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...
Monday 27 August 2007
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...
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