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.

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.

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...