30 November 2014

Lessons from the Widow and her Mite

My favorite thing to do in Niger on a Sunday is drive an hour up the road, weaving around broken-down-trucks and boys-driving-the-harvest-home-on-donkey-carts, to attend a tiny village church.

Humble, in every sense of the word, this small community of brothers and sisters faithfully meets to give thanks for the little they have; together they learn how the Living Word of God should change their daily lives.

We were some of the first to arrive, which gave us ample time to greet others fully and to be received with great welcome and joy.  As we were invited to choose our benches, a small elderly woman approached the side door of the church.  I didn't know it then, but this Little Old Lady was about to teach me a profound lesson.

01 November 2014

The View from Here: OPD Portraits

Took the new camera for a quick spin around the Outpatient Department (OPD).  Still trying to figure out all the diversity with ISO and other perks of the upgrade . . . but not too shabby for the second use.

28 September 2014

Lessons on Unloveliness

'Is she the only child in the world like this?'

Sitting next to me on the bench outside of the therapy gym, the young mother slowly began to trust us with what was really in her heart.  B. looked up at me, waiting to hear the answer.

'No, there are other cases,' I assured her.

'Really?' she asked in disbelief.  'Cause I've never seen anyone else's child look like this!  Show me!  Bring me to the village where there is another child like this!'  Her tone was one of deep fear and deeper sorrow.  'My husband says she's cursed.'

I took a deep breath and silently prayed . . . how does one begin to explain the genetics of a rare skin condition to a mom who never attended primary school?  How could we convince her that this was hereditary, not a deliberate act of aggressive evil against her child?  How would we support her from afar as she feels isolated and alone, refusing to give up on her little girl?

I didn't know how, so I told her a story instead.

18 September 2014

Lessons from a Tetanus Survivor

'Thank you,' S. whispered to me in English before transitioning back to Hausa.  'I thought I was dead, but you gave me my life back.'

We were sitting on a mat, under a tree in the Ambulatory Care Unit behind the hospital.  Already today she had done her own laundry in a modified position and climbed a small set of stairs.  A world away from relearning how to swallow her own saliva.

I looked up from the patch of sand where I was etching designs with a stick.

Our eyes met, and I smiled.

'Thank you, my friend,' she repeated and she leaned her forehead against mine.

17 September 2014

No Free Shows in Therapy

When I worked at Temple University Hospital, as I helped my patients don a hospital gown over their bare backsides, I'd tell them that the first rule of therapy was: No Free Shows.

Things are little different here in Galmi.  Bare breasts are no big thing, and the fewer clothes children wear, the less the burden of the laundry load.  Kids come to therapy naked all the time.  And I've even had many older children wear nothing but an open hospital 'gown' as if it were a untied robe.  So it's always a bit surprising when I have a kiddo who is super specific about when he's all covered up.

16 September 2014

Three Therapists in One: A New Meaning to the Holistic Approach

One of the hardest-but-at-the-same-time-best parts of my job, professionally speaking, is the necessity to be a full-service therapist.  That would be an OT, PT and Speech Therapist all rolled into one . . . although, I'm pretty sure that's not what they mean when they say OT comes from the 'holistic approach'.

My work with S. is the perfect example of this.

S. survived tetanus, a horrific disease that caused all of her muscles to become rigid, including those required for swallowing and breathing . . . two functions necessary for survival.  Which is why I was consulted: chest PT for her aspiration pneumonia and speech therapy for swallowing.

When I went to see her last Monday for our session, she told me that she didn't like me and I should just leave her to die.

11 September 2014

A Local Legend

Since leaving the US in 2009, I've racked up my share of good stories.  Some funny . . . some unbelievable . . . some interesting . . . and some moving.

Every once in a while one of those stories becomes a bit of a legend.  And this is one of them.

I hadn't really thought it was that good of a story . . . it sort of was just one of those new-normal kind of stories.

That is, until I shared it with a group of summer interns on the eve of their departure.

09 September 2014

WhiteGirl and the Owner of Spiciness

As you know by now, I have a big soft spot in my heart for kiddos who have been extremely burned. They are the bravest and sweetest little people I get to work with.  Often they come to our hospital for a couple of months and we follow up with them each month for a year.  Needless to say, they quickly wriggle their way into our therapy department family.

Little H. is no exception.  

A four year-old who was badly burned in January when, wrapped in a thick blanket and unsupervised, she went to warm herself by a cooking fire.  The base of the blanket ignited and she couldn't get it off fast enough.  When her family found her, they thought she was already dead.

But Little H. is a fighter.

And I confess, I think it's her abundance of tanka (a mix of hot chilies and spices used in local cuisine) that I love most.

08 September 2014

It's a Girl

Well, it's official.  B. is a daddy!

For those of you who have come to Galmi and worked alongside us, you will know that B. has a soft spot for the kiddos that pass through our doors.  And last week he and his sweet wife finally got to take one home.

My camera broke in April, so I don't have any photos of her by herself yet . . . but B.'s sister told me that her kids have been saying that baby has my eyes.  Maybe it's time we have a genetics lesson!



29 August 2014
Barka da zuwa, baby Stephanie!
We're so excited that you're finally here!

21 August 2014

Ebola in West Africa: Five More Ways to Pray

It's been nearly a month since the world's attention was turned to a little corner of west Africa where the deadliest Ebola outbreak in human history has occurred.  Today the most famous Ebola patients in history were declared 'virus free' and released from the hospital.  But despite the spotlight and the thankfulness we feel for their healing and survival, the spread of Ebola continues.

The good news is, this outbreak continues to be contained within four countries . . . the devastating reality is that new cases are being diagnosed each day and people are dying.

And while most of you reading this won't be able to 'give a helping hand' to help bring this crisis to an end, you can play a very active role . . . keep praying.

03 August 2014

Today I had Leprosy

When I was 20, I went to India to be the project photographer for a children's book about street kids.  I was studying SportsMedicine at the time, but was still secretly very much on the fence between a career in physical rehabilitation and a life of freelance adventures all captured on film (yes . . . film . . . I'm older than I look!).

It was in India that I new I wanted to work in a developing country . . . with populations that are underserved . . . and with people that are at a great risk for being overlooked.  It was in India that I knew for sure I wanted to become an Occupational Therapist . . . because I saw, with my own eyes, the havoc that disease and injury could do to the human body.

Diseases like leprosy.

Only today, I became the one disabled.

30 July 2014

How I Pray When No One Is Listening

Taking the bus is always an adventure and often comes with good stories.

B. and I went to the capital for a training on an appropriate technology initiative happening in Niger and other west African countries. We found out about it two weeks ago and have been looking forward to it since.

We were thrilled to get to be a part of the movement to improve the lives of disabled Nigeriens and we had high hopes for this trip.

That is until we got on the bus. 

28 July 2014

Ebola in West Africa: Five Ways to Pray

This weekend, we in the SIM family received word that a doctor and another SIM employee at ELWA Hospital in Liberia tested positive for Ebola.  ELWA is one of the west African hospitals also operated by SIM.  ELWA has been combating the virus since the outbreak reached Liberia, and has taken the precautions necessary . . . but the heartbreaking reality is, Ebola doesn't discriminate between who is the patient and who is the caregiver.

As the news is being spread around the world (you can read more hereherehere and here), the need for prayer is great.  SIM's motto is By Prayer . . . because we believe that our own efforts can only go so far.

We need you to pray.  Here's how:

24 July 2014

Niger in the News

This post in the NewYork Times came through on my facebook feed this morning.

What struck me at first was the advertised headline was 'Niger is poor and located in the desert'.  My first reaction was: well, NYT, at least you've got your first facts straight.

One line I can't get away from in the body of the text:  The country’s women, held back by their husbands and by imams who inveigh against “Western” notions like birth control, don’t demand it.  

"The country's women . . . don't demand it." 

Well, Mr. Nossiter, it's interesting to me that all the way from Dakar you assume Niger's women are free to make such demands.

Read the article here.

23 July 2014

A Dose of the Best Medicine

I did my undergrad degree in Athletic Training . . . also known as Sports Medicine or Sports Physio in some places.  So when I moved to Galmi to start up the therapy department, I didn't feel too out of my element when I needed to see just as many (if not more) traditionally Physical Therapy cases as I do Occupational.

There are still PT patients that stump me or who require knowledge way beyond my bag-of-tricks . . . and when that happens, I call in the virtual-cavalry and get expert opinions via email from Physio colleagues around the world.  It's kind of like our own form of distance learning, just without the exams or tuition fees.

About a year ago I started getting consulted for dysphagia (swallowing difficulties) with stroke patients.  It pulled me out of my comfort zone a little bit, but going off the advice of a Speech and Language Pathologist from my Philly days, I got by.   But last week a visiting ENT (Ear-Nose-Throat doc) arrived and that's when it got really exciting challenging intimidating stimulating interesting.

18 July 2014

The Big 'C'

'Uh, D├ęborah, what is cancer?'

I looked up from my teaching notes and blinked at the five men circled around me in the wound care room of the OR.

'What did you ask?' I question, assuming I must have misunderstood.

'You're talking about dressings for patients with cancer, but we don't know what that is.'

I looked at each one, hoping I'd get an indication that they were joking . . . but they weren't.  Four OR Techs and a NurseAnesthetist-in-training, and they didn't know what cancer was.

15 July 2014

Where There Is No Hospice

**I wrote this post over a month ago, but couldn't bring myself to finish it, let alone publish it.  I have detailed heavier cases . . . shared events I find more devastating.  But for some reason, this was just too difficult at the time.  It's happened before, just doesn't usually take a month to process.**

Our Little Girl of Peace passed away early Thursday morning.  Her burns were just too severe for her little body.  And her battle was over.  We just don't have the resources here to change certain outcomes.

That afternoon I sat next next to a mom who was cradling her frail child.  Pressed against her mother's chest, this precious one looked to be four, maybe five years old.  Her skin hung from her boney frame, eyes hollow and deep.  AIDS had ravaged her little body . . . malnourished and weak, the doctor admitted her, hoping to do something to ease her suffering, but recognizing the prognosis wasn't good.

On Friday, our last patient of the day presented to the gym with an atypical concoction of symptoms.  'Stroke' had been listed, but it became quickly apparent that the history I was getting was not what had been given to the doctor.  And as I transferred M. from the wheelchair to the treatment mat, the back of my hand, which was sandwiched between her left arm and her chest, could feel the enormous mass in her breast.

What started off as a localized cancer, had spread to her brain causing her potpourris of symptoms.  A quick chat back with the doctor--there wasn't much we could do.

14 July 2014

Confessions of an Educated Woman

'He says he has 17 children--no, wait, 18.'  B. translated, and counted, as my new patient attempted to list off the names of his offspring.

Trying to do cognitive retraining with a 40-ish year old man who suffered from a traumatic brain injury (TBI) two weeks ago can be challenging . . . attempting to do it in Hausa without wasting anyone's time takes a lot of creativity.

Since I'm limited by language and he's limited by severe immediate recall deficits, we ended up limping along together and some how he made progress.  I'd say it's because of my education; my patient and his friends, however, wouldn't agree.

05 June 2014

Niger in the News

1 in 4 Nigerien girls are married before age 15 . . . 4 out of 5 by 18.  For some, it's just business.

04 June 2014

Refuge Gone Wrong

When over 200 Nigerian girls were kidnapped from their boarding school in April, the world was outraged.  Using hashtags and digital polaroids, the phenomenon that is social media took the story viral, making famous the militant fundamentalist group that has been terrorizing Nigeria and recruiting young men in Niger.

Across the border our Nigerian brothers and sisters live amongst the acute trauma of kidnappingsbombings and massacres.  And while on this side we don't face the same acute horrors, we do feel the secondary effects.

On Friday, I wrote about the Little Girl of Peace, who had been brought to our hospital with severe burns after a car accident.  Turns out, she is a refugee.

30 May 2014

The Peace Left With Us

"There are six new burn admissions upstairs," B. said as I walked into the gym this morning.  I knew it was pretty serious if he hadn't at least said good morning first.

When I got up to the surgical ward, I found them all, lined up on gurneys in the front atrium across the nurses's station.  Three adults, two teenage boys and a little girl.

Upon seeing them, I knew this was no ordinary house fire.

29 May 2014

Niger in the News

This happened just up the road from us . . . pretty interesting article from the BBC about slavery in Niger.  Makes me wonder how many of these 'fifth wives' pass through our hospital doors on a regular basis.

Niger Sees First Slavery Conviction Over 'Fifth Wife'



And then there's this one, just for fun, which gives me one more reason to try to get up to Agadez some day.

25 May 2014

Tomorrow I'll Say Goodbye

This morning I found out that a very important little friend of mine took her last breath yesterday.  For those of you who have been reading my ramblings since my arrival in Niger, you might remember R.'s story.  For those of you that are new, you can check out bits of our time together here, here, here, here and here.

R. was the patient that convinced my Nigerien colleagues that I was a worthwhile part of the team.  Suddenly I was so much more than another single white girl that showed up on the bush plane one day.  R. was one of their's, and by providing her with a make-shift wheelchair that would meet her unique needs, I cared for their whole community.

Suspicion dissolved into understanding . . . invisible barriers came crumbling down.  They got it: I wasn't here to give life, I was here to give living.  Because of her, others came . . . because of her, others trusted me with their loved ones.

R. was the breakthrough . . . and now she's gone.

14 May 2014

A Handful of Miracles

In the three years I've been in Galmi, we've had some amazing therapists and therapy students come to visit.  Whether they've come for two week or two months, our OTs and PTs have all left their mark.

While I was away, we've had an OT-extraordinaire here covering.  M. has been a breath of fresh Canadian air for our little department . . . and has definitely made an impression.

Yesterday she was telling me about an unusual case she saw while I was gone . . . and today I got the rest of the story from B.

12 May 2014

The Night I was Almost Stabbed in the Shower

You know that scene in Psycho . . . when the woman's in the shower . . . and then the knife comes hacking down . . . and the blood circles the drain . . . and the freaky screeching music is playing in the background.

Yeah, that was reenacted tonight in my bathroom.

Kind of.

You see, the shower part was the same . . . but instead of a knife or blood, it was the most gigantic scorpion I've ever seen!  And I knew one of us wasn't going to make it out of the tub alive.

09 May 2014

The Comfort and Sorrow of Ikea

Getting out of Niger . . . away from the dust and the heat, out of the fishbowl . . . seems to always come with mixed emotions. 

Feeling stress physically leave me body . . . it’s kind of like a slow leak, a little bit at a time until I notice that I’m breathing differently, almost normal, but not quite.

Overwhelmed with gratitude for every blade of grass or evergreen needle . . . capturing each lapping wave in my mind’s eye to save for later.

Cherishing single-customer taxis and fixed prices at the market . . . savoring fresh cheese and enormous strawberries and everlasting cucumbers.  

And then there’s Ikea.  

30 April 2014

April is OT Month

April ends today.  So does Occupational Therapy Month.

I had big ideas and grand intentions to spend this month publishing wonderful posts about the worlds greatest profession, opening your eyes to the wealth of understanding that is summed in two little letters: O and T.

But I didn’t write them . . . not even one.  And now the month is over.

Sorry, OT, I dropped the ball.  

Maybe next year.

Next year I will explain to the world what it is that we do . . . and why it is an essential portion of the healing process . . .  and why we are an integral part of healthcare teams . . . and why the whole world needs our services.

Next year.

Yeah, next year I will offer links to valuable OT resources around the web, like so many other OT bloggers have done . . . and I will promote this life changing profession that builds and restores quality of life, meaningful participation, purposeful existence and functional independence.  Because that is what we are about: quality, meaning, purpose and function.  

Next year I will tell you about how we who practice Occupational Therapy believe that all humans have value, regardless of capabilities . . . and that physical, cognitive, psychological or socioeconomic limitations do not nullify the right to human worth.  


But it will have to wait until next year.  Because April is over . . . but then again, for our patients whose lives are changed by Occupational Therapy, every day is OT Day.

22 March 2014

The Cost of a Check Up

Lately my mind has been occupied by the reality of the great cost of seemingly small decisions pertaining to life in these parts.  A patient who runs into a burning house in order to salvage her life savings.  Or the son who decided to hold his father upright while walking because he can't spare the extra money on a walker.  Or the grandmother who hasn't eaten for two days because her kiddo has a therapy appointment.

My Favorite F. came to see me on Wednesday.  She was supposed to come last week, but they didn't have enough money for the bushtaxi fare to get to the NGO clinic that would drive them the rest of the way to the hospital. 

When they arrived, Granny greeted me and immediately helped herself to a floor mat that was rolled up in the corner.  She spread the mat in the middle of the gym, laid down and fell asleep.  When she awoke about half an hour later, I asked if she was unwell and needed to see the doctor.

'I'm fine,' she said.  'Just hungry.'

19 March 2014

Desperate Measures

Over the weekend, another of my long-stay burn patients died.  When she was admitted six weeks ago, her sister informed me that she was 130 years old. 

I double checked a few times to makes sure this wasn't just another language error on my part.  Nope!  I had heard correctly, 130!  

I used my mad-skills in the art of chiniki (bartering for the best price possible with a vendor at the market) and eventually I got her down to 80.

The right side of her face was badly burned, but from the unaffected side, 80 was an estimate I could work with.

As I continued through the WHO international burn registry data form that we are piloting, I began to ask very specific questions about the cause of her burns . . . she had been burned in a house fire, but her story was incredibly unique.

11 March 2014

The Ears of Your Skin

Proprioception.

That's what we in the biz say when we're talking about your body's ability to know precisely where it is in space.  It's what allows you to close your eyes and touch your finger to your nose . . . or to clasp a necklace behind your head . . . and to walk on sand without spraining every joint in your body.

You see, throughout the human body, there are these little receptors . . . they gage pressure and position and then send nano fast messages to the necessary muscles which will manipulate the involved joints in order for the body to respond appropriately.

Yesterday, we had one of our frequent flyers come back to see us because he's got secondary issues as a result of an old heel fracture and bad ankle sprain.  Apart from some stiffness and weakness, his main problem was that he still hasn't regained his proprioceptive sense . . . but in order for him to buy into the exercises, he'd have to first understand why they were necessary . . . which meant I'd have to explain it to him . . . in . . . Hausa.

04 March 2014

With Grief and Trembling

Yesterday morning, just before lunch, a patient was sent to see me.  Under the 'diagnosis' section of my referral form the doctor had written 'intention tremors significantly impairing function, cause unknown.'

Immediately my thoughts went to the overhaul of tests and months of treatment this gentleman would have received if we lived anywhere other than here . . . even after three years of this, I had to take a minute a grieve the imbalance between what could be and what is.  


This man came to me as a last hope, it helps no one if I say 'Well, since you can't spend weeks in a highly specialized neuro unit of a rehab hospital, I can do nothing for you.  Sorry.'  No . . . I was going to have to do something.

08 February 2014

Niger in the News

Great photos of Niger . . . mostly Niamey, Agadez and Arlit.  Maybe next time Reuters will stop by Galmi . . . we do draw around a hundred 'tourists' a year!

http://in.reuters.com/article/2014/02/05/pictures-report-idINRTX1891X

29 January 2014

The Language of Grief

Yesterday, a bit unexpectedly, I found myself wandering through a neighborhood across the street from the hospital.  Normally this would be no big deal, but because this was an unplanned visit in the middle of my workday, I didn't have a head covering with me.

About an hour earlier I had received the news that a three-year-old patient of mine, little A., had died the day before while I was still in Niamey.  I knew I would need to go visit his family; I figured I'd wait until I could change out of my scrubs and put something on my head.

But, as I learned yesterday, when it comes to grief, in Galmi, it matters most that you've shown up.

27 January 2014

Once an OT, Always an OT

Becoming an OT has ruined me forever!

I can’t people watch without analyzing the person’s gait pattern, I can’t walk into a building without noticing its accessibility, and clearly I can’t take a commercial airline flight without doing an ADL toileting session!

RUINED!!  FOREVER!!

20 January 2014

An Apple a Day

The other day, my little pal, F., came back for a checkup [for the rest of her story, click here, here
and here].  I was able to complete the mask that would cover her entire face and forehead; as long as Granny keeps it pulled tight, we should be able to soften the scars that have already formed and prevent new ones over the areas of skin that have recently healed.

When we were all done, I treated her to a piece of candy and Granny to a shiny green apple.

'What on earth is it??' Granny asked as she twisted and turned the piece of fruit, inspecting it's skin.

'An apple,' I stated, using it's French name as I don't know what they are called in Hausa.

'A WHAT?!?!?' she asked.