The Apartment, Wazas, and the local area

So - the apartment. You already know about the gas cylinder, and thus that I have the ability to cook, which is an improvement over the Catholic Mission where I was previously. The availability of gas is pretty good, certainly compared to Addis, where it was common not to be able to find any for a couple of days. The longest I've seen them not have it for here is an afternoon, and the absence of kerosene burners is undoubtedly a blessing. The apartment also has a shower complete with a hot water tank with an orange light which comes on when you flick the switch by it; this has no discernible effect on the temperature of the water, but I like to pretend it might work. However, as the water is never freezing, varying in temperature with the time of day (cold in the morning, lukewarm following a day's sun), and given that I have no way of knowing if, like the last gas cylinder, the hot water tank harbours murderous intentions towards me, I've stopped using it at all.

The fridge, however, is a glorious duck-egg green, and keeps water, mangos, and the local beer (Flag) deliciously chilly. There's also a brand new washing machine which I was enormously excited by given the absence of laundrettes (à la Addis) or Padmina (à la Vellore), so one of the first things I bought was a large and expensive box of washing powder (German, slightly bizarrely). The blissful feeling as I loaded the machine with dirty clothes and powder in anticipation of gleaming whites at the end of it was deflated somewhat when I pressed the ON button and nothing happened.

It wasn't plugged in, so I plugged it in and pressed the ON button again.

Nothing happened.

It was then that I realised it wasn't plumbed in either.

I briefly debated trying to attach the inflow pipe to the tap, but reasoned that breaking what is clearly my erstwhile landlord's prize kitchen ornament would be bad form. And more to the point, would be significantly more likely to flood the kitchen and add to the list of appliances which have it in for me than to clean any clothes. So I did them by hand in the sink outside, drowning a small legion of ants in the process to cheer myself up.

All in all, however, the apartment is great - I have a view from the balcony over the hut village which stretches along the road in a muddle of thatched rooves, bleating goats, incompetent cockerels (3am is not dawn), and plumes of bluish smoke. Currently the presence of the hut village is ruined somewhat by the presence of what I think in Djerma is a Waza, which amounts to a gaggle of Islamic holy men with loudspeakers preaching to the masses. It's a little like the mad people you can normally find on Oxford Street preaching the seemingly-contradictory message that God loves you but you'll burn in an eternal lake of fire unless you repent your sins. Or perhaps more like the televangelist extremists who are essentially more successful, capitalism-friendly versions of the nutters on street corners, the ones who drive limos, drink champagne, condemn abortion and homosexuality, and hire gigolos on the sly because they know that that is what Jesus would do. Apart possibly from the paying rentboys part.

All the Waza folk do, according to Matt (of whom more in the next missive) is tell people not to trust the white man, and to give them money for new mosques. The former is good general advice (and mild compared to what the US religious right are saying about the non-white man), but roughly a century too late and today is mostly aimed at stopping the locals converting to Christianity thanks to the large number of Christian aid organisations working here. The second is a little harder to stomach, literally given how little food the people here have, but they do at least spend the money on mosques rather than, say, methampethamine.

I wish that they'd SHUT UP, though. It's ten o'clock on a saturday, fer chrissakes.

The apartment is also 12 mins walk from the hospital, five minutes from the best bakery I've found in Niamey, which sells baguettes for 15p which are invariably still warm when you buy them, and seriously good croissants and patisseries which I tend to have a couple of times a week. There are also plenty of restaurants in the area, a couple of general stores/supermarkets (NB: you would be wrong to think of Tesco at this point), fruit and vegetable sellers, and craftsmen hawking their wares.

The prices of most things here go through the roof when you're un blanc - I stopped at one shop on the way back from the hospital and asked the kid behiond the counter how much a bag of dates was. He had to wake up the boss, who was snoozing on the floor by the counter on his mat.
Kid: "How much are these?"
Proprietor (rubbing sleep from his eyes): "700."
Kid (to me): "They're 700."
Proprietor (following the kid's gaze): "Ah! They're 1250."

I laughed, thanked them, and left.

The souvenir-hawkers aren't so bad - their first price is invariably outrageous, but accompanied by the disclaimer that "we can discuss the price - and I'll do you a good deal." Although they are pretty expert - one moment of weakness and you find yourself getting absolutely robbed blind - I've hit on a surprisingly effective counter-strategy. I just say that as I'm here for two months, all I want to do for now is see things and get an idea about prices. I then stick steadfastly to this position as they say that I can buy something small today and the rest later, n'est-ce pas? (which, incidentally, I have just realised translates literally as "innit". Who'd have thought it of the French?). I say no, I'll just have to keep things around the apartment. The shopkeep rejoins with, well, what would you pay for this today? I reply, as I said already, I'll buy at the end of my stay. The less scrupulous then chuck in the ridiculous "I have to sell something so I can eat"; I flatter myself that my eye for malnutrition is by now pretty good, and these are by no means poor people, so any trying that line go in the dirty box and I don't go back in their shops. By the time I leave, the attrition has generally seen their price halve when I'm not even haggling. Most are, like the Nigérien people in general, a friendly lot who are ultimately just trying to make a living (albeit by fleecing wealthy, credulous whites), and they always respond cheerfully when I say hi, whether I go to see their new arrivals or not. I've even had tea with one or two (insanely strong, necessarily sweet, and cooked over hot coals. The tea is removed and the leaves covered with fresh water while the brew is mixed with more sugar and passed between two glasses to cool it to drinking temperature), and done an impromptu knee consultation with a kid at another; my advice even seems to have worked!

My favourites are the guards, though - most residential blocks have a guard - ours is an ex-army man called Djibo Ibrahima who was enormously helpful with the gas - and all NGO offices and residences have 1-4 in uniform. The main purpose of the NGO guards is to sit around drinking tea, playing cards, and running errands for their empployers (eg: fetch me some cigarettes, please). Djibo sits around in a sleeveless T-shirt and chases out goats. They're all phenomenally friendly, and a group of them I got talking to have been teaching me some Djerma and Hausa. Initially they did both at once, but they soon realised this was just confusing, so we're sticking mostly to Hausa now, and I pay them in occasional baked goods.

Oh - one more thing - the identity of my new friend is none of the above. The apartment doesn't have nets on the windows, and there's one in the bathroom which doesn't shut - so I'm indebted to this lady (she's just below the handle - got her?) for spinning her web right by the crack the mozzies get in, and for having produced a batch of mini-spiders to expand upon her good work. All the dark blobs in the web are mozzies in their little silken cocoons, and since I moved the loo paper the fact the cocoons are dropped from the web onto the top of the cistern has caused no further problems.

And on that note...

Calling a spade a spade, not taking prisoners, and conventional pest control

First, it being why I'm here and all that, the hospital. Monday was promising if uneventful: I met the medical director and indeed a clutch of other directors and was told to come back the following day at 11am to start. Sadly I went to this meeting without Dr. Marianne, as she had "completely forgotten" about me, so tuesday became a rerun of monday with her in attendance. We agreed, as indeed we had on monday, that I'd do three weeks paediatrics and three weeks internal medicine, and, again as on monday, that I should come back the next day to start. Although at 8am, not 11.

At this point I should probably explain why I didn't burst into tears being forgotten by my contact here. Her response to my text on monday evening outlining the days' events was roughly, I went to collect Achille [her husband, who's also delightful], and he asked how you were, and I realised I had completely forgotten about you! (Her response of course also involved putting monday on a one-day loop, but there you go). In England, I think it'd be safe to say that sort of comment could get you taken off people's Christmas Card Lists, but here it isn't rude.

People are just very direct, and being honest when they've forgotten about you is just part of it. So I am referred to as "un blanc" (a white) in French, or as "yo" (a stranger) in Djerma; if people think you look tired, for instance having woken you up at a conference, they will tell you so; and a complete stranger introduced himself to me while I was eating some corn which women barbecue at the side of the street largely to tell me that "people cannot believe you are eating that". "Why?", I asked. "Parce-que c'est un blanc", 'because it's a white'. It's also perfectly acceptable, even polite, to refer to strangers by their profession in the local languages using a term meaning literally keeper, so that a man selling bread at a street stall becomes "keeper-of-the-bread", and is happy to be referred to as such; and if I'm walking the 10 minutes from the hospital to my apartment in scrubs, the first link in the chain of standard greetings (of which much more later) becomes "Bonsoir, docteur". So I'm walking back in scrubs pretty much every night, obviously.

In this sense, the Nigériens are a little like Yorkshiremen: they call a spade a spade. So it was on my first day in Pédiatrie A, where they deal with children between 0 and 2 years old. I turned up and was greeted by a formidable-looking female doctor who I'd met at the conference the previous week but whose name has sunk into the dozens I failed to learn while sleepwalking through it, and who I will therefore refer to temporarily as "the big boss". The staff meeting included three Nigérien students, two 7th years and one 4th year, the big boss, and a handful of doctors and nurses. Straight off the bat I was asked if I'd like to introduce myself, and so was immediately grateful that A-level French is heavy on vous voulez vous presenter? Then she grilled me on exactly what medicine I'd done so far, on the nature of the elective and on how it fitted into my course, culminating in "alors c'est un stage obligatoire", so it's a compulsory elective?

I confirmed this, and the big boss smiled. "Good. So, for you two [indicating the 7th years] and you [indicating me], you will be here every morning in time for the staff meeting at 8am. Don't turn up at ten past and ask us to wait for you. Then there are ward rounds in the morning, and you will stay until they finish - sometimes 11:30, sometimes 15:30. Then you can go or stay as you like, but you will each present a case [patient] at the meeting while you are here, and when the doctor you are following is on-call, you will stay at night or at the weekend with them. [Turning to the 4th year, whose placement is 'volontaire'] It's not as important for you, but you must do what you think will be best for you."

So not many prisoners taken there, all things considered. She's rarely on the wards, which is a shame, as I'd like to see how she handles patients...! The fourth-year (Rashid) and I have been Dr. Idrissa all week. On the first morning we were joined by one of the 7th years, who was a total joy. She spent the entire time looking bored and sulking and then, when Dr. Idrissa invited her to listen to one of the kids' heart murmurs, replied angrily, "I understood that we were here to observe how you work, not to do things ourselves!". This is roughly the equivalent of waiting until someone offers you a slice of cake and then kicking them in the face. Dr. Idrissa replied equally angrily but, to my disappointment, in Hausa well beyond my meagre abilities, and she grudgingly listened to the boy's murmur (ejection systolic, probably physiological, since you didn't ask). Happily she buggered off somewhere else on thursday.

Medically, it's been roughly what I was expecting - lots of diseases which would be basically unthinkable in the UK, including a textbook case of tetanus (another of the doctors, Mahamadou, lifted him with one hand under his back and his arms, legs, and head remained completely rigid), a kid with (for Niger) unseasonal meningitis who is Very Unwell, the obligatory score of malaria cases and a half-dozen with cerebral malaria, which is so exotic and life-threatening that it has even featured on House. And there are three full wards of malnourished kids - CRENI I (centre restoration...uh...let's just say 'refeeding', shall we?) for the severe ones, who then go to CRENI transition, then to CRENI II, and then hopefully home; there are also a lot of cases elsewhere in the other wards. They are mildly depressing in a Live Aid, swollen-bellied kind of way, and this impression is aided by the wealth of flies who buzz merrily around the wards and enhanced by the extraordinary smell of the unit. I spent some time in the fistula unit in my 'free' friday afternoon, and the smell there was nothing compared to the paeds ward, where the absence of any nappies except among the most wealthy Nigériens, coupled with the fact that almost every kid in hospital has diarrhoea and vomiting makes the baseline smell strong enough that it's only converted into something unsettling rather than outright nauseating by the popular practice of burning sticks of incense. The kids are, however, also very sweet, and also clever: they cry as soon as they see anyone in a white coat, whether they are carrying a needle or not. Having sat in on an afternoon's bloodletting with the nurses (doctors and nurses both wear white coats here, which adds a note of sweat, predominantly mine, to the background symphony of aromas) and having watched one of them, take aim at a vein running diagonally across the back of a baby's hand, push it through the skin at 45 degrees, and then flatten out and advance it into the vein, out of the vein again, and back out the opposite side of the hand, I can see why white coats make them nervous.

Also as I'd expected, they're desperately short on resources, although not as many as you might expect - they do, to take one example, have both human and horse tetanus immunoglobulin, and thankfully the mother of the affected baby can obviously afford them. By contrast, they have almost no gloves in the bloodletting department, so my arrival with a bunch has been treated with great excitement. However, this doesn't extend to the patients, whose NG tubes (feeding tubes into their stomachs) are regularly pulled out and kept in plastic bags by mum until someone can, er, put the same one back in again. Which is a little unhygenic.

Particularly given the very orthodox local pest control.

There is more to say but I need to get home, so I'll do some more hospital stuff later...

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.

Death by conference, thunderstorms, and Living Without Bucket Showers

Friday 3rd

The conference is over, praise be, and Dr. Marianne's husband Achille has found me a studio apartment to move into while I'm here, which is pretty exciting. Thus far I've been at the Catholic Mission, which is cheap by Niamey standards (7 quid a night, and I get a 10% 'doctor discount' on top!), the room is clean, has a fan and nets over the "Four-Poster" beds (metal beds with four posts welded to the corners - a surprisingly useful trick, as it happens), and a (cold) shower ensuite. There's a shady courtyard outside which I am not the only one to find pleasant - last night when I got back there was a large, rather beautiful moth drying itself under one of the trees, and tonight this fellow.

I met him following an evening drinking with the peace corps lot and listening to Nigérien music, which was roughly as you might expect traditional African music to sound if played by a four-piece guitar band so that people could get down on the dance floor to it. It wasn't quite what I was expecting, but it was fun.

Mon 6th
No posts over the weekend - the internet and the power took turns to fail all across the city, and I spent most of the time moving to the new apartment, buying stuff for it, and taking shelter from the biggest thunderstorm yet. Today has, predictably, been taken up mostly by taking paperwork to the hospital and being told to come back tomorrow. Now I have to run to the bank to change some travellers' cheques - more tomorrow, maybe!

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.