Reflections from home

Liz and I left Galmi three weeks ago today and there hasn’t been an hour that has gone by that I haven’t thought about my experience there.  I am going to apologize in advance for the length of this post but since I anticipate that it will be the last I had lots to share.

I can't tell you how wonderful it feels to be home. To sleep in my own bed sans earwigs and mosquito netting or to take a hot shower or to drink water from the tap. The experience was incredible but truth be told the conditions in Galmi take someone of more emotional strength than I have and I have nothing but admiration for those who have committed themselves to the hospital for the long haul. They are doing admirable work under the most challenging of conditions.  Before we left YenMei asked Liz and I what would be the first thing we did when we got home and what we would have for our first dinner back?  Knowing Liz’s husband Arnie as we do Liz just politely just giggled.   As for me, I was already dreaming of the supermarket and knew I would hop in the car and head to nearest produce section.  I was not disappointed....the color, the variety.....it was like heaven.  Since Matthew’s coming out rainbows have never be the same for me but never have I been so happy to see the rainbow of colors as I was that Sunday afternoon.  I grabbed a little bit of many things and came home and made a large tray of roasted veggies to go with the mac n’cheese I’d put in the freezer just for that night.  Not even a lobster roll on the deck of some Maine coastal eatery could have made me happier.  While I can’t say that we were ever truly hungry we certainly craved a little variety in our diets as rice with onions or yogurt with granola gets old after a while even if you can get a can of tuna or some raisins to add.   And, while I hope not to put back on the six and a half pounds that I lost I am enjoying the supermarket more than ever.

As I reread some of the earlier messages I sent to Caitlin for posting I realized I hadn't really said much about the challenges of nursing. Before I left I knew that Kendrick wanted me to help develop strategies for getting the nurses to do more nursing, particularly patient assessments. Sounds like it shouldn't be that hard right. Well in Galmi nothing is easy.

A bit of background....when we think of nurses in the U.S., whether they are diploma or BSN each has passed the NCLEX exam. In Niger, nurses have approximately 1 year of additional training beyond about 6th grade.  Nurses aides about 6 months. Nurses are predominantly Christian and speak French whereas the nurses’ aides are typically Muslim and speak the local dialect of Housa.  Any attempt to change the responsibilities of one group ultimately ends up with them screaming bias. Unfortunately, someone hired them with job titles such as IV nurse, oral medication nurse, IV/IM medication nurse, etc. so they see their responsibilities to jobs not patients. Once the meds are passed out they consider their job done and sit in the "nurses station" on their cell phones, yes, despite the level of poverty everyone seems to have a cell phone.   Any suggestion that perhaps they check an IV that isn't flowing or needs replacement is all but ignored unless one is very persistent. The fact that the two groups speak different languages is also problematic as you can imagine and since only one or 2 have basic English, the universal language of the docs there's a whole other layer of problems. The hospital offers Housa classes to anyone staying over 4 months and French classes are mandatory if you commit to more than 2 years. But the intake nursing note is in French as is most of the patient's chart with the docs writing their notes in English. Amidst this all I could think of is that the US is headed toward these problems with the multiple languages now being "supported" in schools, drivers manuals, election ballots etc, rather than insisting folks learn English but that's a discussion for another time.

The only semblance of nursing care I witnessed was in the Ushe (ICU) where there is an assigned nurse to the "ward" and even her assessment consists of taking a temperature at the start of every shift.   No pulse, no blood pressure, etc.  And to make it worse the nurses feel as though they work harder than their colleagues down the way at the government hospital, which the administration is quick to say they do....as the expectations for patient care and survival are higher.   Since it’s all about the paycheck many would happily work less at the government hospital despite deplorable conditions and an even lower patient survival rate so one has to balance demands with the risk of a limited work force quitting.  I don’t envy the hospital administration one bit.

Given that math skills are even less pervasive than language skills the one nurse per shift capable of calculating medication dosages sits her entire shift and calculates what amount of medication the nurses should give. For example: if a doc writes an order for 40mg of Lasix that comes 10mg/ml she writes on the medication administration sheet that that patient needs 4ml given.   One of the ideas I passed along to Kendrick was to offer English and math classes to the nurses during the week.  By rotating the nurses for 2-3 half hour “breaks” during the week to attend class everyone might benefit in the long run.  The other idea YenMei and I worked on was redoing the nursing assessment section of the patient chart.   Since the most I ever saw written in that section was a couple of temperatures surely there had to be a better format that would encourage the nurses to pay more attention the patients.   I’ll be eager to hear from YenMei once she and Kendrick have a chance to go over what we came up with.

As I said to Megan, the Medical Teams liaison, during my debriefing, the system in Galmi isn’t really set up for nurses to jump right in and pick up the extra load of patient care.  It is however, a fascinating and fabulous place to learn and grow personally and professionally.  As an outsider only there for a short period of time I had to tread lightly.   It’s no secret that the road to hell is paved with good intentions so......I tried very hard to let the native nurses direct me and use me in whatever way was helpful.   They were really surprised but delighted to find I knew how to put in IVs (almost as surprised as they were to find I could count to five in French when teaching them to use the Ambubags).  Of course they thought it was odd that I wanted to flush the line after it was in and never did understand that the reason their lines had to keep being replaced was because they never flushed them.  With no sense of time...the idea that taking 5 seconds to flush a line could save them 5-10 minutes down the road had no meaning and I never was able to get them to change their practice.....just one of many challenges in nursing culture that needs work. 

By the time I got home I was eager, excited even, to go back to work.  I am so grateful for the life I’m living and I know that as difficult as it was at times my Galmi experience was invigorating.  I needed to do this despite the concerns, even open anger, of my family.  What has been hard to return to is the size of the patients.  250lbs is not at all unusual for a VA patient but last week I actually had a patient that was just over 600 lbs.  After seeing so many people on the brink of starvation it’s hard to deal with the obese patients that make up so much of our population, but I knew that I would be changed and would have things to work on when I got back. 

I am working on a PowerPoint so I can share photos in some semblance of order.  Will hope to figure out how to get that posted by the end of the week.  In the meantime let me say THANK YOU!   I could not have done this without your love, support and prayers and hope that in some small way I have helped you understand the challenges faced by an amazing group of people trying to make the world a better place one patient at a time. 

Camels and bikes

So you can't survive emotionally here without a little fun. Some folks borrow a vehicle from the compound and head off to other bush villages where a missionary guesthouse offers a place to stay. For Liz and me we took a camel ride!  Like donkeys, camels are common here and are often found "parked" in the hospital parking lot next to the bush taxis that deliver patients or the donkey carts that carry heavy loads of millet or sorghum. The ride is a bit like being on a very tall horse....think 22-25 hands....with no reins or stirrups.  Thankfully we were advised to bring a pillow to sit on as the "saddle" is wooden, prevented from slipping by long wooden poles that run chest to buttock.  From the height  of the camel we were able to see over the walls some surround their family compound with and get a different perspective than we had from the street.
My real adventure occurred on Sunday when Yen Mei and I headed out for a bike ride to a neighboring village. We started out headed east on the airstrip. At the far end was a gate to a road rutted from the traffic of donkey carts and motorcycles.  Before we could reach it we had to get cross about 100 feet of tall grass.  Given the number of viper bites seen at the hospital we shouted and stomped our feet to scare away any potential would be snakes.  I can't say I was excited about this part of our journey but once safely through it was back on the seat and off we went. The road was crowded with women and young girls carrying basins on there head filled with foods for sale or carrying grains home for pounding into flour. The local well was a large pit with muddy water but a young man was busily filling 5 gallon water jugs so he could water his onion field.  There was a network of cement troughs that served not only for irrigation but also the local swimming hole.  At an intersection we came across a trough wider and deeper than others where 40-50 children were jumping and splashing and having the type of fun we wish for all children. After seeing the blank stares and sunken faces of so many children at the hospital it was uplifting to see kids having old-fashioned fun.  We crossed the small bridge slipping and sliding in the wet clay mud.  One young boy following us slipped and fell becoming covered in mud followed by the roar of laughter from the others. It seems as though children everywhere find similar things funny.  When the children realized I had stopped to take a photo I was swarmed by kids, naked, covered in mud, all wanting their photo taken and of course grabbing for the camera to see their picture. Lesson learned.  Be more discrete when you take pictures!   Now covered in mud myself from the many hands that grabbed at me Yen Mei and I continued on.  We never did get to the other village as we had to turn around due to time.   On the way back we decided to take a different route. Unknowingly to Yen Mei this path didn't have a bridge over the drainage ditch so we were forced to hike up our skirts ( remember women must wear long skirts even to ride camels or bikes) and lifting our bikes high we waded across the drainage ditch filled with knee high filthy water. Knowing that schistosomiasis is common here the first thing I did upon returning was to shower scrubbing my legs especially well with soap and water.
So the whole skirt and head covering thing makes no sense to me as patients male and female alike lay on steel gurneys in the surgical ward stark naked for hours with no sign of any self consciousness and with not so much as a washcloth sized piece of fabric to cover any part.  Not surprisingly, women nurse openly in public and in the OB ward when asked if they are making milk the lift up their wrap expose a breast and give the nipple a good squeeze sending milk often a foot or more.  You don't want to be bending over to examine the patient and ask that question.  So why cover up so conservatively in one setting and not at all in another?  I've no clue but if I ever hear an explanation I'll let you know.
As ready as I am for a reprieve from heat and dust there's something sad about saying goodbye as well. I know I've said it before but the folks here are nothing short of incredible.  I learned yesterday that the principle OB who's been here 20+ years was exciled last year for 10 months.  Something about the German consulate getting word of threats to her. I would have been on the first plane out of Niger but she used the time in Niamey to write protocols, a project otherwise put off by babies to deliver. Some people face their calling with far more courage than I have.
To leave however you have to get through customs.  Since I have managed to catch a cold, or at least that's what I'm hoping it is and Liz is worried with my red nose, cough and glassy eyes I may get more than a once over by airport screeners.   While I'm not febrile, I promised her I'd take a Tylenol or 2 before we head to the airport tomorrow night.
Be well my friends and keep the staff here in your prayers that they are able to continue to do the good work God has called each of them to do.  They are making difference!

Thinking about truly living one's faith

I'm not usually one at a loss for words until I have to speak from the heart and then I become a slobbering sentimental fool. Such is how I felt yesterday as I tried to thank the Hospital community for there kindness over the past 2 weeks. Liz and I have shared many meals with folks here mostly in their homes but also in our cottage. Truly the folks here humble me in a way no other trip has.  The members of this community give of themselves selflessly. The docs are on call every 2-3 nights, the surgeons even more often and like boarding school everyone has other jobs to keep the community emotionally and spiritually healthy.  But despite the endless demands and less than ideal working conditions they persevere.
Yesterday morning Liz and I went with 9 others to a bush church.  For 17 years the pastor and his family have offered Sunday church services in a small community about 10km from the hospital. More often than not its just he and his family and a few folks from the hospital that attend and yet he continues to prepare meaningful messages with the hope that he will make a difference. That's faith that humbles.   The Sunday Liz and I were in Niamey waiting to fly here to the hospital we attended church services at the boarding school where the older missionary kids go. As the guards opened the gates to let our vehicle in we drove what was essentially an obstacle course, snaking around barrels before reaching the straight portion of the drive to the building where the service was to be held. In a predominantly Muslim country there are of course groups that are not happy to have Christian missionaries around and so the obstacle course serves as a deterrent should would be extremists decide to attack.  While there were health and safety risks with other mission trips this is the first one where I have come to better understand the courage it takes to practice one's faith.
Two hymns from yesterday that really struck me were Blessed Be the Name of the Lord and He's Got the Whole World in His Hands, songs I've sung many times before and yet here, surrounded by these people who truly put there faith into action you can't help but feel moved in a unique way. I still want that coconut drink though.

Update

OK I confess.....sun, sand and surf sound pretty good right now as does one of those fancy drinks in a coconut with an umbrella served by a tanned cabana boy. I feel like a weeny saying that given the years some folks have devoted to being here but 2 weeks is enough for me. If our flight left tomorrow I would only be sad to leave some incredible people behind but the dirt and smells have worn me out in a way no other mission/service trip has.   Sleep comes with difficulty as the earwigs drop from the mosquito netting.  No matter how thorough the sweep I do before tucking in there always seem to be several that manage to land on your head just before you drift off. Then you're left lying awake wondering if there are more or whether it's safe to finally close your eyes.  If there are earwigs in Istanbul I'll be on the next flight home.


I went to the weekly open market on Wednesday with a seasoned market shopper but food and spices that are sold from mats on the ground I just couldn't make appeal to me no matter how tired I might be of bland food or how much i crave fruit or veggies.  All I could think about was the woman with the tape worm hanging from her anus to her knees and in the end after hand-over-hand removal ended up to be 6 feet long.....at least her bowel obstruction treated several weeks ago was now finally gone...... Or the cases of typhoid and cholera, round worms or any other of a multitude of illnesses associated with dirt and/or feces which here are pretty much a standard mixture.    Oh the many simple things of life at home that are truly blessings taken for granted on a daily basis.


Yesterday was spent putting together a "code cart" or trolly as carts here are called.  Given the diseases that most folks suffer from CPR is not really a helpful option and I've yet to see a single EKG done here, in fact haven't even seen the machine.   The code trolly is do r airway support.  After chasing the 3" spiders from the cart and hosing it down I found a couple of Ambu bags some face masks that could be resurrected and pharmacy had a couple of OPAs and NPAs that I was able to include as well.  With the cart stocked with a few other things the nurses were given a little in-service on how and when to use the equipment   Not earth shattering but they do see asthma and smoke inhalation and had no idea how to use any of the equipment.   Considering that I've seen more than one roadside Petrol seller lying on a mat under his table, old liquor bottles filled with petrol, Smoking a cigarette I suspect at some point the cart will come in handy.  In the meantime I hear stories from Liz about patients from the clinics (the emergency department is open only when clinic is not so 1-3 and between 6pm and 8am) and dinner conversation is not for the weak of stomach but it's how we all process the experience of each day.

Hugs and blessings to you all.  May you find something each day to be grateful for,
Laurie

10 Days Down

Liz and I have now been here for 10 days with another week to go. The list of diseases we've seen and experiences we've had are amazing both in and out of the hospital.  Liz has been busy rounding on patients she has admitted from clinic  as well as being on call every third night.....something she says she hasn't done in many years.  We are both faithfully taking our Malarone, an anti-malarial and while I was scared about the potential for nightmares it's Liz whose sleep has been disrupted. I'm sleeping like a baby but she is awake multiple times during the night and says she has much more sympathy for folks with sleep issues than she did before.  Despite sleep concerns well keep taking it as 2 folks on the compound have come down with Malaria but both were here during the rainy season.

 Meals have required lots of creativity.  Rice, lentils, quinoa, granola and yogurt make up much of our diet. When available we get to throw in bits of onion, garlic or vegetables.  I actually bought a great papaya the other day that we add to yogurt. I will be eager for  meat and spices by the time this trip is done.  Barbecued ribs sound really good right now but the only meat I've seen here so far has been grilled on the side of the road and unless my histology is really rusty it's mostly organ meat (liver, kidney and lung seem to be favorites) but after hearing a story about being served fried lung and having maggots come out when cutting I'll stick to rice and lentils and let the folks eager for reality TV status eat off the street here.  Today's market day so during rest our plan is to see what we can buy to add some interest or flavor.

While Liz has an interpreter with her almost all the time I haven't  had that luxury which has limited greatly what I can do.  In the medicine ward I spend at least part of every day checking IVs, making sure they are patent and that fluids are running as they should.  There's no real sense of nursing practice here, it's just a job for a paycheck.  When IVs are placed they aren't flushed so when fluids are hung and connected the "nurse" walks away.....job done.....with no care whether the fluids are actually flowing which is why I check.  Since the needle system they use does not have safeguards to prevent backflow one has to be extra careful particularly given the incidence of HIV but I was shown 2 ways that seem to take care of the issue but neither one would I even consider using at home.


After feeling like I'd bugged the nurses enough yesterday about IVs and the importance of flushing them when they are first inserted I spent this morning in OB, making rounds with a German OB/GYN whose been here 30+ years and is very excited to teach. After rounds we headed to the OR for a C-section and tubal ligation (it was the woman's 9th pregnancy and she was severely anemic with malaria) She had been in labor 3 days before coming to the hospital.  Thankfully her baby was born alive and is expected to do fine. That can't be said for many of the babies born even here in the hospital as 2kg seems to be large and are often26-30 weeks. One yesterday was 24 weeks and 800grams.  It didn't make it through the night.  Aside from low birthweight and premie babies there are an extraordinary number of molar pregnancies which have to be terminated.


At home I never leave for the hospital wondering if someone is still alive yet that's part of our daily conversation in the morning as we head up the dusty dirt road from the little cottage to the hospital. I wonder how some of these folks do this day after day for years. I envy their strength, endurance and faith


Enough for now,
Laurie

My Day Off

It's Saturday and it feels odd as I'm not expected anywhere and with Liz on call she was limited in what she could do.  The compound is especially quiet as the Aussies have borrowed a vehicle and made the trek to a larger village several hours from here (the equivalent of going from Welches to Gresham in Oregon or Bremen to Waldoboro in Maine) and the others are in Niamey visiting.   After sleeping in late and a half hour walk back and forth on the airstrip (yes, the airstrip functions as the compound's track.  It's about 1/2 mile long but because it's clear of brush it's relatively viper free which makes it the best place to bike or walk).  Now all sweaty it was time to try out the compound swimming pool.  Don't let you head envision Palm tree or cabana boys. It's more like cement pond complete with slimy stuff on the bottom. On the way though I heard "Auntie Laurie" and found Naomi and Anna, 2 young girls high up in a tree.  It seems as though sharing a single meal with a family earns you Auntie status here.  Anyway it was clear to them where I was headed, towel  over my shoulder and water bottle in hand, so I invited them to swim if it was ok with their moms.  You'd think I'd offered winning lotto tickets.  In no time at all they were back with suits on, eager to swim.
> Sleeping in, a walk, a swim....I feel guilty as i know Liz is off seeing patients that will be the folder of lunchtime conversation if she manages to get a break. The plan after lunch is for me to go into "town" and see if the outfits Liz and I had made are ready.  The nurse I've been helping, Yen Mei offers to come with me as Liz made me promise I wouldn't go alone.  Anyway YM explains that in her first 5 months here she went to town everyday to learn the language and she clearly made friends. The shopkeepers seem excited to see her and it's not because she has money throw around. She's from Malvasia and was sent here by here church at home.  As we make our way from stall to stall I ask her why she doesn't barter as is the custom and she explains that because she knows the fair prices of everything the shopkeepers don't even try to cheat her.  I'm glad she's with me because I would so have gotten ripped off.  The only person better for the job might be Elizabeth (from the VA) who I'm sure could talk these folks into buying sand. With my outfit in one hand, half a large winter squash in the other and a few other things in a nylon bag Mindy gave me for my birthday we make our way back to the compound.   En route I meet Patrick a young resident in a tropical medicine fellowship program from the U of Kansas.  He's on OB call this weekend and is excited about the C-sections he's gotten to do today and especially about seeing his first molar pregnancy (a genetic anomaly that causes a false pregnancy or tumor that gives off HCG).  I tell him I would love to see a C-section or other interesting OB stuff as we are seeing increasing numbers of female patients at the VA and he promises to call me if he gets called in later.  I tell him only if the hour is reasonable.  Is that lazy of me?  Perhaps but at this stage I need my sleep, he's young, I'm old  and there are no shortage of births to be observed here daily after a decent nights sleep (that is if one can avoid the earwigs) I just thought what other excitement is there on a Saturday night in the middle of nowhere.  These days though I only go to the "early show".  One of the terrific things about this experience is the opportunity to learn. If your willing to offer a set of hands there's someone who's willing to teach you what you need to do to be of help.  Of course there's also the multitude of things that need doing and should have been done by nursing staff that just don't get done. IVs that aren't patent so fluids that should be running aren't, vitals that should be taken each shift are lucky to be done once a day and forget assessments....they. are nonexistent by nursing staff.  It's almost embarrassing to have the same professional title of nurse. In Niger to be a nurse requires 1 year of schooling beyond the norm which is about 6th grade and to be able to read and write something most natives can't do even in Hausa, their native tongue.  Not exactly equal preparation for the same job.

> Well enough for now. Headed to bed just in case a call comes in the next few hours.  Truth be told I'm not eager to make my way by flashlight along the paths to the hospital in the dark, even with an almost full moon.
Love to all,
Laurie

Life Outside the Hospital

Life on the hospital compound is much like my time teaching at boarding school.   There are 70 folks who live here give or take depending on volunteers like Liz and me. They range from a German OB who's been here 30+ years to several tropical medicine residents from Kansas and an Family NP from Missouri who are here for 4-6 months and short termers like Liz and me who come for a few weeks.   It's an international crowd with quite a few Aussies, several older couples and a number of young families with as many as 5 children.  There's a strong sense of community and time built into every day to foster that.   Aside from a couple of national nurses and/or nurses aides everyone leaves the hospital from 10-10:30 for morning tea and again from 1-3 for lunch and rest.  On Wednesdays during tea time we all gather at the CC (community center) for cinnamon rolls.  There a guy on a motorbike that brings beef and chicken for purchase there as well.  There's a school on the compound with a single teacher for grades 1-6.  From 6-8 they are home schooled or sent to boarding school in Niamey.   Twice a week a compound coop opens for the purchase of a VERY limited supply of basics and twice a week vegetable traders come to sell what VERY limited produce is available.   Earlier in the week Liz and I made our way to the fabric shop, 6 yards for 6000cfa or $12.  Then we made our way to the tailor where for $3-5 he will make us each an outfit, complete with headscarf (turns out anything that covers your head is ok so my hijabs have been cut to bandanas which are much more comfortable).   Given the language barrier there's no telling what the outfits will come out like.
Our accommodations are a bit like camping with walls but I'm grateful for a flush toilet and ceiling fans since it's typically in the mid 90s by 9am.  We are however deluged with earwigs and despite the mosquito netting over the bed the earwigs still manage to drop onto you during the night.....gross.   With the Rainey season over I have yet to see a mosquito tho Liz says she saw ONE.
The long termers have been wonderful providing us with eggs and bread and a few other staples until we can get to the coop or traders (since we arrived the week of Festival of the Sacrifice the traders, etc didn't come with produce early in the week and it's unclear whether they wull show up today).  It's amazing what great meals folks can prepare out of nest to nothing or veggies we wouldn't think of putting in the cart but when it's what you have you make-do.  I had really thought this would be a serious chance for some wt loss but my clothes aren't feeling any looser.  Darn.
Well back to business.  Hope you are all well, love Laurie

Greetings!

So the whole blog thing is a dud as the Internet here is not able to handle much beyond email so I'll just give you a quick rundown of my 3 days on the wards. There are 3 basic ward A, B and C with 8, 12 and 14 beds respectively plus an isolation ward for TB patients (D ward) and a 10 bed overflow, E ward.  Before E ward is used each of the others must be full which here means that each bed has at least 2 patients and if they are small enough 3.  Each patient can have 1 family member at a time with them. This person sleeps on a mat on the floor, takes care of the patients toileting needs and food provisions.  At night outside the hospital compound can be found additional family members sleeping on mats ready to take their turn at the bedside or cooking over open fires so the patient will have food.   If patients need blood they must supply their own donors so often docs will rarity for blood but it may not be given for a day or at all depending upon if a donor shows up.  Each morning the benches outside the donation area are filled.  All patients show up malnourished with malaria, cries under 20 and knocking on death's door because they wait so long or the 4 hour trek is a deterrent.   In 3 days time I've seen 2 DKA, a neurogenic bladder hydrocephalus, mumps, TB, 2 viper bites, and the agonal breaths take by  2 patients where as I checked the brachial artery of one baby was gently told that CPR was not done here.   Aside from being on the ward I've been meeting with a woman working on nursing projects.  One of these is how to get nurses to do more patient assessments and actually fill orders in a timely way.  (For example one of the patients I saw today was a 2 year old admitted for malnutrition and malaria and had had 200ccs of milk ordered per day and had not gotten any in 3 days).   My afternoons have been spent during an assortment of things    Yesterday I spent assembling and setting up 2 cardiac monitors and an neonatal bed/warmer for the OB ward so that I can train the docs and midwives on their use this afternoon.  What tomorrow brings is a mystery.  Love to all, Laurie

Leaving the house shortly

Finally packed, I enjoyed the last of a hot shower for a while and thought I was on the home stretch of ready to go.

Then I got the bright idea to synch my iPad only to get a "failure to update, must restore to original settings" message, one of just a few last minute surprises.

We learned late yesterday that the missionary based airline, SIMair, doesn't fly on Sundays.  Since Liz and I arrive in Niamey from Istanbul late Saturday evening we now have to wait until Monday morning to leave for Galmi Hospital.  

Then another surprise......all along MTI had been telling us that Liz and I could each check two 50lb bags free of charge. So, friends were scrounging yard sales for large suitcases for MTI to fill with the supplies the hospital had indicated they were in need of.  Liz and I picked those filled bags up last Friday, added a few things the hospital staff had personally asked us to bring, only to find out yesterday when we checked in online that we were each only allowed 1 free checked bag, the other two will cost $100 each. They not only have medical supplies but also a washing machine timer  and spark plugs which someone is hoping with make a vehicle run so we can't exactly just leave them behind.  

I suspect these won't be the last of the surprises in store for us.

Hugs to you all!  

Last minute preparations

My bags are packed and I'm ready to go.....well almost.....there are still so many little things left to do.

Thought I would remind those of you reading this how this trip came to be.   After reading The Elephant Whisperer by Lawrence Anthony, for book club, Liz and I decided we wanted to visit Thula Thula, an elephant preserve in northern South Africa.  Not having any clue how truly big Africa is we thought.....we'll go to Thula Thula for a week or so and then head to Niger and help Kendrick (an old friend of Liz's and the now director of Galmi Hospital in Galmi, Niger, West Africa).  Once we started looking into travel it was clear that this two-stop plan wasn't going to work.  By then we had read enough about Niger to know that we needed to devote our energies to helping Kendrick and his staff and forgo the idea of going to Thula Thula.  You know what they say about the best laid plans.....

So what was it about Niger that called us?
In 2012, Niger was declared by Save the Children as “the worst place in the world to be a mother” because of the high incidence of maternal and infant mortality.  Given how much of my life has been devoted to children I knew it was a place I was called to.  Kendrick specifically asked Liz and I to consider coming in the fall as that's when his patient population swells to 3 times the number of beds the hospital has available (think AAA, BBB, CCC for those of you working in the ED with me) due to malaria.  
I also love that Galmi Hospital’s mission is “to see native Nigeriens grow in capacity to provide competent medical and spiritual care for their fellow citizens of all ethnic and economic backgrounds”.   I believe that the best way to help people over the long-term is to help them help themselves.  I hope that I am able to do just that.  I have been working on several powerpoints and know that a large part of what I will be doing is nursing education.  

For those of you who might be interested in a bit more background information on the various organizations associated with this trip.....
You can learn more  about Galmi Hospital at   http://galmi.org/index.php/about/galmi-hospital.

Galmi Hospital is just one of numerous hospitals world-wide owned and run by SIM (http://www.sim.org/) a faith-based, non-profit organization founded in 1893 by two Canadians and an American.

Medical Teams International:  https://www.medicalteams.org/