Wednesday, May 16, 2012


May 16, 2012


We said goodbye to our heroes...the full time missionaries at Galmi Hospital, and took a small plane to Niamey. The city is crowded with slums. People trying to survive the day by selling anything they can from small carts on the side of the busy road. At a stop light, a boy about 10 years old washes our windshield and another even younger tries to sell boxes of Kleenex. Overloaded bicycles, motorcycles and goat carts fill the street. The goat on the lap of the motorcycle driver replaces his helmet...no helmets are visible in Niamey.
We flew to Paris and during my 6 hour layover I rested, ate and reflected. I wonder how many women in Niger have ever felt full, comfortable and safe?

I have been home for 10 days and carry thoughts of Galmi with me throughout the day and night. My answer to the question "how was it?" can only be...
humbling, inadequate, vulnerable, powerful, gruesome, intense, unimaginable, unbelievable
hot, scorched, dry, thirsty, dusty, smelly
God has given me a new sense of peace because I depended on him more in the last month than ever before in my 48 years of life. I am learning that true peace can only come from depending on God moment by moment.

As I process the last few weeks, questions keep filling my mind....
  • Why do we have everything and they have nothing?
  • If we could get funding, what would make the biggest impact at the hospital? (nursing school is just one of the answers...)
  • How can we begin to change the mentality of the nurses who think concretely, are understaffed and have gruesome working conditions?
  • How do we reach the pregnant women in the villages with education, nutrition and vitamins and help avoid the exceedingly high rates of maternal and infant death in Niger?
  • If those questions aren't overwhelming enough- what about the oppression and illiteracy of the women in Niger? Even the women treat each other harshly (except for the "grandmas" who are my favorite)



What can we do today?
Pray for the long term missionaries at Galmi Hospital, and the patients and staff.

The hospital  will gladly accept contributions. They have a benevolent fund which you can contribute to which pays for treatment for patients who can’t afford it. Also, the hospital is going through a big rebuilding phase, and so donations can be made towards the building of the new obstetrics ward, which hopefully will provide a cleaner, more private environment for women. . At this stage I think the biggest need is the building project, as there are regular contributors to the benevolent fund. You can contribute to either of these online at http://www.sim.org.au/online-giving/c/Projects/p/galmi-hospitalhttp://www.sim.org/index.php/project/97450http://www.sim.org/index.php/project/84400

You may have seen recently that Niger is the worst place to be a mother: http://www.smh.com.au/world/african-nation-ranked-worst-for-being-a-mother-20120508-1yb0c.html  so I know that any contribution you make will be greatly appreciated, as Galmi hospital works to improve the health care of women in Niger.


The sweet 15 year old who had a hysterectomy. She got choked up when I gave her the handknit blanket

Joy in the midst of suffering (her baby died)

Malnourished babies from birth


The midwife weighing a newborn

The woman with the herniated uterus on bedrest waiting to deliver until term
Patients waiting in 110 degree heat outside the hospital gate

The consent forms are all signed with a thumbprint because most of the women are illiterate

Henna decorated feet are common

Clinic sink

One of the long term missionaries helping a trauma victim

Thank you for all of your prayers and support.
With thanksgiving and gratitude,
Drea


Monday, May 7, 2012

Photos from Galmi....
Out patient "bathrooms"

She was one of the few toddlers who wasn't afraid of my white skin

In patient bathroom

OB ultrasound...dusty and old...but critical

Grandma, baby and mom in the bamboo room

Village girls

He really wanted his photo taken, but you wouldn't know by his expression!

Carrying food to a patient

Preparing for surgery- boots, apron, bar of soap and an old sink

The town well

Carrying water

The girls at the market

Kids carrying kids...all over

Learning how to grind maize (I don't think she thought I was doing a very good job!)

Grandma giving baby a bath on the postpartum ward

The Grandmas...always joyful despite the circumstances

The "pre op" hall

Reused vacuums...again and again

Village girls we visited (I showed them Sophie's picture too)

Sweet newborn...notice the meconium stained hair

Burn victim (from the open fire pits)

I gave her the hat and she loved it!

The "puzzle"

Woman in labor. They were on a yellow plastic tarp once their water broke (it's over 100 degrees in the room)

Newborn being weighed by the midwife

Thursday, May 3, 2012


May 3, 2012 10:30 pm
We started the day with a stressed second twin that had just delivered. He was not breathing on his own, but had a good heart rate. We breathed for him the manual way for about 30 minutes. Each of us was praying on our own, and then one of the head physicians here led us to pray as a group as we all laid hands on the baby. Within 5 minutes he was breathing on his own! We were very thankful and knew it wasn't anything that we did with our limited resources here. He has continued to breathe on his own, but developed a high fever and has never really “woken up” which is very concerning. He would be in the NICU at home....there isn't one here...not even close.
The electricity went out for 10 minutes in the middle of a repair of another ruptured uterus. Thankfully she wasn't bleeding because we could not see a thing and just stood there and held pressure until the lights came back on. Later in the day the same thing happened during a D and C. The anesthetist opened his cell phone and held the dim light near the patient so we could finish her surgery.
We went to the CREN today to distribute many of the baby and toddler clothes that were donated. The CREN or Center for Education and Nutrition is a place behind the hospital where mothers and their malnourished children live for a period of time. The children are rehabilitated nutritionally, and the mother's are educated about how to make full proteins and keep their family healthy. The children were so precious. It was uplifting to see their smiles and healing bodies. One of the older sisters was there visiting. She looked about 10 so I gave her a little puzzle as a gift. She had no idea what it was, nor did the 20 mothers observing. They fingered the pieces and looked at me confused! I knelt in the dirt and put the puzzle on an old piece of wood and showed them all how to put it together. There were lots of “ahhhs and ooohs” spoken as some of them began to understand. I also gave her some crayons which she had never seen. She looked at me again as did the other mothers and I quickly whipped some paper out of my fanny pack and they began coloring. It amazed me that the things we learn in preschool are so foreign to even the adults here.
We took the newborn onsies to OB and gave them to each of the mothers. The heart wrenching part about that was all the mothers who gave birth to dead babies were also there. I would have given them a pen (which I was giving to the staff), but they don't use pens and most don't have paper or know how to write.
Most people don't know their age here. They have no official birthday. I think of what a big deal I like to make of birthdays at home- to celebrate one another and to make them feel loved. Life here is so different. I doubt the majority of people here have ever felt special, singled out or really celebrated. They live life in survival mode day.... after day....after day.... in the dust and scorching heat.
Psalm 63 says “O God, you are my God, earnestly I seek you; my soul thirsts for you, my body longs for you in a dry and weary land where there is no water.”
It is one of my favorite chapters in the Bible, but the dry and weary land where there is no water really doesn't fit in Portland! I think David was in Niger when he wrote this!


The other verse that has been on my heart a lot her is James 1:27: “ Religion that god our Father accepts as pure and faultless is this: to look after orphans and widows in their distress and to keep oneself from being polluted by the world.”


I leave in the morning and travel about 45 hours home which gives me lots of time to process and pray. I am humbled by it all....the life and death decisions that I question I made here....the millions who struggle to survive daily....the missionaries who dedicate their lives to service and true sacrifice...

Thank you for your prayers and encouragement. Please continue to pray for Galmi hospital, the missionaries serving here and the people of Niger.
With Gratitude,
Drea

Wednesday, May 2, 2012

May 2, 2012  9:45 pm

We started the morning with a c-section for a woman who had labored for 4 days. I have never been more thankful for every cry I hear as a new life emerges. The little boy was covered with old sticky meconium and still had a robust cry. Our next patient wasn't as fortunate. Her baby had died before coming to the hospital, and I initially thought her uterus had not ruptured because she was only 7 months along and it would be extremely rare. This morning her abdomen was more tender and we were more suspicious of a rupture. Indeed, she had ruptured through the top of her uterus, and the reason became clear when we realized she had a uterine anomaly. She had a unicornuate uterus, which means she had a half sized uterus and was missing a tube and ovary, as well as her right kidney. After we finished reparing the uterus I noticed a cyst on her only ovary and it turned out to be a dermoid with black curly hair and teeth inside (sorry for you squeemish folks, but to me it was interesting).
This afternoon in clinic a beautiful young woman came in for what I thought was just an ultrasound to determine her due date. Her swollen belly was obvious under her long pink head covering. She was accompanied by her mother and 1 year old daughter. Just as I was motioning her towards the ultrasound, she took off her head covering and revealed a cantelope sized tumor on her left shoulder. I had the general surgeon take a look at it, and he felt it was an osteosarcoma. He said as soon as the baby delivered (in 6 weeks) he would need to amputate her arm and even then she would probably not survive. I know she saw my wet eyes as he was explaining this to her in Hausa. It broke my heart looking at her daughter knowing she would not grow up with her mommy. After we prayed for her, OB called and urged me to come. As I was walking briskly down the hot, gruesome smelling hallway I whispered a prayer that I would arrive to see a live baby. Instead I saw a dead baby with the body delivered and the head entrapped. Hal and I experienced this our first night and I chose not to write about it, but it is too common here and extremely disturbing. The reason this baby had died was very clear on ultrasound. Her head was as big as a soccer ball and completely filled with fluid. After I delivered the baby I told the patient (via the interpreter) that the baby would not have lived and it wasn't her fault that she died. I could see the relief on her face. I wonder how many women here think they are guilty for their baby dying (when really they are the victim in many ways).
People don't throw anything away here. I was instructed by the director of the hospital to feel free to throw away the old oxygen masks, vacuums, amnihooks and bulb suctions as I  (almost secretly) replaced them with new items we had brought from the states. We finally have an oxygen mask that will fit the baby.
People also don't waist a bite of food. Remember the saying your mother told you about cleaning your plate because of the starving children in India....well it's true for Niger. Everything that possibly could get eaten, is eaten. It amplifies the amount of food waist I see just in my own house, let alone the city of Portland and our country. I felt guilty putting some old cooked rice in the compost here because I thought it would be seen.
My morning devotion from Jesus Calling really hit home as I prepared to dive in for my last 48 hours here....
"Living in dependence on me is the way to enjoy abundant life. You are learning to appreciate tough times, because they amplify your awareness of my presence. Tasks you used to dread are becoming rich opportunities to enjoy my closeness. When you feel tired, you remember that I am your strength; you take pleasure on leaning on me."
Everyday I remind myself that everything is possible with God....I just need to get out of the way and let him lead me through it all.
I am grateful for the opportunity to serve here and I pray you all hear God's calling to serve from your backyard, to your city or half way around the world. It doesn't matter where you are, if your heart is willing, God will work. 

Tuesday, May 1, 2012

Galmi Hospital Post-partum ( and sometimes intrapartum) ward...


( I am unable to upload more photos after 2 hours of trying, but I thought this one photo would say 1000 words)






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....