Cultural Studies

Although we have lived here before and we have some experience with the culture and customs, it seems every day there is some new cultural lesson to be learned. Often it is simple and funny. Other times it is complex and sad. There have been a few funny ones happen since we got here. 

When Tab first started working, she went around greeting people. One of the people that she came to greet did not 'recognize her shape'.  Apparently, she is bigger than she used to be. I spent the first couple weeks here, sick with various things. I lost about 15 lbs. Someone remarked to me that I have shrunk to my familiar size. Yeah, I get it, we are getting older and bigger. 

One morning one of the ladies that helps keep our house clean, told me about how her daughter-in-law had a pain in her stomach. I didn't really think that much of it. Later on that morning she started a story about a trip she took to a local village that eventually involved her daughter-in-law having more stomach pain. I did suggest that we pray for her and so we did. She mentioned in her prayer that Tab would help her. I was a little confused. Slowly I began to realize that she was sick enough to see a doctor and was in fact scheduled for an operation that morning. Tab was to be her surgeon. I think there was an assumption that I already knew all about it. However, out of a respect for privacy and habit, my wife never actually tells me anything specific about any patient, here, or at home. So, unless you tell me about the surgery that Tab has done to you or your friend or family, I will have no idea that it has happened.  Anyway, she kept bringing it up because she was hoping that I would give her some time off to go take care of her grandson while his mother was in surgery and father was at work. I didn't really put all this together until she called her son, who speaks perfect English, to ask me if she could have the rest of the day off. Of course I agreed, and I would have happily given her the whole day off if I had realized at the time that she was indirectly asking for fear of insulting me or being rejected. Tab said the surgery was a success and she should make a full recovery. 

Spinach Trees

During many months here it is difficult to find a variety of vegetables. Cabbage and cucumbers seem to be available almost year round, but can be expensive. Nigeriens use the leaves of various native plants and trees, such as baobab leaves, to add to sauces.  A few weeks ago, I learned from a friend that the leaves of one of the trees on the compound can be cooked and used like spinach. So, I decided to try it.

According to Wikipedia;
"Cnidoscolus aconitifolius, commonly known as chaya, tree spinach, or spinach tree, is a large, fast-growing and leafy perennial shrub. Chaya is one of the most productive green vegetables. Young Chaya leaves and the thick, tender stem tips are cut and boiled as a spinach. It is a tasty vegetable and is exceptionally high in protein, calcium, iron, and vitamin A. In fact, levels of Chaya leaf nutrients are two- to threefold greater than any other land-based leafy green vegetable."

The kids enjoyed gathering leaves from the several Chaya trees around the compound.

Unfortunately, the leaves cannot be use for fresh because raw chaya leaves are toxic- they release cyanide when eaten.  But, if the leaves are boiled for 5-15 minutes the cyanide is inactivated and the leaves are safe to eat. 

Boiling the out the cyanide!

I put some "spinach" in a tuna quesadilla for lunch. Juliet and I liked it- it doesn’t have a very strong flavor to me. However,  Luke strongly disliked the flavor. Too bad. I guess we will  have to continue with a mostly cabbage and cucumber diet for now...although I think I will continue to experiment a bit with the "spinach tree" to see if there is a better way to serve it.  

Some Good News

It feels like we are witnessing miracles when some of our sickest patients survive.

Owen* is a severely malnourished boy with intestinal perforation from typhoid. He was so weak he couldn't even sit up in bed.  We fixed the hole in his intestine and closed his abdomen. Unfortunately, his tissue was so weak from malnourishment that his stitches eventually tore through and  a week after his surgery the abdominal wound opened up exposing his intestines. 😔We put a vacuum suction dressing on to keep his intestines inside.

With good wound care and nutritional supplementation he slowly improved to where he was sitting up when we came by on rounds.

Here he is a a couple of weeks later- ready to get his wound VAC removed and to be discharged to the nutritional rehabilitation center: 

One Day...Every Day

A typical work day in Galmi...

Most days start with an hour-long resident teaching conference, followed by rounding on the surgical patients. At any time, there are about 80 surgical patients in the hospital, divided into three teams. So, I end up seeing about 25-30 patients, which takes 1-3 hours depending on how sick the patients are and how much time is spent teaching. Next, work starts in the operating room and clinic. 

Following are three of the OR patients from one day this week: 

Three-year-old boy with bilateral neck swelling, left neck abscess. We drained the abscess, which turned out to be mostly an infected tumor- likely lymphoma.😔

35-year-old man with bowel blockage. He had been in the hospital in another country, but refused operation there so he could be seen at Galmi Hospital. He was actually feeling mostly better by the time I saw him in clinic a few days later, but since he had no prior surgery, an operation was needed to figure out the cause of his recurrent obstruction.  

A mass blocking his intestine. Likely cancer. 😔 He recovered quickly from the operation, but unfortunately his prognosis is quite poor since chemotherapy is not available. 

25-year-old woman in labor with severe heart failure of pregnancy. She couldn’t tolerate spinal anesthesia because of her heart failure, so her twins were delivered by C-section using only local numbing medication. Both babies were beautiful, perfectly formed, and appeared full-term but hadn't survived the labor. They had clearly died several hours before the mom made it to the hospital. This was her fourth pregnancy. All three of her other babies were also deceased (I don’t know the reasons, but, death in children under 5 is not that unusual here).   😩🥺💔

Typically tragic. 

Small Happenings

It’s been a fairly busy last couple of weeks. We have now gone about one week without any serious illnesses. Yay!  

Following are a few pictures of random happenings over the last week or so:

It’s rainy season and the rains have come just in time. The plants that were starting to wither away have come back to life and are flourishing. We are planning to plant some beans in the garden space next to our house. To get the space ready, or neighbor’s cows and sheep have been coming over to munch down the grass. 

Can you guess what food our kids miss the most? Hot dogs.

The kids (especially T) were very excited this week when, by special request, some friends procured a few packages of frozen hot dogs from the big city a few hours away. They were a big hit. We now have some stored in the freezer for special occasions. 

Chicken hot dogs- imported from Brazil, apparently! 

Weaver birds are busy making nests in a tree right outside the surgical ward. They are very noisy and fascinating birds.

You can't really see the birds well in this picture- but there are dozens of bright yellow birds chattering away and building their "upside down" nests. You can read more about them and see a better close up picture on Wikipedia here.