Things You Might See in Niamey

First, a disclaimer: still no Niamey pictures. Can I blame it on the heat? Today's not actually that bad, just humid. And overcast. I feel like I'm being steamed. Possible bright sides to this condition include- less static electricity; knowing when you're dehydrated because you run out of sweat and become the only dry thing for miles; you might be able to cook something, very slowly, perhaps thinly sliced carrots.

And now, a quick lesson in the proper pronounciation(s) of the word Niamey:

Niamey is pronounced NEE-am-aay if you are an American speaking with another American (rhymes with FREE-spam-day, sounds kind of like Miami if you pronounce Miami the Spanish way).

If you are an American speaking with a Nigerien, you would say something like Nee-ahm-AYE (rhymes with Free-um-FLY).

But if you are in a rural village, the N is replaced with a Y, and the capital city suddenly has just two syllables and sounds like Yum-EYE.

I should also add that I opened this up for discussion with six other volunteers and none of us can agree on any of it. So, I guess you can just say it however you want.

Here are two neat things that you might see in Niamey:

1. Tall white camels carrying loads of hand-woven grass mats, being led by ropes through their noses by men in robes. I see these guys every day, and every day I try not to stare. Camels are just so unlike any animal I am familiar with in the states-- their gait, their size, their expressions-- so they always capture my attention. I hope I never, ever get used to seeing camels.

2. Enthusiastic taxi drivers. I agree with Alex- some of my most memorable conversations take place in taxis with the driver and his other passengers. The way city taxis roll here is an adventure in itself: you stand on the side of the road, wave one down. He pulls up but doesn't stop, just pauses long enough for you to shout out where you want to go. If he wants to go there, or is planning on going near there, he'll motion you in with a nod, and you jump in and join the other 2 or 3 people already in the car (all, presumably, going somewhere close to where you're going). If he isn't going where you're going, he shakes his head and zooms away, leaving you feeling rejected, a little miffed, in the hot sand on the curb.

Once you finally enter a cab, you become an accepted member of an exclusive, travelling, temporary, 4-member-only club for people with shared interests insofar as you all have business in a common neighborhood. It's a nice atmosphere, most of the time. And it's a guarantee that at least one of the other passengers, if not all of them and the driver to boot, will gush gratitude and admiration for your efforts to know and speak Hausa. Most of the time, I get out of cabs feeling like I just got the pep-talk of a lifetime. It's nice to be appreciated. And driven around.

The city and two friends

I am still in Niamey, buzzing around from one idea to the next, getting to know the city a little better each day. The doctors are gone, early, leaving me with a few days to look around the city (and the internet...) before I go on vacation next week.

Things that come to mind when I think of Niamey: wide dirt roads. bright sun. humid air. lines and lines of wooden tables along the streets, piled high with mangoes, melons, tomatoes, cabbage, onions, eggplants. meat- lamb, goat, beef- grilling on large open fires. people. large, healthy people wearing large healthy clothes in large healthy colors, redorangepinkgreenblue. skinny, bent over people wearing skinny, bent over clothes in shades of grey and brown. taxis and motorcycles careening all over the paved roads and getting stuck in the sandy ones. lots to seesmellhear here. I haven't taken my camera out in the city, but I bet you'd like to see some pictures so I'll try to remember tomorrow.

In a few hours I'll go back to the hospital to visit. I went two days ago, hung out with Joumare for awhile. She told me "Reading is great but one day you should get a husband. Marriage is good for you". Thank you, Joumare. Today when I see her again, I'll give her the 3 yards of thick, dark blue and white cloth that I bought at the big market yesterday, and she will embroider it for me with bright threads of yellow and pink. She's very proud of Fulani arts, and it's no wonder- they use color beautifully. Their embroidered fabric is like looking up at night and seeing flowers instead of stars.

A Fulani textile, without embroidery.

I want to tell you about one of the nurses here, because he is somewhat of an enigma- a marvelous enigma- given what I've seen in Niger so far. Souley is a male nurse anesthetist. He is young, probably in his twenties, and he interacted and cared about the fistula patients in a way that completely blindsided me. I guess, after seeing women as caretakers in this country for so long, and having zero precedents of men providing direct, compassionate care to women, I was not at all prepared to see Souley doing everything to make the women physically comfortable and emotionally at ease during their surgeries. Even when he didn't speak their language, he was tender, attentive, and always at the patient's side. One of the American doctors, an anesthesiologist, commented to me "Souley is a very fine nurse. I can't even get him to leave to take a lunch break." Even after 6 hours of surgery, he's there, checking on everything. I know this is his job, so you could say he's just doing it, but it's more than that somehow. Not all of the nurses are like that. Many of them are rough and distracted, and warranted many a gruff correction from the visiting staff. But Souley was perfect. A young guy, taking good care of women and girls in a place where women and girls are expected to take care of themselves. It caught me offguard. And I can say- even now, with a lump in my throat!- that watching Souley work was the only time that any tears made it out of my eyes during this whole thing. Just when I think I know what to expect from someone they go and blast me to outerspace. Here's to Souley!

Some docs

Last morning of surgery- with Evangeline, Liz, and Star. Evangeline is a nurse, Liz and Star are both surgeons. They were all really great.

Rachida

This is one cool little girl. Rachida has it going on! She's a tough cookie, plus she surprises you with a smile at the most unlikely, most needed times. Maybe, hopefully, circumstances will work out for her to get surgery down the road.

A daughter

This sweet girl is here in Niamey with her mom, who is awaiting surgery. I couldn't resist that grin.

A note about donations to the Community Classroom Project: Peace Corps has been working on their website, and this has severely interrupted the donation process. Bad timing!! A few folks have been able to get through, and thank you SO MUCH! You may find it easier to donate by phone: 1-800-424-8580 Extension 2170. This is a phone tree; just wait until you are cued to enter the extension number, and you will talk to an actual person. (To avoid the phone tree, call direct: 202-692-2170) The office hours are 8:30-5:00 Eastern Time.

Last days with the docs

Here are Tuni, Fatima, and Zeinaba. Zeinaba and Tuni came with me all the way from Foloa to see if the doctors could do some work for Zeinaba. The woman in the middle is a friend of theirs who lives in Niamey and came to visit them in the courtyard.

In the last two days of the mission I translated for Ramatou, Hamsa, Rachida, Halima, and Miyeba. Ramatou is a forty year old Beriberi woman, from a village way out east. I didn't have Hwanta to translate the Beriberi into Hausa for me, so this was another very mime-y surgery. She had a fistula repaired, and was looking good in recovery this morning! Hamsa is a Zarma woman in her twenties, and again, this was a multi-lingual event! Zarma, Hausa, English, Doctortalk.

Rachida, one of my 8 year old charges, was put under anesthesia as well yesterday, but only for an exam. I dressed both her and her mother up in scrubs, so they could be together before the drugs were administered. Long story short, the doctors determined they can't operate on her here; she may be another candidate for an over-seas operation. Maybe one day. We can dream.

Halima is a twelve year old girl from Zinder (a 13-16 hour bus ride east), who came here all by herself. She is a bright and intelligent child; you can see it in her eyes. She listens. Her history is violent, and when combined with her complicated anatomical issues the doctors decided surgery was too risky this time around. Halima has a Peace Corps Volunteer in her village out east who'll keep an eye out for her.

Last but not least, Miyeba! Miyeba is the only woman who speaks her language in the entire hospital. She's Gourmance, an ethnic group from the Nigerien border with Burkina Faso. The Gourmance are known for their distinct language, filing their teeth into points, having short unbraided hair, and for not conforming to Islam. Miyeba is dark-skinned and observant, and she must be awfully brave and independent to have made it here without any common language. She'd had her urethra cut by a traditional doctor who was trying to increase the size of her vagina; we've had a few cases like this. (It is not the same as genital mutilation, in which the clitoris is cut.) This being my fourth or fifth time translating for a patient whose language I don't speak, I was a lot better at communicating stuff to her. Her surgery was quick- about 2 hours- and hopefully successful.

And that's the end of that. The doctors leave tonight at midnight, two days ahead of schedule. I really enjoyed working with most of them, and am proud that they're Americans! They did a lot of incredible work here, and changed the lives of many a girl and woman. I'll continue to go to the hospital to check on the post-operative women for a few days, but the translating is all over. Thanks for checking in.

We're tired today

I'm a zombie today. I need to get more sleep! Will work on that. In other news: today was slow for me, because most of the patients were Zarma speakers. I translated for one woman this morning, Maimuna. She's a 26 year old Tuareg from Agadez, and she only speaks Tamachek. So, I did alot of miming and smiling, nodding and holding of hands. One of the male nurses in the room is Tuareg, so I could call him over for help when something significant was going on. Otherwise we were pretty quiet.

Maimuna is a gorgeous woman- smooth, golden skin, straight black hair, big black eyes. She was pregnant with her first baby last year; after a 6 day labor the baby was removed, stillborn. She is a small person, very slight, and impossible not to notice. She's here with a few other Tuareg women; they are captivating and warm, and always greet me even though we share few words in common. The surgeons said her fistula is the worst that they have seen yet, but they also said they were able to do a lot of good work on her. I visited her in recovery this evening; she was surrounded by three Tuareg women and two Tuareg men. The men spoke Hausa, so I was able to talk directly with them, which was great. They wanted to know if they could give her yogurt (what is it with men giving women yogurt? Or is this a coincidence?). I like Maimuna's family.

I've continued to have some interesting conversations with the anesthetist. He's been observing some pretty fascinating differences in the ways Nigerien women react to surgery, anesthesia, and pain medication, relative to the way American women react. He says the Nigerien women, hands down, require fewer meds of lower strength, and do not seem to suffer many of the side effects that Americans have. Examples: American women get itchy and scratch alot when they get spinals. Nigeriens do not. Americans get more headaches and neckaches from spinals. Nigeriens don't get very many. Americans feel pain sooner and request sedatives, Nigeriens tend to bear it all. The anesthesiologist showed me all of these pain meds he expected to be running out of; he hasn't even opened most of them! Also, when we do rounds to visit the women in recovery, we keep finding women who haven't even started taking their pain meds yet (there is no nurse to dispense meds, and so the women have to keep track of all of their antibiotics, Percoset, Advil etc. ) They are in pain, but they wait until we come by to start taking them-- these are women who just had all sorts of crazy surgery, and they're not even taking Tylenol! Take that, pain! It's very humbling. I have vowed never to complain about an annual exam, ever again. That's small beans, ladies. Very small beans.

There's more. I was told this afternoon to go tell Bichara (one of my 8 year old girls) and her mother that she'd be getting surgery tomorrow. I went, I told them, I gave them the whole pre-op shpeel. And then, not a half hour later, I was told that no, never mind, she will not be getting surgery. I.was.so.pissed. I won't go too much into the details of all of this, but I will say that if the doctors had put their heads together and been honest from the beginning, they could've told this girl last week that surgery wouldn't happen this time around. Instead, they made promises they couldn't keep, and as a result this girl and her family have spent a week living at the hospital expecting surgery. I insisted that the surgeon come with me to break the news, because she is his patient, and she deserves to be told by him. It really sucked. But, Bichara's mom Eki is a tough and composed lady, and she was as gracious as you could expect. Bichara, by the way, has gotten less shy around me and now holds my hand when I'm nearby. I got their phone number, and will try to get Bichara's name on the list for the next round of surgeries, in October. There is some talk of trying to fly her to the US for surgery, because she needs some very specialized work, but I don't know if that will go beyond just talk.

And now, this zombie needs some rest. More news to come. Thanks again, to everyone who reads this blog! It means alot to me to know you're out there.

The courtyard

This is the hospital courtyard where the women wait/sleep/eat/live/hang out. Some women are here short term, just for the weeks during surgeries. But many are here for months, and many consider this their home. Several young women have lived here for a few years. On the left you can see a bunch of beaded bracelets set out for sale (the buyers being the visiting doctors). The women sleep on bright plastic mats like the ones in the foreground.

Another day in surgery

When we finished today, after 11 hours in the chilly, sterile, beige-and-seagreen world of the operating room, the other translators and I crammed into a taxi and realized we look realllly ragged. We had many laughs at each others' expenses. (expenses? sure) But we sure clean up well. Yep, we clean up well, and then we go to bed and sleep like rocks. It feels good to do good work.

So, today: I translated for Rabi, Fatima, and Joumare. Rabi is 20, a stoic, composed young woman who stayed calm through her whole surgery, which took all morning. She barely said a word, and managed to sleep for awhile (with no extra meds). Her biggest (and best) reaction was the giant grin she flashed us when I told her that the surgery went perfectly. Yay!

Rabi was similar- she's 18, and has been through 3 previous surgeries. She knows the drill, and hardly flinched when they gave her the spinal. I was very impressed. She slept (again, no extra meds, just the spinal), so I chatted with the anesthetist about all of the different types of doctors. Rabi's surgery went very well!

Joumare is Fulani, and she speaks both Hausa and Fulfulde. She's one of the most amiable people that I know-- so easy to be around, and interested in the world, and one of those people you look forward to seeing. I met her at the beginning, when I was going around meeting all of the women; she stood out partially because of her ethnicity and appearence, but also because of how warm she was to me. I mentioned her earlier, after doing her interview. Joumare is probably in her 40s, and lives in Agadez. She has one grown son who's a tailor and jewelry maker; she's selling some of his stuff iin the hospital courtyard (it's very pretty!) Joumare's fistula started 3 months ago, after she had a hysterectomy performed. During her surgery today, we found out that the reason she was leaking urine was because whoever did her hysterectomy stapled her bladder (by accident? on purpose, stupidly?), leaving it with a bunch of holes. After a whopping 5 hours in surgery, Joumare's bladder is as good as new. Awesome! Next on the list for her: nutrition. She needs to put on a few pounds.

All of you Wisconsin family folks will appreciate the conversation Joumare and I had during her surgery-- she told me how to make cheese, Fulani style. The Fulani's are herders, milk sellers, cheese makers: she knows her cheese. Joumare rules.

Happily, all of my translations today were happy stories. I was a busy bee for awhile there; there were about two hours when both Rabi and Fatima were getting worked on, so I kept going back and forth to sit with each one. There was one rough moment this morning; when the surgeons opened up a Zarma woman on the table next to ours, they found a lot of cancer in her abdomen. They cut some of it out, but not all of it, and they weren't able to operate on her fistula. It is hard to know something like that before the person herself knows. I don't know how I would tell her that news.

What else. We had some unfortunate news this morning- the doctors may be leaving a few days early to avoid a strike that's about to happen at the airport. They're worried that if they don't leave early they'll get stuck here. I know I am biased, but I wish they would just stay...I know it would screw up their plans and schedules at home if they weren't able to leave right away, but just think of all of everything they could do here! I am dreading telling dozens of women that, in fact, they won't be getting that surgery that they were told they'd get. Not a cool situation.

Further bulletins as events warrant. In the meantime-- thank you for reading! Celebrate your health!

With Sa'a

With Sa'a

Hey guys-

Just want to let you know that I'm doing alright! I'm not allowing myself to think about the awful side of things too much, because then I get upset, which isn't helpful. I keep reminding myself of that, and maybe I've already said it to you. It keeps me level.

We just got off- an extra long day. It's 7:15pm. I was in surgery all day again; I translated for Hamsatou in the morning, and Sa'a all afternoon. Hamsatou is in her mid forties, and has had fistula for over 15 years. She had two children, both stillborn. Her surgery took a really long time, but the doctors said she should see an improvement, which I guess is all that you can hope for sometimes. One thing about this surgery was that Hamsatou is from Diffa and speaks Beriberi, so I got my OWN translator, Hwanta, to help me talk with her. Hwanta is in her twenties, and is also awaiting fistula surgery. She sat with me in the frigidly cold operating room for three hours, translating Beriberi to Hausa, which I then translated to English.

Sa'a is thirty, and has three living children. Her last child did not survive childbirth, and it was after this labor that Sa'a's fistula started. I feel like I really connected with this woman. When I first called out her name, she seemed very serious and apprehensive, which obviously is to be expected. But unlike many of the other women, Sa'a asked alot of questions. About procedures, doctors, tools. And she stayed very calm throughout the whole thing- no extra pain meds, no sedative, nothing. She was totally lucid the whole time. So, of course, we chatted. She kept asking what the doctors were doing (the anesthesiologist and I rigged up a blanket across her knees so she couldn't see much). I mentioned this to the doctors, who were immediately like "Really?! Cool! Tell her this is part of her fallopian tube!!" and then held up a piece of flesh with giant tweezers. Sa'a blanched and said "I don't want them to show me!!" No kidding, Sa'a. In addition to having her fistula repaired (water tight! said the doctors), she had her tubes tied. It wasn't a procedure she was expecting before today, but this morning she talked with the doctors about the chances that any fistula repair she had done would be destroyed if she conceived again, and she agreed to having a 'tubal litigation'. I personally found it questionable that they would spring that on her and not give her time to think about it. But it's done.

After surgery I went out to tell her friend, Haoua, that she was fine. And I met her husband! He came! Isn't that cool?! I was so happy that I may have startled him with my enthusiasm. He asked me if he could bring her some yogurt (no, but still a very sweet gesture). Later I explained her meds and recovery to him, and he listened very carefully. I think Sa'a is in good hands.

I visited Sahara in recovery this morning and this afternoon, and she is feeling better than she did yesterday evening. Evidence: she joked with me about buying a sheep liver for her for dinner. And she told me I would be prettier if I had some facial scars. So yes, I think she's doing alright for now. She's in a room with 20 other recovering women, which is good for morale, and especially good for collective teasing of the translators.

Bichara and Rachida are both waiting surgery- looks like it'll be Monday. Bichara, the shyer (sp?) one has warmed up to me a ton, and I can get her giggling in no time now. Rachida is cute as ever and tried to follow me into a restricted area today...oops.

Translating

With Dajowre in surgery

The team

Translating, with a patient, anesthetist, nurse, and surgeons in the background.

What Sahara went through

Today was alright. I translated for my first surgery. The doctors are doing all of the most complicated surgeries first, so the women have more time to heal while the doctors are still here. So I got in at 8 and right away jumped into surgery clothes (scrubs, plus funny hairnet and boot covers and face mask and goggles), and brought Sahara in for surgery. Her story, the more I think about it, brings up red hot anger from the pit of my belly, and I despise whoever did this to her. She's probably about 15 years old. She was married at age 10. She was pregnant and had her baby at age 12. Her labor lasted five days; her child didn't survive childbirth. And she was left with a gaping hole from which she leaked feces and urine, as well as damaged nerves in her left leg. I hate thinking about what she went through.

So that is the worst part. The best part is that three months ago, she came to Niamey (all by herself, no family with her, not to mention her husband. Where is he? Does he even know what happened to her? Does he care? I'm sorry to lash out like this, but not sorry enough to not do it. Where is her family?). And today, three surgeons performed surgery on her for five hours-- they took some muscle from her leg and used it form a 'sling' that will hold her urethra up so she won't leak (which they accessed through the vagina and a hole they cut in her abdomen), and then they cut out a bunch of scar tissue and reconstructed her rectum. They said that everything went as well as they could have hoped, and are confident that she will see a major improvement. They gave her an epidural, so she was only numb from the waist down. For the first hour she was really anxious (so was I), and it didn't help that we had no sheet to keep us from seeing what the doctors were doing. She started to get more panicky, so I asked her if she'd like to be more sedated, which she did. The anesthesiologist gave her some meds to keep her drowsy. I stayed with her, anyway, because every once in awhile she would be more lucid and I didn't want her to feel alone. Now she's in the recovery room, on lots of pain meds, with an ice-pack I made out of three bags of frozen juice. Please send Sahara some comfort and some love.

After surgery I went back to our little meeting room and laid down for a long time. Eventually I went back out to talk with some of the women awaiting surgery, many of whom are making stacks upon stacks of beaded bracelets while they wait. I will buy tons and tons of them, to bring home and give to you all, who are helping by just thinking of us over here.

And that is what I did today.

The Surgery Room

There are two surgery rooms, with two operating tables in each. Teams of three American surgeons, one American Anesthesiologist, a few Nigerien and American nurses, and one Peace Corps translator work at each table. The rooms are pretty crowded, and very busy.

Mode: Kickass

There's something verrry cool about wearing scrubs. This is me and Krista, chillaxin' before surgeries started yesterday morning. Try not to be intimidated.

Fistula Days 2-3: Exams

Today and yesterday were full days. We did, I think, at least forty exams each day. An exam is like an annual exam but waaaay worse in every possible way. The women are poked and stretched and prodded, in order to determine why and where they're leaking. For anyone who wants more details on this, I can tell you about it later.

Yesterday I translated for Bachira, Mariama, Sakina, Joumare, and Tawra. Our responsibilities as translators are to help the women change into hospital gowns, bring them into the examination rooms, be with them throughout the exam (takes 30-60 minutes, sometimes longer), and translate for them the whole time. It requires some new Hausa vocab, to say the least.

Today, I had Fachima, Habsatou, Bintou, Fatima, Sa'a, Habi, Nana Hanatou, Rachida, and Djaliatou. My mind is full of their stories and I'm finding it hard to concentrate on writing about anything-- I want you to know everything, but there's just so much. I will start, I guess, and see how it goes.

Habi is seventeen years old. She's beautiful, with dark eyes and a large, careful smile. She knows 'hello', 'how are you', and 'i'm fine'. She limps, because her nerves in one leg got damaged during labor. Habi was pregnant at age 13, and had one son, stillborn. She has had several surgeries to correct the leaking of urine and feces; she no longer leaks feces but continues leaking urine. She has lived at the hospital for a few years. During her exam today, the doctors decided that they will not operate on her, because she has too much internal scarring, and the surgery is unlikely to succeed.

Bintou is twenty years old. She is serious and direct, and came from a village from way out east. She has never been pregnant or had a child. She leaks urine because her urethra was cut in order to enlarge her vagina. Her clitoris is intact. The doctors will perform surgery next week.

Nana Hanatou is in her early forties. She talks a lot! I ask her one question and her answer deviates all over the place, ultimately being about her grandchildren. She leaks urine, but it turns out it's not because of a fistula. After doing a bunch of tests (and putting an IV of indigo into her hand, which was pretty fascinating for me and her to watch), the doctors determined that she has an easily reparable condition in which one of her ureters (sp?) runs to her uterus instead of wherever it's supposed to go. Anatomy. She'll get surgery in a week.

Joumare is older, maybe in her fifties. She has one grown son who is a tailor. I don't remember the details of her fistula, but I do know that she's going to get surgery next week. The doctors said they won't perform it until she beefs up a little; she's very slight and malnourished. They're going to give her power bars! She was pretty excited about that. She also said she's going to bring me some new clothes.

Fachima is twenty years old. She is petite, not even 5 feet tall, and is quick to smile. She shouts my name every time she sees me. She had one daughter last year, stillborn, after three days of labor. Her bladder has a large hole in it, so the doctors aren't sure surgery will work; they estimated 60% chance of success. They'll try tomorrow.

Some other women are here who don't have fistula, exactly, but other gynecological/pelvic/obstetrical/rectal issues. Today I translated for a woman with stress incontinence, one with a fallen uterus, and another with a large hernia.

Fistula Day 1: All personal

Today we gathered medical histories on all of the women and girls. The term 'medical history' used to sound so impersonal to me-- it seemed like a neutral term, the simple compilation of facts. But now I see that it's all personal, and it requires you (the translator) to ask a lot of sensitive questions.

Such as: When did you start leaking urine? Do you also leak feces? Is it constant, or only when you're walking? What caused your fistula? Was it after childbirth? How many children have you had? How many are living? How many were stillborn? Are you married? How old were you when you got married? How old were you when you had your first baby? Do you still sleep with your husband? Have you had surgery before? Did it work?

Depending on what the answers are, a person can feel really, really shitty after telling them to a total stranger.

And this first day I definitely felt like a total stranger. A real jerk, for coming in and asking too many questions about things that I perceived as upsetting. How does a person learn, in question #26, that a woman has given birth 4 times and lost all 4 babies, and then move on to question #27 and ask whether they were boys or girls? And then on and on.

I talked with some of the women about this. Well, I wasn't 'talking' about it- I apologized for it. And without exception, they all said "We're here to get better, we'll tell you everything, don't worry about it". So. I did my best to be private and gentle with these sharp questions.

Ramatou, her daughter Eki, and Eki's children, Bichara and Monseur, with me, sitting in the courtyard at the National Hospital at the end of the day. Bichara (in red headscarf) is getting surgery this week for a condition she was born with. She does not have obstetric fistula. I will be her translator.

Fistula Mission

Yesterday I started doing translations for obstetric fistula patients at the National Hospital in Niamey. I'll be here for this work for two weeks, so you'll hopefully hear from me much more frequently (daily internet access! holler!).

Obstetric fistula is a condition most often caused by prolonged childbirth. Simply put, fistula is a hole between the bladder and the vagina or the rectum and the vagina, which leads to the leaking of urine and/or feces. Women develop obstetric fistula when, after being in labor for a very long time, their internal tissues begin to die because of lack of oxygen. My understanding is that the weight and pressure of the fetus essentially crushes the woman's organs, which begin to disintegrate. Prolonged labor is more often seen in young girls; their bodies aren't fully developed and are not ready for childbirth. When I say prolonged labor, I mean 2 to 5 days. Other causes of obstetric fistula that I have encountered are genital mutilation and botched hysterectomies.

Women and girls with obstetric fistula are able to function in 'normal' society to varying degrees, depending on the severity of their case. Some women leak urine constantly, while others only leak when standing, working, or walking. Depending on the community in which the woman lives, and the age at which she gave birth/developed fistula, she may or may not be ostracized for her condition. Because perpetual leaking, the women often smell strongly of urine. Those who also leak feces have it harder. In the short time that I've been working with these women, it seems like most of them move out of their husband's house and back to their own family's home. They may remain married, but do not have much contact with their husbands. Many of them are divorced. In the vast majority of cases, the babies do not survive childbirth.

So there are some of the basics about fistula. At the National Hospital in Niamey, there's a wing for women with fistula to live while they await surgery. Currently there are over 80 women waiting here. One of the surgeons on staff knows how to repair a fistula, and groups of American doctors come through 3 times a year for two weeks to do what they can for as many women as possible. The latest group just got in on Sunday night, and I'll be translating for them during their stay.

We just started yesterday, and there's already so much to tell. I think maybe the easiest way for you to know about what's going on here is for me to just give you a play by play-- to tell you about what we're doing, how the women are, the ups and the downs.

A co-ed meeting and a new project

A view of the village, with the mosque on the left, granaries on the right, seasonal lake in the background. A clinic was not feasible, however the villagers decided that a new multi-purpose classroom is also a much-needed addition to the community.

And, newest to the list....drumroll....

New Classroom!

Here's what happened: Months ago, in December, I held a big meeting with a bunch of men to discuss potential projects I could collaborate with them on in my last year here. After brief deliberation, they decided that they wanted to try to get a clinic built here. I have no beef with that: spend five minutes here and you will see the need, which varies from mild to severe to absolute, for health care. If I started to name the ailments, accidents, and tragedies that should not have ended as such, I will never stop and this entry will become a list of sadness.

So the short story there is that I rode my bike to lots of faraway offices where fat men wearing boubous and with easy access to doctors all told me "No way, we're not putting a clinic in Foloa. Even if you build it, it won't get staffed and you'll have the same problem stocking it with medicine that all of the other clinics have." Eventually, as of last week, I stopped pushing and moved on to plan B.

Plan B meant having another village meeting. This time, I met with 100+ men and women (the co-edness of it was a point of great amusement to all involved) to discuss other, more feasible projects for my next 8 months here. It was a productive meeting- people talked, asked questions, argued, yelled, nodded, laughed, and eventually agreed. We're going to try to raise funding for a new classroom for our school. Go us! We have three existing 'real' classrooms used by about 180 students, and one millet stalk classroom used by a class of 72. (72 kids, all under the age of 8, one teacher. Try not to think about it...). So, there's a need. And there's a means:

As of March, 2009, the village has raised over 30% of the total cost of the project, more than their expected portion.
As of April 6, 2009, Peace Corps has approved a detailed proposal for raising funds through the Peace Corps Partnership Program. So here goes, folks:

If you would like to donate to the Community Classroom Project, please go to the Peace Corps Partnership listing for this project. Any money you donate is tax-deductible, and 100% of it goes towards my project. We in the community all thank you for your interest and your support.

What's happening with young girl's education

Hadiza's father, Mano (on the right), died in January

Young Girls Education: I'm still sponsoring Hadiza, with funding from the Friends of Niger organization, in her attendance of junior high. Hadiza and I are gradually getting to know each other better; she comes to visit me every time she's home on break from school. It's been a hard year for her family, and truly our whole village, because her father Mano got very sick in October and passed away recently, in late January. Mano was a major person in my life here, and I miss his presence in the shade on the corner where we used to hang out. I had developed photos of him and his family while I was home for Christmas, so it was good to be able to give them to Hadiza and her Mom, A'I. Hadiza's teachers informed me that although she was lagging behind most of last semester, she's doing better in her classes now, and they are hopeful that she'll be able to pass her exams in June.
We went to Maradi together for a conference 2 weeks ago, which was really great for both of us. (See the Alvin AiIey post from a while ago.)
Next: A big new project in the works

Women's literacy in the village

The estimated literacy rate for women in Niger is just 9%. In my village it is even lower, less than 1%.

Women's Literacy: And by women, I mean Two Women. Mariama and Rasida, my two sister-like girlfriends, have been bugging me for a year to teach them to read. Rather, Mariama has been bugging me. She is hilarious and full of antics, and I cannot get enough of her or her son Oweli (another child of my heart).
Why did it take me so long to start this??? For the last week and a half we've met every night for an hour, from 8-9pm, to learn our letters. So far they know M, A, S, O, R, D, I, B, K, and N. Now we're working on recognizing syllables- MA, NA, DA, RA, etc.
It's a lot of fun, and as my Dad observed, possibly the most radical thing I'm doing here. True that.
Next: Young girls' education