Monday, April 16, 2018

Meet my friends: Mary

I met Mary through another missionary woman here. I think I'd arrived to Nigeria just a few weeks before and I'd asked this fellow missionary to take me fabric shopping. I'd just gone shopping with her to buy fun fabric at the local cloth market and was already googling "free online dress sewing patterns" (I mean, when you drag a 27-pound sewing machine halfway across the world, you gotta use it!) when she said, "Oh, let me just take you to my tailor."

I had to think for a minute. Usually when someone says they'll introduce you to their tailor, they're a celebrity, a news anchor, a politician, or a CEO of a Fortune 500 company--they're not usually a normal missionary mom with three kids who lives in Nigeria. But here, almost everyone has "their tailor," a woman who can look at a book of fashion designs or a blurry photo on a flip phone and re-create the design with whatever fabric you bring her. If your tailor is really good, she may even suggest altering the design a bit to suit the type of fabric you brought or to fit your body style.

So, after the fabric market, my friend and I went directly to Mary's shop which was tucked behind a church down this narrow dirt street with chickens and stray dogs roaming around. I told Mary I had really no idea what I wanted, as long as it was a dress with sleeves (to fit the required dress code) and was loose (for the heat) and non-restrictive (for the movement a PT needs). She grabbed a stub of a pencil, sharpened it with a straight edge razor, and grabbed her notebook that was nearly falling apart. A few minutes later she showed me a sketched design of a pretty wrap-around dress with puffed sleeves (Anne of Green Gables reference, anyone?). I was sold.

She grabbed a tape measure off the wall, measured me about 5 places (all the while remembering them in her head without writing them down until she was done measuring), and told me a price. I think it was something like $3.70. (Oh, and the fabric was only $9.80 for a 6-yard length). I paid her and she told me to come back in a week. I was a bit blown away by how easy--and how cheap--it was!

I went back a week later to "pick my dress" (we don't say "pick up" in Nigerian English), and brought her a load of other cute fabrics for her to sew up. Ever since then, I've brought new missionaries to her and have returned many times to have her make something or just to "greet."

This was my Christmas dress

This is one of my favorite dresses--it has pockets!

She even made my parents and me matching outfits when they were last here!
When I found out that my parents were coming to visit me a few weeks ago, I wanted to get Mary a small gift. My mom brought a pair of nice sewing scissors (can all the fellow sewers give me an "Amen!"), and one morning after I saw my PT patients at the hospital, Mom and I went to Mary's shop. She was absolutely ecstatic about the scissors and even showed me the huge pile of fabric she planned to cut that day for customers' orders.

This young girl in the front helps out at Mary's shop, running errand to the market to buy buttons, hemming the fabric headscarves, and learning the basics of tailoring. 

I praise God for friends like Mary who make me laugh, who keep me clothed, and who teach me about Nigerian fashion--even if she does remind me that I've changed sizes since she first measured me all those months ago!

Monday, March 26, 2018

Medical questions like you've never heard before!

I knew that when I came here to Nigeria, I'd have to learn a lot of things. I was expecting to learn Hausa, to learn how to ask simpler and more effective medical questions, and to learn how to explain things better to uneducated patients. What I wasn't expecting to learn is how to ask questions like this! Can you figure out what each of these medical questions is really asking?

"When you pee, do ants come to that place?"
                This is an easy test for severe diabetes where the patient's urine is full of glucose.

"When you feel pressed, can you make it to that place before the urine it does drop?"
                I ask this one a lot to determine if she has symptoms of urge incontinence. Since most of my patients' homes do not have toilets or indoor plumbing, and they use the bush or a communal pit latrine, I can't really ask about "making it to the bathroom in time."

"Do you feel like you have pepe in your front?"
                It's another way to ask about dysuria (burning with urination) that is common with urinary tract infections. Also, many women don't know the word "vagina" or "urethra," so we use "your front" or "the place of urine" commonly.

"Do you have a runny stomach?"
                Do you have diarrhea?

"When you get up from bed, your eyes they do turn you?"
                This is a straight up pidgin English way to ask about dizziness or orthostatic hypotension.

"Are you purging?"
                Are you vomiting?

"Do you have heat?"
                This could be asking about fever or pain, depending on their other complaints.

"Have you taken pounded yam today?"
                We always ask this question of our post-surgical patients. They will start by eating a porridge or hot cereal, but when they progress to pounded yam we know they're feeling better.

"Go and drink 2 sachets pure water and one Coke, then come back when you feel pressed."
                This is our way of kicking urine production into high gear when a patient is complaining of urinary leakage but we don't see a fistula. It could be something called a "ureteric fistula" where one of the kidney's ureters dumps directly into the vagina instead of into the bladder. This can be congenital (from birth), or as a result of a cut ureter during an abdominal surgery. If they come back and we see clear urine gathered in the vagina and not the purple dye we put in their bladder, we can confirm it's a ureteric fistula.

"Do you take lots of pepe on your food?"
                This is the first thing we ask when a patient complains of heartburn, yet we know that asking her to reduce the amount of the super hot chili pepper powder she sprinkles on just about any kind of food is like asking a fish to stop swimming!

I bet you've never been asked any of these questions before!

Wednesday, March 21, 2018

Two are better than one...

"Two are better than one, because they have a good reward for their toil. For if they fall, one will lift up his fellow. But woe to him who is alone when he falls and has not another to lift him up!" 
Ecclesiastes 4:9-10 ESV

There are currently two women with foot drop in our ward. Foot drop occurs for these women when they're in prolonged childbirth; the baby's head pressed on the nerves that run from the spine, through the pelvis, and down to the muscles in the legs and feet. In mild cases, this will resolve on its own within a few months. But for others, they experience severe leg muscle weakness and the inability to lift their toes when the walk, so they limp and drag that leg. I don't have the ability to perform nerve tests for these women to see if they'll regain nerve function and therefore muscle strength, but I can at least work on correcting their walking so that they're safe and they can move around on their own in a more efficient manner.

When these women came for Tuesday clinic a few months ago, I recognized their foot drop. Along with a reminder card of their date for surgery, I gave them a card to come for physical therapy the next morning where I showed them a few exercises to do at home and another card to see me the day after surgery.

They came after their surgeries like they were supposed to, but due to a communication mix-up, one came as I was nearly about to leave for the day! After finishing treating all my patients, the woman translating for me asked the obvious question: "Since you're not seeing them for urine problems and we taught them basically the same exercises today, why can't they come together next time?" She was exactly right!

So today we did a brief session of exercises on the plynth before working on walking and balance exercises. Here they are working on an exercise to strengthen the muscles on the outside of their hips.

The plastic buckets by their feet are holding their catheter bags. It's a bit of a hassle making sure these don't get in the way or get accidentally tugged on during therapy, but we make it work!
Then we moved out to the "babban parlour" (big parlour/room) which we use as a waiting room during Tuesday clinic. I like to use that area for therapy because it's just outside my clinic and because it's a big open space that's quiet and free from distractions.

I knew at one of the ladies would really need help balancing during the sidestepping, heel-to-toe, and backwards walking, and the other lady would probably benefit too, so I just had them hold each other's hand while they walked. It was fun to see them laugh at their own mistakes and losses of balance, as well as to see the stronger lady slow down  to match the pace of the other. Here, they're doing backwards walking to get work on ankle mobility, balance, and body awareness/"listening" to their feet.

At the end, I asked them, "What that hard to do?" They both laughed and nodded. Then I asked, "Was it easier to do it together and help each other?" Again, they nodded. 

One of these women identifies herself as a Christian, the other as a follower of Islam. Despite the ongoing tribal and religious tension in this area of Nigeria and the recent attacks in the villages surrounding Jos, there was peace in this room today. They were simply two women facing the same challenge, and facing it together.

I hope to come back to this topic in the future and talk about how God holds our hands when we are going through difficult things--He doesn't leave us to falter. But we have to reach out  and take His hand and put our trust in Him.

It's not every day that I see Jesus show up in my clinic or that the Holy Spirit brings the Word alive right before my eyes. But today was one of those days.

Monday, March 19, 2018

Meet my friends: Lami

This is my friend Lami. She started working at my housing compound over 20 years ago and she’s seen dozens of short term missionaries come and go during that time. She’s an invaluable help as she cleans and cooks for us once a week.

Lami cooks for me on Mondays, and I can count on her knocking on my door and calling out, “Salamu alaikum” (peace be on you -- originally an Arabic blessing that has carried over into Hausa) about 8am. We greet each other, then ask how the other’s family is, how the weekend was, and how we slept the night before.

We finally get around to looking over the shopping list I’ve hurriedly put together just a few minutes before, making sure that she can read my writing and understands any specialty items I may have written on the list. We also chat through the dishes I’d like her to make for me. I’ve found that when I stick to her well-known repertoire of recipes, the results are almost-always guaranteed to be delicious!

My list today:
  • 6 pink apples
  • 1 bunch carrots
  • 1 bunch coriander leaf (cilantro)
  • 2 pears (avocados)
  • 2 mangos
  • bananas
  • 50N lettuce (you can get about 2 heads for 50N)
  • tomatoes
  • vinegar
  • 1 can of kidney beans
  • 2 cans of tomato paste
  • 1 mudu sugar (a mudu is about a quart by volume)
  • 2 mudus flour
  • 1 mudu rice
  • 2 packages simas (margarine used for baking)
  • 1 container of plain yogurt (which I will use as starter for my own yogurt. This is really the only source of fresh dairy available so when we have a "runny stomach," yogurt is a great follow-up to the strong antibiotics.

I bet that looks a little different than your grocery list! No meat, no packaged products, very little dairy. But that's a pretty normal shopping list for me!

So after giving Lami money to shop with, I headed out the door to work and she headed off to the main market for vegetables, the one store in town that sells fresh dairy items, the Western-style (ish) supermarket for the canned items, and the local provision shop for the rice/flour/sugar.

I walked back in from work about 1pm to the smell of  baking bread and frying onions and garlic. I think those are some of the most heavenly smells! She was making homemade English muffins and this fabulous carrot/cilantro/lentil soup that I absolutely love!

But we did have a bit of a discussion about which pan to cook the English muffins in. It went something like this:
"I didn't know which pan you wanted me to use. I think this one is OK." (My Calphalon non-stick skillet I brought over with me)
                           "That's fine. It doesn't really matter to me. I think there's a big pan in the cabinet if you want                                    the pan to be very hot."
"Oh, that one! It's eaten too much!"
"You know that big, big one that's too heavy. It's taken too much food. That's why it's so big!"
                           "Ah, I understand."
"So if you're missing any food, you check the cabinet. You'll find that pan has eaten it!"

I've never heard that a 16" Lodge brand cast-iron skillet got to be so heavy because it ate too much! I guess there's always a first time for everything! Turns out, that cast-iron skillet was brought over by a missionary many years ago and it's been passed down to various other missionary wives. The current owner had overhead me complaining about not being able to make good cornbread without a cast-iron skillet and she agreed to let me borrow it while I'm here.

Ah, never a dull moment when Lami is here! I've learned that it's just better to stay out of the kitchen while she works since she makes a bit of a mess. (But it's always cleaned up when she leaves!)

On another note: I'm amazed that this woman can turn out loaves of bread in 90 minutes flat--including mixing (forget measuring anything!), kneading, rising, and baking. I am super spoiled by her homemade bread.

And if I happen to be home while she's cooking, I ask questions about her life and family, or she tells me how it used to be in Nigeria or within the mission community.
I've learned a lot from her during the year she's worked for me and I am proud to call her my friend.

Sunday, March 11, 2018

2018 VVF Reunion

The main hospital gate (viewed from inside the compound looking out on the busy main road outside)
Reunion is undoubtedly the best part of our year! Last year, I'd just arrived in country a week before, I didn't understand any Hausa, and I didn't really know what was going on--this year, I could follow along with the program and I knew many of the patients that came to celebrate!

Reunion is three-day event, Thursday through Saturday, but women start coming a week or so in advance! That meant that our Tuesday clinic this past week was insanely busy with 68 women (usually, it's 20-30), so we had to split clinic into two 6-hour days!

It was fun to come through the main hospital gate each morning and greet the women sitting on the steps outside the VVF center. They spend most of their day chatting, re-doing each others' intricate hair braiding, and relaxing.

The program started on Thursday with food, crafts, and movies after sundown. Our kitchen team usually cooks for 20-30 women every day (all food for VVF patients on the ward and in the hostel is provided free of charge), but cooking for this many women involved getting a few more hands to help out!

When I asked what they were doing, I heard, "washing the meat." I didn't bother to ask any more! Then the meat was liberally seasoned with sliced onions, ground red pepper, and seasoning cubes (mostly salt and MSG)

These women spent several hours peeling the large yams with sharp knives, then slicing them into chunks for boiling. Later, the yam was pounded to make a starchy dish eaten with spicy red stew.

Here, the kitchen staff are cooking up huge pots of red stew to serve with the pounded yam. One missionary refers to these large cooking vessels as "cannibal pots"... they certainly are big enough for that!
Friday continued the celebration with some group cooking activities, one-on-one spiritual counseling provided by our chaplaincy team and pastoral students from the local seminary, meetings with former patients (especially those who've had radical surgeries as we're looking to get follow-up information that could be used in future research papers), and a musical group that came in to entertain the women with songs and group games.

These women found the shade of the huge mango trees to be a perfect place to set up their afternoon of cooking. They're making "puff puff," a yeasted sweet dough similar to cake donuts that's scooped with bare hands and dropped into hot oil. The puff puff would be served for breakfast the next morning.

The woman in the center is Esther, or as we call her, "Mama VVF." She keeps an eye on all the women staying in the hostel and helps run some of the skills-training programs.

But Saturday is really the big day!

The women cueing up for breakfast!
The reunion celebration is held out in the "VVF Village," a place near the back of the hospital compound where there's a 100+ bed hostel, a two-storey training building, and several homes for VVF staff members. There's also a large open area where we set up tents and hundreds of plastic chairs for everyone. But people don't stay seated for long... when the music gets going, everyone starts dancing!

Even the little-est ones can't help but dance!

Even my colleague Grace got up to dance!

Later on in the program, four women told their stories. They were all fairly similar--in childbirth for 3+ days, eventually taken to a local hospital where the baby was pronounced dead/had a cesarean to remove the dead baby, started leaking urine within a month or so, finally found their way here (2 months to 35 years later), and at least one surgery before they were finally dry.

Once again, one of our youngest attendees couldn't keep from dancing as music played between each woman's testimony.

Later, we had a Freedom Ceremony for fourteen of our recent patients who were dry. This is similar to the Freedom Ceremony we have every Tuesday morning before clinic; they danced, sang, and each received a new piece of fabric. The key phrase was "Mun gode Allah!" (We thank God!)

We had a special presentation of several manual sewing machines, sewing tables, and knitting machines donated by a group of students in the UK partnering with a Nigerian PhD student who is writing her dissertation on our VVF women. These women had gracefully shared their stories with this student and also been designated as women in need who could benefit from these machines.

After a few more speeches by hospital administration and donors, we ended the celebration with more dancing.

And then I was snagged into tons of photos with various women. Out came flip cell phones as each woman wanted to take photos with the baturia (white woman)!

Then we got this selfie of us three SIM missionaries who serve here at Evangel VVF Center. Those smiles were certainly not forced--we'd had a wonderful celebration!