Yesu ben n’kanu

I returned to the clinic on Tuesday after the afternoon rest period to find a man curled up in the fetal position on one of the benches outside the consultation room. Despite so many people being very sick, I have never seen a patient appear in such agony. Looking over the shoulder of the nurse I was working with at the lab results –it confirmed this man’s case was malaria. Thinking I would assist the nurse in preparing the IV solutions and following her directions, I soon realized that I was left alone. All the nurses were called into a meeting and I discovered that the statements that I had been responding “oui, oui” to without really knowing what I was agreeing to were questions from the doctors and nurses if I could take care of the patient while they had their meeting. I’m very familiar with the routine now: medicine to get the fever down first, glucose with vitamins and malaria medication added afterwards. This situation gave me the opportunity to feel like he was my patient. No one was there to help tell him what was going on, except me: that the IV, yes, it would hurt a little when I put it in, and that he would have to stay for at least eight or so hours. I really enjoyed getting to build this nurse/patient relationship that I haven’t had a chance to be able to much yet because I’m usually with another nurse who is in charge. It was fun laughing together the next day that yes, he could call me his American nurse, but not his wife.

Later in the week after the girls and I returned from a long walk (in which the eldest took the whole time explaining to me what the movie “Babe” was about) Felix told me that a woman was in labor and he was going to go back to the clinic at 10pm to see how things were. I went with him, and two hours later a 2.2 kg baby was in the arms of his mother. This was my first experience of getting to spend extended time with a mom who is waiting to have her child (the other births were much quicker.) Holding the 17 year-old’s hair back as she vomited and giving her oxygen while telling her repeatedly “it’s ok, it’s ok,” were some of the things I did. In Burkina, the mom’s are walking within minutes after birth, and most leave the next day. I’ve spent some time with the midwife helping her with pre-natal examinations. It’s fun trying to figure out which way the baby is presented and listening for the heart beat with the ultrasound. Another interesting thing about African culture is if a woman gets pregnant, she doesn’t immediately tell all her friends. In fact, she will try to keep it a secret for as long as possible- sometimes this is to keep others from putting curses on her child.

One of the women from the Nav team got sick and stayed at Felix and Nema’s house for a couple days before she returned home. It was very uplifting for me to have a fellow American around to chat with and discuss what thoughts I have been having during my time here. Without a team coming with me sometimes I don’t realize the ways God has been so good to me, because I don’t have anyone to debrief with or talk out what I’m experiencing. I got a taste of this with her, and it was refreshing.

I’ve learned some songs in Jula (one of the village languages here) from the workers at the hospital and really enjoy trying to memorize them. (Jesus loves me, and I’ve got peace like a river in my soul). I sang them to Dorcas, the girl who help out cooking and cleaning at Felix and Nema’s home and she was delighted, since they were in her language.

I return home in a little less than a week (August 3, 11:30pm I fly into the Indy airport and I hope mom, and dad, you are there!) and it’s amazing to realize that six weeks will have gone by. If you are praying, please pray that this last week is especially used by God to advance his Kingdom here on earth.

I cannot thank you enough for the many emails and prayers you have sent to encourage me while I've been here. They have been a huge blessing.

A Bunch of Threes

God has been so faithful in not only showing me what medical missions is like every day at the clinic, but through many conversations I have been having with Felix and Nema. Each time I walk away with my mouth gaping and my mind spinning; it is not an easy or comfortable life by any stretch of the imagination. They have had so many struggles with workers who steal, workers who abuse patients, workers who say one thing and do another. In Africa nurses go to school for three years and then are required to work for at least a year wherever the government puts them. Many times this is in a village where they are the only health care professional (no doctors.) They are looked at as gods because in African society you don’t ask questions, you just let the person who knows fix everything. So many of these new nurses will be practicing skills wrong, prescribing incorrectly, or harming patients without anyone to check up on them, rebuke them, or teach them correctly, all the while having patients think everything is fine. Then when they finish their time they come and get a job with this mindset of being all-knowing, and continue to treat patients in the same way. Nema says she wishes she could grab those nurses before they are a year in and teach them how to care on the patient’s level. Nema shows me a servants heart. I am learning how to love people more like Jesus does by watching her work.

This week a team of Navigators came to Burkina Faso for three weeks to run a camp. I went with Felix to the airport to meet them and really enjoyed greeting the newcomers and filling them in on tips of life in Burkina (proper greetings, typical meals, never wearing tennis shoes, etc) They came over to Felix and Nema’s home for a meal and for the first time I felt like I wasn’t the guest in their home, but a friend making others feel welcome. I helped squeeze lemons with the girls to make fresh lemonade and drove with Felix around town at 1030 pm to find fresh French bread! They will come to the clinic later in their trip to help out, so it will be a blessing to get to spend more time with them.

It has continued to rain at least three or more times a week. This past Saturday my friend Egier and I went out again on his motorbike to see more things in Ouaga. On our way back we drove right under an enormous dark cloud which drastically changed the temperature and pelted our skin with forceful drops of rain. Before hand, we saw one of the three dams in the city and also road out to a town, Loumbila, where there amidst huts, vendors, and donkey carts of the rural terrain is a resort-type area with a pool, playground, and beachfront. It was a perplexing site. Egier let me try to drive the motorbike, and well, I’m not too good. The changing of the gears is difficult for me, and I really wish I had learned to drive a manual car better previously. A highlight of the day was getting to drink mango juice with ICE!!

The clinic has been busy this past week, and I have never felt so many burning babies before. My knowledge of pediatrics is limited, but its not hard to tell when a child comes in with this dim look in his eye and hardly responds to your touch that something is really wrong. 40 degree C temperatures (104F) are all too common, and many of these children are hospitalized and receive treatment for malaria. Three more babies have been born, and unfortunately I haven’t been there to see the births. I really enjoy getting to hold the newborns (they are actually little here unlike so many chunky American babies!) and pray for them while looking into their deep dark eyes (also hoping this helps them to learn not to be afraid of white people!) I do wound care on two or three patients a day typically - seeing many motorbike accident wounds, dog bites, and burns. One elderly woman has an enormous wound on her ankle and comes in almost every day to have it cleaned and wrapped. I really enjoy the 10 minutes we spend together shooing the flies away and working the betadine into the crevices of her leg.

I realized this week that I am getting used to African nursing in some aspect. Setting drip rates with my watch instead of a machine, filling out patient’s little blue books that hold their medical information instead of having hospital records, sterilizing equipment to get it ready for the next use, etc. Call lights, hospital food, bedrails…what are those?

I would ask for continual prayer in interacting with patients and workers. I have written many verses out in English for the workers, and enjoy slowly repeating proper pronunciation with them. I pray to be bold with patients in my limited French and try to interact with them even better. I am asking God to make me be a nurse for Him, the ultimate Doctor, who gives the true healing. I just want to be the person how helps people follow the Doctor’s orders.

A Trip to Tougan

It’s fun to feel home away from home. I returned Sunday from Tougan, a small city north of Ouaga (a 5 hour bus ride away) where I was visiting and helping at a clinic there. What a different world it was, not only getting there, but once in the town. During the five hours of being jostled and bounced in a bus with too many passengers, I saw “the bush” of Burkina: miles of no man’s land filled with short trees and cracked clay ground. Every so often we would pass a small village that to me looked like a mix between what I picture in my head of Bible-times houses and medieval style houses, depending on if the structure included a hut-like dwelling made from brick or clay. These were rudimentary structures that were often in disrepair. The rest of the land was being cultivated by mostly women and children that I saw, bending tirelessly at the waist and digging into the soil with picks. Donkeys are prevalent and slowly pulled meager bits of farm equipment along as children as young as five whipped them into obedience. Under the shade of many trees I could see farmers resting with their bikes, goats, or babies. Tougan was so much quieter than Ouaga, probably because it was so small, and very green! There were virtually no cars on the dirt roads, and hardly any motor bikes. We experienced rush hour there: herds of animals coming in from the fields down the main road followed by women with bundles of sticks on their heads, men on bikes with dead pigs tied behind, and children riding on donkeys.

The clinic at Tougan was another eye-opening experience as I got to give IVs using a rubber glove for a tourniquet, and a normal needle and syringe (rather than an IV cannula) to enter the vein. There was no doctor, no lab, and no refrigeration. This means that the nurses prescribe and treat patients based off of the symptoms they see and are told, and the medication they have to offer is very limited. The three-room clinic (a consultation room, pharmacy, and patient room with 3 beds) makes a big difference though in this quiet town because patients would tell us that they traveled hours to get there- sometimes as many as 30 km!! I’m getting better and better at breaking the ampoules of quinine, the malaria med prescribed to everyone, and have comfort knowing that even if patients might not have malaria and take it, they won’t be harmed. (Since this clinic can’t do a blood test to confirm malaria, they just give it to pts. with fever, headache, abdominal pain, etc.) I really enjoyed the time we spent each morning before we started seeing patients where we read a passage from the Bible in three languages: French, English, and Jula, the language spoken by the people in Tougan. It was beautiful to hear, and I picked up on a few words, including “toobabu,” meaning “white person,” which was yelled by all the children who would see us, and “barka,” meaning “thank you.”

So after several days away of seeing lots of skin infections and feverish children, it was a good feeling to come back to Ouaga and feel comfortable on my stomping grounds. The girls and I took a long walk (they seemed very happy I was back) and saw the sky flooded with bats. We detoured some territorial dogs and even chased a frog into the water. This is what I’m getting used to, rather than the many cockroaches, termites, snails, and bright red bugs I saw in Tougan!

Prayer requests continue to be strength in knowing how to relate to people when language is limited. I’m thankful God has given me good relationships with many of the hospital workers in Ouaga, and I’m praying that spiritual conversations with them can occur. I am praising God for letting me spend the time in Tougan with some other American women (studying to be doctors)- it was refreshing to share experiences with people who understand my culture. I would also like to ask God for extra endurance and patience for Felix and Nema as the huge malaria season is hitting and lots of people are coming in very sick. Thanks so much!!

Family Life

Living with a family means that I get to experience their family life, which can be really fun. On Saturday the girls wanted to go swimming, so they blew up their kiddy pool and splashed in delight as I took pictures of them (I’ve wanted to put pictures on the blog, but the computer system here has a mind of its own). Another time I went with Felix to watch the girls play tennis. There are courts nearby at an International School, and it was fun hearing tennis lingo in French.

Felix and Nema have friends coming in and out on occasion, and one of their family friends offered to take me on his motorbike and see the city. What an experience this was! (You feel like you have to brush your teeth afterwards; the dust is profuse!) It was very interesting seeing how the city changes- from dirt roads that are really just pot holes strung together, to wide paved streets with massive houses and multistory buildings. I saw the University of Ouagadougou, their new stadium, a large monument, and even a fancy hotel art gallery! There is a newly built mall in the very upper-class region on the city, but it is mostly vacant because of the price it takes to lease a space. The mall offers one thing that is nice for an American, fixed prices.

Nema took me to “the main market,” and despite my other travels out of country and in markets, I have never experienced such chaos. Not 10 seconds inside we were flooded by men shoving products in our faces and pleading for us to come into their shops. “Good price! Good price! You like? I have more!?” The market is rows and rows of tiny shops that are shoved full of merchandise from shoes to fabrics and dyes. Nema reminded me that if I really wanted something nice I should tell her and she would come back alone and get it for me, because the merchants won’t reduce their price to someone they think has a lot of money (because I’m white). She did an excellent job of bartering for a few items I did purchase.

Fried plantanes is a favorite and common dish here, and I also have enjoyed their fish (which is bought alive and appears on your plate with scales and fins). Oh yes, how could I forget, (concerning food,) on the road yesterday I saw a motorbike making more noise than usual. When I looked I saw little goats tied together at their feet and flung on the back of the bike with their heads dangling down. PETA would be horrified! Not soon afterwards there was a large truck with chickens tied in the same manner balanced on top in a crate!

I was challenged to learn some Bible verses in French (from the friend who took me to see Ouaga) and it has been difficult but fun. It helps me learn vocab faster and it also gives me something to talk about with the other workers at the hospital. Since some of them do not follow Christ, it’s an easy way to bring up spiritual thoughts. This week I’m working on 1 Corinthians 10:13- wow! The workers like to hear me talk in French, and even if I am amusement to them, I pray that this is God working in their hearts.

Till next time that the power holds on long enough for me to post!

Nursing In Africa

Nursing in Africa is not like nursing in the United States. I learned this over and over again throughout this past week. One of the major things that I have discovered through talking with Nema and Felix, and also witnessing with my eyes, is that nurses here don’t always really care for patients. Although the ministry of the hospital I am at is Christian based, not all the workers have the same mindset. In America it is drilled into us nursing students’ minds- patient comfort, patient comfort- in Africa, its whatever the nurse feels like doing at the moment. This becomes a frustrating situation for the Kohols because they work endlessly to teach their workers to care for patients well and safely, but often they refuse to change. Since patients don’t play the “I’ll sue you” game in Africa, this makes a lot of things slide.

During a surgery Felix was performing I got to take the position of the scrub nurse and hold tools, wipe up excess blood, and manipulate the skin for better access. Although this may sound grotesque to you, it was an honor and fascinating experience for me.
A young man came in another day with a cut in his head, needing stitches. With the help of Felix, I got to anesthetize him and put sutures in. Thank goodness he was young, strong, and patient because the whole process that I have watched many times is a lot harder to do. Sewing skin in the head with a fish-hook looking needle and tying slippery suture-string with gloves on is challenging. I have great amazement at all the doctors who whip the process out with no trouble.

Nurses in America do not diagnose or prescribe. Nurses in Africa do. At the hospital, you can pay $1000 CFA ($2) to see a nurse or $2000 CFA ($4) to see the doctor, so many patients see a nurse. I found myself more than once this week sitting behind the consultation desk asking horribly worded questions in bad French (with my vast knowledge from my 2 weeks of study and a dictionary) to patients who must think I am crazy. I hear their situation, assess their condition, write in their medical records, and then have to come up with a diagnosis and prescribe them medicine. Fear not, there is another nurse with me helping me along, but still, the whole concept is so foreign to me. It is helpful that their pharmacy is small and most people need the same tests and exams done (malaria test, parasite test, infection test, etc).
I got to put my first IV in a child, and I have mixed feelings about the matter. It was very difficult for me to do something I knew would cause great pain and terror to an already hurting child, yet the aftermath was so encouraging. I can’t erase the picture from my mind of the much healthier little boy running around the clinic in sparse clothing the next day, holding his IV bag in hand with the tubing draped around his body, smiling.

I know I will have more non-medical news to pass on to you soon, so if this was not your forte, do not fear. My experiences are very great beyond the hospital walls.

God is teaching me more than ever how to live out the verse that says “Let us not love with words or tongue but in actions and in truth.” It is so hard not to be able to say all the things I want to to patients, but I am grateful more than I ever have that God is multilingual. I can always pray for patients, and know that God understands, even when they don’t. Nema has been my main teacher in this concept, and I love getting to watch her pray out-loud with the patients before many major procedures and births.

Thanks for all your prayers and encouragements you have given me!