Last Days

This is my last blog post from Kakata, Liberia. I will soon be headed home. Back to what I thought was covered in snow but just learned it has all melted and this makes me a little disappointed. I was looking forward to some down time in my house, painting my kitchen cabinets and watching the snow fall. Winter is not over so I can still dream of this happening.

I wanted to thank you all for your prayers and support during this time. One of my main reasons in wanting to come work at an Ebola Treatment Unit (ETU) is that I wanted to bring awareness that ‘Ebola is Real’ (the slogan for Ebola here in Liberia), and that ebola is still very active and is still causing havoc in West Africa. You would not know this by watching or reading the news because it is not there. Some people were surprised I was coming because they thought the outbreak was done since they had not heard about it on the news in a long time. It is still very active and although the numbers have decreased dramatically, there is still the fear that it could spring up again. Fear that people will become complacent and not be as vigilant anymore in not touching or watching what they eat or question why this person is sick or go to a funeral and touch the body. There are still people dying. There are still hospitals running off of fear of any patient who is brought in. Patients who are not getting adequate care in clinics or hospitals because at one clinic close to here, over 20 healthcare workers died of ebola. The fear is real and patients are dying because of this. 

Two nights ago I had my first patient death on my shift. In the last six weeks since being here, there have been about seven deaths although none from ebola. All from things we can not give a definite diagnosis to. This man came in very sick. He was admitted at eight in the evening and was gone by six in the morning. It is so hard to imagine dying in an ETU with no family or friends around. Alone. In a small room with grey tarps for walls. Poor lighting. Bugs flying everywhere from the quick dump of rain a day ago. This man was brought in pretty unresponsive although he would fight us when we were trying to get an IV line placed. We checked on him throughout the night but beyond giving fluids and a very limited amount of medications available, there was nothing else to be done. I tried washing his face but that made him more agitated. He was incontinent of thick, black, tarry looking stool. This would assume blood, but no way to definitively test for this. Checking the inside of your lower eyelid can also give you an idea of what your blood levels are. His were white which means he had lost quite a bit of blood, but again, no way to know for sure. (I have met many doctors throughout my time working in West Africa who can give a accurate blood count level by pulling down and looking at the color of the inside of the lower eye lid.) Because of his fever, possible bleeding, weakness, and patient condition, he was brought to the ETU under suspicion of ebola. I was called into the ETU early in the morning to confirm that he had passed. He had. The viral load on an ebola patient after death is extremely high and because we still did not know his status, we had to treat him as though he was positive. The sprayer sprayed him with the chlorine solution and we covered him with a paper sheet. There is a team who deal sole with patients who have died, so in the morning the burial team came in and put him in two body bags, spraying each with chlorine before taking him to the morgue. The county and family then decide together where the body can be buried as we do not have a burial site on our land. By the afternoon we received the blood results and the patient was not positive for ebola. That was good new for the community and all that had cared for the patient in his home and at the other clinic. The family will never know what exactly this man died from. Lassa hemorrhagic fever and ebola have very similar presentations so there is thought this could have been it, but we will never know for sure. 

Please keep praying for an end to this ebola outbreak. Not just here in Liberia, but also in Sierra Leone and Guinea. Pray for these countries as they will have to learn to deal with what comes next. How to move from a state of fear to a state of rebuilding the healthcare systems. Rebuilding families who have lost so many. Children who have lost both mother and father. Pray for those who have survived ebola and their continued reintegration back into their communities. Pray for healthcare that can meet the needs of the people they are here to serve. It’s heartbreaking knowing what can not be offered. 

I wanted to say hi the all the kids at Sandhill Elementary! My mom has been reading this blog to her students so I just want to say: read the news. Get good grades. Learn about what is going on in the world and see what you can do to make a difference in your own community…and give my mom a hard time. You are all very fortunate to be able to get the education that you do! 

Some More Pictures

The ETU from the water tower. Suspect ward on the right. Confirmed on the left.

One of the ambulances.

I got to hold an adorable baby!

A man mixing the chlorine in the water.

Rubber trees in the Firestone plantation.

Barracuda for lunch at the beach.

The Weather

What do you talk about when there is nothing else to talk about?

The weather.

It's good there is nothing to talk about. Yesterday Mali reached its 42 day period without any new ebola cases so it is considered cleared! Wonderful news! Last week here in Liberia, only 8 new cases in the country! Again, fabulous! There were even two days where there were no reported cases. We are still getting suspect cases in but nothing confirmed, which is great news for the country.

So, the weather is changing here. Up until yesterday I would have to wear a sweatshirt to the board rounds in the morning because it got so cold overnight. When I would work nights and come to check on things at 1am or 5am, the nurses and staff would be dressed in down coats and wool hats. A sweatshirt was enough for me. I enjoyed the change in temperature. Today, though, I went down for board rounds at 7am and by the time I got there I was already sweating. After rounds and the morning meeting I ran back to my room and got on weather.com. I actually found Kakata, Liberia! 8am and it was 77 degrees with 94% humidity... did I say it was at 8am???

I worked the morning shift today so I was dressed in PPE and in the unit by 8:30. Before I even left the dressing room, sweat was filling my goggles. Within fifteen minutes my goggles were fogging up so much that my only respite were the sweat beads running from the top of my goggles, clearing a way for me to see. Gross, maybe, but I was thankful for the sweat so I could see!

Ebola Sucks

Ebola sucks. 

Not just the actual disease, but everything ebola has affected. The fear it has instilled in entire countries. The even further breakdown in an already fragile healthcare system. Villages lost by death. Families losing mothers and fathers, aunts and uncles, grandparents, children. Whole families lost. An entire village on one side of the street, gone. Families needing to be quarantined after a loved one dies—who will feed them to keep them quarantined? Who will meet their needs to keep them safe and in turn, everyone else around them? Stories of houses burned down out of fear. People getting forced out of villages from fear of them having the virus and no one being called to help. Found barely alive but no food or water for days. Stories of families hiding bodies or sick loved ones from fear of what an ETU does to whoever enters. A country that has a ‘Liberian hand shake’ and touches out of affection now has billboards saying, “No Touching”. It was, and is, a sign of respect and sharing condolences when someone passes to touch the body of the dead, to braid their hair, to be with them, and now it is known that a person who has died of ebola is even more virulent after death. Death breeds death if the body is touched. 

When a patient is brought into an ETU, we test and treat for ebola. All patients get malaria medications when they arrive, vitamins and a broad spectrum antibiotic to help other possible infections. That is it. That is all. There are other medications we can give for nausea, pain and IV fluids if needed, but the treatment we give here is ebola focused. We can’t do testing for electrolytes or lassa fever, another hemmoragic disease. In the three weeks I have been here, we have had three pregnant women come in. Anyone with unexplained bleeding is sent to an ETU. Pregnant women come in with vaginal bleeding. A full term mother was here my first week. She had not felt the baby move for at least a day. There is nothing that can be done until blood tests come back, and the blood test needs to be negative three days after symptoms start, meaning a patient could be on the suspect side of the unit for three days until their lab results come back. During this time diagnostic tests can not be done. Tests can not be run for other things. Ultrasounds can not be done to check the status of a baby. People are sick and dying while waiting for test results. This is awful to see. A mother with a baby inside that she knows is not moving and there is nothing that can be done until the negative ebola test comes back. Hospitals outside of the ETU will not take someone with ‘unexplained bleeding’ until they have a negative test. 

Ebola sucks.

It has been around for awhile, ebola. Small outbreaks here and there. This is obviously the largest one yet and what is so crazy is that still very little is known about what treatment is best. Should you force IV fluids? Should you not? Should you give this medication or that? One ETU does it this way and another does it like this. Whose mortality rates are better and is it because of the treatments given or is it because more patients at one ETU have patients who have to walk two days to get there while another has patients who can be admitted the same day? What is best? What is right? Are you doing more harm or less by doing this or that? What antibiotic is best to give? What type of IV fluids? Question after question and it seems like there is never a good answer. 

Some Pictures from an ETU

Me, ready to go in.

White: Clean Water

Green: 0.05% Chlorine

Red: 0.5% Chlorine

Doffing Area

Drying Boots

Merry Christmas!

Training

I’m currently in Bong, the other ETU about two hours north of Kakata. I’m not actually AT the ETU, I’m at the university that is housing everyone for the ETU. The trip up here was eventful. You might think that the road would be enough excitement with all the potholes and manoeuvring around  construction sites and anything and everything else in your way but we ended up with a flat tire. Our driver removed the flat and was unable to jack up the car anymore to put the spare on. Good thing he pulled onto the dirt. He ended up having to dig so the tire would fit. I’m up here for training for the next few days. They have just as many patients as we do… hardly any. It’s a good thing, but not what I was expecting. Hopefully this means the outbreak is decreasing. I went for a walk around the university today and met the French professor for the university. He was telling me that it should be opening next month along with the other schools in the country. I have been hearing rumours to this and hopefully they will be true! It’s crazy driving by so many schools and not seeing a single child at any of them. All schools closed and any large gatherings were forbidden when the outbreak got out of control. 

Here are some pictures of the ETU I am at:

Just kidding. I tried... many times to upload pics. Will have to be for another post. Internet is driving me crazy these days.

The girl I wrote about in the previous post is doing well. She still spikes fevers at times but overall she is doing well!

Happy New Year!

The 11 year old boy, Ujeh, who had been in the confirmed side of the ETU since I arrived finally got his negative blood results and went home! It was a time of celebration when he found out he was going home. Before his results came in, a 14 year old girl came in positive and we admitted her to the unit. Her mother died two weeks ago of ebola and she recently started having symptoms. She is a beautiful girl. I had no idea what to expect when I was suiting up in my PPE to meet the ambulance. This was the first confirmed ebola patient I was going to admit and Ujeh, even though he was positive, he didn’t look it. He had gone through the worst before I arrived and I did not witness that part of it. Although she was strong enough to walk, I could see the fear in her. Who wouldn’t be afraid, and yet a child, all alone. Her mother recently died of a disease killing so many and into her village pulled a truck, an ambulance. A truck with blue and orange tarps to form an enclosed area in the back. She was put back there alone and was being taken to a place she did not know, alone. Getting out of the ‘ambulance’ she was meet by a man spraying her every step and dressed so all she could see were his eyes. She rounded into the triage area and when I asked her name I was glad she could understand English. Patience. Her name is Patience. Such a beautiful name for this scared girl. After the initial triage we walked across the ETU to the confirmed side of the ward, the sprayer spraying every step. I learned she is in the fifth grade and likes math. The other nurse who was there and the sprayer were so encouraging to her and as we were getting ready to leave her the sprayer asked if we could pray with her. She said yes and we prayed. Walking out and leaving her in her room was hard. Ujeh was there which was good that she could see him better and about to leave well, but it was hard imagining what she was thinking and feeling. Alone in this large tent in a small room with grey tarp walls. 

I went in and saw her twice yesterday. She was not feeling well in the morning but felt better as the day went on. Her blood tests came back in the afternoon and it looks as though she is already improving. 

Christmas Time in an ETU

Today marks one week of me being here. It’s funny looking back at my expectations and what I thought I would be walking into and what the reality really is. 

There are two sides to the Ebola Treatment Unit (ETU) where patients stay. When they are first admitted they go into the suspected ward. After their labs are drawn and we get results back, the next day, then they are either discharged home or to the hospital if they are sick with something else, or if their labs come back positive for ebola, then they are moved to the confirmed side of the ETU. There has been one 11 year old boy on the confirmed side since before my arrival. All the patients we have gotten in on the suspected side have all been negative for ebola thus far so they are here for less than 24 hours usually. The boy in the confirmed ward is getting stronger every day and is expected to go home soon. On Christmas Eve he was up dancing and showing off his moves.

The pace here is a lot slower than I was expecting. It’s a good thing, I know, meaning there are not as many cases coming in. When you come out of the unit, there is not much else to do until the next time you go in which can be many hours later. I’ve been talking with many of the national nurses and that has been interesting. Everyone here knows many people who have died from ebola and they have all been affected in some way. All the schools have been closed since the outbreak became severe, so many of the nurses who were in school are working here as nursing aids. A nurse I was talking with yesterday was telling me about how many families in his village were quarantined in their homes when someone in their family became sick. The community would have to bring them food and if a person died, the right people would come and remove the body. He was telling me about how he grew up as a child in the midst of the war, became a refugee and eventually moved back here when it was safe. The country was rebuilding and now this. It’s a difficult time for everyone. 

On Christmas Eve we had a celebration for the workers. Lots of preaching and dancing in full form. Lights and decorations and fake trees were put up throughout the ETU to make it festive. A good friend sent me this LINK which was my Christmas message this year. Also, take a look at THIS which a couple others sent me which I found really funny. You need to watch it to the end. I hope you all had a great Christmas and remember why we celebrate!

Arrival

After 36 hours of traveling I made it to Liberia without much hassle. My luggage even arrived which I’m told does not have often so I should be proud of that. I was pretty anxious on my flights here, not knowing what I would be walking into but as soon as the plane touched down my nerves were calmed. I had arrived and there was no turning back. 

Stepping off the plane I smelled it. I smelled Liberia. It’s hard to put into words what that smell is, but it smelled of Liberia. Before entering the airport, you washed your hands with bleach water and had your temperature taken. Only then were you allowed inside. I made it through and quickly found others with IMC. I shook hands with another newcomer and realized that was the last time I would be shaking hands here. Physical contact is not allowed as it can spread the virus. As we were driving down the road I had to laugh to myself. So many memories came back from seven years ago when I was here last. People with their hand out, shaking it to get a taxi. Driving at night, you are to flash your brights when you are close to the oncoming car so they know you are there (I never understood that). The large billboards which I remember having election information or condom use on them were now covered with information on ebola. 

Yesterday morning I went into the ebola unit for the first time. I was in there for about forty minutes and that was long enough for me for the first time. Getting suited up was a chore but there were many people there to help. Not the slightest skin could be showing. You had people to tie you, tape up your gloves, check and double check you were safe to enter. I appreciated that. It’s not because I am new that all the help was there, it is the way it is done, even for an experienced ebola nurse. It’s the same thing coming out of the unit. You stand with your hands up as you are sprayed with bleach water. Another person then tells you step by step what you do to remove your PPE, protective gear. After every step your gloved hands are washed with bleach water. When you finally have everything off and your hands are washed and boots cleaned, you change your scrubs. Drenched in sweat. Soaked. Many of the Liberian nurses would come out and not have a drop on them. Maybe my body will get used to this too, but for now, drenched sweaty scrubs it is. 

Ebola

Adding a post after so long can only mean one thing...

I am returning to the continent that I love and call home.

Since the Ebola outbreak started over a year ago, my heart has been breaking for West Africa. The fear and death and uncertainty that has overtaken that part of the world is overwhelming. When I think of West Africa, I think of the people. The hospitality, smiles, joy, love that the people have shown me during the three years I have spent there breaks my heart knowing what they are going through. I decided not long ago that I would move forward and apply to go and see what happened. I knew doors could open or doors could close but I decided I would keep moving until God told me no.

He didn't.

Doors closed, but others opened and I kept moving and I'm glad I did because now I am about to leave.

I just got my plane ticket and will be leaving this Friday. I will be going to Liberia with International Medical Corps (IMC). They were featured on 60 Minutes a few weeks ago. You can watch the episode here.

I ask for your prayers. Prayers for those infected with ebola. Prayers for strength and grace in this journey. For safety and strong health. For strength in wearing the protective gear while treating the patients. Prayers for everything and anything God brings you to pray for.

I will update on here as I can. Thank you for your prayers and support.

Act of Faith

For many of the women we serve, coming to the center is an act of faith. On Thursday we discharged an old woman who had her fistula repaired and she is dry. In the clinic as we were doing her final discharge screening and education she told us it was difficult for her to come in the first place. She didn't have the support of anyone in her family or village. They kept telling her that the problem she has is not treatable. There is no help for her. It is pointless for her to even try. She has this problem for a reason so she needs to learn to live with it.

She came anyway.

I laugh thinking about it because she told us there are four other women waiting for her return in her village. They all have the same problem she did but they waited for her to come back and report what happened here. This older woman came out as a guinea pig to see what would happen to her. I have heard this before. Patients coming out, knowing others in their villages who have fistula. There has to be one brave enough to make the first step to come. For this one woman, if she goes home dry, the others will follow.

No pressure here.

The hard part is when a patient comes and she leaves wet. There are many reasons a patient can leave wet: a failed surgery, a healed fistula but the woman has stress incontinence, some women need multiple surgeries to be completely dry... When she goes home this won't be translated well. You are either wet or dry. If you are dry, others will come. If you are wet, they don't see the point in coming.

This patient is dry and she will go home and report what she experienced here. I am looking forward to the day I look out the windows in the clinic and see the four patients from her village sitting there waiting...

Dentist

Me and my dentist

I have never been one to really be sick. Never broken a bone. Never been hospitalized.

Never, until a year ago. 

In the last year I have: broken my pelvis, been to the emergency room in Sierra Leone, had X-rays, a CT scan, ultrasound, mammogram, MRI and yesterday I was able to add Niger dentist to the list. All of those things listed, except the MRI, were all done in West Africa. Someone told me today I should write a book about my medical experiences here. I don't have enough to fill a book but I have come away with some good stories.

It's always a good day when the local grocery store has chocolate. Not just any chocolate, but good chocolate. The Toblerone, triangular goodness that melts in your mouth unless you forget to put it in the fridge, then it melts in your cupboard. On Sunday I was enjoying my piece of chocolaty goodness when it became a bit crunchier than normal. It wasn't the grit of added sand that accompanies many meals here, this was like a rock. This was a big part of my tooth. Luckily it was one of my back teeth so you couldn't see it, but I wanted to gag when I felt this gaping hole with my tongue. Being a nurse my mind started racing. I was going to get an infection, then abscess, then major tumor. Luckily I live with missionaries who have lived here for a long time and knew of a good dentist in the area. He was able to see me early yesterday morning and June, Leng and Ashley all accompanied me on this adventure.

We walked right in to this small room that had a desk, a dentist chair and supplies. I was quickly told to sit down so I did. All I knew was that I didn't want anyone drilling in my mouth or doing anything that was not necessary. I didn't want any shots or teeth pulled. I can't believe my lack of French or Hausa after living here for almost ten months. June and Leng did a great job keeping me informed about what was going on. Yes, a large part of my tooth broke off but luckily it was a clean break and all the dentist had to do was fill it back in. Only a small amount of drilling to make it possible to add more cement to fill in the hole. It was even white. I kept my eyes closed, knowing Ashley was right there taking pictures and making sure everything was ok. I had to. The needle, which was never used, was sitting right at eye level tempting my fears. It was better to just close my eyes and pray it was all over soon.

All in all it was a memorable experience. The hole is filled and even though it is temporary, June had the same thing happen to her a long time ago and went to the same dentist and her temporary fix lasted a long time. I pray that is the same in my case as well. It is still a bit rough. The dentist apologized for not having a buffer to smooth it but it's not bad. All this for about $4.

Visit the dentist in Niger... check.

Thankful

Last year when I was living in Sierra Leone my sister sent me a book called One Thousand Gifts. It was a great book that helped me changed my outlook on my situation there. It helped me find joy in everyday things I encountered. In the stressors I had, I was able to think about and notice the little things which caused me to see each situation differently. It helped me to persevere through some difficult times.

Last Sunday I decided to start a list. I have been making a list of things I am thankful for. It has helped me change the way I have looked at some of the situations I encountered this week. As I started writing this list I kept having an overwhelming urge to write a list of challenges this week as well. I didn't. I needed to focus on the blessings of my days. Yes, there were days I just wanted to come home and crawl back into my bed, turn on my ac and sleep, but when you take the time to stop and look around, you notice blessings in the midst of challenges. Here are a glimpse of things I have been thankful for over the past six days:

• Having a flashlight on my phone
• I have not gotten malaria this year
• Packing nyquil/dayquil when I came
• Purple flowers growing among the corn stalks being harvested
• Patients being discharged to the village
• Dead earwigs
• Bananas erupting from their pods on the pigmy banana tree
• Moringa trees growing larger
• Women returning on time for their surgical appointments
• Ants marching creating veins in the sand
• A newly hired nurse
• Long walks home
• Skirts that make you walk a step slower
• Receiving two roosters as a thank you gift inside the hospital
• A finished malaria policy
• Kosai
• Old patients returning dry
• Watching people harvest their crops
• Women pounding their grains
• Listening to country music in the car
• With the windows down
• At night
• Turning down country music and rolling up the windows while passing through checkpoints
• Water filters that make brown water drinkable
• Friends who will protect me from bats
• Two hens purchased for the roosters so we can have eggs
• Air conditioning in my bedroom
• Watching patients doing rounds on each other--on the fresh post-op patients to make sure they are ok
• Losing patients but then finding them sitting under a tree in the dirt behind the OR
• Training nurses to take over my jobs
• Nurses who work hard
• Rice and beans for lunch
• Learning a new word in hausa and using it appropriately 
• Just standing in the pharmacy (the only room in the ward with air conditioning)
• Being told I can go to Niamey with Ashley to say goodbye
• The way the young patients wear their gowns
• Having my massive set of keys reduced by three
• Excitement by patients who are brought into the ward for surgery 
• Bottle of some sort of sugared nuts
• Chocolate in the grocery store
• Buying a purple shirt at Wrangler
• Witnessing an ultrasound of a patient who did not know she was pregnant
• Showing this woman her child inside her womb
• Seeing the tiny hands, feet, spine and all four chambers of this tiny heart beating inside her

Family

Yesterday we had one of the largest clinic we have seen. 30 women in four hours. Most were new women we have not seen before and the majority of them were scheduled for surgeries this month. We have a very busy month ahead but it's exciting to have so many women who will be able to come through our doors. For now they will be staying in the village where the village manager will be starting her literacy classes. 

Today there were two women who came to the hospital. One was here a few months ago and had surgery but she needed to return for a planned follow-up surgery. I walked her out to the village and when we were half way down the path, to the point where the women in the village could recognize the patient I was walking with, claps and yelling started coming from the huts. Many of the women recognized this patient from before and it was like a home coming. There was even one who jumped up and danced down the walkway to us so she could carry her baggage and give her a huge hug.

I love how the women become a family to one another. So many of them travel from one fistula center to the next hoping for a permanent cure and they get to know each other. The one who danced down the walkway to greet this patient I was admitting knew her from her previous surgery done here. Even on the ward it is incredible to watch the women and how they interact with one another. Not just with each other, but with the nurses. Last night one of the patients walked around to all the doors making sure they were closed tight and locked before the patients went to sleep. Another is sick with malaria and just feels awful. The other patients come, carrying their catheter bags, to help change the bed and pads of this women. They bring her water and talk with her. We are not short staffed with nurses and we don't expect this of our patients. We have never asked the women to do this. They do it because they know better than any of us what they are each going through. I watched as an older woman helped a girl about half her age use a pot to pee in because she had an IV running. When a woman returns from the operating theatre, there are patients on the ward who will make their own rounds. They will make sure the women have water or someone to talk to since they can not move in bed because of the anesthesia. They love each other and care for each other more than I ever could as a nurse. 

Food

I made a new friend. The boys who live next door lost their ball in a pile of bushes. The local boys they were playing with did not want to help them look for the ball because they saw two chameleons living in the bush. Most people here don't like chameleons because they think they bite. I don't know if Simon found his ball, but he did find this chameleon. I was in my house when he yelled for me to come out because he had caught one. It wouldn't be too hard to catch because they move so slow. 

I get a lot of questions about what I eat. This picture is bissap. I had it first when we went to Park W in April and I have been wanting it again ever since. Hauwa, my boss, picked me up some at the market. They are leaves that you boil and it makes a deep red, bitter tasting drink. Add some sugar and it's pretty amazing. 

In the mornings as I walk to work there is a small market right outside the hospital. Many people will stop and buy this, fanke. There is another fried ball like thing called kosai which I prefer to this, but it's more difficult to make so that will be for another days lesson. Ashley and I had a fanke cooking lesson this past Sunday. Hannatou, our translator in the hospital, and Hawa, one of the nurses, came to Ashely's place for the lesson. It's basically flour, yeast, sugar and water, then you fry it in oil. The kosai that I really like is similar and looks the same but it is made from bean flour. Add some yagi pepper to it and it's fabulous!

Moringa

I have been wanting to write this post for a long time now. I love that we hired a gardener/landscaper. He has been working here for a couple months now. What I didn't realize until yesterday is that I have been calling him the female form of his name for the last two months but no one wanted to correct me. I feel so bad. He just laughs and says ba matsala, no problem. He has done a great job landscaping the area around the hospital. I was really excited to talk with him about planting moringa trees when he was hired.

I first heard about moringa trees about ten years ago when I took a Mercy Ships class about tropical medicine and they spoke on moringa trees. These trees are incredible. They were basically created to grow here. Everything I read about these amazing trees calls them nature's medicine cabinet. One ounce of moringa contains 7 time the vitamin C found in oranges, 4 times the vitamin A of carrots, 3 times the iron of spinach, 4 times as much calcium as milk and 3 times the potassium of bananas. What else is there to say? I get so excited when I think about these trees and what they can do for this area of the world if people would tap into them. I can't wait for ours to get big enough to have pods. I read they can produce 400-1000 new seeds a year. Plenty to send all the women here home with some seeds! I have a great vision for these trees and the ways they can first help our women, and then teach the women how to take them home and help their communities with them.

So, my first talk with our gardener was about planting these moringa trees. Two days later he brought in about 25 of these trees to line the walkway out to the village. Yesterday we had our first moringa harvest and ate of the abundant leaves. Another great thing about moringa is how quickly it grows. Our trees were planted about six weeks ago and we are already eating from them. I have a book on all that you can do with the leaves and plants and pods. Everything from antibiotics to skin infections to diabetes and low blood pressure, anemia, diarrhea, water purification... the list continues of all the ways it can be used.

Moringa

Crops and Painting

On my walk home from work today Ashley pointed out how tall the crops are getting. I am 5'8'' tall so you can see the height. These crops are huge! We have been getting a lot of rain which is fabulous for the crops but not so fabulous for Niamey. If you have not heard, Niamey is flooding. It has completely flooded the SIM school there and they are having to look for another place. Please pray for Niamey and the flooding. It has left many homeless and destroyed many crops with the rising river. Check out the BBC news on it here. http://www.bbc.co.uk/news/world-africa-19384377

Last week we painted again. Again, when I told the women to paint whatever they wanted they giggled and just looked at me before they painted random shapes. I painted the picture in the upper right then they all started copying mine. I think I will make some postcards as samples and see what they do with those as far as copying them. I really love what they came up with!

I don't eat a lot of meat here. When I go home, one of my major food cravings is for Red Robin. Here, we pulled over and got guinea fowl from this guy. It was pretty pretty good. There are some things I continue to struggle with food wise. Meat is one of them. I was excited that when I bought this because  he cut it up and cooked it longer on the fire. When I took it home and started pulling if off the bone I hit a vein and blood came spurting out. Overall it was good meat, but I don't know if I will buy meat again here.

Painting

Painting on the ward

The other day was painting afternoon on the ward. First, it was the painting of the fingernails. Then we pulled out the paints, paper and brushes that my parents and Anita and Cal donated. Thanks! When I told the women what we were doing, they looked very confused and asked what they should paint. We told them they could paint anything. It took some time for them to get into it but when they did they enjoyed it and painted some great things.

A bladder stone

This picture was taken on a short trip I made here to Niger in 2010. It is a picture of an X-ray of a bladder stone which was in one of our fistula patients. This woman was transported to another hospital where she had it removed. We had to send her in an ambulance because she was very sick and we wondered if she would survive. She returned to the center two weeks ago and on Tuesday she was discharged home. Dry. She has had multiple surgeries for this problem and she is finally leaving happy! I love it when patients from my first trips here come back so I can see how they are doing.

Nurse Picture

My ward nurses

It's difficult to get lined up. Smiling is even harder for some. It always makes me laugh because you can be talking with someone and tell them you will take their picture and they automatically put their arms to their sides and don't smile. For many of the patients, if I want them to smile I ask to see their teeth and you will at least get half a smile. 

We started this week with a couple surgeries on Monday and that was all. By the end of the week we were all learning more about what it means that things happen best in God's time. Wednesday and Friday we had surgeries. The new moon is coming soon to signal the end of ramadan. Hopefully along with that we will have more women arriving for surgeries. Please pray for this.

If there is something specific you would like to hear more about, leave me a comment and I'll fill you in on what you would like to know more about.

Just Another Saturday

The pastor with baby Rebecca

My day started at seven this morning. I got up, put on a new outfit and met with some others from the compound to walk to a nearby fulani village for a baby naming ceremony. This 2kg baby was born a week ago. She is so tiny and so beautiful. After visiting the mother and holding the baby we went out and sat with the women under a covering. They wait about a week to announce the name of the child. All morning I was hoping the pastor would hold the baby above his head and say, Simba. Spoiler alert: that did not happen. There was buildup to the name being announced. It is a biblical name. From Genesis. The sister of... someone I can't remember. Rebecca. The child was named Rebecca. After the announcement the town crier yelled out and for the rest of our time there, at random intervals, he would cry out her name. After the pastor gave his sermon the baby was brought out by a friend since the mother stays in her house area for 40 days. Festivities go on all day but we only stayed for about an hour and a half.

My new outfit
On the walk home from the ceremony

From the ceremony we drove to Maradi for Saturday shopping. Today was the first day I bought what I call fly meat. Meat from the market. I will let you ponder why I call it fly meat:

Fly meat

From the market we went to the hospital. If you read my last blog post, you may remember that I talked about to do lists from January. The very first thing on my first to do list was to tile the patient sinks in their bathroom. It was really grossing me out that they were just cement. Today when we got to the hospital, there were two guys there tiling the sinks! Eight months later I can cross that off my to do list!

Patient sinks being tiled

After grocery shopping it was time for henna in the village. Hawa, Ashley and I spent the afternoon in the village with the ladies. Haoua, the nurse in the operating room, brought a girl out to do this for us. We had been talking about getting it done since we got here. It took all afternoon and into the evening but it was a really good afternoon. Ashley went first then Hawa so it gave me time to take a nap under a tree. There was a nice breeze all afternoon and the ladies were a blast to hang out with. It was the most relaxing afternoon I have had in a long time. I don't think I would ever want a tattoo, but this will wash off in a few weeks. I kind of feel like Madonna with her 80's style gloves although I love the design on my feet. I have been trying to get my Bible study homework done this evening but I am so distracted by my hands that I don't know if I can.

Henna

This week we have two surgeries on Monday. After Monday our surgical numbers are a bit low. Because we are in the season of ramadan, people do not travel. Many Muslims also do not like to go to the hospital for elective procedures because then they will not be able to participate in the fast. Because of this, we have a long slow month ahead of us. We know the women are out there so please pray that they will come. Coming right off of July where we did 40 surgeries and we were pretty busy, I am nervous about slowing down the pace because of my nurses. Being new, I'm afraid they will become lazy even though I have no reason to think that of them.

On a side note, I have been asked to post more pictures of the patients. Being here and working so closely with the women, I would love to post lots of pictures of them. The more time I spend with the women, the more protective of them I become. I can not post pictures of them on my blog though in an effort to protect them and their privacy. Sitting with them today in the village, all of us resting on the mats, I was thinking that if I was at home on a Saturday afternoon I would probably be hanging out with some friends. Yes, the women are our patients, but I do think of them as friends. We laugh together, cry together, rejoice and hug when they come back for three month follow-ups. Today I spent my Saturday afternoon with friends and I loved it.