Thursday, November 16, 2017

Girls will be girls...

Sometimes I get tired of doing the same thing in the physical therapy clinic. But 75% of my patients have the same diagnosis (stress urinary incontinence), and the remaining 25% have one or more of a handful of diagnoses (urge urinary incontinence, fecal incontinence or seepage, urinary retention, urethral leaking, obstetric-caused foot drop, and leg weakness). I will usually get 1-5 visits with each woman, so it feels like I'm constantly starting over.

But this week was different...

One of my current patients, let's call her Fatima, is just a teenager. Following a stillbirth a few months, she developed significant foot drop as well as urinary incontinence. We are grateful that she doesn't have a fistula that requires surgical intervention, but her pelvic muscles are too weak to provide any assistance to the bladder and the urethral sphincter. The prolonged pressure on the nerves in her pelvis during the prolonged labor are the nerves that control the muscles in her legs, especially the muscle on the front of the shin that pulls the toes up. Now she must hike up her hip and really bend her knee to move that leg forward as she walks or else she'll drag her toes and trip.

I have limited diagnostic tools and treatment options. And even if more sophisticated treatments like biofeedback, internal electrical stimulation, AFOs (ankle-foot-orthoses), and neuromuscular re-education were available, I'd spend so long explaining it to the patient in order to 1) allow us to try it and not be afraid of it or 2) understand what she's supposed to do in coordination with the machine. So I use my own hands, a limited supply of Theraband, a pillow, a set of stairs, a plastic chair, and a exercise ball... and D__, a very patient nurse aide who interprets for me and is learning how to be a PT tech.

But some days you just gotta get out of the small PT room (12' x 15') and get moving! And if you're in Nigeria, you can't move without music! There's an open area just outside the door to the clinic that's usually full of plastic chairs where women wait to be seen in our Tuesday medical clinic. I decided to move our session out there so we could have more room.
The fabric panels on the right hide the floor-to-ceiling wooden shelves that are full of unsorted patient files from the early years of the VVF Center. Can you say dusty!!! I use the whiteboard to draw out exercises for patients as well as when I'm teaching D__. The treatment table was custom-built this past summer with a donation from the PT Assistant class at Northeast Texas Community College where I used to guest lecture. It's the perfect height for me... but my patients have to use the steps to get up there!

The PT clinic is down the hallway where that glass door is.

For the last week we've been working on weight shifting, single leg balance, normalizing the length of her steps as she walked, and entire leg strength on the affected side. Yesterday, we decided to incorporate all of those activities into a sort of therapeutic dance. D__ and I would slowly do each step and Fatima would mirror us as best as she could. After struggling with balance, I held out my hands so she could use me for balance. She was shy, but then both hands appeared from the folds of her hijab and she placed her palms in my hands and we began to dance.

I thumbed through my phone to an album of Nigerian worship music and hit play. As the music drifted down the hall to the rest of Evangel VVF Center, some of our youngest patients come to say hello. These three little girls are either awaiting surgery or recovering from surgeries to correct urinary problems they've had since birth. Usually, this is the result of a duplicated ureter that implanted into the vagina into the bladder so the urine produced by the kidney just flows out without any control. Other times, female genital cutting can damage the urethra and bladder, and still others have abnormal urinary systems due to birth defects like spina bifida and epispadius. 


One of our more adventurous young patients (the girl on the right in the red and black dress) marched right in and sat down on one of the wooden benches lining the hallway, the other two peeked around the corner until I invited them to join in the dancing with "ku zo" (you (plural) come). We all held hands, formed a circle, and mostly just swayed and step-tapped side to side. Occasionally D__ or I would call out "ki juya" (turn) or "yanzu, ki sa ƙafarki a baya" (now, put your foot behind) to mix things up a bit. I'm not sure Fatima understood my Hausa, but at least she could follow my demonstration.

As I stepped back to allow D__ a chance to work with Fatima, I was excited to see her putting weight evenly on both legs, better awareness of her problematic foot so she could do a grapevine step, and how hard she was trying to get up on her tippy-toes. But my heart was thrilled to see the smile on her face as she danced and had an opportunity to just be a teenager again. 

Girls all over the world love to dance. What a blessing it is to help Fatima get moving again. But please pray that each of these sweet girls will meet the Savior so that one day we'll hold hands and dance together again in heaven!
D__ in the middle and Fatima on the far right
_____________________________________________________

I didn't catch any photos of us dancing, but I happened to catch this adorable picture of one girl "backing her baby." She even leaned over at the waist, placed the water bottle on her back, and reached around with the scarf to tie the "baby" on her back. When it slipped out, one of the other girls helped her tie Baby more securely. I'm reminded that young girls will mimic what they see their mothers doing. In the US, I've seen girls swaddle a pinecone in their jacket, pretend to feed it, and even "shush" me because I'm being too loud and "baby is sleeping." Here in Nigeria, a water bottle and a borrowed scarf help this young girl practice her Mommy-skills. Too precious!








Monday, November 13, 2017

What I've learned so far


In the eight months I've lived here, I've discovered a lot of things about Nigeria.
  1. When traffic comes to a standstill because of a car, it's not that the car broke down but that the car "has spoilt."
  2. Cilantro is called "coriander leaf." This makes so much more sense!
  3. It is perfectly acceptable to park alongside the road, even when it blocks a lane of traffic.
  4. It is acceptable to slow down in the right hand lane, pause, roll down your window, and buy phone credit/airtime from the boys selling it at nearly every major intersection.
  5. It is also acceptable for a driver to pause alongside a roadside vegetable stall, lean over the passenger seat and yell out the window to do their produce shopping.
  6. "I added a bit to the up because you're a bit like this (gestures by spreading out the hands)" means "I added some fabric to the top of your skirt because you're tall."
  7. While there's no fresh milk to be found, and boxed milk is expensive, there is a plethora of brands of powdered milk. Pick your brand and milkfat % carefully--some dissolve well in coffee/tea and other brands are suitable only for making homemade yogurt.
  8. Living in an agricultural country means that produce is pretty cheap... but it's also seasonal and spoils quickly.
  9. Think twice about killing that cockroach with Raid. The chemical smell lingers for days.
  10. I'm not sure why a package of 100 serviettes/paper napkins is $0.22 and a roll of 100 sheets of paper towels is $1.
  11. The first thing you do after waking up is to see if your ceiling fan is on. If it is, you can linger a bit before getting up and putting on the electric kettle for coffee. If the power's out, you'd better get up now and get the stovetop kettle going.
  12. There's an art to getting in and out of bed without lifting the mosquito net up too high or opening it for too long. Those little insects are amazing at getting inside and bothering you all night!
  13. If the power's on, do laundry. Who knows when it'll go off again.
  14. This time of year, even though it's still warm outside and you'd prefer to have the windows open to get a breeze, keep them closed. You might as well close the curtains too. Otherwise the fine dust will get all over everything in your house.
  15. Be prepared to greet everyone you meet, especially the compound guards and those you see every morning.
  16. There's something wonderful about Nigerian-made peanut butter. 
  17. Said peanut butter makes amazing peanut butter cookies.
  18. Drink a liter of water before and after a workout. You'll sweat it all out anyway.
  19. Don't drink coffee on Sunday mornings before church. It'll make sitting through a 2.5+ hour service really difficult!
  20. Don't underestimate how much money you'll need when you go shopping at one of the three grocery stores--if something is in stock, buy it now!
  21. Hoard the small bills--taxi and keke drivers rarely have change and can get annoyed by having to rifle through to give you change.
  22. Be prepared to wake up early and go to bed early. The traffic sounds will wake you up anyway.
  23. Appreciate the lingering after a meeting, visitors in your office, and stopping to chat with people along the road. There's no need to rush.
  24. When someone says that a program or event will start "by 9am," it really means "at 9am." Don't come early.
  25. When greeting a Nigerian in English, they will still use Hausa grammar and sentence structure. Whether you say "Yaya aiki" or "How is the work?" you'll should still respond with "Mun gode Allah" or "We thank God."
  26. Keep a wrap skirt nearby for when visitors show up at your house or you have to step outside for a minute. Wearing shorts outside is never appropriate.
  27. There are traffic rules, but very few know them and no one follows them. When stopped at a roundabout waiting to enter the circle, be prepared for cars or kekes coming up on either side of you trying to enter first.
  28. There's no such thing as jay-walking here and the few pedestrian overhead bridges aren't used. Just look both ways and run across.
  29. Roadside stalls sell cheap food (lunch and a drink for less than $1 sometimes). But be sure it's a place that someone you trust has recommended... gastrointestinal bugs are really annoying.
  30. When you feel ill, be sure to keep any eye on your temperature. Malaria should always be in the top 3 differential diagnoses.
  31. When people say that Jos is the nicest place in Nigeria, they're not joking! At least, weather-wise.
  32. You'll find misspellings, wrong word choice, and missing punctuation everywhere... even in official programs, menus, billboards, and businesses' signs.
  33. Everyone has a title. Some have two or three. I would be Miss Doctor Kate... and my pastor is Reverend Doctor Jeremiah.
  34. Protocol is important. If you're invited to speak at an event, make sure to acknowledge and greet all officials and dignitaries... or at least say, "I wish to stand on existing protocol..."
  35. Most streets have no name and very few have signs. You give directions to your house by saying which roundabout you live closest to and many businesses' addresses will be "such and such business name across from such and such well-known building."
  36. When someone says they'll "flash you" they mean that they'll call your number so you'll have it in your phone.
  37. Never underestimate the power of sending someone a .gif with some saying superimposed over a random photo of flowers, animals, or tourist attraction. This morning I received a .gif via WhatsApp from a Nigerian friend of mine: "Hot coffee. With you. Very Good Morning" overlaying a photo of a coffee cup and roses spinning.
  38. Only buy at the market what you can carry home.
  39. When flagging down a taxi, point in the direction you want to go at the next junction. Then if they're heading that direction, they'll slow down enough for you to call out your destination. If they want to take you there, they'll stop and let you get in.
  40. When shopping with other people, the shop owner can expect you to make change for each other if he doesn't have exact change.
  41. Anti-perspirant deodorant is a joke. Just take a shower every day and sweat like the rest of us.
  42. Learn to breathe through your mouth when driving through the meat market.
  43. Be sure to tell the schwarma or suya shops "Ba peppe" (no pepper), or else they'll douse your food with spicy Nigerian dried pepper. 
  44. "I wasn't feeling fine" is an appropriate reason for any absence.
  45. If you want to give something to a street child, either give them money or buy them something from a vendor's cart. Handing them candy from your purse can be bad since some would say you've cursed the candy.
  46. When looking for something in specific, expect to go to a lot of different shops. Or be willing to pay a bit extra at the first shop for them to send their shopboy around to find it for you.
  47. When bargaining, sometimes you don't have to say anything. Just keep quiet or have a surprised look on your face and they may start dropping the price anyway.
  48. When someone says the price is "one one hundred" it means the price is one hundred naira for each item, not 1,100 for all. The same goes for "two two fifty" which can mean 250 for one, or fifty for each of the two items.
  49. "NEPA has gone" means "the power's off"
  50. Church activities are a very important part of life. Similar to old-school tent revivals in the US which were conducted each evening for a week, there will be events every evening at the Nigerian church leading up to an anniversary service, youth week, or prayer service.
and....

     51. Nigerians are generally friendly, welcoming, and kind. Despite the culture shock, it's really a wonderful place to live.

Monday, November 6, 2017

Girls' Transition House Dedication


A few weeks ago I had the chance to attend the dedication of the new building for the Girls' Transition Home. This is the ministry that two of the girls at my compound are directly involved with and I'd been hearing about preparations for the dedication for weeks!

Last year when Dad and I were visiting Nigeria and I was still in the application process to come and serve with SIM, we were able to visit the old Girls' Transition House and meet the girls. I knew that I wouldn't recognize all of them again or remember their names, but I was excited to see them again.

When we arrived, one of the girls showed us around the new building. It's divided into two long halls, one for the girls in middle school and one for the girls in high school, with six rooms in each hall. The girls live four to a room, which they like so that their friends and sisters are nearby. There's also a common room in each hall for discipleship groups to meet or for girls to hang out, and a small study room. In the future, the ministry would like to build an additional building as a vocational training room to teach the girls skills like sewing, baking, and hair dressing.

Outside, the place is surrounded by a wall of cement blocks to keep out stray animals, and beyond the wall there is plenty of land for farming. The girls were out there earlier this summer to plant maize and various fruit trees and already they're getting some of the harvest!

Once the tour was finished, we gathered in chairs under awnings set up in the courtyard.





Shortly, the program began. Several groups gave special numbers: the choir from the local church where the girls attend sang two beautiful songs about God's faithfulness, two girls read self-written poems, and then the girls all gathered to sing the Kristyn and Keith Getty song "By Faith." You can watch the video and hear for yourself (sorry for the background noise--the wind was really blowing that day!)



Afterwards, several people gave short messages of blessing and admonition to the girls, including the local church council leader, the president of our church denomination's wife, and SIM and Nigerian leaders of this ministry, and even the tribal leader of the surrounding community. You could really sense that this project has God's blessing and that the community is welcoming to these girls.
Jess ended up sitting with some of the girls during the program. They've really taken a shine to her!

True to Nigerian fashion, after the ceremony, we were all taken inside for a meal of fried rice and a piece of chicken along with a soda. With all the people to feed, I'm sure it took an army to cook that much food!

Then, as we were driving the forty-ish minutes back to Jos, we saw the girls carrying the plastic chairs they'd borrowed back to the church so they'd be ready for Sunday morning service the next day. Carrying a stack of chairs isn't as hard when you can carry them on your head!


Honestly, this land and the money to build the Girls' Transition Home was such a huge blessing! Finding the right piece of land took several years and during that time, a lady was generous enough to allow the 16 or so older girls to stay in her vacant home for free. Now that the permanent center has been built, the younger girls have graduated from the mixed-gender care center closer to town and have moved in to the older girls' house. There is now room for over forty girls!

That means there are a lot of school uniforms to buy at the beginning of each school year, that's a lot of rice and yams and vegetables to buy for their meals each day, and that's a lot of young hearts to care for. Pray with us that God will continue to bring in the finances and also bring a couple to serve as live-in house parents.

To  read more about the building of this wonderful home, click here: GOD'S GREAT MIRACLE AT GTH

You can give directly to fund the remaining building projects as well as the ongoing ministry at Girls' Transition Home by clicking here: DONATE HERE

Thursday, October 12, 2017

Greetings and morning routines...

I'm starting to get a morning routine. On the days I go to the hospital, the same keke driver picks me up at the same time. I come out of my compound to find his keke parked by the side of the road and he's usually just around the corner eating breakfast from the little stall under the tree where the college-aged girl fries up yam and kosai for the morning customers.

Photo credit
When we arrive to the hospital gate, the guards let us in without a question (kekes are not usually allowed into the hospital compound) and always greet me with,"Sannu likita! Ina kwana?" (Good morning doctor(fem)! How was your night?"

When I walk up the steps of the VVF Center, I call out greetings to the women and children sitting there. They're usually doing laundry, eating breakfast, caring for their babies, or just enjoying being outside.

Photo Credit: Dr. Steven Shephard
Then I greet whichever nurse or aide is sitting at the table in the foyer (usually admitting patients to the VVF ward, answering questions, or looking for patient cards), poke my head into the nurses' office and greet anyone there, wave and call out "Sannuku!" (Hello all) as I walk by the VVF ward, and then see if any of the surgeons are in their offices to greet them.

Photo credit: SIM archives
Photo credit: SIM archives
Once all of that is completed, it's about 9:15am and I'm ready to join the doctors for rounds of the VVF ward, assist as a clerk in the Tuesday VVF clinic, or see my caseload of patients.

Greetings are a big deal here. It's super offensive to ignore a greeting and many times someone has had to tell me, "Kate, she/he is greeting you." Ooops, sometimes I just didn't hear it!

At the end of the day, I make my way around the VVF center saying goodbye. The proper response is usually something like, "Sai gobe?" (see you tomorrow?) or "Sai an jima, ki huta gajiya" (see you later, go and rest your tiredness.) I answer with, "Yaowa, sai gobe. Allah ya kai mu." (OK, see you tomorrow. God take us.) And as they call out with the proper "Amin" (Amen), I'm out the door.

Then something unusual happened this afternoon. Maina* (you've heard about her from my newsletters, name changed) had returned to the center, bringing about 15 women with her who had some sort of urinary incontinence or fistula problem. When I came down the steps after work, she saw me and called out, "Sannu likita!" and came over to give me a hug. After exchanging a few greetings, she told me an entire paragraph in Hausa that I didn't catch....

So I greeted her again and then turned to greet the other women sitting on the steps. One of the ladies had a very young infant with her, so I went to go and take a closer look. As I reached out to touch his tiny hand I heard Maina laugh. I looked up to hear her saw, "Likita, ki son yaran!" (Doctor(fem), you like children!) Maina has seen me enough times to know that if there is a cute little African baby anywhere in the room, I must go over and say hello. She also knows I will greet the mother and immediately peer around her back to greet her child she's carrying on her back. I replied in Hausa that I like children, but I don't have any--and they all laughed (whether at me and my poor Hausa or the content of my statement, I don't know!).

Then they all proceeded to gather around me and someone pulled out a phone and started taking photos of me. The concept of the selfie has made it here to Nigeria and young Nigerians like to take all sorts of posed photos of themselves, but these women seemed to prefer just having a photo of a westerner in their flip phones. So of course, I had to pull out my camera and show them how a group selfie is done...



So with their friendly laughter in my ears I turned and walked back to the gate to flag down a keke to take me home. It's nice to know that when I return tomorrow they'll be waiting for me again with a fresh set of Hausa greetings... because you never if the state of  someone's family and house and husband and children and on and on and on may have changed overnight!

Thursday, August 17, 2017

When you go hiking, bring your camera, water, rain jacket.... and an inner tube?

A few weeks ago, all of us single missionaries were invited to go a hike with two of the missionary families. Now that the heat has past and we're in the middle of rainy season, I knew it would a be gorgeous hike--but I wasn't prepared for just how green it was!

We drove about an hour out from town, past the retreat center where I went for the big missionary Easter weekend get together, and turned off onto a dirt path. I wasn't sure our two Toyota Siennas (one of which had been purchased just a few weeks ago) would make it, especially when we drove across a spillway in water at least a foot deep. But I'm learning that both missionary and Nigerian drivers take their cars to the limits here (Dad, I promise that I'll never drive through water too deep nor take my car on roads where we're tipped 30 degrees or more!)

We piled out of the cars, grabbed our water bottles and cameras, and took off after our leader who has very long legs and sets a good pace!

We were following the path of an aqueduct that carries water from three reservoir lakes about three miles to the edge of the plateau and then dumps it straight down! Along the way, there is a small hydroelectric dam that supplies power to some of the larger industries in town. I've been told that even in dry season, the aqueduct is full of water.




We walked and walked, snapping photos along the way. When we got to the first aqueduct bridge two of the guys decided to walk/run across it on the metal spans.
Here he contemplates it...

He starts by walking on the metal edging...

Then decides to just go for it!


So of course, when we got to the second bridge one of the girls had to try it!

As we kept hiking, it started to drizzle. That's the thing about rainy season--you never know when it's going to rain or for how long! Thankfully, I had brought along my rain jacket, but it was so humid that I just took it off and got wet along with the others!

After about a mile of following the aqueduct through the brush, we started to hear a waterfall.




It got louder and louder until...



Yes, that is water dumping off the edge of the plateau into the Kaduna River. Doesn't it look like the perfect place to take an inner tube and go down like a water slide?

Seriously... you have to hear how loud it was!


We hiked a bit further down to this huge pipe (I think it's a 3' diameter) that carries water down to the turbines at the bottom. The water channel we'd passed is just for the overflow when the water is too high to all flow through this pipe. Some of us decided to walk down the pipe and others to walk alongside the pipe to a place about halfway down where we stopped to take in the view.


Me, three of the other single missionaries and the two moms. We were missing the two guys, the dads, and one of their daughters. 
J__ has become one of my best friends here. She's always up for a random adventure or a quiet night in with dinner and a movie.

 Isn't the view of the Kaduna River gorgeous!


This is also the border between Plateau State (my state) and Kaduna State.


From where we stopped to take photos, the pipe angle changes from about 35 degrees to nearly 60 degrees and became impossible to navigate so we turned back and retraced our steps back to the last reservoir.
The view back up to the top
On our way back, we went by the reservoir.



Aren't I blessed to live in a place this beautiful!

So, all in all the hike was only about three miles, but the path was overgrown in parts and super slippery in others! From satellite photos, it's possible to see the incredible difference between rainy and dry season! The yellow/red line is the path of the aqueduct that we followed from the reservoir to the pipe.
Satellite photo taken in May

Satellite photo taken in January
I'm gonna have to go back here with a group during dry season. I've heard that you can follow the pipe all the way down to the river and then walk back up the dry riverbed, but it's a 5-8hr hike!  I usually dislike fast and steep roller coasters, water slides, and other asundry adrenaline-pumping things of that sort... but when I go back, I just might bring my inner tube. (Just don't tell my missionary insurance company--or my parents!)