Monday, August 29, 2016

Vision Trip #3: Danja, Niger

 To read about the first part of my trip in Nigeria, click here.
To read about the second part of my trip in Galmi, Niger, click here.

After eating yummy cinnamon buns on Wednesday morning, we loaded up into the car, strapped our bags on top, and drove about three hours to the SIM hospital in Danja, Niger.
Praying with some of the Galmi staff before we left
All packed up and ready to go!





We passed through the town of Maradi on our way to Danja. Maradi is the local government center (similar to a state capital), and it has a small airport that appears to only be used for private or chartered planes. Maradi is only about 20 miles north of the Nigeria border, so a lot of trade goes through Maradi.

This guy is the African version of the milk man. His motorcycle-cart carries big plastic sacks of little 500ml water bags
One of the used clothing markets in Maradi

This shop sells pre-made hijabs in various colors and lengths
It's very common to see rows and rows of cement cinder blocks curing in the sun. Much of the construction in Maradi is done with cement

The main drive into the Danja compound


The hospital has both a fistula center and a designated leprosy center
After settling in, one of the missionary families took Dad and I on a walk through the fields surrounding the hospital. The SIM property is quite extensive, so much of it is farmed by locals, similar to sharecropping. The original idea was to bird-watch, but our friends also pointed out some interesting plants and trees along the way.



On Thursday morning, we started off the morning by joining in with staff devotions in the Danja Fistula Center. It was in Hausa, and then the director gave some announcements in French, but one of the nursing staff kindly translated for us!
The beautiful chapel building
Afterwards, we had a tour of the fistula center and of the rest of the hospital.
The ward can have up to 80 women at a time! Right now it was empty, as the women had graduated to the village.
Like many mission or NGO hospitals, there's a focus on maternal and infant care. Here, the infant clinic will distribute "Plumpy Nut" to infants and children who are severely malnourished. It requires no mixing and is shelf-stable; all the mama has to do is tear off a corner of the packaging and the paste can be squeezed out, perhaps by the child himself while he is on his mama's back. Plumpy Nut is made out of peanuts and fortified with other nutrients.

After our hospital tour, the director's wife took us to the fistula village out back. Here, the women will live for about three months while learning to do embroidery and knitting, some basic school lessons, and have the opportunity to partake in a 3x/wk exercise class. The ladies were gracious to show us the embroidered baby wrappers (fabric lengths about 2m long used to tie babies onto a mama's back) they were making to sell. Gina, the missionary psychologist also spends time with these women sharing Bible stories and doing group counselling/trauma support.


Me, Nancy (director's wife), and Gina (psychologist) holding a tool used for community education regarding fistula and obstructed childbirth. The fabric flipchart uses simple to understand graphics and written descriptions in Hausa, Fulani, and French.
I was able to sit in on the group exercise class that Esther runs. Esther is a Nigerien nurse who received some therapy training from the missionary PT who was just there, and she helps out the Nigerien PT who is over in the hospital. The women have a program focused on core and leg strengthening, and many of them knew it entirely by heart! I was encouraged to see exercises like bridges, heel raises, clamshells, and quadruped leg extensions.
Heel raises and standing hamstring curls
Esther (standing in the blue shirt) supervising ladies doing sidelying clamshells

I think I just introduced some of the women to their first selfie! 
In the afternoon, Dad and I had some time to rest at the beautiful guesthouse. We brought our plastic chairs out into the breezeway and enjoyed a cup of tea. We also watched the butterflies and the neighbor's chicken scratching in the guesthouse courtyard.



I might have made friends with the pet cat. She belongs to the missionary PT who is on home assignment now, so Gina's taking care of her and all the missionary families feed her scraps. She went by "Ugly Kitty" and I never found out her real name!
Our rooms were small, but clean. I had an air conditioner unit AND a ceiling fan! This was also the first time the entire trip that we used mosquito nets, praise God!
Each room had a small quilt handmade by a quilter's guild in Australiahow cool!

On Friday, we were able to meet Dr. Intengre, the fistula surgeon. The center is just a few years old and was funded largely by Worldwide Fistula Fund, so there is a lot of potential there! I returned to the exercise class, and this time Esther asked me to show some more exercises. I decided it was easier to advance some of the exercises they were already used to doing than to teach new ones, especially because my knowledge of French matched Esther's knowledge of English!

We ate lunch with the director at the hospital canteen. You never know what's going to be on the menu for the day. We were blessed to have "rice and sauce" and a soda for about $2/person. The sauce was made from moringa leaf (a vitamin & mineral-rich plant that's grown in West Africa) and seemed to be mixed with tomato, but I didn't ask. Like Dad says, "if it was good, don't ask what it was!"

In the afternoon, I went out to the fistula village with Gina as she used Bible flipcharts to tell the story of creation, how sin entered the world, and why Jesus' death erased the punishment for our sin. She'd told pieces of the story before, so some of the women volunteered here and there to help her re-tell it. I sat on the ground with the other women under their tin shelter and when I pulled out my own knitting project, I think I made about 20 new friends!

I also spent some time with Samalia, the PT who treats all the leprosy, surgical, and orthopedic cases. He is a recent graduate of a PT program in Niger, and he had lots of questions to ask me. I wrote down a few exercise suggestions to better help him treat low back pain (it seems like that's a tough diagnosis for any new PT around the world!) and worked with Esther to develop an advanced set of exercises for her class. I decided to draw the exercises out with stick people so she wouldn't have to try to translate my written descriptionwe both laughed at my horrible drawing skills.
I think every clinic has a stash of walkers and mobility devices!
Samalia and I talked through appropriate use of modalities like heat/ice/diathermy (I'd never actually seen a diathermy unit before!), then he and Esther helped me start a list of helpful words and phrases in English, Hausa, and French. We exchanged email addresses and I look forward to corresponding with him as he grows in his clinical skills and I learn how to treat conditions far more advanced than usually seen in America.

On Saturday, we had a few hours to enjoy a cup of tea and both Dad and I to finish our books, then it was time to drive to the airport in Maradi. We met Ian again and loaded up for an hour-long ride to Galmi. There we picked up another passenger, and then flew back to Niamey.

The Maradi airport
The view of Maradi from a couple hundred feet up
The view of the main road leading South to the Nigerian border
Pretty African fields from about 3,000 ft up
This is what African villages look like from 8,000 ft up
We were taken to the home of the SIM Niger Director. We chatted for a few hours, then they took us out to a lovely restaurant for dinner. We got back to their home about 930pm and Dad and I had to be up at midnight! Our taxi driver came for us at 1230am and took us to the airport in time for our 3am flight.

We took quite a circuitous route back homewe went through Casblanca, Morocco; Madrid, Spain; and Miami, Florida! During our layover in Madrid we found a Starbucks and a duty free shop selling Kinder Eggs!
If I fly through an airport in a country I've never been to before, does that count as visiting ?
Venti iced caramel macchiato please! (Decaf, so I can get some sleep on this next 8 hour flight!)
If you don't know the magic that is Kinder, you are seriously missing out! Too bad they're illegal in the US due to the small parts being a choking hazard!
We arrived home on Sunday, the same day we left Nigertime zones are weird thingsand Mom met us at the airport with chocolate and a few of our favorite foods!

All in all, Dad and I had a great trip and enjoyed meeting everyone, seeing the facilities, and hearing about the work God is doing through SIM in Niger and Nigeria.

I remember Dad asking me one day as we were sitting at the Danja guesthouse drinking tea, "So, do you know where you're going to go?" I told him my thoughts, and he agreed with me. God couldn't have been more clear! So, where am I going? Well, you'll just have to wait and read the next post!

Sunday, August 21, 2016

Vision Trip #2: Galmi, Niger

To read about the first part of my trip, click here.

After leaving on Jos, Nigeria, our next stop was Galmi, Niger! We flew through Togo and Burkina Faso on the way to Niger's capital city of Niamey where we stayed overnight at the SIM guesthouse. One of my friends from college has an older sister who is a missionary in Niger with her family, so we were able to reconnect with them and have dinner at their home.
Getting ready to board the ASKY plane in Abuja, Nigeria
The brand new terminal in Lomé, Togo. It's so different than when we were last here in 2011!
The next day (Saturday) was rainy, but it turned out to be a perfect day for flying! Ian, the SIMAir pilot took us back to the airport where he filed his flight plan, then we went out to the SIMAir hangar. Instead of driving 7 hours to Galmi, took a 2.5 hr ride in a 4-seater plane from the Niamey airport directly to the dirt runway at the SIM hospital! I enjoyed looking out the window and taking photos while Dad had fun talking on the headset with Ian, our pilot.
That's the ASKY plane we came in on the night before!

"...Mike Romeo cleared for takeoff"
N-1, the only main East-West road in Niger
It's "rainy season" now, so everything is green!



I shot this 7-minute video of our final descent and landing at Galmi. At the 3:50 minute mark you can see the entire hospital and town laid out along the N-1 road.

We were met by a welcoming committee of missionaries, their children, and a few "missionary dogs!" SIMAir regularly flies in and out of Galmi bringing supplies, mail, and short term missionaries, so everyone looks forward to watching the plane come in!

Saturday afternoon we had lunch with Deb and her husband James, and then met Heidi, the pilot's daughter who is interested in pursuing therapy after highschool and had come to shadow Deb for a few days. I had met Deb at the Global Missions Health Conference last November, so it was fun to see her again! She took us on a tour of the whole hospital and then showed us the therapy clinic. I loved seeing the anatomy charts, stationary bike, gym balls, and the closet full of pediatric therapy toys that are found in any therapy clinic around the world!
A few of the nurses
The front gate of the hospital
I've seen some creative ways of storing therapy balls before, but I think using basketball hoops is the best one yet!
I think every occupational therapist has a fun closet of goodies like bubbles, puzzles, and toy cars!
"Le squelette humain" (the human skeleton) chart

When Deb arrived a few years ago, she was given this notebook as she was the first therapist at Galmi in almost 30 years! This notebook contains locations of therapy supplies, suggestions for making adaptive equipment, and names of hospital staff that had some therapy training.
I also met Lisa, a family medicine physician who is serving at Galmi for a couple of weeks. Turns out we're both alumnae from UT Southwestern Medical Center!
Lisa and me
Saturday night we joined with the rest of the missionary community for dinner at Picnic Rocks, a place just a mile or so out of town where you can get a great view of the surrounding area. We had dinner with a family originally from Singapore, so we laughed about things we miss in Singapore and even slipped back into "Singlish." Once the sun went down, we enjoyed stargazing before heading back to the compound.
The view from Picnic Rocks of the N-1 road and the Galmi Reservoir
Chicken rice with our new Singaporean friends!
Sunset over Galmi
On Sunday, we went to church with Steven and Carol, the directors at Galmi hospital. The service was nearly four hours long, in a mix of French and Hausa. I could follow along with a few of the hymns that were in my Hausa hymnal and switched back and forth between Hausa and English Bibles during the sermon.
Visitor introductions at church. I finally got to wear the dress I had made in Togo again!

A Hausa hymnal ("Allah" is their name for God, not the Islamic Allah)
In an African church, men sit on one side and women on the other
Monday and Tuesday I went with Deb to the therapy clinic. Deb is an American-trained occupational therapist, but has picked up quite a lot of physical therapy skills by necessity. She has also trained one of the nurses in some therapy skills, so he sees patients on the hospital wards while Deb works mostly in the clinic. I was able to assist Deb with a few therapy evaluations, tried to mime and gesture my way through teaching an adult how to use crutches, and we worked together on a few toddlers with developmental delay.
"Eye Care in Developing Countries" and "The Handbook of Tropical Medicine" anyone?
Monday afternoon is when the clinic does its weekly club foot clinic. There they use the Ponsetti method of serial casting to correct the position of the foot while the baby is still young. It's something that can be quite effective if started early enough and if the mama will bring her baby back each week for a new cast, then be compliant with the adaptive shoes during "naps and nights" until the child is walking. It's always hard to pin down a squirming baby in order to correctly wrap their entire leg in a plaster castgood thing plaster hardens quickly!
Heidi mastered the art of distraction that's so crucial to getting a good plaster cast!
Isn't she precious!
After we were done in the clinic for the day, Deb took us to the market in Galmi, as well as on a few of the dirt roads to visit some of her former patients. We stopped by to talk with some of the older retired men in Galmi and Dad asked for a picture with all of them; I think he could fit right in with these men and solve world hunger over a cup of tea!
Yes, they really do have camels here!

On the way back to the hospital compound, Deb helped us buy a chicken fresh off the grill for 2500cfa (or about $5 USD) as well as some oranges (which have a green peel) and these amazing fried cakes that are made out of bean flour (what Nigeriens call beans we would call black eyed peas).

Tuesday morning started off quite slow, so we did a bit of organization in the therapy clinic. For those of you who have been around therapy clinics, you know there's always that one supply room that's crammed full of stuff that you might need one day!

Deb has been given a number of adaptive shoes for club feet, compression garments for burns, and supplies for making her own splints and slings, and she showed us some of the locally made adaptive shoes and splints. Last year she'd taken a lace-up cast shoe (worn to protect the plaster on the sole of the cast from breaking down while walking on it) to a local shoemaker to see if he could replicate it. He said, "No problem! I make shoes like that all the time for camel hooves!"

I enjoyed playing with a five year-old boy who was in the hospital to get a skin release following some severe burns. It was fun to see him smile when the matchbox cars came out! Deb shared with me that toy cars are a hit with both boys and girls; girls are so used to being around real babies that dolls that don't move and cry can be confusing and even scary!

About 30 minutes before the clinic was to close for lunch and midday rest, six patients showed up! I did an eval on a teenage girl and decided she needed a referral for a hip x-ray, we did some therapy for a young toddler who still isn't sitting up, and set up some patients to come back later in the week.

After midday break, Deb and I decided the rain looked like it would hold off long enough for her to take me on a walk through the millet fields out behind the hospital to visit a couple villages. We set off with our cameras and water bottles and traipsed through flooded fields and along muddy cow paths to see what life as a Nigerien farmer looks like.




The ladies were careful to tell us where to step as we crossed the stream!
Some village children who were excited to have their photo taken!

These mud storage buildings with thatch roofs are designed for millet storage
We followed these guys and their cart of onions back to town
Galmi is well-known for its purple onions. (You can even buy Galmi onion seeds here!). Farmers plant millet, beans, and onions for their own use, then plant onions to sell for profit to wholesalers. Local children will use dried grasses to weave basket structures which will later be stitched onto the top of the sack. Eventually, the sacks will be piled high onto trucks to be taken to Nigeria or wherever they'll eventually be sold to the consumer.
Sacks of onions piled up, waiting to be sold
A stack of woven sack tops
Onions are stored in thatch structures like this. They're elevated off the ground by rocks so that air can circulate and prevent the onions from rotting.
Onions headed off to market
How would you like to stack this truck of onion sacks by hand?
While Deb and I were traipsing around the millet fields of Niger and saving the world one therapy patient at a time, Dad was spending time with the leadership team of the hospital. What started off as a conversation with the director over Sunday lunch turned into two days of meetings! Dad was able to use his executive coaching and strategic planning skills to facilitate some discussions regarding the hospital's mission and vision. He and I were both praying we'd be able to encourage the staff at each place we went, and this was one way God answered our prayers!

Wednesday Dad and I hitched a ride with a missionary family back to the SIM hospital in Danja, Niger which is about three hours away. However, we were strictly told, "You can't leave before cinnamon buns!" This Wednesday morning tradition is a gathering time for all the missionaries, and they were sure to set aside a few buns for Ian and those coming in on the SIMAir flight!

We watched the plane take off, said goodbye to all of our new friends at Galmi, and then it was time to pile into the car for the drive to Danja!
Deb and me
Dad and Steven, the director at Galmi
And just to show that Dad and I were still having fun...
"Hey Dad, we've got to make funny faces with our orange slices!"