April 26, 2012   9:30 pm

                                                In front of Galmi Hospital

As I sat down to write this post, I realized that there were comments from my other posts. Thank you all for your support, prayers and encouragement. It means so much to all of us here. The power just went out, and it gets hot quick without a fan! The humidity was up to 40% today but it felt 5 degrees hotter! The patients lie on beds without sheets, just the cracked mattress and the clothes on their backs. No pillows ( it makes me embarrassed because I used to feel like I could only get a good night's sleep with 4 pillows...). The patient's mother or care giver spends her day and night on a mat on the floor by the bed and stays up a lot of the night holding the baby. These women wear their lives on their faces. Wrinkles, tribal scars, and missing teeth, yet I have determined they are the most joy filled group of people in the hospital. Maybe they have experienced so much suffering that they REALLY know the joy of Jesus. They inspire me.
The women here are so oppressed. As children, they are fed last and treated much worse than their brothers. Most are forced to marry at an unimaginably young age. They are uneducated, and unable to read, and the next thing they know they are pregnant. They may not realize it until months into the pregnancy, and when labor hits they have no idea what to expect. Their bodies may be too immature to give birth, and their labors are life threatening. Many women with obstructed labors end up with a fistula or connection between their uterus and bladder. They drip urine all day long. They smell terribly, and are quickly outcast from their society. There are probably over 100,000 women with fistulas just in Niger. About 4 hours away, there is a leprosy hospital, and they just added on a fistula hospital. There is a surgeon ready to operate, but sadly there is no anesthesiologist. If any of you know one, please encourage them to serve! The patients and staff are waiting.
We had another patient die today. I am sick about it. We did everything we could. She probably died of sepsis. Her baby had died before delivery because her uterus had ruptured. As I close my eyes, I visualize her holding her baby in heaven. No more sickness.... no more pain... no more tears...

Yesterday we were in clinic and God must have prompted us to go over to "OB". We arrived to find a laboring woman with a stressed baby (because we listened- the nurses listen every 1-2 hours in labor). She was complete, so we quickly delivered the baby by vacuum, and reduced the tight cord around his neck. I loved hearing the cry! Right next to her a woman was laboring and I was asked to check her for malpresentation. I ultrasounded just over her pubic bone and thought the arm was in front of the head. I checked her and she was complete with an elbow or leg presenting. We quickly got her to c-section and I reached in and delivered a healthy breech baby boy. While I was cutting his cord, MC (the wonderful family practice fellow here) said, "hey there's another baby!". Sure enough his little sister entered the world, and praise God they were both healthy! I don't want to think about what would have happened if we had not just wandered over to OB at that time.
Just after returning to clinic I saw a patient who had lost both of her children at age 2, and was about 37 weeks pregnant. I was so excited to show her her live baby on ultrasound until she said as she was laying down on the table that she was bleeding. I hesitated before placing the ultrasound on her, because I knew what was coming. I wish I hadn't been right. Her baby didn't have a heartbeat. We prayed with her and sent her to OB to start her induction. She delivered in the middle of the night.
I also admitted a 15 year old who had a pelvic mass and no period ever. She had pain about once a month and I thought she may have an imperforate (or blocked) hymen, but I was unable to examine her in clinic because she was developmentally delayed and I didn't want to traumatize her. We took her to surgery today, and were surprised to find normal vaginal and cervical anatomy. We needed to open her abdomen to remove the mass, and I have never seen anything quite like it. The grapefruit sized mass was taking up her left pelvis and sacrum and after a lot of dissection we identified kind of a uterus, but no ovaries. The mass had engulfed her uterus and we were forced to remove it. I know it was the right thing, but I feel sad for her. I kept thinking of Sophie. If she were having major surgery like this girl, she would be in a top notch hospital with balloons and flowers and tons of people praying. She would have access to counseling and medication to help her through it. She would fully understand....but not this girl. Please pray for her.

During rounds this morning, a nurse came up to me and told me the hysterectomy was ready. I knew nothing about it. She had been scheduled over a month ago because of a mass. There was no ultrasound, or CT. I thought...well I guess the surgery is her CT. She was 50, and the mass was easily palpable in her thin abdomen. It turned out to be a softball sized totally necrotic fibroid. I don't think it was malignant, but there is limited pathology here, and it's too expensive and far away for the patient. I returned to clinic only to diagnose dead twins, about 5 months into pregnancy. It was the first time I saw a woman cry when she learned about her babies. She is on OB now being induced. I am on call and I pray she delivers uneventfully.

Yesterday we went to the market. It's once a week, and just as you would expect...Costco in Galmi! It was stuffed with people, spices, meat, soap, homemade cigarettes, piles of junk, material, flip flops, bowls...you name it. Most people have a few missing teeth in the front so that if they get tetanus (lock jaw), they have a way to get food into their mouth. The girls were all dressed up with black lip liner and carried big loads on their heads. All that, in the dust and 110 degree heat was a bit overwhelming!

My prayer for our patients here and for all of you comes from 2 Corinthians 6:12-
" Therefore we do not lose heart. Though outwardly we are waisting away, yet inwardly we are being renewed day by day. For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all. So we fix our eyes not on what is seen, but on what is unseen. For what is seen is temporary, but what is unseen is real."