rest later, n'est-ce pas? (which, incidentally, I have just realised translates literally as "innit". Who'd have thought it of the French?). I say no, I'll just have to keep things around the apartment. The shopkeep rejoins with, well, what would you pay for this today? I reply, as I said already, I'll buy at the end of my stay. The less scrupulous then chuck in the ridiculous "I have to sell something so I can eat"; I flatter myself that my eye for malnutrition is by now pretty good, and these are by no means poor people, so any trying that line go in the dirty box and I don't go back in their shops. By the time I leave, the attrition has generally seen their price halve when I'm not even haggling. Most are, like the Nigérien people in general, a friendly lot who are ultimately just trying to make a living (albeit by fleecing wealthy, credulous whites), and they always respond cheerfully when I say hi, whether I go to see their new arrivals or not. I've even had tea with one or two (insanely strong, necessarily sweet, and cooked over hot coals. The tea is removed and the leaves covered with fresh water while the brew is mixed with more sugar and passed between two glasses to cool it to drinking temperature), and done an impromptu knee consultation with a kid at another; my advice even seems to have worked!
My favourites are the guards, though - most residential blocks have a guard - ours is an ex-army man called Djibo Ibrahima who was enormously helpful with the gas - and all NGO offices and residences have 1-4 in uniform. The main purpose of the NGO guards is to sit around drinking tea, playing cards, and running errands for their empployers (eg: fetch me some cigarettes, please). Djibo sits around in a sleeveless T-shirt and chases out goats. They're all phenomenally friendly, and a group of them I got talking to have been teaching me some Djerma and Hausa. Initially they did both at once, but they soon realised this was just confusing, so we're sticking mostly to Hausa now, and I pay them in occasional baked goods.
Oh - one more thing - the identity of my new friend is none of the above. The apartment doesn't have nets on the windows, and there's one in the bathroom which doesn't shut - so I'm indebted to this lady (she's just below the handle - got her?) for spinning her web right by the crack the mozzies get in, and for having produced a batch of mini-spiders to expand upon her good work. All the dark blobs in the web are mozzies in their little silken cocoons, and since I moved the loo paper the fact the cocoons are dropped from the web onto the top of the cistern has caused no further problems.
And on that note...
The fridge, however, is a glorious duck-egg green, and keeps water, mangos, and the local beer (Flag) deliciously chilly. There's also a brand new washing machine which I was enormously excited by given the absence of laundrettes (à la Addis) or Padmina (à la Vellore), so one of the first things I bought was a large and expensive box of washing powder (German, slightly bizarrely). The blissful feeling as I loaded the machine with dirty clothes and powder in anticipation of gleaming whites at the end of it was deflated somewhat when I pressed the ON button and nothing happened.
It wasn't plugged in, so I plugged it in and pressed the ON button again.
Nothing happened.
It was then that I realised it wasn't plumbed in either.
I briefly debated trying to attach the inflow pipe to the tap, but reasoned that breaking what is clearly my erstwhile landlord's prize kitchen ornament would be bad form. And more to the point, would be significantly more likely to flood the kitchen and add to the list of appliances which have it in for me than to clean any clothes. So I did them by hand in the sink outside, drowning a small legion of ants in the process to cheer myself up.
All in all, however, the apartment is great - I have a view from the balcony over the hut village which stretches along the road in a muddle of thatched rooves, bleating goats, incompetent cockerels (3am is not dawn), and plumes of bluish smoke. Currently the presence of the hut village is ruined somewhat by the presence of what I think in Djerma is a Waza, which amounts to a gaggle of Islamic holy men with loudspeakers preaching to the masses. It's a little like the mad people you can normally find on Oxford Street preaching the seemingly-contradictory message that God loves you but you'll burn in an eternal lake of fire unless you repent your sins. Or perhaps more like the televangelist extremists who are essentially more successful, capitalism-friendly versions of the nutters on street corners, the ones who drive limos, drink champagne, condemn abortion and homosexuality, and hire gigolos on the sly because they know that that is what Jesus would do. Apart possibly from the paying rentboys part.
All the Waza folk do, according to Matt (of whom more in the next missive) is tell people not to trust the white man, and to give them money for new mosques. The former is good general advice (and mild compared to what the US religious right are saying about the non-white man), but roughly a century too late and today is mostly aimed at stopping the locals converting to Christianity thanks to the large number of Christian aid organisations working here. The second is a little harder to stomach, literally given how little food the people here have, but they do at least spend the money on mosques rather than, say, methampethamine.
I wish that they'd SHUT UP, though. It's ten o'clock on a saturday, fer chrissakes.
The apartment is also 12 mins walk from the hospital, five minutes from the best bakery I've found in Niamey, which sells baguettes for 15p which are invariably still warm when you buy them, and seriously good croissants and patisseries which I tend to have a couple of times a week. There are also plenty of restaurants in the area, a couple of general stores/supermarkets (NB: you would be wrong to think of Tesco at this point), fruit and vegetable sellers, and craftsmen hawking their wares.
The prices of most things here go through the roof when you're un blanc - I stopped at one shop on the way back from the hospital and asked the kid behiond the counter how much a bag of dates was. He had to wake up the boss, who was snoozing on the floor by the counter on his mat.
Kid: "How much are these?"
Proprietor (rubbing sleep from his eyes): "700."
Kid (to me): "They're 700."
Proprietor (following the kid's gaze): "Ah! They're 1250."
I laughed, thanked them, and left.
The souvenir-hawkers aren't so bad - their first price is invariably outrageous, but accompanied by the disclaimer that "we can discuss the price - and I'll do you a good deal." Although they are pretty expert - one moment of weakness and you find yourself getting absolutely robbed blind - I've hit on a surprisingly effective counter-strategy. I just say that as I'm here for two months, all I want to do for now is see things and get an idea about prices. I then stick steadfastly to this position as they say that I can buy something small today and the rest later, n'est-ce pas? (which, incidentally, I have just realised translates literally as "innit". Who'd have thought it of the French?). I say no, I'll just have to keep things around the apartment. The shopkeep rejoins with, well, what would you pay for this today? I reply, as I said already, I'll buy at the end of my stay. The less scrupulous then chuck in the ridiculous "I have to sell something so I can eat"; I flatter myself that my eye for malnutrition is by now pretty good, and these are by no means poor people, so any trying that line go in the dirty box and I don't go back in their shops. By the time I leave, the attrition has generally seen their price halve when I'm not even haggling. Most are, like the Nigérien people in general, a friendly lot who are ultimately just trying to make a living (albeit by fleecing wealthy, credulous whites), and they always respond cheerfully when I say hi, whether I go to see their new arrivals or not. I've even had tea with one or two (insanely strong, necessarily sweet, and cooked over hot coals. The tea is removed and the leaves covered with fresh water while the brew is mixed with more sugar and passed between two glasses to cool it to drinking temperature), and done an impromptu knee consultation with a kid at another; my advice even seems to have worked!
My favourites are the guards, though - most residential blocks have a guard - ours is an ex-army man called Djibo Ibrahima who was enormously helpful with the gas - and all NGO offices and residences have 1-4 in uniform. The main purpose of the NGO guards is to sit around drinking tea, playing cards, and running errands for their empployers (eg: fetch me some cigarettes, please). Djibo sits around in a sleeveless T-shirt and chases out goats. They're all phenomenally friendly, and a group of them I got talking to have been teaching me some Djerma and Hausa. Initially they did both at once, but they soon realised this was just confusing, so we're sticking mostly to Hausa now, and I pay them in occasional baked goods.
Oh - one more thing - the identity of my new friend is none of the above. The apartment doesn't have nets on the windows, and there's one in the bathroom which doesn't shut - so I'm indebted to this lady (she's just below the handle - got her?) for spinning her web right by the crack the mozzies get in, and for having produced a batch of mini-spiders to expand upon her good work. All the dark blobs in the web are mozzies in their little silken cocoons, and since I moved the loo paper the fact the cocoons are dropped from the web onto the top of the cistern has caused no further problems.And on that note...
Monday, 13 August 2007
Calling a spade a spade, not taking prisoners, and conventional pest control
First, it being why I'm here and all that, the hospital. Monday was promising if uneventful: I met the medical director and indeed a clutch of other directors and was told to come back the following day at 11am to start. Sadly I went to this meeting without Dr. Marianne, as she had "completely forgotten" about me, so tuesday became a rerun of monday with her in attendance. We agreed, as indeed we had on monday, that I'd do three weeks paediatrics and three weeks internal medicine, and, again as on monday, that I should come back the next day to start. Although at 8am, not 11.
At this point I should probably explain why I didn't burst into tears being forgotten by my contact here. Her response to my text on monday evening outlining the days' events was roughly, I went to collect Achille [her husband, who's also delightful], and he asked how you were, and I realised I had completely forgotten about you! (Her response of course also involved putting monday on a one-day loop, but there you go). In England, I think it'd be safe to say that sort of comment could get you taken off people's Christmas Card Lists, but here it isn't rude.
People are just very direct, and being honest when they've forgotten about you is just part of it. So I am referred to as "un blanc" (a white) in French, or as "yo" (a stranger) in Djerma; if people think you look tired, for instance having woken you up at a conference, they will tell you so; and a complete stranger introduced himself to me while I was eating some corn which women barbecue at the side of the street largely to tell me that "people cannot believe you are eating that". "Why?", I asked. "Parce-que c'est un blanc", 'because it's a white'. It's also perfectly acceptable, even polite, to refer to strangers by their profession in the local languages using a term meaning literally keeper, so that a man selling bread at a street stall becomes "keeper-of-the-bread", and is happy to be referred to as such; and if I'm walking the 10 minutes from the hospital to my apartment in scrubs, the first link in the chain of standard greetings (of which much more later) becomes "Bonsoir, docteur". So I'm walking back in scrubs pretty much every night, obviously.
In this sense, the Nigériens are a little like Yorkshiremen: they call a spade a spade. So it was on my first day in Pédiatrie A, where they deal with children between 0 and 2 years old. I turned up and was greeted by a formidable-looking female doctor who I'd met at the conference the previous week but whose name has sunk into the dozens I failed to learn while sleepwalking through it, and who I will therefore refer to temporarily as "the big boss". The staff meeting included three Nigérien students, two 7th years and one 4th year, the big boss, and a handful of doctors and nurses. Straight off the bat I was asked if I'd like to introduce myself, and so was immediately grateful that A-level French is heavy on vous voulez vous presenter? Then she grilled me on exactly what medicine I'd done so far, on the nature of the elective and on how it fitted into my course, culminating in "alors c'est un stage obligatoire", so it's a compulsory elective?
I confirmed this, and the big boss smiled. "Good. So, for you two [indicating the 7th years] and you [indicating me], you will be here every morning in time for the staff meeting at 8am. Don't turn up at ten past and ask us to wait for you. Then there are ward rounds in the morning, and you will stay until they finish - sometimes 11:30, sometimes 15:30. Then you can go or stay as you like, but you will each present a case [patient] at the meeting while you are here, and when the doctor you are following is on-call, you will stay at night or at the weekend with them. [Turning to the 4th year, whose placement is 'volontaire'] It's not as important for you, but you must do what you think will be best for you."
So not many prisoners taken there, all things considered. She's rarely on the wards, which is a shame, as I'd like to see how she handles patients...! The fourth-year (Rashid) and I have been Dr. Idrissa all week. On the first morning we were joined by one of the 7th years, who was a total joy. She spent the entire time looking bored and sulking and then, when Dr. Idrissa invited her to listen to one of the kids' heart murmurs, replied angrily, "I understood that we were here to observe how you work, not to do things ourselves!". This is roughly the equivalent of waiting until someone offers you a slice of cake and then kicking them in the face. Dr. Idrissa replied equally angrily but, to my disappointment, in Hausa well beyond my meagre abilities, and she grudgingly listened to the boy's murmur (ejection systolic, probably physiological, since you didn't ask). Happily she buggered off somewhere else on thursday.
Medically, it's been roughly what I was expecting - lots of diseases which would be basically unthinkable in the UK, including a textbook case of tetanus (another of the doctors, Mahamadou, lifted him with one hand under his back and his arms, legs, and head remained completely rigid), a kid with (for Niger) unseasonal meningitis who is Very Unwell, the obligatory score of malaria cases and a half-dozen with cerebral malaria, which is so exotic and life-threatening that it has even featured on House. And there are three full wards of malnourished kids - CRENI I (centre restoration...uh...let's just say 'refeeding', shall we?) for the severe ones, who then go to CRENI transition, then to CRENI II, and then hopefully home; there are also a lot of cases elsewhere in the other wards. They are mildly depressing in a Live Aid, swollen-bellied kind of way, and this impression is aided by the wealth of flies who buzz merrily around the wards and enhanced by the extraordinary smell of the unit. I spent some time in the fistula unit in my 'free' friday afternoon, and the smell there was nothing compared to the paeds ward, where the absence of any nappies except among the most wealthy Nigériens, coupled with the fact that almost every kid in hospital has diarrhoea and vomiting makes the baseline smell strong enough that it's only converted into something unsettling rather than outright nauseating by the popular practice of burning sticks of incense. The kids are, however, also very sweet, and also clever: they cry as soon as they see anyone in a white coat, whether they are carrying a needle or not. Having sat in on an afternoon's bloodletting with the nurses (doctors and nurses both wear white coats here, which adds a note of sweat, predominantly mine, to the background symphony of aromas) and having watched one of them, take aim at a vein running diagonally across the back of a baby's hand, push it through the skin at 45 degrees, and then flatten out and advance it into the vein, out of the vein again, and back out the opposite side of the hand, I can see why white coats make them nervous.
Also as I'd expected, they're desperately short on resources, although not as many as you might expect - they do, to take one example, have both human and horse tetanus immunoglobulin, and thankfully the mother of the affected baby can obviously afford them. By contrast, they have almost no gloves in the bloodletting department, so my arrival with a bunch has been treated with great excitement. However, this doesn't extend to the patients, whose NG tubes (feeding tubes into their stomachs) are regularly pulled out and kept in plastic bags by mum until someone can, er, put the same one back in again. Which is a little unhygenic.
Particularly given the very orthodox local pest control.
There is more to say but I need to get home, so I'll do some more hospital stuff later...
At this point I should probably explain why I didn't burst into tears being forgotten by my contact here. Her response to my text on monday evening outlining the days' events was roughly, I went to collect Achille [her husband, who's also delightful], and he asked how you were, and I realised I had completely forgotten about you! (Her response of course also involved putting monday on a one-day loop, but there you go). In England, I think it'd be safe to say that sort of comment could get you taken off people's Christmas Card Lists, but here it isn't rude.
People are just very direct, and being honest when they've forgotten about you is just part of it. So I am referred to as "un blanc" (a white) in French, or as "yo" (a stranger) in Djerma; if people think you look tired, for instance having woken you up at a conference, they will tell you so; and a complete stranger introduced himself to me while I was eating some corn which women barbecue at the side of the street largely to tell me that "people cannot believe you are eating that". "Why?", I asked. "Parce-que c'est un blanc", 'because it's a white'. It's also perfectly acceptable, even polite, to refer to strangers by their profession in the local languages using a term meaning literally keeper, so that a man selling bread at a street stall becomes "keeper-of-the-bread", and is happy to be referred to as such; and if I'm walking the 10 minutes from the hospital to my apartment in scrubs, the first link in the chain of standard greetings (of which much more later) becomes "Bonsoir, docteur". So I'm walking back in scrubs pretty much every night, obviously.
In this sense, the Nigériens are a little like Yorkshiremen: they call a spade a spade. So it was on my first day in Pédiatrie A, where they deal with children between 0 and 2 years old. I turned up and was greeted by a formidable-looking female doctor who I'd met at the conference the previous week but whose name has sunk into the dozens I failed to learn while sleepwalking through it, and who I will therefore refer to temporarily as "the big boss". The staff meeting included three Nigérien students, two 7th years and one 4th year, the big boss, and a handful of doctors and nurses. Straight off the bat I was asked if I'd like to introduce myself, and so was immediately grateful that A-level French is heavy on vous voulez vous presenter? Then she grilled me on exactly what medicine I'd done so far, on the nature of the elective and on how it fitted into my course, culminating in "alors c'est un stage obligatoire", so it's a compulsory elective?
I confirmed this, and the big boss smiled. "Good. So, for you two [indicating the 7th years] and you [indicating me], you will be here every morning in time for the staff meeting at 8am. Don't turn up at ten past and ask us to wait for you. Then there are ward rounds in the morning, and you will stay until they finish - sometimes 11:30, sometimes 15:30. Then you can go or stay as you like, but you will each present a case [patient] at the meeting while you are here, and when the doctor you are following is on-call, you will stay at night or at the weekend with them. [Turning to the 4th year, whose placement is 'volontaire'] It's not as important for you, but you must do what you think will be best for you."
So not many prisoners taken there, all things considered. She's rarely on the wards, which is a shame, as I'd like to see how she handles patients...! The fourth-year (Rashid) and I have been Dr. Idrissa all week. On the first morning we were joined by one of the 7th years, who was a total joy. She spent the entire time looking bored and sulking and then, when Dr. Idrissa invited her to listen to one of the kids' heart murmurs, replied angrily, "I understood that we were here to observe how you work, not to do things ourselves!". This is roughly the equivalent of waiting until someone offers you a slice of cake and then kicking them in the face. Dr. Idrissa replied equally angrily but, to my disappointment, in Hausa well beyond my meagre abilities, and she grudgingly listened to the boy's murmur (ejection systolic, probably physiological, since you didn't ask). Happily she buggered off somewhere else on thursday.
Medically, it's been roughly what I was expecting - lots of diseases which would be basically unthinkable in the UK, including a textbook case of tetanus (another of the doctors, Mahamadou, lifted him with one hand under his back and his arms, legs, and head remained completely rigid), a kid with (for Niger) unseasonal meningitis who is Very Unwell, the obligatory score of malaria cases and a half-dozen with cerebral malaria, which is so exotic and life-threatening that it has even featured on House. And there are three full wards of malnourished kids - CRENI I (centre restoration...uh...let's just say 'refeeding', shall we?) for the severe ones, who then go to CRENI transition, then to CRENI II, and then hopefully home; there are also a lot of cases elsewhere in the other wards. They are mildly depressing in a Live Aid, swollen-bellied kind of way, and this impression is aided by the wealth of flies who buzz merrily around the wards and enhanced by the extraordinary smell of the unit. I spent some time in the fistula unit in my 'free' friday afternoon, and the smell there was nothing compared to the paeds ward, where the absence of any nappies except among the most wealthy Nigériens, coupled with the fact that almost every kid in hospital has diarrhoea and vomiting makes the baseline smell strong enough that it's only converted into something unsettling rather than outright nauseating by the popular practice of burning sticks of incense. The kids are, however, also very sweet, and also clever: they cry as soon as they see anyone in a white coat, whether they are carrying a needle or not. Having sat in on an afternoon's bloodletting with the nurses (doctors and nurses both wear white coats here, which adds a note of sweat, predominantly mine, to the background symphony of aromas) and having watched one of them, take aim at a vein running diagonally across the back of a baby's hand, push it through the skin at 45 degrees, and then flatten out and advance it into the vein, out of the vein again, and back out the opposite side of the hand, I can see why white coats make them nervous.
Also as I'd expected, they're desperately short on resources, although not as many as you might expect - they do, to take one example, have both human and horse tetanus immunoglobulin, and thankfully the mother of the affected baby can obviously afford them. By contrast, they have almost no gloves in the bloodletting department, so my arrival with a bunch has been treated with great excitement. However, this doesn't extend to the patients, whose NG tubes (feeding tubes into their stomachs) are regularly pulled out and kept in plastic bags by mum until someone can, er, put the same one back in again. Which is a little unhygenic.
Particularly given the very orthodox local pest control.
There is more to say but I need to get home, so I'll do some more hospital stuff later...
Battleplan: the next three steps...
You can take the drop in frequency of these missives from almost daily to weekly as an indication of how much harder I tend to work in hospital compared to the admittedly low baseline of at conferences (it only in fact qualifies as a baseline because one burns calories even while asleep). Since last writing I have:
(1) Moved into an apartment, where I have made a new friend who is already very dear to me
(2) Started work in paediatrics, where I have slept not at all
(3) Spent a weekend in the bush at Garbey-Kourou, where I did two informal consultations, slept under the stars, and got sunburnt.
Each will have its own missive, hopefully early this week as I get time.
(1) Moved into an apartment, where I have made a new friend who is already very dear to me
(2) Started work in paediatrics, where I have slept not at all
(3) Spent a weekend in the bush at Garbey-Kourou, where I did two informal consultations, slept under the stars, and got sunburnt.
Each will have its own missive, hopefully early this week as I get time.
Monday, 6 August 2007
Death by conference, thunderstorms, and Living Without Bucket Showers
Friday 3rd
The conference is over, praise be, and Dr. Marianne's husband Achille has found me a studio apartment to move into while I'm here, which is pretty exciting. Thus far I've been at the Catholic Mission, which is cheap by Niamey standards (7 quid a night, and I get a 10% 'doctor discount' on top!), the room is clean, has a fan and nets over the "Four-Poster" beds (metal beds with four posts welded to the corners - a surprisingly useful trick, as it happens), and a (cold) shower ensuite. There's a shady courtyard outside which I am not the only one to find pleasant - last night when I got back there was a large, rather beautiful moth drying itself under one of the trees, and tonight this fellow.
I met him following an evening drinking with the peace corps lot and listening to Nigérien music, which was roughly as you might expect traditional African music to sound if played by a four-piece guitar band so that people could get down on the dance floor to it. It wasn't quite what I was expecting, but it was fun.
Mon 6th
No posts over the weekend - the internet and the power took turns to fail all across the city, and I spent most of the time moving to the new apartment, buying stuff for it, and taking shelter from the biggest thunderstorm yet. Today has, predictably, been taken up mostly by taking paperwork to the hospital and being told to come back tomorrow. Now I have to run to the bank to change some travellers' cheques - more tomorrow, maybe!
Thursday, 2 August 2007
Conference II, 419 scams, and French names
Thursday 2nd August
Halfway through, and I'm quite bored. I can't decide whether the week wasted out of hospital is worth the fact that this is a ready-made elective portfolio; on balance I don't think so. However, the leather conference bag is pretty good, as are the heated arguments which break out after every other session and insert inexcusable delays before tea or lunch.
It's not that the data being presented isn't interesting - it's just that it seems fundamentally pointless to be addressing it. 700 maternal deaths per 100,000 and a 25% infant mortality are shockingly high, but unless you change the culture (in which contraception use runs at 5%) and the economy (it's something like the poorest country in the world and is hit by famines every couple of years) you'll just be worsening the imbalance between food supply and demand, and the people you "save" will end up starving to death. Upshot - you have to wonder if you were addressing the right question.
But enough of that – I met my first nutter last night in a taxi. I got in outside the Canadian embassy and was en route to a swanky French restaurant (called, in classic Gallic fashion, Thabakady), and evidently my fellow passenger sniffed an opportunity.
"Hello my friend!" he began, ignoring the fact I had asked for my destination in French. "What is your name?"
"Nicolas," I told him, feeling that his reaching out through the window of a moving vehicle to shake hands was a little excessive. "I'm Womo," (I'm not sure of the name – his English wasn't great, ok?) "and I have come here from Liberia."
I nodded politely, thinking that it was an awfully long way to have come and not the most obvious destination. "I came here because the fighting in Liberia was too much for me, and I have a problem which you can help with! I have come with lots of dollars - I was very lucky to be able to bring them with me."
And bang! I was in a real-life version of one of those Nigerian 419 scams which are proof that the internet, like life, dislikes the stupid.
"I'm pleased you managed to leave Liberia with so many dollars!" I rejoined.
"Ah, but my friend - it is difficult for me here," (presumably because of the exchange rate?) "The people here, they are Muslims, you see, and I am a Christian." He paused nervously, not realising that he hadn't got any chances to blow by 'being' the wrong religion. "They are not kind, these people. I am not telling them about my prblems - you are in fact the only person I've told, and I'm glad you're going to help me."
"I'm afraid I'm not from America, so I don't think I can really help you with these dollars."
"Ah, but my friend, I am very fortunate to have met you! What I'm saying to you is, strike while the iron is hot!" (He had lost me here as well, although not in the way he hoped)
"Um - yes. I still don't see exactly what you want me to do." (And by 'what' I mean 'how', and by 'you want me to do' I mean 'how you plan to fleece me of large sums of foreign currency')
"Ah! Well, when I came here they kept my bags! So, all I need is for you to come with me to the Red Cross office and ask them for my bag." (Hm. Although this sounds unlikely, I don't see how it could involve my getting robbed...perhaps he's genuine after-)
"We cannot go now - but we must arrange a time. And then, when they give you my bag, they will give you your money back."
Notice how "your money" came out of left-field there? Me too.
At this point we reached Thabakady, I paid the taxi driver his 40p fare and leapt out. My New Friend and his hitherto silent accomplice leapt from the car to see if they could close the deal. They couldn't, but Thabakady was very good.
Halfway through, and I'm quite bored. I can't decide whether the week wasted out of hospital is worth the fact that this is a ready-made elective portfolio; on balance I don't think so. However, the leather conference bag is pretty good, as are the heated arguments which break out after every other session and insert inexcusable delays before tea or lunch.
It's not that the data being presented isn't interesting - it's just that it seems fundamentally pointless to be addressing it. 700 maternal deaths per 100,000 and a 25% infant mortality are shockingly high, but unless you change the culture (in which contraception use runs at 5%) and the economy (it's something like the poorest country in the world and is hit by famines every couple of years) you'll just be worsening the imbalance between food supply and demand, and the people you "save" will end up starving to death. Upshot - you have to wonder if you were addressing the right question.
But enough of that – I met my first nutter last night in a taxi. I got in outside the Canadian embassy and was en route to a swanky French restaurant (called, in classic Gallic fashion, Thabakady), and evidently my fellow passenger sniffed an opportunity.
"Hello my friend!" he began, ignoring the fact I had asked for my destination in French. "What is your name?"
"Nicolas," I told him, feeling that his reaching out through the window of a moving vehicle to shake hands was a little excessive. "I'm Womo," (I'm not sure of the name – his English wasn't great, ok?) "and I have come here from Liberia."
I nodded politely, thinking that it was an awfully long way to have come and not the most obvious destination. "I came here because the fighting in Liberia was too much for me, and I have a problem which you can help with! I have come with lots of dollars - I was very lucky to be able to bring them with me."
And bang! I was in a real-life version of one of those Nigerian 419 scams which are proof that the internet, like life, dislikes the stupid.
"I'm pleased you managed to leave Liberia with so many dollars!" I rejoined.
"Ah, but my friend - it is difficult for me here," (presumably because of the exchange rate?) "The people here, they are Muslims, you see, and I am a Christian." He paused nervously, not realising that he hadn't got any chances to blow by 'being' the wrong religion. "They are not kind, these people. I am not telling them about my prblems - you are in fact the only person I've told, and I'm glad you're going to help me."
"I'm afraid I'm not from America, so I don't think I can really help you with these dollars."
"Ah, but my friend, I am very fortunate to have met you! What I'm saying to you is, strike while the iron is hot!" (He had lost me here as well, although not in the way he hoped)
"Um - yes. I still don't see exactly what you want me to do." (And by 'what' I mean 'how', and by 'you want me to do' I mean 'how you plan to fleece me of large sums of foreign currency')
"Ah! Well, when I came here they kept my bags! So, all I need is for you to come with me to the Red Cross office and ask them for my bag." (Hm. Although this sounds unlikely, I don't see how it could involve my getting robbed...perhaps he's genuine after-)
"We cannot go now - but we must arrange a time. And then, when they give you my bag, they will give you your money back."
Notice how "your money" came out of left-field there? Me too.
At this point we reached Thabakady, I paid the taxi driver his 40p fare and leapt out. My New Friend and his hitherto silent accomplice leapt from the car to see if they could close the deal. They couldn't, but Thabakady was very good.
Wednesday, 1 August 2007
Killer fans, killer conferences,
Wednesday 1st August
Today hasn't started well. I got up at 6:45 for a 7:15 pickup, the shower doesn't drain (though is not too cold and involves no buckets), and while wriggling into my shirt I failed to remember there was a ceiling fan. This meant that I spent the 45 mins I had spare while I waited for my lift (which was late) delving into the small pharmacy I'd brought with me for TCP and bandages. And feeling like a real muppet given the number of times Ben and I joked about exactly this in Ananda Bhavan in India.
Then, having lovingly packed gloves and scrubs for the hospital, Dr. Marianne took me to the conference pictured above instead of the hospital, so I'm currently sat here waiting for the president's wife (pic to follow if I can find a scanner) to show up and open proceedings. Which do look interesting enough, but last three days. There is one slightly alarming abstract, but more on that if I stay awake during it. At least the official photographer loves me even in my red gingham shirt.
Yesterday I met the rain for the first time (note to Mum: you were right about something about this country! It is the rainy season! But please don't take this as encouragement to leave me more comments telling me to wash my hands / not talk to strangers / etc.) - it was impressive largely because of what it does to the ground. The streets turn a much darker red, but the water collects only at the edges of the roads, while the centre remains pretty solid. This makes being a pedestrian a little hazardous, and if the bastard in the NGO 4WD that coated me from the waist down in a spray of red mud is at the conference, I'm letting his tyres down.
On the culinary front, neither of yesterday's meals involved tubes and neither featuredf what I take to be the Nigérien specialty of sandy rice. Much as it sounds, this is rice with some sand in.
Anyway, the official photographer has stopped taking pictures of the only other white man here and it looks like Mrs. President is clearing her throat, so I'd better look attentive...
Today hasn't started well. I got up at 6:45 for a 7:15 pickup, the shower doesn't drain (though is not too cold and involves no buckets), and while wriggling into my shirt I failed to remember there was a ceiling fan. This meant that I spent the 45 mins I had spare while I waited for my lift (which was late) delving into the small pharmacy I'd brought with me for TCP and bandages. And feeling like a real muppet given the number of times Ben and I joked about exactly this in Ananda Bhavan in India.
Then, having lovingly packed gloves and scrubs for the hospital, Dr. Marianne took me to the conference pictured above instead of the hospital, so I'm currently sat here waiting for the president's wife (pic to follow if I can find a scanner) to show up and open proceedings. Which do look interesting enough, but last three days. There is one slightly alarming abstract, but more on that if I stay awake during it. At least the official photographer loves me even in my red gingham shirt.
Yesterday I met the rain for the first time (note to Mum: you were right about something about this country! It is the rainy season! But please don't take this as encouragement to leave me more comments telling me to wash my hands / not talk to strangers / etc.) - it was impressive largely because of what it does to the ground. The streets turn a much darker red, but the water collects only at the edges of the roads, while the centre remains pretty solid. This makes being a pedestrian a little hazardous, and if the bastard in the NGO 4WD that coated me from the waist down in a spray of red mud is at the conference, I'm letting his tyres down.
On the culinary front, neither of yesterday's meals involved tubes and neither featuredf what I take to be the Nigérien specialty of sandy rice. Much as it sounds, this is rice with some sand in.
Anyway, the official photographer has stopped taking pictures of the only other white man here and it looks like Mrs. President is clearing her throat, so I'd better look attentive...
Tuesday, 31 July 2007
Niamey, offal, nicknames, and banditry
So I'm arrived on Monday morning, a little under two hours late, after an impromptu three-and-a-half hour wait for my flight out of Casablanca, which was two hours late. The only good thing about this was that I got talking to a Peace Corps volunteer called Tina who was heading back to Niamey after her holiday, so I had some insider info on the place when I got in, and thanks to her fluency in Hausa, I didn't get fleeced for the taxi into town.It was 27 degrees when I landed at 5am and got progressively hotter from there, so I went to bed until just after noon under the AC, then headed down to the hospital to try to find my contact there. The third doctor I tried had heard of her and sent me off to a clinic up the road; I arrived just after she'd left, so then had to wait around for a Dr. Cheikh so I could get her phone number.
My slight unease at the absence of any central admin type office and my near-total reliance on one person was allayed by the fact everyone was so helpful - Dr. Cheikh was chatty, kept saying he was sure there would be no problems in a way which suggested pasty white people turned up in his clinic wanting to do electives roughly every second monday, and even lied about the quality of my French on several occasions.
So I left to wander around the city, which is quite pleasant. Although there's almost no grass, meaning that underfoot is either bitty tarmac or a reddish-orange dirt. The buildings are mainly concrete, although from the taxi ride in it looks like there are mud-brick and thatch areas on the outskirts. None of them are particularly attractive, however, and there's no Sheraton hotel here to dazzle among the shanty-towns and to allow Brangelina to stay in it while picking some poor orphan who will, over time, realise that they've traded the squalor of poverty for the degradations of a brief movie/musical/famous-for-being-famous career followed by a succession of stints in rehab and the front pages of most newspapers, culminating in a death from overdose or in a carcrash which may even be younger than they'd have got had they stayed put. There are some quite bizarrely attractive government buildings like the Ministry for Energy, which I will attempt to photograph later. Generally, though, it's a city plonked down in a bit of desert which happens to have a river nearby - so it's dry, dusty, and seriously, seriously hot. I got tanned yesterday wearing factor 40 - it's that hot.
Last night involved calling Dr. Marianne, and then heading out for dinner and drinks with a bunch of the Peace Corps lot (Tina, Noah, Emily, Whitney, and someone else). I say "someone else" because one of the first bits of info I got was that they are only all in Niamey every couple of months - normally they're out in villages (<1000 people, no electricity or running water, etc) where they work with the local people doing health education and so on. Part of the deal is that their host families give them names in the local language, i.e. which they can pronounce (apparently "Whitney" is impossible). The guy whose name I can't remember was given the nickname "Rashid", and although he is never called that by the other yanks, it removed any possibility I would remember his actual name. We went to a bar out west of the hospital (marked on the map above above the last R of 'river') and drank 60p giant bottles of beer; as ever, I fell asleep for about 20 mins in the middle of the evening, but woke up in time to head outside and find some street food. The others ordered rice and potatoes which the woman fished from the cauldron of meat sauce; thinking this a really poor option, I went for rice-and-meat. The sauce was great, but the meat was basically tubes - I couldn't decide if they were aorta or windpipe, but probably the former - so I think I'm going to stick to the potatoes next time...
This morning I checked out of the expensive hotel I'd been in the first night (28 quid a night!) and into the Catholic mission (7 quid a night) which is central, clean, and looks good. I also met Dr. Marianne in person, although this also involved running around with her while she helps Dr. Borreima organise a UNICEF conference on maternal and paediatric health. This will I'm sure be pretty interesting (and I may get to go), but meetings about it are not so interesting, and I battled manfully to stay awake. However, everything looks set for the elective, and I've decided to split it between paediatrics and internal medicine...so we shall see how that pans out.
The only other thing I must add is that if any of you are thinking of going on holiday, don't take traveller's cheques. Amex charge a flat fee of ten quid however much you exchange, and the bank takes another 2%; so if you try to change 100 euros, you end up paying 20% in fees. When you then try to change 400 euros, you get told you can only change a maximum of 200 a week. The fees on this mean that the bank gets 2%, Amex get just over 9%, and you get shafted. Had I taken it all in cash and been robbed, I'd have paid less for the excess on my insurance than I would in fees to Amex on the traveller's cheques I've brought...
I'm off to find something for dinner that isn't mostly offal. Bye for now.
Monday, 30 July 2007
Arrival
I'm here - the flight was uneventful bar my bag getting stopped going through the scanner (me: is it the wind-up torch? guard: no. unpack everything. outcome: it was the windup torch), reading the final Harry Potter, and having sprite spilt over me by a clumsy steward.
Niamey so far: hot. Very hot. More to follow - I'm running out of time at the internet cafe...
Niamey so far: hot. Very hot. More to follow - I'm running out of time at the internet cafe...
Tuesday, 24 July 2007
Pre-departure panic
Well, it's not all a panic - I've spent the fortnight before I go in the USA, mostly New York, with a brief trip to Washington DC. Regular readers (I like to pretend you exist: humour me) will recall the life-changing experience which was the Elective Portfolio and how much I felt I grew in a very real sense as a person while completing it. It made me realise the importance of adjusting my personal lifestyle choices and using the elective period to examine whether I'm leading the life I want to; with this in mind, I decided that an orgy of clothes shopping, double-chilliburgers, chocolate milkshakes, and the purchase of expensive electrical gadgets was the best way to prepare myself for visiting the poorest country in the world. Because it will, er, make me appreciate the contrast more, notwithstanding that I'd have to be the sort of person suited only for a job administrating the more pointlessly sadistic components of a medical curricululm not to have recognised this beforehand.
Anyway. My current concerns revolve around the amount of time I've left myself between getting back and leaving; I thought three days would be ample, but unfortunately one is a saturday and another a sunday. Oops. This means friday is going to be insanely busy, and I suspect I will forget at least two very important things. But hey. So long as I remember the suncream and the travel insurance, it's all good.
And the foreign currency.
And my passport.
And our nice red robes...
Wednesday, 20 June 2007
Looks like the school trip's off
It appears my plan to head up to a charity which runs a school for the children of the Touareg nomads may be off. The idea was that I would this charity, help out the visiting doctor, and do a health survey of the local population. Interesting, proper full-on rural medicine, and really useful to do.
The downside? It's right up on the border with Algeria/Mali, and it has been on the FCO list advising against "all but essential travel" for ages. Happily, the info on the relevant bit of Niger changed a couple of days ago, to:
We advise against all travel to the Aïr Massif region and on the road linking Assamaka, Arlit and Agadez. Armed groups are operating in the North and are known to be using land mines. Extreme caution should be exercised when travelling to the following areas: the Ténéré and Kaouar regions; the Azawagh area, particularly the area between the Malian and Algerian borders and the towns of Tahoua and Ingall; the east of the Aïr Massif.
Advice I can take with a pinch of salt; landmines less so. Oh well.
The downside? It's right up on the border with Algeria/Mali, and it has been on the FCO list advising against "all but essential travel" for ages. Happily, the info on the relevant bit of Niger changed a couple of days ago, to:
We advise against all travel to the Aïr Massif region and on the road linking Assamaka, Arlit and Agadez. Armed groups are operating in the North and are known to be using land mines. Extreme caution should be exercised when travelling to the following areas: the Ténéré and Kaouar regions; the Azawagh area, particularly the area between the Malian and Algerian borders and the towns of Tahoua and Ingall; the east of the Aïr Massif.
Advice I can take with a pinch of salt; landmines less so. Oh well.
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