Thursday, July 13, 2017

Thoughts on Luke 5

I'm loving my new clinic space. My desk is right in front of a window where I can look out and see the women chit-chatting, washing laundry, or keeping an eye on their babies. But most importantly, I like having a place to just "be and be available."

This past Wednesday as our compound Summer Bible Study dug into Luke 5, I was struck at how both of the men with leprosy and with palsy met Jesus and what He was doing before they came along. (I know we'd usually call them "the leper" and "the paralytic" but my PT training has taught me to use the more appropriate "patient-centered language!") In some of the gospel accounts of divine healings, we see people reaching out to Jesus, following Him until He noticed them, calling aloud to make sure they weren't overlooked, purposely going to where He was conducting a healing, etc. But these two stories are a bit different.

Luke 5:12 tells of the first patient encounter:
While Jesus was in one of the towns, a man came along who was covered with leprosy.When he saw Jesus, he fell with his face to the ground and begged him, “Lord, if you are willing, you can make me clean.

Jesus was in the town, likely teaching or maybe just living life. This man was an outcast because of his skin condition--he never should have been allowed in the town! The passage doesn't say if Jesus was already healing and then this man came to see if he could be healed too. The way it's written, it doesn't sound like the man was seeking Jesus out, to me it sounds more like he just came upon Jesus and when he saw Him, he decided to ask in faith if Jesus was willing to heal him.

And Jesus committed an act that should have made Him unclean... He touched the man. But Jesus' next instructions to the man to go and show himself to the priests and offer the cleansing sacrifice showed that Jesus had done what no one had ever done before. He'd touched someone unclean and instead of being unclean Himself, He'd made that person clean!

The next section of Luke 5 tells of Jesus teaching in a place that was so crowded the fire marshal would have slapped The Jesus Ministry with a huge fine! God's Spirit of healing was so very present there, and this man's friends decided to take matters into their own hands to get him a front row spot with Jesus. I can imagine that Jesus is teaching and healing amidst dust raining down from above as these friends lift up the tiling until there's enough room to lower the man and his mat down!

Here, Jesus decides to go right to the point and meet the man's real spiritual need. He pauses for a minute to address the Pharisees' judgmental thinking, then says in verses 22-24:
“Why are you thinking these things in your hearts? Which is easier: to say, ‘Your sins are forgiven,’ or to say, ‘Get up and walk’? But I want you to know that the Son of Man has authority on earth to forgive sins.” So he said to the paralyzed man, “I tell you, get up, take your mat and go home.”

mic drop... and stunned silence...

In both of these stories, Jesus was doing His real ministry (teaching and discipling the guys He'd just picked out), but He wasn't bothered when people came to Him with very real physical needs that ostracized them from community. 
Do I come to the  hospital only for the hours that I have scheduled to see patients? Or am I here, going about my other ministry work, available for whoever might walk in and ask if I'm willing to see them? Do I make my patients advocate for themselves or get their friends to push them to see me, or am I available for whatever the Spirit wants to do through me?

Jesus was in the business of spiritual, physical, mental, emotional, and social restoration. When Jesus healed the man with leprosy, He told him to immediately go and fulfill his spiritual duty and get the priests' stamp of approval for community re-integration. When Jesus healed the man with palsy, He forgave his sins first and then in front of the entire crowd restored the man's ability to walk. 
Do I educate each and every patient in a way that she understands so she can explain to her family and husband what her problem is? Do I make sure she understands her clearance for sexual activity and housework so that she can get back to life as normal sooner and reduce the risk of being divorced? Do I take the time to screen for depression and get the chaplains involved? Do I  pray with these patients? Do I pray for these patients after they leave?

Thanks for letting me ponder this aloud.

Saturday, July 1, 2017

Meet Charity...

*Note: Charity has given me permission to share her story, name, and photograph with my supporters and friends of Evangel VVF Center*

Meet Charity, a lovely young woman in her late 20s. She's a mother of four--including a 6-month old little boy, she and her husband are farmers to provide for their family, she speaks Hausa, and identifies as a Christian.

Charity came to Evangel VVF Center in April because she was leaking urine since her last childbirth in January. She had labored at home, just like with her previous three children, but this time she felt that the baby was not positioned correctly for delivery. She attempted to turn the baby herself, and was able to deliver a healthy baby boy. But then she started leaking urine uncontrollably and was unable to walk. She'd been to several traditional healers that had given her herbal medications, all without any improvement.

When her aunt who lives in Jos heard about Charity's condition, she arranged for Charity and her husband to come to Jos to see us at Evangel. So that Tuesday in April when she came for clinic, her husband came with her, actually he carried her. Our physicians examined her and identified that she didn't have a fistula (an abnormal passage between the bladder and birth canal as a result of prolonged obstructed labor, resulting in uncontrolled urine leakage), and referred her to me to diagnose and treat her legs and potentially her pelvic muscles to see if she could regain her ability to walk or to normal bladder function.

As soon as I started performing a neurological screen to assess sensation, reflexes, and voluntary muscle contractions, I realized she had a central nervous system injury--likely some sort of spinal cord compression at the lower thoracic level. I also discovered that her urinary incontinence stemmed from paralysis of the normal pelvic muscles that assist in bowel and bladder control. I had access to AP and lateral view spinal x-rays, but that gave me no real helpful information, just confirmed that she had a malalignment of her lower lumbar vertebrae, which might have been there for some time and due to its location, I doubted that it was the cause of her symptoms. I didn't understand what exactly had happened during her home birth, but somehow she'd damaged her spinal cord. We do not have access to an MRI or CT scan here in the city of Jos, nor is there a neurosurgeon that we could refer her to. Even if she was a surgical candidate, Charity's family probably could not afford it. It was up to me to do whatever I could for her.

Here at Evangel VVF Center, we have a hostel where patients can stay if they're receiving long term care (but don't need to be in the patient ward), waiting for a subsequent surgery, or are enrolled in the skills training program. Charity and her infant son decided to stay to receive physical therapy treatment, and were given beds in the hostel. Charity quickly became friends with the dozen or so other women that were staying there, and her son was well taken care of by the myriad of women who were eager to help. Mama Esther oversees the hostel and also made sure to keep an eye on Charity.

I don't have access to a huge closet of adaptive equipment like in the US, but we made do! Charity was able to borrow the one wheelchair that the VVF center had to transport patients between the operating room and the ward, one of the nurse aides found a smooth wooden board Charity could use as a sliding board to transfer in and out of her wheelchair by her herself, and she borrowed one of my gait belts to use for ankle stretching exercises.

I went to the hostel a couple of days a week; first, to show her how to use the wheelchair and maneuver around to open the doors, get in and out of bed, and not have to rely on someone pushing her. Later, I taught her stretches to help with the night cramps she experienced and to reduce the risk of contractures from prolonged sitting. We did a lot of standing with her holding onto the bunk beds and me assisting at her hips in order to stay up, and later I found that the other women were helping her with this exercise several times a day!

After two weeks of therapy without any changes, I knew the day had come. I couldn't keep her at the hostel forever, and she'd been asking to return home. I've never had to break the news to a patient that they would likely never walk again. Usually in the United States, the doctor does that. He or she will go in with that look on their face, explain all the radiology reports and diagnostic tests, break the news, and then answer any questions the patient will has. Yes, sometimes the physical therapy team has to reiterate the prognosis and help the patient through the various stages of acceptance of their condition, but we aren't usually the ones to make that call. But that is the US, and this is Nigeria.

Charity and I sat down with her aunt who spoke English, our two hospital chaplains, and the Nigerian head of the VVF deparment--Dr. Sunday Lengmang. We explained to her that we had done the best testing we could and concluded that she'd damaged her spinal cord. Because of that spinal injury she would likely never walk again and she would need to have a catheter permanently to drain the urine. Typical to the Nigerian culture, she took the news well, but the chaplains stayed to speak at length with her and pray with her. They also spoke with the family about contributing whatever they could towards to the cost of purchasing a wheelchair. While my heart wanted to just pay for it outright, I knew that it was best to follow the advice of these kindhearted Nigerian chaplains and ask the family to pay whatever they could.

Charity needs a wheelchair long term if she's going to be independent or be able to return to any of her household work. After much checking to find the fair price, I set off for a local medical supply store to find one for her. I stopped at one shop and found a foldable wheelchair with swing-away footrests, but the tires were worn and cracked from sitting in the sun. I left feeling defeated and frustrated. I talked with my neighbor, a missionary occupational therapist who's served here for 13+ years to ask if she knew a place I could buy bicycle tires and inner tubes. She asked one of the Nigerian staff who not only knew a shop that sold bicycle tires, but then went to visit another medical supply shop that had plenty of wheelchairs in stock!

So the next day, my mom (who was in town for a two-week visit) and I walked down to the store. I identified myself as a doctor at the local hospital and asked to see their wheelchairs. After a few minutes, I'd found one I thought would be a good fit for Charity but the salesgirl told me "sorry, that one is spoilt," pointing to the arm rest that was askew. I chuckled, reached over and flipped a level to pop it in, showing her that the armrest is supposed to be like that because it's removable--perfect for Charity since it'll make her transfers a bit easier. Another salesboy came over with a capful of motor oil from the shop's generator and greased up the various hinges and levers for the footrests, brakes, and folding mechanisms.

I paid for the wheelchair, then turned around to find the salesboy a bit confused. He was looking for my car to load the wheelchair in... but we hadn't come in a car. I think he was surprised to see two white people using Nigerian public transportation! He helped us flag down a keke, bargained with the driver to take my mother, me, and the wheelchair directly to the hospital for N300 ($0.84), then helped fold the chair and stuff it in the back seat. 

Back at the hospital, mom and I wheeled the chair back to the hostel and waved at Charity and the group of women who were sitting out on the porch enjoying the sunshine. Mama Esther came over to translate for me as I showed Charity the various features and how to use this new wheelchair safely. She transferred independently (remembering all the safety tips I'd taught her!) into her new chair and wheeled back out to the porch.

Charity's son was napping, but she wanted to make sure he was in the picture too!

She went home with her family later that day after discussions with the nursing staff about how to change the catheter and how to avoid getting bedsores from prolonged immobility. She took the sliding board and gait belt with her so she can continue her home exercise program. Charity knows she is always welcome back at Evangel VVF if any new condition arises, or if her condition spontaneously improves and she needs further physical therapy. But most importantly, she knows that we care about her, that we have done the best we can for her, and that we are committed to helping her get as much independence back as she can.

My motto for ministry here is "Restoring dignity to African women through physical therapy." In Charity's case, I can't do anything to reverse her spinal injury. But, I can do the best neurological screening I can to see if there's any muscles she can use. I can do a thorough sensation screening to identify her risk of skin breakdown. I can get her a quality wheelchair that will last and will help her be up and off the ground. I can teach her how to transfer safely so she doesn't end up with skin tears or get a shoulder overuse injury--and so her husband doesn't hurt himself trying to help her. I can help her keep limber so she is more comfortable and, in case her muscle function returns, she can use all of her joints. I can pray with her (even in English), and get the chaplaincy team involved so they can do home visits to encourage her in the future. I can tell her there's a safe place to get medical care in the future.  I can explain to her as best I can why she's unable to walk so that she doesn't think she's cursed or so her neighbors won't ostracize her.  I can assure her husband there's nothing further to do and tell him it's OK to stop taking her to various traditional healers (who are often expensive). I can help Charity return home where she is comfortable and where her three other children need her. All of those things I can do. And all of those things contribute to her dignity.

I have to do the best I can and leave the rest in God's very capable hands. I have to recognize the limitations of practicing medicine in Nigeria and not compare it to what I learned in school/clinicals. I have to pray for wisdom and patience with myself as I navigate the mission hospital environment. I have to remember to show love through it all.

Please continue to pray for Charity and for her family. 

I want to say a special thank you to each of my financial donors whose gifts not only cover my living expenses but fund a special ministry account for me to use on therapy supplies, assisting patients with medical expenses, and providing equipment for patients like Charity. Thank you for enabling me to help her!

African Tailoring

From an early age, my mom taught me to sew. At first, I had to rip out almost every seam and there were MANY tears involved! Over the years I've come to enjoy sewing and making my own clothes. I like finding fabric on sale (yay Joann and Hobby Lobby coupons!), finding the right pattern, guesstimating how much additional fabric I'd need to lengthen the garment to fit me, and then often stashing the fabric and pattern in the recesses of a closet until we both had a rainy weekend. Then,  Mom and I would carefully lay out the fabric (often on the kitchen table), pin the pattern pieces in the right places, then cut out each piece. Then I'd follow the written directions included in the pattern envelope to put the pieces together to achieve the finished product.

It's different here.

In Nigeria, you go to the section of the main market that sells fabric, choose from the precut 6-yard lengths of fabric... and begin the process of bargaining to get a fair price. You then take the fabric to your tailor along with a picture or drawing of the garment you want. Or if you don't know what you want, you can look through fashion magazines to choose something. It's common to say "I like the sleeves of that picture, but can you make the neckline more like this one? Oh, and can you add embroidery to the hem like this picture?"

Related imageThe fashion magazines are often collections of photos from high class Nigerian weddings where each wedding guest is photographed. The bride usually chooses not only her wedding colors, but particular fabrics in those colors. If you're a real Nigerian friend, then you'll go and purchase that fabric and take it to your tailor to make an outfit to wear to the wedding. You can be as creative as you want! After the wedding, the bride can submit the dozens of photographs to the publishing company and get featured in their quarterly magazine.

A few weeks ago, I received a call from I__, my keke driver. He had just returned from visiting his family in one of the other Nigerian states. A relative had recently started selling locally-dyed wax fabrics, and he wanted to know if I was interested in purchasing some fabric for my parents to have coordinating outfits. Of course! It's not very common to find fabrics dyed/printed here in Nigeria. Most of the nicer quality fabric is actually made in Holland or Ghana.

The second day that my parents were here in Nigeria, I took them to the lady who has made several outfits for me. She measured my parents, showed them various styles of matching dresses and men's trouser & top sets, then took their order. I told her that they wanted to wear their matching outfits for church the next week, and she rushed the order. We went back about a week later to try on the garments and make a few final adjustments.

We went to Hausa church with I__ and his wife. Don't you just love the matchy matchy outfits?

Thursday, June 1, 2017

When in Nigeria...

There are a lot of things that are similar here in Nigeria...

  • Mamas love to show off their babies! I can always walk up to a woman and say hello, then peek around her back to see her baby strapped to her back and make some sort of funny face. I usually get a laugh from both mama and baby!
  • You greet your elders with respect. We don't say "sir" and "ma'am" here, but anyone elder than you is "auntie/uncle" or if they're a generation older they're "mama/oga"
  • I can't get away from US news. I will often catch the 8:30am news brief as I__ takes me to the hospital for work each morning. We listen to the radio announcer read the Nigerian newspaper headlines and is seems that the only global news they cover is about the US! Today I even heard them talking about LeBron James!
  • Everybody has a cell phone. Many are "dumb phones" without data connections, but almost everyone has a cell phone.
  • It's hot and humid here now... a lot like Texas! But the weather is cooler here on the plateau than on the coast in the city of Lagos or in the northern part of Nigeria.
  • It's customary to greet people as you pass them on the street or as you walk by their shop or office. Sometimes the greeting is just called out, but other times you'll stop and chat. 
  • Nigerians tend to talk pretty loudly--a lot like Texans! Sometimes it can seem like two people are yelling, but they're just excited.
  • Everyone has their mama's own version of a family favorite recipe, although here it's not her famous chili,  but instead either "jallof rice," "red stew," or "kunu" (a drink made from corn). And she ain't telling what she puts in it!
...and there are a lot of things that are really different here in Nigeria:

  • Nigerian money doesn't have any coins. (Well, I've heard that there used to be coins, but since inflation and prices skyrocketing, everything is now handled in bills) We have bills for 5, 10, 20, 50, 100, 200, 500, and 1,000 Naira. All the bills are different colors and sizes. Right now the exchange rate is about 350N to the dollar, so you have to carry around a stack of bills if you're going to buy any large purchase. 
  • We don't throw things in the trash without sorting first. I separate my trash into three bins: food scraps, non-burnable trash (tin cans, batteries, etc), and everything else (plastic, paper). I then take it downstairs and either dump it into the cement food pit, the burn barrel, or the other 55gal drum.
  • If you invite guests over, it's a necessity to give them food or at least offer a drink. If you do serve food, you bring it to them to eat and then you may return to the kitchen or another part of the house until they're done. Nigerians don't socialize over meals; meal time is for eating before the food gets cold!
  • There are no fast food restaurants and no drive thrus at restaurants/coffee shops/banks/dry cleaners. (Well we don't even have coffee shops here)
  • There are no traffic lights here. Major intersections have roundabouts / traffic circles, but the smaller intersections have nothing to guide traffic flow. You just look both ways and if it's clear (or you think you're faster than the cross-traffic), you go for it!
  • Water is free here... if you can get it. If you're wealthy, you might have your own bore hole drilled and have a pump to pump the water up to huge tanks stored on your roof or a 2-3 storey scaffold structure nearby. Then the water just flows by gravity into your faucets. If you don't have your own bore hole or it happens to be too shallow, you can carry buckets of water from someone else's house. (We are blessed to have a water line from the very deep bore hole at the SIM headquarters building so we only run out of water when the electricity has been off for days and days so the water pump hasn't been pumping to fill our tanks)
  • There are no lanes of traffic here. Streets either have a cement divider between directions of traffic, or they have nothing at all. Lane striping doesn't exist, nor would drivers pay attention to it even if it did exist! Oh, and U-turns happen anywhere.
  • Electricity doesn't get billed to your home. You have a prepaid meter for each house and it's your responsibility to keep it topped up. Interestingly, the hallway lights and the washing machine I share with the apartment next door are on a different electrical line than my apartment so it's not uncommon to have lights but not be able to do laundry or vise versa.
  • A lot of sinks and toilets are only connected to the sewer line; they don't have a water input line. For this reason, there are often  big buckets of water in the bathroom and you're responsible to use the smaller bucket to flush the toilet and draw out water to wash your hands with. By the way, bring your own toilet paper! (Thankfully I have running water in my bathroom!)
  • Most middle or  lower class people don't own cars. Public transportation is pretty cheap in a keke or a taxi car, and if you need to travel longer distances you can go to a "car park" and find a minivan advertising its destination, pay the fare, and cram in with others going that direction.
  • All women wear a head scarf or head tie to church. This is more than a headband, and often covers the entire head & hair. It's a non-negotiable and you can be denied admittance to the church building if you don't have a head tie--or more often some mama will find you a fabric piece to use!
  • There's no such thing as a cell phone contract. You pay about $1 to get a SIM card registered with the telecom company and then you're all set!
  • To use your cell phone for voice/text or data, you go down to the corner and flag over one of the teenage boys selling "recharge cards." You tell them which telecom company and how much you want to buy, then they hand you little slips of paper with a 16 digit code inside. You call *222*the 16 digit code# and then it applies the monetary amount to your voice/text account for that SIM card. If you want data, then you can either go online to buy whatever data plan you want that's good for 1 day, 7 days, 30 days, a weekend, or nights only for 30 days. You can also enter *229*2*the number of the data plan you want# and buy data that way.
  • Parenting is communal. On days when we run clinic, it's pretty normal for a patient to hand her baby off to another woman when she is called into the exam room. And somehow the mother always seems to know where her baby is, even when the baby was passed off multiple times several hours ago!
  • We don't recycle.  Except for the glass bottles that sodas come in. To buy sodas, you take the empty 30ct crate to the store and then pay about $3 and pick up a full crate. You can mix and match between Coke, orange Fanta, limca (tastes like Mountain Dew), Sprite, and a couple other flavors.
  • Soccer is king! Just today I caught a bit of the game between Mexico and Venezuela while I was at a restaurant for lunch.

Sunday, May 28, 2017

African Flora

I had taken some beautiful pictures of some of the flowering trees when they were in full bloom a few weeks ago... but then I lost my phone and lost all the photos that weren't backed up to cloud storage. Oh wells...

This is a Jacaranda tree. It comes in yellow:
Photo Credit
It comes in purple:
Photo Credit
And it comes in red:

When in full bloom, it looks like this:
Photo Credit

This is a Frangipani tree, also called a Plumeria.

They come in many colors:
Photo Credit

Credit: Richard Snyder

On one side of my compound, we have a whole wall of bougainvillea. Purple, dark pink, and red--I love it!

And then there's this lovely cactus-y thing that if  you let it grow can become a whole tree! We have this pot on our "front porch"