The patients keep coming. This morning we had 5 critically ill patients, 4 caregivers, 3 nurses and 4 doctors in “the” labor room which is a room half the size of one of our labor rooms that we use for just one patient at Meridian park. Two patients were on the floor and two were sharing a bed. Four grandmas squatted together and watched the scene. There is one old blood pressure cuff, one oxygen compressor, 2 very used old cracked oxygen masks, and the IV fluid is hung in glass bottles from the ceiling. There are no monitors of any kind for mother or baby. There are 2 fans that sometimes work, and still it is over 100 degrees in the room. Instruments are used over and over again until they break. They are soaked, but don't appear very clean. It's hard to imagine something is even close to sterile when there are dead flies in the fluid. In the middle of the baking chaos, a nurse ran a depressed baby through the maze of patients and stretchers to the warmer. The only oxygen tube was hooked to a very sick mother, but we had to unhook it and use it for the baby. We worked together to hook up the oxygen and stimulate the baby. I rejoice with each newborn cry at Galmi! The nurses and midwives here have seen it all. They don't get phased, which I am not sure is so good. They diagnose well from experience and treat with what they have. They don't panic, and they don't run, but they do yell in Hausa at each other and the patients, and I have no idea what they are saying. Hal said it well this morning when he called it an obstetrical tsunami. It is overwhelming....

There is rarely a night or day that goes by when we are not called for a woman with a ruptured uterus. The baby is never alive, and the mother is unstable. Women labor for days in their remote village. Often tribal medicine is used which puts the mother and baby's life at greater risk. A prior c-section is not always the cause. We need to tie the woman's tubes because her risk of death from another pregnancy is so great. The majority of women don't understand the reasoning for the tubal ligation, nor their near brush with death.

This morning we were called for a woman in respiratory distress. We think she has cardiomyopathy which is an enlarged malfunctioning heart. It is common in Niger, and the cause is thought to be prolactin. None of it makes physiologic sense to me. The woman was laboring to breathe and 25 weeks pregnant. We gave her a huge dose of a diuretic (per Galmi protocol), and within 10 minutes she was breathing better! She may also have a severe form of Malaria that causes fluid to build up in her lungs. Please pray for her healing. In the states she would be in the ICU with at least 5 consultants and 10 monitors.

I walked down a different medicine ward yesterday and saw a woman wailing. Her severely malnourished child had just died. The family closed his eyes and placed his hands peacefully on his chest. I wanted to extend my sorrow to the family, but I could only do so with expression and not with words. Ten minutes later, I walked back through, and his little body had been wrapped in a mat for the family to carry home.

Today one of the missionaries took us into the local village. We visited a tailor who will make me a Nigerian skirt. He and his family were sitting outside of their 6 foot hut and I commented on his pregnant wife's condition. They started smiling and chuckling and she hid behind the door. I learned the custom is to never talk about the pregnancy in public!

We continued our journey and visited Habeeba. She lives in a 6 foot hut and has another small hut with an open fire pit she uses for cooking. A few chickens scurried around and a goat bleated a welcome. She is friends with our missionary because her daughter married a man the missionary informally adopted. When he was 14 both of his parents died of cholera within a week. His only sister died a year later. His brother is a thief and in and out of jail (I can't imagine what prison is like here). The missionary met him about the time his parents died and gave him a loan to buy some chickens and start a business. 15 year later, the chicken business is still going well and he is grateful. Habeeba's 2 other daughters were peeking at us from the doorway. I learned they were 12 and 14, and I shared with them that I have a daughter the same age. I took their picture and then showed them a picture of Sophie which they loved! Habeeba gave us some corn maze pancakes and wouldn't let us pay her. We brought them back here to enjoy and then filled her pot with food for the missionary to bring back.

Today is a public holiday, “Worker's Day”. It is like our labor day, but a bigger deal. As I write this the hospital employees are dressing in matching outfits, goats are roasting over the fire, and preparations are being made for the big soccer game on the compound. It is a privilege to get to be a part of the local celebration.

Thank you for all of your prayers, support, comments and encouragement.

A wonderful friend gave me a devotion a day to read while I am here, and this comes from today's devotion....

“Pain and sorrow are never wasted when given into God's hands, and their transformation is far beyond our imaginings. The deepest comfort in our mourning is to know that God not only has compassion but actually feels our suffering with us.” Flora Sloson Wuellner

I will post more pictures when the internet is working more efficiently....