Today I got a long e-mail from Alex and Bri, two of the Peace Corps volunteers (PCVs) I met out in Niger; they were up in Winditan, and I ran into them a few times, and saw one of their friends who was ill. The e-mail was great - I'd been wondering how the anniversary of 45 years of Peace Corps in Niger had gone, and Alex's account was astute, detailed, entertaining, even wry in places. It was the sort of e-mail which makes you feel like you've been living in the next village to someone for the past couple of months instead of thousands of miles away.
At the end, though, they revealed that Matt, the PCV I went and stayed with, has had his Peace Corps service cut short because the US army, which he served with in Iraq before going to Niger, have recalled him.
Matt was and is extremely opposed to soldiering as a career. You can read his thoughts on Iraq and agriculture online; while I was out there he got flown back to New York to talk at a veteran's conference, where he was interviewed by Reuters, and appeared on I think the Today programme.
Recalling him is just crazy, and I'm so damn upset for him I can't even say.
Saturday 27 October 2007
Wednesday 26 September 2007
Wake Me Up, Before You Go-Go
Monday 17th
I know I said I wouldn't write again unless something spectacular happened, but it sort of did and, on reflection, the disjointed sprawl of the last missive was a suitable farewell to Niamey only stylistically (one of the best descriptions of the town I've heard was "it's a giant bush village").
Today was really my last day, and has been - entertaining. I met Dr. Marianne last night when she was on call at the private clinic down the road, and she said that she'd take me to the airport, as she was on-call again tonight and so was free during the day. We agreed to meet at 16h. Otherwise, the day was quiet - I spent an hour waiting for two pointless pieces of paper from the internal medicine big chief, most wanting to drill into at first his and then my own kneecaps with boredom. Then a final fling round the local area giving away all the stuff I wasn't going to need, and back for my 4pm rendez-vous with Dr. Marianne.
She was late. I watched some very bad cartoons, and some international Greco-Roman wrestling. She was still late. It reached 5pm. I began to get antsy, not wanting to have to find a taxi just before the end of Ramadan.
I waited some more. At 17:20 I recalled that she had complètement oublié me before, so I went to leave the key at the clinic, feeling a bit pissed off. Happily, I met the watchmen on the way to the clinic and, amid warm farewells, they told me to pay 200CFA (20p) to get to the grand marché, and 300 from there to the airport. This was about one-fifth of what the useless Bradt guidebook suggested.
Walking out with the rucksack felt like the right way to leave Niamey, as it did when the taximan dropped me at a taxi-brousse where a boy in a pink shirt took 500CFA (I was too relieved to be leaving to haggle), loaded my bag, and I climbed in. Midway through the journey, the conductor-boy asked me for the fare. Confused, and with a vague sinking feeling, I explained that I'd already paid 500 to the boy in the pink shirt. The driver scowled. He hadn't passed the money on.
The upshot? Well, you can imagine - I paid another 500. Or so you might imagine - but you would be wrong. What in fact followed was a minute or two's irate muttering in Djerma, followed by the driver - who at this point had not one CFA of my money - giving me my change, and saying darkly, "we'll deal with the boy later". The fare was in fact 125CFA; I gave them double in the end because they'd been so scrupulously honest and not shafted me when it would have been extremely easy to do so.
I did have to walk the final 200m to the airport off the main road and, once inside, deal with a couple of tossers coming up and saying that as I was leaving I had to give them souvenirs of, say, money or my watch, but my day had gone well enough that I was curt and offended-sounding without once resorting to swearing copiously in English.
Then, happily, Dr. Marianne turned up. She explained that she had heard the flight was late and so had just not bothered turning up (NB: she only actually said one of these two things). Her two boys and husband were in tow, and were fun, so we chatted over a Ramadan-flaunting drink in the airport bar. During the course of the conversation, I checked she'd got the note I'd left at the clinic and said the man there had been surprised you were on-call again tonight.
Dr M: "No - it's not me."
Me: "Oh - maybe I misunderstood. I thought he'd checked it - because you'd told me yesterday you were on call again tonight...?"
Dr M: "But I write the rota - I wouldn't put myself on two nights in a row! Why, I'm exhausted!"
Me: "I must have made a mistake."
Dr M: "I have it here - I'll check."
Dr M: "Merde."
Me (glancing at watch, which read 18:58): "What time does it start?"
Dr M: "19:00."
So after some scurrying about and a quick farewell, she wended on her way. It made me feel much better about her having completely forgotten me previously, anyway. And was very amusing.
Check-in was uneventful and surprisingly smooth given that I had expected them to take one look at my e-ticket and throw me out the airport, and it was enlivened by the two energetic kids, one of whom drew in my diary and then danced to Wham! when they came on TV singing Wake Me Up Before You Go-Go. It's a source of some amusement to me that a strictly Muslim country has a main TV channel which not only shows a video featuring George Michael in a tight white T-shirt emblazoned "choose life" about once an hour, but has even adopted a sort of elevator-music version of the song as its theme music. I suspect if they knew of his more recent, non-musical exploits, they might pick a different song...
I was going to write more about how the taxi experience reaffirmed my belief that these are good people, and about how the curtailment of what they can hope for is so depressing, but instead I'll give you a little quote from Alexandra Fuller's rather wonderful book Don't let's go to the dogs tonight:
But our faux-Spanish house, with its stucco walls and its long, cool stretches of linoleum and its vast veranda and its spacious garden, seem, suddenly, exhaustingly, too much.
Mum shakes her head. She says, "I know, Bobo."
"But it's so awful."
"It won't go away." She is watching me stuff plastic bags with clothes. "You can't make it go away."
I sniff.
"It was there before you noticed it."
"I know, but..."
She gets up with a sigh, dusts her knees. She says, "And it will be there after you leave."
"I know, but..."
Mum pauses at the door. "And bring back my plastic bags. We're always short of those," she says.
It's as gentle a reminder as I reckon you could find that just going somewhere, just being somewhere, doesn't change things, no matter how strongly or naively you believe that it might.
As the flight took off, Niamey drifted lazily away from me, a great chaotic raft of white lights surrounded by an ocean of darkness.
I know I said I wouldn't write again unless something spectacular happened, but it sort of did and, on reflection, the disjointed sprawl of the last missive was a suitable farewell to Niamey only stylistically (one of the best descriptions of the town I've heard was "it's a giant bush village").
Today was really my last day, and has been - entertaining. I met Dr. Marianne last night when she was on call at the private clinic down the road, and she said that she'd take me to the airport, as she was on-call again tonight and so was free during the day. We agreed to meet at 16h. Otherwise, the day was quiet - I spent an hour waiting for two pointless pieces of paper from the internal medicine big chief, most wanting to drill into at first his and then my own kneecaps with boredom. Then a final fling round the local area giving away all the stuff I wasn't going to need, and back for my 4pm rendez-vous with Dr. Marianne.
She was late. I watched some very bad cartoons, and some international Greco-Roman wrestling. She was still late. It reached 5pm. I began to get antsy, not wanting to have to find a taxi just before the end of Ramadan.
I waited some more. At 17:20 I recalled that she had complètement oublié me before, so I went to leave the key at the clinic, feeling a bit pissed off. Happily, I met the watchmen on the way to the clinic and, amid warm farewells, they told me to pay 200CFA (20p) to get to the grand marché, and 300 from there to the airport. This was about one-fifth of what the useless Bradt guidebook suggested.
Walking out with the rucksack felt like the right way to leave Niamey, as it did when the taximan dropped me at a taxi-brousse where a boy in a pink shirt took 500CFA (I was too relieved to be leaving to haggle), loaded my bag, and I climbed in. Midway through the journey, the conductor-boy asked me for the fare. Confused, and with a vague sinking feeling, I explained that I'd already paid 500 to the boy in the pink shirt. The driver scowled. He hadn't passed the money on.
The upshot? Well, you can imagine - I paid another 500. Or so you might imagine - but you would be wrong. What in fact followed was a minute or two's irate muttering in Djerma, followed by the driver - who at this point had not one CFA of my money - giving me my change, and saying darkly, "we'll deal with the boy later". The fare was in fact 125CFA; I gave them double in the end because they'd been so scrupulously honest and not shafted me when it would have been extremely easy to do so.
I did have to walk the final 200m to the airport off the main road and, once inside, deal with a couple of tossers coming up and saying that as I was leaving I had to give them souvenirs of, say, money or my watch, but my day had gone well enough that I was curt and offended-sounding without once resorting to swearing copiously in English.
Then, happily, Dr. Marianne turned up. She explained that she had heard the flight was late and so had just not bothered turning up (NB: she only actually said one of these two things). Her two boys and husband were in tow, and were fun, so we chatted over a Ramadan-flaunting drink in the airport bar. During the course of the conversation, I checked she'd got the note I'd left at the clinic and said the man there had been surprised you were on-call again tonight.
Dr M: "No - it's not me."
Me: "Oh - maybe I misunderstood. I thought he'd checked it - because you'd told me yesterday you were on call again tonight...?"
Dr M: "But I write the rota - I wouldn't put myself on two nights in a row! Why, I'm exhausted!"
Me: "I must have made a mistake."
Dr M: "I have it here - I'll check."
Dr M: "Merde."
Me (glancing at watch, which read 18:58): "What time does it start?"
Dr M: "19:00."
So after some scurrying about and a quick farewell, she wended on her way. It made me feel much better about her having completely forgotten me previously, anyway. And was very amusing.
Check-in was uneventful and surprisingly smooth given that I had expected them to take one look at my e-ticket and throw me out the airport, and it was enlivened by the two energetic kids, one of whom drew in my diary and then danced to Wham! when they came on TV singing Wake Me Up Before You Go-Go. It's a source of some amusement to me that a strictly Muslim country has a main TV channel which not only shows a video featuring George Michael in a tight white T-shirt emblazoned "choose life" about once an hour, but has even adopted a sort of elevator-music version of the song as its theme music. I suspect if they knew of his more recent, non-musical exploits, they might pick a different song...
I was going to write more about how the taxi experience reaffirmed my belief that these are good people, and about how the curtailment of what they can hope for is so depressing, but instead I'll give you a little quote from Alexandra Fuller's rather wonderful book Don't let's go to the dogs tonight:
But our faux-Spanish house, with its stucco walls and its long, cool stretches of linoleum and its vast veranda and its spacious garden, seem, suddenly, exhaustingly, too much.
Mum shakes her head. She says, "I know, Bobo."
"But it's so awful."
"It won't go away." She is watching me stuff plastic bags with clothes. "You can't make it go away."
I sniff.
"It was there before you noticed it."
"I know, but..."
She gets up with a sigh, dusts her knees. She says, "And it will be there after you leave."
"I know, but..."
Mum pauses at the door. "And bring back my plastic bags. We're always short of those," she says.
It's as gentle a reminder as I reckon you could find that just going somewhere, just being somewhere, doesn't change things, no matter how strongly or naively you believe that it might.
As the flight took off, Niamey drifted lazily away from me, a great chaotic raft of white lights surrounded by an ocean of darkness.
Thursday 13 September 2007
The final furlong
Monday 10th September
Well, I have 7 days left, or slightly under, as by this time next week I will probably be touching down in Bamako on the first of the four stops before London. They are the aforementioned Bamako for "technical reasons", as my e-ticket prophetically informs me (I'm still torn between being reassured that problems have been predicted and unsettled by their predictability). The second is Dakar some two hours later, where I'm meeting Toyin and Liz; the third, on the 29th September, is Casablanca, where if the outbound flight is any indication I will spend several more than the two hours I'm scheduled to spend there and will meet someone who will be central to my social life for the next two months, and finally London itself.
To answer the question you would ask if you were here: yes, I am ready to leave. Caitlin (Nigérien name: Yakalu), who's a Canadian Boston University student doing premed there who's in Niamey for four months of language and cultural studies, and who I showed round the hospital this morning, asked at lunch whether I'd stay if I could, which I thought was much harder-to-answer and therefore better way of putting the question. I said 'no' with a speed that surprised me. I could do another couple of weeks in paeds - but even there, where they make an effort, my education would suffer from the overall lack of teaching, and I miss UK *standards*. They have standards here, of course, and I am about to go right ahead and judge them, as ultimately I'm out here and while I may only be a medical student and only essentially a tourist and blah, I believe that not only does that mean I am entitled to judge them, but that it also means that in some ways I must. The "you shouldn't travel to the developing world and *judge* them" is crap - if you come out to the third world and have standards of your own, you have to judge what you find here by those standards. If you can look at the 1 in 4 children who die before age 5 here and call that unacceptable, so too can you look at, for instance, the standards of care in hospitals and call them unacceptable. Of course, in terms of writing elective portfolios, doing one gets you marks and doing the other attracts accusations of arrogant colonialist medical students from a failed sociology student who has never heard of post-colonialism and who would cast my use of 'the third world' in the same light despite the fact that Niger, at least, is not developing in any meaningful way, so 'developing' is at best a lie and at worst an attempt to gloss over this fact. Anyway, I will say that the standards of care here in paediatrics are, given the resources available to them, excellent, and that's largely due to Dr. Roubanatou taking no shit and running a phenomenally tight ship. Having spent many a morning in internal medicine sitting around doing nothing while the head of service there sees his private patients until 11am, that lack of organisation is not acceptable. I never thought I'd say this - but I'm actually looking forward to handover meetings when I get back...
Interestingly, in Pédiatrie A, where the highest standards of care are, all treatment is free because the service covers children up to age 2, and until age 5 all medical treatment is free. By contrast in internal medicine, all the patients are paying and are often regulars at the private clinics of the same doctors treating them in hospital - but standards are catastrophically low. Electrolyte levels go unheeded for whole weekends, cardiac arrests are viewed by many as an inconvenience, and too much is treated as "not cardiological" despite this nominally being a general medical service. It's then not properly investigated, worse yet no attempt is made to diagnose it, and they're just referred on to pay a different kind of doctor. Here, a paying service is not only not a better service, it's exponentially worse.
The NHS must not be privatised, ladies and gentlemen. Those say it would mean better care are liars and idiots, and probably have shares in BUPA.
This morning was interesting. Caitlin had expressed an interest in seeing stuff in the hospital when some of the Peace Corps guys and I ran into her and a bunch of other Boston Uni students in a bar, so she came along to ward rounds; we broke from the round part-way through because I thought it'd be good to get her to examine a 10-year-old girl who'd had heart surgery. So she did, and that was great - as you'd perhaps expect, the kid had more signs than you would find in 20 patients back home (central sternotomy scar, 6cm raised jugular venous pressure, heave, ascites, 8cm hepatomegaly, Graham-Steele murmur which I did have to look up) and is a smiley girl. As we went through the exam, mum not unreasonably took the opportunity to ask questions, which was fine, except that they were the sort of questions someone should already have answered. I told her I'd check her daughter's folder more to verify the diagnosis than in any expectation that there'd be any notes in there, and would come back afterwards. She'd had a valve replacement 2 years previously for a congenital mitral stenosis which had gone unnoticed until she'd developed pulmonary hypertension and right heart failure. The op in France was useful in that it had halted the progression of the disease, but none of the existing damage was going to get better.
Entirely reasonably, mother and daughter both wanted to know if she'll be able to go back to school, or if she'll be able to walk 20 metres without getting breathless, or if she's going to *get better*. This is difficult to handle sensitively in a second language without resorting to the short answer to each question, which is "non". I told her that the drugs, we hoped, would improve things, but that the problems with the heart were not going to get better; that the damage there had been done; that there was nothing really that could be done even in France. I didn't dangle the imaginary carrot of a heart-lung transplantation, because it's in practical terms impossible.
Then there was the man who'd been moved to the high dependency unit (four beds within touching distance of one another) when his sodium hit quatre-vingts-treize (93), the woman who died as we did CPR on her waiting for a defibrillator which never came ("there isn't one" "yes there is, it's in A&E" "we can't use that one - it's theirs" etc) and one of the doctors said "it's hardly worth it" as the woman gasped occasionally, and then asked if she could continue the ward round. There was the Bell's palsy which fell between the "cardiology" and the "everything else" chairs, and was sent for a totally pointless CT scan despite the doctor agreeing it was a lower motor neuron lesion, and so on. There have been bright spots: one was the woman who claimed to have met the queen ("she speaks perfect French, Queen Elizabeth"), and Diana, and who shortly after I'd decided she was barking and allowed just a note of sarcasm to creep into my "oh, really?"s turned out to be telling the truth as she was the Belgian ambassador's wife. There there was Ali's wife, who was the first of several friends-of-friends who I was asked to see, and who sweetly but very rapidly irritatingly called me at least twice a day once she got home after I'd seen her to say "I'm in the best of health now". Hadjara, a friend of Alex and Bri's who came in hardly conscious with a raging fever and quite Seriously Unwell, and who I had a short and unsuccessful battle to get checked out for any cause of post-partum abdominal pain bar endometritis, which she in fact had. She got better over a week or so, and I stopped in five or six times to see her and the three or four family members who'd come with her and were sleeping, as she was, on mats, although where she was in a covered corridor, they were under a tree in the yard. All the kids at Hope House were another, that being an orthopaedic rehabilitation centre whose rather cloying name belies the fantastic work they do. I met Jen, the American who runs the care side of things, and her husband Will through Alex and Bri (again) and went out to see what goes on there a couple of times. They have a network of people around the country who identify kids who might benefit from orthopaedic surgery; they then get an assessment and if suitable are offered part-funded surgery. The family have to stump up I think 30,000 CFA (30 quid), with the remaining 90,000CFA+ coming from PRAHN's budget (PRAHN is the organisation which runs Hope House). After the op they then get physio, accommodation, any orthoses they need and general rehab until they're ready to go home and continue exercises independently. THe kids had the usual glee at seeing themselves on a digital camera, and were mostly working hard to get themselves able to walk again or whatever it was. They see a lot of cases of club foot, equinus deformities, windswept and knock-knees, consequences of polio, even one boy whose problems were probably due to sickle cell disease but who was pretty close to a contortionist, so bizarre were his legs, which sloped slowly outwards from lumpy, barely identifiable knees.
Deciding to drink to drink the tap water and to eat food cooked all morning in fire-charred and sun-baked cauldrons which stand in lines at the edges of the huts and which worm-bellied children with thorny sticks beat the goats away from has also been a positive. For 200CFA - 20p - you can get a plate of rice-and-potatoes with a meat and vegetable sauce which is often enough to see you through the day - although I've mixed in some 150CFA brochettes. These are hot, juicy, salty skewers of meat with deceptively spicy 'pimen' which are excellent for keeping your protein levels up without eating the tube-meat. I have eaten other good food here - wonderful thin-crust, crispy pizzas at Caterina's house, vegetarian peanut sauce at Jen and Will's - but stupid though it may sound, I quite like eating on the street. I know I'm still basically a tourist, and so do they - but the first time you order it amuses the women selling it, and the subsequent times they seem genuinely pleased you liked it enough to come back, tourist or no.
Another reason I've enjoyed doing it is that it reveals what nonsense the scare stories are. Yes, you can get terrible bacterial / amoebic / parasitic / etc. illnesses here - but basically only by drinking water straight from the river. An expat who worked at the water purification service reckoned the tests showed it was safer than in the UK, and even when the goats manage to dip their heads into the cauldrons for a second or two, it always has another hour or so's boiling ahead of it. Similarly, before I came out I rather foolishly heeded the tales of how people here will steal anything because they have nothing which I heard and which were repeated in the crappy, ill-informed Bradt guide to Niger. Not once here have I worried about people stealing things. I have been careful who I've told where I'm living when, on a couple of occasions, I haven't wanted impromptu home visits (as when the Man Whose Moto Wasn't Broken basically tailed me back from the hospital asking about my salary), but equally I've left Nigériens alone in the main room of the flat with umpteen small, pocketable objects in view without worrying about it. It seems so absurd that, in a country where everyone, even the man who runs the computer room in the hospital, tells you that you must come and eat when they are eating and you enter the room, and where people you've just met bend over backwards to help you, and where even knowing how to say hello, goodbye and thank you in Djerma or Hausa provokes grins and approving noises - that we Westerners, the poorest of whom is rich beyond most of their imagining, paint them as thieves. Even though I'm six-two and pretty careful, people have tried to steal my phone before in London; my home was broken into twice in four years, and people famously refrain from eye contact on the tube. No stranger has ever offered me food, and our food problems are not those of protein and calorie deficiencies, with famines which cull great swathes of the population every few years and leave the rest emaciated, aching-bellied, but probably still sharing what they have.
I think I will ignore the stories from now on.
The people, then, are the final thing I will miss. TO give perhaps the best example, one of the guys who plays rugby offered to pick me up and take me to training on his motorcycle, so we swapped numbers and sure enough, Djibo did. Even given the lack of helmets, moto is really the only sensible way to get around Niamey - you can manoeuvre more easily around the rain-dug pits in the roads, you stay cool, and you don't get caught in traffic. He then offered to show me the grande mosquée and the grand marché, and called me up to arrange a time, taking his whole saturday to do it and having me round to his one-room home for lunch. Then the following day we rode out to Kouré, an hour or so from Niamey, and home to the last giraffes in West Africa, which it is otherwise impossible to see without a 4x4 hired for tens of thousands of CFA. I had to fight to get him to let me pay for petrol. There are annoying people here, like anywhere - but overwhelmingly - and from what little I've seen it's the case across Africa - the people, who have nothing, don't therefore want to steal from those who do. Instead, they want to talk to you, to find out what you're doing in their country, to show you the country they live in, to share their food and their culture with you, and they do so by and large while asking nothing in return. So while I perhaps won't miss the medicine, I will miss the people and their generosity both.
Barring something spectacular happening (or my flight being cancelled) I plan to spend my time in Senegal setting Africa to rights with Toyin and Liz, largely on the beach and hopefully with a cocktail of some sort, so I don't anticipate writing any more from there. I will finish one rather dry post of facts and figures which will appear before this chronologically, and may add one with links to photo albums, but this is the last of the genuine missives from Niger.
Normal service will shortly be resumed.
Well, I have 7 days left, or slightly under, as by this time next week I will probably be touching down in Bamako on the first of the four stops before London. They are the aforementioned Bamako for "technical reasons", as my e-ticket prophetically informs me (I'm still torn between being reassured that problems have been predicted and unsettled by their predictability). The second is Dakar some two hours later, where I'm meeting Toyin and Liz; the third, on the 29th September, is Casablanca, where if the outbound flight is any indication I will spend several more than the two hours I'm scheduled to spend there and will meet someone who will be central to my social life for the next two months, and finally London itself.
To answer the question you would ask if you were here: yes, I am ready to leave. Caitlin (Nigérien name: Yakalu), who's a Canadian Boston University student doing premed there who's in Niamey for four months of language and cultural studies, and who I showed round the hospital this morning, asked at lunch whether I'd stay if I could, which I thought was much harder-to-answer and therefore better way of putting the question. I said 'no' with a speed that surprised me. I could do another couple of weeks in paeds - but even there, where they make an effort, my education would suffer from the overall lack of teaching, and I miss UK *standards*. They have standards here, of course, and I am about to go right ahead and judge them, as ultimately I'm out here and while I may only be a medical student and only essentially a tourist and blah, I believe that not only does that mean I am entitled to judge them, but that it also means that in some ways I must. The "you shouldn't travel to the developing world and *judge* them" is crap - if you come out to the third world and have standards of your own, you have to judge what you find here by those standards. If you can look at the 1 in 4 children who die before age 5 here and call that unacceptable, so too can you look at, for instance, the standards of care in hospitals and call them unacceptable. Of course, in terms of writing elective portfolios, doing one gets you marks and doing the other attracts accusations of arrogant colonialist medical students from a failed sociology student who has never heard of post-colonialism and who would cast my use of 'the third world' in the same light despite the fact that Niger, at least, is not developing in any meaningful way, so 'developing' is at best a lie and at worst an attempt to gloss over this fact. Anyway, I will say that the standards of care here in paediatrics are, given the resources available to them, excellent, and that's largely due to Dr. Roubanatou taking no shit and running a phenomenally tight ship. Having spent many a morning in internal medicine sitting around doing nothing while the head of service there sees his private patients until 11am, that lack of organisation is not acceptable. I never thought I'd say this - but I'm actually looking forward to handover meetings when I get back...
Interestingly, in Pédiatrie A, where the highest standards of care are, all treatment is free because the service covers children up to age 2, and until age 5 all medical treatment is free. By contrast in internal medicine, all the patients are paying and are often regulars at the private clinics of the same doctors treating them in hospital - but standards are catastrophically low. Electrolyte levels go unheeded for whole weekends, cardiac arrests are viewed by many as an inconvenience, and too much is treated as "not cardiological" despite this nominally being a general medical service. It's then not properly investigated, worse yet no attempt is made to diagnose it, and they're just referred on to pay a different kind of doctor. Here, a paying service is not only not a better service, it's exponentially worse.
The NHS must not be privatised, ladies and gentlemen. Those say it would mean better care are liars and idiots, and probably have shares in BUPA.
This morning was interesting. Caitlin had expressed an interest in seeing stuff in the hospital when some of the Peace Corps guys and I ran into her and a bunch of other Boston Uni students in a bar, so she came along to ward rounds; we broke from the round part-way through because I thought it'd be good to get her to examine a 10-year-old girl who'd had heart surgery. So she did, and that was great - as you'd perhaps expect, the kid had more signs than you would find in 20 patients back home (central sternotomy scar, 6cm raised jugular venous pressure, heave, ascites, 8cm hepatomegaly, Graham-Steele murmur which I did have to look up) and is a smiley girl. As we went through the exam, mum not unreasonably took the opportunity to ask questions, which was fine, except that they were the sort of questions someone should already have answered. I told her I'd check her daughter's folder more to verify the diagnosis than in any expectation that there'd be any notes in there, and would come back afterwards. She'd had a valve replacement 2 years previously for a congenital mitral stenosis which had gone unnoticed until she'd developed pulmonary hypertension and right heart failure. The op in France was useful in that it had halted the progression of the disease, but none of the existing damage was going to get better.
Entirely reasonably, mother and daughter both wanted to know if she'll be able to go back to school, or if she'll be able to walk 20 metres without getting breathless, or if she's going to *get better*. This is difficult to handle sensitively in a second language without resorting to the short answer to each question, which is "non". I told her that the drugs, we hoped, would improve things, but that the problems with the heart were not going to get better; that the damage there had been done; that there was nothing really that could be done even in France. I didn't dangle the imaginary carrot of a heart-lung transplantation, because it's in practical terms impossible.
Then there was the man who'd been moved to the high dependency unit (four beds within touching distance of one another) when his sodium hit quatre-vingts-treize (93), the woman who died as we did CPR on her waiting for a defibrillator which never came ("there isn't one" "yes there is, it's in A&E" "we can't use that one - it's theirs" etc) and one of the doctors said "it's hardly worth it" as the woman gasped occasionally, and then asked if she could continue the ward round. There was the Bell's palsy which fell between the "cardiology" and the "everything else" chairs, and was sent for a totally pointless CT scan despite the doctor agreeing it was a lower motor neuron lesion, and so on. There have been bright spots: one was the woman who claimed to have met the queen ("she speaks perfect French, Queen Elizabeth"), and Diana, and who shortly after I'd decided she was barking and allowed just a note of sarcasm to creep into my "oh, really?"s turned out to be telling the truth as she was the Belgian ambassador's wife. There there was Ali's wife, who was the first of several friends-of-friends who I was asked to see, and who sweetly but very rapidly irritatingly called me at least twice a day once she got home after I'd seen her to say "I'm in the best of health now". Hadjara, a friend of Alex and Bri's who came in hardly conscious with a raging fever and quite Seriously Unwell, and who I had a short and unsuccessful battle to get checked out for any cause of post-partum abdominal pain bar endometritis, which she in fact had. She got better over a week or so, and I stopped in five or six times to see her and the three or four family members who'd come with her and were sleeping, as she was, on mats, although where she was in a covered corridor, they were under a tree in the yard. All the kids at Hope House were another, that being an orthopaedic rehabilitation centre whose rather cloying name belies the fantastic work they do. I met Jen, the American who runs the care side of things, and her husband Will through Alex and Bri (again) and went out to see what goes on there a couple of times. They have a network of people around the country who identify kids who might benefit from orthopaedic surgery; they then get an assessment and if suitable are offered part-funded surgery. The family have to stump up I think 30,000 CFA (30 quid), with the remaining 90,000CFA+ coming from PRAHN's budget (PRAHN is the organisation which runs Hope House). After the op they then get physio, accommodation, any orthoses they need and general rehab until they're ready to go home and continue exercises independently. THe kids had the usual glee at seeing themselves on a digital camera, and were mostly working hard to get themselves able to walk again or whatever it was. They see a lot of cases of club foot, equinus deformities, windswept and knock-knees, consequences of polio, even one boy whose problems were probably due to sickle cell disease but who was pretty close to a contortionist, so bizarre were his legs, which sloped slowly outwards from lumpy, barely identifiable knees.
Deciding to drink to drink the tap water and to eat food cooked all morning in fire-charred and sun-baked cauldrons which stand in lines at the edges of the huts and which worm-bellied children with thorny sticks beat the goats away from has also been a positive. For 200CFA - 20p - you can get a plate of rice-and-potatoes with a meat and vegetable sauce which is often enough to see you through the day - although I've mixed in some 150CFA brochettes. These are hot, juicy, salty skewers of meat with deceptively spicy 'pimen' which are excellent for keeping your protein levels up without eating the tube-meat. I have eaten other good food here - wonderful thin-crust, crispy pizzas at Caterina's house, vegetarian peanut sauce at Jen and Will's - but stupid though it may sound, I quite like eating on the street. I know I'm still basically a tourist, and so do they - but the first time you order it amuses the women selling it, and the subsequent times they seem genuinely pleased you liked it enough to come back, tourist or no.
Another reason I've enjoyed doing it is that it reveals what nonsense the scare stories are. Yes, you can get terrible bacterial / amoebic / parasitic / etc. illnesses here - but basically only by drinking water straight from the river. An expat who worked at the water purification service reckoned the tests showed it was safer than in the UK, and even when the goats manage to dip their heads into the cauldrons for a second or two, it always has another hour or so's boiling ahead of it. Similarly, before I came out I rather foolishly heeded the tales of how people here will steal anything because they have nothing which I heard and which were repeated in the crappy, ill-informed Bradt guide to Niger. Not once here have I worried about people stealing things. I have been careful who I've told where I'm living when, on a couple of occasions, I haven't wanted impromptu home visits (as when the Man Whose Moto Wasn't Broken basically tailed me back from the hospital asking about my salary), but equally I've left Nigériens alone in the main room of the flat with umpteen small, pocketable objects in view without worrying about it. It seems so absurd that, in a country where everyone, even the man who runs the computer room in the hospital, tells you that you must come and eat when they are eating and you enter the room, and where people you've just met bend over backwards to help you, and where even knowing how to say hello, goodbye and thank you in Djerma or Hausa provokes grins and approving noises - that we Westerners, the poorest of whom is rich beyond most of their imagining, paint them as thieves. Even though I'm six-two and pretty careful, people have tried to steal my phone before in London; my home was broken into twice in four years, and people famously refrain from eye contact on the tube. No stranger has ever offered me food, and our food problems are not those of protein and calorie deficiencies, with famines which cull great swathes of the population every few years and leave the rest emaciated, aching-bellied, but probably still sharing what they have.
I think I will ignore the stories from now on.
The people, then, are the final thing I will miss. TO give perhaps the best example, one of the guys who plays rugby offered to pick me up and take me to training on his motorcycle, so we swapped numbers and sure enough, Djibo did. Even given the lack of helmets, moto is really the only sensible way to get around Niamey - you can manoeuvre more easily around the rain-dug pits in the roads, you stay cool, and you don't get caught in traffic. He then offered to show me the grande mosquée and the grand marché, and called me up to arrange a time, taking his whole saturday to do it and having me round to his one-room home for lunch. Then the following day we rode out to Kouré, an hour or so from Niamey, and home to the last giraffes in West Africa, which it is otherwise impossible to see without a 4x4 hired for tens of thousands of CFA. I had to fight to get him to let me pay for petrol. There are annoying people here, like anywhere - but overwhelmingly - and from what little I've seen it's the case across Africa - the people, who have nothing, don't therefore want to steal from those who do. Instead, they want to talk to you, to find out what you're doing in their country, to show you the country they live in, to share their food and their culture with you, and they do so by and large while asking nothing in return. So while I perhaps won't miss the medicine, I will miss the people and their generosity both.
Barring something spectacular happening (or my flight being cancelled) I plan to spend my time in Senegal setting Africa to rights with Toyin and Liz, largely on the beach and hopefully with a cocktail of some sort, so I don't anticipate writing any more from there. I will finish one rather dry post of facts and figures which will appear before this chronologically, and may add one with links to photo albums, but this is the last of the genuine missives from Niger.
Normal service will shortly be resumed.
Monday 3 September 2007
Weddings, boiled leaves, and the only civilian rugby team in Niger.
My third weekend in Niger - and yes, this was now a little while ago - was the product of a series of improbable events. On the way to Garbey-Kourou, one of the people I got talking to during the long wait for a taxi-brousse to leave for the ferry was a guy called Issa, who was friendly in a refreshingly quiet way. Where the kids began by behaving towards me as if I were a sort of walking cash machine, and behaving themselves much like the crowbars needed to get into it, Issa was just pleasant, interested in what I was doing, and we talked briefly about the (benign) lump in his right forearm. He said he was coming in to the National Hospital to have it looked at, so I have him my number and talk him to call me when he did if he felt like it.
Which he did, and we had tea when he came in, and he said that I would have to meet his family. This invitation came sooner than I'd expected when he invited me to his younger sister's wedding that saturday. I ummed and ahhed about it for a while, not
being sure if it'd be weird being the only white person there and, indeed, not having met bride or groom - but in the end, saturday morning saw me up at 6am on my second successive trip out of Niamey.
Unlike the Tillabéri road to Garbey-Kourou, however, this one was largely intact barring the potholes which are a feature of every road here except the three bearing signs explaining that the European Union Has Resurfaced This Road For Your Safety and Comfort. Noble sentiments, except that in Nigérien this evidently translates from French to French roughly as "No potholes. Drive as fast as you can." Things did get a little squashed in the taxi when the fifth person got into the back seat on his wife's lap (this was undoubtedly the best way of doing things given the size of his wife's lap); this made eight of us in the car in total, but all in all it wasn't a bad trip.
Issa met me out of the taxi at Sudarey, his village, and after a whirlwind of meeting his sister's and the groom's large extended family in the space of about fifteen minutes, and having all of them pose for photos, we went to the ceremony. This started around 8am, and was held outside under a large thatched roof which was evidently the village meeting area. Neither bride nor groom was present, and while at a UK wedding this is normally an extremely bad sign, it is apparently the norm here, where wedding ceremonies consist of negotiations between the two families, and are sealed before a large crowd of witnesses with the handout of dates to all present (dates here are, like pretty much everything, very tasty but different - they are a little like soft nuts, and need to be checked for small bugs before eating them). I
continued my role as a sort of additional photographer, and as ever the children all wanted to see themselves on the camera - as, come to that, did many of the adults...You may or may not be able to see more photos here.
It was also the second occasion on which I got to eat boiled leaves, a delicacy I first encountered in Garbey-Kourou. During the rainy season, lots of plants spring temporarily to life in the desert and, being both resourceful and perenially hungry, the locals collect their leaves and boil them. Hence the, er, name. Happily, they add a sauce made from ground peanuts, salt, and spices, and they are thus surprisingly good, even when you eat them from a shared bowl with a group of people you've just met. With your hands. It is not hard to see why infection control is a problem here.
I felt part of the day in a way I hadn't expected to, anyway, and the whole thing was an example of Nigériens being welcoming well above and beyond the call of duty.
That afternoon, back in Niamey, it was time for Curious Happening 2. Before coming here, I'd asked pretty much all my friends if they knew anyone who'd been here. Only one - Isanna - replied, saying that she thought her boyfriend Alex knew someone. Sure enough, Alex's friend Nicola had been here - but had now moved on, so he gave me lots of useful advice (well, the thing you really need to do is to see the North, but of course you can't at the moment because of the rebellion and the mines) and the e-mails of Baptiste and Caterina who were still here. So it was that I met Baptiste one evening and explained that effectively he was a friend's boyfriend's friend's friend, and that it was pretty nice of him to ask me around. He's been really helpful - I've been drinking the Niamey water (i.e. tap water) since week two because he reassured me that he'd seen the test results and it was probably safer than in the UK, except after heavy rain when it goes a bit muddy - and when the conversation turned to the World Cup, he mentioned that an Italian friend of his, Lorenzo, played for one of the two teams here in Niger (the other being the army team). So I called Lorenzo (my friend's boyfriend's friend's - never mind), and headed out to the national stadium on saturday afternoon to train with the only civilian rugby team in Niger.
Sadly we weren't actually in the national stadium, but the training was fun - lots of touch rugby with about 20 Nigériens, a handful of expats, and three French nursing students who had just finished a few weeks out in Zinder. The Nigériens were all fit as the proverbial butcher's dog, and one six-foot six monster later turned out to be both a 2nd row and a three-times national boxing champion; happily I was very nice to him on the pitch. Afterwards, one of the team got the French students and I in to the national stadium, where we obviously ran a 100m race which was won by a Nigérien who started about three metres behind the rest of us but was training there when we arrived. I finished a respectable third. We collectively bottled the weightlifting component of the national games, however...
Monday 27 August 2007
Internal medicine, begging, and cooking dinner
Monday 27th August
Today I started médecine internale, which I had assumed would be the equivalent of general medicine in the UK. How wrong I was. In fact, it seems to be shorthand for neurology / cardiology / whateverthehellshowsupology. Which is fun - and it's quite a relief seeing signs again which aren't just you pinching their tummies and watching the skin fold staying up for about forty minutes because they're so dehydrated. You will be relieved to hear that I pinched not one adult's tummy during today's proceedings.
They have a lot of stroke patients, oddly enough - one tetraplegic who cheerily responded "very well" to the three doctors who asked how he was - and a woman who was in the middle of what I will bet good money was a pretty hefty pulmonary embolism; I will find out tomorrow, I suppose. The head honcho here being a cardiologist, there were also lots of ECGs and a doctor on the ward round who was great at teaching me as we want round, and I think my ECG expertise impressed him at least a bit. It certainly impressed me - I successfully spotted the reverse tick sign of digoxin therapy. Although I was only able to explain this with the aid of diagrams, as I wasn't sure of the French for anything needed to explain it bar 'digoxin' and 'ECG'.
Today was also the day I finally had it with the people here. I've got used to the kids whose only English is "Donne-moi un cadeau!"; I now just go for a curt "non" and then walk briskly off swearing to myself in English and wondering why they feel that tu-toyer-ing me is a good idea in this situation. This afternoon, though, some guy wanders up to me and asks if I remember him. Thinking he might be some shopkeeper I hadn't recalled talking to, I admitted I didn't, and he said oh, I work with you at the hospital! So this is fine, and we get chatting as I'm walking home. Then he drops in that his bike is broken and is at the workshop - and could he borrow 1,000 Central African Francs (CFA) to pay the mechanic. There follows a long and involved discussion of how he lives a long way away and will bring the money to the hospital tomorrow; I show him that I'm only carrying 2000 CFA and say I need them tonight, blah blah blah. I'm obviously reluctant to lend him the money, so he gets a bit shrill - "ah, if you need all this money to eat tonight, then you can't help me now I've broken down". I get a bit pissed off at this point and suggest he ask the mechanic if he can bring the money back to him. He says he doesn't think so. I say, well let's go and see the mechanic. He says, okay.
But then we get ten yards down the road and he changes his mind - perhaps he can borrow a motorbike from one of his friends and go home for the money.
Perhaps you can, sunshine.
The kids are one thing - they've grown up in an environment where looking sweet and asking for presents is, by and large, financially rewarding. They don't, by and large, know any better, and actually the Western governments which pour money into aid work which doesn't attempt to help them work - and probably I'm including a lot of medical aid work in this category - and the tourists who hand out pens and books and candy, are at least as blameworthy as the kids. Adults who lie to you, though, are a different breed.
So still not all sweetness and light, but I had four of Peace Corps lot round for dinner on saturday which was fun. Not exactly haute cuisine, but an interesting bunch - an Iraq vet who's off to NYC to talk about agriculture at a veterans' convention, two vegetarians who'd been living on a commune in Virginia before coming out here, and the last called Lulu - and cooking made the place feel quite homely. And I think the medicine's going to be easier and more varied from here on in...
Today I started médecine internale, which I had assumed would be the equivalent of general medicine in the UK. How wrong I was. In fact, it seems to be shorthand for neurology / cardiology / whateverthehellshowsupology. Which is fun - and it's quite a relief seeing signs again which aren't just you pinching their tummies and watching the skin fold staying up for about forty minutes because they're so dehydrated. You will be relieved to hear that I pinched not one adult's tummy during today's proceedings.
They have a lot of stroke patients, oddly enough - one tetraplegic who cheerily responded "very well" to the three doctors who asked how he was - and a woman who was in the middle of what I will bet good money was a pretty hefty pulmonary embolism; I will find out tomorrow, I suppose. The head honcho here being a cardiologist, there were also lots of ECGs and a doctor on the ward round who was great at teaching me as we want round, and I think my ECG expertise impressed him at least a bit. It certainly impressed me - I successfully spotted the reverse tick sign of digoxin therapy. Although I was only able to explain this with the aid of diagrams, as I wasn't sure of the French for anything needed to explain it bar 'digoxin' and 'ECG'.
Today was also the day I finally had it with the people here. I've got used to the kids whose only English is "Donne-moi un cadeau!"; I now just go for a curt "non" and then walk briskly off swearing to myself in English and wondering why they feel that tu-toyer-ing me is a good idea in this situation. This afternoon, though, some guy wanders up to me and asks if I remember him. Thinking he might be some shopkeeper I hadn't recalled talking to, I admitted I didn't, and he said oh, I work with you at the hospital! So this is fine, and we get chatting as I'm walking home. Then he drops in that his bike is broken and is at the workshop - and could he borrow 1,000 Central African Francs (CFA) to pay the mechanic. There follows a long and involved discussion of how he lives a long way away and will bring the money to the hospital tomorrow; I show him that I'm only carrying 2000 CFA and say I need them tonight, blah blah blah. I'm obviously reluctant to lend him the money, so he gets a bit shrill - "ah, if you need all this money to eat tonight, then you can't help me now I've broken down". I get a bit pissed off at this point and suggest he ask the mechanic if he can bring the money back to him. He says he doesn't think so. I say, well let's go and see the mechanic. He says, okay.
But then we get ten yards down the road and he changes his mind - perhaps he can borrow a motorbike from one of his friends and go home for the money.
Perhaps you can, sunshine.
The kids are one thing - they've grown up in an environment where looking sweet and asking for presents is, by and large, financially rewarding. They don't, by and large, know any better, and actually the Western governments which pour money into aid work which doesn't attempt to help them work - and probably I'm including a lot of medical aid work in this category - and the tourists who hand out pens and books and candy, are at least as blameworthy as the kids. Adults who lie to you, though, are a different breed.
So still not all sweetness and light, but I had four of Peace Corps lot round for dinner on saturday which was fun. Not exactly haute cuisine, but an interesting bunch - an Iraq vet who's off to NYC to talk about agriculture at a veterans' convention, two vegetarians who'd been living on a commune in Virginia before coming out here, and the last called Lulu - and cooking made the place feel quite homely. And I think the medicine's going to be easier and more varied from here on in...
Sunday 26 August 2007
Semi-conferences and past lives
Saturday 26th August
Today I came into the hospital for 8am on a saturday morning for some nebulous affair which the Big Boss informed us was a three-line whip affair (not in so many words, obviously, as I don't think that translates into French). Doing ward rounds with Drs. Abdou and Fifi was quite pleasant, but at 9 we were summoned to the meeting room, where a lot of abnormally well-turned out doctors were lounging around. Of the qualified doctors, only Dr. Abdou was dressed as he normally is, and we were in fact late as when we were initially summoned he had growled "we'll finish this ward".
We then sat in the meeting room. Until 10am, when a portly man in oversized glasses and his nervous-looking sidekick showed up and began setting up a computer; I say began because the projector was projecting precisely nothing, and the two of them and the Big Boss sat looking confusedly at it and the computer in turn. So I trudged up and, with a definite sinking feeling, turned the laptop on. The Big Boss then refused to let me plug the projector back in, saying urgently that we needed to wait! So I did, and lo and behold, it worked. I sat down.
Over the next 45 minutes, I kept having to go up to the computer, first because they couldn't get the USB key to work. Then the images were missing from it (not much I could do about that one). Then they couldn't get the file to open. I tried everything, buoyed by the Big Boss' invaluable supporting monologue, which consisted largely of telling me to do things I had just finished, telling me what to do on screens I am quite sure she had never seen before, or explaining very slowly such technological intricacies as the loading-progress bar to me (apparently, it tells you how loading is progressing, astonishingly). It was a total joy.
Ultimately, despite the benefit of her vast expertise, the plump man and his sidekick gave their talk without the slides, and everyone sat in the room for two hours to hear a fifteen minute presentation without even any bloody pictures. It made me positively nostalgic for the conference, let me tell you...
Today I came into the hospital for 8am on a saturday morning for some nebulous affair which the Big Boss informed us was a three-line whip affair (not in so many words, obviously, as I don't think that translates into French). Doing ward rounds with Drs. Abdou and Fifi was quite pleasant, but at 9 we were summoned to the meeting room, where a lot of abnormally well-turned out doctors were lounging around. Of the qualified doctors, only Dr. Abdou was dressed as he normally is, and we were in fact late as when we were initially summoned he had growled "we'll finish this ward".
We then sat in the meeting room. Until 10am, when a portly man in oversized glasses and his nervous-looking sidekick showed up and began setting up a computer; I say began because the projector was projecting precisely nothing, and the two of them and the Big Boss sat looking confusedly at it and the computer in turn. So I trudged up and, with a definite sinking feeling, turned the laptop on. The Big Boss then refused to let me plug the projector back in, saying urgently that we needed to wait! So I did, and lo and behold, it worked. I sat down.
Over the next 45 minutes, I kept having to go up to the computer, first because they couldn't get the USB key to work. Then the images were missing from it (not much I could do about that one). Then they couldn't get the file to open. I tried everything, buoyed by the Big Boss' invaluable supporting monologue, which consisted largely of telling me to do things I had just finished, telling me what to do on screens I am quite sure she had never seen before, or explaining very slowly such technological intricacies as the loading-progress bar to me (apparently, it tells you how loading is progressing, astonishingly). It was a total joy.
Ultimately, despite the benefit of her vast expertise, the plump man and his sidekick gave their talk without the slides, and everyone sat in the room for two hours to hear a fifteen minute presentation without even any bloody pictures. It made me positively nostalgic for the conference, let me tell you...
Tuesday 21 August 2007
Sweetness and light
I am about two weeks behind. The Garbey-Kourou post, and indeed the details of last weekend, are still brewing.
However, I sort of reached my ghastliness limit today, so this will be rather less an amusing things which have happened to me in Niamey which may or may not have involved my nearly blowing myself up type missive. So skip it if you've just got engaged or something, hey?
The ward round this morning started badly. The first patient was a girl at the upper end of our limits - nearly two, and had been admitted overnight with rampant cerebral malaria: she just lay there with her eyes half-open and rolled up slightly into her head. She didn't respond to being spoken to, shaken gently, or to pain (you can press over the eyebrows or the sternum). Her pupils were dilated and slow to constrict when I shone a torch in them. She had bloody diarrhoea. She was dehydrated (but then they all are). Even Dr. Abdou, who normally takes things in his white-capped, funny-pointy-bearded stride, muttered darkly, "c'est grave, ça" several times. The rest of the new patients all have a decent chance - there was one boy with malaria who'd had a brother who'd died at roughly his age from "a febrile illness" who didn't look very well and weighed 6.5kgs at age 2, but no one else in extremis. I left as Dr. Abdou and the final-year student were finishing some paperwork in the admissions ward and went on to the neonates.
The first baby there was a five-day old boy who'd been born prematurely (they *never* know exactly how early here, but I'd guess not too bad - 32 weeks or so?) whose mother was lying on the bed by him. He looked a little grey. He was not obviously breathing.
I checked. He wasn't breathing, and nor did he have a pulse.
The team took it pretty much in their stride. I was expecting at least some attempt to revive him - but no. I guess the resources just aren't there to resuscitate them, and here it is a big deal, of course, but people are used to death. Mum didn't cry; she and the family all had black headscarves on (they cover only the head, not the face, here) within ten minutes, but they were efficient and dignified, even, in the way they dealt with it.
The notes showed that the nursing staff had noted that he was breathing 12 times a minute and had a pulse of 60 since 2130 monday night. This is normal in an adult - but desperately, immediately life-threateningly low in any child under a year, and particularly in a neonate, where a normal respiratory rate is 30-60 and heartrate 120-160. They had conscientously recorded two more readings through the night, both basically the same, with the last about half an hour before we'd got there. The nurse got an absolute bollocking from the Dr. Roubanatou (the big boss) later, not that it helped the kid much.
Then the next child had spina bifida with a lump almost as big as his head on his back and no ability to move his legs, and in the next room there was a baby who wasn't that ill but whose mother looked like something out a horror movie - she shambled in covered in these circular lesions, coughing blood, and with her lips basically wrecked coughing blood onto her scarf sporadically. Apparently she's HIV positive and had got Stevens-Johnson syndrome in response to some of the drugs; I have no idea of the kid's status, but thankfully she isn't breastfeeding and wouldn't be able to even if she wanted to in the state she's in.
The only positive thing was that the little boy with tetanus looks like he's pulling through.
And I'm sick of being asked for money, although on the walk here tonight two boys carrying water got talking to me and taught me some Djerma, then left without asking for anything, so I bought them pains au chocolat from the patisserie. If the biblical storm last night was a harbinger of today, I am taking this as a sign that tomorrow will be better.
However, I sort of reached my ghastliness limit today, so this will be rather less an amusing things which have happened to me in Niamey which may or may not have involved my nearly blowing myself up type missive. So skip it if you've just got engaged or something, hey?
The ward round this morning started badly. The first patient was a girl at the upper end of our limits - nearly two, and had been admitted overnight with rampant cerebral malaria: she just lay there with her eyes half-open and rolled up slightly into her head. She didn't respond to being spoken to, shaken gently, or to pain (you can press over the eyebrows or the sternum). Her pupils were dilated and slow to constrict when I shone a torch in them. She had bloody diarrhoea. She was dehydrated (but then they all are). Even Dr. Abdou, who normally takes things in his white-capped, funny-pointy-bearded stride, muttered darkly, "c'est grave, ça" several times. The rest of the new patients all have a decent chance - there was one boy with malaria who'd had a brother who'd died at roughly his age from "a febrile illness" who didn't look very well and weighed 6.5kgs at age 2, but no one else in extremis. I left as Dr. Abdou and the final-year student were finishing some paperwork in the admissions ward and went on to the neonates.
The first baby there was a five-day old boy who'd been born prematurely (they *never* know exactly how early here, but I'd guess not too bad - 32 weeks or so?) whose mother was lying on the bed by him. He looked a little grey. He was not obviously breathing.
I checked. He wasn't breathing, and nor did he have a pulse.
The team took it pretty much in their stride. I was expecting at least some attempt to revive him - but no. I guess the resources just aren't there to resuscitate them, and here it is a big deal, of course, but people are used to death. Mum didn't cry; she and the family all had black headscarves on (they cover only the head, not the face, here) within ten minutes, but they were efficient and dignified, even, in the way they dealt with it.
The notes showed that the nursing staff had noted that he was breathing 12 times a minute and had a pulse of 60 since 2130 monday night. This is normal in an adult - but desperately, immediately life-threateningly low in any child under a year, and particularly in a neonate, where a normal respiratory rate is 30-60 and heartrate 120-160. They had conscientously recorded two more readings through the night, both basically the same, with the last about half an hour before we'd got there. The nurse got an absolute bollocking from the Dr. Roubanatou (the big boss) later, not that it helped the kid much.
Then the next child had spina bifida with a lump almost as big as his head on his back and no ability to move his legs, and in the next room there was a baby who wasn't that ill but whose mother looked like something out a horror movie - she shambled in covered in these circular lesions, coughing blood, and with her lips basically wrecked coughing blood onto her scarf sporadically. Apparently she's HIV positive and had got Stevens-Johnson syndrome in response to some of the drugs; I have no idea of the kid's status, but thankfully she isn't breastfeeding and wouldn't be able to even if she wanted to in the state she's in.
The only positive thing was that the little boy with tetanus looks like he's pulling through.
And I'm sick of being asked for money, although on the walk here tonight two boys carrying water got talking to me and taught me some Djerma, then left without asking for anything, so I bought them pains au chocolat from the patisserie. If the biblical storm last night was a harbinger of today, I am taking this as a sign that tomorrow will be better.
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