Sannu!

The Minister of Health of Niger came to the hospital today and was greeted with a great event.  The opening isn't officially until next weekend but as a respect to the minister a preliminary opening was arranged.  Below is a picture of the Minister of Health cutting the ribbon of the fistula center.  My internet is too bad to upload more but I will try again later.

The first surgery has been postponed until Thursday as our sterilizers are not working yet.  In the meantime I helped Sarah take patients histories in the village today and Dr. Arrowsmith is continuing to see patients in the clinic in preparation for the first surgical repair.

I started going into the village where the women are staying.  It is very easy, even with the Hausa-English language barrier, to create a relationship with the women.  They are so excited that we are here to help them and it is an amazing feeling to see them smile at you and instantly want to be your friend.  Because they are isolated from the rest of the Danja village it is clear to see the bond that the women all share.  Danja is seen as a safe place for the women to come because of its long association with the leprosy center adjacent to the newly built fistula center.  The partnership between the leprosy center and the fistula hospital is partly because of the similar social treatment of the two types of patients-- as outcasts of society.  I am trying to brush up on some more Hausa so that I can go see the women and learn more about them.  This has been an amazing and challenging past couple of days-- I will hopefully upload more pictures soon!

A Well Oiled Machine

I didn't get the chance to go get some new clothes today because I wanted to sit in on a meeting for training the full time staff of the hospital.  It is incredible to think that all the staff for a hospital is 12 people-- they all fit into a single room.  This makes things incredibly easy for their communication and understanding of the clear goal of the hospital and quality of care.  I really am seeing hospital administration at its most basic level which is the part of global health administration that I wanted to understand.

Dr. Steve Arrowsmith is conducting the meeting and the first thing that he emphasizes is partnerships.  Centre de Santé et de Leprologie (CSL), Worldwide Fistula Fund (WFF), and Serving in Mission (SIM) are all working together to get this fistula center started.  Each of them has a somewhat different goal so their understanding of one common goal is important at the very start.  Forming strong partnerships that have a solid foundation is especially important in global health work as each group has a different amount of resources to offer to the project.  Dr. Arrowsmith wanted to start this strong partnership at the very beginning.  He also talked about the importance of the hospital in training other people to serve fistula needs in Asia and other parts of Africa.  This will be a teaching hospital to help serve fistula needs all over the world because of its wealth of resources.     

Sarah, a girl a little older than me who is a trained nurse from Washington state was telling her fleet of about 4 nurses what she expects from them:  

"This is a privilege to be here.  These women are hurt and unloved, so we as doctors and nurses have the opportunity to love them. .. I love that the hospital is just a fistula hospital because we can focus solely on these women and their needs.  We have really been given the opportunity to change lives and this is a great tangible way to see that.  Always remember when you are nursing that these women feel shunned and rejected but they have feelings and deserve dignity.  Try and think of what they will need before they need to ask for it.  Take the time to sit with your patients, listen to them, and share your lives with them as well.  When they go home they will look at this place as a place where they were safe and protected.."

Many of the staff had questions about how they treat other primary health problems when they are supposed to only be dealing with fistula.  What if a patient comes in with jaundice or malaria?  Do they send them to another hospital to meet those health needs?  I didn't understand a clear answer to this but from what I understand they will be sent to Maradi with these problems.  I am sure I will see more of this problem after the center opens.

The meeting took a long time as every statement was translated 3 ways: french, hausa, and english.  I sat through the whole thing typing up inventory sheets to post in the stock rooms.  I am excited for our first patient because it will really test how well this oiled machine will work.  

The danja fistula center: pictures as promised

The below pictures are of the operating room in the fistula center. Another is of what remained of the TONS of boxes we unpacked to get all of this set up-- I am now very good at putting together desks and shelves and even the base of an ultrasound machine-- no more stripped screws as with my IKEA snafu over christmas. This has been incredible and theres still so much more to see. The other picture is mark on the plane from Niamey to danja. And of course a quick shot I got in shotgun on the plane. Keep reading as they are training nurses and long term staff tomorrow and since I'm not here long term I plan to go into town to buy some pretty clothes for the opening because apparently the long Anne Klein skirt and tie dye I have isn't in style in Africa.

Bonjour

Good morning from Niger-- this is just a quick post before I leave Niamey because I wanted to take a picture of the Niger river which runs right outside the mission house. Leaving on a small plane for maradi soon, see you later!

Oú allez vous?

I am in Niamey!  I have really good internet access here so I wanted to take advantage of it.  The flight to Niamey from Paris was smooth and when we got on the ground we rode to a mission guest house where we are spending the night.  I am learning a little more of what to expect when we get on the ground in Danja tomorrow.  Jacqui is a RN from Australia but formally trained in the UK.  She is coordinating the nurses on the ground in Danja and claims that she is in need of some extra hands at night.  Once properly trained she says that she could use my help checking catheters, taking vital signs, etc.  Mark is coordinating all the shipments to the hospital and a big container full of medical supplies has just arrived so I expect to be doing inventory on it all tomorrow along with setting up some beds and shelves.

There is also need of a research assistant who will study the time limit for catheterization post-op for fistula patients.  Some hospitals keep the catheter for up to 6 weeks post op-- the longer you leave the catheter in the less the patient is able to control their bladder after the catheter is removed.  There is also a higher risk of urinary tract infection the longer you leave the catheter in.  I'm trying to do some research right now to see what has been studied on time limit for catheterization so that I can help with this once surgeries are in full swing.

In other news, I am loving hearing all the different accents and languages around me.  Here at the mission house I hear spanish, norwegian, french, and english.  It makes me want to study and learn ALL THE THINGS (shout out to Mary French).

Just to give you an idea of where I am and oú je partirai demain (pardon my french, I'm trying to learn more..)  The map below shows my trajectory for tomorrow:

Thanks for reading and I will let you know how my first day on the ground tomorrow goes!

Airports

Hello from Paris! Or from the airport at least. I'm on my way to Niamey now that I have met up with Mark, the director of the Worldwide Fistula Fund along with Jaqui, another nurse who is heading out to the new fistula center to help set it up with us. On the plane to Paris I met a 3rd year medical student from BU who is heading out to Africa to do her clinical rotations as part of the Schweitzer foundation. She went to Niger in undergrad also and was so excited that I am going over there to study maternal health. She went back the summer after college because she loved it so much. I still don't know exactly what to expect but I'm so excited to meet the people and learn about health in a hands on setting.

I wanted to read Cutting for Stone on the plane as many of you have recommended it to me but I didn't have time to pick it up before I left so I grabbed The Emperor of All Maladies: a Biography of Cancer that Professor Tannenhauser recommended to me over the summer when I was telling him about my interest in clinical research. I haven't had any life changing experiences yet (unless you count navigating the Charles de Gaulle airport) so I will start my first blog post with a review of my in flight entertainment:

I think what strikes me most about this book and similar ones like it ("The Immortal Life of Henrietta Lacks" and "Flu: a History of the 1918 Flu") is that they make research sound like results are made every day and it is the most exciting, fascinating career to be a physician scientist-- on par with that of a rockstar or a fireman. Even when I read it, I forget how tedious and frustrating research can be and how long it can take to get real results. I salute the writers who make seemingly mundane acts of running test after test sound like a scene straight out of CSI. It truly brings you back to the "glory" of research. If I weren't heading off to Niger right now I'd be ready to hit the lab and read the literature in the manner that
Siddhartha Mukherjee so eloquently describes. I haven't finished the book yet but I look forward to reading the rest.

Thanks for reading,next stop Niamey! I promise my next post will get down to business as Ive been assured by Mark and Jaqui that we will all be very busy on the ground in Maradi.

A New Adventure

Hello all!

As many of you may know, I am conducting an internship in Maradi, Niger this semester at the Danja Fistula Center with the Worldwide Fistula Fund.  I am incredibly excited to see women's healthcare at the grassroots NGO level and to understand many of the challenges involved with administration of adequate health services with limited resources.

For those of you who may be unfamiliar with obstetric fistula or vesicovaginal fistula, it is a hole that forms between the bladder wall and the vagina due to prolonged childbirth.  Women who are in need of a cesarean section yet are not in adequate facilities for the procedure often develop a fistula.  In childbirth the baby's body presses against the bladder wall cutting off blood supply thus causing tissue death and the formation of a hole.  This hole leaks urine through the vagina and leaves women incontinent due to their lack of bladder control.  Women with obstetric fistula are the most devalued in society and are often isolated due to their urine soaked clothing.  Surgical repair of fistulas is the only treatment and requires proper surgical resources which are often lacking in rural areas of Niger.

At the Danja Fistula Center I will be helping to set up a brand new fistula center that will accept its first surgical patients on February 6.  I will be living on the compound at the hospital viewing surgeries and assisting in community development of prevention methods in nearby villages.  I leave tomorrow for Niger and I look forward to posting about what I am learning and sharing it with everyone.  If you would like to send me a letter my address is below:

SIM NIGER

CSL Danja

 B.P. 10065
9 Rue de la Tarka
Niamey,  Republique du Niger