Saturday, August 25, 2012
Thursday, August 23, 2012
Katy's Conclusion
Going to Niger was not hard. Leaving was hard.
Seeing the oppression and poverty was not difficult. Leaving people in that state was difficult.
I am glad that we have stories and pictures now to be able to spread the word about Galmi Hospital. Because people need to know. People have reacted with horrified surprise that a place as abjectly poor as Galmi exists. How can you care about people you do not know are there? Or respond to a need you do not realize? We and you are no longer ignorant. We can no longer say we do not know. Please don't pretend you don't know.
I'm so thankful to have been able to visit Galmi and work in the hospital there. There is so much suffering that I do not have words for it. There is so much compassion and love too.
I am so astounded by how much wealth we have here in the West. How can poverty like what I've seen here still exist? Seeing these people of Niger - their courage and strength - it sets a fire in your heart. And this fire I've got isn't going out.
I don't know how to conclude, or how to sum up my thoughts in a quick blog post about Niger. But actually I don't really want to wrap up Niger in a little box and tie it with a bow. I am not concluding then, because I am not ending my connection or relationship with Africa. I am not cutting myself off from the oppressed or the marginalized or the poor to pretend they don't exist.
So here is to beginnings. Cheers.
Seeing the oppression and poverty was not difficult. Leaving people in that state was difficult.
I am glad that we have stories and pictures now to be able to spread the word about Galmi Hospital. Because people need to know. People have reacted with horrified surprise that a place as abjectly poor as Galmi exists. How can you care about people you do not know are there? Or respond to a need you do not realize? We and you are no longer ignorant. We can no longer say we do not know. Please don't pretend you don't know.
I'm so thankful to have been able to visit Galmi and work in the hospital there. There is so much suffering that I do not have words for it. There is so much compassion and love too.
I am so astounded by how much wealth we have here in the West. How can poverty like what I've seen here still exist? Seeing these people of Niger - their courage and strength - it sets a fire in your heart. And this fire I've got isn't going out.
I don't know how to conclude, or how to sum up my thoughts in a quick blog post about Niger. But actually I don't really want to wrap up Niger in a little box and tie it with a bow. I am not concluding then, because I am not ending my connection or relationship with Africa. I am not cutting myself off from the oppressed or the marginalized or the poor to pretend they don't exist.
So here is to beginnings. Cheers.
Wednesday, August 22, 2012
Aug 20 We Go to the Capitol
Aug 20 we go to the capitol:Niamey
Stephen Montgomery
is the Director of Galmi Ministries.
He is a passionate advocate and visionary for the ministry,
CEO/administrator and IT Geek all
rolled into one who has been serving in Galmi for almost a decade. He is the principal promoter of the new
maternity unit.
Chad Windsor
is the chief construction engineer.
He grew up as a missionary kid in Nigeria. He did his stint in the US marines Hooya! Now he and his
wife are raising their two children in Galmi for the last 10 years. The entire hospital complex is being
rebuilt and then the old sections that are falling down are being demolished to
make room for further new buildings.
Chad is bringing a new level of excellence and durability to the hospital
which will ensure that the ministry will continue for many more decades to come.
The capitol of Niger does not have a starbucks, McDonalds or
any fast food we would recognize but it does have “seven-eleven”!!
This is where the SIM HQ is located as well as the national
missionary boarding school : “Sahel”. We went to the US Embassy Rec Center
for dinner, RnR and to visit with a broad mixture of missionaries and global
community. We caught up on the Olympic
standings and Nascar, we watched some international “church league softball”. We shopped for souvenirs at the “Grand
Marche”.
SIM Air
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| Parker, another missionary headed to Galmi, and Katy, before take off to Galmi |
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| Brad checks the propeller |
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| Katy |
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| We wear matching blue plaid |
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| On the way back from Galmi to Niamey Katy falls fast asleep |
We are flying from Galmi to the capitol: Niamey
Aug 19
SIM Air
Kevin Rideout knew that he wanted to be a
missionary pilot when he was 12years old.
He grew up as a missionary kid in Nigeria and was fascinated by the
missionaries who did their service in the air like angels delivering what was
needed, people and supplies just in the nick of time. Kevin studied the specialized field of
mission aviation at the Moody Bible College, one of only two suh programs in
the US. Currently, He is the sole
pilot running Niger SIM AIR the main provider of air courier service thoughout
all of West Africa. His partner is
due back next week and his brother is about to join him as well. He and his wife are raising their 4 children here in Niamey
while he flies to a variety of mission stations all over western Africa. They have 2 (sometimes 3 planes and
pilots ) They put close to 1,000 hours per year in the air flying a Cessna and
a Piper. There are probably less than
500 people in the world that do what he does: fly little planes, heavily loaded
for many hours long distances in very extreme conditions and very remote from
all support and in multiple very foreign countries. He does all his own maintenance and repair and must administer
a complex program with a quarter million dollar budget which operates on a
shoestring in the sense that most of the money goes for fuel and maintenance of
his 20yr old aircraft with very little left for extras or miscalculations. If Chad Wnsor, Stephen Montgomery
and Kevin Rideout were not doing what they are doing in support of the Galmi
Mission Hospital then it would not be able to have the impact that it has had
over the last 50 years.
Pictures- Joe, Esther, Newborns
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| This is part of a newly built wing of the hospital. It is not finished yet, so it is not in use yet |
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| Dr. Starke shows Katy around the new building |
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| Brad and Dr. Starke were classmates in medical school. It's that connection that helped us hear about, and travel to, Galmi |
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| This is the foundation of a new radiology building. It is being filled with dirt |
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| The construction crew works long hours of manual labor. The hospital is so grateful for their dedication |
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| Here you can see that the foundation is almost completed |
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| Chad, an ex-marine, is an SIM missionary and construction boss. |
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| He grew up in Nigeria as a missionary kid and has served in Africa and Galmi for many years |
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| Esther, the gynecologist, checks in with a patient in the hospital |
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| Esther personally checks in on her entire ward every day with an entourage of nurses and that cart. This area is the overflow ward. There is not enough rom for these patients in the hospital. |
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| The OB Ultrasound machine is badly in need of replacement due to its age |
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| Healthy newborn! |
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| New baby in the incubator in the one-room neonatal ward |
Tuesday, August 21, 2012
The Worst Place on Earth to Be a Mother
The Maternity Project
The United Nations has rated Niger as the worst place on
earth to be a mother (Norway is the best). It is a complex calculation. The main factors are the very
high death rate of pregnant women and their babies. Other issues are the very extreme lack of health care access
and the multiple ways that the women are oppressed with lack of opportunities
such as very low literacy/education.
Malnutrion and high malaria/TB/HIV all disproportionately affect women. Women having babies suffer in ways we in
the USA just cannot understand, it is beyond our frame of reference or ability
to understand.
SIM Galmi Hospital has had maternity care at the core of
their mission for 50 years and for the last 2 years has been their top priority
in gearing up a new effort to make an impact on behalf the women and children
in their district. A team of US
engineers has designed a new Maternity unit. The fund-raising is well on its way they have raised about
one third of the necessary $250,000 needed. The foundations have been poured for the new
facility and if additional funds come in the project could be ready by the end
of 2013!
Stephen Montgomery
is the Director of Galmi Ministries.
He is a passionate advocate and visionary for the ministry,
CEO/administrator and IT Geek all
rolled into one who has been serving in Galmi for almost a decade. He is the principal promoter of the new
maternity unit.
Chad Windsor
is the chief construction engineer.
He grew up as a missionary kid in Nigeria. He did his stint in the US marines Hooya! Now he and his
wife are raising their two children in Galmi for the last 10 years. The entire hospital complex is being
rebuilt and then the old sections that are falling down are being demolished to
make room for further new buildings.
Chad is bringing a new level of excellence and durability to the
hospital which will ensure that the ministry will continue for many more
decades to come.
Newborns and Cholera
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| New mama sporting sutures after her successful c-section |
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| Katy and Esther check in on a new patient who has been tentatively diagnosed with cholera. One cholera patient easily turns into a thousand, so the situation is being carefully monitored. We can only hope that the disease is not in the town well, but that this is an isolated incident. |
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| Katy coaxed a smile out of this little girl, and was so excited about it |
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| Grandma holds her newborn grandchild |
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| Newborn! |
C-Sections at Galmi
Aug 17
What is a Galmi C-section like?
Most of the time the Nurse midwife makes the decision that
the woman needs a c-section. She
has been managing the labor for many hours or else has done the initial
evaluation after the patient presents.
95% of all deliveries in Niger happen at home. Women only come to hospital if there is a problem. Most patients present for the very
first time after many days at home in labor. Sometimes the baby has died during a very difficult time of
pushing for several days. Often it
is a very long and difficult journey many times impossible, that is women never
make to hospital. The woman is
carried or rides in a donkey cart for many hours or days. There is no ambulance to go to their
home/hut nor taxi service.
The majority of anesthesias are by spinal.
Sometimes, when a spinal cannot be done ketamine is used which induces a
stupor but allows the patient to continue to breathe and is sometimes
inconsistent in how much actual feeling remains. In Galmi the OR is large and well lit. There is a betadine
prep and the nurse anesthetist says a prayer, usually very fervently, for the
patient and the procedure.
Usually the skin incision is vertical because it is faster
and more simple and allows better exposure if there are complications which do
happen frequently. Usually the
uterus is incised in the lower segment transversely just like in the US. Meconium stained fluid seems present in
the majority of c-sections because they have almost universally been stressed
pretty significantly. There is a nurse
present to receive the baby but she is not in a sterile gown like we do in the
US. Therefore, when the baby is
handed off by the surgeon or assistant we must be careful not contaminate
ourselves and so the baby is passed in the old fashioned way seen in movies:
upside down held by the ankles!
Most of the surgeons try to close the uterus in one layer especially if
there is going to be a tubal since they want to conserve suture. I did all my uterus closures in two
layers since that is what I know best how to do. Tubals are common because it is very dangerous to have more
than 2 csections. Closing the
abdomen with the vertical incision is easily and quickly done in one simple
continuous baseball stitch layer.
This does not always give the best looking scar but it is a very
effective and practical closure.
Like in the US most of the time the skin-to-skin time is
about 30mins if all goes well. But
it is common for there to be serious bleeding problems because the uterus does
not always quickly stop bleeding since it has often been in a state of
hypertonic contraction for days and has a propensity to tear and bleed. Patients do not automatically get
pitocin. Drugs to stop bleeding
such as hemabate and cytotec are
often in short or non-existent supply. So it is common to spend 45-60 mins
operating while a blood transfusion is in progress. It is common for women to start with an Hct of 10% (or even
lower!) because of malaria and malnutrition.
In addition to the OR time, just like in the US, there is
the time to get to and from the hospital and go to the changing room for scrubs
and plastic apron, washing hands
is done with regular soap, gown and patient assessment and patient prep and
drape. After the surgery is some post op care and paperwork, changing and
leaving the hospital. So usually
the call to come and return takes 2 ½-3 hours.
On Friday August 17 I did AM rounds and found that one of
the babies I had admitted during Thursday’s afternoon clinic with cerebral
malaria had died. I discharged
three who had made it through the night and were much better and got a second
opinion on one more infant who was not getting better, being told to be patient
and keep doing what we were doing: quinine for malaria, antibiotics and
nutritional support. Then we had clinic.
After AM clinic
I did a C-section for a woman who presented with a previous C-section. This was her second C-section and so
was obligated to have a tubal. Her
baby unfortunately was stillborn and had been dead for several days such that
there was already some decay and infection and a horrible smell. I was in afternoon clinic which overall
was light but did include a 5 year old with an Hct of 11% who I admitted for a
blood transfusion and Quinine for malaria. Later, I went on a walk-about thru the Galmi village.
Next I did another C-section in the afternoon, which was a
primary c-section, that is a first one, done because this woman had had two
previous stillborns. Happily this
baby was alive and well. Then after a brief time to freshen up we were guests
for dinner with our friends Joe and Mame Starke. Joe was a medical school classmate of mine and he is the main
reason I chose to come to Galmi to be able to visit my good friend and assist
in his ministry. We had a
wonderful time with great food and conversation and were just starting our
prayer time when I was called in to do another c-section for a woman who had
been in labor for many days. Her
baby was stillborn and it was difficult to control the bleeding and I was
exhausted when I got home after midnight.
I was called to the OR one more time at 3AM to come in for a
repeat c-section which was just a bit over the edge of my functional
capacity. I got back to bed after
5am and got up at 7:30 to get ready for morning rounds and find out if the
little 5yr old had survived the night.
We both had!
This time in Africa has not been about me doing some great
service. The main event has been
to be present in a place where Gods Spirit is working in a powerful way through
the lives of the fulltime missionaries that live here with their young children
and work day in day out, year after year for these suffering women and
children. I spent most of my time
with Dr. Kendrick Lau. He has been in Galmi for 12 years and
is the Chief of the medical and pediatric depts. He and his wife have 4 children under 13yrs living with them
in Galmi. He is a family physician
and an expert on tropical disease.
He is the hardest working physician I have ever met. His primary language is English but is
fluent in French and Hausa. He
also studied Mandarin in his spare time.
He engages the patients in their own language and is constantly
interrupted with questions about staffing, supplies, and running of the
hospital while he carries the heaviest patient loads, and oh yeah, gets to
orient and supervise the new guy (me) to be sure I don’t kill anyone.
I was also blessed to work alongside Dr Esther Pflaum.
She is a Swiss OB/GYN who worked in Papua New Guinea for many years and
then came to Galmi because she believed it to be the neediest place on
earth. She is the chief of the
maternity unit. She is the only OB
doc and overseas all of the midwives and the 2,400 hospital
deliveries/year. She also manages
all of the newborn care. She has
been in Galmi for about 10 years.
Every morning she personally rounds on every patient in the maternity
ward (approximately 50 women and another 30 children!) . She speaks to the patients with great
compassion and very practical wisdom and expertise, which is applicable to the
context of these women and their children. The women she has personally ministered to is in the tens of
thousands and if you count all the people she has trained and the ripple of her
impact it must be approaching half a million!
In clinic I also worked daily with Dr Matt Megill an internist who is an expert and chief of
the HIV division which is a fulltime job and includes pedes, even newborns and
pregnant women, in addition to adults of all ages. Managing AIDs patients is very complex because every part of
the body is affected and the variety and severity of infections and even
cancers and other organ failure problems are all intertwined and the treatments
are often different than they would be in a standard case, and this is all done
while taking very complex multiple anti-viral drug regimens. Matt has been here for about 6
years. He is academically
brilliant and able to quote the latest studies and research in the field of HIV
care. But he is also the first to
directly share spiritual truths and pray himself with patients. Matt does not do OB but does take his
turn for being on call and seeing patients in the regular out patient dept.
Our time in Galmi has been a great privilege because we have
worked alongside saints who may not be equal to Mother Theresa but they would
be playing softball in her league!
Drs Lau, Pflaum and Megill are like David’s Mighty warriors! They are the captains of God’s forces
here on earth. To see them in
action is like being alongside
Achilles in a Brad Pitt movie!!
Wow! It is surreal,
otherworldly—literally.
I am not saying that these brothers and sister in Christ are
perfect, (they might be very sanctified but I do not know them that well). I know that God seems to delight in
using flawed humans like David and Peter.
What I did witness was super-human love in action! They were being powered by the fuel of
God’s grace and burning it up at a rate just like a Jumbo 747 burns jet fuel
during take off! What an honor to see them in action and be inspired to tap
into Gods grace a little deeper.
Friday, August 17, 2012
8/17 Pictures
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| Katy made our dinner last night - rice, corn, and peaches with soy sauce! Mmm tasty! :) |
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| Healthy twins born today! |
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| Goat. It's what's for dinner. |
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| The town well! |
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| If you don't have a donkey to carry your water, you must carry your own water. For drinking, bathing, washing dishes, doing laundry, cleaning your house...it's gallons and gallons of water |
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| Children in the village |
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| Katy updating the blog with her coca - perhaps Coke needs a new ad? We think this could be a winning entry if there were a contest! |
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| Daouda's cousins. Their parents work at the hospital, so they are home alone making dinner and watching "Aquamarine" a movie about a mermaid starring American child pop star, JoJo |
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| Daouda next to the sign for the Galmi SIM Hospital |
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| Millet is made in these huts |
Brad's Friday
17 August, 2012
It is Friday and the last day of Ramadan. Tomorrow is a big celebration. Many people are slaughtering chickens,
guinea fowl and goats for the big feast.
Everyone in the hospital is eager to go home and the out patient clinic
is not so busy. I am on call for
c-sections which tend to keep happening no matter the calander.
I went on one of my village walk-abouts with one of the
hospital evangelists, Daouda. He
is 23yr old university student and a member of the local Hausa church and is the
music director, playing piano and acoustic guitar. He took me thru Galmi village and we ended up at his uncle’s
house. Both his uncle and aunt
work at the hospital and are the only people in town to have satellite TV! His cousins were watching “Aqua-marine”. We conducted the tour in French and I
did OK. C’est bon!
We had a lady come into clinic just pouring liquid stool
behind her consistent with cholera.
She was near death and had two large bore IV’s and saline started on her
Stat and then testing is being sent to the capitol hospital and then on to
WHO. It would be bad if there is a
cholera epidemic starting here.
They already have one of the worst typhoid burdens in the world, worst
malaria and worst TB and top ten AIDs.
This is a very tough place to live mainly all because of the poverty: therefore malnutrition, no education, no access to clean
water, no access to even the most basic health care like immunizations.
More later
Brad
Thursday, August 16, 2012
Surgery and Ultrasound
Brad's Fourth Day
Blog stuff
Dear Friends
I am glad I have Katy with her high energy and propensity to communicate via blog like others breathe air. The last three days have been a bit of a blur. I have been taking call every other. I have no time then I am exhausted and go to bed then I have no time again. Katy has been giving you the gist of it.
The burden of intense pathology and patient care volume is
always at the edge of being overwhelming.
I have seen so
many things that I have read about but never seen in my 30 year career such as
a case of bowel perforation from typhoid fever. Hysterectomy after c-section. Multiple stillbirths, one from an abruption with a
uterus that was in a “bruised state”. Today I operated on a corneal ectopic pregnancy which
blew out the back and side of the uterus causing very near death bleeding. There have been too many cases to count
of cerebral malaria with seizures.
Gotta go to sleep.
More later
Katy has also been chief cook. We had spaghetti one night and today we ate rice corn and
canned peaches. It was
delicious!!!
Brad
HIV in Galmi
This woman has HIV and is very ill. She has become too weak to walk. She came to the hospital to be seen for a painful rectal tear. Examination revealed fluid in her lungs, which suggests pneumonia. On top of her tear, and HIV, AND pneumonia, she also has tuberculosis. She was admitted to the hospital for treatment.
Snake Bite
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Maternity Patients with Esther
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| Esther, a French gynecologist, has been here for many years |
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| Esther with a newborn baby |
Katy's Third Day
Yesterday I shadowed my dad and Dr. Kendrick on their hospital rounds as they checked on patients. The first patient had died just 20 minutes earlier. He was too sick- his malaria too far advanced. Next we saw a young boy, Djamilan, with typhoid with abdominal swelling because of a bowel perforation. They scheduled him for surgery that afternoon. Next was a 16-month-old with malaria who needed a blood transfusion of rare O-negative blood that the hospital didn't have. Then a 6-day-old baby with icthyosis (the same my dad talked about earlier on this blog). The swelling of his eyelids had completely gone away so he could open his eyes. There is nothing we can do for his skin condition except recommend a lotion and tell the parents to keep him covered to prevent infection. He was discharged. Then was a 7-month-old who weighed only 9 lbs. Then a two-year-old who couldn't breathe. The doctors say he was breathing the way people do just before they die. Very sad. Then the emergency c-section. Then my day was done.
My dad went on to complete three more c-sections, a hysterectomy, a third-degree tear, and assisted on the typhoid patient's bowel repair. He was in the OR for something like six hours straight yesterday. Came home totally exhausted. Then got called back to the hospital for another section
My dad went on to complete three more c-sections, a hysterectomy, a third-degree tear, and assisted on the typhoid patient's bowel repair. He was in the OR for something like six hours straight yesterday. Came home totally exhausted. Then got called back to the hospital for another section
Emergency C-Section
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| Beginning section |
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| Power outage. Waiting for generator. |
The woman had tearing and bleeding in her cervix. The doctors, including my dad, sewed up the tear and closed her up, but she continued to bleed. She had a second surgery later in the day to stop the bleeding, which turned into a complete removal of her utuerus - a hysterectomy.
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