Pictures and Perspective

 My translator, Usman, holding one of our few healthy patients

 Katy, Marta, me and Lisa posing for the album cover of our upcoming record "Galmi, Maybe"

 Malnourished 2-month old

 An exceptionally large and ugly bug (not in my house, thankfully!)

 Short-termers, brought together by the promise of pancakes

 The obligatory "my picture with a cute African kid"

 Katy and Marta riding camels (I hear it is rather uncomfortable)

 Camel shadows (nice picture by Katy)

 Galmi is the "Onion Capitol of the World." What better reason could there be to make onion rings?

 Makes Katy and I look like we were travelling light.

 Shopping on "Market Day"

 Me, Usman, and Katy on our last day

 Note the multiple beds on the floor and beds with multiple patients and their mothers

Recent flooding has caused a lot of damage in Niger, and made this a terrible malaria season.  We were able to see some of the damage as we flew over.

I've been back in the US for almost 2 weeks, during which I have: worked a shift in a small town ER, tried to fill out my advance voting ballot, paid rent, shopped at Walmart, eaten at nearly all my favorite restaurants, seen a movie at the theater, ordered stuff from Amazon, and generally been living the "normal" comfortable life that I was born into.  Ask me how Niger was, and I will have to think for a moment before saying that I saw a lot of really sick kids.

  It is amazing how hard it is to see the whole picture clearly.  When I was in the hospital in Niger my thoughts were nearly consumed with sickness, death, and an overwhelming hatred for malaria.  I couldn't imagine that somewhere in the world were healthy children, likely to survive the week, though I knew that just weeks before I had seen such things with my own eyes.  Now that I am back "home," watching kids in costume ask neighbors for candy it seems surreal that there could be children who haven't had enough to eat any day of their lives, and are losing the battle to fight off a sickness that began with a common bug bite.

  Despite the overwhelming differences between life at a mission hospital in Africa, and life in the suburbs of America, it always surprises me that I am the same.  I don't suddenly become less selfish, or more grateful when I switch contexts, although I am enjoying my temporarily bug free existence!

  All that being said, I think that it's time for me to commit to something more permanent.  I've been accepted by a missions agency and have some possible locations in mind.  Please pray for me as I seek to be obedient (not my strong suit!) to God.  The Global Missions Health Conference is in a week and I am looking forward to seeing friends and hearing from really awesome people doing amazing things around the world, but I also hope that it will be an opportunity to clarify my next steps towards a particular location.

  My job is not to see the big picture clearly, but rather to follow the lead of God who does see everything clearly, who is gracious, abounding in kindness, all-wise, and loving.

 Thank you to all of you who have followed along this journey with me.  God has encouraged me and strengthened me through your prayers.

My life in Niger

I would like to tell you more about my life here in Galmi, Niger.  There is more to it than bugs (thank goodness!) 

  I live in a duplex with my own space.  I have a kitchen, dining area, and living room all connected and then a bedroom with a bathroom attached.  My neighbor is a young woman from the US who is here for a year teaching at the dayschool for missionary kids.  Despite having my own space, it feels a bit cramped and institutional and not homey at all, so I spend most of my time at my friend Marta’s place.  Her living room is more pleasant and personal and I have done most of my cooking in her kitchen.  There is a gas oven/stove in each unit which is lit with a match each use.  No pilot light!  The oven is unpredicatable, but Marta managed to bake a dark chocolate birthday cake for Katy that was amazing, maybe the best I’ve ever had.  Unlike my time in Zimbabwe, water and electricity are reliable here.  There is even a built in water filter at everyone’s kitchen sink. 

  I keep my mosquito net tucked in around my mattress at all times to keep unwanted visitors out of my bed.  They “fixed” (read : doused with insecticide) my swamp cooler so at night I can get the temp in my room down to the 80’s which lets me sleep more comfortably although the night it rained the air was so humid I stuck to everything.  Yesterday the high dipped nearly 20 degrees to 89 and people came to the hospital wearing sweaters.  The fans were off in the hospital because people were cold, so there was no moving air to absorb my sweat.  I am definitely not fully acclimated, but less uncomfortable than the first week.

Last week, I heard that there was a baptism going on at our compound swimming pool, Katy and I went to watch.  It was exciting to see nearly 20 people, most teenagers, be baptized.  I thought that it was interesting that no one here claps, since that is usually my experience of church affirmation in response to a baptism.  They tell me that it is rare to see baptisms here, so I am glad that I got to witness these. 

  Hospital rounds start between 8 and 8:30, and we each round on our own patients that we admit.  Today my stack was the largest it has been: 25, all children.  I was relieved that none of my children were in the deaths box today.  On Saturday, my first weekend call day, a severely ill 17 year old came in.  her blood pressure was 60/? (normal is 100-120/60-80) and despite our efforts to get IV fluids into her, she died within 15 minutes of my seeing her.  I found out later that she was one of the teenagers that had been baptized the weekend before.  Today I sent home about 5 children who would probably be dead without the treatment they received from the hospital and from me.  I sent 2 more to the Nutritional Center to have intensive nutritional support.  I am on call tonight and am afraid that my stack of people to round on tomorrow will be even higher than today.

   We are all working hard and barely keeping up with the burden of malaria here.  My favorite age for kids is between 4 and 8, but it is amazing how hard it is for children born here to make it to that stage.  Most days I work in the under-5 clinic, which is swamped with children brought from near and far, most with malaria and some with something else.  In some ways it is easy, because at this time of the year, we just assume that everyone has malaria, but that makes it hard sometimes to see clearly and notice when something else is going on.  Many children are malnourished.  Children without good nutrition do worse with everything.  Brain development is put on hold and even mild infections can turn life threatening because their bodies can’t fight.  I see between 30 and 50 patients a day in this clinic.

  There was a mother who brought 2 of her children to the clinic.  Her younger child died in the 5 minutes spent writing admission paperwork for the hospital.  A little while later, a child was noticed in the waiting room having a seizure (either from malaria itself or from the fever).  The staff brought the child in to give her medicine, but couldn’t find the mom, who was trying to make arrangements for her dead child.  I don’t know if she lost both her children that day or if maybe the older one lived. 

  I was asked by one of the long term missionary doctors if I am having “more fun” here than in Zimbabwe.  He suggested that I am probably saving a lot more lives here.  That may be true, but I admit that this work makes my soul weary.  Even if 5 or 10 live for every death, I feel the pain of 10-20 deaths a week more strongly than the joy of 100 lives saved.  So pray for me and the other doctors and staff at the hospital.  We are soul weary, even when well rested.  And we are not always well rested. 

For me the constant itching is also trying.  I have mysterious bites all over my body that itch all day long and try to keep me up at night.  I am taking Benadryl every night and Claritin every day, but still the itchiness persists. 

Much as it was in Zimbabwe, cooking is a creative outlet here.  I made delicious onion rings and applesauce this past week, and not so delicious burgers.  I bought meat off a man who had strapped a chunk of cow to his motorcycle and brought it to the compound.  Then I had to dissect the tendons from the meat and figure out how to operate the electric meat grinder.  This may be the freshest ground beef that I have ever eaten and I am more seriously considering being a vegetarian than I ever would have thought possible.

Niger is a hard place.  Not the hardest, but definitely hard.  I don’t know if I will come back, but I think that if God called me here, I would be both honored and humbled that he would entrust such a difficult place to me.  

Creepy, Crawly (Hoppy, Fly-y) Things: The Plagues of Niger

  Many years ago, I decided that for me to go to Africa would prove the existence of God, because I hate bugs so much, only God could get me to go somewhere with so many of them.  I have since learned that while Africa may have some more bugs than home, it isn't usually that overwhelming.  (Caution: if you are squeamish about bugs, skip to the last sentence of this post)

   In talking to my friend Marta last week, I mentioned that I feel like I am experiencing the plagues of Egypt.  This conversation was sparked by noticing the abundance of frogs that are everywhere at night and the random rash that all of us here have on our arms (pretty sure it is from some form of bug not deterred by DEET).  Watching children dying of malaria is also sadly reminiscent of the plague on the firstborn.  At the time of the conversation, I said to Marta, "just watch, the locusts are coming next," to which Marta replied, "yeah, so they told you about that?"  Um, no.  I was just being facetious!  But unfortunately, it is true.  Tonight there were thousands of locusts flocking about the hospital. While I tried to write admission orders on my two patients tonight, no less than 20 locusts landed on me.  Walking to and from the hospital was walking through a swarm of the the flying creatures.  There is a swarm of gnats that has started to hang out right in my doorway.  Earlier this week, I killed a 2.5 inch scorpion in Marta's house.  And I haven't mentioned the 10-15 earwigs that I find in my house daily (and which like to randomly drop from the ceiling onto innocent bystanders).  Or the 5-10 crickets that sneak in under my doors.  Or the web of 50 baby spiders on my door handle today. Or the 30 ants that climbed into my homemade syrup.  And did I mention the malarial mosquitoes? no... that's because even though they may be deadly, I've only seen a few.

  So if any of you wondered... yes, there is a God.  And he is currently training me to survive bugs.. in Africa.  Please pray for me!

The First Week

I regret that it has taken me so long to write an update, but since I did not bring my own computer and started almost immediately working in the hospital, today is my first day to think and write (and cook!) since arriving.

From now on, I have decided that I will always travel with Katy.  God seems to give her special grace in the area of transportation, and all of our flights behaved well and our luggage arrived.  I was able to bring many of the things that the hospital had requested, although I was not able to bring some things because I did not order medications early enough to get the government clearances needed.  I did learn a lot that will help me to plan better next time. ;)  Katy and I arrived in the country of Niger on Sunday afternoon and spent that evening at a guesthouse.  I intermittently turned on the air conditioner in my room for 3 hours during my stay and it was glorious.

We flew to the hospital in the smallest plane that I have ever been on.  It is a 6-seater, but we took out 2 seats to accommodate the trunks we brought along.  We flew over the countryside at about 4000 feet and were able to see the faint green of the crops watered by the recent rains.  By the time I fly back, I am told that all the green will be gone.  This place is what most people picture when they think of Africa, although I have been to many places where the land is lush, with rolling hills and even cool temperatures.  Here it is hot.  110 today.  No air conditioning, only fans.  The temperature inside is in the 90s.  Because of the recent rains, the air is oppressively humid as well, so the sweat that drenches me can’t evaporate away to provide relief.  Culturally, as a woman I must wear a headscarf, which adds to the warmth.  I am missing the cool fall weather that began just as I left.

Malaria has been terrible this year and though the pediatric ward is supposed to hold up to 35 patients, the other day there were 115 pediatric patients.  They share the beds, with 2 to 3 children and their mothers sharing the same mattress.  Additional mattresses are spread in any available space.  The nursing staff are overwhelmed by the number of patients and with 2-3 per bed, often with similar names, it is frighteningly easy to get their charts and medicines confused.  They are all on the same medicines but at different doses.  Thankfully, most of the patients seem to be getting better, although one day last week 26 died between one day and the next.  The hospital staff is noticeably worn down. 

My first day was really difficult.  It is amazing how much variation there can be between different African mission hospitals and I arrived knowing almost nothing about how this hospital functions.  So on Tuesday I followed the other doctors around in the morning.  My French lessons didn’t get as far as I’d hoped, so I’m completely without any communication ability without a translator and there are only a few who speak English.  I write in the charts in mostly English with a few bits of French that I picked up.  But that first day I was reminded by everything including the other staff that I don’t know how to do things here.  At the same time, when I asked for help, I was told that I was slowing things down and when I didn’t ask, I was told that the things I did were wrong.  One of the doctors here hasn’t taken a day off in over 6 weeks, so I understand his impatience, but I definitely went home and cried that night.  First days are always hard. 

The rest of the week has been better.  I had one child die overnight that night.  They had come in too late.  I wrote “near death” on their admission note and unfortunately turned out to be right, but since then, all of my patients have survived.  A mother brought me her 6 year old daughter seizing from malaria.  Her firstborn son had died several years before, and her second-born, a daughter, had died when this daughter before me was born.  Now her only living child was dying and she was panicked.  I led her to the bench we call “the ER” and then had the mother hold her seizing child on the scale so we could know the proper dose of seizure medicine to give.  The needle on the scale bounced with every twitch of the girl’s arms.  But it was enough to get her the medicine.  The first dose didn’t help and after another very long 10 minutes we gave a second dose.  A couple minutes after that, she finally went limp.  I watched to see if she still breathed and was relieved to see her chest rise and fall.  We gave her malaria medicine and Tylenol, and I prayed that she would somehow live, though things looked bleak after at least 15 minutes of seizing.  By the next morning, when I came to round, that patient had faded into the back of my mind surrounded by many other children I had seen.  As I walked into the nurses room, a woman grabbed my hand.  This isn’t unusual, every mother with a child in the hospital wants their child to have the doctor’s attention, so I continued walking with just a brief smile at her.  Then she gestured to the child beside her: a lovely young girl sitting up with bright eyes and a smile.  I continued walking and made it another five feet or so before realizing it was the seizing child from the day before.  God’s memory is perfect.  Though I had forgotten her, He had not.  I pray that the joy in that mother’s face might direct her to the God who saw her distress and saved her child, rather than towards me.

Preparing to Go

I write this while preparing to leave for a new (to me) part of the world.  I am going to live among strangers that I hope to call friends, but there are many things that separate us.  Language, Culture, Race, Religion.  It is possible that some of those I meet may not trust me or like me.  It may even be possible that a few might hate me.  Is that a reason I should not go?  Jesus came to earth for us under similar conditions, and I will follow him in this wherever he leads me.  My Hope is unshakable.  Though the foundations of the earth may falter, the hope found in Jesus Christ is a sure foundation.  There are more people today than ever before in history who do not know that God has declared us his friends based on Jesus sacrifice.  Some of these people live next door to me and across the street.  Many live on the other side of the world.  For years, I have felt and followed a desire to travel further to live out the good news of Jesus.  Aware that I cannot do this on my own strength, I ask you to pray for me.

On Sept 22, I leave for one month in Niger, West Africa.  For a bit of sobering perspective, the U.S. has one doctor for about every 370 people; Niger has one doctor for about every 25,000 people (so I will be VERY busy!)  Two good friends of mine who are both single female doctors are currently there for 4 1/2 months as part of the international family medicine fellowship which I completed just over a year ago.  Traveling with me is another good friend of mine, Katy, who is also a doctor. We look forward to serving alongside the long term missionaries and national staff at the hospital.  We also look forward to seeing our friends and hope to bring refreshment and encouragement (and chocolate!) to them. 

            I am deeply grateful for to all those who have poured into my life.  I want you to know that because you are part of my life you travel and serve with me. (Most of you probably never expected to travel to Africa, huh?) 

Please remember me and the people of Niger in your prayers. 

Specific requests

1. An end to the cholera outbreak

2. That those who lost homes in the recent flooding will be sustained and that rebuilding will be able to progress.

3. That those who need malaria treatment will be able to get it (many hospitals have run out due to the high number of cases currently)

4. That I will be able to take the supplies and medicines that the hospital has requested (lots of red tape on both sides of the ocean)

5.  Ability to communicate well with patients and staff (despite multiple language barriers)

6.  God's guidance about where to do long-term mission work in the future

7.  Physical and spiritual protection

His,

Alexis

Below: world map from 2006 showing population to doctor ratios around the world)