Wednesday, May 9, 2018

The right time...

The Nigerian concept of time is quite different than our own in the States. This picture, while originally meant for South Africa, is still true in Nigeria:


Anyway, God's timing is completely different than our timing. And I've never seen it more true than in something that happened last week.

Tabitha* (name changed) is from a village a few hours away, she has no formal schooling and speaks only her tribal language of Tarok. Tarok is only spoken in this state of Nigeria and as of 1998, fewer than 300,000 people speak it. According to some reports, it's a language that's on the edge of extinction. But for Tabitha, it's the only language she knows. She's the first woman I've met in the year I've been here for whom Tarok is her first language. Needless to say, we don't have a staff member who can translate for her.

She came about two months ago and although we found she didn't have a fistula requiring surgery, she did have significant passive leakage from the urethra and very poor pelvic muscle awareness/strength/endurance--she was a perfect candidate to see me in the pelvic physiotherapy clinic. The next day, she came to see me with her husband. We told the husband in Hausa what his wife should expect during the exam and what we'd ask her to do, then he translated for her and stepped out. My assistant and I stumbled through the exam, but I didn't really get good information because she wasn't able to understand our visual cues. Later, we called the husband back in and told him that I thought she could benefit from therapy and that we'd be happy to see Tabitha for about two weeks. They weren't expecting to stay that long and I could sense that they weren't happy about that. So I suggested they go home and come back when she was ready to stay for 2-3 weeks and to bring a woman who could speak Tarok/Hausa or Tarok/English who could translate for Tabitha. I tried to explain that Tabitha needed to understand her exercises in order to do them properly and that someone would need to be in the room with us during the PT sessions. Her husband, like most male relatives who accompany our patients, feel uncomfortable being present for any female medical exam/consultation.

So away she went. Then, two weeks ago, she comes back to see us for a Tuesday clinic. And there's no female relative with her, only her husband. We ask the husband if he is willing to stay for two weeks and if he can accompany her to each therapy session. He mumbled something and turned away, then Tabitha started to cry. We couldn't figure out what she was saying through her tears, and the husband didn't interpret for her. I was starting to get kind of frustrated because I wanted to help Tabitha and I really didn't want her to be discouraged and go to some traditional healer or try some expensive medication that I knew wouldn't work/might harm her. I wanted to help, but because of the language barrier, she was as trapped as I was.

About this time, a woman we'd seen a few patients earlier in the clinic poked her head in to confirm that the medications she'd picked up at the pharmacy were the right ones. Then she turned to Tabitha and said something that I couldn't understand. Tabitha lifted her face and stopped crying. Then the woman told us, "You know, I can speak for her. I understand Tarok."

Here's where the story gets really cool. Rose (her real name) has been a longstanding patient in the VVF ward. Her patient number has only three digits and right now we're up into the 3,700s! She's had several surgeries, but we've never been able to get her dry. She showed up in early April complaining of leaking stool and urine, and since she isn't a candidate for any future surgeries except for a radical diverting of her kidneys, she was sent to me to "see what I could do for her." (Oh I really love those kinds of referrals...)

Rose was very discouraged the first day she came to see me. She wouldn't look me in the eye, cried during most of the session, and I couldn't seem to get any straight answers out of her about her medical history. Finally, I gave up and because she speaks decent English, I just started asking about her life, her faith, and her community back home. We talked about God's promises that one day we will have new bodies and we will be with Jesus in a place where there is no more pain and suffering. We talked about how she can pray for good sleep every night and in Jesus' name rebuke the demonic influences she perceives in her dreams. We talked about how God has a purpose for her life and that she is not worthless, like some in her village have said. Ladi (the clerk who translates for me now) and I even shared how, although neither of us is married nor do we have children, we have purpose and we can do something productive with our time. And we just prayed for peace and comfort as she planned to stay at the hostel for a few weeks while attending physical therapy.

So fast forward about two weeks to the day that Rose came to see us in clinic to get a medication refill and bumps into Tabitha. Rose offered to stay as long as Tabitha needed, and that she would make sure that Tabitha came at the right time for therapy three mornings a week. I was a bit skeptical of using another patient to translate, especially when we're talking about abstract topics and working on muscle awareness and proprioception, but I didn't have any other option.

So I would tell Rose in English what I wanted Tabitha to do, she would translate, then Tabitha would do as I'd asked or ask a clarifying question back to Rose. When Rose didn't understand my English, Ladi would repeat my instructions in Hausa. It took a bit longer than a normal initial patient session, but by the end of it, Tabitha understood her home exercise program, I had good history and exam information, and I think even Rose understood her own problem and treatment plan better since her condition is somewhat similar to Tabitha's.

Both women have seen improvement in the last few weeks, and I've seen a huge change in both of their demeanors. Tabitha now smiles at me and tests out her Hausa greetings she's learned. Rose comes to greet me when I arrive in the keke each morning and we laugh as I ask the traditional greetings: "Yaya yau?" (how is today?), then "Yaya cikinki?" (how is your body?), and then our own special greeting, "Yaya zuciyarki?" (how is your heart?)

On Monday, Tabitha told me she is dry, and had been for three days. The things that used to elicit involuntary urine leakage no longer bother her, and she was doing all of her exercises as I'd told her. Her face was all smiles and we said together, "Sai godiya!" (praise God!) But when I told her that she could go home, her face fell. She told us, through Rose, that she wanted to stay until Rose was well so they could both go home together; she didn't want to leave her auntie. Rose encouraged her to go home and to reunite with her family, and to just trust God that He would bring her own healing in His timing. Then, just like I'd prayed for Rose that morning, I asked if Rose would pray for Tabitha in Tarok so that she would understand.

I wish you guys could have been flies on the wall in the clinic. What a sweet picture to see a patient praying for another, asking God for safe return journey, good reunion with family, continued health and provision for the future, and beseeching Him to bring her own body healing.

Today when I went to work, Tabitha was still around. Rose tells me that she's waiting for her family to send money for her return journey, and that she plans to go and greet Tabitha's family once she is healed herself. As Rose and I met for her therapy today and I thought quite hard to figure out why she's still leaking despite much improved pelvic musculature and a new medication regimen, we prayed again for God to heal her in His timing.

But regardless if God decides to heal Rose's body (whether through medical intervention or through divine healing) or not, He has already healed her heart and restored her joy. And He has brought her to us just in time so that she could play a role in the healing of a village girl who only speaks Tarok.

Me, Rose, Tabitha, and Auntie Ladi

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!"
                           "What?!?!"
"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.