"newborn babies have no fat?!!?"

this was a moment of revelation for some OB nurse-aides i had the opportunity to teach on the morning i left. starting with prayer, i offered encouragement to these women that their job is very very important, as the children they care for are Gifts from God and the future of their people. Tassala (yellow, right) interpreted as i shared some basics about newborn care.

In one had i had a towel, in the other, one of those blue bulb suctioners. i told them that the 2 most important things they could have when a baby is born i was holding in my hands. i went over clearing the fluid and such out of baby's nose and mouth to help him breathe. and then went on to how important it is to rub, rub and dry the baby to help him stay warm. i was trying to think about how to explain the whole concept of 'heat loss', 'body surface area' and 'thermoregulation' to these Hausa women with minimal schooling/training (who had left numerous babies in the open air, wet and cold...). then i heard coming out of my mouth:
"when babies are first born, they don't have very much fat..."
mutter, Hausa this and that....
Tassala tells me: "this is new information. they had no idea that babies have no fat," she said smiling, "i think this is now making sense to them...."
Well, this isn't exactly true - babies do have some fat, but it was too late and not feasible to go into technical details of why babies can't keep themselves warm. Fact of the matter was - we were getting somewhere! the tone of the little group turned from down-cast eyes and seeming-inattention to engaged faces and some surge of interest.
i reinforced the need to dry off babies, put them close to mom's body, etc.
we talked for a while about breast feeding, including the reasons why babies should not drink water for the first 3 days of life.
they asked me at some point, "you have been here one month - why have you not taught us sooner?"

this whole scene was an answer to many prayers, as historically, the nurses/aides/midwives have been resistant to teaching. so i praise God for this and pray it opens the door for more education and improved care of the precious babies born at Galmi.


[the photo is of me holding a baby whose mother has HIV. when babies are born, they are wrapped up in mom's zunni (cloth for skirt, carrying babies, etc) and often not dried off nor put on mom's body. ]

Adamou and others

to give a few updates on patients for whom i've asked prayer...
(and finally! to add some pictures :) )

Adamou, a 7 y.o. boy with tetanus, who i've cared for about 2 weeks. he has been slowly improving, but on Wednesday morning (the last day i was at Galmi), when i saw him, his grandmother said they were leaving that day.
he needs ongoing prayer - his spasms continue, they need to continue giving him valium regularly and that is a challenge in a culture where many don't have a clock or know how one works to mark time. also pray that their family encountered Christ through their 2 weeks at Galmi. [in the picture, he is actually in some spasm, laying on his grandmother's lap. it didn't appropriate to smile for the picture which J was already taking when he started stiffening again, and it all seemed rather awkward to me. they didn't seem phased by his spasm, nor the photo.]


Rabi
Rabi is a 34 y.o. woman who made my post earlier in the week ("last call"). She died on tuesday, 29 october in the morning, soon after i rounded on her. pray for her baby, who is now an orphan. and her family, that they may find Jesus, the Son of God... the same God who is a Father to the Fatherless.

Fauera (also from post, "last call").
She was doing well as of Wednesday before i left. her abdominal swelling was less, and she will likely survive. i ask for your prayers on her behalf to continue, and perhaps to be a reminder to pray for the witchcraft and traditional remedies that are so so commonly used and often fatal. pray this stronghold will be broken.

Bassirou

Tuesday, my last full day, was a busy, crazy day of things similar to the rest of the month. 2 of the short term MD's had left monday, though, so J was on OB call, leaving me to most of the peds without him. the afternoon shift, however, seemed to cluster several pediatric seizures, blood transfusion needs, a general spirit of chaos and desperation with the death of one of my patients. it happened, for the first time this month, while i was actually on the Ward - the relative came to the nurses station where i was sitting and said the child had died, could she have their papers.

when she said the name/bed number (ER24 - a bed on the floor in a hallway, see photo) - i immediately knew who it was. it was Bassirou. a 5 month old boy who i had seen on several occasions - first in the clinic, treated for diarrhea and malaria, sent home. he had come back still ill, and i admitted him. i had been caring for him the 5 days since, and during that time learned his mother was on ARV's (i.e. on medication for HIV/AIDS). so i tested him, and he was positive for the antibody, which could have been because he had his mother's antibodies from her breastmilk, but his condition seemed to not respond to our antibiotics nor anti-malarials, making me/us suspect he actually did have HIV. the CD4 counts are only run on thursdays, so we were waiting until yesterday for that to come back, to determine where he was on the spectrum of disease. when i saw him on tuesday morning, he was kind of whimpering and didn't look well, had been febrile again, and mom said wasn't eating well. she thought he was whimpering because of the IV that had been in his foot. i again prayed for him as i examined him, at a loss to know how else to treat him.
he died that Tuesday afternoon, 29 october 2008 at 5pm.
as soon as i heard the bed number, i went to see the family - again, the first time i had been nearby when a patient died. i found the mother and other relatives, packing up their few belongings, the mom with tears on her face. an older woman kept saying something in Hausa which i think included "Allah..." - which i had heard is what they say when someone dies, "it was Allah's will, it was Allah's will..." and that they usually don't cry or wail or mourn visibly. they don't even say "i'm so sorry". if you read my earlier post, they say, "sanu."
well, on top of the chaos of the afternoon already, i was in tears, and wanted the mother to know that i had loved her child, too, that he is precious to God and that his life mattered. i gave her a hug, kept saying "i'm so sorry, i'm so so sorry you have to lose your son to this ... "
the family kept saying things in Hausa, packing up, walking toward the door.
i looked for the baby - he was strapped on the older woman's back, as any other child is most of their first few years... yet now unlike all those living, breathing, squirming children. his little feet were sticking out like any other child, still warm. but his head was covered by the cloth, and not sticking out. the mom's eyes met mine, both with tears, and she made a small brief smile. they took their papers, their belongings, their Bassirou, and left. sanu.

my grief was interrupted by the phone - i answered to hear, "Doctor, emergency in OPD". so i went running to the clinic, to find another child seizing, looking horribly pale... the chaos continued to swirl.


(the photo is not of Bassirou, but of the way children, even babies, are carried on the mother's backs. please pray for the chilren of Niger)

things i'll miss and things i won't

things i'll miss:

• the Nigerien children
• the greetings every day, all day (see post)
• the level of acuity/degree of illness (see "things i won't miss" for the other side of this)
• feeling like i'm really meeting a need, engaged in a real battle every day
• wednesday morning gathering for cinnamon buns and coffee
• making yogurt in a jar on the kitchen counter
• the community of missionaries here
• working with others to share the hope of Jesus Christ being the focus of our task
• the quietness and slowness of life (outside the hospital)
• the lack of paperwork (compared to my work in the US)
• the break from 1-3pm each day
• the pastors who preach the Gospel and pray with patients every day

things i won't miss:

• the smells as one walks to and into the hospital
• the flies in the one part of the hallway just outside of B Ward
• the limitations of the hospital (nursing care, staffing, resources)
• the weight of death every day
• malnutrition
• fighting against deep-rooted beliefs and superstitions and lack of education
• the heat
• the bugs - though i've been a victor over a lot of insect life this month
• the lack of value on life
• the scarcity of green vegetables
• call every 3rd night :)
• checking my shoes (and shower and clothes and bed) for intruders every time in put them on
• being far away from loved ones. i'm looking forward to coming home.

Sanu!

This is something i say maybe 237 times each day. it means a number of things in Hausa:
Greetings!
Goodbye!
greetings on your _______ (work, travel, anything really)
various expressions and filler comments
I'm sorry your child died.

most of the 237 times i say "Sanu!" it is with a smile, however, and the beginning of the exchange of greetings that occurs every every day here, with nearly every encounter. it goes something like this:

Greetings! Greetings.
How was the night? the night was good
How is your tiredness? i have no tiredness (regardless)
How's your condition? great!
How's your work? with God's help
[if you're moving on, you leave with "see you later..."]
and this goes on sometimes beyond what i am able to understand...

this exchange happens so that both people are asking and responding to the same questions, almost like a script. it's taken me the whole month to reply and ask the first few appropriately. when i got beyond "sanu" people/patients perked up and were all smiles, saying, "the doctor knows Hausa..." with great pride on their faces.

This has reinforced the importance of greetings to me.
in our casual American culture, we don't value this nearly enough. the above exchange is foundational to the culture here and means that you have to stop and spend a few minutes exchanging the report above. and even though it may not be the real truth - it communicates a value on the person you're greeting - to take time to look in their face and greet them.
Paul the Apostle is every issuing greetings in his letters to the churches, and they take the form of a blessing. that's what i've tried to convey as i greet these dear people in my few words of Hausa:
"i greet you, you have value to me, and i want to know how you are and bless you."
i hope i can continue this attitude upon my return.

last call

today marks the last of the days/nights on call here at Galmi.
it's 3pm on Sunday and so far i've admitted 12 i think. i've heard the ambulance twice. this is a funny thing - because Galmi does not have an ambulance. so that means some other facility (term used very loosely) is bringing someone to the Galmi Medical Center.

• today it was a load of 5 very sick anemic kids from MSF (Doctors without Borders) - all with malaria, all needing transfusions, and one having a seizure in the ER as i examined her.
• another was Salifou - a guy also from MSF who has some sort of badness in his abdomen - typhoid? we're not sure. may never be. fluids and antibiotics to broadly cover the possibilities.
• another was Rabi - a woman who i found in the ER on the floor - mostly unconscious - having some sort of seizure or posturing - and my differential diagnosis includes: cerebral malaria, meningitis or post-partum tetanus. she delivered a baby 7 days ago at home and has been ill for the last 2-3. baby is ok, but hungry, and now she doesn't have milk. and there's not exactly Enfamil on every shelf around here to substitute. so sad...
• another is Faurera - a little girl who had a fever, diarrhea and vomiting, and her family took her to the Shaman (traditional healer) who gave her some potion. now her abdomen is huge, and she is very ill. often these children die from necrosis of the intestine and liver failure. she may just have had malaria, but now, it is that and whatever the toxic effect is of the poison she received. this is SO SO common here - please pray for her and for the Shamans to be no more. they are killing their people. and unfortunately, when the damage has been done, they come to Galmi Hospital and end up dying, which makes the family think it was something the hospital did... this is the deception of the evil one here.

Now, i'm off to follow up on all the tests i ordered and the multiple blood transfusions and such.

i leave on October 30th for another very long day of travel. and i'll be at Galmi until the morning of Oct 30th, so after today - just 2 more days of work. so hard to believe.

today in the clinic...

i've seen a plethora of 'interesting' cases... we were joking that at home (in the US) we sort of "live" for the interesting cases. that being because most of what we see are routine well child checks, visits to check on blood pressure, diabetes, etc. all of which are not very "interesting."
Here, on the other hand, there is an endless stream of "interesting"... to the near complete exclusion of anything routine. Though, i suppose we do call the severe anemia/malaria combo somewhat routine now.
So, the list of interesting cases today:
myelomeningocele/spina bifida
possibly typhoid fever
cystic hygroma (bigger than a large grapefruit attached to a baby's neck) resection
malnutrition
bad malnutrition
babies drinking water not breast milk (unfortunately borders on routine here)
sciatic nerve damage from an injection
a 5 year old with heart failure - i took a video of his chest. it was dancing!
tetanus
syphillis in baby and mom

back to work this afternoon...


Some Updates:

• the woman a while ago with tetanus died.
• i continue to struggle with the nursing care here- it is a major limitation to the quality of care we are able to give. please pray for me to be patient, but also for the nurses to catch a vision for how much of a difference they can make in the patients' lives. And, that they would care! about these people (regardless of tribe!), not just show up because it is their job.
• there are several pretty sick children that need prayer - 6 y.o. girl with cerebral malaria; a 9 mo. old boy with cerebraal malaria and malnutrition. please pray for their healing and that their families would encounter Jesus through this hospital.
• praise to God for some children who have improved from being very very ill.
• pray for someone to be raised up to champion the cause of the infants here - the moms need so so much education, and the in-hospital care we give infants is again sub-standard often due to the inadequate nursing care, and the extent of damage already done by the mothers' feeding water to the babies, etc.

what you can find at the Galmi Market

again, pictures will come later.... but you can use your imagination a little.

the market is an amazing phenomenon in most of the world's cultures, unfortunately not the American one. for example, in the Hausa language, they have words for each day of the week, but more commonly refer to "wednesday" as "galmi" ... because on wednesdays, The Market is in Galmi. "friday" would be "konni" - because The Market is in Konni on fridays. so when i ask what day the fever started, my interpreter says "friday" knowing that I don't know that's when The Market is at Konni, but she and the patient and everyone else knows that friday is market day in Konni, and the patient's answer was ' "konni" is the day the fever started'. Hope you followed that. ... all to say that the life of this culture (and many others i've seen) revolve around The Market.

And today i was reminded of why. it's a lively, colorful scene... teeming with life of all kinds - plant, insect, animal and human. you can literally find almost anything at The Market. here's a small list:
live animals - goats, sheep, cattle
fruits
dried spices
oil - for your car, motorcycle, and cooking, in vodka bottles
carts pulled by donkeys
mattresses
clothes - from all over the world, many used
watches
pharmacy items
undergarments
dead animals (accompanied by insect life)
gourds carved into bowls
woven mats
hides of goats, sheep, cattle
cloth
perfume
DVD player
bikes
notebooks
lawn chairs
sugar in big heaps on the ground
roots that are of the potato family
and... possibly everyone in Galmi and beyond for miles.

Deb and i (Deb is a nurse from the US, here with her husband Alan and 2 kids) were the only white faces in the masses of people there. this earned us 'special' prices and a lot of offers to buy any number of items. she did a great job of navigating the scene (no orderly stalls or straight aisles) and bargainning and we came home with a few of the above items. and a vivid taste/experience of real life here in Niger. i really do love The Market.

pictures of Galmi

i've had some difficulties posting pictures due to a missing link, literally. so the pictures i've been taking on my camera are still on my camera/memory card, stuck there it seems, until i'm home. however, one of the staff here loaned me a camera to take some photos this afternoon... so at least you can see where i am, and a little of the environment i'm in.

enjoy...

this is the back of the hospital, where i enter every day, several times a day. it's a 3 minute walk from my little apartment. there are typically people milling around here most of the time.

this is "A Ward" - 8 beds, all children, with their mothers. One has congenital syphillis, another pneumonia, some with malnutrition, others malaria on top of malnutrition.

this chest x-ray is of a 4 year old girl with Tuberculosis. Bad TB. she came into the clinic leaning forward, breathing 60 times a minute (try it- that's fast, once a second). Her whole RIGHT chest is full of TB effusion (pus into the space between the lungs and the chest wall/ribs that usually has only thin slippery fluid in it) and who knows what underneath. no CT scans here. if you look closely you can see her trachea very deviated. so we decided to drain it using an angiocatheter (small needle with a tube around it) - and got 1 Liter of greenish, thick pea-soup consistency fluid out. i held the basin. Her breathing dramatically improved. We admitted her for intensive TB treatment. i've never seen anything like what i saw and held today.

This is me and Tassala, one of my 2 amazing interpreters. She is a Christian, has several grown children, knows English very well, and Hausa (her native language). She is gifted in being very forward with patients, teaching them good hygiene, how to breastfeed properly, to abandon traditional medicines that harm them, etc. She's funny and a delight to work with. we have played several games of UNO when our patient load slows down. She's been translating for a while, and i keep telling her she's becoming very smart, and will soon be mostly a doctor.

This is the "warmer" (which is not reliably warm, especially when left unattended) and one of the 3 oxygen machines in Galmi hospital. they dwell in OB, and i found myself there again today because another baby was born, early by an unknown # of weeks, and no one told any physician. the OB doc from the US happened upon this little girl, struggling to breathe. i hate to say i'm getting used to this, because watching children die should never be something one becomes accustomed to. she may survive. but i am doubtful, due to the nursing care and the lack of resources. we presumed the mother had some sort of infection and thus delivered early. i gave her a Hausa name that means "Grace".

So, that's a little taste of the scene here. i'll try to do this again - it worked pretty well, and i'll save my great photos from earlier this month for posting once i'm home.

I return to the US Oct 30th. please pray for my last days here to be full, that i might be a vessel of Jesus' love and compassion.

Yogurt Recipe

NOTE: this only works when the ambient temperature is over 100F, preferable 108F or so...
so for all of you in the crisp, lovely days of fall in America - you may need to tuck this away for another day. like for when you come to Africa. Really - you should come to Africa. You can make yogurt right on your kitchen counter!! Not to mention how desperate we are for any and all kind of help... think about it.

Galmi Yogurt
1 c. hot water
1 c. powered milk
1 c. room temp water
1 tbsp of already made yogurt (this is like that friendship bread dough that multiplies... you have to have a starter batch. again: Enter Yoko. she gave me the starter jar.)
1 clean mayonnaise jar

combine all ingredients in jar and put lid on.
wrap in a dish towel.
leave on your counter for 18 hrs.
unwrap.
voila! yogurt.
it is now a staple (the sources of protein are thin here) and i'm obsessed with making new batches. on my 2nd. about to need more powdered milk. never thought i'd seek out powered milk... this has opened up a whole new world!

bright spots at Galmi

Well, after my first full week here, i decided to share some bright spots that are very real and worth sharing, amidst the death and suffering that drones on - like a constant hum in this land.

TWINS!
the Nigerian (from Nigeria, a full time doctor here) general practice MD who does a lot of surgery here tracked me down on saturday to ask that i attend a C-Section delivery of twins. In my mind i wanted to say "what, so i can try to recussitate 2 scrawny babies who will then die in a day or two or seven? because they're too small... and no one feeds them properly... or because the mothers take them home for the Day 8 Naming Ceremony celebration before they're ready...?
But i instead said, "of course - how many weeks?" He didn't know. because she didn't know.
So i prayed, knowing that in the US, i would be one of MANY people attending this delivery - many people with a lot of equipment and training who make neonatal recussitation look like a systematic, well-oiled machine. and in the US it is. Here it is only me. with oxygen tubing that i had to tape together after someone found a "splitter" (i.e. make the one tube of oxygen fork into 2 tubes for the 2 babies, potentially). with towels that come from the sterilized packs of towel and instruments after they are unwrapped. with nothing disposable. with no cute little hat to put on the baby's head. it's not quite like being born into a manger, but it is close in a lot of ways.
And probably the most important way - that God is near. He is the Giver of Life. and He is with me.
So i readied my area in the OR. cleaned off (literally, wiped down, scrubbed) the warmer where babies would lay, taped the tubing, wiped off other supplies visibly dirty, gathered some clean cloths to dry and warm my babies soon to come.
and prayed.
and out came number one - a girl - looking BIG! (a good thing when you're a twin in Niger). she needed a little help. nothing dramatic.
and then number two - a girl - pink and screaming and BIG.
Praise God.
they did great. i was so relieved. and for now, as long as the LORD gives breath, they live.

Cerebral Malaria...
bad news. bad prognosis. children who are affected to this extent by the malaria usually don't live - 40% die with treatment. Of the 10 kids i admitted last night, 1 died already, and likely had cerebral malaria.
Well, i had been treating 2 boys with what i think to be the Cerebral form of malaria. One day last week (wednesday, maybe), it was a particluarly hard day... several kids had died overnight waiting for blood transfusions (in part due to inadequate nursing care, no donor, or they were just really really ill), another baby had died, and i went to see these two boys and thought, "they are looking at death today..." we prayed for them. i kept thinking of them throughout the day. praying frequently. at night. thinking of them. praying they would be there in the morning.
Thursday came. they were there!
the 4 year old boy sat up and looked at me. for the first time in several days. sat up! the day before he had looked death in the face, was unresponsive, not breathing right... and the LORD gave another chance at life. i discharged him yesterday, walking weakly, but without any damage to his nervous system that i could appreciate.
the small 1 year old boy was also better - not quite as dramatic. but better. again we offered praise to the LORD for his mercy and healing. He is still in need of prayer for healing, and that his family would turn to Christ through their time at the hospital. His name is Moustapha.

movie night
in a much less substantial realm, some of us gathered on saturday evening to watch a movie - it was hot, not the greatest sound, no popcorn/rootbeer/candy to pass around... but great to fellowship and kind of divert our attention for a few hours. it's an older movie called "second hand lion" - a pretty cute PG family-ish film i'd recommend. maybe it just seemed good since it was all we had :)

cinnamon buns
even less substantial on many levels - they were a highlight of last thursday. a weekly tradition here. they were a taste of all things lovely and sweet. thanks to Yoko - the lovely, lovely Japanese nurse who has been here for 13 years, fluent in Japanese, English, French and Hausa (the local language). she is sweeter than her cinnamon rolls, gifted in hospitality, is always producing something helpful at just the right time, and also helped me make rice "the Japanese way"... by measuring to the first line on your finger (that's how deep the water should be above the rice). of course!

Cherie and Fey

These patients deserve a post of their own. They are 2 little girls who were born in the last few days... and who also died in the last few days.

Cherie died October 5. She was one of triplets. I don't think she ever knew her name - so i gave her one. Cherie means "dear" in french and she was the 3rd of the triplets. She had hydrocephalus, or so we thought - her head was large, and she was quite small. She was doing ok, though they were all small and early - neither of which carries a good prognosis here especially. She tried eating, but soon we realized that the grandmother was pushing Cherie away when she tried to nurse, telling the mother that she should feed the other 2. the staff tried (though not consistently, because there are SO many mothers and babies every day... and not nearly enough staff) to keep feeding her. without success. Sunday morning we went to check on the babies in the 'nursery' and they handed me Cherie. Dead. so many emotions went through my mind and heart. the women sitting there seemed to be without any. they have grown accustomed to death, it seems.

Fey was born and died on October 6. she was delivered by c-section, then left alone as the mother recovered. on a 'warmer' which doesn't warm up at all and is of no use except to be a cold place to put a baby in the open air. and discovered by Dr. Lydia (OB from the US who has been her 4 times before) who walked by and saw here struggling for air and looking blueish. she came and got me and Dr. J (the FP) and we went to try to recussitate this baby. i found her cold. heartrate barely acceptable, with an oxygen mask on her face NOT CONNECTED TO OXYGEN, struggling to breathe. J and i tried to get her to warm up, pink up, cry... anything... she was early, could have been sick with some infection mom gave her, and probably didn't have adequate development of her lungs either. We did all we could. i don't think her mother ever held her. and she was never named either. so i named her Fey - similar to the word for Faith in French (i think).
These are the first dead babies i have ever held. And that was on days 1 and 2 of my work here at Galmi. Please pray for us as we fight against this culture of death and dying, of despair and of hopelessness in the name of Jesus - who is Life and Hope and Victory.

Galmi

The hospital is literally overflowing. We have expanded the "120" beds into the hallway, into extra rooms, practically outside. More patients than anyone would think possible. and we only admit the very sickest. unfortunately these are usually the very young, and the pregnant women. there are a number of twins, too, and some premature. we have no NICU. we have one oxygen tank outside of the OR. and only one IN the OR, so when mom is receiving oxygen during her C-section, there is none for the babies after they are born. Orders are not carried out with any kind of purpose or sense of urgency, even in the sickest people. there seems to be a general acceptance of the suffering, of the condition of sickness and perhaps not enough experience with people actually getting "better" to see that hurrying would make a difference.
a wise OB doctor from the US, Lydia, said today, "Time at Galmi is like the Lord's time: a thousand hours in His sight are like a day gone by..." more true than you can imagine.

After 2 days of work, i have seen scores of patients. there are several common themes: malaria, malnutrition, severe anemia (Hematocrit of 5-10% is very common, when normal is 35-45%, and is due to malaria) barely compatible with life, malnutrition, malnutrition, measles (5 cases this week), pregnancy-related complications, more malaria, some TB, some HIV (probably underdiagnosed because we don't have enough test kits), diarrhea, pneumonia.

Yesterday we admitted 32 patients. Roughly 25 of them were pediatrics that J and I saw in and out of Room 1 in the outpatient clinic. Most were malnutrition and malaria with severe anemia.
The last patient i saw at 9pm (on my first call night) was a 45 y.o. woman with Tetanus. This is more reason than i will ever need to insist on vaccinations against Tetanus. She had a wound 10 days ago that had since become dirty and infected, and the day before she came to Galmi, her mouth became clenched, unable to open it. This is the way tetanus begins. The mortality is 50% even with good treatment. She did not get good treatment because the orders i wrote for her (to receive medicines to counteract the toxin, antibiotics for her wound) did not get carried out after i left the hospital. when i found her this morning, the spasm and tetany had spread so that she was arched back, more muscles involved, with intermittent spasms causing more pain and distress. The medicines started this morning. Why? i asked again and again... no one seemed to know, but could only guess - "the pharmacy was closed"... and no one called the person on call for the pharmacy to get the medicine that could have changed the course of this woman's life. We prayed desperate prayers (again) this morning - asking Jesus to heal her in spite of our care.

Today in Niamey

Red-orange dirt is everywhere. So is the heat. Inside the guest house where i am staying, the thermometer read 95 F @ 6pm yesterday. There are ceiling fans; the floors are tiled; the water is not hot unless you plug in the hot water heater 1\2 hr before you want to have hot water ... but i haven't minded the cool-ish showers at all!

This morning i struck out early, to go across the road (a combination of red dirt and areas of pavement, interspersed like pot-holes) to the 'nice bakery.' i passed by the gekkos who are my only house-mates at this time. they tend to stay outside, scooting along walls and the red-dirt-covered walks, so i have the house (see picture) to myself.

As i leave the gate-guarded yard, i greet the guard/guards (never sure just how many there are) with 'Bon jour; ça va?', trying desperately to remember high school French and not to say 'buenos dias, como estas' or any number of spanish words and full sentences that are right at the tip of my tongue. The languages here are many - French, Hausa, others i don't know how to spell or say. At Galmi, the staff speak french, english and Hausa (likely others too) and i'll have my own interpreter.

So to cross the road: reminds me of that old video game frogger. again, not unlike any number of places i've been and will likely be again. i was told 'you know it's a nice bakery because a lot of people with cars go there.' i didn't care, since for me with no car, it is nearby ... and it was quite good. Good, though not unique - i have tasted the same variations on a white-flour-with-sugar-on-top-and-some-other-flavor all over the world: bolivia, peru, london, guatemala, zambia, now niger (say: knee-jhair. good) so in some ways, i don't feel much culture shock at all.

The morning was a prayer meeting and small Bible study with staff at SIM (parent organization for Galmi Hospital) office. i walked there after the bakery... more red dirt, more 'bon jours', and walled yards/homes with guards outside. Then, some administrative arrangements, then to the small grocery, again near to the house and office. My favorite items (that i cannot believe we export such that they are in a tiny grocery store in Niamey, Niger) were: Red Bull Energy Drink, Dove soap, Nestle products of all kinds, and Soliel razors for women.

By far the highlight of my time here so far has been spending time with some Americans here who i heard of through Cheryl Dyer (omaha friend): Jeremy and Susan Beebout, and their girls Lydia and Liza. we connected on all sorts of things -- life, medicine, the nations, church and missions. they are delightful, hospitable and i am so! grateful for their friendship.

i go to Galmi tomorrow by small plane. then the work begins...

Niger

good news! i've arrived in Niamey, Niger and have seen God's provision moment by moment throughout my travels and first day here. My flights from Chicago to London to Casablanca to Niamey went off on schedule with no problems at all; and my trip through customs was a miracle - no rummaging through my bags at all.
i am at the home of Jeremy and Susan Beebout, missionaries with Reformed Church of America, and cousin of a friend in Omaha (Cheryl Dyer - thanks, cheryl for the connection!!). They have fed me, shared their internet with me, have given of their time and family to make my first 24 hours here a delight. They are from Iowa, Susan is an internist and they were both involved with the Navigators around the years i was, so we've been discovering all sorts of mutual connections and experiences. Again, Praise the LORD.
I will be here in Niamey until Saturday, when i fly to Galmi on a small SIM plane and begin the work at the hospital.
PRAYER needs: for protection and safety - this is one of my main concerns since i've been here, not in terms of physical danger, but more from getting malaria or other diseases (Susan and one of her girls have had malaria despite being on prophylaxis); and then in a spiritual sense - the Muslim world is where i am right now, and i can feel it. pray that i would be filled with Jesus and that He would be fragrant in my life.