One Last Caesarean before I go

 

Yes I did one last caesarean this morning.  Nothing exciting really, she was stuck in labour, and she had had a previous caesarean, and we didn’t want to push our luck with a ruptured uterus.  There is a new Surgeon here right now and he decided to scrub in to get used to the surgery again.  He works in Newfoundland now, but he is from Edmonton originally and has spent time up north in Inuvik.  He even knows my former Senior Resident that was on call the day that Sean was born – Cal Green.  It’s a small world!  I said Goodbye to all the Midwives today, and they asked me to pray at the daily devotions, but I did it in English.  The two little premature babies are still hanging in there which is truly a miracle.  God is good.  Some of the docs from Ireland left today, and everyone was sad to see them go.  The number of docs drops precipitously around Christmas time – I guess everyone wants to be home with their families.

The clinic was pretty much the same as always.  The Interpreter I had today speaks English and Hausa, but not French.  I had to keep interrupting myself and switching back to English because I have gotten used to doing the clinic in French.  He was a bit upset that I was leaving as he had just said goodbye to the other group that left today.  There was one interesting case today.  There was a lady who was pregnant with a terrible productive cough that was coughing up blood.  Her Chest Xray showed her heart to be slightly enlarged, but I was wondering if she had TB (which is unfortunately very common around here).  The Internal Medicine docs will have a look at her and see what they think.

Well I am mostly packed, and I will try to do my online check in tonight.  My travel time is apparently over 30 hours (there is an 8 hour layover in Paris).  I start in Niamey at 00:30 and because of the time changes I arrive in Vancouver a little after 10 pm.  My dad said he wanted to pick me up so we will see.  It has been an interesting time full of unique moments.  I hope you were able to enjoy some of them as well.

Ecclesiastes 3:1  ESV

For everything there is a season, and a time for every matter under heaven

Malbaza Church

John and Ali Bronts were going to Church in Malbaza today, and I have never been to any church in Niger except the one across the street from the Hospital, so I was thrilled to accept their offer of a ride.  Malbaza is about 20 minutes drive west of Galmi. The main industry there is a huge cement factory.  Apparently it was started by either a Chinese group or an East Indian group, but they ran in to financial difficulties, and it has been taken over by Nigeriens.  They had to bring in a whole bunch of electricity for the plant so there is a brand new substation close by.  You can see them when you are flying in to Galmi, and they stand out from all the mud brick houses.  Church in Malbaza was in English and French and Hausa, all done by the pastor.  The topic was about being prepared (actually the same verses as last Sunday – I wonder if someone is trying to tell me something).  The pastor’s mother came in on the back of a motorcycle (I know someone who will get a kick out of that!), but we drove her home.

On the way to and from Malbaza we talked a bit about some of the construction stuff that is going on in Galmi.  John oversees a fair bit of that work.  I was wrong thinking that the water tanks on the hill above Galmi held all the water for the compound.  When I think about it, those water tanks aren’t big enough given how much water is used.  Turns out they have a well close to the Hospital that has been drilled 1000 feet down and they are constantly pumping water UP to those tanks on the hill, which allows the water to be under pressure for us.   Apparently the tanks hold about 1 day’s worth of water.  The hospital compound also supplies water to the town, and someone comes in with a donkey cart and a bunch of barrels and fills them up.  The pumps did stop once and the people from Galmi took offence that there wasn’t any water for them.  It sounds like they may pay a nominal fee for the water.  John thinks there is a plan in place to try to move away from supplying the town with water and getting them to pump from their own well.

A little more about the banquet last night.  Apparently there is a professional athlete (sort of) in our midst.  Tom Field played kicker for the University of Colorado back in the day and actually had the 4^th highest number of points ever for the university.  Because it was American Thanksgiving, we were treated to Matt Megill describing why American Football was central to thanksgiving.  He even had charts about kicking accuracy etc.  He brought Tom up to the front and interviewed him.  Apparently Tom even tried out for the Denver Broncos, but was actually relieved when he was cut.  Then we went out side and there was a command performance of Tom trying to kick the Galmi equivalent of a football.  Given the equipment available, I thought he did admirably well.

John 4:10

Jesus answered her, “If you knew the gift of God, and who it is that is saying to you, ‘Give me a drink’ you would have asked him, and he would have given you living water”.

Hump Day

What day is hump day again?  Just kidding.  Some of the people here wanted to go on a camel ride so they arranged it for early this morning.  I was in doing rounds, so I did not get to see them riding, just the camels leaving.  Yes they do tend to walk funny and it looks like there would be a lot of swaying back and forth if you were on one.  Is that why they call them “ships of the dessert”?  So yes, those are Dromedary camels (with 1 hump) not Bactrian camels (with 2 humps).  For the curious – here is the Wikipedia paragraph about their humps:  Camels do not directly store water in their humps as was once commonly believed. The humps are actually reservoirs of fatty tissue: concentrating body fat in their humps minimizes the insulating effect fat would have if distributed over the rest of their bodies, helping camels survive in hot climates. In hot and dry environments, within 8 to 10 days only the dromedary camels might consume water which during this period the third of their body's weight may be reduced due to the dehydration. When this tissue is metabolized, it yields more than one gram of water for every gram of fat processed. This fat metabolization, while releasing energy, causes water to evaporate from the lungs during respiration (as oxygen is required for the metabolic process): overall, there is a net decrease in water.  There are many other adaptations, but perhaps that is enough Wikipedia for one post.

There are of course lizards everywhere.  The small ones are quite quick and hard to take a picture of.  The larger ones tend to move more slowly, but can still scramble out of the way if they need to.  They mostly stay out of the house, but sometimes you have to be careful when you are going in and out not to let an unwelcome guest in with you.  Then there are the pigeons.  They seem to like the metal roofs.  At least, they do a lot of running around on my roof, even late in to the night.  That combined with the call to prayers at 5 am limits the amount of sleep a little bit.  I suppose if you’re here long enough all that gets tuned out, like living close to railway tracks or a skytrain line.

Today we will be celebrating American Thanksgiving at the CC.  I get 2 Thanksgivings this year.  Everyone brings something for the meal.  I made it easy on myself and ordered some buns from one of the locals.  So much to be thankful for.  God has been good the whole time, looking after me and keeping me from (too much) sickness.  It is good to see the appreciation from the Nigerien people. They really do like having people come to this hospital and help out here.  And of course, all the people to be thankful for back at home.  So, happy American Thanksgiving to all of you.

1 Chronicles 16:8-9

Oh give thanks to the Lord, call upon his name, make know his deeds among the peoples!

Renovations

Some of the residences around here are getting a little worn around the edges, so they are making some new ones and renovating some old ones.  There is a lot of hand labour involved, but there are power tools as well.  It would be nice to see some of the finished results, but I won’t be around for that.  Talking to Graham Johnstone the orthopedic surgeon, there was a time when there was not air conditioning in the bedrooms.  Glad I missed that period in Galmi’s history.  As it is, I will have just acclimatized to 38 degree dry dusty days and I will be heading back to 6 degree wet rainy days.

If anyone was really worried, the lady that had the seizures and had to go to caesarean yesterday is Hepatitis C and HIV negative.  HIV testing is routine on admission for all patients to Galmi hospital.  The Hepatitis C testing is common but not universal.  I mentioned this in one of my previous posts, but between 2 and 12 percent of the blood donors could be hepatitis C positive.  The littlest of the premature infants that started life at 714 grams had some apneic (not breathing) spells last night.  That is not a particularly good sign.  Still, it’s amazing that he has got this far.  Statistically speaking, for whatever reason, premature girls are more likely to survive and do well than premature boys.  I am just going to leave that there, no speculation on my part.

Those pictures of me in the OR are courtesy of Susanne Baeuerle the OR trauma nurse from Switzerland  (She's the one on the left above - if it wasn't obvious).  She is actually originally from Germany but now lives in Davos.  It’s pretty hard to take a selfie when you’re working in a sterile field.  Especially when there aren’t any laparoscopes around.  She is just here short term as well and will be leaving a few days after me.  She has been to a number of other places in Africa, but has been to Galmi 3 times, and feels like she is starting to know people here better.  Anyways, photo credits to Susanne for some of yesterday’s pictures.

Psalm 29:11

May the Lord give strength to his people! May the Lord bless his people with peace.