Reversing Conakry

A trip anywhere in Guinea, for any amount of time, takes a lot of preparation. You have to prepare your house that you are leaving behind, make arrangements for guarding and animal care (if you have them), prepare food for the trip, make arrangements for where you will stay, prepare and sign a document called an "ordre de mission" that gives you permission to travel in the country, arrange for guards to watch the place, and a myriad of other details that should not be missed.

It is overwhelming at times – sometimes it feels like it would have been better to just stay home.
Returning from a trip is almost more work. Here is a check list of 20 things that needed to be done in order to feel settled from our recent trip to the capital…..

1. Open the house: This involved un-padlocking the side and back doors, and opening the curtains and louver windows.

2. Throw the knife switch which restores solar power to the house. We shut this off to try to prevent damage from lightning storms.

3. Check the fridge and freezer to make sure they are still working and did not shut down in our absence and see if the batteries for the solar system are okay.

4. Turn on the propane for the stove.

5. Plug in the CB-like radio that we use to communicate with our teammates. We unplug that from the batteries and antennae also in case of lightning.

6. Open the outside laundry room where we store dishwashing items, chairs from the back porch, and anything else lying around that we want to secure while we are gone.

7. Unlock the trash pit which we lock to prevent little kids from trying to fish out the things we have thrown away. There is NOTHING of value in there, and it is often mixed with medical waste, but in their little minds, they seem quite sure we are purposefully throwing away numerous treasures that they must have – a dumpster diving of sorts.

8. Unlock the padlocks on the magasin – our “garage” type building where we keep our generator and Jim’s tools.

9. Unlock the padlock on the attic door.

10. Put the stools, mat, trash can, and small plastic tea kettle of water (used by guests for bathroom needs) back out on the porch.

11. Unpack trunks of groceries – we usually shop for 6 – 12 weeks at a time, so there can be a lot of groceries.

12. Unpack the cooler or coolers with the frozen stuff I bought.

13. Bleach, wash, and put away all the fresh fruits and vegetables. Since it is hard to get these in the village, we usually come home loaded up – finding room in the fridge is a problem at times. But the heat requires you to get them in the fridge pretty quickly.

14. Unpack the egg box and put the eggs in a basket on the counter. I usually buy 5 dozen at a time.

15. Sweep, mop, and dust to try to regain a foothold from the insects and spiders that think you have obviously abandoned the place, giving them free reign.

16. Pay the guards for guarding.

17. Greet the people who come to welcome us back. This requires time to sit and answer questions about your trip, and your family and for you to ask about their families and how things are in the village.

18. Give out gifts. Often we gift our closer friends when we come back from a trip – maybe with some fruit or vegetable that is not available in the village yet, or something else. A few of the popular gifts we have given: shoes, flashlights, soap, toothpaste, cooking oil, spaghetti, hair dye, shirts, toys for the kids, potatoes, watches, earrings. We don’t always do it and it is never anything big – just a culturally appropriate “hey, I was thinking about you while I was gone” kind of thing.

19. Record our mileage and expenses from the trip.

20. Clean out the car – throwing out the old ordre de mission, and all the trash that accumulates from traveling and eating as you drive. Also good to check and make sure you have an adequate supply of TP and hand wipes for the next trip.

It usually takes us about 2 – 3 days to accomplish all of these tasks, and one of the many reasons that we think hard and long before taking a trip here in Guinea.

Fixing Our Eyes - Thoughts on the Ebola Crisis

A few months back, I was having some quiet time in the morning and was reading about Peace.  I read the following from the book “Jesus Calling” – “Thank me for the gift of My Peace, a gift of such immense proportions that you cannot fathom its depth or breadth.  When I appeared to my disciples, it was Peace that I communicated first of all.  I knew this was their deepest need:  to calm their fears and to clear their minds.  I also speak Peace to you, for I know your anxious thoughts.”

The semi-recent Ebola outbreak in West Africa has taken center stage in the news.  We really had no idea how much because we have no internet access (other than sending or receiving email) in the village. Most people have no idea where Guinea is on a map.  We began to hear that it was making news across the world, somewhat clued in by the rash of emails asking about our safety and proximity to the virus. We just had NO idea what a splash it was making until we went to the capital last week.  It is right that it should be a leading news article.   This is an Ebola epidemic of epic proportion and many are dying.  The numbers increase daily and there is no cure!

As I read through the articles, news and postings over the past week, a few thoughts struck me.

1.       The majority of the American news reports seem focused more on keeping it out of the US than on concern for the people who are suffering with the disease and others who are battling against it.  That obviously is a generalization, and not the view of everyone, but seems to be a common thread.  It is amazing the level of self-protection that arises in a crisis.  Not that I want it to spread to the US, (though that seems unlikely) but still.  Are most people outside of West Africa concerned for those in the midst of the fight – or just concerned about keeping it out of their borders?

2.       It seems to have sparked an interesting debate on the value of serving overseas.  One of the most prominent articles catching people’s attention was written by Ann Coulter.  While I did not read her complete article, I read a response article called “Are Christian Missionary Narcissistic Idiots?”  It is an interesting read- a little long – but worth it none the less.

Situations like this are really very troubling and heart wrenching for most missionaries who serve overseas.  What is the right answer?  Do we leave - hoping to avoid catching this horrible disease?  Do we stay – and do what we can to help?  Are we “safe” here?  Is “safety” what God calls us to strive for?  What is wisdom?  When are we acting in fear?  

If we decide to leave, what do we say to our national friends?  “Goodbye and good luck.  Hope you don’t get sick.  Sorry that we are leaving and taking a lot of resources with us.  We know you are scared – but we can escape, so we will.”

If we decide to stay, what do we say to our kids, family, friends, and supporters?  “We don’t feel right leaving – we just hope we don’t get sick.  We will do our best.”

Fear takes over – not just fear of Ebola, but fear of making the right decision!  Don’t want to run – don’t want to overstay if it is not safe.  All of it makes me a little twitchy.  I am a nurse in a small clinic in a small village.  I have not knowingly taken care of an Ebola patient.  We are prepared with protective gear - but there are no guarantees in life.  I watched the news as a missionary doctor and another woman working in health care in Liberia fell victim to the disease.  

That news scared me a little – not because they were American, but because they were medical people who knew what they were dealing with and had taken precautions, yet still got sick.  Just a few days back I got sick – runny belly, nausea, achiness – not uncommon symptoms in West Africa.  Any other time, I would not have thought anything of it.  But this time, I was mentally reviewing every patient I had seen recently, scanning in my mind to see if I thought they might have Ebola.  I knew it was not overly rational, but that was the first place my mind headed.

This is really the first time we have had to deal with these questions in the medical realm, though the political situation in countries like this often bring those questions to the surface.  Several years back, we chose to evacuate out of Guinea, on the advice of the US Embassy, because of political instability.  At that point, we were very comfortable with our decision – made even clearer for our family as we sat alone in a guesthouse – listening to constant gunfire around us.  For others, the choice was harder.  They did not feel in danger.  Some chose to wait it out.  Others left.  

In all situations like this – be it political or something like Ebola - there are no easy answers.  Some will chose to go and some will chose to stay.  We continue to wrestle and pray and ask for the God of Peace to give us His peace and wisdom – and to extend it to our families as well.

Lost in Translation

I recently had a rather difficult and interesting experience with a baby delivery.  

 Frankly, I am at the point in my language learning that I feel fairly comfortable in conversations – especially in the medical realm.  Often I bump into words or concepts that I don’t know, but I know enough Yalunka to allow me ask questions and figure out the meaning -usually.  I have come a long way from our first year in the country – where I felt lost a lot of the time. 

 In our new village, though, we are suddenly being exposed to two new languages that I am being challenged to learn.  At first, it was just going to be Pular (spoken by the Fulani tribe that surrounds us) so I set out to add that language to my Yalunka and French.  Fortunately, many of the Fulani also speak Krio – a language that I grew up speaking in Sierra Leone (well, actually a mix of 40 languages that has become one language).  Speaking Krio has saved me many a time as I encounter a Fulani in a medical situation.  

 I have a basic understanding of Pular now and can understand a lot of what is being said in a medical context and can communicate on a toddler level about how to take medicines.  Now, however, as our patient base broadens, the Malinke language (the trade language in the bigger towns in this area) is being used more and more.  Seriously????  I am not that smart!  SLOWLY I am recognizing more and more words in Malinke and can usually communicate how to take medicine –as long it is only one or 2 pills – and taken not more than 3 times a day!

On Friday, a Fulani man came to get me to tell me that his wife was in labor and waiting at the clinic for me.  “Dr.” Sana, the other healthcare worker, was out of town.  I arrived to find a young woman sitting quietly on the porch of the clinic.  One of the midwives arrived at the same time as I did.  We opened up the clinic and go the woman settled on the floor – lying on top of an old tablecloth.  I was beginning to feel frustrated as I tried to talk to her.  I could tell from her medical record that she was full term – and that this was her 6^th baby.   

When I tried to ask how long she had been in labor, and if her water had broken, I was not getting clear answers from anyone.  It was about 6 pm when we arrived in the clinic.  I was tired from working all day, and the midwife was exhausted from not sleeping the night before and from working all day. Added to that is the fact that we are at the end of Ramadan, the month of fasting for Muslims.  All of those things added together to make the midwife a little crabby and not super willing to help.

After getting her settled, we checked progress with her labor.  She was barely dilated.  The midwife wanted to send her back to her home – quite a distance from the clinic.  I said, No, let’s see how she does for a while and if things are going slowly, we can send her to stay with friends here in town.  That way I knew that she could get back to the clinic quickly if needed.  We hung out for about an hour and then check her again.  She had made quite a bit of progress in that hour and was now dilated to 2 cm.   

Since it was her 6^th baby, I wanted her to stay a while longer.  The midwife was quite put out and fussy.  Within another hour, Dr. Sana showed up and we checked her again.  She was about 3 -4 cm.  Dr. Sana and I decided that she was still a little ways from delivering, but that she should stay at the clinic, based on the progress that we had already seen.  With that decided, Sana went to bed (in his room in the clinic) – telling me to call me if we needed him.  He too had been up all night the night before and had just returned from another village with his wife – having to walk the last few miles in the decreasing daylight because their motorcycle broke down and they had to push it home.

By this time, the two other midwives in training had showed up and they were all crabby.  They wanted to send Kadiatou home.  They all insisted she wasn’t really in labor.  Darkness was coming, which meant that it was reaching the time they could break their fast and eat for the evening.    I insisted that they go and eat.  Reluctantly, they agreed and took off, leaving Kadiatou and I alone in the dark clinic.  I was a little frustrated at my lack of ability to communicate, but was thankful for peace and quiet with the three fussing midwives gone.  (Side note here, if I had been up all night the night before and fasted all day, I would likely have been crabbier than they were at that point.)  I settled down on the floor beside her to wait.  She would rest, and then a contraction would hit and she would reach for my hand.  I sat there, praying for her and for the village.

Another hour slipped by.  She was getting increasingly uncomfortable, and so was I.  It was getting late.  I was tired.  The mosquitoes in the clinic were terrible.  I was hungry.  One by one, the midwives came back from eating.  I decided to take a break and come home for a bite to eat and to grab some bug spray.  I returned to the clinic and we sent the two midwives in training home.  Kadiatou didn’t seem to be making a lot of progress, though she continued to have lots of contractions.  I still could not ask her how she was doing.  The midwife settled down to sleep on a patient bed that was in the next room.  I got an old plastic tablecloth and lay down on the floor at Kadiatou’s head, so she could reach my hand if she needed.  I quietly tried to encourage her – knowing that she didn’t understand what I was saying.  I could feel her watching me in the dim light emitted by a small lantern.  

As I lay on the hard, cold floor, I could hear the mosquitoes buzzing in my ears.  I could see spiders crawling on the walls and floors and see other bugs zooming towards and away from the lantern.  I looked over to see a centipede making its way toward my head.  I grabbed my head lamp and smashed it – smelling the nasty odor they emit when killed.  I was exhausted, but sleep wouldn’t come.  I was frustrated that I couldn’t really ask how she was doing.   

Every once in a while, she would tap my hand and look at me pleadingly, asking me to check her progress.  I would check, but explaining what I was finding was difficult.  The baby was coming SLOWLY – I tried to explain with gestures.  I dozed a little, waking up to find Kadiatou throwing up all over the floor by my head.   

I looked at the clock.  It was after 1 am.  I woke the midwife up.  We needed to make a decision about what to do.  We could barely reach baby’s head when we examined her.  It seemed that we were still a long way away from delivery.  Did we keep her at the clinic or send her to a friend’s house?  I wanted to go home, leaving the midwife to sleep in the clinic on the bed – NO go.  She wouldn’t let me leave.  She said – it is YOUR fault we are still here.  I wanted to send her home a long time ago but you insisted she stay here.  I don’t think they baby is coming tonight.   If YOU go HOME, I go HOME.  

 Okay then…… I tried to ask questions of the mom and granny with her – translating through the midwife.  I could understand enough Malinke to know that what I was saying was NOT was the midwife was passing on.  I was getting more and more frustrated.  I felt like I couldn’t get a good handle on how mom was doing and what she wanted to do.  This was her 6^th baby, after all.  It wasn’t like she was a newbie at this.

In the end, we decided to send her to friend’s house in town – knowing that she would only be a few minutes away if she needed to come back.  We told them to come back in a few hours. Kadiatou looked uncertain.  I gave her a few Tylenol.  I debated about waking up Sana to talk to him about it – but decided in the end that the midwife and I could make the decision.  I wrote him a note and slipped it under then door.  She was having lots of contractions and in the back of my mind, I wondered if we were doing the right thing.  But the progress seemed to have slowed, and I knew that she would be just up the road from the clinic, so I sent her on her way and we took off for home.

I got home and fell into bed, exhausted.  I woke up at 7:30am – anxious about Kadiatou and how she had done through the night.  I wondered if they had arrived back at the clinic.  I tried to sit down and have my quiet time and drink some coffee, but I couldn’t concentrate.  I felt like I had failed her.  I should have tried harder to communicate.  I should have insisted that the midwife work harder to talk with her.  I got dressed and ran to the clinic.   

As I passed one of the in-training midwives, I asked how Kadiatou was and if she was at the clinic.  She looked at me funny, and said, no.  I arrived at the clinic and met the midwife.  I asked about our patient.  She started laughing.  Apparently, Kadiatou arrived at her friend’s house, and delivered the baby about 15 minutes later.  15 MINUTES!  

 I felt very stupid.  How did I miss that?  Now I really felt like I had failed her.  How horrible it must have been to know that the baby was coming and to be sent home by the white lady who is supposed to have a clue about delivering babies!  I knew I needed to go and see her, even if I could barely face her.  I asked which house she was in, but they said, wait.  They had sent someone to bring mom and baby to the clinic.  I sat and waited.   

Soon she showed up.  Baby was SO beautiful – a big, healthy boy.  Mom had a BIG smile on her face and thanked and thanked me.  For what????  I wasn’t sure.  The baby was naked, wrapped in a blanket, so I dressed him in a little baby outfit donated by friends in the US.  I told mom in Yalunka how beautiful he was and what a great job she did.  I know she didn’t understand, but I saw her watching me hold and kiss on her baby.  She was smiling and she was thankful.  I was blown away.

I learned a few things through that experience….

1.        I need to listen to my gut more.

2.       I need to work harder to find out what is going on my patient.

3.       Babies do seem to have a mind of their own.

4.       People here are very gracious if they fell like you have tried to help.

5.       Despite my lack of understanding a mutual language with her, I was somehow able to at least communicate that I cared and wanted to help.  She saw that and forgave my mistake.

May I be as gracious to others!

Creepy Crawlies and Things That Go Squish in the Night

I came to Africa knowing that I am not a big “bug” fan.  I am not terrified of them.  I just don’t really like them.  Granted, I had fun making my “bug” collection in high school and I CAN appreciate their contribution to society – circle of life and all.  But if we could figure out a way to get rid of them without destroying the environment, I would be okay with that.  Lying on the clinic floor the other night at midnight, bugs crawling all over, I began thinking about what I DO NOT like about these little creatures…

So in NO particular order, here is a top ten list of my least favorite little creepy crawlies……

1.       Ants – Africa seems to have an abundance of ants.  Some are tiny and are quite large.  We currently have a nest of red sugar ants in our kitchen under the counter (which we thought we had gotten rid of but rediscovered yesterday when I inadvertently flooded the kitchen floor by leaving a faucet on.  When the water ran under the counter, it pushed out lots of these big red ants with their eggs – NASTY!)  

      There are also driver ants – which are black ants that travel in thick lines.  There are little ones and big soldier ants that form tunnels over the rest of them.  They are very destructive to anything in their paths.  They have been known to eat chickens and other animals live and strip their bones bare.  If you get in the middle of them, watch out.  Sometimes they crawl up your legs until they hit a tight spot – i.e. a belt or something – and then they bite!  And they hurt – and they are hard to detach from your body.  I am told that in the past, people used to use the big soldier ants as sutures – they would place the ant on a cut, let it bite down, and then pop off the body – leaving the pinchers and head in place until the cut healed.   

      

       Driver ants are prevalent during the rainy season.  (It can be kind of funny – in a sadistic sort of way – to watch someone else who wandering unknowingly into driver ants – people will strip off their clothes in no time flat to get the little biting things off them!)  The other day, they were all over our back porch- and starting to come into the house. (We can often tell when driver ants are around because we see crickets, spiders, and other insects in abundance on the walls, trying to get away from the ants.)  If we weren’t at home, they would be welcome to come through my house, and clean out any rodents or roaches that might be present. However, we were home, so were less interested in that prospect.

2.       Spiders – I can do some spiders.  We have a big wall spider that lives on our bathroom and I know he eats mosquitoes.  I don’t bother him and he doesn’t bother me.  I do not, however, like spiders who scurry at me, or whose eyes reflect back at me when I am walking at night.  Some spiders here get very large- as big as your hand.  I also am not a big fan of the webs they leave in my house – it ruins the decor! I have woken up before with a line of spider bites across my body.

3.       Centipedes – These also seems to come out during the rains.  Sometimes we find piles of hundreds of these nasty little things.  They come into the house and leave a bad odor when you kill them.  (One of them was approaching my head as I was lying on a plastic sheet on the dirty clinic floor the other night – waiting for a baby delivery.  I quickly smashed it, but had to live with the lingering smell for a while.)

4.       Mosquitos – thankfully we don’t have many mosquitoes in our house.  At night, we sleep under nets to keep them away.  But the clinic is another matter.  I have been there two times at night recently in the rainy season for baby deliveries and the mosquitoes are horrible.  They bite constantly and they buzz in your ears.  When Lizzy and I were there the first night, she got over 30 bites on one foot alone.  So now I carry bug spray in my baby delivery bag – I am fairly certain that is not standard protocol in the developed world!  On top of that, they carry malaria, which kills so many people here.

5.       Other flying insects – Can’t stand little flying bugs that fly into your eyes or ears at night.  These also bring out bats – another creature that I CANNOT stand – especially when you are outside at night and can feel the wind created by them flying by your face!)

6.       Grasshoppers – These little things are wreaking havoc on our garden.  They need to go away!

7.       Caterpillars – Black caterpillars are all over right now.  They will sting you with their hairs if you touch them.  As a kid growing up in Africa, we were told – and put into practice- that if you were stung by a caterpillar, you should cut it open and rub the guts on the sting.  It seemed to work, though I must say that the thought grosses me out as an adult!  On top of eating my garden, they come in the house, and if you step in them, their guts stain the floor for a LONG time! 

8.       Worms – worms are disgusting, especially when they are coming out of a person, crawling under their skin where you can see them and trace their path, or crawling across the whites of people’s eyes.  Enough said!

9.       Flies – Flies are just gross!  You can see them landing on poop – and then they land in our house, on our food.  They are abundant in the clinic – where people come in with festering sores.  We are also having rodent problems in the clinic, so Sana put out rat poison, which was effective, but the rodent died somewhere we could not see, and is currently decaying there – leaving a horrible smell and drawing all kinds of flies!  One day, I was helping to take care of a little girl who had burns covering at least half of her body.  We washed her and bandaged her.  The smell was overwhelming and the flies were everywhere.  The person I was with asked me to pray for healing for her – so I did.  As I opened my mouth to start praying, a fly flew in and I swallowed it.  It gagged me – thinking about where that fly had landed first!

.  .    Toads and frogs – Not a big fan of toads.  Whenever I see one, I look around for a snake following it – trying to catch and eat it.  That is likely from watching too many National Geographic shows.  It is unnerving at night.  Frogs are not so bad.  In fact, I find tree frogs quite cute.  However, I had a rather bad experience with one the other night.  I woke up in the middle of the night to go to the bathroom and discovered a tree frog on the wall in our hallway.  Not sure how he ended up there – as he was a long way from a tree of any kind.  Since I think they are cute, I decided to spare his life, so picked up a trash can so I could move him into it and carry him outside. 

       By this time, Hannah was also awake so I asked her to help me.  We got him in the bucket, and I was feeling quite benevolent as I carried him to the back door.  I opened it to let him out and suddenly felt a nasty squish under my heel.  I picked up my foot and we discovered the tree frog – now quite flat and flailing about – on the rug.  Apparently he had jumped out when I was not looking and landed right where I was about to step.  If you have never stepped on a frog in the middle of the night in your bare feet, I DON’T recommend it.  It is quite a disgusting feeling – I have to say. 

       I was so grossed out and was begging Hannah – who was laughing hysterically, to please get me something to wipe the guts off.  We flipped him off the rug and he was immediately eaten by a cat.  Turning back down the hall, we found another frog.  Strange, because we have never had a frog in the house before – and here we had 2!   I made Hannah carry that one in a bucket – though, because of her prior knowledge about the jumping abilities of tree frogs and her bare feet – continuously tapped on the bucket with a shoe to keep it in.  We were congratulating ourselves for releasing it without incident – watching it hop away – when BAM, it was snatched by another kitten.  Circle of life, I suppose!

Anyway, try as I might to appreciate the good they do, I would be a happy woman if my daily life didn’t not involve any of the aforementioned creatures – especially in the dark!