Esselinks in Portland!

On the events which have caused us to be so silent

2009-02-27T18:45:00.004-06:00

After a long hiatus, I’ve decided it’s time to buck up and finally get back to blogging. I’ve found that unless I blog, I keep no track of events that have gone on in our lives, and how sad would it be to lose memories of these very important years? Plus, we’re such horrible correspondents and we’re terrified of Facebook so there is no other way we really keep people updated.

I have no excuse except that we really have had a lot of things going on. This year, my last year in residency, has been very busy. I was in the ICU in September; then Frank and I went to Ireland in October to visit our dear, dear friend Marion and her husband Dave. Ireland is such a beautiful, green, amazing place with so much history as well as modern-ness. It was also unfortunately very expensive since it was in the midst of American’s plunging currency drop; so though we had fun, it was a rather pricey trip. Still, you all need to go visit Giant’s Causeway on the north coast, Beara Peninsula on the west coast, and the castles. Wow!

So why did we do such a pricey thing, you may ask, seeing as how I’ve got 5 digit loans to pay and I’m still a rather poor resident? Well, we decided it was soon time to settle down and do the family thing and thought hiking the Irish wilderness was a bit hard with a child, so we did it first. And quicker than we ever expected, we found ourselves indeed pregnant. So most of the fall was spent half in terror, half in amazement at this crazy event. It’s one thing to try to imagine being pregnant, another thing to be pregnant. I’m not talking about symptoms. Overall, I’ve had the easiest pregnancy ever. I’ve never had morning sickness, I didn’t show until about week 16, I gained 1 lb up till week 17, I don’t have weird cravings, I’m still running (Though it’s now more of an old woman crawl and it’s not exactly comfortable anymore). No, it’s more the wonder that there is a living creature growing inside of me; that even when I looked and felt exactly the same, there was a new life developing. I thought it might be a little creepy, to imagine this independently squirmy thing inside of me. But the first time we saw the baby move on the ultrasound last week at our 20 week check, and the time I felt the baby move, about 5 days ago, was really just the most joyful experience. Hormones are really a great thing because I can’t imagine how else I could be so protective of and excited by having a parasite making me fat and hungry, yet unable to eat much at one sitting, and unable to sleep on my tummy anymore. But really. If I didn’t already believe in God, I would now, as I can’t imagine how anyone can explain how this amazing process came to be in any other way.

So, as you can imagine, baby has taken lots of time and energy. I was pretty tired most of my first trimester. It’s better now. As my cousin says, making a placenta is hard work! I spent most of October working on a poster presentation for a national research competition while I was working overnight. That wasn’t so fun. But it was so great, because I did my topic on spirituality, which was incredibly different from what people usually do. I chose that topic because I can’t tell you how many patients have had breakdowns in my office visits and obviously had spiritual distress, and I had NO idea how to respond. “there, there”, never seems good enough. So I decided to educate myself on what research has been done on spirituality’s impact on health care and the physician’s response, and then decided what the heck, everyone else should be educated about it too. Hence, my presentation. It was great. Flabbergasted a lot of people, but also raised some awareness of it.

We also went to visit Frank’s family in Amsterdam for New Year’s. My parents came as well, as did my sister-in-law’s parents. It was a big reunion to celebrate Frank’s brother’s 12.5 year wedding anniversary. No, really. Apparently they celebrate that there. It was fun but exhausting. I wasn’t showing much then but everyone kept looking me over and looking very disappointed that I didn’t look any different. I’ve never had so many people ogle my shape so openly before. It’s weird. The other thing everyone scrutinizes is everything that goes into my mouth. If I didn’t eat enough for two sumo wrestlers, I’d get urged to eat more. When I tell people I’m not REALLY eating for two full grown people and in fact in the first trimester, you’re only supposed to eat 300 calories more per day, everyone looked horrified, like I told them I was anorexic and wondered where I got such a stupid idea?? My family forgets that I AM a doctor, I do know SOMETHING about how to eat healthy, even if I do enjoy chocolate a lot! My mom of course spent the whole time telling me not to do everything from opening the drapes to carrying a jug of milk.

Now, I’m just trying to prepare for next year. The baby is due in early July, about a week and a half after I finish residency. It’s hard to believe I’m going to finish soon. I’ve loved my residency program, and I’m feeling very nostalgic already. I can’t imagine the day I don’t start everyday meeting with the other residents and attendings in AM conference. I’m going to miss the intensity of ICU care, the comraderie of being up at 2AM to take care of a very sick patient, the multiple educational lectures and talks and presentations I’ve been privileged to be a part of. I’ve spent 3 very intense years with this program and hospital, experiencing life and death situations that no one else can really understand. At times it’s very isolating. I’ve often felt that it’s harder and harder for me to relate to people not in my profession, as there are no words to express the myriad of feelings I go through when a patient dies under my care and I’m fraught with guilt, regret, sadness or relief, wondering if I did something wrong, wondering if there’s something wrong with me that patients die and 5 minutes later I’ve moved on to admitting the next patient.

I’m terrified of being independent, and not having an attending to help me when I’m torn between two decisions. I always know that if I have a question, I can page my attending or the specialist on call and they have no problems giving me advice; they expect me not to know, and to teach me. But when I’m done here, it’s not as easy. It’s hard to feel like three years is enough! I’m the process of just beginning to interview for outpatient jobs. I’m not going to work till probably 2010, since the baby is due so close to when I finish and I need to take my licensing exam in August. But clinics are so desperate for outpatient doctors, I’ve had multiple clinics contact me and somehow, I keep finding myself with interviews. It’s a nice place to be, but overwhelming. It’s hard to prepare for interviewing when I’ve worked every weekend for 5 weeks, including two 30 hours shifts in the last three weeks. I think I’ll ultimately work for the county clinic, as I still want to serve underserved communities; but we’ll see.

Finally, what is Frank doing? Well, conveniently, he is now working for my hospital system. He is one of their IT specialists, working with systems to monitor how well the hospital programs are working. He loves it there. The people he works with are nice, his hours are flexible, his job interesting, even if it isn’t robotics. Getting hired in this economy late last year was quite the accomplishment, I think. So things are well. I can even page him when I get bored (which I do) (He never pages me). We’ll be in Chicago and Madison in early March as our last travel before baby comes; hope we see some of you!

Uganda Photos Are Up!

2008-04-14T12:07:00.001-05:00

Well, we've finally got some photos up on the web at the link below. If you click on the album itself, then view the photos one at a time (use the "next" link), you can also read some descriptions with each photo. Or you can just view as a slide show without descriptions.

http://www.rhinopeel.com/Gallery/main.php

We'll try to post some additional blog articles in the near future about things we didn't get to write about yet.

The Great Bwindi Quiz!

2008-03-20T03:21:00.002-05:00

Since Barbara wrote about our experience tracking the gorilla’s, and many of our posts here have been somewhat long winded, I though I’d change it up a bit with a little multiple choice quiz. There’s no way to get them all right without guessing, but hopefully it’ll be fun. Answers at the end.

GETTING THERE AND BACK
1. What side of the road did we drive on?
   a. The right
   b. The left
   c. The shoulder
   d. All of the above

2. Where did our driver stop to relieve himself?
   a. A gas station
   b. A local McDonald’s
   c. The side of the road
   d. A random stranger’s house

3. What obstacles slowed the car down?
   a. People
   b. Speed bumps
   c. Herds of cattle
   d. All of the above
   e. None of the above

4. What music did we listen to on the way to Bwindi?
   a. Yanni
   b. Bob Marley
   c. Eminem
   d. Dave Matthews Band

5. How many times did we listen to it?
   a. One time
   b. Two time
   c. 31
   d. On uninterrupted loop

6. How fast did we go?
   a. 50 kmh
   b. 80 kmh
   c. 100 kmh
   d. As fast as possible

7. What ran in fear from our vehicle?
   a. Chickens
   b. Goats
   c. Palm Sunday revelers
   d. All of the above

8. How close did we come to actually hitting any people?
   a. Less than 3 feet
   b. Less than 1 foot
   c. Less than 6 inches
   d. Ouch!

9. What was the most common thing we heard kids say to us as we drove past?
   a. How are you?
   b. Hello!
   c. Give me!
   d. Help us!

AT BWINDI
10. What did our tour operator forget to bring?
   a. Our lodging reservation
   b. Our gorilla permits
   c. His driver’s license
   d. His cell phone

11. Which group of gorillas did we go to see?
   a. Mubare
   b. Habinyanja
   c. Runyankore
   d. Nkuringo

12. How close did we get to the gorillas?
   a. About 30 feet
   b. About 20 feet
   c. About 10 feet
   d. About 5 feet

13. Which of the gorillas made a brief charge at one of our guides?
   a. The silverback
   b. The black back
   c. The baby
   d. The mom

14. What was in the trees near where we found the gorillas?
   a. Chimpanzees
   b. Red tailed monkeys
   c. Baboons
   d. White colobus monkeys

15. Which of the following was not part of our pack lunch provided for the trek?
   a. A sausage
   b. Biscuits
   c. A peanut butter sandwich
   d. A slice of pineapple
   e. A boiled egg

16. What music was playing at the Uganda Wildlife Authority office when we purchased our tickets for the Muyanga Waterfall Trail?
   a. Yanni
   b. Bob Marley
   c. Eminem
   d. Dave Matthews Band

17. What excuse did our guides give for not seeing any monkies along the Muyanga Waterfall Trail?
   a. They are taking their afternoon nap
   b. They are sheltering from the rain
   c. The gorillas have scared them away
   d. They are shy and have run away from you noisy Americans

18. Who has been kicked out of the park?
   a. Farmers
   b. Poachers
   c. The Batwa Pigmies
   d. All of the above

19. Who received compensation for being kicked out of the park?
   a. Farmers
   b. Poachers
   c. The Batwa Pigmies
   d. a and c

20. Which of the following countries were not represented by people we met at Bwindi?
   a. Australia
   b. Malta
   c. China
   d. Austria
   e. Denmark

Answers:
GETTING THERE AND BACK
1. d - Basically, wherever the ride was the smoothest
2. c - No Big Mac's here
3. d, e - Either is appropriate depending on what part of the drive we're talking about
4. b - Overdubbed with Lugandan commentary
5. d - We had the one tape, and it did not change. I'm convinced it was the same on both sides, too.
6. d - Sometimes, it was a little scary...
7. d - I never got tired of watching things jump out of the way of our car, except when we came close to actually hitting things. Most of the time, things were jumping out of the way well in advance.
8. c - We did come awfully close a few times, and one guy got laughed at mercilessly by his friends for nearly getting hit by us.
9. a - We heard all of the choices, but How are you? was far and away the most common. It did not appear that most of them knew an appropriate English response. Choices c and d were only a couple of times total.

IN BWINDI
10. b - How you forget the permits, I have no idea, but they had the receipt and it all got worked out after I paid for some cell phone air time.
11. a - The M-group as we were called, also had the most difficult hike. Runyankore is the language spoken by most people in southwest Uganda.
12. c - We were told we were supposed to be about 7 meters (23 feet) away, but ultimately were less than half that. It was amazing.
13. b - The silverback grunted and left, but the black back actually made a move towards our guide when he got a little too close.
14. b - Red tailed monkeys were jumping in the trees at the forest edge
15. c - We had a cheese sandwich.
16. c - Dave Matthews may be the proudest monkey, but Eminem inspires the UWA.
17. b - While our gorilla trek was clear sun, we got rained on during our hike through the forest.
18. d - Poachers still go in occasionally, but they're fairly well under control and haven't shot a gorilla in Bwindi in over 10 years.
19. a - The farmers got money to purchase new land because they had lost the land they had cultivated. Sadly, the Batwa got nothing because they hadn't cultivated the land, destroying the forest as the farmers had. When the park was created, Uganda felt they could stay in the forest because they lived in harmony with it, but international donors insisted that no human remain, and all hunting and harvesting in the forest should cease.
20. c - We also met some women from the US and England.

Only 1 week left

2008-03-19T05:03:00.003-05:00

It must seem like I've been spending all my time writing during this week given my volume of blogging but in reality, I've just been hoarding them up and being lazy about writing over the last 3 weeks and now that it's almost time to go, I've realizing I need to actually post them! I'm required to journal for my rotation anyway, so this has been a nice way for me to do that.

Anyway, as I write this, Frank is at this moment having a very serious discussion with the 5 year old twins about the afterlife. The alternatives I have heard so far are:

Frank is going to come back as a carrot in his next life.
Frank is going to go to his far-away home in the sky after he dies.
I am going to marry a good friend after Frank dies (???? What does this have to do with reincarnation???)
If Frank comes back as a bunny, will he have enough brains to want to be anything more than a carrot in the next life?

This conversation ends with someone running off in tears….not good….

Anyway, I had a very exhausting week last week, but very good, as my time with the medical students became more defined. I discovered that working with the 3^rd year medical students was a more comfortable place for me and I think they felt comfortable with me, so we had a lot of time together over the last few weeks.

So as I mentioned briefly, the students have quite a few case presentations they have to give, so I spent a lot of time listening to case presentations, which involved standing at the bedside, listening to a very thorough history and physical, and then about 10-15 minutes of me quizzing the student and trying to teach them something they didn’t know about the patient. Sometimes, other students came and listened too and contributed, so these sessions could last up to an hour. The teaching sessions are anything from discussing theoretical treatments for the suspected disease (i.e., if they were in America, which tests could they have done?), going over how to read a chest x-ray systematically, or trying to go over how to do a proper cardiovascular exam. And again, they are so bright, often I had to go home, pour over some book, draw some diagrams, and then come back the next day to tell them whatever it was I had forgotten.

The students also have “tutorial sessions”, where one student had a required topic to teach to the other students, and I precept these sessions. These also last at least one hour. The students also have required teaching sessions with a senior on parts of the physical exam, and then they are required to have me watch them do the physical exam and then critique them. It is so intense, what they have to do! Since the Ugandan doctors are very busy, sometimes it’s really hard for the medical students to find as much teaching time with the doctors as they want. So I was happy to do that for them. I think also that I am a lot softer on them than the Ugandan doctors so they were less afraid to make mistakes around me. (I'm not sure if I'm doing them any favors, though.) Some of the students had never heard a heart murmur or never had anyone watch them do a physical exam so they never knew if they were doing it right or not. And honestly, I remember there were many rotations in medical school where no one ever once saw me interact directly with a patient independently; I could have been the biggest jerk and made up a whole physical exam and I’m not sure anyone would have noticed. So it’s definitely not just in Uganda that this happens. But I’ve never taught as intensely as this before, it’s so exhausting! US doctors are in general not near as thorough in their physical exam skills as Ugandan doctors so I have had to read up very thoroughly on my physical exam. It's very embarrassing.

And every night, I have to go home and do reading as I’m seeing stuff I’ve never really seen before. We see so many patients with meningitis, and these people have true psychosis. Staring off into space in a VERY strange way, rigid in all their limbs, talking nonsensically or not talking at all, unable to bend their necks---I’ve never actually seen this in the US. And even more interesting is trying to figure out the best way to treat these patients, since it’s often done empirically. Meaning, often they can’t afford the lab test we want to do or the lab test was done too late or the patient is deemed too sick to wait for lab tests; therefore, we would do our best to guess what they have and then treat them appropriately. Sometimes, we treated them for the top 3 things. They problem is, if they get better, you have no idea which of the treatments actually helped so you’re left not knowing what diagnosis they actually had.

Today, Sarah, an immunologist from the UK, and I did rounds on my side of the ward (very interesting to try to do rounds without a doctor who spoke the local dialect) and here is an example of some of the patients we saw:

1. Pt with renal failure who had fluid everywhere in her body (and I mean everywhere!). Her lungs are getting flooded and I think it’s only a matter of days till she dies. She really needs dialysis.

2. Pt with a grossly distended belly, so much so that I thought she was 40 weeks pregnant but it turns out it was all fluid in her belly. Her heart filled her chest, crowding out her lungs and she had the loudest heart murmur I ever saw. We wondered if she had a dysfunctional heart valve?

3. 3 patients with meningitis. Most have HIV as well and fortunately, most were improving.

4. Pt with a very large left sided pleural effusion, meaning she had fluid filling her whole left lung. Any attempts to get fluid out of it has failed. She also has a bony chest mass sticking out of her sternum and a very, very large liver. We wonder if she has cancer? Maybe a surgeon can come do a biopsy for us?

5. 2 patients with probably STD’s which look very painful. One of them most likely needs to have an abscess opened but not sure how to contact the gynecologist?

6. Pt with a total body sloughing skin rash of some sort, and nobody knows why. Most likely a drug reaction, but who knows which drug she took?

7. A 14 year old girl who looks 7; she has very, very bad hypothyroidism which has stunted her growth but there is no hormone replacement available to her. She might never go through puberty.

8. 14 year old patient with the largest spleen I have ever felt, filling her whole abdomen, looking very pale and sick and breathing fast. Probably has a cancer and maybe malaria, but can’t afford any labs. Even if we could diagnose cancer, there is no chemotherapy, so the best option she would have is hospice.

9. 3 patients with TB---1 with plain old TB in the lung, but the other have TB everwhere---TB in the kidneys, TB in the brain, TB in the gut. They get transferred to TB ward once they are stable.

It’s amazing to me how long these patients will wait before they come to the doctor. In the US, I hardly ever see these kinds of physical exam findings as people come to the doctor way before it gets that serious. People here often think if they come to the hospital, they die, so they avoid it; but by doing so, it’s a self-fulfilling prophecy as they often come too late for us to help them. I wish there was a way to change this but it’s a cultural as well as a money issue. Thank goodness I’ve been lucky and most people on my side have gotten better.

Probably overall, the hardest thing is to try to keep a balance between being sensitive to the cultural differences and resource limitations here, but also wanting to keep patient care as excellent as possible. It’s easy to fall into either trap: On one hand, foreigners are often indignant and upset that this pt with meningitis didn’t get a lumbar puncture the day of admission, and why didn’t he get this morning’s dose of antibiotics, and why hasn’t he had iv fluids, and why didn’t anyone check his blood pressure more than once in 24 hrs? On the other hand, after a few days, it’s easy to see a very sick patient with chronic renal failure who doesn't make urine, but there is no dialysis, so all you can do is give water pills, hope the potassium is ok, and advise the family the pt will die soon; you move on without attempting to push for that ekg or serum creatinine or albumin to make sure you don’t miss something potentially curable or handle side effects of your treatments properly. I’ve come to the conclusion that though we have to learn to work gracefully with the limited resources that are here, we have to challenge the sometimes lackadaisical attitude of health care workers here to be as attentive as possible despite the limited resources (and of course this is a gross generalization); and that we also can’t forget that it’s unfair to have such incredibly disparate health care in the world; the status quo is not ok. I feel like I'm saying we should try to make sure that people here don't die of potentially curable diseases more often due to factors we might be able to help change such as apathy, drug availability and cost, but it is ok to accept that people die here more often due to many other problems that can't be changed fast or easily and we need to have patience and understanding. I think I'm doing a bad job at trying to understand a complex situation so forgive me if I just confused or offended anyone.

Bwindi

2008-03-17T05:20:00.004-05:00

We just got back from Bwindi Impenetrable Forest, and I wanted to get some thoughts out while my memory is still fresh since it was such a memorable experience! So if you’ve ever heard of the movie Gorillas in the Mist, you know there is a subset of gorillas called mountain gorillas, and they are some of the most sociable animals in the world. They live in family-groups of about 8-30, on average, consisting usually of one silverback, the leader of the group, 4-5 females, a bunch of juveniles (up to age 14), a bunch of infants (less than 1-2 yrs old), and maybe one black back, who will grow up the be the next silverback. They have no predators where they live. They live in only 2 places in the world, which are adjacent to each other: The Virungas National Park, which is shared by Democratic Republic of Congo and Rwanda, and Bwindi, in southwestern Uganda. They are an endangered species, and none have ever been successfully bred in captivity. So you can't see them anywhere else in the world.

In these three countries, there are habituated gorilla groups, meaning, they more or less have a defined area they call their permanent home and they are used to humans. The rangers told us it takes about 2 years to habituate a group. Now, language was a little bit of a problem but here’s what I gather happens, more or less. To do this, the rangers spend time tracking gorilla families; there’s about 30 families in total in Bwindi. Once the rangers find one that seems to more or less stay within one area so they are easily trackable, they assess them for potential of habituation. What they look for, I can’t tell you. But once they are deemed a potential, the rangers start to visit them every day for at least 1-2 hrs, just getting the gorillas used to their presence. Usually, gorillas won’t bother attacking anything as long as it isn’t too close. The silverback is about 200 kg, on average; they have no predators, and they are not carnivores. They only fight with other gorilla groups. Little by little, the rangers get closer and closer. At some point, the silverback decides the rangers are too close and charges. The rangers stand their ground; if they run, the silverback will jump them and attack; if they stand their ground, the silverback will growl and thump his chest and threaten but generally will not attack as long as he sees the rangers are doing nothing threatening. This goes on for about a year, until the gorilla group no longer charges the rangers even if they walk amongst the gorillas. You know how you sometimes see antelopes wandering around buffalo and neither of them particularly pay much attention to each other even if they’re right next to each other? Well, it’s something like that. The rangers then bring “mock visitors” as a trial. If this goes well, the group is habituated and it is deemed safe to bring tourists to visit them.

There are only 24 permits to go gorilla tracking in Bwindi a day; 8 for each of the 3 habituated groups. This is in part to limit the chance of the gorillas getting diseases from us and to make sure there isn’t careless trampling of the forest. We manage to get two and set off on Friday afternoon. It takes us 5 hrs to get there. The first 3 was spent basically driving straight west on a paved road with lots of potholes and speedbumps (I guess speedbumps are the equivalent of stop signs here), and then we hit this unpaved dirt road. It had even more potholes, lots of rocks, and it was dusty. It wound its way up and up and up into a lush hilly/mountainous area that was sparsely populated. We passed an infinite number of tea plantations, matoke (a kind of palm tree bearing bananas but not as we think of them), and fruit trees. Much of the scenery was looking out into a steeply terraced mountainside with goats and cows everywhere. It was misty and a little chilly, giving it an otherworldly, movie-like feel. Little dirty kids with only a long brown shirt one would run to the road and wave frantically at us, yelling “hello”, which I think is the only English many of them could say. If it weren’t for the endless jouncing about, it would’ve been a very pleasant drive. It took about 2 hrs, 5 villages, and a little bit of rain before we got there.

If it wasn’t for Bwindi, I can’t imagine any tourists would come to such a remote place. The town is called Buhoma and it’s just a tiny village that supports Bwindi. Everything revolves around the gorillas, but since there’s only 24 permits at a time, there aren’t more than 40 tourists at any given time there. Still, just within the park entrance there are about 5 guesthouses. We stayed at a modest one called Buhoma Community Rest Camp which was immaculately clean but not luxury. As with anywhere you go, we were served tea on arrival at their restaurant (an open air round hut about the size of our living room). You can actually pitch a tent there, stay in a 6-bed dormitory, or have your own “banda”, which is just a separate small enclosed “room”, anything from a small cement hut to what we ended up having. We have a “self contained” (has a private bathroom) structure, which consisted of a roofed shelter; under the shelter is a porch with a table and two chairs, a large room-sized tent with a queen bed, 3 tables, a pair of slippers and a mosquito net, and behind the tent is a cement bathroom with a shower, a table, a toilet, and a mirror. There is no sink and no divider between shower and toilet. Still, it was clean and had lots of toilet paper and constant hot water, yay! The hot water is from a firewood stove so it doesn’t depend on electricity but it smells like woodsmoke. The view is SPECTACULAR. Bwindi really is what looks like an impenetrable rain forest set on a bunch of steep mountains and our porch looked right onto one of the mountainsides. We could see monkeys in the trees from our porch. We did have to use kerosene lanterns at night but we didn’t stay awake much after dinner anyway so it wasn’t a big deal.

The next morning, at 7 sharp, we had a big breakfast, went through about 45 min of orientation, and off we went! It was fun to meet so many people from different countries even among the 12 of us who were there that day. We went with a young Australian couple, a guide, and two armed guards. Each of the three groups were in different areas. We ended up with the group with the hardest hike but the most spectacular view. We hiked for about 40 min up a steep old road, on a dirt path through a matoke forest, till we got to the top of one of the mountains. I felt a little bit like Julie Andrews in The Sound of Music as they struggled over the Austrian Alps except it was very sunny, humid, green, and buggy. We ascended about 1000 feet at this point. They had already sent rangers ahead to find the gorillas for us. We were in luck; the gorillas were in a glade in the forest that was pretty much free of trees and we were going to be able to see them quite clearly.

About 20 min later, we’re there. They were sitting right in a glade of tall grass, leaves and small trees about 5 feet tall, eating, about 200 feet away from some very tall forest trees. We just saw some rustling branches; then, all the sudden, we saw a gorilla not even 10 feet away from us! It was indescribable. They’re about human height but weigh closer to 150 kg, I’d guess. There were 9 of them, including 1 baby. They were just sitting there, munching on leaves and branches. As we stared at them and took picture after picture, they didn’t even look at us half the time. It’s like they really didnn’t care that we were right there. The silverback didn’t like us much, when we got too close he’d roar a little and beat his chest and walk away, but otherwise, he left us alone. The baby was so curious, it was just like a human baby. He had soft long silky fur and kept looking at us and inching closer until the mom got fed up with him crawling away and grabbed him and put him in her lap. Then the baby started sucking his thumb! It was amazing. The rest of the family just ate with clear enjoyment all around us and casually watched us watch them. We spent our allowed one hour with them, then trekked back.

I’ve been trying to think why we are so fascinated with them. In part, it’s the movie; in part, it’s what they represent: a species of animals who exist in a very small part of our world, and whose habitat is threatened by human expansion. We are becoming much more aware of these species and we cherish them; but there’s not many animals who will let us see them in their natural setting like these gorillas will so it’s a rare experience. I think it’s also that they live in this incredibly beautiful place which we’d love to see anyway (would I travel a crazy distance to walk through a boggy swamp or trek in -50 degree weather to see the gorillas? Honestly, no; I’m too wimpy for that). Finally, there’s something very human about the gorillas that I just can’t explain. They are very intelligent and seem to express emotions. They form very strong relationships and have loyalty. The mothers love their babies and keep a very close eye on them. The gorilla babies are very curious and toddle about as cutely as any human toddler. They use their hands to cram food in their mouths and chew with as much relish as any person eating a burger at a barbeque. And if you’re like me, you’re happy to see them in the wild. As much as I know zoos are a good thing, I often feel like some of the more intelligent animals just aren’t happy there. They’re not able to do what they were born and bred to do and somehow, they know it. In the wild, they’re in their element, literally. They’re healthy and peaceful and they belong there. I think it reminds us that there is a right place for everything, that we all on this world have our spot. Animals and humans alike are an equal part of this complex dance of life and when we respect that, it’s a beautiful thing. God had an order and purpose in mind when He made us and everything in this world, and there’s nothing like being reminded that everything on this earth is cherished by God, so we should too. Ugh, I'm cliche-ing. Let me stop.

Small kindnesses

2008-03-17T05:08:00.001-05:00

Yesterday, I met the first patient here who really made me want to cry. If I hadn’t gone to Nigeria, I think I would’ve been more shocked at the seemingly more futile nature of medicine here, but I was worrying that maybe I’d gotten too hardened. It seemed to me that I too quickly was able to shake my head, say “what a shame”, and move on, with too many patients. For instance, we see many patients who have chronic kidney disease. In the US, they would be seen by a nephrologist, had many tests done to diagnose the cause, put on many kidney-saving medications, get routine lab checks to make sure we’re preventing complications, and eventually, if they need it, be on dialysis. Here, if they have plenty of money, these things might happen; but most of them can’t even afford what we consider the most basic of labs or medications. People with kidney disease are put on meds that can cause dangerously low potassium; but there’s no use checking potassium levels, as there’s no supplemental potassium to give. They patients often come into the hospital with fluid everywhere in their body, as their kidneys can’t get rid of water appropriately. So we see these patients on rounds, we give them what meds we can and hope the side effects won’t kill them. We tell them they’ll die of their disease in a year, most likely, and we discharge them still fluid overloaded, but what can we do? And I have very quickly learned to accept that this is ok, as it’s just how it is. So we move on to the next patient. Don’t get me wrong, patients here do get excellent care and the doctors are so smart, but the reality is, they just don’t have as many resources as we have in the US. Of course, despite this lack of resources, many patients who come to the hospital are healed as well, but sometimes it’s easy to forget that when I see so many people die of curable diseases.

But yesterday, one of the students took me to the TB ward. We see LOTS of TB here. (I coughed just once today and freaked out---unlikely I’ll get it, but still!) One of the things I have been doing like crazy this week is to listen to case presentations. The 3^rd year medical students are required to have a number of observed case presentation and physical exams, and I am most definitely less daunting than their usual “seniors” (that’s what they call anyone in a higher position than them). One part of the case presentations is that I’m expected to quiz them endlessly in the Socratic method so it ends up being a very involved teaching session. So I walked with the student to the TB ward, a building at the far end of the hospital. Unlike the very crowded medicine ward, the TB ward seems deserted. There are only about 10 patients here and capacity is probably about 40 beds. It is very quiet and only half the patients have “attendants” (in Uganda, most of the patient’s care is provided by their family; the family is responsible for feeding them, bringing sheets, changing clothes, making sure labs get done, giving meds, etc; they are called attendants). If there is no attendant, if the nurse has time, she will attempt to give meds and maybe feed the patient. If the patient has no money, he can’t get any labs done, he can only get the few meds provided for free from the hospital and he only gets food if someone is feeling charitable towards him (I think it’s often a fellow patient or a nurse or student). This particular patient was a young 25 year old man without any attendant or money. He had bad TB which we thought had gone to his brain, so he was psychotic. He couldn’t talk. When we approached his bed, my med student waved his hand in front of this man’s face and the man didn’t react at all. He just started blankly in space. He hadn’t moved from the position he had been placed in on arrival about 18 hrs prior. The bowl of potatoes someone had given him the night before was still sitting on his bedside table untouched. His free medications from the morning had not been given. He was very cold to touch and dehydrated and looked AWFUL. The day before, the med student told me, the patient had been lying in his own diarrhea for 24 hrs and since he had no attendant, no one cleaned him. The med student took pity on him and had a nurse help him clean the patient up and brought in a pair of pants for the man to wear.

My med student started to present the case to me, but two seconds later stopped. He didn’t have the heart to continue with the man in such a sorry state. So, instead, he put the chart down and started to feed the man a small bottle of a high-protein beverage which someone had donated to him. The man could hardly swallow and still couldn’t focus his eyes on us but he was clearly pathetically eager to drink something. We coaxed him to take his meds and ever so patiently, my med student fed him the whole bottle. After doing that, we tried to find a nurse to help us give him his iv fluids and a few other treatments. The med student then presented the case to me. We discussed his problems, discussed what we should do to treat it, and then went back to find the nurse. She had a tray of things prepared for the man, but she indicated that she didn’t have time to do it and that we should do it. Now mind you, the med student had no obligation to do this. My student was in the medicine ward; once the patient is transferred to the TB ward, he’s officially under the care of another team and my student has no responsibility to him anymore. It was 4:30 PM; the student had come back of his own volition to present a case to me for his own learning and no other reason. He certainly could’ve told the nurse, “have the next shift nurse do it”, and left it at that. But he decided to follow up on it and do it himself, as we feared no one would do it in time if we didn’t.

Of course, the man was so sick, he could die no matter what we do. But I just thought it was so sad, that this man had a disease that could be curable, but he would probably die because there was no one there to give him his meds, or feed him. It seemed so awful that he should lie alone and forgotten in a hospital bed, and if it hadn’t been for one medical student’s compassion, he wouldn’t even have a pair of pants on. But if he were to live, in large part it would be due to one student’s kindness. And it was this that made me aware again that no matter how futile or unjust it all can seem, and no matter how hard it is to feel you can make any difference, you still have to try. Even the small things matter. Despite having more limitations, Ugandans use a combination of kindness, smarts, and strength of will to heal each other and themselves and I will endeavor to be remember that this can prevail while still being aware of the need to equalize care everywhere.

Higher Mathematics

2008-03-10T04:29:00.003-05:00

Originally written on Thursday, March 6
One of the problems with going on a working vacation with no plans is that you don’t really know what kind of work you’ll end up doing until you speak to someone after arriving. That makes it impossible to prepare. Along those lines, Claudia’s husband Joel came here with the idea that he’d try to give some supplemental tutoring or teaching at one of the local schools. So on Monday he invites me to come along to the International Window School here in Mbarara. We have no introduction, but Joel figures we can walk in and offer our services.

To me, this sounds a bit presumptuous. Here come the white Americans, offering to teach at the Ugandan school where of course they could use our help. I’m not entirely comfortable with the setup. In addition, Joel’s plan involves me teaching math. He figures I’m an engineer, so I should be pretty good at math. The school is primary up through secondary (essentially elementary school and high school combined), so I really have no idea what I might end up teaching if they want us to do so.

When we got to the school, I discover that it’s a boarding school for girls only. This was something Joel had neglected to tell me. I’m not really sure if that makes me more or less comfortable about the idea. There’s a large metal gate at the entrance large enough to let a small truck through. When we knock, a small door in the gate opens and we introduce ourselves to the gate keeper. He tells us to wait, and a few minutes later comes back with a visitor slip for us to fill out. We write down that we’re inquiring about teaching, and a few minutes after handing it back, are ushered inside.

We’re greeted by Edith, who’s role in administration isn’t entirely clear, but she’s very friendly despite what appears to be some annoyance with this unannounced intrusion into her day. Joel tells her that he’s heard of the school and its good reputation, and that we were wondering if we might provide some supplemental teaching for the students. He mentions that I’m an engineer and could teach math or English, and that he could teach either of those or geography. Quick side note – Joel teaches geography in Portland and his 5-year old son Will has been working on drawing various maps with an earnestness that is absolutely wonderful to watch.

Edith thinks briefly, then tells us that she’s not the person to talk to and goes to fetch Geoffrey. Geoffrey’s exact role in the administration is never fully explained, either, but it’s clear that he has some authority over the curriculum and the teachers. His demeanor also suggests that our intrusion isn’t entirely welcome, but he feels obliged to entertain us and our impression is that he’s trying to figure out exactly what he might get out of this whole business. Joel goes through his pitch again, and Geoffrey talks about the difficulty of having us inserted into the middle of the semester and interrupting what the regular teachers are teaching. We also share that we’re here for only a few weeks, which makes it additionally difficult to figure out how to get involved. Finally, we settle on some after school sessions in which we can answer student questions for the highest level students (Secondary 4 or S4). We’ll each have our own classroom. I’ll do math and Joel his geography. At this point, Joel offers to have us come back that afternoon. He seems to be ignoring the fact that I haven’t really looked at high school math since, well, high school.

Thankfully, Geoffrey suggests we come back after classes the next day (Tuesday), so the students have some time to come up with questions they’d like to ask. I’m thinking he’s just not prepared for our intrusion quite yet. Either way, he takes us along to introduce us to the S4’s who will be invited to our sessions. We interrupt three different classrooms, are introduced by Geoffrey, and then head off.

At home in the evening, I went over what I could remember from algebra and geometry and also reviewed an algebra book that Claudia’s oldest daughter, Madeleine has with her to do some exercises in. She’s only in 5th grade, but quite smart. The book goes from very basic stuff to some more advanced high school stuff, so the latter parts are potentially useful to me. In reality, though, I have no idea what to expect.

Tuesday afternoon, Joel and I head back to the school to meet up with Geoffrey and find our classrooms. This time, we’re let right in when we get there and soon Geoffrey ushers us upstairs to the classrooms in which we’ll teach. The girls in the school are done for the day, but those that wanted to could come to our sessions. Geoffrey asks us to do about an hour and a half, and then we drop Joel off at his classroom. At this point, I’m very aware that I’m totally alone on this, my big fear being that they’ll ask me to solve a problem for them that I have no idea how to do and I’ll be a total flop. Geoffrey’s billed me as an engineer and an “expert” in math, so being unable to solve any problem is going to be quite embarrassing.

I start with 5 students and no chalk. The eraser is a piece of sponge, which works far better than most erasers I’ve used in the US in the past. I start by saying “Good afternoon and welcome!” - which draws a chorus of laughter. Hmm… ok, I’m not sure why that’s so funny, but I suppose it’s just funny to hear my odd American accent. I check to make sure all the buttons on my shirt are buttoned. I then grab a half inch piece of chalk I spotted on the floor, but a few moments later one of the girls hands me some from her bag. I tell them that I’m going to help them with some problems, so if they give me a problem, then I’ll do it with them on the board, however I’m going to ask them to solve the problem and I’ll help them when they get stuck. This is my big secret plan, hoping that they won’t get stuck and I’ll just write on the board what they tell me. Maybe they’ll jog my memory a bit.

Ready for a good algebraic equation to solve, I ask for the first problem and am given one with the height and vertex angle of a cone, needing to find the surface area. Naturally, I have no idea what the formula is for the surface area of the cone is. Sure, I used to know it, but that was about 15 years ago, so my big secret plan is put to the immediate test. I ask the students what the formula is for the surface area of a cone, and one of them mumbles something so quietly that I’m not sure if she’s thinking to herself or really trying to answer. Thinking about it, I’m not really sure how much interaction they normally have with their teachers. Maybe it’s all lecture. Maybe wrong answers are so embarrassing to them that they’re afraid to state something boldly. They’re almost certainly unsure of what to make of their muzungu teacher.

I manage to coax a formula out of the student and proceed to use basic trig functions, at the students prompting to solve the problem. About halfway through it, someone from the school delivers some brand new chalk to me, allowing me to return my other chalk to the student. Of course, as soon as I use the new chalk, I break it, and find out later that Joel had the same problem with his chalk, so it’s not just me. Anyway, the students are pretty bright despite how incredibly shy they are with me. While I started out with 5 students, more keep coming into the room. I continue to get occasional burst of laughter as I’m writing something on the board, but just have to ignore it and keep going.

Filling the hour and a half turns out to be fairly easy, but I’m very grateful when it’s over. By this point, I’ve got about 40 students in my room, and I’m working on a 4th problem. I had another cone problem (find the volume of the solid left by cutting the top off of a cone) and an algebraic expression to factorize which looked really hard at first but proved to be very easy. The last problem, however, is one that I wasn’t sure at all about. I was given a circle and two secants meeting at a point outside the circle. Some additional lines are drawn, and given two of the angles in the drawing, we need to find two others. I’m really not sure where to go with this. The angles I’m given don’t give me a lot of information, and I can’t remember the properties of angles inside a circle. The students also instruct me to give one angle an incorrect measure. I tried to show them why their mistake wasn’t possible, but they continue to ignore it, and happily, that’s when the time is up. Happily, because I know their choice is wrong, but I don’t have a correct answer for them.

We’re going back on Friday, and I promised to follow up with them then, but unfortunately, I still haven’t been able to solve the problem. I’ve researched some of the properties of the triangles and keep coming back to the conclusion that there are multiple solutions to the problem. In other words, I need another predefined value in order to come up with a unique solution. Joel looked at it too and came to the same conclusion, but he admits that his knowledge of the subject isn’t beyond mine. It’s entirely possible the solution is not intended to be unique, but the way the problem is defined, it looks like it should be. Maybe they copied it down wrong and left something out, I don’t know, but it’s very frustrating! We’ll see how it goes tomorrow.

Epilogue (written Monday, March 10)
At some point you’ll hear more about what happened on Friday during the day, but for now I thought I’d just finish this post by telling you how my experience returning to International Window School went on Friday afternoon. When Joel and I got to the school, it didn’t take long before we were off to the classrooms, along the way greeting the students we recognized from last time. Although we were there at 4:30, the S4 students were still in a class, and as a result, we didn’t have any students at all for a little while.

Around 5 pm or so, a few students walked in to my classroom, but they were all younger students, so I decide to wait with a repeat of my geometry problem until some S4 students showed up. After all the preparation and agonizing over the problem, it turned out that not a single S4 came, so I never did the problem with them! I am going back tomorrow afternoon (Tuesday), so perhaps I’ll see them then, but I don’t have any idea if they’ll still be interested or not.

In many ways, I enjoyed the Friday session more than the first one. The students that were there numbered about 6, and the small number allowed them to cluster around the front of the room and interact far more with me individually than the larger group did. The problems were all algebra problems, which was fun and fairly easy, and I felt like they got a better understanding of how to do the problems since the group was small. They also were very good about asking questions and responding to mine, which really helped me feel like they were learning.

EDITOR'S NOTE: I just wanted to say that for some reason, our slow internet connection has made it difficult to post pictures on the blog from here (although the one above seems to have taken). We'll post if we are able, and certainly put some up when we get back, but for the meantime, you'll have to deal with text only. Sorry!

hospital staff

2008-03-05T08:37:00.004-06:00

So the work I do here will have to be spread out in many blogs, since there's so much to tell! I thought I’d try to explain the hospital a little bit today. The hospital is similar to ones I’ve seen in other parts of Africa. There are a series of interconnecting buildings for each ward; I spend most of my time in the female and male general wards, which consist of two rooms with two rows of about 25 beds in each row. There is an ICU of some sort which I haven’t found yet; and there are three small rooms where the new patients are admitted to the hospital before a bed assignment happens. There is about 1 nurse per ward, and I haven’t quite figured out what they do yet beside give some iv medicines, answer a few questions for the patients, and occasionally help us position a patient or organize a chart. I’m sure they do more but I’m not sure what. The families of the patients feed the patient, give oral meds, bathe the patient, and generally take care of them. They often just lie on a pallet on the floor in between each patient’s bed (about 2 feet of space!). Privacy for procedures only occurs when a small screen is dragged in.

The medical students really seem to be the main force behind patient care here. There are 30 of them on our wards at once. 30!! In Portland, there are 6 at most at any given time. They do EVERYTHING. They check vitals, give iv meds, draw blood, take urine samples, run slides to the labs, do biopsies, counsel the patients and their families, get patients to pay for laboratory tests in advance and then chase down the results of the labs and put them in the chart, start iv’s, start oxygen, etc. They actually even get to decide to admit patients themselves; they see them in the outpatient clinic and if they think a patient should be admitted, they walk them over to the general wards, put them into a small holding room, and write out this huge history and physical. They then present the patients to the attending and senior resident in post-take rounds and hope the attending agrees to admit the patient; I honestly don’t know what happens if the attending does not agree!

It’s hard to comprehend the differences in the role of the medical student here. It seems at times as if the medical student has too much responsibility and not enough supervision, but at the same time, I think we in the US often baby our medical students because we don’t want to offend patients. No one wants to be the first patient who a medical student tries an iv on, you know? And we are reluctant to ask. Plus, we are spoiled by having nurses who do everything in the US. I haven’t started an iv since medical school. Here, no one else will do it but the medical student, so there is no choice. In part, the residents and doctors are so busy, they don’t have time to help each of the students as much as they would like, so the student learn more independently than we do in the US. But in another part, I think there is simply the expectation that the medical students should be more independent, too. They do work really hard. The old British system seems to be a harsher system than we have in the US, and medical students are “pimped” (asked question upon question about a certain disease until no one knows any more answers) quite a bit more than I am used to. I think it generates more independent reading and memorization than I ever did. I am amazed at the amount of knowledge they retain. They have a much more formal relationship with their attendings than I am used to and sometimes I feel sorry for them as they seem a bit fearful of their attendings but it could also just be me not understanding the cultural deference that young people give to their elders here. They seem so eager to have any personal teaching time so I am happy to do that for them. I worry sometimes I may not have much to teach them but I’m trying to be confident that two years of residency DOES make a difference! They are all very polite and nice and I enjoy working with them. In fact, everyone I work with has been kind and fun and polite, which is what I had heard about Uganda. You do have to spend a lot of time greeting people before getting to anything else in the conversation but it does seem quite genuine, actually, not just a mumbled “how are you doing” without waiting for an answer but true concern for “how are you? How was your morning? How are your children?” etc, etc.

As for the residents, there are only 2 interns here and they have 12 hrs on, 12 hrs off EVERYDAY; no days off! During their 12 hrs, they do all new admissions and any cross-cover calls on all the patients with a little help from the senior on call (I think). After intern year, they do a year or two of research and clinical practice of some sort. Then they come back for 3 post graduate years. So I am the equivalent of a post graduate level 1 since I just finished my internship, but the level of proficiency is not the same; I think experience-wise I might be closer to a PG level 2. There are 3 residents in each PG level. I won’t even attempt to explain their convoluted schedule to you!

I haven't yet figured out how many attending physicians there are but I think there are about 8. A few of them are UK doctors who are just the brightest, funnest people and thanks to them, our white faces aren't too strange here so I don't get stared at quite as much as I thought I might. All of them seem to be incredibly devoted to constantly up-ping the standard of care in this hospital and I think it is just great.

Chicken?

2008-03-05T08:30:00.003-06:00

I just noticed there's what appears to be a chicken on the Uganda flag Frank put on our blog page...is it supposed to be there? I thought the flag just had 3 bars of black, red, and yellow. I feel too stupid to ask a Ugandan about it and the time it takes to load an image on dial up is too long for me to look it up online.

Greetings from Uganda! Before I get too far, I want to give a caveat to my blogging. Anyone who knows me well, knows that I often say things in a way that isn’t always the most tactful, even if I had the best intentions. Sometimes when I blog, it just comes out all wrong and occasionally I don’t proofread. So then, sometimes when I write I thoughtlessly offend someone, and I apologize in advance for that. I think I can honestly say I never mean to be hurtful but I know it doesn’t always come off that way.

Frank has told you about our trip to Uganda so I won't rehash. I'll start from our home here.

We live in a house with essentially 8 other people, 3 kids and 3 adults; there is another couple who doesn’t actually have a room in the house but they are here all the time so it’s like the 10 of us are living together. 5 of them are part of one family-- one of the attending doctors from Portland and her family; the other couple is her brother and sister in law, and the last person is an ob/gyn resident. There will be two more doctors joining us shortly. You would think sharing 2 showers and 3 toilets would be a problem, but it really isn’t at all. It’s fun having so many people as there is always someone to do things with and always someone making yummy meals. And the food! Though we are missing some things, in general, the fruits and vegetables are fabulous---the pineapples! Passionfruit! Mangos! Cucumbers! Tomatoes! Mmmhhhh…the first day, Frank and I ate a whole pineapple for lunch; then snacked on passionfruits; then for dinner I wolfed down a salad full of tomatoes, avocados, cukes, carrots, and garlic; and my stomach told me in no uncertain terms to please never eat so many uncooked acidic foods in one go ever again. All the fruit we have lying around generates a lot of fruit flies but fortunately, there is a baby lizard living under our fruit basket so that helps a lot. The Ugandan food is similar to Nigeria’s with some sort of starchy mashed staple and a meat “stew” of some sort, but they have this deep-fried samosa-naan-tortilla thing that is SOOO good, yet so unhealthy….and they drink a lot of tea. British influence, I guess. Though there are a lot of Indian people here, Ugandans can’t take hot foods of any sort in general so they don’t understand our obsession with the expensive Indian restaurants.

My days here have already gotten into a pattern. We are generally at the hospital from 8AM-12:30 PM, starting with some sort of meeting or lecture; then at 9, we have “post-take” rounds, where we talk about last night’s admissions. At 10 AM, we do work rounds, seeing every patient. I'll tell you more about the actual work and patients later. We break for lunch, and since I live across the street from the hospital, I come home. In the afternoon, I try to have teaching sessions with the medical students a few times a week and the other days I spend the afternoon preparing for the sessions. It’s actually a hard task because Ugandan students ALWAYS want to know EVERY detail. If you tell them a medication helps preserve kidney function, they want me to explain the mechanism behind it. If you tell them a burn patient may have low potassium, they want me to explain why. And they can patiently sit for 1.5 hrs asking question after question until we tell them that’s it for today! Then at 5PM we try to go back for afternoon post-take rounds, where we go over admissions of the day time, and then we’re done. I have no call here, as my task is primarily to teach, so evenings are always a big dinner, clean up, and then a few hours to talk, email, read, and play games, mainly. The weather here is perfect, almost always highs in 70-80’s, at night in the 50-60’s, and it rains madly, like a monsoon, about 1 hr a day, then clears up. The equator is a nice place! There aren’t that many bugs, either. It’s actually quite safe and we leave our windows and doors wide open till the last person goes to sleep. Tonight, we stood on our covered porch and watched first the many stars, then the lightning while rain poured down. It abruptly went away and now there’s just a cool breeze with the sounds of crickets everywhere. It's such a change from life in the US; so much slower, and social. You feel like you can savor every minute.

Arrival

2008-03-04T01:55:00.004-06:00

Well, we made it to Mbarara after a rather long trip. Barbara got off work at around 7 am on Thursday, came home and showered, and then we were off to the airport. Everything went remarkably smoothly. Our flight to Seattle was uneventful, the only frustration being that we were sitting on the left side of the plane. A morning trip to Seattle from Portland is much nicer to sit on the right side due to the fact that all the large mountains (Hood, St. Helens, Rainier), go by on the right, and they’re quite majestic in the morning light. From Seattle we caught our 9 hour flight to Amsterdam. While waiting there for our flight, we ran into one of the ICU nurses from Providence who is also spending some time in Uganda. We didn’t realize we’d be on the same flight, so that was rather fun. The other funny thing that happened was while going through the security line at the gate in Amsterdam, I beeped while going through the metal detector, so the security guard took me aside and checked me for any hidden items. He spoke to me in English the whole time, then asked for my passport and upon seeing that it is a Dutch passport, immediately apologized embarrassingly and finished the process in Dutch.

And that was the most eventful thing that happened, which given the length of the trip, I thought was pretty nice. We landed in Entebbe after an 8 hour flight from Amsterdam and a driver from our hotel was there to pick us up. All our bags came in ok and the immigration and customs control didn’t give us any issues, either. The hotel, which is right on Lake Victoria was a bit strange. It struck us as rather expensive for Africa, and we found out that Bill Clinton had stayed there while President. Needless to say, we didn’t stay in his suite.

We had no trouble obeying the signs not to feed or play with monkies given the fact that there weren’t any around. However, there were a number of pretty neat birds and one of the hospital staff chased a 4 foot lizard of some sort off the grounds.

Our driver to Mbarara, James, was exceptionally punctual, and we loaded our bags for the 6 hour drive and headed out. Probably the first thing that was striking was how green everything was. A variety of palm trees were scattered in amongst the other flora. The reddish clay seems remarkably similar to the clay we encountered on our trip to Nigeria two years ago (yes, yes, I told you I’d try to avoid the Nigeria comparisons, but it’s really hard not to compare!). Shops line the main road where you can buy all sorts of things from motorcycle tires to cell phones to fresh produce from whatever is being grown by the people that own the land nearby.

Traffic was heavy, and the main road was a single lane almost the whole way. Passing is common, and due to the common presence of large vehicles on the road and blind turns, drivers use their turn signals to warn people not to pass them when traffic is coming. Uganda was a British colony, so people drive on the left side of the road. Our driver James would use his right turn signal to tell drivers not to pass when traffic was coming, and we got the impression that he used it quite frequently. It was pretty common to be passing someone and have traffic coming pretty much head on with little chance to get out of the way, but we always made it. We also felt that James would come very close to hitting things as he was going by, but he never did and we weren’t really worried about it after a while.

About halfway to Mbarara, we took a quick stop at the equator to take a picture and grab a drink. There’s a souvenir store there that’s part of an AIDS help network, with all the proceeds going to support the fight against AIDS. You can also pay to watch water swirl down a drain in opposite directions on opposite sides of the equator line. They even have a drain right on the equator where it all just flows in straight, but we didn’t really think it was worth the money to see water go down a hole, so we just took a picture.

The roads were filled with vehicles carrying all sorts of things. We saw a motorbike carrying a passenger who was transporting a large pane of glass. I’m not sure if it was a window or a windshield but he was holding it perpendicular to the wind, which struck me as rather un-aerodynamic, but I have a feeling that holding it sideways would’ve been physically rather difficult. There were also numerous trucks carrying thousands of bananas each. These trucks are about the size of a standard UPS truck, but open on top instead of in the back. They were filled with bananas, all still attached to their bunches (I estimate about 100 in a bunch) to the point where they were overflowing out of the top. We also saw trucks carrying various other things, including cattle and lumber and other produce.

At any rate, we arrived safely in Mbarara thanks to James, and were happy to feel the air get cooler as we traveled. Mbarara is a bit higher in elevation than Entebbe and Kampala, and the difference in temperature was quite apparent. Mbarara is cattle country, and the main rotunda as you enter the city has a statue of a longhorn right in the middle. These cattle are different from the Texas longhorn that Americans are familiar with, their horns sticking out more vertically than horizontally.

One of the things that really surprised us was the prevalence of speed bumps. All along our drive down from Entebbe, we’d slow down in the towns and trading centers due to a series of anywhere from 3 to 10 speed bumps, typically spaced a few hundred yards apart. Most of these come in the 2 to 4 inch variety that you can drive over without really slowing down much, but in Mbarara they have some that are a good 1-2 feet tall. These are really great at slowing down traffic. In addition, they’re really good at keeping us up at night. One of these just happens to be on the main road right outside our apartment. Traffic slows down some at night, but those that do come by don’t typically take the bump all that slowly. These also tend to be large trucks transporting fuel or goods from Rwanda up to Kampala, meaing they’re large, industrial trucks. Large, noise, clangy, banging trucks. Very restful.

The other sound that has been keeping up at night are dogs. We have yet to figure out if it’s just dogs or if it’s dogs with the occasional hyena response, but either way, it’s noisy. As for other animals in the city, there aren’t very many of interest. Among birds, it’s a bit more interesting. Storks are incredibly common, and I keep praying that none of them will be dropping any babies off at our apartment. They’re certainly large enough to do so. We also nearly had an ibis walk in yesterday afternoon, but he thought better of it.

Ready to Go!

2008-02-28T00:55:00.004-06:00

Well, the bags are packed, the bills are paid, and the puppies are confused and subdued. We’re set to head off tomorrow morning! Well, Barbara and I are anyway. The puppies are set to head over next door, although they don’t quite realize it yet. They’re going to have a great time with Pat and her chocolate lab Jake.

The picture is how my friends from OHSU sent me off before my final day there last week. My cube was filled with various stuffed African animals as well as an incredibly large cardboard syringe. Presumably, that once held the HGH that Bob the gorilla (sitting on my keyboard) used to get so buff. Another picture was taken with me in it, but since it’s hard to tell which one is me and which one is the gorilla, I figured I’d post just this one. I’m sad to be leaving a bunch of really fun people, but I don’t have any regrets about choosing this trip. I’m sure it’ll be a wonderful character building experience. Hopefully, the character building will involve as little sickness as possible, but that’s what immodium and cipro are for.

Speaking of poop, the poops are definitely going to be missed. It’s weird to think that I get so much fun out of having a little dog sitting in my lap or throwing the ball for them and watching them race back as fast as they can whilst trying to steal it from each other. They’re great friends who always love us no matter what, and it’s often humbling to get frustrated with them when they just have no idea they’ve done anything wrong.

Anyway, we’re off to Uganda! We’ve got 20 hours of flight time ahead of us! Woo hoo! The best part of the next few days will be finally getting to Mbarara and settling in to our new home for the next few months. I know it’s going to be quite different from Nigeria, but the fact that we’ve been to Africa before has caused many of the concerns I had to be minimized this time around. For example, we’ll be cooking all our own food, and the idea of going to the market to buy my own food when I don’t speak the language was intimidating the first time I did it. Now that I’ve done it once, at least I don’t have that level of unfamiliarity to get past.

One of the things that worries me is that I will constantly be comparing Uganda to Nigeria. That’s not really fair to either place, so hopefully I can have the grace to do it objectively and in a way that is as respectful as possible. Probably the more interesting side of things for you all is how it compares to the U.S., and that is something I’m a bit more qualified to report on. I can tell you right now, even before going, that the weather is warmer this time of year than it is in Portland. See? That’s the kind of brilliant insight you have to look forward to. Hopefully, Barb will post some or you’ll be stuck with this dribble. Anyway, we’ll be thinking of you all as we travel!

Off to Uganda!

2008-02-10T13:44:00.003-06:00

Wow, the last time I posted here was in June of 2006. Good thing Barbara's so much better at posting regularly than I am!

If you haven't noticed, the blog title has changed to Esselinks in Uganda. Yes, just as we went to Nigeria two years ago, we're heading to Uganda this year. This time it'll be for just a month, but we're every bit as excited as we were last time. The path to get to this point, however, has been quite different. When Barbara was looking for residency programs at the end of medical school, one of the first things she would ask about was whether or not there would be an opportunity to practice abroad during her residency. She feels very strongly that doing so is not only of benefit to the communities that she goes to serve, but also of great benefit to her own perspective as a physician here in the States. If you've read any of her past bloggings on our trip to Nigeria, you know that we here in America have a lot that we can learn from other cultures. At any rate, Providence Portland (PPMC) was one of those residency programs that Barbara inteviewed with that partners regularly with a hospital overseas to send residents there. In PPMC's case, that hospital is located in Eldoret, Kenya.

So last fall, Barbara heard from her program director that she'd be able to accompany them on their trip to Kenya this march. We made preparations and also started to investigate whether or not I would be able to come along. Then, Kenya held their election in late December and amidst accusations of vote rigging, the nation erupted in violence. Eldoret was one of the places affected greatly and from what we've heard, is still somewhat unstable even as Kofi Annan works to resolve the political crisis. I decided for sure that I would be going along with Barbara regardless of what affect that had on my current employment. I just felt very strongly that Barbara would not be going alone, and that passing on an opportunity like this was not something we were willing to consider. Despite the unstable situation, we were still eager to go to Kenya. We knew from Nigeria that the western press isn't typically a good indicator of the situation as it really is. Often, the danger is overly dramatized and the implication is that it's more widespread than it is in reality. At other times, you simply don't get any information at all. For example, in Nigeria, we spent most of our time in Jos, nearly a full day's drive from the coastal region where the oil related kidnappings have happened, yet the western impression of Nigeria is that the entire country is rife with it. We felt none of that in Jos and thought that perhaps Kenya would be similar.

As it turns out, that wasn't really the case. The word we got from various people in Kenya was that the violence was indeed less frequent than the press made it sound, but it was taking place in Eldoret and the neighboring areas. While the residency director didn't tell us we weren't going to be allowed to go, it became fairly clear that was what would happen. We were hoping that we'd be able to go back to Jos instead, but PPMC said no to Nigeria. I guess because it's not a country they've gone to before and the oil region has enough problems to scare people about the rest of the country. Fortunately, Barbara connected with a local physician planning to head to Mbarara, Uganda this March, and things have worked out so that we'll be able to go along there instead.

Just like we did for Nigeria, we'll try to post regularly while we're gone about the trip and our experiences there. Internet access will probably be rather limited, so I don't know how much we'll really be able to post, but we'll certainly write about it and post later if we have to. If you're interested in supporting us, please just pray that the trip would go well and that it would be both safe and a great learning experience for everyone involved. We hope to be as respectful as possible of Ugandan culture but we're sure we won't fully understand everything. Our dogs Sophie and Teddy will be staying with our neighbor who has a chocolate lab. The four of them get along tremendously, so no worries there. Finally, do pray for Kenya as what's gone on there over the past two months is just very tragic. I can't begin to understand the depth of emotion that has led to the current situation, but I do hope that things resolve peacefully from here forward.

I'm a Bad Person

2008-02-10T13:44:00.001-06:00

I can't really begin to express how grateful I've been to all the support I've recieved from people since my mom passed away last November. I can tell you I feel very blessed to have friends who've sent me cards, emails, and flowers to encourage me. I also feel guilty for not having written a single thank you card. No one has been more of an encouragement to me than Barbara, and I can't imagine having had to go through this without her. She also encouraged me to sing at the funeral, an experience I was terrified of, but knew my mom loved watching from heaven. It was the right thing to do and I think it helped me feel like I had some closure.

It's been a bit of an odd experience since. I find myself wondering why I haven't cried more or why I can still go about my daily life as if everything's the same. Since we returned to Portland, there have only been a couple of cases where it's really affected me. One of those times was when I installed the curtains she sent to me the Tuesday before she died, which we found waiting for us when we got back to Portland. I didn't put them up till late January, and they're tremendously beautiful, but somehow it felt like another act of goodbye. In reality, it's a tribute to one of the things that she got a great deal of satisfaction out of doing. I do miss her still, but her passing is a natural part of life, and I'm happy that she's in a much better place now where the miseries of this world can't touch her.

Thanks so much to all of you who've sent support, either via card, flowers, prayer, or simply a kind thought. They do make a difference.

Mother in laws, memories, and death

2007-11-25T21:46:00.001-06:00

My mother in law was a looker.

It’s very strange, to go through old photos, and see what your parents and grandparents and their generation looked like when they were young. In general, they were beautiful, happy, and young! Like us. It surprises us, to think of them as being like that, because we always remember them as our parents---older, more worn down with the years, and simply, well….our parents. People who frown at our scandalous habits, yelled at our choice of dress, disapproved of our boy/girlfriends.

In the 1960’s, my mother in law was a beautiful young woman with photo after photo of herself at the beach with friends, on the arm of various men at parties, clearly having some scandalous habits of her own! But then there were other pictures, too---photos of her clearly adoring her three little kids. She had many loving photo albums, painstakingly handmade, of each of her children from their birth on (though we couldn’t find one that was exclusively of Frank---that was kind of funny, as everyone knows Frank was her favorite child). There were many pictures of her with her family, and pictures of her in every place imaginable---Switzerland, Singapore, Israel, etc. What an interesting life she had!

Many of you know my mother in law passed away on Thanksgiving morning, very suddenly. It has been hard to think of her as “dead”, as opposed to just away, since to everyone’s knowledge, she was just fine up until the actually event. Despite the fact there have been numerous phone calls, visitors, and even discussions with the funeral home, I don’t think besides the first shock of hearing the news, it had really felt real. Today, we had the long hard discussion of her memorial service, and we actually got to see her and say goodbye. It does seem more real now. But it’s actually been a lot of fun, really, putting her service together. You see, she was a very loving, happy person with a great sense of humor, and looking at her old photos and remembering her favorite things was a very easy thing to do. Over the past 10 years, she was pretty sick and was a tenth of her normal self, so it was very easy to forget that she used to be a funny, high energy person. But going over her old things reminded us of this.

She loved the Lord, and we have no doubt that she is with her daughter Karien, who died more than 20 years ago, so we have no sadness about where she is. And we are so grateful she died painlessly, quickly, without any suffering. That’s the kind of death everyone wants. We really mourn only for ourselves, you know? But what I think about most is my future children, and the sadness I feel that they’ll never know one of their grandmothers. That they will never be spoiled by her, never visit her during summer break, never hear grandma tell embarrassing stories about their dad. They’ll never learn to say “Oma”, the Dutch word for grandmother, with as much familiarity as I would wish.

I can’t tell you how grateful we are for the support we have received. Frank was supposed to be part of a wedding yesterday, a very happy event with so many of our friends who we haven’t seen in a year, but not only were the bride and groom so understanding about Frank backing out of the wedding, many of them got together and sent the most beautiful flowers to us. My chief resident called to tell me to take as much time as I needed, even though the resident covering for me went into pre-term labor and now everyone is scrambling to cover for me! There are so many other stories I won’t bore you with, but it’s been amazing.

I think about death a lot, as I’m thinking about going into end of life care as my specialty, and I was thinking about how we like to make death this scary, far-away thing. In America, as soon as someone dies, it’s like suddenly the person is gross. They are left to the hospital, no one wants to touch them or see them or have anything to do with their body, and if the body is seen again, it is with some sense of revulsion. I find it SO strange. We loved those people, in their bodies, for their entire lives---we should be able to say goodbye and deal with their bodies in a loving fashion as well. After all, we may believe the spirit has left and moved on, but the body held the one we loved for so many years---we should honor that! Anyway, it’s time to go through more pictures again. Thank you, everyone, for thinking of us and praying for us.

Of cigarettes, games, weddings, and more

2007-09-15T23:18:00.000-05:00

Well, so my attempt to blog more regularly definitely is not working. My friend Zac reminded me today that I have been totally remiss in writing, so I thought I'd do so. I wish Frank would write as well but he's a big writing loser (I'm hoping if he finds out I insulted him he might make an appearance in this blog).

What to tell you? Residency has been going well. Some random highlights:
-a patient handed me a bright orange cigarette box with 5 cigarettes in it at our last office visit together. I had been working with him to quit smoking for some time. He gave me the last cigarettes he didn't smoke as a trophy, he said. On it, he had taped a white sheet of paper all around it that was writing by his dog, who thanked me for saving her human. Some people thought it was very strange, and some thought it was very nice, or both. Unfortunately, at that same office visit he managed to get into an altercation with MA which took the better half of the office visit to get resolved, sort of, with him. It started off with whether Maine or Alaska was colder and degenerated from there.
-ICU overnight wasn't near as bad as I thought it would be. I carry a white cloud around, meaning, when I'm on a difficult rotation or call, my night tends to be very quiet. I spent 5 days a week for a total of 2.5 weeks as the lone ICU resident from 8 PM to 7 AM.....scary! But overall, it was a very quiet 2 weeks. I tried to put a catheter into the neck of a 370 lb guy...what a disaster. We had a poor lady who developed an air leak from her lung to her subcutaneous tissue, meaning she had air in her muscles, her eyelids, her neck, etc. It was VERY strange and scary at the same time.
-clinic: don't get me started. Love it and hate it at the same time. I have patients who are very dependent on me. It's kind of sweet that they like me so much but also kind of irritating that they refuse to talk to ANY other doctor in the clinic. And people, if you don't have insurance, GET IT. Being uninsured in America is one of the most tragic and sad things out there.

Weddings: My brother got married about 6 weeks ago. It was a beautiful wedding. They looked so happy. It was nice to see family who I haven't seen in a long time, though I must say, there was a LOT of getting lost as my family tried to get around Champaign, IL.

Games: We had some friends come to visit us from Madison, WI. While we were in Madison, we spent many fun days with these friends, particularly having games night! We would cook a yummy meal together, drink a lot of wine, listen to a lot of music, and play games. Not average games like monopoly or cranium (though we do play those on occasion) but settlers of catan and trains and roborally and all these strategy games (you really ought to try them). We also went camping together. So when we moved to Portland, we determined we'd try to continue to camp together at least once a year. So they came to visit us this past week, for which I am so grateful. Camping along the Oregon coast is a beautiful but very unpredictable thing. Our dogs proved that they really can run along the beach all day long without stopping and got sand all over our tent. We ate so much food all week after they left, I hardly ate anything. Now that they are gone, the house seems strangely empty and quiet and slightly melancholy. I don't miss doing dishes for 5 people, however.

Dogs: Sophie tore a toenail off and has been licking it incessantly for days. It's driving me crazy.

Frank: is now on his 4th load of laundry. Ah, smelly camp clothes, dog towels, guest bed linens, beach towels.....

Finally, our grapes are ripening. Fruit here is AMAZING. We've been eating the best peaches, berries of all sorts, melons, and cherries since April. We have our own concord grape vine and Frank made like 30 jars of jelly last year. Mmmh, jelly. I miss you all; if you come visit, we'll give you some jelly.

Thoughts from the third week of my second year

2007-07-16T00:18:00.000-05:00

I'm relieved to say that being a second year is fun! It's frustrating, different, astonishing, but not near as scary as I thought it would be. I've lived through my first code, multiple RRT's (pre-codes), and my first overnight call. My hours are better. And, trying to manage an intern and a medical student has taught me:
A. I really have learned a lot, even though I feel like I can't learn enough!
B. Trying to teach someone requires a lot of patience
C. I'm REALLY Anal.
D. Trying to prioritize codes, patients, clinic calls, pages, and all the other craziness that goes along with being a second year is hard!

Still, getting to be more in charge has been fun. Letting my intern write notes and answer pages is even more fun. But I truly enjoy seeing how I can help someone grow. I like interacting with the families more closely, and talking to the consultants and attendings. Medicine is even more fascinating this way.

I thought I'd try something different and attempt to write about a particularly memorial patient once a week or so, as most of what are the highlights or struggles of my week revolve around a particular patient. I've learned so much about people and society too, through my patients. Of course, there are privacy rules so I'll have to be appropriately vague. This week, I thought I'd tell you about a lady we had, 88 years old, who came to us in terrible shape. She was painfully thin, blind, slightly demented, and hornery as they came. She couldn't even sit up without help. She had been found unconscious by a friend, no one knew how long she'd been like this. Long story short, she has been living alone, unsafely, for two years now. She had never married, no kids, no living relatives but a nephew, who was worried sick about her. She had had adult protective services called on her many times but she refused to let them in. She was determined to live her life as independently as she could and to die "on her own two feet, kicking and screaming", just as she'd lived her life. She had had her electricity cut off because she'd forgotten to pay the bills. She was paranoid, so she refused to let anyone help her with her bills. She thought we were trying to poison her and steal all her money. She thought she was getting along quite fine, thank you, and was eating like a horse and getting to the store herself and we were all crazy to think she needed more help. This, of course, put us in a bad spot, as it was clear this was not true and she was not safe to go home herself and that she was delusional. We were able to find a way to start the guardianship process for her nephew and to get her to agree to go to a nursing home, but I had such mixed feelings about all of it. It was sad to me, that she had had no one to look after her for so long. It seemed sad to me that we live in a society where we are too busy to take care of our elderly people and instead send them to places where all they see are other old, sick people. What a way to cheer them up! We felt bad that she so obviously didn't want to go to a nursing home, and we basically were trying to convince her to do something she didn't want to do, but we couldn't send her home. We just couldn't, it would be like sending her to her death. Maybe she'll find she likes the nursing home, where they can wait on her and she can eat all she wants. I was impressed with her indomitable spirit. Maybe she will get better and go home in spite of our dire predictions. I rather hope so.

Thoughts from 6/29/07, the end of my internship

2007-07-16T00:17:00.000-05:00

It’s been a little more than a year now that I started my internship, and in two days, I will be a 2^nd year resident. I can’t believe how fast it’s gone, and how far I’ve come in one year. Most of the time, I despaired at ever learning more. I always felt no matter how much I read, or how hard I worked, I never knew enough. I felt the information I was trying to take in went in one ear and out the other and why did it take reading something 5 times for anything to stick? (my dog is sliming my shorts as I type this with his wet nose) But then, I met the new interns. They are nice, intelligent, wonderful people. But it helped me to realize that I indeed have come a long way. So many little things that I never knew were important until tried to explain it to someone else. Such as, the social worker is your best friend. When trying to discharge a patient to a nursing home, make sure you fill out the right kind of paperwork. If someone doesn’t have insurance, you can’t get them much aid. If a patient’s belly is rigid, no matter what they say, it’s BAD. You can call the pulmonologists day or night, and they’ll be nice, but be careful of some other subspecialists. And on, and on, and on….

It’s made me feel a little more confident that I’ll be ok as a second year. My program director made the good point that we’re very good at being interns. We like being interns. So now that we’re second years and have an intern to supervise, we’re going to let the intern do what had been our job, and learn a whole new role, and it’s going to be hard at first to let go. And it’s true. I’m very comfortable being an intern. I know what it’s all about. Also, interns don’t have final responsibility. We’re pretty low on the chain, as far as responsibility goes, so now that I’ll be more responsible, I’m nervous. I’m nervous running codes, and being alone overnight in the ICU and being in charge of making sure wards teams run efficiently. I’m nervous to teach my medical student and be the one to call family members everyday. So many decisions to make everyday, I wish I felt 100 percent confident. But no one does, so I just try to remember that and be excited that I’m moving on.

I’m also very happy that I’ve learned that I love taking care of patients. Being a doctor of the underserved in the US is hard. Our health care system doesn’t work. It just doesn’t, in any way at all, and it’s hardest on those who need it most. It truly breaks my heart to think of all my patients who I want to do so much for but can’t. I can’t even list them all. I have my undocumented Mexican worker, a young man with 4 children and a wife, who has a particularly aggressive cancer and will die without treatment but is terrified of being deported and I have a hard time getting him to fill out paperwork so we can at least do some charity care for him through my hospital. Another patient, only in his 50’s, who had a stroke with residual cognitive defects such that he can’t even get to my office on the bus himself or else he gets lost, loses his bus pass, has a panic attack, etc. His brother provides for them both and he can’t even apply for disability until three months after his stroke occurred. Meanwhile, he can’t afford occupational therapy so these first few months, which are often the crucial months for rehabilitation, he has slowly lost function when he should have been gaining it back. Then there’s one of my meth user, who has had a few near-death experiences because of her meth use, who has finally admitted using to me after many months of me knowing she was a user, but who was afraid to tell me because she’s had such bad experiences with people looking down on her or turning her away in the past even though she truly wants to quit. Next, there’s the homeless guy I took care of in the hospital with diabetes, who needs insulin but gets his medications stolen on the street all the time so he never has medications for longer than a week after he leaves the hospital. He’s a very nice guy but it’s clear he is a little slow and it’s also clear that the other people who live on the streets take advantage of him and dupe him at every turn. He will die from his diabetes soon, I can tell. The fact the he is still alive now is a downright miracle to me. He promised he would come to see me in clinic so I could take care of him. He never came.

Finally, there was my experience at the jail. I have this great rotation called population based health at my program, which is two weeks of learning about health care systems, health disparities, all the needs in medicine, and how people try to solve these problems. My program wants us to be a part of changing the system, and to be socially responsibility, and not just complain about it or forget about the things that need to be changed. One thing we do is spend a day in the jail. What an experience. Like Africa, I think every doctor ought to spend some time at the jail. It is a very sad place. It is a place we put psychiatric patients, who have nowhere else to go. It’s a place we put drug abusers, who really need to be at rehab but are in jail instead. It’s a place for those who aren’t safe on the streets and actually feel safer in jail. And health care in the jail, well, there IS free care but it’s only certain things. Very limited. And these guys have such basic physical needs, it’s sad that only in jail can these guys get any care at all. We turn such a blind eye to those less fortunate than us, and being in medicine makes it impossible for me to do so. Yet I feel there’s so little I can do. I hate it.

p.s. 1 year ago we were in Nigeria...

2007-03-30T02:08:00.000-05:00

At this time last year,we were in Nigeria. We were thinking a lot about that recently. Now, we hear about Nigeria all the times in the news, about the captured internationals, civil war impending, corrupt officials, and the scary upcoming elections. It makes Nigeria sound so terrible. Yet, it is not by any means all of what Nigeria is, and certainly not what I remember best. Going there was one of the most life changing events in my life, and now, only a year away, it seems like such a long time ago. I still wake up at times and think I hear the sound of the fan going at night, muffled through the mosquito net. I still at times while at church, close my eyes and see the brightly colored clothes, the loud happy music, and miss it fiercely. I miss the mouth watering pineapples and the dusty roads under bright sun. I miss the happy wonderful people I worked with. I miss feeling all the time that God is everywhere, in everything, that my existence is entirely bound up in His will. I can only hope that every person will have an experience in his/her life which will shake them up in such a way.

On dogs, chocolate, mermaids, and other happy topics

2007-03-29T20:04:00.000-05:00

Hello! It is a beautiful spring day in Portland---70 degrees, sunny, everything is blooming already, and I have a day off! I’m sitting under a tree in our backyard filled with glossy green leaves and huge pink blossoms with yellow middles---anyone know what that tree is??? The tulips and roses are coming up, and I’ve discovered we have a huge patch of green onions (or chives---I’m not sure which!) growing by our back door which is letting out the most amazing aroma---I considered taking a bite out of it but decided that I didn’t want to give my dogs a bad example! The dogs have grown up so much now, it’s amazing. They’re almost 9 months now; I can actually let them just hang out in the backyard with me without worrying they will chew on every last tree, twig, flower, and stone out here. They’ve leveled out at about 20-24 lbs, so they’re still small dogs but I think the perfect size. I wish you could all see how cute they are. They’ve made me very popular in the neighborhood!

Since I last wrote, I have now finished two rotations: palliative (or end of life) care, and a general wards month. I can’t sum up palliative care at all, except to say it was great. I loved every minute of it. Many people wonder why I like end of life care---it seems morbid, I’m told. I wish I could express just how much of a privilege it is to be able to share someone’s death, and be a part of making it peaceful. It’s on the same level as attending someone’s birth. I see it as a similar thing. After all, everyone is born, and everyone dies. There’s no getting around it. But I also think there is more than just this life, that the soul goes on, and goes on a different journey. So death, well, I think it’s sad because of the loss we, the ones left behind, experience; but not because of death itself. It’s a new beginning of sorts. Sure, I’m scared of dying, there’s so much still I want to do. People I don’t want to lose. And the fear of the unknown. Yet, when the time comes, I hope I can embrace it as just another beginning, a start to something even better, and end as joyfully as I came to this life. And that’s my hope for everyone. So to be able to be a part of that for someone else, it’s really a great thing.

Plus, people are real at the end of their life in a way they are at no other time. There is no time for superficiality. There is no time to push away hard questions, and avoid dealing with hard situations. People think about their lives in a way that I wish everyone did. They ask those hard questions: what is the meaning of my life? Where am I going? What do I have left to do? What legacy do I leave behind? Who do I regret being mad at? Is there a God? And though I don’t have any answers, I can still be there to listen and encourage them to talk to people who can help them find those answers. As for myself, I’ve learned that I am lucky, because I know what my purpose is. I’ve asked myself those questions, many times, and I know where I stand. There are days when I don’t feel very spiritual. Days when I just want to get through every task and I don’t think about the meaning of my life or what I want to accomplish today. Yet I know that there is one thing by which I live every minute of my life, whether I am good at it or not, and it’s to love God, and to love people as God loves them. That’s it. I can’t imagine a life without that purpose. And it’s reassuring, to know no matter how mundane things are, at my core I have that truth to hold onto. I wish everyone had some truth they held precious as well too.

I change my mind about my dogs. They’re idiots. They’re now eating the grass.

Anyway, on to lighter things! I have 2 more days off, due to a freak of luck during rotation changes---yay!!! But then I start nightfloat----booo. 7 Pm to 8 AM for two weeks. Yuck. But I won’t think about that. Instead, I wanted to be happy and list the top 10 things that either are making me happy or that we’re looking forward to in the next few months:

1. There are 4 Moonstruck chocolate truffles waiting to be eaten by me (if you’ve never had Moonstruck chocolate, you really, REALLY need to come to Portland, it’s the BEST chocolate ever) which my senior (there’s always a junior and senior resident on general wards teams) gave me. I assume it means he thought I did an ok job but I haven’t had the guts to outright ask yet---no one wants to be the intern that everybody thinks is unreliable and terrible, so though I haven’t gotten any terrible feedback yet, every rotation I wonder if this is going to be rotation where someone tells me I did something really bad. But chocolate strikes me as a nice way of letting me know I did ok.

2. Frank apparently does a good mermaid impression. A few years ago, we were playing Cranium or something and Frank had to get us to guess the word “mermaid”. We didn’t get it; he was disgusted. Recently, one my favorite fellow interns had a deep fry turkey party (long story) which I couldn’t go to because I was overnight call but Frank went, and the next morning as I’m trying to finish my work so I can do home, I heard various reports of what actually went on; apparently Cranium was played again, and Frank again had to act like a mermaid, and everyone got it in seconds. He felt vindicated. A girl can’t go wrong when she’s married to a man who does good mermaid impressions. I also heard something about Frank being a bike messenger???

3. We’re going to Stephen and Karen’s wedding in May. I’ve recently been missing Madison a lot. We really loved Madison, and our friends there, and though I love Portland as well, part of my heart is still there. I hate moving.

4. My brother is getting married in August. His fiancée is very funny and fun, and I think she makes him more funny and more nice than he already is. I’m so happy for them and I can’t wait. I love weddings. Love them!

5. Baseball season starts. I hate baseball, but now Frank has something which makes him deliriously happy to occupy him when I am working a lot.

6. Our tulips from Holland are starting to come up, I can’t wait to see what they look like (Except our dogs keep running over them, sigh….)

7. We went hiking with our dogs along one of the waterfalls in the mountains just 40 minutes away from our house on a beautiful warm sunny day last weekend. They hiked for two miles without any complaints, and it wasn’t an easy hike (wasn’t hard either, though). I was very impressed with their stamina for such little dogs!

8. We’re going to hear the Oregon opera do the Magic Flute for my birthday in May. It’s my favorite opera, so I’m very excited!

9. Frank finally managed to find us a church whose style we seem to like, though it seems full of yuppies. I’m trying hard not to become a yuppie.

10. Many of my friends are having babies. I love it. What an affirmation of life and family. Sometimes being a doctor stinks, as it makes having a baby so much more difficult….I’ve come to the conclusion that I’ll never work full time. I want time with my family, time with nature, time for myself. And babies sure need to fit in there somehow!

One more; can’t help; I’m a happy person right now!

11. I was lucky to have many patients on wards this month who reminded me of why I wanted to be a doctor. One patient, who was very ill, greeted me every morning with “how are you?” even when it took him many tries and a lot of gasping to actually get the words out. I couldn’t believe he would still ask me how I was when he was on the brink of death. His family was amazingly sweet and being Asian, pressed gifts of pearl necklaces on the doctors which we could not refuse. Now, normally, we can’t accept gifts from our patients---doctors don’t want to be seen as bribeable, basically. But being a good Asian girl, I understood that it was truly a cultural way of showing appreciation and I was quite touched. He ended up dying, which was sad but not sad. Because I knew he had lived a good long life, and a gracious one, even to the literal end of his days, and he left behind a legacy of love and graciousness in his family. I may not like paperwork or bureaucracy or insurance companies or many of the hoops I have to go through as a doctor, but in the end, I’m happy to say that the times of interactions I have with my patients, and knowing that I’m helping them even a little, makes this all worth it.

The ER: not like TV

2007-01-19T17:44:00.000-06:00

Ok, the ER is NOTHING like the TV show makes it out to be! Well, I shouldn’t say nothing, but it’s really much more mundane than the show lets on. There are crazy people for sure; there aren’t enough psych beds for all the people who need them, so often they sit in the ER for days until a psych bed open. Last night, a man was banging on the locked door of his room, screaming for hours, while the guards sat outside his door and we tried our best to ignore it. There’s also the demented old ladies, who start making Xena war cries when you try to listen to their hearts and wander out naked if you’re not watching. There’s also the spectacular cases, the young healthy person who spontaneously gets a head bleed, is rushed in and has to be intubated emergently and a hole drilled into her head ASAP; or the guy who comes in actively seizing and you need three burly guys to hold him down while you try to inject medicines in him ASAP. But for the most part, most people you see are a lot less exciting. Lots of shortness of breath, chest pain, back pain, broken bones, fevers, stomach pains, etc. And to set the record straight, as far as I can tell, there’s NO doctors having sex in the laundry room!!

I’m not fond of ER work, as I am a slow, methodical person, and I don’t like thinking fast, but it’s been good for me. Though I understand the need for electronic records and Frank is an electronic medical records guru, it’s AMAZING how much faster I am when I don’t have to type my notes as I go along, I don’t have enter in computer orders, and I can just dictate away. I’ve seen some children and pregnant women, which I REALLY didn’t want to do, but actually, being in Nigeria helped me as I did see lots of kids then. As I’m wont to, I’ll tell you a story which I think represents my ER experience so far, meaning, horrible, great, and humorous, all at once!

So two days ago, at 7 AM, I picked up the first chart, which was a pregnant lady coming in for vaginal bleeding. Great, I thought. Not only do I HATE doing pelvic exams, she’s pregnant! I was terrified I would do something stupid and miss something very big, like a miscarriage or something. So I tell the ER attending physician that I’m not very comfortable with Ob-Gyn. He says, “great! This’ll be a good chance to learn. Go in there and see her.” Ok, then. So I go in there. It turns out that she’s not only a few months pregnant with a few days of bleeding, she doesn’t speak English, this is her 12th pregnancy, and she’s only seen a doctor once before this. I do the vaginal exam; it takes me forever to find the cervix; I think I found it, but I was terrified I had missed something---had I missed it somehow, and didn’t see she was bleeding like mad, or that there was tissue hanging out, or something obviously very bad? It’s hard for me not to have noticed something like that, but I just didn’t want to mess around with someone’s baby! Calm down, I tell myself. She’s probably just bleeding, and the baby’s fine, you’re overreacting. So we send her to Ultrasound. Her labwork comes back and everything seems fine. The Ultrasound report comes back; there is NO baby in the uterus. Uh oh! So I call the Ob-gyn doc, who comes to see her, and reassures me the patient probably miscarried by then and there was nothing to see, and the patient is fine, she should just come to be re-examined in Ob clinic tomorrow, but I’m feeling wretched. The first patient of the day, I’m already terrified, and I have to tell her she miscarried. I’m a wimp; the ER attending sees her before I do and breaks the news himself. He can probably tell I’m scared and doesn’t trust me to do a good job of breaking it to them, which is probably true! It's better for them that someone more experienced than me is talking to them about it than I. I guess I should’ve been braver and gone back in there. But this is one of the exact reasons I didn’t go into family practice; let someone else deliver babies and break this kind of news, not me! (do stories like this inspire confidence in you as to what kind of doctor I am???? I realize I shouldn't be telling people how terrified I am---but really, underneath it all, no matter how terrified I am, I do what I have to, and that's all there is to it. I'm still learning. But terrified or not, I don't think I've made any big mistakes yet---pray really hard this remains true!!!)

another long ICU story

2007-01-19T16:37:00.000-06:00

Hi,

It's 5 AM, and instead of catching what little sleep I can while I am overnight in the ICU, I am awake, typing this entry. It is actually pretty quiet, much quieter than I was expecting, but I still can't sleep. I slept for about an hour and then got woken up to my alarm on my pager, set an hour too early. I have two pagers, my personal one and the ICU code pager, and I was so disoriented, I had no idea which pager it was, so I did what is instinct: when in doubt, jump out of bed and run to the ICU to make sure everything is ok. It wasn't till I got there that I realized I had mistakenly set my alarm clock too early. But, by then, the nurses had seen me and it was too late to go back to bed. It doesn't matter anyway; no matter how tired I am, it is impossible for me to sleep when I am in the ICU overnight. My adrenaline is going, people are sick, and I just NEED to know what is going on. I hope I outgrow it.

Yes, I am back in the ICU, back where I first started this whole residency thing. It is so much less scary the second time. Though I still feel harried all the time and like I know NOTHING, at the same time, I am more comfortable with things in general. Somehow, things don’t seem quite as scary, and I know that help is only a phone call away, if I ever feel in over my head. I also have confidence that I can now do the things I have to do, even if I don’t like it. I can intubate someone myself if I have to. I can put in a central line (put a big iv line into one of the major vessels that goes into the heart—yikes!) if I have to. I can do CPR if I have to. In fact, weirdly enough, I like it better than many of the outpatients I have to do. I like it better than genital exams or cleaning out ears or colonoscopies. Isn’t that weird??

Anyway, tonight has only been harrowing in that one of my own clinic patients is here in the ICU, and she’s dying. Already dead, really, and I can’t make any sense of my many emotions about it. She was one of my first clinic patients I ever saw. She didn’t like doctors, didn’t feel they did anything for her, but wanted to get whatever she could from them. She was a smoker who was ruining her lungs and heart by continuing to smoke, and had a terrible social situation. Through many office visits, I got her to open up to me and trust me. It was one of my biggest victories as an intern, the day she told me she felt I really cared about her. And though I have not been able to help her much, she attempted to quit a few times, which is more than she’s done before. She came to see one of my partners in clinic for what seemed like the 3rd pneumonia in three months. My partner called me to talk about it. It appeared on her most recent CXR, the radiologist found that pneumonia had returned in the exact same spot and wondered if it was an obstructive pneumonia. Meaning, was there a mass pushing on a bronchus and making her prone to pneumonias? I immediately was worried, because something in my bones told me yes, she did have a mass, and yes, it was a cancer. I asked my partner to admit her to the hospital immediately, because she has no phone and can’t get around easily, and I knew she’d need a big work up. We were able to find her and admit her. Her breathing got so bad, she had to be admitted to the ICU, where I was. We were happy to see each other, though at this point, I had spent a lot of time wondering if I should have thought about cancer sooner; had I missed some signs? Could she have been cured sooner, if I had thought of it? I was ridden with guilt and uncertainty. Meanwhile, she was running around telling everyone I was the cutest and sweetest thing there was; talk about making the guilt worse!

Anyway, to make a long story short; a CT was done, showing a mass, and what looked like liver lesions. The lung docs tried to biopsy the mass and couldn’t; everyone thought the safest thing would be to biopsy the liver through interventional radiology. The biopsy was done. Half an hour later, she was complaining of a pain in her belly, and her abdomen was getting bigger and bigger. She’s rushed back to radiology. It appears in doing the biopsy, they hit the hepatic artery, one of the major blood vessels in the liver, and she is bleeding like stink into her liver. They are able to stop the bleeding; but by then, she’s bled so much, she isn’t perfusing the rest of her organs, and her heart stops. They code her and successfully resuscitate and intubate her, but it’s a mess. Her kidneys have stopped, her blood pressure is incredibly low, all the clotting factors in her body are out of whack, and her chances of coming out of this functional is very bad. Meanwhile, she has very bad circulation to her legs; her smoking has caused some of the vessels in her leg to be very thin, and now that her blood pressure is so low, her right leg is ice cold and dying.

I have had talks with her in the past about what to do if she were to be critically ill. She has expressed numerous times that she doesn’t want to live if she can’t live independently. She’s rather die than go to a nursing home, never mind being on a mechanical ventilator. If she can’t live by herself, she’d rather we just let her die. I thought we were there. However, the kidney docs thought we could try emergency dialysis to get all the toxins our of her system and maybe we could reverse things. I am VERY dubious, but I’m the intern. I agree. 9 hour after that decision is made, it’s been a nightmare. Dialysis hasn’t done anything. Her blood pressure remains adequate only with 4 medications to keep it high, and with extra fluids poured into her. She is so swollen, she isn’t urinating, and she looks worse and worse by the hour. Her leg is ice cold and blue. The nurse is frantically trying to get me to try all kinds of stuff; bicarb, check blood gases, more fluids, etc. I tell the nurse she can do it, but I think it’s worthless. I feel that I should have just let her die hours ago. I should’ve stood up to the other docs, said, “I know my patient; her chances of getting back to a meaningful recovery is slim; let’s just let her die in peace”. But instead, in trying these last ditch attempts to save her, I am harming her instead. She looks horrible. She will now never recover to any meaningful existence. She’s basically dead, despite all the machines and nurses are doing in there.

But could I have denied her this last chance at life? It was a slim chance, but was it really right for me to say, let’s not even try it? Now that we have tried it, I know it didn’t work, and I know she looks even worse. But this is all hindsight. At that moment in time, before we started dialysis, if this were my mother, and I knew there was a slim chance, but still a chance, that this treatment could help her, wouldn’t I want the doctors to try? I don’t know. I know that because it was a complication of a standard procedure, an unexpected tragedy, we all felt we had to do something to save her. But was this the right response? I guess now we can tell the family, look, we tried everything. But also, part of me is somewhat relieved, that she isn’t recovering, though guiltily so (I am a very guilty person). For, if we did save her, to what would I save her to? She has cancer, I am sure of it. She’d have maybe two more years to live; years either with toxic chemotherapy and radiation, or years without treatment where she could die slowly, in excruciating pain. It seemed like a mercy to spare her that. But who can predict the future? Maybe she would have lived many more happy years.

It is somehow so much harder to watch your own patient die than someone you never knew until they came into the hospital. I tell myself I won’t cry tomorrow morning at rounds, when I have to tell everyone what happened to her overnight, and what I think we should do. But I know I will. For I know I will tell them to stop the treatment and end her life. I tried to help her in life, and don’t feel I was able to. I tried to help her in death, and I feel I failed her then too. I want to go into palliative care and give people good deaths; I certainly did not do that for her. My only consolation is that if she was running around telling people how sweet I was, she must’ve felt I was at least trying. I guess that’s something.

it's not a fun blog article

2006-10-30T19:07:00.000-06:00

I was inspired to write after having visited my friend Sarah's blog site. I find I have so little time to email, no matter what my good intentions are to spend 1 hour emailing a week, and her blog is a good way for me to see what is going on in her life. My residency director encouraged us to try to keep a journal during our first year, because we will have gone through so many new and powerful experiences that would be good for us to remember; so here's my attempt to kill two birds with one stone. Now warning: I try not to get too sermony on these blogs, as who wants to read all these deep thoughts about my struggles with my faith? Yet, I am finding more and more that it is impossible to separate how I'm struggling with my intern year from my faith, because without it, I think I would be a quivering, wailing mess. So sorry if this is a long discourse on my spiritual struggle!

I have just finished my outpatient rotation, which was exhausting. I was expecting it to be an easier rotation, as I technically had normal office hours and had the weekends off (two days in a row, wow!). But, I was rarely done before 7-8PM and outpatient is...frustrating. One of my preceptors told me my only real criticism was that perhaps I was coming off as cynical to my attendings, and I was surprised to hear her say that because I've talked plenty with the other residents and I'm not any more or less cynical than they are. But on reflection, I can see why she would have said that. We are an underserved clinic. We help people mostly without insurance. Most of my patients are very sick, disabled, former drug users, current drug users, homeless, formerly homeless, don't speak English, don't have high school education, have a psychiatric illness, etc. Not all, but most. And you would never, ever believe how hard it is to get one single thing for them. For every medication I want to give them, if I don't have samples, I have to send in what feels like 10 forms and referrals, and I still often get denied. If I can get my diabetic patient insulin free, well, I still have to figure out how he's going to get syringes, glucometer, strips for the glucometer, transportation to come visit me every two weeks to figure out how much insulin he should get, etc. I have a patient who needs a simple anti-fungal powder, as the cream she is using doesn't keep her rash dry and a powder would help to keep the area dry. Simple enough, you say? Wrong. Apparently, medicare doesn't cover that. It's a cosmetic thing, they say, this rash. Even though it's red, scaly, itchy, hasn't gone away in years, and makes it hard for her to wear anything around her waist, it's cosmetic. So either I have to go to a hearing and tell some sort of arbitrator from the insurance company why I think she needs it medically, or she has to pay out of pocket. I'm told I should be grateful, that medicare pays for my salary. Why should I be grateful to be in a system where the poorest are left behind, and the rich can get whatever they want? Why should I be grateful that they pay me to fill out their paperwork for hours and then deny me anyway?

So yes, I am getting bitter. But I'm trying not to. Yes, it's a flawed system; yes, I need to do something to help change it, and not just complain. I don't want to forget this anger. I don't want to say, "well, I can't do anything about it, let me just learn to be realistic, work within the system, do what I can, and beTo help them best, I need to know how to work the system best, and in the most cheerful way possible, for my own mental health. But at the same time, it's NOT ok. It's NOT ok that some people have to fight for anything they can get their hands on and others can have anything they want. But I understand that to be sane, and practical, and wise, I need to learn to do both, work within the system, and change it, and do them both with a cool head. So I'm trying to learn.

It's so hard. I came to medicine for one reason, and one reason alone: because I felt this was the way God wanted me to love people as Jesus did, through medicine. That is my goal. I can't cure people; no one can, but God. But I can help them, and love them, and let them know that there's someone out there who has at least a tiny bit of their well being in mind. And it frustrates me so much, to feel so helpless and incompetent and useless. I want to be this well of knowledge for them, a place where they feel they can get help. I want to have resources for them and help them with not just their cholesterol but also to be there when they're about to run out of housing or their daughter ran away or they can't get food. I want to know everything I can to help them, and I know so little. Both book knowledge, and practical knowledge. I know I'm learning book wise. I feel like I'm failing when I try to find someone to help them with housing and food and cough syrup---there just aren't enough resources to help all those who don't have enough money or family support. But in both aspects, the more I know, the more I realize I don't know! It's impossible to keep up with all the new meds; all the questions your patients will ask you, all crazy medical conditions out there. I know a lot of it is experience. But boy do I want it now!

When it comes to my atittude towards my patients, I think I'm doing ok. I think my patients like me. I have had a few patients tell me that they feel I've tried to do more for them than any doctor in many years. One man told me he spent most of his life feeling unloved, until he started going to the church he's been going to for a few years, and now I make him feel like he has a doctor who loves him too. This was a success, I told myself. Because I know that medically, I haven't really done much for him. He has such bad medical conditions he's trying to sell his house of many years because he can't take care of it, and nothing I do is making any difference. Yet, he thanked me for caring for him anyway. And it's those moments that remind me what I'm doing all this for. It's those moments in which God reminds me that He doesn't care how smart I am or how many people's blood pressures I get under control. I know my love is a shadow of His, but it's enough.

And of course it's not always easy to love all your patients. There, I struggle with cynicism again. It's hard to love the self-destructive patient, the one who continues to use heroin even though it means they come in over and over again for detox or fights or because it makes their other medical conditions act up. It's hard to love them when I spend a lot of time trying to get them medicines they say they can't afford, yet they have enough money to buy heroin. It's hard not to feel used, and not to feel like it's all futile, why even bother? But God loved the prostitutes and tax-payers and reached out to them first; so, so will I, and try to have a good attitude about it.

Finally, it's hard to know how to grow and learn from all this. If I don't know a particular medical condition or how to treat it, I can look that up and read about it. But what do I do when I want to know how to make sense of all the emotions being an intern brings? How do I learn to deal with my feelings of incompetence and worthlessness, and sometimes sheer terror, that I might kill someone in my ignorance? How do I heal my own emotional and spiritual hurts from this process, and figure out what I was supposed to learn from it all? Some days, I get through the day with a smile on my face and an air of confidence that I know is fake, and wonder no one figured it out. Maybe they did, but kindly didn't say anything. But those days, I get into my car at night and cry all the way home. Not often, but sometimes. And then I remember that all I need to do is lay it before God. Because truly, we look for all kinds of ways to heal ourselves and talk about things and group therapy, etc, etc, etc, but really, God can carry all my hurts and teach me all things. He wants to take them from me, but I have to remember to give it to Him! And when you're tired and just want to sleep, it's hard to get the energy to do so. But I'm trying to remember that it's like jogging for me. I often don't feel like jogging when I get home; I'm tired, it's dark and rainy, I just want to eat dinner and lay on the couch. But when I do go, I love it. It invigorates me, it give me energy for the rest of the evening, and my body feels so much healthier later. And so my spirit is too. I may be weary and don't want to do it, but once I do, it's amazing how refreshed I feel, how comforted, to know that God can take it all, and make something beautiful of it in my life too. And week after week, I run the same circle, forgetting to trust Him, struggling to remember God and take the time to seek Him out; but He is patient and faitful and helps me anyway.

The dogs are crazy.

2006-09-20T22:42:00.000-05:00

Hello. It's been a long time as I often come home way too tired to want to do anything but crash. And then on top of it, we were stupid enough to get puppies about 1 month ago. They're incredibly cute, but incredibly annoying too. I can't wait till they grow up and do not want to pee everywhere. I keep telling myself they'll be so much more fun then.

Anyway, things here have been ok. It's so hard to explain what being an intern is like. The worst times are the times when I am on overnight call, and I am expected to answer questions for patients from 5 teams, which usually is something like 45 patients. It doesn't sound like a lot, but when the pager goes off, sometimes two or three pages at the same time, and all night long, it sure feels overwhelming. I hate being called to do death pronouncements, esp. I do that for the whole hospital except the ICU when I am on overnight call. Those nights, I'm so scared that people are going to die because I'm so painfully inexperienced. At the same time, I tell myself over and over that it's God and not me that is control of life and death, and there's actually very little I can do to harm a patient. Truth is, most of my pages are over silly things, like someone needs tylenol or someone needs a sleeping pill or someone needs food. That, I can do. But the calls that come about someone having a seizure or someone not able to breathe or someone's heart rate is 150--that really worries me. I'm never really alone, my senior is always there but no one wants to wake up their senior and admit they can't do something unless it's truly an emergency, so we all just blunder along and hope our mistakes are reversible in the morning.

At the same time, I've been struck by how much more I am able to love people, in my position. When I came back from Africa, everyone wondered if I would be able to apply the work I did there to my patients here in the US. It seems easy to serve those who are so poor, and to serve those in a country where it's ok to pray with your patient. Here, it's not. Yet, the need is different but just as great. I do have my own clinic, which is mostly underserved patients, so I definitely see the poor people here in the US. But in addition, even the "non-poor" people in the US have great needs. We have so much technology, so many advances, people think we should be able to cure everything and help everything. In general, we don't really know how to deal with suffering. It's frustrating for the patient, that they can't have their problems totally alleviated. It's frustrating for me, that I can't help them as much as I want to. And so many people seem to come from non-ideal situations---families that are dysfunctional, people who are lonely, people who have drug addictions, people who have incurable, long-time diseases which are just inevitably getting worse. I find these people need kindness and love more than anything else we do. And that's mostly all I tried to do in Africa, too.

My senior resident today told me that in time, everyone starts to distance themselves from their patients, putting a barrier between us and them, not caring as much if you connect or not, because you have to or you go crazy. I hope that isn't true for me. I hope I always will strive to make my patient feel I am connecting with them and listening to them. I don't feel like I'm very good at it at the moment, because somehow my days end up being so tied up by paperwork writing orders and talking to other doctors and running around going to conferences, I end up talking to my patients for at most 20 minutes a day. It's pathetic. But I just pray all the time that God is working through me somehow, and that's all I can do. I hope the long hours won't make me bitter. I hope someday the pretending to know what I'm doing will become I actually know what I'm doing. But we'll see.

It's finally raining here in Portland, this is the first week it's rained since we got here. Our grapes are in full season so Frank is making grape jelly like mad, the dogs are constantly wet and muddy, and the mountains have disappeared. But still, we had three months of straight sun and beautiful weather so I can't complain. I'd better go read some articles now, but I hope you are all well. I miss everyone.

Time in the ICU

2006-07-31T00:29:00.000-05:00

Hello,

I've been out of the ICU for 4 days now, and not only am I still exhausted, I'm still trying hard to process everything that happened. It's been a really rough 5 weeks, one of the most challenging but amazing experiences I've ever had and I'll try to share only a tid tad bit with you (though that's probably too much anyhow!).

The first week, even though we overlapped with the interns-soon-to-be-seniors, things were so overwhelming. Neither Amanda (the other intern)nor I had been in medical school at all for almost two months by this point; neither or us had had a hard core, internal medicine rotation for almost half a year, and I had been in Nigeria for two months, learning medicine so different from the US. So we felt we knew nothing. Then, we were expected to learn the system; the right way to write orders; how to staff patients with attending physicians; how to talk with consultants; how to print out the proper forms to admit someone; and so on. The paperwork is incredible, annoying, and unfortunately quite mandatory! We wasted so much time just learning the basics.

And of course, the hardest of all, patient care. There's nothing like finally being responsible, making decisions for someone who is so seriously ill, and being the person everyone comes to about a patient's care. Our senior gave us the advice that even when you're terrified, you have to look like you know what you're doing; that even though everyone knows you are new and don't know what you're doing, you have to pretend like you do. Because the nurses, and respiratory therapists and pharmacists are great, but I'm the one who's ultimately in charge. And if they don't feel like I'm confident, they'll get anxious and feel like the burden is on them and will worry about their patient---not to mention, if they don't trust me, that's a bad precedent for my relationship with them in the future. So I grew very good at being very calm, taking the time to think before responding to a very distraught nurse (in the beginning, any little thing the nurses did in a distraught way got me all distraught and panicky and unable to think!), and then being able to fudge it with them; after which I promptly went the back room, panicked, paged my senior resident, or looked up the answer REALLY fast online. But the point is, I learned to panicked where they couldn't see me!

And then there's the nights when you're on call alone. You know you have a senior resident on the floor, but you're the first one everyone goes to in the ICU, and things that aren't as scary at 3PM when everyone's there, are WAY more scary at 3 AM. When your patient has a heart rate of 150, or your patient develops a temperature of 39.5 degrees celcius, or your patient's blood pressure has dropped to 80/40---those moments are so, so, scary at night. Even though you know what do, somehow, it's so hard to think when the nurses are upset, you're by yourself, and that person might die, fast, in front of you. Or, someone's blood pressure is 80/40, a new patient is coming in from the ER who has overdosed on heroin, and you're doing CPR on a person, practically cracking their chest, because they aren't breathing. That's when you want to cry!

But you just do it. And honestly, one of the hardest things, but often most rewarding things, was not the medical therapy part, but communicating with the patients and their families. It was so hard to pick up a patient in the morning, never having seen him before, trying to look at his chart for 5 minutes, before having to tell his family, which often consisted of 30 people, that the patient was probably going to die. Or, having to explain to an angry husband how his wife was having multi-organ failure as a rare complication to a common procedure and everyday, finding something new to tell him was going wrong. Or watching the nicest patient I ever had get sicker and sicker from his cancer and eventually die from it. Not only is it hard emotionally, I often felt like they had all these questions, and I was so inadequate to answer them. I just didn't know, when I knew someone with ten more years of experience would have known. That was really tough.

But then, there were the great things. Watching the cancer patient die, but knowing his family was at peace with it and I had been a part in helping them with it. The day one of my heroin overdosing patients came back to the ICU to thank me for the care I gave to him. This man should have died, he was so sick, and even when he woke up, he was completely out of his mind, not functional, and begging me to kill him. To see him awake, alert, smiling, and talking like a normal person---I almost cried. Just to know that patients and their families depend on you to help them and you actually can help them most of the time, even if sometimes it is just to keep them informed and hug them, that is an amazing thing.

And finally, the sense of comraderie I had with the people I worked with was great. I chose this program for many reasons but one was that everyone seemed to work together so well, and the ICU really solidified that for me. God really blessed me in Amanda especially. She is a Christian as well, perhaps the only one committed Christ follower in the intern class, and just a wonderful person. We literally cried on each other's shoulder; we prayed together, and it was such a privilege to be able to do that. Here in the US, it's not like Nigeria, where you can pray openly for each other and for your patients; here, it's almost illegal! But we had so many people tell us we were doing well, even though we never felt that way, and our seniors never made us feel stupid and always went out of their way to check on us.

So that's way too much for now, but I needed to share! So I hope to hear from you all soon and I'll hopefully be more available now that I've been set free from the ICU!

Hmm, In Nigeria We Would've...

2006-06-27T12:53:00.000-05:00

One of the interesting things about being back in the US for a month and a half has been how often we compare life here to what it was like for us in Nigeria, or how we think Nigerians would've reacted to certain situations. One of the first examples of this was the day after we left Nigeria. We spent a few days in Amsterdam with my brother and the first thing that was obvious (besides how cold it was - 60's F) was how much water was everywhere. The Netherlands is right on the ocean, and it rained while we were there. It's a country where canals criss cross the landscape resulting in beautifully green pastures for cows and sheep. Now irrigation wasn't so odd, but seeing fountains there strictly for the beauty of watching water cascade in arches from the mouths of strange creatures sculpted from bronze certainly was. It struck us that in Nigeria it would've seemed wasteful and extravagant, especially in the dry part of the year we experienced in March and April. In the Netherlands, it was a nice display for people to watch in the park.

Barbara has now been through the first week and a half of her residency program here in Portland, and the first week was largely orientation. I should probably let her tell this story, but I'm not sure when she'll have time (she came home after a 16 hour workday on Sunday :( ). During orientation, she and her fellow new interns were given a briefing on how to use a rather expensive mask when dealing with patients who have tuberculosis, which is transmitted via the air. She turned to another intern who did a medical rotation in west Africa and asked, "Did you ever wear anything for tuberculosis in Africa?" No, was the immediate response. The person instructing them in the use of the mask said that in the past 20 or so years, he's only had to use it about 5 times. In Nigeria, there was no counting how many patients you would come across with tuberculosis in a single day, and Barbara never wore a mask. She'd wash up after every patient, and the kids with it would often sneeze on her, but thank God she didn't catch it. It struck me that the real difference here isn't that you're particularly likely to catch it (if you were, Barbara would have it by now), but rather that because it's so uncommon here, if you were to pass it on to another patient you'd be in for a world of trouble. It wasn't economical, and certainly not practical to wear a mask for every patient in Nigeria that had the disease. The American Lung Association puts TB at about 5.1 cases per 100,000 Americans. However, around the world, there's a new infection every second, according to the World Health Organization.

There's countless other times that we think about how our life here is different from life in Nigeria. Traditional Nigerian clothing seems much more practical than western wear. In the US, we shop all sorts of different stores until we find something that we like the fabric, style, and fit of. Traditional Nigerian clothes were tailored after the fabric was chosen to a style that you discussed with the tailor (the photo is of the tailor that made Barbara's two Nigerian outfits). How much easier is that! I've also discovered that even though I didn't spend a whole lot of time in cars in Nigeria, the freedom of expression used with the car horn has translated somewhat into my bones. I honk at other cars a lot more freely here, and Barb laughs at me everytime.

I think one of the questions that arises is really what we learn from comparing the two cultures, and that's pretty hard to say. It's not something I feel like I'll have figured out in a month and a half, or even probably a year and a half. It's going to take a long time. I will say that some of the comparisons really have informed me about how people are different in different cultures. We value different things and we react to the same events differently. I don't think I'd have as much insight into that if had spent less time in Nigeria, and I also think I'd understand to a much greater extent if I'd spent more time there. Some of the comparisons are merely, ok, we're different and that's ok. Others are more along the lines of, hmm, we really seem to have things backward here, or hmm, they've missed the boat on that over there. Both places could use change, and both places could learn from each other. One question that has plagued me is whether or not the good things from both are compatible in the same society, and for many of them, I just don't know.

We're In Portland!

2006-06-21T19:53:00.000-05:00

Today our stuff arrived at our new home in Portland and the long process of unpacking begins. The picture here is of us at Grinnell Lake in Glacier National Park, which is located in northwest Montana, a cold and desolate place that just happens to be amazingly beautiful. Our friend Jason assures us that the part of Montana he comes from is far more boring, so we're not as jealous of his hometown as we might've been.

We left Madison on the 9th after selling our old house, and arrived here in Portland on the 15th. In the meantime, we went to Mount Rushmore, the Badlands, Devil's Tower, and spent two days hiking in Glacier. Yes, we stopped at Wall Drug. Yes, it's just as unexciting as everyone who's been there claims it to be. It's really just a big store. That's it. Plus, you can only get legal drugs. I'm certain that most other places that sell drugs from or up against a wall sell the good stuff, but Wall Drug was a disappointment in that regard. Oh, and we saw the battle field where Custer made his last stand in one of those famous moments of ill-addvised machismo that pervades American culture (the Alamo, anyone?).

Anyway, we had a really good time in Glacier, and although we couldn't actually go to any of the glaciers (the trails were closed because they were still too dangerous from the snow), we could see them from lower down. Plus, there was lots of other snow. We went up to Logan Pass and enjoyed a good snowball fight. Actually, I threw a snowball at Barb and she yelled at me and that was it. Actually, I didn't even throw it AT her, I intentionally threw it in front of her and she STILL yelled at me. Next time I'll probably just hit her to make it worth the response I'm destined to get. So Logan pass was covered in snow even in June, which was really fun becase it was about 70 F out and so the snow was nice and refreshing. And there was a Dutch biker gang.

So we drove on through eastern Washington/Oregon which is a miserably desolate part of the country, but were excited to reach Portland where there was once again trees and greenery. The weather out here is beautifully sunny every day. Most days we've been able to see Mt. Hood while driving around. Anyway, we miss you folks and will be writing more about Nigeria again once we get settled in. Who knows when that will be given how many boxes we have! We won't have internet at home for another week or so either. Happy 1st day of summer!

We are still alive!

2006-05-14T23:13:00.000-05:00

Hello dear friends,

We've been back to Wisconsin for about 8 days now but it feels like a long time, because we've had so much to do. We haven't forgotten our promise to write more, especially Frank, I think, as he's shared less than I have to this point, but since we're trying to move to Portland, OR, which is clear across the country, in less than a month, it's been very hectic. And after having been in Nigeria, where we learned to slow down and actually enjoy our days and live life fully, it has been very hard to get back into the frantic way of life here. In addition, I finally graduated two days ago so our families have been here, and today is Mother's Day and tomorrow my birthday, so we've been busy celebrating and entertaining.

I did want everyone to know that tomorrow, we're going to have an open house where all of our friends and supporters can stop by to see our pictures (we printed about 250 of them and I've already enjoyed showing them to many people)and hear our stories and see the Nigerian handicrafts (including our clothes!) that we brought back, and also so we can thank people personally for caring about us and Nigeria. So you Nigerians, everyone's going to hear about you tomorrow, and how much we loved you! And everyone else, I wish you could all come. Anyway, we'll be in Portland for about a week starting on Wednesday to find a house and a job for Frank so please keep that in your prayers! Thanks a lot, more later!

Comment on Barbara's last post

2006-05-04T19:23:00.000-05:00

We are on the last leg of our journey, safely here in Charlotte, NC. We are attempting to stay awake to account for the 6 hour time difference and I am exhausted but I wanted to respond to a comment one of my Nigerian friends just sent me. Throughout this blog I have tried to not paint a negative picture of Nigeria--I didn't want people to think it is a sad, dangerous, pitiable place, as many people think of Africa. There are sad things, and dangerous places, but I personally never felt unsafe, and there are many good and wonderful things too, as much to rejoice in as to be sad about. So I did try not to mention the things that I found disturbing and outright wrong during most of my blogs. But I felt that in order to be honest about what I had been struggling with while I was here, I wanted to at least once write a few of the things that bothered me. Of course it is all based on limited experience and my biased point of view.

In an attempt to be brief, I wrote some generalized statements about what I disliked about Nigeria that perhaps came off the wrong way, and I apologize for that. As is with all experiences, Nigerians have mixed feelings about Nigeria, and I have had mixed exposures to Nigerian point of view. Perhaps I did not get across that I love Nigeria, and for the most part, the people are what I will miss most. What is definitely true is that for every person who tried to rip me off, there were two people who tried to help me. And for every person who tried to be my friend just so I could help them in some way, there were five people who were my friends just because they were kind enough to share their great personalities with me. My friends were all people I would trust with my life, and it was they, along with the missionaries and many of my patients, who made my time in Nigeria so wonderful. Some Nigerians truly are bitter, and who can blame them, but many are quite happy. As I said before, Nigerians are a joyful bunch, able to praise God even when they have lost so many things in their lives. Almost all Nigerians I spoke to love Nigeria, despite its problems, and were happy to be there; but many knew people who would do anything they could to leave Nigeria, and hence, our problems with people trying to get us to help them with visas. Certainly it was not everyone, but it was more than once; and even one person is disconcerting for an American, because it is simply unacceptable behavior in the US.

So in short, it is not an easy situation, nor something easy to write about in an unbiased way. There is no doubt that there is much suffering and much joy entwined, much corruption and honesty side by side. That's partly what makes it so hard---you simply can't get your head around the fact that such extremes of values could exist seemingly side-by-side within the same culture, sometimes even within the same person. My impression is that this is true all over Africa, and is not just unique to Nigeria. But I hope those in Nigeria could understand that we who are from a different culture try our best to get our brains around it but it's hard.

I have appreciated all dialogues and all comments about our writings, because this is how we learn from each other, challenge each other, and keep each other accountable. So please, keep writing, and I will continue to clarify myself the best I can! I would like to finish by saying our time in Nigeria was so enriched by those people who couldn't be in Nigeria physically but prayed alongside us, and also by those who we met in Nigeria---Becca and Marion, Claudia, the Anthises and Naatz's and Ardills and Truxtons and Blyths, the Gwamnas and Onwuka's, the Spring of Life staff, the registrars/house officers Drs. Pops and Dennis and Kenneth and Salihu and Falegan and Joseph and many other doctors, too many to write out all their names, and the Maigadis and so, so many others---we'll miss them all.

Barbara’s reflections during the last week in Nigeria

2006-04-29T03:10:00.000-05:00

We are leaving Nigeria in tomorrow, and I’ve told you a lot about what I’ve been doing, but it’s hard to express how I’ve been impacted by things here. I myself can’t even really make sense of all my experiences, or understand fully what God is trying to teach me, but I am grateful for them all. Today, I was asked what my positive and negative experiences have been here. I’ve loved my time here. I never expected to love Nigeria. When I first came, everything was so different, it all seemed so dirty and disorganized and I didn’t think I could ever get used to it. But the human spirit is so adaptable, and now things I once thought were so foreign seem commonplace. For a while, even treating HIV patients became ho-hum, and I began to be de-sensitized to it. Partly because I had to be, in order to continue working among them and not become depressed, but also partly because there are so many life-threatening problems here, HIV became just another one of them. But getting familiar with Nigeria allowed me to see what I’ve really loved here. I love their generous and loving spirit, their easy laughter. I loved that here, co-workers are friends too, and everyone values community and family over work. I’ve enjoyed the fact that I can stop by the residents’ homes without asking and know I am welcomed, and they in turn know that if they are sick, I’m going to stop by to visit them. I’ve loved my work in the hospital. Everyday, I ask God to help me to love my patients, and I am so grateful for the opportunities He’s given to me, to encourage and pray for my patients, to help them understand medical issues, to counsel them and help them to be healthier and safer. I’m thankful for the opportunities I had to go on village outreaches, to work with HIV patients, to help those on the streets. I came to Africa because I didn’t want to be one of those people who saw starving people on TV and said, “oh, how terrible”, and then promptly change the channel and forgot they existed. I wanted to come and face poverty face on and, even though I know I can do so little, I wanted to at least try. I am so grateful that I could do it. There were times, when I was faced with a dirty, smelly, starving villager, who had a nasty rash and nasty teeth and looked so sick, that I asked myself, “what are you doing here?” You don’t want to touch them, you don’t know what they’ve got, and how can you help them anyway? Maybe you can give them some short-term medications, but you’ll only help them for one week. Who’s going to help them for the next month, the next year? But thank God He gave me the compassion to want to touch them and help them anyway, because something is better than nothing, and they get so little love in their lives. Personally, I’ve loved that here, we have time. We have time to spend time with God, time to reflect on our everyday experiences, time to be refreshed and rejuvenated. And most importantly, I’ve loved living everyday, feeling as if the Lord was in everything I was doing.

There are, of course, things about Nigeria I will not miss, things I did not enjoy. I won’t miss the inefficiency, the corruption, the absolute waste of time and money. It is so sad to me that even at Evangel, which is a Christian mission hospital, there are workers who steal money, who give jobs to their family members who are completely unqualified for it, and who are lazy and irresponsible. And this happens all over Nigeria! I won’t miss the fact that accountability and consequences are often nonexistent here, that if you make a commitment and then break it without telling anyone, it’s not a big deal, and if you somehow “misplace” the money, nothing will be done to you. I won’t miss that everyone tries to convince us to help them get visas to the US, even some of our supposed “friends”, or tries to marry me to their son until they find out I’m already married. I won’t miss the unpredictable electricity, water, internet, phone service, etc. I will always be sad that the residents here are bitter because they took ten years to get through medical school, not because they failed but because of strikes and corruption, and it will always make them feel cheated.

It is hard to explain how God has changed us, yet I know He has. I will never be able to walk past poverty again without desperately wanting to do something about it. I will not be able to look at all the things we have in the US, all the wealth, without some sense of waste. Here, where death is an everyday, common occurrence, life is celebrated even more so, and joy is to be found wherever you can. I hope I will take that back to the US with me. I am afraid that in the US, the sense of living life intensely, as if every day mattered, will get lost in all the THINGS we do. In the US, we like to fill our time with “important” things---meetings, extra-curriculars, exercising, shopping, church, sports, music, etc---don’t get me wrong, they’re all good things, and we mean well, yet, we’re so busy, we lose track of the most important commandment ---to love God, and to love each other as God loves us. We just need to slow down!

Over these past few months, I’ve been so encouraged by all the comments you, my friends and family, have given to us. I don’t feel I’ve done anything brave, special, or exciting, yet it seems many people have felt encouraged and/or challenged by our experiences. I am so glad that our work here could be making some impact back home too. We have had so much support and love from you and are just so glad you could share this time with us. Please pray for us as we prepare to come home, and pray for a safe journey and a good reunion with you all. We will be home on May 5th, and will continue this blog until we run out of experiences we want to share.

AIDS Ministry

2006-04-29T02:51:00.000-05:00

I wrote a little bit earlier about Spring of Life (SOL) and what they did, but I’d like to go into more details, as I came to Africa intending to focus on HIV ministry. Spring of Life for me embodies much of what my time in Nigeria has been like---both great joy and great frustration. Nigeria has roughly an 8-9% HIV positive rate, which on the surface seems very little compared to countries like Botswana at 30%, but it’s deceiving as Nigeria comprises about 20-25% the population of all of Africa. So many Africans who are HIV positive live in Nigeria. The stigma of HIV is not as great as it was, but is still quite a hindrance. We see many patients who don’t want anyone to know they are HIV positive, not even their spouses, because they are afraid of being abandoned, abused, or simply just can’t deal with the perceived shame of it all. We even see people who refuse to get tested themselves when their spouse dies of HIV because they just can’t bear knowing they have HIV. It’s ethically a hard decision for the SOL counselors, because we’re supposed to respect patient privacy and assure we won’t tell anyone, but at the same time, it is hard for us to see a husband with HIV, taking anti-retrovirals (ARV’s) (HIV medications), who is getting better on the meds, but refuses to tell his family, and as a consequence, the wife and children die of HIV without ever knowing they have it. It’s hard not to feel like the man has killed his family while preserving himself. Unfortunately, we see many cases like this and sometimes we tell them they can’t be treated unless they bring their family in to be treated, but sometimes this scares them off and they never come back again. Would it have been better to have been less forceful and just treated him and counseled him persistently but gently, hoping in time he would change his mind? We don’t know.

It’s also quite difficult because there are no guidelines to help handle difficult situations. Come to think of it, there are few guidelines at all. In December, PEPFAR (the President’s Emergency Plan for AIDS Relief, an American program working through the Nigerian government) came to Evangel and said they wanted to give us money to start free treatment for HIV patients. Which is great. However, they said they wanted us to start ASAP and have 500 patients enrolled by May and 1000 in a year. Now, that is a crazy expectation. But we had to agree or risk losing the funding. So in February, they started the PEPFAR program here with very little training and it has been a management nightmare. Since SOL has been the ECWA HIV ministry for a while, it seemed logical that SOL might handle the PEPFAR program, but Evangel decided it wanted to handle it themselves. The miscommunication has been terrible. At SOL, usually what happens is when a patient comes in, he/she get pre-test counseling, so the patient understands what testing means, how you get HIV, what the next steps are, etc. Then they are tested, and then they get post-test counseling. If they are positive, they are enrolled into PEPFAR, set up to go to clinic to get initial testing done to see if they need ARV’s, and if they need ARV’s, they are counseled on side effects, told they must take their medications everyday, etc, and someone follows up with them, even doing home visits to make sure they are ok and taking medications properly. However, if a patient doesn’t go to SOL, if they instead show up at clinic without going to SOL first or find out they are HIV positive during a hospital admission, well, then, all bets are off as to what happens to them. Some people get put on ARV’s and are never told what side effects to expect or are never told why they can’t miss even one day of medications (HIV becomes resistant to medications very, very fast if you miss doses). Depending on what doctor you see, you may take anywhere from 3 to 7 different lab tests before you start ARV’s. You might be asked to take an antibiotic for life, or you might be asked to take it only until you start ARV’s. You might be told you have to pay for all medications that aren’t ARV’s, or you might be told PEPFAR will pay for all your medications. You might be referred to SOL for follow up, but you might not. The point is, the doctors are told, “here you are, here’s some HIV patients, here’s the PEPFAR paperwork you must fill out, go to it!” and they have no idea what is allowed, what isn’t, what they need to do, etc. And SOL gets frustrated because patients who should be counseled don’t get counseled, no one tells them when their patients get admitted or discharged, etc., so patients often get suboptimal treatment when they very easily could have gotten great care. Training would really help, so each person involved in PEPFAR knows his role and what he needs to do, and guidelines would be great, too, so that each patient gets consistent and good quality care, no matter which doctor they see. But PEPFAR allows each hospital to do their own thing and expects them to do it NOW, and it really causes chaos. It really doesn’t help that patients can really be difficult too. You often talk to them and explain their disease and their medications till you’re blue in the face, and they will say, “yes, yes, yes”, but next week, it’s like you never had the conversation. Sometimes you give them medications and instead of taking them they sell them for ten times as much. Sometimes they stop taking their medications and you never know why. Some never come back for follow up. I have learned to never ask why, because there is never a good answer.

A good example of all these problems is an HIV positive patient of mine named Monday, who came in a few days ago from another hospital. He had been admitted there because he had been (and still is) very sick from HIV, with very severe anemia. He had a huge open ulcer on his back that the other hospital finally felt they couldn’t deal with so they sent him to us after he had been there almost a month. When I read the admission notes, I was under the impression that he was on ARV’s already and we were giving it to him. After a few days, though, I realized something was wrong. Every medication we give a patient must have a prescription written and it must be documented on his drug chart, and I had not seen any ARV’s on his drug list. He’s too sick to come to clinic, so clearly he wasn’t getting ARV’s there. He had never been seen by anyone at SOL, so no one there was helping him get the ARV’s. There were no labs reflecting routine investigations to follow his disease, no signs we were doing anything to treat him for HIV. A later note indicated that we were going to look into starting him on ARV’s, contradicting the idea that he was already on ARV’s. I went to speak with him, and it turns out that I was the first person to ever really sit down and find out what his situation was! Monday was from a town 1.5 hours away from Jos and had been started on ARV’s in January. There is no PEPFAR there, so he was paying himself. He couldn’t afford the medications anymore so he stopped taking ARV’s in March. Someone told him to come to Jos to get free medications, but they didn’t know which hospital. He ended up at a hospital that didn’t have PEPFAR. When they admitted him, they asked him if he had taken ARV’s. He said yes. They never bothered to find out if he still was taking it, if he had some left, etc. They just assumed he did and never looked into it. And he is partially to blame, because he never told them more about it. He never said, “yes, I took them but now I’m not, I came here to get free medications”. He only answered what they asked and that was it. It’s a common occurrence here.

So he went at least a month without ARV’s. When he was admitted to Evangel, the same thing happened. They read the note from the other hospital that said he was on ARV’s, they asked him if this was true, he said yes, and that was that. The doctors here have been too busy to look into it, and didn’t think to refer the patients to SOL because, well, are they supposed to? Who knows. It’s tragic because he probably has drug resistant HIV now, and who knows what he was taking? Not him. What should we give him now? Who knows. The doctors will of course do the best they can, but his options are limited. He said that he had people who were treating him, but he felt as if many people had deaf ears and never listened to what he had to say, and didn’t explain much to him. He often felt helpless and hopeless and didn’t know what to do. And, good old stigma, he never told his wife. She became suspicious when he kept getting sick and hospitalized so this week she went to get tested, and sure enough, she’s HIV positive and needs treatment. So I prayed with him and went to SOL and spoke with them about him. I hope he never gets lost to treatment again, and always has someone who will listen to him through SOL.

Monday has such a sad story, as many of our patients do, and the complexity of culture, poverty, poor management, etc, can seem overwhelming. How can we help when so many things need to change and don’t seem like they ever will? Yet, for every Monday that we have, we also have those patients who do well, who we help, and they get better. We have two little boys named Shama and Shaibu who were the sickest babies you’ll ever see, they looked like tiny shriveled old men when I first met them. Both were from poor families where everyone was starving and sick. I thought they would die. Yet, SOL stepped in, helped them with hospital bills, gave them money for food, taught them good nutrition, went every week to visit them at home, and it has been a miracle. They both put on weight and have cheeks now!!! They look around curiously with bright eyes, like normal babies, and smile. When we see patients like that, we think, “thank God, we could help at least one person, and that makes this all worth it,”, and to see the smile on their mothers’ faces as we make a big deal over how good their babies look--it’s beautiful. It reminds me that despite the problems, Africa has many happy stories too.

Edo-Delta Camp – The Rest of Camp

2006-04-24T03:43:00.000-05:00

Here's a picture of a camper doing his Morning Watch. For many of the campers, it's the first time they've ever had a concept of setting aside time to read the bible on their own each day.

Saturday started where Friday left off, with no running water. The generator that had been too powerful for the dining hall lights proved too weak to pump water in the water tank, and the main generator was still broken. With no water, the cooks couldn’t make breakfast, so we went about our morning schedule and skipped breakfast. I felt like the campers were starting to accept the camp schedule and flow of life at division call and morning watch, and I also felt like they got flag raising more than the day before. During Bible Ex, bread came, so we gave out bread and campers paid 5 Naira for 50 cl water sachets at breakfast. During the success talk, an extra generator was brought and pumped enough water to get it flowing in the pipes again, but it wasn’t enough for cooking lunch and bathing. After the talk, campers immediately went to bathe, and there wasn’t enough water left to make lunch, so lunch was delayed as a result. After lunch, enough water had been pumped to get a shower, and I was quite grateful.

Campers were much more interested in Carnival time, and it went well. Activity two was short and the group really wanted to do Human Knot again, so we just did that. As we headed to sports, the sky got very dark and overcast. In the middle of our game of amoeba tag, the sky opened up and poured rain as I hadn’t seen in all my time in Nigeria. Since it was Easter weekend, the evening program was to be a showing of pieces of the Passion of the Christ (Mel Gibson’s), and I was to help set up the meeting hall with some white paper for a screen. As a result, I missed dinner and just had some bread and water, but given the chaos of the previous night, I must say it didn’t bother me all that much.

Easter Sunday we had running water all day and that was really nice. Camp wasn’t really any different except that at Division Call and Flag Raising we talked about Easter and the resurrection of Christ. The success talk encouraged campers to “Make a Difference”, “Be Effective”, and “Be Someone, Somewhere”, and the campers seemed genuinely interested in the message. A big theme of the talk was about making something out of their lives for a positive impact on the people around them. In the afternoon, I taught the bowline and taut line hitch in my knot-tying class, and we also did a human knot that resulted in two smaller circles of 4 people each, much to the delight of the group.

The evening program was a bonfire with time for campers to give testimonies about what God had done in their lives during camp. We started it off with about an hour of singing and dancing around the fire, and I got laughed at as I danced around the fire with the campers. I’m not a very good dancer and my sense of rhythm was severely lacking compared to theirs. On top of that, I still hadn’t been able to learn all of the songs that were sung, but I think the campers enjoyed having me along. I was curious what the campers would say during the testimonies since the camp had been so short and they’d been so slow to warm up to the camp program, but there were some interesting things said. Two in particular stood out to me. One camper mentioned that he had never understood what it was to have a quiet time alone with God before, and he’d learned to do that. Another camper stood up and declared, “My 1000 Naira was not a waste!” This was encouraging in the sense that I really wondered on Friday how many of the campers were really happy that they’d decided to come.

After the evening program, we had time for campers to come and say their memory verses to us, and if they did, they would get a certificate the next morning. I was especially touched by one camper who wanted to say them but hadn’t learned them yet. He couldn’t read, so his hut leader and him stayed up trying to teach him the verses. Although we were there till 2 am, he didn’t have them down by the time we closed up shop for the night. I was really frustrated that he hadn’t been able to do it in that amount of time, but also very impressed by the dedication that both he and his hut leader showed.

Monday morning we again were out of running water and wouldn’t have it again before we left. We had the campers help us move the benches back into the classrooms and after breakfast, had what we called a Goodbye Circle. Claudia and Uncle Victor handed out the memory verse certificates, and she also asked about decisions that people had made during camp. The hands that were raised indicated the camp had a much stronger impact on the campers’ lives than I was expecting, and I felt really good about that. Campers left rather quickly after that, and I spent the afternoon helping clean up and organize so we could travel back to Jos the next day. In the evening I was able to call Barbara in Jos, and it was good to speak to her although she was under the impression I was to be coming home Monday instead of Tuesday.

The ride home on Tuesday was rather uneventful, although we got a later start than we were hoping since we still had many things to attend to before we left. We bought pineapples at a price of about 40 cents each and also stopped to get the truck serviced in Abuja. For dinner, I ate pounded yam and egussi in a tiny shanty restaurant next to the Toyota dealer. Everyone stared at me as I ate with my hand and Akim told me it looked like I’d been doing it for years. Considering there were hotels across the street with nice restaurants, he also said that the patrons there had probably never seen a white man eating in a place like that, and certainly not with his hand. It was really good to get back to Jos, even though I got home after 10 pm. The shower was one of the most pleasant I’ve had.

In all, the camp turned out to be quite a success, with many of the campers going home happy that they had come. Considering my frustrations of Friday night, I really felt good about how the camp had gone. I was very glad to have had the opportunity to go and be a part of it, and getting to know many of the campers was really a blessing.

Edo-Delta Camp – Camp Arrives!

2006-04-24T03:36:00.000-05:00

Here's some folks playing volleyball at the Jos campground. The camp encourages sports where everyone can play. For example, we may play Crazy Soccer, where the men have to play with their hands clasped behind their back, the women can pick up the ball a la rugby, and as many as 4 balls are in play at once. It keeps the game lively and active, and while many campers don't like the idea at first, the soon realize how fun it is once they start to play.

Thursday morning we woke up with the anticipation of campers coming between 2 and 5 pm. We finished up some training in the morning and also finished moving the classroom benches into the dining hall so campers would have tables to eat at (they were awfully heavy!). We got registration organized and then had to wait. Although we had 2 campers by noon, no one else showed up till after 5 pm, and they didn’t finish coming till after 10 pm. By the end of the day, we had about 55 campers. That was far fewer than the 130 we were told to expect, but Claudia mentioned that for a DCC’s first camp, 50-60 is a pretty good turn out. In the same way that staff had come over several days, campers would continue to come during camp and we finished with a total of 92 campers, 20 of which didn’t come till Saturday or Sunday.

Friday was the first real day of camp, and we began with our regular schedule. I had been up till 3 AM the night before, sorting out camper activity preferences with Akim, Ema, and Claudia, so I’d gotten less than 4 hours sleep and was not in a good mood. It didn’t help that the campers didn’t come to division call when the whistle was blown. We sent them off to do their morning watch, and then went on to flag raising. It seemed as though they found the whole formality of it all tedious and strange. They laughed at the way the color guard marched in the colors, but the did pay attention when Claudia spoke about the need for prayer over the nation. I was going to teach drama during the activity one hour, but other hut leaders had volunteered to do that so I offered to do an improve comedy class a la Comedy Sportz. I wasn’t too surprised that no one signed up since I wasn’t sure they would understand what it was, and I was glad to have the hour free. I hoped to use the time to catch up on sleep from the night before, but with new campers arriving I helped with their registration instead. At lunch, we had bean curry but didn’t have enough spoons for everyone, so some campers and the staff had to wait for others to finish. Meal time was a bit unruly as campers didn’t understand why we wanted them to stay at their tables with their hut-mates instead of getting up to talk to friends in other huts. They also wanted to leave the dining hall as soon as they were done eating, which was also not part of how we wanted their meal time experience. They also wanted to socialize and wash up right after lunch, and because of all this, most didn’t get to rest hour until it was half over.

Campers were very slow in coming to Carnival time, and when Akim asked for volunteers, no one wanted to come up front. We practically begged for a few, and finally got some. Akim got four teams of two people and blindfolded them, then gave them each a bag of ground nuts (peanuts), and the first to feed each other all their nuts would be the winner. Campers erupted in laughter as groundnuts were fed to people’s eyes, throats, and noses instead of their mouths, and the apathy and apprehension surrounding Carnival were starting to fade. We also gave 6 campers each a 35 cl bottle of Fanta and a straw, then had a contest to see who could drink it the fastest. The whole camp was shocked to see a girl win, and she became an instant celebrity.

The second activity hour I had volunteered to teach knot-tying. I didn’t really know what people would make of it, but figured I had learned enough knots in Boy Scouts that I could teach some basic ones. Campers were again slow in coming to the activities, and it was clear that they were getting tired of being shuttled around from one thing to the next. I had 8 campers come to my knot tying class, and I asked them their names and why they had come. All but 2 of them said they didn’t know what knot tying would be so they figured it would be something new and interesting. Now, I didn’t actually have any rope, so the next thing I did with them was a human knot, where everyone stands in a circle, grabs hands with someone else, and then we try to undo the knot. None of the campers had ever done anything like it before, and when they saw the initial tangle of arms they looked at me for guidance in how to undo themselves. I told them I wasn’t going to help and that they needed to figure it out themselves, at which point they told me they didn’t think it could be done. I told them I’d seen it done over and over again, and eventually Chimdindu took charge and suggested a few maneuvers that began to help. Slowly, people started to believe it could be done and when we finished with a full circle again, they were truly excited. I learned the next day that several had gone back to their huts and taught their friends the same game, which I thought was really neat. Like I said, I didn’t have any rope, so I untied my shoes and as we passed around my shoelaces, people learned the square knot and the slip knot before it was time for games. Most people in Nigeria were leather sandals, so mine were the only shoelaces we had to go around, but they worked fine, and people seemed genuinely interested in learning the knots.

After Activity Two was Sports/Games, and when the whistle blew and I went out to the field, Ema was trying to get everyone together. The hut leaders were not getting their campers to the field, and the campers were all just wandering around camp chatting. It was very frustrating. Some of the male campers went to the field expecting to play football, and then left when they learned we wouldn’t be doing that. The female campers didn’t come in the first place because they also expected the men would be playing football. Ema left in frustration, and when I saw him I told him I’d try to help get the campers together and that he should come out again. I went off and found campers starting to congregate on the field, and a minute or two later Ema came out and we managed to get most of the campers ready for sports. Ema started us off with some warm-up exercises, much to the groans of the campers, but they participated, and found them very funny in a way I didn’t fully understand. Ema then got the campers into two teams and we did a relay race where each team had to pass a ball to the person behind them through their legs. They really found this entertaining, too, and Claudia later told me that they don’t really have Physical Education in schools here the way we do in the U.S., so these types of games are totally new to them. Accusations of cheating on the other team were rampant and there was much rejoicing when one team finally won.

When we went to wash up after the games, the running water at camp had stopped. We’d used up the water in the water tank and campers were not excited. The school generator had broken and there was no way to pump water up into the tank. Dinner proved to be chaotic. The dining hall wasn’t connected to the standard generator so a spare had been brought in, but this one was too powerful for the fluorescent lights and burnt out the bulbs, resulting in darkness in the dining hall until we managed to get enough candles so each table could have one (the rest of our dinners would be by candlelight). Meals at camp were served buffet style and huts were called to come get food in order, but as soon as some campers had finished their meals they would come up for seconds before others had gotten anything at all. It seemed as if everyone was talking very loudly in the echo-y room and no one was staying at their table. Claudia was not happy, and at this point I had gotten so frustrated with the constant battle to get campers to behave according to the camp rules that I wondered if they’d ever get anything out of camp at all. It was probably the low point of the camp for me and I was very frustrated.

After dinner, we went to the main hall for the evening program which was to be the Oprah Winfrey show. One of the female hut leaders was Oprah, and she was to have four guests. When I got to the hall, I found out that I was one of the guests! The show was to be questions about relationships to give campers a godly perspective on dating, and Yusuf was supposed to be the married man on the panel but he’d left with the truck to try to get the generator fixed so we would have water the next morning. So I became the married man on the panel. I answered some questions about what my relationship with Barbara was like during the dating and courtship phases, but it was also awkward in that no one laughed at the parts of the story I thought were funny. After the show, Uncle Victor (all the staff were referred to as Uncle or Auntie), who is the Edo-Delta DCC chairmen spoke to the campers about their behavior during the day. He talked about how the camp was not a conference and how the campers needed to do better to follow the schedule and the requests we made for appropriate camp behavior. It was very awkward to me, and I felt a little embarrassed that I had come down from Jos, from the U.S. even, and was imposing a completely different set of behavioral rules on these people than they were used to. At the same time, I knew that the rules were there to help them learn lessons in ways they wouldn’t otherwise. I went to bed frustrated and tired, hoping Saturday would be better.

Edo-Delta Camp – Staff Training

2006-04-22T11:56:00.000-05:00

Again, since I don't have pictures from the Edo-Delta Camp yet, here's a picture from last year's Jos 2005 camp. Knitting was also one of the activities we had at the Edo-Delta camp. Teaching people to knit gives them the potential to create something with their hands they can later go sell. It gives them economic potential to better their own lives when the going gets rough. I've also seen people here wear jackets and wool caps in the mornings in Jos when it gets below 85 degrees, so people here have a very different sense of what makes cold weather.

Ok, back to the Edo-Delta Camp. At this point, it probably makes sense to explain a little about the camp structure and what happens at camp. Campers will be placed into huts (cabins) of 8 campers. Each hut has a hut leader (counselor). Each division (Senior Boys, Junior Boys, Senior Girls, Junior Girls) has a hut chief or division leader. The hut chiefs are responsible for the whole division, which means getting the hut leaders to do their jobs. The also report to the senior staff, which is the camp director and assistant director. Coming from Jos, we provided the senior staff and the hut chiefs, while the Edo-Delta DCC would provide the hut leaders. It was these folks that we were planning to spend a little more than 3 days training.

One important thing to realize is that the concept of a youth camp is a foreign idea to Nigeria. They’re very familiar with conferences, where people come and hear a variety of speakers speak, but that’s very much a student-teacher type of relationship. Youth camps are more a series of organized activities with some direct teaching, but most of the learning is interactive and experiential. Our challenge with staff training was to teach the hut leaders how to provide the interactive and experiential experience to their campers, so we did that by putting them through a few days of what camp would be like. We spent a lot of time reminding the hut leaders that this was a camp, and not a conference, so they were going to have to think about things differently than they were used to. For the staff that was there through most of the training, I think they did a good job understanding.

As I said previously, the camp staff was supposed to come for training on Sunday evening. We’d been told by the DCC to expect about 130 campers and 25 staff, and that would be very good numbers for a DCC having their first ever camp. When no one had arrived by 5pm on Sunday, we went into Benin City to get some ice cream. When we got back, there were about 6 people waiting for us, not all of whom were camp staff. There was just one female hut leader and a couple of male hut leaders, so that evening we gave them an introduction to what the camp would be like and told them that the next morning, we would start running through the camp schedule so they could experience what the campers would experience. Staff would slowly trickle in over the next few days, giving us 10-12 staff by the time campers started arriving on Thursday. We had two more show up with the campers, so they got the 20-minute staff orientation and were sent off to work.

The Edo-Delta camp schedule was a little different from the Jos camp schedule, but here’s what it would look like:
6:00 am – All Staff Devotions
6:30 am – Capers (campers clean up their huts and an assigned area of the camp grounds)
7:00 am – Bath and dress
7:45 am – Divisional Call (the Hut Chiefs lead a brief song and devotion before Morning Watch)
8:00 am – Morning Watch (this is what we call quiet time alone with God at camp – we used the booklets I had helped write during my first few weeks in Jos)
8:40 am – Flag Raising (a time to pray for the nation of Nigeria and its leaders)
8:50 am – Breakfast
9:30 am – Bible Exploration (bible study led by hut leaders with their huts – aka Bible Ex)
10:30 am – Canteen (Campers can buy snacks and drinks)
11:00 am – Success Talk (speaker)
12:00 pm – Activity One (each hut leader and staff would teach an activity such as Football, Drama, Singing, Cooking, etc.)
1:15 pm – Lunch
2:00 pm – Rest Hour
2:45 pm – Canteen
3:00 pm – Carnival (jokes, riddles, and silly games/contests)
3:50 pm – Activity Two
5:00 pm – Sports/Games
6:15 pm – Hut Break (time for campers to wash up for dinner)
6:30 pm – Dinner
7:30 pm – Evening Program
9:00 pm – Hut Devotions
10:00 pm – Lights Out

A quick additional comments about flag raising: Nigeria is a collection of many different tribes collected together in a nation formed by their European conquerors years ago. People don’t always think of themselves as having loyalty to their country the way Americans display patriotism because it was a bit of a false construct imposed upon them. Flag raising helps encourage people to pray for their country and those in leadership. It’s a good way to encourage people to pray about what the leaders are doing rather than simply complain, which happens a lot here. I think we in the US can learn from this too, at times. Akim and Ema are both former campers who now help out as camp staff, and they both indicated that the flag raising portion of the camp helped them think of themselves as Nigerians, and give them a stronger heart for seeing the nation succeed as a whole.

Anyway, that’s the idealized camp schedule as it was supposed to run, but as you might imagine from many of the other posts we’ve put on this Blog, things here often don’t go as planned. I can’t think of a single day I was down in Benin City that we followed the schedule exactly, but I’m getting ahead of myself a little, as I’m supposed to be talking about the staff training.

The staff were supposed to be trained from Sunday night through Thursday morning, with Monday through Wednesday following the regular camp schedule as closely as made sense. Since we only had a few staff arrive on Sunday, we really got started Monday morning with the folks we had. Everything went according to schedule most of the morning. For Bible Ex, we taught the bible studies that the hut leaders would have to teach during camp with the theme of the camp being Psalm 23:1 – “The Lord is my shepherd.” Instead of the success talk and evening programs, Claudia and the other staff would teach the hut leaders about what camp was to be like.

One of the challenges we dealt with throughout the staff training was that the camp cooks weren’t going to arrive till camp started, so all our meals were being prepared by women of the local church and then brought to the camp. That meant that we never knew exactly when we would eat our meals, even though we’d provided them with a schedule of our meal times. For example, our lunch on Monday didn’t arrive till about 5 pm, which in turn meant that our dinner arrived at about 9:30 pm. Often it was late simply because they were waiting for transportation to bring it to us, and we were always grateful when it arrived, but we often spent time just waiting around because we were expecting it soon.

For sports on Monday and Wednesday, we played football (soccer!) and everyone was eager to see how the bature (white man) would fare. I had told them I wasn’t very good, having played very little football over the years. The only time I used to play regularly was in elementary school, to give you an idea of my experience, although I did play a lot while we were in Honduras with Blackhawk Church two years ago, but that was only a week long trip. I figured I would play hard and that would make up for whatever lack of skill was present. I did my best to pass and played what I considered pretty good defense, including a pretty good slide tackle to prevent a goal once. I also played some goalie and managed to have some saves, including one where I stopped Ema one-on-one. I thought he went easy on me, but still was surprised he hadn’t scored, as he had me on the ground. Akim paid me a big compliment when he told me I was much better than advertised and that I “didn’t play like an American.” I later found out that this means I dribbled and passed instead of just booting the ball up-field.

Despite the low staff turnout, it seemed as though the staff really was getting the idea. Claudia had spoken about how the camp was really a construction site, and we were building campers. We talked about what we wanted to build into each camper, and what the tools we were going to use to do that. One of the biggest was the idea that at camp, each hut leader would be a role model and mentor to their campers. Akim spoke about how each camper was similar and different to a lump of clay. It was an interesting analogy that got the staff thinking about what youths are like and how we can influence them both for better and for worse. We also spoke about things that our parents or elders did when we were growing up that we found helpful in our lives and things they didn’t do that we wished they had done. All of this were things that we ought to try to do for our campers. As we shared our responses, the staff also began to realize that everyone is a little different in what they need and what they find useful.

By the time staff training was done, we were eager for the campers to arrive, but we were also wary about the limited staff we had. We only had 2 female hut leaders by the time we went to bed on Wednesday, which meant that Joyce would have to take on that role, too. I felt like the staff training hadn’t gone very quickly because of all the sessions of talks and also the fact that we spent a lot of time waiting around for our meals. Camp, I hoped, would be move much smoother.

Edo-Delta Camp – First Impressions

2006-04-22T09:35:00.000-05:00

Since I was gone for 10 days for the Edo-Delta Camp, I’m going to try to consolidate this to a few different posts. Also, I wasn't able to bring my camera with me, and I don't yet have a copy of the video we took while there, so I'm going to post some other fun pictures that we haven't let everyone see yet. This picture is of the cooks at the Jos camp from last year. They're preparing some meat, and in the background you can see the pots on the fires.

On April 8, Claudia came and picked me up at 7:30 am so we could head down to the the Edo-Delta DCC for the first ECWA Camp Youth Alive in the south! ECWA divides it’s churches into District Church Councils, and the Edo-Delta one broke off of Lagos two years ago. Camp was to be held just outside of Benin City, a 10 hour drive south of Jos, where we’re staying while here in Nigeria. I was a little nervous about the trip as I’d been told that the weather would be really hot and humid (Jos is hot, but very dry). I was also expecting to eat a lot of Nigerian food and didn’t know if I’d like it or if my stomach would be able to handle it all. Also, we’d been told that the youth in and near Benin City are somewhat hostile, and would prove to be difficult campers. However, this is exactly why I came to Nigeria: to help out with the camp ministry, so I was very excited to be going, too.

Along for the trip were Claudia (camp director), Akim (assistant director/activities), Yusuf (crafts/music/hut chief), Ema (sports/hut chief), and Joyce (hut chief). The drive down gave me an opportunity to experience many things I hadn’t experienced in Jos. First, we stopped for breakfast in what can best be described as a shanty market. I had some bread and a fried egg from a “restaurant” that consisted of two rickety wooden benches and a single proprietor who cooked over a small fire. I had been warned by SIM personnel that the food in these types of places isn’t always safe to eat, but on a trip like this I was to experience a lot of things, and since everyone else was eating there, I wasn’t too worried about it. The drive was long and rather uneventful, and we started to approach Benin City late in the afternoon. We also noticed, as we went further south, that the buildings were older. Most roofs here are made of corrugated metal, and while many in Jos still shine silver, the roofs further south were brown with rust. The terrain had also changed from something that resembled a woodland savannah to jungle. We passed a huge palm tree orchard as the sun was setting, and it was very beautiful. Camp was to be held at a school, and we pulled in to the gate a little after dark, which was around 6:30 pm.

I noticed two things as I got out of the truck: I was very stiff and sore from squeezing 4 in the backseat of the truck for the past 10 hours, and it was DANG HUMID! I started sweating right away. After a dinner of rice at one of the pastor’s houses, we went back to the school and found bunk beds in one of the staff buildings. As I slept that first night, I continued to wake up repeatedly throughout the night with sweat running down my face from the humidity. Almost the whole time I was down there, I’ve never experienced so much heat and humidity in combination to make me sweat as much as I did, and it didn’t let up at night, making it hard for me to sleep well while I was there.

The next day was Palm Sunday, and the staff would be arriving in the evening to begin their training. We went around to the different parts of the camp and prayed for the different buildings and the field, that they would be places where the campers would be safe, have fun, and learn what God wanted them to learn during camp. Having little idea of what schools were like in Nigeria (I’d only seen missionary or village schools to this point), I was surprised at how extensive the school compound was. The school is just off them main road into Benin City, and after entering the gate there is a large football (soccer for you Americans) field on the right. To the left is a large hall where we would have our all-camp gatherings. Directly in front were school offices and along the length of the field was a long building with 6 classrooms in it. There were 3 identical buildings parallel and behind this building. At the far end of the classroom buildings was a two story building with a large room on each floor that would become our dining hall. We prayed for each of these buildings and the field.

We would stay in staff quarters located behind the gathering hall. The school did not have a connection to NEPA (Nigerian electric company), so a generator was used in the evening to provide power for our building. It also provided power for the water pump which would pump water into a holding tank located at the far end of the football field. If the tank ran dry, we would no longer have running water. The staff quarters I stayed in did have a toilet (bucket flushed) and sink, and there was also a shower which was really just a pipe with water coming out. There was no hot water, but with the heat there, that was never a problem as I never wanted it!

One other thing worth mentioning in this post is the food I ate while away. The whole time I was at camp, both during the staff training and the actual camp, our food was cooked by a group of Nigerian cooks. I did my best to eat all that was provided for me. Breakfast was almost always plain white bread with tea, and I was dumbfounded by how much plain white bread my Nigerian friends could eat! I was served curried beans regularly. Sometimes with fried plantains, other times with boiled yams, and occasionally just by themselves. The beans became my favorite dish there, which given how little I enjoy beans at home surprised me greatly, but it was nice because we had this almost every day for lunch! I also ate semovita with a variety of sauces. Semovita is a dough-like substance made from the inside of corn kernels. You eat it by ripping off a piece and dipping it in egussi or vegetable sauce. Gari, made from cassava, was eaten in two ways. When prepared in epa form, it’s eaten like semovita. It’s also served in a powder/flake form, in which case you mix it with water and you can then either drink it or eat it with a spoon. Gari in this form soaks up water and expands quite a bit, so people joked that the gari was a 24-hour meal while the semovita was a 12-hour meal because of how much gari expands in your stomach. I liked the epa form of gari, but not the powdery one. Semovita wasn’t one of my favorites either. We were also occasionally served rice with some sauce on it. Absolutely everything was very spicy, so if for some reason I had cooled enough to the point where the humidity was not making me sweat, the food would. I was glad that I had learned to eat spicy food growing up, because it really was quit hot. The Nigerians told me that you can tell if someone is healthy by whether or not they sweat while eating the food. I will say that the one value of sweating this much is that even a warm breeze feels a little cooler when you’re soaking wet. Despite the fact that I ate all sorts of new and unusual foods to my taste, I never had a problem with anything I ate.

Church and fellowship

2006-04-17T17:25:00.000-05:00

Many people have asked how church and fellowship have been here, so I’d thought I’d answer that here. Church and fellowship here in Nigeria has been great, so much more rewarding than I was expecting. There are a great number of churches here, percentage wise much more than the US, I think, but how many of them as truly Christian as we think of it and how many of them are just culturally Christian, I don’t know. We go to JETS (Jos ECWA theological seminary) church, which is a mostly Nigerian church whose senior pastor, pastor Maigadi, is none other than our beloved Kauna’s (you know Kauna, the wonderful Nigerian who is in charge of us STA’s and teaches us how to shop in the market!) father. Her family is just the greatest. Pastor Maigadi went to seminary in the US and is now a professor at JETS as well. One of her brothers is on the worship team and is a great singer.

So JETS church is a neat place for us for many reasons. Some of the Nigerian doctors go there, who we know, as do some of the missionaries. A family that our church in Madison supports also goes to JETS church. So we feel that we already know quite a few people there. The service is so lovely. The music there is wonderful. Nigerians are so musical. The worship there is loud, boisterous, joyful, and beautiful. It’s a combination of English, Hausa, and other tribal languages. The pastor gives messages which are always thought-provoking and interesting. It’s neat going to a seminary church because there are often times where there is a Q & A session before or after the sermon, and since there are theology students, the discussion can be quite lively. Everyone wants to ask questions and give answers. The church also has a fun tradition to greet new people. Visitors stand up and tell their names and where they’re from. Then, they all go to the front of the church. The worship team sings a song, and everyone from the church then files down, singing and dancing, to shake your hand and welcome you to their church. It’s really quite the experience!

After service, they have a room set aside where they herd visitors to have snacks and drinks and meet with some people from the church. It’s also fun just to look around at church, because Nigerians wear beautiful outfits, mostly tailor-made, and it’s always colorful. It’s so much more expressive than American clothes, because everyone chooses their own fabric and style. Also, in church, every woman has to have her hair covered. Some women have the most elaborate hair coverings---tall, looped every which way, with multiple layers and knots, you just can’t believe they can tie one piece of cloth like that. The younger girls have what look almost like headbands, so that their hairstyles can be seen. Here it’s very improper for a man and a woman to show affection in public, even married couples, so you never see opposite sexes holding hands but you do often see two people of the same sex holding hands. It’s common between good friends. We see it a lot at church and I never get used to it!

Incidentally, Easter at JETS was one of the best services I’ve ever been to. In a place where death is always so close, life is celebrated even more joyfully, so the resurrection of Christ is a great cause for celebration here. They also celebrated Pastor and Mrs. Maigadi’s 25th wedding anniversary, which was so fun. Their 4 children composed and sang a song for them (in 4 part harmony), there was cake and a hilarious slide show of what they looked like in the early 80’s and a lot of laughter. Nigerians never miss a chance to greet and hug someone, so at some point the music was started up and everyone got into a line and sang and danced their way to the Maigadis to hug them and congratulate them. What love!

We’ve also had great fellowship with the doctors here. The residents here work much harder and accept much less pay than their classmates to work at a missions hospital. They get really good experience here, but at the same time, I admire the fact that many of them really do have a heart for God and want to love their patients. The doctors have a Bible study once a month, which Marion, Becca, and I attended, and it was wonderful. People here are so much less shy than in the US. They like to think, to share their opinions, to have opinions! It makes for very good discussion and learning. They love to sing and like I said, everyone can sing well here so it’s beautiful music. They also always offer way too many yummy snacks! It’s just amazing to me, that no matter where I am in the world, there are people who know the same songs, worship the same God, and are part of the same family of Christ. I never even knew these people existed 5 weeks ago, yet, here I am, sharing deep thoughts with them, eating with them, singing with them.

EMS

2006-04-17T17:13:00.000-05:00

Last week, Marion, Becca, and I went to EMS school, which is an ECWA school where Nigerian missionaries can send one child to school for free. It must be such a tough choice, because they have to somehow pick, either the smartest one or the oldest or what, I don’t know, but only one, and the other children often won’t get any education, since there’s no money. These kids are often quite neglected medically. Since they are missionary kids, many people think, “oh, we don’t have to give money to take care of them, they’re not as bad as the street orphans”, but yet, there isn’t any money to give them decent medical care. So we went to do physical exams on them. White doctors try to do it once a year, roughly. Dr. Anthis sent us and told us she thought we’d be able to get through them in 1.5 hours. We set up shop in one of the classrooms and each of us had a bench and an interpreter, and off we went. We quickly realized we were NOT going to be done in 1.5 hours, as there were 110-120 of them, and we had to take their histories, treat them, counsel them, and pray for them. Even if we spent a minute a person, that would still be longer than 1.5 hours!!!! Plus, we’re medical students, and we’re new at it, so it probably took us twice as long as it would have taken Dr. Anthis.

We were there for 3 hours and saw about 66 kids. We saw the usual big mix of things. Most were healthy, but there were a lot of coughs, fever, stomach aches, fungal infections, malaria, ear infections, etc. I also counseled many of the older girls about sex and being careful and saving themselves for marriage, which was an interesting experience for me, having not really done it before. They were quite shy about it, but after seeing all the HIV I’ve seen here in Africa, believe me, I was quite motivated to do it, shy or not shy! They all got de-worming medications. They were mostly so well behaved, and I was surprised that most of them really enjoyed being prayed for, as most kids aren’t like that in the US! We decided to quit when it got dark and returned the next morning to finish the other 60-70 kids. We didn’t have interpreters this time, so we just pulled out our little Hausa book, learned some critical words, which got us through, and finished much quicker than the day before.

We had a tour of the school, which includes the girls and boys hostels, kitchen (VERY small), classrooms, main building, and playground. Each child does all his/her own cleaning, laundry, etc., and they all participate in chores around the school. These kids are so amazing. They all love God and their families so much, even the youngest ones. They are dirty, have so few clothes, do tough chores, are so far from their families, don’t eat nutritious food, and endure many other hardships, yet they have time to laugh, smile, enjoy themselves. They loved having us and followed us everywhere. They were so cute and bright and so social. I don’t understand what it is about these kids---they’re all so much less bratty than US kids, yet, once they grow up, they often forget the good teaching they have. Many youths here don’t work, they sleep around, they lie and cheat, they don’t want to work hard—sadly enough, I think it’s so many years of a hard life at a young age that changes them. It robs them of their native decency and trust and honesty. They endure suffering without complaining as a child, but at some point, it just proves to be too much and they break. It’s very tragic. Of course it’s not everyone, many Nigerians are decent and wonderful and all are joyful and strong, but in general, in Nigeria, you jut aren’t trustworthy until you prove yourself so.

Gidan Bege and Blindtown

2006-04-17T16:59:00.000-05:00

Hello! Here’s another fun and exciting experience we’ve been able to have here in Nigeria. It’s called Gidan Bege clinic! Gidan Bege, if you remember, is the ministry which took us to the village outreach. Dr. Cindy Anthis, one of the missionary doctors, runs a free clinic mostly for women and children at Gidan Bege every Wednesday. Marion, Becca, and I have been taking turns going there, sometimes all three of us, sometimes only two of us. It consists of us, Dr. Anthis, a Nigerian medical student, and anywhere from 3-6 health care workers all crammed in a small room, all on two long benches, seeing anywhere from what feels like 50-150 patients in about two hours. It’s loud all the time. We do the best physical exams we can in this setting, but often, you just have to rely on the history of the illness and treat whatever the top three diagnoses might be. We end up being very liberal with handing out medications, because you never know if they’re going to come back, and you want to make sure you cover for the most dangerous illnesses that they might have. We see a lot of cough, fever, rash, eye problems, hypertension, diarrhea, malnutrition, etc. Dr. Anthis is pretty amazing and for the sicker ones, who really need hospital care but can’t afford it, she often pays for their care.
Gidan Bege is a pretty amazing place---we get a chance to talk with the boys (formerly living on the streets) who live there, and visit the jewelry shop, sewing shops, prostheses shop, etc---people, many widows and ex-homeless people, are trained to do these things to support themselves and I am incredibly impressed at their successes.
Then we go to Blind Town, which is quite an experience. This is a section that the government put aside for people who are blind, and it is very, very poor. Many of them can’t travel to see a doctor, being without money or sight. Mostly Muslims live here. Apparently, Muslims inflicted by bad diseases are often turned out of their homes to beg, because one of the pillars of Islam is to give alms to the poor, so those with bad diseases are made to beg as a way to support this important pillar. At least, this is what I am told. Apparently the Christians take care of their own, so there are few here. It is frightfully dirty, crowded, dusty, and smelly. There are animals everywhere. It is a warren of alleys with tiny hovels, one against the other. We went down each alley way, and people crowded everywhere around us. Though Dr. Anthis and Gidan Bege have been coming for a while, apparently they never lose their fascination with bature (white people). All the kids wanted to touch the bature and grabbed Marion, Becca, and I all over. Multiple kids grabbed our hands at the same time and it’s hard to get them to let go. Dr Anthis is an amazing teacher and is good about letting us do things. She lets us do BP’s, exams, etc. Anything that needs to be done, it’s done, right there on the streets. I’ve never done such down and dirty medicine before. Two of the health care workers hauled around a big medicine bag and we handed them out as we could. We saw similar things to Gidan Bege, such as astronomical hypertension, worms, infections of all sorts, coughs, heart failure, and just complications from many chronic diseases that we hardly see in the US because we control it before it damages our bodies. Dr. Anthis also spent time trying to convince women to do family planning. Muslim men often have many wives and don’t believe in birth control. One lady we saw needed to have birth control, she had heart failure from pregnancy and almost died with the last one but her husband refuses to let her. He’d rather see her die than try to help her not have another baby, which is hard for us to understand, yet, Dr. Anthis is just patient and is slowly trying to win the husband over. She has more grace than I do!
All in all, Blindtown was a great experience but overwhelming. It’s hard to explain how suffocating it can be to have thirty kids circling you at any given time, clutching you. It’s hard to explain how frustrating it is to see the suffering, the poverty, around every corner. It feels like there is no end to the people who need help, that we could give out medications and see people till we dropped and still, there would be more people that needed help. It makes you feel quite down, sometimes. At the same time, if we didn’t come, there wouldn’t have any help. They wouldn’t have anyone to care for them, no one to share the love of Christ with them. And something is better than nothing. Sometimes, you just want to run away from the ugliness of it all, but I’m trying to remind myself that it was for this very reason God brought us to Africa. He wants us to give love in places where there is little love, and He wants me to be in a place where I’m not totally comfortable, so I can stretch myself and learn to rely on Him completely.

ViIlage Outreach

2006-04-11T15:36:00.000-05:00

This is a long one! I’d like to share about the village outreach I went on this weekend, as I’ve learned more from this than anything else I’ve done here in Nigeria. Gidan Bege, which means “house of hope”, is an urban ministry of ECWA/SIM. They have a building in town which is a clinic, vocational school, transitional housing for street kids, and a place where the sports ministry is run. It is really an all-purpose place. Gidan Bege every few months or so goes on a village outreach. Someone working at Gidan Bege has a connection in a village somewhere, and they decide that we should go out and minister to that village. They usually go from Friday to Sunday and take their outreach team, which consists of many Gidan Bege workers, volunteers, and senior boys. The street kids, who are orphans literally found living in the streets, grow up in different Gidan Bege ministries, and when they are old enough, they begin to participate themselves in Gidan Bege ministries. It’s absolutely amazing. Some of these boys have the worst stories. They have no families, and often have been abused, were starving and physically pathetic when they were found. They usually have had little, if any education. Gidan Bege takes them in and gives them a life back. To see them now part of an outreach team, reaching out to others who are as needy as they were, boys who are now healthy, studious, happy, and love God---it’s one of the great miracles God has done here. They really were a joy to work with and treated us like we were their long-lost relatives.

It was a very, very typical Nigerian adventure, for sure! It certainly started out in typical Nigerian fashion. First of all, we arrive at 9AM at Gidan Bege with our van packed full of sleeping bags, tents, sound equipment, food and water in a cooler, and our own stuff (very little), expecting to leave soon after we got there. As we pull up, there are about 30 Nigerians standing around outside, near a white van. Many young men between 18-24 years of age, were milling about, many carrying guitars and drums and other random instruments. We get out and greet everyone in the usual long but joyful fashion. There was a team of about 13 Americans who were on a short-term missions trip who were supposed to join us but weren’t there yet. We wait about half an hour, then it turns out that someone thinks we were supposed to go pick them up instead. No one knows what to do, so we try to call the person in charge of the Americans, but we don’t reach them. So we wait another half an hour, then someone decides we should go get them. Our van only has Becca, Marion, and I (Frank is away at a camp), the driver Mark, and Jummai, a health care worker at Gidan Bege. Jummai and Mark decide we should go to the bakery on our way. Then, Jummai remembers we’re supposed to go pick something up from a pastor at Gidan Bege. Well, that something turns out to be two women traveling to a village “near” the one we’re going to and three sacks of some sort of grain! So off we go, about half an hour behind the other vans by now, and 1.5 hours behind total.

We drive for about 2 hours and drop off one lady, then another. It is soon apparent to me that their villages aren’t exactly “close” to our intended village---we backtrack for about half an hour, so now we’re 1 hour behind the other vans. At some corner, we meet the pastor of the ECWA church which is the nearest ECWA church to the village we are going to. He was waiting for us. However, it’s not like there are any directional signs in Nigeria, and this village we’re going to is in the bush somewhere, on a dirt path off the main road. He’s not sure which dirt road they took. So, for about an hour, every couple of small villages, the pastor would pull over, and ask some villagers if they saw two white vans full of white people and Nigerians drive past. We kept going till we found a village where they said the vans turned off onto a dirt road. We picked up two people there who I guess directed us to the village, but we might have been just giving them a ride. We drive for another 20 minutes through what looks like a scarcely inhabited savannah bush area, and how our driver knew which dirt roads to take, I don’t know. But we finally arrive at a decent size village, and all the villagers are standing there, staring at the Americans. They’ve mostly never seen a white person before and hardly anyone speaks English. Though the other two vans have been there for about an hour, they haven’t done anything but greet people. We go to a small hut to eat lunch, and soon, every window and doorway is filled with the villagers staring at us. At least 100 people watched us eat in solemn silence. It’s INCREDIBLY disconcerting to find that everything you do, every word you speak, every move you make, no matter how trivial, is being watched by just about EVERY person in the village. It gives me so much sympathy for the lions in a zoo!

We then set up shop outside of a Catholic church in the middle of town and get to business. The Gidan Bege boys start playing music and entertaining the children. The Americans pair up with other Gidan Bege people and sit in the church to counsel, pray with, and share the gospel with the villagers. Becca, Marion, and I have an interpreter and our own medical stations. Emmanuel, a Nigerian medical student, and two health care workers, Jummai and Mercy, are there as well, for a total of 6 medical stations. The villagers line up outside the church and give their names and requests, and we all start seeing them.

I’m told we saw 240 people that first afternoon. They just kept coming. It’s hard to explain what it was like. Many people have never seen a doctor before, certainly not a white one. The nearest hospital is who knows where, and I didn’t see more than three vehicles in the village. They are all dirty, somewhat or very malnourished, have terrible teeth, and worms. There is one water source not very close, and it is used for bathing themselves, their cars, their clothes, drinking, etc. We didn’t see water the whole time we were there except the drinking water we brought with us. Almost everyone has stomach complaints, a lot because of the worms, and everyone has back aches and headaches. It’s no wonder. They are farmers who work hard, and all Nigerians carry many, many pounds on their heads. We saw many things we could treat, such as ear infections, malaria, rashes, fungal infections, bladder infections, worms, etc, but we also saw many things we couldn’t help. Cataracts, broken bones healed wrong, very, very sick babies, women who had just given birth and were still bleeding and in pain, large livers and spleens, even one cleft lip and palate. Those, we tried to counsel and convince they needed to go to a hospital, but it’s so hard. They don’t have money or transport. But surely some of the ones I saw would die otherwise. Some of those sickly babies looked like they had HIV and I wished I had some HIV test kits with me. In one way, it's so discouraging, to know people might die of things that could so easily be treated if they had the resources. On the other hand, being a medical worker in Nigerian teaches you something you hardly learn in the US: That we are limited beings. We can't save everyone. We aren't meant to. We are meant to heal the best we can, and the rest is up to God. We don't have power over life and death, and if our patient dies, well, we didn't cause him to die. So we learn humbleness, and just be happy with the victories we do have in healing people.

What I actually found most trying was the cultural differences. There were two main problems: the villagers communicate symptoms and dates differently than we do, and sometimes, they tell half-truths or lies to get what they want. For instance, the first few patients I saw, I asked, “what is the problem?” I was told stomach ache. I’d ask my usual set of questions: “where is it, do you have diarrhea, do you have vomiting, do you see blood in either?” The answers I’d get are: “the pain is all over, I have diarrhea, I have vomiting, I sometimes see blood.” I soon learned that I very specifically had to ask, “when was the last time you had blood in your diarrhea?” because the answer was often, “last year”. Or, I learned to ask, “when do you vomit? What do you vomit? How much?” because I’d often get, “I vomit only a little bit of whitish stuff after I ate”, which isn’t really vomit. Sometimes I would ask if they had blood in their urine, and at first they’d say yes, then when I started asking more detailed questions, I’d get, “well, no, I don’t really have blood in my urine”. I don’t know if they didn’t understand my interpreter or if I was asking the question incorrectly, or if they were lying or what. So it became this game of trying to find the right question to ask to get the right answer. Sometimes, they just didn’t know how to answer. They’d tell me they had body pain, but they didn’t know where. I’d ask, “is it your head, or your throat, or your legs, your mouth….”etc, etc, etc, and they’d say no to everything, but still insist they had pain. I would just tell them I can’t treat them if I don’t know what I am treating, but I always gave everyone a course of multivitamins and de-worming pills anyway.
Jummai and Mercy told me that many Nigerians simply don’t know how to answer the question, as in, for some reason, villagers can’t answer straight, and they also said that many of the villagers had nothing wrong. It’s just that most hardly ever see a doctor, and if their neighbor got a pill, well, they want a pill too! They want whatever free thing they can get their hands on, and you can’t convince them they don’t need a cough syrup if they don’t have a cough! If their son gets a cough syrup, then by God, they should get a cough syrup too.

I also learned a few things about myself. After what must have been the 50th stomach ache, headache, backache, and fever I saw in a row, I began to be very skeptical, and very tired of seeing the same thing. I began to suspect that each person had told their neighbor to tell the stupid white person that they had a stomach ache and she’d give you a pill, and they’d all decided to play the same trick. It’s hard to show grace when you’re tired, frustrated, and can’t get a straight answer from anyone. Jummai and Mercy were quite skeptical and often sent patients away after scolding them for coming with false complaints. Since I was sitting by them, I found my skepticism boosted by theirs. Becca and Marion, who were sitting on the other side of the room, were much better at being compassionate and believing the patient. I suspect that the truth again lay somewhere between us---Becca and Marion being a bit too gullible and Mercy, Jummai, and I being too skeptical. At the end of the clinic, I reminded myself that loving my patients was my priority, and resolved to do better the next day and look to the spiritual as well as the physical suffering.

Clinic ended around dinner time, except, there was no dinner! The pastor who sent us to this village hadn’t told the village we were coming, because in the past some villages had been told we were coming and they were all excited and prepared meals and a celebration, and then we had to cancel for some reason, and it was a huge disappointment. So this time, we just showed up without prior notice. So, no one had dinner except Marion, Becca, and I—we ate the same thing we had for lunch, bread with jam, and oranges. During the evening, they set up a screen and had a movie and other visual arts presentations and a man who spoke to the village and prayed for them. He asked how many people were moved by everything they saw and experienced today, and over 200 decided to dedicate their lives to Christ. It is hard to know how many were genuine or were just caught up in the moment, but if even half were sincere, then it was an amazing thing. The ECWA pastor arranges for follow-up, and everyone got together and prayed in little groups with these people. We finished the evening with singing. Nigerians love to sing and sing in wonderful harmony, so it was great.

We slept in tents that had been put up in the middle of town. As we made our way to the tents, the villagers all stood in a circle around the tents and stared solemnly at us again. Becca, Marion, and I tried to find a place to sneak off to in order to go to the bathroom without anyone seeing us (no, there was no toilet or any sort, just the bush and the toilet paper and hand sanitizer we brought) and we ended up having to go far out into the bush and turning off our flashlights so no one could see us. The tents weren’t in great shape so there were holes and I was dreading the mosquitoes coming in. Sure enough, there were mosquitoes all night long in our tent. I decided I’d rather be bitten than put a sheet over me because it was SO hot. We didn’t sleep well---someone was playing the guitar for hours into the night, there was a loud radio somewhere in the village, the dogs were barking, the mosquitoes were buzzing in our ears, and someone in the next tent was snoring VERY loudly, but it was what I expected.

By 6AM the next morning, the villagers were back, standing outside our tents, waiting for us to come out. I can’t describe to you how grubby we felt in the morning---we couldn’t even wash our hands with water, and we had layers of dust, dirt, sweat, sunscreen, insect repellent, and hand sanitizer on. We had a quick prayer/worship time, another trip to the bush, and by 8AM, we were back at our clinic stations. It was much the same as the day before. I was able to be more patient that day. We ran out of many medications by noon, so we quit. The Nigerians were staying another dy, but the American team and the three of us were going home that day. And as usual, we got delayed going home. We meant to leave soon after clinic ended, but one of the American little boys on the team had run off with the village boys to find the water hole to chase around monkeys and was nowhere in sight. Our driver Amos and some Gidan Bege and village kids went to find him. We sat roasting in the car for almost 45 minutes while the villagers stood and stared at us. The kid came back on someone's shoulders, in a throng of Nigerian villagers and Gidan Bege kids like a returning champion. Amos went missing for another 30 minutes until we sent some boys to find him, and finally he came back. So we left, 1.5 hours late in true Nigerian fashion. And of course, we get a flat tire about 1 hour out. We pull over, thankfully near an intersection with a town and not in the middle of the bush somewhere. Most of the men go off to roll the tires to get pumped (the spare was flat too). The rest of us try to stand in the shade, which is still hot, and avoid bugs. After half an hour later they're back, get the tire back on, and off we go. We get home with no more mishaps and thank God for showers that work!

Traditional Healer

2006-04-11T10:33:00.000-05:00

Hello! Marion, Becca, and I had a very busy week last week, all of which I'd like to share, but it would be way too long in one posting, so I'll just do a bunch of postings in a row (if my connection is good enough!). I'd like to start with the traditional healer we went to see at Miango. Paul, the man who takes care of the dogs and guards and generally the whole compound, took us, as it is his home town. It is about 30 minutes-1 hr away, and it is a lovely small town in the country, surrounded by big rocks. We were expecting that they would be old men who had been taught the art of herbs as a family tradition, but they were not that at all. The healers were two or three men, in their late 30-s to early-40s, who believed God gave them a gift of learning healing herbs. They didn’t have a teacher, it seems, they taught themselves. They told us they gathered their own herbs, which mostly seemed to be from common trees and plants around. They took their children to help and teach them about the herbs. They are farmers for a living, and they charge patients if they can pay and don’t charge if the patients can’t pay. They see it as their calling from God, their way of service. They have a house that acts as an inpatient ward of sorts, when needed. They see themselves as healers as much as doctors are, except that know there are some conditions they can’t treat and then they send them on to the hospital. They have absolutely no quarrel with the hospital or Western medicine. They just wished their practice was accepted by Western-style doctors with the same equanimity. They showed us many of their herbs. They had herbs for everything from colds to cirrhosis to anemia to giving energy. They even had a combination of herbs that they say cures early stage HIV infection. They say they had four patients who were tested for HIV and were positive but were still healthy and unaffected, and after taking the herbs, they were re-tested and were HIV negative. Of course, we were somewhat skeptical, but I encouraged them to keep very careful track of their research and bring it to the attention of the hospital, because if it really can cure early stage HIV, well, it’s a priceless thing. I believe in herbal medicines; after all, many drugs we have now are simply chemicals distilled from plants and herbs. But still, they need to have good strong evidence before anyone will believe them. It’s not good to get your hopes up with HIV treatment, as nothing has panned out yet!

They asked for prayers, that they find money to have a real inpatient ward and that people might believe in what they do. In Nigeria, traditional healers are often the occult, also witch doctors of a sort. Herbal medications often come along with charms and belief in the spirits and things like that. It’s not that I don’t believe in evil spirits or spiritual warfare, but when you start believing you can manipulative spirits or nature through charms and incantations, well, that’s witchcraft. So being a Christian herbal healer is a very rare thing. We prayed for them, and they prayed for us, and then we went to the market. Apparently, each small town had a market day, where sellers from many different towns and villages would all come, and they’d have a very big market. It seemed you could buy just about anything from credit for a cell phone to pots to fish in this market. Becca took a picture of the market and managed to offend the ladies we were trying to buy cose from. Apparently, many Nigerians don’t like having their pictures taken. Some, because they feel you shouldn’t take a picture of them unless they are in their best outfits. Others, because they think you’re trapping their spirits in a picture and won’t be able to get them back. And still others think you might be trying to scam them and steal the patterns of their goods, so they don’t want any pictures taken of what they are selling. Anyway, we were trying to buy cose, which is a generic term for some sort of dough-like substance deep fried in palm oil, which is a very fatty, red oil. The dough can be a bean paste, or pounded cassava or yam (both are starchy roots like potatoes but taste different, more starchy and bland). I love the bean cose. They have a big pot of boiling oil at the market, and they cook them right there in front of you and you can get a big handful for next to nothing. Paul finally sweet-talked them into selling some to us and we burned out tongues eating them right out of the pot!

On the way home, Paul had to stop and greet every person we came upon. Since it was his village, he knew everyone, and in Nigeria it is so impolite not to stop and have a long greeting with people you know. It was remarkable; even 15 minutes from the village, at a military checkpoint, he ran into someone he knew. Apparently, the army men at the checkpoint, Paul, and two men on a motor bike all played together as children. Somehow, the two men on the bike insulted one of the army men when they were asked to stop for a routine search, so the army man took the keys to the bike and refused to give them back until the bike men apologized (or gave money, I suspect). Paul got out and spoke to the army men at length, reminding them that no matter who insulted who, God asks us to forgive and give grace to those who insult us, and so on. The army men were finally swayed and gave the keys back. We go back on the road (most roads in Nigeria are either run-down potholed sort-of paved roads or bumpy dirt roads but neither are particularly comfortable and none have any traffic rules of any sort) and finally arrived home tired, hot, and hungry (this is a common way we arrive home from anywhere). Wow!

Yankari

2006-04-04T15:27:00.000-05:00

Saturday morning, we woke up early (although not too bright) and gathered our things for a trip to Yankari National Park. Barbara and I grabbed our cooled water from the fridge, our food, and our bags, and met Becca and Marion at the van. We’d rented one of the SIM/ECWA vans and Michael from the SIM office had offered to be our driver for the weekend. Yankari is a 3-4 hour drive from Jos, and is located northeast of Jos in Bauchi province.

The drive to Yankari was the first time any of the four of us had been off the plateau that Jos sits on since we first arrived. Although we were very sleepy, Michael seemed wide awake and drove us safely. The countryside didn’t seem too different from on the plateau, and for the first few hours of the trip, the roads were smooth and traffic wasn’t too bad. At least, that was the impression I got when I wasn’t trying to sleep off the early wake up time. I did my best to stay awake with Michael at first, and after fighting off the sleep for about half an hour I succumbed to the weight of my eyelids and dozed most of the rest of the way. I did wake up when we drove through Bauchi, which is the capitol of Bauchi province. Bauchi struck me as very similar to Jos although much less hilly. Michael said it was a bit smaller than Jos, but we didn’t really drive around enough there to be able to tell.

A little ways after Bauchi, we turned off the main road, and a little further down we came to the gates of Yankari. We had to stop there and pay the entrance fee, for which we had to get out of the van and sign a guest book. We also had to pay a fee for the van and for the use of our cameras in the park. Altogether it came to a little less than $20, more than a third of which was for the use of our digital camera. A regular old film camera is 10 times less to take into the park. As we were waiting for everyone to sign the book, two Nigerian policemen came up to me and we started chatting, and soon they asked if they could have a ride to their motorbike which had a flat tire about 20 km down the park road, so we invited them along and put their spare in the back and drove in. The park road was paved. Well, I should really say it was paved once, and now the pavement had gigantic pot holes in it, so we drove with at least 1 and often both sets of wheels on the shoulder. It wasn’t any less bumpy but at least the bumps were smoothed out, without jagged pavement edges to rip at our tires. The clay under the pavement is easily washed away in the rainy season. Regular signs were posted indicating that “Animals Have The Right Of Way”. I later learned that this didn’t apply to guinea fowl. We dropped the police at their bike, and a little while later were at our destination.

Arriving at the welcome center an hour after we entered the park, we checked into some huts. Accommodations come in varying sizes at the park, and Barbara and I stayed in a round hut with a large bedroom and a single bathroom. There was no running water, but there were buckets and giant stores of water spread throughout, so used that. There was a porch outside as well, and there were baboons and warthogs wandering around. I haven’t mentioned yet that the moment we got out of the air conditioned van, we were struck with sweltering heat the likes of which I don’t believe I’ve ever experienced before. It was a dry heat that felt like it was well over 100 degrees, and the breeze that blew felt like it was wafting air directly out of an oven into my face.

Fortunately, the compound is located right next to the Wikki Warm Springs, so we changed into our swim suits and headed down to the water for a swim. The spring bubbles up out of the base of a sandstone wall set in a ravine down from the hut area. The water comes out at 88 degrees all year round regardless of weather. I was surprised that it still felt warm to the touch when I got in, but it was much cooler than the surrounding air and was quite relaxing. There was a small current, and swam up and down the 300 meter length of spring, sometimes just sitting in the shallow areas for about 3 hours.

Being in the middle of a nature reserve, the spring wasn’t devoid of wildlife near the banks, although there weren’t any fish. There were small lizards everywhere, although that’s no different than Jos. They’re more common than squirrels in Nigeria. The primary thing the spring had in abundance was flies, including tsetse flies, which would fly around your head and occasionally bite you in the shoulder if you held it above water. Fortunately, I didn’t get bit, although Barbara got a bite on her hand which was not so pleasant. I also saw a light brown bat flying around and watched him settle in a tree about 3 feet from the water. At one point, I was watching him and he stretched out his wings and hung by just one claw and I soon realized that he was getting ready to move so I stayed and watched. After a few moments, he swooped down towards me, and as I ducked away he landed in the middle of the spring! He began flapping his wings in a swimming sort of motion and swam about 10 feet along the surface of the water while drinking before heading back onto the bank. It was one of the oddest things I’d seen. A short while later the baboons came down the hill from the hut area to join us. We watched from the water as 50-80 baboons descended the slope towards the water, ignoring the stairs completely. How rude! I was expecting to see them jump right in and join us, but instead, they either walked along the bank or stopped at the edge to have a drink. They drank in a position similar to a swimmer on the blocks at the start of a meet, and I really wanted to get behind one and shove him in the water, but I thought better of it. Barbara and the others cooed at the babies clinging to the backs or bellies of their mothers. I have to say they were awfully cute. Much cuter than human babies. ;)

After our swim we went up and had lunch and then took a quick nap, preparing for the 3:30 pm Safari truck. At about 3:15, Michael came by and told us he’d seen the truck leave at 3:00 with a full load of students, but when he asked about it was told they’d have another at 4, so we waited some more. When the truck came back, we watched it unload about 50 people, and although large, they were literally packed in there. We got the later tour and had about 15 people, which gave us just enough room for everyone to have a seat and we were VERY thankful that the first truck had taken most of the folks interested in going.

We were told that the animals are free to roam and were wild, so anything we saw would be based on the luck of the day, so we set out with hopes that we’d catch a glimpse of some animals along the rivers drinking.

We saw some water buck as well as some bush buck, which people in the US would know better as antelope. One of the things we quickly learned with both these animals was how well they were camouflaged for their habitat. Eyeing movement was the key t seeing them, and once you saw them, it was often hard to point them out to other people until they moved again. The terrain was referred to as the savannah woodland, with tall grasses and many small trees in the range of 10 to 15 feet tall. There were also much taller trees mixed in, and near the river the bush was thick with flora and the trees were much taller, too. We saw many birds including the red-throated bee-eater and the gray-headed kingfisher. The latter was a particularly beautiful bird, as the non-gray part was a brilliantly bright blue with black trim around the wings and tail. Most of the birds fled at the approach of the large truck, so we weren’t able to get any good pictures of them. We also saw quite a few tantalus monkeys in the forest, and they eyed us with curiosity as they jumped among the branches.

After driving for some time, the guide suddenly stopped the truck and commanded us to be quiet. He then pointed into the woods and as I looked, I saw trees and nothing else. Then I noticed movement about 200 yards from the vehicle as someone informed me that there were elephants. The guides led us out of the truck and into the forest to get a closer look, and soon we were 50-100 feet from a pack of about 50 elephants ranging in size from ones that were about 10 feet tall to enormous beasts that looked as big as the hut we were staying in. The sight of these elephants filing through the woods in a tight cluster looked like a pack of boulders on the move. Several of them turned to eye us warily as they passed, but since we didn’t get any closer, they soon decided we weren’t a threat and they moved on. The elephants were taking a path that led them around a rocky hill outcropping and as I watched, one of the Nigerians on the tour with us tapped me on the shoulder, pointed, and said, “There’s the king.” As I looked up, I could see what appeared to be the largest elephant in the pack standing atop an outcropping of rock, surveying his pack as it went by. It was breathtaking to see this parade of gigantic animals from so close, and humbling to see how their leader watched over them. Seeing one or two of them in a zoo in the US doesn’t compare in the least to the experience.

After the tour, we returned to our huts and then headed down to dinner at the restaurant. Since the power had gone out in the entire compound, we had a candlelight dinner of chicken and our choice of starch (I had spaghetti while Barbara had fries) covered in a red sauce that we’ve come to love here. It’s sort of a spicy meat sauce, and probably tastes so good in large part due to the amount of oil in it. After dinner, we stayed up and chatted a bit on the porch given that it seemed even hotter inside our huts, but we were so worn out by the heat that we went to bed not long after. With the fans not working because we had no power, we tried to get rest in the heat, but it was not easy. In the morning, shortly after we woke up we heard a banging on the door, and Barbara went to the door to ask who it was and got no response. She looked out the window and there was a rather large baboon. I went to one of the other windows, and remarked that there were three more just off of our porch. With that, one of the smaller ones jump up at the window right at me and clawed at the screen before rejoining his friends. Seems they were looking for some breakfast, too.

We had some breakfast in our hut with no more interruptions from the baboons, and then went on the morning tour. We saw many of the same animals, although we saw a rather impressive species of stork, several red monkeys, as well as a pregnant water buffalo. We saw another pack of elephants that we drove a little way off the road to see. As the last one passed, we soon realized there was one more bringing up the rear. It was a rather large elephant and was probably somewhat old, and it hobbled with a limp that prevented it from keeping pace with the rest. Our guide mentioned that it would either heal or eventually be left behind to die by the rest of the group. The same group of elephants crossed our road a little further down, and the lame one had caught up by this point.

We returned back to the camp and went for another swim being joined only briefly this time by the baboons. We had some lunch and then loaded up the van to head back to Jos. The drive was uneventful again, although after talking with Michael for a bit I was very glad he was able to drive us. His wife is pregnant with their third child and is due in May, so they’re saving up for the expensive C-Section she’ll have to undergo as well as the post-surgical care, which is a total of about 30,000 naira, quite a lot for his family. The driving trips pay him well, and it’s extra income he hasn’t planned for so he can put it directly towards those savings. I told him that I hoped he enjoyed the trip, too, and he seemed to really enjoy his time swimming with us. We were very glad to have him along, not just for his driving, but also for his ability to translate when needed (not too often), and just for the chance to get to know him better. He's an awfully kind person and we felt very much like he cared just as much about us having a good time as we did for him.

Hospital Wards

2006-04-02T13:10:00.000-05:00

Hello! Another week is almost gone, and we have been busy as usual. I have been working at the hospital in the medicine ward. Some things about medicine are so different here, and some things are so similar. We start our mornings with rounds, like we do in the US, and what happens here is that the house officer (intern) and I trade off doing the scribe work and scut work. We write the note, write prescriptions, take blood pressures and pulses, and hunt down lab results, papers, etc. They don’t really do as much of a physical exam as I’m used to, but often there are interesting signs and then I just stop scribing and go examine the patient, and the doctors are very good about helping me with that. Americans are afraid to hurt others so we don’t press nearly as hard when palpating stomachs or moving aching limbs---Nigerians want to get to the root of the problem quickly, so they press hard and elicit the pain response quite quickly!

I’m learning that they don’t do as much here simply because they can’t. For instance, the shorter physical exam. They do a thorough exam when a patient is first admitted, but after that, your physical exam findings may not affect how you treat the patient so you do as much as might be helpful, and that’s it. They are better at working on intuition than we do in the USA. There are limited drugs, limited scans, limited lab tests we can do here. They don’t have the drugs or equipment or training, and even if they did, most patients don’t have the money to pay for these things. Patients usually don’t come in till they are on the verge of dying, so often you can’t do anything for them anyway. So for instance, a young lady came in with fever, bloody diarrhea, cough, and liver dysfunction. We don’t do cultures because they often don’t have the means to be sterile enough, we can’t do a CT because we don’t have the equipment, so we just treat the likeliest cause---an infection. We give her three different antibiotics to cover for malaria, meningitis, and a gastroenteritis, and oxygen through nasal prongs and hope for the best. Four days later, she is dead. We visited her every morning and she worsened everyday, but what could we do? We treated her for what we thought she had, and clearly it didn’t work but we have no way to figure out what was wrong with our treatment. I know that a lot of the times in the beginning, I thought there was gross negligence going on, but now I realize that it’s just that they don’t have the same resources we do. One of the residents told me he hated internal medicine because you had to watch all these people with problems who you couldn’t really help and just died on you, and I tried to explain that it was a little different in the US since people came for regular check ups and didn’t get so sick before coming to the doctor. Preventative care is such a beautiful thing!

Their matter-of-fact attitude towards death I think is one of the biggest differences. Not that it doesn’t affect them when patients die, they are compassionate people, but, they see it so much it doesn’t bother them quite the same way it bothers Americans. I think it keeps you humble, because it reminds us that we aren’t gods. We can’t do everything, we can’t save everyone. We are helpless, we are limited, and after you do your best, all you can do is leave it in God’s hands. I think many doctors in the US forget this, and think they can save anyone and beat themselves up when their patient dies.

After rounding, we go to clinic. So here’s big difference number two. Time is fluid in Nigeria, even in medicine. Clinic starts whenever rounds end, whether at 9:30 or noon. Patients just show up and get into some sort of line and wait. They can wait 2 minutes or 6 hours, depending on when they show up in relation to when we show up. There are no appointments, Nigerians don’t do appointments. And when you want to get a hold of them, it’s hard, because many don’t have phones, and their postal system isn’t as structured, so many people put their churches or schools as their address and you have no idea where they really live. Big difference number 3: Privacy doesn’t really exist here. We see them sometimes privately, sometimes not. Nurses, other patients, other doctors, and other random people are always coming into the room and conducting their business while the patient is still there. Patients will often try to cut the line and come in before you’re done with a patient and stand there waiting, or two of us are in one room, both seeing patients. Sometimes I see them myself and then talk to a doctor about them, sometimes I help the doctors write the prescriptions, do the exam, etc. There is no co-signing here. They watch me, but they trust me to make sure I am responsible and do the right thing! Scary, but good training for becoming an intern.

We do clinic until all the patients are seen, and then we have a variety of things occur: following up on patients in the wards, going to lecture, admitting new patients, or going home! On call, we sit in the emergency room and see patients. I usually see them myself and then discuss it with the resident briefly. We see a lot of fever (always treat for malaria!), diarrhea, headaches, body aches, but we do see some really bizarre things too. Very, very bad cellulitis from a corn stalk puncture, very nasty breast cancer, hemorrhagic fever, lots of weird eye problems, and various other weird things. We also see a lot of motor vehicle accidents. The bikes, the lack of traffic rules, the people racing across the street---it’s not surprising, and usually they’re bad accidents and people die. Even in these serious accidents, the doctors and nurses don’t hurry because there’s not much we can do. We can’t intubate, do CT’s, type and cross quickly and get the appropriate blood, do continuous EKG’s, etc, which are all things necessary to keep to a person alive after a serious accident. Plus, patients need to pay a 5000N deposit before they’ll get any treatment, and how many Nigerians have that on them at a moment’s notice? Not many considering that’s a pretty good months wages for most.

Lastly, the one thing I have enjoyed so much is that the hospital is a mission hospital. When I was at Spring of Life, my favorite thing to do was pray with the patients. It is the same at Evangel. It is such a privilege to be able to minister not just to the physical needs, but the spiritual and emotional needs as well. In the US, we forget that keeping a person healthy means looking at the whole person, and that sometimes until you fix the emotional and spiritual needs, you may not be able to help the physical needs. Here at Evangel, sometimes it is very hard in the busy-ness of things to make the time to talk with the patients, but many of the doctors do, and it’s amazing to see. Sometimes, as a Christian, I can be so critical, I can see all the things I’m supposed to do, all the people I’m supposed to help, and then I feel very down that I’m doing such a poor job. But then something happens to remind me that God doesn’t need big things to happen, he just wants something to happen. I had the joy of being able to pray with a patient and one of the house officers a few days ago, and I can’t tell you how much that moved me. The house officer can’t be much older than me, if at all, yet, his words were from a person 10 years wiser than me. I could tell that his words, and our prayer time with her, meant more to her than all the medical treatment we’d given her in the past 4 days, when she arrived in a critically ill state. It was the first patient I was able to pray with here at Evangel, and it wasn’t a big thing, nothing heroic. Yet, I know the Lord found that time we spent with her to be a precious, precious thing in His eyes. The Nigerians are teaching me, the Lord is teaching me, my patients are teaching me. It’s a great thing!

ECWA Camp Youth Alive (ECYA) Update

2006-03-31T17:19:00.000-06:00

So this week has had some rather big ups and downs. Wednesday morning, after a very late night downloading clip are at awfully slow speeds, the Morning Watch books were completed. Claudia was excited and so was I. They were a day late for our deadline, but the printer assured us we could still get it done in time for the Edo-Delta camp which we leave for in a week. Meanwhile, one of Claudia’s camp staff, Akim, and I have been working on a promotional video to advertise the camp. Some footage of the camp was shot last year during the 2005 camps, and we went through the video to pull out the different parts of the camp day. Wednesday afternoon, Akim and I went to the house of the missionary who’ll be helping us compile the video as he needed to know the timing of the video. It all went smoothly, and hopefully it’ll only be a short time before we can get the rest of it lined up and ready to compile.

Thursday evening, the camp committee met to discuss business for the coming summer. The primary goal of the agenda was to determine how much to charge campers for a week of camp, and I soon found this to be an extraordinarily frustrating task. Claudia had done a lot of work to narrow down the costs of the camp, and when all was said and done, it came to about $38 for a week of camp. It included $24 for 3 meals a day for 7 days. It included a camp t-shirt. Also included was the craft fee, which was $4.50, and the crafts aren’t the same you’d find in an American camp. Instead, they’re things like sandal making, reed art, and knitting, all of which are things the campers can take home with them and actually make some money off of. They’re skills that empower the campers to try starting a small business. Other fees included were related to other camp activities, as well as maintenance of the campground.

Well, suffice to say the committee was none too happy to see $38 on the bottom of the page. Last year, campers were asked to pay $21, and the actual cost was quite a bit more than that. As a result, the camp is still in debt from subsidizing the extra cost. Not only that, but for a person to make $50 in a month isn’t uncommon here, so paying ¾ that much for a week of camp simply isn’t possible for people. Even at $21 last year, most of the campers were sponsored by other missionaries because they couldn’t afford to come. The 2-hour meeting soon ran to 3 and still the committee was having a hard time. Ask people to pay the full price in order to keep the camp running, or ask a lower price and hope that the extra money will come via donations? It’s awfully tough to understand what to do. The money simply isn’t there, but the camp is such a great place for kids to go. Many of the current staff are former campers, and many have gone on to better places as a result of things they learned at camp. The people involved see the benefits, but it’s so hard to know what to do when money issues come up.

While Claudia and I were frustrated by the committee’s indecision, they did empower her to make a final call on what to charge. In addition, they also called for some fundraising to begin ASAP. As a result, I spent the entire day today working on an ECWA Camp Youth Alive brochure to make available to churches and organizations. It included pictures and a description of the camp’s goals, needs, and program. We feel like it came out really well, and I’ve never done anything like it before so it was rewarding to be able to pull it together in just one day. We really need to have some results come out of it, though, and Claudia needs wisdom in her decision about the finances.

Hospital Life

2006-03-25T09:50:00.000-06:00

Thank God for the weekend! Nigeria's currently holding a census, and it has been occurring pretty peacefully for five days now, and everything has been slow. As we expected, the travel curfew for the census has been extended for two more days, so everyone is expected to stay home tomorrow and Monday as well. Of course, the hospital continues to work but everything else is pretty much closed. I still hear a lot of traffic and noise outside of the compound, so I’m sure there are many people not obeying the curfew, but I’m not surprised. Who is going to catch these people, anyway?

I myself was counted yesterday. Though the hospital is officially on a “holiday” schedule, still the urgent care and emergency room must be running. So I was taking call with one of the doctors when the census takers came. They were actually quite nice and it only took a few minutes. I was surprised that he wanted to count me but he said they counted everyone who was in Nigeria for longer than a week and was here during the census. I had heard they were asking questions about what languages you speak, how many cars you have, what religion are you, etc, but he didn’t ask me any of those questions. He mostly asked questions about where I lived and education and career, if I was married, how old I was, etc. Then he fingerprinted me and marked my thumb with a permanent marker, almost just like they did in Iraq to show they voted!

Yesterday was also a rough day for Marion, Becca, and I. We had been trading calls Thursday and Friday and had been seeing many interesting things. We see a lot of malaria, typhoid, diarrhea, rashes, work injuries, road accidents, urinary tract infections, and fevers from who knows what. It’s different from the US in that when you come to the ER, few tests are done here. Most people can’t afford many tests and there are few facilities to have them done anyway, so usually we just do a physical exam and treat based on the history and our findings. Sometimes we do lab work, but only if we really think we need it. Plus, the lab wasn’t working yesterday! In addition, everything must be paid first by the patient before it will be done, even lab work, so sometimes they have to find the money first and this can take a while.

Anyway, yesterday was slow but we did have a little girl come in who was very ill. Blessing (not her real name) was 1 year old and was severely malnourished. She was painfully thin, dehydrated, lethargic, and breathing in very fast, noisy little gasps. Her mother explained that four days ago, Blessing started having diarrhea and vomiting. They took her to the doctor and she was given an antibiotic. The antibiotic didn’t help, and last night Blessing began to breathe in those little gasps. The father said Blessing didn’t sleep all night. I was very puzzled, because the parents looked rather healthy and well fed and was very concerned about her, so I couldn’t understand why Blessing looked so underfed and why they had waited till the morning to bring her in. However, there are so many factors that could account for it. One thing is that they were first time parents and might not have realized Blessing was quite sick last night and should have brought her in as soon as she started breathing strangely. After all, everyone gets vomiting and diarrhea here and usually antibiotics make it better. Another thing is that some tribes here don’t believe in giving children high protein food because they think it might bring something bad to the child; for instance, children might not get poultry products because the tribe thinks they’ll then have a tendency to become a thief. So even though the child is fed, he/she might be lacking the right sort of nutrients. Finally, I wondered if the child might have HIV. The family had never been tested. She was admitted to try to hydrate her and give her IV antibiotics.

This never happened. She was taken away to pediatrics, and because she was so little, no one could get an IV in her, though everyone tried for a long time. When they finally did get one in, it was into a small vein, and it is hard to get more than a trickle of fluid into a small vein. When the chief resident tried to inject some fluid into the IV, the fluid couldn’t go in and instead splashed over Marion’s and Becca’s faces. The mother was quite worried; no one had told her what was going on but she knew something wasn’t going well. Becca was able to talk to her and pray with her. Unfortunately, the child died soon after. The mother was hysterical and ran outside, and no one could find her.

To make matters worse, the lab soon reported that Blessing had been HIV positive. This means she most likely had gotten infected from her mother, and the father was therefore probably infected too. This whole young family probably had HIV but no one knew, until now. And, since the fluid that got splashed on Marion and Becca contained some of Blessing’s blood, they now had the tough decision of deciding if they wanted to take anti-HIV medications or not, which is a big decision; the medications are expensive, have lots of side effects, and you have to take them for a long time. Based on their individual exposures, Marion decided to, and Becca did not, but both were quite shaken.

And where was I? I wasn’t even there. I had gone home to get lunch. Usually, we try to keep it to two of us at a time, as three medical students in one situation can be a bit excessive. But I felt bad about everything. I felt bad I wasn’t there. I felt bad that I hadn’t thought to stop and see Blessing before I went to lunch. There is a certain blasé attitude about death and pain here. In the US, we spend lots of money trying to save people in everyway, and if someone dies, it’s almost like it’s a failure. Here, it’s the opposite. If someone is very ill, it’s almost like they feel, why bother? We don’t have the resources to really try to save them and they’re probably going to die anyway, so no rush. I don’t know how to deal with this attitude, I feel we should probably have something between the US’s and Nigerian’s attitudes. I find that I’ve very easily fallen into an attitude of, “I know this is not the way it should be, but I don’t know how I, a lowly medical student, can do anything to change it, or how to be different, so I’ll just follow their lead.” I think I need to learn to fight this, to learn that I can love these people no matter what goes on around me. I can take the time to pray with them, and talk to them, and counsel them, even if it’s hard to communicate due to language and cultural issues.

I also wonder if my own attitude towards death is right. I have been volunteering with HospiceCare for 3 years now, and all of my patients die. Yet, though it is sad, it is not terrible to me. I see death as a natural part of life, and everyone is meant to die. It is sad that some people die in pain, or die when they’re young, or die a “preventable” death. Yet, we can’t save them. We aren’t meant to save anyone, only God does that. And if He chooses to take someone, it is not our mistake, or our failure, it is His way. So though Blessing’s death was very sad to me, it wasn’t depressing. It makes me feel heartless, though, to be so prosaic about it. What did keep me up all night was wondering if anyone told Blessing’s parents that she had HIV, and if anyone counseled them on what it meant, that they had to get tested and the implications for the family. I kept waking up, wondering how I could have loved them more, and wishing I had been able to pray with them and be with them as Becca had. So please pray for Becca and Marion, for Blessing’s family, for the doctors, and for me, most especially that we might let the Lord work in us through this situation and the next crisis we encounter be handled with more grace and love.

Tumu

2006-03-22T13:20:00.000-06:00

Hello! It has rained for the first time since we came to Nigeria today. Perhaps it means the start of the rainy season, but I hope not. My understanding is that during the rainy season, it pours for like an hour, then stops, and it’s hotter and muggier than ever afterwards, and the bugs come out! On the other hand, everything grows and flowers like crazy, so that is something amazing to see. It’s certainly true that the dust hasn’t been nearly as bad in the last few days. The rain was extra nice today because we didn’t have water today for half the day and I thought that would be how I’d have to showever but praise God it’s working again. We’ve been lucky and though the electricity has gone out almost everyday since we’ve been here, often many times a day, it always comes back on just a few minutes later. Still can’t get our internet to work at home, though!

So I thought I’d tell you about our village trip this weekend. We went to the village of Tumu, which is where our friend Kauna, whose job is partly to take care of us short term assignments (STA’s), is from. Her immediate family is here in Jos but the rest of her paternal family is in Tumu, about one hour outside of Jos. It is a very bumpy ride in a very hot van. The village is exactly what you think African life would be like. It is a small village set in a valley ringed with tall rocky hills, with scrubby trees and lots of agriculture. They live in mud and brick buildings that look like huts but are bigger, and some have thatched roofs and some have tin roofs. Most houses are actually a compound of several buildings all in a square with a courtyard in the middle. Often, there'll be a small granary in the courtyard. There is no electricity or running water, and there are chickens, goats, sheep, dogs, and lizards everywhere. There are also lots of kids, and they are funny in that they are shy and don’t want to actually talk to us or touch us, but they want to follow us everywhere and stare at us. The village is so nice compares to Jos. In Jos, everywhere you go, there are cars, motorbikes, vans, people, people, people, markets, rubbish, noise, etc. It also smells terrible from all the car pollution. People in Jos on the streets, even though they see white people a lot, still stare at you and yell out to you and often you feel like you’re a circus attraction. At the village, they make you feel like you’re an honored guest. They don’t stare and yell out, but instead they talk to you and greet you and bring you to their home to have a drink. When we go walking to see the agriculture (They are growing yams, green peppers, tomatoes, etc), the men stop in their jobs to look but wave in a very friendly fashion when we greet them and suggest places for us to visit. We see a natural bubbling spring, which is their source of water for the crops. We walk along a dusty path into the rocky hills and around the corner is a small lake made from a dam. There is a man fishing; he is floating on a barrel, and when he catches a fish, he throws it into the barrel! There are many fish jumping in the lake and it has a red clay beach. It’s so hot, we want to throw ourselves in, but the parasites waiting for us in there make us all think better of it!

We go back to visit a blacksmith who has a little boy fanning the flames for him with what looks like a woven mat, and he is planning to make some farming tools, I believe. Then we have lunch, which is a potluck of things we have brought. Of course the grandmothers want to feed us their porridge but we’re afraid of getting sick. Did I explain that there are two grandmothers? Kauna’s grandfather had two wives, and though he has died, they live together in the same house with one of the wives’ sons and his family. They are as cute as anything. They don’t let you take pictures unless they are all dressed up, so they go get changed into their best outfits, and they come out wearing the exact same outfit! Kauna’s uncle uses a very long stick to shake some lemons out of their tree for us, and we head back after about 4 hours at the village. It doesn’t sound like long, but when you’re outside in 95 degree weather, it’s a very tiring experience!

This week, Nigeria is conducting a nationwide census. It hasn’t had one since 1991. It is quite the thing. Apparently, the local governments have trained special people to go to each household and count people and ask all sorts of questions. It’s quite confusing, because as you can imagine, in a place where many people don’t have electricity or phones, and if you do, it’s unreliable, and there’s not really a postal service, how do you relay information to the mass public? And, nothing’s ever organized here so no one knows what’s going on. We understand it’s somehow a very political thing; for instance, there’s something about figuring out who speaks what language (Most everyone speaks some Hausa, English, and their tribal language), and what religion you claim to be, etc, but we don’t fully understand the issues. Nigerians identify themselves more by tribe than as a Nigerian, and this can cause all sorts of tension in government. Here in Jos I have seen a lot of Fulani and Ibo people, but of course there are like 250 tribes in Nigeria! Also, religion here is interesting. There are a lot of true Muslims and true Christians (At least, as we think of “true” Muslims and Christians), but also many whose Christianity and Islam are, as one doctor put it to me today, “neither here nor there”, and is all mixed up with their tribal religion. Also, they don’t always correlate the truths they believe in their religion with the way they should live their lives, so there are many Christians, for instance, who say they believe in Jesus and live by the Bible, but are also having unprotected pre-marital sex and don’t think twice about it.

Anyway, the census is supposed to last from the 21st to the 25th, and we’ve heard various things, that there should be no movement at all and everyone should stay home during this time, or no movement only during the last two days, or maybe it’ll get extended two more days. But in any case, many people are staying home and businesses are closed because no one knows, and there’s no good way to get information around so it’s like a week long holiday. Of course, I still hear all sorts of traffic and the hospital is still going. But even the hospital is calling Thursday and Friday a holiday and will run like it’s Christmas. Frank is working from home as a result. Also, the Christian organizations in Nigeria are having a two day strike next Monday and Tuesday to protest against the violence in the Muslim northern states regarding the Danish cartoons, so there’s a whole week for Frank to stay home! It’s nice for him. Also, apparently there will be people posing as census takers but are really thieves, so we’re supposed to be careful who we let in during this time. I’m assuming they won’t come count us but who knows. I don’t intend to be home to find out, as I will still be working anyway (I’m helping to deliver babies this week!), but maybe Frank will have the fun. Well, that’s enough for now, bed time!

Camp Ministry

2006-03-20T01:24:00.000-06:00

Here’s a picture of me playing basketball with some of the kids at Gidan Bege. Note that we don’t have a hoop, so we’re really just passing the ball around and dribbling around people, but it was fun. We’ll write more about Gidan Bege in the future. I’ve been working with Claudia for the past week now on the ECWA Camp Youth Alive (ECYA) ministry. ECYA is a youth camp with a vision somewhat like summer camp back in the States. The camp is designed to be a 6 day camp, although depending on who the camp is for, it may be shorter. The concept of summer camp didn’t really exist in Nigeria a while ago. There simply isn’t the money or leisure time for that sort of thing here. However, people are starting to see it as a really good way to reach the youth of the country, so since the mid 1990’s, Claudia’s been running camps in the summers.

We’re located in Plateau State, which is in north-central Nigeria, and this coming April, the first ECYA camp in the south will take place. It’ll be near Benin City, and with camp only 3 weeks away, we’ve still got a lot of work left to do. As a Christian camp, there are bible studies and morning quiet time booklets that need to be finished and printed before camp. Camp t-shirts need to get made, and there are a host of administrative issues that require organization and cooperation between Claudia and the district council in which the camp will be held. I’ve been working with Claudia on getting the devotional booklets and bible study material typed up and formatted in the computer over the past week, as well as writing some of them myself.

When Americans think of summer camp, they think of something a litte different from what camp is like here in Nigeria. First, the concept of youth is different here. In the US, we mostly think of youth as being under 18 years old. Here, the camper age range is suggested as 12-22, but campers as old as 30 will come, too. It’s very difficult to find a job here, and many folks under 30 are still unemployed and living with their parents, so they’re still considered youths.

On Saturday afternoon, I was to go out at 2 pm to the ECYA grounds just outside of Jos where Claudia had the Urban Frontiers Mission spending a weekend retreat. The First ECWA Church of Jos had sent a group of people to help smooth out the bumpy, dirt access road. Claudia had purchased some laterite, a clay-like material that they use to fix roads. In the rainy season, the road becomes a riverbed and much of it washes away, making it very rough. By filling in the large holes with rocks, and then surrounding with laterite, we were hoping to resolve the problem at least somewhat. Laterite also has the added advantage that instead of washing away, it sticks together when it gets wet, so it doesn’t wash away quite as easily.

Claudia decided that she would like to use the ECWA pickup to help move some of the materials, so we headed back to Jos and picked it up. Unfortunately, the truck didn’t have any petrol in it, so we had to get some fuel. It was about 3pm, and something Claudia told me that I didn’t realize is that it’s very hard to find an open gas station in the middle of the day. They’re open in the morning when it’s cool, and they’re open later in the day, too, but not in the middle of the day. The first two places we tried were both closed, and we found a Texaco station that was open but had a very long line of cars and motorbikes waiting. We drove on, and after checking 4 or 5 more stations, went back to the Texaco.

The Texaco station was organized disorganization. Only one pump was being used. A row of cars stretched out of the station into the street. A row of motorbikes was next to them, and a second row of cars formed a motorbike sandwich. With just the one pump open, the wait was long and slow. They’d fill a car on one side of the pump, then fill one or two motorbikes, then fill a car on the other side of the pump and so on. Occasionally, a car would pull in from the front of the line and back up to the pump, effectively cutting the line. Claudia told me that these folks are typically friends of the station owner, and it was annoying to see happen but there wasn’t really anything we could do about it. After a long 30-40 minutes, we finally got our fuel and were set to head back to camp. Claudia had phoned ahead to have the work on the road begin with the wheelbarrows due to our delay, so hopefully, we’d be there in time to help with the truck.

Then, as we were pulling out of the station, the engine died. Claudia tried restarting it several times, but I eventually had to get out and push it back into the station so we wouldn’t block the exit way. After about 5 or 10 minutes, we were able to get a mechanic to take a look at it. He checked the spark plugs and various cables and hoses and none of those seemed to help. Then the started playing with the carburetor and that seemed to be the problem. He made some adjustments with a screwdriver, cleaned out some dirt and grime with the same screwdriver, checked the pressure with his hand, and did a lot of other simple checks. An hour later, the truck was again running, and a half hour after that, we’d paid and were convinced the truck wasn’t going to stop on us again 10 minutes down the road.

We finally pulled into the camp at around 5:30 pm, on time enough to see the hard working group putting the final touches on their contribution to filling in the road with laterite and stones. It was not encouraging. The amount of work, and the improvement it made seemed like a drop in the bucket compared to what needed to be done. However, that’s how this type of a project needed to be completed. The money and manpower simply isn’t there to get it done all at once. To really fix the road, it needs to be elevated and have grass planted on the sides to prevent it all from washing away in the rains. Considering how hot and dry it’s been since we’ve arrived, that’s hard to imagine without looking at the ruts the rains have already created.

And The Winner Is...

2006-03-20T01:16:00.000-06:00

Portland! Friday morning we learned that Barbara will be spending her Internal Medicine Residency in Portland, Oregon with the Portland Providence Medical Center. Portland was a program that she really liked, although we’re a bit sad that it’ll be so far away from our family and friends. Thanks to all of you who’ve prayed and encouraged us in this time.

A special thanks to Hillary for checking on it and being willing to take care of any potential match issues that might’ve come up. We look forward to seeing you and Ryan in Jos in April!

Barbara's Thoughts On Our First Week

2006-03-16T03:43:00.000-06:00

Dear friends,

It is hard to write in a succinct fashion everything that has happened
in the past week since we've left for Africa, but we'll try some
highlights for now and expand later on, as we've got six more weeks to
talk about what's been going on here!

First of all, thank you so much for all your prayers. Our flight from
Charlotte to Newark to Amsterdam to Abuja (25 hours in total!) was
totally uneventful. Everything was on time, and our baggage, which we
worried about a lot, was totally fine. We were esp worried at Abuja
that they would search our bags and we'd have to explain the medical
equipment, computers, books, etc, that we were bringing for Evangel
hospital (where I am working), but as soon as they heard we were with
SIM/ECWA (Serving in Missions, the group we are with, and Evangelical
Church of Western Africa, their native sister organization) they let us
go quite easily. Praise the Lord!

The first night, when we arrived last Wednesday, we were in Abuja, the
capital of Nigeria. It was hot, humid, and the electricity went out
three times during the night---it made it hard to sleep! SIM has a few
private drivers and cars, so they had sent a driver and a car to pick us up in Abuja. We stuffed the back of the station wagon to the brim with luggage (no looking out the back window!) and drove the 3 hours to Jos on Thursday morning. On the way to Jos, we passed many roadside markets selling fresh carrots, tomatoes, cabbage, and yams, which are a potato-like staple here in Nigeria. People were stopping their cars and talking to people on the roads constantly, everywhere. Even though it was the middle of the morning, people all seemed to be wandering around outside. No one seemed to work inside, and indeed we find that is true, few people have “office” jobs here. We learn that the people, congestion, and market areas are very common all over. Roads are very scary, as no one seems to obey traffic laws and there are many, many motorbikes which are driven very, very dangerously. Along the way, we passed several military checkpoints, which are there to deter armed robbery along the highways, and we passed out small Bibles we had brought to some of them. They love books in Nigeria, as they are very expensive, and the military men look quite bored often, so something to read is great for them. I really hope they read them earnestly!
The countryside is quite dry and scrubby, but it is amazing what will grow even in the dry season. For some reason, the weather has been strange and it had been raining when it shouldn’t have been, and unseasonable hot a month ago, and unseasonable cool now. But still, we saw lots of big mango and lemon trees, very brightly flowering trees with flowers of all colors, my favorite are the orange-peachy ones. There was lots of open land. It appears it is true that the Nigerians do not really value their agricultural abilities, and much land that looked like it was once farmed is now empty. We did pass many yam fields---big, root-like tuberous starched much like potatoes. It is a staple of the country and they eat them either boiled and deep fried, or pounded into a soft, doughy, more bland style. There were many little goats roaming around and gaunt cows with big horns, wild dogs, wild cats, and kids everywhere.
So, we arrived in Jos, which is cooler than most of Nigeria because it is high above sea level. Evangel compound, where we are staying, is actually behind Evangel hospital, which is itself quite a few buildings. There are guards at the hospital gates, and then when we reached the living quarters, which is a fair way past the hospital buildings, we reached another set of gates, also guarded day and night. There are about 30 families who live on the compound, about 10 white families and the rest Nigerians. The houses are surprising spacious and comfortable. Our apartment has fours rooms, a tiny kitchen, bathroom, bedroom, and living/dining room. It is next door to another apartment with two other STA’s (short term assigments) who are medical students from Ireland and Britain (Maryon and Becca), and also by the watch dogs’ kennel (who I can hear barking all night long). It would have been quite clean, except with the Harmattan, EVERYTHING was covered in dust.
How shall I describe the Harmattan? Basically, sand storms in the Sahara end up blowing dust all the way across sub-Saharan Africa, and it ends up looking like a lot of smog/fog. It’s terrible---it gets on everything and doesn’t come off. You can clean a surface, and a few hours later it looks like you didn’t clean at all. By the end of the day, if you’ve been outside at all, your hair is grey, your feet and hands are dusty, your eyes are burning, and it’s just gross. The only nice thing about it is that it only happens when it’s not too hot, so in Jos, it has been quite nice---probably only in the low-mid 80’s and it’s not humid at all, so it actually feels quite cool in the shade and at night.
We spent the first 5 days getting adjusted---meeting families in the compound and the other SIM/ECWA workers, learning to shop at the market (more about that later!), learning to bleach our food, boil and filter water, learn to take a taxi, tour the SIM headquarters, etc. We started officially working this Monday. Yesterday, I started out at morning report at the hospital, where the doctors grill the residents on what happened to the patients the day before. I'll have more on the medical work later. The hospital is a big compound of many interlocking buildings. It is a combination of general wards, which are big rooms with many people in it, semi-private and private rooms, depending on their money. In Nigeria the care of the patient often rests on their families instead of the nurses, so there are people lounging around everywhere. The only room that has air conditioning or a fan is the X-Ray room. There are about 5 white doctors and I can't tell how many Nigerian doctors and about 5-6 residents. There are no medical students except Maryon, Becca, and I.
However, I actually started working at Spring of Life, which is their AIDS counseling clinic. They do not do the “medical” things, but instead do home visits, pre and post testing counseling, HIV testing, and decide if people need to go to the doctor. I go on home visits with people from the clinic to check up on patients, and also have started doing some HIV testing. It is actually quite easy technically, BUT. During that time, I thought with a lot of amusement how Nigerians would laugh their heads off at the patient privacy ideas that we hold so dear in America. Imagine what they’d do in the US if I tried to do a quick blood HIV test on someone with an audience of 30 other patients all giving words of advice and laughing at them when someone winced or if one of us messed up. Well, that is what happens in Nigeria. But like I said, more on medical stuff later!

One thing I have learned is to give an extra 10 minutes to allow for the guards trying to teach us Hausa! There are guards everywhere here, as unfortunately there can be armed robberies anywhere here, and I usually pass about 2-3 on my walk to the hospital. In Nigeria, when you greet someone, you greet them extensively. It goes something like this:

Good morning!
Thank you, good morning.
How is your tiredness?
There is no tiredness!
How is your work?
Thank God for our work.
How is your husband?
Good, thank you.
How is your family...
and so on, and on and on.

You can imagine that if we have to do this every time we meet someone, it takes a while to get anywhere! So the guards stop us and try to get us to do the proper greetings every time I pass. It is quite rude not to stop and do this greeting with people you know and pass, no matter where you are, and Nigerians don’t believe in hurrying, so you always have to stop, no matter how late you are. Nowadays, I have to also greet the gardeners, the men who dig the ditches, the laundress, the personal drivers, etc, etc, etc…who would have thought so many people would be out and about along the way to work??

First Leg of the Journey

2006-03-06T19:45:00.000-06:00

We left for Charlotte, NC yesterday at about noon, and the weather in Madison was pretty rotten. It was snowing and the temperature was right around 30 F. It was very odd to think that in 3 days, we'd be experiencing weather more than 90 F. As we sat on the Dane County Regional Airport runway, the de-icing crew was hard at work spraying us down to prepare us for the flight to Detroit, where we would stop over on the way down to Charlotte. Sitting in the plane, we'd already avoided our first minor difficulty that we expected to encounter. Two of our bags were over the 50 lb limit that the airlines impose on domestic travel, but with the reconstruction efforts at the airport, the ticket agents didn't have any scales with which to weigh our bags. We could tell that the attendant at the counter, although easily strong enough to lift all of our bags, knew we were carrying the extra weight, but he couldn't charge us for it considering there were no scales. While we were prepared to pay if needed, it sure was nice to know that it was one minor thing we didn't have to deal with. With all the snow and ice, we left an hour late, but didn't have any trouble catching our connection in Detroit for the trip down to SIM headquarters.

After spending today in Charlotte, learning about Nigeria and some of the experiences we might face during our two months there, it's awfully good to know that therre are so many people praying over our trip. We spoke about it this evening before dinner, and though we know our experiences in other countries to this point are useful in shaping how we'll respond to our new surroundings, things will still be very different in Africa. Our experience in Honduras two years ago with Blackhawk Church has prepared us somewhat for serving in a community with drastically lower standards of living, but we also recognize that the rural setting we were in there will be different than the more urban setting of Jos. Neither of us have ever travelled to any part of Africa, either, and the cultural mindset is quite different than in South America. One of the SIM staff here challenged us to think about our world view. He argued that the easiest way to learn to deal with a culture from a dramatically different world view would be to first understand ours. He also warned us to be cognizant of when our cultural American world view influenced how we developed our biblical world view and vice versa. While the bible was written to specific groups of people, it was written for all people of all times. That means that a biblical world view should be extensible to all cultures, although an American world view wouldn't necessarily be the same. Often, it's hard to differentiate between the two. Some areas overlap, but others are in direct conflict. We pray that we'll be given the wisdom to discern when our American world view is being challenged but our biblical one is not. Those are the situations where we need to show grace and learn to love Nigerian culture.

We are a little nervous about what will happen once we get to the airport in Abuja. We leave Charlotte tomorrow at 1:45, and after stops in Newark and Amsterdam, will arrive in Abuja at 8:55PM their time on Wednesday. We have been warned that we might find the airport a bit of an experience and pray that we will collect all our baggage, get through customs, and meet up with our driver safely and swiftly. We will stay in Abuja overnight as it is not wise to drive at night, and on Thursday we will drive out to our final destination, Jos. We'll breathe a big sigh of relief once we are there! We'll be in touch again once we're settled in.

Snowy Madison

2006-03-03T01:23:00.000-06:00

I thought it might be fun to show a picture of our house less than two weeks before we leave. It's been sunny of late, but we do still have a good amount of snow on the ground as you can see in this picture.

I'd also like to send a shout out to my friends and coworkers at Epic who are following this Blog. Yesterday was my last day at work there, and while I've been too busy to really think about what it means to be temporarily unemployed, I'll certainly miss the folks I worked with when I get a new job.

A Week Away

2006-02-26T23:13:00.000-06:00

Well, it's a week to go before we leave Madison to head to Charlotte for orientation and then it's off to Nigeria! We're very excited. The UW InterVarsity Graduate Christian Fellowship that we're a part of gave us an opportunity to share with them at the last large group meeting about what we've learned during our time in Madison and how that impacted our decision to head off on this trip. We're in the process of getting everything together to be packed up before we go, trying to decide what type of food we want to bring with us that may not be easy to get while we're there. In particular, we've been getting herbs and spices that aren't easy to come by in Africa.

Barbara's trying to figure out what medical books she wants to bring with her, but the hardest part for her has been trying to decide what "fun" books she wants to take. She reads a LOT, and that's one of the key ways in which she relaxes, so she's hoping to take some that can keep her entertained for a little while if we need a break from being in a different place. I suspect the hardest part will come after the first week or two, when we've had a chance to settle in and culture shock starts to hit us a little. We're excited, but we also realize that we'll be in a very different place than any we've ever been in. It'll be a challenge to get used to being so far from our friends and family.

One Month Before Departure!

2006-02-06T23:44:00.000-06:00

Well, we're a month away from heading off, now, and things are really picking up in terms of getting everything ready. Barbara's finished getting the rest of her immunizations that she needs before heading off. I still need to get some of mine. We still have support letters coming in, so if you haven't yet responded and are planning on doing so, please do so soon! We greatly appreciate all the folks who will be praying for us while we're away.

One of the things that has surprised and encouraged us is the amount of encouragement I've recieved from the folks at my current job who've now learned more details of what we'll be doing while we're in Nigeria. Barbara's found that many of her colleagues in Med School have supported her, but there's an element of expectation that many of the med students will go on trips like this. For my co-workers, that's clearly not the case. Many have expressed their excitement that I'll be working with ECWA Camp Youth Alive and it's really made my decision to take these two months feel like the right thing. I have a ton to do at the office to prepare folks to take over for me when I leave, but I'm confident that this will work out well and that God is in control of the situation.

From Our Support Letter

2006-01-24T23:58:00.000-06:00

As you know, we regularly look for ways to be obedient to God’s call in how to serve Him. 2 years ago, He sent us on a short missions trip to Honduras, and this experience set a desire in Barbara to serve in a longer medical missions trip. The Lord provided the opportunity for her to spend 2 months at the end of medical school on an international elective. He opened the doors for Frank to come with her, and so we will serve from 3/7/06 to 5/6/06 in Jos, Nigeria, with SIM. SIM stands for Serving in Mission, and is an interdenominational, international missions organization whose main focus is to glorify God through evangelizing to the unreached, ministering to human need, discipling believers, and equipping churches to fulfill Christ’s Great Commission.

Nigeria is a West African country slightly more than twice as large as California. It is the most populous African country and is composed of more than 250 ethnic groups. Some of the most populous and politically influential are the Hausa, Fulani, Yoruba, and Igbo. Despite being one of the world’s biggest oil exporters, Nigeria is beset by AIDS, corruption, political instability, inadequate infrastructure, and poor macroeconomic management. About 60% of the population is below the international poverty line. There is tension between Christians (50% of the population) and Muslims (40% of the population), that sometimes leads to violence.

Barbara will be serving at the Evangel hospital, working both in the hospital and out in the community, focusing especially on AIDS patients and palliative care. Frank will be serving at a youth camp, helping the camp coordinator organize activities for campers while there and follow-up for when they go home.

This is a big step into the unknown for us, and we know that we cannot do this without both God’s help and your help. We know we will be facing culture shock, poverty, unusual medical conditions, violence, and poor living conditions like we have never faced before, and we need your prayers to see us through. We ask that you pray for the problems in Nigeria and for the work we will do there. We desperately want to love the Nigerians and to show them Christ’s face through our words and actions. We ask that you pray for us in that regard, and pray for those who we will meet.

Finally, we ask that you pray for our fund raising process. We will need to raise $9500, primarily to cover flight costs, medical insurance, visas, and daily living expenses while we are there.

Blog Open!

2006-01-24T19:22:00.000-06:00

Greetings, and welcome to our blog about our trip to Nigeria. Check back here for (hopefully) regular updates on how the trip is going and what we're up to.