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...
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