Day in My Life

This week has been insane – really, it has felt just out of control. My daily lists have fallen by the wayside as I have attempted to keep some semblance of control over my life. I am sure whatever semblance of control I had was a simple mirage, but it made me feel better. The week was filled with emergencies – both in the village and a late night trip to SLM to see a missionary kid who was sick – and complicated medical cases – all piled on top the daily routine and work of life here in the village.

Thursday was an example……

I woke up at 6:30 am with a kiss from my husband who was heading out for a jog. I dozed back to sleep and finally dragged myself out of bed at 7:30. In order to feel relaxed with my time with the Lord, I got a few jobs out of the way first. Thursday is laundry day, so I prepped the machine, pulling all the buckets and other things that get shoved in our outdoor laundry room, sorted the clothes, and got the first load ready in anticipation of Isatu’s arrival for work. I also carried out the dirty dishes and set up the tubs for Kanko to come and wash the dishes. I was then ready for some coffee (which Jim had graciously made) and some quiet time praying and reading the Bible- asking the Lord to give me love for people that day.

Jim arrived home shortly after that, and then Sayon came for coffee. I popped my head out the door to ask him about a patient I had seen the day before (on my supposed day off) and asked about his family. Isatu arrived and since Jim was out visiting with Sayon, I ran out to try and start the generator myself. Jim had done some work on the exhaust pipe the day before, and the generator didn’t sound quite right as I tried to start it, so I called Jim and asked him to do it.

I greeted Isatu and chatted with her for a few minutes and ran back into the house to get coffee for her. I also swept the house quickly and prepared Kanko and Isatu’s salary for the week. (Thursday is market day and the ladies LOVE that they can count on a weekly pay that provides for their families meals – and I LOVE that they help me so much with some house work!) I wiped down all of the counters and the table. The dry season dust is incredible. On a normal day, you can wipe everything down and come back by afternoon to write your name in the dust.

I sat down to write a few emails. I write a daily email to the boys in Senegal– usually a short but a quick reminder that we love them, miss them, and are praying for them. That day also included emails related to team stuff, a few to supporters and one to an OB-GYN in Fort Wayne who has been gracious to help with questions related to that field. I needed to discuss a delicate female issue that had been presented by a woman the day before.

In the middle of my email, I got called out to the porch by Jim to deal with a girl who had fallen and scraped up her leg during a bicycle accident. I try really hard not to work in the mornings as I am trying to get school done with Hannah and house work done, but when people are bleeding, it is a little hard to say come back in a few hours. I got her cleaned up and on her way. I was heading to finish emails and do the few subjects of school with Hannah that require my help when I got called out to the back porch where Isatu needed to talk with me.

I sat on the porch for a while as Isatu explained her desire to buy red oil, dried fish, bouillon cubes, and onions – all staples in daily cooking here – in bulk so that she could have them to sell to women on a daily basis. Those are usually only available on market day – and women purchase them for a day or two. But then they run out. So wise business women go to the bigger towns and purchase all of that for a slightly lower price and then come back and sell it through the week and make a small profit.

Of course, business ventures take capital. And since there is no bank here in town, she was coming to me. I often do give loans to my workers, knowing that 1. Some purchases need to be bigger than a one week salary in order to be profitable and 2. I can just pull it off their paycheck a little at a time – erasing the worry of not getting paid back. We negotiated a little and came to an agreement of how much she could borrow. I went to get her the money. The whole process took probably 30 minutes. I was trying to be patient.

Back inside the house, Hannah and I did school and then I stirred up a batch of muffins for breakfast the next day, got lunch ready to pop in the oven, and started supper preparations. My morning was nearly gone. I usually exercise for about 45 minutes in the morning, but had been having pain in my foot and I was fairly certain that jogging on it would be a bad idea. I have no idea how I would have fit it in anyway. I put water on for a shower and heard a motorcycle stop and then commotion on the porch. It was one of the former chiefs – who had been sick and had gone for treatment to the hospital.

Mordeka had come the day before (my day off), asking me to look at all of the medicine and the hospital record. I put him off until Thursday – making a concession to see him at noon instead of making him wait until evening for 2 reasons – 1. Because he was a former chief and the guys felt that I should give him a little deference since he was part of the reason we were allowed to move into the village and 2. Since it was a Thursday, I knew my porch would be filled to overflowing and that reviewing everything would take a big chunk of time that would put me behind with other patients. Isatu was finished with the laundry, so I went out to the back porch to look over her work and tell her thank you so much – something that she wants at the end of every work day.

I then stuck my head out the front door, greeted the chief, and told him that I needed to wash and would be right out. He was happy with that. I ran in and took a quick shower. Lunch was ready but I wanted to get the chief finished up first. I was heading out the front door, when Isatu called me from the back porch. She had been out to purchase some items, but the price was higher than she thought, so could I add to her debt? I was getting a little fussy, but since I had already advanced her several weeks pay, what were 2 more? I went in to get the money, and then listened to her blessings. By the way, she said, there is a boy on the front porch whose foot is so injured she was afraid. Great - I thought.

I went out to the front porch to find the chief dutifully waiting, and a boy, about 10 years old, who had been injured when a tree limb fell on his foot. The problem was that it had happened out in the bush – and in the process of walking back into town, the blood has mixed with the dirt, which turned into mud. The injury scared everyone so badly, that they refused to wash the foot. So, by the time they drove on the moto to see me, several miles away, the dry air had caked the mud on.

I couldn’t tell what was flesh and what was mud. I tried and tried to wash it but was having little success removing the mud. Finally I went inside, looking for something to soak the foot in. I found an old Tupperware and put water, soap, and Betadine in it and soaked and scrubbed as much of the mud away as possible. What I discovered under the mud was that the 2 smallest toes had been crushed, exposing the bones, and that a layer covering most of the ball of his foot had been sheared off. (No matter how many times they explained what happened, I couldn’t figure out how both of those things occurred in the same accident.)

I wanted to send them to the hospital, figuring that at least one of the toes would need to be amputated, but Sayon said that they don’t really do that, and could I try to take care of it here. Why not? I said, but if it looks like it will not get better, he has to go anyway. (I suppose that exposes my lack of faith in the medical system!) I finished scrubbing out as much mud as I could, bandaged him up, gave him a tetanus shot, started him on pain meds and antibiotics, and sent them on their way – with instructions to come back the next evening. I was exhausted. But there sat the chief, looking at me expectantly. OYE!

I called in the house and told Jim and Hannah to go ahead and eat. It was after 1 pm and I knew it was going to be a while. So I grabbed his medical record and unpacked the 2 plastic bags of medicine that he had with him and started to sort through it all. He had about 15 different medicines – some of which I had never heard of. I got out my drug book and tried to figure out what they were. There were partial treatments which he had started but stopped several days before because he was afraid to take them.

There were STRONG antibiotics, cough meds, pain killers of all varieties, and some lidocaine (a topical anesthetic). Since he had not had any surgery, I asked where he had gotten it. He said the doctor had given it to him as a gift – in case someone in the village needed it. Yikes. I told him to please NOT use it. I sorted through the rest of it, taking some away since they weren’t ever finished anyway. I encouraged him to take them all well, and to rest and eat well, and to come and see me if he wasn’t totally better when he got done. He thanked me and left. I went back inside and ate a quick lunch and chatted with Jim for a while. It was after 2 pm when I was done.

I called Dawn Cluckie (our teammate) by radio to check on her since her husband was in CKY. We chatted for a few minutes about their family and then discussed a few medical cases that she had questions about. I told her to call if she and Adam needed anything while Bruce was gone. Then I went outside to send emails by satellite modem and then take down the laundry which was now dry.

Isatu showed back up and helped me take down the clothes. She wanted to let me know she had purchased the red oil that she needed and to thank me for helping her. By the time I got back inside to read the emails, it was after 3 pm, when I usually start work on Thursdays. Considering how much time I had already spent on the porch, I knew I needed to be a little late. I explained that to the group on the porch and quickly read emails and finished preparing supper.

When I finally got outside, there was a big crowd waiting. Over the following few hours, I saw 22 patients. As the last one left, Jim and Hannah set the table and we starting eating around 7 pm. Afterwards, we watched a show together and I fell into bed – exhausted. Sadly, that was how most of my week went. I would never have survived without Jim and Hannah’s help! Here is hoping that this week is NOT so crazy!

Eyes on the Prize

Lately, I have spent a lot of time burdened by questions that arrive on a daily basis here in the village. They are almost exclusively in regard to the medical work that I do on the porch. Don’t get me wrong – I love what I do – most days.

I feel blessed and humbled that God allows us to be here and also blessed and humbled (and a little frightened some days) by the trust that people put in my ability to help them. If only they knew how many hours I spent pouring over books and looking up medicine and making sure my diagnosis is correct and that the medicine I am giving is not interacting with something else. So, in regard to kids – it is fairly uncomplicated. I have permission to help most of the kids who arrive on my porch seeking help. It does get complicated occasionally, as I will explain later. But for the most part, it is great.

Adults are a whole other issue. While I have been given permission by the medical supervisor in the area to treat kids, I have been restricted to only helping the adults who have already been treated by another clinic, but have not gotten better. Why? Well, kids tend to get sick faster than adults and don’t have the ability to get themselves to medical treatment. But the goal of the medical supervisor – and mine too – is for the clinic that they are building here in town to get finished. That way, even when we are not around, there will be medicine available to our friends here.

If EVERYONE comes here for free medicine, then there is no incentive to build a clinic. I keep telling everyone – let’s get the clinic finished, and then kids and women and men can all get medicine. And I believe what I am preaching – in theory. It is all well and good – until a sick adult shows up on my porch. Then things get hazy.

See, there are 2 clinics in the area – both about 10 miles in either direction from us. Both are staffed by health care workers. So, in theory, I can feel good about sending adults there for treatment. The problem is that, often, they don’t actually have medicine at the clinic. And what they do stock is one kind of antibiotic, one kind of malaria medicine, and usually some aspirin and Tylenol. Rarely do they have all 3 at the same time.

The clinics might be staffed by competent people – but even the smartest, most compassionate medical people can’t help sick people if there is no medicine. The other alternative is to get transport to Faranah, the main town in the area where there is a hospital. The problem there is that you have to pay 20,000 fg just to get there (and of course, you will eventually have to get home…). That is about 2 days pay for the average worker.

Then you have to buy the medicine. And you may or may not get good medicine. Recently a person came back with a medical chart that said they had been given Chloroquine at a government hospital – a medicine that I have been told is illegal to sell in the country because it is no longer effective against malaria. And they will end up paying, at the least, 50,000 – 100,000 for medicine that is often ineffective. Now you are up to 9 - 14 days worth of wages for the average farm worker – and often they still aren’t better.

As an alternative, people often go to the market stands to buy medicine from people who mostly can’t read and who mostly are interested in getting money. So, for malaria, you might come away with Chloroquine (again- useless), maybe Tylenol – though it is usually mixed with something else, bottles of vitamins, and maybe some birth control pills or steroids. Kids and adults can come away with the same doses.

So, I turn people away on the principle that we want incentive for the clinic to be built. And we do – because in the long run, it will benefit the town and the people in the surrounding area. Meanwhile, I sit here with LOTS of good, effective medicine that they could get for maybe 20,000 – 40,000fg. So what do I do? Help people with the short term goal of treating them and ignore the long term goal?

That is what my heart tells me to do – because I HATE to see people suffer. On the other hand, if I did that, I would quickly have HUNDREDS of people on my porch – and the clinic would NEVER get finished. Or do I turn them away, knowing that it will eat up a lot of their money and usually they won’t get better anyway? With that, hopefully the suffering will entice people to finish the last, very small portion of the clinic that needs to be done and everyone in the area can benefit.

Many days those choices are very hard as I look into the eyes of people who are suffering. I know what it is like to have a sick family member and be desperate for treatment for them. Often, I send people away, and they come back with medical charts that just make me angry when I see the needless money that is spent on useless medicine.

Daily, I try the best I can to show compassion, to explain why we are desperate for the clinic to be finished, and occasionally give out a few Tylenol. My prayer is that they will see that I care and that I really do want to help.

In another case involving a young boy is another example of sacrificing long term goals for short ones. This kid suffers from what I think is osteomyelitis (a bone infection). I started him right away on antibiotics and began to talk with the dad about going to the mission hospital. We could see the knee (where the infection was sitting) swelling more and more as the antibiotics did their job. I tried twice to drain it but without success. I put my foot down and told the dad – you HAVE to take him. Alright he said – I will go to my village and get money. (We offered to pay for the transportation for the boy and his entire hospital stay – the dad just needed to come up with the money to get a helper down there.)

By the time he returned a few days later, the kid’s knee was huge and ready to be drained. I was afraid to do it – fearing that if I did, the dad would think I had made him better and refuse to take him. But I couldn’t take the look on the boys face and was trying to imagine bouncing over terrible roads for 8 -10 hours to get to the hospital with the knee like that. So, I drained it.

I got cups and cups of pus out of it. I gave him pain meds and sent him home. The next day, dad came back to me and said – he slept SO well last night – now he is ALL better and we don’t have to go to the hospital. I could have kicked myself. Why did I drain it? I should have just left him like that so the dad would see how serious it was. I gave the dad a stern lecture and we are in the process of seeing if he will indeed take the boy to the hospital. I have explained – until I am exhausted – that I took care of the top infection, but there is still sickness smoldering underneath!

Choices are hard and I can only hope that people see compassion and love in me – whether I help with the treatment now – or keep my eyes on the goal of a clinic here in town. Some days, nither choice seems right!

It's a Love/Hate Kind of Thing

We are currently in the middle of dry season. In the US, of course, we have four seasons, but in West Africa, we have 2 – rainy and dry. In the rainy season, it….. rains – a lot. In the dry season, it… does not rain. At. All. Not too hard to figure out, I know.

For us, dry season runs from about October until May. The beginning and end of dry season is HOT. I don’t mean a little warm. I mean sweat dripping off your elbows, running down your back, too miserable to sleep HOT. But, for a short window in the middle, there are about 2 months of cold weather. And I don’t mean just a little cold. I mean 5 blankets at night, fuzzy slippers, stocking caps, long pants and shirts 50 degree COLD. In fact, about 2 weeks back, we hit 45 degrees one night. It was unbelievable. I could barely surface from under the blankets in the morning.

I enjoy the cooler weather. I like sipping hot drinks and covering up with blankets and cats (at least until I have to get out of bed in the morning.)

Here are some of my favorite dry season things….

1. The cool weather.

2. The dryness that allows clothes to dry on the line in just a few hours.

3. It is rice harvest time – so I know my friends have food to eat.

Like many things in life, there is a definite down side to dry season.

Burns: The rice harvest brings much rejoicing with the arrival of food. It is great for me to know that my friends are eating well at this time of year. Unfortunately, many of the burns I see at this time of year are due to the fires of burning the rice chaff that has been removed. They have machines that remove the rice chaff and it gets piled higher and higher as the harvest continues.

In order to get rid of it, people burn it, which is not a problem until more rice chaff is placed on the top and the stuff underneath continues to smolder. Kids, not thinking, often walk through it and burn themselves. One little 22 month old that I have been caring for was in the care of his slightly older brother who accidently dropped him in the burning chaff. Panicked, he left the baby there and ran for help, while the toddler’s feet and legs continued to burn. Other burns are caused by hot water or the fires that everyone sits around, desperately trying to keep warm.

Allergies: Now is the time for allergies to be in full gear – mostly due to the controlled (or at times not so controlled burning) of the drying grass. People burn any and all dry grass during the evenings -mostly to prevent accidental fires that have been known to wipe out whole sections of villages. The fires produce tons of smoke and seem to carry allergens all over the place. If you are prone to allergies or asthma, watch out.

Chapped, dry feet: Along with the dry, cold air comes dry, cracked feet. I usually experience it myself, though, for some reason, I managed to escape it this year. Last year, my heels were bleeding and painful as a result of the weather. And though I was able to escape it this year, many people who show up on my porch were not. The same thing applies to lips. People come begging for lip balm for their kids and themselves.

Dust: The cooler weather is a result of the harmattan winds blowing down from the desert. With the cold weather comes dust – and lots of it. You can dust your furniture in the morning and then write your name in the dust by afternoon. Almost makes dusting pointless! We are not as bad as people closer in the desert, who tell us that, if you lay still in your bed at night, you can wake up outlined with sand/dust by morning….

All in all, I enjoy this time of year. Like anything, I guess you have to take the good with the bad. . . .