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)

Tanzania

My time in Tanzania both flew and crawled by. I was so anxious to head home that at times it seemed the week would never finish, but now I can't believe it has gone by!  You may recall that my first week in Africa, I posted a snail that I saw so it seems reasonable to show you the huge snail that I saw in my final week in Africa.

Last Sunday we did something I haven't ever done in Tanzania before: we went to "city church." Usually we go out to one of the villages. Pastor Raymond (who has the biggest and most beautiful smile on earth) preached the sermon and a couple excellent choirs sang. The sermon was in Swahili, so I can't say what it was on, but the singing was delightful.

Afterward we ate lunch with the pastors and the bishop. My home church has helped to sponsor the education of several young men who are now leaders in the church. So many of them are familiar faces that I have seen again and again during my trips to Tanzania. Lunch also included a special treat. Apparently in the 2 years since my previous visit, Pepsi has moved into Tanzania (it used to have only Coke) and introduced the joys of Mt. Dew.

On Monday we began clinic by driving out at 7:15 in the morning to a village over two hours away on the far side of the mountains. The drive is beautiful, but jarring since very little of the way is paved. There were several times that I earnestly thought we were going to get stuck in the mud. But we arrived and set up our clinic in a school. School was let out especially so we could do this, and I think we doctors saw every student in addition to the many people from that village and surrounding villages. Many people were well. Some had malaria. Many had intestinal worms. Some had elephantiasis. I saw a woman who likely had advanced cervical cancer.

Our team included a pediatric nephrologist, an ER nurse/paramedic, several nurses, a dentist, a pharmacy student, an optometrist and several helpers of various backgrounds. This is the first trip where I have really felt like I was the most qualified physician, and that made it difficult as I still have plenty of questions and would have loved to have someone to go to with those questions. On the other hand, because I was feeling so anxious to get home, I almost wished I hadn't agreed to come to Tanzania, but I was definitely needed.

After my time in Zimbabwe, I am very aware of HIV. There was a Tanzanian nurse and HIV educator who joined our team and helped us do HIV testing. I think during the week we did around 600 tests. I didn't order them terribly often, but feel like God really led me to order them on a couple of patients. I tested a young girl pregnant with her first baby. She had not yet had any prenatal care and was around 15 weeks pregnant. Mostly I was checking for malaria, but since we were drawing blood, it seemed reasonable to do HIV testing also. As it turned out, she was positive. This puts her in a very difficult position. She has to somehow go home and convince her husband that they should both go for testing. If she reveals that she has been diagnosed, he will likely blame her. On the other hand, now that she knows her status, she may be able to prevent the baby from getting the disease. Please pray for Grace and her husband and baby.

Another patient that stood out was a 13 year old girl, Esther. She had a beautiful smile and alert, curious eyes. There is a special spark in her and when I saw her I thought she could grow up to be a doctor if she wanted. Her mom and little brother were there at the clinic with her. Much like my other patient, there was nothing that overtly suggested HIV, but I wanted to check them for malaria and so went ahead and did both tests. Esther and her mom got the surprising and difficult news that they have HIV. This poor 13 year old with so much potential, and such a difficult struggle ahead...

I saw several patients with infertility who I could pray for, but there was nothing medically that we were equipped to do for them.  It was hard to deal with being so limited in our diagnostic abilities and treatment capabilities.  After working in the hospital in Zimbabwe, this just felt like such inadequate care.  As the week progressed, I went from praying with a couple patients a day to praying with all my patients, because I recognized that my medical care was not going to be enough.  I also asked the patients if they had anything they wanted me to pray about and many said a good life, or success in business, or healthy animals.  A few women prayed that their children would come to church.  Please join me in praying that God will bless those I met this week with the life that is found in Jesus, and that he will multiply and complete our feeble attempts to bring healing.  

travelling adventures and misadventures...

So I arrived at the Zimbabwe airport very early last Thursday to catch my flight to Tanzania. No one at the airport seemed to know where the check-in for my airline was, but after about an hour someone arrived at one of the counters and began checking in the few of us who were waiting. My bags were checked, and praise the Lord the weight was ok. (Flying within the African continent involves a much lower weight allowance than flying to the US from Africa.) I was feeling very Zen at that time so the delay didn't phase me too much and I bought a Coke to help me wake up. I began to feel a bit nervous that my flight didn't appear on the departures monitor, but I was reassured by the fact that my boarding pass looked legit and there were at least a few other passengers waiting for the flight. A lady approached me and asked if I was waiting for the flight and I said yes. Then she asked, "are you Alexis?" Uh oh. "yes." "Your connecting flight to Tanzania doesn't fly today." In fact, there is never a flight on this airline to Tanzania on Thursday. Despite the fact that I have a confirmation number for the imaginary flight, I am escorted back out of the airport and my departure stamp in my passport is crossed out.

They did tell me there was a flight on Friday. I called the missionary who had dropped me off and asked to come back home with her for another night. Because of the delay, I was present for the arrival of a new missionary team which was headed by a doctor I apprenticed with in medical school. I had actually lived with his family for a month, so it was wonderful to catch up.

On Friday I headed out to the airport again. I briefly encountered the issue that I wasn't on the passenger list, but that got sorted and I arrived in Tanzania at 1Am on Saturday. Unfortunately the medical team I was meeting had already departed for our headquarters, 3 hours from the airport. The Tanzanian missionaries, however, had been able to change my reservation at the last minute so I had a place to stay. They also left me enough money to pay the cab driver and buy a bus ticket in the morning. I actually came up about three dollars short because I asked the taxi driver to help me find an ATM, and then I realized that I couldn't remember my PIN. Ooops! He forgave me the shortfall (maybe to get rid of the crazy American girl).

The next hurdle was that the bus I was on (with no money...again) had one of my suitcases underneath the bus in storage. The headquarters is on the road the bus takes, but they usually only drop you off if you have no luggage underneath. I spent some prayer on the issue because I couldn't afford another ride back to headquarters, and lo and behold, they let me off right where I needed to be! (maybe once again to get rid of the crazy American girl!) Oh, and on the bus, would you believe there was a vendor with a cold can of Mt Dew? I got him to accept an American dollar for it. :)

And so, despite all the craziness, I arrived and met up with the medical team on Saturday evening.

Final thoughts on my time in Zimbabwe...

The end of my 5 months in Zimbabwe caught me by surprise; it came so fast. Overall this experience has strengthened my faith in God. Some of you may know that I seriously considered not coming to Africa. After my last long stay in Africa, I made one of those rash statements that goes something like “God, I’m not coming back to Africa unless I’m married.” And last year, I dated someone who I could imagine sharing life with, except that life would have to be in the U.S. He loved Jesus and loved serving others, but didn't feel called to do that overseas. And this brought me to my Jonah moment. Choosing for myself, I thought that being married in the States sounded better than being single overseas. Then I got swallowed by a fish. Ok, well actually I just ended up in a situation where saying no to going to Zimbabwe seemed so catastrophic that I had to say yes. So I came to Zimbabwe more or less against my will.

But in Zimbabwe I found myself overwhelmed by the sense that I belonged. I was surprised by contentment even in the incredibly difficult and heart wrenching situations which arose daily. God graciously provided the right people at the right times so I never felt alone. He scattered flowers on my path every morning, sent me valentine’s candy, Mt Dew, and beautiful letters of encouragement from home. He restored my soul. And I am so grateful for his mercy that gives us not what we deserve, not what we want, but what we most desperately need.

I spent the last night before my flight out watching a total lunar eclipse from on top of a huge rock covered by ancient cave paintings. And I spent many nights as I walked between the my house and the hospital staring up at the stunning array of uncountable stars. I watched and experienced the tremendous power of Victoria Falls as an entire continent worth of water crashes over the edge. I saw the rainbows cast by sunlight through the mist. And I walked with lions. And I am blown away that the God who, with a word, created such things also knows me and loves me. He knows you and loves you even better than you are able to know and love yourself. I am honored that he has given me the great joy of proclaiming that truth to his children in Zimbabwe who may feel that he has forgotten them. And I am glad to share it with you too.

Some other things I hope to remember from my time in Zim include the

universal desire to be acknowleged, valued, and appreciated. It can be easy to do great damage in ministry by not acknowledging the importance of others contributions. And it is really easy to unintentionally overlook or simply fail to express appreciation and respect. We can drive away people who are vital to our mission and work, by not letting them know it and by treating them as less vital than ourselves. We truly are a body and the eye should not say to the hand, because you are not an eye, I don’t need you.

I am so grateful for the friends God has given me in Zimbabwe. It was very hard to say goodbye. Please pray for Rejoice, Anna, and Priscilla who I am already missing.

One of the hardest things about serving in Zimbabwe was realizing that some people hated me for my skin color, while others ascribed to me special status or knowledge because of it. There were people who viewed me as an invader, and those who looked to me to be a savior. And in some sense I am both and neither. I am so grateful for those who opened their homes and their lives and their hearts to me despite my different culture and skin.

Look out world! Alexis is behind the wheel in Africa!

So this last weekend in Zimbabwe was quite an adventure.  The original plan was actually for me to travel into the capital city on Friday and sit on my duff until my plane flew out this Thursday.  Which honestly sounded seriously boring, but beggars can't be choosers and in Zim, I am definitely in the beggar position with regards to transportation.  I was exceptionally grateful to be offered a couple extra days to say my goodbyes to the hospital  and my friends here.  Then on Thursday morning, I received a strange invitation.  One of the missionaries, Anna, had agreed to drive some of the local staff across Zim for a college graduation of one of their children.  But they needed 2 drivers and the second driver was now unavailable.  Would I like to drive a vehicle to the town of Mutare in the mountains of Zimbabwe leaving Friday mid morning?  To be honest the whole thing sounded crazy.  I have never driven in Africa.  They drive on the left side of the road which makes turning and passing confusing.  The speeds are in kilometers per hour.  To leave the hospital requires driving through the river.  And I have never met the person graduating.  So I was considering ways to say no to this absurd suggestion when I found myself considering that, originally, I had planned to be sitting around doing nothing.  It seemed like God had given me some extra time at the hospital and maybe I should pass along the gift.
  So Friday morning I rounded in the female ward, threw some warm clothes in a backpack (Zimbabwe winter is here) and agreed to the crazy scheme.  Thankfully the missionary had an automatic transmission in her car (I don't think I could learn to drive in Africa, while learning to drive a manual transmission, while transporting people across the country).  We were picking up the second car and the extra people halfway into the journey, so we began in the same car, with the missionary coaching me on how to drive, and the passengers warning me when we were coming up to sharp curves in the road or places where people they knew had been in car accidents.  Arriving in Harare, we split into 2 vehicles.
  So why did they need me?  Well having a drivers license is not a given in Zimbawbe.  Many people here never learn to drive at all.  Passing the driving test here is very difficult without paying a bribe, and many people can't even think of affording a vehicle to drive.  (We frequently have patients arrive at the hospital by ox-cart).
  So at this point, I am driving a borrowed car in a foreign city with passengers who have never driven a car.  I stuck to Anna's bumper as closely as I dared, because if we got lost I didn't know how to get found again.  Amazingly, in answer to many prayers we made it safely to Mutare by about 8p.m. (involving a fair bit of night driving which is also awkward).  The "highway" is actually very nicely paved, but only 2 lanes and passing requires pulling into the oncoming traffic lane on the right and it's super hard to judge speed and distance of oncoming vehicles based on the headlights.  Add to that the fact that I saw a lot of pedidles (not sure how to spell this, but cars with only 1 working headlight).  After driving back and forth across town we found our way to the relatives house that we were staying at.
  On arrival, all 14 of us poured out of cars to sit around the living room and exchange greetings.  This is not a mere hello, but a long involved discussion of the family relationships represented and recognition of each individual with a recitation of how they are connected.  This was followed by dinner.  I was shown out the back of the house to an attached small "bathroom."  This consisted of a toilet bowel set in the ground and a large bucket of water to pour into the hole to flush.  During the day they have running water, but at night no such luck.  After dinner we began to figure out sleeping arrangements.  Blankets were pulled out and laid on the cement living room floor so that 5 of us girls could sleep there.  Then 5 other women slept on the kitchen floor, while the 8 men piled into the single bedroom.  It was very cold overnight and there was no heat, but I did get a little sleep.

In the morning, people began waking up at 4:30 to start water boiling so we could all bathe.  One at a time we made our way out into the frigid morning and claimed a steaming bucket of hot water.  This we carried into the "bathroom" from last night.  In theory I was supposed to scrub down with the water, but it was so cold, I decided against it.  The graduation was at 9am outdoors on a beautiful, if chilly, campus.  Mahatmas Gandhi's grandson was the guest speaker.  Then  we headed back into town.
  The best part of the trip for me was getting to hear the people in my car discuss their thoughts on many issues in Zimbabwe and the hospital.  It really helped me to get an idea of what things look like to Zimbabweans.  I also had the opportunity to ask questions on their thoughts.  I think that travelling with local staff on long drives might just be a good strategy for building relationships and learning.
  Saturday night Anna and I escaped to a delicious Italian dinner in the capitol and the crawled between cold sheets at the guesthouse in search of sleep.

  Sunday I attended a wonderful church with Anna.  The congregation is truly a blended multicultural group and it was enjoyable to hear some testimonies of God at work from Zimbabweans.

  And in answer to many prayers, I arrived safely back at the hospital on Sunday afternoon.

A Final Project

  As my time at Karanda is finishing up, I was thinking about what I might be able to do to leave things here a little better than when I found them.  First I decided to clean the drain in my shower, which had never drained well since I moved in.  One very large slimy hairball later, that problem was solved, and I felt empowered to take on another project.

  During my time here, one of the things that has caught my attention is the difficulty encountered in resuscitating newborns.  There are many times that despite attempts being made, the newborn resuscitation fails.  Sometimes this seems to be related to baby being born far too early or having severe problems during the delivery or even having severe birth defects.  Other times infants who could survive seem to die because the attempted resuscitation is incomplete, haphazard, or completely neglected.  So as a last minute attempt to make things better, I asked permission to try and address this issue.

  With the help of a girl here who is an artist, I created a large (~3ft x 2ft) poster designed to take the guesswork out of resuscitation and give those attempting it a easy and visible algorithm to follow.  There were already a couple papers on the wall with neonatal resuscitation information, but they were too small and complex to be referenced during a resuscitation.

  Here was the result of our attempts...

 
In case you are wondering about Step 9, Chiremba is the Shona word for doctor, which is to say that steps 1-8 don't require a doctor and can be done by the midwives, nurses, and even nursing students.

  I was really proud of the aforementioned poster, but the sad truth is that after I handed the poster to one of the midwives to put up on the wall last Thursday afternoon, the poster hasn't been seen since.  Not quite sure what happened.  Several people have searched for the poster to no avail.  Now I don't know whether to spend a couple hours making another poster, or not.  The culture here is such that perhaps someone thought the poster was wrong or inappropriate or even offensive in some way, but since it would be too confrontational to tell me, they instead "lost" it.  Hmmm... I wonder.

  With the help of one of our anaesthetists and my friend, Rejoice, who is a midwife, I also made a chart of commonly used supplies and medicines for newborns with their sizes and doses, so that there will be an easy quick reference for treating these babies.  This I will print out and put up on the wall in the hopes that even if my other poster is never found or recreated, it will help some anyway.

  I also sorted through the resuscitation supplies to determine what items were missing.  In the process I fixed the pediatric pulse oximeter (checks oxygen levels) which hadn't worked for a long time.  I also found a small IV pump that would allow us to accurately give the fluids needed by our newborns (currently a real challenge).

 I would love to see more results like the ones below...