Postscript 1: Niger to Iraq

Today I got a long e-mail from Alex and Bri, two of the Peace Corps volunteers (PCVs) I met out in Niger; they were up in Winditan, and I ran into them a few times, and saw one of their friends who was ill. The e-mail was great - I'd been wondering how the anniversary of 45 years of Peace Corps in Niger had gone, and Alex's account was astute, detailed, entertaining, even wry in places. It was the sort of e-mail which makes you feel like you've been living in the next village to someone for the past couple of months instead of thousands of miles away.

At the end, though, they revealed that Matt, the PCV I went and stayed with, has had his Peace Corps service cut short because the US army, which he served with in Iraq before going to Niger, have recalled him.

Matt was and is extremely opposed to soldiering as a career. You can read his thoughts on Iraq and agriculture online; while I was out there he got flown back to New York to talk at a veteran's conference, where he was interviewed by Reuters, and appeared on I think the Today programme.

Recalling him is just crazy, and I'm so damn upset for him I can't even say.

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.

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.

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...

Niamey, offal, nicknames, and banditry

So I'm arrived on Monday morning, a little under two hours late, after an impromptu three-and-a-half hour wait for my flight out of Casablanca, which was two hours late. The only good thing about this was that I got talking to a Peace Corps volunteer called Tina who was heading back to Niamey after her holiday, so I had some insider info on the place when I got in, and thanks to her fluency in Hausa, I didn't get fleeced for the taxi into town.

It was 27 degrees when I landed at 5am and got progressively hotter from there, so I went to bed until just after noon under the AC, then headed down to the hospital to try to find my contact there. The third doctor I tried had heard of her and sent me off to a clinic up the road; I arrived just after she'd left, so then had to wait around for a Dr. Cheikh so I could get her phone number.

My slight unease at the absence of any central admin type office and my near-total reliance on one person was allayed by the fact everyone was so helpful - Dr. Cheikh was chatty, kept saying he was sure there would be no problems in a way which suggested pasty white people turned up in his clinic wanting to do electives roughly every second monday, and even lied about the quality of my French on several occasions.


So I left to wander around the city, which is quite pleasant. Although there's almost no grass, meaning that underfoot is either bitty tarmac or a reddish-orange dirt. The buildings are mainly concrete, although from the taxi ride in it looks like there are mud-brick and thatch areas on the outskirts. None of them are particularly attractive, however, and there's no Sheraton hotel here to dazzle among the shanty-towns and to allow Brangelina to stay in it while picking some poor orphan who will, over time, realise that they've traded the squalor of poverty for the degradations of a brief movie/musical/famous-for-being-famous career followed by a succession of stints in rehab and the front pages of most newspapers, culminating in a death from overdose or in a carcrash which may even be younger than they'd have got had they stayed put. There are some quite bizarrely attractive government buildings like the Ministry for Energy, which I will attempt to photograph later. Generally, though, it's a city plonked down in a bit of desert which happens to have a river nearby - so it's dry, dusty, and seriously, seriously hot. I got tanned yesterday wearing factor 40 - it's that hot.

Last night involved calling Dr. Marianne, and then heading out for dinner and drinks with a bunch of the Peace Corps lot (Tina, Noah, Emily, Whitney, and someone else). I say "someone else" because one of the first bits of info I got was that they are only all in Niamey every couple of months - normally they're out in villages (<1000 people, no electricity or running water, etc) where they work with the local people doing health education and so on. Part of the deal is that their host families give them names in the local language, i.e. which they can pronounce (apparently "Whitney" is impossible). The guy whose name I can't remember was given the nickname "Rashid", and although he is never called that by the other yanks, it removed any possibility I would remember his actual name. We went to a bar out west of the hospital (marked on the map above above the last R of 'river') and drank 60p giant bottles of beer; as ever, I fell asleep for about 20 mins in the middle of the evening, but woke up in time to head outside and find some street food. The others ordered rice and potatoes which the woman fished from the cauldron of meat sauce; thinking this a really poor option, I went for rice-and-meat. The sauce was great, but the meat was basically tubes - I couldn't decide if they were aorta or windpipe, but probably the former - so I think I'm going to stick to the potatoes next time...

This morning I checked out of the expensive hotel I'd been in the first night (28 quid a night!) and into the Catholic mission (7 quid a night) which is central, clean, and looks good. I also met Dr. Marianne in person, although this also involved running around with her while she helps Dr. Borreima organise a UNICEF conference on maternal and paediatric health. This will I'm sure be pretty interesting (and I may get to go), but meetings about it are not so interesting, and I battled manfully to stay awake. However, everything looks set for the elective, and I've decided to split it between paediatrics and internal medicine...so we shall see how that pans out.

The only other thing I must add is that if any of you are thinking of going on holiday, don't take traveller's cheques. Amex charge a flat fee of ten quid however much you exchange, and the bank takes another 2%; so if you try to change 100 euros, you end up paying 20% in fees. When you then try to change 400 euros, you get told you can only change a maximum of 200 a week. The fees on this mean that the bank gets 2%, Amex get just over 9%, and you get shafted. Had I taken it all in cash and been robbed, I'd have paid less for the excess on my insurance than I would in fees to Amex on the traveller's cheques I've brought...

I'm off to find something for dinner that isn't mostly offal. Bye for now.

Looks like the school trip's off

It appears my plan to head up to a charity which runs a school for the children of the Touareg nomads may be off. The idea was that I would this charity, help out the visiting doctor, and do a health survey of the local population. Interesting, proper full-on rural medicine, and really useful to do.

The downside? It's right up on the border with Algeria/Mali, and it has been on the FCO list advising against "all but essential travel" for ages. Happily, the info on the relevant bit of Niger changed a couple of days ago, to:

We advise against all travel to the Aïr Massif region and on the road linking Assamaka, Arlit and Agadez. Armed groups are operating in the North and are known to be using land mines. Extreme caution should be exercised when travelling to the following areas: the Ténéré and Kaouar regions; the Azawagh area, particularly the area between the Malian and Algerian borders and the towns of Tahoua and Ingall; the east of the Aïr Massif.

Advice I can take with a pinch of salt; landmines less so. Oh well.

Preparation

So I am off to Niamey in Niger this summer for my elective - two months of living in the poorest country in the world (according to the UNDP Human Development Index) and experiencing some medicine without anyone squabbling over whether they should get this or that drug on the NHS, or whether having to pay to have your GP look at your cold at 11:30 at night.

Needless to say, I'm looking forward to it - it's also part of Francophone West Africa, so I get to brush up on my French and perhaps try to learn Hausa. My mother is not looking forward to it: she thinks I will catch some hideous disease there and/or be kidnapped by fundamentalists and held for ransom. I've been trying to persuade her that it's no more or less dangerous than Vellore or Addis Ababa where I've already been - but to no avail.

However, one of the fun things had been deciding what kit I'm going to take out with me - I don't mean all the things I'm going to have to nick from the hospital beforehand (e.g. boxes of gloves, probably a bunch of needles, syringes and cannulae, all that sort of thing), but more things I can buy to take out with me.

First is a wind-up torch. I think it looks pretty cool, don't you? And if it's anything like Addis, where the lights went out during surgery several times, it may even be lifesaving... The photo to the right may explain why the lights went out - that was one of the three plugs in the theatre they used for caesarean sections...