22 March 2014

The Cost of a Check Up

Lately my mind has been occupied by the reality of the great cost of seemingly small decisions pertaining to life in these parts.  A patient who runs into a burning house in order to salvage her life savings.  Or the son who decided to hold his father upright while walking because he can't spare the extra money on a walker.  Or the grandmother who hasn't eaten for two days because her kiddo has a therapy appointment.

My Favorite F. came to see me on Wednesday.  She was supposed to come last week, but they didn't have enough money for the bushtaxi fare to get to the NGO clinic that would drive them the rest of the way to the hospital. 

When they arrived, Granny greeted me and immediately helped herself to a floor mat that was rolled up in the corner.  She spread the mat in the middle of the gym, laid down and fell asleep.  When she awoke about half an hour later, I asked if she was unwell and needed to see the doctor.

'I'm fine,' she said.  'Just hungry.'

19 March 2014

Desperate Measures

Over the weekend, another of my long-stay burn patients died.  When she was admitted six weeks ago, her sister informed me that she was 130 years old. 

I double checked a few times to makes sure this wasn't just another language error on my part.  Nope!  I had heard correctly, 130!  

I used my mad-skills in the art of chiniki (bartering for the best price possible with a vendor at the market) and eventually I got her down to 80.

The right side of her face was badly burned, but from the unaffected side, 80 was an estimate I could work with.

As I continued through the WHO international burn registry data form that we are piloting, I began to ask very specific questions about the cause of her burns . . . she had been burned in a house fire, but her story was incredibly unique.

11 March 2014

The Ears of Your Skin

Proprioception.

That's what we in the biz say when we're talking about your body's ability to know precisely where it is in space.  It's what allows you to close your eyes and touch your finger to your nose . . . or to clasp a necklace behind your head . . . and to walk on sand without spraining every joint in your body.

You see, throughout the human body, there are these little receptors . . . they gage pressure and position and then send nano fast messages to the necessary muscles which will manipulate the involved joints in order for the body to respond appropriately.

Yesterday, we had one of our frequent flyers come back to see us because he's got secondary issues as a result of an old heel fracture and bad ankle sprain.  Apart from some stiffness and weakness, his main problem was that he still hasn't regained his proprioceptive sense . . . but in order for him to buy into the exercises, he'd have to first understand why they were necessary . . . which meant I'd have to explain it to him . . . in . . . Hausa.

04 March 2014

With Grief and Trembling

Yesterday morning, just before lunch, a patient was sent to see me.  Under the 'diagnosis' section of my referral form the doctor had written 'intention tremors significantly impairing function, cause unknown.'

Immediately my thoughts went to the overhaul of tests and months of treatment this gentleman would have received if we lived anywhere other than here . . . even after three years of this, I had to take a minute a grieve the imbalance between what could be and what is.  


This man came to me as a last hope, it helps no one if I say 'Well, since you can't spend weeks in a highly specialized neuro unit of a rehab hospital, I can do nothing for you.  Sorry.'  No . . . I was going to have to do something.

08 February 2014

Niger in the News

Great photos of Niger . . . mostly Niamey, Agadez and Arlit.  Maybe next time Reuters will stop by Galmi . . . we do draw around a hundred 'tourists' a year!

http://in.reuters.com/article/2014/02/05/pictures-report-idINRTX1891X

29 January 2014

The Language of Grief

Yesterday, a bit unexpectedly, I found myself wandering through a neighborhood across the street from the hospital.  Normally this would be no big deal, but because this was an unplanned visit in the middle of my workday, I didn't have a head covering with me.

About an hour earlier I had received the news that a three-year-old patient of mine, little A., had died the day before while I was still in Niamey.  I knew I would need to go visit his family; I figured I'd wait until I could change out of my scrubs and put something on my head.

But, as I learned yesterday, when it comes to grief, in Galmi, it matters most that you've shown up.

27 January 2014

Once an OT, Always an OT

Becoming an OT has ruined me forever!

I can’t people watch without analyzing the person’s gait pattern, I can’t walk into a building without noticing its accessibility, and clearly I can’t take a commercial airline flight without doing an ADL toileting session!

RUINED!!  FOREVER!!

20 January 2014

An Apple a Day

The other day, my little pal, F., came back for a checkup [for the rest of her story, click here, here
and here].  I was able to complete the mask that would cover her entire face and forehead; as long as Granny keeps it pulled tight, we should be able to soften the scars that have already formed and prevent new ones over the areas of skin that have recently healed.

When we were all done, I treated her to a piece of candy and Granny to a shiny green apple.

'What on earth is it??' Granny asked as she twisted and turned the piece of fruit, inspecting it's skin.

'An apple,' I stated, using it's French name as I don't know what they are called in Hausa.

'A WHAT?!?!?' she asked.

31 December 2013

Lessons on Caring Until it Hurts

I like your Christ, I do not like your Christians.
Your Christians are so unlike your Christ.
                                         ~Mahatma Gandhi

Last week a man came to my gym looking for a new pair of metal forearm crutches.  I asked for his paperwork.  He didn't have anything . . . claimed he had been told by the security guard at the front of the hospital that all he had to do was come down to see the white lady who gives away crutches for free.  I told him he had to first pay for a hospital card then pay for the crutches.  He said he had no money.

Maybe it was because I had already paid for several other patients' care that week . . . or because I had just come from a meeting with the hospital's director discussing the charges that would be implemented on 1 January for all therapy services . . .  or because I don't think giving everything away for free is the solution for poverty in Niger . . . or because I didn't like this guys attitude thinking he could just rock up to our gym and demand that we give him things . . . or because he wasn't satisfied with the wooden crutches we have, he wanted metals ones.  Regardless, he was going to have to follow the rules, like everyone else.

So what's he got to do with Mahatma Gandhi's opinion on Jesus and His followers??

I'll get there.

But first I want to tell you a story about a woman I met today.

28 December 2013

A Year Already

Christmas was just the other day . . . and New Year's is on Wednesday . . . and somehow it just now hit me that 2013 is T-3 days OVER!  How did that happen??

It was this time last year I said goodbye (again) to my family and so many of 'my people' with whom I had spent six months reconnecting in the US.   I'll be honest, it wasn't easy getting on the plane . . . I had no idea what this year was going to bring . . . it had the brand new potential for such great things and also deep heartache.  Being back home had started to feel a little normal, but so did returning to Niger once I stepped foot on the ground. 

I can't believe it's been twelve months . . . it barely feels like twelve weeks!  Where did it go!

But so much has happened!  Our therapy department went from living in a walk-in-closet to being a proper gym!  I nearly died scaling a treacherous waterfall in the jungles of BurkinaFaso (okay, that may be a slight exaggeration . . . but it felt treacherous . . . and everywhere in the world is a jungle compared to Niger!).  I led an improve training session on burn splinting and positioning for doctors and nurses from across the African continent (they were so hungry to learn!!).  I survived a collision with an exploding donkey (thank God the truck's windows were closed!!  YUCK!) . . . and walked amongst giraffes and hunted elephants (simmer down PETA, I was shooting with my camera!).

And then there were these twelve moments:

25 December 2013

The View from Here: My Day as a Tourist in Galmi

Last Wednesday was a public holiday: National Day.  I think it has something to do with no longer being a French colony . . . but I'm really not sure and have been too busy converting photo formats and therapizing patients to bother googling it.

Since I tend to be more of a procrastinator-type personality . . . though I prefer works-best-under-pressure . . . I decided not to tick of the many things on my Don't-Have-A-Honey Do List and be a tourist for a day instead.

Seven of us non-Nigeriens trekked to the far reaches of our village and went to visit with the Clay Pot Maker, the Blacksmith, the Spoon Welder and the Baker.  It was fascinating and lots of fun.  We were followed by hoards of children who loved having their photos taken.  And by the end of the day, my camera was as exhausted as I was.

23 December 2013

April Fools!

The other day I went to the workshop to snag a set of keys for a hospital vehicle I was borrowing for a few hours.  The shop was technically closed, as it was a public holiday, but D. who manages our maintenance department was working anyway.  As I entered his office, I greeted D. and the Fancy Man sitting with him.

I knew this man a little . . . he sometimes contracts with the hospital's construction project, and he once brought his son to see me, hoping I could get him a prosthetic leg.  So, I've seen him around, but other than the standard greeting process, we've never really had a conversation.

Until then.

21 December 2013

I've Got Your [Naked] Back

I woke up this morning feeling confident about my Hausa . . . I've had a few surprising interactions this week when I understood what was being said and the Nigeriens I was talking to didn't turn to someone else for clarification!  It may seem small, but for me, successful communication attempt was a huge victory.  My Hausa still leaves a lot to be desired, but I can make a few jokes and I've gotten really good at pretending to understand what is happening around me.

I woke up this morning feeling confident about my Hausa . . . let's just say, I shouldn't have.

13 December 2013

Immanuel: God's Great Act of Vulnerability

I wrote this for SIMNiger's bimonthly newsletter.  Based on the feedback I got from my colleagues, I thought I'd share it here.  Only twelve days till Christmas . . . and regardless of cultural traditions, it is the day that we who follow Jesus have set aside to remember His birth.  He came into this world humbly, and that is how He lived.  We have a lot to learn from His example of humility, compassion, and, yes, even vulnerability:

It’s starting to feel like each term has it’s own theme.  As the first year of my second term draws to a close, it’s become obvious that this go around is all about vulnerability.  Many of us subconsciously define vulnerability and weakness as synonyms . . . but I continually face the reality that vulnerability is actually quiet strength.  

Living vulnerably requires courage and risk.  It is blessing at the risk of pain.  But God calls us not to a life of self-protection, rather of self-denial.  The Christian Life demands the Death of Self,  and if I am to live as a disciple of Jesus, I am called to follow His example of a life lived out in the quite strength of vulnerability.

10 December 2013

Babu Husband, Babu Car

'Déborie, was that your car I saw you driving earlier today?' Granny asked me.

'Uh-uh.  It is the car of the hospital.' I answered in broken Hausa.  'I with boxes big . . . there are muscles . . . but . . . boxes big BIG!!  I no walk with boxes.  I pick up and boxes go inside car.'

Granny's head nodded in understanding but the blank stare on her face betrayed her.  She didn't have a clue what I was talking about.

Maybe it's because I didn't actually know the Hausa word for 'box' but instead just pointed to one and said 'this thing'.

'Wait until B. gets back.  He'll explain whatever it is you're talking about!' Granny smiled, revealing her goro stained teeth.  'Déborie,' she started again.  'Why don't you have your own car?  Foreigners are rich, you should have a car!'

I paused, wondering if I had actually understood her correctly.  I played the words around in my head again . . . I was 87% sure that's what she had said.  So I answered her with the first thing to come to mind:

'Babu husband, babu car!'