Avec Deux Mains

Confessions of a Spiritual Mason

noreply@blogger.com (Deborah) — Thu, 09 Feb 2012 18:43:00 +0000

You know, not every story at Galmi has a funny moment or blog-post-worthy victory.

It is nearly impossible to walk from one end of our hospital to the other without being stopped by a suffering patient who is desperate for pain medication or barely clinging to life.

We work tirelessly to keep patients alive, and in the end, they still die. Despite all efforts.

It's exhausting. And discouraging.

But lately I find myself ducking behind a wall . . . it's not too high, but just enough that I can drop to my knees and hide behind it for a little while.

And I confess, I'm struggling with that.

I know boundaries are necessary for survival. I've read all kinds of books on the subject. I know they are healthy and important to keep. Without them, we wouldn't survive.

But 'having boundaries' is not where I'm battling with myself . . . my inner dialogue is about walls. What's the difference between a 'boundary' and a 'wall'?

I would say that a 'boundary' is a conscious behavioral parameter that one sets in order to maintain healthy relationships and balance. A 'wall' however, is for self-protection . . . to keep them out and me in.

I'd even suggest that 'walls' are much more unconsciously built . . . a product of habit or the outcome of deep hurt.

It came as quite a shock to me early last week when I realized I was in the process of building a wall.

I was told by the OR staff that there was a new burn patient coming in for a debridement . . . and I needed to stick around to help them out. But by the time our other patients were done with their burn dressing changes, he never arrived.

As I went back to the ward to start therapy treatments, I spotted him in one of our four as-close-to-an-ICU-as-we-can-get-at-the-moment beds. He had been lathered in zinc-oxide cream, which made him look like an inside-out Oreo.

I went to his bed and gave his family some instructions on caring for him while he was in the hospital: the importance of using his mosquito net, of turning the overhead fan off if he felt cold, of washing his clothing and sheets with water at least once a day, changing his sheets right away if they become soiled.

He tried to speak to me, but his face and throat were so swollen from the burns, sounds hardly came out.

I picked up his chart to find out what happened: a gasoline explosion.

I looked at his age: 18.

I looked where he was from: northern Nigeria.

I looked at the extent of his burns: 95%.

But I didn't look at his name.

I couldn't.

I knew he was not going to survive. With 95% of his total body surface area burned, his chance of survival in a Burn Intensive Care Unit of a Level 1 Trauma Hospital in the West would be considerably low . . . but here, where we have no intubation, no ventilators, no trachs, no heart monitors . . . he was given pain meds to make him as comfortable as possible, but that was it . . . that was all we could do.

It wasn't until two days after he died that I realized I didn't know his name.

What bothered me, wasn't that I didn't know his name. What bothered me was that it didn't bother me that I didn't know his name.

I had built a wall in order to survive.

But then, today, I lost another burn patient. She was 17 and had fallen into boiling water.

The difference was, I knew her name. And I knew her mother. And we walked circles around the hospital. And I tried to keep her alive.

So as I sit here grieving, I still have no 'right answers' about my walls. I do know that, like it or not, sometimes they are there. And some days I wish they were shorter, and other days I wish they reached as high as the minarets in town.

And regardless of what my 'right answers' will be, I have no doubt that if I am to live like Jesus, it means when the bleeding woman in the crowd reaches out, I am to stop and ask 'Who touched me?'

It Takes [Going To] A Village

noreply@blogger.com (Deborah) — Sun, 05 Feb 2012 20:36:00 +0000

It's time for another episode of The (Long) Story Behind The Photo.

Every Thursday, the Therapy Department holds a club-foot clinic . . . we counsel mom's that club-foot is a malformation and not the result of a sin they've committed or a curse someone has put on the family . . . we remove the cast or splint from the week before, reposition baby's foot with a little more stretch, and recast him so he's stuck until he comes back to see us . . . oh yeah, and we make babies scream. And boy, are they loud!

So far we've had two kids. So that's two kids that should have been crippled, that will now be ambulators! How's that for 'making the lame to walk'!

Things were going really well, until little A-H got some sand in his cast that resulted in a small wound on his shin. (Brace yourself . . . Short-Story-Long Girl strikes again!)

His mom brought him in and asked that we not cast him until the wound healed. The doctor assured her that we would clean it and bandage it and the cast would act as a protective barrier. She wasn't convinced. We compromised by cutting a little window in the cast so that she could clean the little wound (about the size of a US dime).

The next week she came back. Our original gauze was still in place, and it was FILTHY! Not infected, just covered in dirt from all the crawling he does on the earthen floors of their house.

She said she wanted us to take the cast off until the wound healed.

Our physician somehow managed to convince her that was a bad idea and we needed to keep going with the process.

That was Thursday.

Around 10:45 Friday morning, Momma rounded the corner of my office with a screaming A-H strapped to her back.

He was upset.

So was she.

She begged me to remove the cast, promising to come back when the wound was healed. The baby had screamed all night.

I tried to hunt down the doc . . . who, as it turns out, was off in a village following up on sick child.

'You'll have to wait until this afternoon when he is back. You have to see the doctor. I can't take it off without him seeing his leg.' What I really meant was 'I can't put the cast back on by myself' but I don't know how to say that in Hausa.

She had gone from being upset to being angry. But she agreed to wait.

When the doctor finally came back, several hours later, we gathered the necessary instruments to remove the cast and to replace it.

A-H continued his screaming aria.

As we removed the cast, we saw the problem wasn't his little wound, the problem was that during the casting process, baby kicked hard, lurching his leg into extension, followed by a quick reflex reaction on the part of the doc to force his knee bent and ankle back into it's proper dorsi-flexed position.

We saw the resulting crease and tried to correct it.

But we hadn't.

The pressure on his little ankle was too painful.

And he let the whole neighborhood know . . . all night long!

When we had arrived at the cause of the problem, Momma was already packing up her stuff to go. We asked her to give him to us to recast.

With tears seeping from her eyes, she refused.

She thanked us on behalf of her husband, and informed us that she and A-H would not be returning. The family appreciates the work we've done, thus far, but they are done with us.

We tried to convince her to let us go ahead and cast . . . and at one point, I'm certain, we almost did.

Empathetic attempts didn't succeed, nor did the reminder that if they stop now, baby will never walk normally. Ever.

But the more we pushed, the harder she cried. 'My husband says "no more".' Her reaction made me wonder what would have happened to her had the baby shown up at the house with another cast on his leg.

She was leaving. There was no changing her mind.

We asked if her husband would be willing to come on Monday and meet with us. She said she would ask.

As she was tying A-H to her back, the doc gave her 1000cfa (about $2) to help her with the taxi fare home. She refused it.

Having never had a Hausa person refuse money before, he insisted. She was offended and left.

Seconds later, she was back. This time yelling.

He tried again, and then disappeared around the corner. She went after him.

Thinking the drama was over (famous last words), I started cleaning up.

She was back.

Only this time she was yelling at me. She put, a now quiet and calm, A-H on the floor next to her purse. She began digging through it and then throwing things in the air. She was yelling . . . I understood 'white' . . . 'doctor' . . . 'money'. . . 'one thousand'.

I grabbed a passing nurse. 'Is she saying she dropped the money that the doctor gave her and now she can't find it?' He stopped and listened to her rantings. 'Yes. That is what she said.'

I told her not to worry, we could replace it.

And this is when the hysteria started. She began screaming at me . . . then wailing . . . the screaming at me again.

A crowd had formed . . . and the onlookers all wanted to act as intermediaries. So not only was she screaming, but baby had started up again, and the mob was all chattering away, each one trying to out-voice his neighbor.

Another innocent nurse walked by. I grabbed him. 'You're going to help me!' I threatened.

He started talking to her, then to me in French. But I couldn't hear him over the crowd.

So I did what anyone with Bronx-blood flowing through her veins would do: I raised my hands above my head and yelled louder than the rest of them!

I NOT UNDERSTAND!!! NOT A LOT OF HAUSA!!! NOW!!! ONE TO SPEAK!!! FINISHED!!!!!

They all stopped. Silenced. And stared at me.

'Now,' I said to the nurse. What is the problem?'

I didn't know what she said, but I understood that she had been significantly offended by the money.

I said to her, in French, that it was not meant as an offense, instead, it was to help her with the taxi, since she normally comes once a week, but now she had come again, and we were asking them all to return on Monday.

All she needed to hear was 'taxi' and she understood. She left, but was still very worked up and emotional over the whole thing.

The nurse followed me into my office. 'Do you understand why she was offended?' he asked.

Turns out, when the doc told her that if we didn't continue with casting and splinting, her son would never walk normally, if at all. So when he gave her the money, she interpreted it as though he were putting a curse on her son . . . condemning him to a life as nothing more than a beggar.

I knew that when she had walked out the door, she would not be coming back.

And while it would be a detriment to little A-H for the rest of his life, what pained me was that she left thinking those that work at the Christian hospital are unkind hypocrites. That all that she had been told about who Jesus is and how much He loves Nigeriens would be stained by those past few minutes.

It was agreed upon, that if the father didn't come to see us, we would go to see them.

And that's just what happened.

First we had to visit the village Chief.

We sat under a lean-to type shelter and shot the breeze. Then we left.

Somewhere in the course of our visit we acquired a tour-guide and the pastor of the village's two-person church.

The directions we had to the house weren't very accurate and so we took quite a few wrong turns. But eventually, we arrived. A-H's father came out to the road to greet us, and we followed him to their home.

Momma came out of the house carrying Baby. He saw our team and was fine . . . until, of course, he spotted me. His eyes got big . . . and he began to wail.

We all sat together and, after the almost-as-long-as-this-story greetings, we discussed why we had come. The doc shared what the problem had been with this most recent cast. He explained the whole process of the treatment intervention. He explained that it was a four year process, but the most involved part would soon be over. He explained that after those four years, A-H's foot would be as perfect as if he had never been born with a club foot and he could grow up to play football (soccer) for Niger.

Walking with Momma back to the car. You can see
little A-H's feet sticking out from behind her back.

Momma explained what she understood to have been the problem . . . the doc explained to the father how that was a misconception.

By the time we were done, the whole neighborhood had shown up and with them, two disabled children and a sick old lady. Now I understand why Jesus had to get away from the multitudes from time to time! As history's first mobile clinic, the mobs just kept bringing their sick and disabled to Him!

When it came time to go (and the reason you've read this far), Momma did a very unexpected thing.

She reached down and took my hand. She squeezed it all the way to the car and wouldn't let go. When it was time to get in the car, she gathered all her fears, looked me in the eye and said 'Na godé so say. Sai Jeudi.' (I am so very thankful. See you Thursday.)

Fair Game, False Advertising

noreply@blogger.com (Deborah) — Sat, 04 Feb 2012 11:57:00 +0000

I'm sitting here watching the 2010 film Fair Game . . . within the first 15 minutes, one of the main characters travels to Niger. Except, it's NOT Niger! It can't be. The cows are too fat, and the goats are too furry. The taxis are black and the license plates on the cars are not long and skinny. The gendarmes don't have the right camo uniforms. The architecture of the city is wrong. There are too many airplanes at the airport. There are cafés on the street. The city is loaded with tall apartment buildings and palm trees. The dirt is a light golden color, not rust. And there is not a single red Kasea motorcycle to be found.

Niger's only on the screen a few minutes . . . but it's longer than the scenes shot in Kuala Lumpur. And those are accurate city shots. The director also filmed in Cairo, Baghdad, New York, and DC. All of which are recognizable cities.

I guess that's the key, huh? Be a recognizable place in order to get accurate depiction. When the director, Doug Liman, shot The Bourne Identity, he refused to film in Canada, saying, 'Well, just because they speak French in Canada doesn't mean it looks anything like Paris.'

Maybe I've become a bit cynical . . . but just because it feels like Africa, doesn't mean it's Niger.

You can't just throw a bunch of Africans in vibrantly colored but clearly dirty cloth with big bowls on their heads on a sidewalk next to a herd of cows crossing a busy street of honking cars and call it 'Niger.' I mean, where are the Tuaregs, or the camels, or the Fulani, or the kids selling airtel phone cards at the red lights?

What does it matter?? You ask. And to be honest, I'm not sure why it bothers me. Maybe because this country gets very little publicity as it is . . . so when it is 'recognized' by an industry as influential as Hollywood, it would be nice if they took the time to get it right.

So, Mr. Liman, if you do make it to Niger with your camera, please be sure to stop by in Galmi for a cup of tea. (Let's consider that an open invitation to any of you who happen to make it out here!)

The Owner of the Giving of Walking

noreply@blogger.com (Deborah) — Sat, 04 Feb 2012 09:33:00 +0000

'Ban likita ba. Babu magana. Ni, mai ba da tafiya.'

'I am not a doctor. I don't have any medicine. Me, I'm the owner of the giving of walking.'

Three sentences I use even more than 'Kafa, ittatchi; kafa, ittatchi.' ('Foot, crutches; foot, crutches.) For our patients, being Western means being a doctor. Being a doctor means giving out medicine. A good portion of my day is spent being stopped in the hospital hallway, told of an illness or compliant of pain, and asked for medicine which will help.

In return for saying that I'm not a doctor, I receive a look that tells me the person I'm speaking to finds me to be a selfish liar who just doesn't want to help. But if I give an alternative, I usually get the Nigerien equivalent to a pat on the back and 'job well done, keep it up.'

So, that is my new superhero identity. Goodbye Short-Story-Long Girl, hello Owner-of-the-Giving-of-Walking.

And some days, getting a patient mobile does feel like it requires superhuman powers.

Like the other day . . . we have a visiting Ortho for a couple of months. He came and asked if I could give a platform crutch to kid that had been in a motorcycle accident. He had a cast from his toes to his thigh, and another one from his fingers to his elbow. He could bear no weight on either one. Oh, and 'his head got knocked around pretty good too, so he's a bit out of it.'

When 'Sorry, we don't have platform crutches here!' and 'Is he really sufficiently cognitively intact and safe enough to be strapped to a long piece of wood?' didn't work, I went to see a carpenter about making me something that might possibly resemble a platform crutch.

I drew a sketch and explained in French how this should work. I grabbed a few scraps of wood and tried to act it out. He's a bright guy and seemed to get what I needed.

We went back to the hospital together and took some measurements, as I knew in order for this to work in the end, it would not be adjustable and we'd have to get it right the first time.

A work week later and we were in business.

I went to pick up the crutches. They were almost right . . . a wee bit short, and the platform a bit high, but it was better than nothing.

I went and found my guy, strapped his arm onto the plank of wood, prayed for divine intervention, and explained how this was going to happen.

The process was definitely hindered by his inability to stay alert and awake for semi-extended periods of time . . . and his ability to follow verbal commands. But eventually he got the hang of it . . . thanks to my other role as The Owner of the Yelling of Uh-uh Ba Haka! (NO! NOT like that!)

Pélé

noreply@blogger.com (Deborah) — Sat, 28 Jan 2012 07:51:00 +0000

I’ve had a really fantastic caseload this week. I’ve been busy, but my patients are challenging, and interesting, and I’ve really enjoyed them as people!

There’s K. with the TBI . . . his enthusiasm in each treatment session is contagious and his determination is inspiring.

And H. who comes for hand therapy . . . she expresses deep gratitude with each small step of progress which helps remind me that I love my job, not for the thank you’s, but for the small steps that help people live again.

There’s also Little H. who still cries and hides his face every time he sees me coming, but whose struggle to survive keeps present in my mind the reality that life is fragile and short, but worth the fight.

I have others too, but I really want to tell you about M. . . . who, after today, will be fondly referred to as ‘Pélé.’

A couple of years ago, M. was in a motorcycle accident which caused an incomplete spinal cord injury (SCI). That means, he some use of some muscles from mid-chest down, but not all. And even some of those are super weak.

M.’s doctor asked me to see him to give him a cushion for his wheelchair, as he has been admitted to the hospital for a pressure wound. But according to my French-to-Hausa translator, who talked to his Hausa-to-Tamajeq translator, he doesn’t have a wheelchair.

Instead, he pointed beneath his hospital bed.

Much to my surprise, there, under the mattress, I found the metal frame (and some wooden supports where the metal broke down) of a BEDSIDE COMMODE! You know, the toilet-chair that you find in medical supply stores, long-term-care facilities, and OT gyms. Except, the seat was missing.

I stared at it.

Then looked back at him.

‘Ban gani ba’ I said (I don’t understand).

‘Tafiya’ he answered (walking).

I blinked.

‘Ama, ban gani ba’ I repeated (but, I don’t understand).

‘TA-FI-YA’ he slowly said again, as if it was the actual words I was stumped on.

Eventually he understood my confusion and made his way to the edge of the bed to demonstrate.

His brother place the commode-turned-walker in front of him. He placed his hands then swung his body into a standing position.

CRASH!

I jumped.

With one swoop, he had lifted the commode and threw it slightly ahead of him, levered his body upward on the armrests and took a step. He turned toward me and flashed me a toothy smile. My eyes were as big as his upper arm muscles.

The problem with his current commode-setup is that it’s rather short, and therefore difficult to walk. I thought, at first, about reminding him of the other obstacles to the ambulation process that he was facing . . . but decided to play the optimist for once.

When I arrived a year ago, I was given half a dozen metal walkers that I was asked to use or get rid of. I figured one would be the perfect height for M.

I walked into the room and his eyes lit up as if he had seen The Tree in Rockefeller Center for the first time. He couldn’t get up fast enough.

But his arms aren’t used to the new position. And since we OT’s don’t actually work for a living, but play all day long, I decided M. needed a little football (that’s soccer for all you Americans) in his therapy session.

The problem with my master plan was that the new-to-him walker has a bar pretty low to the ground, so even if I bowled a strike, when he ‘kicked’ the ball it hit the bar and bounced right back at him.

The only way it was going to work was if the walker was behind him. I pulled out a stool.

‘Sit’ I commanded in Hausa. He looked at me, puzzled, but obeyed. I lifted the walker above him, turned it, and wedged it between him and his bed.

‘Okay, stand up.’

He placed his hands on the backwards handles, shot a concerned look that conveyed his doubt, and raised his body.

The father of the boy in the bed next to him gently rolled the ball toward M. as initiated his triceps and lifted his body.

With all his might he activated his weak hip flexors and whipped his right foot forward.

The ball sprang back toward his neighbor’s father.

We all cheered!

‘Akwai Pélé!’ (There’s Pélé!) I shouted.

M. beamed with satisfaction and pride.

The ball was rolled again, and this time his kick was a little more accurate.

‘Olé, olé, olé, olé, olé, olé!’ I started to sing.

And before I knew it, the three other patients in M.’s room joined in!

Oh Yeah, I'm Still Here

noreply@blogger.com (Deborah) — Wed, 25 Jan 2012 23:59:00 +0000

Sometimes I forget that I'm not working the US any more. One would think that my surroundings would remind me on a minute-by-minute basis . . . but no.

And normally I don't remember until I do something my patients find ridiculous!

Like, today, for example.

I rounded the corner to my office to find a man sitting on the floor, against the wall, facing my door. His crutches were sprawled out next to him. His companion was standing to his right.

He held his outpatient treatment card up to me . . . and I was relieved to find that he wasn't coming for crutches . . . since he obviously had his own pair.

He was, however, coming to learn a few basic exercises to keep his knee mobile.

Which, on the surface, sounds like a pretty easy task . . . but throw in a language barrier and a man who's clearly never won a round of charades and the stage is set for a really funny treatment session.

I had him start up on my treatment table . . . legs out straight . . . telling him to push his knee straight down into the table. Thankfully he was wearing shorts, which around these parts is rare on a grown man, especially in January, which is still considered 'cold season' (it's quarter to one in the morning, and my thermometer is reading 77F/25C). So I could see his quad contracting . . . or in his case, not contracting.

I tried explaining again.

He didn't get it.

I tried acting it out.

Nope, nothing.

His friend with him understood and tried talking him through it in Hausa. But he just couldn't motor-plan enough to figure it out.

I stuck my hand under his knee and told him to squish my hand.

Still didn't work.

I finally gave up that tactic and told him to scoot over.

Unaware of what I was going to do next, he moved. I hopped up on the table. His jaw dropped.

I grabbed his hand. His eyes bulged.

I shoved his hand under my knee and pushed down. He nearly had a heart attack.

'Ka gani?' ('Do you get it?') I asked.

He was speechless, but his friend roared with laughter.

It was at that moment, as my patient began to breathe again and his friend tried not to wet his pants, that I remembered I was in Niger.

Niger in the News

noreply@blogger.com (Deborah) — Sun, 22 Jan 2012 19:36:00 +0000

Interesting article on the food crisis in Niger and the ongoing conflict in the northern region of our southern neighbors.

Click here to read it straight from the BBC.

Flash. Mob.

noreply@blogger.com (Deborah) — Fri, 20 Jan 2012 13:51:00 +0000

We all have a Bucket List. Mine is decently long. But I confess, sometimes I add things after I've already done them, because I'm not actually creative enough to come up with interesting and adventurous Must-Do-Before-I-Kick-It's.

But one thing that has been on The List since I first discovered it, was to dance in FlashMob.

And so, that's just what I did.

Now, before your imagination goes too wild, for those of you spend no time on YouTube and who have no idea what a FlashMob is, let me explain.

A Flash Mob is when a large group (the 'mob') gathers in a public place and pretends to be just normally participating in the same thing as everyone else (like shoppers wandering a mall or tourists at the Eiffel Tower or commuters in Grand Central Station). When all of a sudden, something starts to happen (the 'flash'). Sometimes the mob simultaneously freezes . . . they stand in place as if time has stopped. With others FlashMobs, one person will 'spontaneously' begin to sing or dance as others 'randomly' join in.

But I assure you, there's nothing spontaneous or random about it! These routines have been carefully organized and thoroughly rehearsed.

At least, the ones that make it to YouTube are!

But here at Galmi, we do things a little bit . . . um . . . what's the world . . . disorganized . . . no that's not it . . . not-well-thought-through . . . no, that's not it either . . . SPONTANEOUS!

Two weeks ago, when all of SIMNiger was in the capital for our annual conference, late one night (when most of the creative magic happens), my friend Cool-J asked me to show her some of my fab Bollywood dance moves.

Since it was dark and I didn't think anyone else would see, I let loose a little and wowed her and two of our other friends with my stellar moves . . . well, at least they would have been wowed had they not been laughing hysterically at me.

'Those would make AWESOME FlashMob moves!' Cool-J said.

'I've ALWAYS wanted to be in a FlashMob!' I said.

'Let's do it!' she insisted.

Most people make the wrong assumption that I enjoy being up in front of people . . . or that I like making a fool of myself before a large audience . . . I guess it's because it happens so frequently (at least the making-a-fool-of-myself part).

But I dug in my heels and refused.

No way was going to dance in front of two hundred and fifty-ish people.

Unfortunately, I was out numbered.

The plan was to organize a group of women to join us . . . we were hoping for 20 . . . run through a few simple moves and then in the midst of the Saturday evening program, execute and deliver . . . it was now 11 o'clock Friday night . . . we certainly did not have time on our hands.

As we talked through the list of women we would ask to join us in our a-last-minute spontaneous if-we-don't-pull-this-off-exactly-we'll-look-like-fools dance, I became discouraged and incredibly doubtful. But before I knew it, I had I swallowed my pride and found myself in front of a microphone explaining our 'genius' plan to a room full of skeptical women.

The plan was to meet in a secret location for half an hour to learn the (simple-only-if-you're-coordinatively-inclined) steps.

I prayed for a miracle and hoped for 20.

But missionary women never cease to shock and amaze me! We had over double what I was expecting!

Being an OT, and therefore the resident expert in giving oral instructions on movement and body positioning, I was assigned the task of teaching the routine. (Oh to have been a fly on the wall!)

And the ladies did great!

We practiced a few times without then with the music (Jai Ho, the theme song from Slumdog Millionarie) and then we were off . . . hoping they would all show up in the end.

When the time came, the music started. Cool-J and nôtre amie E. started us off . . . after 8 beats I joined in with the retired wife of our conference speaker. We were in the front row on the left side . . . so other than Cool-J and E., there was no way to know if anyone else was with us.

It wasn't until we reached the middle point when we all moved to the aisle, did I find we were not, in fact, alone.

No . . . all those who had practiced with us, danced with us . . . and even some who didn't! We were truly a mob!

We managed to get women dancing who would never have dreamed of participating. We had all demographics, all types. We would each forever be a part of the SIMNiger-Conference-FlashMob-Sisterhood.

What can I say?? That's how we roll in Galmi!

Promises . . . Galmi Style

noreply@blogger.com (Deborah) — Thu, 19 Jan 2012 22:26:00 +0000

One of the worst parts of living in Galmi is that our compound has a revolving door. In my first year here, we've had over 100 'short term' folks come, help, and leave. ONE HUNDRED! That's a lot of hellos and goodbyes.

Today, our friend, SwissA, left.

Saying goodbye is a way of life here . . . but it doesn't really get easier.

To ease our grief with the departure of yet another who shares our experiences in this crazy corner of the world, Cool-J and I ate chocolate.

I never thought anything could trump PeanutButter M&Ms . . . until I was given some DarkChocolate and Raspberry DovePromises. OH MY GOODNESS!! Stop what you're doing, right now and go out and hunt some down . . . oh wait, you're reading my blog post . . . never mind . . . FINISH READING, then go and buy some. You will never be the same.

So Cool-J and I sat, sipping coffee and savoring DovePromises.

'Enjoy the childhood joys of winter,' Cool-J read aloud.

'WHAT?!?!' she cried out. 'WINTER?!?! I HATE YOU DOVE!'

Just as she was starting to feel better about our friend leaving, the failed-greeting-card-writers at the DoveChocolate headquarters dashed her down to the pit of despair.

'I think they meant cold season' I offered, trying to console her. I grabbed a sharpie and crossed out 'winter' and wrote in 'cold season.'

Enjoy the childhood joys of ~~winter~~. cold season.

OOOH! That was fun! So we kept going:

Satisfy your sense of surprise . . . when there's a mouse in the house or a roach in your shoe.

Catch ~~snow~~ dust flakes on in your ~~tongue~~ lungs.

Feel free to be yourself . . . as long as your legs and head are covered.

Sleep in late tomorrow . . . but don't expect a shower because Ousman will be watering the plants.

Satisfy your sense of surprise . . . all night, on the toilet, after an evening of spicy Nigerien food and unfiltered water. (story here)

Chocolate won't let you down . . . it clings to your hips (until Hot Season at least).

The fastest way to my heart is chocolate . . . or diet coke, or care packages, or ice cream, or anything that says 'just add water and stir.'

Indulge your sense of enjoyment . . . with milk powder, onions, and nescafé.

Sleep late tomorrow . . . unless you're on call; or the birds dance on your roof; or it's just way too hot, even to sleep.

My Own Mango Princess

noreply@blogger.com (Deborah) — Wed, 18 Jan 2012 23:35:00 +0000

If you've never read Where is the Mango Princess by Cathy Crimmins , you should. It is the firsthand account of a wife's journey with her husband as he returns to life after a Traumatic Brain Injury (TBI). It's funny and sad all at the same time.

Kind of like my therapy session with L. today.

L. has a brain injury. He's only just woken up from a coma and has massive physical and cognitive deficits. And according to his brothers, he's demonstrating personality changes.

It is hard to sit in front of an early 20-something who presents like a cross between a three-year-old and an old man who's had a stroke. It is heartbreaking to know the long road ahead of him and the extremely limited resources his family. To know that his ability to walk safely is a high priority because he will never have access to a wheelchair.

But it's not all sad.

It's exciting to watch as patients with TBIs progress from one day to the next, especially at the beginning of their recovery. Every new movement or spoken word, each command followed or step taken is a major victory that is celebrated.

And sometimes, funny things happen . . . or are said . . . in the midst of the therapy session.

L. and I were working on visual tracking and acuity, accuracy with grasp/release, ability to follow simple one-step and two-step commands, sitting tolerance and balance, dynamic reach, and object recognition . . . which is all a fancy way to say, I had wooden blocks and he had to reach for them, take them, then give them back to me.

At one point, I held out a square block and asked him, in Hausa, 'What is this?'

He stared at the block for a few seconds. He leaned a little to check out the other side.

A smile crept across his face as he was sure he had found the word for 'wooden block' tucked away in the language cortex of his brain.

'MOOOOSSSSSQUITO!' he shouted.

Adventures in TBI

noreply@blogger.com (Deborah) — Wed, 18 Jan 2012 15:06:00 +0000

I like burn care. I'm good at it. I understand it. It makes sense. It's logical. The burn healing process is predictable.

Unlike that of traumatic brain injuries (TBI). Which is anything but predictable!

Right now, on my caseload, I have two guys in their early 20's that both have a severe TBI. And while at first I was a bit nervous about it, I'm having a ball!

Both were unconscious for five to six weeks . . . and are now slowly regaining speech and motor function. We work on simple command following, visual processing, coordination, balance, ambulation, attention, reaction time, activity tolerance, short term memory and recollection, impulsivity control, active movement, and functional capacity.

Needless to say, they've come A LONG way, and have even further to go.

It's challenging to treat a brain injured patient when we can only communicate partially. With one of the two, K., I can speak French . . . at least for the first 15 minutes . . . then as he starts to get tired, we move to Frausa, a mix of French and my sorry Hausa. After about another 15 minutes, he's had too much and all my commands must be in his mother-tongue . . . let's just say I'm happy his brother is there to translate Deb.Hausa to RealHausa!

Another challenge to the process is that both boys are illiterate. I tried, the other day, to do some cognitive retraining with K. by drawing shapes on a piece of paper. I asked him to copy them, one by one. With his typical three second response-time-delay, he picked up his pencil and began drawing circles all over the page. 'Look!' he started (three second pause) 'I'm writing in Arabic!' We didn't go too much further with that activity.

So, when resources are limited, we get creative.

A few months back we had a surgical resident from the US come to work with us. She left me all sorts of wonderful toys . . . uh . . . I mean . . . EQUIPMENT . . . therapeutic equipment . . . which included a bag of red balloons. Which is nice, because I love red.

I pulled out a balloon and blew it up.

POP!

His brothers and I jumped. Three seconds later, K. looked up to find the source of the noise.

I grabbed another balloon.

This time it held its shape.

I tapped the balloon in K.'s direction, not sure what the outcome would be.

He reached up, instantaneously, and hit it back in my direction.

We volleyed for about 10 seconds before the balloon hit the ground. He impulsively lunged from his wheelchair toward it, nearly spilling onto the floor himself.

Once safely back in the chair, we started again. I tapped the balloon, he swatted.

SMACK!

Our child's-party-favor-turned-therapeutic-tool hit me square on the nose. I thought it was funny, but no one else responded . . . so I didn't either.

Three seconds later, K. erupted into uncontrollable laughter!

I'll Be Ready

noreply@blogger.com (Deborah) — Fri, 13 Jan 2012 12:53:00 +0000

Yesterday I was working with a guy who shares a room with three other patients. Each of the four has a caregiver who sleeps on a mat on the floor at the base of the patient's bed. It makes for a crowded treatment session, but after a year, I'm getting used to it.

As I was helping my patient sit up in bed when suddenly there was some background music. It was a ringtone coming from the brother of the man staying in the bed across from my patient. It took him a few runs through to find where he had put his phone, so I had enough time to recognize the tune.

I knew the tune, but couldn't place it. I began humming it to myself. And that's when it hit me!

It was the theme song from Baywatch! HA!

The Cries We Like to Hear

noreply@blogger.com (Deborah) — Thu, 12 Jan 2012 12:39:00 +0000

For about six weeks now, I've been treating a little boy who is not quite two. Little H. has partial thickness burns over the entire right side of his body. He was burned by hot oil.

It has taken a significant effort to keep this little guy alive. There were several periods over the last month and half that I wasn't sure he would survive. At one point he refused to eat or drink anything and his surgeon ordered a nasogastric tube.

It took a few educational sessions, but we were able to teach his mom how to feed him via the tube in his nose and how to keep it clean. We had to put little mittens on his hands, yet he still managed to pull the tube out twice.

But it was working. He was thriving and starting to maintain a healthy weight. He began eating again from his mouth.

So they discharged the tube.

And I went to Niamey for the conference.

But within only a week, he had stopped eating again and had lost so much that he was nothing more than (burned) skin and bones.

When I did his wound care on Tuesday, I was certain I would break his leg simply by lifting it.

The doctor again ordered an NG tube and we taught the woman with him, his father's other wife, how to feed him and encouraged her to try to get him to eat orally as well. She was a quick learner and understood that if Little H. didn't eat he was going to die.

Little H. and I have a love/hate relationship. I love him and he hates me. Dysfunctional, I know, but we make it work. Hey, I can't hold it against him . . . I make him cry and hurt and scream. I make his pain worse. And he's too little to understand why.

Normally, he only has to look and me and he starts crying.

When I left work yesterday, this precious baby was too weak and limp to move on his own . . . too weak even to whimper when he saw me.

I wasn't sure he'd make it through the night.

When I came in this morning, I checked the stack of charts, first, before heading to his room. I admit I've reached my max capacity for lost babies . . . and I didn't think I could handle another one. Not today.

But his chart was there! He had survived!

I went into the room.

He was sleeping in the bed next to his father's other wife. She saw me and lit up.

'Look!' she said as she pulled Little H. into her arms.

He slowly turned his face toward mine, took a good look, and began to scream!

The momma and I both began to cheer!

He was strong enough to turn his head! Strong enough to scream!

Throughout his dressings this morning he was a natural little wiggle worm!

The road to recovery is still a very long one . . . but praise be to God, Little H. is back on it!!

Pipe Dreams

noreply@blogger.com (Deborah) — Wed, 11 Jan 2012 21:40:00 +0000

Today, I shared a fabulous bonding moment with the old plumber that works for our hospital. I love this old man . . . not as much as I love my own Soho from the OR, but almost. He's gentle and kind and always assumes I speak more Hausa than I actually do.

My shower has always had a bit of a drip . . . but while I was away for the conference, it turned into more of a stream.

I had been advised that when it comes to leaky faucets, it's best to try and fix it yourself. So that's what I did.

But that was a really dumb idea.

I know about as much about plumbing as I do brain surgery . . . which should have been my first hint not to touch anything.

I fiddled with a few knobs and before I knew it was holding the only movable part of my shower in my hand.

Oops!

At first I couldn't get it back on . . . but with a little elbow grease and prayer for a miracle, the nozzle slipped back in place.

My fear of not being able to shower greatly outweighed my desire to Mrs.FixIt (we all get to play the 'shallow' card once in a while). So, this morning, I called in the big guns.

I left Soho the Plumber alone in my bathroom to work his magic. After a little while, I stepped in to check on the progress.

He resembled the Little Dutch Boy . . . just old and African.

He was leaning over the side of the tub, left hand pressed flat over the hole where the water faucet was supposed to be. In his right hand was the biggest wrench I've ever seen.

He was soaking wet!

Suddenly the wrench slipped from his grasp and landed with a thud on the floor of my tub. I instinctively reached for it . . . just as he did.

Water came shooting from behind his hand . . . right into my face!

It was only for a split second, but it was enough!

And like the water spewing from my shower came our roars of laughters!

He got the spout covered again and we managed to communicate enough for a handoff of the pieces he needed to finish the job.

We laughed again and again as he recounted the story to me in Hausa, as if I hadn't been there!

Sweet Applause

noreply@blogger.com (Deborah) — Wed, 11 Jan 2012 07:02:00 +0000

No, I haven't been ignoring you . . . or holed up like a hermit. I've been away at our annual country-wide spiritual life conference in the capital. So not to worry, I've got a few pre-written saved-up posts coming your way. Thanks for your patience.

Yesterday, one of our short-termers, Cool-J, came to work with me. She shadowed me for the morning and then shared a bit on her own blog . . . which I HIGHLY recommend! So please skip on over to Cool-J's No Zebras Here and read her account of Sweet Applause.

How Not To Build Rapport

noreply@blogger.com (Deborah) — Thu, 29 Dec 2011 21:49:00 +0000

This morning a little girl from the Under 5 Clinic came to see me. She's nearing three and cannot walk. She was a little bit like a rag doll . . . really floppy . . . and absolutely adorable.

She came into my office hidden under her mom's flowing head covering. We all three sat on the floor, ready to play . . . well, at least I was ready to play. She was ready to scream.

And that's all she did for the next half an hour!

Despite all efforts to distract her with toys and bubbles, she sat and screamed at the top of her lungs.

Eventually, I gave up trying to play and started to show her mom some simply 'play'-like exercises she could do to work on trunk control and balance. They only live about 25 minutes from Galmi, so I had been hopeful that they would be able to come back for therapy on a more regular basis.

However, since Little L. didn't seem to be able to get calm, I gave up that dream pretty quickly.

Trying to teach mom a few things proved a bit difficult without a Hausa vocabulary large enough to include terms like 'sitting balance' and 'standing endurance' and 'gently pull her this way and push her that way' I decided to call in a translator.

My nurse-by-day-matchmaker-by-night friend came to my aid. She said what I couldn't say and explained what I wanted Little L.'s mom to do.

We were mid exercise-explaination, when all of a sudden my tiny patient stopped shrieking sounds and began yelling words. My friend turned to me:

'She said she will play if you leave the room.'

Unfortunately, they all seemed to miss my whole purpose in being there.

Curious to see what she would do, and hopeful for a better chance to evaluate her functional capacity, I went into the hallway.

'Woviaj iaj flkvja owij alkfv oaiwjrg vlkz vmlk ageoijv lk!' my patient shrieked. Her mom and my friend began to laugh.

'She said she doesn't want you to play peek-a-boo with her, so you need to leave and go where she cannot see you.'

Eventually I was allowed back in the room . . . but with my entrance came another round of shrieks. She admitted to being afraid of my skin . . . and there was no convincing her that I was there to help and play, not hurt.

Needing to fill out some paperwork, I decided to try one last resort.

From a pile of freshly cleaned linens, I pulled out a pink bed sheet and draped it over my head.

But . . . my sorry excuse for a Halloween costume worked!

For the first time in over 45 minutes, the child had stopped screaming!

I guess I've found the new Therapy Department uniform!

TED Gets It Right Again

noreply@blogger.com (Deborah) — Mon, 26 Dec 2011 18:34:00 +0000

Alberto Cairo is an Italian PT who works with the Red Cross in Afghanistan.

Lessons from the Tour

noreply@blogger.com (Deborah) — Tue, 20 Dec 2011 21:01:00 +0000

This morning the operating room staff went for a tour of the new Post-Surgical Building. Our current facility is the original (plus some simple extensions as we grew), dating back to the 1960's. The cement is crumbling, there is barely any airflow, it's dark, and it was time for a change. So we are nearing the end of Phase I, next up is OB, then medicine/peds, then . . . I forget.

It's been a long process (not sure how long, but I'm confident that someone from my team will read this and let me know just how long, so be sure to check back for details). And we're nearing the end!

But you don't want to read about buildings . . . okay, really, I don't want to write about buildings, I want to write about people. So, I arrived on the tail end of the OR staff's tour of the new facility. And experiencing it with them was a privilege.

At first, with all the Oooh's and Aaah's I heard as I approached the building, I half expected to see the Rockefeller Center Christmas Tree up in the foyer . . . instead it was the hospital logo painted on the wall.

'Déborah! Régarde! C'est trop modern!' the Chef d'équip (the boss) of the OR said to me.

The were impressed with everything . . . tile on the floor, strips painted in the hallway, the metal and glass doors, the high ceilings in the hallways . . . it was like nothing they'd ever seen.

They gaped, wide eyed; they gasped with glee.

It was the way I felt the first time I walked into the lobby of the Ritz.

Back home, this new building would be nothing spectacular . . . it wouldn't be prized, it wouldn't be impressive.

But it's all about perspective, isn't it?!?!

Here, on the south-side of the Sahara, when I see metal, cement, and floor tiles, my friends and coworkers see the Taj Mahal of hospitals.

Our Director was telling me that he took some staff through the other day, and one turned to him and asked 'So this building is for staff only right?' 'No, it's for our patients!' 'But it's too nice [for villagers]!!'

Like children around the Christmas tree, my coworkers were awed. It was spectacular to see their faces and enjoy their delight. To feel their glee and share their wonder. Not because I was impressed with a building I've entered many times through it's process . . . but because their joy gave me joy.

As I was following them back to the 'old' hospital, I had to wonder if I was feeling, on a very small scale, how God our Father feels when we find joy in His creation. When we are in awe of what He has done for us. When we are speechless at His gifts.

With Christmas only a few days away, it was a strong, tangible, example of the way I should walk into the stable . . . seeing The Baby in the manger as if for the first time. Hearing the wonder of His birth as if I was a child. Rejoicing that the story doesn't end with the wise men bringing gifts.

Knowing, that when I delight in the coming of the Son, the Father delights in having given Him.

Stupid Birds

noreply@blogger.com (Deborah) — Thu, 15 Dec 2011 21:45:00 +0000

While most of our local wild life doesn't span beyond the imagination of donkeys, camels, chameleons, snakes and the ugliest spiders on the face of the earth, we do have quite an array of birds. There are swallows that dive to drink out of our swimming pool . . . and these beautiful blue ones that don't do much of anything except fly away the moment they sense a camera within a 10meter radius.

And there are the pigeons.

Stupid pigeons.

Like everywhere else in the world, our Galmien pigeons leave a mess of poop and feathers, and generally contribute nothing to society.

Being a native NewYorker, pigeons have always just been a part of the scenery.

But it's one thing to see a legion of pigeons on your metal roof. It's another to hear them.

The first few days my mom was here, she waged war with the winged squatters . . . armed with a broom, she let them know who was boss. After a few banging tirades, they found another roof and filed a Change-of-Address form with the post office.

They were gone.

For good.

Or so I thought.

Two days ago I started to notice some soft scratches coming from above. I thought nothing of it. Then yesterday, just as I was falling asleep for a much-needed nap, I was startled awake by a thump which was followed by an array of clicking, clacking, and clattering.

In an angry tirade (HEY!! Those stupid birds woke me up from my nap!) I grabbed my broom and ran outside.

There they perched . . . scattered across my roof.

Forgetting I was already holding my broom, I bent down and picked up a rock.

I launched it into the air.

It went up, then straight back down next to my feet. The birds silently mocked me.

I picked it back up and lobbed it again.

This time it landed a few feet in front of me, but still quite a ways from the roof.

The bored birds blinked at me and shifted their weight from one claw to the other resulting in that awful sound a metal shovel makes as it scrapes snow from an asphalt driveway.

That's when I remembered the broom.

I lunged toward the house and with a might CRASH-BOOM-BANG my enemies retreated. They fled for nearby branches or another corner of the roof. So I swung again.

When I returned from work (having never gotten my nap, mind you) I found them there again. This time, my rock throwing was a little more successful and the pigeons left without much fight.

Naïvely, I thought I had won. I went to sleep last night to the sound of silence above me, and I was satisfied with my victory.

Little did I know they were perched, waiting, ever so silently conniving their attack plan.

At six-thirty this morning my alarm went off as it always does. I hit snooze, as I always do.

And just as I rolled to doze back into my slumber, those stupid birds began practicing their tapdance routine!

The harder I tried to ignore them, the louder they tapped and the faster they danced.

'GO AWAY YOU STUPID BIRDS!' I screamed at them. I'm certain now that my outburst only encouraged their jig.

I jumped up, grabbed a sweatshirt and wrap around skirt to throw over my pajamas, ripped my broom from it's resting place and fumbled for my keys.

As I flung the front door open, those stupid birds froze mid-saché.

In the midst of my rage I had a lucid moment . . . 'Hey, those birds are sitting on the roof just off to the side of my window . . . EXACTLY ABOVE MY BED!!!!' And while I was impressed with the precision of their tactical positioning, that really boiled my blood!

That was the last straw!

Maybe it was my awesome death stare, or the fire shooting from my nostrils, but all it took was one quick step forward with my broom raised and they were out of there!

You better believe, this means war!

A Kettle, a Pot, a Log, and a Crocodile

noreply@blogger.com (Deborah) — Wed, 07 Dec 2011 13:53:00 +0000

I've been back from dropping my mom at the airport since Sunday. Today is Wednesday. And still hospital employees say good morning by first asking how she is . . . if she arrived safely . . . and when I'm getting married.

Today it was a man who works in the outpatient chart room.

The three employees that pass their days in an oversized walk-in-closet asked me how old I was. When I told them, they gasped. The younger man shot back, 'You need to hurry up!'

The older man in the room laughed at him and said 'And who are you to say that?' And continued to give him a hard time in Hausa about being 40 without a wife.

I chuckled.

'You know, we have a saying in English,' I started to say knowing I would have to explain it in the end . . . but it was only after I had started that I realized I only knew of one word I could use in my new Hausa context for which we have multiple synonyms in the US.

'The big pot says to the little pot, hey, you're black.'

They stared at me.

I blinked at them.

'Uh . . . it means that one points out that the other is covered with charcoal from the fire, but doesn't recognize that he too is covered with soot.'

They stared at me some more, then gave me a courteous little nod.

I was surprised because my Nigerien friends are often speaking to me with Hausa proverbs that they translate into French.

I guess the African saying is true: A log can float in a river, but it will never be a crocodile.

Maybe Close Is Good

noreply@blogger.com (Deborah) — Tue, 06 Dec 2011 11:03:00 +0000

I just had a brilliant conversation with my gardener's father in English.

It all started when he asked how my mom was doing . . . if she had arrived safely in the US . . . how she liked Niger . . . and so on. Then he asked how many sisters I had in the US who would take care of her since I was here. I told him I had no sisters.

'But, how many brothers?' he asked.

'One.'

'ONLY ONE!!!'

'But he has three children.'

'It is better than two. And brother, he has how many?'

'He's 33.'

'And you have 30?'

'Yes.'

'It is the time for marry.'

'I'm thinking about it.' I told him.

'It is not good to be very old without some children. Because, you will be very old when you marry and very old when you have some children and if you are young with some children it is very good to school [raise] the children but if you are very old it is difficult to school the children.'

I thanked him for his advice. But he wasn't finished.

'We have concern for you. You are too alone. It was good when Momma was here, but now you have no one. You find husband now. It is not good for a woman to have the house and the work but no husband.'

I wasn't in the mood for another counter-cultural women's-lib chat this week (and it's only Tuesday!), so I decided to oblige him. 'Okay, I'll think about it.'

'But not an old man.'

I chuckled at the thought . . . and reassured him. 'Well, then I will look for a young one.'

'Maybe 20?' he suggested.

I laughed.

'Oh no,' he said, reconsidering. 'You white people do not like that much. You want man and women [note the singular and plural there!] close. Maybe two three years. But no ten. That too many.'

I laughed again. He continued.

'We Hausa, we like it big difference.'

He paused and thought to himself.

'But then, many times, we have big big problem. Maybe close is good!'

This Is How We Roll

noreply@blogger.com (Deborah) — Sun, 04 Dec 2011 19:33:00 +0000

I write this blog to help you better understand what life is like for an outsider in this little corner of the world I'm currently calling home . . . okay, so really it's to help ME better understand my not-so-brand-new-anymore context . . . but you've been invited to be a 'fly on the wall'. So in the spirit of the holistic approach, I documented my trip from the capital back home via the Nigerien version of the BulletTrain: the bus.

Since most of you will never have the privilege of riding the bus in WestAfrica, here it is, chronicled as it was happening:

04:40

It's 4:40am. I've been on the bus half an hour and we are still sitting in the parking lot.

Outside the morning air is comfortably cool. In here, however, I've broken a sweat. And there's nothing quite like breathing the recycled air of 75 strangers.

I was supposed to get here earlier, but my cab driver showed up 40 minutes late. Which, from his point of view, was a courtesy, as I wouldn't have to wait as long for the bus to leave...since we westerners are impatient and don't like waiting.

What he doesn't realize is that this is a 7 hour trip and by showing up 'late' I've lost the advantage of getting a decent seat.

He's clearly never been forced to squeeze in next to the biggest Hajiya on the bus!

In addition to the lack of seating options, arriving late also means no overhead storage space. But I learned something on my last bus trip: it's culturally acceptable, in situations such as these, to push.

Not wanting to be buried alive under a few kgs of semiprecious carrots and cucumbers, I shoved my reusable walmart bag above me, forcing multiple plastic trash bins and various winter coats to yield to my arrival.

But I'm second guessing that decision all of a sudden as we've just now pulled out of the gate and already the bags of two passengers ahead of me have tumbled to the floor taking out an old Tuareg man in the process. I'm hoping the force of my wedged veggies will act upon the resistance of the parkas surrounding them, and stay put.

05:30
I've been trying to sleep, but there's just something about three clashing odors of incense that is keeping me awake. Or maybe it's Hajiya snoring in my right ear.

05:5o
We've just pulled off the road. 94% of the passengers have descended from the bus.

It's prayer time.

Carrying mats, beads and plastic kettles of water for washing hands, face and feet, my fellow travelers have filed onto the shoulder of Main Street (the sole paved road that runs east from Chad to Burkina Faso to the west), face where the sun has yet to rise, bow and pray.

07:08

I was just dozing off again as we made our first drop-off/pick-up. It wasn't the passengers shoving by that startled me awake, no it was the roar of the jet propelled air conditioner that came on overhead.

I guess this is why I was advised to keep my sweatshirt handy.

07:47
We are back on the road. An employee of the bus company is heading down the aisle...I guess this would be the equivalent of a commercial airline's beverage service: a homemade bean cake in a baggie and a banana flavored yogurt-in-a-bag!

I thought about asking for a diet coke, but the guy didn't seem to have much French.

As he made his way down the aisle, he pulled the plastic trash cans from the overhead storage and spaced them evenly between rows. And while I am thankful that we have all been encouraged to dispose of our rubbish in a conscientious manner, something tells me these are going to get the way when the time comes for me to disembark.

10:30
I've spent the past five hours sliding off my seat. One would think that if the left illiac crest of the pelvis is wedged beneath the arm rest, the body would stay put.

Throughout my training, I've always been taught, if you want to control the movement of the entire body, the pelvis is the steering-wheel.

Well, I'm sorry to break the laws of anatomy and kinesiology, but truth is, when the bench seats of a bus are covered with a thick plastic tarp, no matter how jammed ones pelvic girdle maybe, the slip-n-slide is inevitable.

Maybe it wouldn't have been so bad if big Hajiya hadn't occupied her seat as well as half of mine.

11:48

We are just minutes away from Galmi! Wow that went much quicker (and quieter) than I was anticipating. The old lady across the aisle on my left saw I was gathering my things together. She smiled and welcomed me to Niger. She told me she was happy I was here and glad to have seen me today on the bus.

One of my favorite things about living in WestAfrica is how friendly the people are. Warm and welcoming . . . wherever you go. Even big Hajiya, when she was awake and out from under her blanket.

21:01

I have a special souvenir from my bus trip . . . a nice big black-and-blue bruise on my left hip where my illium was crushed beneath the seat's armrest for seven hours.

I tried applying the just-push-till-it-gives rule to my seat-mate, but Hajiya just wouldn't budge! Next time I'm getting there early so I can find the tiniest little granny and claim her for the trip!

Knock-Off Magic

noreply@blogger.com (Deborah) — Sat, 03 Dec 2011 07:10:00 +0000

Late Thursday night, I put my mom on a plane and she went back home. The month went quickly, and she had a wonderful experience being here.

And when in Niamey, for whatever reason, it's important to take an extra day or two and run as many errands as one possibly can. Like taking advantage of having a small grocery store. Or checking out prices on garden hoses. Or eating in a restaurant. Or . . . well, all the things you can't do when you live in a big village.

My friend B. is leaving for a bit and was in need of some jeans. I needed to find some fabric for a friend, and so, together, we grabbed a taxi and made our way to Le Grand Marché (The Big Market). It's called Le Grand Marché because it's a huge outdoor market and you can find nearly everything imaginable (if you just look hard enough) as opposed to Le Petit Marché (The Little Market) where loud vendors sell fruits and veggies and bullion cubes and frozen chicken and plastic buckets and brooms.

How's that for Pay-Less?

But as is true to the nature of Open Air African Markets, Le Grand Marché is really just a crowded shopping-mall of stalls (instead of shops) . . . and the food court is actually kids wandering the street out-front selling roasted meat, bags of sugared peanuts, and an assortment of tomatoes, guavas, and onions from a tray carried on his or her head.

We weaved our way to the Mostly-Women's-Clothing Section. Stall after stall was wallpapered with slim-fit skinny jeans and tops most appropriate for a night club . . . not what one would expect from such a modest and conservative culture . . . but I guess that's the bottom layer under all the coverings.

My friend wanted jeans she could wear without having to paint them on in the morning, so it was continual strike-outs for the first half an hour.

Eventually we found a place that had a pair of what seemed to be almost-boot-cut. She gave them a try.

The man stepped out of his booth and pulled a rolled-up sheet down over the door to make her an improvised little changing room.

While she was in there, the vendor next door offered me some name-brand shoes at 'A Veddy Good Pryce.' I assured him I was only looking today, and turned away.

'Well, then, you need to look.'

'CRAP!' I thought, 'I need a better line! Like: Oh, I can't wear shoes like those, I'll break my ankles, and then my neck . . . but that may be a bit too complicated for my current level of Hausa.'

My internal dialogue was interrupted when the vendor insisted that I check out his 'name-brand' shoes. Feeling a little trapped, I glanced over . . . and nearly wet my pants.

It's a pretty lousy shot, but not bad for being discrete
with a camera phone!

Hanging there was a pair of women's shoes claiming to be Sketchers. What first tipped me off was that these weren't exactly Sketchers style . . . but then again, I haven't lived in the US in nearly 2 and a half years, and fashion changes.

So I moved in for a closer look.

The label was a fake.

It looked like it had been cut out from an advertisement . . . or maybe even a photocopy of an advertisement . . . and glued onto the inside of the shoe!!

I wanted to laugh out loud . . . but there are just some things that don't translate.

Being a native of NewYorkCity, I'm quite familiar with Knock-Offs . . . you know, brands like Prado and Catch and Okey . . . I mean, in ChinaTown they get it that we can all overlook a swapped out or dropped letter . . . in fact, it's what we've come to love and appreciate in our Falls-Apart-After-10-Minutes Knock-Offs. It's what we want. It's what we expect.

But a decoupaged tag?? That brings us to a whole new level of magic!

His Brain Is Speaking English

noreply@blogger.com (Deborah) — Mon, 28 Nov 2011 20:58:00 +0000

This morning I was asked to see a patient who came in for an operation and had a stroke while he was recovering. The doctor told me that he had left hemiplegia, so I knew it was right side (of the brain) involvement. But since we live in a world of Where-There-Is-No-MRI, I had no idea what to expect.

It's been a while since I've had a patient with an acute stroke . . . but it's like riding a bike. One with a cool basket in the front and streamers in the handle bars!

I met with my patient in the morning and again in the afternoon. The second time around both his sons were bedside.

They watched as I helped their father sit at the side of the bed and tried to evaluate his functional capacity as well as his physical and cognitive limitations . . . which is quite difficult when my questions translate as:

Where is hand of you? There is hand of you!

and:

You give car me . . . no . . . you give cup me! Good! There is car . . . no, cup!

I'm sure his sons were evaluating my cognitive functional capacity throughout the whole session!!

Let just say there was plenty of 'babu Hausa' to go around. Unfortunately neither of my patient's sons spoke English or French. Although, I did give both languages a try. They just stared blankly at me.

I tried again.

Still nothing.

Words were coming out of my mouth . . . I was telling them what they needed to know and do . . . but they weren't understanding because I was not speaking their language.

Eventually the whole sight was painful enough for my patient's neighbor, and he offered up the service of his elementary English.

The sons and I went back and forth a bit through our new . . . translator. They expressed that they understood some of the things I was encouraging them to do, and I asked if they had any questions.

They did: What happened to our father?

One thing I've learned as an OT is the necessity to take complex concepts and simplify them for the non-medically-trained to understand. I make big words small . . . just don't ask me to make them big again . . . or spell them. But despite my efforts at simplifying the explanation of a Cerebral Vascular Accident, or 'Stroke', the terms were still too technical for our translator.

I tried again.

It wasn't working.

My gut reaction was to express frustration at our lack of a common language . . . and that's when it hit me . . . their father's body was experiencing our same frustration!

'Right now, your father's brian is speaking in English. But his body speaks Hausa. So, we have to teach his brain Hausa again so that his body can understand what his brain is telling it to do.'

That, they understood.

Sure it doesn't answer the physiological question of 'What happened to our father?' but they understood that there has been a change in the part of the body calling the shots . . . and that the brain and the rest of him could learn to communicate again.

All thanks to our earlier attempts of failed communication.

I guess 'babu Hausa' really does come in handy!

When the Cultural Tables Turn

noreply@blogger.com (Deborah) — Thu, 24 Nov 2011 12:40:00 +0000

Yesterday one of my burn patients asked if she could leave for a day or two and then come back. I thought it an odd request, but today her baby turns seven days old.

According to the local customs, turning seven days old entitles one to a name and a big party, the biki. I've been to a few, and yes, they are quite a big deal. Excessive quantities of pounded millet and sauce are prepared for the early morning meal . . . everyone you know, and maybe some you don't, comes to celebrate the birth and the giving of the name . . . everyone gives a gift to the mother and she in turn offers a little goodie bag . . . and then a sheep is slaughtered, bled, and skinned.

Yeah, it's a pretty big deal.

A big enough deal that a woman with third degree burns covering three quarters of her leg wants to leave the hospital and come back tomorrow.

As an Occupational Therapist I was intrigued by this request. Being a holistic profession, in our practice we take into consideration all the aspects of a person's life and how their current state of injury, illness or disability effects, hinders, and impairs her ability to participate in the life she wants to be living. We ask the question 'what is important to my patient' and we use her definition of 'purposeful and meaningful' to drive our treatment planning.

To my patient, this biki was more important than her own health and I wanted to know why.

I turned to two of my Nigerien colleagues and asked a whole series of questions like:

Q: Why does it have to be today? A: Because it's seven days after the birth.

Q: But why? A: Just because.

Q: Why does the mother have to be present when she spends the whole time inside the house and not actually enjoying the festivities? A: To accept gifts and hand out party favors.

Q: Why the granny can't go in her place? A: Because it has to be the mom.

Q: Why can't the family just accept the gifts for her? A: (I never got an answer, just two shocked expressions)

Q: What happens if the baby doesn't have a biki? Will he live his whole life being called Jariri (Baby Boy)? A: What kind of a question is that?

Q: I still don't understand, why can't the family just accept all the gifts and explain that the mother is in the hospital and can't make it? A: .......

My last question was met with a question, and suddenly the cultural tables turned. Without realizing it, I went from student to teacher, novice to expert.

'Well, then, in your country who slaughters the sheep?' my friend asked. I blinked at him, 'I'm sorry, the what?' 'The sheep. Who slaughters the sheep?' he replied as he drew his thumb across his throat.

I smiled. 'We don't do that.'

'WHAT?!?! You don't kill a sheep at your bikis?!?!?!'

'We don't have bikis.'

'WHAT?!?! NO WAY!!! Then when does the baby get a name??'

'Usually the parents decide together on a name before the baby is born.'

'WHAT?!?! BEFORE THE BABY IS BORN!!! THAT'S CRAZY!'

And considering how many still-births there are here and how many children do not survive their first weeks, giving a baby a name before he has even taken a breath is ludicrous.

'So if you don't have bikis when do people give gifts?'

'We do that before the baby is born too.'

My friends were dumb-founded and confirmed with one another in Hausa that they were, indeed, understanding me correctly.

'So then you take the baby and present him at the church?'

'Yes, but not for several months.'

'WHAT?!?!?! So when does the family come to visit??'

I explained that in my culture when a woman gives birth, the last thing she wants is a whole of company hanging around the house. And that it's really only the family that lives close by, except for the parents and maybe the closest siblings who come right away. But for the most part, we keep our distance to allow new-mamma to get some rest.

The pair were completely blown away by this bazaar culture I come from. So I thought I'd really lay it on thick and informed them that in my part of the world, when a person is sick they prefer not to have visitors.

That was the last straw . . . sick people who want to be left alone?!?!?! Without the whole village coming and sitting on your floor, saying nothing, just staring at you?!?!?!

My colleagues had heard enough. They didn't want another word about this foreign land where babies are named too soon and a man with the flu suffers isolated from all those that love him.