We witnessed a miracle today! I woman delivered one of her twins in her village 2 days ago and came to the hospital with the other one still inside of her. I did not want to put the ultrasound on her, but when I did the other twin had a healthy heartbeat! We brought her to surgery, and delivered a healthy little boy. We all were teary (including the mom) when he cried! I am not sure how the woman got to the hospital, but many times it is by donkey or donkey cart to the road, then motorcycle or an overstuffed taxi. It may take a day or two. It is amazing that she and her baby didn't loose much blood, and she didn't have signs of infection. Praise God!

The community here is incredible. The men, women and children that dedicate their lives to full time mission work are inspiring. They cook amazing meals with limited access and supply. They are real with their emotions, but always have a sense of God's peace and provision. They live out the meaning of sacrifice, and exude a palpable joy even in the midst of pain, suffering, heat, dust, and tragedy. Please pray for the missionaries of Galmi hospital. They are truly the hands and feet of Christ here.
The hospital administrator that also doubles as a lab technician interpreted for me today as I told the 15 year old girl and her grandmother that she would be unable to have babies. I explained that most likely even without the surgery she would not have gotten pregnant, and now without her uterus ( which was engulfed by the tumor), she certainly would not have babies. The administrator explained to them the need to be honest with any man pursuing marriage. In his words...men marry here to have children. If she failed to tell him and then failed to get pregnant, he might beat her and would almost for sure take another wife. I pray she knows her identity in Christ, and that others see that in her. She has a beautiful smile.
There is never a day without death here, and never a day without joy. The people here are so grateful, and kind. I am humbled by their responses to bad news, pain, and suffering. Most are just trying to make it through the day. I remember Hal saying that people here think that we must have a hard time being a Christian in America with all the distractions, noise and busyness in our lives. I think they are right. When you  have nothing, you really understand your need for God.

I am trying to focus on trust because that decreases worry, and gratitude because that decreases self pity. Our pastor once said "your faith will be revealed by how you respond to everyday events".....
With a thankful heart,
Drea

The 3 1/2 pound baby girl I delivered yesterday died in the middle of the night. We did everything we could with these limited resources, but she needed more oxygen. It would never happen in the states. I feel so helpless.
At 4am I was called to see a pregnant woman with cerebral malaria. She was lying on the stretcher with a older woman on either side of her. She was non responsive in a coma like state, but intermittently she would wail. I hesitantly placed the ultrasound on her belly to check the baby and the heart rate was in the 60s. I felt totally overwhelmed with the ethics of the decision. I prayed and cried. If I did a c-section the baby would probably still die, and we would also put the mother's life at even more risk. I pleaded with Jesus to make the decision, and not me. With tears rolling down my face,  I decided against the c-section. We treated the mother with the hospital protocol for cerebral malaria. The mortality is about 20% and even higher in pregnant women. I prayed under the stars on the way back to my apartment and couldn't sleep the rest of the night. I researched cerebral malaria, and there was nothing more we could do...no ventilators, telemetry, or ICU. Her baby died an hour later, and she died shortly thereafter.
This morning as I was journaling about her, the song "Blessings" was playing...."what if the storms in this life are just your blessings in disguise.....what if 1000 sleepless nights is what it takes to know you're near."
The Galmi emotional roller coaster took an upward turn today. I had a day off, and 5 of us went on a 3 hour camel ride. We rode out to a village and were greeted by the chief. He invited us into his hut, and all the children in the village gathered around. They were especially interested in the 3 year old boy who was with us. The chief left for a few minutes and returned in his full turban and robe and wanted his picture taken! The village felt very peaceful. This has been a very dry year, and they are worried about starvation hitting even more in a few months. It was heart wrenching looking at the children knowing they might be even hungrier soon. Tomorrow a few people are going to bring a picture of the chief back to him and some food for the children. I just wanted to scoop them all up.

Hal Vick and I with our new friends!

Sweet village children

The village chief

 

In the midst of all of this, God is closer than ever. When I arrived, the verse on my table was the same verse I claimed my first mission trip almost 7 years ago....
"I have set the Lord always before me; because he is at my right hand, I will not be shaken."
Blessings and Peace,
Drea

April 27, 2012    9:15pm

Last night about 1am the nurse called me and said the c-section is ready. I had no idea who it was, but it was no time for conversation with my limited French and my brain half asleep. I walked up to the hospital which is about 100 yards from my apartment in the gated compound. The big dipper was out and it reminded yet again of how big God is! I arrived on OB and the nurses pointed me to surgery. The operating room is found by weaving my way through dark dingy smelly hallway, often lined with people in stretchers. The patient was on the table, and the anesthetist told me she was OP (posterior or baby was "face up")...that was the history! I examined her and sure enough she was 9cm and OP and still quite high. This was her 8th child, but she only had 4 living children at home (an all too common tragic scenario in Niger). Her husband had consented to a tubal ligation, which is required for it to be done unless she has had 8 babies or 2 prior c-sections. The surgery went well, and she delivered a healthy baby boy!
During the surgery, the nurse came in the room and said in her limited English, that another patient was there who had a history of 2 prior stillbirths. I quickly made my way back to OB after the c-section and examined the patient. She was about 9cm and with my doppler I could hear a healthy fetal heart beat. The nurses only listen every 2 hours, and the midwives do all the vaginal births, but I hovered.....
I was nervous enough that when she was almost complete I asked her to push (via the nurse in French to the patient in Hausa). The patient refused. I listened again to the baby and the heart beat was closer to 100. I asked for a vacuum and the grabbed a used one off the counter. I didn't care at the time, this baby had to get delivered. The midwives and nurses were standing about 20 feet away and it was just me and this poor woman, on a dirty cracked mattress, naked and scared. Finally I convinced the nurses to help the patient push. I was praying constantly and my heart was racing. After about 5 contractions she delivered and the baby was limp. I quickly cut the cord and put the baby in the warmer behind me. I couldn't feel her heartbeat at the umbilical cord. The nurse started giving the baby oxygen while I held the mask with one hand and gave the baby chest compressions with the other hand with the baby's head against my rib cage. Oh how I missed the awesome baby nurses from Meridian Park! It seemed like eternity, but the baby started to come around and finally cried after about 10 minutes. When I brought her over to her mother, she gave me a big smile! The 2 grandmas were there and watching the whole time. They too gave a tooth-lacking grin at the sound of the baby's cry. One of them was so happy, she undid her skirt and showed me her basketball shorts underneath! I couldn't believe it! Then she started dancing and singing, so I joined her! From one emotion to the other extreme...that is life here in Galmi.

Her first live baby!

Rejoicing with Grandma!

We were in clinic a few hours later (it was a short night), and a woman came in with a low placenta, but no previa and no bleeding. She was about 34 weeks so we gave her precautions and instructions and told her to come back in a week. Her friend came back about 30 minutes later and said she was bleeding a lot. We raced out to the out patient bathrooms which are a row of tin, roofless, filthy pit toilets, to find her standing in a pool of blood. Thankfully our wonderful interpreter ran for a wheelchair and we got her to surgery quickly. One thing that is great here is the efficiency of getting a surgery going. The reason it is great is because there are no check lists, and the charting is limited (which isn't always in the patient's favor). The baby gave us a good cry at delivery during the c-section, but weighed only 3 1/2 pounds. After the c-section I went straight back to OB only to find what I had expected. The nurses idea of resuscitation is to put the baby still on the wet rag (not blanket) on the warmer, with the warmer OFF and a huge oxygen mask on that covers the whole face...and then they leave the baby ALONE and chit chat in their office around the corner. Most of you know I am fairly calm, but this TOTALLY PUSHES MY BUTTONS. There are so many unavoidable deaths. If they would only do basic resuscitation and stay with the baby the first hour, it would make such a difference. Thankfully, the baby was still alive, but limp. I tried to stress with the nurses what she needed, and I stayed with the baby the next hour to be sure she transitioned. The pediatrician (who leaves next week) came and saw her, and was able to place a small feeding tube into the stomach because she wouldn't nurse and was so small. I pray she makes it. In the states she would be totally fine.
Just before coming back here a woman came in with no fetal movement. She has had 8 children, but only 3 are still living. The ultrasound confirmed the baby had died. Her expression was flat and her eyes void of tears. The nurses are so used to this, they didn't even seem phased...

"Jesus wept, and in his weeping he joined himself forever to those who mourn. He stands now throughout all time, this Jesus weeping with his arms about the weeping ones:
'Blessed are those who mourn, for they shall be comforted.'
He stands with the mourners, for His name is God-with-us.
Jesus wept."
Ann B. Weems

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."

April 25, 2012  9:30 pm

A few stats on Niger...

• The population is 14 million ( in Nigeria it is 140 million), and most of the people live in small villages
• Niger is in the top 3 countries world wide in infant and maternal mortality
• There is one doctor for every 30,000 people
• The literacy rate is 16%, and 90+% of that is men

The Hospital...

• The smell is like hot formaldehyde mixed with every old rotten bodily fluid
• The equipment is either non existent, broken, out-dated, or in a back room "somewhere"
• The sinks are rusty, and the surgical scrub sink in equipped with a bar of soap, and one very old scrub brush, and the faucet has to be turned off by hand
• The patients line the hallways in stretchers, wait patiently on the floor, lie in a hospital bed in a room with 25 other beds and 25 other family members caring for the patients
• The clinic attached to the hospital is overflowing all day
• Despite the heat, the smell, and the suffering, most patients and family members offer a friendly "sannu" (hello) with a fist raised (instead of waving the hand)....

Other observations...

• The hospital is "out of ibuprofen"
• There is no local anesthesia used with spinals
• There is no rhogam (if a mother is Rh negative)
• There are no fetal monitors, no non-stress tests, only a few dopplers and fetascopes
• There are 2 ultrasound machines which are GOLD around here- I cannot imagine trying to make a diagnosis without one, especially because so many other avenues are not available
• There is a limited lab that runs slow and often machines are broken, or lab orders forgotten
• There are no "codes", no code cart, no epinephrine, no ventilators...people just die (often of preventable causes)
• Power outages are common- at least hourly, even in surgery. We just put pressure on the incision and wait patiently
• Neonatal recessutaion is almost non- existent. There is no fetal pulse ox or meconium aspirator. The wet towel stays under the baby. There is no way to place an umbilical line in a newborn and placing an IV only happens if a certain nurse is around (and she wasn't last night).
• There are no patient or baby ID bands...JACHO would have a stroke assessing this place!
• There are no diapers in the hospital or on any baby I have seen in town.

Today I tried to picture Jesus on the floor with the patients, in the dirty corner of the clinic, and in the operating room. His peace is here, and often reconized by the patients first. May you all feel it where ever you are, and whatever you are doing...his is with us, and he is bigger than all of this.
With gratitude,
Drea

April 24 , 2012 3pm

The internet isn't working which is common, so I am writing this to post at a future time. In my first few days here, I have seen more than in 18 years of practice, and 4 years of residency. Yesterday morning's rounds felt surreal, and not in a comforting kind of way. We had over 35 patients on the postpartum ward, all in the same room with grandmothers in mats on the floor next to each patient bed. The over flow patients are in the “bamboo room” where they sleep on mats on the concrete floor and it is often over 100 degrees just in that room. Of the 35 patients, almost half had delivered a dead baby either at the hospital or at home. We would know that only because there was no baby with them, yet they are surrounded by other mothers holding their babies. Most women here have had at least half of their babies die if not at birth, then within the first year of life. Five women had ruptured their uterus in labor ( I have only seen this once), and all of those babies had died. Three women had ecclampic seizures, and 2 women had severe blood pressure issues but were too early to deliver. We are hoping to keep them pregnant so their babies have some chance of survival and that means 36+ weeks around here.

It is not unusual to see a woman with a hematocrit <10....for you medical people, yes, I did write “hematocrit”. We have women with hematocrits of 4, 6 and 8 on the ward currently. For those non medical people, hematocrit is our blood count and “anemia” is defined as <35. In the US we transfuse for sure at 20, and I have never seen anyone walk with a hematocrit of <15. Malaria is the most frequent reason.

All of this felt overwhelming also because Hal had called me to help him in the middle of the night with a horrific scene. A woman had arrived at the hospital with a dead baby hanging out of her and the head was stuck inside. I honestly couldn't believe it. The baby was full term, and a little girl. We were finally able to get her out, and I was unable to get the picture of that baby out of my mind, so I barely slept. I do believe she is in the arms of Jesus, which is the only way to find hope in this suffering.

After rounds I started a hysterectomy on the only slightly obese patient I have seen. Most are extremely thin. She had a fibroid uterus and 2 huge >10cm ovaries. Both were stuck with adhesions and difficult to extract. I was thankful to have Hal there to help! After the surgery, I opened both cysts and one was an obvious dermoid (look this up on the internet to get grossed out if you don't know what it is), and the other looked malignant on the inside. There were no other signs of malignancy, so I hope and pray she does okay. There certainly isn't estrogen here to give this newly menopausal woman. The 110 degree weather won't help her hot flashes either.

Just when we thought things were calm (first mistake), we were called to see a patient with severe abdominal pain. By ultrasound she was 12 weeks pregnant, and the baby seemed to be in the abdominal cavity. Sure enough, we opened her and found over 2 liters of blood and a ruptured cornual pregnancy (the corner of the uterus had blown apart because the pregnancy got too big for the “corner” of the uterus). In the middle of the surgery, someone came in and told us she was BD+ (HIV or bad disease positive). We asked permission from her husband to tie her tubes, which I quickly accomplished. Another pregnancy could have resulted in her death ( because of the risk of recurrent uterine rupture) and the death of her baby (from HIV).

The part of the day that shook me the most was 3 of our patients died. One who had malaria and had arrived last week with a ruptured uterus and dead baby, one who got a severe infection from a 20 week intrauterine fetal demise, and one we never met but was scheduled for a D and C. This morning when I woke up, I said a prayer for the families and children these women left behind. It's easy to feel defeated when death is so common here.

This morning I was able to hand a woman her live baby boy. She had a scheduled c-section because she had three babies die at term. I will not forget the look on her face when she heard her baby cry!

The verse in my devotion this morning reminded me how big God is...

Psalm 47:10 says “Be still and know that I am God; I will be exalted among the nations, I will be exalted in the earth”.

We all feel your prayers, and are grateful.

Drea

I have seen more severe medical conditions here in 2 days than I have ever seen. Eclampsia is a severe form of "toxemia" or pregnancy induced hypertension because the woman has siezures. I have NEVER seen it, and so far 2 women in 2 days have had eclampsia. The treatment is IV magnesium, valium and delivery. Thankfully the babies survived. Not so with our first c-section this morning. A woman came in with pain and bleeding for 5 days, and the ultrasound sadly revealed a dead baby. Hal was concerned about uterine rupture, and he was right. When we did the c-section the baby was outside the uterus, and the uterus had ruptured. The placenta was also outside the uterus. The woman has 5 living children, this was her 9th pregnancy, and she wanted her tubes tied. It was the safest choice because if she labored again she could easily die before making it to the hospital. After the surgery we told the "grandmas" who were with her (she was alone initially) that the baby had died. They still smiled because they were so thankful that their daughter survived.
Another woman arrived shortly thereafter with a 35 week pregnancy, live baby, and a huge abdominal wall hernia. Hal described it well....it looked like a gallon paint can trying to balance on her stomach. She had typhoid fever a year ago and a ruptured bowel (which is common) resulting in a huge surgery that had herniated from the weight of this pregnancy. We are hoping to keep her pregnant a while longer so the baby has a better chance of survival. For you medical people we were pretty sure that just under her crusted peeling flat umbilicus was dry peritoneum! She is on antibiotics and IV fluids for now.
Everyone here, men, women, children and babies are severly sick. They often try "home remedies" which can be dangerous before traveling to Galmi hospital. We have a separate room for tetnus patients, and isolation rooms for TB patients. HIV here is abbreviated "BD"...take a moment to guess what that means.....bad disease.
All of this puts life in such a different perspective. I didn't complain or even feel like complaining when my "air cooler" stopped working in the 109 degree heat today, but I am thankful it is back on because it really helps for sleep.
We had church on the compound today, and it was awesome to worship with the missionaries here. They are amazing people who are here through it all and have a wonderful sense of God's joy and peace that is contagious.
May you all feel his peace as you journey through your day.
Drea

April 21st 9:30pm
We arrived safely in Galmi today after spending the night at a SIM guest house in Niamey, Niger. We were treated to a wonderful Indian meal by our mission host Dr. Christopher Zoolkoski. The flight from Paris only lands in Niamey every other day, and we were the only ones there. Thankfully customs was a breeze (thank you for your prayers). The only issue was one of the customs officers thought our dermabond (surgical super glue) was antibiotic ointment and he wanted some for his foot! Niamey was hot, dusty and busy. Small shack like shops cluttered the sides of the streets along with goats and dogs. Most women were wearing full head coverings and many had large loads balanced on their head and a baby on their back. They all dress in wonderful bright fabrics which cover the mid arm almost to the ankle (showing more of the body is considered seductive and improper).

We took a small plane with SIM pilot Ed from Calgary Cananda. He has flown as a missionary pilot for 15 years, and has been flying a total of 30 years. Needless to say, the flight felt very safe from the copilots seat. The views on the 90 minute flight to Galmi were composed of small villages surrounded by desolate land, few small trees and muddy dry rivers. I cannot understand how the people survive, especially during the "dry season".

We were greeted with a warm Galmi reception off the landing strip in 105 degree weather. The hospital compound is gated and in addition to the hospital has many small apartments, a community center/church/library, a small store, and a small pool. They opened the store which is usually open twice a week so Hal and I could buy supplies such as powdered milk, rice, canned beans, butter and oatmeal.

After a hosted lunch (which was delicious especially considering the limited supplies here!), we toured the hospital. I guess one is really never "ready" to see such suffering, poverty, and desparation. It was dark and crowded. I wanted to speak to the people, but need to learn Hausa first, and improve my French to communicate with the nurses. We arrived just after a woman had undergone a c-section. She was lying on a stretcher in the hallway, with only her incision covered, and the baby was in a completely different room unattended on a warmer with an adult sized oxygen mask on. The only other person in the room was another woman in labor who was all alone. I kept going back to check on the baby and felt reassured when he was vigorous enough to pull off the oxygen mask! There was another patient, only 6 months pregnant who was brought in seizing last night, and another with a 20 week intrauterine demise.

My devotion a few days ago (from Jesus Calling ) said: "When you are shaken out of your comfortable routines, grip My hand tightly and look for growth opportunities"...and that is what I hope to do.

Thank you for all of your love and support!
Drea

Niger Africa April 19-May 5, 2012

Dear Friends and Family,
I am leaving for Niger in a few days and hope to update you with this blog. I will be serving at Galmi Hospital  (www.galmi.org ) with Dr. Vick and the full time missionaries who have dedicated years to the people of Niger. We are going under the umbrella of Medical Teams International ( www.medicalteams.org ). Thank you in advance for your support and prayers.
To God be the Glory,
Drea