Community Barbeque

We have been settling in at Galmi for a few weeks and, unfortunately, most of that time one or more of us has been sick. I guess that comes with the territory. Tab had a full week of work last week and I did a day or so, but, unfortunately, we keep getting interrupted by our kids vomiting on stuff. We have been taking prophylactic anti-malaria medicine for several weeks now but that did not stop one of our kids from getting malaria. We also had some sort of food contamination issue the other day. I was lucky enough not to eat any of the offending food and, therefore, I got to be the one that ran around with buckets and rags cleaning up while everyone else was sick. Thankfully, everyone seems to be on the mend and we should be back to our regularly scheduled programs soon. 

One of the more interesting activities we have participated in lately is a community barbeque. One of our friends has a herd of sheep and one of the lambs got the bloat. There is no vet here and they tried several things, but nothing worked to cure the problem. It was clear the animal was going to die, and the only real option was to euthanize it. 

Typically, the customs here do not allow for eating animals that are dying. In fact, there are quite a few things one must do before butchering an animal for it to be acceptable to eat. There are some good reasons not to eat an animal that is sick especially if you don't know why it is dying. However, in this case, it was just an animal eating the wrong thing or too much of it. I don't think that poses a danger to our health. So, our friend set up a butcher to come cut it up and take it to a man who would cook it. It was all a very interesting process. 

One of the more interesting processes is the cooking part. Back home, there is barbeque culture where people use charcoal or propane or smokers to cook and finish meat. Often people have very strong opinions of what is the best way to cook a hamburger or steak or brisket on a barbeque or a smoker or what-have-you.  

Here, there is also a serious meat cooking culture. They set up a fire very spread out on the ground and put sticks and rods through the carcass making it flat. sometimes they have a grate or grill to lay it on.  They spend hours and hours roasting it next to the fire adding spices and oil quite frequently. Then, when it is done, they wrap it in a paper bag and deliver it to the feast. It doesn't always look great, but I can assure you that it has the tenderness and flavors that everyone can love. 

After the meat was delivered, my friend took the meat off of the bones and onto a serving tray, and since there was so much meat that is best served hot, everyone here was invited to come and bring a side dish. It reminded me of a 4th of July barbeque, with kids running everywhere with food and sugary drinks. It was one of the better meals I have ever had in Niger, not just because of the meat, but also because of the community that was a part of it. 

the nightmare continues...

Well, we were quite happy that Luke was able to get his tooth filled. Until last night during dinner, a very soft taco/rice dinner,  Luke reached his tongue back and the brand-new filling was gone!  :(  It lasted less than 24 hours and we are back to where we started. We aren't sure what to do now. Does he go back to the same dentist? Do we leave the tooth as is and hope its ok for the next six weeks? Do we try a different Nigerian dentist? Or, do we rummage through the dental equipment here to try to find material to fix it ourselves?  Maybe.

We are certainly trying very hard to not damage any more teeth...and thus I was a bit dismayed to find this as I was eating some delicious Nigerian ground nuts today:

one of these things is not like the other

yep, that's a peanut-shaped rock- didn't get me this time. 

Needless to say, we are now chewing things very carefully in this household!

This is my nightmare...

 It all started at dinner two nights ago. We were eating a delicious baked spaghetti with extra ground beef. So good. Then crunch. Not an unusual thing, there's often a little sand or stones or bone or something hard in the food here. I started fishing out little pieces of bone with my tongue. Satisfied that there was nothing hard left in my food I swallowed it. That's when I realized that something was wrong. Where once I had an intact wisdom tooth, I now had a sharp cavity on the one corner.
I got quite a sinking feeling. I don't think that I would feel quite that bad if were we in America, But here, in rural Africa, I was sort of panicking inside.

Tab had a look at it. She didn't think it looked so bad, but who knows. It looked like some pink was showing? It didn't hurt, but that didn't mean that it wouldn't start. Based on a quick internet search, I should see a dentist right away. We went to the neighbor's house to see what they thought. Those doctors concluded I should see a dentist. But where? There is no dentist here. Well, it turns out that there is a dentist in a town about a three hour drive from here.  And, there just happened to be someone going to there in the morning so we arranged for me to ride with them. We left at six a.m. well before the sun was up. The road was rough but I slept no problem.

We arrived in the big city about 9. First stop was the dentist. The dentist office was in the middle of the city. The driver stopped and told me the dentist was down an alley and around a corner. I exited the vehicle and off they went to run their errands, they would pick me up when I was done.

Walking past open sewer and trash heaps in a dark and muddy alley way made me nervous. But there it was, I entered the gate and walked past a guard half asleep until he saw me.  I asked him "where is the dentist?" he pointed up to the second floor.

It was a decent looking place,  with a sleeping receptionist/assistant inside. I woke her up, she was surprised to see a white man, I am sure. I filled out the card and paid the consult fee and then she called the dentist to let him know that he had a patient waiting. In america, dentists are always busy, but here they seem to be quite free and see patients and do the work all on the same day.

I sat in the waiting room with no electricity and read a book I brought. 45 minutes later, the dentist arrived. He came in and started preparing things. One of the first things he did was yell for the guard down by the entrance to turn the generator on. After a few minutes the assistant/receptionist invited me into the procedure room. I told him I broke a tooth. he looked in my mouth and told me I broke the cusp off my tooth and he could fix it with a filling. He could do it immediately and it cost 7000 ~30 dollars. I agreed and he went and got the supplies, he also had the guard turn on an air compressor. Most dentist chairs are run on compressed air.

The room was okay, clean by west African standards. the dental chair and equipment seemed to be from the eighties. The dental tools were kinda stained but they came out of a sterilizer box. I could plainly see the sterilizer out on the balcony. I just hope it worked and they followed proper sterile techniques and this wasn't just for show.

Before you know it he had the drill in my face ready to go. He said he had to prepare the area and that "this will be sensitive." From the moment I realized my tooth was broken I suspected I would have a guy drilling and scraping in my mouth without pain killers.  It wasn't too bad. A few minutes later he was done. We talked for a bit about where I was from, and what I was doing in Africa. I asked him about his practice and where he learned dentistry.

This is the shelves of supplies that the dentists "sells" you to use during your procedure. It includes things like gloves and masks and composite filling etc. Anyways, the assistant was nice enough to pick out all the things that I would need.
I paid and waited for my ride to come back and pick me up. They came by and picked me up about 11. Enough time for my Ibuprofen to kick in. We ran errands that day all over town and finally got home about 6 p.m.

On our way home the driver kept stopping to buy things on the side of the road. Bread, water, and then this!

   The driver was very excited to have the opportunity to buy this guy for a mere 300~ a dollar and a half. I have posted about these before. In hausa they are called gufiya. One night two years ago a friend and I caught two of these things. I guess they are a prized meal here too.   hh

electricity

I didn't get much sleep last night.

First, I was on call, and I don't sleep well knowing that I could be called at any time to wake up and go to work.

Second, just as I was getting in to bed, I was called for an emergency C-section. It ended up being a woman with a ruptured uterus, so we didn't finish operating until around midnight.

Third, the power went out sometime during the night and it was pretty warm with no fan. Not a big deal, although I did think it was a bit strange that we didn't switch over to generator power. Usually, we switch over if the power doesn't come back on within 20 minutes or so. I thought maybe the guy who switches the generator was just asleep. I knew it was a bad sign when I walked into work at 6:30 am and saw the man who switches the generator (J) standing with a headlight on outside of the switch room in deep conversation with one of the head maintenance personnel. Turns out there was a big wahala (trouble).

This is the electricity story of the day:

5 am: The main power line went out in a nearby town when someone struck and knocked down a power pole there.

6 am: J switched us to the generator only to discover a problem with the automatic transfer switch for the large, non critical generator. The generator was running, but the switch was stuck in the wrong position and wouldn't let the generator power through. The compound, well pump, central sterilization, and most of the rest of the hospital were out of power all day, except for the operating rooms, pharmacy, and parts of obstetric and medicine ward.

7 am: The men in charge (J & K) were able to text questions to an electrical engineer in the capitol. They formulated a plan to get the power back online.

8 am J located the broken coupling responsible for the problems.

12 noon: We stopped all elective operations because we didn't have any power to run the equipment to sterilize our instruments and drapes. I went home and the walk home was HOT. When I walked into the house it felt nice and cool. Then I looked at our inside thermometer and it read 102F!!! I put the thermometer outside for a few minutes- it quickly went to 111F in the shade and over 122F in the sun!! No wonder 102F felt cool.

Somewhere mid-day, the town used up all the water in their tower.

The rest of the afternoon was spent looking for a mechanical solution which ended up to be a piece of angle iron with two holes drilled in it and a bolt to keep the switch engaged.

6:20pm Big generator started powering compound, pump and hospital! Yea!!!

7pm The local electricity came back on, but we will stay on generator overnight to ensure that the well pump is able to refill the water towers and our fridges and freezers get back to good working temperatures.

on a positive note...our freezer is now defrosted. we've been meaning to do that for awhile and just hadn't got around to it

We're just happy to have power again! 

J and K will be trying to get replacement parts from the states to fix the switch.

We are very grateful to the four men who spent the whole day working on the problem. And we are very grateful for electricity. It is hot here now and we were actually contemplating spending the night in the operating room where the critical generator supplies power to the air conditioners. :) Also, Luke will actually have a job to return to tomorrow.

Electricity is an amazing thing. This is the second time in three weeks that I have had to contingency a plan for a prolonged period without electricity. It is amazing the amount of work not having electricity creates. It is also amazing the amount of things you no longer have to worry about if you do not have electricity. Never a dull moment here.

the fan incident

It wasn't my brightest moment.  The ceiling fan was furiously spinning in an attempt to combat the desert heat...spinning so fast that the blades were almost invisible...I say. In a moment of excitement, whilst sticking party decorations to the ceiling, my hand met up with the fan's blades with a loud "smack." Insert obvious Advice: Don't stick your hand in the fan. Its hurts. Also, according to Luke, the blades can cut your hand off.

Thankfully, despite a little blood and some bruising, my hand remains intact.

 Intact enough to remove this:

Can you see the abnormality?

Kind of pretty, don't you think?

Wahala

Let me introduce you to a wonderful Hausa word: Wahala  (pronounced wuh- hall- uh). Wahala can be loosely translated as “trouble” or “problem.”  The light fuses were just the beginning of the wahala last week.

Monday afternoon at 2:30 the chef (who is the manager of the OR) informed me that the big washing machine was broken and we only had three packs (sets of sterile gowns/towels/drapes) left.  Consequently we had to cancel all of the non-emergent operations for the rest of the day. Apparently the washing machine had broken that morning, but they had not informed the OR or started washing  by hand. So, we discussed that they should tell us earlier next time and start washing by hand if the machine breaks again. Ok, fine, no big deal.  By Tuesday the washing machine was up and running again.  

Thursday I spent the day in clinic. One of the nice things about clinic is the mid-afternoon break. Clinic closes from about 1pm-3pm. At 2 pm I was pretty exhausted and looking forward to a quick nap. I had been asleep for about fifteen minutes when the phone rang. It was the chef. “Doctor T, we have a wahala in the bloc, the washing machine broke again and we only have three packs left. Can you come?”  I woke up and walked back up to the hospital. First, I talked to the chef…in a combination of broken English and Hausa I figured out that at 2:30 he was told that the washing machine was broken and they didn’t have any more gowns or drapes they could sterilize. Only 3 packs were left. We had 2 emergency laparotomies scheduled already, and a couple more elective cases planned. And, who knows what emergencies could come in? So, we moved the elective cases to the next day and decided to go ahead with a laparotomy.

Then I found M in the pharmacy to ask for her advice. We walked together over to housekeeping with see what was happening with the broken washing machine. There we saw a huge washing machine propped up on its side next to a large pile of dirty OR gowns and drapes. Thee laundry men were sitting staring at them both. It was obvious that the washer hadn’t been working all day. 

the big washers (one has been broken for a while, the other works...sometimes)

Why didn’t they tell us in the morning instead of waiting until there was a crisis? Just two days ago, the laundry supervisor, N, had promised M that he would call immediately if the washing machine broke again. But, he hadn’t. So, she told him that she was very unhappy, even angry, that he hadn’t kept his word.  And that they shouldn’t wait to let the OR know when the washing machine was broken. Also, they should start immediately to wash by hand. Well, he didn’t take that too well. In fact he said he wasn’t going to talk to her for a month because she had gotten angry with him. Anger is taken very seriously in this culture.

He then disappeared for a while and we again talked to some of the other laundry personnel to figure out why the OR wasn’t informed and why we weren’t washing the clothes by hand (that is how most people wash their clothes here). Soon, N returned and shortly thereafter about eight guys from the shop were there working on the washing machine. I think after about 20 minutes of explaining and listening, they finally understood that if we don’t have sterile gowns or drapes, we can’t operate. And if we can’t operate and an emergency comes in…someone could die.

M and I went back to the sterilization room at the hospital to try to figure out why we only had a one-day (or less) supply of gowns and drapes. Seems like we should have some reserve, right?!  Turns out we had been running low on gowns and when they ripped/worn out they weren’t being replaced. Also turns out that we had a whole box of new gowns down in the pharmacy ready to be used!  The pharmacy staff just didn’t know that the OR needed them.  M brought them up from pharmacy and the immediate crisis was resolved.  I got to clinic an hour late. 

The next morning, I stopped by the sterilization room where the man who folds and sterilizes the equipment proudly showed me a huge stack of sets, all ready for the OR!

One more wahala solved...for now

lights out

I knew it would be challenging and busy around here with the other surgeons away at conference. I thought most of my stress would come from caring for patients. Not so far. Its been all the other stuff...equipment, laundry, conflict resolution...

The day after the surgeons left the power went out while I was in the middle of an operation for typhoid perforation. Nothing new. Power outages usually occur several times daily. So, we did what we usually do. We counted to three out loud, the generator came on and the room lights came on.  But, the operating light did not come back on. We tried the second OR light. It didn’t work either. No light, no vision…no surgery. 

Now, before he left, Dr. J told me that we had been  having some issues with the OR lights and the fuses burning out with the frequent power surges. He told me that he would leave some extra fuses in case we needed them.  I thought he said he put them in the surgical office, so I quickly looked there. No fuses. My patient was still on the OR table, so we borrowed a fuse from an OR light in the other room and I finished the operation. Then…I did a thorough search of the surgical office, OR, and supply closet. No fuses. Only 2 of the 6 OR lights were still working. We needed more fuses. In desperation, I called Dr. J’s wife, M.  Right away, she located the fuses in Dr. J’s house! Whew. She replaced the four fuses…but that means we only have 6 fuses remaining. We have been losing almost one fuse a day. Not good. Especially since the fuses have to come all the way from America.

So, M suggested that I talk to the shop and have them run the operating rooms on generator power during the day. I did. They said I would have to talk to the chief executive officer of the hospital to get approval for that. I guess it is pretty expensive to run the generator all day. We are still working on a more permanent solution. Until then, I will keep my head lamp close by just in case.